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Objective:To analyze the risk factors,clinical characteristics and prognosis of the pneumocystis pneumonia(PCP) that is one of the severe pulmonary complications after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:The clinical features,laboratory data,treatment and outcomes of patients with PCP after allo-HSCT in our hospital from January,2016 to January,2021 were retrospectively collected and analyzed.Results:Twenty three cases who met the clinical diagnostic criteria of PCP were enrolled. The median time of diagnosed as PCP after transplantation was 221 days. The computed tomography (CT) of chest indicated diffuse ground glass opacity.The median of β-1,3-D glucan consentration was 894.25 ng/L, and 91.3% of the cases were over 60 ng/L.The lymphocyte count in 60.9% cases was lower than 1×10 9/L;CD4 +T lymphocyte count in 65.2% of patients was less than 200/μL. Pneumocytis sequences of mNGS were positive in all 21 cases.15 patients were complicated with mixed infection.All patients were treated with TMP-SMX,18 patients were cured and 5 patients died. Conclusions:Patients with PCP after allo-HSCT progresses rapidly, and which is usually with multiple infections. Serum β-1,3-D glucan concentration increase contributes to the diagnosis of PCP.And mNGS in alveolar lavage fluid is highly sensitive to Pneumocystis, which helps patients get treatment in time, so as to reduce mortality.Patients with respiratory failure progressing to a need for mechanical ventilation and high flow oxygen inhalation suggest a poor prognosis.
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Objective@#To evaluate the diagnostic value of bronchoalveolar lavage (BAL) for pulmonary complications in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and its safety.@*Methods@#Patients with pulmonary complications after allo-HSCT underwent BAL. Microbiological smears, culture, PCR of CMV-DNA, EBV-DNA and TB-DNA, macro genomes new generation sequencing (mNGS) techniques were performed to detect pathogens in BAL fluid (BALF) .@*Results@#A total of 73 allo-HSCT patients with 86 times of pulmonary complications enrolled this prospective study. They underwent 132 times of BAL procedures. The clinical diagnoses of 88.4% cases were made based on BALF analysis. Of them, 67 cases (77.9%) had infectious pulmonary complications, including 29 cases (33.7%) of fungal infection, 18 cases (20.9%) of mixed infection, 11 cases (12.8%) of viral infection and 9 cases (10.5%) of bacterial infection. The other 9 cases (10.5%) of non-infectious pulmonary complications included 8 cases (9.3%) of idiopathic pneumonia syndrome (IPS) and 1 case (1.2%) of pulmonary infiltration of lymphoma. The diagnoses of the remaining 10 cases (11.6%) were not determined. The platelet counts of 33 patients were less than 50×109/L before BAL. None of them developed severe bleeding complications during or after BAL. Transient fever occurred in 10 patients after BAL. Blood cultures showed staphylococcal bacteremia in them and anti-infection therapies were effective. No life-threatening complications occurred in all of the patients during or after BAL.@*Conclusion@#BALF analysis was informative for the diagnosis of pulmonary complication and safe for patients with pulmonary complications after allo-HSCT.
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Objective@#To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for elderly patients with advanced myeloid neoplasm.@*Methods@#From September 2014 to September 2017, 30 consecutive hospitalized 50-plus-year-old myeloid neoplasm patients were retrospectively analyzed. At the time of transplantation, 6 patients reached complete remission and the others remained no remission after treatment. The donors were identical sibling (12), matched unrelated (6) and haploidentical family member (12), respectively. 18 patients received RIC while 12 patients received MAC conditioning regiments consisted of Busulfan, cytarabine, fludarabine or clarithromycin±TBI, respectively.@*Results@#Five patients died early in the conditioning stage, 24 patients successfully engrafted. The median time of neutrophil engraftment was 14(10-18) d, whereas platelet engraftment was 15(10-19) d. Six cases (25%) experienced aGVHD grades Ⅱ, 8 cases (32%) cGVHD, including moderate to severe cGVHD in 2 cases (8%). Seven, 7 and 5 cases developed CMV viremia, pneumonia and herpeszoster, respectively after transplantation, but no patients died of infections. The median follow-up time of the patients was 7(0.5-38) months. Twenty-one patients were still alive. The estimated 2 years OS and LFS were 62.5% (95% CI 39.2%-85.8%) and 59.2% (95% CI 26.9%-91.5%), respectively. Univariate analysis showed that HCT-CI was the only factor influencing OS.@*Conclusion@#Allogeneic hematopoietic stem cell transplantation could improve the survival of elderly patients with myeloid neoplasm.
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Objective To evaluate the efficacy of peripheral blood combined with cord blood model for haplo-hematopoietic stem cell transplantation and the occurrence,survival of complications in patients of different ages.Methods From January 2014 to December 31,2017,there were 50 patients undergoing haploid allogeneic hematopoietic stem cell transplantation in our department.There were 39 males and 11 females.The median age was 35 (9-67) years.The stratification was divided into 3 groups.In group A,17 patients were younger than 30 years old;in group B,19 patients were between 30 and 49 years old,and in group C,14 patients were not less than 50 years.No remission was assessed before transplantation in this group.On the morning of the reinfusion,the selection of a third-party umbilical cord blood for transfusion reduced the occurrence of GVHD.Peripheral blood was infusion in the afternoor.All patients were treated with ATG + CSA + shortterm MTX to prevent GVHD.Results Two patients died of infection prior to graft,4 (8.0％) patients were graft failure.The median time of ANC≥0.5 × 109/L (range) and platelet ≥20 × 109/L (range) in the other patients were 14d(10-22 d) and 20(11-186) d,individually.The median time of full donor chimerism(range)was 28d(14-42 d).Graft failure was occurred in one case (5.9％),two cases (10.5％) and one case (7.1％) in each group,with no statistically significant difference (x2 =0.282,P =0.868).With a median follow-up of 7.2 months (0.4-27.2 months),12 (24％) had aGVHD of Ⅱ-Ⅳ degrees,among them,6 cases (35.3％) in group A,5 cases (26.3％) in group B,1 case (7.1％) in group C had aGVHD of Ⅱ-Ⅳ degrees.There was no significant in the incidence of aGVHD in three groups (x2 =3.624,P =0.180).Twenty-nine (58％) patients had viral infections after transplantation.One patient in both group A and B relapsed,and there was no recurrence in group C.21 (42％) patients died and 29 (58％) patients survived.The predicted 2-year overall survival (OS) was 60.2％.In group C,the 2-year overall survival (OS) was 77.1％.Conclusion The haploidentical hematopoietic cell transplantation model of peripheral blood combined with third-party umbilical cord blood transfusion has a good outcome and prolonged survival time in high-risk elder patients.The use of suitable conditioning regimens did not increase the incidence of aGVHD and virus infection.
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<p><b>OBJECTIVE</b>To report an acute promyelocytic leukaemia (APL) case with translocation of rob (13;21) t(15;17) (q22;q21) and review its clinical and laboratory characteristics.</p><p><b>METHODS</b>Based on routine karyotype analysis and bone marrow morphology, we further used double color double fluorescent in situ hybridization (DCDF-FISH) and reverse transcriptase PCR (RT-PCR) to examine the patient's abnormities on cytogenetic and molecular biology, and reveal the clinical characteristics of this rare translocation also from the related literatures.</p><p><b>RESULTS</b>The clinical manifestation and bone marrow morphology examination of this patient were in accordance with pathologic feature of APL. On first visit, immunophenotyping analysis showed positive myeloid markers. Through R-banding, the patient's karyotype was confirmed as 45, XX, rob(13;21) t(15;17) (q22;q21) [6]/45, XX, rob(13;21) [14]. FISH results showed that 68.9% cells were typical t(15;17) pattern. The positive rates of fusion gene of PML-RARα detected by RT-PCR was 25.8%. Patient was treated by induction and consolidation therapy, the karyotype was 45, XX, rob(13;21 )[20] after complete remission. The positive rate of fusion gene of PML-RARα by FISH and its level were 2.5% and 0.003% respectively.</p><p><b>CONCLUSION</b>APL with rob (13;21) t(15;17) (q22;q21) was very rare, which was accorded with clinical and laboratory characteristics of APL. The value of chromosome abnormality as a prognostic marker in APL needs to be further observed..</p>
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Humans , Chromosome Aberrations , Chromosome Banding , Chromosomes, Human, Pair 15 , Chromosomes, Human, Pair 17 , Chromosomes, Human, X , In Situ Hybridization, Fluorescence , Karyotype , Leukemia, Promyelocytic, Acute , Oncogene Proteins, Fusion , Remission Induction , Translocation, GeneticABSTRACT
<p><b>OBJECTIVE</b>To evaluate the curative efficacy and safety of two regimens, Hyper CVAD/MA and CHOP/CHOP, in the treatment of primary peripheral T cell lymphoma (PTCL).</p><p><b>METHODS</b>The clinical data of 80 primary PTCL patients were retrospectively analyzed, and the efficacy and safety of the two regimens, Hyper CVAD/MA and CHOP/CHOP, were evaluated.</p><p><b>RESULTS</b>Of 80 patients with primary PTCL, 23 were treated with Hyper CVAD/MA regimen (HM group, experimental group) and 57 with CHOP or CHOP-like regimen (CC group, control group). The differences between overall response rate (ORR) among HM group and CC group (78.3% vs 54.4%, P = 0.047), ORR in patients with IPI score of 0-2 (86.7% vs 55.2%, P = 0.037), courses of chemotherapy to achieve remission (4 vs 6, P = 0.004), median progression-free survival (PFS) time (24 months vs 12 months, P = 0.039) and 1- year PFS rate (82.6% against 45.6%, P = 0.006) were statistically significant. The relapse rates were similar between 2 groups (50.0% vs 54.8%, P = 0.744). The 2-year and 3-year progression-free survivals and 3 year overall survival were not significantly different (P > 0.05). Patients in Hyper CVAD/MA group are more susceptible to neutropenia (<1.5 × 10⁹/L) (73.9% vs 38.6%, P=0.004).</p><p><b>CONCLUSION</b>The curative effect of Hyper CVAD/MA regimen as induction therapy in treatment of PTCL patients except ALK positive PTCL patients was better than that of CHOP/CHOP-like regimen.</p>
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Humans , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , Disease-Free Survival , Lymphoma, T-Cell, Peripheral , Drug Therapy , Neoplasm Recurrence, Local , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To analyze the impact of the occurrence and severity of acute and chronic graft versus host disease (GVHD) on the long-term outcome of allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for leukemia.</p><p><b>METHODS</b>A total of 231 patients with leukemia, who underwent allo-HSCT in Changhai Hospital from Jan 1st, 2001 to Dec 31th, 2011, were retrospectively analyzed. The overall survival (OS), disease-free survival (DFS), transplantation-related mortality (TRM) and relapse rate (RR) were estimated according to the degree of acute and chronic GVHD.</p><p><b>RESULTS</b>(1) Among the 224 assessable patients, aGVHD was observed in 85 patients, in which 46 developed grade I, 25 grade II and 14 grade III-IV. A total of 213 patients who survived beyond 100 days, cGVHD was observed in 109 patients, in which 84 developed limited cGVHD and 25 extensive cGVHD. (2)The incidence of 3-year OS and EFS of patients with aGVHD grade 0-I was significantly higher than that of grade II-IV (69.5% vs 33.6%, P<0.01; 60.7% vs 33.7%, P<0.01). The 3-year TRM of patients with 0-I grade aGVHD was significantly lower than that of the grade II-IV group (15.0% vs 56.7%, P<0.01). (3)The 5-year OS of patients with limited cGVHD was higher than patients without or with extensive cGVHD (79.8% vs 55.6% and 56.4%, P<0.01 and P=0.038, respectively). The 5-year TRM in patients with extensive cGVHD was higher than patients with limited cGVHD (14.1% vs 41.1%, P=0.018). However, the 5-year RR in patients without cGVHD was higher than patients with limited cGVHD or extensive cGVHD (47.2% vs 10.9% and 12.4%, P<0.01 and P=0.007, respectively). (4) The COX analysis showed that unrelated donor and myeloablative conditioning regimen were main factors affecting aGVHD; Meanwhile, aGVHD was the only factor affecting the cGVHD.</p><p><b>CONCLUSION</b>Our results showed that the patients with acute GVHD tended to have poor outcomes, especially with grade III-IV. On the contrary, the patients with limited cGVHD had lower RR and a long-term DFS.</p>
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Humans , Disease-Free Survival , Graft vs Host Disease , Leukemia , Therapeutics , Peripheral Blood Stem Cell Transplantation , Retrospective Studies , Transplantation Conditioning , Transplantation, Homologous , Treatment Outcome , Unrelated DonorsABSTRACT
<p><b>OBJECTIVE</b>To investigate the patients' characteristics and efficacy of prognosis evaluation by International Prognosis Scoring System (IPSS) and Revised International Prognosis Scoring System (IPSS-R) in patients with myelodysplastic syndrome (MDS).</p><p><b>METHODS</b>Prognostic value of IPSS and IPSS-R was evaluated on clinical data from 159 MDS patients, according to WHO classification.</p><p><b>RESULTS</b>With a median age of 44 years (range:15-80 years), MDS patients had the frequency of 38.56% with abnormal karyotype, including the most common abnormality +8 (20/153, 12.6%). 34 of 142 patients transformed into leukemia. Age and the level of β2 micro-globulin were the prognostic factors by multivariate analysis and IPSS-R had a better prognostic significance. The differences in cumulative survival between IPSS subgroups were significant (P<0.05) except that between low- and intermediate I-risk group (P>0.05). There were statistical differences for IPSS-R low risk group vs high or very high risk group, and intermediate risk group vs high or very high risk group (P<0.05). IPSS-R enables IPSS subgroups re-stratification and split IPSS intermediate I-risk group into two subgroups with different prognosis.</p><p><b>CONCLUSION</b>There were significant differences in age of onset, distribution of prognosis scoring system subgroups and abnormal karyotype compared with those in Europe and America. The proportion of higher risk (worse than good karyotype) in IPSS-R was higher than that in Europe and America. Age and the level of β2 micro-globulin were prognostic factors. Both IPSS and IPSS-R were applicable in Chinese MDS patients and the latter performed better. Applying IPSS-R to re-stratify IPSS subgroups helps evaluate prognosis more accurately and improve treatment outcomes.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Humans , Middle Aged , Young Adult , Asian People , Karyotype , Karyotyping , Leukemia , Multivariate Analysis , Myelodysplastic Syndromes , Prognosis , RiskABSTRACT
Objective To detect the value of serum galactomannan (GM) for diagnosis of invasive aspergillosis (IA) in hematological patients. Methods We prospectively evaluated the diagnostic value of twice-weekly screening for circulating Aspergillus fumigatus with sanditch enzyme linked immunosorbent assay. Results On the basis of the analysis of 472 serum samples from 113 episodes of 92 patients, the sensitivity, specificity, positive and negative predictive values of the sandwich ELISA for proven and probable IA cases were 83.3 %, 91.1 %, 78.9 % and 93.1 %, respectively, when samples with 2 consecutive positive results≥0.7 were used. Furthermore, GM antigenemia was detected before the onset of radiologic signs with a median of 7 days (range, 1-14 days), before isolation of Aspergillus with a median of 4 days (range, 1-7 days),and before anti-fungal therapy with a median of 6 days (range, 1-15 days). Conclusion The sandwich ELISA for GM detection is a reliable method for early diagnosis of IA in patients with haematological diseases.
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Objective To explore the relationship between the expression of LIGHT/HVEM in patients after allo-HSCT and the development of GVHD. Methods The expression of LIGHT and HVEM in T lymphocytes was detected by FACS Calibur. Results All patients achieved engraftment and hematopoiesis reconstitution, aGVHD occurred in 9 of 26 patients (34.6%) with grade Ⅲ-Ⅳ aGVHD in 3 cases. Seven cases developed cGVHD (26.9%). LIGHT was not expressed in T lymphocytes from healthy donors and patients without GVHD, while constitutive expression of HVEM was detected. When aGVHD occurred, the expression levels of LIGHT in T lymphocytes were significantly increased, while those of HVEM decreased. After GVHD was controlled, the expression levels of those co-stimulators went back to normal On the day 15 after transplantation, the expression of LIGHT in T lymphocytes of patients with aGVHD later was significantly higher, while that of HVEM lower than in those without aGVHD. The patients with aGVHD of grades Ⅲ-Ⅳ demonstrated higher LIGHT expression than in those with aGVHD of grades Ⅰ-Ⅱ. Conclusion The expression of LIGHT and HVEM might be involved in the development of GVHD after allo-HSCT and could be used as one of the useful indicators in predicting aGVHD.
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Objective To investigate the characteristics of pathogenesis and therapeutics of myelodysplastic syndrome(MDS)and aplastic anemia(AA)combined with autoimmune disease(AID).Methods Retrospective analysis and follow-up visit of 111 patients with MDS and 56 patients with AA in our hospital were studied.Results There were 9(8.1%)of 111 patients with MDS and 2 (3.6%)of 55 patients with AA coexistent with AID.Autoimmune hemolytic anemia(36.4%)and Behcet Disease(18.2%)were common among those combined with AID.5 patients had AID proceeding to the occurrence of MDS/AA.4 patients had simultaneous occurrence of AID and MDS/AA.2 patients developed AID three years later after the diagnosis of MDS.Conclusion There was a certain intrinsic relationship between MDS/AA and AID.
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To analyze the outcome of allogeneic peripheral blood stem cell transplantation(allo PBSCT) for hematological malignancies and prevention of complications, forty one patients with hematological malignancies were treated with allo PBSCT. One regimen of prophylaxis for acute graft versus host disease(GVHD) was the combination of cyclosporine(CsA)and methotrexate(MTX),another mycophenolate mofetil(MMF) with cyclosporine and methotrexate .The results showed that all patients were successfully engrafted .The incidence of over grade Ⅱ acute GVHD after HLA matched transplantation was 21 05%(8/38). Chronic GVHD occurred in 19/25(76%) patients. Three of thirty four patients with acute leukemia(CR 1 ) and CML(CP) after HLA matched transplantation relapsed(8 82%). The disease free survival was 71 43%(10/14) after follow up for more than 2 years. The results suggest that the incidence of acute GVHD in allo PBSCT appears to be similar to allo BMT, but the incidence of chronic GVHD in allo PBSCT is higher than that in allo BMT. Infection and interstitial pneumonitis are the main cause of death.
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20?10 9/L on day 16 (range 9~35).Over grade Ⅱ acute GVHD occurred in three patients(25%) and chronic GVHD occurred in five patients, including three patients with localized chronic GVHD and two with extensive chronic GVHD . The incidence of acute GVHD in allo-PBSCT is similar to allo-BMT, while care should be taken for the occurrence of chronic GVHD.