Clinic Outcome of Allogeneic Stem Cell Transplantation in 45 Patients with MDS / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the clinical features and prognosis of patients with myelodysplastic syndrome (MDS) who received allogeneic hematopoietic stem cell transplantation (allo-HSCT).</p><p><b>METHODS</b>A total of 45 patients with MDS and transformed acute myeloid leukemia (tAML) who received allo-HSCT between January 2009 and December 2014 were enrolled in this study. The effects of different conditioning regimens, donor and chemotherapy before transplantation on the clinical outcome were analyzed retrospectively.</p><p><b>RESULTS</b>The median follow-up time for these patients was 54.6 months (ranged from 1 to 72.1 months), the 4-year cumulative overall survival (OS) and disease-free survival (DFS) rates were 77.1% and 62.1%, respectively. In myeloblative conditioning group and reduced intensity conditioning group, the 3-year cumulative OS rate was 69% and 68.6% (HR = 1.0, P = 0.984), respectively, the 3-year cumulative relapse rate was 17.6% and 33.3% (HR = 3.389, P = 0.162). The 100-day cumulative rate of aGVHD (38.6%) in HLA-identical nonsibling group was similar to HLA identical sibling group (37%) (HR = 1.089, P = 0.885); meanwhile the similar 3-year commulative OS rate was achieved in the 2 groups (72.7% and 70%) (HR = 0.952, P = 0.942). Among 26 patients with RAEB-2 and t-AML, the 2-year cumulative OS were 66.7% and 58.3% (HR = 1.265, P = 0.750) and 2-year cumulative relapse rates were 20.0% and 12.5% (HR = 0.417, P = 0.477) in non-chemotherapy and CR post-chemotherapy subgroups. The 1-year cumulative OS rate was 53.5% and 84.8% in the group with or without aGVHD. The patients with aGVHD had higher transplantation related mortality (TRM) compared with patients without aGVHD (HR = 15.0, P =0.011).</p><p><b>CONCLUSION</b>The reduced intensity conditioning doesn't reduce OS rate in patients with MDS, and elderly patients can benefit from it. The OS rate is similar between HLA-identical sibling and HLA-identical nonsibling allo-HSCT. The chemotherapy before transplantation cannot prolong the survival of MDS patients.</p>

A Retrospective Study of Ph Negative Adolescent and Young Adults with Acute B Lymphoblastic Leukemia in Two Centers / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To analyze the therapeutic efficacy of different consolidation therapies after induction remission on Ph negative adolescent and young adults with acute B lymphoblastic leukemia, and to explore the effect of different risk factors on prognosis.</p><p><b>METHODS</b>The treatment and efficacy of 80 Ph negative B-ALL in patients of 16-39 years old in the Hematology Department of 301(65 cases) and 309(15 cases) hospital from 1999 to 2016 are retrospectively analyzed. The patients received combined induction chemotherapy of 4 or 5 chemotherapeutic drugs (VDCLP/ VDLP/ DOLP/ IOLP). After remission patients received consolidation protocols of 3-5 cycls, and then received allo-HSCT or haploidentical HSCT. The median follow-up time was 29 (6-153) months.</p><p><b>RESULTS</b>HSCT was carried out after CR1. The 5-year OS and EFS of allo-HSCT group(n=29) was (73±16)% and (67±17)%, respectively, while those of haploidentical-HSCT group(n=20) were (53±22)% and (53±22)%, respectively, and those of pediatric-inspired protocols(n=31) was (63±17)% and (50±18)%, respectively. The difference between OS and EFS in 3 group was not statistically significant(P>0.05). The re-remission rate of recurrent patients was (50±23)%. On the one side, the cumulative incidence of TRM of pediatric-inspired protocol was better than that of HSCT (P<0.05). On the other side, the cummulative incidence of relapse (CIR) of pediatric-inspired protocol was poorer than that of HSCT, yet without significant difference (P>0.05). The median remission time of CR2 in patients was 14(2-36) months. Univariate and multivariate analysis were performed in 65 patients, and showed an abnormal result of CD13 or CD33 positive, CD22 negative, indicating a poor prognosis(P<0.05).</p><p><b>CONCLUSION</b>In the adolescent and young adult patients with PhB-ALL treated by pediatric-inspired protocols, the survival time is similar with that in allo-HSCT group. However, more prospective clinical studies of random control test(RCT) should be carried out.</p>

Secondary antifungal prophylaxis in hematological malignancy patients with previous invasive fungal disease / 中国实验血液学杂志

Invasive fungal disease (IFD) causes a high morbidity and mortality in patients with hematological malignancies. Reactivation of IFD after chemotherapy or hematopoietic stem cell transplantation (HSCT) is very common and associated with poor prognosis. Secondary antifungal prophylaxis (SAP) is effective in preventing IFD recurrence. With effective SAP, a history of IFD is not an absolute contraindication to allogeneic HSCT or continuation of high-dose chemotherapy. In recent years, a variety of antifungal drugs such as voriconazole, itraconazole, AmB and caspofungin have been found to be effective for SAP. However, its management during granulocytopenia and immunosuppression remains challenging. This review summarizes the current status of SAP in patients with hematological malignancies.

Differential diagnosis of metastasis from non-metastatic lymph nodes in cervical cancers: pilot study of diffusion weighted imaging with background suppression at 3T magnetic resonance / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Diffusion weighted imaging with background suppression (DWIBS) is potentially useful in detecting metastatic lymph nodes. This study aimed to evaluate the efficacy of DWIBS at 3T magnetic resonance (MR) for diagnosing metastatic lymph nodes in cervical cancer.</p><p><b>METHODS</b>This retrospective study included 25 patients with cervical cancer who underwent MR examination and were treated by hysterectomy and lymphadenectomy. The metastatic and non-metastatic lymph nodes were histologically proven by operation. Apparent diffusion coefficient (ADC) values, long-axis diameters, short-axis diameters, ratio of short- to long-axis diameters of all the identifiable lymph nodes were measured and compared.</p><p><b>RESULTS</b>Twenty-five primary tumor lesions, 17 metastatic lymph nodes and 140 non-metastatic lymph nodes were pathologically confirmed in 25 cases with cervical cancer. The difference of ADC values between primary tumor lesions, metastatic and non-metastatic lymph nodes were statistically significant (F = 7.93, P = 0.001). There was no statistically significant difference between primary tumor lesions of cervical cancer and metastatic lymph nodes (t = -0.75, P = 0.456), and the difference between primary tumor lesions and non-metastatic lymph nodes was statistically significant (t = 4.68, P < 0.001). The ADC values, long-axis diameters, short-axis diameters, ratio of short- to long-axis diameters of metastatic and non-metastatic lymph nodes were (0.86 ± 0.36) × 10(-3) mm(2)/s vs. (1.12 ± 0.34) × 10(-3) mm(2)/s, (1.51 ± 0.41) cm vs. (1.19 ± 0.36) cm, (1.16 ± 0.35) cm vs. (0.77 ± 0.22) cm, 0.78 ± 0.17 vs. 0.68 ± 0.19 respectively, and statistically significant difference existed between two groups.</p><p><b>CONCLUSIONS</b>DWIBS at 3T MR has the distinct advantages in detecting pelvic lymph nodes of cervical cancer. Quantitative measurement of ADC values could reflect the degree of restriction of diffusion of metastatic and non-metastatic lymph nodes. The combination of size and ADC value would be useful in the accurate diagnosis of metastatic lymph nodes.</p>