ABSTRACT
Treatments for patients with hematologic malignancies not in remission are limited, but a few clinical studies have investigated the effects of salvaged unrelated cord blood transplantation (CBT). We retrospectively studied 19 patients with acute leukemia, 5 with myelodysplastic syndrome (MDS with refractory anemia with excess blasts [RAEB]), and 2 with non-Hodgkin's lymphoma who received 1 CBT unit ≤2 loci human leukocyte antigen (HLA)-mismatched after undergoing myeloablative conditioning regimens between July 2005 and July 2014. All of them were in non-remission before transplantation. The infused total nucleated cell (TNC) dose was 4.07 (range 2.76-6.02)×107/kg and that of CD34+ stem cells was 2.08 (range 0.99-8.65)×105/kg. All patients were engrafted with neutrophils that exceeded 0.5×109/L on median day +17 (range 14-37 days) and had platelet counts of >20×109/L on median day +35 (range 17-70 days). Sixteen patients (61.5%) experienced pre-engraftment syndrome (PES), and six (23.1%) patients progressed to acute graft-versus-host disease (GVHD). The cumulative incidence rates of II-IV acute GVHD and chronic GVHD were 50% and 26.9%, respectively. After a median follow-up of 27 months (range 5-74), 14 patients survived and 3 relapsed. The estimated 2-year overall survival (OS), disease-free survival (DFS), and non-relapse mortality (NRM) rates were 50.5%, 40.3%, and 35.2%, respectively. Salvaged CBT might be a promising modality for treating hematologic malignancies, even in patients with a high leukemia burden.
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Young Adult , Allografts , Anemia, Refractory, with Excess of Blasts/therapy , Cord Blood Stem Cell Transplantation , Graft vs Host Disease , Leukemia, Biphenotypic, Acute/therapy , Lymphoma, Non-Hodgkin/therapy , Anemia, Refractory, with Excess of Blasts/mortality , Cord Blood Stem Cell Transplantation/mortality , Disease-Free Survival , Follow-Up Studies , Graft vs Host Disease/mortality , Hematologic Neoplasms/mortality , Hematologic Neoplasms/therapy , Leukemia, Biphenotypic, Acute/mortality , Leukemia, Lymphoid/mortality , Leukemia, Lymphoid/therapy , Leukemia, Myeloid/mortality , Leukemia, Myeloid/therapy , Leukemia/mortality , Leukemia/therapy , Lymphoma, Non-Hodgkin/mortality , Myelodysplastic Syndromes/mortality , Myelodysplastic Syndromes/therapy , Retrospective Studies , Remission Induction/methods , Treatment OutcomeABSTRACT
To assess the correlation and difference between various endoscopic grades and indices for assessment of endoscopic disease activity in inflammatory bowel disease [IBD]. Eighty consecutive patients with ulcerative colitis [UC], and 31 patients with Crohn's disease [CD] were evaluated based on multiple endoscopic criteria between June 2006 and February 2007 at the Department of Gastroenterology of Renji Hospital, Shanghai, China. Two experienced endoscopists evaluated the endoscopic findings using various systems independently. Data were analyzed using Kendall's coefficient of concordance and Spearman correlations. For the systems of UC and CD, Kendall's coefficients of concordance were 0.714 [p<0.001] and 0.342 [p<0.001]. There was no significant difference between the 2 systems of UC [all p<0.01]. However, no statistically significant concordances were found between Chinese Grading System of Crohn's Disease [CGSCD] and Crohn's Disease Endoscopic Index of Severity [CDEIS] [rs=0.323, p=0.076]. Significant differences in frequencies were detected among endoscopic systems for UC [p=0.001]. It was suggested in our study that endoscopic grading and scoring systems of UC had satisfactory concordance, and CGSCD showed room for improvement. However, the modified Baron scale was tend to severe category, while Jeroen classification was tend to mild category