Clinical Study of Cytomegalovirus Infection after Allogeneic Hematopoietic Stem Cell Transplantation / 中国实验血液学杂志

OBJECTIVE@#To explore the risk factors of cytomegalovirus (CMV) and refractory CMV infection (RCI) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and their influences on survival.@*METHODS@#A total of 246 patients who received allo-HSCT from 2015 to 2020 were divided into CMV group (n=67) and non-CMV group (n=179) according to whether they had CMV infection. Patients with CMV infection were further divided into RCI group (n=18) and non-RCI group (n=49) according to whether they had RCI. The risk factors of CMV infection and RCI were analyzed, and the diagnostic significance of Logistics regression model was verified by ROC curve. The differences of overall survival (OS) and progression-free survival (PFS) between groups and the risk factors affecting OS were analyzed.@*RESULTS@#For patients with CMV infection, the median time of the first CMV infection was 48(7-183) days after allo-HSCT, and the median duration was 21 (7-158) days. Older age, EB viremia and gradeⅡ-Ⅳacute graft-versus-host disease (aGVHD) significantly increased the risk of CMV infection (P=0.032, <0.001 and 0.037, respectively). Risk factors for RCI were EB viremia and the peak value of CMV-DNA at diagnosis≥1×104 copies/ml (P=0.039 and 0.006, respectively). White blood cell (WBC)≥4×109/L at 14 days after transplantation was a protective factor for CMV infection and RCI (P=0.013 and 0.014, respectively). The OS rate in CMV group was significantly lower than that in non-CMV group (P=0.033), and also significantly lower in RCI group than that in non-RCI group (P=0.043). Hematopoietic reconstruction was a favorable factor for OS (P<0.001), whereas CMV-DNA≥1.0×104 copies/ml within 60 days after transplantation was a risk factor for OS (P=0.005).@*CONCLUSION@#The late recovery of WBC and the combination of EB viremia after transplantation are common risk factors for CMV infection and RCI. CMV-DNA load of 1×104 copies/ml is an important threshold, higher than which is associated with higher RCI and lower OS risk.

Clinical Analysis of Matched Sibling Donor Allogeneic Hematopoietic Stem Cell Transplantation in the Treatment of Young Patients with Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To investigate the efficacy and safety of matched sibling donor allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of young patients with multiple myeloma (MM).@*METHODS@#The clinical data of 8 young patients (median age：46 years) with MM who underwent allo-HSCT from HLA-indentical sibling donors in the First Affiliated Hospital of Chongqing Medical University from June 2013 to September 2021 were collected, and their survival and prognosis were retrospectively analyzed.@*RESULTS@#All the patients were successfully transplanted, and 7 patients could be evaluated the efficacy after transplantation. The median follow-up time was 35.2 (2.5-84.70) months. The complete response (CR) rate was 2/8 before transplantation and 6/7 after transplantation. Acute GVHD developed in 2 cases and extensive chronic GVHD developed in 1 case. Within 100 days, 1 case died of non-recurrent events, and 1-year and 2-year disease-free survival were 6 and 5 cases, respectively. At the end of follow-up, all the 5 patients who survived for more than 2 years survived, and the longest disease-free survival time has reached 84 months.@*CONCLUSION@#With the development of new drugs, HLA-matched sibling donor allo-HSCT may be a curable treatment for young patients with MM.

Clinical Study of Haploid Allogeneic Hematopoietic Stem Cell Transplantation Combined with Post-transplant Cyclophosphamide in Severe Aplastic Anemia Patients / 中国实验血液学杂志

OBJECTIVE@#To evaluate the clinical effect of haploid allogeneic hematopoietic stem cell transplantation(haplo-HSCT) in the treatment of severe aplastic anemia (SAA), and to explore the efficacy different between post-transplant cyclophosphamide (PT/Cy) and standard-dose ATG.@*METHODS@#The clinical data of 38 patients with SAA in our hospital from January 2012 to December 2019 were collected and retrospectively analyzed. The efficacy was evaluated. The patients with haplo-HSCT were divided into low-dose ATG combined with PT/Cy group and standard-dose ATG group, and the blood cell hematopoietic reconstruction time, GVHD incidence, mortality and survival time of the patients in the two groups was compared.@*RESULTS@#Among the 32 patients, hematopoietic reconstitution were detected in 9375%(30/32) recipients. The median time of neutrophil and platelet engraftment was 15(10-22) days and 13(7-30) days, respectively. The incidence of GVHD was 21.89%, the incidence of infection was 93.75%, and the 2-year overall survival rate was 84.38%. The hematopoietic reconstitution time, incidence of GVHD, mortality rate and survival time were no statistical differences between the patients in the two groups(all P>0.05).@*CONCLUSION@#Haplo-HSCT is an effective method for the treatment of SAA，low-dose ATG combined with PT/Cy can lighten the economic burden on patients, it would be a feasible treatment plan for SAA with light side effect.

Clinical Significance of Minimal Residual Disease Monitoring by Multi-parameter Flow Cytometry before Allogeneic Hematopoietic Stem Cell Transplantation for Prognosis of Acute Leukemia Patients / 中国实验血液学杂志

OBJECTIVE@#To investigate the clinical significance of minimal residual disease (MRD) monitoring by multiparameter flow cytometry (MFC) before allogeneic hematopoietic stem cell transplantation (allo-HSCT) in acute leukemia.@*METHODS@#81 cases of patients with AL treated with allo-HSCT in Department of Hematology, the First Affiliated Hospital of Chongqing Medical University form July 2015 to July 2018 was selected and retorspectively analyed. of which 79 patients were in CR and two patients were in non-CR. The CR group was further divided into two groups of MRD and MRD based on the MRD level prior to HSCT.@*RESULTS@#Among 81 patients, there were statistically significant differences in the three-year overall survival(OS) (CR 82.2%: NCR 0%), cumulative relapse incidence(RI) (CR 17.7%; NCR 100%) and leukemia-free survival rate(LFS) (CR 42.3%: NCR 0%) between CR and NCR group(P<0.05). Among 79 CR patients, MRD was negative in 30 patients while positive in 49 patients, there was significant differences in the three-year overall survival between MRD and MRD group. The results of univariate analysis showed that the MRD group showed lower LFS compared with that of MRD group （10.5% vs 36.2%）(P＜0.001，95%CI).@*CONCLUSION@#MRD patients shows longer LFS as compared with that of MRD patients, therefore, MRD monitoring by MFC before allo-HSCT is very important for the prognosis of the AL patients.

Multivariate analysis of the efficacy of laparoscopic splenectomy in the treatment of immune thrombocytopenic purpura / 中华外科杂志

<p><b>OBJECTIVE</b>To identify factors that can effectively predict the efficacy of laparoscopic splenectomy (LS) in the treatment of immune thrombocytopenic purpura (ITP).</p><p><b>METHODS</b>From January 2007 to September 2012, 78 patients with ITP underwent laparoscopic splenectomy were retrospectively analyzed. According to the postoperative platelet (PLT) count and haemorrhagic manifestations, they were divided into effective group and ineffective group. Nine influencing factors were univariate analyzed and multivariate analyzed.</p><p><b>RESULTS</b>In effective group (65 cases) and ineffective group (13 cases), average PLT count of 1 day before surgery was 47×10(9)/L vs. 21×10(9)/L, average operative time was (166 ± 46) minutes vs. (139 ± 29) minutes. Univariate analysis result: PLT count of 1 day before surgery (Z = -2.776, P = 0.005) and operative time (t = 2.723, P = 0.011) was statistically significant in 2 groups, the rest factors did not significantly influence the result. Multivariate analysis revealed that only PLT count of 1 day before surgery was statistically significant (OR = 0.964, 95%CI: 0.932-0.997, P = 0.031) in 2 groups, but operative time (P = 0.051) was not statistically significant.</p><p><b>CONCLUSIONS</b>PLT count of 1 day before surgery is a predict factor in LS for ITP. Because of the limited sample number, further multi-center prospective study with large sample is warrant.</p>

Mechanism of G2/M blockage triggered by activated-Chk1 in regulation of drug-resistance in K562/A02 cell line / 中国实验血液学杂志

The study was purposed to investigate the effect of phosphorylated-chk1 on cell cycle and apoptosis of human erythroleukemic cell line K562 and K562/A02, and to explore the mechanism of chk1 in regulation of drug-resistance of leukemia cells. After treatment with adrimycin for six hours, the cell cycle distribution was detected by flow cytometry; the Chk1mRNA expression was detected by RT-PCR and the Chk1 phosphorylation level was detected by Western blot. Under the condition of down-regulation of Chk1mRNA expression in cells transfected with Chk1 short hairpin RNA, the cell apoptosis rates were detected by flow-cytometry following adrimycin. The results indicated that the proportion of K562/A02 cell line in G2/M phase was (54.12 +/- 0.57)% at 6 hours after drug treatment, significantly higher than that of K562 cell line (36.99 +/- 1.28)%. No evident difference of the Chk1mRNA expression was observed between K562 and K562/A02 cell lines, while elevated Chk1 phosphorylation following DNA damage induced by adriamycin was observed in the K562/A02 cell line (0.79 +/- 0.56), significantly higher than that in K562 cell line (0.27 +/- 1.47). The cell apoptosis rate of the Chk1 shRNA group in K562/A02 cell line was 3.84-fold of blank vector group, but that in K562 cell line was 1.30-fold of blank vector group. It is concluded that the increased chk1 activity that delay the progress of cell cycle are associated with cellular resistance to adrimycin in the K562/A02 cell line.

Biological characteristics and ability of supporting hematopoiesis of bone marrow mesenchymal stem cells pre- and post-cryop-reservation / 中国实验血液学杂志

This study was aimed to observe the biological characteristics of cryopreserved bone marrow mesenchymal stem cell (MSC) and to examine their abilities to support in vitro hematopoiesis. Bone marrow MSC were cryopreserved in -196 degrees C liquid nitrogen for 4 weeks (short term) and 9-15 months (medium term) with IMDM containing 10% DMSO, 40% fetal calf serum as cryoprotectant. The viability, proliferation, immunophenotype, in vitro differentiation and ability of supporting hematopoiesis of thawed MSC were investigated and compared with these of pre-cryopreserved MSC. The results showed that the cell viability were (93 +/- 2.51)% and (90 +/- 3.75)% for MSC cryopreserved as long as 4 weeks or 9-15 months respectively. However, there were no changes detected, as compared with pre-cryopreserved MSC in immunophenotype, abilities of proliferation and supporting colony forming of CFU-GM, CFU-E and CFU-GEMM. It is concluded that bone marrow-derived MSC can be stored in liquid nitrogen for short-term (4 weeks) or medium-term (9-15 months) without changes of abilities of proliferation, differentiation and hematopoiesis support.

Indoleamine 2, 3-dioxygenase activity in acute myeloid leukemia cells contributing to tumor immune escape / 中国实验血液学杂志

This study was aimed to investigate the mechanism of indoleamine 2, 3-dioxygenase (IDO) activity in acute myeloid leukemia cells contributing to tumor immune escape. Myeloid leukemia cells were isolated from bone marrow of 23 patients with acute myeloid leukemia (AML) and IDO expression was detected by immunochemistry and RT-PCR methods. Then mixed lymphocyte reaction (MLR) of one way was carried out, leukemia cells were used as stimulating cells and T-lymphocytes were used as reactive cells in culture with or without 1-MT. T-lymphocyte proliferation rate was determined by MTT assay and IDO activity in supernatant of MLR was detected by high-performance liquid chromatography (HPLC). The results showed that IDO expression was found in 17 out of 23 cases of acute myeloid leukemia cells; IDO enzyme activity in leukemia cells inhibited T-lymphocyte proliferation in MLR cultures. It is concluded that IDO activity expressing in leukemia cells can suppress T-lymphocyte proliferation responses, which may be contributing to tumor immune escape.

Comparative Study of Mesenchymal Stem Cells Derived From Human Umbilical Cord Vein and Adult Bone Marrow / 中国生物工程杂志

Mesenchymal stem cells (MSCs) are promising candidates to develop new cell-based therapeutic strategies and bone marrow represents the main source of MSCs for experimental and clinical application currently. How to obtain enough MSCs is the biggest challenge faced by the experimental and clinical application. The difference of morphology, growth pattern, immunophenotype and multilineage differentiation of MSCs derived from human umbilical cord vein and their multiple differentiation capacity were investigated. The results showed that MSCs derived from human umbilical cord vein and normal adult bone marrow were similar in biological characteristics. They not only grew in fibroblast-like cells mode but had great expansion potency and multilineage differentiation ability in vitro. The MSCs derived from human umbilical cord vein may be an excellent alternative source for experimental and clinical application.