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Objective:To compare the clinical outcomes and safety of haploidentical donor (HID)and HLA-matched sibling donor(MSD)hematopoietic stem cell transplantation(HSCT)for severe aplastic anemia(SAA).Methods:From January 1, 2012 to December 31, 2019, retrospective review of clinical data was performed for 75 SAA patients undergoing HSCT at Department of Hematology, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.Based upon donor sources, they were divided into two groups of MSD(49 cases)and HID (26 cases). And two groups were compared with regards to hematopoietic recovery, graft-versus-host disease(GVHD)infection and overall survival(OS).Results:Time of platelet and neutrophil engraftment of two groups was comparable(11 d vs.11 d, P=0.84; 11 d vs.12 d, P=0.08). Compared with HID group, MSD group had a lower incidence of acute GVHD(46.2% vs.18.4%, P=0.01)with a comparable incidence of grade Ⅱ-Ⅳ acute GVHD(26.9% vs.14.3%, P=0.24), grade Ⅲ-Ⅳ acute GVHD(15.4% vs.4.1%, P=0.09)and chronic GVHD(23.9% vs.23.1 %, P=0.71). A reactivation of CMV occurred in 27(55.1%)MSD and 22(84.6%)HID recipients( P=0.01). And the incidence of EB viremia was 69.4% and 61.5% respectively.After a median follow-up period of 54.0 and 18.5 months, the estimated 3-year OS rate of MSD and HID groups were 94.0% and 88.0% respectively ( P=0.35). Conclusions:HID HSCT is an effective and relatively safe option for SAA patients, especially for those in urgent need of treatment without MSD or refractory/relapse to immunosuppressive therapy.
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Objective@#To evaluate possible effects of Gelctin-9 on acute graft versus host disease (aGVHD) development and clinical outcomes in patients before and afer allogeneic hematopoietic stem cell transplantation (allo-HSCT) .@*Methods@#Peripheral blood samples were obtained from 29 patients and 15 healthy volunteers with heparin anticoagulant tubes. Samples were analyzed using ELISA kits to measure the serum concentrations of Galectin-9.@*Results@#Patients developing aGVHD had significantly lower level of Galectin-9 [ (7.96±1.18) μg/L] before allo-HSCT compared with those not developing aGVHD [ (12.37±0.97) μg/L, P<0.001]. And after allo-HSCT, the consentration of Galectin-9 increased markedly in patients developing aGVHD [ (17.78±1.78) μg/L] compared with those not developing aGVHD [ (9.45±0.80) μg/L, P<0.001]. Patients developing 3-4 grade aGVHD had significantly higher level of Galectin-9 [ (23.25±2.59) μg/L] compared with those developing 1-2 grade aGVHD [ (14.37±1.45) μg/L, P=0.008] and those without aGVHD [ (9.45±0.80) μg/L, P<0.001]. The patients with lower level of Galectin-9 after allo-HSCT (<13.61 μg/L) showed more favorable clinical outcomes compared with those with higher level of Galectin-9 (≥13.61 μg/L) . The 3-year overall survival rates were (100.00±6.05) % and (69.23±12.80) %, respectively (P=0.009) . The cumulative incidence of non-relapse mortality was significantly higher in high Galectin-9 group [ (23.08±11.69) %] in comparison with low Gaelctin-9 group [ (0.00±7.39) %] (P=0.023) . There was no significant difference between the two groups in terms of the cumulative incidence of relapse. The cumulative incidence of relapse at 3 years were (8.33±7.98) % and (12.50±8.27) % in high and low Galectin-9 groups, respectively (P=0.708) .@*Conclusions@#The serum concentration of Galectin-9 at the time of engraftment after allo-HSCT may be used as a predictor for the development and severity of aGVHD. Galectin-9 might be considered as a potential new approach to regulate transplant rejection to achieve desirable survival.
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With a global pandemic trend, coronavirus disease-2019 (COVID-19), starting a breakout in December 2019, has posed a great threat to people's lives, health and safety. Regarding how to manage hematopoietic stem cell transplantation (HSCT) center, treat non-COVID-19 HSCT patients, follow up patients after HSCT and resume the orderly treatment of transplant patients, our transplantation center has accumulated a wealth of practical experience and formulated a series of standard processes. This article was intended to summarize the management experiences of HSCT center under the pandemic of COVID-19 epidemic, provide references for effectively managing HSCT center in future public health crises and treat noncommunicable disease transplant patients in a timely and effective manner.
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Objective In order to evaluate the possible effects of myeloid-derived suppressor cells (MDSCs) on graft versus host disease (aGVHD) development and clinical outcomes,this study systematically detected the dynamic changes of MDSCs accumulation in patients during the first 100 days after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods Peripheral blood was obtained from 30 patients and 10 healthy volunteers with heparin anticoagulant tubes for 6 mL.For patients,peripheral blood was collected during the first 100 days after allo-HSCT and MDSCs levels were detected by flow cytometry.For measuring the serum concentrations of IL-6,IL-10,IL-1β,TNF-α,Arg-1,HO-1 and iNOS,samples were analyzed using ELISA kits.Results Patients developing aGVHD were infused with significantly less number of MDSCs [(39.94 ± 8.383) 106/kg]than in those not developing aGVHD [(209.0 ± 57.68) 106/kg,P =0.002 6];Patients developing aGVHD Ⅰ-Ⅱ and patients without aGVHD received significantly greater number of MDSCs [(61.96 ± 13.67) 106/kg and (209.0 ± 57.68) 106/kg] than in those developing aGVHD Ⅲ-Ⅳ [(20.37 ±4.304) 106/kg,P =0.013 9].After allo-HSCT,the mean percentage of MDSCs increased markedly in patients developing aGVHD [(7.725 ± 1.460)％] as compared with those not developing aGVHD [(3.423± 1.044)％,P =0.021 3].The high MDSCs group (＞53.712 × 106/kg) showed more favorable clinical outcomes than in the low MDSCs group (≤53.712 × 106/kg).The 2-year overall survival rate as 100％ in high MDSCs group,and 50％ in low MDSCs group (P =0.001 3).The cumulative incidence of 2-year relapse was 6.250％ and 29.252％ in high MDSCs group and low MDSCs group respectively (P =0.112 3).The cumulative incidence of NRM was significantly lower in high MDSCs group (0％) than in low MDSCs group (49.519％,P=0.001 8).MDSCs frequencies significantly increased in patients developing aGVHD after allo-HSCT.After allo-HSCT,the concentrations of IL-6,IL-10,TNF-α,Arg-1,iNOS and HO-1 were significantly elevated in patients developing aGVHD.Conclusion The number of MDSCs when engraftment may be used as a predictor for the development and severity of aGVHD.MDSCs might be considered as a potential new approach to regulate transplant rejection and achieve long-term survival.
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Objective To investigate the risk factors of gastrointestinal graft versus host disease(GVHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT).Method 214 patients receiving allo-HSCT from 2003 to 2012 were enrolled in this study,and assessed on the degree of gastrointestinal GVHD.The effects of the primary diseases status,gender,age,conditioning regimen intensity,donor type,the number of cells positive for the CD34 expression,and the use of anti-lymphocyte immunoglobulin (ALG) in the pretreatment scheme on the occurrence of gastrointestinal GVHD was studied.The responses of different degrees of GVHD to immunotherapy were evaluated.Result Univariate and multivariate analyses revealed that the graft type and the conditioning regimen intensity were the risk factors of gastrointestinal GVHD (P＜0.05).Conclusion Donor type and conditioningregimen intensity may be the main risk factors of gastrointestinal GVHD.
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Objective:To compare the effects of a single dose of dexrazoxane or cAMP and their combined use on anthracycline cardiotoxicity in the multiple treatment course of patients with hematological malignancies to explore better alternatives for reducing an-thracycline cardiotoxicity. Methods: In the study, 80 patients were randomly divided into 4 groups with 20 cases each. Group A ( cAMP group) received cAMP 20 ml·d-1 for a week before every treatment course. Group B was treated with dexrazoxane and adria-mycin at a dosage ratio of 10∶1 via a fast intravenous drip 30 min before the application of anthracycline chemotherapy, and the 20 ml cAMP was given once a week before the chemotherapy session. Group C only received dexrazoxane. Anthracyclines was administered 30 min before each chemotherapy session. Groups A, B, and C were the experimental groups, and group D was designed as the blank control group. All groups received four complete cycles of chemotherapy. The ECG changes, echocardiography ( left ventricular ejection fraction, LVEF) and B-type brain natriuretic peptide ( BNP) values of all the groups were observed before and after the chemotherapy. Results:As for the ECG changes, group B and C had lower incidence rate of abnormal ECG than group A and D(P<0. 008 3). Sig-nificantly decreased LVEF and increased BNP values were observed in group A, B and C compared with those in the control group ( P<0. 05), and group B showed the most significant effect. Conclusion:All of the studied treatments can effectively reduce anthracy-cline chemotherapy-induced cardiotoxicity in cancer patients, and the combination of cAMP and dexrazoxane exhibits the best effect. Dexrazoxane has better protective effect on myocardial cells than cAMP.
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Objective To determine the concentration of soluble PD-1 (sPD-1) in the sera of patients with recurrent genital herpes (RCH), and to explore the significance of abnormal expression of sPD-1 in RCH. Methods Serum samples were obtained from 88 healthy blood donors, 74 patients with RCH including 34 cases of outbreak-stage RCH and 40 cases of stable-stage RCH. The serum level of sPD-1 was measured by monoclonal antibody labeling and enzyme linked immunosorbent assay (ELISA). Results A significant difference was observed in the serum level of sPD-1 between the patients with RGH and the blood donors (33.06 ± 17.5 μg/L vs. 53.07 ± 26.3μg/L, P < 0.01) and between the patients with outbreak-stage RGH and those with stable-stage RGH (27.47 ± 12.9 μg/L vs. 37.71 ± 19.6 μg/L, P< 0.01). Conclusions There is a low expression of sPD-1 in patients with RGH, which may be one of the mechanisms underlying the escape of HSV- Ⅱ from immunologic surveillance and development of immunological tolerance.
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Objective To clone the full-length of human Gill cDNA and construct the recombinant lentiviral expressing vector pLOX-Gfil for eukaryotic expression,providing a basis for further study on the biological functions of Gfil.Methods Total RNA was isolated from K562 cells,and the full-length Gfil cDNA was amplified by RT-PCR and then ligated with pGEM-T vector after retrieve and purification.The ligation product was transformed into competent cells DH5a.The positive recombinant clones were selected and identified by a complementation,restriction endonuclease digestion.The cloning vector and the lentiviral vector pLOX first digested with BarnH I were ligated and transformed.The enzyme and PCR analyses were performed to confirm the recombinant vector,and then DNA sequence analysis.Results A fragment of 1.2 kb was obtained by RT-PCR.The enzyme and PCR analyses revealed that the correct Gfil cDNA was cloned.The sequence of cloned cDNA was identical to the sequence deposited in GenBank (NM005263).Conclusion Gfil was cloned correctly and the recombinant lentiviral vector pLOX-Gfil for eukaryotic expression was constructed successfully.
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objective To establish a new method for isolation and identification of mixed erythrocytes with different blood groups from the patients following ABO-incompatible allogeneic haematopoietic stem cell transplantation(allo-HSCT),and investigate its application in post-transplantation survival erythrocytes.Methods The erythrocyte blood group antigens from the patiehts following ABO-incompatible allo-HSCT were agglutinated by the antibodies known.centrifuged at 800×g and 50×g to isolate agglutinated and unagglutinated erythrocytes respectively step by step.These erythrocytes collected were counted and identification respectively.Results The sensitivity,accuracy,recovery and reproducibility of the new method were 1%,100%,92.5%and 100%,respectively.The post-transplantation survival erythrocytes mixed with patient's erythrocytes from 18 patients following ABO-incompatible allo-HSCT were successfully isolated and identified by provided methods.It was the first time to identify the survival erythrocytes 11 th to 72 th day after allo-HSCT.The amount of the survival erythrocytes had been changing following post-transplantation periods.Conclusions The method can be widely employed in the isolation and identification of mixed erythrocytes with different blood groups.It provides reliable method to study the clinic significance of the changes of the survival erythroeytes from the patients following ABO-incompatible allo-HSCT.