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A case of a 47-year-old female patient who had a severe headache for 2 days was reported. Spontaneous subarachnoid hemorrhage (SAH, hunt-Hess classification Ⅱ level)-anterior communicating aneurysm rupture was diagnosed by brain CT and digital subtraction angiography (DSA) examination.Intravascular interventional aneurysm embolization was performed, and the patient appeared progressive limb weakness 5 days after operation. Physical examination revealed grade Ⅱ upper limb muscle strength and grade Ⅰ lower limb muscle strength. The muscle tone of the extremities was decreased,and the tendon reflex disappeared. The pinprick pain was decreased below the double wrist joints and the ankle joints. After neuroelectrophysiology test and cerebrospinal fluid assay, the patient was diagnosed as Guillain-Barré syndrome associated with subarachnoid hemorrhagic aneurysm embolization.
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Objective@#To investigate three different types of donor hematopoietic stem cell transplantation (HSCT) for intermediate and high-risk myelodysplastic syndrome (MDS) .@*Methods@#Between August 2001 and May 2015, 167 consecutive patients with MDS in intermediate and high-risk who underwent allogeneic HSCT were analyzed retrospectively.@*Results@#With the median follow up of 60 (12-177) months, The total 5-year DFS was 67.8% (95%CI 60.0%-75.6%) . Among three different types of donor, 5-year DFS rates were 68.0% (95%CI 54.1%-81.9%) in MSD-HSCT vs 77.4% (95%CI 62.1%-92.7%) in MUD-HSCT vs 64.0% (95% CI 52.4%-75.6%) in Haplo-HSCT (P=0.632) , respectively. Univariate analysis showed that median disease course before HSCT was the influencing factor of DFS (P=0.018) . Five-year relapse and TRM had no correlation with the above-mentioned factor.@*Conclusions@#Haplo-HSCT for intermediate and high-risk MDS achieved similar effect produced by MUD or MSD, Haplo-HSCT could be used as an important alternative donor. allo-HSCT must be performed on intermediate and high-risk MDS patients as early as possible after diagnosis.
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Objective@#To investigate the effect of minimal residual disease (MRD) monitoring by multiparameter flow cytometry (MFC) pre-conditioning on prognosis of acute myeloid leukemia in first complete remission (CR1-AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) , and to explore the value of MRD monitoring by MFC in the prognosis evaluation on allo-HSCT in CR1-AML.@*Methods@#Between April 2012 and March 2015, consecutive 186 patients with CR1-AML who underwent allo-HSCT were analyzed retrospectively. MRD in BM before conditioning was detected by eight-color MFC. Any level of residual disease was considered to be MRD positive.@*Results@#①Of 186 patients, MRD was negative in 151 patients, positive in 35 patients (<1% in 25 patients and 1% to 3% in 10 patients) . ② With the median follow up of 18 (5-41) months, two-year DFS was 80.0% (95%CI 68.5%-92.3%) . Univariate analysis showed that MRD positive patients had lower DFS[62.9% (95%CI 50.6%-75.2%) vs 88.9% (95%CI 76.6%-100.0%) , P<0.001], higher relapse[11.4% (95%CI 4.1%-29.0%) vs 3.3% (95% CI 0.6%-20.9%) , P=0.003] and higher NRM [25.7% (95% CI 8.1%-43.3%) vs 7.9% (95% CI 1.3%-26.5%) , P=0.001] after HSCT compared with that of MRD negative patients. Secondary AML showed lower DFS than primary AML [60.0% (95% CI 42.4%-76.6%) vs 86.0% (95% CI 68.4%-100.0%) , P=0.004]. ③Multivariate analysis indicated that MRD positive pre-HSCT was the independent risk factor on DFS [HR=4.565 (95%CI 2.918-9.482) , P<0.001], relapse [HR=5.854 (95%CI 1.538-22.288) , P=0.010] and NRM [HR=3.379 (95%CI 1.361-8.391) , P=0.009] after allo-HSCT in CR1-AML.@*Conclusion@#MRD positive pre-conditioning was the only negative impact factor for patients with CR1-AML after allo-HSCT. MRD by MFC can be used to assess the prognosis of CR1-AML after allo-HSCT.
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Objective@#To analyze the effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) .@*Methods@#Retrospective analysis of 258 patients with AML in CR (186 cases in CR1, 72 cases in CR2) who underwent allogeneic HSCT in our hospital between April 2012 and March 2015 according to NCCN (2015) risk stratification. Of them, 63 cases were classified as low risk, 112 cases intermediate risk and 83 cases high risk.@*Results@#①With the median follow up of 18 (5-41) months, two-year disease free surviva (DFS) in 258 patients was 78.0% (95% CI 60.4%-96.6%) . Two-year DFS in AML after transplantation was 78.6% (95% CI 61.0%-96.2%) in low risk, 76.0% (95% CI 84.0%-93.6%) in intermediate risk and 80.3% (95% CI 62.7%-97.9%) (P=0.886) in high risk groups respectively. ②Univariate analysis showed that DFS has no significant difference in patient age, the median disease course before HSCT, the WBC number at the beginning of the disease, blood routine and chromosomes examination before transplantation, extramedullary disease before transplantation, disease status before transplantation, conditioning regimen, donor type, donor and recipient sex, recipient blood type, transfused MNC number, transfused CD34+ cell number and transfused CD3+ cell number. DFS was significant lower in primary AML than that in secondary AML (P=0.006) and also lower in MRD positive than that in MRD negative (P=0.003) . The accumulative relapse was significant higher in CR2 compared to that in CR1 (P=0.046) . Accumulative non-relapse mortality (NRM) was significanlyt higher in secondary AML compared to that in primary AML (P=0.004) and also higher in MRD positive compared to that in MRD negative (P=0.010) . ③Multivariate analysis showed that MRD positive was the only significant factor in DFS and NRM.@*Conclusion@#Allo-HSCT treatment of AML CR patients could achieve a high efficacy, which is similar between CR1 and CR2 patients. There is no significant correlation between NCCN (2015) risk stratification and the prognosis of AML patients with allo-HSCT treatment. Pre-conditioning MRD status monitored by multiparameter flow cytometry was the only impact factor on DFS and NRM in allo-HSCT for CR-AML patients.
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<p><b>OBJECTIVE</b>To evaluate the efficacy of HLA- haploidentical donor hematopoietic transplantation (Haplo- HSCT)for severe aplastic anemia (SAA)by compared with the same period of unrelated donor transplantation (UD- HSCT).</p><p><b>METHODS</b>Of a cohort of 50 SAA patients between September 2012 and July 2014, 26 patients underwent UD- HSCT and 24 patients Haplo- HSCT.</p><p><b>RESULTS</b>OS rate was 91.3% with a median follow-up of 9 (2-26)months. According to transplant type, there was no significant difference between UD- and Haplo-HSCT (96.1%vs 86.0%,P=0.30). 3 of 50 (6%)patients had primary engraft failure. Haplo- HSCT developed higher significantly incidence of Ⅱ- Ⅳ aGVHD (37.5%vs 3.83%,P=0.003)and cGVHD (37.5%vs 15.3%,P=0.030)than UD-HSCT. Haplo-HSCT also had significantly higher incidences of CMV viremia (78.2%vs 46.1%,P=0.005)and EBV viremia (43.1%vs 16.0%,P=0.040), respectively than UD-HSCT. But the incidences of hemorrhagic cystitis were similar between two transplant types (39.1%vs 23.0%,P=0.120).</p><p><b>CONCLUSION</b>This study showed favorable outcome of Haplo-HSCT for SAA, which was comparable with UD-HSCT.</p>
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Humans , Anemia, Aplastic , Therapeutics , Hematopoietic Stem Cell Transplantation , Incidence , Treatment Outcome , Unrelated DonorsABSTRACT
Objective To observe the expression of forkhead or winged helix transcription 3 (Foxp3) in colon cancer tissue and paracancerous tissue,and detect the level of serum interleukin (IL)-17 in colon cancer patients and healthy human,to explore the changes of regulatory T cell (Treg cell) and Th17 cell in the process of occurrence and development of colon cancer.Methods The expression of Foxp3 in 56 patients with colon cancer and paracancerous tissue and 15 cases with normal colon tissue was measured by immunohistochemical SP method and the level of serum IL-17 was determined by enzyme-linked immunosorbent method.Results The level of serum IL-17 in colon cancer tissue was higher than that in normal colon tissue [(9.1 ± 2.3) ng/L vs.(6.2 ± 1.5) ng/L],and there was significant difference (P =0.007).Foxp3 positive cell number in colon cancer tissue was more than that in normal colon tissue and paracancerous tissue (24.1 ± 6.4 vs.2.7 ± 1.1 and 8.7 ± 2.3),paracancerous tissue was more than normal colon tissue,and there was significant difference (P ＜ 0.01).The level of serum IL-17 in colon cancer tissue with TNM Ⅲ was higher than that in TNM Ⅰ-Ⅱ [(8.5 ± 2.1) ng/L vs.(5.4 ± 0.9) ng/L],Foxp3 was more than that in TNM Ⅰ-Ⅱ (25.8 ± 6.2 vs.18.2 ± 4.4),and there was significant difference (P＜ 0.01).There was no significant difference in the level of serum IL-17 between middle-high differentiated adenocarcinoma and low differentiated adenocarcinoma [(9.4 ± 1.1) ng/L vs.(8.9 ± 1.8) ng/L] (P ＞ 0.05).Foxp3 in middlehigh differentiated adenocarcinoma was more than that in low differentiated adenocarcinoma (26.8 ± 5.5 vs.17.2 ± 3.2),and there was significant difference (P ＜ 0.01).Conclusions Detection of IL-17 and Foxp3 can provide a new way of targeting therapy for colon cancer.IL-17 levels and Foxp3 expression are closely related to the immune status of local tumor tissues,the joint detection is benefitial to the further understanding of the patients with tumor immune state,provide basic information for tumor immunotherapy.
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Objective To observe the therapeutic effect of Qili Qiangxin capsule combined with glucocorticoid for treatment of patients with dilated cardiomyopathy accompanied by refractory heart failure. Methods A prospective study was conducted. Forty-eight patients with dilated cardiomyopathy and refractory heart failure in Hebei Cangzhou Central Hospital were enrolled,and they were randomly divided into three groups:control group,treatmentⅠand treatmentⅡgroups(each,16 cases). All groups were treated with conventional anti-heart failure western treatment, meanwhile additionally prednisone was given to treatment groupⅠand groupⅡ,firstly 40 mg/d,then the dosage of 5 mg was decreased in every 5 days until reaching 5 mg per day;in treatment groupⅡ,besides the same treatment of group I,the traditional Chinese medicine therapy Qili Qiangxin capsule 4 granules(one capsule 0.3 g)each time and 3 times a day was added,2 months being the therapeutic course in all the patients. The clinical efficacy and cardiac functional indexes,such as the left ventricular end-diastolic volume(LVEDV),the left ventricular end-systolic volume(LVESV),the left ventricular ejection fraction(LVEF)and the plasma B type brain natriuretic peptide (BNP),etc. were observed in 1 week and 2 months after treatment. Meanwhile the electrocardiogram(ECG),aspartate transaminase(AST),alanine aminotransferase(ALT),urea nitrogen(BUN),serum creatinine(SCr),blood routine, urine routine examination and the adverse effects were investigated. Results The total effective rates in treatment groupⅠand treatment groupⅡwere significantly higher than those in the control group〔after treatment for 1 week:81.2%(13/16),81.2%(13/16)vs. 43.8%(7/16);after 2 months:87.5%(14/16),93.7%(15/16)vs. 50.0%(8/16), all P<0.05〕. After treatment,the LVEDV,LVESV and BNP were lowered and the LVEF was increased in the three groups,and the above indexes in treatment groupⅡwere improved more significantly than those in groupⅠ〔LVEDV (mL):142.4±33.0 vs. 174.8±52.5,LVESV(mL):111.6±23.7 vs. 132.4±29.0,LVEF:0.421±0.037 vs. 0.390±0.045,BNP(μg/L):1.944±0.751 vs. 3.038±1.905,all P<0.05〕. Conclusion Qili Qiangxin capsule combined with glucocorticoid may effectively improve the cardiac function and clinical symptoms in near and forward future in patients with dilated cardiomyopathy accompanied by refractory heart failure,thus it may elevate the patients' life quality.
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<p><b>OBJECTIVE</b>To observe the conditioning regimen, efficacy and side effects of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for hemophagocytic lymphohistiocytosis (HLH).</p><p><b>METHOD</b>From 2010 to 2012, a total of 11 cases after allo-HSCT were evaluated including 8 cases with familial hemophagocytic lymphohistiocytosis (FHL) and 3 cases with Epstein-Barr virus (EBV) related HLH. Allo-HSCT from HLA haploidentical HSCT was performed for 3 cases and unrelated allo-HSCT for 8 cases; 7 cases underwent allo-HSCT with conditioning regimen of etoposide (VP16), busulphan (Bu), fludarabine (Flu) and antilymphocyte globulin (ATG) and 4 cases with Flu, melphalan (Mel) and ATG. Cyclosporine (CsA) or tacrolimus, mycophenolate (MMF) and methorexate (MTX) were used for prevention of graft versus host disease (GVHD). Four cases received anti-CD25 MoAbs, 7 cases received cord blood and 1 of them received haploidentical bone marrow to prevent GVHD.</p><p><b>RESULT</b>Three cases died after allo-HSCT. The median overall survival time of the 8 cases evaluated was 585 days (154-1 115 d). All the patients were successfully engrafted. Acute GVHD (aGVHD) occurred in 8 cases, including 3 cases of gradeI/II and 5 cases of grade III/IV. Chronic GVHD (cGVHD) occurred in 4 cases. Seven cases had cytomegalovirus (CMV) reactivation.</p><p><b>CONCLUSION</b>The allo-HSCT was successful in treating primary and refractory hemophagocytic syndrome.</p>