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1.
Article in English | WPRIM | ID: wpr-691374

ABSTRACT

<p><b>BACKGROUND</b>Acupuncture can not only be used for well-known diseases, but also for so-called modern lifestyle-related diseases. Using innovative methods like e.g. new analyses of heart rate variability (HRV), it is also possible to investigate diseases like burnout syndrome, ie., qi deficiency in Chinese medicine (CM).</p><p><b>OBJECTIVE</b>The main object of this research protocol is to perform research on the relationship of burnout syndrome and heart rate (HR) and HRV.</p><p><b>METHODS</b>A total of 175 patients with burnout syndrome (qi deficiency syndrome) in five groups and 35 healthy volunteers will be investigated. Based on random numbers generated by computer and concealed in opaque envelops, the patients will be assigned to four acupuncture groups using Zusanli (ST 36) acupuncture stimulation, Guanyuan (CV4) acupuncture stimulation, both points, and both points with Streitberger device respectively, and a moxibustion group using both points mentioned above, with 35 cases in each group. Altogether four different experiments are planned. Experiment 1 includes 70 subjects and is a comparison between a burnout group and a control group (healthy volunteers). The evaluation parameters are different scores and indices of HR and HRV. Experiment 2 includes 140 subjects and compares the efficacy of different acupuncture points. In experiment 3 (105 subjects), acupuncture and moxibustion should be compared to healthy volunteers. Experiment 4 (70 subjects) investigates the long-term therapeutic effects of acupuncture and moxibustion on the scores of qi deficiency and HR/HRV in qi deficiency patients. In both the acupuncture and moxibustion groups, a total of 10 treatments will be performed.</p><p><b>CONCLUSIONS</b>The joint research aims at the scientific evaluation of CM, mainly in the field of HRV. This parameter could be a very good indicator of the state of health and can be inflfluenced by different acupuncture methods, as shown in the past.</p>


Subject(s)
Acupuncture Therapy , Adult , Austria , Burnout, Professional , Therapeutics , China , Female , Heart Rate , Physiology , Humans , Life Style , Moxibustion , Research Design
2.
Chinese Medical Journal ; (24): 1096-1102, 2013.
Article in English | WPRIM | ID: wpr-342232

ABSTRACT

<p><b>BACKGROUND</b>Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapy for many hematological diseases, but there are many complications following allo-HSCT, among which neurological complications (NC) are one of the most commonly described ones. However, little is known about idiopathic inflammatory demyelinating diseases (IIDDs) of the central nervous system (CNS) in patients following allo-HSCT.</p><p><b>METHODS</b>A nested case-control study was conducted in a large cohort of 1365 patients, who underwent allo-HSCT at the Institute of Hematology and Peking University People's Hospital, between January 2004 and December 2009, 36 patients of whom developed CNS IIDDs. Kaplan-Meier method, univariate and multivariate Cox regression were applied in our statistical analysis using SPSS 16.0.</p><p><b>RESULTS</b>The cumulative incidence of all cases of IIDDs at 6 years posttransplantation was 3.6%. Thirty-five patients (97.2%) suffered IIDDs after transplantation, 16 patients (44.4%) between day 0 to day 100 post-transplantation, 10 patients (27.8%) between day 100 to 1 year post-transplantation, and 9 patients (25.0%) 1 year post-transplantation. Multivariate regression analysis identified donor type (P = 0.031), infection (P = 0.009), and acute lymphatic leukemia (P = 0.017) as independent risk factors for posttransplantation IIDDs. The median survival time of patients with IIDDs was 514 days after transplantation (95%CI: 223 - 805). Survival at 6 years was significantly lower in patients who developed the diseases compared to those who did not (26.6% vs. 73.5%, P < 0.001). Of the 36 patients experiencing IIDDs, 58.3% (n = 21) died. The causes of death were graft-versus-host disease (GVHD) (n = 4), underlying disease relapse (n = 3), infections (n = 12), and other causes (n = 2).</p><p><b>CONCLUSIONS</b>IIDDs is an uncommon but serious complication of allo-HSCT, especially in patients with a primary diagnosis of acute lymphatic leukemia, mismatched transplants, and infections. Our study results indicate that patients with IIDDs tend toward a poor prognosis following allo-HSCT.</p>


Subject(s)
Adolescent , Adult , Case-Control Studies , Central Nervous System , Child , Child, Preschool , Demyelinating Autoimmune Diseases, CNS , Female , Hematopoietic Stem Cell Transplantation , Humans , Infant , Male , Middle Aged , Retrospective Studies , Risk Factors , Young Adult
3.
Chinese Medical Journal ; (24): 2489-2494, 2013.
Article in English | WPRIM | ID: wpr-322173

ABSTRACT

<p><b>BACKGROUND</b>The occurrence of bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare but severe. We examine the role of pre-HSCT chemotherapeutic exposure, pre-HSCT comorbidities, and transplant-related complications in the development of BOS after allo-HSCT.</p><p><b>METHODS</b>A nested case-control study was designed. Cases with BOS and controls matched for the year of allo-HSCT and length of the follow-up were identified from a cohort of 1646 patients who underwent allo-HSCT for treatment of hematologic malignancies between 2006 and 2011. Antithymocyte globulin was used in the partial matched related and unrelated matched donor HSCT, or patients with severe aplastic anemia.</p><p><b>RESULTS</b>Thirty-six patients suffered from BOS; the mean age at the time of presentation was (32.7 ± 12.4) years, and the mean time to presentation was (474 ± 350) days post-HSCT. A pre-HSCT cyclophosphamide dose of ≥ 3.2 g/m(2)(OR = 8.74, P = 0.025), chronic graft-versus-host disease (moderate to severe) (OR = 12.02, P = 0.000), and conditioning regimens without antithymocyte globulin (OR = 2.79, P = 0.031) were independently associated with BOS.</p><p><b>CONCLUSIONS</b>We found that higher pre-HSCT cyclophosphamide exposure, a conditioning regimen without antithymocyte globulin, and moderate to severe chronic graft-versus-host disease are significantly and independently associated with BOS. Based on these results, we can identify patients who are at a higher risk of developing BOS after allo-HSCT, select a more appropriate therapeutic strategy, and improve the outcome of HSCT recipients.</p>


Subject(s)
Adult , Bronchiolitis Obliterans , Case-Control Studies , Female , Follow-Up Studies , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Humans , Male , Middle Aged , Risk Factors , Transplantation Conditioning , Transplantation, Homologous
4.
Chinese Journal of Hematology ; (12): 113-116, 2013.
Article in Chinese | WPRIM | ID: wpr-323432

ABSTRACT

<p><b>OBJECTIVE</b>To retrospectively review the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for chronic myelomonocytic leukemia (CMML).</p><p><b>METHODS</b>The engraftment, graft versus host disease (GVHD), infection, relapse and survival of 12 CMML patients received allo-HSCT were observed. The clinical outcome of allo-HSCT for CMML was analyzed.</p><p><b>RESULTS</b>Twelve (7 males and 5 females) CMML patients with a median age of 39 years old received allo-HSCT including 7 from HLA-matched sibling and 5 from haploidentical related donors. All 12 patients achieved engraftment. The median time of neutrophil engraftment and platelet engraftment were 15 (11 - 20) days and 13 (11 - 18) days, respectively. 4 patients occurred acute GVHD, and 3 occurred chronic GVHD. After the median follow-up of 17.5 months (12 - 32 months), the overall survival, disease free survival and relapse rate were 66.7%, 66.7%, and 16.7%, respectively.</p><p><b>CONCLUSION</b>Allo-HSCT can improve the survival of patients with CMML, and is a effective therapy for CMML.</p>


Subject(s)
Adolescent , Adult , Child , Female , Hematopoietic Stem Cell Transplantation , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Therapeutics , Male , Middle Aged , Retrospective Studies , Survival Rate , Transplantation, Homologous , Young Adult
5.
Chinese Medical Journal ; (24): 3048-3052, 2013.
Article in English | WPRIM | ID: wpr-263527

ABSTRACT

<p><b>BACKGROUND</b>Chronic graft-versus-host disease (GVHD), the commonest long-term complication after allogeneic hematopoietic stem cell transplantation (HSCT), has a negative impact on patients' health related quality of life (HRQoL). This study was designed to investigate the HRQoL in patients with chronic GVHD in China.</p><p><b>METHODS</b>Two hundred and sixty-four patients with chronic GVHD who were ≥ 24 months post-HSCT and had been in continuous complete remission since HSCT were enrolled in this retrospective study. HRQoL was evaluated using an SF-36 questionnaire. Multivariate analysis was used to identify the factors that affect HRQoL in patients with chronic GVHD.</p><p><b>RESULTS</b>HRQoL in patients categorized as having mild and moderate chronic GVHD was significantly better than in those in the severe category. In the moderate chronic GVHD category, markedly poorer HRQoL was observed in patients with both multiple organ involvement and more severe organ impairment than in those without these factors. According to multivariate analysis, chronic GVHD severity had the greatest significant negative impact on patients' HRQoL; whereas being female was associated with a negative impact on psychological health.</p><p><b>CONCLUSION</b>Chronic GVHD severity strongly correlates with negative impacts on patients' HRQoL.</p>


Subject(s)
Adult , Chronic Disease , Female , Graft vs Host Disease , Psychology , Humans , Male , Middle Aged , Quality of Life , Retrospective Studies , Severity of Illness Index
6.
Chinese Journal of Hematology ; (12): 651-654, 2013.
Article in Chinese | WPRIM | ID: wpr-272144

ABSTRACT

<p><b>OBJECTIVE</b>To analyze the prevalence of Epstein Barr Virus (EBV) in patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT).</p><p><b>METHODS</b>We retrospectively analyzed the clinical characteristics of 720 patients received allo-HSCT from January 2010 through December 2011 in the Stem Cell Transplant Center of People's Hospital.</p><p><b>RESULTS</b>Of 720 patients (469 male presented and 251 females), with a median age of 30 years (range, 2 to 67 years) old, 66 patients were presented with EBV reactivation. The cumulative incidence of EBV reactivation was (9.3±1.1)%, with a median days of 54.5 (range, 18 to 253 days). During one- year post-transplantation, the cumulative incidences of EBV reactivation in sibling allo-HSCT, haploidentical HSCT and unrelated donor HSCT were (1.3±0.7)%, (13.7±1.7)%, and (9.1±4.4)%, respectively. In patients with haplo-identical HSCT, the cumulative incidences of EBV viremia, probable EBV disease, and post-transplant lymphoproliferative disease (PTLD) were (5.8±1.1)%, (5.7±1.1)%, and (2.3±0.7)%. The mortality was (33.9±5.9)% in all patients with EBV infection: (63.6±15.8)% in PTLD, (42.3±9.9)% in probable EBV disease, (13.8±6.5)% in EBV viremia. By univariate and multivariate analysis, the use of ATG was an independent risk factor for EBV infection.</p><p><b>CONCLUSION</b>EBV reactivation is a common complication in patients with allo- HSCT, especially high mortality in PTLD and probable EBV disease. The use of ATG was an independent risk factor for EBV infection.</p>


Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Epstein-Barr Virus Infections , Pathology , Female , Hematopoietic Stem Cell Transplantation , Herpesvirus 4, Human , Humans , Lymphoproliferative Disorders , Virology , Male , Middle Aged , Retrospective Studies , Risk Factors , Transplantation, Homologous , Virus Activation , Young Adult
7.
Chinese Medical Journal ; (24): 1952-1959, 2012.
Article in English | WPRIM | ID: wpr-283687

ABSTRACT

<p><b>BACKGROUND</b>Chimerism analysis is an important tool for the surveillance of post-transplant engraftment. It offers the possibility of identifying impending graft rejection and recurrence of underlying malignant or non-malignant disease. Here we investigated the quantitative chimerism kinetics of 21 relapsed leukemia patients after allogeneic hematopoietic stem cell transplantation (HSCT).</p><p><b>METHODS</b>A panel of 29 selected sequence polymorphism (SP) markers was screened by real-time polymerase chain reaction (RT-PCR) to obtain the informative marker for every leukemia patient. Quantitative chimerism analysis of bone marrow (BM) samples of 21 relapsed patients and 20 patients in stable remission was performed longitudinally. The chimerisms of BM and peripheral blood (PB) samples of 14 patients at relapse were compared.</p><p><b>RESULTS</b>Twenty-one patients experienced leukemia relapse at a median of 135 days (range, 30 - 720 days) after transplantation. High recipient chimerism in BM was found in all patients at relapse, and increased recipient chimerism in BM samples was observed in 90% (19/21) of patients before relapse. With 0.5% recipient DNA as the cut-off, median time between the detection of increased recipient chimerism and relapse was 45 days (range, 0 - 120 days), with 76% of patients showing increased recipient chimerism at least 1 month prior to relapse. Median percentage of recipient DNA in 20 stable remission patients was 0.28%, 0.04%, 0.05%, 0.05%, 0.08%, and 0.05% at 1, 2, 3, 6, 9, and 12 months, respectively, after transplantation. This was concordant with other specific fusion transcripts and fluorescent in situ hybridization examination. The recipient chimerisms in BM were significantly higher than those in PB at relapse (P = 0.001).</p><p><b>CONCLUSIONS</b>This SP-based RT-PCR assay is a reliable method for chimerism analysis. Chimerism kinetics in BM can be used as a marker of impending leukemia relapse, especially when no other specific marker is available. Based on our findings, we recommend examining not only PB samples but also BM samples in HSCT patients.</p>


Subject(s)
Adolescent , Adult , Child , Female , Hematopoietic Stem Cell Transplantation , Humans , Leukemia , Genetics , Therapeutics , Male , Middle Aged , Reverse Transcriptase Polymerase Chain Reaction , Transplantation Chimera , Genetics , Transplantation, Homologous , Young Adult
8.
Chinese Medical Journal ; (24): 947-950, 2012.
Article in English | WPRIM | ID: wpr-269320

ABSTRACT

Both human hereditary spherocytosis (HS) and chronic myelogenous leukemia (CML) are life threatening. Herein we have reported the case of a woman with a combined disorder of HS and CML who underwent the matched sibling allogeneic stem cell transplantation. The complete donor erythroid cells were obtained. The red blood cell counts significantly improved throughout life comparing with pre-hematopoietic stem cell transplantation (HSCT). Reticulocyte counts normalized, and BCR-ABL was cleared away. The total bilirubin level was also corrected in this recipient. Our case is a rare example with a combined disorder of HS and CML following allogeneic stem cell transplantation. HS was not a contraindication for patient in the matched sibling transplant setting.


Subject(s)
Adult , Female , Hematopoietic Stem Cell Transplantation , Humans , Spherocytosis, Hereditary , Therapeutics , Transplantation, Homologous
9.
Chinese Journal of Hematology ; (12): 917-921, 2012.
Article in Chinese | WPRIM | ID: wpr-278300

ABSTRACT

<p><b>OBJECTIVE</b>To explore the outcome of human leukocyte antigen (HLA)-mismatched/haploidentical hematopoietic stem cell transplantation (HSCT) for refractory/relapsed acute leukemia (AL) patients and its related risk factors.</p><p><b>METHODS</b>96 refractory/relapsed AL patients who received HLA-mismatched/haploidentical HSCT following conditioning regimen comprised of modified busulfan/cyclophosphamide (BU/CY) plus thymoglobulin (ATG) from Jan 2003 to Jun 2011 were analyzed retrospectively.</p><p><b>RESULTS</b>Of the 96 patients, 61 suffered from acute myeloid leukemia (AML), and 35 acute lymphoid leukemia (ALL), all of them in non-remission (NR) or relapse before transplantation. With a median follow-up of 373 (34 - 3157) d, 33 cases (34%) survived, 31 survived without leukemia, and 35 relapsed. The estimated 3-year overall survival (OS) and disease-free survival (DFS) rate was 30.2% and 29.0%, respectively. The 3-year OS rate was significantly higher for AML patients (39.2%) than for ALL patients (15.4%) (P = 0.005). The estimated 3-year OS probabilities for patients with and without prophylactic donor lymphocyte infusion (DLI) were 38.0% and 11.8%, respectively (P = 0.001). Sex, age, conditioning regimen (BU/CY or not, dosage of ATG), the number of HLA mismatches between the donor and recipient, and the number of infused mononuclear cells were not independent factors affecting OS, DFS and relapse. Multivariate analysis showed that DFS rate was significantly higher in patients receiving prophylactic DLI (P = 0.003), in patients with AML (vs with ALL) (P = 0.037) and with chronic GVHD (P = 0.006).</p><p><b>CONCLUSIONS</b>Haploidentical HSCT may prolong DFS in part refractory/relapsed AL patients and even cure them. Prophylactic DLI may reduce relapse and increase survival; for patients with refractory/relapsed ALL, other therapy for prevention and treatment of post-transplant relapse should be explored.</p>


Subject(s)
Acute Disease , Adolescent , Adult , Aged , Child , Female , Hematopoietic Stem Cell Transplantation , Humans , Leukemia , Therapeutics , Leukemia, Myeloid, Acute , Therapeutics , Male , Middle Aged , Recurrence , Retrospective Studies , Transplantation Conditioning , Transplantation, Homologous , Young Adult
10.
Chinese Medical Journal ; (24): 2301-2308, 2011.
Article in English | WPRIM | ID: wpr-292845

ABSTRACT

<p><b>BACKGROUND</b>Analysis of changes in recipient and donor hematopoietic cell origin is extremely useful to monitor the effect of hematopoietic stem cell transplantation (HSCT) and sequential adoptive immunotherapy by donor lymphocyte infusions. We developed a sensitive, reliable and rapid real-time PCR method based on sequence polymorphism systems to quantitatively assess the hematopoietic chimerism after HSCT.</p><p><b>METHODS</b>A panel of 29 selected sequence polymorphism (SP) markers was screened by real-time PCR in 101 HSCT patients with leukemia and other hematological diseases. The chimerism kinetics of bone marrow samples of 8 HSCT patients in remission and relapse situations were followed longitudinally.</p><p><b>RESULTS</b>Recipient genotype discrimination was possible in 97.0% (98 of 101) with a mean number of 2.5 (1-7) informative markers per recipient/donor pair. Using serial dilutions of plasmids containing specific SP markers, the linear correlation (r) of 0.99, the slope between -3.2 and -3.7 and the sensitivity of 0.1% were proved reproducible. By this method, it was possible to very accurately detect autologous signals in the range from 0.1% to 30%. The accuracy of the method in the very important range of autologous signals below 5% was extraordinarily high (standard deviation <1.85%), which might significantly improve detection accuracy of changes in autologous signals early in the post-transplantation course of follow-up. The main advantage of the real-time PCR method over short tandem repeat PCR chimerism assays is the absence of PCR competition and plateau biases, with demonstrated greater sensitivity and linearity. Finally, we prospectively analyzed bone marrow samples of 8 patients who received allografts and presented the chimerism kinetics of remission and relapse situations that illustrated the sensitivity level and the promising clinical application of this method.</p><p><b>CONCLUSION</b>This SP-based real-time PCR assay provides a rapid, sensitive, and accurate quantitative assessment of mixed chimerism that can be useful in predicting graft rejection and early relapse.</p>


Subject(s)
Adolescent , Adult , Child , Female , Genotype , Hematopoietic Stem Cell Transplantation , Humans , Male , Middle Aged , Polymorphism, Single Nucleotide , Genetics , Real-Time Polymerase Chain Reaction , Methods , Reproducibility of Results , Transplantation Chimera , Genetics , Young Adult
11.
Chinese Medical Journal ; (24): 1517-1523, 2011.
Article in English | WPRIM | ID: wpr-353952

ABSTRACT

<p><b>BACKGROUND</b>The cause of late-onset hemorrhagic cystitis (LOHC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains obscure. In clinical practice, some LOHC patients respond to immunosuppression. The aim of this study was to determine the immune pathogenesis of LOHC post allo-HSCT.</p><p><b>METHODS</b>With the diagnosis of LOHC, patients were given initial treatment consisting of fluid hydration, alkalization and forced diuresis, and empirical anti-viral therapy for 10 - 14 days or until a week after the virus became negative. The nonresponders were applied corticosteroid. Seven to ten days later, patients' response was evaluated. Along with treatment, CD19(+) B lymphocyte subsets were measured at various study points.</p><p><b>RESULTS</b>From October 2009 to March 2010, we found 28 cases of LOHC occurred in 25 patients who underwent allo-HSCT in our hospital. Except that three cases were not treated according to the protocol, the other 25 cases were divided into three groups: anti-virus responders (Group A, n = 6), corticosteroid responders (Group B1, n = 16), corticosteroid and anti-virus nonresponders (Group C, n = 3) according to their clinical response. Percentages of CD19(+)CD5(+) B lymphocytes were not significantly different among three groups at onset of LOCH. However, in Group B1 after the first anti-virus phase, percentages of CD19(+)CD5(+) lymphocytes significantly increased comparing with those at onset (P = 0.022), and then significantly decreased at PR (P = 0.003) and CR (P = 0.002) with corticosteroid treatment. But significant change was not observed in Groups A and C.</p><p><b>CONCLUSION</b>The immune etiology seems to be involved in the development of LOHC and the proportion of CD19(+)CD5(+) lymphocytes may serve as a cellular biomarker to predict the response to corticosteroid in LOHC.</p>


Subject(s)
Adolescent , Adrenal Cortex Hormones , Therapeutic Uses , Adult , Antigens, CD19 , Metabolism , B-Lymphocytes , Metabolism , CD5 Antigens , Metabolism , Child , Child, Preschool , Cystitis , Drug Therapy , Allergy and Immunology , Therapeutics , Female , Flow Cytometry , Hematopoietic Stem Cell Transplantation , Humans , Male , Middle Aged , Young Adult
12.
Chinese Journal of Hematology ; (12): 25-28, 2010.
Article in Chinese | WPRIM | ID: wpr-283892

ABSTRACT

<p><b>OBJECTIVE</b>To analyze the presentations and treatments of unexplained multiple effusions after allogeneic hematopoietic transplantation (allo-HSCT) and their relationships with chronic graft-versus-host disease (cGVHD).</p><p><b>METHODS</b>The data of 1385 allo-HSCT patients from Jan.1999 to Nov. 2008 in our institute were reviewed retrospectively.</p><p><b>RESULTS</b>cGVHD occurred in 911 patients, including 327 (35.8%) limited cGVHD, and 198 (21.7%) extensive cGVHD. Effusions were identified in 28 patients. Nine cases were from infections and two tumor relapses. Cirrhosis and hypoproteinemia caused ascites in 6 patients. The small amount pericardial effusions occurred in 7 patients, which were related to the toxicity of drugs. The remaining 4 patients had large and recurrent sterile effusions involving peritoneal, pericardial, pleural cavities and/or testicular sheath cavity. These 4 cases were all middle aged men and received transplantation from HLA identical siblings. The effusions had an insidious onset and were or were proved to be transudate. Examinations of the effusions for bacteria, virus and yeast were negative. The only diagnoses of the patients were cGVHD. All of the patiants responded to low dose steroid and alive, but only one achieved complete remission.</p><p><b>CONCLUSION</b>The unexplained recurrent multiple effusions after allo-HSCT might be a rare manifestation of chronic GVHD.</p>


Subject(s)
Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Humans , Recurrence , Retrospective Studies , Transplantation, Homologous
13.
Chinese Journal of Hematology ; (12): 323-327, 2010.
Article in Chinese | WPRIM | ID: wpr-353616

ABSTRACT

<p><b>OBJECTIVE</b>To explore the dissociation of graft-versus-leukemia (GVL) effects from graft-versus-host disease (GVHD) in the patients who experienced GVHD during leukemia relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT).</p><p><b>METHODS</b>The primary disease, disease status, GVHD, response to donor lymphocyte infusion (DLI) and prognosis were analysed in 11 leukemia patients who relapsed with GVHD after allo-HSCT.</p><p><b>RESULTS</b>Of the 11 relapsed, 5 were acute lymphoblastic leukemia and 6 acute myeloid leukemia. Five received DLI before relapse and all developed post-DLI GVHD, including 2 grade II acute GVHD (aGVHD), 1 limited chronic GVHD (cGVHD) plus grade II aGVHD, and 2 extensive cGVHD. After relapse of the 5 patients, 2 received Chemo-DLI, one achieved CR with extensive cGVHD and then relapsed again, the other didn't achieved CR. The other 6 patients didn't received DLI before relapse and also developed post-HSCT GVHD while relapsing, including 3 extensive cGVHD, 1 grade I aGVHD and 2 grade II-IV aGVHD. After relapse, these 6 patients received Chemo-DLI, 2 achieved CR and then relapsed again, 4 didn't achieved CR.</p><p><b>CONCLUSION</b>The elicited GVHD after allo-HSCT may not accompany effective GVL effects inhibiting leukemic relapse.</p>


Subject(s)
Graft vs Host Disease , Graft vs Leukemia Effect , Hematopoietic Stem Cell Transplantation , Humans , Leukemia, Myeloid, Acute , Precursor Cell Lymphoblastic Leukemia-Lymphoma
14.
Chinese Medical Journal ; (24): 463-468, 2007.
Article in English | WPRIM | ID: wpr-344873

ABSTRACT

<p><b>BACKGROUND</b>Allogeneic stem cell transplantation is a potential curative approach in patients with multiple myeloma. The very high transplant related mortality associated with standard allogeneic stem cell transplantation is currently the major limitation to wider use of this potentially curative treatment modality. The challenge for clinical investigators is to reduce the incidence of post-transplant complications for patients receiving autologous hematopoietic stem cell transplantion for multiple myeloma. In this study the toxicity and efficacy of modified myeloablative conditioning regimen followed by allogeneic stem cell transplantation was investigated in patients with multiple myeloma.</p><p><b>METHODS</b>The conditioning regimen consisted of hydroxyurea, cytarabine, busulfan, cyclophosphamide, and semustine. Ten patients underwent allogeneic transplantation among them hydroxyurea (40 mg/kg) was administered twice on day-10 and cytarabine (2 g/m(2)) was given on day-9, busulfan was administered orally in four divided doses daily for 3 days (days-8 to -6). The dose of busulfan was 12 mg/kg in the protocol followed by cyclophosphamide intravenously over 1 hour on days-5 and -4 (1.8 g/m(2)), and with semustine (Me-CCNU) 250 mg/m(2) on day -3.</p><p><b>RESULTS</b>Chimerism data were available on all patients and all patients achieved full donor chimerism without graft failure. Six patients had not acute graft-versus-host disease (GVHD, 36.4%; 95% CI: 13.9% - 38.6%). Two patients (18.2%) developed grade I acute GVHD (95% CI: 10.9% - 35.9%) and grade II acute GVHD occurred in one patient (9.1%; 95% CI: 8.4% - 32.3%). Severe grade IVa GVHD was seen in one patient, who died from acute GVHD. The incidence of chronic GVHD was 22.2% (95% CI: 11.7% - 36.7%), among them one died of severe grade IV GVHD and one developed multiorgan failure on day +170; the treatment-related mortality was 22.0% (95% CI: 10.3% - 34.1%). The overall 4-year survival rate was 67.8% (95% CI: 16.3% - 46.7%). The estimated 4-year progression-free survival rate was 58.5% (95% CI: 13.7% - 41.8%). The 4-year complete remission was 72.7% (95% CI: 27.8% - 49.6%). One patient relapsed after 4 months and achived the complete remission after receiving the donor lymphocyte infusion.</p><p><b>CONCLUSIONS</b>Modified conditioning regimen busulfan-cyclophosphamide with peripheral blood stem cells + bone marrow cells transplantation result in a low incidence of severe GVHD with a relatively low treatment-related mortality, high complete remission rates and a long-term survival.</p>


Subject(s)
Adult , Busulfan , Cyclophosphamide , Female , Graft vs Host Disease , Epidemiology , Hematopoietic Stem Cell Transplantation , Humans , Male , Middle Aged , Multiple Myeloma , Mortality , Therapeutics , Transplantation Conditioning , Transplantation, Homologous
15.
Chinese Journal of Hematology ; (12): 518-521, 2006.
Article in Chinese | WPRIM | ID: wpr-243921

ABSTRACT

<p><b>OBJECTIVE</b>To explore the indication and optimum time for treating myelodysplastic syndrome (MDS) by allogeneic hematopoietic stem cell transplantation (allo-HSCT) with HLA identical sibling grafts.</p><p><b>METHODS</b>From June 1997 to Sep. 2004, a total of 30 patients with MDS were treated with allo-HSCT from HLA-identical sibling donors in our institute. On HSCT, 4 patients had refractory anemia (RA) , 2 RA with ringed sideroblasts (RARS) , 7 RA with excess blasts(RAEB) , 14 RAEB in transformation (RAEB-t) , 3 already progressed to secondary AML. For IPSS system, 6 patients were in intermediate- I risk group, 11 in intermediate- li risk group, and 13 in high risk group. The modified BU/CY conditioning regimen was used. Four patients received bone marrow transplantation (BMT), 8 received peripheral blood stem cell transplantation (PBSCT) , and 18 received BMT + PBSCT.</p><p><b>RESULTS</b>The 3-year expected overall survival (OS) was 63.61%, 3-year expected disease-free survival ( DFS) 61.41%, and relapse rate 5.26%; OS for RA/ RAS, RAEB and RAEB-t/AML subgroup was 83.33%, 34.29% and 66.67% , respectively, and all had no statistic difference among them. OS for IPSS-intermediate and high risk subgroup was 64.7% , and 69.0% respectively, also had no statistic difference. 3-year expected OS in no aGVHD,grade I - II aGVHD and grade III - IV aGVHD group was 57.75% , 100% and 0% , respectively (P = 0.009). Pre-HSCT chemotherapy, disease subtype and cGVHD all had no correlation with LFS or OS (P > 0.05).</p><p><b>CONCLUSION</b>For young MDS patients having HLA-identical sibling donors, HSCT should be the first line therapy and performed as soon as possible.</p>


Subject(s)
Adolescent , Adult , Contraindications , Female , Follow-Up Studies , Hematopoietic Stem Cell Transplantation , Methods , Histocompatibility Testing , Humans , Male , Middle Aged , Myelodysplastic Syndromes , Mortality , General Surgery , Prognosis , Survival Rate , Transplantation Conditioning , Transplantation, Homologous
16.
Chinese Journal of Hematology ; (12): 656-660, 2005.
Article in Chinese | WPRIM | ID: wpr-255826

ABSTRACT

<p><b>OBJECTIVE</b>To improve the outcome of hematopoietic stem cell transplantation from unrelated donors.</p><p><b>METHODS</b>Sixty-six patients with hematological diseases (40 cases of acute leukemia, 24 chronic myeloid leukemia, and one each severe aplastic anemia and beta-thalassemia) received bone marrow (BMT, n = 48) or peripheral blood stem cell transplantation (PBSCT, n = 18) from HLA-compatible unrelated donors after BUCY or TBI conditioning. Forty patients received longer and intensive GVHD prophylaxis (cyclosporin A from day -10 combined with mycophenolate mofetil).</p><p><b>RESULTS</b>Sixty-four patients achieved sustained donor engraftment. The median time of leukocyte engraftment was 15 days, being significantly earlier in PBSCT group compared with BMT group (12 vs 16 days, P = 0.002). The cumulative incidence rates of grades I-II and III-IV acute GVHD at day 100 were 57.15% and 32.25%, respectively. Chronic GVHD was seen in 21 of the 36 evaluable cases and ten of them were extensive type. Six patients relapsed and 27 dead, the overall survival at 5 years was 52.91%. The COX method analysis showed that HLA-compatible level and source of graft affected the incidence of aGVHD. The patients transplanted from HLA-matched donor with high resolution and PBSCT had the less probability for aGVHD. Patients without GVHD or with longer and intensive GVHD prophylaxis had significantly improved OS.</p><p><b>CONCLUSION</b>The key to improvement the outcome of HCT from unrelated donor is to reduce the incidence and severity of aGVHD by selecting the HLA-matched donor, intensifying the immunosuppression at the early stage of transplantation.</p>


Subject(s)
Adolescent , Adult , Female , Graft vs Host Disease , Allergy and Immunology , Hematopoietic Stem Cell Transplantation , Methods , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome
17.
Article in Chinese | WPRIM | ID: wpr-278862

ABSTRACT

In order to explored the change of PML/PML-RARalpha protein during tetraarsenic tetrasulfide (As4S4) treatment, acute promyelocytic leukemia (APL) cells from a group of newly diagnosed APL patients were examined by indirect immunofluorescence staining with anit-PML monoclonal antibody. The results showed that all samples typically presented many microspeckle signals throughout the nucleus before treatment. The redistribution occurred as early as on the second day after As4S4 treatment, which revealed loss of microspeckles with the presentation of a few large speckles. Anti-PML staining also emerged in the perinuclear cytoplasm. At last, microspeckles and large speckles all disappeared. When the therapy was combining all-trans-retinoic acid (ATRA) with As4S4, similar results were obtained. However, APL cells from patients treated with ATRA alone performed totally different appearance, presenting microspeckles and large speckles at the same time, followed with entirely large speckles. The conclusion is that As4S4 makes redistribution of PML/PML-RARalpha protein in leukemic cells from APL patients during the treatment, which is quite different from that during the treatment of ATRA.


Subject(s)
Adolescent , Adult , Aged , Antineoplastic Agents , Therapeutic Uses , Arsenicals , Therapeutic Uses , Female , Fluorescent Antibody Technique, Indirect , Humans , In Situ Nick-End Labeling , Leukemia, Promyelocytic, Acute , Drug Therapy , Metabolism , Male , Middle Aged , Neoplasm Proteins , Nuclear Proteins , Oncogene Proteins, Fusion , Promyelocytic Leukemia Protein , Transcription Factors , Tretinoin , Therapeutic Uses , Tumor Suppressor Proteins
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