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This is a report of three cases of three male patients. One of the patients had myelodysplastic syndrome, and two had aplastic anemia; their ages were 28, 32, and 21 years old, respectively. Two patients underwent sibling allogeneic hematopoietic stem cell transplantation, and one underwent haploidentical hematopoietic stem cell transplantation. All the patients showed elevated hemoglobin and hematocrit at 6, 16, and 9 months after transplantation, with normal white blood cells and platelets and no splenomegaly. All causes of secondary polycythemia were ruled out. Bone marrow morphology showed no erythroid hyperplasia. The PCR result for BCR-ABL (P210, P230, P190, and variants) was negative, and there were no mutations at the amino acid site 617 of JAK2, exon 12 of JAK2, exon 9 of CALR, and amino acid site 515 of MPL. All three patients had hypertension. One patient was treated with amlodipine, and the other two patients were treated with angiotensin receptor blockers. The durations of erythrocytosis for these three patients were 6 years and 3 months, 4 years and 7 months, and 5 years and 3 months, respectively through December 2022. There was no tendency for spontaneous remission. Erythrocytosis after hematopoietic stem cell transplantation is a rare complication. Previous reports in the literature suggest that the mechanism of post-transplant erythrocytosis in recipients of allogeneic hematopoietic stem cell transplantation may be different from that of recipients of other transplants.
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Objective To establish the index system of nursing quality evaluation for patients with hematopoietic stem cell transplantation. Methods Based on the Donabedian structure-process-result three-dimensional quality management model, the evaluation index system of nursing quality of stem cell transplantation was constructed by combining qualitative and quantitative research of literature inquiry, case review, expert inquiry and analytic hierarchy process. Results Through the second round of expert consultation, the effective recovery rate of the expert questionnaire was 100% , the expert authority coefficient was 0.813, 0.859, and the coordination coefficient was 0.235 and 0.278 respectively (P< 01). Three primary indicators, 14 secondary indicators and 48 tertiary indicators were formed to evaluate the quality of care in stem cell transplantation. The index weight coefficient was established and the consistency test was passed. Conclusion The quality index system of hematopoietic stem cell transplantation nursing is well defined, its weight allocation is reasonable, the index is clear, and it is scientific and operational.
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Objective: To discuss the pathogenesis,clinical manifestations,diagnosis,differential diagnosis, treatment,and prognosis of the patient with rituximab (RTX)-induced interstitial lung disease (ILD) (RTX-ILD).Methods:A male patient aged 19 years old was confirmed as classical Hodgkin's lymphoma more than 2 years ago,and received autologous hemopoietic stem cell transplantation (HSCT)when the disease recurred 1 year ago.Two months after HSCT,the maintenance chemotherapy was given every month with 375 mg· m-2 RTX,but the mediastinal recurrence appeared during the period,then the mediastinal residual lesion radiotherapy was done for 10 times.However,8 d after the third RTX chemotherapy,the patient experienced post-exercising tachypnea,fever,cough,chest congestion,and limb weakness.The chest CT scanning results suggested ground gloss opacity on both lungs,and blood gas analysis suggested a hypoxemia.Neither antibacterial nor antifungal treatment worked well.Afterwards,the sequential etiological examination showed the negative results,and the bronchoscope examination showed the normal results as well.Considering about the possibility of RTX-ILD,RTX was stopped immediately and turned to intravenous infusion of methylprednisolone 40 mg per day.Results:Five d later,the symptoms of the patients were improved,and the follow-up methylprednisolone was changed to oral and gradually reduced to discontinuation.Conclusion:RTX-ILD is relatively rare,and its clinical manifestations lack specificity. Hormonotherapy is the main method in treatment of RTX-ILD. The patients sensitive to hormonotherapy have better prognosis than those insensitive to hormonotherapy.
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Objective To evaluate the clinical outcome of autologous hemopoietic stem cell transplantation (AHSCT) for hematological malignancies. Methods Data of 61 patients with hematological malignancies who underwent AHSCT in Xiangya Hospital from April 1994 to August 2008 were retrospectively analyzed. There were 30 acute non-lymphoblastic leukemias (ANLL), 25 non-Hodgkin lymphoma (NHL), 3 Hodgkin lymphoma (HL), and 3 plasmacytoma. Mel 160 mg/m2 + Ara-C 2.0/2.5 g × 2 +Cy 1.8 g/m2 × 2, or TBI 8-10 Gy + Cy 1.8 g/m2 × 2 were mainly included in pretreatment regimens. Results All patients had rapid hemopoietic reconstitution. There was one patient who died of heart failure during the transplantation process. The rate of AHSCT related death was 1.6 %. The median follow up duration was 52(2-211) months. Forty-seven of 61 patients were still alive during the analysis. The probabilities of disease free survival (DFS) at 5 years were significantly different between these two groups: (77.5±5.5) % for AHSCT groups and (31.6±7.3) % for synchronous intensive chemotherapy groups(P ＜0.01). Conclusion AHSCT can be safely performed as an important treatment constituent for hematological malignancies.
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Objective To explore the influence of cryopreservation by ladder-style freezing from low temperature refrigerator to liquid nitrogen on hemopoietic stem cell(HSC)transplantation.Methods From April 2001 to April 2006,31 cases treated with HSC transplantation were randomized to controlled-rate freezer-liquid nitrogen group(n=15)and refrigerator-liquid nitrogen group(n=16)in Department of Hematology of 1st People's Hospital of Yunnan Province.The hemopoietic reconstitution time was observed,and the viability of HSC was determined by trypan blue exclusion test in two groups.Results No significant differences were found in transfusion values of mononuclear cells(MNC)and CD34+ cells,rates of trypan blue exclusion and time of ANC0.05).Conclusion Cryopreservation of HSC can produce successful engraftment by ladder-style freezing which has cryoprotectant solution containing final concentrations of 3-percent hydroxyethyl starch,4-percent human serum albumin,and 5-percent DMSO,and its effect is the same as traditional controlled-rate method with 10-percent DMSO cryoprotectant.The new freezing procedure is faster and easier,and freezing cost is reduced.
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The prognosis of invasive aspergillosis in allogeneic bone marrow transplantation recipients is grave in the absence of bone marrow recovery in spite of antifungal treatment with amphotericin B. Beneficial role of granulocyte transfusion in neutropenic patients with fungal infection has been re-evaluated since granulocyte colony-stimulating factor made effective collection of granulocyte possible. And Liposomal amphotericin appears to be an effective alternative to conventional amphotericin B with much less toxicity. A 34-year-old patient with acute lymphoblastic leukemia developed invasive pulmonary aspergillosis during very early period of allogeneic hemopoietic stem cell transplantation. We treated the case successfully with liposomal amphotericin and granulocyte transfusion and surgery in spite of known high mortality of invasive aspergillosis in transplantation patients.
Subject(s)
Adult , Humans , Amphotericin B , Aspergillosis , Bone Marrow , Bone Marrow Transplantation , Granulocyte Colony-Stimulating Factor , Granulocytes , Invasive Pulmonary Aspergillosis , Leukemia , Mortality , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Prognosis , Stem Cell Transplantation , Stem CellsABSTRACT
Objective To explore the possibility of cytochrome P-450 3A5 (CYP3A5) genotype as a major factor to guide individualized employment of cyclosporin A(CsA) through a comparative study of CsA concentrations in the peripheral blood of hemopoietic stem cell transplant recipients with different CYP3A5 genotypes. Methods Olymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to genotype CYP3A5 gene, and CsA concentrations were detected by a commercial fluorescence polarization immunoassay. Result There were significant differences in CsA concentrations, including standardized trough concentrations C0 and two h peak concentrations C2 , in the two CYP3A5 genotypes found in our samples, and both C0 and C2 in wild homozygotes were lower than heterozygotes. Conclusion CYP3A5 polymorphism is highly associated with CsA concentrations in hemopoietic stem cell transplant recipients, and CYP3A5 genotype may be a predictor to the dose requirement before clinically employment of CsA.
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Treatment of all the cases were based on differential diagnosis of zheng. Oral medicines were given to the cases in two groups, the damp - heat type and the type of Yin - deficiency blood - heat together with dampness. Of the 15 cases, 14 were markedly effective, a relapsed case was ineffective, the average days of antipyresis was 5 days, demonstrating that the therapy was rather satisfactory and helpful to their convalescence.