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BACKGROUND:Despite unrelated cord blood transplantation is expected to become an important method for treating malignant hematological diseases,the manifestation and clinical characteristics of acute graft-versus-host disease in the gastrointestinal tract still require further in-depth investigation. OBJECTIVE:To analyze the clinical characteristics of intestinal acute graft-versus-host disease after unrelated cord blood transplantation. METHODS:A retrospective analysis was conducted on 668 malignant hematological disease patients after unrelated cord blood transplantation who underwent hematopoietic stem cell transplantation subspecialty in the Department of Hematology,First Affiliated Hospital of University of Science and Technology of China from December 2016 to December 2020.Among them,clinical data of 138 patients with intestinal acute graft-versus-host disease were analyzed,including 76 males and 62 females,with a median age of 13(1-62)years.All patients were treated with a myeloablative regimen(without antihuman thymocyte globulin)and cyclosporin A combined with mycophenolate mofetil to prevent graft-versus-host disease. RESULTS AND CONCLUSION:(1)The patients with intestinal acute graft-versus-host disease had diarrhea of varying degrees,most of which were yellow-green,yellow-brown watery stools or mucous stools.53 patients(38.4%)had blood stools,82 patients(57.9%)had skin involvement,18 patients(13.0%)had a secondary intestinal bacterial infection,and 90 patients(65.2%)had cytomegaloviremia.(2)The clinical characteristics of patients(70 cases,50.7%)with grade 1-2 intestinal acute graft-versus-host disease were compared with those(68 cases,49.3%)with grade 3-4 intestinal acute graft-versus-host disease.It was found that the age of grade 3-4 intestinal acute graft-versus-host disease patients was higher than that of grade 1-2 intestinal acute graft-versus-host disease patients(P<0.001),and they were complicated with cytomegaloviremia probably(P=0.035).Diarrhea lasted longer(P=0.00)and the length of hospital stay increased substantially(P<0.001).However,there were no significant differences in recipient gender,pre-transplant disease status,HLA matching,diagnosis,combined skin graft-versus-host disease,and secondary intestinal infection rate in patients of the two groups.(3)These findings conclude that the clinical characteristics of intestinal acute graft-versus-host disease after unrelated cord blood transplantation are complex,which affects the prognosis and quality of life of patients seriously and requires early identification and precise treatment.
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Objective:To evaluate the efficacy of allogeneic hematopoietic cell transplantation(allo-HSCT) using unrelated cord blood or haploidentical donors in the treatment of children with primary immunodeficiency diseases (PID).Methods:The clinical data of 60 children with PID admitted to Chinese People′s Liberation Army General Hospital-Sixth Medical Center from April 2014 to October 2019 were retrospectively analyzed, including 56 cases of chronic granulomatous disease, 2 cases of severe combined immunodeficiency disease, 1 case of high-IgM syndrome and 1 case of severe congenital neutropenia.All patients underwent allo-HSCT, including 12 cases receiving the transplantation from unrelated cord blood (UCB group) and 48 cases from haploidentical donors combined with a third party unrelated cord blood (haploid group). Among these patients, there were 59 males and 1 female, with a median age of 3.4 years.All patients received a myeloablative conditioning regimen based on Busulfan.The prophylaxis of acute graft versus host disease (aGVHD) was performed based on Cyclosporine.In the UCB group, the median dose of mononuclear cells and CD 34+ cells was 0.67×10 8/kg and 0.51×10 6/kg recipient body weight, respectively; In the haploid group, bone marrow and peripheral stem cells from haploid donors were infused on day 01 and day 02, respectively.The third party cord blood was infused 4 hours before bone marrow infusion.The median dose of mononuclear cells and CD 34+ cells of bone marrow and peripheral stem cells from haploid donors was 9.97×10 8/kg and 5.12×10 6/kg recipient body weight, respectively.Kaplan-Meier method was used to analyze the overall survival rate. Results:The median day to neutrophil and platelet engraftment was 13.0 days and 23.5 days, respectively.The rate of complete donor chime-rism was shown 30.0 days after transplantation.There was no case with primary engraftment failure, and 1 case with secondary engraftment failure.The incidence of grade Ⅰ-Ⅱ and grade Ⅲ-Ⅳ aGVHD was 43.3% and 15.5%, respectively.The incidence of chronic graft versus host disease with limited skin type was 6.7%, while that with extensive type was 1.1%.The median follow-up period was 818 days.There were 6 death cases, among which, 5 cases died from infection and 1 case died from heart failure.The total mortality related to transplantation was 11.9%.A total of 53 cases survived without diseases.The estimated 5-year failure free survival and overall survival rate was 83.9% and 88.1%, respectively.Conclusion:The efficacy of allo-HSCT in the treatment of children with PID using unrelated cord blood and haploidentical donors is favorable.
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ABSTRACT Background: Immunological life-threatening complications frequently occur in post-hematopoietic stem cell transplantation (HSCT), despite matching recipient and donor (R/D) pairs for classical human leukocyte antigens (HLA). Studies have shown that R/D non-HLA disparities within the major histocompatibility complex (MHC) are associated with adverse effects post-HSCT. Methods: We investigated the impact of mismatches of single-nucleotide polymorphisms (SNPs) in C4A/C4B genes, for showing the highest diversity in the MHC gamma block, on 238 patients who underwent HLA 10/10 unrelated donor (URD) HSCT. The endpoints were acute graft-versus-host disease (aGVHD), chronic graft-versus-host disease (cGVHD) and mortality. One hundred and twenty-nine R/D pairs had 23 C4-SNPs typed by PCR-SSP (Gamma-Type™v.1.0), and 109 R/D pairs had these 23 SNPs identified by next-generation sequencing (NGS) using the Illumina platform. Results: The percentage of patients who received HSC from HLA 10/10 donors with 1-7 mismatches was 42.9%. The R/D pairs were considered C4 mismatched when bearing at least one disparity. These mismatches were not found to be risk factors for aGVHD, cGVHD or mortality after unrelated HSCT when SNPs were analyzed together (matched or mm ≥ 1), independently or according to the percentage of incompatibilities (full match for 23 SNPs; 1-3 mm and >3 mm). An exception was the association between 1-3 mismatches at the composite of SNPs C13193/T14952/T19588 with the development of aGVHD (P = 0.012) and with grades III-IV of this disease (P = 0.004). Conclusion: Our data are not consistent with the hypothesis that disparities in C4A/C4B SNPs increase the risks of post-HSCT adverse effects for the endpoints investigated in this study.
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Humans , Child , Adolescent , Adult , Genes, MHC Class I , Complement C4a , Complement C4b , Hematopoietic Stem Cell Transplantation , Polymorphism, Single Nucleotide , Polymorphism, Genetic , Mortality , Graft vs Host DiseaseABSTRACT
BACKGROUND: Umbilical cord blood hematopoietic stem cell transplantation is more and more widely used as a radical treatment for acute leukemia, but its therapeutic effect in different leukemias has not been compared. By comparing the efficacy of diseases, it can guide different patients to choose the transplantation method.OBJECTIVE: To compare and analyze the therapeutic effect of umbilical cord blood hematopoietic stem cell transplantation on acute myeloid leukemia and acute lymphocytic leukemia. METHODS: Clinical data of 306 cases of acute leukemia treated by unrelated umbilical cord blood hematopoietic stem cell transplantation were retrospectively analyzed, including 112 patients with acute myeloid leukemia and 194 with acute lymphoblastic leukemia. All patients received myeloablative conditioning without antithymocyte, and the prevention of graft-versus-host disease was cyclosporine combined with mycophenolate mofetil. RESULTS AND CONCLUSION: (1) Except that the relapse rate after acute lymphoblastic leukemia transplantation was slightly higher than acute myeloid leukemia, the efficacy of the two groups of patients after receiving unrelated umbilical cord blood hematopoietic stem cell transplantation was basically the same. (2) In the group of adolescents and young adults (aged 15-39 years), the rate of neutrophil and platelet implantation in acute myeloid leukemia was faster than in acute lymphoblastic leukemia. Among them, CD34+ cell number and pretreatment program were independent influencing factors for neutrophil implantation, while CD34+ cell number was also an independent influencing factor for platelet implantation. In this age group, the recurrence rate of acute lymphoblastic leukemia patients after transplantation was still higher than that of acute myeloid leukemia, in which chronic graft-versus-host disease was an independent influencing factor. (3) Immune reconstruction testing after transplantation suggests that cord blood CD8+ T cell reconstruction in patients with acute myeloid leukemia was better than in acute lymphoblastic leukemia patients 4 months after transplantation. (4) The above data show that pre-treatment of unrelated cord blood transplantation without antithymocyte globulin has a good effect on acute lymphocytic leukemia and acute myeloid leukemia. Department of Hematology of The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China is qualified for stem cell transplantation.
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BACKGROUND: Allogeneic hematopoietic stem cell transplantation is still the only cure method for acquired severe aplastic anemia. How to select patients for treatment has become a research hotspot in recent years. OBJECTIVE: To review the progress of allogeneic hematopoietic stem cell transplantation from three aspects: HLA full-phase matched unrelated donor hematopoietic stem cell transplantation (MUD-HSCT), unrelated cord blood transplantation (UCBT) and haploidentical hematopoietic stem cell transplantation (HID-HSCT). METHODS: Literatures on allogeneic hematopoietic stem cell transplantation for severe aplastic anemia collected in PubMed, CNKI full-text database and WanFang database from 2000 to 2018 were retrieved with the keywords “unrelated donor; haploidentical; unrelated cord blood; severe aplastic anemia” in Chinese and English. RESULTS AND CONCLUSION: MSD-HSCT is the first-line treatment for severe aplastic anemia, but in view of China’s special national conditions, HLA matched donor is not easy to find. As an important alternative treatment, MUD-HSCT is close to MSD-HSCT. However, the incidence of graft versus host disease and severe infection after MUD-HSCT is still higher than that after MSD-HSCT. It is still necessary to consider multiple factors when choosing MUD-HSCT treatment. Umbilical cord blood hematopoietic stem cells are widely used because of their abundant sources and high match success rate. The probability of UCBT is very high when the amount of pre-frozen total nucleated cells is more than 3.9×107/kg. However, in view of the delay of UCBT and immune function reconstruction, unless other transplantation methods are not feasible in clinical treatment of severe aplastic anemia and immunosuppressive therapy fails in the first course of treatment, UCBT should not be considered. HID-HSCT has the advantages of easy access and good compliance of donors and is close to full-matched transplantation. It has become an important alternative to transplantation. The use of baliximab and/or antithymocyte globulin is expected to reduce the incidence of graft versus host disease and expand the clinical application of HID-HSCT.
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BACKGROUND: A great progress has been achieved in the allogeneic hematopoietic stem cell transplantation for aplastic anemia. However, graft-versus-host disease and graft failure after transplantation are still the main causes of non-relapse death, which seriously affect the survival of patients. OBJECTIVE: To summarize the current status and progress of allogeneic hematopoietic cell transplantation in the treatment of aplastic anemia. METHODS: The first author retrieved PubMed, CNKI, WanFang and VIP databases for the articles concerning allogeneic hematopoietic stem cell transplantation for aplastic anemia published from January 1990 to September 2019. The keywords were “aplastic anemia, matched sibling donor hematopoietic stem cell transplantation, unrelated donor hematopoietic stem cell transplantation, haploidentical hematopoietic stem cell transplantation, cord blood transplantation” in Chinese and English, respectively. Finally 55 eligible articles were included for result analysis. RESULTS AND CONCLUSION: HLA-matched sibling donor allogeneic hematopoietic stem cell transplantation is the first choice. Unrelated donor hematopoietic stem cell transplantation may be an effective and feasible first-line therapy in pediatric severe aplastic anemia patients with no matched sibling donors. Haploidentical hematopoietic stem cell transplantation and cord blood transplantation can also be important transplantation methods for severe aplastic anemia when lack of HLA-matched donors.
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BACKGROUND: In recent years, umbilical cord blood has gradually become a crucial alternative source of stem cells for related and unrelated bone marrow or peripheral blood hematopoietic stem cell transplantation, which is increasingly used in the treatment of hematological malignancies in children. OBJECTIVE: To compare the clinical efficacy of sibling donor umbilical cord blood transplantation and unrelated umbilical cord blood transplantation for treating hematological malignancies in children. METHODS: The clinical data of children with hematological malignancies who received umbilical cord blood transplantation at the Hematopoietic Stem Cell Transplantation Center of the First Affiliated Hospital of Zhengzhou University between January 1, 1998 and December 31, 2018 was retrospectively analyzed. All the patients received myelablative conditioning regimen, and cyslosporine A combined with or without mycophenolate mofetil were concurrently adopted for graft-versus-host disease prophylaxis. RESULTS AND CONCLUSION: (1) Two patients in the sibling donor umbilical cord blood transplantation group and three in the unrelated umbilical cord blood transplantation group did not attain hematological engraftment and subsequently died from infection, and other patients succeeded in hematological engraftment. The median time of neutrophil and platelet engraftment in the sibling donor umbilical cord blood transplantation and unrelated umbilical cord blood transplantation groups was [17 days (11-43 days), 18 days (12-45 days), P=0.307] and [20.5 days (15-50 days), 27 days (18-56 days), P=0.773]. There was no significant difference between the two groups. (2) The incidence of acute graft-versus-host disease and chronic graft-versus-host disease in the sibling donor umbilical cord blood transplantation and unrelated umbilical cord blood transplantation groups was 36% vs. 43% (P=0.737) and 15% vs. 33% (P=0.412). There was no significant difference between the two groups. There was also no significant difference in the incidence of infection after transplantation between sibling donor umbilical cord blood transplantation and unrelated umbilical cord blood transplantation groups (56% vs. 71%, P=0.343). (3) There were no significant differences in the 2-year overall survival (61% vs. 36%, P=0.301), or 2-year relapse-free survival (56% vs. 33%, P=0.151). The 5-year overall survival and 5-year relapse-free survival in the sibling donor umbilical cord blood transplantation and unrelated umbilical cord blood transplantation groups were 54% vs. 24% (P=0.044) and 50% vs. 20% (P=0.039). The results showed that there was a significant difference in long-term survival rate between two groups. (4) Our results reveal that both sibling donor umbilical cord blood transplantation and unrelated umbilical cord blood transplantation are safe, effective and applicable for children with hematological malignancies. In particular, there are significant benefits in the long-term survival of substitute donor transplantation for pediatric patients with hematological malignancies.
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The efficacy and safety of co-transplantation of unrelated donor peripheral blood stem cells (UD-PBSCs) combined with umbilical cord mesenchymal stem cells (UC-MSCs) in refractory severe aplastic anemia-Ⅱ(RSAA-Ⅱ) were analyzed retrospectively. Fifteen patients with RSAA-Ⅱ underwent UD-PBSCs and UC-MSCs co-transplantation, among whom 14 cases had hematopoietic reconstitution without severe graft versus-host disease (GVHD). The 5-year overall survival rate was 78.57%. Combination of UD-PBSCs and UC-MSCs transplantation could be a safe and effective option for RSAA-Ⅱ.
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Objective@#To evaluate the outcomes of human leukocyte antigen (HLA) matched unrelated donor hematopoietic stem cell transplantation (MUD-HSCT) for adult acute myeloid leukemia (AML) in a single center.@*Methods@#Consecutive adult AML who received MUD-HSCT in our center from January 2008 to April 2017 were studied retrospectively, comparing with patients undergoing matched sibling donor (MSD) -HSCT in the same period. The rates of overall survival (OS) , disease free survival (DFS) , relapse, non-relapse mortality (NRM) , engraftment, acute and chronic graft-versus-host disease (aGVHD and cGVHD) were analyzed.@*Results@#A total of 247 consecutive cases were enrolled, including 46 patients with MUD-HSCT and 201 with MSD-HSCT. All the patients experienced neutrophil engraftment except for one patient who died early in the MSD group, but the median day of engraftment was longer in the MUD group (15.0 vs 14.0, P=0.017) . The accumulative engraftment rate of platelet was comparable between the two groups (93.5%vs 98.0%, P=0.128) . The accumulative incidences of aGVHD (50.0%vs 46.3%, P=0.421) and cGVHD (37.8%vs 43.0%, P=0.581) were not statistically different between the two groups. Compared with the MSD group, the accumulative NRM rate at+36 months after transplantation was significantly higher in the MUD group (22.0%vs 10.4%, P=0.049) , while the relapse rate was not statistical difference (20.5 vs 28.3%, P=0.189) . Both the 3-year OS (61.6%vs 63.3%, P=0.867) and DFS (57.5%vs 61.6%, P=0.760) were comparable between the two groups. Four independent risk factors were confirmed by the multivariate analysis: patient age ≥45 years old, CR2 or NR before transplantation, a history of extramedullary infiltration and the occurrence of grade Ⅲ-Ⅳ aGVHD. No statistical differences were demonstrated in the survival rate between MUD-and MSD-HSCT in different subgroups.@*Conclusions@#The outcomes, such as GVHD, relapse, OS and DFS, were comparable between MUD-and MSD-HSCT for adult AML, but higher incidence of NRM and longer time to neutrophil engraftment in the MUD group. MUD-HSCT is practical and feasible for adult AML who are lack of MSD.
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Objective: To evaluate the outcomes of human leukocyte antigen (HLA) matched unrelated donor hematopoietic stem cell transplantation (MUD-HSCT) for adult acute myeloid leukemia (AML) in a single center. Methods: Consecutive adult AML who received MUD-HSCT in our center from January 2008 to April 2017 were studied retrospectively, comparing with patients undergoing matched sibling donor (MSD) -HSCT in the same period. The rates of overall survival (OS) , disease free survival (DFS) , relapse, non-relapse mortality (NRM) , engraftment, acute and chronic graft-versus-host disease (aGVHD and cGVHD) were analyzed. Results: A total of 247 consecutive cases were enrolled, including 46 patients with MUD-HSCT and 201 with MSD-HSCT. All the patients experienced neutrophil engraftment except for one patient who died early in the MSD group, but the median day of engraftment was longer in the MUD group (15.0 vs 14.0, P=0.017) . The accumulative engraftment rate of platelet was comparable between the two groups (93.5%vs 98.0%, P=0.128) . The accumulative incidences of aGVHD (50.0%vs 46.3%, P=0.421) and cGVHD (37.8%vs 43.0%, P=0.581) were not statistically different between the two groups. Compared with the MSD group, the accumulative NRM rate at+36 months after transplantation was significantly higher in the MUD group (22.0%vs 10.4%, P=0.049) , while the relapse rate was not statistical difference (20.5 vs 28.3%, P=0.189) . Both the 3-year OS (61.6%vs 63.3%, P=0.867) and DFS (57.5%vs 61.6%, P=0.760) were comparable between the two groups. Four independent risk factors were confirmed by the multivariate analysis: patient age ≥45 years old, CR2 or NR before transplantation, a history of extramedullary infiltration and the occurrence of grade Ⅲ-Ⅳ aGVHD. No statistical differences were demonstrated in the survival rate between MUD-and MSD-HSCT in different subgroups. Conclusions: The outcomes, such as GVHD, relapse, OS and DFS, were comparable between MUD-and MSD-HSCT for adult AML, but higher incidence of NRM and longer time to neutrophil engraftment in the MUD group. MUD-HSCT is practical and feasible for adult AML who are lack of MSD.
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Humans , Middle Aged , Graft vs Host Disease , HLA Antigens , Hematopoietic Stem Cell Transplantation , Leukemia, Myeloid, Acute/therapy , Retrospective Studies , Siblings , Unrelated DonorsABSTRACT
Objective To evaluate the efficacy of unrelated donor allogeneic hematopoietic stem cell transplantation (allo-HSCT) for leukemic children .Methods Clinical data of 54 leukemic children undergoing allo-HSCT were retrospectively analyzed from May 2006 to March 2018 .According to the source of donor ,they were divided into matched sibling donor allo-HSCT group (MSD ,n = 27 ) and unrelated donor group (URD ,n= 27) .The clinical outcomes of leukemic children receiving URD allo- HSCT were assessed and those in MSD allo-HSCT group were enrolled as control .Results One patient with refractory AML was not implanted in URD group and the remaining 53 cases were successful in hematopoietic reconstitution .The time of neutrophil and platelet ,the incidence of acute graft-versus-host disease (aGVHD ) , chronic GVHD (cGVHD ) , generalized cGVHD and their transplant-related complications including pulmonary complications ,hemorrhagic cystitis between two groups were not statistically different (P> 0 .05) .The incidence of serious aGVHD ,cytomegalovirus (CMV) and EB virus (EBV) infection was significantly higher in URD group than that in MSD group (P< 0 .05) .The proportion of non-recurrent deaths in URD and MSD groups was 80％ and 31 .3％ respectively and the difference between two groups was statistically significant ( P = 0 .041) .The 3- year disease-free survival rate (DFS) of URD group and MSD group was (52 .9 ± 9 .8 )％ ,(38 .5 ± 8 .7 )％ and the overall 3-year survival rate (OS) was (57 .9 ± 9 .5)％ and (46 .5 ± 9 .7)％ respectively . The inter-group difference was not statistically significant ( P > 0 .05 ) .Conclusions In leukemic children ,although the incidence of complications post URD allo-HSCT is significantly increased , the prognosis is comparable to MSD allo-HSCT .It is a good choice when there is no suitable sibling donor .
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Five patients with Fanconi anemia who received hematopoietic cell transplantation were retrospectively analyzed. The conditioning regimens included fludarabine, cyclophosphamide and anti-thymocyte globulin. Two patients received both bone marrow and peripheral blood stem cells as the source of stem cell grafts from haploidentical matched related donors, while the others received peripheral blood stem cells from unrelated donors.All patients tolerated well and reached hematopoietic reconstitution. One patient died of intracranial infection.During follow-up,4 patients survived independent of transfusion with full donor chimerism.
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Objective To analyze the predictive value of serum interleukin-27 (IL-27) for acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) from unrelated donors. Methods Serum samples were collected from 72 patients after receiving allo-HSCT from unrelated donors during January to December 2012. Serum samples collected from 70 patients received allo-HSCT in 2013 were used for confirmation. All patients received myeloablative conditioning regimen prior to allo-HSCT. Cyclosporin A (CsA)+mycophenolate mofetil (MMF)+short-term methotrexate (MTX) were used for GVHD prophylaxis. Serum IL-27 levels in patients with aGVHD were measured by ELISA. The pre-dictive value of IL-27 index,defined as the ratio of serum IL-27 level at neutrophil engraftment to that before pre-conditioning regimen, for allogeneic HSCT was retrospectively analyzed. Results Serum IL-27 index was significantly decreased in patients with gradeⅡ-ⅣaGVHD(grade 0-Ⅰ : 1.89±0.68 vs gradeⅡ-Ⅳ :1.26±0.49;P<0.000 1). IL-27 index had good value for grade Ⅱ-Ⅳ aGVHD (AUC=0.782,95% CI:0.675-0.889,P<0.001). Patients with a lower serum IL-27 index (<1.33) were more likely to have a higher cumulative incidence of grade Ⅱ-Ⅳ aGVHD than those with a higher serum IL-27 index (P<0.001). Multivariate analysis confirmed that low IL-27 index was the most significant risk factor for gradeⅡ-Ⅳ aGVHD (HR=4.50,95% CI:2.1-9.8,P<0.01). These findings were consistent with the results found in the serum samples collected in 2013. Conclusion Low IL-27 index could be used to predict the incidence of grade Ⅱ-Ⅳ acute GVHD after allo-HSCT from unrelated donors.
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BACKGROUND: A number of alternative donor options exist for patients who fail to find domestic HLA-matched donors for allogeneic hematopoietic stem cell transplantation (allo-HSCT). We assessed physicians' perspectives on allo-HSCT donor selection when a matched domestic donor is not available. METHODS: We administered a questionnaire survey to 55 hematologists (response rate: 28%) who attended the annual spring conference of the Korean Society of Haematology in 2015. The questionnaire contained four clinical allo-HSCT scenarios and the respondents were asked to choose the most preferred donor among the given options. RESULTS: In all four scenarios, the hematologists preferred a matched international donor over partially mismatched unrelated domestic or haplo-matched family donors. The numbers of hematologists who chose a matched international donor (HLA 8/8) in cases of acute myeloid leukemia, chronic myeloid leukemia, acute lymphoblastic leukemia, and aplastic anemia were 37 (67.3%), 41 (74.6%), 33 (60.0%), and 36 (65.5%), respectively. The important factors that affected donor selection included “expecting better clinical outcomes (40.5%)” and “lower risk of side effects (23.4%).” The majority of participants (80%) responded that allo-HSCT guidelines for donor selection customized for the Korean setting are necessary. CONCLUSION: Although hematologists still prefer perfectly matched foreign donors when a fully matched domestic allo-HSCT donor is not available, we confirmed that there was variation in their responses. For evidence-based clinical practice, it is necessary to provide further comparative clinical evidence on allo-HSCT from haplo-matched family donors and fully matched unrelated international donors.
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Humans , Anemia, Aplastic , Donor Selection , Hematopoietic Stem Cell Transplantation , Korea , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Leukemia, Myeloid, Acute , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Stem Cell Transplantation , Stem Cells , Surveys and Questionnaires , Tissue Donors , Unrelated DonorsABSTRACT
Unrelated living organ cross -transplantation has rich connotation and complex constructs .Revie-wing on the legislative attitudes of countries and regions around the world , there are three types including absolute prohibition , strict limit and explicit permission .From the perspectives of law , ethics and practice in our country , unrelated living organ cross-transplantation has had a legitimate basis .In the future, our country should recognize unrelated living organ cross -transplantation by legislation .In addition, it should strictly limit its applicable condi-tions and procedures , further to improve the distribution and sharing system of organ transplantation and explore the establishment of appropriate compensation systems for organ donors .
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Unrelated living organ cross -transplantation has rich connotation and complex constructs .Revie-wing on the legislative attitudes of countries and regions around the world , there are three types including absolute prohibition , strict limit and explicit permission .From the perspectives of law , ethics and practice in our country , unrelated living organ cross-transplantation has had a legitimate basis .In the future, our country should recognize unrelated living organ cross -transplantation by legislation .In addition, it should strictly limit its applicable condi-tions and procedures , further to improve the distribution and sharing system of organ transplantation and explore the establishment of appropriate compensation systems for organ donors .
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Objective To assess the effectiveness of unrelated donor (URD) allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of severe aplastic anemia (SAA),and the difference between URD allo-HSCT and matched sibling donor (MSD) allo-HSCT.Methods According to the source of donors,the SAA patients subject to allo-HSCT were divided into MSD allo-HSCT group (MSD group) and URD allo-HSCT group (URD group) from October 2001 to December 2016 in Henan Cancer Hospital.The efficacy and transplantation related complications were compared between two groups.Results There were no statistically significant differences in hematopoietic reconstitution and graft rejection between two groups.The incidence of grade Ⅱ-Ⅳ acute GVHD and chronic GVHD was higher in the URD group than in the MSD group (30.76％ vs.8.57％,P =0.026;26.92％ vs.5.71％,P =0.021).However,other transplant-related complications including pulmonary complications and hemorrhagic cystitis,incidence of EBV and CMV reactivation and venous occlusive disease showed no significant difference between two groups.The estimated 5-year over survival was (73.6 ± 8.7) ％ in the MSD group and (72.7 ± 9.5) ％ in the URD group (P =0.878).There was no significant difference in 5-year disease-free survival between two groups (73.6 ± 8.7％ vs.70.3 ± 10.2,P =0.668).Conclusion URD-HSCT is a novel treatment approach and could be considered as first-line therapy in selected patients without MSD.
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BACKGROUND: The hematopoietic stem cell bank has been actively recruiting registrants since 1994. This study systematically reviews its operations and outcomes over the last 20 years. METHODS: Retrospective data on a total of 47,711 registrants were reviewed. Relevant data were processed using PASW Statistics for Windows, version 18.0. RESULTS: As of 2013, the Korean Network for Organ Sharing database contained 265,307 registrants. Of these, 49,037 (18%) registrants committed to hematopoietic cell donation from 1994 to 2013. Fifty-seven percent of the registrants were men, and 43% were women. The reasons for opting out of the registry included refusal to donate (70%), family refusal (28%), and others (2%). The donation willingness of registrants was significantly higher than those who refused to receive a mail to confirm their continued enrollment (χ2=6.103, P=0.013). The bank successfully coordinated a total of 512 donors among newly matched donors from 1995 to 2013, of which the bone marrow and peripheral blood stem cell accounted for 40.8% and 59.2% of the total donations, respectively. CONCLUSION: Our recruitment activities focus on promoting voluntary registration and the importance of updating personal contact information. We expect that these data may be useful for diverse studies and demonstrate the positive impacts on the donation program.
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Female , Humans , Male , Bone Marrow , Bone Marrow Transplantation , Hematopoietic Stem Cells , Peripheral Blood Stem Cell Transplantation , Personnel Selection , Postal Service , Retrospective Studies , Stem Cells , Tissue DonorsABSTRACT
BACKGROUND: The National unrelated hematopoietic stem cell (HSC) donor program started in 1994. The Korean Red Cross (KRC) has participated in this program from the start as a recruiting organization. Results of 20 years of donor recruitment were analyzed to make suggestions to manage potential donors more effectively and improve retention rate. METHODS: Statistics on registration, deregistration, and donation of potential HSC donors registered in the Korean Network for Organ Sharing (KONOS) registry from 1994 to 2013 were analyzed. For donors recruited by the KRC, gender and age distribution, and reasons for self-withdrawal were also analyzed. RESULTS: As of 2013, a total of 265,307 potential HSC donors have been registered in the KONOS registry, among which 38.8% have been recruited by the KRC. Rate of self-withdrawal from the registry was lower for the KRC than the mean of all recruiting organizations (15.9% vs 21.8%). Reasons for withdrawal were objections by family members (34.9%), medical conditions (28.8%), change of donors' mind (21.7%), and other personal reasons (14.6%). The overall retention rate during the 20 year period for KRC was 63.7% which was higher than that of KONOS (58.1%). CONCLUSION: The lower self-withdrawal rate and higher retention rate of donors recruited by the KRC are the result of continuous education of donors to maintain their willingness to donate not only during recruitment but also after registration. This study will help to improve the retention rate and manage registered donors more effectively.
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Humans , Age Distribution , Education , Hematopoietic Stem Cells , Red Cross , Tissue DonorsABSTRACT
Background: Kidney transplantation is the best treatment for end stage kidney disease. The allograft allocation system considers immunological factors and time in waiting list, but not the age of donors or recipients, in spite that both have prognostic relevance. Aim: To study the fairness of the allograft allocation system considering the age of donors and recipients. Material and Methods: Based in the age distribution of donors and waiting list of patients for kidney transplantation, we constructed probability functions for receiving a graft as an allocation system based on age changes from a strict to a more lax criteria. Finally, we compared our model with the real transplants performed during 2012. Results: The probability distribution for receiving a kidney transplantation is displaced to the right compared with the age distribution of graft donors. This gap increases as the procuring hospitals enlist progressively older graft candidates without accepting older donors in parallel. An allocation system that maintains age parity between donors and recipients is fairer that other that allows lax criteria for the same allocation. This phenomenon is attenuated if the procurement acceptance criterion allows older donors. Conclusions: It is necessary to reduce the gap between donor and recipient ages for kidney transplantation to improve the fairness of the graft allocation system.