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BACKGROUND:The incidence rate of peripheral T cel lymphoma is high in Asia, and peripheral T cel lymphoma is aggressive with generaly poor prognosis. However, there is no standard treatment strategy. OBJECTIVE:To retrospectively analyze the therapeutic effect of autologous hematopoietic stem cel transplantation on peripheral T cel lymphoma as wel as relevant toxic and side effects. METHODS:A retrospective review was conducted in 35 patients with peripheral T cel lymphoma who underwent autologous hematopoietic stem cel transplantation from March 2003 to April 2014, including 22 cases of extranodal NK/T-cel lymphoma (nasal type), 1 case of angioimmunoblastic T-cel lymphoma, 8 cases of peripheral T cel lymphoma (non-specific), 3 cases of ALK-positive anaplastic large cel lymphoma, and 1 case of ALK-negative anaplastic large cel lymphoma. Al of 35 patients were classified pathologicaly according to WHO pathological type in 2001 and 2008, and received the high-dose chemotherapy with vincristine, cytarabine, etoposide, mitoxantrone, semustine, cyclophosphamide, and total body irradiation. RESULTS AND CONCLUSION: After a median folow-up of 54 (9-120) months, the probabilities of overal survival and disease-free survival after transplantation were 80% (n=28) and 71% (n=25), respectively. Eight cases (23%) relapsed after transplantation, seven of which died. It was safe with mild and moderate transplantation related side-effects on opportunistic infections, oral cavity mucosa and bladder responses and so on, and there were no severe, life-threatening late complications. Autologous hematopoietic stem cel transplantation may be an effective and safe treatment for peripheral T cel lymphoma, and there is a better benefit in peripheral T cel lymphoma patients with first complete remission.
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BACKGROUND:Hematopoietic stem cel transplantation is a promising treatment for a variety of malignant and nonmalignant disorders. But noninfectious pulmonary complications folowing hematopoietic stem cel transplantation are a major cause of morbidity and mortality in these patients. And the diagnosis and treatment are difficult. OBJECTIVE: To review the noninfectious pulmonary complications after hematopoietic stem cel transplantation in terms of onset time, risk factors, clinical manifestations, characteristics of the high-resolution CT, histopathological measurement, related genes and treatment options. METHODS: A computer-based search of VIP, PubMed and Sciencedirect databases was performed for articles related to noninfectious pulmonary compli cations after hematopoietic stem cel transplantation published from January 2005 to October 2014. The key words were “HSCT, pulmonary complications, non-infectious, pirfenidone” in Chinese and English in the title and abstract. Finaly, 31 articles were included in result analysis. RESULTS AND CONCLUSION: The incidence of noninfectious pulmonary complications after hematopoietic stem cel transplantation has become more and more, with atypical clinical manifestations and limited diagnosis and treatments. According to the different clinical onset time, diagnostic criteria, clinical manifestations and the appropriate laboratory tests, clinicians can make early diagnosis and early intervention. Especialy, the usage of high-resolution chest CT and bronchofiberscope for bronchoalveolar lavage as wel as the timely drug administration can improve the survival rate of patients with noninfectious pulmonary complications after hematopoietic stem cel transplantation.
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BACKGROUND:Alogeneic hematopoietic stem cel transplantation (alo-HSCT) is an effective mean to cure severe aplastic anemia, and especialy haplotype transplantation is regarded as a transplantation system with Chinese characteristics, and rank at the international leading level. OBJECTIVE:To explore the patterns of haplotype alo-HSCT as a new immune tolerance method for severe aplastic anemia and to solve the transplantation rejection and graft-versus-host disease. METHODS:Twelve patients with severe aplastic anemia who underwent haplotype alo-HSCT at the Department of Hematology, General Hospital of Beijing Military Area, China from April 2013 to May 2014 were enroled. Al these patients received the new regimen of inducing immune tolerance through the application of high-dose cyclophosphamide (400 mg/m2, consecutively 3 days before transplantation; 50 mg/kg, consecutively 3 days after haplotype transplantation). RESULTS AND CONCLUSION:The median time of neutrophil recovery was 17 (13-21) days, and the median time of platelet recovery was 21 (15-31) days. After transplantation, there were one case of degree II acute graft-versus-host disease and one case of chronic graft-versus-host disease, both of which were controled. The folow-up time was 6 months at least, and the median time was 11 months. During the folow-up, one case died of rejection reaction and one case died of severe lung infection. These findings indicate that the new method of inducing immune tolerance with high-dose cyclophosphamide after transplantation for severe aplastic anemia has significant effects in reducing graft-versus-host disease and transplantation-related mortality rate.
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BACKGROUND:Reduced-intensity conditioning alogeneic hematopoietic stem cel transplantation (RIC-alo-HSCT) is proved being one of the effective methods to cure hematologic malignancies recently, which has been used more and more in patients with matched sibling or matched unrelated donor year by year. It is more suitable for elderly patients or younger patients combined with any organ dysfunction or complications. However, matched sibling and matched unrelated donors are not easy to be obtained for RIC-alo-HSCT. While HLA-haploidentical donor can be quickly found in family members for the patients who need receiving RIC-alo-HSCT. Fewer papers for reduced-intensity conditioning haploidentical hematopoietic stem cel transplantation (RIC-haplo-HSCT) have been reported in the world, and none in China, so the review for RIC-haplo-HSCT is necessary. OBJECTIVE:To reveiw the application of RIC-haplo-HSCT and its prospect. METHODS:Using “nonmyeloablative conditioning, reduced intensity conditioning, HLA-haploidentical, hematopoietic stem cel transplantation” as key words, we retrieved Wanfang, CNKI and PubMed databases, and foreign language search platform (1997-2014) by computer for literatures about RIC-haplo-HSCT. According to the inclusion and exclusion criteria, 25 articles in English were selected for our review ultimately. RESULTS AND CONCLUSION: This review shows that RIC-alo-HSCT with matched sibling and matched unrelated donor is widely used and has a better result increasingly. RIC-haplo-HSCT is carried out relatively late and less, and its engraftment, infection, transplant-related mortality, graft-versus-host disease, long-term disease-free survival and overal survival in the early period is a bit weak, but overal the situation has been recently improved significantly. Currently RIC-haplo-HSCT is feasible, especialy for patients lack of matched sibling donor and matched unrelate donor, and HLA haploidentical donor becomes the most potential source of hematopoietic stem cels. RIC-haplo-HSCT retains strong graft-versus-leukemia effect, and is easy to look for donor, as wel as there are sufficient cels for subsequent treatments such as donor lymphocyte infusion, which through a graft-versus-leukemia effect can eliminate the patient’s malignant cels, especialy for elderly patients and younger patients combined with any organ dysfunction or complications. However, due to the relative short time to carry out RIC-haplo-HSCT, how to choice optimal RIC regimen and optimal opportunity and how to reduce transplant-related mortality, graft-versus-host disease and relapse rate require further in-depth studies.
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BACKGROUND:Hematopoietic stem cel transplantation is the main treatment for leukemia, lymphoma and other blood diseases, but there are various negative factors during the transplantation process that have important implications for the success of hematopoietic stem cel transplantation. OBJECTIVE:To analyze the psychological characteristics of patients undergoing hematopoietic stem cel transplantation and to focus on the implementation effects of psychological intervention. METHODS: From January 2012 to December 2013, totaly 92 patients were admitted at the Hematopoietic Stem Cel Transplantation Center, the majority of whom had received autologous peripheral blood stem cel transplantation. Fifty-five of 92 patients were subjected to alogeneic stem cel transplantation, including 48 cases of relative sources and 7 of unrelated peripheral blood stem cel transplantation. Bone marrow suppression and composite grafting were carried out in some patients. According to the characteristics of negative factors at the different stages of stem cel transplantation, targeted interventional measures were performed, including psychological supports, prevention, observation and treatment of complications, and whole environmental protection programs. RESULTS AND CONCLUSION:Hematopoietic stem cel transplantation was successfuly implemented in al patients who had good compliance behaviors (medication, diet, and daily schedule), and had no the folowing adverse events: psychological stress, out of emotional control, destroying objects. No significant difference was found in the incidence of complications, the incidence of adverse events, and patient satisfaction rate during 2012-2013 (P > 0.05). Because the hematopoietic stem cel transplantation has strong specificity, patients need to strictly comply with the treatment path, stay long in laminar flow wards longer, and bear a greater psychological and physiological burden, whose behaviors are severely restricted. We should strictly implement aseptic standards, strengthen ward management and provide good guidance and support for patients, so as to reduce post-transplantation complications and ensure the successful completion of hematopoietic stem cel transplantation.
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BACKGROUND:Prevention and treatment of graftversus host disease and elevation of graft survival rate are core problems needed to be solved in alogenic hematopoietic stem cel transplantation. Thus, it is necessary to find a new immunosuppressant. Recent studies showed that histone deacetylase inhibitor has immunomodulatory effects. OBJECTIVE:To observe the effects of histone deacetylase inhibitor SAHA on acute graftversus host disease in mice and the immunomodulatory effects. METHODS: C57BL/6(H-2b)→BALB/C(H-2d) was selected as donor and recipient of complete alotransplantation. At 3, 5, 7, 9 and 11 days after transplantion, mice in the treatment group were intraperitonealy given SAHA (35 mg/kg) (0.2 mL). Mice in the control group were intraperitonealy given sterile water 0.2 mL/time. Flow cytometry, real-time quantitative PCR and pathology were used to compare the clinical manifestations, survival time and CD4+CD25+Foxp3+ cel percentage of acute graftversus host disease in mice of both groups. RESULTS AND CONCLUSION:In the treatment group, the time of acute graftversus host disease was delayed and the extent was reduced and survival time was longer compared with the control group. Survival rate was significantly higher in the treatment group than in the control group (P < 0.05). After transplantation, the proportions of CD4+CD25+Foxp3+ cels gradualy increased with prolonged time in the treatment group. On the contrary, the proportions of CD4+CD25+Foxp3+ cels gradualy decreased with prolonged time in the control group (P < 0.05). Above data suggested that SAHA delayed the occurrence of acute graftversus host disease and lessened the severity of acute graft versus host disease possibly through elevating the proportion of CD4+CD25+Foxp3+ cels.
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Objective] By detecting the peripheral blood lymphocyte subsets of AML patients before and after taking cyclosporin A, preliminary discussion on making two hours effects of cyclosporin A on lymphocyte subsets in the body. [Methods] Fasting and taking cyclosporin A two hours of the expression of peripheral blood T, B lymphocytes and NK cel were detected by flow cytometry in 43 cases of patients with AML after transplantation. At the same time, application of chemiluminescence detection concentration of cyclosporin A. [Results] The results of cyclosporin A concentration: Fasting group is 125.43 ±65.94 ng·ml-1. Taking two hours group is 564.46 ±258.67 ng·ml-1; Taking two hours group compared with the fasting group, CD3+ cel is significantly reduced and NK cel is significantly increased, but CD4+, CD8+, CD19+cel and CD4+/CD8+ have no obvious change. [Conclusions] Taking cyclosporin A 2 hours can achieve distribution and affect the number of CD3+ cel in the body, but can not affect the B cel . To AML patients after transplantation, in order to achieve the appropriate concentration and keep abreast of the body's immune status of patients, it is necessary to monitor the concentration of cyclosporin A and lymphocyte subsets during their taking cyclosporin A, which helps us determine the prognosis.
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BACKGROUND:Cytokines play an important role in the occurrence and development of graft-versus-host disease, but there is a current lack of reports on the association between cytokines and graft-versus-host disease after al ogeneic hematopoietic stem cel transplantation for treatment ofβ-thalassemia major. OBJECTIVE:To investigate the association between cytokines and graft-versus-host disease after al ogeneic hematopoietic stem cel transplantation forβ-thalassemia major. METHODS:We observed the dynamic variation of interleukin 6, interleukin 8, interleukin 12, tumor necrosis factor-αand macrophage migration inhibitory factor in 11 children withβ-thalassemia major before onset of graft-versus-host disease, when graft-versus-host disease occurred, at days 4 and 7 after onset of graft-versus-host disease, and when graft-versus-host disease disappeared. RESULTS AND CONCLUSION:There was a significant difference in serum levels of interleukin-6, interleukin-12, tumor necrosis factor-α, macrophage migration inhibitory factor in different time points, and the highest levels of different cytokines appeared when graft-versus-host disease occurred, fol owed by those at 7 days after graft-versus-host disease. There was a significant difference in serum levels of interleukin-8 in different time points, and the highest level appeared at 4 days after graft-versus-host disease. The dynamic expression of interleukin-6, interleukin-8, interleukin-12, tumor necrosis factor-α, macrophage migration inhibitory factor can estimate the immune function ofβ-thalassemia major patients who develops graft-versus-host disease after al ogeneic hematopoietic stem cel transplantation, and can be used as the immunobiology indicators for the early diagnosis of graft-versus-host disease.
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BACKGROUND:There are abundant cel populations in the placenta that attracts more and more attentions because of high content of CD34+cel s. It is expected to become a new source of hematopoietic stem cel s for the treatment of hematologic diseases and other malignant diseases. OBJECTIVE:To investigate the amount of cel s derived from placenta, their colony forming ability, and their chimerism analysis. METHODS:Five placentas obtained from five healthy ful-term cesarean women were treated with perfusion method and tissue digestion for the cel col ection. Flow cytometry was used to detect the proportion of CD34+cel s in the placenta and cord blood, fol owed by the culture of cel colonies as wel as regular observation of cel morphology and counting. PCR amplification with sequence-specific primers and sequence-specific oligonucleotide probes were used to examine HLA type of placenta, umbilical cord blood, and maternal peripheral blood;Short tandem repeat PCR was used for chimerism analysis. RESULTS AND CONCLUSION:There were more CD34+cel s in the placenta than in the umbilical cord blood. The placenta had good ability to form multiple colonies in vitro, and there were maternal source components in the placenta. It is concluded that the amount of cel s in the placenta and their biological functions exhibit the potential use of placenta as a new source of hematopoietic stem cel s.