Nursing care of a patient with severe aplastic anemia type Ⅱ treated with umbilical cord blood transfusion sequentially combined with second haploid allogeneic bone marrow transplantation / 中国实用护理杂志

Objective To summarize the nursing care for one successful haploidentical allogeneic bone marrow transplantation (haplo-BMT) for one patient with severe aplastic anemia type-Ⅱ (SAA-Ⅱ). The patient accepted an umbilical cord blood transfusion sequentially combined with the second haplo-BMT after an engraftment failure of the first haplo-BMT. The experience of nursing care will be discussed and shared for patients with a second haplo-BMT. Methods The comprehensive nursing cares were utilized during haplo-BMT, it included preventive measures for secondary infections, closely control of side effects, promptly nursing intervention for gastrointestinal mucositis, hemorrhagic cystitis and epilepsy, psychological nursing for appeasing emotional variations, and addition of intravenous indwelling needle if necessary. Results The patient achieved a successful stem cell engraftment and survived a long-term granulopenia (granulocytes＜0.1×109/L) which lasted for 52 days with a recovery of varied complications. Conclusion The comprehensive nursing care can reduce the risk for secondary infections and other complications, it shed a new light on second allogeneic bone marrow transplantation for complicated patients

Induced Pluripotent Stem Cells-derived chimeric Thymus transplantation enhances T cells Reconstitution and prevents GVHD in Murine after allogeneic Bone Marrow Transplantation / 实用医学杂志

Objective To explore the effects of iPS cells-derived chimeric thymus transplantation on T cells reconstitution and graft versus host disease of murine after allo-BMT. Methods iPS cells-derived chimeric thymus was grafted under the renal capsules of mice after allogeneic IBM-BMT. The mice were divided into three groups:IBM-BMT group, IBM-BMT+TT group and IBM-BMT+DLI group. Four weeks after BMT, T lymphocyte subsets in the peripheral blood were analyzed by flow cytometry, the degree and pathological examination of GVHD were observed, respectively. Results Percentage of CD8+T cells in IBM-BMT group, IBM-BMT+TT group and IBM-BMT+DLI group was(5.52 ± 0.83)%,(11.10 ± 1.49)%and(8.49 ± 0.82)%respectively, there was signifi-cant difference between pairwise comparisons(P<0.05), and percentage of CD4 + T cells of the peripheral blood in IBM-BMT+TT group(9.60 ± 0.69)%was significantly higher than IBM-BMT group(6.42 ± 1.40)%and IBM-BMT+DLI group(8.07 ± 0.65)%(P<0.05) . IBM-BMT group and IBM-BMT+TT group showed less clinical and histopathological scoring of GVHD than IBM-BMT + DLI group. Conclusion iPS cells-derived chimeric thymus transplantation could effectively accelerate T cells reconstitution and prevent GVHD after allo-BMT.

Human Bone Marrow Subpopulations Sustain Human Islet Function and Viability In vitro.

Aims: Allogeneic bone marrow (BM) has been shown to support human islet survival and function in long-term culture by initiating human islet vascularization and β-cell regeneration. Various BM subpopulations may play different roles in human islet functions and survival. In this paper we investigated the effects of BM and its subpopulations, endothelial progenitor cells (E) and mesenchymal (M) cells on human islet’s β-cell function and regeneration. Study Design: Isolation and identification of subpopulations from human bone marrow and culture with allogeneic human islet to investigate effects of different cell population on human islet function and regeneration. Place and Duration of Study: Department of Medicine, Center for Stem Cell & Diabetes Research, RWMC, Providence, RI, USA, between 2010 - 2014. Methodology: Human islets were distributed from Integrated Islet Distribution Program (IIDP) and human bone marrow (BM) was harvested by Bone marrow transplantation center at Roger Williams Hospital. BM subpopulation was identified cell surface markers through Fluorescenceactivated cell sorting, applied in flow cytometry (FACS), islet function was evaluated by human ELISA kit and β cell regeneration was evaluated by three methods of Cre-Loxp cell tracing, β cell sorting and RT-PCR for gene expression. Results: Four different BM and seven different islet donates contributed human tissues. We observed islet β-cell having self regeneration capability in short term culture (3~5 days) using a Cre-Loxp cell tracing. BM and its subtype E, M have similar benefits on β cell function during coculture with human islet comparison to islet only. However, only whole BM enables to sustain the capability of islet β-cell self regeneration resulting in increasing β cell population while single E and M individual do not significantly affect on that. Mechanism approach to explore β-cell self regeneration by evaluating transcription factor expressions, we found that BM significantly increases the activations of β-cell regeneration relative transcription factors, the LIM homeodomain protein (Isl1), homologue to zebrafish somite MAF1 (MAFa), the NK-homeodomain factor 6.1 (NKX6.1), the paired box family factors 6 (PAX6), insulin promoter factor 1 (IPF1) and kinesin family member 4A (KIF4a). Conclusion: These results suggest that BM and its derived M and E cells enable to support human islet β-cell function. However, only BM can sustain the capability of β-cell self regeneration through initiating β-cell transcriptional factors but not individual E and M cells suggesting pure E and M cells less supportive for islet long-term survival in vitro.

Establishment of an acute graft-versus-host disease animal model in EL4 T-cell leukemia/lymphoma mice / 中华实用儿科临床杂志

Objective To establish an acute graft-versus-host disease (aGVHD) model in EL4 T-cell leukemia/lymphoma mice,for providing experimental model to prevent aGVHD while maintaining graft-versus-leu1 mia (GVL) effect during allogeneic bone marrow transplantation (Allo-BMT).Methods Male BALB/c (H-2Kd)mice were used as donors and female C57BL/6(H-2Kb) mice were used as recipients.C57BL/6 hosts were given 9.5 Gy lethal total body irradiation at 4 hours prior to transplantation.Mice were randomly assigned into 3 groups and each group contained 17 recipients:The recipients in radiation group were injected with 0.2 mL RPMI 1640 as control.The recipients were injected with donor bone marrow cells (5 × 106/mouse) and splenocyte for aGVHD(5 × 106/mouse).The recipients in EL4 T-cell leukemia/lymphoma aGVHD group were injected with donor bone marrow cells (5 × 106/mouse) and plus 500 EL4 cells (5 × 106/mouse).General state,life span and histopathology of the recipient mice and detected chimera were observed.Results The results showed that the mean survival time in radiation group was (10.10 ± 0.43) days,in aGVHD group was(28.12 ± 5.01)days,in EL4 T-cell leukemia/lymphoma aGVHD group was (31.05 ±5.48) days.The mean survival time in aGVHD group and EL4 T-cell leukemia/lymphoma aGVHD group were significantly longer than that in radiation group(all P ＜ 0.01),but there was no significant difference between aGVHD group and EL4 T-cell leukemia/lymphoma aGVHD group (P ＞ 0.05).Histopathological analysis in several target organs (skin,liver and small intestine) confirmed the presence of sever GVHD in aGVHD group and EL4 T-cell leukemia/ lymphoma aGVHD group.Pathological examination showed disorganization of normal tissues and leukemic cell infiltration in EL4 T-cell leukemia/lymphoma aGVHD group.Conclusion The EL4 T-cell leukemia/lymphoma aGVHD mice model is reliable to the experimental research of aGVHD.

Inhibition of endothelial progenitor cells against hepatic vein thrombosis after allogeneic bone marrow transplantation / 中华器官移植杂志

Objective To (e)xplore inhibition of endothelial progenitor cells (EPCs) against hepatic vein thrombosis after allogeneic bone marrow transplantation (BMT).Methods Balb/c mice were randomly divided into three groups: (1) BMT group [Balb/c mice were injected intravenously with 5 × 106 bone marrow cells after total body irradiation (TBI)]; (2) EPCs co-transfusion with bone marrow cells group: 5 × 105 EPCs were infused into recipient mice simultaneously; (3) Normal control group.Liver index was detected on the day 0,5,10,15 and 20 after transplantation.Hepatic vein thrombosis,hepatic cells and vascular endothelial damage were observed under the light microscopy after H&E staining.The injury of liver cells,liver veins,hepatic sinusoidal endothelial cells (SECs)and platelet adhesion conditions were observed under a transmission electron microscope (TEM).The proportion of activated platelets and TNF-α concentration in peripheral blood were detected by using flow cytometry.Results On the day 0,5,10,15 and 20 after transplantation,the proportion of activated platelets,liver index and TNF-α concentrations in BMT group and EPCs co-transfusion group showed an upward trend,peaked on the 15th day,and then decreased.However,they were still significantly higher than those in normal control group (P＜0.05).The above parameters in EPCs co-transfusion group at each time point were significantly lower than those in BMT group (P＜0.05).As compared with BMT group,platelet adhesion decreased,hepatic vein thromboses were reduced,hepatocyte swelling and necrosis were alleviated,and liver damage repaired rapidly in EPCs co-transfusion group.Conclusion EPCs co-transfusion with bone marrow cells could inhibit the hepatic veins thrombosis and ameliorate liver damage significantly.

Recurrent Pneumomediastinum and Subcutaneous Emphysema Complicating Chronic Graft versus Host Disease after Allogeneic Bone Marrow Transplantation

Several noninfectious pulmonary complications can be associated with chronic graft versus host disease (GVHD). Obstructive airway disease can be a clinical feature of chronic GVHD and the histopathology reveals characteristic lesions of bronchiolitis obliterans. Bronchiolitis obliterans is an obstructive pulmonary disorder affecting the small airways, and it was first described as a late complication of allogeneic bone marrow transplantation (BMT). Spontaneous pneumomediastinum and subcutaneous emphysema can occur in the setting of severe bronchiolitis obliterans and only rarely are they the first sign of such disease. We describe here a case of a 27-year old woman who developed recurrent pneumomediastinum and subcutaneous emphysema that were secondary to the bronchiolitis obliterans that complicated chronic GVHD after allogeneic BMT.

Association of Hospital Procedure Volume with Post-Transplant Survival for Allogeneic Bone Marrow Transplantation / 예방의학회지

OBJECTIVE: To examine the association between hospital procedure volume and treatment outcomes following allogeneic bone marrow transplantation (allo-BMT). METHODS: Out of 1, 050 patients who received allo-BMTs between 1998 and 2000 in 21 Korean hospitals, 752 with first allo-BMT and complete data were included in this study. Study subjects were divided into the following three groups according to cumulative hospital experience of all-BMTs during the study period: low ( or =50 cases) volume. Patient outcome was defined as early survival at day 100 and one-year survival. Multiple logistic regression analyses were performed to examine the association between hospital experience and survival at day 100 and one year. RESULTS: When the low volume group was defined as the reference group, the adjusted relative risks (RR) of survival at day 100 for the high volume group were 2.46 (95% CI, 1.13-5.36) for all patients, 2.61 (1.04-6.57) for those with leukemia, and 2.20 (0.47-10.32) for those with aplastic anemia. For one-year survival, adjusted RR for the high volume group were 2.52 (1.40-4.51) for all patients, 1.99 (1.01-3.93) for leukemia, and 6.50 (1.57-26.80) for aplastic anemia. None of the RR for the medium volume group was statistically significant. Patient factors showing significant relationship with survival were donor-recipient relation, human leukocyte antigen matching status, time from diagnosis to transplant, and disease stage. CONCLUSION: The study results suggest that the cumulative experience of hospitals in providing allo-BMT is positively associated with patient survival.

A case of successful allogeneic bone marrow transplantation in a HBV-positive severe aplastic anemia patient with prophylactic lamivudine treatment / 대한내과학회지

Reactivation of hepatitis B virus (HBV) infection has been known to be a serious complication of immunosuppressive or cytotoxic chemotherapy in HBV carriers or chronic hepatitis B patients. We report here a 25-year-old woman who has severe aplastic anemia and chronic hepatitis B underwent successful allogeneic bone marrow transplantation (BMT) with prophylactic lamivudine treatment and showed no evidence of reactivation of hepatitis B, HBV DNA elevation, or liver dysfunction. This result suggests that prophylactic administration of lamivudine to a BMT recipient of chronic hepatitis B might be a safe and promising measure to prevent fatal liver dysfunction.

Influence of 1,25-(OH)_2D_3 and salvia miltiorrhiza on T cell subsets and immune status in rats after allogeneic bone marrow transplantation / 第三军医大学学报

Objective To investigate the effect of 1,25-(OH)2D3 and salvia miltiorrhiza on T cell subsets and cytokines in rats after allogeneic bone marrow transplantation.Methods Female Wistar rats were used as recipients and male SD rats were used as donors.All Wistar rats were divided into aGVHD group and intervention groups at random,and the intervention groups were further divided into 1,25-(OH)2D3 group,salvia miltiorrhiza group and combination group.The changes of T cell subsets (CD4+ and CD8+) and cytokine (IL-2,IFN-?,IL-4 and IL-10) in every group were detected and measured.Results When the presentation of aGVHD was relatively conspicuous,CD4+ and CD8+ were increased,and the increase of CD4+ was predominant.Compared with the difference prior to transplantation,the difference was statistically significant (P

Effect of Donor Lymphocyte Infusion for a Patient with Isolated Knee Joint Relapse of Acute Lymphoblastic Leukemia after Allogeneic Bone Marrow Transplantation / 대한혈액학회지

Isolated extramedullary relapse of acute lymphoblastic leukemia (ALL) after allogeneic bone marrow transplantation (BMT) in the absence of marrow involvement is a rare event, and the mechanisms underlying the selective involvement of extramedullary sites remain undefined. These might be due to relapse in sanctuary sites where the leukemic cells are resistant to preparative regimen, or a stronger graft-versus-leukemia effect in the marrow as compared with peripheral tissues. We report an adult ALL patient who experienced isolated extramedullary relapse in the right pretibial soft tissue and knee joint 42 months after allogeneic BMT. He was treated with localized radiotherapy followed by systemic chemotherapy and donor lymphocyte infusion. After treatment, he is currently well with no evidence of leukemia recurrence for 12 months.