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Objective:To investigate the effect of autologous hematopoietic stem cell transplantation (auto-HSCT) bridging to chimeric antigen receptor T cell (CAR-T) immunotherapy for follicular lymphoma (FL) transformed to B-lymphoblastic leukemia/lymphoma (B-LBL).Methods:The diagnosis and treatment of 1 patient with FL transformed to B-LBL admitted to the First Hospital of Soochow University in August 2020 were retrospectively analyzed and the literature was reviewed.Results:The male patient was 65 years old, and was diagnosed as FL (stage Ⅳ group A, FL international prognostic index -1 score 3 points, high-risk group) in August 2020. And then he was given 6 courses of RB (rituximab combined with bendamustine) regimen, with complete remission (CR) at mid-term and end-stage PET-CT, followed by regular maintenance therapy with rituximab every 2 months, and disease progressed after 4 courses of maintenance therapy. According to the results of histopathology and bone marrow aspiration in December 2021, he was diagnosed B-LBL involving the bone marrow. Partial remission was achieved after induction therapy with zanubnulindb combined with hyper CVAD (cyclophosphamide + doxorubicin + vindesine + dexamethasone) regimen, followed by auto-HSCT bridging to CAR-T treatment targeting CD19 and CD22, which proceeded smoothly with cytokine release syndrome grade 0, immune effector cell-associated neurotoxicity syndrome grade 0. The patient successfully underwent hematopoietic reconstruction and orally taken ibrutinib after discharge. PET-CT indicated CR 2 months after transplantation and he was still in disease-free survival state.Conclusions:The prognosis of FL transformed to B-LBL is poor, and auto-HSCT bridging to CAR-T can improve the prognosis and prolong the survival time of patients who cannot undergo allogeneic hematopoietic stem cell transplantation.
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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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Allogeneic hematopoietic stem cell transplantation ( allo-HSCT) is an effective therapy for the treatment of various malignant and non-malignant hematological diseases. Acute graft-verse-host-dis-ease ( aGVHD) , a major complication following allo-HSCT, is one of the predominant causes of GVHD-re-lated mortality. The development of aGVHD is a typical pathologic process with the release of inflammatory cytokines in great quantities, resulting in the occurrence ofcytokine storm and causing specific pathologi-cal damages by attacking the recipient organ. Therefore, identification of biomarkers specific for aGVHD of-fers promise to the treatment of aGVHD. In this review, we summarizes the functions of several typical in-flammatory cytokines, including IL-1β, IL-6, IL-17A and IL-10, and their mechanisms in the development of aGVHD in order to provide references for the prevention and treatment of aGVHD.
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Objective To investigate the clinical effect and safety of integrative medicine in treatment of gastrointestinal manifestations of Henoch-Schonlein purpura (HSP) in children.Methods 90 children with gastrointestinal manifestations of HSP were randomly divided into two groups,45 cases in each group.Control group was given hydrocortisone and prednisone,the treatment group was given self decoction of Chinese medicine on the basis of the control group.Clinical efficacy was observed after two courses.Results Total effective rate of the treatment group was 95.56％,which was higher than that of the control group(77.78％) (P ＜0.05).The disappearance time of HSP of the treatment group [(12.32 ± 3.59) d] was significantly shorter than that of the control group [(18.56 ± 4.18) d](P ＜ 0.05),and the incidence rate of adverse reactions has a significant reduction (4.44％ vs 11.11％,P ＜ 0.05).Conclusion Adjuvant treatment with Chinese medicine on the basis of western medicine in treatment of gastrointestinal manifestations of HSP in children,can significantly improve the clinical efficacy.
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Objective To study the chemical constituents of the medicinal fungus Shiraia bambusicola.Methods Chromatography on silica column and preparative HPLC were used to purify the compounds;Spectroscopic methods including 1H-NMR,13CNMR,and MS were used to elucidate their structures.Results Nine compounds were isolated and identified as 3,6,8-trihydroxy-l-methylxanthone(1),3,8-dihydroxy-6-methoxy-1-methylxanthone(2),2,3,6,8-tetrahydroxy-l-methylxanthone(3),3,4,6,8-tetrahydroxy-l-methylxanthone(4),pregn5(10)-en-3?,17?,20?-triol(5),macrosphelide A(6),(+)-griseofulvin(7),griseophenone A(8),and 11,11′-dideoxyverticillin A(9).Conclusion Compounds 1-9 are obtained from the fungus S.bambusicola for the first time.