Résumé
Objective To analyze the side effects of in-vitro amplification human leukocyte antigen (HLA)-haploidentical donor immune cell infusion(HDICI) in childhood malignant patients,and to provide the basis for how to nurse these patients.Methods From September 2011 to September 2012,twelve hospitalized childhood malignant patients were recruited in Cancer Center of Sun Yat-sen University,and they received a total of 92 times of HDICIs for immunotherapy.Side effects were carefully observed both during and 2 hours and 24 hours after each infusion,and we also provided psychological nursing,pre-infusion nursing,side effect analysis and corresponding care during infusion,post-infusion education and follow-up for every childhood patient.Results Among 92 times of HDICIs,fever occurred in 20 cases,of whom 6 cases were with chills,1 case with febrile convulsion,all achieved remission after receiving symptomatic treatment.5 cases were also recorded with a slight change of mood.Vital signs were all stable both during and after every HDICIs; and no nausea,vomiting,abdominal pain,diarrhea,rash,swelling or allergic reaction was observed.Neither change of the hemogram nor biochemical indexes was recorded before or after every course of HDICI.Conclusions Our study showed that HDICIs for immunotherapy in childhood malignant patients were safe,and during the whole infusions,much attention should be paid both for psychological nursing,pre-infusion anti-anaphylactic treatment,temperature monitoring,discovery of the precursor of febrile convulsion promptly,symptomatic treatment against corresponding side effects,and post-infusion education and follow-up,all those above are of great importance for childhood malignant patients who received HDICIs for immunotherapy successfully.
Résumé
The outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been improved over past 50 years due to the advances in HLA matching and increasing sources of HSC donors,such as developments and progressions of HLA-matched sibling donor transplantation (MSDT),umbilical cord transplantation (UCBT/CBT),unrelative donor transplantation (URDT),and HLA haploidentical transplantation (haplo-SCT).To review and discuss progressions in field of allo-HSCT,we studied relative advances reports of Education Program Book,54th-ASH,2012.Howeover,the outcomes of allo-HSCT can be quite different according to different diseases,disease phase or patient age.Furthermore,according to our local experiences,we emphasize again significance of HSCT donor safety.
Résumé
Objective: To evaluate the anti-tumor and side effects of activated-HLA haploidentical peripheral blood tem cells (haplo PBSCs) in the treatment of advanced refractory solid tumor patients. Methods: Forty-two patients with advanced refractory tumor, who were diagnosed in our hospital from Oct. 2004 to Oct. 2007, were enrolled in this study (all patients signed informed consent), including 12 with ovarian cancer, 9 with renal cancer, 8 with lung cancer, 8 with breast cancer, 2 with colon cancer, 2 with gastric cancer, and 1 with melanoma. The donors were healthy direct relatives of the patients; the donors' haplo-PBSCs were mobilized, collected, and activated by rhIL-2 in vitro. The clinical efficacy and side effects of haplo-PBSCs therapy were assessed by CT/PET-CT scanning, RESIST standard, KPS score, and clinical response rates, etc. Results: All 42 patients received one episode of haplo-PBSCs treatment. The progression-free survivals (PFS) were 6 months and the clinical beneficial rate (CR+PR+SD) was 73.8%. The beneficial rate of life quality was 76.2% and the KPS increased by 20 (0-30) points on average after haplo-PBSCs treatment. The patients with KIR unmatched in GVH direction had better outcomes than those with KIR matched or KIR unmatched in HVG direction (P<0.05), and the clinical beneficial rate, PFS and total beneficial rate were 94.1% vs 60.0%, (13.4±1.3) vs (8.0±0.9) months, and 89.5% vs 65.2%, respectively (all P<0.05). The donor/recipient relation as the mother/child had a better outcome than that as the father/child (P<0.05). Patients with renal cancer or ovarian cancer had better outcomes than those with other cancers, with clinical beneficial rates being 90.0% and 81.8%, respectively. Conclusion: Activated haplo-PBSCs therapy can induce non-specific anti-tumor effect, and improve the clinical symptom and life quality of advanced tumor patients.
Résumé
Objective To study the effect of feto-matemal microchimerism in the treatment of activated human leukocyte antigen (HLA) haploidentical mobilized peripheral blood cells against solid tumors. Methods Genomic DNA samples of 25 pairs of HLA haploidentical donors and recipients were extracted. The donor-derived HLA-DRB loci were detected with nested PCR-sequence specific primer(SSP) typing. The mixed lymphocyte proliferation action between the patients and respective donors, the engraftment of donor's cells and the serum levels of Th1/Th2 type of cytokines were measured with MTT,FISH and EIJSA method respectively. The survival time of patients with or without feto-matemal microchimerism were compared as well. Results Using nested PCR-SSP typing, the positive rates of feto-maternal microchimerism in the 25 pairs of HLA haploidentical donors and recipients were 40% in the maternal/children pairs and 0 in the paternal/children pairs. The chimerism positive patients showed less proliferation activity when cocultured with respective donors as compared with unrelated ones (P=0.03).Only one chimerism positive patient experienced the engraft of donor's cell 3 months after treatment as the donor derived XX chromosome was identified with FISH. When the data of chimerism positive patients were deleted, the serum levels of IFNγ 1 month after treatment dropped dramatically from 171.4 (26. 3～258.4) ng/L to 29. 4(1.2～39.9)ng/L. The survival time in chimerism positive patients of the maternal/children pairs was significantly longer than that in chimerism negative patients, which was (31.2±4. 3) months and (11.1±3.3) months, respectively (P=0.036). Conclusion Feto-maternal microchimerism might induce anergy in the HLA haploidentical donors, favor the engraftment of donor's progenitors and maintenance of positive microenvironment and prolong the survival time.
Résumé
Six patients with severe aplastic anemia treated with horse anti-human thymocyte globulin (ATG) and androgen. Four of these patients were only given ATG (ATGAMR), 16 mg/Kg/dose x 10 doses. The remaining two cases received an infusion of maternal HLA-haploidentical marrow cells following ATG therapy. One patient had a complete response, three had a partial response, one showed minimal improvement and two were non-responders. The two patients who received the additional haploidentical marrow cells showed a hematologic recovery sooner than the ATG alone cases. The toxicity of the ATG therapy was tolerable. Long term follow up of there patients and further studies of this treatment in aplastic anemia with pediatric age group are under way.