Research on the relationship between disease composite index and the prognosis of allogeneic hematopoietic stem cell transplantation / 白血病·淋巴瘤

Objective To assess the impact of a composite index which combines the prognosis of specific hematologic malignancies and the disease remission state pre-transplant on the efficacy of allogeneic hematopoietic stem cell transplantation.Methods A total of 148 patients who underwent allogeneic hematopoietic stem cell transplantation from Jan,2007 to Feb,2012 in the Blood and Marrow Transplantation Center of Ruijin Hospital were included in this retrospective analysis.According to the composite score,patients were classified into low-risk group (n =17),medium-risk group (n =100) and high-risk group (n =31).The overall survival (OS),event free survival (EFS),treatment related mortality (TRM) and relapse rate (RR) were analyzed.Results Significant difference had been found on OS (76.5 ％ vs 66.0 ％ vs 41.9 ％,P =0.002),EFS (70.6 ％ vs 57.0 ％ vs 32.3 ％,P =0.001) and RR (41.9 ％ vs 27.0 ％ vs 5.9 ％,P ＜ 0.001) among the three groups.However,there was no impact on treatment related mortality (23.5 ％,17.0 ％,29.0 ％,P =0.190).Multivariate analysis suggested that the composite index affecting the OS,EFS and RR of allogeneic hematopoietic stem cell transplantation (P =0.005,P =0.001,P ＜ 0.001),but not the TRM (P =0.666).To some extent,it was an independent prognosis index on RR.Conclusion The composite index is closely related to the efficacy of allogeneic hematopoietic stem cell transplantation.

Gender mismatch, use of anti-thymoglobulin, and occurrence of graft-versus-host disease in preparative regimen are associated with high incidence of post-engraftment hemorrhagic cystitis in allogeneic hematopoietic stem cell transplantation / 白血病·淋巴瘤

Objective To evaluate the risk factors of developing post-engraftment hemorrhagic cystitis (HC) in patients receiving allogeneic stem cell transplantation (allo-HSCT).Methods Retrospective data was collected from 92 patients with acute leukemia (acute myeloid leukemia 41 and acute lymphoblastic leukemia 51) who underwent allo-HSCT from 2000 to 2010,and the association of pre-transplantation parameters with the incidence of post-engraftment HC was analyzed.Results Forty-three patients had HLA-matched donors and 49 had unrelated donors.Of these patients,25 developed HC at a median of 35 days (day +20 to +65) after allo-HSCT.In the univariate analysis,unrelated donor,gender mismatch (female donor to male recipient),conditioning containing busulfan,graft-versus-host disease (GVHD),prophylaxis with cyclosporine (CSA) + methotrexate (MTX) + mycophenolate mofetil (MMF),use of anti-thymoglobulin (ATG) and development of GVHD were associated with increased incidence of HC.In the multivariate study,gender mismatch (P =0.001),use of ATG (P ＜ 0.001),and GVHD (P =0.007) remain as independent factors for the increased risk of HC.More importantly,with these 3 factors,it is able to classify patients into 4 groups with risk of postengraftment HC at (7.7±4.6) ％,(22.9±7.1) ％,(48.2±10.5) ％,and 100.0 ％,respectively.Conclusion This retrospective study identified the gender mismatch,use of ATG in the preparation regimen,and aGVHD as important risk factors to predict the development of post-engraftment HC.Based on these risk factors,it is possible to classify patients into different risk groups for post-engraftment HC.Prospective study with a large cohort of patients is warranted to confirm the findings.Future clinical trial for HC prevention and treatment must be carried out on the intermediate and high-risk patients.

Antithymocyte globulin for graft-versus-host disease prophylaxis in hematopoietic stem cell transplantation from unrelated donors: a retrospective report / 白血病·淋巴瘤

Objective To assess the impact of antithymocyte globulin (ATG) on the incidence of graft-vs-host disease (GVHD) in hematopoietic stem cell transplantation from unrelated donors.Methods A total of 92 patients with hematological malignancies including leukemia,myelodysplastic syndrome (MDS) and lymphoma who underwent hematopoietic stem cell transplantation from unrelated donors from January 1999 to December 2011 were included in this retrospective analysis.Patients were classified into ATG group (n =66)and non-ATG group (n =26) according to the GVHD prophylaxis regimen.The incidence of acute GVHD (aGVHD) and chronic GVHD (cGVHD),risk factors of aGVHD and cGVHD and impact of ATG on the overall survival (OS),treatment related mortality (TRM) and relapse rate were analyzed.Results Grade Ⅱ-Ⅳ aGVHD (26.7 ％ vs 44.0 ％,P=0.12) or grade Ⅲ-Ⅳ aGVHD (13.3 ％ vs 8.0 ％,P =0.74) were not significantly different between ATG and non-ATG group.However,the incidence of cGVHD in the ATG group was significantly lower (34.0 ％ vs 72.2 ％,P =0.005) than non-ATG group.The incidence of extensive cGVHD was also significantly reduced (10.0 ％ vs 44.4 ％,P =0.005) compared to non-ATG group.In multivariate analysis,the use of ATG prophylaxis significantly decreased the cGVHD (RR =0.22,95 ％CI 0.081-0.599,P =0.003) while one allele mismatch of human leukocyte antigen (HLA) was associated with increased risk of cGVHD (RR =3.25,95 ％ CI 1.39-7.61,P =0.007).As to the extensive cGVHD,the use of ATG was the only independent factor (RR =0.05,95 ％ CI 0.009-0.240,P ＜ 0.001).With a median follow-up of 12 months (1-84 months),ATG prophylaxis had no impact on OS rate (60.4 ％ vs 43.1％,P =0.41),TRM rate (19.8 ％ vs 34.3 ％,P =0.43) and relapse rate (40.6 ％ vs 33.6 ％,P=0.54).Conclusion In hematopoietic stem cell transplantation from unrelated donors,ATG prophylaxis total dose of 6 mg/kg may significantly decrease the incidence of cGVHD and extensive cGVHD without increase of TRMand relapse rate and impairment of OS.