Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history / 中华医学杂志(英文版)

BACKGROUND@#The impacts of previous cardio-cerebrovascular disease (pre-CCVD) on the outcomes of hematopoietic cell transplantation (HCT) are not well described. Patients with pre-CCVD may often be poor candidates for HCT. This study aimed to investigate the impact of pre-CCVD on transplant outcomes.@*METHODS@#A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status. The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared. The primary endpoints were post-transplant cardio-cerebrovascular disease (post-CCVD) and non-relapse mortality (NRM). We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios (HRs).@*RESULTS@#The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group. No significant differences were noted in terms of engraftment, overall survival (OS) (67.00% vs. 67.90%, P = 0.983), or relapse (29.78% vs. 28.26%, P = 0.561) between the pre-CCVD group and the control group. The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls (14.68% vs. 17.08%, P = 0.670). However, pre-CCVD was associated with an increased incidence of post-CCVD (HR: 12.50, 95% confidence interval [CI]: 3.88-40.30, P < 0.001), which was an independent risk factor for increased NRM (HR: 10.29, 95% CI: 3.84-27.62, P < 0.001) and inferior OS (HR: 10.29, 95% CI: 3.84-27.62, P < 0.001).@*CONCLUSIONS@#These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure, leading to a risk of post-CCVD. Post-CCVD was a powerful predictor for high NRM and inferior OS. Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.

Efficacy and Safety of Low-dose Amphotericin B in Different Antifungal Strategies for Treatment of Invasive Fungal Disease in Patients with Hematological Malignancies / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of low-dose amphotericin B (AmB) in different antifungal strategies for treatment of invasive fungal disease(IFD) in patients with hematologic malignancies. Metheds: The clinical dada of the patients were collected and analyzed retrospectively and the levels of creatinine (Cr), urea nitrogen (BUN) and potassium (K) before and after using low-dose AmB were compared and statistically analyzed.</p><p><b>RESULTS</b>Among 97 cases, 2 cases were diagnosed as invasive fungal disease (IFD), 11 cases were diagnosed as clinical probable IFD, 15 cases were diagnosed as possible IFD, 69 cases were undefined IFD. The response rate of all patients treated with low-dose AmB was 69.4%, the response rate for targed therapy was 72.7%, the response rate for diagnosis-driven therapy was 63.6%, the response rate of empirical therapy was 75%, the efficacy of the combination with other antibiotics was 50%, 66.7% and 75%. According to all the patients received AmB, only 7 cases was detected with higher level of Cr (7.2) than normal and this level come back to normal with in 7 days after drug withdrew. Although the Cr level in serum after 1 day of drug withdrew was higher than that before administration of drug(64.86±3.00 vs 58.76±1.67 µmol/L) and was with statistical difference(P<0.05), but did not show significant difference in comparison with the level after drug withdrew 7 days (58.43±1.68 µmol/L,P>0.05).</p><p><b>CONCLUSION</b>AmB injection is an effective and safe method in empirical therapy and diagnosis-driven antifungal therapy for neutropenic, febrile patients with hematological malignancies.</p>

Clinical Characteristics and Prognosis of 21 Cases of Acute Lymphoblastic Leukemia with Central Nervous System Leukemia / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics, therapeutic efficacy survival and prognosis of patients with adult acute lymphoblastic leukemia (ALL) accompanied by central nervous system leukemia (CNSL).</p><p><b>METHODS</b>The clinical and cerebrospinal fluid (CSF) features, diagnosis and treatment, therapeutic efficacy and survival rate of 21 cases of acute lymphoblastic leukemia (ALL) with central nervous system involvement (CNSL) were analyzed retrospectively.</p><p><b>RESULTS</b>Out of 21 cases, 10 cases were B cell acute lymphoblastic leukemia(B-ALL), 6 cases were T cells acute lymphoblastic(T-ALL), 4 cases were determined as no clear typing, 1 case was Burkitt lymphoma/leukemia, 7 patients had CNSL at the time of diagnosis, and 14 patients were showed CNS relapse. Clinical manifestations included headache, facial paralysis, limb weakness and blurred vision, etc. Their median follow-up time was 19(6-40) months,from them 10 cases died, 7 cases survived, 4 cases were lost to follow up. Patients had CNSL at the time of diagnosis, their peripheral blood LDH≥600 U/L or not achieving complete remission (CR) after 1 course of treatment with poor prognosis, and the difference is significant (P< 0.05). Radiotherapy and allogeneic stem cell transplantation (allo-HSCT) could improve the patient's survival. Multivariate analysis showed that the LDH and allo-HSCT was significantly correlated with survival time (P=0.048, P=0.013).</p><p><b>CONCLUSION</b>There are no specific clinical manifestations, CSF features and imaging manifestations of ALL accompanied by CNSL, and the diagnosis of CSF is needed to find the leukemia cells in CSF. The factors for poor prognosis include LDH≥600 U/L, no CR of patients after 1 course of treatment, existence of CNSL at the diagnosis. ALL patients with CNSL have a poor prognosis. Intrathecal injection combined with systemic chemotherapy, radiation therapy and allo-HSCT after CR is the feasible and effective treatment regimen.</p>

A New Goal for Tyrosine Kinase Inhibitor Therapy in Chronic Myeloid Leukemia: Treatment-free Remission -Review / 中国实验血液学杂志

Tyrosine kinase inhibitor (TKI) therapy significantly improved the prognosis and outcome of patients with chronic myeloid leukemia(CML). Long-term therapy of TKI drugs was often accompanied with financial burden and the rise of chronic adverse effects. At present, the treatment-free remission (TFR) has been gradually regarded as the new ultimate aim to the patients with long-term CML. In clinical trials, the patients with the therapy of imatinib stopping TKI treatment after acquired deep molecular reaction still maintained remission. Here, the research progress on discontinuation of TKI therapy and how to better grasp the safety of drug withdrawal strategy are reviewed. However, the radical cure of CML needs more further research.

Imatinib Combined with VP Low Dose Regiment for Treating Newly Diagnosed Adult Patients with Ph-positive ALL / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the inductive therapeutic effects of imatinib combined with VP low dose regiment on adult patients with Ph-positive acute lymphoblastic leukemia (Ph(+) ALL).</p><p><b>METHODS</b>Fourteen newly diagnosed adult patients with Ph(+) ALL were treated with VP regimen, and imatinib (400 mg/d) was added at the 8(th) day. VP regimen would be stopped when neutropenia lasted for 1 week or complicated with infection, fever, etc. Therapeutic effects were assessed by bone marrow morphology and quantitative analysis of BCR/ABL:ABL at the 28(th) - 33(rd) day. Patients could be treated with imatinib combined with chemotherapy for consolidation and maintenance therapy or were treated with allogeneic hematopoietic stem cell transplantation after complete remission.</p><p><b>RESULTS</b>Fourteen cases obtained CR1 after first course of treatment, the median decline of BCR/ABA:ABL was 55.89 (10.25 -180.97) %; during the induction chemotherapy, pulmonary infection occurred in 3 patients, diarrhea in 1 patients, facial edema in 3 patients, however, all these patients were cured after symptomatic treatment, only 1 patient died of relapse after transplantation.</p><p><b>CONCLUSION</b>In the period of tyrosine kinase inhibitor (TKI), inductive chemotherapy combined with imatinib and low dose VP can obtaine satisfactory CR rate and decrease the toxicity of the traditional drugs. It is suggested that TKI combined with VP regimen chemotherapy can achieve CR1 and make possible for allo-HSCT, from which patients can achieve the long-term survival.</p>

Clinical study of haploidentical peripheral blood stem cell transplantation without ex vivo T-cell depletion for high-risk hematological malignancies / 中国实验血液学杂志

This study was aimed to explore the efficacy and associated complications of haploidentical peripheral blood stem cell transplantation (hi-PBSCT) without ex vivo T-cell depletion in treatment of hematological malignancies. 15 high-risk patients received HLA 1-3 loci (A, B, or DRB1) mismatched hi-PBSCT. The modified Bu/Cy or TBI/Cy regimen was used for preconditioning of patients. The anti-thymocyte globulin, cyclosporin A, methotrexate and mycophenolate mofetil were used for GVHD prophylaxis. 4 cases were administrated with anti-CD25 monoclonal antibody. G-CSF-mobilized peripheral blood stem cells were infused, with the median number of infused nucleated cells was 8.16 (3.92-10.86)x10(8)/kg and that of CD34+ cells was 4.51 (1.27-5.95)x10(6)/kg. The results showed that the rapid engraftment was observed in all cases. The median times of neutrophil recovery>or=0.5x10(9)/L and platelet recovery>or=20x10(9)/L were 14 (11-19) and 22 (11-52) days after transplantation respectively. 6 cases developed acute GVHD of grade I-II, and 2 cases experienced chronic extensive GVHD. Infection within 100 days after hi-PBSCT was documented in all cases. 8 cases were subjected to bacterial infection, and six got cytomegalovirus infection. Relapse occurred in five cases. Overall survival of patients was 46.7% (7/15), with a median follow-up of 213 (42-589) days. In conclusion, hi-PBSCT provides an effective alternative treatment for high-risk patients in lack of matched donors, and to reduce the high transplantation-related mortality.

An effective method for T-cell and B-cell simultaneous depletion in vitro from mobilized peripheral blood stem/progenitor cell graft for haploidentical transplantation / 中国实验血液学杂志

Depletion of T and B cells from the graft is prerequisite for haploidentical transplantation to decrease the risk of GVHD and EBV-associated lymphoproliferative disease. This study was aimed to investigate the performance of T-cell and B-cell simultaneous depletion from mobilized peripheral blood stem cells (PBSCs) for the first time in China, using anti-CD3 and anti-CD19 antibodies conjugated to magnetic microbeads by the CliniMACS device. The depletion efficiency of T-cell and B-cells was analyzed by flow cytometry; the function of the stem cells after depletion was evaluated using colony assays. The results indicated that the mononuclear cell count prior to T- and B-cell depletion was 4.88 x 10(10). After depletion, the percentage of T cells was 0.02% with a log (10) depletion of 4.4. The percentage of B cells was less than 0.01% with a log (10) depletion of at least 3.3. The product contained not only CD34(+) stem cells, but also NK cells, monocytes and granulocytes. After T- and B-cell depletion the purity of CD34(+) cells was 0.98%, the number of CD34 cells was 1.84 x 10(8) and their recovery rate was 69.7%. The number of NK cells was 2.54 x 10(9) and the recovery rate of NK cells was 71.7%. In vitro colony assays showed no negative impact on function of the hematopoietic stem cells. In conclusion, the CliniMACS system can be used to efficiently deplete T and B cells from PBSCs simultaneously, without adverse effect on biological function of hematopoietic stem cells. This study provides technical platform for haploidentical hematopoietic stem cell transplantation.

Clinical characteristics and prognostic factors in 73 patients with peripheral T cell lymphoma / 中南大学学报(医学版)

OBJECTIVE@#To investigate the clinical features,therapy and prognosis of patients with peripheral T cell lymphoma(PTCL), and to find out the prognostic factors of the disease.@*METHODS@#The clinical data of 73 patients with PTCL were reviewed.The median pre-treatment disease course was 3 months.Fifty-five patients were males, and 18 were females, with the median age of 42 years.Five patients received the combined chemo-radio therapy, 65 received chemotherapy alone, and the other 3 patients were treated with auto hematopoietic stem cell transplantation (HSCT).@*RESULTS@#Of all the patients, the overall 3 -year and 5-year survival rates were 38% (28 /73) and 22% ( 16 /73) respectively.The survival rates decreased with the progression of the Ann Arbor stages.The survival rate of the patients with B symptom (fever, night sweat, and weight loss) or the international prognostic factors index ( IPI)>2 was lower than those of the patients without B symptom or IPI<2.The patients with the increased CA125 or D-dimer lever had the worst curative effect.@*CONCLUSION@#Peripheral T cell lymphoma is highly aggressive with poor prognosis.The clinical features,Ann Arbor staging, IPI and B symptom are important prognostic factors.CA125 and D-dimer may be also important prognostic factors.