Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-419X.2019.06.009
Yueyang Li, Su Liu
Lymphoma is a malignant tumor with high heterogeneity. Chemoradiotherapy alone is not sufficiently effective for highly invasive lymphomas. Autologous hematopoietic stem cell transplantation(auto-HSCT) plays an important role in the first-line treatment of patients with invasive lymphomas, which can improve the the efficacy of such patients.The common conditioning regimens are high-dose chemotherapy with or without total body irradiation(TBI) in lymphoma patient before auto-HSCT. The clinical usage of these conditioning regimens were limited due to the complications and poor patient tolerance.Therefore, various improved conditioning regimens emerged based on above regimens and the participation of targeted drugs are hot topics in current research.This article summarize the efficacy, toxicity and research advances of conditioning regimens for auto-HSCT in lymphoma. Key words: Lymphoma; Transplantation conditioning; Transplantation, autologous; Hematopoietic stem cell transplantation; Molecular targeted therapy
{"title":"Reasearch progress of conditioning regimens for autologous hematopoietic stem cell transplantation in patients with lymphoma","authors":"Yueyang Li, Su Liu","doi":"10.3760/CMA.J.ISSN.1673-419X.2019.06.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-419X.2019.06.009","url":null,"abstract":"Lymphoma is a malignant tumor with high heterogeneity. Chemoradiotherapy alone is not sufficiently effective for highly invasive lymphomas. Autologous hematopoietic stem cell transplantation(auto-HSCT) plays an important role in the first-line treatment of patients with invasive lymphomas, which can improve the the efficacy of such patients.The common conditioning regimens are high-dose chemotherapy with or without total body irradiation(TBI) in lymphoma patient before auto-HSCT. The clinical usage of these conditioning regimens were limited due to the complications and poor patient tolerance.Therefore, various improved conditioning regimens emerged based on above regimens and the participation of targeted drugs are hot topics in current research.This article summarize the efficacy, toxicity and research advances of conditioning regimens for auto-HSCT in lymphoma. \u0000 \u0000 \u0000Key words: \u0000Lymphoma; Transplantation conditioning; Transplantation, autologous; Hematopoietic stem cell transplantation; Molecular targeted therapy","PeriodicalId":13774,"journal":{"name":"International Journal of Blood Transfusion and Hematology","volume":"42 1","pages":"514-518"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46601582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-419X.2019.06.010
Congxiao Zhang
T cell exhaustion is a state of T cell dysfunction arises during various chronic viral, bacterial, parasitic infections and neoplastic disease, characterized by the stepwise loss of T cell function or even absence of the cell. Chimeric antigen receptor T cell (CAR-T) immunotherapy achieves the effect of treating tumors by collecting functionally active T cells from patients and conferring their ability to recognize tumor antigen in a human leukocyte antigen (HLA)-independent manner, and it has been widely used in treating leukemia, lymphoma and several solid tumors. To some degrees, the success of CAR-T immunotherapy was determined by the quality of T cells. Therefore, T cell exhaustion is one of huge obstacles of CAR-T immunotherapy. To explore the impact of T cell exhaustion on leukemia treatment, and provide new ideas for the immunotherapy of leukemia, the authors discussed the characteristics of T cell exhaustion in leukemia and the progresses of CAR-T immunotherapy. Key words: T-lymphocytes; Leukemia; Immunotherapy, adoptive; Receptors, chimeric antigen; T cell exhaustion
{"title":"T cell exhaustion and chimeric antigen receptor T cell immunotherapy in leukemia","authors":"Congxiao Zhang","doi":"10.3760/CMA.J.ISSN.1673-419X.2019.06.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-419X.2019.06.010","url":null,"abstract":"T cell exhaustion is a state of T cell dysfunction arises during various chronic viral, bacterial, parasitic infections and neoplastic disease, characterized by the stepwise loss of T cell function or even absence of the cell. Chimeric antigen receptor T cell (CAR-T) immunotherapy achieves the effect of treating tumors by collecting functionally active T cells from patients and conferring their ability to recognize tumor antigen in a human leukocyte antigen (HLA)-independent manner, and it has been widely used in treating leukemia, lymphoma and several solid tumors. To some degrees, the success of CAR-T immunotherapy was determined by the quality of T cells. Therefore, T cell exhaustion is one of huge obstacles of CAR-T immunotherapy. To explore the impact of T cell exhaustion on leukemia treatment, and provide new ideas for the immunotherapy of leukemia, the authors discussed the characteristics of T cell exhaustion in leukemia and the progresses of CAR-T immunotherapy. \u0000 \u0000 \u0000Key words: \u0000T-lymphocytes; Leukemia; Immunotherapy, adoptive; Receptors, chimeric antigen; T cell exhaustion","PeriodicalId":13774,"journal":{"name":"International Journal of Blood Transfusion and Hematology","volume":"42 1","pages":"519-523"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49358794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-419X.2019.06.005
Li-Yan Sun, Yunping Xu, W. Hong
Objective To analyze relationship between positive genotype of human leukocyte antigen(HLA)-E*01∶03 and acute leukemia (AL). Methods From January 2013 to December 2015, a total of 136 patients with AL who underwent blood group matching at Shenzhen Blood Center were included in this study as AL group. Among them, there were 78 male patients and 58 females; the age was (39±23) years. A simple random sampling method was used to select 182 health blood donors who participated in voluntary blood donation at the Shenzhen Blood Center in the same period. Among them, there were 101 male donors and 71 females; and age was (38±19) years. The sequence of exon 3 of HLA-E gene was determined by PCR-sequence based typing (SBT) method, and the genotype of HLA-E gene was determined. The peripheral blood lymphocytes from 54 patients in AL group and 64 healthy blood donors in control group were separated by density gradient centrifugation. The relative expressions of HLA-E on lymphocytes were detected by flow cytometry. The expression levels of plasma soluble HLA (sHLA)-E from 54 patients in AL group and 64 healthy blood donors in control group were detected by enzyme-linked immunosorbent assay (ELISA). The genotype frequencies of subjects in the two groups were compared by Chi-square test. The relative expression levels of HLA-E on peripheral blood lymphocytes and the expression level of sHLA-E in plasma were compared by independent samples t test, respectively. This study was in line with the procedures followed in this study were in accordance with the standards established by the Medical Ethics Committee of the Shenzhen Blood Center, and this study was approved by the committee (Approval No. SZBC-2017-007). All the subjects signed the informed consents for clinical trials and informed contents were obtained from all subjects. Results ① The genotype frequency of HLA-E*01∶03 positive genotype was 90.4% (123/136) of patients in AL group, which was higher than that of 77.5% (141/182) in control group, and the difference was statistically significant (χ2=9.286, P=0.002). ② Among the 54 patients in AL group and the 64 healthy blood donors in control group, the difference of relative expression levels of HLA-E on peripheral blood lymphocytes from subjects with HLA-E*01∶03 positive genotype between the two groups were not statistically significant [(3.3±0.4) vs (3.6±0.2); t=0.77, P=0.440]. The relative expression level of HLA-E on peripheral blood lymphocytes from patients with HLA-E*01∶03 negative genotype in AL group was (1.6±0.2), which was lower than that of (2.5 ± 0.2) in control group, and the difference was statistically significant (t=2.95, P=0.010). ③ Among 54 patients in AL group and 64 healthy blood donors in control group, the expression level of sHLA-E in plasma from patients with HLA-E*01∶03 positive genotype in AL group was (31.2±0.4 ) pg/mL, which was higher than that of (18.2±0.3) pg/mL in control group, and the difference was statistical
{"title":"Correlation between HLA-E*01∶03 positive genotype and acute leukemia","authors":"Li-Yan Sun, Yunping Xu, W. Hong","doi":"10.3760/CMA.J.ISSN.1673-419X.2019.06.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-419X.2019.06.005","url":null,"abstract":"Objective \u0000To analyze relationship between positive genotype of human leukocyte antigen(HLA)-E*01∶03 and acute leukemia (AL). \u0000 \u0000 \u0000Methods \u0000From January 2013 to December 2015, a total of 136 patients with AL who underwent blood group matching at Shenzhen Blood Center were included in this study as AL group. Among them, there were 78 male patients and 58 females; the age was (39±23) years. A simple random sampling method was used to select 182 health blood donors who participated in voluntary blood donation at the Shenzhen Blood Center in the same period. Among them, there were 101 male donors and 71 females; and age was (38±19) years. The sequence of exon 3 of HLA-E gene was determined by PCR-sequence based typing (SBT) method, and the genotype of HLA-E gene was determined. The peripheral blood lymphocytes from 54 patients in AL group and 64 healthy blood donors in control group were separated by density gradient centrifugation. The relative expressions of HLA-E on lymphocytes were detected by flow cytometry. The expression levels of plasma soluble HLA (sHLA)-E from 54 patients in AL group and 64 healthy blood donors in control group were detected by enzyme-linked immunosorbent assay (ELISA). The genotype frequencies of subjects in the two groups were compared by Chi-square test. The relative expression levels of HLA-E on peripheral blood lymphocytes and the expression level of sHLA-E in plasma were compared by independent samples t test, respectively. This study was in line with the procedures followed in this study were in accordance with the standards established by the Medical Ethics Committee of the Shenzhen Blood Center, and this study was approved by the committee (Approval No. SZBC-2017-007). All the subjects signed the informed consents for clinical trials and informed contents were obtained from all subjects. \u0000 \u0000 \u0000Results \u0000① The genotype frequency of HLA-E*01∶03 positive genotype was 90.4% (123/136) of patients in AL group, which was higher than that of 77.5% (141/182) in control group, and the difference was statistically significant (χ2=9.286, P=0.002). ② Among the 54 patients in AL group and the 64 healthy blood donors in control group, the difference of relative expression levels of HLA-E on peripheral blood lymphocytes from subjects with HLA-E*01∶03 positive genotype between the two groups were not statistically significant [(3.3±0.4) vs (3.6±0.2); t=0.77, P=0.440]. The relative expression level of HLA-E on peripheral blood lymphocytes from patients with HLA-E*01∶03 negative genotype in AL group was (1.6±0.2), which was lower than that of (2.5 ± 0.2) in control group, and the difference was statistically significant (t=2.95, P=0.010). ③ Among 54 patients in AL group and 64 healthy blood donors in control group, the expression level of sHLA-E in plasma from patients with HLA-E*01∶03 positive genotype in AL group was (31.2±0.4 ) pg/mL, which was higher than that of (18.2±0.3) pg/mL in control group, and the difference was statistical","PeriodicalId":13774,"journal":{"name":"International Journal of Blood Transfusion and Hematology","volume":"42 1","pages":"488-493"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45620557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-419X.2019.06.013
Yu Hu, Bo Zheng
Acute hyperleukocytic leukemia (AHL) refers to acute leukemia patients whose peripheral white blood cell count(WBC) is more than 100×109/L. It is called hyperleukocytosis (HL), when peripheral WBC is more than 100×109/L. It is common in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). AHL has a rapid onset, rapid progress, high early mortality and poor prognosis, which is a critical disease in hematology department. Because of its complications such as leukostasis, tumor lysis syndrome (TLS), disseminated intravascular coagulation (DIC), patients′ lives are threatened and need urgent intervention. Therefore, how to reduce the early mortality of patients with AHL is an important research topic. This article reviews the epidemiology, pathophysiology and clinical manifestations of AHL, especially the current treatment options. Key words: Leukocytosis; Leukemia; Tumor lysis syndrome; Acute hyperleukocytic leukemia; Lyperleukocytosis; Early mortality; Epidemiologic studies; Leukostasis
{"title":"Research progress of hyperleukocytic acute leukemia","authors":"Yu Hu, Bo Zheng","doi":"10.3760/CMA.J.ISSN.1673-419X.2019.06.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-419X.2019.06.013","url":null,"abstract":"Acute hyperleukocytic leukemia (AHL) refers to acute leukemia patients whose peripheral white blood cell count(WBC) is more than 100×109/L. It is called hyperleukocytosis (HL), when peripheral WBC is more than 100×109/L. It is common in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). AHL has a rapid onset, rapid progress, high early mortality and poor prognosis, which is a critical disease in hematology department. Because of its complications such as leukostasis, tumor lysis syndrome (TLS), disseminated intravascular coagulation (DIC), patients′ lives are threatened and need urgent intervention. Therefore, how to reduce the early mortality of patients with AHL is an important research topic. This article reviews the epidemiology, pathophysiology and clinical manifestations of AHL, especially the current treatment options. \u0000 \u0000 \u0000Key words: \u0000Leukocytosis; Leukemia; Tumor lysis syndrome; Acute hyperleukocytic leukemia; Lyperleukocytosis; Early mortality; Epidemiologic studies; Leukostasis","PeriodicalId":13774,"journal":{"name":"International Journal of Blood Transfusion and Hematology","volume":"35 7","pages":"535-542"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41248376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To analyze the clinical efficacy of decitabine combined with ruxolitinib regimen in the treatment of patients with newly diagnosed chronic myelomonocytic leukemia (CMML), and explore the effects of gene mutations on the prediction of efficacy and prognosis. Methods From March 2016 to August 2018, five cases of newly diagnosed patients with CMML admitted to the Department of Hematology, Ruijin Hospital North Affiliated to Shanghai JiaoTong University School of Medicine were selected as study subjects. Among them, there were 3 male patients and 2 female patients, with a median age of 60 years. In this study, the treatment regimens were deccitabine combined with rucotinib: deccitabine 20 mg/(m2·d), d1~3; rucotinib 5~10 mg/d, d1~28, 4 weeks as a course of treatment. At the end of each treatment course, the efficacy was evaluated based on the bone marrow cell morphology of the patients. Adverse reactions related to treatment were observed. The variant allele frequency (VAF) of 22 types of acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) related genes was detected before and after treatment. The follow-up period was up to May 1, 2019, with an interval of 1 month. The clinical features and efficacy of 5 patients with CMML were retrospectively analyzed, as well as the changes of related VAF of genes before and after treatment. The procedure of this study is accordance with the requirement of the revised World Medical Association Declaration of Helsinki in 2013. Consent form was obtained from all subjects. Results ① Among the 5 patients received the combination of descitabine and rucotinib regimen, 3 patients obtained overall response, among which patient 2 received complete remission (CR), patient 3 received hematologic improvement (HI), and patient 5 received bone marrow complete remission (mCR). Patient 4 had no effect. Patient 1 had disease progression (PD). All patients′ spleen size decreased (extent of reduction>50%). ② All the 5 patients showed myelosuppression after chemotherapy, among which patient 3 had the most severe myelosuppression and the longest period of myelosuppression, up to 2 months. Chest CT results of patient 1, 3 and 4 showed pulmonary infections, which was improved after active anti-infection treatment. Patient 1 and 4 had diarrhea. Patient 3 presented mild liver function impairment. Patient 5 presented constipation. And all symptoms improved after symptomatic and supportive treatment. ③ The results of VAF of mutations of patients before and 6 months after treatment showed, JAK2 V617F VAF (17% to 0), SRSF2 P95H VAF (44% to 39%) were decreased, and CBL H398P VAF (15% to 60%), TET2 Q273fs VAF (87% to 95%) were increased in the bone marrow specimens of patient 1. In patient 2, SRSF2 P95L VAF (69% to 49%) and CBL R420Q VAF (45% to 1%) were decreased, ASXL1 G710fs VAF (47% to 49%) was almost unchanged, and TET2 L1721W VAF (32% to 50%) was increased. In patient 4, SRSF2 P95L VAF (29% to 7%), TET2 Q705X
{"title":"Clinical analysis of decitabine combined with ruxolitinib regimen in treatment of newly diagnosed chronic myelomonocytic leukemia","authors":"Jiaming Li, Yu-bao Chen, Sujiang Zhang, Zeying Yan, Ying Wang, Zhiyin Liu, Haimin Sun","doi":"10.3760/CMA.J.ISSN.1673-419X.2019.06.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-419X.2019.06.004","url":null,"abstract":"Objective \u0000To analyze the clinical efficacy of decitabine combined with ruxolitinib regimen in the treatment of patients with newly diagnosed chronic myelomonocytic leukemia (CMML), and explore the effects of gene mutations on the prediction of efficacy and prognosis. \u0000 \u0000 \u0000Methods \u0000From March 2016 to August 2018, five cases of newly diagnosed patients with CMML admitted to the Department of Hematology, Ruijin Hospital North Affiliated to Shanghai JiaoTong University School of Medicine were selected as study subjects. Among them, there were 3 male patients and 2 female patients, with a median age of 60 years. In this study, the treatment regimens were deccitabine combined with rucotinib: deccitabine 20 mg/(m2·d), d1~3; rucotinib 5~10 mg/d, d1~28, 4 weeks as a course of treatment. At the end of each treatment course, the efficacy was evaluated based on the bone marrow cell morphology of the patients. Adverse reactions related to treatment were observed. The variant allele frequency (VAF) of 22 types of acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) related genes was detected before and after treatment. The follow-up period was up to May 1, 2019, with an interval of 1 month. The clinical features and efficacy of 5 patients with CMML were retrospectively analyzed, as well as the changes of related VAF of genes before and after treatment. The procedure of this study is accordance with the requirement of the revised World Medical Association Declaration of Helsinki in 2013. Consent form was obtained from all subjects. \u0000 \u0000 \u0000Results \u0000① Among the 5 patients received the combination of descitabine and rucotinib regimen, 3 patients obtained overall response, among which patient 2 received complete remission (CR), patient 3 received hematologic improvement (HI), and patient 5 received bone marrow complete remission (mCR). Patient 4 had no effect. Patient 1 had disease progression (PD). All patients′ spleen size decreased (extent of reduction>50%). ② All the 5 patients showed myelosuppression after chemotherapy, among which patient 3 had the most severe myelosuppression and the longest period of myelosuppression, up to 2 months. Chest CT results of patient 1, 3 and 4 showed pulmonary infections, which was improved after active anti-infection treatment. Patient 1 and 4 had diarrhea. Patient 3 presented mild liver function impairment. Patient 5 presented constipation. And all symptoms improved after symptomatic and supportive treatment. ③ The results of VAF of mutations of patients before and 6 months after treatment showed, JAK2 V617F VAF (17% to 0), SRSF2 P95H VAF (44% to 39%) were decreased, and CBL H398P VAF (15% to 60%), TET2 Q273fs VAF (87% to 95%) were increased in the bone marrow specimens of patient 1. In patient 2, SRSF2 P95L VAF (69% to 49%) and CBL R420Q VAF (45% to 1%) were decreased, ASXL1 G710fs VAF (47% to 49%) was almost unchanged, and TET2 L1721W VAF (32% to 50%) was increased. In patient 4, SRSF2 P95L VAF (29% to 7%), TET2 Q705X ","PeriodicalId":13774,"journal":{"name":"International Journal of Blood Transfusion and Hematology","volume":"42 1","pages":"482-487"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43078465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-419X.2019.06.014
Y. Wang
Mammalian target of rapamycin (mTOR) is a serine/threonine protein kinase that is involved in the immune pathogenesis of autoimmune hemolytic anemia (AIHA) by regulating different types of T cell, B cells and dendritic cells (DC). mTOR inhibitor acts on the mTOR signaling pathway. It can up-regulate the number of regulatory T cell (Treg) and down-regulate the number of helper T cell (Th), Th2, and Th17. It plays an important role in the treatment of recurrent/refractory AIHA. The authors review the molecular structure of mTOR, mTOR signaling pathway, the regulation of mTOR involved in immune cells, and the treatment of AIHA with mTOR inhibitors. Key words: TOR serine-threonine kinases; Anemia, hemolytic, autoimmune; T-lymphocytes, regulatory; Th1 cells; Molecular targeted therapy; Immunosuppressive agents
{"title":"Research progress of mammalian target of rapamycin and occurence of autoimmune hemolytic anemia","authors":"Y. Wang","doi":"10.3760/CMA.J.ISSN.1673-419X.2019.06.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-419X.2019.06.014","url":null,"abstract":"Mammalian target of rapamycin (mTOR) is a serine/threonine protein kinase that is involved in the immune pathogenesis of autoimmune hemolytic anemia (AIHA) by regulating different types of T cell, B cells and dendritic cells (DC). mTOR inhibitor acts on the mTOR signaling pathway. It can up-regulate the number of regulatory T cell (Treg) and down-regulate the number of helper T cell (Th), Th2, and Th17. It plays an important role in the treatment of recurrent/refractory AIHA. The authors review the molecular structure of mTOR, mTOR signaling pathway, the regulation of mTOR involved in immune cells, and the treatment of AIHA with mTOR inhibitors. \u0000 \u0000 \u0000Key words: \u0000TOR serine-threonine kinases; Anemia, hemolytic, autoimmune; T-lymphocytes, regulatory; Th1 cells; Molecular targeted therapy; Immunosuppressive agents","PeriodicalId":13774,"journal":{"name":"International Journal of Blood Transfusion and Hematology","volume":"42 1","pages":"543-547"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46537424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-419X.2019.06.011
Di Wu
Elderly patients with acute myeloid leukemia (AML) are difficult to treat due to higher proportion of high risk factors and the efficacy of conventional chemotherapy remains unsatisfying. In recent years, researches concerning risk stratification of elderly patients with AML have prompted the individualization of therapeutic approaches. Besides, the advent of hypomethylating agents(HMA), novel targeted drugs, immunotherapy and the improvement of hematopoietic stem cell transplantation (HSCT) have shown promising prospects in elevating remission and survival rates while lowering treatment-related toxicities, thus providing new orientations of the diagnosis and treatment of this special population. This article reviews literatures of progress in the treatment of elderly patients with AML in aspects of stratified evaluation, chemotherapy, HMA, molecular targeted therapy, immunotherapy, cyclin kinase inhibitors, HSCT, and so on. Key words: Leukemia, myeloid, acute; Aged; Geriatric assessment; Demethylation; Molecular targeted therapy; Immunotherapy; Hematopoietic stem cell transplantation
{"title":"Progresses in treatment of elderly patients with acute myeloid leukemia","authors":"Di Wu","doi":"10.3760/CMA.J.ISSN.1673-419X.2019.06.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-419X.2019.06.011","url":null,"abstract":"Elderly patients with acute myeloid leukemia (AML) are difficult to treat due to higher proportion of high risk factors and the efficacy of conventional chemotherapy remains unsatisfying. In recent years, researches concerning risk stratification of elderly patients with AML have prompted the individualization of therapeutic approaches. Besides, the advent of hypomethylating agents(HMA), novel targeted drugs, immunotherapy and the improvement of hematopoietic stem cell transplantation (HSCT) have shown promising prospects in elevating remission and survival rates while lowering treatment-related toxicities, thus providing new orientations of the diagnosis and treatment of this special population. This article reviews literatures of progress in the treatment of elderly patients with AML in aspects of stratified evaluation, chemotherapy, HMA, molecular targeted therapy, immunotherapy, cyclin kinase inhibitors, HSCT, and so on. \u0000 \u0000 \u0000Key words: \u0000Leukemia, myeloid, acute; Aged; Geriatric assessment; Demethylation; Molecular targeted therapy; Immunotherapy; Hematopoietic stem cell transplantation","PeriodicalId":13774,"journal":{"name":"International Journal of Blood Transfusion and Hematology","volume":"42 1","pages":"524-529"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49421162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-419X.2019.06.003
Xiaoning Wang, Ying Zhang, Juan Ren, Huachao Zhu, Jieying Xi, Mei Zhang
Objective To investigate the clinical effect and prognosis of sub-standard dose of donor stem cell infusion(DSI) mobilized by granulocyte colony-stimu1ating factor(G-CSF) in patients with relapsed acute leukemia (AL) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods From January 2010 to April 2017, a total of 17 patients with relapsed AL after allo-HSCT in Department of Hematology, the First Affiliated Hospital of Xi′an Jiaotong University were included in the study. They were divided into DSI combined chemotherapy group (n=7) and chemotherapy alone group (n=10) according to different treatment after relapse. The basic clinical data of patients with relapsed AL after allo-HSCT were collected by retrospective analysis. The infusion dose of DSI, treatment results, adverse reactions and survival outcomes were observed in both groups. Kaplan-Meier method was used to draw the overall survival (OS) and survival after first relapse (SAR) curves of two groups. The OS and SAR rate were compared by Log-rank test between two groups. This study protocol was approved by the ethics committee of the First Affiliated Hospital of Xi′an Jiaotong University (Approoal No. XJTU1AF2010LSL-020). Informed consents were obtained from all patients before treatment. Results ① The median age of patients in DSI combined chemotherapy group was 28 years (11-49 years), 3 cases were positive in fusion gene, and 6 cases were achieved complete remission(CR)1 before transplantation, none of them had graft versus host disease(GVHD). The median age of patients in chemotherapy group was 22 years (15-37 years). The fusion gene was positive in 4 cases, and 2 cases had GVHD. ② In DSI combined chemotherapy group, 5 patients received single DSI treatment after conventional chemotherapy, and 2 patients received DSI treatment in every two weeks. Three patients (3 / 7) achieved CR. There were 4 patients with grade Ⅰ ~Ⅱ aGVHD of skin and liver, 3 patients with grade Ⅳ myelosuppression and pneumonia. Up to the end of follow-up, 1 patient survived and 6 died in DSI combined chemotherapy group. ③In the chemotherapy group, 3 patients (3 / 10) achieved CR after treatment. Up to the end of follow-up, 4 patients survived and 6 patients died. ④ The 1-year and 3-years OS rates of patients in DSI combined chemotherapy group were 57.1% and 19.0%, respectively, and those of patients in chemotherapy group were 66.7% and 17.8%, respectively. There were no significant differences between two groups (χ2 = 2.122, 0.136; P=0.58, 0.68). There was no significant difference in 1-year SAR rate between two groups (41.3% vs 29.8%; χ2=3.165, P=0.43). Conclusions The combination of G-CSF mobilized sub standard dose DSI with chemotherapy may improve the CR rate of patients with relapsed AL after allo-HSCT. Reducing dose of DSI may reduce the incidence of severe GVHD without affecting the therapeutic efficacy and graft versns leukemia(GVL) effect. Key words: Leukemia;
{"title":"Clinical analysis of sub-standard dose of donor stem cell infusion mobilized by granulocyte colony-stimulating factor in treatment of relapsed acute leukemia after allogenic hematopoietic stem cell transplantation","authors":"Xiaoning Wang, Ying Zhang, Juan Ren, Huachao Zhu, Jieying Xi, Mei Zhang","doi":"10.3760/CMA.J.ISSN.1673-419X.2019.06.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-419X.2019.06.003","url":null,"abstract":"Objective \u0000To investigate the clinical effect and prognosis of sub-standard dose of donor stem cell infusion(DSI) mobilized by granulocyte colony-stimu1ating factor(G-CSF) in patients with relapsed acute leukemia (AL) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). \u0000 \u0000 \u0000Methods \u0000From January 2010 to April 2017, a total of 17 patients with relapsed AL after allo-HSCT in Department of Hematology, the First Affiliated Hospital of Xi′an Jiaotong University were included in the study. They were divided into DSI combined chemotherapy group (n=7) and chemotherapy alone group (n=10) according to different treatment after relapse. The basic clinical data of patients with relapsed AL after allo-HSCT were collected by retrospective analysis. The infusion dose of DSI, treatment results, adverse reactions and survival outcomes were observed in both groups. Kaplan-Meier method was used to draw the overall survival (OS) and survival after first relapse (SAR) curves of two groups. The OS and SAR rate were compared by Log-rank test between two groups. This study protocol was approved by the ethics committee of the First Affiliated Hospital of Xi′an Jiaotong University (Approoal No. XJTU1AF2010LSL-020). Informed consents were obtained from all patients before treatment. \u0000 \u0000 \u0000Results \u0000① The median age of patients in DSI combined chemotherapy group was 28 years (11-49 years), 3 cases were positive in fusion gene, and 6 cases were achieved complete remission(CR)1 before transplantation, none of them had graft versus host disease(GVHD). The median age of patients in chemotherapy group was 22 years (15-37 years). The fusion gene was positive in 4 cases, and 2 cases had GVHD. ② In DSI combined chemotherapy group, 5 patients received single DSI treatment after conventional chemotherapy, and 2 patients received DSI treatment in every two weeks. Three patients (3 / 7) achieved CR. There were 4 patients with grade Ⅰ ~Ⅱ aGVHD of skin and liver, 3 patients with grade Ⅳ myelosuppression and pneumonia. Up to the end of follow-up, 1 patient survived and 6 died in DSI combined chemotherapy group. ③In the chemotherapy group, 3 patients (3 / 10) achieved CR after treatment. Up to the end of follow-up, 4 patients survived and 6 patients died. ④ The 1-year and 3-years OS rates of patients in DSI combined chemotherapy group were 57.1% and 19.0%, respectively, and those of patients in chemotherapy group were 66.7% and 17.8%, respectively. There were no significant differences between two groups (χ2 = 2.122, 0.136; P=0.58, 0.68). There was no significant difference in 1-year SAR rate between two groups (41.3% vs 29.8%; χ2=3.165, P=0.43). \u0000 \u0000 \u0000Conclusions \u0000The combination of G-CSF mobilized sub standard dose DSI with chemotherapy may improve the CR rate of patients with relapsed AL after allo-HSCT. Reducing dose of DSI may reduce the incidence of severe GVHD without affecting the therapeutic efficacy and graft versns leukemia(GVL) effect. \u0000 \u0000 \u0000Key words: \u0000Leukemia; ","PeriodicalId":13774,"journal":{"name":"International Journal of Blood Transfusion and Hematology","volume":"42 1","pages":"476-481"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47090388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-419X.2019.06.001
X. Liu
Transplantation associated thrombotic microangiopathy (TA-TMA) is a significant complication after hematopoietic stem cell transplantation (HSCT), and may lead to a high risk of death. It is a multifactorial disorder focused on small vessel endothelial injury which can be trigged by varieties of mechanisms during HSCT. The complement system is found to play a role in the development of TA-TMA. Current laboratory diagnostic criteria are unsatisfactory and the latest diagnostic criterion includes activation of the complement system. But the pathological diagnosis remains to be the golden standard. Blocking the complement system with eculizumab may be one of the effective treatment for high-risk patients with TA-TMA. This article reviews the status on pathogenesis, diagnosis and treatment of TA-TMA. Key words: Thrombotic microangiopathies; Hematopoietic stem cell transplantation; Endothelium, vascular; Complement system proteins; Transplantation associated thrombotic microangiopathy; Endothelial injury; Eculizumab
{"title":"Status on pathogenesis, diagnosis and treatment of hematopoietic stem cell transplantation associated thrombotic microangiopathy","authors":"X. Liu","doi":"10.3760/CMA.J.ISSN.1673-419X.2019.06.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-419X.2019.06.001","url":null,"abstract":"Transplantation associated thrombotic microangiopathy (TA-TMA) is a significant complication after hematopoietic stem cell transplantation (HSCT), and may lead to a high risk of death. It is a multifactorial disorder focused on small vessel endothelial injury which can be trigged by varieties of mechanisms during HSCT. The complement system is found to play a role in the development of TA-TMA. Current laboratory diagnostic criteria are unsatisfactory and the latest diagnostic criterion includes activation of the complement system. But the pathological diagnosis remains to be the golden standard. Blocking the complement system with eculizumab may be one of the effective treatment for high-risk patients with TA-TMA. This article reviews the status on pathogenesis, diagnosis and treatment of TA-TMA. \u0000 \u0000 \u0000Key words: \u0000Thrombotic microangiopathies; Hematopoietic stem cell transplantation; Endothelium, vascular; Complement system proteins; Transplantation associated thrombotic microangiopathy; Endothelial injury; Eculizumab","PeriodicalId":13774,"journal":{"name":"International Journal of Blood Transfusion and Hematology","volume":"42 1","pages":"461-468"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46721327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-419X.2019.06.012
Y. Wan, Tao Wu
Main tissue compatibility complex class Ⅱ molecular transverse activation factor (CⅡTA) is a transcribed activation factor which is considered the main regulatory factors in the major histocompatibility complex (MHC) class Ⅱ expression. CⅡTA gene regulates the immune function by affecting the transcription level of MHC class Ⅱ molecules. Mucosa-associated lymphoid tissue (MALT) lymphoma is a type of B-cell lymphoma originated from MALT at the outer margin of lymph nodes. The absence of MHC class Ⅱ molecular expression on the surface of tumor cells, causes tumor cells to evade immune surveillance. This is an important pathogenesis of MALT lymphoma. Here, the article reviews the significance and research progress of the expression of CⅡTA gene in MALT lymphoma. Key words: Lymphoma, B-cell, marginal zone; Genes, MHC class Ⅱ; Activating transcription factors; Immunomodulation; Molecular targeted therapy; CⅡTA gene
{"title":"Research progress of CIITA gene in mucosa-associated lymphoid tissue lymphoma","authors":"Y. Wan, Tao Wu","doi":"10.3760/CMA.J.ISSN.1673-419X.2019.06.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-419X.2019.06.012","url":null,"abstract":"Main tissue compatibility complex class Ⅱ molecular transverse activation factor (CⅡTA) is a transcribed activation factor which is considered the main regulatory factors in the major histocompatibility complex (MHC) class Ⅱ expression. CⅡTA gene regulates the immune function by affecting the transcription level of MHC class Ⅱ molecules. Mucosa-associated lymphoid tissue (MALT) lymphoma is a type of B-cell lymphoma originated from MALT at the outer margin of lymph nodes. The absence of MHC class Ⅱ molecular expression on the surface of tumor cells, causes tumor cells to evade immune surveillance. This is an important pathogenesis of MALT lymphoma. Here, the article reviews the significance and research progress of the expression of CⅡTA gene in MALT lymphoma. \u0000 \u0000 \u0000Key words: \u0000Lymphoma, B-cell, marginal zone; Genes, MHC class Ⅱ; Activating transcription factors; Immunomodulation; Molecular targeted therapy; CⅡTA gene","PeriodicalId":13774,"journal":{"name":"International Journal of Blood Transfusion and Hematology","volume":"42 1","pages":"530-534"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49644922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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