Objective: To analyze the risk factors of primary poor graft function (PGF) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with myeloid malignancies and the impact of primary PGF on survival.
Methods: The clinical data of 146 patients with myeloid malignancies who underwent allo-HSCT in our hospital from January 2015 to December 2021 were retrospectively studied. Some relevant clinical parameters which may affect the development of primary PGF after allo-HSCT were selected for univariate and multivariate analysis, as well as performed survival analysis.
Results: A total of 9 patients (6.16%) were diagnosed with primary PGF, and their medium age was 37(28-53) years old. Among them, 1 case underwent matched sibling donor HSCT, 1 case underwent matched unrelated donor HSCT, and 7 cases underwent HLA-haploidentical related donor HSCT. Moreover, 5 cases were diagnosed as cytomegalovirus (CMV) infection, and 3 cases as Epstein-Barr virus (EBV) infection. Univariate and multivariate analysis showed that CD34+ cell dose <5×106/kg and pre-transplant C-reactive protein (CRP) >10 mg/L were independent risk factors for occurrence of the primary PGF after allo-HSCT in patients with myeloid malignancies. The 3-year overall survival (OS) rate of primary PGF group was 52.5%, which was significantly lower than 82.8% of good graft function group (P < 0.05).
Conclusion: Making sure pre-transplant CRP≤10 mg/L and CD34+ cell dose ≥5×106/kg in the graft may have an effect on preventing the occurrence of primary PGF after allo-HSCT. The occurrence of primary PGF may affect the OS rate of transplant patients, and early prevention and treatment are required.
Objective: To investigate the safety, efficacy, and prognosis of high-dose melphalan in combination with autologous hematopoietic stem cell transplantation (ASCT) for the treatment of multiple myeloma (MM).
Methods: The clinical data of 17 patients with newly diagnosed MM who underwent ASCT as first-line consolidation therapy at the Yijishan Hospital of Wannan Medical College from March 2020 to October 2022 were retrospectively analyzed. The safety, efficacy, and prognosis of this treatment approach were evaluated.
Results: Of the 17 patients, 10 were male and 7 were female, with a median age of 56 (45-64) years. The stem cell engraftment rate was 100%, with a median neutrophil engraftment time of +10 (9-12) days and a median platelet engraftment time of +12 (10-21) days. The incidence of oral mucositis and intestinal infection after transplantation was 100%, with 2 cases of pulmonary infection, 1 case of urinary tract infection, 1 case of skin infection, and 11 cases of transient elevation of serum amylase. After transplantation, 13 patients achieved a complete response (CR) or better, and the CR rate showed an increasing trend compared to before transplantation (13/17 vs 8/17; P =0.078). The median follow-up time was 18 (6-36) months, and 15 patients survived without progression, 1 patient experienced disease progression, and 1 patient died due to clinical relapse and abandonment of treatment. The 2-year overall survival (OS) rate and progression-free survival (PFS) rate were approximately 90.0% and 83.9%, respectively.
Conclusion: High-dose melphalan in combination with ASCT as first-line consolidation therapy for MM can enhance the depth of patient response, further improve therapeutic efficacy, and the transplant-related complications are controllable, making it a viable option worth promoting in clinical practice.
Objective: To analyze the dynamic changes of neutrophil percentage-to-albumin ratio (NPAR) during treatment with bortezomib-lenalidomide-dexamethasone (VRD) in patients with multiple myeloma (MM), and explore the relationship between NPAR value and short-term prognosis of MM patients.
Method: The data of 80 MM patients who underwent VRD chemotherapy at Tangshan Workers Hospital from January 2019 to April 2021 were retrospectively analyzed. NPAR levels were measured before VRD chemotherapy (T0), and on the first day of the third (T1), sixth (T2), and eighth (T3) chemotherapy cycles. All patients were followed up for 1 year, with the recurrence, progression, or death occurring within 1 year after the completion of VRD treatment as the endpoint event. The patients were divided into a good prognosis group and a poor prognosis group based on the follow-up results. The changes in NPAR at T0, T1, T2, and T3 in the two groups were statistically analyzed. The restricted cubic spline method was used to analyzed the relationship between NPAR and adverse short-term prognosis in MM patients undergoing VRD chemotherapy.
Results: Among the 80 MM patients, 25 cases (31.25%) had poor short-term prognosis, including 19 cases (23.75%) of progression or recurrence, and 6 cases (7.50%) of all-cause mortality. The levels of neutrophils and NPAR in the poor prognosis group at T0, T1, T2 and T3 were higher than those in the good prognosis group at the same period, while the albumin levels in the poor prognosis group at T0, T1, and T2 were lower than those in the good prognosis group at the same period (P < 0.05); There was no significant difference in albumin levels between the poor prognosis group and the good prognosis group at T3 (P >0.05). Within the poor prognosis group and the good prognosis group, the levels of neutrophils and NPAR decreased sequentially at T0, T1, T2, and T3, while the levels of albumin increased sequentially, and the differences between each stage were statistically significant (P < 0.05). The restricted cubic spline model showed an approximate J-shaped curve between the risk of poor short-term prognosis and the pre-treatment NPAR level in MM patients (P < 0.05). If the pre-treatment NPAR>0.52, the risk of poor short-term prognosis in MM patients increased with the increase of NPAR value.
Conclusion: After VRD treatment, the NPAR value of MM patients gradually decreases, and there is a correlation between the NPAR value before VRD treatment and the risk of poor prognosis after treatment. If NPAR>0.52 before treatment, the higher the NPAR value, the higher the risk of poor short-term prognosis in MM patients.
Vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic syndrome (VEXAS) is a recently discovered adult-onset autoinflammatory syndrome characterized by methionine somatic mutations affecting the activation of ubiquitin system in the X-linked gene UBA1 . Patients present with a wide range of inflammatory manifestations (fever, neutrophil dermatosis, chondritis, pulmonary infiltrates, ocular inflammation, venous thrombosis) and hematological impairment (giant cell anemia, thrombocytopenia, bone marrow and pre-erythrocyte vacuoles, bone marrow dysplasia), consequently contributing to significant morbidity and mortality. Current treatment management method is not well developed, and the main existing therapies are aimed at controlling inflammatory symptoms or targeting UBA1 mutations. Symptomatic supportive care includes control risk factors (such as infection and thrombosis), component transfusion, and use of hematopoietic drugs. This review aims to summarize new advances of the pathogenesis, clinical manifestations and treatment of this disease in the past two years.
Objective: To summarize the clinical characteristics of patients with combined pneumocystis jiroveci pneumonia (PJP) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Methods: The clinical manifestations, laboratory tests, imaging findings, and treatment outcomes of 21 allo-HSCT patients with PJP diagnosed at the First Affiliated Hospital of Soochow University and Soochow Hopes Hematology Hospital from July 2018 to July 2023 were retrospective analyzed.
Results: Among the 21 patients, the male -to-female ratio was 2.5∶1, and the median age was 36 years old with a range of 15-62 years. The median time to diagnosis of PJP after transplantation was 225 days. The clinical manifestations lack specificity, and the main clinical symptoms include respiratory symptoms (dyspnea, cough, sputum, etc.) and fever. Laboratory examination revealed peripheral blood lymphocyte counts decreased in 15 cases, CD4+ T lymphocyte absolute values less than 200 cells/μl in 19 patients, C-reactive protein levels significantly increased in 20 patients, lactate dehydrogenase levels increased in 14 patients, and 1,3-β-D-glucan detection levels increased in 14 patients. Chest CT manifestations can be divided into three types: ground glass type, nodular type, and mixed type. Among them, the incidence of ground glass type was the highest (18/21), with 2 cases of nodular type and 1 case of mixed type. The sequence number of Pneumocystis jiroveci was detected through mNGS (15-57 570), and 11 patients had mixed infections. In terms of treatment, TMP-SMX, Caspofungin, and methylprednisolone were administered, and 17 patients achieved improvement in their condition. Four patients died, all of whom died from respiratory failure.
Conclusion: PJP is a critically ill condition after hematopoietic stem cell transplantation, and diagnosis is difficult. Early diagnosis can achieve better prognosis. The sensitivity of mNGS in diagnosing PJP is high, providing the possibility of early and accurate diagnosis for clinical practice, which is worthy of application and promotion.
Objective: To investigate and assess hemolytic transfusion reaction in patient with complex and combined anti-Fya and anti-Jkb which so as to provide a safety blood transfusion strategy.
Methods: ABO/Rh blood grouping, antibody screening and identification, and Coombs' tests were performed by the routine serological methods include manual tube and automatic blood group analyzer with matching micro-column gel cards from Diagnostic Grifols and Jiangsu LIBO. The hospital information system and laboratory information system were used to collect dada on patients' blood routine tests, liver and kidney function, coagulation, cardiac function, and other clinical indicators before and after blood transfusion were analyzed and compared in conjunction with the patients' clinical manifestations.
Results: The patient's blood group was A/CcDEe. Before two transfusion, the anti-body screening were positive which identification were anti-Fya and anti-Fya combined with anti-Jkb respectively, while the Coomb's test were positive with anti-C3 and anti-IgG combined with anti-C3 respectively. No agglutination and hemolysis was observed in saline medium cross-matching test before two transfusion of Fya- red blood cell. But before re-transfusion agglutinated reaction was observed in cross-matching test by DG Gel ®Coombs, which strength was 2+ on whether major or minor side. The patient developed soy sauce urine/hemoglobinuria and fever after transfused Fya- red blood cell again. Primary laboratory indicators were observed to be elevated, include C-reactive protein from 3.06 mg/L to 29.97 mg/L, total bilirubin from 21.4 μmol/L to 276.3 μmol/L, direct bilirubin from 8.4 μmol/L to 135.6 μmol/L, lactate dehydrogenase from 166 U/L to 1453 U/L. Urinary free hemoglobin test was 4+. The main laboratory indicators reflecting the heart, liver, kidney and circulatory coagulation function also have vary increased and gradually returned to normal after a week.
Conclusion: Jkb-incompatible transfusion of the Kidd blood group system can lead to acute hemolytic transfusion reaction, but in emergency implementing incompatible transfusion due to IgG antibodies outside of the primary blood group (such as ABO/RhD) can ensure the implementation of emergency operation.
Mesenchymal stem cells (MSC) possess unique immunomodulatory properties and have enormous potential in the treatment of graft-versus-host disease (GVHD). However, the low implantation and survival rates of MSC in vivo, coupled with their weak immunosuppressive functions, have resulted in unstable clinical efficacy in the treatment of GVHD. Preconditioning of MSC with hypoxia, active molecules and gene modification can enhance the function of MSC and improve the implantation rate, survival rate and therapeutic effect of MSC. This review summarized the strategies for enhancing the efficacy of MSC in the treatment of hematopoietic stem cell transplantation complicated with GVHD in recent years, aiming to provide new strategies for optimizing the application of MSC in the prevention and treatment of GVHD.
Objective: To explore the effect of TP53 mutation variant allele frequency(VAF) on the prognosis of diffuse large B-cell lymphoma(DLBCL) patients.
Methods: This study included 155 patients with DLBCL who were first diagnosed in the People's Hospital of Xinjiang Uygur Autonomous Region from March 2009 to March 2022. Complete clinical data and paraffin-embedded tumor tissue samples were obtained, and DNA was extracted from tumor tissues. The gene mutation profile of DLBCL patients was detected and analyzed by second-generation sequencing technology. Kaplan-Meier method was used to analyze the mutation status of TP53 gene and the relationship between mutation VAF and OS. Cox regression univariate and multivariate analysis was use to analyze the independent factors affecting OS. A nornogram model for predicting 1, 3, and 5 years OS in DLBCL patients were established to evaluated the performance of the model based on C-index and calibration curves.
Results: The average value of TP53 mutation VAF in male DLBCL patients was significantly higher than that in female patients (P < 0.05). Patients with TP53 mutantion had shorter OS than those with wild-type patients (P =0.030). The optimal VAF threshold for TP53 mutation based on OS stratification was 33.61% (P < 0.001), and patients with TP53 mutation VAF ≥34% had shorter OS than those with TP53 mutation VAF < 34% and wild-type patients (P < 0.001). Multivariate Cox analysis showed that TP53 mutation VAF≥34% was an independent poor predictor of OS ( HR =4.05, P < 0.001), and IPI score ≥3 was an independent predictor of OS poor ( HR =2.27, P =0.008). In combination with factors with independent prognostic significance obtained from multi-factor analysis, we constructed a nomogram model for predicting 1-year, 3-year, 5-year OS in DLBCL patients. The results showed that the C index of TP53 mutation VAF combined with IPI model was 0.743, which predicted the value of 1-year, 3-year, and 5-year OS in DLBCL patients. Calibration curves show that the model has good agreement between predicted and actual survival of DLBCL patients at 1-year, 3-year, and 5-year.
Conclusion: TP53 mutation VAF has prognostic value in DLBCL patients, and TP53 mutation VAF≥34% is an independent risk factor for OS in DLBCL patients. The prognosis model of TP53 mutation VAF combined with IPI nomogram constructed in this study has good predictive performance for DLBCL patients.
Objective: To analyze the type and distribution characteristics of irregular antibodies in 71 847 hospitalized patients who prepared to accept blood transfusion, and to explore their role in safe blood transfusion.
Methods: 71 847 patients who applied for red blood transfusion from January 2020 to October 2023 were selected. All specimens were screened and identified for the irregular antibody by microcolumn gel antiglobulin technique.
Results: Among the 71 847 patients preparing for accept blood transfusion, 301 cases tested positive for irregular antibodies（0.42%）. Of these 301 antibody-positive patients, 252 (83.72%) exhibited alloantibodies. The Rh blood group system was the most common, accounting for 179 cases (59.47%). Antibodies in Rh blood group system included anti-E (135,44.85%), anti-E + c (24,7.97%), anti-C + e (10,3.32%), anti-c (6,1.99%), anti-D (3,1.00%), and anti-D + C (1,0.33%). By analyzing 301 cases with irregular antibodies, it found the positive rate of >60 years old group was higher than that in ≤60 years old (0.61% vs 0.33%), female group was higher than that in male group (0.50% vs 0.31%), internal medicine and gynaecology and obstetrics groups were both higher than that in surgery group (1.25% vs 0.20%; 0.32% vs 0.20%), group with pregnancy/transfusion history was higher than that in non-pregnancy/transfusion history (0.64% vs 0.13%), the differences were statistically significant (P < 0.05).
Conclusion: In the routine monitoring of the blood group, it is necessary to detect RhE, so as to reduce the positive rate of irregular antibodies greatly and further ensure the safety of blood transfusion.
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