International journal of hematology-oncology and stem cell research最新文献

Background: Umbilical cord blood is widely regarded as a viable option for allogeneic hematopoietic stem cell transplantation (HSCT) and serves as a potential alternative to bone marrow due to its numerous advantages. These include a non-invasive collection process, a high concentration of hematopoietic stem and progenitor cells, and a lower risk of graft rejection. However, its application in adult patients is limited by the suboptimal dose of stem cells available in a single umbilical cord blood unit. This insufficient cell dose increases the risk of engraftment failure and post-transplant mortality, posing a significant challenge for its use in adult populations. Materials and Methods: This study aims to develop a protocol for expanding umbilical cord blood mononuclear cells (UCB-MNCs) using a serum-free culture medium called StemSpan, supplemented with a mesenchymal stem cell (MSC) feeder layer and a combination of growth factors. The growth factors used include stem cell factor (SCF), thrombopoietin (TPO), fibroblast growth factor-1 (FGF-1), and heparin. The expansion culture was applied to 20 UCB samples and maintained over a period of 13 days. Data collected from the experiments were analyzed using the SPSS program (Statistical Package for the Social Sciences) for Windows, version 21. Results: The protocol led to a notable increase in the viable mononuclear cell counts, the absolute hematopoietic stem and progenitor cell counts, and the clonogenic progenitors. Conclusion: This designed protocol could support the expansion of the umbilical cord blood mononuclear cells, including hematopoietic stem and progenitor cells, which could provide hope for better engraftment in adult patient transplantations. The designed protocol could effectively promote the expansion of umbilical cord blood mononuclear cells, particularly hematopoietic stem and progenitor cells. This advancement offers promising potential for improving engraftment outcomes in adult patient transplantations.

Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma (CTCL) and is characterized by a heterogeneous clinical course and variant stage involvement. Indolent disease is usually observed in its early stages. However, the treatment options for patients with advanced MF are limited and have poor outcomes. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potential curative treatment for refractory cases. Here, we describe the case of a 34-year-old man who was diagnosed with MF at an advanced stage. Eight months before allo-HSCT, the patient received six courses of polychemotherapy based on cyclophosphamide, doxorubicin, vincristine, and prednisolone, which were administered every three weeks. A partial response was obtained. He underwent allo-HSCT after a myeloablative conditioning regimen and remained in complete remission (CR) for 26 months posttransplantation. Our findings confirm that allo-HSCT can be a curative option for refractory MF.

Background: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard treatment for Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL) in cases of relapsed or refractory disease. Various salvage chemotherapy regimens have been introduced with specific response rates, toxicity profiles, costs, and stem cell damage before stem cell harvest. The optimal salvage regimen for these patients is unclear. Materials and Methods : In this retrospective analysis, 276 patients with HL and NHL with relapsed or refractory disease after initial treatment that received ESHAP (etoposide, methylprednisolone, cytosine arabinoside, and platinum) or IEV (ifosfamide, epirubicin, etoposide) as salvage regimen were included. We aimed to compare the efficacy of these two chemotherapy regimens as a life-saving treatment in recurrent or refractory disease. Results: The mean age of patients was 33.96 ± 12.39 years. Hodgkin's lymphoma accounted for 60.1% and non-Hodgkin lymphoma (DLBCL) accounted for 39.9% of patients. The overall response rate (ORR) was 79.8% (50% complete response (CR)) for patients with Hodgkin lymphoma who received the ESHAP and 85.6% (55.1% CR) for the IEV regimen. Patients with non-Hodgkin's lymphoma who received the ESHAP plus rituximab regimen had an ORR of 60.9% (CR 40.3%), and patients who received the IEV + Rituximab chemotherapy regimen had an ORR of 72.4% (CR 42.4%) (P = 0.03). However, the mortality rate was lower in patients who received the IEV chemotherapy regimen. Conclusion: IEV treatment is superior to ESHAP in patients with recurrent or refractory Hodgkin's and non-Hodgkin's lymphoma.

Although there have been some reports of oral hairy leukoplakia (OHL) in patients with hematologic neoplasms, to the best of our knowledge, this study is the first to report this lesion affecting a patient with polycythemia vera. A 54-year-old male patient diagnosed with polycythemia vera presented with non-removable white patches with a rough surface on the bilateral border of the tongue. According to clinical, histopathological and in situ hybridization features, OHL was established. Two months after diagnosis, the patient developed splenomegaly and initiated ruxolitinib. Bone marrow biopsy showed post-polycythemia vera myelofibrosis. The patient underwent allogeneic haploidentical hematopoietic stem-cell transplant, achieving complete remission of the oral lesion. OHL is an important marker of immunosuppression. In the present case, OHL was diagnosed during the progression of polycythemia vera to myelofibrosis and its early diagnosis may have contributed to a better clinical outcome.

Background: Immune checkpoint inhibitors have significantly improved outcomes in select cancers; however, not all patients respond to these therapies, and the duration of the response varies among responders. Markers predictive of the response to immunotherapy, such as PD-L1 expression determined by immunohistochemical staining of tumor sections and microsatellite status, have been identified. Some of these are used in companion diagnostics approved for clinical practice. Additional easy-to-use biomarkers may help clinicians to predict the efficacy of these drugs in individual patients. Materials and Methods: A retrospective review of the medical records of patients with metastatic cancer treated with immune checkpoint inhibitors in our cancer center was performed to identify the clinical and hematologic parameters associated with survival outcomes. Results: Among the 163 patients included in the study, most had lung cancer, followed by kidney cancer, melanoma, and bladder cancer. Most patients (61.3%) were male and had good performance status. Nivolumab and pembrolizumab were immune checkpoint inhibitors utilized in 85.9% of cases. Age, sex, and primary cancer type were not associated with survival outcomes. Among the peripheral blood parameters evaluated, lymphocytopenia was the strongest predictor of adverse survival outcomes in univariate analysis and the only clinical or hematologic biomarker that retained significance for overall survival (OS) prediction in multivariate analysis. Conclusion: Among the clinical and hematologic parameters routinely used in the clinic, a lymphocyte count below 1 x 10⁹/ L was predictive of adverse OS in patients with metastatic cancers receiving immune checkpoint inhibitors.

Thrombotic thrombocytopenic purpura (TTP) is a medical condition characterized by a decreased activity of the ADAMTS13 protease for cleaving the von Willebrand factor. It contributes to thrombotic microangiopathy. In this report, we described a case of TTP followed by significant adverse effects during therapeutic plasma exchange (TPE) treatment. The patient received TPE with a time interval from plasma transfusion. A 30-year-old female was evaluated for headaches and bruises on her arms and legs. Laboratory testing revealed thrombocytopenia and anemia. The identification of thrombocytopenia with severe schistocytosis was verified by the analysis of a peripheral blood smear. After confirming a diagnosis of TTP, TPE was performed as therapy. To avoid the complications arising during the previous TPE sessions, we conducted plasma exchange with albumin followed by FFP injection, with a six-hour interval between them. This strategy successfully alleviated the patient's symptoms. Therapeutic plasma exchange (TPE) with a time interval from plasma transfusion can be successfully used in patients with severe TPE complications.

Blastic plasmacytoid dendritic cell neoplasms (BPDCN) are rare, aggressive hematologic neoplasms. Awareness about this neoplasm has increased after it was defined as a clonal plasmacytoid dendritic cell disease under histiocytic/dendritic cell neoplasms in the World Health Organization 2022 classification of myeloid and Histiocytic/Dendritic Neoplasms¹. Therapies include chemotherapy or immunotherapy^2-4 though stem cell transplantation (SCT) is the best consolidative approach in eligible patients⁵. Here, we present one intensive therapy-ineligible and two intensive-therapy-eligible patients with different presentations of BPDCN.

Background: Glioblastoma is a prevalent and challenging malignant brain tumor. Secretome therapy using human umbilical cord mesenchymal stem cells (hUCMSCs) appears to be a promising treatment for glioblastoma. This study analyzed the potential of the hUCMSC secretomes (hUCMSCs-sec) for glioma therapy. Materials and Methods: Characterization of hUCMSCs was performed by examining certain markers, including CD44, CD90, CD105, CD73, CD13, CD19, CD14, CD45, CD34, and HLA-D. The cells' ability to differentiate into adipocytes, chondrocytes, and osteocytes was evaluated. Cytotoxic effect on Glioblastoma (GBM) cells was analyzed using 2-[2-methoxy-4-nitrophenyl]-3-[4-nitrophenyl]-5-[2,4-disulfophenyl]-2H-tetrazolium (WST-8). mRNA relative expression, including homeobox (HOXA5, HOXB1, HOXC9 and HOXC10), insulin-like growth factor binding protein 2 (IGFBP2), Extracellular signal-regulated kinases (ERK), Epidermal growth factor receptor (EGFR), and Caspase 3 (Casp3), were quantified by quantitative Reverse Transcription Polymerase Chain Reaction (qRT-PCR). Results: The hUCMSCs-sec was successfully isolated and identified, showing positive markers and its capacity to differentiate into chondrocytes, adipocytes, and osteocytes. hUCMSCs-sec exerted a cytotoxic effect on GBM cells and upregulated the expression of Casp3, whereas it decreased the expression of HOX, IGFBP2, EGFR, and ERK in GBM cells. Conclusion: The secretomes from hUCMSCs show potential for GBM cell therapy by improving the deregulation of HOX, inducing apoptosis, and inhibiting cell proliferation genes.

Background: Acute lymphoblastic leukemia affects both adults and children. Mixed phenotype acute leukemia (MPAL) is a rare subset featuring blasts with multiple lineage-specific antigens. Diagnosis is made via flow cytometric immunophenotyping with specific CD markers. This study aims to correlate MPAL's incidence, hematological findings, clinical profiles, and immunophenotypic features with treatment outcomes and prognostic significance. Materials and Methods:  A total of 750 cases of acute leukemia involving pediatric and adult patients were examined at SCB Medical College and Hospital in Cuttack, Odisha. Based on the WHO 2008 criteria, twenty-nine cases of MPAL were identified using morphological, cytochemical, and immunophenotypic features. The study covered all age groups admitted to the Department of Hematology from September 2011 to April 2021. Results: Flow cytometric analysis of 750 cases showed B lymphoblastic leukemia as the most common subtype. Of the 29 MPAL cases (3.86%), 15 were B/myeloid, 13 T/myeloid, and one B/T/myeloid. Twenty-three cases received induction chemotherapy, with 12 achieving complete remission. The median survival was 11months, with a 15-month survival rate of 39%. Pediatric patients had a 60% survival rate at 15 months, compared to 30% for adults.  Conclusion:  MPAL is a rare acute leukemia diagnosed through flow cytometry. Prognostic factors include age at onset, CD34 negativity, HLA-DR presence, BCR-ABL fusion, and MLL rearrangement, which indicate a poor prognosis. Children tend to have better outcomes and complete remission than adults, with therapies for ALL being more effective than those for acute myeloblastic leukemia.

Background: Chronic Kidney Disease (CKD) is a public health concern with anemia being a major complication. RET-He is a cost-effective parameter to assess iron status in CKD, but further research is necessary to assess its correlation with existing parameters. This study attempted to investigate the correlation between RET-He, iron status, and erythrocyte indices among CKD patients. Materials and Methods: A cross-sectional study involving 110 CKD patients who underwent routine hematology and iron profile tests (serum iron/SI, total iron binding capacity/TIBC, transferrin saturation/TSAT, and ferritin). RET-He was then measured using a Sysmex XN-1000 hematology analyzer. Statistical tests were used to define the correlation between RET-He), iron status, and erythrocyte indices. Results: There was a significant positive correlation between RET-He and SI (r = 0.349; p = 0.000), TSAT (r = 0.393; p = 0.000), and ferritin (r = 0.279; p = 0.003). Among CKD patients with excess iron levels, there was a moderate correlation between RET-He and TSAT (r = 0.404; p = 0.000). Conclusion: The study found a significant correlation between RET-He levels and iron status markers in CKD patients. RET-He is recommended as an additional parameter to assess iron status and as an additional method to estimate TSAT and ferritin levels, especially in settings where chemistry analyzers are unavailable. Further research is required to establish RET-He cut-off values for identifying excessive iron levels in CKD patients.