HLA-identical sibling allogeneic peripheral blood stem cell transplantation with reduced intensity conditioning compared to autologous peripheral blood stem cell transplantation for elderly patients with de novo acute myeloid leukemia.

We conducted a retrospective registry-based analysis to compare the outcome of 361 allogeneic human leukocyte antigen (HLA)-identical peripheral blood stem cell transplants (PBSCT) with reduced intensity conditioning (RIC) to that of 1369 autologous (auto) PBSCT in patients aged 50 years or older with de novo acute myeloid leukemia (AML), performed from 1997 until 2003 and reported to the European Group for Blood and Marrow Transplantation. Median age was 58 and 57 years in the RIC and auto groups, respectively. RIC patients had more advanced disease at the time of transplant. At a median follow-up of 24 months for RIC and 16 months for auto, multivariate analysis showed a lower risk for relapse (RR 0.77, P=0.013) without increased non-relapse mortality (NRM) in RIC patients (RR 1.26, P=0.28). Moreover, leukemia-free survival (RR 1.22, P=0.02) and overall survival (OS) (RR 1.32, P=0.005) were superior in the RIC group. In patients in 1st (CR), fewer relapses were counterbalanced by significantly increased NRM. Therefore, there was no survival advantage in this subgroup. In patients in 2nd or subsequent CR, LFS and OS were superior in the RIC group. RIC transplants show encouraging results in this older patient population with de novo AML.     

Reduced-intensity conditioning therapy with fludarabine,idarubicin, busulfan and cytarabine for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia and myelodysplastic syndrome

We retrospectively analyzed allogenic stem cell transplantation (allo-SCT) outcomes in 82 patients with AML or MDS were conditioned with fludarabine, idarubicin, intravenous-busulfan and cytarabine (FIBA) or busulfan and cyclophosphamide (BuCy). Compared to BuCy regimen, reduced intensity conditioning (RIC) with FIBA was associated with a lower incidence of severe acute GVHD, lower NRM and a similar relapse rate. There was no significant difference in the 3 year overall survival (OS), but this is possibly due to the limited number of patients. The FIBA regimen is promising to replace BuCy regimen because of better security and similar relapse rate.     

氟达拉滨代替环磷酰胺的移植前预处理方案对髓系白血病疗效的Meta分析

目的:评价氟达拉滨代替环磷酰胺的移植前预处理方案对髓系白血病的疗效及安全性。方法:计算机检索筛选获取所有移植前预处理方案为白消安+环磷酰胺（BU+CY）或白消安+氟达拉滨（BU+FLU）的临床对照研究,评价纳入研究的质量并进行资料提取后,采用Stata 12.0软件进行Meta分析。结果:共纳入9篇文献,其中2篇随机对照试验,7篇病例对照研究,Meta分析结果显示:BU+FLU预处理方案恶心呕吐反应比BU+CY方案较小（P=0.031）;肝脏毒性、心脏毒性均小于BU+CY组（P=0.009,P=0.004）,且5年OS优于BU+CY组（P=0.000）。结论:BU+FLU的预处理方案或许可以取代传统的BU+CY方案。     

Treosulfan based reduced toxicity conditioning followed by allogeneic stem cell transplantation in patients with myelofibrosis

Allogeneic transplantation is the only potentially curative strategy for myelofibrosis, even in the era of new drugs that so far only mitigate symptoms. The choice to proceed to allogeneic transplantation is based on several variables including age, disease phase, degree of splenomegaly, donor availability, comorbidities and iron overload. These factors, along with conditioning regimen and time to transplantation, may influence the outcome of ASCT. We report 14 patients affected by myelofibrosis with a median age of 57 years (range, 41–76) receiving a treosulfan‐fludarabine based reduced toxicity conditioning. Patients (pts) received a stem cell transplantation from an HLA identical (n = 10) or matched unrelated donor (n = 4). All pts had a complete myeloablation followed by engraftment and in 12 out of 13 evaluated pts donor chimerism was 100% at 1 month. In most cases a reduction of splenomegaly and a reduction (or resolution) of bone marrow fibrosis was observed. After a median follow‐up of 39 months (range, 3–106), the 3‐year probability of overall survival and disease free survival was 54 +/? 14% and 46 +/? 14%, respectively. The cumulative incidence of non‐relapse mortality at 2 years was 39 +/? 15%. Causes of non‐relapse mortality were: infection (n = 2), GvHD (n = 2) and haemorrhage (n = 1). We can conclude that a treosulfan and fludarabine based conditioning has a potent myeloablative and anti‐disease activity although non‐relapse mortality remains high in this challenging clinical setting. Copyright © 2014 John Wiley & Sons, Ltd.     

马利兰+氟达拉滨预处理异基因造血干细胞移植治疗白血病的临床研究

目的:探讨马利兰+氟达拉滨（Bu/Flu）预处理方案异基因造血干细胞移植治疗白血病的临床疗效。方法:30例患者中,急性淋巴细胞白血病（ALL)12例,急性髓系白血病（AML）12例,其中1例为MDS转化,慢性粒细胞白血病（CML）6例;其中急性白血病未缓解或复发状态下移植6例,CML加速期患者1例。供者干细胞为G-CSF动员后采集的HLA配型全相合或一个位点不合的同胞（21例）或非血缘（9例）外周血造血干细胞,有1例成人ALL患者接受HLA配型相合的双份脐带血移植。预处理方案包括:注射用马利兰3.2mg/(kg·d)×3-4d,氟达拉滨30mg/(m2·d)×4-6d,同胞不全相合和非血缘移植患者加用兔抗人胸腺细胞免疫球蛋白（ATG）2.5mg/(kg·d)×3d。输注外周血单个核细胞数7.73（0.36-16.0）×108/kg,CD34+造血干细胞数3.26（0.77-17.6）×106/kg。用环孢素+短疗程甲氨喋呤或环孢素+吗替麦考酚酯预防移植物抗宿主病（GVHD）。采用DNA短串联重复序列多态性（STR）分析方法鉴定供者干细胞植入情况。结果:29例患者重建造血,检测外周血白细胞STR-DNA证实均为100%完全供者植入,1例非血缘全相合患者未植入于短期内死亡外,其余患者为完全供者型,植入率为96.7%。血缘相关HSCT和非血缘相关HSCT白细胞植活的中位时间分别为11（8-17）d和13(9-15)d;血小板植活的中位时间分别为13（7-22）d和14(8-25)d。出现急性GVHD 14例,占46.7%,其中I-II度10例（33.3%）,III-IV度者4例（13.3%）;6例发生慢性局限性GVHD,发生率为20.0%。随访1-66个月（中位时间20个月）,总体生存率（OS）为63.3%,无事件生存率（DFS）为51.7%。结论:Bu/Flu预处理方案移植治疗白血病相关并发症轻,有很好耐受性和较好疗效,是值得推广应用的预处理方案。     

静脉剂型白消安为主的预处理方案对接受异基因造血干细胞移植的白血病患者的疗效及相关毒性

背景与目的:白消安(busulfan,Bu)是异基因造血干细胞移植预处理方案中的常用药物,口服Bu由于胃肠道吸收不稳定,影响移植疗效且毒性风险增加.本研究评价静脉剂型Bu联合环磷酰胺(cyclophosphamide,Cy)(Bu/Cy)作为异基因外周血干细胞移植(allogeneic peripheral blood stem cell transplantation,allo-PBSCT)预处理方案的疗效和安全性.方法:15例白血病患者采用静脉剂型Bu/Cy,20例采用口服Bu/Cy预处理方案,观察两组的疗效及相关毒性.结果:静脉剂型Bu组15例(100.0%)患者获得造血重建,中性粒细胞和血小板植活中位时间分别为移植后12(9～15)天和15(11～24)天,急性移植物抗宿主病(acute graft versus host disease,aGVHD)6例(40.0%),其中Ⅰ～Ⅱ度4例,Ⅲ～Ⅳ度2例.预处理相关毒性,7例(46.6%)发生呕吐,1例(6.7%)口腔粘膜炎,1例(6.7%)出血性膀胱炎,2例(13.3%)肝功能损害.中位随访时间为180(35～420)天,14例(93.3%)截止随访时仍生存,1例死于严重aGVHD合并肺部、中枢神经系统真菌感染.静脉剂型Bu组在肝脏毒性、口腔粘膜炎发生率分别明显低于口服组(13.3% vs.60.0%、6.7% vs.80.0%),差异均有统计学意义(P＜0.01),而在造血重建、aGVHD、胃肠道反应、出血性膀胱炎等方面差异均无统计学意义.结论:静脉剂型白消安组成的Bu/Cy方案作为白血病allo-PBSCT预处理,疗效确切且毒副作用降低.     

马利兰﹢氟达拉滨预处理异基因造血干细胞移植治疗白血病的临床研究

目的：探讨马利兰﹢氟达拉滨（ Bu/Flu）预处理方案异基因造血干细胞移植治疗白血病的临床疗效。方法：30例患者中,急性淋巴细胞白血病（ ALL）12例,急性髓系白血病（ AML）12例,其中1例为MDS转化,慢性粒细胞白血病（ CML）6例;其中急性白血病未缓解或复发状态下移植6例,CML加速期患者1例。供者干细胞为G-CSF动员后采集的HLA配型全相合或一个位点不合的同胞（21例）或非血缘（9例）外周血造血干细胞,有1例成人ALL患者接受HLA 配型相合的双份脐带血移植。预处理方案包括：注射用马利兰3.2mg/（kg·d）×3-4d,氟达拉滨30mg/（m2·d）×4-6d,同胞不全相合和非血缘移植患者加用兔抗人胸腺细胞免疫球蛋白（ATG）2.5mg/（kg·d）×3d。输注外周血单个核细胞数7.73（0.36-16.0）×108/kg,CD34﹢造血干细胞数3.26（0.77-17.6）×106/kg。用环孢素﹢短疗程甲氨喋呤或环孢素﹢吗替麦考酚酯预防移植物抗宿主病（ GVHD）。采用DNA短串联重复序列多态性（ STR）分析方法鉴定供者干细胞植入情况。结果：29例患者重建造血,检测外周血白细胞STR-DNA证实均为100％完全供者植入,1例非血缘全相合患者未植入于短期内死亡外,其余患者为完全供者型,植入率为96.7％。血缘相关HSCT和非血缘相关HSCT白细胞植活的中位时间分别为11（8-17）d和13（9-15）d;血小板植活的中位时间分别为13（7-22）d和14（8-25）d。出现急性GVHD 14例,占46.7％,其中I-II度10例（33.3％）,III-IV度者4例（13.3％）;6例发生慢性局限性GVHD,发生率为20.0％。随访1-66个月（中位时间20个月）,总体生存率（ OS）为63.3％,无事件生存率（ DFS）为51.7％。结论：Bu/Flu预处理方案移植治疗白血病相关并发症轻,有很好耐受性和较好疗效,是值得推广应用的预处理方案。     

Feasibility of autologous peripheral blood stem cell transplantation in elderly patients with acute myeloid leukemia

Most studies showing that autologous stem cell transplantation (ASCT) is feasible in older patients with acute myeloid leukemia (AML) referred to highly selected patients considered as eligible after complete remission (CR) achievement and bone marrow or peripheral blood stem cell (PBSC) collection. This study evaluated the feasibility of ASCT from 155 consecutive AML patients aged over 60 years (median age 72 years, range 61 - 94) programmed to receive ASCT by using PBSCs after CR achievement. Overall, 90 out of 155 patients (58%) were judged as eligible for aggressive chemotherapy and 45 (50%) achieved CR. Among these, 36 (80%) received consolidation and 32 (89% of consolidated) were monitored for PBSC mobilization. A successful collection was registered in 25/32 patients (78% of monitored). Finally, 20 patients received ASCT. Reasons for not autografting five mobilizing patients included relapse pre-ASCT, toxicity, and refusal. Median survival was 4 months for the whole patient population and 19 months for patients actually autografted. Overall, 20 out of 90 patients accrued into intensive chemotherapy (22%) and 20 out of the entire patient population (13%) underwent ASCT. It is concluded that APBSCT can result in an improvement of therapeutic results in AML of the elderly, but it is feasible in a minority of selected patients.     

氟达拉滨替代环磷酰胺的清髓性预处理化疗联合异基因造血干细胞移植治疗急性白血病的对照研究

目的 探讨氟达拉滨替代改良BuCy方案中环磷酰胺的预处理方案在异基因造血干细胞移植中的安全性及有效性.方法 对45例急性白血病患者进行异基因造血干细胞移植,其中23例采用改良BuCy预处理化疗,22例采用BuFlu方案（氟达拉滨每天40 mg/m2,用5d,来替代改良BuCy方案中的环磷酰胺）进行预处理化疗.移植均采用外周血造血干细胞移植.移植后观察比较两组预处理方案相关不良反应、植入、移植物抗宿主病（GVHD）、感染发生和长期随访下的无病生存情况.结果 除改良BuCy组1例患者死于预处理后脑出血,其余患者均获得成功植入.两组患者预处理不良反应发生率差异无统计学意义（P＞0.05）;BuFlu组患者病毒感染较改良BuCy组高（P=0.009）,而Ⅲ～Ⅳ度急性GVHD发生率较低[26.1％（6/23）比4.5％（1/22）,P=0.046].中位随访41个月,改良BuCy组非复发死亡4例（17.4％）,BuFlu组非复发死亡2例（9.1％）（P=0.665）.两组复发率分别为30.3％（7/23）和40.9％（9/22）（P=0.474）;5年总生存率分别为（55.1±l 1.9）％和（61.4±10.8）％（P=0.659）,无事件生存率分别为（44.5±12.1）％和（22.1±12.3）％（P=0.747）.结论 氟达拉滨替代改良BuCy方案中环磷酰胺的预处理化疗耐受性较好,严重GVHD发生率低,总生存率无明显差异.应用时应注意移植中感染及复发的风险.     

白消安联合氟达拉滨低毒预处理异基因造血干细胞移植治疗恶性血液病13例

 【摘要】　目的　探讨经白消安+氟达拉滨（Bu+Flu）方案低毒清髓预处理异基因造血干细胞移植（allo-HSCT）治疗恶性血液病的临床疗效。方法　对13例接受Bu+Flu方案预处理造血干细胞移植白血病患者的临床资料进行回顾性分析。预处理方案为Bu+Flu,同胞不全相合和非血缘移植患者加用兔抗人胸腺细胞免疫球蛋白（ATG）。用环孢素A+短疗程甲氨蝶呤或环孢素A+吗替麦考酚酯预防移植物抗宿主病（GVHD）。采用DNA短串联重复序列（STR）多态性分析方法鉴定供者干细胞植入情况。结果　13例患者均能耐受Bu+Flu预处理方案,未发生严重的预处理相关并发症。中性粒细胞植活中位时间11 d（9~15 d）,血小板植活中位时间13 d（8~25 d）。10例患者造血重建,检测其外周血白细胞STR-DNA证实均为100 %完全供者植入。出现急性GVHD 5例（38.5 %）,可评估的10例患者中,出现慢性GVHD 4例（40.0 %）;无Ⅱ度以上重型GVHD。中位随访11个月（1~39个月）,总生存率为76.9 %（10／13）,无病生存率为61.5%（8／13）。死亡病例原因均为疾病复发。结论　Bu+Flu方案低毒清髓预处理可减轻移植相关并发症,患者有很好耐受性和较好疗效。     

异基因外周血干细胞移植后外周血出现幼稚粒细胞与白血病复发的关系

目的了解异基因外周血干细胞移植（allo-PBSCT）后白血病复发与外周血幼稚粒细胞的关系。方法97例白血病患者经allo-PBSCT治疗,于14、30、60、90、120、180d及1年以后骨髓随访时同时观察外周血幼稚粒细胞出现情况,分析与白血病复发的关系。结果97例中,15例发生白血病复发。在30d及其以后外周出现幼稚粒细胞的57例中,复发14例,复发率24．6％,而30d及其以后外周血未出现幼稚粒细胞者的40例中仅有1例复发,复发率2．5％（P〈0．05）。复发与不复发者移植物抗宿主病（GVHD）差异无统计学薏：义（P〉0．05）。结论白血病复发与移植后外周血幼稚粒细胞有关．复发后治疗难度大,预后差。     

Allogeneic peripheral blood stem cell transplantation in acute non-lymphoblastic leukemia.

Unmodified allogeneic peripheral blood stem cell transplantation (alloPBSCT) was performed in 20 consecutive acute non-lymphoblastic leukemia (ANLL) patients from their HLA-identical siblings. There were 11 males and 9 females. Median age was 34 years (range 17-43). Donors were primed with 2.5-15 micrograms/kg/day s.c. granulocyte-colony stimulating factor (G-CSF, Neupogen, Roche). Conditioning regimen was Bu (16 mg/kg) + Cy (120 mg/kg) in 19 patients and high dose Ara-C (3 gr/m2 twice daily for 3 days) for one patient who relapsed after bone marrow transplantation. Eighteen patients were in CR1. CsA + short-term MTX (n = 19) or CsA alone (n = 1) were used for graft versus host disease (GVHD) prophylaxis. The median number of apheresis procedures for each patient was 2 (2-4). A median of 6.5 (3.2-38.2) x 10(8)/kg MNC or 9.4 (2.2-12.4) x 10(6)/kg CD34+ cells were given. Median days to reach granulocyte of > 0.5 x 10(9)/l and platelet of > 50 x 10(9)/l were 12 (10-14) and 15 (11-35) respectively. Day 100 transplant-related mortality was 20 per cent (4/20). Grade 2 to 4 AGVHD was seen in 8 out of 17 (47%) evaluable patients. Severe AGVHD occurred in 3 out of 17 (18%). Clinical CGVHD of all grades developed in 12 out of 17 (70%) evaluable patients. The mean disease-free survival and overall survival were 17 (range: 8-33 months) and 18 months (range: 10-34 months), respectively. In conclusion, alloPBSCT in ANLL is associated with a faster engraftment, no greater incidence of AGVHD, but increased risk of CGVHD.     

Multicenter randomized phase II trial of idarubicin vs mitoxantrone, combined with VP-16 and cytarabine for induction/consolidation therapy, followed by a feasibility study of autologous peripheral blood stem cell transplantation in elderly patients with acute myeloid leukemia.

To compare the antileukemic efficacy of idarubicin and mitoxantrone in elderly patients with acute myeloid leukemia (AML) and to evaluate the feasibility of autologous transplantation using PBSC after consolidation in those with a good performance status, 160 patients (median age 69 years), with AML at diagnosis, 118 of them with de novo AML and 42 with AML secondary to myelodysplastic syndrome or toxic exposure (sAML), received induction treatment with idarubicin, 8 mg/m2/day or mitoxantrone, 7 mg/m2/day, on days 1, 3, and 5, both combined with VP-16, 100 mg/m2/day on days 1 to 3 and cytarabine (araC), 100 mg/m2/day, on days 1 to 7. G-CSF, 5 microg/kg/day, was administered after chemotherapy in patients aged more than 70 years. Patients in complete remission (CR) received one course of consolidation using the same schedule as for induction except the araC administration was shortened to 5 days. Some patients younger than 70 years were then scheduled for autologous stem cell harvest on days 5 to 7 of G-CSF, 5 microg/kg/day, initiated after hematopoietic recovery from consolidation. Autologous transplantation was performed following an additional chemotherapy conditioning. Ninety-five patients (59%) achieved CR, without significant difference between the idarubicin (56% CR) and mitoxantrone (63% CR) group. There was also no significant difference in CR rate between de novo AML (63%) and secondary AML (55%) (P = 0.12). Patients aged < 70 years had 67% CR, while patients aged > or = 70 years had 49% (P = 0.02). There was no significant difference in the duration of aplasia between the two arms. Median time to neutrophil recovery was 22 days in patients who received G-CSF following induction and 27 days in patients who did not (P = 0.006). Severe extrahematologic toxicities of induction did not differ between the two arms and included sepsis (39%), diarrhea (13%), hyperbilirubinemia (8%), hemorrhage (6%) and vomiting (6%). Overall, 14 patients (9%), died from toxicity of induction. First consolidation was administered in 74 patients of whom seven (9%) died from toxicity. Nineteen patients have received transplantation. Median time to recovery of neutrophils > 0.5 x 10(9)/l was 13 days and of platelets > 50 x 10(9)/l 43 days following consolidation. There were two toxic deaths. Median disease-free survival and survival from time of achieving CR of non transplanted patients are 6 and 7 months respectively without difference between the two arms. Fourteen transplanted patients relapsed at a median of 5 months post-transplant. We conclude that this regimen is well tolerated and has a good efficacy to induce CR, without a significant difference in efficacy and toxicity between idarubicin and mitoxantrone. Intensive postinduction, including transplantation, is feasible; however, this procedure did not seem to prevent early relapse in the majority of patients. Neither the high rate of CR nor consolidation nor transplant procedure in a selected group of patients did translate into improved DFS and/or survival.     

异基因造血干细胞移植两种预处理方案的比较

背景与目的:预处理方案是造血干细胞移植成功的关键因素之一。本研究的目的是比较异基因造血干细胞移植两种预处理方案治疗白血病的优缺点。方法:21例采用白消安(busulfan,BU)16mg/kg加环磷酰胺(cyclophosphamide,CY)120mg/kg方案(BU/CY组);23例采用全身照射(totalbodyirradiation,TBI)7.5～8.5Gy加CY120mg/kg方案(TBI/CY组)。结果:BU/CY组和TBI/CY组3年无病生存率分别为61.5%与64.7%,复发率分别为23.8%与26.0%,两者差异无显著性(P>0.05)。BU/CY组肝脏毒性发生率高于TBI/CY组,分别为80.9%与54.3%(P<0.05),均无发生肝静脉闭塞病。BU/CY组口腔和胃肠道毒性发生率(33.3%与42.9%)则明显低于TBI/CY组(78.2%与78.2%)(P<0.05);膀胱和肺毒性的发生率两组相似,前者为23.8%与26.0%,后者为14.3%与13.0%(P>0.05),但TBI/CY组发生1例致死性的Ⅳ级肺毒性。两组均未发生心脏、肾和中枢神经系统不良反应。结论:BU/CY组疗效与TBI/CY组相当。BU/CY组预处理方案易于实施,患者耐受好,髓外毒性低。     

Comparison of allogeneic stem cell transplantation,high-dose cytarabine,and autologous peripheral stem cell transplantation as postremission treatment in patients with de novo acute myelogenous leukemia

BACKGROUND: Postremission therapy is critical in maintaining complete remission (CR) in patients with de novo acute myelogenous leukemia (AML). The aim of this trial was to compare allogeneic stem cell transplantation (SCT), high-dose cytarabine (ara-C; HiDAC), and autologous SCT as postremission therapy in patients with de novo AML. METHODS: One hundred twenty patients age 相似文献   

以IMAC预处理方案的自体外周血干细胞移植治疗急性髓细胞白血病的临床观察

 目的　应用IMAC预处理方案观察自体外周血干细胞移植（APBSCT）治疗急性髓细胞白血病（AML）的疗效。方法　用APBSCT治疗AML 14例。预处理方案：IMAC。结果　全部病例移植后造血重建,目前无病生存8例（57.1 %）,平均生存时间26（8～72）个月,无移植相关性死亡。结论　IMAC预处理方案对AML是安全和有效的方案,预处理方案加入去甲氧柔红霉素有望提高总生存期。     

Early diagnosis followed by front-line autologous peripheral blood stem cell transplantation for patients affected by POEMS syndrome

The acronym POEMS refers to polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes. This disease is progressive and weakening for patients and lead to death generally for neurological problem without therapy. We treated four patients affected by POEMS syndrome with front-line chemotherapy and autologous peripheral blood stem cell transplantation (aPBSCT). After a median follow-up of 40.5 months (range 12–52), all patients are alive with slow but progressive improvement in neurological disease, skin changes, performance status and without evidence of clonal plasmacytosis and organomegaly. In conclusion early diagnosis is crucial to obtain best response and improve clinical outcome.     

Immune reconstitution after allogeneic stem cell transplantation with reduced-intensity conditioning regimens.

Reduced-intensity conditioning (RIC) regimens have been increasingly used as an alternative to conventional myeloablative conditioning (MAC) regimens for elderly patients, for patients medically infirm to qualify for conventional allogeneic stem cell transplantation (SCT), and for disorders in which traditional MAC-SCT are associated with high rates of non-relapse mortality. One of the theoretical advantages of RIC-SCT is that it might lend to better immune reconstitution after transplantation due to less damage of the thymus, allowing regeneration of naive T cells derived from prethymic donor stem cells, and due to the proliferation of immunologically competent host T cells that survive the conditioning regimen. Although limited, studies comparing immune recovery following RIC and MAC-SCT have been insightful. One of the main difficulties of these studies is the current spectrum of RIC protocols, which vary considerably in myeloablative and immunosuppressive potential, resulting in apparently contradictory findings. In spite of this, most reports have shown significant quantitative and/or qualitative differences in T- and B-cell reconstitution after RIC-SCT in comparison with conventional SCT. This paper will review current knowledge of immune reconstitution following RIC-SCT.     

Rare myeloid sarcoma/acute myeloid leukemia with adrenal mass after allogeneic mobilization peripheral blood stem cell transplantation

Myeloid sarcoma （MS） is a rare hematological neoplasm that develops either de novo or concurrently with acute myeloid leukemia （AML）. This neoplasm can also be an initial manifestation of relapse in a previously treated AML that is in remission. A 44-year-old male patient was diagnosed with testis MS in a local hospital in August 2010. After one month, bone marrow biopsy and aspiration confirmed the diagnosis ofAML. Allogeneic mobilization peripheral blood stem cell transplantation was performed, with the sister of the patient as donor, after complete remission （CR） was achieved by chemotherapy. Five months after treatment, an adrenal mass was detected by positron emission tomography-computed tomography （PET-CT）. Radiotherapy was performed for the localized mass after a multidisciplinary team （MDT） discussion. The patient is still alive as of May 2013, with no evidence of recurrent MS or leukemia.