Analysis of the efficacy of autologous peripheral blood stem cell transplantation in high-risk neuroblastoma

Objective: This study aimed to analyze the efficacy of autologous peripheral blood stem cell transplantation for high-risk neuroblastoma in China.Methods: The data of 90 high-risk neuroblastoma patients treated with the CCCG-NB 2015 regimen were reviewed. The baseline clinicopathological characteristics and prognosis were analyzed and compared. In addition, the prognoses of tandem autologous stem cell transplantation and single autologous stem cell transplantation groups were compared.Results: The results of survival analysis showed that autologous peripheral blood stem cell transplantation based on this pretreatment regimen significantly improved the prognosis of children in the high-risk group. The 3-year event-free survival (EFS) and overall survival (OS) rates for the transplantation group and the nontransplantation group were 65.5% vs. 41.3% (p=0.023) and 77.1% vs. 57.9% (p=0.03), respectively. There was no difference in the distribution of baseline clinical case characteristics between the single transplantation group and the tandem transplantation group (p>0.05), and there was no significant difference in EFS and OS between the two groups (p>0.05).Conclusion: Based on this pretreatment programme, autologous peripheral blood stem cell transplantation is safe and tolerable and significantly improves the prognosis of children in the high-risk group. The value of tandem autologous stem cell transplantation is worthy of further discussion, which should consider various aspects such as the transplantation medication regimen and the patient''s state.     

Hematologic Recovery after Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Children with High-Risk Solid Tumors

Although the number of studies using tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/autoSCT) for the treatment of high-risk pediatric solid tumors has been increasing, documentation of hematologic recovery after tandem HDCT/autoSCT is very limited. For this reason, we retrospectively analyzed the hematologic recovery of 236 children with high-risk solid tumors who underwent tandem HDCT/autoSCT. The median numbers of CD34⁺ cells transplanted during the first and second HDCT/autoSCT were 4.3 × 10⁶/kg (range 0.6-220.2) and 4.1 × 10⁶/kg (range 0.9-157.6), respectively (P = 0.664). While there was no difference in neutrophil recovery between the first and second HDCT/autoSCT, platelet and RBC recoveries were significantly delayed in the second HDCT/autoSCT (P < 0.001 and P < 0.001, respectively). Delayed recovery in the second HDCT/autoSCT was more prominent when the number of transplanted CD34⁺ cells was lower, especially if it was < 2 × 10⁶/kg. A lower CD34⁺ cell count was also associated with increased RBC transfusion requirements and a higher serum ferritin level after tandem HDCT/autoSCT. More CD34⁺ cells need to be transplanted during the second HDCT/autoSCT in order to achieve the same hematologic recovery as the first HDCT/autoSCT.     

Optimal Time to Start Peripheral Blood Stem Cell Collection in Children with High-Risk Solid Tumors

In order to clarify the optimal timing for peripheral blood stem cell (PBSC) collection, PBSC collection records of 323 children who were scheduled to undergo autologous stem cell transplantation from two study periods differing in the timing of PBSC collection were analyzed. In the early study period (March 1998 to August 2007, n=198), PBSC collection was initiated when the peripheral WBC count exceeded 1,000/µL during recovery from chemotherapy. Findings in this study period indicated that initiation of PBSC collection at a higher WBC count might result in a greater CD34⁺ cell yield. Therefore, during the late study period (September 2007 to December 2012, n=125), PBSC collection was initiated when the WBC count exceeded 4,000/µL. Results in the late study period validated our conclusion from the early study period. Collection of a higher number of CD34⁺ cells was associated with a faster hematologic recovery after transplant in the late study period. Initiation of PBSC collection at WBC count > 4,000/µL was an independent factor for a greater CD34⁺ cell yield. In conclusion, PBSC collection at a higher WBC count is associated with a greater CD34⁺ cell yield, and consequently a faster hematologic recovery after transplant.     

Poor outcomes for IgD multiple myeloma patients following high-dose melphalan and autologous stem cell transplantation: a single center experience

Immunoglobulin (Ig) D multiple myeloma (MM) accounts for 2% of all MM cases and has been reported to be associated with poor prognosis compared with other MM subtypes. The aim of the present study was to compare the effects of high-dose melphalan treatment and autologous stem cell transplantation (ASCT) on the survival of patients with IgD MM and patients with other MM subtypes. Between November 1998 and January 2005, a total of 77 patients with MM who underwent ASCT at the Asan Medical Center were enrolled in this study. High-dose melphalan (total 200 mg/m2) was used as high-dose chemotherapy. The study population was divided into two groups based on MM subtype: those with IgD MM; and those with other MM subtypes. A total of 8 patients with IgD MM were identified, accounting for about 10% of the study population. Thirty-six patients (47%) had IgG MM, 17 patients (22%) had IgA MM, and 16 patients (20%) had free light-chain MM. The two groups were similar in baseline characteristics. The median follow-up was 17 months and the median overall survival (OS) was 39 months. In the IgD MM group, median eventfree survival (EFS) and OS were 6.9 and 12 months, respectively. In the patients with other MM subtypes, median EFS and OS were 11.5 and 55.5 months (p=0.01, p<0.01), respectively. Multivariate analysis of all patients identified IgD subtype (p=0.002) and Southwest Oncology Group (SWOG) stage 2 or greater at the time of ASCT (p=0.01) as adverse prognostic factors for survival. In this small study at a single center in Korea, patients with IgD MM had poorer outcomes after ASCT than did patients with other MM subtypes.     

Tandem high-dose chemotherapy and autologous stem cell transplantation in young children with atypical teratoid/rhabdoid tumor of the central nervous system

The feasibility and effectiveness of tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/autoSCT) were evaluated in children younger than 3 yr of age with atypical teratoid/rhabdoid tumors (ATRT). Tandem HDCT/autoSCT was administered following six cycles of induction chemotherapy. Radiotherapy (RT) was administered if the tumor relapsed or progressed, otherwise, it was administered after 3 yr of age. Tumors relapsed or progressed during induction chemotherapy in 5 of 9 patients enrolled; 3 of these 5 received tandem HDCT/autoSCT as a salvage treatment. One patient died from sepsis during induction chemotherapy. The remaining 3 patients proceeded to tandem HDCT/autoSCT; however, 2 of these patients showed tumor relapse/progression after tandem HDCT/autoSCT. All 7 relapses/progressions occurred at primary sites even in patients with leptomeningeal seeding. Toxicities during tandem HDCT/autoSCT were manageable. A total of 5 patients were alive with a median follow-up of 20 (range 16-70) months from diagnosis. Four of 5 patients who received RT after relapse/progression are alive. The probability of overall survival at 3 yr from diagnosis was 53.3% ± 17.3%. Our tandem HDCT/autoSCT is feasible; however, early administration of RT prior to tandem HDCT/autoSCT should be considered to improve the outcome after tandem HDCT/autoSCT.     

Clinical results of high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation in children with advanced stage rhabdomyosarcoma

Regardless of improvement in cure of Rhabdomyosarcoma (RMS), the results in treatment of advanced stage of RMS in children are still dismal. Recently, high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (HDC/APBSCT) has been tried to manage the advanced high-risk RMS patients. We investigated the effectiveness of HDC/APBSCT by reviewing the clinical records of high-risk pediatric RMS patients in single institute database. Over twenty years, 37 patients were diagnosed as RMS with high-risk at the time of first diagnosis. These patients were classified as two groups according to treatment method. The first group was HDC/APBSCT and the other was conventional multi-agent chemotherapy group. Differences of clinical results between the two groups were analyzed. The median age of patients was 5 yr, ranging from 6 months to 15 yr. The 5-yr event free survival rate (EFS) of all patients was 24.8% ± 4.8%. HDC/APBSCT group and conventional multi-agent chemotherapy group were 41.3% ± 17.8% and 16.7% ± 7.6% for 5-yr EFS, respectively (P = 0.023). There was a significant difference in the result of HDC/APBSCT between complete remission or very good partial response group and poor response group (50% ± 20.4% vs 37.5% ± 28.6%, P = 0.018). HDC/APBSCT can be a promising treatment modality in high-risk RMS patients.     

High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Children with High-Risk or Recurrent Bone and Soft Tissue Sarcomas

Despite increasing evidence that high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) might improve the survival of patients with high-risk or recurrent solid tumors, therapy effectiveness for bone and soft tissue sarcoma treatment remains unclear. This study retrospectively investigated the feasibility and effectiveness of HDCT/auto-SCT for high-risk or recurrent bone and soft tissue sarcoma. A total of 28 patients (18 high-risk and 10 recurrent) underwent single or tandem HDCT/auto-SCT between October 2004 and September 2014. During follow-up of a median 15.3 months, 18 patients exhibited disease progression and 2 died of treatment-related toxicities (1 veno-occlusive disease and 1 sepsis). Overall, 8 patients remained alive and progression-free. The 3-year overall survival (OS) and event-free survival (EFS) rates for all 28 patients were 28.7% and 26.3%, respectively. In the subgroup analysis, OS and EFS rates were higher in patients with complete or partial remission prior to HDCT/auto-SCT than in those with worse responses (OS, 39.1% vs. 0.0%, P = 0.002; EFS, 36.8% vs. 0.0%, P < 0.001). Therefore, careful selection of patients who can benefit from HDCT/auto-SCT and maximal effort to reduce tumor burden prior to treatment will be important to achieve favorable outcomes in patients with high-risk or recurrent bone and soft tissue sarcomas.     

Double high-dose chemotherapy with autologous stem cell transplantation in patients with high-risk neuroblastoma: a pilot study in a single center

Double high-dose chemotherapy (HDCT) was applied to 18 patients with highrisk neuroblastoma including 14 patients who could not achieve complete response (CR) even after the first HDCT. In 12 patients, successive double HDCT was rescued with peripheral blood stem cells collected during a single round of leukaphereses and in 6 patients, second or more rounds of leukaphereses were necessary after the first HDCT to rescue the second HDCT. The median interval between the first and second HDCT (76 days; range, 47-112) in the single harvest group was shorter than that (274.5 days; range, 83-329) in the double harvest group (p<0.01). Hematologic recovery was slow in the second HDCT. Six (33.3%) treatment-related mortalities (TRM) occurred during the second HDCT but were not related to the shorter interval. Disease-free survival rates at 2 years with a median follow-up of 24 months (range, 6-46) in the single and double harvest group were 57.1% and 33.3%, respectively. These results suggest that successive double HDCT using the single harvest approach may improve the survival of high-risk patients, especially who could not achieve CR after the first HDCT despite delayed hematologic recovery and high rate of TRM during the second HDCT.     

Oral mucositis in patients with leukaemia following high-dose chemotherapy and autologous haematopoietic stem cells transplantation

Historically, oral mucositis (OM) has been identified as a symptom developing in patients undergoing irradiation due to head and neck cancers, those undergoing therapy in preparation for a stem cell transplant, or receiving special therapeutic protocols due to acute myeloid leukaemia. It results from direct toxic injury to the mucosal epithelial cells by the immunosuppressive regimen. In this article we want to describe pathogenesis, diagnostic and actual possibility of treatment of OM. The literature reports several rating scale for OM that have been used for patients undergoing cancer therapy. The most useful of them are Oral Toxicity Scale and Oral Mucositis Assessment Scale. In the prevention and treatment of OM associated with standard chemotherapy various drugs and agents acting locally and systemically are used. Many of them are still remaining in the course of research.     

The risk of cytomegalovirus infection in non-myeloablative peripheral stem cell transplantation compared with conventional bone marrow transplantation

Non-myeloablative allogeneic peripheral stem cell transplantation (NST) is a novel therapeutic strategy for patients with hematologic malignancies. Whether non-myeloablative transplants are associated with increased risk of cytomegalovirus (CMV) infections is unknown. To clarify this issue, we compared the outcome of CMV infection following 24 allogeneic non-myeloablative peripheral blood stem cell transplants and 40 conventional bone marrow transplants (CBT). The NST regimen consisted (mg/kg). Twelve patients (50%) in the NST group and 17 (43%) in the CBT group developed positive antigenemia before day 100 (p=0.60). The time to the first appearance of positive antigenemia was not different between these two groups (p=0.40), and two groups showed similar initial and maximal antigenemia values (p=0.56 and p=0.68, respectively). Only one case of CMV colitis developed in the CBT group whereas CMV disease did not develop in the NST group. Although statistically insignificant, the treatment response against CMV antigenemia using ganciclovir was in favor of NST group. In conclusion, there was no difference in the risk of CMV infection between NST group and CBT group. Further prospective and controlled study is needed to clarify the impact of non-myeloablative procedure on the outcome of CMV infection.     

骨髓间充质干细胞在致敏与非致敏BALB/c小鼠造血干细胞移植中的应用

背景：造血干细胞移植对多种疾病具有治疗作用,但其取材不便,且细胞数量受年龄限制等原因,故而应用具有一定局限性。 目的：探索骨髓间充质干细胞在致敏与非致敏BALB/c小鼠造血干细胞移植中的应用价值。 方法：将BALB/c小鼠骨髓细胞在体外进行分离,采用贴壁培养的方法获得间充质干细胞,使用流式细胞仪对细胞表面的分子标记进行检测。应用异基因脾细胞输注方法建立致敏动物模型,用绿色荧光染料标记骨髓间充质干细胞,分别移植到致敏和非致敏的受体小鼠体内,并在移植后的不同时间点对间充质干细胞的归巢情况进行检测。对致敏BALB/c小鼠进行照射预处理,联合应用异基因骨髓细胞与同基因间充质干细胞移植,观察BALB/c小鼠的生存情况。 结果与结论：移植48 h后,间充质干细胞在致敏受体和非致敏受体小鼠分别归巢于脾脏和骨髓。在造血干细胞的移植实验中,致敏BALB/c小鼠接受异基因骨髓细胞与同基因骨髓间充质干细胞联合移植,结果显示致敏BALB/c小鼠全部在移植后12-15 d死亡,生存的中位时间是14 d,而仅接受异基因骨髓细胞移植的致敏BALB/c小鼠的中位生存时间为13 d。说明细胞移植后在致敏受体内间充质干细胞主要归巢为脾脏和骨髓,联合应用间充质干细胞移植对异基因造血干/祖细胞植入致敏受体体内并没有起到有效的促进作用。 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

脂肪间充质干细胞移植后肝硬化大鼠血生化指标的变化

BACKGROUND:Stem cell transplantation is a promising treatment of advanced liver disease, and adipose-derived mesenchymal stem cells have become another kind of popular cells following bone marrow mesenchymal stem cells. OBJECTIVE:To investigate the influence of adipose-derived mesenchymal stem cell transplantation on blood biochemical indices of liver cirrhosis rats. METHODS:Sixty rats were equally randomized into normal control, model and cell transplantation groups. Model rats of liver cirrhosis were made in the latter two groups through intragastric administration of carbon tetrachloride. One week after successful modeling, rats were given intraperitoneal injection of adipose-derived mesenchymal stem cell suspension in the cell transplantation group, and given normal saline in the other two groups. RESULTS AND CONCLUSION:Compared with the normal control group, the model group showed a significant increase in the levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin, total protein in liver tissues, serum level of malondialdehyde, 15-minute indocyanine green retention rate and degree of hepatic fibrosis, and a significant decrease in serum albumin level, serum albumin/globulin, levels of glutathione peroxidase and cyclic guanosine monophosphate in liver tissues. On the contrary, these indicators were all improved in the cell transplantation group compared with the model group. Moreover, CM-Dil-positive cells were visible in the liver tissue of rats undergoing adipose-derived mesenchymal stem cell transplantation. All these findings indicate that adipose-derived mesenchymal stem cell transplantation can reduce liver cirrhosis in rats by acting on blood biochemistry levels.     

造血干细胞移植：受者的心理特点及心理支持

背景：造血干细胞移植是治疗各类白血病、淋巴瘤等血液系统疾病的主要手段,移植过程存在着许多影响治疗效果的负性因素,对于患者能够顺利完成造血干细胞移植有着重要的影响。 目的：分析造血干细胞移植患者心理特点,重点评价心理干预实施效果。 方法：2012年1月至2013年12月造血干细胞移植中心共收治患者92例,多数患者均实施过自体外周血干细胞移植,接受异体干细胞移植55例,其中同胞48例,非血缘外周血造血干细胞移植7例,部分行骨髓抑制或复合移植。针对移植过程中不同阶段负性因素的特点,实施心理支持、并发症预防观察与处理、全环境保护方案等干预措施。 结果与结论：所有患者造血干细胞移植均获得成功,遵医行为良好,未出现心理应激、情绪失控、破坏物品等不良事件,服药依从性、饮食依从性、作息依从性均良好。2012年与2013年并发症发生率、不良事件发生率、患者满意率差异无显著性意义(P > 0.05)。由于造血干细胞移植具有较强的特殊性,患者需要严格的治疗路径,留置层流病房较长,行为严重受限,承受较大的心理、生理负担,应严格落实无菌标准,加强病区管理,做好患者指导、支持工作,减少移植并发症发生,使移植能够顺利完成。中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程全文链接：     

Changes in renal function after different tandem hematopoietic stem-cell transplantation approaches in patients with multiple myeloma

This study was done to observe the alteration of the estimated glomerular filtration rate (eGFR) in multiple myeloma patients according to type of tandem hematopoietic stem cell transplantation (HSCT). Forty-one patients were enrolled in this study. Twenty patients underwent autologous HSCT (auto-HSCT) and 21 patients underwent allogeneic HSCT (allo-HSCT). The changes in eGFR after the two tandem HSCT modalities were different between the two groups, according to the donor of stem cells (P = 0.016). In the auto-HSCT group, the eGFR, recorded 12 months after secondary HSCT, was significantly decreased compared with the eGFR recorded before stem cell mobilization (P = 0.005). Although there was no significant difference, the trend showed that the eGFR after allo-HSCT decreased from the previous HSCT until a month after secondary HSCT. In addition, after 6 months of secondary HSCT, the eGFR recovered to the level recorded prior to the HSCT (P = 0.062). This difference may be due to total body irradiation, a calcineurin inhibitor, or maintenance therapy. Changes in renal function would be monitored closely for these patients. The recovery of the eGFR would be a main focus for the patients treated with the total body irradiation or the calcineurin inhibitor, a progressive decline of the eGFR would be also crucial for the patients treated with maintenance therapy.     

胚胎来源肝干细胞肝内移植后在小鼠体内的分布及分化

BACKGROUND:As many factors can lead to liver injury, we attempt to use the “therapeutic liver regeneration” technology in clinical treatment of liver diseases by promoting liver regeneration. OBJECTIVE:To investigate distribution and differentiation of embryonic liver stem cells in mice after intrahepatic transplantation via a transplantation approach. METHODS:Liver injury models were prepared in 20 BALB/c mice, and then randomly equivalently assigned into two groups: 70% partial hepatectomy with intrahepatic transplantation with 1×10⁵ embryonic liver stem cells in control group; therapeutic liver regeneration model plus intrahepatic transplantation with 1x10⁵ embryonic liver stem cells in observation group. At 1 and 2 weeks after cell transplantation, the liver parenchyma of mice was observed. And at 2 weeks, both of the two groups underwent confocal immunofluorescence assay. Besides, blood samples of mouse tail vein were collected to detect levels of serum albumin. RESULTS AND CONCLUSION:At 1 week after cell transplantation, in the liver parenchyma, green fluorescence was sparsely distributed in the two groups, and the distribution density had no significant difference between the two groups; at 2 weeks after cell transplantation, hepatic cord-like structures appeared in the liver parenchyma of two groups, and the green fluorescence distribution in the control group was limited, but significantly expanded in the observation group. At 2 weeks after cell transplantation, positive albumin expression in the liver parenchyma was significantly higher in the observation group than in the control group, and there was no significant difference in levels of serum albumin between two groups (P > 0.05). To conclude, after transplantation of embryonic liver stem cells in the therapeutic liver regeneration model mice hepatocytes can be effectively integrated into the host hepatic plate, differentiate in the liver, and partially trigger the function of hepatocytes.     

Clinical characteristics and outcomes of posttransplant lymphoproliferative disorders following allogeneic hematopoietic stem cell transplantation in Korea

Between 1995 and 2003, seven cases of posttransplant lymphoproliferative disorder (PTLD) were identified among 1,116 patients who received allogeneic hematopoietic stem cell transplantations (HSCT) at Catholic HSCT Center (overall incidence 0.6%). Five (71.4%) patients had episodes of acute graft-versus-host-disease (GVHD) and were treated with steroids. Cervical lymphadenopathy was observed in most cases (71.4%), but clinical symptoms varied depending on the involved sites. Pathologic findings varied: 1 case of plasmacytic hyperplasia, 3 of polymorphic PTLD, 2 of diffuse large B-cell lymphoma, 1 of large T-cell lymphoma, which proved to be associated with Epstein-Barr virus (EBV). The proportion of EBV-negative PTLD was 33.3%. Five patients demonstrated a good response to treatment (treatment response rate 71.4%). The overall mortality was 42.8%, and one death was directly attributable to PTLD. The incidence of PTLD is expected to increase, based on the rising use of grafts from alternative donors and recent clinical features of PTLD manifested by a disseminated and fulminant nature. It is necessary to have a high level of suspicion when monitoring patients and readily adopt prompt and effective cellular immunotherapy for PTLD.     

脐带间充质干细胞移植对不同证型系统性红斑狼疮患者的效果分析

背景：系统性红斑狼疮按中医辨证分为热毒炽盛等4个症型,治疗以补肾养阴,清化淤毒为主,但仍有许多患者治疗效果不佳。间充质干细胞具有多向分化、造血支持和免疫调节的功能,目前已有多项研究用于治疗难治性、复发性系统性红斑狼疮,取得良好疗效。目的：探讨脐带间充质干细胞移植对不同证型系统性红斑狼疮患者的疗效。方法：系统性红斑狼疮患者21例,经中医辨证分成热毒炽盛证、肝肾阴虚证、脾肾阳虚证及气滞血瘀证4型,分别统计患者脐带间充质干细胞移植前后各型的临床及实验室指标变化。结果与结论：脐带间充质干细胞移植1,3,6个月均可有效减少系统性红斑狼疮患者实验尿蛋白含量,降低系统性红斑狼疮疾病活动指数评分(P < 0.01)。与移植前比较,移植脐带间充质干细胞后1,3,6个月可显著减少肝肾阴虚型患者尿蛋白含量(P < 0.01),移植后1,3个月对热毒炽盛及气滞血瘀型尿蛋白含量为轻度减少(P < 0.05),脾肾阳虚型患者在植后1个月时的尿蛋白含量轻度减少(P < 0.05)。脐带间充质干细胞移植可提高所有中医分型患者的血浆白蛋白含量(P < 0.01),其中对热毒炽盛型效果稍差(P < 0.05)。脐带间充质干细胞移植后各型患者外周血血小板有上升趋势,但与移植前相比差异无显著性意义。结果说明,脐带间充质干细胞移植治疗系统性红斑狼疮有效,对不同症型的系统性红斑狼疮患者的疗效有一定的差异。 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

Central pontine myelinolysis in a patient with acute lymphoblastic leukemia after hematopoietic stem cell transplantation: a case report

We describe a 37-yr-old man who developed central pontine myelinolysis (CPM) after allogeneic hematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukemia. After HSCT, desquamation developed on the whole body accompanied by hyperbilirubinemia. The liver biopsy of the patient indicated graft-versus-host disease- related liver disease, and the dose of methylprednisolone was increased. Then, the patient developed altered mentality with eye ball deviation to the left, for which electroencephalogram and magnetic resonance imaging (MRI) scans were done. Brain MRI scan demonstrated the imaging findings consistent with central pontine myelinolysis and extrapontine myelinolysis. He did not have any hyponatremia episode during hospitalization prior to the MRI scan. To the best of our knowledge, presentation of CPM after allogeneic HSCT is extremely rare in cases where patients have not exhibited any episodes of significant hyponatremia. We report a rare case in which hepatic dysfunction due to graft-versus-host disease has a strong association with CPM after HSCT.     

脐血干细胞移植干预妊娠期高血压模型大鼠的作用

BACKGROUND:With the depth understanding of mesenchymal stem cells, mesenchymal stem cells are found to exert a prominent effect on immune regulation and anti-inflammation. OBJECTIVE:To investigate the therapeutic effect of umbilical cord blood stem cell transplantation on endotoxin-induced hypertension in pregnant rats. METHODS:Twenty-four pregnant Sprague-Dawley rats were randomized into three groups with eight rats in each group: control, model and experimental groups. Endotoxin-induced hypertension models were made in the model and experimental groups. Meanwhile, rats were given intravenous injection of umbilical cord blood stem cell suspension (1 mL) in the experimental groups and the same volume of normal saline in the control and model groups. Therapeutic effects of umbilical cord blood stem cell transplantation were observed through detection of systolic blood pressure, urine protein level, serum white blood cell quantity and Ang II and ET-1 expression. RESULTS AND CONCLUSION:Compared with the control group, the systolic blood pressure, urine protein level and serum white blood cell quantity of rats were increased significantly in the model group, and over time, endotoxin continuously promoted these parameters in the model group. After cell transplantation, a significant reduction in systolic blood pressure, urine protein level and serum white blood cell quantity of rats was found in the experimental group compared with the model group (P < 0.05). After modeling, the expression levels of Ang II and ET-1 were decreased significantly, while these levels were increased significantly after cell transplantation (P < 0.05). These findings indicate that umbilical cord blood stem cell transplantation may have a certain therapeutic effect on gestational hypertension in rats, which may be realized by regulating the secretion of endothelial injury-related factors.     

Allogeneic stem cell transplantation for patients with advanced hematological malignancies: comparison of fludarabine-based reduced intensity conditioning versus myeloablative conditioning

We compared the outcomes of allogeneic hematopoietic stem cell transplantation using reduced intensity and myeloablative conditioning for the treatment of patients with advanced hematological malignancies. A total of 75 adult patients received transplants from human leukocyte antigen-matched donors, coupled with either reduced intensity (n=40; fludarabine/melphalan, 28; fludarabine/cyclophosphamide, 12) or myeloablative conditioning (n=35, busufan/cyclophosphamide). The patients receiving reduced intensity conditioning were elderly, or exhibited contraindications for myeloablative conditioning. Neutrophil and platelet engraftment occurred more rapidly in the reduced intensity group (median, 9 days vs. 18 days in the myeloablative group, p<0.0001; median 12 days vs. 22 days in the myeloablative group, p=0.0001, respectively). Acute graft-versus-host disease (>or=grade II) occurred at comparable frequencies in both groups, while the incidence of hepatic veno-occlusive disease was lower in the reduced intensity group (3% vs. 20% in the myeloablative group, p=0.02). The overall 1-yr survival rates of the reduced intensity and myeloablative group patients were 44% and 15%, respectively (p=0.16). The results of present study indicate that patients with advanced hematological malignancies, even the elderly and those with major organ dysfunctions, might benefit from reduced intensity transplantation.