Ph染色体阳性白血病患者经伊马替尼治疗后行异基因造血干细胞移植的疗效观察

目的探讨Ph染色体阳性白血病患者经伊马替尼治疗后行异基因造血干细胞移植的疗效。方法回顾性分析2001年6月至2005年6月北京大学人民医院血液病研究所住院的难治性Ph染色体阳性的39例白血病患者经伊马替尼治疗后再行异基因造血干细胞移植的效果,观察伊马替尼对造血重建、移植物抗宿主病(GVHD)、总存活率(OS)、无病存活率(DFS)、复发率和移植相关并发症的影响。结果伊马替尼治疗后,18例患者血液学完全缓解,9例骨髓缓解,4例部分缓解,4例无效或疾病进展,总有效率79.49%,无重度非血液学毒性反应;移植后中性粒细胞和血小板植活中位时间分别为14d和13.5d;Ⅱ~Ⅳ度和Ⅲ~Ⅳ度急性GVHD累积发生率分别为61.53%和15.38%;根据对伊马替尼治疗的效应分为完全缓解组和未完全缓解组,其3年预期OS和DFS分别为(73.51±9.61)%对(36.36±14.50)%和(61.28±12.37)%对(31.25±13.98)%,3年累积复发率为20.41%对75.00%;4例患者死于重度移植相关并发症。结论应用伊马替尼后行异基因造血干细胞移植是一种安全、有效的治疗难治性Ph染色体阳性白血病的方法,尤其达完全缓解后行移植,可望提高此类患者的临床治愈率。     

含克拉屈滨强化预处理方案异基因造血干细胞移植治疗第一次完全缓解期急性白血病的疗效和安全性观察

目的 观察含克拉屈滨强化预处理方案异基因造血干细胞移植(allo-HSCT)治疗第一次完全缓解期(CR₁)急性白血病(AL)的疗效和安全性。方法 回顾性分析2021年6月至2023年8月在广西壮族自治区人民医院血液内科移植中心接受含克拉屈滨强化预处理方案allo-HSCT治疗的11例CR₁高危和微小残留病(MRD)阳性的低中危AL患者的临床资料,分析其一般资料、移植特征、造血重建情况以及生存情况。结果 11例患者移植后均获得造血重建,中性粒细胞中位植入时间为12(11～13)d,血小板中位植入时间为13(11～14)d。粒细胞植入前发生肺部感染2例,血流感染1例,抗感染治疗后均好转。4例发生Ⅰ～Ⅱ度急性移植物抗宿主病,4例发生慢性移植物抗宿主病,均为轻中度。中位随访时间为280(87～667)d,生存10例,死亡1例,预期1年的总生存率为90.00%,无病生存率为78.80%。结论 对处于CR₁的高危和移植前MRD阳性的低中危AL,采用含克拉屈滨强化预处理方案能够降低复发率,改善总体生存,未增加预处理的相关毒性,具有较好...     

G-CSF动员后异基因骨髓联合外周血干细胞移植治疗血液病

目的 探讨粒细胞集落刺激因子(G-CSF)动员的异基因骨髓与外周血干细胞混合移植后造血重建、移植物抗宿主病(GVHD)、复发及生存情况.方法 45例血液病患者进行了动员后的异基因骨髓联合外周血干细胞混合移植,人白细胞抗原(HLA)全合37例,1～3个位点不合8例.38例恶性病中32例采用清髓性预处理,6例为减低强度预处理;7例重型再生障碍性贫血(SAA)均采用环磷酰胺联合兔抗人胸腺细胞球蛋白(ATG)及甲泼尼龙预处理.采用环孢素联合霉酚酸酯预防移植物抗宿主病,HLA不全相合患者加用ATG.供者给予G-CSF连续5天皮下注射,注射后第5天采集外周血干细胞,第7天采取骨髓血.结果 45例患者均获得快速造血重建,中性粒细胞绝对计数≥0.5×109/L,血小板≥20×109/L的中位时间分别为移植后的12(8～18)天和16(10～28)天.10例发生了急性GVHD(22%),Ⅱ度以上1例.可评估的42例患者中16例出现了慢性GVHD,7例为广泛型(16%).复发9例,死亡11例,其余34例中位随访时间16月(10～46月),可评估的2年无病生存率为75%.结论 G-CSF动员后的异基因骨髓联合外周血干细胞移植治疗血液病可获快速造血重建,移植相关死亡率及重度急、慢性GVHD的发生率低,复发率不增高.     

减低剂量预处理对异基因造血干细胞移植治疗恶性血液病疗效观察

目的:探讨应用减低剂量的氟达拉宾、白消安和环磷酰胺(FBC)方案预处理对异基因造血干细胞移植(alloHSCT)治疗恶性血液病疗效的影响。方法:19例恶性血液病患者移植前进行减低剂量的FBC预处理。采用磷酸氟达拉宾(Flud)30mg/m2·d-1静脉滴注5d。白消安(Bu)0.6mg/kg、4次/d,共3d。环磷酰胺(CTX)30mg/kg·d-1静脉滴注,共2d,随后施行HLA配型的同胞或父亲供者的造血干细胞移植。术后采用环孢素及霉酚酸酯预防移植物抗宿主病(GVHD)。结果:全部患者的造血功能均获得快速重建。白细胞升至1.0×109/L以上,中位时间为(11.4±4.6)d。中性粒细胞升至0.5×109/L以上,中位时间为(11.9±6.7)d;血小板升至20×109/L以上,中位时间为(12.2±3.5)d。供者细胞完全植入15例,混合嵌合性植入4例,1例出现宿主排斥移植物(HVG)反应,进行供者淋巴细胞输注(DLI)2次后,达到完全供者嵌合。11例出现急性GVHD(57.89%),7例出现慢性GVHD(36.83%),2例HLA配型不完全相合者死于急性GVHD。结论:减毒的FBC预处理方案allo-HSCT治疗恶性血液病疗效肯定,并发症少,是治疗恶性血液病的有效方法。     

HLA位点不全相合的异基因干细胞移植治疗白血病的临床分析

目的：探讨HLA不完全相合的造血干细胞移植治疗白血病的新方法.方法：将8例白血病患者接受FBC预处理方案后行异基因粒细胞集落刺激因子（G-CSF）动员的骨髓和外周血干细胞联合移植，观察造血重建和移植相关的并发症情况.结果：1例2位点不合患者植入失败，其余7例完全植入，白细胞恢复时间13.5 d，血小板恢复15.1 d，7例患者Ⅰ～Ⅱ度急性移植物抗宿主病（GVHD）发生率57.1%（4/7），局限性慢性GVHD发生率83.3%，未出现严重的心、肝和肺脏并发症.移植后6个月生存率62.5%.结论：用FBC预处理方案和GCSF动员后的骨髓和外周血干细胞联合移植的方法对于HLA不相合的移植安全有效。     

异基因造血干细胞移植治疗黏多糖病I型1例

目的:MPS-1H是一种进展型黏多糖代谢性遗传病,常导致早期死亡。我们进行了异基因造血干细胞移植(allo-HSCT)治疗该病的初步尝试。方法:1例2岁MPS-1H幼儿接受了其HLA不全相合姐姐allo-HSCT。预处理方案为马利兰、环磷酰胺和抗胸腺细胞球蛋白;移植物抗宿主病(GVHD)预防包括环孢素、短程甲氨喋呤、赛尼哌和骁悉。移植后评价植入、不良反应和疗效。结果:完全供者嵌合14d,中性粒细胞>0.5×109/L,11d,血小板>50×109/L,28d。未发生严重的GVHD和移植物衰竭。植入后MPS-1H的临床症状明显改善,认知能力持续增加。结论:早期allo-HSCT可减轻疾病的症状,改善生活质量和存活。     

非清髓单倍体造血干细胞移植联合格列卫治疗慢性粒细胞白血病

目的:探讨格列卫联合非清髓性单倍体造血干细胞移植在治疗慢性粒细胞白血病(CML)中的作用。方法:4例CML患者,采用移植前、后口服格列卫,以环磷酰胺、阿糖胞苷、抗胸腺细胞球蛋白、赛尼派、环胞素A等作非清髓性预处理的单倍体异基因外周血造血干细胞移植。结果:移植过程顺利,4例患者均植入成功,嵌合性植入。中性粒细胞>0.5×109/L天数,16(10~21)d;血小板>20×109/L天数,10(4~15)d。3例发生Ⅰ~Ⅱ度皮肤急性移植物抗宿主病(GVHD),1例发生Ⅳ度皮肤慢性GVHD。1例+27d死于肺部感染并多脏器功能衰竭,1例死于Ⅳ度皮肤慢性GVHD并发感染。2例无病存活(随访16个月仍健在),且Ph+染色体,bcr-abl融合基因转阴。结论:非清髓单倍体造血干细胞移植联合格列卫治疗CML,具有降低移植前白血病细胞负荷,抑制残留白血病细胞增殖,促进供者完全嵌合状态的转变,增强抗移植物白血病(GVL)效应的作用,是一种有效的治疗方法,值得进一步临床研究。     

异基因造血干细胞移植治疗黏多糖病Ⅰ型1例

目的:MPS-1H是一种进展型黏多糖代谢性遗传病,常导致早期死亡.我们进行了异基因造血干细胞移植(allo-HSCT)治疗该病的初步尝试.方法:1例2岁MPS-1H幼儿接受了其HLA不全相合姐姐allo-HSCT.预处理方案为马利兰、环磷酰胺和抗胸腺细胞球蛋白;移植物抗宿主病(GVHD)预防包括环孢素、短程甲氨喋呤、赛尼哌和骁悉.移植后评价植入、不良反应和疗效.结果:完全供者嵌合14 d,中性粒细胞＞0.5×109/L,11 d,血小板＞50×109/L,28 d.未发生严重的GVHD和移植物衰竭.植入后MPS-1H的临床症状明显改善,认知能力持续增加.结论:早期allo-HSCT可减轻疾病的症状,改善生活质量和存活.     

异基因造血干细胞移植治疗进展期难治性急性髓系白血病17例分析

目的研究异基因造血干细胞移植(allo-HSCT)治疗进展期难治性急性髓系白血病(AML)的临床疗效。方法收集2002年5月至2011年6月苏州大学附属第一医院血液科收治的17例未缓解期难治性AML患者,采用改良马利兰+环磷酰胺(12例)或全身放疗+环磷酰胺(5例)的清髓性预处理方案行allo-HSCT,采用环孢菌素A(CsA)加短程氨甲蝶呤(MTX)预防移植物抗宿主病(GVHD),部分患者加入霉酚酸酯(MMF)。结果 15例成功获得造血重建,中性粒细胞>1.0×109/L和血小板>20×109/L的中位时间分别为12.5(11～14)d和12.5(10～15)d。急性GVHD发生率为53.3%(8/15),可评估的9例中,5例发生慢性GVHD,均为局限性。移植相关病死率为29.4%(5例),移植后成功获得完全缓解的14例中6例血液学复发,其中2例合并髓外复发,复发率为42.9%。中位随访5(0～71)个月,至今有6例无病生存(DFS),2年DFS为35.3%。结论 Allo-HSCT治疗进展期难治性AML仍不失为一种有效的挽救手段,其中发生慢性GVHD的患者预后较好,而移植相关并发症及移植后复发是影响患者生存的主要因素。     

静脉滴注白消安和氟达拉滨预处理方案行异基因造血干细胞移植治疗髓系血液病疗效观察

目的探讨静脉滴注白消安(Bu)和氟达拉滨(Flu)作为预处理方案,进行异基因造血干细胞移植治疗髓系血液病的疗效。方法选取2003年10月至2005年4月成都军区昆明总医院血液科髓系血液病患者9例,其中急性非淋巴细胞白血病(ANLL)3例,慢性粒细胞白血病(CML)5例,骨髓增生异常综合征(MDS)1例,均进行同胞白细胞抗原(HLA)全相合异基因造血干细胞移植。预处理方案采用移植前第6天至移植前第3天静脉滴注白消安3.2mg/(kg.d),共4d;移植前第6天至移植前第2天静脉滴注氟达拉滨30mg/(m2.d),共5d。环孢素A和霉酚酸酯(骁悉)联合应用预防移植物抗宿主病(GVHD)。结果9例患者均成功植入,中性粒细胞>0.5×109/L的平均时间为12d;血小板(PLT)>20×109/L的平均时间为14d。中位观察时间为31个月。除轻微胃肠道反应外,无严重的预处理相关毒性,移植后1个月检测证实均为供者型完全植入。发生急性GVHD2例,慢性GVHD1例。9例患者中8例无病存活。结论静脉滴注Bu/Flu预处理方案,移植相关毒性小,治疗髓系血液病安全有效。     

异基因造血干细胞移植治疗高危恶性血液病

目的 分析HLA配型相合同胞供者异基因造血干细胞移植（allo-HSCT）治疗高危恶性血液病的疗效及影响疗效的相关因素。方法 回顾性分析90例有高危因素的恶性血液病患者,其中急性髓细胞白血病（AML）43例,急性淋巴细胞性白血病（ALL）28例,急性混合细胞性白血病（AHL）2例;移植前处于第1次完全缓解期（CR1）11例,均为Ph染色体阳性,第二次及以上CR期23例,未缓解／复发39例;骨髓增生异常综合征（MDS）-难治性贫血伴原始细胞增多或难治性贫血伴原始细胞增多一转化型17例。预处理方案采用全身照射加环磷酰胺（CY／TBI）方案11例,白消安加环磷酰胺方案79例。干细胞来源包括骨髓移植（BMT）27例,外周血造血干细胞移植（PBSCT）30例,BMT＋PBSCT33例;移植物抗宿主病（GVHD）预防采用经典环孢素A加短程甲氨蝶呤（MTX）。平均随访时间为15个月。结果 至随访终点,62．2％（56／90）存活,55．5％（50／90）无病存活,31．1％（28／90）复发。HSCT后预计4年累积总体生存率（OS）为45．5％,无病生存率（DFS）为34．9％。移植前处于CR、未缓解／复发和MDS患者HSCT后4年的累积0s分别为54．0％、28．2％和70．1％（P=0．027）。发生0～Ⅰ和Ⅱ～Ⅳ度GVHD的患者HSCT后的4年OS分别为57．6％和26．7％（P=0．015）,而患者性别、年龄、移植前有无脑膜白血病、预处理方案、干细胞来源均不是OS,DFS及复发的影响因素。多因素分析表明,移植前处于CR期者长期生存率明显提高,而ALL长期生存率明显低于AML／MDS。结论 对有高危因素的血液系统恶性肿瘤患者,选择allo—HSCT可使部分患者延长无病生存乃至根治。移植前处于CR期者长期生存率明显提高,ALL复发率明显高于AML／MDS。对于急性白血病挽救性治疗争取在取得CR后移植;对于MDS患者一经诊断,无需化疗,可尽早移植。     

Allo-HSCT for acute leukemia of ambiguous lineage in adults: the comparison between standard conditioning and intensified conditioning regimens

Knowledge concerning the clinical and biological characteristics of acute leukemia of ambiguous lineage (ALAL) is limited so that there has been a lack of uniformity in treatment. In this report, we retrospectively investigated the effect of intensified conditioning on adult ALAL undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). A total of 59 patients with ALAL (male in 37 cases and female in 22 cases) were consecutively enrolled in the data analyses. Twenty-four patients received the standard conditioning (total body irradiation (TBI)?+?cyclophosphamide (CY) or busulfan?+?CY protocol) and 35 received the intensified conditioning (TBI?+?CY?+?etoposide or fludarabine?+?cytarabine plus TBI?+?CY?+?etoposide protocol). Five-year transplant-related mortality was 17.6?±?9.6 % and 25.5?±?8.0 %, the 5-year overall survival (OS) post-transplantation was 23.8?±?8.9 % and 64.0?±?8.4 %, disease-free survival was 16.7?±?7.6 % and 55.8?±?9.4 %, the 5-year cumulative incidence of relapse was 80.8?±?8.5 % and 28.8?±?9.9 %, respectively, in the standard and the intensified group (P?=?0.380, P?=?0.029, P?=?0.005, and P?<?0.001). Both univariate and multivariate analysis indicated that the intensified conditioning regimen and acute graft-versus-host disease were favorable factors to reduce the relapse. The younger patients, patients with CR at the time of transplantation, and the intensified conditioning regimen were favorable factors to elevate the survival. In conclusion, intensified conditioning regimens followed by allo-HSCT might improve long-term survival and decrease relapse of leukemia in adult ALAL compared to the standard conditioning regimens.     

Impact of anti-HLA antibodies on allogeneic hematopoietic stem cell transplantation outcomes after reduced-intensity conditioning regimens

Anti-human leukocyte antigen (HLA) antibodies are associated with several complications in solid organ transplantations, but their impact after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is not yet well defined. To evaluate the relevance of anti-HLA antibodies, we have retrospectively analyzed 107 peripheral blood allo-HSCTs after reduced-intensity conditioning regimen between 2005 and 2010. Acute myeloid leukemia and multiple myeloma were the most frequent malignancies in the cohort. The detection of anti-HLA antibodies was systematically performed in all patients before transplantation. Anti-HLA antibodies were present in 24 patients (22%). There was no significant impact of anti-HLA antibodies on engraftment, incidence of relapse, and incidence of acute graft-vs-host disease. The presence of anti-HLA antibodies was associated with significantly worse overall survival (p = 0.006) and event-free survival (p = 0.024) after stratification on sex. The 3-year probability of overall survival was 34% without anti-HLA antibodies and 16% in their presence. Patients with anti-HLA antibodies had a higher transplant-related mortality associated with life-threatening vascular complications. Our study supports that anti-HLA antibodies should be tested and considered as an important impacting factor for transplantation outcomes after reduced-intensity conditioning allo-HSCT. We recommend its consideration before allo-HSCT in the donor-recipient selection parameters.     

异基因造血干细胞移植治疗白血病76例临床观察

目的观察不同来源的异基因造血干细胞移植治疗白血病的疗效并探讨主要并发症的处理方案。方法对2001年9月至2007年3月第四军医大学西京医院血液科76例白血病患者行异基因造血干细胞移植治疗,其中慢性粒细胞白血病34例,急性髓性白血病24例,急性淋巴细胞白血病15例,T细胞淋巴瘤/白血病3例。人类白细胞抗原(HLA)全相合的同胞供者57例,1个HLA位点不合同胞供者3例,HLA单倍型半相合同胞供者7例,非血缘供者9例。预处理方案采用改良的马利兰联合环磷酰胺(BUCY)或改良的环磷酰胺联合全身放疗及阿糖胞苷或鬼臼乙叉甙(CyTBI Ara-c/VP-16)方案。采用标准的环孢素A(CsA)联合短期甲氨蝶呤(MTX)方案预防移植物抗宿主病(GVHD);无关供者移植加用抗人胸腺细胞球蛋白,单倍型半相合移植同时加用CD25单克隆抗体。结果96.1%(73/76)获得植入。24.7%(18/73)出现急性GVHD,32.9%(24/73)出现慢性GVHD;合并重症肝静脉闭塞病2例;并发纯红细胞性再生障碍性贫血5例。随访3~72个月,现存活56.6%(43/76),43.4%(33/76)在移植后1~36个月时死亡,19例死于白血病复发,14例死于移植相关并发症。结论多种来源的异基因造血干细胞移植是治疗白血病的有效方法,于慢性粒细胞白血病慢性期、急性白血病缓解期移植效果较好,移植前处于高危难治状态的病例复发率仍较高。     

Thiotepa/cyclophosphamide/TBI as a conditioning regimen for allogeneic hematopoietic stem cell transplantation in patients with myelodysplastic syndrome

In all, 18 patients (30-56 years; median 49) with MDS underwent allogeneic HSCT from related (n=12) or unrelated (n=6) donors after a conditioning regimen comprising thiotepa, cyclophosphamide, and TBI. GVHD prophylaxis consisted of cyclosporine (n=15) or tacrolimus (n=3) with short-course methotrexate. Four patients had low-risk disease (refractory anemia or complete remission after chemotherapy) and 14 patients had high-risk disease (RAEB, RAEB-t, or AML). Grade II-IV acute GVHD developed in six patients and chronic GVHD in 10. With a median follow-up of 31 months, the 2-year survival probability is 75% for low-risk patients and 57% for high-risk patients. One patient died of leukemia and six of treatment-related causes. This conditioning regimen requires further study in patients with MDS.     

Total body irradiation and granulocyte colony-stimulating factor-combined high-dose cytarabine as a conditioning regimen in allogeneic hematopoietic stem cell transplantation for advanced myelodysplastic syndrome: a single-institute experience

In this study, we retrospectively evaluated the efficacy and safety of total body irradiation (TBI) and granulocyte colony-stimulating factor (G-CSF)-combined high-dose cytarabine as a conditioning regimen for allogeneic hematopoietic stem cell transplantation (HSCT) in patients with advanced myelodysplastic syndrome (MDS). We evaluated 22 patients with advanced MDS, including refractory anemia with excess blasts (RAEB; n=10), RAEB in transformation (n=2), acute myelogenous leukemia transformed from MDS (n=6) and chronic myelomonocytic leukemia (n=4). The conditioning regimen consisted of 12 Gy of TBI and high-dose cytarabine (3 g/m(2)) every 12 h for 4 days, and the cytarabine was combined with continuous administration of G-CSF. The stem cell sources were bone marrow or peripheral blood stem cells from human leukocyte antigen (HLA)-identical siblings (n=12) and bone marrow from HLA serologically matched unrelated donors (n=10). Three patients experienced disease relapse, two of whom died of disease progression. Of 22 patients, 16 are currently alive and disease-free. The 5-year estimated overall survival, disease-free survival, relapse and non-relapse mortality rates are 76.7, 72.2, 16.6 and 14.1%, respectively. These results suggest that G-CSF-combined high-dose cytarabine could be a promising component of the conditioning regimen of allogeneic HSCT for advanced MDS, providing a low incidence of both relapse and treatment-related mortality.     

Late Relapse of Acute Myelogenous Leukemia Followed by Epstein-Barr Virus—Associated Lymphoproliferative Disease 11 Years After Allogeneic Bone Marrow Transplantation

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) following myeloablative conditioning represents the treatment of choice for patients with chemotherapy-resistant leukemia. We describe a 49-year-old man with advanced, refractory acute myelogenous leukemia (AML) that was treated successfully by allogeneic bone marrow transplantation from a sibling donor with HLA mismatched at 1 locus. However, the patient developed a quiescent form of chronic graft-versus-host disease (GVHD) 7 years after transplantation, requiring long-term immunosuppressive therapy. AML relapse was documented 11 years after transplantation. Subsequently, Epstein-Barr virus (EBV)-associated posttransplantation lymphoproliferative disorder (PTLD) was also diagnosed. Immune reconstitution after allo-HSCT might have been impaired by the persistent chronic GVHD and the prolonged administration of immunosuppressive agents. As a result, immune surveillance against remaining quiescent leukemic cells as well as viral infection may have been defective, leading to the relapse of leukemia and EBV-associated PTLD.     

Reduced BUCY 2 and G-CSF-primed bone marrow associates with low graft-versus-host-disease and transplant-related mortality in allogeneic HSCT

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the ideal treatment for several diseases. However, the morbidity and mortality associated with the procedure might limit its widespread use; therefore, we implemented reduced BUCY2 as conditioning method along with the use of G-CSF-primed bone marrow (G-BM) in order to reduce complications, including graft-versus-host-disease (GVHD), and to improve survival in these patients. An analysis of transplant characteristics, complications, and survival of patients undergoing an allo-HSCT using this conditioning regimen (busulfan 12 mg/kg and cyclophosphamide 80 mg/kg) plus G-BM was performed. Forty patients were included from 1999 to 2015. All of them had a HLA-matched donor, with a median age of 32 years (range 16–59), and 55% were male. The most frequent diagnosis was myelodysplastic syndrome (MDS) in 14 patients (35%), followed by acute lymphoid leukemia (ALL) in 12 (30%). The mean of CD34+ was 2.09 × 106/kg. The mean time to neutrophil and platelet recovery was 20 and 18 days, respectively. The most common toxicity was mucositis (75%) with grade III–IV in 53% of cases. Acute GVHD appeared in 12.5 and 35% of patients developed chronic GVHD. Transplant-related mortality (TRM) was 10%. Five-year relapse-free survival was 69%, and the 5-year overall survival was 69.5%. Our conditioning method along with G-BM preserves an immunosuppressive and myeloablative effect allowing eradication of the malignant clone and achieving adequate bone marrow engraftment with acceptable toxicity, low incidence of GVHD, and low TRM, representing a favorable alternative for allo-HSCT.     

How can we intervene to mitigate post-transplantation relapse in AML? Strategies to mitigate post-transplantation relapse in AML

Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative approach for patients with acute myeloid leukemia (AML), relapse is a common occurrence. Several strategies, such as choice of conditioning regimen, donor lymphocyte infusions, pharmacologic agents, and cellular therapy approaches, are currently being developed to improve transplantation outcomes. This review outlines some important interventions and considerations to lower the burden of post-transplantation relapse in AML.     

Allogeneic hematopoietic stem cell transplantation for Epstein-Barr virus-associated T/natural killer-cell lymphoproliferative disease in Japan

Epstein-Barr virus (EBV)-associated T/NK-cell lymphoproliferative disease (LPD) has been linked to several different disorders. Its prognosis is generally poor and a treatment strategy has yet to be established. There are reports, however, that hematopoietic stem cell transplantation (HSCT) can cure this disease. To clarify the current situation regarding allogeneic hematopoietic stem cell transplantation (allo-HSCT) for EBV-associated T/NK-LPD, a nationwide survey was performed in Japan. Data for 74 patients were collected. There were 42 cases of chronic active EBV infection (CAEBV), 10 cases of EBV-associated hemophagocytic lymphohistiocytosis (EBV-HLH), and 22 cases of EBV-associated lymphoma/leukemia (EBV-lymphoma/leukemia). Of those with CAEBV, 54% had the EBV-infected T-cell type and 59% with EBV-lymphoma/leukemia had the EBV-infected NK-cell type. Most patients with EBV-HLH and EBV-lymphoma/leukemia received allo-HSCT within 1 year after onset compared to only 14% of patients with CAEBV. The event-free survival (EFS) rate following allo-HSCT was 0.561 +/- 0.086 for CAEBV, 0.614 +/- 0.186 for EBV-HLH, and 0.309 +/- 0.107 for EBV-lymphoma/leukemia. The EFS of allo-HSCT with conventional conditioning was 0.488 +/- 0.074 and with reduced-intensity conditioning was 0.563 +/- 0.124. Thus, in a substantial number of cases, EBV-associated T/NK-LPD can be cured by either allogeneic conventional stem cell transplantation or reduced-intensity stem cell transplantation.