Production and Characterization of a Tumor-Specific Monoclonal Antibody Act19 Recognizing an Epitope Distinctive from Sialosyl-Tn on the TAG72 Antigen

Aims

A murine monoclonal antibody ACT19 directed at the TAG72 tumor-associated antigen, which was originally defined by the B72.3 antibody, was established.

Methods

This was done by immunizing mice with the bovine mucin followed by the selection of hybridomas secreting antibodies with the desired specificity. In order to better characterize this antibody, its immunoreactivity was compared to that of the B72.3 antibody.

Results

The data showed that the ACT19 antibody bound specifically to the TAG72 antigen as the B72.3 antibody did. However, there were some differences between ACT19 and B72.3. Firstly, the immunoreactivity of ACT19 for the bovine mucin was lower than that of B72.3. Secondly, the immunoreactivity of ACT19 for the TAG72 antigen was not inhibited by N-acetylgalactosamine, nor was that of B72.3. Thirdly, ACT19 did not compete the binding reactivity of B72.3 for the TAG72 antigen. This suggests that the epitope defined by ACT19 is different from the sialosyl-Tn epitope recognized by B72.3. Immunoperoxidase staining of various tumors, normal and embryonic tissues for ACT19 was carried out. For the various tumors, only adenocarcinomas from the colon and stomach showed remarkable positivity. All the normal tissues were negative, except for weak positivity involving the zona reticularis of the adrenal cortex, and intestinal goblet cells. Embryonic tissues showed a wide spectrum of positivity with staining of the small and large intestine, stomach and renal tubules.

Conclusions

The ACT19 antibody appears to be a useful marker for colon and stomach cancers, and this additional anti-TAG72 antibody may be useful in conjunction with the B72.3 antibody in pathology and clinical application.

Tisagenlecleucel, an approved anti-CD19 chimeric antigen receptor T-cell therapy for the treatment of leukemia

On August 30, 2017, the U.S. Food and Drug Administration (FDA) approved Novartis' tisagenlecleucel (CTL-019, Kymriah), which is a synthetic bioimmune product of anti-CD19 chimeric antigen receptor (CAR) T cells, for the treatment of relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL). This was a milestone in tumor immunology on account of the significant antitumor effect of tisagenlecleucel for the treatment of relapsed/refractory B-ALL patients. Conventional standard therapies for B-ALL have high failure rates, thus developing new therapies is crucial for patients with B-ALL. Results from clinical trials indicate that anti-CD19 CAR T-cell therapies could successfully induce high response rates in B-ALL patients. However, related toxicities, such as cytokine release syndrome and CAR T-cell-related encephalopathy syndrome, may be severe or even fatal, and the management of such toxicities is therefore vital. This review will focus on the clinical application of anti-CD19 CAR T-cell therapy in B-ALL treatment, including design features of CAR constructs, therapeutic use of tisagenlecleucel, CAR T-cell therapy clinical trials and related toxicity, and prospects for cancer immunotherapy.

Abstract P4-06-18: Clinical application of multigene panel testing and genetic counseling for hereditary/familial breast cancer risk assessment: Prospective single center study

Background

The identification of individuals at elevated risk for hereditary cancers has allowed the development of consensus recommendations for cancer screening and prevention. The introduction of multigene panels may identify more individuals with breast cancer gene mutations than does testing for BRCA1/2 alone. Therefore, the multigenerational panel increase the need for genetic counseling suggesting preventive approach or cancer-specific screening to patients and family members. The rapid clinical introduction of multigene panel testing, however, have several issues such as low- to moderate-risk gene mutations and clinical recommendations. We collect the mutation results and clinical recommendations after testing with multigene panel and giving genetic counseling.

Methods

We had developed multigene panel consisted of 64 genes related to hereditary cancer through previous study and prospectively enrolled 104 individuals who were appropriate candidates for hereditary breast cancer evaluation. The patients were tested with 64-gene panel(Celemics) and results were provided by us 4˜10 weeks later. We checked the family history of cancer and made a pedigree before testing.

Result

Among 104 participants, 26 patients harbored deleterious mutations, most commonly in high to moderate-risk breast/ovarian cancer genes (BRCA1/2, BRIP, RAD51 and RAD51D), Lynch syndrome gene(MSH6) and other genes(FH, SPINK1). We recommended the cancer-specific screening and/or preventive approach for mutation-positive patients and suggested additional genetic test for the family members. Among them, 6 (23%) patients received Risk reducing procedures (Prophylactic mastectomy or oophorectomy) and most of them(19 patients(73%)) received cancer specific screening.

Conclusion

We demonstrate the use of multigene panel testing for hereditary breast cancer and will suggest the process of the genetic counseling including indication and results analysis with multigene panel testing.

Citation Format: Lee E-S, Han W, Kim Y, Rhu J, Park JH, Kim K-E, Ju YW, Kim R, Lee H-B, Moon H-G, Noh D-Y. Clinical application of multigene panel testing and genetic counseling for hereditary/familial breast cancer risk assessment: Prospective single center study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-06-18.

Abstract P4-06-16: Frequency of pathogenic mutation in patients at high risk for hereditary breast cancer

Background: Next-generation sequencing technology allows the simultaneous sequencing of multiple target genes. We developed a gene panel containing 64 genes which were associated with various hereditary cancers. This study was performed to evaluate the frequency of pathogenic mutations associated with hereditary cancer among Korean patients at high risk hereditary breast cancer using multi-gene sequencing panel.

Methods: A total of 252 breast cancer patients with high-risk hereditary cancer were included. Among them, 179 patients (71.0%) had multiple primary cancers including breast cancer, 27 patients (10.7%) were diagnosed with bilateral breast cancer at age 40 or younger. Thirty-five patients (13.9%) had breast cancer family history of more than 2 relatives. With the 64-gene panel, sequence variants were detected by next-generation sequencing technology.

Results: Sixty seven patients (26.8%) were found to have 77 germline pathogenic mutations, 12 in BRCA1, 13 in BRCA2, 9 in CDH1, 3 in FH, 5 in MSH2, 2 in MSH6, 4 in NAT1, 6 in PTCH1, 3 in RAD51, 7 in RET, 4 in SPINK1, 3 in TP53 and one each in ALK, BRIP1, CHEK2, MLH2, MUTYH, and PTEN. In 20 patients (4.0%), 2 (n=9) or 3 (n=1) pathogenic mutations were detected. In 227 patients with BRCA1/2 negative, CDH1 (n=7), RET (n=7), PTCH1 (n=5), and MSH2 (n=5) were the most prevalent pathogenic mutations.

Conclusions: The 64 gene panel detected germline pathogenic mutations in 26.8% of Korean breast cancer patients with feature of hereditary cancer. Mutations of BRCA1, BRCA2, CDH1, RET, and PTCH1 were the most prevalent variants.Mutation carriers were considered as high risk to develop malignancy and recommended to receive genetic counseling and intensive cancer screening.

Citation Format: Shin H-C, Yoo T-K, Lee H-B, Moon H-G, Noh D-Y, Han W. Frequency of pathogenic mutation in patients at high risk for hereditary breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-06-16.

Abstract P2-06-01: Molecular characterization of human malignant phyllodes tumors reveals potential targeted approaches

Malignant phyllodes tumor (MPT) which belong to the fibroepithelial neoplasm spectrum is a rare type of breast malignancy, and currently there is no effective targeted approach available for MPT. In this study, we tried to identify key genomic alterations and biologic pathways in MPT by whole exome and RNA sequencing of nine MPT tissues. Whole exome sequencing revealed somatic alterations in EGFR, MED12, PIK3CA, PIK3R1, PDGFRA, PDGFRB, PTEN, and TP53. Transcriptome sequencing showed dysregulation of ECM-receptor interaction, focal adhesion, and PI3K-Akt signaling in MPTs when compared to normal breast or invasive breast cancer tissues. Based on the transcriptome profiles, the MPTs were classified into two subtypes; fibrous subtype with upregulation of stromal genes such as collagens and epithelial subtype with upregulation of E-cadherin and Claudins. The molecular classification of fibrous and epithelial subtypes was validated in 28 paraffin-embedded MPT tissues. The fibrous subtype showed higher mitotic index and increased risk for recurrence when compared to the epithelial subtype. We established a patient-derived xenograft model from one fibrous subtype MPT which harbored somatic mutation in PIK3R1 and PDGFRB. In that model, targeted treatment against PIK3CA/mTOR and PDGFR pathways effectively suppressed the tumor growth in vivo. Our data provide insights on the biologic understanding of MPT and suggest a clinically relevant molecular classification. Furthermore, we show that developing effective targeted approaches in MPT can be possible with genomic profiles and patient-derived xenograft models. The clinical efficacy of targeting PDGFR and PIK3CA/mTOR pathways in MPT should be tested in future clinical trials.

Citation Format: Moon H-G, Yun J, Hong BS, Lee E, Lee H-B, Han W, Kim J-I, Noh D-Y, Heo W, Hur S, Kang W, Lee C. Molecular characterization of human malignant phyllodes tumors reveals potential targeted approaches [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-06-01.

Abstract P3-01-14: Nomogram predicting axillary lymph node metastases to skip intraoperative analysis of sentinel lymph nodes

Background: According to the American College of Surgeons Oncology Group Z0011 trial, complete axillary lymph node dissection (ALND) did not affect survival of patients with clinical T1-T2 invasive breast cancer and one to two sentinel lymph nodes (SLNs) metastases treated with lumpectomy, adjuvant systemic therapy, and radiation therapy. A significant proportion of breast cancer patients may not require ALND, in whom intraoperative analysis of SLNs can be omitted reducing operation time and cost. The aim of this study was to develop a nomogram predicting three or more axillary lymph nodes (ALNs) metastases based on preoperative imaging and clinicopathological factors.

Methods: The training set consisted of 1030 patients with clinical T1-T2 invasive breast cancer and clinically negative ALN who received surgery at Seoul National University Hospital (SNUH) between January 2010 and December 2013. Preoperative imaging techniques including ultrasonography (US), computed tomography (CT), positron emission tomography (PET), and clinicopathological features associated with three or more ALN metastases were evaluated by logistic regression analysis. A nomogram predicting three or more ALNs was developed with statistically significant factors. The validation set consisted of 781 independent patients who received surgery at SNUH between January 2014 and December 2015.

Results: Of the 1030 patients, 89 (8.6%) had three or more ALN metastases. Multivariate analysis showed that three or more ALN metastases was independently associated with tumor size (cm) by US (p<0.001), suspicious ALNs findings in US (p<0.001), chest CT (p<0.001), and PET/CT (≥ 1.4 SUV, p<0.001). Established nomogram evaluating the probability of three or more ALNs metastases includes the above four associated factors. The areas under the receiver operating characteristic (ROC) curve of the nomogram were 0.866 (95% confidence interval [CI] 0.826-0.905) for the training set and 0.867 (95% CI: 0.801-0.932) for the validation set. With cutoff point of 142, false negative ratio is 3.6%, and 8.6% of patients were candidates for intraoperative SLN analysis.

Conclusion: Patients with a strong possibility of three or more ALNs metastases can be identified using preoperative imaging methods including US, CT, and PET. The nomogram measuring this prospect may be valuable in skipping intraoperative analysis of SLNs with advantage of reduced operation time and cost.

Citation Format: Park JH, Ju YW, Kim KE, Rhu J, Kim Y, Lee E, Lee H-B, Moon H-G, Noh D-Y, Han W. Nomogram predicting axillary lymph node metastases to skip intraoperative analysis of sentinel lymph nodes [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-14.

Abstract P4-12-11: Cost effectiveness of oncotype Dx for early stage breast cancer under National health insurance

Background : Oncotype Dx is being used increasingly for risk stratification to identify for patients with estrogen receptor-positive (ER+), node negative early-stage breast cancer who are most likely to benefit from adjuvant chemotherapy. In Korea, all citizens are covered by national health insurance (NHI), besides patients just pay 5% of hospital bill, if who diagnosed with cancer. NHI can help solve the financial burden for cancer patients.

So the acquisition costs of the Oncotype DX test are sometimes a barrier to its widespread use. This study was conducted for existing cost-effectiveness analyses of Oncotype DX in Korea.

Methods : We analyzed the hospital expenses of patients who diagnosis with LN-negative ER-positive early-stage breast cancer from October 2010 to October 2016 in Seoul National University Hospital. All patients are possible candidates for adjuvant chemotherapy. Among them 273 patients were tested Oncotype Dx. A cost-utility analysis (CUA) was performed.

We analyzed the hospital expenses of chemotherapy by regimens who underwent adjuvant chemotherapy patients, and costs of accompanying adverse event. Each costs of therapy were derived from the hospital administration and expressed by USD. (KRW convert into USD) We also analyzed every patient charges and real expense.

Result :

Of 273 patients, 39(14.3%) were underwent adjuvant chemotherapy. The patients proportion by regimens are FAC(56.4%), AC(10.3%), AC followed by weekly paclitaxel (5.1%), TC(10.3%), AC followed by docetaxel (5.1%), TC and CMF etc. Each patient's hospital expense are roughly 3,000 USD (2,200 – 4,000 USD), it including all costs of laboratory test, computer tomography, chest x-ray, chemoagents and other medications. Of these costs, patients should pay only 5% so it could be around 150 USD (110-200USD).

Disccusion ;

The economic benefits of Oncotype DX are modelled by an overall reduction in chemotherapy usage, thus avoiding associated costs and disutility, and an increase in chemotherapy usage in the high RS group, reducing the risk of recurrence and improving health outcomes. Several studies shows Oncotype DX has been proposed to better estimate baseline risk and response to chemotherapy, to appropriately target chemotherapy to higher risk patients. In the costeffectiveness model, decision making with Oncotype DX in addition to standard decision-making tools is compared with standard decision making without Oncotype DX. From this study, most patient (234 of 273, 85.7%) who are possible candidates for adjuvant chemotherapy avoiding the treatment. A number of studies have looked at the impact of Oncotype DX on clinical decision making. But under the special environment of Korea that most costs who diagnosed with cancer covered by National Insurance health, it relatively expensive than other conturies. So it deserve much consideration that necessity of further studies and reaserches to develop new tools that could be more reasonable in cost in Korea.

Citation Format: Kim Y, Han W. Cost effectiveness of oncotype Dx for early stage breast cancer under National health insurance [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-12-11.

A Novel Bifunctional Endolytic Alginate Lyase with Variable Alginate-Degrading Modes and Versatile Monosaccharide-Producing Properties

Endo-type alginate lyases usually degrade alginate completely into various size-defined unsaturated oligosaccharide products (≥disaccharides), while exoenzymes primarily produce monosaccharide products including saturated mannuronate (M) and guluronate (G) units and particularly unsaturated Δ units. Recently, two bifunctional alginate lyases have been identified as endolytic but M- and G-producing with variable action modes. However, endolytic Δ-producing alginate lyases remain undiscovered. Herein, a new Flammeovirga protein, Aly2, was classified into the polysaccharide lyase 7 superfamily. The recombinant enzyme and its truncated protein showed similar stable biochemical characteristics. Using different sugar chains as testing substrates, we demonstrated that the two enzymes are bifunctional while G-preferring, endolytic whereas monosaccharide-producing. Furthermore, the catalytic module of Aly2 can vary the action modes depending on the terminus type, molecular size, and M/G content of the substrate, thereby yielding different levels of M, G, and Δ units. Notably, the enzymes preferentially produce Δ units when digesting small size-defined oligosaccharide substrates, particularly the smallest substrate (unsaturated tetrasaccharide fractions). Deletion of the non-catalytic region of Aly2 caused weak changes in the action modes and biochemical characteristics. This study provided extended insights into alginate lyase groups with variable action modes for accurate enzyme use.

A chondroitin sulfate and hyaluronic acid lyase with poor activity to glucuronyl 4,6-O-disulfated N-acetylgalactosamine (E-type)-containing structures

GlcUAβ1-3GalNAc(4S,6S) (E unit)-rich domains have been shown to play key roles in various biological functions of chondroitin sulfate (CS). However, an enzyme that can specifically isolate such domains through the selective digestion of other domains in polysaccharides has not yet been reported. Here, we identified a glycosaminoglycan lyase from a marine bacterium Vibrio sp. FC509. This enzyme efficiently degraded hyaluronic acid (HA) and CS variants, but not E unit-rich CS-E, into unsaturated disaccharides; therefore, we designated this enzyme a CS-E-resisted HA/CS lyase (HCLase Er). We isolated a series of resistant oligosaccharides from the final product of a low-sulfated CS-E exhaustively digested by HCLase Er and found that the E units were dramatically accumulate in these resistant oligosaccharides. By determining the structures of several resistant tetrasaccharides, we observed that all of them possessed a Δ^4,5HexUAα1-3GalNAc(4S,6S) at their non-reducing ends, indicating that the disulfation of GalNAc abrogates HCLase Er activity on the β1-4 linkage between the E unit and the following disaccharide. Δ^4,5HexUAα1-3GalNAc(4S,6S)β1-4GlcUAβ1-3GalNAc(4S,6S) was most strongly resistant to HCLase Er. To our knowledge, this study is the first reporting a glycosaminoglycan lyase specifically inhibited by both 4-O- and 6-O-sulfation of GalNAc. Site-directed and truncation mutagenesis experiments indicated that HCLase Er may use a general acid-base catalysis mechanism and that an extra domain (Gly⁷³⁹-Gln⁷⁹⁶) is critical for its activity. This enzyme will be a useful tool for structural analyses and for preparing bioactive oligosaccharides of HA and CS variants, particularly from E unit-rich CS chains.

Unmanipulated haploidentical transplantation conditioning with busulfan, cyclophosphamide and anti-thymoglobulin for adult severe aplastic anaemia

We conducted a retrospective analysis to evaluate outcomes of haploidentical transplantation in adult severe aplastic anaemia (SAA) patients. Fifty-one adults received haploidentical transplantation between May 2011 and December 2016. Patients were administered busulfan (Bu), cyclophosphamide (Cy) and anti-thymoglobulin (ATG) as conditioning regimens, followed by bone marrow and peripheral blood transplantation. The patients' median age was 25 years. Forty-nine patients survived for more than 28 days and all achieved donor myeloid engraftment. The median time for myeloid engraftment and platelet recovery was 13 days (range, 10-21) and 17.5 (range, 7-101) days. The cumulative incidence (CI) of grade II-IV and III-IV acute GvHD) was 20.00±0.33% and 6.00±0.12%, respectively. The incidence of chronic GvHD was 14.00±0.36% and 25.90±0.71%, and that of moderate-severe chronic GvHD was 2.51±0.06% and 6.92±0.25% at 1 and 3 years, respectively. The 3-year estimated overall survival and failure-free survival were both 83.5±5.4% with a median follow-up of 21.1 months. Multivariate analysis showed hematopoietic cell transplantation-specific comorbidity index (HCT-CI) score of ⩾3 was significantly associated with worse outcome. Haploidentical transplantation conditioning including Bu/Cy/ATG was a safe and effective strategy for adult SAA patients, and HCT-CI might be an outcome predictor in these patients.

Associations between MRI-detected early osteophytes and knee structure in older adults: a population-based cohort study

OBJECTIVES

To describe prevalence of osteophytes (OPs) detected only by magnetic resonance imaging (MRI) but not by standard X-ray in older adults and to evaluate longitudinal associations with knee structural changes.

METHODS

837 participants were randomly selected from the local community and had MRI scans to assess knee OPs and other structures. OPs detected only by MRI but not by standard X-ray were defined as MRI-detected early OPs (MRI-OPs for short). OPs detected by both MRI and X-ray were defined as established-OPs.

RESULTS

The prevalence of MRI-OPs was 50% while the prevalence of established-OPs was 10% and no-OPs was 40% at total tibiofemoral (TF) compartment at baseline. Compared with no-OPs, participants with MRI-OPs had greater risks of increased cartilage defects in all TF compartments (RR 1.37, 95%CI 1.07-1.74) and bone marrow lesions (BMLs) only in medial TF compartment (RR 1.49, 95%CI 1.06-2.11), after adjustment for age, sex, BMI, cartilage defects, BMLs and/or joint space narrowing; participants with established-OPs had greater cartilage volume loss at total (β -2.02, 95%CI -3.86, -0.17) and lateral tibial sites (β -5.63, 95%CI -9.93, -1.32), greater risks of increased cartilage defects in total (RR 1.66, 95%CI 1.15-2.40) and medial TF compartments (RR 1.49, 95%CI 1.20-1.69) and BMLs in all TF compartments (RR 1.88, 95%CI 1.22-2.89), after adjustment for covariates.

CONCLUSION

MRI-OPs were associated with changes in knee structures, and the associations were similar but not as prominent as those for established-OPs. These suggest MRI-OPs may have a role to play in knee early-stage osteoarthritic progression.

[Relationship between screening and colorectal cancer incidence: a systematic review and meta-analysis]

Objective: To explore a relationship between screening and incidence for colorectal cancer (CRC). Methods: Medline, Scopus, BIOSIS Previews, and the Cochrane Library were searched for studies, which included any randomized controlled trial (RCT) about CRC screening with a report on using endoscopy in screening arms and a usual care in control arms. Results: Nine qualified trials, four one-time and five two-or-more-time screening programs, were included in this review with 997 131 persons randomized and a median follow-up of 10-28 years. In an intention-to-screen analysis, screening was associated with a reduced incidence of advanced CRCs by 10%-60%. Compared with control groups, incidence of CRC firstly increased and then decreased following a screening procedure. Five RCT with six screening arms reported incidences at different follow-up time points, and the incidence ratios at the last time of follow-up were 0.96 (95%CI: 0.86-1.06), 0.80 (95%CI: 0.70-0.92), 1.02 (95%CI: 0.91-1.14), 0.80 (95%CI: 0.70-0.90), 0.83 (95%CI: 0.73-0.94) and 0.94 (95%CI: 0.85-1.05) at the 9.0th, 10.9th, 13.0th, 18.0th, 18.0th, and 19.5th year after baseline, respectively. Compared with population-based screening, people in the hospital/clinic-based screenings had more benefits from CRC incidence reduction, particularly for those with high endoscopy rates, more lesions detected and resected by screening. Conclusions: This study indicates that screening is likely associated with reduction of CRC incidence after 10 years since baseline screening, and this reduction seems to be highly affected by CRC risk of population screened, screening procedure program, and compliance to screening program including accepting endoscopy.

[Clinical value of PCR for viral detection of bronchoalveolar lavage fluid in the diagnosis and treatment of pneumonia after allogeneic hematopoietic stem cell transplantation]

Objective: To analyze the clinical value of real-time PCR for virus detection in the diagnosis and treatment of patients after allo-HSCT who had no infection evidence of pneumonia using routine pathogen detection panel. Methods: The clinical data of 71 episodes with acute lung injury from May 2015 to March 2017 after allo-HSCT in hematology department of Peking University People's Hospital (PKUPH) were retrospectively analyzed. PCR for virus detection and other routine pathogen detection tests were performed on bronchoalveolar lavage fluid (BALF) samples. Results: Among 71 episodes with acute lung injury, a total of 15 patients were diagnosed as lower respiratory tract disease merely associated with virus (detection rate of 21.13%) , 19 episodes were absent of lower respiratory tract infection. The median time from allo-HSCT to the occurrence of lung injury were 176 (49-1 376) d and 196 (57-457) d respectively (z=-0.191, P=0.864) . There were no statistical differences for baseline characteristics and clinical features between two groups. The 100-day attributable mortalities were 13.3% (2/15) and 26.3% (5/19) (χ(2)=0.864, P=0.426) . Patients with low-dose steroids treatment had favorable outcome than those with high-dose steroids treatment (the dose of methylprednisolone ≥250 mg/d as standard) [4.2% (1/24) vs 60.0% (6/10) ]. In patients with detectable virus in BALF, 2 patients died with early high-dose steroids treatment, while 11 patients survived with no steroids treatment or late application. Conclusions: Virus infection should be considered in post-HSCT pneumonia patient with negative result using routine pathogen detection panel. Expanding virus detection panel by PCR in BALF could increase diagnostic precision and might be instructive to treatment.

[Analysis of risk factors related to the prognosis in patients with late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation]

Objective: To investigate the prognostic factors of late-onset severe pneumonia (LOSP) in patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: From January 2009 to December 2015, 68 patients with LOSP after allo-HSCT at Peking University Institute of Hematology were enrolled. In this retrospective study, univariate and multivariate analysis were used to evaluate the prognostic factors for LOSP after allo-HSCT. Results: The median time from allo-HSCT to the development of LOSP was 213 (90-2 330) days. The overall survival rate was 42.6% (29/68). The median survival time from LOSP to death was 21 days. Early mortality was defined as death within 21 days after LOSP, as late death more than or equal to 21 days. The median oxygenation index was 199.15 (92.21-290.48) mmHg. LOSPs in thirty-two patients (36.8%) were caused by virus, bacteria, fungi or mixed pathogens. The median C-reactive protein (CRP) was 75.65 (0.94-451.00) mg/L. The median procalcitonin (PCT) was 0.66 (0.00-249.00) μg/L. The higher PCT value indicated an early higher mortality rate by the ROC curve (PCT: cut-off ≥0.94 μg/L). Furthermore, multivariate analysis suggested that PCT more than or equal to 0.94 μg/L was a risk factor for early death of LOSP (OR=5.77, 95%CI 1.66-20.11, P=0.006). LOSP occurred later or equal to 213 days after allo-HSCT was also a risk factor of early death in LOSP (OR=4.74, 95%CI 1.33-16.89, P=0.017). No previous history of chronic graft versus host disease (GVHD) (OR=4.50, 95%CI 1.58-12.83, P=0.005) and LOSP later or equal to 213 days (OR=4.40, 95%CI 1.61-11.99, P=0.004) were the risk factors of late death in LOSP. Conclusions: PCT more than or equal to 0.94 μg/L and LOSP later or equal to 213 days are the risk factors of early death in LOSP. No previous chronic GVHD and LOSP later or equal to 213 days are the risk factors of late death in LOSP.

Effects of temperature and grazing on soil organic carbon storage in grasslands along the Eurasian steppe eastern transect

Soil represents the largest terrestrial organic carbon pool. To address global climate change, it is essential to explore the soil organic carbon storage patterns and their controlling factors. We investigated the soil organic carbon density (SOCD) in 48 grassland sites along the Eurasian steppe eastern transect (ESET) region, which covers the Inner Mongolia grassland subregion and Mongolia grasslands subregion. Specifically, we analyzed the SOCD in the top 30 cm soil layer and its relationships with climatic variables, soil texture, grazing intensity and community biomass productivity. The results showed that the average SOCD of the ESET was 4.74 kg/m², and the SOCD of the Inner Mongolia grassland subregion (4.11 kg/m²) was significantly lower than that of the Mongolia grassland subregion (5.79 kg/m²). Significant negative relationships were found between the SOCD and the mean annual temperature (MAT), mean annual precipitation (MAP) and grazing intensity in the ESET region. The MAT and grazing intensity were identified as the major factors influencing the SOCD in the ESET region; the MAP and MAT were the major factors influencing the SOCD in the Inner Mongolia grassland subregion; and the MAT and soil pH were the major factors influencing the SOCD in the Mongolia grassland subregion.

Associations between proximal tibiofibular joint (PTFJ) types and knee osteoarthritic changes in older adults

PURPOSE

To describe the cross-sectional associations between proximal tibiofibular joint (PTFJ) type configurations and knee joint structural abnormalities in older adults.

METHODS

A total of 967 community-based participants were studied. T1-weighted fat-suppressed magnetic resonance image (MRI) with spoiled gradient recalled echo sequence was utilized to assess the PTFJ type configurations. Knee cartilage volume, cartilage defects, bone marrow lesions and osteophytes were measured. Linear regression and binary logistic regression analyses were used to examine the associations between PTFJ type configurations and knee joint cartilage volume as well as knee structural abnormalities, respectively, after adjustment for potential confounders.

RESULTS

Seven PTFJ types including plane (49.4%), trochoid (31.9%), double trochoid (4.3%), saddle (5.4%), condylar (5.3%), trochlear (3.5%) and ball & socket (0.2%) were observed. Plane type was used as the comparator. In multivariable analyses, irregular joint types (comprising the five uncommon joint types) were associated negatively with cartilage volume, and positively with knee cartilage defects, bone marrow lesions and osteophytes in the lateral (but not medial) compartments. In contrast, trochoid type was only associated with reduced femoral cartilage volume, but not with knee cartilage defects, bone marrow lesions and osteophytes.

CONCLUSIONS

Irregular PTFJ joint shapes are associated with osteoarthritic changes in the lateral, but not medial, tibiofemoral compartment in older adults. The causal relationship needs to be examined in future longitudinal studies.

[Comparison of clinical features of hemorrhagic cystitis after haploidentical and matched sibling donor allogeneic hematopoietic stem cell transplantation]

Objective: To compare incidence and clinical features of hemorrhage cystitis (HC) after haploidentical donor (HID) allogeneic hematopoietic stem cell transplantation (HSCT) and matched sibling donor (MSD) HSCT. Methods: Medical records of 609 (including 406 HID-HSCT and 203 MSD-HSCT cases) hematologic malignancies patients treated with HSCT undergoing myeloablative conditioning regimen from January 2011 to December 2012 were analyzed retrospectively. Results: HC occurred 183 in HID and 17 ones in MSD respectively. The cumulative incidence of HC in HID group was higher than in MSD group[ (45.6±2.5) % vs (8.5±2.0) %, χ(2)=77.331, P<0.001], and the cumulative incidence of severe HC (grade 3-4) in HID cases was also higher than in MSD ones[ (11.2±1.9) % vs (2.1±1.1) %, χ(2)=12.883, P<0.001]. All HCs were occurred within 180 days in both groups. The median time to onset in two groups were 27 days after HSCT (range 0-177 days) and 29 days after HSCT (range 6-72 days) respectively (P=0.766) . The median duration of HC in two groups were 21 days (range 3-157 days) and 13 days (range 5-67 days) , respectively (P=0.182) . The total efficiency of treatment in two groups were 69.9% and 70.6% respectively (χ(2)=0.003, P=1.000) . Conclusion: The cumulative incidences of HC and severe HC were higher in HID cases than in MSD ones. The median time to onset and median duration of HC and therapeutic outcome between HID and MSD were comparable.

[Allogeneic hematopoietic stem cell transplantation associated thrombotic microangiopathy: 16 cases report and literature review]

目的

分析异基因造血干细胞移植（allo-HSCT）相关血栓性微血管病（TA-TMA）患者临床特征、疗效及转归。

方法

回顾性分析2013年1月至2015年6月于苏州大学附属第一医院接受allo-HSCT后发生TA-TMA的16例患者临床资料。

结果

纳入研究的852例allo-HSCT患者，16例（1.9%）发生TA-TMA，中位随访时间14个月，1年累计发生率为（2.3±0.6）%。16例患者中，男7例，女9例，中位年龄41(12~54）岁，中位发病时间为移植后72(21~525) d, PLT中位数为20(11~36）×10⁹/L，HGB中位数为74(56~99）g/L，LDH中位水平为762(309~1 049) U/L，外周血破碎红细胞比例中位数为3%（2%~13%），所有患者ADAMTS13活性均>60%。10例出现精神症状，7例肌酐水平升高。TA-TMA确诊后的主要治疗措施为钙调磷酸酶体抑制剂的减停、激素及血浆置换疗法，8例经治疗后病情得以控制，治疗有效；8例患者治疗无效死亡。治疗无效组8例患者中5例合并急性肠道移植物抗宿主病（GVHD），治疗有效组患者无一例合并肠道GVHD；8例治疗无效患者中5例外周血破碎红细胞比例>5%，而治疗有效组破碎红比例最高为4%；治疗无效患者LDH及肌酐中位水平均高于治疗有效组，分别为826(674~1 310) U/L对636(309~941）U/L及127(70~215）µmol/L对56(22~101）µmol/L。

结论

TA-TMA是allo-HSCT后的一类严重并发症，可导致全身多器官功能损伤，即使采取治疗早期病死率仍较高，疗效与病情轻重及有无并发症有关。

Knee effusion-synovitis volume measurement and effects of vitamin D supplementation in patients with knee osteoarthritis

OBJECTIVE

To develop a measure of knee joint effusion-synovitis volume and to examine the effect of vitamin D supplementation on effusion-synovitis in people with knee osteoarthritis (OA) and low vitamin D levels over 24 months.

METHOD

Symptomatic knee OA patients with low 25-(OH)D levels (12.5-60 nmol/l) were recruited for a multi-centre, randomised, placebo-controlled and double-blind trial. Participants (age 63 ± 7 years, 208 females) were allocated to either 50,000 IU monthly vitamin D₃ (n = 209) or placebo (n = 204) for 24 months. Knee effusion-synovitis volume in suprapatellar and other regions was measured on magnetic resonance imaging (MRI) using OsiriX software. The intra-class correlation coefficients (ICCs) were used to test inter- and intra-rater reliabilities. The least significant change criterion was used to define the increase/decrease in effusion-synovitis volume.

RESULT

The reproducibilities of effusion-synovitis volume measurement were high with ICCs ranging from 0.93 to 0.99. Over 24 months, effusion-synovitis volume remained stable in the vitamin D group but increased in placebos with a significant between-group difference (-1.94 ml, 95% confidence interval (CI): -3.54, -0.33). This effect was evident in those with baseline effusion-synovitis and with suprapatellar effusion-synovitis. The proportion with an increase in effusion-synovitis volume was lower in the vitamin D group than placebo (risk ratio (RR): 0.87, 95% CI: 0.77, 0.97).

CONCLUSION

This highly reproducible effusion-synovitis volume measurement could be a promising outcome measure in OA trials. Vitamin D supplementation could retard the progression of effusion-synovitis which can potentially benefit people with an inflammatory OA phenotype.

Draft Genome Sequence of Paenibacillus sp. Strain MY03, a Terrestrial Bacterium Capable of Degrading Multiple Marine-Derived Polysaccharides

The bacterium Paenibacillus sp. strain MY03, isolated from the root soil of cypress, can effectively degrade marine-derived polysaccharides such as agar, alginate, and chitin. Here, we present the draft genome sequence of MY03. Putative enzymes, including 3 agarases, 1 alginate lyase, and 1 chitinase, were found.