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Rui Z, Yan C, Wang Z, Yuan Y, Luan C, Wang L. The effects of alfacalcidol combined with calcitonin in the treatment of osteoporosis and its influence on levels of inflammation. Am J Transl Res 2024; 16:1690-1700. [PMID: 38883381 PMCID: PMC11170591 DOI: 10.62347/zmal4724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/10/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To investigate the effectiveness of Alfacalcidol combined with Calcitonin in the treatment of osteoporosis and its influence on the degree of pain, bone metabolism indexes, bone mineral density and inflammatory factor levels. METHODS In this retrospective study, 110 patients with osteoporosis treated in The Second Affiliated Hospital of Shandong First Medical University from January 2019 to June 2021 were selected as the study subjects. According to different treatment methods, these patients were divided into an observation group and a control group with 55 cases in each group. Patients from the control group were treated with the alfacalcidol capsules alone, while those from the observation group were treated with the alfacalcidol capsules combined with intramuscular calcitonin injection. Patients in both groups were treated for 6 months continuously. The treatment effect, visual analogue scale (VAS) score and Oswestry disability index (ODI), bone mineral density (BMD), serum markers levels such as calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), tartrate-resistant acid phosphatase-5b (TRACP-5b), insulin-like growth factor (IGF-1), type I procollagen amino terminal propeptide (PINP) and β-collagen special sequence (β-Crosslaps), the levels of inflammatory factor including interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), quality Life Questionnaire Core 30 (QLQ-C30) scores and incidences of adverse reactions were evaluated and compared between the two groups. RESULTS The effective rate of patients in the observation group was 90.91%, which was significantly higher than 74.54% in the control group (P<0.05). There was no significant difference in the term of VAS score, ODI score, serum markers levels, bone mineral density, inflammatory levels, QLQ-C30 before treatment between the two groups. Compared with the control group, the post-treatment VAS score, ODI score, the levels of IL-6, TNF-α, TRACP-5b, PINP and β-Crosslaps in the observation group were obviously lower, while the post-treatment QLQ-C30, bone mineral density, Ca, P, ALP, IGF-1 levels were significantly higher (all P<0.05). No statistical differences were found in the incidences of adverse reactions between the two groups (P>0.05). CONCLUSION The combination of Alfacalcidol combined with Calcitonin is effective in the treatment of osteoporosis patients, which can effectively improve the levels of bone metabolism indexes and bone mineral density, alleviate the symptoms, enhance the life quality and reduce the levels of inflammation. Therefore, it is worth promoting.
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Affiliation(s)
- Ze Rui
- Department of Foot and Ankle Surgery, The Second Affiliated Hospital of Shandong First Medical University Tai'an, Shandong, China
| | - Chao Yan
- Department of Hand Surgery, The Second Affiliated Hospital of Shandong First Medical University Tai'an, Shandong, China
| | - Zhiwei Wang
- Department of Foot and Ankle Surgery, The Second Affiliated Hospital of Shandong First Medical University Tai'an, Shandong, China
| | - Yufeng Yuan
- Department of Intensive Care Unit, Tai'an Traditional Medicine Hospital Tai'an, Shandong, China
| | - Chunyu Luan
- Department of Respiratory, The Second Affiliated Hospital of Shandong First Medical University Tai'an, Shandong, China
| | - Lin Wang
- Department of Orthopedics, The Second Affiliated Hospital of Shandong First Medical University Tai'an, Shandong, China
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Saqib M, Shahbaz N, Malik M. Treatment of Rhupus Syndrome With Aplastic Anemia Using Cyclosporine and Hydroxychloroquine: A Case Report. Cureus 2024; 16:e60875. [PMID: 38910697 PMCID: PMC11192584 DOI: 10.7759/cureus.60875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Rhupus syndrome is an autoimmune disorder that combines the symptoms of lupus and rheumatoid arthritis. It is a rare condition that affects the connective tissues of the body such as the joints, muscles, and skin. The symptoms of rhupus syndrome can be similar to those of lupus, including joint pain, fatigue, and skin rashes. However, rhupus syndrome can also cause symptoms of rheumatoid arthritis, such as joint stiffness and swelling. Treatment for rhupus syndrome usually involves a combination of medications and lifestyle changes to manage symptoms and improve the overall quality of life. A 24-year-old female patient was referred by a local physician for evaluation of pancytopenia. Her history dates back to six months when she developed progressive fatigue, dyspnea on mild exertion, and polyarthralgia. Initial laboratory investigations revealed pancytopenia, positive antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA), and anti-cyclic citrullinated peptide (anti-CCP) antibodies. Bone marrow examination confirmed the diagnosis of aplastic anemia. She was started on cyclosporine with an aim to maintain a trough level between 200 and 250 ng/mL. She responded well with hematological recovery in three to four months. This case highlighted the excellent response to cyclosporine hematologically and clinically in rhupus syndrome complicated with aplastic anemia. Further studies are required to establish the long-term efficacy of cyclosporine in this patient population.
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Affiliation(s)
- Maleeha Saqib
- Internal Medicine, Shifa International Hospital, Islamabad, PAK
| | - Nighat Shahbaz
- Clinical Hematology, National Institute of Bone Marrow Transplant, Rawalpindi, PAK
| | - Mustafa Malik
- Internal Medicine, Shifa International Hospital, Islamabad, PAK
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Li H, Kong D, Zhao Y, Liu X, Xiao F, Li X, Hu J, Chen Y, Li S, Wang B, Chen Y, Jiang Y, Liu X, Feng X, Guo Y, Feng X, Ren J, Wang F, Han Y, Donelan W, Yang L, Xu D, Tang D, Zheng C. Irisin protected hemopoietic stem cells and improved outcome of severe bone marrow failure. Biomed Pharmacother 2023; 169:115863. [PMID: 37952356 DOI: 10.1016/j.biopha.2023.115863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
Acquired aplastic anemia (AA) is a bone marrow failure (BMF) disease, characterized by fatty bone marrow (BM) and BM hypocellularity resulted from auto-immune dysregulated T cells-mediated destruction of BM haemopoietic stem cells (HPSC). The objective of this study was to investigate potential therapeutic effect of irisin, a molecule involved in adipose tissue transition, on AA mouse model. Our results showed that the concentration of irisin in serum was lower in AA patients than in healthy controls, suggesting a role of irisin in the pathogenesis of AA. In the AA mice, irisin administration prolonged the survival rate, prevented or attenuated peripheral pancytopenia, and preserved HPSC in the BM. Moreover, irisin also markedly reduced BM adipogenesis. In vitro results showed that irisin increased both cell proliferation and colony numbers of HPSC. Furthermore, our results demonstrated that irisin upregulated the expression of mitochondrial ATPase Inhibitory Factor 1 (IF1) in HPSC, inhibited the activation of mitochondrial fission protein (DRP1) and enhanced aerobic glycolysis. Taken together, our findings indicate novel roles of irisin in the pathogenesis of AA, and in the protection of HPSC through stimulation of proliferation and regulation of mitochondria function, which provides a proof-of-concept for the application of irisin in AA therapy.
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Affiliation(s)
- Hui Li
- Center for Gene and Immunotherapy, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Dexiao Kong
- Hematology Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China; Institute of Biotherapy for Hematological Malignancies, Shandong University, Jinan, China; Shandong University-Karolinska Institute Collaborative Laboratory for Stem Cell Research, Shandong University, Jinan, China
| | - Yi Zhao
- Center for Gene and Immunotherapy, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xia Liu
- Department of Respiratory Intervention, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Fang Xiao
- Department of Health Care and Geriatrics, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoyan Li
- Hematology Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jianting Hu
- Shandong Pharmaceutical Academy, Shandong Provincial Key Laboratory of Chemical Drugs, Jinan, China
| | - Yingjie Chen
- Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan, China
| | - Shengli Li
- Department of Hematology of Jining No. 1 People's Hospital, Jining, China
| | - Baozhu Wang
- Department of Pharmacology, School of Pharmaceutical Sciences, Shandong University, Jinan, China
| | - Yuan Chen
- Central Research Laboratory, The second hospital of Shandong University, Jinan, China
| | - Yang Jiang
- Hematology Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China; Institute of Biotherapy for Hematological Malignancies, Shandong University, Jinan, China; Shandong University-Karolinska Institute Collaborative Laboratory for Stem Cell Research, Shandong University, Jinan, China
| | - Xiaoli Liu
- Hematology Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China; Institute of Biotherapy for Hematological Malignancies, Shandong University, Jinan, China; Shandong University-Karolinska Institute Collaborative Laboratory for Stem Cell Research, Shandong University, Jinan, China
| | - Xiumei Feng
- Shandong University-Karolinska Institute Collaborative Laboratory for Stem Cell Research, Shandong University, Jinan, China
| | - Yanan Guo
- Hematology Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoli Feng
- Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan, China
| | - Jing Ren
- Hematology Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fang Wang
- Institute of Medical Sciences, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ying Han
- Institute of Medical Sciences, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - William Donelan
- Department of Urology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Lijun Yang
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Dawei Xu
- Shandong University-Karolinska Institute Collaborative Laboratory for Stem Cell Research, Shandong University, Jinan, China; Department of Medicine, Division of Hematology, Center for Molecular Medicine (CMM) and Bioclinicum, Karolinska Institute, Stockholm, Sweden
| | - Dongqi Tang
- Center for Gene and Immunotherapy, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Chengyun Zheng
- Hematology Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China; Institute of Biotherapy for Hematological Malignancies, Shandong University, Jinan, China; Shandong University-Karolinska Institute Collaborative Laboratory for Stem Cell Research, Shandong University, Jinan, China.
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Youssef MAM, Ghazaly MH, Abdelfattah MA. Alternative treatment modality for severe aplastic anemia in a resource-limited setting: a single-institution prospective cohort study from Upper Egypt. Ann Hematol 2023; 102:2997-3006. [PMID: 37704874 PMCID: PMC10567959 DOI: 10.1007/s00277-023-05440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/03/2023] [Indexed: 09/15/2023]
Abstract
This study compared the efficacy and safety of CsA monotherapy with eltrombopag (E-PAG) + CsA combined treatment in children with severe aplastic anemia (SAA). The study including 30 children had SAA. Ten were a retrospective cohort treated with CsA monotherapy. The other 20 were prospective cohort received E-PAG + CsA. All patients were evaluated for partial (PR) and complete (CR) hematological response at 3, 6, and 12 months. overall response (OR), overall survival rates (OS), and treatment safety. OR for the E-PAG patients was 40% after 3 months of therapy. At 6 months, this had increased to 75% with significantly higher CR rate (40%) than in the CsA group (p = 0.0001). After a year of treatment, the CR for the E-PAG + CsA regimen had increased to 50% and the OR to 85%, compared to 20% in the CsA group (p = 0.0001). The OS at 12 months was 100% in the E-PAG+ CsA group compared to 80% in the CsA cohort. At 24 months, the OS in the E-PAG + CsA group was 90%. In conclusion, E-PAG+ CsA was found to be a safe and effective alternative treatment for children with SAA particularly in countries with limited resources.
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Affiliation(s)
- Mervat A M Youssef
- Children Hospital, Hematology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammed H Ghazaly
- Children Hospital, Hematology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mai A Abdelfattah
- Children Hospital, Hematology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
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Liu NA, Liu JQ, Liu Y, Zhu Q, Zheng D, Li F, Meng LZ, Qiu M. Rehmannia Glutinosa Polysaccharide Regulates Bone Marrow Microenvironment via HIF-1α/NF-κB Signaling Pathway in Aplastic Anemia Mice. AN ACAD BRAS CIENC 2023; 95:e20220672. [PMID: 37556607 DOI: 10.1590/0001-3765202320220672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/31/2022] [Indexed: 08/11/2023] Open
Abstract
Aplastic anemia (AA), a rare disorder, is associated with bone marrow microenvironment (BMM). Presently, AA treatment is of great difficulty. This study aimed to explore the mechanism of action of Rehmannia glutinosa polysaccharide (RGP) in AA. Busulfan was used to induce AA in BALB/c mice; blood cell count and Ray's Giemsa staining were used to assess the severity of hematopoietic failure; HE was performed to assess the pathological state of the marrow cavity; ELISA was performed to assess IL-4, IL-10, IL-6, IL-12, IL-1β, TNF-α, MCP-1, VEGF, and EPO; and WB was performed to evaluate the effects of RGP on the HIF-1α/NF-κB signaling. Significant downregulation of hemocyte levels in the blood and nucleated cells in the bone marrow was reversed by RGP and Cyclosporine A (CA). Compared with the AA group, dilating blood sinusoids, inflammation, hematopoiesis, decreased bone marrow cells and megakaryocytes were alleviated by RGP and CA, and the HIF-1α/NF-κB signaling was inhibited too. Notably, RGP was more effective when used in combination with CA. In this study, we established a relationship between BMM and the HIF-1α/NF-κB signaling pathway and found that RGP regulates BMM by suppressing the activation of the HIF-1α/NF-κB signaling. Thus, RGP exerts a pharmacological effect on AA.
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Affiliation(s)
- N A Liu
- Chongqing Hospital of Traditional Chinese Medicine, Department of Oncology, No.6, Panxi Seventh Branch Road, Jiangbei District, Chongqing, 400021, China
| | - Jun-Qiu Liu
- Zhejiang Chinese Medical University, School of Pharmaceutical Science, No. 548, Binwen Road, Binjiang District, Hangzhou, Zhejiang Province, 311402, China
| | - Yong Liu
- Chongqing Hospital of Traditional Chinese Medicine, Department of Oncology, No.6, Panxi Seventh Branch Road, Jiangbei District, Chongqing, 400021, China
| | - Qing Zhu
- Chongqing Hospital of Traditional Chinese Medicine, Department of Oncology, No.6, Panxi Seventh Branch Road, Jiangbei District, Chongqing, 400021, China
| | - Dandan Zheng
- Chongqing Hospital of Traditional Chinese Medicine, Department of Oncology, No.6, Panxi Seventh Branch Road, Jiangbei District, Chongqing, 400021, China
| | - Feng Li
- Chongqing Hospital of Traditional Chinese Medicine, Department of Oncology, No.6, Panxi Seventh Branch Road, Jiangbei District, Chongqing, 400021, China
| | - Ling-Zhan Meng
- Chongqing Hospital of Traditional Chinese Medicine, Department of Oncology, No.6, Panxi Seventh Branch Road, Jiangbei District, Chongqing, 400021, China
| | - Min Qiu
- Chongqing Hospital of Traditional Chinese Medicine, Department of Oncology, No.6, Panxi Seventh Branch Road, Jiangbei District, Chongqing, 400021, China
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Gurnari C, Pagliuca S, Maciejewski JP. Clonal evolution in aplastic anemia: failed tumor surveillance or maladaptive recovery? Leuk Lymphoma 2023; 64:1389-1399. [PMID: 37356012 PMCID: PMC11104022 DOI: 10.1080/10428194.2023.2215614] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 06/27/2023]
Abstract
Clonal evolution to secondary paroxysmal nocturnal hemoglobinuria (PNH) or myeloid neoplasia (MN) represents one of the long-term complications of patients with aplastic anemia (AA). The recent evidence in the field of immunology and the application of next-generation sequencing have shed light on the molecular underpinnings of these clonal complications, revealing clinical and molecular risk factors as well as potential immunological players. Particularly, whether MN evolution represents a failed tumor surveillance or a maladaptive recovery is still a matter of controversy in the field of bone marrow failure syndromes. However, recent studies have explored the precise dynamics of the immune-molecular forces governing such processes over time, generating knowledge useful for potential early therapeutic strategies. In this review, we will discuss the immune pathophysiology of AA and the emergence of clonal hematopoiesis with regard to the adaptive and maladaptive mechanisms at the basis of secondary evolution trajectories operating under the immune pressure.
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Affiliation(s)
- Carmelo Gurnari
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedicine and Prevention, PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Simona Pagliuca
- Sérvice d‘hématologie Clinique, ChRu de Nancy, Nancy, France
- CNRS UMR 7365 IMoPa, Biopôle de l‘Université de Lorraine, France Vandœuvre-lès-Nancy
| | - Jaroslaw P. Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Abouee-Mehrizi A, Rasoulzadeh Y, Solali S, Esmaeilizadeh H, Iraji Z, Mesgari-Abbasi M. Hematotoxicity induced by simultaneous exposure to noise and toluene in New Zealand white rabbits: Synergistic and antagonistic effects. Toxicol Ind Health 2023:7482337231180404. [PMID: 37303071 DOI: 10.1177/07482337231180404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Exposure to numerous pollutants is prevalent in workplaces. Examination of combined exposure to different harmful physical factors and chemicals has offered new insights into toxicology in recent years. This study aimed to investigate the hematological alterations caused by exposure to noise and toluene. Twenty-four New Zealand white rabbits were exposed to 1000 ± 50 ppm toluene and/or 100 ± 5 dB noise for 14 consecutive days. Exposure to noise and toluene changed a number of parameters of white blood cells (WBC), red blood cells (RBC), and platelets on different days after the exposure. Simultaneous exposure to noise and toluene increased WBC, and exposure to noise and toluene alone decreased RBC. Exposure to noise and toluene alone increased basophile, monocyte, and neutrophil counts. The coefficient of variation of red blood cell distribution width (RDW-CV) and the standard deviation of red blood cell distribution width (RDW-SD) significantly increased after co-exposure to noise and toluene. Platelet levels increased in the noise-exposed and the co-exposed groups and decreased in the toluene-exposed group. Furthermore, co-exposure to noise and toluene induced dissimilar synergistic and antagonistic effects on the hematological indices. According to the results of this study, simultaneous exposure to toluene and noise can aggravate some hematotoxic effects compared to exposure to noise or toluene alone. The results also demonstrated the vital role of the modulatory mechanisms of the body in controlling the detrimental effects of stressors.
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Affiliation(s)
- Amirreza Abouee-Mehrizi
- Department of Occupational Health Engineering, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yahya Rasoulzadeh
- Department of Occupational Health Engineering, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Solali
- Department of Immunology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Esmaeilizadeh
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeynab Iraji
- Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehran Mesgari-Abbasi
- Drug Applied Research Center (DARC), Tabriz University of Medical Sciences, Tabriz, Iran
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8
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Gavriilaki E, Tragiannidis A, Papathanasiou M, Besikli S, Karvouni P, Douka V, Paphianou E, Hatzipantelis E, Papaioannou G, Athanasiadou A, Marvaki A, Panteliadou AK, Vardi A, Batsis I, Syrigou A, Mallouri D, Lalayanni C, Sakellari I. Aplastic anemia and paroxysmal nocturnal hemoglobinuria in children and adults in two centers of Northern Greece. Front Oncol 2022; 12:947410. [PMID: 36439498 PMCID: PMC9684709 DOI: 10.3389/fonc.2022.947410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/17/2022] [Indexed: 09/14/2023] Open
Abstract
Bone marrow failure (BMF) syndromes are a group of various hematological diseases with cytopenia as a main common characteristic. Given their rarity and continuous progress in the field, we aim to provide data considering the efficiency and safety of the therapeutic methods, focusing on the treatment of aplastic anemia(AA) and paroxysmal nocturnal hemoglobinuria (PNH). We enrolled consecutive patients diagnosed with BMF in two referral centers of Northern Greece from 2008 to 2020. We studied 43 patients with AA (37 adults and 6 children/adolescents) and 6 with classical PNH. Regarding classical PNH, 4 patients have received eculizumab treatment with 1/4 presenting extravascular hemolysis. Among 43 patients with aplastic anemia, PNH clones were detected in 11. Regarding patients that did not receive alloHCT (n=15), 14/15 were treated with ATG and cyclosporine as first line, with the addition of eltrombopag in patients treated after its approval (n=9). With a median follow-up of 16.7 (1.8-56.2) months from diagnosis, 12/14 (85.7%) are alive (4-year OS: 85.1%). AlloHCT was performed in 28 patients. Five patients developed TA-TMA which did not resolve in 3/5 (all with a pre-transplant PNH clone). With the follow-up among survivors reaching 86.3 (6.3-262.4) months, 10-year OS was 56.9%, independently associated with PNH clones after adjusting for age (p=0.024). In conclusion, our real-world experience confirms that novel treatments are changing the field of BMF syndromes. Nevertheless, there is still an unmet need to personalize algorithms in this field.
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Affiliation(s)
- Eleni Gavriilaki
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Athanasios Tragiannidis
- 2Paediatric Department, American Hellenic Educational Progressive Association (AHEPA) Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Papathanasiou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Sotiria Besikli
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Vassiliki Douka
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Eleni Paphianou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Emmanuel Hatzipantelis
- 2Paediatric Department, American Hellenic Educational Progressive Association (AHEPA) Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giorgos Papaioannou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Anastasia Athanasiadou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Anastasia Marvaki
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Alkistis-Kira Panteliadou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Anna Vardi
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Ioannis Batsis
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Antonia Syrigou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Despina Mallouri
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Chrysavgi Lalayanni
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Ioanna Sakellari
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G Papanicolaou Hospital, Thessaloniki, Greece
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Sharma V, Kumar P, Kumar R, Chakraborty S, Namdeo M, Sazawal S, Kanga U, Seth T, Mitra DK. Interferon-gamma and perforin-positive T cells in acquired aplastic anemia: implication in therapeutic response. Clin Exp Immunol 2022; 207:272-278. [PMID: 35553631 PMCID: PMC9113177 DOI: 10.1093/cei/uxab006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/24/2021] [Accepted: 12/09/2021] [Indexed: 11/12/2022] Open
Abstract
Acquired aplastic anemia (aAA) is an autoimmune disease, characterized by infiltration of T lymphocytes in the bone marrow with destruction of hematopoietic stem cells by the effector cells. Interferon-gamma (IFN-γ) and perforin are important mediators of cell destruction. In this flow cytometry-based study, we have investigated the percentage of intracellular IFN-γ+ and perforin+ CD5+ T cells in peripheral blood of newly diagnosed aAA patients before and after immunosuppressive therapy (IST). Patients were categorized as per standard disease severity and response to IST. The median percentage of IFN-γ+ and perforin+ CD5+ T cells was higher in untreated patients compared to healthy controls. The percentage of these cells was also increased in untreated severe and very severe aplastic anemia when compared with non-severe aplastic anemia patients. In patients before and after IST the median percentage of T cells producing IFN-γ and perforin was elevated in non-responders as compared to partial plus complete responders. The higher percentage of IFN-γ+ and perforin+ CD5+ T cells may be useful as an early diagnostic marker for aberrant activation of immune system and predict poor response to IST in aAA patients, who will benefit from alternative therapy.
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Affiliation(s)
- Vandana Sharma
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabin Kumar
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sushmita Chakraborty
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Manju Namdeo
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Sudha Sazawal
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Uma Kanga
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Tulika Seth
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipendra Kumar Mitra
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
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Huang LF, Li L, Jia JS, Yang Y, Lin SY, Meng FK, Zhang DH, He GS. weFrontline Therapy Options for Adults with Newly Diagnosed Severe Aplastic Anemia: Intensive immunosuppressive therapy Plus Eltrombopag or Matched Sibling Donor Hematopoietic Stem Cell Transplantation? Transplant Cell Ther 2022; 28:586.e1-586.e7. [DOI: 10.1016/j.jtct.2022.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/14/2022] [Accepted: 05/17/2022] [Indexed: 11/15/2022]
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11
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Zhang Y, Zhang Y, Ge H, Li N, Liu C, Wang T, Fu R, Shao Z. Identification of potential pathogenic genes for severe aplastic anemia by whole-exome sequencing. J Clin Lab Anal 2022; 36:e24438. [PMID: 35435273 PMCID: PMC9102512 DOI: 10.1002/jcla.24438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/24/2022] [Accepted: 04/02/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Severe aplastic anemia (SAA) is a syndrome of severe bone marrow failure due to hyperfunction of CD8+ T cells. While, the genetic background of SAA is still unknown. In this study, we tried to explore the possible genetic variants in CD8+ T cells of SAA patients. METHODS We performed whole-exome sequencing (WES) in CD8+ T cells of 4 SAA patients and 7 normal controls. The mutations that existed in SAA but not in NCs were identified as candidate genes. Then, we compared them with genes in the enriched KEGG pathway of differently expressed genes (DEGs) from previous RNA-seq. After analyzing the types of mutations, we identified possible pathogenic genes and validated them by RT-PCR. Finally, we compared them with the autoimmune disease-related genes in DisGeNET database to select the most possible pathogenic genes. RESULTS We found 95 candidate mutant genes in which, 4 possible pathogenic genes were identified: PRSS1, KCNJ18, PRSS2, and DGKK. RT-PCR results showed that compared with NCs, PRSS1 and KCNJ18 mRNA expression was significantly increased in SAA patients (p < 0.05), PRSS2 was also increased in SAA patients but without statistical difference, and DGKK gene could not be detected by RT-PCR in SAA patients. In addition, PRSS1 was associated with autoimmune diseases from the DisGeNET database. CONCLUSION The mutations of PRSS1, KCNJ18, PRSS2, and DGKK, especially PRSS1 in CD8+T cells, may be involved in the immune pathogenesis of SAA.
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Affiliation(s)
- Yang Zhang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Zhang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongyu Ge
- Department of Infectious Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Nianbin Li
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Chunyan Liu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Ting Wang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zonghong Shao
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
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12
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Design, synthesis, and pharmacological evaluation of sinomenine derivatives on rings A and C: Novel compounds screening for aplastic anemia targeting on cytotoxic T lymphocyte. Eur J Med Chem 2021; 225:113791. [PMID: 34450495 DOI: 10.1016/j.ejmech.2021.113791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/29/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022]
Abstract
Cytotoxic T lymphocyte (CTL), a key effector cell in aplastic anemia (AA) immune injury, is shown to be a potential target for AA drug therapy. However, there is no candidate for this target till now. Oriented by the inhibition activity of CTL and macrophage derived nitric oxide (NO), a series of novel sinomenine derivatives on rings A and C are designed, synthesized and screened. Among them, compound 3a demonstrates the best inhibitory activity on CTL with an IC50 value of 2.3 μM, and a 97.1% inhibiton rate on macrophage NO production without significant cytotoxicity. Further, compound 3a exhibits substantial therapeutic efficacy on immune-mediated BM failure in AA model mice by improving the symptoms of anemia and the function of BM hematopoiesis, and shows more advantages in life quality improving than cyclosporine A (CsA). Its efficacy on AA at least partly comes from targeting on activated cluster of differentiation (CD)8+ T cell. Additionally, 3a also shows much less toxicity (LD50 > 10.0 g/kg) than sinomenine (LD50 = 1.1 g/kg) in preliminary acute toxicity assessment in mice, and has a low risk to inhibit hERG to cause cardiotoxicity. These results indicate that compound 3a merits further investigation for AA treatment by targeting on CTL.
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13
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Shao Y, Qi W, Zhang X, Ran N, Liu C, Fu R, Shao Z. Plasma Metabolomic and Intestinal Microbial Analyses of Patients With Severe Aplastic Anemia. Front Cell Dev Biol 2021; 9:669887. [PMID: 34497802 PMCID: PMC8419359 DOI: 10.3389/fcell.2021.669887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/20/2021] [Indexed: 11/20/2022] Open
Abstract
Aplastic anemia results from bone marrow failure caused by an autoimmune abnormality, but the pathogenesis of severe aplastic anemia (SAA) is not well characterized. To identify potential metabolic markers of SAA and to further elucidate the pathogenetic mechanisms of SAA, we performed a metabolomic study of plasma samples and characterized the intestinal microbiota of patients with SAA and healthy controls. Patients with SAA had more Enterobacteriales and Lactobacillales, but fewer Bacteroidales, Clostridiales, and Erysipelotrichales than healthy controls. At the species level, the abundances of Escherichia coli and others including Clostridium citroniae were higher, whereas those of Prevotella copri, Roseburia faecis, and Ruminococcus bromii were lower. Eight metabolites showed significantly different plasma concentrations in the SAA and healthy control groups. Coumaric acid, L-phenylalanine, and sulfate were present at higher concentrations in the SAA group; whereas L-glutamic γ-semialdehyde, theobromine, 3a, 7a-dihydroxy-5b-cholestane, γ-δ-dioxovaleric acid, and (12Z)-9, 10-dihydroxyoctadec-12-enoic acid were present at lower concentrations. In conclusion, patients with SAA show abnormalities in both their plasma metabolomes and intestinal microbial compositions. These differences might reflect the molecular mechanisms involved in the defective immunity that characterizes SAA.
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Affiliation(s)
- Yuanyuan Shao
- Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Weiwei Qi
- Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaomei Zhang
- Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Ningyuan Ran
- Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Chunyan Liu
- Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Rong Fu
- Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Zonghong Shao
- Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, China
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14
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Huang J, Huang L, Liu S, Lin S, Cheng Y, Jiang X, Xue H, Li C, Chen C. Clinical Outcome of Acquired Post-Immunosuppressive-Therapy Aplastic Anemia in Pediatric Patients: A 13-Year Experience in Two Southern China Tertiary Care Centers. Int J Gen Med 2021; 14:3133-3144. [PMID: 34239322 PMCID: PMC8259937 DOI: 10.2147/ijgm.s313898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of the present study is to evaluate the efficacy, complications, and contributing factors of immunosuppressive therapy (IST) response in children with acquired aplastic anemia (AA) and to explore optimal therapeutic methods for different clinical AA types. Methods A total of 130 children diagnosed with acquired AA underwent IST in the Department of Pediatrics at Sun Yat-sen Memorial Hospital and the Department of Pediatrics at Seventh Affiliated Hospital, Sun Yat-sen University, between January 1, 2006, and July 15, 2020. The overall survival (OS), response rates, complications, and response predictors were analyzed. The response rates were compared according to clinical AA type. Results All 130 children with AA were followed up with for a median of 50.6 months. Among the patients, 25 had non-severe AA (NSAA), 64 had severe AA (SAA), and 41 had very severe AA (VSAA). All patients initially received IST. In 13 patients, the IST failed; these patients received an allo-hematopoietic stem cell transplant as a salvage regimen. The OS rate was 90.3% ± 2.8%, and the response rates at 3, 6, 9, and 12 months were 34.19%, 39.32%, 49.57%, and 66.67%, respectively. The prolonged follow-up period might have led to higher response rates, especially in patients with SAA and VSAA. A multivariate logistic regression analysis of prognostic factors was conducted; the results showed that high red blood cell (RBC) and platelet (PLT) counts were associated with a high overall response rate and that the RBC count at diagnosis is a major contributing factor. Conclusion With the use of rabbit anti-thymocyte globulin, proper cyclosporine management, and a prolonged IST follow-up period, a higher number of patients with acquired AA than normal achieved response. Proportionally, the number of patients who achieved remission within 12 months was higher in the SAA group (38.18%→63.64%) and VSAA group (28.95%→65.79%) than in the NSAA group (58.33%→75%). Higher RBC and PLT counts at diagnosis can predict a favorable outcome.
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Affiliation(s)
- Junbin Huang
- Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, People's Republic of China
| | - Lifen Huang
- Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, People's Republic of China
| | - Su Liu
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, People's Republic of China
| | - Shaofen Lin
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, People's Republic of China
| | - Yucai Cheng
- Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, People's Republic of China
| | - Xiaoyun Jiang
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 518000, People's Republic of China
| | - Hongman Xue
- Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, People's Republic of China
| | - Chikong Li
- Division of Haematology/Oncology/BMT, Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, 999077, People's Republic of China
| | - Chun Chen
- Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, People's Republic of China
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CCR5 maintains macrophages in the bone marrow and drives hematopoietic failure in a mouse model of severe aplastic anemia. Leukemia 2021; 35:3139-3151. [PMID: 33744909 DOI: 10.1038/s41375-021-01219-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 12/11/2022]
Abstract
Severe aplastic anemia (SAA) is an acquired, T cell-driven bone marrow (BM) failure disease characterized by elevated interferon gamma (IFNγ), loss of hematopoietic stem cells (HSCs), and altered BM microenvironment, including dysfunctional macrophages (MΦs). T lymphocytes are therapeutic targets for treating SAA, however, the underlying mechanisms driving SAA development and how innate immune cells contribute to disease remain poorly understood. In a murine model of SAA, increased beta-chemokines correlated with disease and were partially dependent on IFNγ. IFNγ was required for increased expression of the chemokine receptor CCR5 on MΦs. CCR5 antagonism in murine SAA improved survival, correlating with increased platelets and significantly increased platelet-biased CD41hi HSCs. T cells are key drivers of disease, however, T cell-specific CCR5 expression and T cell-derived CCL5 were not necessary for disease. CCR5 antagonism reduced BM MΦs and diminished their expression of Tnf and Ccl5, correlating with reduced frequencies of IFNγ-secreting BM T cells. Mechanistically, CCR5 was intrinsically required for maintaining BM MΦs during SAA. Ccr5 expression was significantly increased in MΦs from aged mice and humans, relative to young counterparts. Our data identify CCR5 signaling as a key axis promoting the development of IFNγ-dependent BM failure, particularly relevant in aging where Ccr5 expression is elevated.
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16
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Treg sensitivity to FasL and relative IL-2 deprivation drive idiopathic aplastic anemia immune dysfunction. Blood 2021; 136:885-897. [PMID: 32294156 DOI: 10.1182/blood.2019001347] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/07/2020] [Indexed: 12/12/2022] Open
Abstract
Idiopathic aplastic anemia (AA) has 2 key characteristics: an autoimmune response against hematopoietic stem/progenitor cells and regulatory T-cells (Tregs) deficiency. We have previously demonstrated reduction in a specific subpopulation of Treg in AA, which predicts response to immunosuppression. The aims of the present study were to define mechanisms of Treg subpopulation imbalance and identify potential for therapeutic intervention. We have identified 2 mechanisms that lead to skewed Treg composition in AA: first, FasL-mediated apoptosis on ligand interaction; and, second, relative interleukin-2 (IL-2) deprivation. We have shown that IL-2 augmentation can overcome these mechanisms. Interestingly, when high concentrations of IL-2 were used for in vitro Treg expansion cultures, AA Tregs were able to expand. The expanded populations expressed a high level of p-BCL-2, which makes them resistant to apoptosis. Using a xenograft mouse model, the function and stability of expanded AA Tregs were tested. We have shown that these Tregs were able to suppress the macroscopic clinical features and tissue manifestations of T-cell-mediated graft-versus-host disease. These Tregs maintained their suppressive properties as well as their phenotype in a highly inflammatory environment. Our findings provide an insight into the mechanisms of Treg reduction in AA. We have identified novel targets with potential for therapeutic interventions. Supplementation of ex vivo expansion cultures of Tregs with high concentrations of IL-2 or delivery of IL-2 directly to patients could improve clinical outcomes in addition to standard immunosuppressive therapy.
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17
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Zu Y, Zhou J, Fu Y, Fang B, Liu X, Zhang Y, Yu F, Zuo W, Zhou H, Gui R, Li Z, Liu Y, Zhao H, Zhang C, Song Y. Feasibility of reduced-dose posttransplant cyclophosphamide and cotransplantation of peripheral blood stem cells and umbilical cord-derived mesenchymal stem cells for SAA. Sci Rep 2021; 11:253. [PMID: 33420287 PMCID: PMC7794355 DOI: 10.1038/s41598-020-80531-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022] Open
Abstract
Posttransplant cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis is an effective strategie for patients receiving matched sibling donor hematopoietic stem cell transplantation (MSD-HSCT) and haploidentical HSCT (haplo-HSCT). We evaluated the effectiveness and safety of reduced-dose cyclophosphamide, 20 mg/kg for 13 patients in MSD-HSCT cohort and 25 mg/kg for 22 patients in haplo-HSCT cohort, on days + 3, + 4 combined with cotransplantation of peripheral blood stem cells (PBSCs) and human umbilical cord-derived mesenchymal stem cells (UC-MSCs) for severe aplastic anemia (SAA). In MSD-PTCy cohort, the times to neutrophil and platelet engraftment were significantly shorter than those in the MSD-control cohort (P < 0.05). The cumulative incidence of acute GVHD (aGVHD) at day + 100 (15.4%) was lower than that in the MSD-control cohort (P = 0.050). No patient developed chronic GVHD (cGVHD). The 1-year overall survival (OS) and event-free survival (EFS) rates were 100% and 92.3%. In haplo-PTCy cohort, the times to neutrophil and platelet engraftment were significantly shorter than those in the haplo-control cohort (P < 0.05). The cumulative incidences of aGVHD at day + 100 and 1-year cGVHD were 31.8% and 18.2%, and the 1-year OS and EFS rates were 81.8% and 66.9%. Reduced-dose PTCy and cotransplantation of PBSCs and UC-MSCs is an acceptable alternative to patients with SAA.
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Affiliation(s)
- Yingling Zu
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China
| | - Jian Zhou
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China.
| | - Yuewen Fu
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China
| | - Baijun Fang
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China
| | - Xinjian Liu
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China
| | - Yanli Zhang
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China
| | - Fengkuan Yu
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China
| | - Wenli Zuo
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China
| | - Hu Zhou
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China
| | - Ruirui Gui
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China
| | - Zhen Li
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China
| | - Yanyan Liu
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China
| | - Huifang Zhao
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China
| | - Chengjuan Zhang
- Center of Bio-Repository, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China
| | - Yongping Song
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450000, People's Republic of China.
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Alshaibani A, Dufour C, Risitano A, de Latour R, Aljurf M. Hepatitis-associated aplastic anemia. Hematol Oncol Stem Cell Ther 2020; 15:8-12. [PMID: 33197413 DOI: 10.1016/j.hemonc.2020.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/24/2020] [Indexed: 02/08/2023] Open
Abstract
Hepatitis-associated aplastic anemia (HAAA) is a rare illness, characterized by onset of pancytopenia with a hypoplastic bone marrow that traditionally occurs within 6 months of an increase in serum aminotransferases. HAAA is observed in 1% to 5% of all newly diagnosed cases of acquired aplastic anemia. Several hepatitis viruses have been linked to the disease, but in many cases no specific virus is detected. The exact pathophysiology is unknown; however, immune destruction of hematopoietic stem cells is believed to be the underlying mechanism. HAAA is a potentially lethal disease if left untreated. Management includes immunosuppression with antithymocyte globulin and cyclosporine and allogeneic hematopoietic stem cell transplantation.
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Affiliation(s)
- Alfadel Alshaibani
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Carlo Dufour
- Hematology-Oncology-HSCT Pole, G.Gaslini IRCCS Children Hospital, Genova, Italy.
| | - Antonio Risitano
- Department of Clinical Medicine and Surgery, Bone Marrow Transplant Center, Federico II University of Naples, Naples, Italy.
| | - Regis de Latour
- Saint Louis Hospital, Paris Diderot University, Paris, France.
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Efficacy of Rabbit Antithymocyte Globulin as a First-line Therapy in Children With Aplastic Anemia. J Pediatr Hematol Oncol 2020; 42:e702-e706. [PMID: 32969848 DOI: 10.1097/mph.0000000000001885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The efficacy, safety, and outcome of rabbit antihuman thymocyte globulin (rATG) as initial therapy for children aplastic anemia (AA) were evaluated. PATIENTS AND METHODS Sixty-one children with AA were retrospectively analyzed, including 43 patients with severe AA and 18 patients with transfusion-dependent nonsevere AA. All patients received rATG in combination with cyclosporine A between September 2005 and January 2015. RESULTS The overall response rates were 55.7%, 68.9%, and 68.9% at 6, 12, and 18 months, respectively. Surprisingly, the overall complete response rate kept increasing from 9.8% at 12 months to 39.3% at 18 months, indicating a delayed response for rATG. Overall survival at 5 and 10 years was 72.1% and 67.2%, respectively. The overall survival of patients who responded between 3 and 12 months was significantly higher than that of nonresponders (71.4% vs. 47.4%).Antithymocyte globulin-related adverse reactions were significantly higher in severe AA (83.7%) than in nonsevere AA (55.6%) and these reactions were controllable and not life threatening with comprehensive measures. CONCLUSIONS This retrospective study shows an encouraging response and survival results in children with AA treated with rATG. Prolonged assessments were needed to evaluate the delayed responses to rATG. rATG could be used as an alternative in the first-line treatment of childhood AA.
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20
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Liu Z, Wu X, Wang S, Xia L, Xiao H, Li Y, Li H, Zhang Y, Xu D, Nie D, Lai Y, Wu B, Lin D, Du X, Jiang Z, Gao Y, Gu X, Xiao Y. Co-transplantation of mesenchymal stem cells makes haploidentical HSCT a potential comparable therapy with matched sibling donor HSCT for patients with severe aplastic anemia. Ther Adv Hematol 2020; 11:2040620720965411. [PMID: 33194162 PMCID: PMC7605036 DOI: 10.1177/2040620720965411] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022] Open
Abstract
The application of haploidentical hematopoietic stem cell transplantation (HSCT) with mesenchymal stem cell (MSC) infusion as a treatment regimen for severe aplastic anemia (SAA) has been reported to be efficacious in single-arm trials. However, it is difficult to assess without comparing the results with those from a first-line, matched-sibling HSCT. Herein, we retrospectively reviewed 91 patients with acquired SAA. They received HSCT from haploidentical donors combined with MSC transfer (HID group). We compared these patients with 103 others who received first-line matched-sibling HSCT (MSD group) to evaluate relative treatment efficacy. Compared with the patients in the MSD group, those in the HID group presented with higher incidences of grades II–IV and III–IV acute graft versus host disease (aGvHD) and chronic graft versus host disease (cGvHD) (p < 0.05). However, the incidence of myeloid and platelet engraftment, graft failure, poor graft function, and extensive cGvHD were comparable for both groups. The median follow-up was 36.6 months and the 3-year overall survival rate was similar for both groups (83.5% versus 79.1%). Univariate and multivariate analyses revealed that time intervals greater than 4 months from diagnosis to transplantation, experienced graft failure, poor graft function, or grade III–IV aGvHD were significantly associated with adverse outcomes. All HID patients received MSC co-transplantation with hematopoietic stem cells. However, the infused MSCs were derived from umbilical cord (UC-MSC group; 43 patients) or bone marrow (BM-MSC group; 48 patients) and were administered at different medical centers. We first compared the outcomes between the two groups and detected that the BM-MSC group exhibited lower incidences of grade III–IV aGvHD and cGvHD (p < 0.05). This study suggests that co-transplantation of hematopoietic and MSCs significantly reduces the risk and incidence of graft rejection and may effectively improve overall survival in patients with SAA even in the absence of closely related histocompatible donor material.
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Affiliation(s)
- Zenghui Liu
- Guangzhou University of Chinese Medicine; The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoxiong Wu
- First Affiliated Hospital of PLA General Hospital, Beijing, China
| | | | - Linghui Xia
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haowen Xiao
- General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Yonghua Li
- General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Hongbo Li
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuping Zhang
- Guangzhou First People's Hospital, Guangzhou, China
| | - Duorong Xu
- First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Danian Nie
- Second Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yongrong Lai
- First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bingyi Wu
- Affiliated Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Dongjun Lin
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xin Du
- Shenzhen Second People's Hospital, Shenzhen, China
| | - Zujun Jiang
- General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Yang Gao
- General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Xuekui Gu
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No 16, Jichang Road, Guangzhou, Guangdong Province, 510405, PR China
| | - Yang Xiao
- Stem Cell Translational Medicine Center, The Second Affiliated Hospital of Guangzhou Medical University, No. 250, Changgang East Road, Guangzhou, Guangdong Province, 510260, PR China
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21
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Successful Hematopoietic Stem Cell Transplantation from a Matched Related Donor with Beta-Thalassemia Minor for Severe Aplastic Anemia. CHILDREN-BASEL 2020; 7:children7100162. [PMID: 33020370 PMCID: PMC7599690 DOI: 10.3390/children7100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022]
Abstract
The first-line treatment for severe aplastic anemia (SAA) patients is hematopoietic stem cell transplantation (HSCT), with full-matched related donors considered the most suitable. We report a case of SAA in which the patient successfully underwent HSCT from a donor with β-thalassemia minor. The patient in this case underwent HSCT from a human leukocyte antigen (HLA)-matched younger brother with β-thalassemia minor. A 7-year-old girl was referred to our facility following a 6-month history of easy bruising and pallor. Laboratory examinations showed pancytopenia and hypocellular bone marrow with cellularity of <5%. She was diagnosed with acquired SAA, and HLA typing of her family members was performed. Her younger brother was an HLA-matched sibling but had β-thalassemia minor. Since his hemoglobin levels were maintained at 10-11 d/dL, he was considered a suitable HSCT donor. The conditioning regimen included fludarabine, cyclophosphamide, and anti-thymocyte globulin. The CD34+ and CD3+ cell counts were 6.6 × 106/kg and 0.48 × 108/kg, respectively. White blood cell engraftment was evident on day +11. Regimen-associated toxicities, such as anorexia and enteritis, were mild; no infections occurred, and no symptoms of acute graft-versus-host disease (GVHD) were observed. The 30-day follow-up bone marrow examination revealed normocellular marrow with 80%-90% cellularity. Acute or chronic GVHD has not been reported, and good performance status has been observed throughout the 5 years after HSCT. β-thalassemia minor patients can be considered as bone marrow donors for SAA patients.
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Leukocyte telomere length in patients with transfusion-dependent thalassemia. BMC Med Genomics 2020; 13:73. [PMID: 32487251 PMCID: PMC7268254 DOI: 10.1186/s12920-020-00734-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background Thalassemia is a hereditary hemolytic anemia with a severity ranging from mild, non-transfusion dependent to severe chronic anemia requiring lifelong transfusion. Transfusional iron overload is a major complication in patients with transfusion-dependent thalassemia (TDT). Telomeres are sequences of nucleotides forming the end caps of chromosomes that act as a DNA repair system. Iron overload in thalassemia can cause increased oxidative stress which leads to cellular damage and senescence. This may result in telomere length shortening. The degree of telomere length shortening may reflect the severity of thalassemia. Methods This research aimed to study the leukocyte telomere length in patients with TDT in comparison to non-thalassemic individuals and to identify the clinical and laboratory parameters that are associated with telomere length. We conducted a cross-sectional study in patients with TDT aged ≥18 years. Leukocyte telomere length was measured by real-time quantitative PCR. Results Sixty-five patients with TDT were enrolled onto the study. There were 37 female patients (54.4%). The median age was 27 (18–57) years, and mean pre-transfusion hemoglobin level was 7.1 (± 1.07) g/dL. The mean telomere to single copy gene (T/S) ratios of patients with TDT and the controls were 0.72 ± 0.18 and 0.99 ± 0.25, respectively (p < 0.0001). There was a significant correlation between the T/S ratio and age (p = 0.0002), and hemoglobin level (p = 0.044). There was no correlation between telomere length and other factors. Conclusions Our study showed that TDT patients had shorter leukocyte telomere length compared with controls. Leukocyte telomere shortening in TDT was an aging-dependent process and associated with lower hemoglobin level.
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Jia W, Zhen M, Li L, Zhou C, Sun Z, Liu S, Zhao Z, Li J, Wang C, Bai C. Gadofullerene nanoparticles for robust treatment of aplastic anemia induced by chemotherapy drugs. Am J Cancer Res 2020; 10:6886-6897. [PMID: 32550910 PMCID: PMC7295067 DOI: 10.7150/thno.46794] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023] Open
Abstract
Aplastic anemia (AA) is characterized as hypoplasia of bone marrow hematopoietic cells and hematopenia of peripheral blood cells. Though the supplement of exogenous erythropoietin (EPO) has been clinically approved for AA treatment, the side-effects hinder its further application. Here a robust treatment for AA induced by chemotherapy drugs is explored using gadofullerene nanoparticles (GFNPs). Methods: The gadofullerene were modified with hydrogen peroxide under alkaline conditions to become the water-soluble nanoparticles (GFNPs). The physicochemical properties, in vitro chemical construction, stability, hydroxyl radical scavenging ability, in vitro cytotoxicity, antioxidant activity, in vivo treatment efficacy, therapeutic mechanism and biological distribution, metabolism, toxicity of GFNPs were examined. Results: GFNPs with great stability and high-efficiency antioxidant activity could observably increase the number of red blood cells (RBC) in the peripheral blood of AA mice and relieve the abnormal pathological state of bone marrow. The erythropoiesis mainly includes hemopoietic stem cells (HSCs) differentiation, erythrocyte development in bone marrow and erythrocyte maturation in peripheral blood. The positive control-EPO promotes erythropoiesis by regulating HSCs differentiation and erythrocyte development in bone marrow. Different from the anti-AA mechanism of EPO, GFNPs have little impact on both the differentiation of HSCs and the myeloid erythrocyte development, but notably improve the erythrocyte maturation. Besides, GFNPs can notably decrease the excessive reactive oxygen species (ROS) and inhibit apoptosis of hemocytes in blood. In addition, GFNPs are mostly excreted from the living body and cause no serious toxicity. Conclusion: Our work provides an insight into the advanced nanoparticles to powerfully treat AA through ameliorating the erythrocyte maturation during erythropoiesis.
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Gu C, Zhu X, Qiao X, Zhai X, Shi W, Xie X. Multivariate logistic analysis of predictors of response to immunosuppressive therapy in children with aplastic anemia: a double-center study. ACTA ACUST UNITED AC 2020; 24:282-289. [PMID: 31793407 DOI: 10.1080/16078454.2019.1565149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Immunosuppressive therapy (IST) composed of antithymocyte globulin (ATG) and cyclosporine A (CSA) is one of the standard therapies in pediatric patients with acquired aplastic anemia (AA), but predictors of IST are lack of consensus. PROCEDURES Ninety-four patients from two pediatric medical centers in China were included between January 2005 and March 2018. Clinical factors associated with the efficacy were analyzed according to multivariate logistic regression model previously established. RESULTS We discovered that overall responsiveness was 77.66%. Five out of 35 factors were statistically significant in univariate analysis. Based on the cutoff point chosen by receiver operating characteristic (ROC) curve, 5 continuous variables were made categorical, among which 3 variables with significance were employed to establish the logistic regression equation. Based on these 3 variables, we found that starting IST within 126 days of the first appearance of symptoms (X1, p = .003), absolute neutrophil count (ANC) higher than 0.435×109/L (X2, p = .012), and rate of decreased actual lymphocyte count (ALC) higher than 59.2% within the 1st week after IST (X3, p = .001) were three independent risk factors for response to IST. The rate of decreased ALC higher than 59.2% after IST was the most significant variable (OR = 9.355, Log (P) = -2.161 + 2.149X1 + 1.662X2 + 2.236X3). The accuracy, sensitivity, and specificity of the model were 86.2%, 94.5% and 57.1%, respectively. CONCLUSION Duration of AA, ANC and decreased ALC rate after IST might predict the response to IST, among which the rate of decreased ALC after IST is the most important predictive factor.
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Affiliation(s)
- Changjuan Gu
- Department of Paediatrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xiaohua Zhu
- Department of Haematology, Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Xiaohong Qiao
- Department of Paediatrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xiaowen Zhai
- Department of Haematology, Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Wei Shi
- Department of Paediatrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xiaotian Xie
- Department of Paediatrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
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Allogeneic Hematopoietic Cell Transplantation in Patients With Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria Clones: Time for a Change. Hemasphere 2020; 4:e345. [PMID: 32309782 PMCID: PMC7162086 DOI: 10.1097/hs9.0000000000000345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/21/2019] [Accepted: 02/03/2020] [Indexed: 11/26/2022] Open
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Im SH, Kim BR, Park SM, Yoon BA, Hwang TJ, Baek HJ, Kook H. Better Failure-Free Survival and Graft-versus-Host Disease-Free/Failure Free Survival with Fludarabine-Based Conditioning in Stem Cell Transplantation for Aplastic Anemia in Children. J Korean Med Sci 2020; 35:e46. [PMID: 32080987 PMCID: PMC7036341 DOI: 10.3346/jkms.2020.35.e46] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/24/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study aimed to assess the outcome of stem cell transplantation (SCT), including overall survival (OS), failure-free survival (FFS) and graft-versus-host disease (GvHD)-free/failure-free survival (GFFS), and to analyze prognostic factors in children with aplastic anemia (AA). METHODS From 1991 to 2018, 43 allogeneic SCT recipients were enrolled in the study to investigate the demographic characteristics, survival outcomes and prognostic factors. RESULTS With the median follow-up of 7.1 years, the estimated 10-year OS, FFS, GFFS were 86.0%, 60.5%, and 51.2%, respectively. Matched related donors (MRD, n = 28) showed better 10-year OS than unrelated donors (n = 15) (96.4% vs. 66.7%; P = 0.006). Engraftment failure was seen in 13 patients (30.2%). Donor-type aplasia was seen in 13.8% (4/29) after fludarabine (Flu)-based conditioning (Flu-group), while in 42.6% (6/14) after cyclophosphamide (Cy)-based regimen (Cy-group) (P = 0.035). Six patients died. The 10-year OS in Cy-group was 92.9% (n = 14, all MRD), while that of Flu-group was 82.1% (n = 29; P = 0.367). But Flu-group tended to have better FFS and GFFS than Cy-group, although Flu-group had less MRDs (41.4% vs. 100%; P = 0.019), and higher proportion of previous immunosuppressive treatment (IST; 62% vs. 21.4%, P = 0.012). In MRD transplants, OS was similar between Flu-group (100%, n = 14) and Cy-group (92.9%, n = 14), while FFS (100.0% vs. 42.9%; P = 0.001) and GFFS (85.7% vs. 35.7%; P = 0.006) were significantly better in Flu-group. Stem cell sources, irradiation in the conditioning, and method of GvHD prophylaxis did not significantly influence the outcome. CONCLUSION This study reviewed SCT outcomes for pediatric AA with changes of transplant strategies over the last 25 years. The FFS and GFFS were higher in Flu-group than in Cy-group, especially in matched related transplantation. Graft failure including donor-type aplasia remains troublesome even with Flu-based conditioning. Further refinement of transplant strategies to ensure better quality-of-life should be pursued.
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Affiliation(s)
- Seung Hwan Im
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Bo Ram Kim
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Soo Min Park
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Bo Ae Yoon
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Tai Ju Hwang
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Environmental Health Center for Childhood Leukemia and Cancer, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hoon Kook
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Environmental Health Center for Childhood Leukemia and Cancer, Chonnam National University Hwasun Hospital, Hwasun, Korea.
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Pagliuca S, Ruggeri A, Peffault de Latour R. Cord blood transplantation for bone marrow failure syndromes: state of art. Stem Cell Investig 2019; 6:39. [PMID: 32039261 DOI: 10.21037/sci.2019.10.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/16/2019] [Indexed: 12/20/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) and immunosuppressive therapy (IST) represent the milestones of the treatment algorithm for idiopathic and inherited bone marrow failure (BMF) disorders. However, patients lacking a suitable donor or failing IST still have a poor prognosis. Cord blood transplantation (CBT) has extended the possibility of HSCT for many patients in case of the absence of an eligible donor, and although in the last years, this procedure is less used in several hematological diseases, it remains an option for the treatment of patients with BMF syndromes. Nevertheless, optimization of conditioning regimen and cord blood unit selection is warranted to reduce the risk of graft failure and transplant-related mortality. This review summarizes the state of art of CBT in the field of BMF diseases, focusing on historical and recent issues in idiopathic aplastic anemia and inherited disorders.
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Affiliation(s)
- Simona Pagliuca
- Hematology and Transplantation Unit, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Annalisa Ruggeri
- Department of Pediatric Hematology and Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy.,Eurocord-Monacord, Hôpital Saint Louis, Paris, France.,Cellular Therapy and Immunobiology Working Party of EBMT, Leiden, The Netherlands
| | - Régis Peffault de Latour
- Hematology and Transplantation Unit, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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ZHU LL, FAN LD, HU MH, MA FL, QI J. Hematopoietic effect of small molecular fraction of Polygoni multiflori Radix Praeparata in cyclophosphamide-induced anemia mice. Chin J Nat Med 2019; 17:535-544. [DOI: 10.1016/s1875-5364(19)30075-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Indexed: 12/18/2022]
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Gu L, Fu B, Sui X, Xu H. Abnormal expression of b10 cell frequencies: possible relation to pathogenesis and disease severity of aplastic anemia. ACTA ACUST UNITED AC 2019; 65:637-646. [PMID: 31166440 DOI: 10.1590/1806-9282.65.5.637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 01/09/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Aplastic anemia (AA) is an immune-mediated disease that destroys hematopoietic cells through activated T lymphocytes. B lymphocyte-mediated humoral immunity also plays an important role in the pathogenesis of AA. Regulatory B cell (Breg) subpopulation, which is defined as "B10", secretes interleukin 10 (IL-10). The objective of our experiment was to investigate whether the scale-down proportion of B10 cells in AA patients may play a key role in the pathogenesis. METHODS A total of 38 AA patients (14 SAA patients and 24 NSAA patients) and 20 healthy control subjects were included. All subjects did not suffer from autoimmune diseases or any other diseases affecting the immune system, such as infectious diseases. Bone marrow mononuclear cells (PBMCs) were isolated and analyzed by Flow cytometry (FCM) and Immunofluorescence double-labeling assay. The relationship between the relative proportions of B10 and ProB10 and their associations to AA, as well as disease severity, were assessed by common clinical indicators and then examined. RESULTS Our analyses revealed AA patients had significantly lower proportions of peripheral B10 and B10pro compared to healthy controls. SAA patients had a substantially lower percentage of B10 cells and B10pro cells compared to NSAA patients. In addition, B10 cells and B10pro cells were negatively correlated with absolute neutrophil counts, hemoglobin levels and platelet, and absolute reticulocyte counts in AA patients. CONCLUSIONS The present study attempted to elucidate the potential role of the scale-down proportion of B10 cells in the pathogenesis of AA.
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Affiliation(s)
- Lihua Gu
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Bin Fu
- The Department of Hematology of Heze Municipal Hospital, Heze, China
| | - Xiaohui Sui
- The Department of Hematology of Heze Municipal Hospital, Heze, China
| | - Hongzhi Xu
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Therapeutic Outcomes of Haploidentical Allogeneic Hematopoietic Stem Cell Transplantation in Patients With Severe Aplastic Anemia: A Multicenter Study. Transplantation 2019; 102:1724-1731. [PMID: 29677078 DOI: 10.1097/tp.0000000000002200] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Haploidentical donor (HID) allogeneic hematopoietic stem cell transplantation (HSCT) is an alternative curative treatment for patients with severe aplastic anemia (SAA) who do not have suitable matched related donors (MRD). The aim of this study was to compare the therapeutic outcomes of HID-HSCT with those of MRD-HSCT for SAA. METHODS A total of 235 SAA patients who underwent HID-HSCT (116) or MRD-HSCT (119) at 11 transplantation centers from January 2007 to January 2016 were included. Complications and survival outcomes were evaluated and compared between the 2 groups. RESULTS The HID group had a lower incidence of secondary graft failure but higher incidences of acute graft-versus-host disease (aGVHD) and chronic GVHD (cGVHD). However, the incidence of severe aGVHD (grades III-IV), poor graft function, and infections was comparable between groups. Patients in the HID group had a significantly lower survival and overall survival rates than those in the MRD group. The estimated 3-year survival rates for the MRD and HID groups were 82.82% and 75.00%, respectively. Ferritin levels, graft failure, poor graft function, severe aGVHD, and infections were the significant risk factors for survival. CONCLUSIONS The overall survival rate is acceptable for patients who underwent HID-HSCT, making it a feasible treatment choice for SAA patients.
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Rogers ZR, Nakano TA, Olson TS, Bertuch AA, Wang W, Gillio A, Coates TD, Chawla A, Castillo P, Kurre P, Gamper C, Bennett CM, Joshi S, Geddis AE, Boklan J, Nalepa G, Rothman JA, Huang JN, Kupfer GM, Cada M, Glader B, Walkovich KJ, Thompson AA, Hanna R, Vlachos A, Malsch M, Weller EA, Williams DA, Shimamura A. Immunosuppressive therapy for pediatric aplastic anemia: a North American Pediatric Aplastic Anemia Consortium study. Haematologica 2019; 104:1974-1983. [PMID: 30948484 PMCID: PMC6886407 DOI: 10.3324/haematol.2018.206540] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/28/2019] [Indexed: 12/21/2022] Open
Abstract
Quality of response to immunosuppressive therapy and long-term outcomes for pediatric severe aplastic anemia remain incompletely characterized. Contemporary evidence to inform treatment of relapsed or refractory severe aplastic anemia for pediatric patients is also limited. The clinical features and outcomes for 314 children treated from 2002 to 2014 with immunosuppressive therapy for acquired severe aplastic anemia were analyzed retrospectively from 25 institutions in the North American Pediatric Aplastic Anemia Consortium. The majority of subjects (n=264) received horse anti-thymocyte globulin (hATG) plus cyclosporine (CyA) with a median 61 months follow up. Following hATG/CyA, 71.2% (95%CI: 65.3,76.6) achieved an objective response. In contrast to adult studies, the quality of response achieved in pediatric patients was high, with 59.8% (95%CI: 53.7,65.8) complete response and 68.2% (95%CI: 62.2,73.8) achieving at least a very good partial response with a platelet count ≥50×109L. At five years post-hATG/CyA, overall survival was 93% (95%CI: 89,96), but event-free survival without subsequent treatment was only 64% (95%CI: 57,69) without a plateau. Twelve of 171 evaluable patients (7%) acquired clonal abnormalities after diagnosis after a median 25.2 months (range: 4.3-71 months) post treatment. Myelodysplastic syndrome or leukemia developed in 6 of 314 (1.9%). For relapsed/refractory disease, treatment with a hematopoietic stem cell transplant had a superior event-free survival compared to second immunosuppressive therapy treatment in a multivariate analysis (HR=0.19, 95%CI: 0.08,0.47; P=0.0003). This study highlights the need for improved therapies to achieve sustained high-quality remission for children with severe aplastic anemia.
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Affiliation(s)
- Zora R Rogers
- Pediatric Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taizo A Nakano
- Center for Cancer and Blood Disorders, Department of Pediatrics, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Winfred Wang
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alfred Gillio
- Hackensack University Medical Center, Hackensack, NJ, USA
| | | | | | | | - Peter Kurre
- Oregon Health and Science University, Portland, OR, USA
| | | | | | - Sarita Joshi
- Nationwide Childrens Hospital, Columbus, OH, USA
| | | | - Jessica Boklan
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Grzegorz Nalepa
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - James N Huang
- UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | - Bertil Glader
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | | | - Maggie Malsch
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Edie A Weller
- Division of Hematology and Oncology and Biostatistics and Research Design Center of the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - David A Williams
- Boston Children's Hospital and Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Akiko Shimamura
- Boston Children's Hospital and Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
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Li Y, Ding S, Liu C, Chen T, Liu H, Li L, Shao Z, Fu R. Abnormalities of quantities and functions of CD56bright natural killer cells in non-severe aplastic Anemia. ACTA ACUST UNITED AC 2019; 24:405-412. [PMID: 30907293 DOI: 10.1080/16078454.2019.1590963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The mechanism of non-severe aplastic anemia (NSAA) is not clear. It may be different from severe aplastic anemia (SAA). CD56bright NK cells (regulatory NK cells) is a subgroup of NK cells that produce immunoregulatory cytokines and express high-affinity IL-2 receptor. To investigate CD56bright NK cells quantities and function in patients with NSAA and to explore how CD56bright NK cells participate in the progress of this disease. METHODS In this study, we analyzed the quantitative and functional changes of CD56bright NK cells in peripheral blood of patients with NSAA by using Flow Cytometry (FCM) before and after immunosuppressive therapy (IST). The expressions of activating receptor (NKG2D, NKp46, NKp44), inhibitory receptor (NKG2A, CD158a, CD158b) and perforin and granzyme B were detected by FCM. IL-2 and IL-18 levels in serum were detected by ELISA. The correlation between these parameters and clinical indicators of patients were evaluated. RESULTS We found that the percentage of CD56bright NK cells in newly diagnosed NSAA patients was higher than that in normal controls (p = .011, p < .05). The median expression of NKG2D in patients with NSAA was higher compared to that in normal controls (p = .021, p < .05), and the expression of CD158a was lower (p = .047, p < .05). The concentrations of IL-2 and IL-18 in the serum of patients with NSAA were higher than those in normal group. CONCLUSION These findings suggest that increased and activated CD56bright NK cells might play a protective role in the pathogenesis of NSAA.
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Abstract
WHO database mentions that the global anemia-affected population is 24.8%. To name a few conditions in which compromisation of the red blood corpuscles and hemoglobin occurs are iron deficiency anemia, gestational anemia, anemia due to malaria and parasitism, hemolytic anemia, sickle cell anemia. The line of treatment in case of anemia involves administration of iron supplements, plasmapheresis, steroids, blood transfusion at regular intervals, and lifestyle changes. The systematic approach applied for the pharmaceutical molecules should be equally inculcated in the case of nutraceuticals. The traditional system when woven carefully with the novel drug delivery system will give effective nutrient delivery. Functional foods have inherent nutritional value. Nutraceuticals and functional food cannot cure the anemic condition, but help the patient lead life almost like a normal individual.
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Yang Y, Yang WR, Wu ZJ, Zhao X, Zhang L, Jing LP, Zhou K, Li Y, Peng GX, Li Y, Li JP, Song L, Ye L, Fan HH, Zhang FK. [Delayed hematologic response to immunosuppressive therapy in severe aplastic anemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 37:1038-1043. [PMID: 28088966 PMCID: PMC7348502 DOI: 10.3760/cma.j.issn.0253-2727.2016.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
目的 分析极重型/重型再生障碍性贫血(V/SAA)患者一线免疫抑制治疗(IST)迟发血液学反应特征,探讨难治性V/SAA尽早二次治疗的合理性。 方法 回顾性分析一线接受IST的533例V/SAA患者临床资料,定义IST后6个月内获得血液学反应为应时反应,定义6~12个月获得血液学反应为迟发反应,观察迟发反应的发生率、血液学反应质量及其影响因素。 结果 533例患者中,45例(8.44%)获得迟发反应,占未获得应时反应且继续接受环孢素A治疗患者的29.03%(45/155)。至IST后12个月及随访结束时迟发反应组血液学反应质量均劣于应时反应组(χ2=62.616,P<0.001和χ2= 6.299,P=0.043)。迟发反应组VSAA患者比例高于应时反应组(57.8%对38.3%,P=0.013),外周血网织红细胞(ARC)比例、ARC计数以及ANC更低,多因素分析显示治疗前ARC<10×109/L的患者获得应时反应的机会明显减少[OR=3.641(95% CI 1.1718~7.719),P=0.001];未发现独立预测IST后6个月无效患者获得迟发血液学反应的因素。6个月未获血液学反应患者5年总生存率为76.50%(95% CI 71.6%~81.4%)、无事件生存率为29.10%(95% CI 25.2%~33.0%),均显著低于应时反应组患者的97.6%(95% CI 96.6%~98.6%)、84.0%(95% CI 81.1%~86.9%)(P值均<0.001)。 结论 V/SAA患者IST获得迟发血液学反应难以预测,比例较小,疗效质量相对较差。难治性V/SAA患者尽早进行挽救治疗是合理的。
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Affiliation(s)
- Y Yang
- Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
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Noronha SA. Aplastic and Hypoplastic Anemias. Pediatr Rev 2018; 39:601-611. [PMID: 30504252 DOI: 10.1542/pir.2017-0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Suzie A Noronha
- Division of Pediatric Hematology/Oncology, University of Rochester, Rochester, NY
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Alzahrani N, Ashor N, Fathi T, Bukhari D, Zaher G. Idiopathic severe aplastic anemia with a delayed response to immunosuppressive therapy: a case report. Clin Case Rep 2018; 6:1029-1032. [PMID: 29881557 PMCID: PMC5986045 DOI: 10.1002/ccr3.1517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/20/2018] [Accepted: 03/12/2018] [Indexed: 01/27/2023] Open
Abstract
Bone marrow transplantation is the definitive treatment of severe aplastic anemia; however, with the absence of this option, combined immunosuppressive therapy with antithymocyte globulin (ATG) and cyclosporine A is used as a first‐line therapy. This case report highlights the possible delay in response to ATG protocol in treating aplastic anemia.
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Affiliation(s)
| | - Nshwa Ashor
- King Abdulaziz University Jeddah Saudi Arabia
| | - Traji Fathi
- King Abdulaziz University Jeddah Saudi Arabia
| | | | - Galila Zaher
- King Abdulaziz University Hospital Jeddah Saudi Arabia
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37
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Epstein Barr Virus Infection Affects Function of Cytotoxic T Lymphocytes in Patients with Severe Aplastic Anemia. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6413815. [PMID: 29862282 PMCID: PMC5976969 DOI: 10.1155/2018/6413815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/05/2018] [Indexed: 12/26/2022]
Abstract
Severe aplastic anemia (SAA) is characterized by pancytopenia and failure of hematopoietic function and is caused by excessive functioning of cytotoxic T lymphocytes (CTLs). EBNA-1, a nucleoprotein of the Epstein Barr virus (EBV), can influence the proliferation and function of lymphocytes. We therefore tested the number of EBV copies in the CD8+ T cells of 27 patients with SAA and 10 healthy control subjects and observed the influences of EBNA-1 upon the CD8+ T cells of patients with SAA. The results showed that more EBV copies were found in the CD8+ T cells of patients with untreated SAA than in patients with SAA in remission or in the healthy control subjects. Their copy number was positively correlated with the expression of granzyme B and perforin, the secretion level of interferon-γ in CD8+ T cells, and the viability of CD8+ T cells, whereas no correlation was seen between the copy number and the interleukin 4 secretion level or the apoptosis rate. Meanwhile, the expression of granzyme B and perforin was reduced after EBNA-1 gene knockdown, whereas the interferon-γ secretion level and cell viability declined. Therefore, we infer that EBV infection may be a factor in the activation of CTLs and in damaging the bone marrow hematopoietic function of patients with SAA.
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Riveros-Perez E, Hermesch AC, Barbour LA, Hawkins JL. Aplastic anemia during pregnancy: a review of obstetric and anesthetic considerations. Int J Womens Health 2018; 10:117-125. [PMID: 29535558 PMCID: PMC5836687 DOI: 10.2147/ijwh.s149683] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aplastic anemia is a hematologic condition occasionally presenting during pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management is challenging, and treatment requires a coordinated effort by an interdisciplinary team, in order to provide safe care to these patients. In this review, we describe the current state of the literature as it applies to the complexity of aplastic anemia in pregnancy, focusing on pathophysiologic aspects of the disease in pregnancy, as well as relevant obstetric and anesthetic considerations necessary to treat this challenging problem. A multidisciplinary-team approach to the management of aplastic anemia in pregnancy is necessary to coordinate prenatal care, optimize maternofetal outcomes, and plan peripartum interventions. Conservative transfusion management is critical to prevent alloimmunization. Although a safe threshold-platelet count for neuraxial anesthesia has not been established, selection of anesthetic technique must be evaluated on a case-to-case basis.
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Affiliation(s)
- Efrain Riveros-Perez
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | | | | | - Joy L Hawkins
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
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Mesenchymal Stem Cell Benefits Observed in Bone Marrow Failure and Acquired Aplastic Anemia. Stem Cells Int 2017; 2017:8076529. [PMID: 29333168 PMCID: PMC5733198 DOI: 10.1155/2017/8076529] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/15/2017] [Accepted: 09/10/2017] [Indexed: 12/16/2022] Open
Abstract
Acquired aplastic anemia (AA) is a type of bone marrow failure (BMF) syndrome characterized by partial or total bone marrow (BM) destruction resulting in peripheral blood (PB) pancytopenia, which is the reduction in the number of red blood cells (RBC) and white blood cells (WBC), as well as platelets (PLT). The first-line treatment option of AA is given by hematopoietic stem cell (HSCs) transplant and/or immunosuppressive (IS) drug administration. Some patients did not respond to the treatment and remain pancytopenic following IS drugs. The studies are in progress to test the efficacy of adoptive cellular therapies as mesenchymal stem cells (MSCs), which confer low immunogenicity and are reliable allogeneic transplants in refractory severe aplastic anemia (SAA) cases. Moreover, bone marrow stromal cells (BMSC) constitute an essential component of the hematopoietic niche, responsible for stimulating and enhancing the proliferation of HSCs by secreting regulatory molecules and cytokines, providing stimulus to natural BM microenvironment for hematopoiesis. This review summarizes scientific evidences of the hematopoiesis improvements after MSC transplant, observed in acquired AA/BMF animal models as well as in patients with acquired AA. Additionally, we discuss the direct and indirect contribution of MSCs to the pathogenesis of acquired AA.
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Wang C, Zhang T, Wang Y, Li Y, Liu C, Liu H, Li L, Ding K, Wang T, Wang H, Shao Z, Fu R. The shortening telomere length of T lymphocytes maybe associated with hyper‑function in servere aplastic anemia. Mol Med Rep 2017; 17:1015-1021. [PMID: 29115638 PMCID: PMC5780068 DOI: 10.3892/mmr.2017.8014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 10/30/2017] [Indexed: 11/06/2022] Open
Abstract
Severe aplastic anemia (SAA) is a primary disorder of severe bone marrow failure characterizing with extreme pancytopenia and a profound diminution of bone marrow progenitor cells, which is associated with T cell hyper‑function. Abnormal telomere shortening of bone marrow mononuclear cell has been reported in AA, which may lead to genomic instability, and result in cell senescence or apoptosis. Notably, certain studies identfieid that lymphocytes of shortening telomere length have undergone apoptosis escape in autoimmune diseases. In order to investigate the association between telomere lengths and function of T lymphocytes in SAA, the relative telomere lengths (RTLs) of different subtypes of T lymphocytes were investigated by flow‑fluorescent in situ hybridization in 30 patients with SAA and 25 healthy controls. Then the levels of expression of cluster of differentiation 28 (CD28), CD158 and CD70 were measured, which represent the function of T lymphocytes. The apoptosis rate and the cell cycle progression of CD8+T lymphocytes, and the level of secretion interferon‑γ and tumor necrosis factor‑α were also measured. Finally, the correlation between telomere length and these functional events of CD8+T lymphocytes was analyzed in patients with SAA. The results showed that RTLs of CD8+T lymphocytes in SAA were significantly shorter compared with those in controls. Furthermore, in patients with SAA, CD8+T lymphocytes are associated with T cell hyper‑function, which is related to the RTL. Thus, the shorter RTLs of CD8+T lymphocytes in SAA may be associated with hyper‑function of these cells, which contribute to the pathogenesis of SAA.
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Affiliation(s)
- Chaomeng Wang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Tian Zhang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Yihao Wang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Yang Li
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Chunyan Liu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Hui Liu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Lijuan Li
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Kai Ding
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Ting Wang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Honglei Wang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Zonghong Shao
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
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The herbal decoction modified Danggui Buxue Tang attenuates immune-mediated bone marrow failure by regulating the differentiation of T lymphocytes in an immune-induced aplastic anemia mouse model. PLoS One 2017; 12:e0180417. [PMID: 28683082 PMCID: PMC5500321 DOI: 10.1371/journal.pone.0180417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/22/2017] [Indexed: 12/12/2022] Open
Abstract
Angelicae Sinensis, Radix Astragali and Rhizoma Coptidis are all herbs of modified Danggui Buxue Tang (DGBX) and are extensively applied herbs in traditional Chinese medicine for the treatment of anemia and inflammation. In this study, immune-induced AA mice were used as an animal model, and the immunosuppressive agent, Ciclosporin A (CsA), was used as a positive control. Multiple pro-inflammatory cytokines were examined by bead-based multiplex flow cytometry. The T-cell subsets were assessed using a fluorescence-activated cell sorter (FACS). Western blot analysis was used to estimate the protein expression levels of specific transcription factors for T helper cells (Th1, Th2 and Th17) and key molecules of the Janus-activated kinase (Jak)/signal transducer and activator of transcription (Stat3) signaling pathway. DGBX treatment could significantly increase the production of whole blood cells in peripheral blood (PB); inhibit the expansion of Th1 and Th17 cells; increase the differentiation of Th2 and Tregs cells; regulate the expression levels of T-bet, GATA-3, RORγ and proinflammatory cytokines; and decrease the expression levels of key molecules in the Jak/Stat signaling pathway. These results indicate that DGBX can regulate the differentiation of T lymphocytes, resulting in immunosuppressive and hematogenic functions on AA mice. DGBX might be a good candidate for inclusion in a randomized study for AA with more data on the possible side effects and doses used in humans. Ultimately, it may be used for applications of traditional medicine against AA in modern complementary and alternative immunosuppressive therapeutics.
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Nishikawa E, Yagasaki H, Hama A, Yabe H, Ohara A, Kosaka Y, Kudo K, Kobayashi R, Ohga S, Morimoto A, Watanabe KI, Yoshida N, Muramatsu H, Takahashi Y, Kojima S. Long-term outcomes of 95 children with moderate aplastic anemia treated with horse antithymocyte globulin and cyclosporine. Pediatr Blood Cancer 2017; 64. [PMID: 27808465 DOI: 10.1002/pbc.26305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 08/24/2016] [Accepted: 09/12/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Currently, the standard management of moderate aplastic anemia (MAA) has not been well described, although the superiority of the combination of antithymocyte globulin (ATG) and cyclosporine (CyA) over CyA alone has been demonstrated in terms of hematological responses and failure-free survival (FFS). PROCEDURE We adopted this therapeutic strategy and treated 95 children with MAA who were enrolled in two consecutive prospective studies between October 1992 and August 2009. RESULTS For these patients, the 6-month response rate was 54.7% (complete response, 13.7%; partial response, 41.1%). There were no statistically significant differences in the overall response rates between the transfusion-dependent (48.8%, n = 41) and transfusion-independent groups (59.3%, n = 54; P = 0.4). Treatment failure was defined as the requirement of salvage treatment, and was observed in 52 patients. The 10-year FFS was 44.0% (95% confidence interval [CI], 32.9%-54.6%). Of the 22 patients who underwent a second immunosuppressive therapy (IST), 12 responded. Forty patients underwent hematopoietic stem cell transplantation as second- or third-line therapy and three died of complications. Consequently, the 10-year overall survival rate was 96.0% (95% CI, 88.0%-98.7%) with a median follow-up period of 103 months (range, 29-221 months). CONCLUSIONS Although current guidelines recommend only observation for patients with transfusion-independent MAA, the results of our study justify early intervention with ATG and CyA in those patients. A prospective randomized trial is warranted to clarify the risks and benefits of early intervention with IST and observation alone until progression to severe AA in patients with MAA.
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Affiliation(s)
- Eri Nishikawa
- School of Medicine, Nihon University, Itabashi, Japan.,Graduate School of Medicine, Nagoya University, Japan
| | | | - Asahito Hama
- Graduate School of Medicine, Nagoya University, Japan
| | - Hiromasa Yabe
- School of Medicine, Tokai University, Isehara, Japan
| | - Akira Ohara
- School of Medicine, Toho University, Ohta, Japan
| | | | - Kazuko Kudo
- School of Medicine, Fujita Health University, Aichi, Japan
| | | | - Shouichi Ohga
- Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Akira Morimoto
- School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | | | - Nao Yoshida
- Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | | | | | - Seiji Kojima
- Graduate School of Medicine, Nagoya University, Japan
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Allegra A, Innao V, Penna G, Gerace D, Allegra AG, Musolino C. Telomerase and telomere biology in hematological diseases: A new therapeutic target. Leuk Res 2017; 56:60-74. [PMID: 28196338 DOI: 10.1016/j.leukres.2017.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/24/2017] [Accepted: 02/05/2017] [Indexed: 11/29/2022]
Abstract
Telomeres are structures confined at the ends of eukaryotic chromosomes. With each cell division, telomeric repeats are lost because DNA polymerases are incapable to fully duplicate the very ends of linear chromosomes. Loss of repeats causes cell senescence, and apoptosis. Telomerase neutralizes loss of telomeric sequences by adding telomere repeats at the 3' telomeric overhang. Telomere biology is frequently associated with human cancer and dysfunctional telomeres have been proved to participate to genetic instability. This review covers the information on telomerase expression and genetic alterations in the most relevant types of hematological diseases. Telomere erosion hampers the capability of hematopoietic stem cells to effectively replicate, clinically resulting in bone marrow failure. Furthermore, telomerase mutations are genetic risk factors for the occurrence of some hematologic cancers. New discoveries in telomere structure and telomerase functions have led to an increasing interest in targeting telomeres and telomerase in anti-cancer therapy.
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Affiliation(s)
- Alessandro Allegra
- Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva "Gaetano Barresi", University of Messina Via Consolare Valeria, 1, 98125 Messina, Italy.
| | - Vanessa Innao
- Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva "Gaetano Barresi", University of Messina Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Giuseppa Penna
- Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva "Gaetano Barresi", University of Messina Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Demetrio Gerace
- Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva "Gaetano Barresi", University of Messina Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Andrea G Allegra
- Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva "Gaetano Barresi", University of Messina Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Caterina Musolino
- Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva "Gaetano Barresi", University of Messina Via Consolare Valeria, 1, 98125 Messina, Italy
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Qi W, Ren Y, Fu R, Wang H, Liu C, Shao Z. Detection and Significance of CD4+CD25+CD127dim Regulatory T Cells in Individuals with Severe Aplastic Anemia. Turk J Haematol 2017; 32:220-7. [PMID: 25912955 PMCID: PMC4563197 DOI: 10.4274/tjh.2013.0410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: To investigate the relationship between CD4+CD25+CD127dim regulatory T cells (Tregs) and immune imbalance in acquired severe aplastic anemia (SAA). Materials and Methods: The quantity of CD4+CD25+CD127dim Tregs in 44 SAA patients and 23 normal controls was measured by flow cytometry. Correlations between Tregs and T cell subsets, dendritic cell (DC) subsets, granulocyte counts, and percentage of reticulocytes (RET%) were analyzed. Results: The percentage of CD4+CD25+CD127dim Tregs in peripheral blood lymphocytes (PBLs) of untreated patients was lower than in recovery patients and normal controls (0.83±0.44% vs. 2.91±1.24% and 2.18±0.55%, respectively, p<0.05). The percentage of CD4+CD25+CD127dim Tregs in CD4+ T lymphocytes of recovery patients was higher than that of untreated patients and normal controls (9.39±3.51% vs. 7.61±5.3% and 6.83±1.4%, respectively, p<0.05). The percentage of CD4+ T lymphocytes in PBLs of untreated patients was lower than in recovery patients and normal controls (13.55±7.37% vs. 31.82±8.43% and 32.12±5.88%, respectively, p<0.05). T cell subset (CD4+/CD8+ ratio) was 0.41±0.24 in untreated patients, which was lower than in recovery patients (1.2±0.4) and normal controls (1.11±0.23) (p<0.05). DC subset (myeloid DC/plasmacytoid DC ratio, DC1/DC2 ratio) was 3.08±0.72 in untreated patients, which was higher than in recovery patients (1.61±0.49) and normal controls (1.39±0.36) (p<0.05). The percentage of CD4+CD25+CD127dim Tregs in PBLs was positively associated with T cell subset (r=0.955, p<0.01) and negatively associated with DC subset (r=-0.765, p<0.01). There were significant positive correlations between CD4+CD25+CD127dim Tregs/PBL and granulocyte counts and RET% (r=0.739 and r=0.749, respectively, p<0.01). Conclusion: The decrease of CD4+CD25+CD127dim Tregs in SAA patients may cause excessive functioning of T lymphocytes and thus lead to hematopoiesis failure in SAA.
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Fujiwara T. GATA Transcription Factors: Basic Principles and Related Human Disorders. TOHOKU J EXP MED 2017; 242:83-91. [DOI: 10.1620/tjem.242.83] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Tohru Fujiwara
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine
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46
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Xin J, Breslin P, Wei W, Li J, Gutierrez R, Cannova J, Ni A, Ng G, Schmidt R, Chen H, Parini V, Kuo PC, Kini AR, Stiff P, Zhu J, Zhang J. Necroptosis in spontaneously-mutated hematopoietic cells induces autoimmune bone marrow failure in mice. Haematologica 2016; 102:295-307. [PMID: 27634200 DOI: 10.3324/haematol.2016.151514] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/12/2016] [Indexed: 12/11/2022] Open
Abstract
Acquired aplastic anemia is an autoimmune-mediated bone marrow failure syndrome. The mechanism by which such an autoimmune reaction is initiated is unknown. Whether and how the genetic lesions detected in patients cause autoimmune bone marrow failure have not yet been determined. We found that mice with spontaneous deletion of the TGFβ-activated kinase-1 gene in a small subset of hematopoietic cells developed bone marrow failure which resembled the clinical manifestations of acquired aplastic anemia patients. Bone marrow failure in such mice could be reversed by depletion of CD4+ T lymphocytes or blocked by knockout of interferon-γ, suggesting a Th1-cell-mediated autoimmune mechanism. The onset and progression of bone marrow failure in such mice were significantly accelerated by the inactivation of tumor necrosis factor-α signaling. Tumor necrosis factor-α restricts autoimmune bone marrow failure by inhibiting type-1 T-cell responses and maintaining the function of myeloid-derived suppressor cells. Furthermore, we determined that necroptosis among a small subset of mutant hematopoietic cells is the cause of autoimmune bone marrow failure because such bone marrow failure can be prevented by deletion of receptor interacting protein kinase-3 Our study suggests a novel mechanism to explain the pathogenesis of autoimmune bone marrow failure.
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Affiliation(s)
- Junping Xin
- Oncology Institute, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA .,Research and Development Service, Hines VA Hospital, Hines, IL, USA.,Department of Molecular Pharmacology and Therapeutics, Loyola University Medical Center, Maywood, IL, USA
| | - Peter Breslin
- Oncology Institute, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA.,Department of Biology, Loyola University Chicago, IL, USA.,Department of Molecular/Cellular Physiology, Loyola University Medical Center, Maywood, IL, USA
| | - Wei Wei
- Oncology Institute, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | - Jing Li
- Department of Biology, College of Life and Environment Science, Shanghai Normal University, P.R. of China
| | - Rafael Gutierrez
- Oncology Institute, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | - Joseph Cannova
- Oncology Institute, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | - Allen Ni
- Oncology Institute, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | - Grace Ng
- Oncology Institute, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | - Rachel Schmidt
- Oncology Institute, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | - Haiyan Chen
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Vamsi Parini
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Paul C Kuo
- Oncology Institute, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | - Ameet R Kini
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Patrick Stiff
- Oncology Institute, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | - Jiang Zhu
- State Key Laboratory for Medical Genomics and Shanghai Institute of Hematology and Collaborative Innovation Center of Hematology, Rui-Jin Hospital; Shanghai Jiao-Tong University School of Medicine, P.R. of China
| | - Jiwang Zhang
- Oncology Institute, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA .,Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
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Kordasti S, Costantini B, Seidl T, Perez Abellan P, Martinez Llordella M, McLornan D, Diggins KE, Kulasekararaj A, Benfatto C, Feng X, Smith A, Mian SA, Melchiotti R, de Rinaldis E, Ellis R, Petrov N, Povoleri GAM, Chung SS, Thomas NSB, Farzaneh F, Irish JM, Heck S, Young NS, Marsh JCW, Mufti GJ. Deep phenotyping of Tregs identifies an immune signature for idiopathic aplastic anemia and predicts response to treatment. Blood 2016; 128:1193-205. [PMID: 27281795 PMCID: PMC5009512 DOI: 10.1182/blood-2016-03-703702] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/01/2016] [Indexed: 11/20/2022] Open
Abstract
Idiopathic aplastic anemia (AA) is an immune-mediated and serious form of bone marrow failure. Akin to other autoimmune diseases, we have previously shown that in AA regulatory T cells (Tregs) are reduced in number and function. The aim of this study was to further characterize Treg subpopulations in AA and investigate the potential correlation between specific Treg subsets and response to immunosuppressive therapy (IST) as well as their in vitro expandability for potential clinical use. Using mass cytometry and an unbiased multidimensional analytical approach, we identified 2 specific human Treg subpopulations (Treg A and Treg B) with distinct phenotypes, gene expression, expandability, and function. Treg B predominates in IST responder patients, has a memory/activated phenotype (with higher expression of CD95, CCR4, and CD45RO within FOXP3(hi), CD127(lo) Tregs), expresses the interleukin-2 (IL-2)/STAT5 pathway and cell-cycle commitment genes. Furthermore, in vitro-expanded Tregs become functional and take on the characteristics of Treg B. Collectively, this study identifies human Treg subpopulations that can be used as predictive biomarkers for response to IST in AA and potentially other autoimmune diseases. We also show that Tregs from AA patients are IL-2-sensitive and expandable in vitro, suggesting novel therapeutic approaches such as low-dose IL-2 therapy and/or expanded autologous Tregs and meriting further exploration.
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Affiliation(s)
- Shahram Kordasti
- Department of Haematological Medicine, King's College London, London, United Kingdom; Haematological Medicine, King's College Hospital, London, United Kingdom
| | - Benedetta Costantini
- Department of Haematological Medicine, King's College London, London, United Kingdom; Haematological Medicine, King's College Hospital, London, United Kingdom
| | - Thomas Seidl
- Department of Haematological Medicine, King's College London, London, United Kingdom
| | | | - Marc Martinez Llordella
- Division of Transplantation Immunology & Mucosal Biology, King's College London, London, United Kingdom
| | - Donal McLornan
- Haematological Medicine, King's College Hospital, London, United Kingdom
| | | | | | - Cinzia Benfatto
- Department of Haematological Medicine, King's College London, London, United Kingdom
| | - Xingmin Feng
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; and
| | - Alexander Smith
- Department of Haematological Medicine, King's College London, London, United Kingdom; Haematological Medicine, King's College Hospital, London, United Kingdom
| | - Syed A Mian
- Department of Haematological Medicine, King's College London, London, United Kingdom
| | - Rossella Melchiotti
- National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom
| | - Emanuele de Rinaldis
- National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom
| | - Richard Ellis
- National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom
| | - Nedyalko Petrov
- National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom
| | - Giovanni A M Povoleri
- Division of Transplantation Immunology & Mucosal Biology, King's College London, London, United Kingdom
| | - Sun Sook Chung
- Department of Haematological Medicine, King's College London, London, United Kingdom
| | - N Shaun B Thomas
- Department of Haematological Medicine, King's College London, London, United Kingdom
| | - Farzin Farzaneh
- Department of Haematological Medicine, King's College London, London, United Kingdom
| | - Jonathan M Irish
- Department of Cancer Biology, Vanderbilt University, Nashville, TN
| | - Susanne Heck
- National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom
| | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; and
| | - Judith C W Marsh
- Department of Haematological Medicine, King's College London, London, United Kingdom; Haematological Medicine, King's College Hospital, London, United Kingdom
| | - Ghulam J Mufti
- Department of Haematological Medicine, King's College London, London, United Kingdom; Haematological Medicine, King's College Hospital, London, United Kingdom
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Marsh JCW, Mufti GJ. Clinical significance of acquired somatic mutations in aplastic anaemia. Int J Hematol 2016; 104:159-67. [DOI: 10.1007/s12185-016-1972-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/19/2016] [Accepted: 03/02/2016] [Indexed: 11/29/2022]
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Pandey T, Thomas S, Heller MT. Current Indications, Techniques, and Imaging Findings of Stem Cell Treatment and Bone Marrow Transplant. Radiol Clin North Am 2016; 54:375-96. [PMID: 26896230 DOI: 10.1016/j.rcl.2015.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The role of stem cell therapy in the treatment of hematologic and nonhematologic conditions is ever increasing. A thorough knowledge of the applications of stem cells and transplant physiology is essential for understanding the imaging manifestations. Stem cell imaging includes molecular imaging, and diagnostic and interventional radiology. It is possible to make a diagnosis of various complications and diseases associated with stem cell transplant. This article presents a simplified overview of stem cell applications and techniques with focus on hematopoietic stem cell transplant imaging.
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Affiliation(s)
- Tarun Pandey
- Department of Radiology, University of Arkansas for Medical Sciences, Slot #556 West Markham Street, Little Rock, AR 72205, USA.
| | - Stephen Thomas
- Department of Radiology, University of Chicago, 5841 South Maryland Avenue, MC 2026, Chicago, IL 60611, USA
| | - Matthew T Heller
- Radiology Residency Program, Division of Abdominal Imaging, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 201 East, Wing PUH, Pittsburgh, PA 15213, USA
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50
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Wang X, Yuan T, Wang W, Chen L, Wang H, Liu Y. Acute promyelocytic leukemia transformation in a patient with aplastic anemia: a case report with literature review. Int J Clin Exp Med 2015; 8:20675-20678. [PMID: 26884990 PMCID: PMC4723835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/02/2015] [Indexed: 06/05/2023]
Abstract
Aplastic anemia (AA) is a hematological disorder presenting with pancytopenia in peripheral blood and hypocellularity in bone marrow. AA patients with immunosuppressive therapy and granulocyte colony-stimulating factor treatment have a risk of development of acute leukemia including acute myeloid leukemia (M0, M1, M2, M4, M5, M6) and acute lymphoblastic leukemia. However, AA with transformation to acute promyelocytic leukemia (APL) has never been reported. Here, we reported a patient initially diagnosed with AA. while 19 years later, PML/RAR αfusion gene were detected and the patient was eventually diagnosed as APL. The diagnosis and management of this interesting case are discussed.
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Affiliation(s)
- Xiaoning Wang
- Department of Hematology, The First Affiliated Hospital of Xi’an Jiaotong UniversityShaan Xi, P. R. China
| | - Tingting Yuan
- Department of Clinical Laboratory, Affiliated Hospital of Yulin, Traditional Chinese Medicine of Shaan Xi ProvinceP. R. China
| | - Wenjuan Wang
- Department of Hematology, The First Affiliated Hospital of Xi’an Jiaotong UniversityShaan Xi, P. R. China
| | - Limei Chen
- Department of Hematology, The First Affiliated Hospital of Xi’an Jiaotong UniversityShaan Xi, P. R. China
| | - Huaiyu Wang
- Department of Hematology, The First Affiliated Hospital of Xi’an Jiaotong UniversityShaan Xi, P. R. China
| | - Yalin Liu
- Department of Hematology, The First Affiliated Hospital of Xi’an Jiaotong UniversityShaan Xi, P. R. China
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