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Xu LP, Lu PH, Wu DP, Huang H, Jiang EL, Liu DH, Cao WJ, Zhang X, Fu YW, Li NN, Chen XC, Zhu XY, Liu QF, Xia LH, Zhang YC, Xu YJ, Li FC, Hu J, Liu SX, Liu RR, Ma XD, Tang XW, Luo Y, Zhang XH, Huang XJ. Hematopoietic stem cell transplantation activity in China 2022-2023. The proportions of peripheral blood for stem cell source continue to grow: a report from the Chinese Blood and Marrow Transplantation Registry Group. Bone Marrow Transplant 2024:10.1038/s41409-024-02419-8. [PMID: 39322652 DOI: 10.1038/s41409-024-02419-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 08/29/2024] [Accepted: 09/12/2024] [Indexed: 09/27/2024]
Abstract
Over past two years, a total of 39,918 hematopoietic stem cell transplantation (HSCT) cases were reported, with 18,194 and 21,714 transplants performed in 2022 and 2023, respectively. Autologous HSCT accounted for 6562 cases (31%) in 2022, while allogeneic HSCT comprised 12,632 cases (69%). In 2023, the number of allogeneic HSCTs exceeded 15,000, maintaining a 69% share. Participation in the 2022 and 2023 surveys included 193 and 212 transplantation teams, respectively, from 27 provinces, municipalities, or autonomous regions. The leading indication of HSCT was acute leukemia, including acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and mixed phenotype acute leukemia, with a total of 17,421 cases. AML was the most common disease (10,339, 38%) for allogeneic HSCT, which was followed by ALL (5925 cases, 21%). Peripheral blood emerged as the primary source of stem cell grafts, utilized in 54% of matched sibling donor transplants and 77% of haploidentical donor transplants. The BuCy-based conditioning regimen was the most prevalent, used in 53% of allogeneic HSCT cases in the past two years. This survey offers a comprehensive overview of the current HSCT landscape and serves as a valuable resource for clinical practice.
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Affiliation(s)
- Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Pei-Hua Lu
- Hebei Yanda Lu Daopei Hospital, Langfang, Hebei & Beijing Lu Daopei Hospital, Beijing, China
| | - De-Pei Wu
- The First Affiliated Hospital of Soochow University, National Clinical Research Center for Hematologic Disease, Soochow, China
| | - He Huang
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Er-Lie Jiang
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | | | - Wei-Jie Cao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xi Zhang
- Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Yue-Wen Fu
- Henan Cancer Hospital, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Nai-Nong Li
- Fujian Medical University Union Hospital, Fujian Provincial Key Laboratory of Hematology, Fujian Institute of Hematology, Fuzhou, China
| | - Xin-Chuan Chen
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiao-Yu Zhu
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | | | - Ling-Hui Xia
- Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yi-Cheng Zhang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ya-Jing Xu
- Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fu-Chun Li
- Nanfang-Chunfu Children's Institute of Hematology, Taixin Hospital, Dongguan, China
| | - Jiong Hu
- Shanghai Institute of Hematology, Ruijn Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Si-Xi Liu
- Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Rong-Rong Liu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Di Ma
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiao-Wen Tang
- Hebei Yanda Lu Daopei Hospital, Langfang, Hebei & Beijing Lu Daopei Hospital, Beijing, China
| | - Yi Luo
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
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Wei X, Zhu W, Li J, Zhou S, Zhu Q, Ma X, Han Y, Wang Y, Miao M, Qiu H, Wu D, Wu X. The Role of Pre-existing Anti-HLA Antibodies in Severe Aplastic Anemia Patients Undergoing Allogenic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2024; 30:902.e1-902.e11. [PMID: 38740139 DOI: 10.1016/j.jtct.2024.05.008] [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: 01/03/2024] [Revised: 04/15/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
The objective is to underscore the significance of pre-existing anti-HLA Abs in the context of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for SAA. A retrospective analysis was conducted using data from 244 SAA patients who underwent allo-HSCT between January 2016 and October 2022. The patient cohort was divided into 2 groups based on the presence of pre-existing anti-HLA Abs. Out of 244 SAA patients, 82 were tested positive for anti-HLA Abs. Seventeen patients were tested with DSA in haplo-HSCT. We found that the presence of pre-existing anti-HLA Abs did not influence neutrophil engraftment (P = .600); however, it resulted in delayed platelet recovery (P = .006). Comparatively, patients with anti-HLA Abs demonstrated lower overall survival (OS) compared to their counter parts without anti-HLA Abs (P = .001), with a correspondingly elevated transplant-related mortality (TRM) in the former group (P = .002). Multivariate analysis established pre-existing anti-HLA Abs as an independent risk factor for impaired platelet recovery (HR 1.67, 95% CI 1.16 to 2.44, P = .006) and OS (HR 2.19, 95% CI 1.03 to 4.67, P = .043). However, there were no differences between DSA and non-DSA patients after desensitization in haplo-HSCT. In summary, the presence of pre-existing anti-HLA Abs in SAA patients undergoing allo-HSCT appears to detrimentally affect platelet recovery and overall prognosis.
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Affiliation(s)
- Xiya Wei
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Wenjuan Zhu
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Jing Li
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Shiyuan Zhou
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Qian Zhu
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiao Ma
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Yue Han
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Ying Wang
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Miao Miao
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Huiying Qiu
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Depei Wu
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiaojin Wu
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
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Luo D, Qu Y, Wang D, Zhang B, Sun M, Xiong H, Lu J, Yang R, Zhao M, Liu H, Jiang H. Comparison of upfront haploidentical hematopoietic stem cell transplantation and salvage haploidentical hematopoietic stem cell transplantation after immunosuppressive therapy in children with acquired severe aplastic anemia - a multicenter study. Front Immunol 2024; 15:1384640. [PMID: 38720904 PMCID: PMC11076848 DOI: 10.3389/fimmu.2024.1384640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Background For children with severe aplastic anemia, if the first immunosuppressive therapy (IST) fails, it is not recommended to choose a second IST. Therefore, for patients without matched sibling donor (MSD) and matched unrelated donor (MUD), haploidentical hematopoietic stem cell transplantation (Haplo-HSCT) can be chosen as a salvage treatment. This article aims to explore the comparison between upfront Haplo-HSCT and salvage Haplo-HSCT after IST. Methods 29 patients received salvage Haplo-HSCT, and 50 patients received upfront Haplo-HSCT. The two groups received Bu (Busulfan, 3.2mg/kg/d*2d on days -9 to-8), CY (Cyclophosphamide, 60mg/kg/d*2d on days -4 to-3), Flu (fludarabine, 40mg/m2/d*5d on days -9 to -5) and rabbit ATG (Anti-thymocyte globulin, total dose 10mg/kg divided into days -4 to -2). Results The OS of the salvage Haplo-HSCT group showed no difference to the upfront Haplo-HSCT group (80.2 ± 8.0% vs. 88.7 ± 4.8%, p=0.37). The FFS of the salvage Haplo-HSCT group also showed no difference to the frontline Haplo-HSCT group (75 ± 8.2% vs. 84.9 ± 5.3%, p=0.27). There was no significant difference in the incidence of other complications after transplantation between the two groups, except for thrombotic microangiopathy (TMA). In the grouping analysis by graft source, the incidence of II-IV aGVHD in patients using PBSC ± BM+UCB was lower than that in the PBSC ± BM group (p=0.010). Conclusion Upfront Haplo-HSCT and salvage Haplo-HSCT after IST in children with acquired severe aplastic anemia have similar survival outcomes. However, the risk of TMA increases after salvage Haplo-HSCT. This article provides some reference value for the treatment selection of patients. In addition, co-transplantation of umbilical cord blood may reduce the incidence of GVHD.
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Affiliation(s)
- Danqi Luo
- Department of Hematology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuhua Qu
- Department of Hematology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Dao Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Benshan Zhang
- Department of Hematology, Hunan Children’s Hospital, Changsha, Hunan, China
| | - Ming Sun
- Department of Hematology, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Xiong
- Department of Hematology, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Lu
- Department of Hematology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Rui Yang
- Department of Pediatric Hematology, First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
| | - Mingyi Zhao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Haiyan Liu
- Department of Hematology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hua Jiang
- Department of Hematology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
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Fu W, Gao S, Luo Y, Chen L, Chen J, Gao L, Wang L, Xu L, Wang Y, Wang Z, Yue W, Cheng H, Tang G, Wang J, Yang J, Ni X. Comparison of Stem Cell Transplantation Using Unrelated, Haploidentical, and Sibling Donors for Patients with Acquired Severe Aplastic Anemia: A Single-Center Retrospective Cohort Study. Transplant Cell Ther 2024; 30:245.e1-245.e8. [PMID: 37977336 DOI: 10.1016/j.jtct.2023.11.012] [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: 09/09/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
The preferred donor (haploidentical donor [HID] versus matched unrelated donor [URD]) choice in patients with acquired severe aplastic anemia (SAA) who lack an HLA-matched sibling donor (MSD) and fail upfront immunosuppressive treatment (IST) therapy is unknown. We retrospectively investigated SAA patients (n = 58) who underwent allogeneic stem cell transplantation (allo-SCT) between January 2012 and October 2022. The 5-year overall survival (OS) and 5-year failure-free survival (FFS) were comparable among the URD (n = 8), HID (n = 25), and MSD (n = 25) cohorts (OS: mean, 87.5 ± 11.7% versus 98.0 ± 6.5% versus 83.3 ± 7.6% [P = .926]; FFS: mean, 60.0 ± 18.2% versus 87.0 ± 7.0% versus 78.3 ± 8.6% [P = .222]). Multivariate analysis revealed that primary engraftment failure independently predicted OS and secondary graft failure predicted FFS among SAA patients who underwent allo-SCT, but donor type and age were not predictive of these outcomes. An urgent second SCT for patients with engraftment failure may be an effective salvage treatment. Our findings show that an alternative donor SCT is indicated for eligible SAA patients without an MSD even if age ≥40 years.
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Affiliation(s)
- Weijia Fu
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Su Gao
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Yanrong Luo
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Li Chen
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Jie Chen
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Lei Gao
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Libing Wang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Lili Xu
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Yang Wang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Ziwei Wang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Wenqin Yue
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Hui Cheng
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Gusheng Tang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China
| | - Jianmin Wang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China.
| | - Jianmin Yang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China.
| | - Xiong Ni
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, China.
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Wang H, Bi X, Zhang R, Yuan H, Xu J, Zhang K, Qi S, Zhang X, Jiang M. Adipose-Derived Mesenchymal Stem Cell Facilitate Hematopoietic Stem Cell Proliferation via the Jagged-1/Notch-1/Hes Signaling Pathway. Stem Cells Int 2023; 2023:1068405. [PMID: 38020206 PMCID: PMC10653966 DOI: 10.1155/2023/1068405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/29/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Poor graft function (PGF) is a life-threatening complication following hematopoietic stem cell transplantation (HSCT). Current therapies, such as CD34+ cell infusion, have shown limited effectiveness. Conversely, mesenchymal stem cells (MSCs) show potential in addressing PGF. Adipose-derived mesenchymal stem cells (ADSCs) effectively support long-term hematopoietic stem cell proliferation. Therefore, this study aimed to investigate the mechanisms underlying the long-term hematopoietic support provided by ADSCs. Methods ADSCs were isolated from mice and subsequently identified. In vitro experiments involved coculturing ADSCs as feeders with Lin-Sca-1+c-kit+ (LSK) cells from mice for 2 and 5 weeks. The number of LSK cells was quantified after coculture. Scanning electron microscopy was utilized to observe the interaction between ADSCs and LSK cells. Hes-1 expression was assessed using western blot and real-time quantitative PCR. An γ-secretase inhibitor (GSI) was used to confirm the involvement of the Jagged-1/Notch-1/Hes-1 pathway in LSK cell expansion. Additionally, Jagged-1 was knocked down in ADSCs to demonstrate its significance in ADSC-mediated hematopoietic support. In vivo experiments were conducted to study the hematopoietic support provided by ADSCs through the infusion of LSK, LSK + fibroblasts, and LSK + ADSCs, respectively. Mouse survival, platelet count, leukocyte count, and hemoglobin levels were monitored. Results ADSCs showed high-Jagged-1 expression and promoted LSK cell proliferation. There was a direct interaction between ADSCs and LSK cells. After coculture, Hes-1 expression increased in LSK cells. Moreover, GSI-reduced LSK cell proliferation and Hes-1 expression. Knockdown of Jagged-1 attenuated ADSCs-mediated promotion of LSK cell proliferation. Furthermore, ADSCs facilitated hematopoietic recovery and promoted the survival of NOD/SCID mice. Conclusion The hematopoietic support provided by ADSCs both in vivo and in vitro may be mediated, at least in part, through the Jagged-1/Notch-1 signaling pathway. These findings provide valuable insights into the mechanisms underlying ADSCs-mediated hematopoietic support and may have implications for improving the treatment of PGF following HSCT.
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Affiliation(s)
- Hongbo Wang
- Hematology Center, The First Affiliated Hospital of Xinjiang Medical University (Xinjiang Uygur Autonomous Region Institute of Hematology), Urumqi 830054, China
- Stem Cell Research Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Xiaojuan Bi
- The State Key Laboratory of Pathogenesis and Prevention of Central Asian High Incidence Diseases, Institute of Clinical Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Rongyao Zhang
- Hematology Center, The First Affiliated Hospital of Xinjiang Medical University (Xinjiang Uygur Autonomous Region Institute of Hematology), Urumqi 830054, China
- Stem Cell Research Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Hailong Yuan
- Hematology Center, The First Affiliated Hospital of Xinjiang Medical University (Xinjiang Uygur Autonomous Region Institute of Hematology), Urumqi 830054, China
- Stem Cell Research Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Jianli Xu
- Hematology Center, The First Affiliated Hospital of Xinjiang Medical University (Xinjiang Uygur Autonomous Region Institute of Hematology), Urumqi 830054, China
- Stem Cell Research Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Kaile Zhang
- Hematology Center, The First Affiliated Hospital of Xinjiang Medical University (Xinjiang Uygur Autonomous Region Institute of Hematology), Urumqi 830054, China
- Stem Cell Research Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Songqing Qi
- Hematology Center, The First Affiliated Hospital of Xinjiang Medical University (Xinjiang Uygur Autonomous Region Institute of Hematology), Urumqi 830054, China
- Stem Cell Research Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Xue Zhang
- Hematology Center, The First Affiliated Hospital of Xinjiang Medical University (Xinjiang Uygur Autonomous Region Institute of Hematology), Urumqi 830054, China
- Stem Cell Research Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Ming Jiang
- Hematology Center, The First Affiliated Hospital of Xinjiang Medical University (Xinjiang Uygur Autonomous Region Institute of Hematology), Urumqi 830054, China
- Stem Cell Research Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
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Ye M, Liu G, Yang Y, Yang H, Ren J, Chen W, Gao Z. Network pharmacology and experimental verification of the potential mechanism of Er-Xian decoction in aplastic anemia. Sci Rep 2023; 13:17385. [PMID: 37833363 PMCID: PMC10575897 DOI: 10.1038/s41598-023-44672-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/11/2023] [Indexed: 10/15/2023] Open
Abstract
To investigate the potential mechanism of Er-Xian decoction (EXD) in treating aplastic anemia (AA), the active components of EXD were screened by the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), and the targets of the components were predicted by the Swiss Target Prediction database. AA targets were collected from the GeneCards, OMIM, DisGeNET, PharmGKB, DrugBank, and TTD databases, the intersection of AA targets and EXD targets was calculated, and an herb-component-target network was constructed by Cytoscape 3.7.2 software. The STRING database was used for protein‒protein interaction (PPI) analysis, and Cytoscape 3.7.2 software was used to construct a PPI network and perform topology analysis. The core targets were imported into the DAVID database for gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. The molecular docking software AutoDock was used to measure the affinity between active components and key targets. Finally, we established a mouse model of AA and verified the key targets and signaling pathways of EXD by RT‒PCR, ELISA and Western blot analysis. A total of 53 active components were screened from EXD, 2516 AA-related targets were collected, and 195 common targets were obtained. An herb-component-target network and a PPI network were successfully constructed, and 36 core targets were selected from the PPI network. The main active components of EXD include luteolin, kaempferol, berberine, etc., and key targets include PIK3CA, AKT1, STAT3, etc. GO functional enrichment analysis showed that cell components, molecular functions and biological processes with significant correlations were macromolecular complexes, protein serine/threonine/tyrosine kinase activity and protein phosphorylation, respectively. KEGG pathway analysis showed that the pathways with significant correlations included the PI3K-Akt signaling pathway and JAK-STAT signaling pathway. Molecular docking results showed that the tested key targets had good affinity for the corresponding active components. In AA mice, we found that EXD significantly increased white blood cell count, red blood cell count, platelet count and hemoglobin levels, increased mRNA levels of PIK3CA, PIK3CD, AKT1, JAK2, STAT3 and MAPK1, and promoted phosphorylation of PI3K, AKT, ERK1/2 and STAT3. In summary, EXD acts on PI3K, AKT, STAT3 and other targets through berberine, luteolin, quercetin and other components to regulate the PI3K-Akt pathway, JAK-STAT pathway and other pathways, thus exerting its therapeutic effect on AA. This study explained the Chinese medicine theory of treating AA with EXD by tonifying kidney-yang and provides a scientific basis for the use of EXD in treating AA.
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Affiliation(s)
- Mei Ye
- Department of Hematology, The Affiliated Hospital of Panzhihua University, Panzhihua, China
| | - Guangxian Liu
- Department of Pharmacy, The Affiliated Hospital of Panzhihua University, Panzhihua, China
| | - Yujun Yang
- School of Basic Medicine, Panzhihua University, Panzhihua, China
| | - Hongyu Yang
- Department of Clinical Laboratory, The Affiliated Hospital of Panzhihua University, Panzhihua, China
| | - Juan Ren
- Department of Clinical Laboratory, The Affiliated Hospital of Panzhihua University, Panzhihua, China
| | - Wenfei Chen
- Department of Pharmacy, The Affiliated Hospital of Panzhihua University, Panzhihua, China
| | - Zeli Gao
- Department of Hematology, The Affiliated Hospital of Panzhihua University, Panzhihua, China.
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7
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Liu HX, Wei DL, Shao S, Jiang Y, Li S, Zhu J, Wang C, Zhao CX. [Impact of immunosuppression intensified conditioning regimen for patients with strong positive pre-transplantation donor-specific anti-HLA antibodies (DSAs) undergoing haploidentical hematopoietic stem cell transplantation]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:654-659. [PMID: 37803839 PMCID: PMC10520227 DOI: 10.3760/cma.j.issn.0253-2727.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Indexed: 10/08/2023]
Abstract
Objective: To explore the efficacy of immunosuppression intensified conditioning regimen in patients who have strongly positive donor-specific Anti-HLA antibodies (DSAs) and received a haploidentical hematopoietic stem cell transplantation (haplo-HSCT) . Methods: Clinical data of 10 patients with strongly positive pretransplant DSAs (defined as MFI ≥10000) were retrospectively analyzed in this study. All of them received a haplo-HSCT in the Hematology Department of Shanghai Zhaxin Traditional Chinese & Western Medicine Hospital. Results: ① Of all ten patients, three were males, and seven were females, with a median age of 53.5 (36-64) years. Of the 10 patients, three were diagnosed with acute myeloid leukemia, two were myelodysplastic syndromes (MDS), two were chronic myelomonocytic leukemia (CMML), two were in an accelerated phase of chronic myeloid leukemia (CML-AP), and one was primary myelofibrosis (PMF). ② Conditioning regimen consisted of fludarabine (Flu) /busulfan (Bu) combined with whole-body irradiation (TBI) /cyclophosphamide (Cy). ③ On the seventh day after transplantation, the median pretransplant DSA level was MFI 15 999 (10 210-23 417) and 10 787 (0-22 720). ④ Eight patients acquired hematopoietic reconstitution; the median time of neutrophil engraftment was 14 (10-16) days; and 18 (14-20) days for platelet engraftment. After a median follow-up of 12.5 (1.5-27) months, primary graft failure was found in one patient and another with poor graft function. Seven patients remained in a disease remission state, and all were DSA-negative. Conclusions: An intensified immunosuppression conditioning regimen can efficiently decrease the level of donor-specific anti-HLA antibodies (DSAs), leading to good short-term efficacy.
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Affiliation(s)
- H X Liu
- Department of Hematology, Shanghai Zhaxin Traditional Chinese& Western Medicine Hospital, Shanghai 200435, China
| | - D L Wei
- Department of Hematology, Shanghai Zhaxin Traditional Chinese& Western Medicine Hospital, Shanghai 200435, China
| | - S Shao
- Department of Hematology, Shanghai Zhaxin Traditional Chinese& Western Medicine Hospital, Shanghai 200435, China
| | - Y Jiang
- Department of Hematology, Shanghai Zhaxin Traditional Chinese& Western Medicine Hospital, Shanghai 200435, China
| | - S Li
- Department of Hematology, Shanghai Zhaxin Traditional Chinese& Western Medicine Hospital, Shanghai 200435, China
| | - J Zhu
- Department of Hematology, Shanghai Zhaxin Traditional Chinese& Western Medicine Hospital, Shanghai 200435, China
| | - C Wang
- Department of Hematology, Shanghai Zhaxin Traditional Chinese& Western Medicine Hospital, Shanghai 200435, China
| | - C X Zhao
- Department of Hematology, Shanghai Zhaxin Traditional Chinese& Western Medicine Hospital, Shanghai 200435, China
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Wu LQ, Huang LF, Yang H, Ye BD, Sheng JP, Yu QH, Yang Y, Jia JS, Zhang DH, Lin SY, He GS, Li JY. Comparison of haploidentical-allogeneic hematopoietic stem cell transplantation and intensive immunosuppressive therapy for patients with severe aplastic anemia with an absolute neutrophil count of zero: a retrospective study. Ann Hematol 2023:10.1007/s00277-023-05256-9. [PMID: 37193759 DOI: 10.1007/s00277-023-05256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/30/2023] [Indexed: 05/18/2023]
Abstract
A retrospective analysis was conducted based on the clinical data from 60 patients older than 16 years from January 2016 to January 2021. All the patients were newly diagnosed with severe aplastic anemia (SAA) with an absolute neutrophil count (ANC) of zero. We compared the hematological response and survival of haploidentical-allogeneic hematopoietic stem cell transplantation (HID-HSCT) (n = 25) and intensive immunosuppressive therapy (IST) (n = 35) treatments. At six months, the overall response rate and complete response were significantly higher in the HID-HSCT group than those in the IST group (84.0% vs. 40.0%, P = 0.001; 80.0% vs. 17.1%, P = 0.001). With a median follow-up of 18.5 months (4.3~30.8 months), patients in the HID-HSCT group had longer overall survival and event-free survival (80.0% vs. 47.9%, P = 0.0419; 79.2% vs. 33.5%, P = 0.0048). These data suggested that HID-HSCT might be an effective alternative treatment option for adult patients with SAA with an ANC of zero, which requires further validation in an additional prospective study.
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Affiliation(s)
- Li-Qiang Wu
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Li-Fang Huang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Yang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Bao-Dong Ye
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Jian-Ping Sheng
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Qing-Hong Yu
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Yan Yang
- Department of Hematology, The First Hospital of Jilin University, Changchun, China
| | - Jin-Song Jia
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Dong-Hua Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng-Yun Lin
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
| | - Guang-Sheng He
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China.
| | - Jian-Yong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
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9
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Wu L, Zhou M, Li Y, Chen X, Mo W, Wang C, Xu S, Zhou W, Deng T, Zhou R, Pan S, Wang S, Zhang Y. Prospective study of a modified posttransplant cyclophosphamide regimen for severe aplastic anemia patients with HLA-haploidentical transplantation. Transplant Cell Ther 2023:S2666-6367(23)01245-9. [PMID: 37098408 DOI: 10.1016/j.jtct.2023.04.015] [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: 03/03/2023] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 04/27/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative modality for severe aplastic anemia (SAA). The availability of haploidentical donors has expanded valid choices for SAA. However, previous posttransplantation cyclophosphamide (PTCy)-based protocols for HLA-haploidentical HSCT in SAA patients are associated with relatively delayed neutrophil and platelet engraftment. We prospectively studied HLA-haploidentical HSCT using bone marrow combined with peripheral blood stem cells as grafts and a modified PTCy regimen for treating SAA; we evaluated the efficacy and safety of this regimen, which had an increased dose (from 4.5 mg/kg to 6.0 mg/kg) and backward adjusted timing (from day -9 to -7 to day -5 to -3) of antithymocyte globulin (ATG) compared with previous PTCy protocols. Seventy-one eligible patients were included in this prospective study between July 2019 and June 2022. The median time to and cumulative incidence (CI) of neutrophil and platelet engraftment were 13 days (range, 11-19) and 97.2±2.2% and 12 days (range, 7-62) and 94.4 ± 2.9%, respectively. Five patients experienced graft failure (GF), including 2 with primary GF and 3 with secondary GF. The CI of GF was 7.0±3.1%. The interval between diagnosis and transplantation (≥1 year) was a risk factor for GF development (HR 8.40, 95% confidence interval (1.40-50.47), p=0.02). No patients developed grade IV acute graft-versus-host disease (aGVHD) or severe chronic GVHD (cGVHD). The 100-day CI of grade II-IV aGVHD and 2-year cGVHD were 13.4±4.2% and 5.9±2.9%, respectively. With a median follow-up of 580 days (range, 108-1014) for 63 survivors, the estimated 2-year overall survival (OS) and 2-year GVHD-free and failure-free survival (GFFS) were 87.3% (95% confidence interval, 79.4-96.0) and 83.8% (95% confidence interval, 74.9-93.7), respectively. In conclusion, the PTCy regimen with an increased dose and backward adjusted timing of ATG is an effective and feasible choice for treatment with HLA-haploidentical HSCT using BM combined with PBSCs as grafts, with a high rate of and faster engraftment, a low rate and intensity of aGVHD and cGVHD, and prolonged OS and GFFS.
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Affiliation(s)
- Liangliang Wu
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China; Division of Cell, Developmental and Integrative Biology, South China University of Technology, Guangzhou, China
| | - Ming Zhou
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yumiao Li
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaowei Chen
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wenjian Mo
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Caixia Wang
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shilin Xu
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei Zhou
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tingfen Deng
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ruiqing Zhou
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shiyi Pan
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shunqing Wang
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Yuping Zhang
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
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Marrapodi MM, Mascolo A, Roberti D, Martino MD, Rafaniello C, Riccardi C, Rossi F. The efficacy and the safety of eltrombopag in pediatric patients with severe aplastic anemia: a systematic review. Front Pediatr 2023; 11:1149718. [PMID: 37168802 PMCID: PMC10166202 DOI: 10.3389/fped.2023.1149718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/31/2023] [Indexed: 05/13/2023] Open
Abstract
Background Acquired aplastic anemia (AAA) in pediatric patients is a rare disorder characterized by hypocellular bone marrow and pancytopenia. Eltrombopag, an oral thrombopoietin receptor agonist, provides a hematologic improvement in adults with severe aplastic anemia (SAA) refractory to immunosuppressive therapy (IST). The association of ELT and IST was approved by the US Food and Drug Administration (FDA) for adults and children ≥2 years of age as a first-line treatment for SAA. However, the effects of ELT on pediatric patients with SAA remain controversial and limited. Methods and findings We conducted a systematic review of the most recent literature from Pubmed, Web of Science, and Embase, published up to 20th December 2022, in order to evaluate the available evidence on the efficacy and safety of ELT added to IST for the treatment of SAA in the pediatric population. Conclusion Eltrombopag added to the IST has shown a good safety profile, without manifestations of excessive toxic effects, although not all the results obtained from our studies support the addition of ELT to the IST in the first-line treatment of children with SAA. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022325859.
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Affiliation(s)
- Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Correspondence: Maria Maddalena Marrapodi
| | - Annamaria Mascolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Domenico Roberti
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Martina Di Martino
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Concetta Rafaniello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Consiglia Riccardi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesca Rossi
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
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11
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Chen RL, Ip PP, Shaw JJ, Wang YH, Fan LH, Shen YL, Joseph NA, Chen TE, Chen LY. Anti-Thymocyte Globulin (ATG)-Free Nonmyeloablative Haploidentical PBSCT Plus Post-Transplantation Cyclophosphamide Is a Safe and Efficient Treatment Approach for Pediatric Acquired Aplastic Anemia. Int J Mol Sci 2022; 23:ijms232315192. [PMID: 36499545 PMCID: PMC9739033 DOI: 10.3390/ijms232315192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/11/2022] Open
Abstract
Most cases of acquired aplastic anemia (AA) arise from autoimmune destruction of hematopoietic stem and progenitor cells. Human leukocyte antigen (HLA)-haploidentical nonmyeloablative hematopoietic stem cell transplantation (HSCT) plus post-transplantation cyclophosphamide (PTCy) is increasingly applied to salvage AA using bone marrow as graft and anti-thymocyte globulin (ATG) in conditioning. Herein, we characterize a cohort of twelve AA patients clinically and molecularly, six who possessed other immunological disorders (including two also carrying germline SAMD9L mutations). Each patient with SAMD9L mutation also carried an AA-related rare BCORL1 variant or CTLA4 p.T17A GG genotype, respectively, and both presented short telomere lengths. Six of the ten patients analyzed harbored AA-risky HLA polymorphisms. All patients recovered upon non-HSCT (n = 4) or HSCT (n = 8) treatments. Six of the eight HSCT-treated patients were subjected to a modified PTCy-based regimen involving freshly prepared peripheral blood stem cells (PBSC) as graft and exclusion of ATG. All patients were engrafted between post-transplantation days +13 and +18 and quickly reverted to normal life, displaying a sustained complete hematologic response and an absence of graft-versus-host disease. These outcomes indicate most AA cases, including of the SAMD9L-inherited subtype, are immune-mediated and the modified PTCy-based regimen we present is efficient and safe for salvage.
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Affiliation(s)
- Rong-Long Chen
- Department of Pediatric Hematology and Oncology, Koo Foundation Sun Yat-sen Cancer Center, Taipei 11259, Taiwan
- Correspondence:
| | - Peng Peng Ip
- Institute of Molecular Biology, Academia Sinica, Taipei 115024, Taiwan
| | - Jy-juinn Shaw
- School of Law, National Yang Ming Chiao Tung University, Hsinchu City 30093, Taiwan
| | - Yun-Hsin Wang
- Department of Chemistry, Tamkang University, Tamsui, New Taipei City 251301, Taiwan
| | - Li-Hua Fan
- Department of Pharmacy, Koo Foundation Sun Yat-sen Cancer Center, Taipei 11259, Taiwan
| | - Yi-Ling Shen
- Institute of Molecular Biology, Academia Sinica, Taipei 115024, Taiwan
| | - Nithila A. Joseph
- Institute of Molecular Biology, Academia Sinica, Taipei 115024, Taiwan
| | - Tsen-Erh Chen
- Institute of Molecular Biology, Academia Sinica, Taipei 115024, Taiwan
| | - Liuh-Yow Chen
- Institute of Molecular Biology, Academia Sinica, Taipei 115024, Taiwan
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Xu ZL, Xu LP, Wu DP, Wang SQ, Zhang X, Xi R, Gao SJ, Xia LH, Yang JM, Jiang M, Wang X, Liu QF, Chen J, Zhou M, Huang XJ. Comparable long-term outcomes between upfront haploidentical and identical sibling donor transplant in aplastic anemia: a national registry-based study. Haematologica 2022; 107:2918-2927. [PMID: 35615930 PMCID: PMC9713560 DOI: 10.3324/haematol.2022.280758] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/13/2022] [Indexed: 12/14/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a curative option for severe aplastic anemia (SAA), and transplantation from identical sibling donors (ISD) has been recommended as a first-line treatment. Haploidentical donor (HID) transplantation for SAA has made great advances; thus, an increased role of HID-SCT in SAA should be considered. We performed a national registry-based analysis comparing long-term outcomes in the upfront HID or upfront ISD SCT setting. A total of 342 SAA patients were enrolled, with 183 patients receiving HID SCT and 159 receiving ISD SCT. The estimated 9-year overall survival and failure-free survival were 87.1±2.5% and 89.3±3.7% (P=0.173) and 86.5±2.6% versus 88.1±3.8% (P=0.257) for patients in the HID and ISD SCT groups, respectively. Transplantation from HID or ISD SCT has greatly improved quality of life (QoL) levels post-HSCT compared to pre-HSCT. The occurrence of chronic graft-versus-host disease was the only identified adverse factor affecting each subscale of QoL. Physical and mental component summaries in adults as well as physical, mental, social, and role well-being in children were all similar between HID and ISD SCT at 5-year time points. At the last follow-up, the proportion of returning to society was comparable between the HID and ISD groups, showing 78.0% versus 84.6% among children and 74.6% versus 81.2% among adults. These data suggest that haploidentical transplant can be considered a potential therapeutic option in the upfront setting for SAA patients in the absence of an HLA-identical related or unrelated donor.
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Affiliation(s)
- Zheng-Li Xu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - De-Pei Wu
- The First affiliated Hospital of Soochow University, Soochow, China
| | | | - Xi Zhang
- Xinqiao Hospital affiliated to Third Military Medical University, Chongqing, China
| | - Rui Xi
- General Hospital of Lanzhou Military Region of PLA, Lanzhou, China
| | - Su-Jun Gao
- The First Hospital of Jilin University, Changchun, China
| | - Ling-Hui Xia
- Xiehe Hospital affiliated to Huazhong University of Science and Technology, Wuhan, China
| | - Jian-Min Yang
- Changhai Hospital affiliated to Second Military Medical University, Shanghai, China
| | - Ming Jiang
- The First affiliated Hospital of Xinjiang Medical University, Urumchi, China
| | - Xin Wang
- Shandong Provincial Hospital, Jinan, China
| | - Qi-Fa Liu
- Nanfang Hospital affiliated to Southern Medical University, Guangzhou, China
| | - Jia Chen
- The First affiliated Hospital of Soochow University, Soochow, China
| | - Ming Zhou
- Guangzhou First People's Hospital, Guangzhou, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; Peking-Tsinghua Center for Life Sciences, Beijing, China.
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13
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Ni R, Fan L, Zhang L, Song Y, Wang H, Wang A, Liu B. A mouse model of irradiation and spleen-thymus lymphocyte infusion induced aplastic anemia. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:932-945. [PMID: 36004514 DOI: 10.1080/16078454.2022.2113356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The immune-induced aplastic anemia (AA) mouse model has been used for the study of AA. However, there were no uniform conditions for establishing a model and no assessment of immunological homeostasis. Our study aimed to identify the conditions of establishing a model and assess the AA model in immunology and pathology. METHODS We induced an AA mouse model by the combination between sublethal irradiation and spleen-thymus lymphocyte infusion. The success of establishing the AA model was identified by blood routine tests and pathology of bone marrow. The frequency of Th17 and Treg cells was measured by flow cytometry. The frequency of CD34+ and CD41+ cells was detected by immunohistochemical technique.IL-6, IL-8, IL-17, TNF-α and IFN-γ were evaluated by ELISA. RESULTS The 137Cs sublethal irradiation (5 Gy) and spleen-thymus lymphocyte infusion (5 × 106) induced the AA mouse model successfully. The AA mice had a long lifetime and manifested pancytopenia and bone marrow failure. The percentage of Th17 cells increased and the percentage of Treg cells decreased distinctly in AA mice. The area of hematopoietic tissues and count of CD34+ cells and CD41+ cells were significantly reduced in AA mice.The level of cytokines, IL-6, IL-8, IL-17, TNF-α and IFN-γ, was increased significantly in peripheral blood and bone marrow. CONCLUSION Our data suggest that the improved AA mouse model conforms to the diagnosis standard of AA and simulates the immune internal environment of human AA. The AA mouse model has a longer lifetime and unbalances of Th17/Treg cells caused the destruction of CD34+ cells and CD41+ cells, which was immune-mediated pathogenesis to adapt to long-term research.
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Affiliation(s)
- Runfeng Ni
- Department of traditional Chinese medicine, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Leiwei Fan
- Department of traditional Chinese medicine, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Le Zhang
- Department of traditional Chinese medicine, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Yanqi Song
- Department of traditional Chinese medicine, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Haijin Wang
- Department of traditional Chinese medicine, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Aidi Wang
- Department of traditional Chinese medicine, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Baoshan Liu
- Department of traditional Chinese medicine, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
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14
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Yao D, Tian Y, Li J, Li B, Lu J, Ling J, Zheng D, Yao Y, Xiao P, Meng L, Hu S. Association between haploidentical hematopoietic stem cell transplantation combined with an umbilical cord blood unit and graft- versus-host disease in pediatric patients with acquired severe aplastic anemia. Ther Adv Hematol 2022; 13:20406207221134409. [PMID: 36324490 PMCID: PMC9619284 DOI: 10.1177/20406207221134409] [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: 01/26/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) based on granulocyte colony-stimulating factor plus anti-thymocyte regimens (‘Beijing Protocol’) provides a salvage treatment for patients of acquired severe aplastic anemia (SAA) in China. However, graft-versus-host disease (GVHD) is a major impediment of haplo-HSCT due to human leukocyte antigen disparity. Recently, haplo-HSCT combined with umbilical cord blood (UCB) (haplo-cord HSCT) is performed in clinical trials to potentially reduce the risk of severe GVHD. Nevertheless, studies comparing GVHD in pediatric patients receiving haplo and haplo-cord HSCT for SAA are limited. Objective: The objective of this study was to investigate the impact of UCB co-infusion on GVHD in pediatric patients receiving haplo-HSCT for SAA. Design: We conducted a retrospective study of 91 consecutive SAA children undergoing haploidentical transplantation based on the ‘Beijing Protocol’ with or without co-infusion of UCB in our center. Methods: All patients received uniform non-myeloablative conditioning and GVHD prophylaxis. We compared baseline characteristics and transplant outcomes between the haplo (n = 35) and haplo-cord (n = 56) recipients. Results: All 91 patients achieved hematopoietic recovery from haploidentical donors, with a higher incidence of peri-engraftment syndrome observed with the haplo-cord group as compared with the haplo group (75.0% versus 48.6%, p = 0.029). Notably, the haplo-cord group showed a lower incidence of II–IV acute GVHD (aGVHD) than the haplo group (16.1% versus 42.9%, p = 0.002). Observed incidences of chronic GVHD (cGVHD) and moderate to severe cGVHD in the haplo-cord group were also lower than that in the haplo group (25.6% versus 51.3%, p = 0.019; 16.2% versus 41.3%, p = 0.016, respectively). Haplo-cord HSCT was identified as the only factor associated with a lower incidence of II–IV aGVHD and cGVHD in multivariate analysis. However, no differences were observed between the two groups for infections and survival outcomes. Conclusion: Our data indicated that co-infusion of UCB in ‘Beijing Protocol’-based haplo-HSCT may be effective for reducing the risk of severe GVHD in SAA children.
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Affiliation(s)
| | | | | | | | - Jun Lu
- Department of Hematology, Children’s Hospital of Soochow University, Suzhou, China,Jiangsu Children’s Hematology & Oncology Center, Suzhou, China,Di Yao is also affiliated to Department of Pediatrics, Hangzhou First People’s Hospital, Hangzhou, China
| | - Jing Ling
- Department of Hematology, Children’s Hospital of Soochow University, Suzhou, China,Jiangsu Children’s Hematology & Oncology Center, Suzhou, China,Di Yao is also affiliated to Department of Pediatrics, Hangzhou First People’s Hospital, Hangzhou, China
| | - Defei Zheng
- Department of Hematology, Children’s Hospital of Soochow University, Suzhou, China,Jiangsu Children’s Hematology & Oncology Center, Suzhou, China,Di Yao is also affiliated to Department of Pediatrics, Hangzhou First People’s Hospital, Hangzhou, China
| | - Yanhua Yao
- Department of Hematology, Children’s Hospital of Soochow University, Suzhou, China,Jiangsu Children’s Hematology & Oncology Center, Suzhou, China,Di Yao is also affiliated to Department of Pediatrics, Hangzhou First People’s Hospital, Hangzhou, China
| | - Peifang Xiao
- Department of Hematology, Children’s Hospital of Soochow University, Suzhou, China,Jiangsu Children’s Hematology & Oncology Center, Suzhou, China,Di Yao is also affiliated to Department of Pediatrics, Hangzhou First People’s Hospital, Hangzhou, China
| | - Lijun Meng
- Department of Hematology, Children’s Hospital of Soochow University, No. 92 Zhongnan Street, Suzhou 215025, Jiangsu, China,Jiangsu Children’s Hematology & Oncology Center, Suzhou, China
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15
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Yang Y, Zhang M, Li M, Li Y, Yang W, Liu Z, Wang H. Unrelated umbilical cord blood can improve the prognosis of haploidentical hematopoietic stem cell transplantation. STEM CELL RESEARCH & THERAPY 2022; 13:485. [PMID: 36153563 PMCID: PMC9509542 DOI: 10.1186/s13287-022-03170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/03/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) is widely used as a curative treatment strategy for most types of hematological diseases. However, strategies for enhancing the graft versus leukemia (GVL) effect without aggravating the graft versus host disease (GVHD) effect are still being pursued.
Methods
A retrospective cohort study was performed to compare the outcomes between combined unrelated umbilical cord blood (UCB-haplo HSCT) and haplo HSCT.
Results
The results showed that neither acute GVHD (aGVHD) nor chronic GVHD (cGVHD) was increased in the UCB-haplo HSCT group, and the engraftment and infection rates were similar between the two groups. However, overall survival and progression-free survival were significantly improved, while transplantation-related mortality and relapse were significantly decreased in the UCB-haplo HSCT group by both univariate and multivariate analyses.
Conclusion
Our results indicated that the addition of a UCB unit could improve the prognosis of haplo-HSCT and enhance the GVL effect without increasing the incidence of GVHD.
Trial registration
The cohort study was retrospectively registered at https://www.chictr.org.cn as ChiCTR2100046681.
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16
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Dong N, Zhang X, Wu D, Hu Z, Liu W, Deng S, Ye B. Medication Regularity of Traditional Chinese Medicine in the Treatment of Aplastic Anemia Based on Data Mining. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:1605359. [PMID: 36062179 PMCID: PMC9436587 DOI: 10.1155/2022/1605359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022]
Abstract
Objective Aplastic anemia (AA) is an uncommon disease, characterized by pancytopenia and hypocellular bone marrow, but it is common in the blood system. The medication rules of traditional Chinese medicine (TCM) in the treatment of AA are not clear, for which it is worth exploring the medication rules by data mining methods. Methods This study used SPSS Modeler 18.0 and SPSS statistics to analyze the cases of AA from Zhejiang Provincial Hospital of Chinese Medicine (ZJHCM) from March 1, 2019, to March 1, 2022. Data mining methods, including frequency analysis, cluster analysis, and association rule learning, were performed in order to explore the medication rules for AA. Results (1) A total of 859 prescriptions, which met the inclusion criteria, consisted of 255 herbs. In descending order of the frequency of herbal medicine, we have Danggui, Huangqi, Shudihuang, Fuling, Gancao, Shanyao, Shanzhuyu, Baizhu, Dangshen, and Xianhecao. (2) Frequency analysis of herb properties: the Four Qi of 255 kinds of TCMs are mainly warm and neutral medicines. The Five Flavors are mainly sweet medicines, followed by bitter medicines. The main meridians are the liver, spleen, and kidney. (3) Clustering of medications: TCMs with the top 20 frequencies are classified into 9 groups by cluster analysis. (4) Association rule analysis of high-frequency herbs: using the Apriori algorithm, the results showed that there were 3 herb pairs with support of over 0.3 and 12 herb pairs with confidence above 0.85. Conclusion The basic pathogenesis of AA (Sui Lao) is spleen and kidney essence deficiency, Qi deficiency, and blood stasis. The main herbs have warm and neutral properties, sweet tastes, and liver, spleen, and kidney meridian tropisms, whose purpose is to tonify the kidney and invigorate the spleen, tonify Qi, and promote blood circulation.
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Affiliation(s)
- Nanxi Dong
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xujie Zhang
- The College of Control Science and Engineering, Zhejiang University, Hangzhou, China
| | - Dijiong Wu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhiping Hu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenbin Liu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shu Deng
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Baodong Ye
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
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17
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Durrani J, Groarke EM. Clonality in immune aplastic anemia: Mechanisms of immune escape or malignant transformation. Semin Hematol 2022; 59:137-142. [PMID: 36115690 PMCID: PMC9938528 DOI: 10.1053/j.seminhematol.2022.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 11/11/2022]
Abstract
Aplastic anemia (AA) is the prototypic bone marrow failure syndrome and can be classified as either acquired or inherited. Inherited forms are due to the effects of germline mutations, while acquired AA is suspected to result from cytotoxic T-cell mediated immune attack on hematopoietic stem and progenitor cells. Once thought to be a purely "benign" condition, clonality in the form of chromosomal abnormalities and single nucleotide variants is now well recognized in AA. Mechanisms underpinning this clonality likely relate to selection of clones that allow immune evasion or increased cell survival the marrow environment under immune attack. Widespread use and availability of next generation and other genetic sequencing techniques has enabled us to better understand the genomic landscape of aplastic anemia. This review focuses on the current concepts associated with clonality, in particular somatic mutations and their impact on diagnosis and clinical outcomes in immune aplastic anemia.
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Affiliation(s)
- Jibran Durrani
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health.
| | - Emma M Groarke
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health
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18
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Wang X, Huang R, Zhang X, Zhang X. Current status and prospects of hematopoietic stem cell transplantation in China. Chin Med J (Engl) 2022; 135:1394-1403. [PMID: 35866344 PMCID: PMC9481431 DOI: 10.1097/cm9.0000000000002235] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Hematopoietic stem cell transplantation (HSCT) is a highly effective and unique medical procedure for the treatment of most hematological malignancies. The first allogeneic transplantation was performed by E. Donnall Thomas in 1957. Since then, the field has evolved and expanded worldwide. The first successful allogenic HSCT (allo-HSCT) in China was conducted in 1981. Although the development of allo-HSCT in China lagged, China has since made considerable contributions to the process of HSCT worldwide, with more than 10,000 HSCTs performed annually. In particular, haploid HSCT (haplo-HSCT) technology represented in the Beijing Protocol has demonstrated similar efficacy to human leukocyte antigen-matched HSCT and has gradually become the pre-dominant choice for allo-HSCT in China. Currently, the number of haplo-HSCT procedures exceeds 5000 per year, and the Beijing Protocol has been greatly improved by implementing updated individualized strategies for controlling complications, relapse, and infection management. In addition, innovative haplo-HSCT technologies developed by different medical transplantation centers, such as Soochow, Zhejiang, Fujian, Chongqing, and Anhui, have emerged, providing inspiration for the refinement of global practice. This review will focus on the current activity in this field and highlight important trends that are vital in China's allo-HSCT process, examining the current viewpoint and future directions.
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Affiliation(s)
- Xiaoqi Wang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing 400037, China
| | - Ruihao Huang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing 400037, China
| | - Xiaohui Zhang
- Peking University People's Hospital & Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - Xi Zhang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing 400037, China
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19
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Long-term follow-up of haploidentical transplantation in relapsed/refractory severe aplastic anemia: a multicenter prospective study. Sci Bull (Beijing) 2022; 67:963-970. [PMID: 36546031 DOI: 10.1016/j.scib.2022.01.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/23/2021] [Accepted: 01/18/2022] [Indexed: 01/06/2023]
Abstract
In recent decades, haploidentical stem cell transplantation (haplo-SCT) to treat severe aplastic anemia (SAA) has achieved remarkable progress. However, long-term results are still lacking. We conducted a multicenter prospective study involving SAA patients who underwent haplo-SCT as salvage therapy. Long-term outcomes were assessed, mainly focusing on survival and quality of life (QoL). Longitudinal QoL was prospectively evaluated during pretransplantation and at 3 and 5 years posttransplantation using the SF-36 scale in adults and the PedsQL 4.0 scale in children. A total of 287 SAA patients were enrolled, and the median follow-up was 4.56 years (range, 3.01-9.05 years) among surviving patients. During the long-term follow-up, 268 of 275 evaluable patients (97.5%) obtained sustained full donor chimerism, and 93.4% had complete hematopoietic recovery. The estimated overall survival and failure-free survival for the whole cohort at 9 years were 85.4% ± 2.1% and 84.0% ± 2.2%, respectively. Age (≥18 years) and a poorer performance status (ECOG >1) were identified as risk factors for survival outcomes. For QoL recovery after haplo-SCT, we found that QoL progressively improved from pretransplantation to the 3-year and 5-year time points with statistical significance. The occurrence of chronic graft versus host disease was a risk factor predicting poorer QoL scores in both the child and adult cohorts. At the last follow-up, 74.0% of children and 72.9% of adults returned to normal school or work. These inspiring long-term outcomes suggest that salvage transplantation with haploidentical donors can be routine practice for SAA patients without human leukocyte antigen (HLA)-matched donors.
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20
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Li Y, Lu X, Wang N, Zhang X, Cao Y, Xiao Y, Meng F, Zhang D, You Y, Zou L, Cheng H, Guo J, Zhang Y, Huang Z, Yuan G, Wei J, Wang H, Xia L, Zhang Y. Comparisons Between modified PTCY and G-CSF/ATG Regimens for Haploidentical Transplantation in Patients with Aplastic Anemia. Transplant Cell Ther 2022; 28:396.e1-396.e9. [PMID: 35513253 DOI: 10.1016/j.jtct.2022.04.021] [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: 01/24/2022] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Haploidentical transplantation has become an alternative treatment option for aplastic anemia patients without matched sibling donors or matched unrelated donors. Recently, the post-transplantation cyclophosphamide (PTCY) regimen and granulocyte colony-stimulating factor (G-CSF)/antithymocyte globulin (ATG) regimen have become the most common protocols used worldwide. OBJECTIVE We designed this retrospective study to compare the outcomes of patients receiving a modified post-transplantation cyclophosphamide (mPTCY) regimen versus the G-CSF/ATG regimen. STUDY DESIGN We retrospectively reviewed and analyzed the clinical data of 130 aplastic anemia patients who underwent haplo-HSCT and received the mPTCY regimen (n=55) or G-CSF/ATG regimen (n=75) between Jan 2013 and Jun 2021 across seven transplant centers. RESULTS Neutrophil engraftment was successful in all patients within 30 days in the G-CSF/ATG group. The cumulative neutrophil engraftment rate in the mPTCY group was 96.36% (95% CI, 94.57-97.57, P=0.010). The median time of neutrophil engraftment in the G-CSF/ATG group was 10 (7-28) days, which was more rapid than that observed in the mPTCY group (P <0.001). There were no significant differences in the incidence of graft versus host disease (GVHD) between the two groups. The cumulative incidence of II-IV acute GVHD was 18.40% (95% CI, 4.27-40.31) in the mPTCY group and 19.32% (95% CI, 5.86-38.58) in the G-CSF/ATG group, while the cumulative incidence of III-IV acute GVHD was 7.31% (95% CI, 0.09-37.48) in the mPTCY group and 7.57% (95% CI, 0.20-34.19) in the G-CSF/ATG group. Similarly, no significant difference was observed between the two groups in terms of overall survival (OS), failure-free survival (FFS), and GVHD relapse-free survival (GRFS). The 2-year OS, FFS and GRFS rates were 95.91% (95% CI, 84.59-98.96), 92.25% (95% CI, 80.59-97.03) and 86.68% (95% CI, 73.98-93.44), respectively, in the mPTCY group and 86.67% (95% CI, 76.64-92.59), 81.28% (95% CI, 70.45-88.46) and 77.20% (95% CI, 65.89-85.16), respectively, in the G-CSF/ATG group. The transplantation-related mortality (TRM) rate was significantly higher in the G-CSG/ATG group than in the mPTCY group (13.33% in the G-CSG/ATG group versus 1.96% in the mPTCY group, P=0.022). In multivariate analysis, female donors, a higher hematopoietic cell transplantation comorbidity index (HCT-CI) and III-IV aGVHD were associated with worse survival outcomes. CONCLUSIONS In conclusion, the mPTCY and G-CSF/ATG regimens led to similar outcomes in AA patients, but quicker engraftment was observed with the ATG/G-CSF regimen, and a lower incidence of TRM was observed with the mPTCY regimen.
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Affiliation(s)
- Yun Li
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430030, China
| | - Xuan Lu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430022, China
| | - Na Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430030, China
| | - Xiaoying Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430030, China
| | - Yang Cao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430030, China
| | - Yi Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430030, China
| | - Fankai Meng
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430030, China
| | - Donghua Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430030, China
| | - Yong You
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430022, China
| | - Liang Zou
- Department of Hematology, Wuhan No. 1 Hospital, Wuhan, Hubei,430022, China
| | - Hui Cheng
- Department of Hematology, Wuhan No. 1 Hospital, Wuhan, Hubei,430022, China
| | - Jingming Guo
- Department of Hematology, Yichang Central People's Hospital, Yichang, Hubei, 443003, China
| | - Youshan Zhang
- Department of Hematology, Jingzhou First People's Hospital, Jingzhou, HuBei, China,434000
| | - Zhiping Huang
- Department of Hematology, Jingzhou Central Hospital, The second Clinical Medical College, Yangtze University, Jinzhou, Hubei, China,434020
| | - Guolin Yuan
- Department of Hematology, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441021, China
| | - Jia Wei
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430030, China
| | - Huafang Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430022, China
| | - Linghui Xia
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430022, China.
| | - Yicheng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430030, China; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei,430030, China.
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21
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Wang Q, Ren H, Liang Z, Liu W, Yin Y, Wang Q, Wang Q, Sun Y, Xu W, Qiu Z, Ou J, Han N, Wang J, Dong Y, Li Y. Comparable Outcomes in Acquired Severe Aplastic Anemia Patients With Haploidentical Donor or Matched Related Donor Transplantation: A Retrospective Single-Center Experience. Front Med (Lausanne) 2022; 8:807527. [PMID: 35141252 PMCID: PMC8820587 DOI: 10.3389/fmed.2021.807527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
Clinical data of patients with severe aplastic anemia (SAA) were retrospectively analyzed to evaluate the outcomes of haploidentical hematopoietic stem cell transplantation (HID-HSCT) with matched related sibling hematopoietic stem cell transplantation (MSD-HSCT) in complications and survivals. Thirty consecutive patients were enrolled in the study with a median follow-up of 50 months (range 4, 141), and the median age of the patients was 21 years (range 3, 49). All the patients achieved myeloid engraftment in the two cohorts. The cumulative incidences of platelet engraftment were 95.5 and 100% in HID cohort and MSD cohort, respectively. The median time for neutrophil and platelet recovery was 11 (range 9, 19) and 15 (range 10, 25) days in HID cohort, and 12 (range 10, 19) and 14 (range 8, 25) days in MSD cohort. The cumulative incidences of grade II–IV and grade III–IV acute graft vs. host disease (aGvHD) in HID cohort and in MSD cohort were 18.9 vs. 14.3% (p = 0.77) and 10.5 vs. 0% (p = 0.42), respectively. The cumulative incidences of chronic graft vs. host disease (cGvHD) was 22.7% in HID cohort and 25.5% in MSD cohort (p = 0.868). The 5-year overall survival (OS) rates and 5-year failure-free survival (FFS) rates in HID cohort and MSD cohort were 85.1 vs. 87.5% (p = 0.858), 80.3 vs. 87.5% (p = 0.635), respectively. The median time to achieve engraftment, cumulative incidence of aGvHD and cGvHD, and the 5-year OS and FFS rates were not significantly different between the two cohorts. We suggest that HID-HSCT might be a safety and effective option for SAA patients without a matched donor.
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22
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Zhang D, Yu J, Liu L, Wang F, Wang S, Xie X, Li Y, Jiang Z. Acute arrest of hemopoiesis presenting as severe aplastic anemia: a retrospective analysis. Hematology 2021; 26:1057-1063. [PMID: 34902294 DOI: 10.1080/16078454.2021.2010329] [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: 10/19/2022] Open
Abstract
OBJECTIVE The clinical manifestations of acute arrest of hemopoiesis (AAH) are very similar with severe aplastic anemia (SAA). Currently there are no clear diagnostic criteria to distinguish AAH from SAA. Differentiation of AAH from SAA is challenging in the routine clinical practice. This study aimed to analyze the clinical and laboratory features between AAH and SAA patients. PATIENTS AND METHODS We performed a retrospective study with cohort of 425 suspected patients who were hospitalized to the First Affiliated Hospital of Zhengzhou University from 1 January 2019 to 31 December 2020. We identified 11 AAH patients and 49 SAA patients to investigate the differentiation diagnostic features. RESULTS Clinical and laboratory examinations of 11 patients with AAH met the diagnostic criteria of SAA, and hematopoietic recovery occurred within a median time of 12 (4-21) days. The median time for neutrophils to recover above 1 × 109/L and platelet to recover above 50 × 109/L in all patients with AAH was 5 (3-8) days and 8 (1-13) days, respectively. Compared with the control group SAA, the 11 AAH patients were older, with a median age of 53 (21-69) years old, and their first symptom is usually fever. CONCLUSIONS The spontaneous remission of AAH was rapid in most patients, and relapses were rarely observed. With supportive treatment, the AAH patients would show significant improvement on blood routine about a week, otherwise the patients should be treated as early as possible with the SAA regimen.
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Affiliation(s)
- Danfeng Zhang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jifeng Yu
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Lingling Liu
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Fang Wang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Shujuan Wang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xinsheng Xie
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yingmei Li
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Zhongxing Jiang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
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23
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Ding L, Han DM, Zheng XL, Yan HM, Xue M, Liu J, Zhu L, Guo ZK, Mao N, Ning HM, Wang HX, Heng Zhu. Infusion of haploidentical hematopoietic stem cells combined with mesenchymal stem cells for treatment of severe aplastic anemia in adult patients yields curative effects. Cytotherapy 2021; 24:205-212. [PMID: 34799271 DOI: 10.1016/j.jcyt.2021.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/11/2021] [Accepted: 09/22/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AIMS Despite the great advances in immunosuppressive therapy for severe aplastic anemia (SAA), most patients are not completely cured. Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) has been recommended as an alternative treatment in adult SAA patients. However, haplo-HSCT presents a higher incidence of graft failure and graft-versus-host disease (GVHD). The authors designed a combination of haplo-HSCT and umbilical cord-derived mesenchymal stem cells (UC-MSCs) for treatment of SAA in adult patients and evaluated its effects. METHODS Adult patients (≥18 years) with SAA (N = 25) were given HLA-haploidentical hematopoietic stem cells (HSCs) combined with UC-MSCs after a conditioning regimen consisting of busulfan, cyclophosphamide, fludarabine and anti-thymocyte globulin and intensive GVHD prophylaxis, including cyclosporine, basiliximab, mycophenolate mofetil and short-term methotrexate. Additionally, the effects of the protocol in adult SSA patients were compared with those observed in juvenile SAA patients (N = 75). RESULTS All patients achieved myeloid engraftment after haplo-HSCT at a median of 16.12 days (range, 11-26). The median time of platelet engraftment was 28.30 days (range, 13-143). The cumulative incidence of grade II acute GVHD (aGVHD) at day +100 was 32.00 ± 0.91%. No one had grade III-IV aGVHD at day +100. The cumulative incidence of total chronic GVHD was 28.00 ± 0.85%. The overall survival was 71.78 ± 9.05% at a median follow-up of 42.08 months (range, 2.67-104). Promisingly, the protocol yielded a similar curative effect in both young and adult SAA patients. CONCLUSIONS The authors' data suggest that co-transplantation of HLA-haploidentical HSCs and UC-MSCs may provide an effective and safe treatment for adult SAA.
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Affiliation(s)
- Li Ding
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China; Department of Experimental Hematology and Biochemistry, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China.
| | - Dong-Mei Han
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Xiao-Li Zheng
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Hong-Min Yan
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Mei Xue
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Jing Liu
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Ling Zhu
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Zi-Kuan Guo
- Department of Experimental Hematology and Biochemistry, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China; Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China; Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China
| | - Ning Mao
- Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China
| | - Hong-Mei Ning
- Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China; The Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Heng-Xiang Wang
- Air Force Medical Center, People's Liberation Army, Beijing, People's Republic of China
| | - Heng Zhu
- Department of Experimental Hematology and Biochemistry, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China; Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China; Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China; Graduate School of Anhui Medical University, Hefei, People's Republic of China
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Xu ZL, Huang XJ. Optimizing outcomes for haploidentical hematopoietic stem cell transplantation in severe aplastic anemia with intensive GVHD prophylaxis: a review of current findings. Expert Rev Hematol 2021; 14:449-455. [PMID: 33945370 DOI: 10.1080/17474086.2021.1923475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has resulted in increased levels of disease-free survival in severe aplastic anemia (SAA). Haploidentical transplantation (haplo-SCT) was previously not recommended due to unacceptable incidences of graft-versus-host disease (GvHD) and graft failures. With the advent of intensive GvHD prophylaxis strategies, the outcomes obtained with haplo-SCT for SAA have gradually improved.Areas covered: A comprehensive search considered PubMed reported articles before 1 February 2021, presented abstracts, and clinical trials pertaining to haplo-HSCT for SAA. This manuscript covers modern approaches with intensive GvHD prophylaxis in haplo-SCT for SAA. The representative methods consist of granulocyte colony stimulating factor (G-CSF) plus ATG-based and posttransplantation cyclophosphamide (PT-Cy)-based protocols.Expert opinion: Currently, haplo-SCT has become a feasible option for treating SAA. The G-CSF/ATG-based protocol included the largest sample size and reported comparable survival rates with identical siblings. The PT-Cy protocol resulted in a relatively lower incidence of GvHD and seemingly poorer but continuously improved engraftment with augmented conditioning. The optimized outcomes are constantly updated with the modification of the conditioning regimen, donor selection, graft source and GvHD prophylaxis. In the future, we should pay more attention to quality of life in addition to survival, and personalized haplo-SCT may improve outcomes.
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Affiliation(s)
- Zheng-Li Xu
- National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Jun Huang
- National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
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