Subjective and Objective Assessment of Monoenergetic and Polyenergetic Images Acquired by Dual-Energy CT in Breast Cancer

Objective@#To objectively and subjectively assess and compare the characteristics of monoenergetic images [MEI (+)] and polyenergetic images (PEI) acquired by dual-energy CT (DECT) of patients with breast cancer. @*Materials and Methods@#This retrospective study evaluated the images and data of 42 patients with breast cancer who had undergone dual-phase contrast-enhanced DECT from June to September 2019. One standard PEI, five MEI (+) in 10-kiloelectron volt (keV) intervals (range, 40–80 keV), iodine density (ID) maps, iodine overlay images, and Z effective (Z eff) maps were reconstructed. The contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) were calculated. Multiple quantitative parameters of the malignant breast lesions were compared between the arterial and the venous phase images. Two readers independently assessed lesion conspicuity and performed a morphology analysis. @*Results@#Low keV MEI (+) at 40–50 keV showed increased CNR and SNR breast lesion compared with PEI, especially in the venous phase ([CNR: 40 keV, 20.10; 50 keV, 14.45; vs. PEI, 7.27; p < 0.001], [SNR breast lesion: 40 keV, 21.01; 50 keV, 16.28; vs.PEI, 10.77; p< 0.001]). Multiple quantitative DECT parameters of malignant breast lesions were higher in the venous phase images than in the arterial phase images (p < 0.001). MEI (+) at 40 keV, ID, and Z eff reconstructions yielded the highest Likert scores for lesion conspicuity. The conspicuity of the mass margin and the visual enhancement were significantly better in 40-keV MEI (+) than in the PEI (p = 0.022, p = 0.033, respectively). @*Conclusion@#Compared with PEI, MEI (+) reconstructions at low keV in the venous phase acquired by DECT improved the objective and subjective assessment of lesion conspicuity in patients with malignant breast lesions. MEI (+) reconstruction acquired by DECT may be helpful for the preoperative evaluation of breast cancer.

Subjective and Objective Assessment of Monoenergetic and Polyenergetic Images Acquired by Dual-Energy CT in Breast Cancer

Objective@#To objectively and subjectively assess and compare the characteristics of monoenergetic images [MEI (+)] and polyenergetic images (PEI) acquired by dual-energy CT (DECT) of patients with breast cancer. @*Materials and Methods@#This retrospective study evaluated the images and data of 42 patients with breast cancer who had undergone dual-phase contrast-enhanced DECT from June to September 2019. One standard PEI, five MEI (+) in 10-kiloelectron volt (keV) intervals (range, 40–80 keV), iodine density (ID) maps, iodine overlay images, and Z effective (Z eff) maps were reconstructed. The contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) were calculated. Multiple quantitative parameters of the malignant breast lesions were compared between the arterial and the venous phase images. Two readers independently assessed lesion conspicuity and performed a morphology analysis. @*Results@#Low keV MEI (+) at 40–50 keV showed increased CNR and SNR breast lesion compared with PEI, especially in the venous phase ([CNR: 40 keV, 20.10; 50 keV, 14.45; vs. PEI, 7.27; p < 0.001], [SNR breast lesion: 40 keV, 21.01; 50 keV, 16.28; vs.PEI, 10.77; p< 0.001]). Multiple quantitative DECT parameters of malignant breast lesions were higher in the venous phase images than in the arterial phase images (p < 0.001). MEI (+) at 40 keV, ID, and Z eff reconstructions yielded the highest Likert scores for lesion conspicuity. The conspicuity of the mass margin and the visual enhancement were significantly better in 40-keV MEI (+) than in the PEI (p = 0.022, p = 0.033, respectively). @*Conclusion@#Compared with PEI, MEI (+) reconstructions at low keV in the venous phase acquired by DECT improved the objective and subjective assessment of lesion conspicuity in patients with malignant breast lesions. MEI (+) reconstruction acquired by DECT may be helpful for the preoperative evaluation of breast cancer.

Autologous hematopoietic stem cell transplantation for treatment of multiple myeloma patients with renal impairment / 白血病·淋巴瘤

Multiple myeloma (MM) is a common hematological malignancy with renal impairment in approximately 50% of patients. Sever renal impairment occurs in 15%-20% of newly diagnosed multiple myeloma patients. 200 mg/m2 melphalan-based regimen (Mel 200 regimen) as conditioning regimen of autologous hematopoietic stem cell transplantation (AHCT) is suitable for multiple myeloma patients with mild or moderate renal impairment, and 400 mg/m2 melphalan-based regimen (Mel 140 regimen) is fit for multiple myeloma patients with severe renal impairment. As the first line therapy for multiple myeloma patients with renal impairment, AHCT can increase response depth, repair renal function and improve survival. AHCT is a safe and beneficial procedure for MM patients with renal failure.

Autologous hematopoietic stem cell transplantation for treatment of multiple myeloma patients with renal impairment / 白血病·淋巴瘤

Multiple myeloma (MM) is a common hematological malignancy with renal impairment in approximately 50% of patients. Sever renal impairment occurs in 15%-20% of newly diagnosed multiple myeloma patients. 200 mg/m2 melphalan-based regimen (Mel 200 regimen) as conditioning regimen of autologous hematopoietic stem cell transplantation (AHCT) is suitable for multiple myeloma patients with mild or moderate renal impairment, and 400 mg/m2 melphalan-based regimen (Mel 140 regimen) is fit for multiple myeloma patients with severe renal impairment. As the first line therapy for multiple myeloma patients with renal impairment, AHCT can increase response depth, repair renal function and improve survival. AHCT is a safe and beneficial procedure for MM patients with renal failure.

Autologous hematopoietic stem cell transplantation for treatment of multiple myeloma patients with renal impairment / 白血病·淋巴瘤

Multiple myeloma (MM) is a common hematological malignancy with renal impairment in approximately 50% of patients. Sever renal impairment occurs in 15%-20% of newly diagnosed multiple myeloma patients. 200 mg/m2 melphalan-based regimen (Mel 200 regimen) as conditioning regimen of autologous hematopoietic stem cell transplantation (AHCT) is suitable for multiple myeloma patients with mild or moderate renal impairment, and 400 mg/m2 melphalan-based regimen (Mel 140 regimen) is fit for multiple myeloma patients with severe renal impairment. As the first line therapy for multiple myeloma patients with renal impairment, AHCT can increase response depth, repair renal function and improve survival. AHCT is a safe and beneficial procedure for MM patients with renal failure.

Current status of allogeneic hematopoietic stem cell transplantation for treatment of peripheral T-cell lymphoma / 白血病·淋巴瘤

Peripheral T-cell lymphoma (PTCL) is a kind of heterogeneous neoplasms mostly with strong invasiveness, a tendency of recurrence and drug resistance and poor prognosis. Five year disease-free-survival (DFS) rate of PTCL is less than 30% under the treatment setting of chemotherapy and autologous stem cell transplantation. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has a role of a graft-versus-lymphoma effect in the treatment of PTCL, meanwhile, long DFS rate of allo-HSCT for the treatment of relapsed and refractory PTCL reaches 35%-50%. Therefore, allo-HSCT is an effective treatment method for PTCL patients.

Clinical outcomes of peripheral blood stem cell transplantation for aggressive peripheral T-cell lymphoma / 中华血液学杂志

Objective@#To evaluate clinical outcomes of autologous and allogeneic peripheral blood stem cell transplantation (PBSCT) for aggressive peripheral T-cell lymphoma (PTCL).@*Methods@#From June 2007 to June 2017, clinical data of PTCL patients who underwent PBSCT were assessed retrospectively.@*Results@#Among 41 patients, 30 was male, 11 female, and median age was 38(13-57) years old. Seventeen patients with autologous PBSCT (auto-PBSCT) and 24 patients with allogeneic PBSCT (allo-PBSCT) were enrolled in this study. Eight patients (8/17, 47.1%) in auto-PBSCT group were ALK positive anaplastic large cell lymphoma (ALCL), 7 patients (7/24, 29.2%) with NK/T cell lymphoma and 9 patients (9/24, 37.5%) with PTCL-unspecified (PTCL-U) in allo-PBSCT group (P=0.035). There were 58.8% patients (10/17) in complete response (CR) status and 11.8% (2/17) in progression disease (PD) status before transplantation in auto-PBSCT group, and 8.3% (2/24) in CR status and 45.8% (11/24) in PD status before transplantation in allo-PBSCT group (P=0.026). The 2-years cumulative overall survival (OS) were (64.0±10.8)% and (53.5±9.7)% for auto-PBSCT and allo-PBSCT respectively (P=0.543). The 2-years cumulative disease-free survival (DFS) were (57.1±12.4)% and (53.5±10.6)% for auto-PBSCT and allo-PBSCT respectively (P=0.701). In patients with dead outcomes after PBSCT, 83.3% (5/6) of death cause was relapse in auto-PBSCT and 41.7% (5/12) of death cause was relapse in allo-PBSCT.@*Conclusion@#Both auto-PBSCT and allo-PBSCT were effective for PTCL. Allo-PBSCT maybe was better than auto-PBSCT for high-risk PTCL with poor prognosis.

MRI analysis of regional homogeneity and gray matter structure in chronic subjective tinnitus / 中国医学影像技术

Objective To observe changes of brain function synchronized activity and gray matter structure alterations in patients with chronic subjective tinnitus (ST) with MRI.Methods Resting-state fMRI and 3D T1WI were obtained in 21 chronic ST patients (case group) and 21 healthy volunteers (control group).The voxel-based morphometry and regional homogeneity (ReHo) were used to analyze changes of the gray matter structure and volume.Results Compared with control group,ReHo values of the right superior,middle and inferior temporal gyrus increased in case group (P＜0.05),ReHo values of the right middle orbital frontal gyrus/inferior triangle frontal gyrus,left middle frontal gyrus/angular gyrus and cerebellar vermis decreased (P＜0.05),and the gray matter volume of the right middle temporal gyrus,superior dorsolateral frontal gyrus and left superior medial frontal gyrus decreased in case group (P＜0.01).Furthermore,Re Ho values of the right middle temporal gyrus were positively correlated with tinnitus handicap inventory scores (r=0.604,P=0.005) in case group.Conclusion The neural function synchronized activity and gray matter volume changes in the auditory and non-auditory brain regions of patients with chronic ST,providing references for finding possible neuroimaging markers.

Subbands analysis of amplitude of low-frequency fluctuations in type 2 diabetes mellitus patients: a resting-state functional MRI study / 中华放射学杂志

Objective To investigate changes of spontaneous brain activity in patients with type 2 diabetes mellitus (T2DM) by fractional amplitude of low-frequency fluctuations (fALFF) on subbands, and the possible relationship between these changes and cognitive impairment caused by T2DM.Methods Twenty-two T2DM patients and twenty-three healthy control subjects were involved in this study between December 2013 and June 2014 and the demographic and clinical data (fasting plasma glucose and HbA1c level) were obtained in all subjects.General cognition was assessed by MMSE in all subjects, and memory performance was assessed by Auditory Verbal Learning Test (AVLT) in T2DM group.3D-T1 structural and resting-state functional MRI data were collected by MR scanner.Then fALFF value on slow-5 (0.010-0.027 Hz) and slow-4 (0.027-0.073 Hz) were calculated respectively using DPARSF V2.3.Intra-group and inter-group t-tests were conducted by REST V1.8.Partial correlation among fALFF values extracted from significantly different brain regions, clinical data and AVLT score of T2DM patients were calculated , using age as covariate.Results Compared to the healthy controls, T2DM patients showed increased fALFF values in bilateral anterior cingulate gyrus (cluster=130, t=4.4487, P＜0.05) and partial left cerebelum areas (cluster=89, t=3.8409, P＜0.05) in frequency band slow-5.Moreover, the T2DM patients showed decreased fALFF values in bilateral middle occipital gyrus and precuneus (Left: cluster=102, t=-3.4806.Right: cluster=151, t=-5.1355.All P＜0.05) in frequency band slow-5.While in frequency band slow-4, the T2DM patients showed increased fALFF values in left inferior temporal gyrus (cluster=104, t=4.8631, P＜0.05), and decreased fALFF values in right lingual gyrus (cluster=91, t=-3.7146, P＜0.05).There was positive correlation between fALFF values of middle occipital gyrus and precuneus and AVLT immediate memory score (r=0.456, P=0.038).Conclusions T2DM patients exhibit abnormal spontaneous activity among brain regions associated with cognition, including brain regions related to default mode network on slow-5, and brain regions related to semantic cognition and visual information processing on slow-4.The abnormal regions exhibit different spatial patterns depending on the subbands of low-frequency fluctuations.

Interferon α: the salvage therapy for patients with unsatisfactory response to minimal residual disease-directed modified donor lymphocyte infusion / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Minimal residual disease (MRD)-directedmodified donor lymphocyte infusion (mDLI) is used to treat relapse after hematopoietic stem cell transplantation (HSCT). For patients who experience an unsatisfactory response tomDLI, relapse is usually inevitable. Therefore, we sought to evaluate the efficacy ofinterferon α therapy in these patients.</p><p><b>METHODS</b>Regular MRD monitoring was carried out after the HSCT. The patients who were MRD-positive underwent mDLI. Patients with an unsatisfactory response to mDLI received interferon α therapy (3 million units, twice weekly) with regular monitoring of MRD. To ensure the immunomodulatory effects of interferon α, immunosuppressant treatment would be stopped before interferon α treatment.</p><p><b>RESULTS</b>Five patients with an unsatisfactory response to mDLI treatment received interferon α (3 had t (8;21) chromosomal translocation acute myeloid leukemia, and 2 had common acute leukemia). They had significantly reduced or resolved MRD. Four patients developed chronic graft-versus-host disease. Two of the 5 patients reported transient fevers, and no significant bone marrow suppression was observed. All of them were in continuous complete remission after interferon a treatment. The median survival time was 469 days (range 368-948 days).</p><p><b>CONCLUSIONS</b>In patients with an unsatisfactory response to MRD-directed mDLI, interferon a may directly or indirectly induce the graft-versus-leukemia effect to improve mDLI efficacy and clear MRD.</p>

Second transplantation for 22 patients with graft failure after first allogeneic stem cell transplantation / 中华血液学杂志

<p><b>OBJECTIVE</b>To improve the understanding of treatment for graft failure by analyzing the efficacy of second transplantation for graft failure after first allogeneic stem cell transplantation (allo-HSCT).</p><p><b>METHODS</b>Twenty-two patients encountered graft failure after first allo-HSCT from Peking University Institute of Hematology were retrospectively reviewed. The incidence of re-engratment, graft versus host disease (GVHD) and overall survival (OS) was analyzed. Also the factors associated with re-engraftment and OS were analyzed in multivariate model.</p><p><b>RESULTS</b>Twenty-two patients encountered graft failure, including 12 primary graft failure and 10 secondary graft failure. 13(59.1%) patients acquired engraftment. And 13 patients acquired neutropil engraftment with median time of 15 (7-26) days, while 9 patients acquired platelet engraftment with median time of 12 (7-14) days. None of the factors included in mulivariate analysis showed impact on engraftment. The treatment related mortality at 100 day and 3 years after second transplantation was 40.9% and 72.7%, respectively. The main cause of death was infection (13/17). The 3-year OS was 22.7%, and the main cause of death was infection (13/17). The factors associated with OS included primary graft failure [P=0.001, HR 40.207 (4.828-334.868)] and receiving second transplantation in 60 days after first transplantation [P=0.003, HR 12.340 (2.290-66.498)].</p><p><b>CONCLUSION</b>Second transplantation may be an effective salvage choice for graft failure. However, the efficacy was far from satisfactory.</p>

Analysis of risk factors for secondary cytopenia after allogeneic hematopoietic stem cell transplantation / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the incidence and risk factors for secondary cytopenia after allogeneic hematopoietic stem cell transplantation (allo-HSCT).</p><p><b>METHODS</b>The clinical data of a total of 260 patients received allo-HSCT between Jan 1, 2006 to Jan 1, 2008 were retrospectively analyzed for the incidence and risk factors of secondary cytopenia. According to the hematopoietic reconstitution after transplantation, the patients were divided into (1) secondary neutropenia group; (2) secondary thrombocytopenia group and (3)secondary poor graft function group.</p><p><b>RESULTS</b>During the 100 days after allo-HSCT, the secondary neutropenia (38.8% vs 18.0%, P=0.0005) or secondary thrombocytopenia (25% vs 12%, P=0.01) occurred in haploidentical HSCT (haplo-HSCT) patients were more often than that in HLA-matched group. Poor graft function showed no significant difference between the above two groups (5.6% vs 2.0%, P=0.21). Multivariate analyses revealed that cytomegalovirus (CMV) infection significantly increased the risk of secondary neutropenia. GVHD and CMV infection were independent risk factors for secondary thrombocytopenia. Meanwhile, CMV infection was an independent risk factor for secondary poor graft function.</p><p><b>CONCLUSION</b>Secondary cytopenia remains a serious complication following allo-HSCT, especially in haplo-HSCT. Higher occurrence of GVHD and CMV infection may lead to higher incidence of secondary cytopenia in haplo-HSCT.</p>

Immunosuppression for 6-8 weeks after modified donor lymphocyte infusion reduced acute graft-versus-host disease without influencing graft-versus-leukemia effect in haploidentical transplant / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In haploidentical hematopoietic stem cell transplantation (HSCT), the duration of graft-versus-host disease (GVHD) prophylaxis after modified donor lymphocyte infusion (DLI) was the only risk factor of DLI-associated grades 3-4 acute GVHD. However, the successful application of modified DLI depended not only on the reduction of severe GVHD, but also on the preservation of graft-versus-leukemia (GVL) effect. Therefore, this study was performed to compare the impact of prophylaxis for 6-8 weeks and prophylaxis for <6 weeks on GVL effect after modified DLI in haploidentical HSCT.</p><p><b>METHODS</b>A total of 103 consecutive patients developing hematological relapse or minimal residual disease (MRD)-positive status after haploidentical HSCT and receiving modified DLI were investigated retrospectively. Fifty-two patients received prophylaxis for 6-8 weeks after modified DLI; the remaining 51 patients received prophylaxis for <6 weeks.</p><p><b>RESULTS</b>First, compared with prophylaxis for <6 weeks, prophylaxis for 6-8 weeks reduced incidence of relapse in total patients (26.6% vs. 69.0%, P < 0.001). Besides, prophylaxis for 6-8 weeks also reduced incidence of relapse in 54 patients developing hematological relapse post-transplant (P = 0.018) and in 49 patients developing MRD-positive status post-transplant (P < 0.001). Second, prophylaxis for 6-8 weeks reduced incidence of acute GVHD (P < 0.05), reduced the therapeutic application of immunosuppressive agents (P = 0.019), but increased the incidence of chronic GVHD (P < 0.05). Third, prophylaxis for 6-8 weeks improved overall survival and disease-free survival in total patients, as well as in patients developing hematological relapse post-transplant and in patients developing MRD-positive status post-transplant (P < 0.05).</p><p><b>CONCLUSIONS</b>In haploidentical HSCT, prophylaxis for 6-8 weeks after modified DLI does not reduce GVL effect, but reduces the incidence of DLI-associated acute GVHD compared with prophylaxis for <6 weeks. This strategy will probably improve the safety and efficacy of modified DLI further.</p>

Allogeneic hematopoietic stem cell transplantation for myelodysplastic syndrome: indications and controversy of pre-transplant chemotherapy / 白血病·淋巴瘤

The indications for myelodysplastic syndrome (MDS) to receive allogeneic hematopoietic stem cell transplantation (allo-HSCT) were established on the basis of FAB diagnosis,International Prognosis Scoring System (IPSS) and World Health Organization Prognosis Scoring System (WPSS).It was recommended that patients of IPSS intermediate risk Ⅱ and of high risk should receive allo-HSCT at diagnosis,and those with intermediate risk Ⅰ and of low risk might benefit from deferred transplantation.Dynamic monitoring of marrow morphology and the risk of disease are needed for appropriate timing of transplant.Patients of intermediate risk and low risk with low platelet count,pneutropenia or blood infusion dependence are indicated for transplantation.The advantage of chemotherapy pre-HSCT in those indicated patients has been controversial.Up to now,there has been few data showing benefit of pre-chemotherapy or hypomethylating therapy.

Comparative study on clinical features of cytomegalovirus infection after allogenic hematopoietic stem cell transplantation from HLA haploidentical related donors vs HLA-matched sibling donors / 中华器官移植杂志

Objective To compare the clinical features of cytomegalovirus (CMV) infection and CMV disease after allogeneic hematopoietic stem-cell transplantation (HSCT) from HLA haploidentical related doors vs.HLA-matched sibling donors.Methods A total of 327 patients who received allogeneic HSCT from Jan.2011 to Dec.2011 were enrolled.There were 312 patients who had complete serological data before HSCT including 216 cases of HLA haploidentical related HSCT and 96 cases of HLA-matched sibling HSCT.Monitoring of CMV antigenemia was performed by using real-time quantitative (RQ) PCR after transplantation.Risk factors were compared by univariate and multivariate analysis.Results The cumulative incidence of CMV infection and CMV disease was (80.1 ± 2.7) ％ and (8.7 ± 2.0) ％ in HLA haploiddentical HSCT group,and (21.1 ± 4.9) ％ and 0 in HLA-matched sibling HSCT group respectively,and the difference was statistically significant between the two groups (P＜0.01).Univariate analysis revealed that HLA haploidentical related HSCT,less than 20 years of age,high risk disease,CMV-IgG serum positivity in patients or donors,acute graft-versus-host disease (aGVHD),EB viremia,and hemorrhagic cystitis were the risk factors of CMV infection.HLA haploidentical related SCT and hemorrhagic cystitis were the risk factors for CMV disease.Multivariate analysis showed that patients less than 20 years of age had a significantly high incidence of CMV infection.Patients from HLA-matched sibling HSCT,low risk disease,aGVHD,hemorrhagic cystitis had a significantly low incidence of CMV infection.Conclusion Compared with patients receiving HLA-matched sibling HSCT,those who received HLA haploidentical related HSCT had significantly high incidence of CMV infection and CMV disease,which were correlated with incidence of hemorrhagic cystitis.

The efficacy and safety of recombinant human granulocyte colony stimulating factor primed donor peripheral cell harvest in treatment of poor graft function after allogeneic stem cell transplantation / 中华内科杂志

Objective To assess the efficacy and safety of recombinant human granulocyte colony stimulating factor (rhG-CSF) primed donor peripheral blood stem cell (PBSC) on the treatment of poor graft function (PGF) after allogeneic stem cell transplantation(allo-HSCT).Methods The patients diagnosed as PGF after allo-HSCT and transfused with rhG-CSF primed PBSC from January 2003 to November 2012 were retrospectively analyzed.Hematological response was assessed at day 30 after transfusion.Graft versus host disease (GVHD) was assessed until 6 months after transfusion.Results There were 28 patients including 21 men and 7 women with a median age of 28 (12-50) years old.Of these patients,16 were diagnosed as primary PGF.The median number of transfused mononuclear cells was 2.0 (1.0-5.8) ×108/kg.Totally 42.9％ (12/28) patients achieved good response.Eight patients (28.6％) developed GVHD.Sixteen patients (57.1％) survived.Age (≤/＞ 28 years),gender,donor type (matched sibling/mismatched related),additional conditioning regimen prior to transfusion,time of neutrophil engraftment (≤/＞ 18 days) time of transfusion (≤/＞ 100 days after allo-HSCT) and number of mononuclear cells (≤/＞ 2.0 × 108/kg) did not impact hematological response.However,response rate of primary PGF (4/16) was significantly lower than that of secondary PGF (8/12) (P =0.022).Conclusion Transfusion of PBSC mobilized by rhG-CSF could be considered as an option to treat secondary PGF after allogeneic stem cell transplantation.

The risk factors and prognosis of transplant-associated thrombotic microangiopathy following acute graft-versus-host disease / 中华内科杂志

Objective To investigate the risk factors and prognosis of transplant-associated thrombotic microangiopathy (TA-TMA) following acute graft-versus-host disease (aGVHD),and to evaluate the factors that might influence the prognosis of TA-TMA.Methods A nested case-control study was designed.Cases with TA-TMA (n =33) and controls (n =77) matched for age at allogeneic hematopoietic stem cell transplantation (allo-HSCT) and length of follow-up were identified from a cohort of 356 patients who suffered from aGVHD after allo-HSCT between 2009 and 2011.Results The median time to presentation of TA-TMA was 3.5 (1.2-23.0) months post-HSCT.The median time from diagnosis and first-line treatment failure of aGVHD to TA-TMA diagnosis was 25 (7-257) days and 15 (5-257) days,respectively.aGVHD occurring beyond 60 days after allo-HSCT,initial grade Ⅲ-Ⅳ aGVHD,first-line treatment failure and receiving tacrolimus as second-line treatment were independently associated with the occurrence of TA-TMA,and patients with two or more risk factors were at higher risk (OR =210.0,P =0.000).Twenty-two (66.7％) TA-TMA patients died.Progressive TA-TMA was the significantly adverse factor affccting the survival of TA-TMA cases.None of therapies could improve prognosis of patients with TA-TMA.Conclusion Many characteristics of aGVHD were associated with TA-TMA,which help us to identify the individuals who are at higher risk of developing TA-TMA following aGVHD and to select the more reasonable GVHD therapeutic strategies.

The value of the current diagnostic criteria of pulmonary invasive fungal infection after allogeneic hematopoietic stem cell transplantation / 中华内科杂志

Objective To analyze the practicality of current diagnostic criteria of invasive fungal infection (IFI) in patients with hematologic diseases/malignant tumors,so as to enhance the recognition of characteristics of pulmonary IFI after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods The clinical features of 51 cases with IFI after allo-HSCT were analyzed retrospectively.Results Pulmonary IFI accounted for 42.1％ (51/121) of the whole infectious pneumonia diagnosed among the patients admitted during the study.One (2.0％) case was proven diagnosis ; 24 (47.1％) were probable diagnosis and 26(51.0％) were possible diagnosis.The using of immuno-suppressors and corticosteroids,and the presence of graft-versus-host disease (GVHD) were the main host factors.The patients with two or more host factors simultaneously accounted for 66.7％ (34/51) of all pulmonary IFI patients.Totally 94.1％ (48/51) of the patients with pulmonary IFI presented nodules and/or patches as the main features in high resolution computed tomography (HRCT) scanning.The positive rates of fungal antigen detection were 58.6％ for G test and 33.3％ for GM test,which were relatively high.Twenty patients (39.2％) showed decrease of arterial partial pressure of oxygen and hypoxia in blood-gas analysis.Conclusions For the diagnosis of pulmonary IFI post allo-HSCT,the administration of immuno-suppressors and corticosteroids,and the presence of GVHD were the main host factors.Nodules and/or patches were the main features in HRCT image.Fungus antigen detection is the main tool to support clinical diagnosis.

Etiological analysis of fever in the first 24 hours following allogeneic peripheral stem cell transfusion / 中华内科杂志

Objective To investigate the incidence and pathogenesis of fever within the first 24　hours following allogeneic peripheral stem cell transfusion and to analyze the associated risk factors.Methods Totally 114 patients received allogeneic hematopoietic stem cell transplantation(allo-HSCT)between October 2009 and August 2010 were enrolled and clinical data of febrile patients within 24 hours　following peripheral stem cell transfusion were retrospectively analyzed.Multivariate logistic regression analysis was performed to identify the risk factors for transfusion related fever.Results Thirty-two (28.1％)out of the 114 patients had a fever within 24 hours after allo-HSCT.All of them were human leukocyte antigen(HLA)mismatch transplantation.The median time of the temperature elevated was 2.5(0-18.0)hours after the infusion with a median time of the peak of 7.8(3.5-23.0)hours after the infusion.Fever was attributed to definite infection in 6 patients and no definite infection in the remaining 26 patients.None of them were hemolytic,which was attributed to transfusion related fever.Multivariate analysis showed that female donor and high count of peripheral leukocyte of donor peripheral blood were significant predictors for transfusion related fever.Conclusions Most of post-infusion fever within 24 hours after HLA mismatch related transplantation has no identifiable infectious focus.The risk factors for transfusion related fever are female donor and high number of peripheral leukocyte of donor blood.

The efficacy and safety of rituximab in treatment of Epstein-Barr virus disease post allogeneic hematopoietic stem-cell transplantation / 中华内科杂志

Objective To investigate the efficacy and safety of rituximab on Epstein-Barr virus (EBV) disease post allogeneic hematopoietic stem-cell transplantation.Methods A retrospective analysis was performed based on clinical data of 26 patients diagnosed as EBV disease and received rituximab from June 2006 to March 2012 in People's Hospital,Beijing University.Eleven patients were diagnosed as posttransplant lymphoproliferative disorders (PTLD) by histopathology and remaining 15 were diagnosed as probable EBV disease.Patients received a rituximab dose of 375 mg/m2 once a week.Efficacy was evaluated as revised response criteria for non-hodgkin lymphoma (NHL),and side effects during infusion were evaluated by Common Terminology Criteria for Adverse Events.Results Patients received 78 infusions with a median of 3 (1-6) infusions in each.There were no severe side effects during the infusion of rituximab.The 1st,2nd,3rd,4th,8th week cumulative complete remission (CR) were (11.5 ± 6.3)％,(42.2 ±10.2) ％,(64.4 ± 10.0) ％,(74.6 ± 9.4) ％,(87.3 ± 7.9) ％,respectively.The overall response rate was 84.5％,and the CR rate was 73.1％.The CR rate was higher among patients with single organ involved than those with multiple organs involved (10/10 vs 9/16,P =0.023).The CR rate was higher in patients with probable EBV disease than those with PTLD (13/15 vs 6/11,P =0.095),while there was no statistically significant difference.The incidence of one-year and two-year overall survival since onset of rituximab were (55.7 ± 10.2)％ and (39.6 ± 12.4)％,respectively.Survival rate was higher among the patients with single organ involved than those with multiple organ involved (8/10 vs 5/16,P =0.041).Survival rate was higher in patients with probable EBV disease than those with PTLD(11/15 vs 2/11,P =0.015).Conclusions Rituximab appears to be safe and effective for EBV disease.Due to a potential good response in probable EBV disease,we suggest rituxmab should be given based on probable EBV disease;meanwhile the pathological results should get early if possible.Prospective trial is needed to provide evidence so as to define optimal therapy of rituxmab.