Correlation between anti-human leukocyte antigen antibodies and the outcomes of matched sibling donor transplantation in patients with hematological diseases / 白血病·淋巴瘤

Objective:To explore the relationship between anti-human leukocyte antigen (HLA) antibodies and transplant outcomes in patients with hematological diseases who underwent matched sibling donor transplantation (MSDT).Methods:A retrospective analysis was conducted in 168 patients with hematological diseases who received MSDT in Peking University People's Hospital from March 2015 to November 2017. All patients received detection of anti-HLA antibodies before transplantation, and the correlation between anti-HLA antibodies and transplant outcomes such as hematopoietic cells implantation, blood product transfusion and prognosis after transplantation were analyzed.Results:Among the 168 patients, 28 (16.7%) were positive for anti-HLA class Ⅰ or class Ⅱ antibodies, and 14 (8.3%) were positive for both anti-HLA class Ⅰ and class Ⅱ antibodies. All patients received neutrophil engraftment, 164 patients (97.9%) received platelet engraftment. Univariate analysis showed that there were no effects of anti-HLA antibodies on neutrophil engraftment and engraftment time, platelet engraftment and engraftment time, the volume of red cell transfusion, the volume of platelet transfusion, overall survival (OS) rate, disease free survival (DFS) rate and transplant-related mortality (TRM) in patients with hematological diseases underwent MSDT (all P > 0.05). Multivariate analysis showed that platelet engraftment was associated with better OS ( HR=0.065, 95% CI 0.017-0.252, P < 0.01), better DFS ( HR=0.083, 95% CI 0.024-0.289, P < 0.01) and lower TRM ( HR=0.094, 95% CI 0.014-0.626, P=0.015). Conclusion:Anti-HLA antibodies have no effect on transplant outcomes of patients with hematological diseases who have received MSDT.

Classifying AML patients with inv(16) into high-risk and low-risk relapsed patients based on peritransplantation minimal residual disease determined by CBFß/MYH11 gene expression.

Ninety acute myeloid leukemia (AML) patients with inv(16) were monitored CBFß/MYH11 transcript around allogeneic hematopoietic stem cell transplantation (allo-HSCT). A total of 23 patients received HLA-matched sibling donor transplantation (MSDT) and 67 patients received unmanipulated haploidentical hematopoietic stem cell transplantation (haplo-HSCT) were analyzed in this study. Patients were divided into four groups based on CBFß/MYH11 expression prior to transplantation (pre-MRD): with negative (group 1)/positive (group 2) pre-MRD before MSDT; with negative (group 3)/positive (group 4) pre-MRD before haplo-HSCT. The results showed that patients in group 2 had the highest cumulative incidence of relapse (2-year CIR, 40.7%), the lowest leukemia-free survival (2-year LFS, 50.8%), and overall survival (2-year OS, 62.5%). The other three groups of patients had comparable outcomes. The patients were also classified into the other three groups according to CBFß/MYH11 value of + 1 month after transplantation: group 5: pre- and post-transplant MRD were both negative; group 6: the value of post-transplant MRD was lower than 0.2%; group 7: the value of post-transplant MRD was higher than 0.2%. Group 7 had the highest CIR and the lowest LFS. These results indicated that AML patients with inv(16) were able to be separated into high-risk and low-risk relapse groups based on peritransplant MRD determined by RQ-PCR-based CBFß/MYH11. Haplo-HSCT might overcome the negative impact of pre-MRD on patient outcomes compared to MSDT.

Advances in allogeneic hematopoietic stem cell transplantation / 白血病·淋巴瘤

In recent years,the application of haploidentical stem cell transplantation makes it possible for every transplant candidate to have a donor.Therefore,choosing best donor and dealing with transplantrelated complications,such as promoting engraftment,decreasing graft-versus-host disease and relapse,become key issues to improve transplant outcomes.The advances in allogeneic hematopoietic stem cell transplantation will be reviewed.

Influence of remifentanil combined with propofol on sober and insulin resistance in patients after esophageal cancer radical surgery / 中国基层医药

Objective To study the effect of remifentanil combined with propofol on sober and insulin resistance in patients after esophageal cancer radical surgery.Methods According to the digital table,63 patients with esophageal cancer were randomly divided into the control group (n =32 cases) and the observation group (n =31 cases).The control group were anesthetized through fentanyl plus propofol,while the observation group were anesthetized through remifentanil plus propofol.The level of consciousness and insulin resistance were analyzed.Results 5min after extubation,the OAAS scores of the observation group was (3.8 ± 1.6) points,which was better than that of the control group [(2.9 ± 1.3) points] (t =2.4540,P ＜ 0.05).Compared with preoperation,the insuhn resistance of the two groups were all increased after operation (all P ＜ 0.05).And the insulin resistance in the control group was higher than that in the observation group (P ＜ 0.0 5).Conclusion Remifentanil combined with propofol can improve the level of consciousness and decrease insulin resistance in patients after esophageal cancer radical surgery.