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Everyone has a donor: contribution of the Chinese experience to global practice of haploidentical hematopoietic

Meng Lv, Yingjun Chang, Xiaojun Huang

《医学前沿（英文）》 2019年 第13卷 第1期   页码 45-56 doi: 10.1007/s11684-017-0595-7

摘要： Human leukocyte antigen (HLA)-matched donors for hematopoietic stem cell transplantation (HSCT) have long been scarce in China. Haploidentical (haplo) donors are available for the vast majority of patients, but toxicity has limited this approach. Three new approaches for haplo-HSCT originated from Italy, China, and USA in 1990 and have been developed to world-renowned system up to now. The Chinese approach have been greatly improved by implementing new individualized conditioning regimens, donor selection based on non-HLA systems, risk-directed strategies for graft-versus-host disease and relapse, and infection management. Haplo-HSCT has exhibited similar efficacy to HLA-matched HSCT and has gradually become the predominant donor source and the first alternative donor choice for allo-HSCT in China. Registry-based analyses and multicenter studies adhering to international standards facilitated the transformation of the unique Chinese experience into an inspiration for the refinement of global practice. This review will focus on how the new era in which “everyone has a donor” will become a reality in China.

关键词： haploidentical hematopoietic stem cell transplantation     conditioning     graft-versus-host disease     relapse     infection     donor selection    

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Outcomes of haploidentical bone marrow transplantation in patients with severe aplastic anemia-II that

《医学前沿（英文）》 2021年 第15卷 第5期   页码 718-727 doi: 10.1007/s11684-020-0807-4

摘要： Severe aplastic anemia II (SAA-II) progresses from non-severe aplastic anemia (NSAA). The unavailability of efficacious treatment has prompted the need for haploidentical bone marrow transplantation (haplo-BMT) in patients lacking a human leukocyte antigen (HLA)-matched donor. This study aimed to investigate the efficacy of haplo-BMT for patients with SAA-II. Twenty-two patients were included and followed up, and FLU/BU/CY/ATG was used as conditioning regimen. Among these patients, 21 were successfully engrafted, 19 of whom survived after haplo-BMT. Four patients experienced grade II–IV aGvHD, including two with grade III–IV aGvHD. Six patients experienced chronic GvHD, among whom four were mild and two were moderate. Twelve patients experienced infections during BMT. One was diagnosed with post-transplant lymphoproliferative disorder and one with probable EBV disease, and both recovered after rituximab infusion. Haplo-BMT achieved 3-year overall survival and disease-free survival rate of 86.4%±0.73% after a median follow-up of 42 months, indicating its effectiveness as a salvage therapy. These promising outcomes may support haplo-BMT as an alternative treatment strategy for patients with SAA-II lacking HLA-matched donors.

关键词： severe aplastic anemia     non-severe acquired aplastic anemia     haploidentical bone marrow transplantation     outcomes    

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Positive stool culture could predict the clinical outcomes of haploidentical hematopoietic stem cell

Lijuan Hu, Qi Wang, Xiaohui Zhang, Lanping Xu, Yu Wang, Chenhua Yan, Huan Chen, Yuhong Chen, Kaiyan Liu, Hui Wang, Xiaojun Huang, Xiaodong Mo

《医学前沿（英文）》 2019年 第13卷 第4期   页码 492-503 doi: 10.1007/s11684-019-0681-0

摘要： We aimed to identify the effect of positive stool cultures (PSCs) on the clinical outcomes of patients undergoing haploidentical hematopoietic stem cell transplantation (haplo-HSCT) ( = 332). PSCs were observed in 61 patients (PSC group, 18.4%). Enterobacteriaceae in stool specimens was associated with a higher risk of bloodstream infection, and in stool specimens was related to a higher risk of platelet engraftment failure. The cumulative incidence of infection-related mortality 1 year after haplo-HSCT in the PSC group was higher than that of the patients who showed persistently negative stool cultures (NSC group; 19.2% vs. 8.9%, = 0.017). The probabilities of overall survival (71.4% vs. 83.8%, = 0.031) and disease-free survival (69.6% vs. 81.0%, = 0.048) 1 year after haplo-HSCT for the PSC group were significantly lower than those for the NSC group, particularly for patients who had in their stool specimens. In multivariate analysis, in stool specimens significantly increased the risk of mortality and was associated with poorer survival. Our results showed that PSC influenced the clinical outcomes after haplo-HSCT, particularly those who had in their stool specimens.

关键词： haploidentical     hematopoietic stem cell transplantation     stool culture     Candida    

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Comparison of reference values for immune recovery between event-free patients receiving haploidentical

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《医学前沿（英文）》 2018年 第12卷 第2期   页码 153-163 doi: 10.1007/s11684-017-0548-1

摘要：

To establish optimal reference values for recovered immune cell subsets, we prospectively investigated post-transplant immune reconstitution (IR) in 144 patients who received allogeneic stem cell transplantation (allo-SCT) and without showing any of the following events: poor graft function, grades II?IV acute graft-versus-host disease (GVHD), serious chronic GVHD, serious bacterial infection, invasive fungal infection, or relapse or death in the first year after transplantation. IR was rapid in monocytes, intermediate in lymphocytes, CD3+ T cells, CD8+ T cells, and CD19+ B cells, and very slow in CD4+ T cells in the entire patient cohort. Immune recovery was generally faster under HLA-matched sibling donor transplantation than under haploidentical transplantation. Results suggest that patients with an IR comparable to the reference values display superior survival, and the levels of recovery in immune cells need not reach those in healthy donor in the first year after transplantation. We suggest that data from this recipient cohort should be used as reference values for post-transplant immune cell counts in patients receiving HSCT.

关键词： immune reconstitution     hematopoietic stem cell transplantation     event-free patients     reference range    

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Risk factors for chronic graft-versus-host disease after anti-thymocyte globulin-based haploidentical

Meng Lv, Xiaohui Zhang, Lanping Xu, Yu Wang, Chenhua Yan, Huan Chen, Yuhong Chen, Wei Han, Fengrong Wang, Jingzhi Wang, Kaiyan Liu, Xiaojun Huang, Xiaodong Mo

《医学前沿（英文）》 2019年 第13卷 第6期   页码 667-679 doi: 10.1007/s11684-019-0702-z

摘要： Chronic graft-versus-host disease (cGVHD) is a major complication following unmanipulated haploidentical hematopoietic stem cell transplantation (haplo-HSCT). We aimed to identify the risk factors for cGVHD in patients who underwent anti-thymocyte globulin-based haplo-HSCT for acute myeloid leukemia ( =280). The diagnosis of cGVHD was in accordance with the National Institutes of Health consensus criteria. A total of 169 patients suffered from cGVHD. The patients who had 3 loci mismatched had a higher 8-year incidence of cGVHD (total, 66.0% vs. 53.7%, =0.031; moderate to severe, 42.4% vs. 30.1%, =0.036) than the patients who had 1 to 2 loci mismatched. The patients who had maternal donors had a higher 8-year incidence of moderate to severe cGVHD (49.2% vs. 32.9%, =0.024) compared with the patients who had other donors. The patients who had grades III to IV acute GVHD (aGVHD) had higher 8-year incidence of cGVHD (total, 88.0% vs. 50.4%, <0.001; moderate to severe, 68.0% vs. 27.0%, <0.001) compared with the patients without aGVHD. In multivariate analysis, grades III to IV aGVHD was the only independent risk factor for cGVHD. Thus, further interventions should be considered in patients with severe aGVHD to prevent cGVHD.

关键词： acute graft-versus-host disease     chronic graft-versus-host disease     National Institutes of Health consensus criteria     acute myeloid leukemia     anti-thymocyte globulin    

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疾病危险度-共患病指数在单倍型造血干细胞移植中的应用 Article

莫晓冬, 张晓辉, 许兰平, 王昱, 闫晨华, 陈欢, 陈育红, 韩伟, 王峰蓉, 王景枝, 刘开彦, 黄晓军

《工程（英文）》 2021年 第7卷 第2期   页码 162-169 doi: 10.1016/j.eng.2020.12.005

摘要： 和造血干细胞移植共患病指数（hematopoietic cell transplantation-specific comorbidity index, HCT-CI），提出适合单倍型造血干细胞移植（haploidentical

关键词： 疾病风险指数     疾病风险共病指数     造血细胞移植     共病指数     造血干细胞移植     单倍体    

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标题 作者 时间 类型 操作

Everyone has a donor: contribution of the Chinese experience to global practice of haploidentical hematopoietic

Meng Lv, Yingjun Chang, Xiaojun Huang

期刊论文

Outcomes of haploidentical bone marrow transplantation in patients with severe aplastic anemia-II that

期刊论文

Positive stool culture could predict the clinical outcomes of haploidentical hematopoietic stem cell

Lijuan Hu, Qi Wang, Xiaohui Zhang, Lanping Xu, Yu Wang, Chenhua Yan, Huan Chen, Yuhong Chen, Kaiyan Liu, Hui Wang, Xiaojun Huang, Xiaodong Mo

期刊论文

Comparison of reference values for immune recovery between event-free patients receiving haploidentical

null

期刊论文

Risk factors for chronic graft-versus-host disease after anti-thymocyte globulin-based haploidentical

Meng Lv, Xiaohui Zhang, Lanping Xu, Yu Wang, Chenhua Yan, Huan Chen, Yuhong Chen, Wei Han, Fengrong Wang, Jingzhi Wang, Kaiyan Liu, Xiaojun Huang, Xiaodong Mo

期刊论文

疾病危险度-共患病指数在单倍型造血干细胞移植中的应用

莫晓冬, 张晓辉, 许兰平, 王昱, 闫晨华, 陈欢, 陈育红, 韩伟, 王峰蓉, 王景枝, 刘开彦, 黄晓军

期刊论文