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Decitabine in combination with idarubicin within a modified busulfan/cyclophosphamide conditioning regimen for patients with advanced myelodysplastic syndrome:A prospective multicenter clinical cohort study

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Chinese Medical Journal 2024年第9期137卷 1115-1117页

作者： Yigeng Cao Mingyang Wang Fuxu Wang Wenwen Guo Yueshen Ma Xiaoyun Li Yi He Aiming Pang rongli zhang Weihua Zhai Xin Chen Qiaoling Ma Jialin Wei Donglin Yang Yong Huang Dan Feng Jia Liu Xin Gao Shupeng Wen Wen Wang Tao Wang Ying Li Xiaosheng Fang Yingchun Li Xiaohan zhang Yun Cai Yongqi Wang Weijie Cao Runqing Lu Sizhou Feng Rong Guo Yuewen Fu Xin Du Zhuogang Liu Xin Wang Ling Wang Liangming Ma Chuanfang Liu Xuejun zhang Mingzhe Han Erlie Jiang Department of Hematopoietic Stem Cell Transplantation Center State Key Laboratory of Experimental HematologyNational Clinical Research Center for Blood DiseasesHaihe Laboratory of Cell EcosystemInstitute of HematologyBlood Diseases HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeTianjin 300000China Department of Hematology Second Hospital of Hebei Medical UniversityHebei Key Laboratory of HematologyShijiazhuangHebei 050000China Center for Information and Resource State Key Laboratory of Experimental HematologyNational Clinical Research Center for Blood DiseasesHaihe Laboratory of Cell EcosystemInstitute of HematologyBlood Diseases HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeTianjin 300000China Department of Hematology Qilu Hospital of Shandong UniversityJinanShandong 250000China Department of Hematology Shanxi Bethune HospitalThird Hospital of Shanxi Medical UniversityTaiyuanShanxi 030032China Department of Hematology Qingdao Central HospitalUniversity of Health and Rehabilitation SciencesQingdaoShandong 266042China Department of Hematology Shandong Provincial HospitalCheeloo College of MedicineShandong UniversityJinanShandong 250000China Department of Hematology Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandong 250000China Department of Hematology Shengjing Hospital of China Medical UniversityShenyangLiaoning 110000China Department of Hematology Shenzhen Second People’s HospitalThe First Affiliated Hospital of Shenzhen UniversityShenzhen University School of MedicineShenzhenGuangdong 518000China Department of Hematology Henan Cancer HospitalCancer Hospital Affiliated Zhengzhou UniversityZhengzhouHenan 450000China Department of Hematology Department of HematologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenan 450000China

To the Editor:Allogeneic hemopoietic stem cell transplantation(allo-HSCT)represents the only long-term survival treatment choice for patients with myelodysplastic syndromes(MDS)and MDS/myeloproliferative neoplasm(MPN).Unfortunately,post-hemopoietic stem cell transplantation(HSCT)relapse remains a cause of treatment failure and the results of salvage treatments are *** better conditioning regimens is urgently *** studies have shown synergistic antileukemic effects between decitabine(DEC)and idarubicin(IDA).[1]In an attempt to design a conditioning strategy with very low toxicity but considerable myelosuppressive activity and potential immune-enhancing effects for patients with high-risk MDS and MDS/MPN,we combined DEC and IDA with busulfan,cyclophosphamide,andudarabine for a modied myeloablative regimen in this prospective,multicenter cohort study(hereafter referred to as the“DEC/IDA study”).

关键词： regimen myelo patients

异基因造血干细胞移植治疗DEK-NUP214融合基因阳性急性髓系白血病患者12例疗效分析

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中华血液学杂志 2024年第4期45卷 383-387页

作者：申昱妍杨栋林何祎庞爱明陈欣马巧玲张荣莉魏嘉璘翟卫华韩明哲姜尔烈冯四洲中国医学科学院血液病医院(中国医学科学院血液学研究所) 血液与健康全国重点实验室国家血液系统疾病临床医学研究中心细胞生态海河实验室天津300020 天津医学健康研究院天津301600

2016年11月至2022年8月期间,12例DEK-NUP214融合基因阳性急性髓系白血病患者在中国医学科学院血液病医院接受异基因造血干细胞移植(allo-HSCT)。12例患者中男5例,女7例,中位年龄34(16~52)岁。12例患者初诊时均检出DEK-NUP214融合基因阳... 详细信息

2016年11月至2022年8月期间,12例DEK-NUP214融合基因阳性急性髓系白血病患者在中国医学科学院血液病医院接受异基因造血干细胞移植(allo-HSCT)。12例患者中男5例,女7例,中位年龄34(16~52)岁。12例患者初诊时均检出DEK-NUP214融合基因阳性,10例患者染色体核型分析显示t(6;9)(p23;q34)易位(2例患者未行染色体核型分析),11例患者检出FLT3-ITD突变,11例患者检出WT1高表达。9例患者allo-HSCT前处于第一次完全缓解状态,1例患者疾病未缓解,2例患者处于复发状态。所有患者均接受清髓性预处理,5例患者接受同胞全相合造血干细胞移植,7例患者接受单倍体造血干细胞移植。移植物单个核细胞中位数为10.87(7.09~17.89)×10^(8)/kg,CD34^(+)细胞中位数为3.29(2.53~6.10)×10^(6)/kg。所有患者均获得造血重建,粒细胞植入中位时间为14(10~20)d,血小板植入中位时间为15(9~27)d。移植后1年移植相关死亡率为21.2%。移植后1、3年累积复发率分别为25.0%、50.0%,无白血病生存率为(65.6±14.0)%,总生存率为(72.2±13.8)%。

关键词：急性髓系白血病中国医学科学院造血干细胞移植造血重建移植物染色体核型分析总生存率 DEK

异基因造血干细胞移植治疗骨髓增生异常综合征伴原始细胞增多282例生存分析及WHO 2022分类不同亚型的生存比较

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中华血液学杂志 2024年第5期45卷 445-452页

作者：王慧马润芝庞爱明杨栋林陈欣张荣莉魏嘉璘马巧玲翟卫华何祎姜尔烈韩明哲冯四洲中国医学科学院血液病医院(中国医学科学院血液学研究所) 北京协和医学院血液与健康全国重点实验室国家血液系统疾病临床医学研究中心细胞生态海河实验室天津300020 天津医学健康研究院天津301600 青岛大学附属烟台毓璜顶医院烟台264000

目的评估异基因造血干细胞移植(allo-HSCT)治疗骨髓增生异常综合征伴原始细胞增多(MDS-EB)的疗效和预后影响因素,比较WHO2022分类不同亚型患者的预后。方法纳入2006年10月至2022年12月在中国医学科学院血液病医院接受allo-HSCT的282例MD... 详细信息

目的评估异基因造血干细胞移植(allo-HSCT)治疗骨髓增生异常综合征伴原始细胞增多(MDS-EB)的疗效和预后影响因素,比较WHO2022分类不同亚型患者的预后。方法纳入2006年10月至2022年12月在中国医学科学院血液病医院接受allo-HSCT的282例MDS-EB患者,按照WHO 2022诊断标准重新分类为骨髓增生异常肿瘤伴原始细胞增多1型/2型(MDS-IB1/IB2)(222例)、MDS伴纤维化(MDS-f)(41例)和伴双等位基因TP53突变的MDS(MDS-biTP53)(19例)三组,对其临床资料进行回顾性分析。结果①282例患者中位年龄46(15~66)岁,男191例,女91例,MDS-EB1118例(42%),MDS-EB2164例(58%)。②282例MDS-EB患者中256例(90.8%)移植后获得造血重建,原发植入功能不良11例(3.9%),继发植入功能不良15例(5.3%)。移植后100 d急性移植物抗宿主病(GVHD)累积发生率为(42.6±3.0)%,Ⅱ~Ⅳ度急性GVHD累积发生率为(33.0±2.8)%;移植后1年慢性GVHD累积发生率为(31.0±2.9)%。移植后128例(45.4%)患者发生巨细胞病毒(CMV)感染,63例(22.3%)患者发生菌血症,35例(12.4%)患者发生肺部真菌感染,17例(6.0%)患者发生EB病毒感染。③移植后中位随访时间为22.1(19.2~24.7)个月,3年总生存(OS)率、无病生存(DFS)率分别为71.9%(95%CI 65.7%~78.6%)、63.6%(95%CI 57.2%~70.7%),3年非复发死亡率(NRM)为17.9%(95%CI 13.9%~22.9%),3年累积复发率(CIR)为9.8%(95%CI 6.7%~13.7%)。影响移植后OS的独立危险因素包括单体核型(MK)(P=0.004,HR=3.26,95%CI 1.46~7.29)、造血干细胞移植合并症指数(HCI-CI)≥3分(P<0.001,HR=2.86,95%CI 1.72~4.75)、发生Ⅱ~Ⅳ度肠道急性GVHD(P<0.001,HR=5.94,95%CI 3.50~10.10)。④MDS-IB1/IB2组移植后3年OS率、DFS率均优于MDS-biTP53组[OS:72.0%(95%CI 63.4%~80.7%)对46.4%(95%CI 26.9%~80.1%),P=0.020;DFS:67.4%(95%CI 60.3%~75.3%)对39.7%(95%CI 22.3%~70.8%),P=0.015],3年CIR低于MDS-biTP53组[7.3%(95%CI 4.3%~11.4%)对26.9%(95%CI 9.2%~48.5%),P=0.004]。MDS-IB1/IB2组、MDS-f组、MDS-biTP53组移植后3年NRM分别为16.7%(95%CI 12.1%~22.1%)、20.5%(95%CI 9.4%~34.6%)、26.3%(95%CI 9.1%~47.5%)(P=0.690)。结论allo-HSCT是MDS-EB的有效治疗手段,单体核型、HCI-CI、Ⅱ~Ⅳ度肠道急性GVHD是影响患者OS的独立危险因素。WHO 2022分类有助于区分不同亚组患者allo-HSCT后疗效,allo-HSCT能够改善MDS-f患者的不良预后,但MDS-biTP53患者移植后复发风险较高。

关键词：骨髓增生异常综合征骨髓增生异常肿瘤异基因造血干细胞移植预后

Increase in chloride from baseline is independently associated with mortality in intracerebral hemorrhage patients admitted to intensive care unit:A retrospective study

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Journal of Intensive Medicine 2022年第4期2卷 274-281页

作者： Dawei Zhou Tong Li Dong Zhao Qing Lin Dijia Wang Chao Wang rongli zhang Department of Critical Care Medicine Beijing Tongren HospitalCapital Medical UniversityNo.1 Dongjiaominxiang StreetDongcheng DistrictBeijing 100730China

Background:Hyperchloremia is associated with increased mortality in critically ill *** objective of this study was to investigate the association between increased chloride levels and mortality outcomes in intracerebral hemorrhage(ICH)patients admitted to the intensive care unit(ICU).Methods:We performed a retrospective study of all patients diagnosed with ICH and included in the Medical Information Mart for Intensive Care(MIMIC-III)from 2001 to *** criteria were the first diagnosis of ICH,ICU length of stay(LOS)over 72 h,and not receiving hypertonic saline *** chloride perturbation within 72 h of admission was evaluated as a predictor of *** increase in chloride from baseline was dichotomized based on an increase in chloride in 72 h(≤5 mmol/L or>5 mmol/L).The primary outcome was 90-day ***:A total of 376 patients(54.5%male,median age 70 years,interquartile range:58–79 years)were *** overall 90-day mortality was 32.2%(n=121),in-hospital mortality was 25.8%(n=97),and Day 2 acute kidney injury(AKI)occurred in 29.0%(n=109)of *** prevalence of hyperchloremia on admission,during the first 72 h,and an increase in chloride(>5 mmol/L)were 8.8%,39.4%,and 42.8%,*** adjusting for confounders,the hazard ratio of increase in chloride(>5 mmol/L)was 1.66(95%confidence interval:1.05–2.64,P=0.031).An increase in chloride(>5 mmol/L)was associated with a higher odds ratio for 90-day mortality in both the AKI and non-AKI ***:An increase in chloride from baseline is common in adult patients with ICH admitted to *** increase is significantly associated with elevated *** results support the significance of diligently monitoring chloride levels in these patients.

关键词： Intracerebral hemorrhage Hyperchloremia Normal saline Serum chloride Mortality

艾沙康唑与伏立康唑作为口服序贯治疗恶性血液病患者侵袭性曲霉菌病的疗效及安全性比较

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临床血液学杂志 2024年第1期37卷 14-18页

作者：张潇予魏嘉璘翟卫华张荣莉杨栋林庞爱明马巧玲陈欣冯四洲韩明哲姜尔烈何祎中国医学科学院血液病医院(中国医学科学院血液学研究所) 实验血液学国家重点实验室国家血液系统疾病临床医学研究中心细胞生态海河实验室天津300020 天津医学健康研究院

目的:探究并分析比较口服艾沙康唑胶囊与伏立康唑片剂在血液病患者抗真菌口服序贯治疗的疗效及安全性。方法:回顾性分析中国医学科学院血液病医院干细胞移植中心2019年11月至2023年1月诊断为侵袭性曲霉菌病,并应用伏立康唑针剂抗真菌治... 详细信息

目的:探究并分析比较口服艾沙康唑胶囊与伏立康唑片剂在血液病患者抗真菌口服序贯治疗的疗效及安全性。方法:回顾性分析中国医学科学院血液病医院干细胞移植中心2019年11月至2023年1月诊断为侵袭性曲霉菌病,并应用伏立康唑针剂抗真菌治疗的患者共45例。其中22例患者应用伏立康唑片口服序贯治疗,23例患者应用艾沙康唑胶囊口服序贯治疗。结果:艾沙康唑组中仅1例患者评价治疗无效,其余22例治疗有反应的患者中17例评估为完全缓解,治疗缓解率为95.65%(22/23),完全缓解率为73.91%(17/23)。伏立康唑治组的治疗缓解率为86.36%(19/22),完全缓解率为50.00%(11/22)。2组患者在治疗缓解率上差异无统计学意义,且2组患者服药期间耐受性良好。结论:应用伏立康唑针剂静脉抗真菌治疗后应用艾沙康唑胶囊口服序贯与伏立康唑片口服序贯治疗相比疗效相当,且安全性良好。

关键词：侵袭性曲霉菌病血液肿瘤造血干细胞移植

Risk factors associated with hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation

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Blood Science 2022年第2期4卷 83-88页

作者： Biao Shen Yueshen Ma Haixiao zhang Mingyang Wang Jia Liu Jiaxin Cao Wenwen Guo Dan Feng Donglin Yang rongli zhang Xin Chen Qiaoling Ma Weihua Zhai Sizhou Feng Mingzhe Han Aiming Pang Erlie Jiang 无 State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood DiseasesHematopoietic Stem Cell Transplantation CenterInstitute of Hematology and Blood Diseases HospitalPeking Union Medical College and Chinese AcademyTianjinChina Administration Office of Biostatistics Center for Information and ResourcesInstitute of Hematology and Blood Diseases HospitalPeking Union Medical College and Chinese AcademyTianjinChina Office of Institute of Hematology and Blood Diseases Hospital Peking Union Medical College and Chinese AcademyTianjinChina

Hemorrhagic cystitis(HC)is a common complication of allogeneic hematopoietic stem cell transplantation(HSCT).The incidence is about 7%to 68%,and some patients have to suffer a long period of frequent,urgent,and painful urination,which brings great *** study aimed to analyze risk factors of HC and its effect on patient *** collected the medical records of 859 patients who underwent HSCT at our hospital between August 2016 and August *** with and without HC were matched using propensity score matching at a 1:1 ratio based on sex,age,and diagnosis,and logistic regression analyses were used to identify factors associated with *** used Kaplan–Meier curves to analyze the survival rates of patients in the HC and non-HC *** also analyzed the relationship between BK viral load and the occurrence of HC using receiver operating characteristic curve(ROC)*** propensity score matching,there were 131 patients each in the HC and non-HC *** the HC group,89 patients(67.9%)had mild HC(stage II°)and 43(32.1%)had severe HC(stage III–IV).The median interval between stem cell transplantation and HC development was 31(3–244)*** analysis indicated that donor age,hematopoietic stem cell source,HLA,acute graft-versus-host disease,busulfan,anti-thymocyte globulin(ATG),total body irradiation,cytomegalovirus(CMV)(urine),and BK polyomavirus(BKV)(urine)were significantly associated with ***,CMV(urine),and BKV(urine)were independent risk factors for HC based on the multivariate *** Kaplan–Meier survival analysis showed no significant difference between the HC and non-HC groups(P=0.14).The 1-and 2-year survival rates in the HC group were 78.4%and 69.6%,respectively,and the corresponding rates in the non-HC group were 84.4%and 80.7%,*** analysis indicated that a urine BKV load of 1×10^(7) copies/mL was able to stratify the risk of *** conclusion,when the BKV load is>1×10^(7),we needtobe aware of the potential for

关键词： Allogeneic hematopoietic stem cell transplantation Hemorrhagic cystitis Prognosis Risk factors

Risk factors for CMV infection within 100 days posttransplantation in patients with acute leukemia

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Blood Science 2022年第3期4卷 164-169页

作者： Juan Chen Aiming Pang Yuanqi Zhao Li Liu Runzhi Ma Jialin Wei Xin Chen Yi He Donglin Yang rongli zhang Weihua Zhai Qiaoling Ma Erlie Jiang Mingzhe Han Jiaxi Zhou Sizhou Feng State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood DiseasesHaihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeTianjin 300020China

Objective:To investigate the risk factors for cytomegalovirus(CMV)infection within 100 days and the relationship between early CMV infection and 1-year relapse for patients with acute leukemia following allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:Three hundred fifty-nine patients with acute leukemia who received allo-HSCT at our center between January 2015 and January 2020 were retrospectively ***:Of 359 patients,48.19%(173)patients experienced CMV infection within 100 days *** univariate and multivariate logistic analysis,haploidentical-related donor(HRD)(P<0.001;odds ratio[OR],5.542;95%confidence interval[CI],3.186–9.639),and ratio of CD3^(+)CD8^(+)cells in lymphocytes<14.825%(P<0.001;OR,3.005;95%CI,1.712–5.275)were identified as 2 independent risk ***-year relapse rate(RR)between the CMV infection group and the non-CMV infection group was not statistically significant(18.5%vs 19.9%,P=0.688).When we divided the total cohort into AML,ALL,and MAL subgroups,there were no significant differences as well(P=0.138;P=0.588;P=0.117;respectively).Conclusion:In conclusion,donor type(HRD)and the insufficient recovery of CD3^(+)CD8^(+)cells were independent risk factors for CMV infection within 100 days posttransplantation in patients with acute *** infection within 100 days did not influence the incidence of relapse in 1 year for patients with acute leukemia.

关键词： Acute leukemia Allogeneic hematopoietic stem cell transplantation Cytomegalovirus Risk factors Relapse

新型靶向药吉瑞替尼在伴FLT3突变急性髓系白血病治疗的临床应用进展

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白血病．淋巴瘤 2023年第6期32卷 377-381页

作者：张荣莉姜尔烈中国医学科学院血液病医院(中国医学科学院血液学研究所)实验血液学国家重点实验室国家血液系统疾病临床医学研究中心、细胞生态海河实验室天津300020

伴有FLT3突变的急性髓系白血病(AML)患者复发风险高、预后差, 以索拉非尼为代表的一代靶向FLT3的药物在治疗AML中存在选择性差、疗效弱等特征, 以吉瑞替尼为代表的新型的二代FLT3抑制剂对FLT3的抑制作用更强、特异性更高、脱靶毒性更低,... 详细信息

伴有FLT3突变的急性髓系白血病(AML)患者复发风险高、预后差, 以索拉非尼为代表的一代靶向FLT3的药物在治疗AML中存在选择性差、疗效弱等特征, 以吉瑞替尼为代表的新型的二代FLT3抑制剂对FLT3的抑制作用更强、特异性更高、脱靶毒性更低, 大大提高了伴FLT3突变的AML患者的疗效。文章就吉瑞替尼的作用机制及临床应用进展进行综述。

关键词：白血病髓系急性基因突变 fms样酪氨酸激酶3 吉瑞替尼

Intravenous-oral itraconazole versus oral posaconazole in preventing invasive fungal diseases for acute leukemia patients

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Blood Science 2023年第2期5卷 106-110页

作者： Li Liua Xiaolei Peia Runzhi Maa Yi Hea rongli zhanga Jialin Weia Qiaoling Maa Weihua Zhaia Aiming Pang Erlie Jiang Mingzhe Han Donglin Yang Sizhou Feng Hematopoietic Stem Cell Transplantation Center National Clinical Research Center for Blood DiseasesState Key Laboratory of Experimental HematologyHaihe Laboratory of Cell EcosystemInstitute of Hematology&Blood Diseases HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeTianjin 300020China

Invasive fungal diseases(IFDs)are major and lethal infectious complications for patients with neutropenia after *** with intravenous and oral suspended itraconazole(200 mg Q12h intravenously×2 days followed by 5 mg/kg·d orally in twice)or oral suspension of posaconazole(200 mg Q8h)was administered for preventing *** only 2 episodes of proven IFDs were not included after propensity-score matching(PSM),while the incidence of possible IFDs was 8.2%(9/110)in itraconazole group and 1.8%(2/110)in posaconazole group,respectively(P=.030).In clinical failure analysis,the failure rate of posaconazole group was lower as compared to the itraconazole group(2.7%vs 10.9%,P=.016).Both intravenous-oral itraconazole and posaconazole suspension are effective in preventing IFDs,while posaconazole suspension seems more tolerable.

关键词： Acute leukemia Antifungal prophylaxis Invasive fungal disease Itraconazole Posaconazole