Cytokine-induced killer (CIK) cell therapy, an adoptive T-cell immunotherapy, has been reported to be a safe and effective mode of treatment for patients with metastatic diseases, lymphoma and acute leukaemia. To investigate the clinical efficacy of cytokine-induced killer cells for the treatment of refractory lymphoma, the present clinical study was conducted. A total of 8 male patients with a mean age of 41 years (range 22-65) who were pathologically diagnosed with malignant lymphoma (Hodgkin's disease, 2 and non-Hodgkin's lymphoma, 6) were enrolled. CIK cells were expanded by priming with IFN-γ, monoclonal antibody (mAb) to CD3 and IL-1α, followed by the addition of IL-2 the following day using peripheral blood mononuclear cells (PBMCs) of the 8 male patients. The CIK cells were then transfused back to the patients as treatment. On day 13, the CIK cell count reached 7-18×10(19) (mean, 12.7×10(9)), a 44- to 140-fold increase (mean, 98-fold). The average percentage of cells expressing CD3(+), CD4(+), CD8(+) and CD3(+)CD56(+) were also increased from 50.9±3.5, 29.9±1.7, 41.3±3.2, 1.6±0.2% to 90.2±1.6, 40.6±5.5, 52.8±4.9 and 33.1±4.0%, respectively. Patients showed measurable radiographic tumor reduction, increased T-cell subset levels, and relief of symptoms after treatment. No severe toxicity or side effects were reported. CIK cells developed by this culture method have a high in vitro proliferation rate and tumor-killing capacity. In conclusion, CIK cell treatment of patients with malignant lymphoma achieves effective clinical responses, causing few side effects.
<b><i>Background:</i></b> The survival of patients with acute myeloid leukemia (AML) with t(8;21) was reported to be shorter in China than in other countries. <b><i>Patients:</i></b> We analyzed the correlation between different cytarabine (Ara-c) regimens and outcome in 255 t(8;21) AML patients in China who received postremission consolidation chemotherapy only. <b><i>Results:</i></b> The 5-year overall survival (OS) of the high-dose Ara-c group (HDAC; 2≤ Ara-c ≤3 g/m<sup>2</sup>), intermediate-dose Ara-c group (MDAC; 1.0≤ Ara-c <2.0 g/m<sup>2</sup>), low-dose Ara-c group (LDAC; 0.2< Ara-c <1.0 g/m<sup>2</sup>) and standard-dose Ara-c group (SDAC; 0.1≤ Ara-c ≤0.2 g/m<sup>2</sup>) were 65.3, 39.4, 25.2 and 27.9%, respectively (p = 0.003). In the HDAC group, but not in the MDAC group, the 5-year OS of patients who achieved 3-4 cycles of chemotherapy was superior to those who underwent 1-2 cycles (84.4 vs. 43.6%, p < 0.05), and the 3-year OS of patients who achieved an accumulated 36 g/m<sup>2</sup> of Ara-c was significantly higher compared to those who did not (85.3 vs. 39.2%, p < 0.05). Multivariate analysis indicated that factors such as WBC >3.5 × 10<sup>9</sup>/l, PLT ≤30 × 10<sup>9</sup>/l, and extramedullary infiltration were associated with a poor prognosis. <b><i>Conclusion:</i></b> The survival of t(8;21) AML patients treated with high-dose Ara-c (≥2 g/m<sup>2</sup>) was superior to other dose levels in postremission consolidation chemotherapy. Patient survival was improved by 3-4 cycles of chemotherapy with an accumulated concentration of 36 g/m<sup>2</sup> of Ara-c. WBC >3.5 × 10<sup>9</sup>/l, PLT ≤30 × 10<sup>9</sup>/l and extramedullary infiltration could be indicative of a poor clinical prognosis.
Objective To explore the efficacy and safety in the treatment of relapsed or refractory lymphoma after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods The method of allo-HSCT was adopted to treat 7 patients with relapsed or refractory lymphoma from January 2007 to January 2012 in the General Hospital of Beijing Military.The primary disease included 6 cases of NHL and 1 case of HL.4 cases had one recurrence,2 cases had two or more relapses,and 1 case was primary refractory.The patients had an average age of 33.7 years old (ranging froml8 to 48-year-old) and included 4 males and 3 females.The patients included 2 cases of diffuse large B-cell (DLBCL) and 1 for each case of T lymphoblastoid cell type (T-LL),skin extranodal NK/T cell type (ENKTCL-N),hepatosplenic T-cell type (HSTCL),Burkitt' s type (BL),and HL mixed cell type.3 patients were in remission while 4 patients did not achieve remission at the time of transplantation.3 cases had donor and recipient HLA matching while the remaining 4 mismatched.Bone marrow and peripheral blood stem cell transplantation were used in this study.Patients were pretreated with fludarabine,melphalan,anti-human thymocyte globulin cyclosporin A (CsA) and methotrexate (MTX) to prevent graft-versus-host disease (GVHD).Toxicity,GVHD and disease-free survival were monitored in patients after transplantation.Results 6 patients tolerated conditioned regimen and achieved hematopoietic reconstitution.Implantation evidence testing confirmed 100 ％ hematopoietic from donors.Follow-up was up to January 2011 with a median of 29.6 months (1-70 months).The overall survival rate was 71.4 ％.5 patients had acute GVHD and 4 experienced chronic GVHD.1 patient died of infection and 1 died of relapse,and the rest patients were alive.The longest disease-free interval was up to 70 months.Conclusion allo-HSCT is effective and safe for relapsed or refractory lymphoma.It can be a key technology of extensive clinical use for treating relapsed or refractory lymphoma.
Key words:
Lymphoma, recurrence, refractory; Transplantation conditioning; Hematopoietic stem cell transplantation, allogeneic; Long-term survival; Graft vs host disease
Objective To explore the effect and feasibility with pretreatment added to idarubicin of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the refractory acute myeloid leukemia.Methods 27 patients (13 males and 14 females) with refractory acute myeloid leukemia received allogeneic hematopoietic stem cell transplantation from August 2010 to December 2012 in the Beijing Military Region General Hospital,with the FAB classification of M1 1 case,M2 10 cases,M3 1 case,M4 1 case,M5 11cases and M6 3 cases.However 18 of the 27 cases were the recurrence,and 9 cases were the second or more remission.22 cases were treated with transplantation of the bone marrow combining peripheral blood of donors.5 cases were treated with peripheral blood.All patients were treated with pretreatment consisting of cytarabine,busulfan,fludarabine and added to idarubicin (15 mg/m2,-10,-9,-8 d).Graft-versus-host disease (GVHD) was prevented by combining variety of immunosuppressants including cyclosporin A (CsA),methotrexate (MTX),and anti-thymocyte immunoglobulin (ATG).The regimen-associated side effect,incidence of GVHD and disease-free survival probabilities were observed after HSCT.Results All of the 27 patients acquired hematopoietic reconstitution.Conditioning regimen was well tolerated and no pre-treatment-related adverse reactions or cardiac toxicity events to early death happened.The bone morrow initial engraftment time was 11 to 23 days,with an average time of 15 days.The median follow up time was 12 months (5-33months),13 patients had experience of acute GVHD,and 11 patients had experience of chronic GVHD.2patients died of GVHD.13 cases had serious infection and 1 case died of infection,and 5 of the 7 recurrence cases died of relapse.The rest 19 patients were alive.All patients treatment-related mortality,relapse-related mortality and overall survival rates were 11.1％ (3/27),18.5 ％ (5/27) and 70.4 ％ (19/27),respectively.Conclusion The patient is well tolerated conditioning regimen with pretreatment added to idarubicin,which is feasible and safe.It can reduce the refractory leukemia relapse rate or improve long-term survival after transplantation without incrasing complications.
Key words:
Leukemia, myeloid, acute; Hematopoietic stem cell transplantation, allogeneic; Idarubicin; Recurrence; Refractory
Objective
To explore the efficacy and safety of haplotype allogeneic hematopoietic stem cell transplantation (allo-HSCT) in treatment of childhood severe aplastic anemia(SAA).
Methods
From Jan.2010 to Jan.2013, 16 children with SAA who received haploidentical allo-HSCT were studied, including 10 male and 6 female, aged from 3 to 13 years old, and the mean age was 7.8 years.The median time from diagnosis to transplantation was 15.5 months (1 to 80 months). Before transplantation, all patients received Cyclosporin A(CSA) therapy, and 10 of them received Anti-Thymocyte Globulin(ATG) intensive immune therapy.Donors received granulocyte colony-stimulating factor (G-CSF) mobilization, and stem cell transplantation were collected from both peripheral blood and bone marrow.Cyclophosphamide(CTX)+ Fludarabine(FLU)+ ATG program was used as conditioning regimen, and combined immunosuppressive agents were used for graft-versus-host disease(GVHD)prophylaxis, including CSA, Amethopterin (MTX), tacrolimus (FK506), etc.Toxic and side effect, GVHD and disease-free survival of these children after transplantation were observed.
Results
Fifteen cases of children reached hematopoietic reconstitution, one patient had no evidence of engraftment, one showed rejection after implantation, for the 14 engrafted children with neutrophils≥0.5×109/L and platelets≥20×109/L, the average time was 18.5 days and 24.6 days, respectively.Implantation was confirmed by the evidence of 100% of donor hematopoiesis.With a median follow-up duration of 24.8 months (3-45 months), 6 cases developed acute GVHD, 3 cases showed chronic GVHD, 1 died of GVHD and 2 died of infection, the other 11 patients remained in disease-free survival, and the disease-free survival rate was 68.8% (11/16 cases).
Conclusions
Haplotype allo-HSCT were safe and very effective in treatment of childhood SAA, and can be widely carried out in clinical treatment.
Key words:
Haplotype; Allogeneic hematopoietic stem cell transplantation; Severe aplastic anemia; Graft-versus-host disease; Child
Objective To explore the effect and feasibility of reduced intensity allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of relapsed or refractory acute myeloid leukemia (AML) in elderly patients.Methods Six elderly patients with relapsed or refractory AML received reduced intensity conditioning allo-HSCT from January 2012 to January 2014 in Beijing Military Region General Hospital,including 5 males and 1 females,aged from 61 to 68 years old with mean age of 64.6 years old.Donors received granulocyte colony-stimulating factor to mobilize and used peripheral blood stem cell transplantation.Pretreatment scheme was reduced the strength of pretreatment for fludarabine combined with busulfex and cytarabine,cyclophosphamide.Preventive donor peripheral blood stem cell infusion was used after 3 months of transplantation and observed toxicity,GVHD and disease-free survival in patients after transplantation.Results All patients reached hematopoietic reconstitution,the average time were 21.5 d and 24.2 d respectively with neutrophils ≥0.5×109/L and platelets ≥20×109/L.Implantation was confirmed by the evidence of 100 ％ of donor hematopoiesis.With a median follow-up duration of 11.5 months (5～18 months),three cases occurred GVHD in all patients,one died of GVHD and other two cases died of relapse,the other three patients remained disease-free survival,the disease-free survival rate of 2-year was 50 ％,the longest disease-free survival time up to 30 months.Conclusion Reduced intensity allo-HSCT is an effective therapeutic method for relapsed or refractory AML in elderly patients.
Key words:
Leukemia, myelocytic, acute; Transplantation conditioning; Allogeneic hematopoietic stem cell transplantation; Elderly; Disease-free survival; Graft vs host disease
This study aimed to compare the efficacy and safety between haploidentical hematopoietic stem cell transplantation (HHCT) and immunosuppressive therapy (IST) for the treatment of pediatric acquired severe aplastic anemia (SAA). The clinical data of 28 children with SAA treated from June 2010 to October 2014 at our hospital were retrospectively reviewed. Of these patients, 18 were treated with HHCT and 10 with IST. The median follow-up time was 23.5 months (range, 3-52 months). There was no significant difference in overall survival rate between the HHCT group and the IST group (66.7% vs. 70%, P > 0.05). Graft-versus-host disease occurred in 83.3% (15/18) of the HHCT group, including 5 cases with grade III or higher. In comparison with IST, HHCT has similar efficacy and safety profiles in the treatment of pediatric SAA.
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