[Clinical study of mesenchymal stem cells from third-party donors in the treatment of refractory late onset hemorrhagic cystitis after allogeneic hematopoietic stem cell transplanation].
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Objective: To examine the efficacy and safety of third-party bone marrow-derived mesenchymal stem cells (MSCs) in the treatment of refractory delayed hemorrhagic cystitis (LOHC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Twenty patients with refractory LOHC received conventional therapy combined with MSCs obtained from third-party donors' bone marrow (BM) . MSCs were given intravenously at a dose of 1 × 10(6) cells/kg once weekly until either the symptoms improved or no changes in LOHC were seen after continuous infusion four times. BK viruria (BKV) -DNA, JC viruria (JCV) -DNA, and CMV-DNA were detected by real-time quantitative PCR before and 8 weeks after the MSCs infusion. Results: ① Of the 20 patients with refractory LOHC, 15 were males, and 5 were females, and the median age was 35 (15-56) years. There were 5 cases of acute lymphoblastic leukemia (ALL) , 9 cases of acute myeloid leukemia (AML) , 5 cases of myelodysplastic syndrome (MDS) , and 1 case of maternal plasma cell like dendritic cell tumor (BPDCN) . There were 4 cases of HLA identical transplantation and 16 cases of HLA incomplete transplantation. ②The median number of MSC infusions for each patient was 3 (range: 2-8) . Seventeen patients achieved complete response, and one had a partial response after treatment. The overall response rate was 90%. Over a median follow-up period of 397.5 days (range 39-937 days) post-transplantations, 13 patients survived, and 7 died. The causes of death included aGVHD (1 case) , infections (5 cases) , and TMA (1 case) . ③The copy numbers of BKV-DNA and CMV-DNA in urine in the 8th week after MSCs infusion were significantly lower than those observed before treatment (11342.1×10(8) copies/L vs 5.2×10(8) copies/L, P=0.016; 3170.0×10(4) copies/L vs 0.2×10(4) copies/L, P=0.006, respectively) , while JCV-DNA did not significantly differ when compared to before treatment (P=0.106) . ④ No adverse reactions related to MSC infusion occurred in any of the 20 patients. Conclusion: Third-party bone marrow-derived MSC has significant efficacy and good safety in the treatment of refractory LOHC after allogeneic HSCT.目的： 观察第三方骨髓来源间充质干细胞（MSC）治疗异基因造血干细胞移植（allo-HSCT）后难治性迟发性出血性膀胱炎（LOHC）的疗效和安全性。 方法： 回顾性分析2018年7月至2020年6月allo-HSCT后发生难治性LOHC 20例患者在常规治疗基础上联合第三方骨髓来源MSC治疗。MSC以每次1×10(6)/kg、每周1次输注，直至症状改善或连用4次无效停用。在MSC治疗前及治疗后第8周应用定量PCR法检测患者尿液标本中BK病毒（BKV）、JC病毒（JCV）、巨细胞病毒（CMV）。 结果： ①20例难治性LOHC患者中，男15例、女5例，中位年龄35（15～56）岁；急性淋巴细胞白血病（ALL）5例，急性髓系白血病（AML）9例，骨髓增生异常综合征（MDS）5例，母细胞性浆细胞样树突细胞瘤（BPDCN）1例；HLA全相合移植4例，HLA不全相合移植16例。②MSC输注中位次数为3（2～8）次。17例患者获得完全缓解，1例获得部分缓解，总缓解率为90.0%。移植后中位随访397.5（39～937）d，13例存活、7例死亡，死亡原因包括急性GVHD 1例、感染5例、血栓性微血管病（TMA）1例。③MSC输注后第8周尿BKV-DNA及CMV-DNA拷贝数较治疗前显著降低（11342.1×10(8)拷贝/L对5.2×10(8)拷贝/L，P＝0.016；3170.0×10(4)拷贝/L对0.2×10(4)拷贝/L，P＝0.006），而JCV-DNA与治疗前相比无明显改变（P＝0.106）。④未发生MSC输注相关不良反应。 结论： 第三方骨髓来源MSC对allo-HSCT后难治性LOHC具有显著疗效且安全性良好。.Keywords:
Hemorrhagic cystitis
Refractory (planetary science)
The situation regarding hemorrhagic cystitis after conditioning for bone marrow transplantation (BMT) in Japan was surveyed and analyzed. Thirty-seven of 110 patients (33.6%) developed hemorrhagic cystitis after conditioning for BMT with cyclophosphamide (CY) and total body irradiation. In two of these 37 patients the cystitis was virus (adenovirus)-induced. In the others it was diagnosed as CY-induced. The severity and duration of CY-induced hemorrhagic cystitis were related to its onset. The delayed type of hemorrhagic cystitis induced by CY seemed to have a poor prognosis and often continued until the patient died. Therefore, late-onset hemorrhagic cystitis should be followed carefully and its prophylaxis may be important. 2-Mercaptoethane sulphonate (mesna) injections for prophylaxis of CY-induced hemorrhagic cystitis were found to be effective in reducing the incidence of the delayed type in 21 (53.8%) of 39 patients treated, but did not reduce the total incidence of CY-induced hemorrhagic cystitis.
Hemorrhagic cystitis
Mesna
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Objective: To explore the characteristics,risk factors,effective prevention and treatment of hemorrhagic cystitis (HC) in patients after hematopoietic stem cell transplantation(HSCT) receiving routine prophylaxis for HC. Methods: Sixty-two patients with hemotologic malignancies after HSCT including 32 cases of auto-HSCT and 30 allo-HSCT, were studied. The relationship between HC and transplantation type or other clinical features was analyzed. The curative effect was observed. Results: Six out of 62 (9.68%)patients developed HC. All of them were patients after allo-HSCT. The average time of onset and the average duration was 46.50 days and 42.50 days respectively. Of 4 patients infected with Cytomegalovirus(CMV),three presented with graft versus host disease(GVHD). One patient suffered from GVHD without in fiction of CMV. After treatment, three of them had complete remission, two of them had partial remission, and one patient had a cystotomy at last. Conclusion: After full prevention, most HC are late-onset and long-lasting. which may be related to allo-SCT, CMV infection and GVHD.
Hemorrhagic cystitis
Cytomegalovirus
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OBJECTIVE The haemorrhagic cystitis(HC) is one of major complications after hematopoietic stem cell transplantation.This research explored the correlation between the infections and haemorrhagic cystitis after hematopoietic stem cell transplantation so as to guide the clinical nursing of the HC patients and to prevent the infections.METHODS A total of 36 HC patients,who underwent hematopoietic stem cell transplantation,were divided into two groups with 18 cases in each.The risk factors for HC were explored.The HLA match,gender,factors for infections including the CMV,endoxin and fungal G trial were compared between the two groups.RESULTS The patients with incomplete HLA match had the higher rate of HC,there was no difference in the gender;there was correlation between the.HC and CMV infection(P=0.038);there was no correlation between the HC and the endotoxin(P=0.5);there was no correlation between the HC and fungal infection G trial(P=0.301).CONCLUSION The HC in the patients who underwent the hematopoietic stem cell transplantation is closely related to the CMV infections,it is necessary to take the prevention and nursing measures.
Hemorrhagic cystitis
Hematopoietic stem cell
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Hemorrhagic cystitis
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Objective To analyze the risk factors and treatment of hemorrhagic cystitis (HC)in recipients who underwent hematopoietic stem cell transplantation.Methods We analyzed the incidence and risk factors for hemorrhagic cystitis in 135 patients undergoing hematopoietic stem cell transplantation (HSCT). The curative effect was observed.Results 14 out of 135(10.4%) patients developed HC. The average time of onset and the average duration was 36.5 days and 20.1 days respectively. After treatment, all of them had complete remission; unrelated donor (OR=7.594, 95%CI 2.425~23.779; P=0.000) were identified as being significantly associated with the occurrence of HC.Conclusion Multiple regression analysis revealed unrelated donor graft recipients to be significant factors.
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Objective To explore the characteristics,risk factors,effective prevention and treatment of hemorrhagic cystitis(HC)in patients post hematopoietic stem cell transplantation(HSCT).Methods From January 2006 to December 2009 the clinical records of eighty-eight patients with hemotologic malignancies after HSCT were reviewed.The relationship between HC and transplantation type or other clinical features was analyzed.Results Fourteen out of eighty-eight(15.9%)patients developed HC after allo-HSCT.Among them,five patients were HLA-identical,twelve presented with graft versus host disease(GVHD),six patients infected with cytomegalovirus(CMV),five patients infected with EB virus.Conclusions HC still occured in these patients.The CMV infection of recipients is a important risk factor of hemorrhagic cystitis after HSCT.
Hemorrhagic cystitis
Cytomegalovirus
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Hemorrhagic cystitis
Mesna
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Although intensive chemotherapy and hematopoietic stem cell transplant(HSCT)are currently used in the treatment of acute myeloid leukemia(AML), a large proportion of patients relapse after treatment. On the other hand, a minority of cases fail to achieve complete remission(CR)after a standard first line treatment. Leukemia relapse and refractory become the main course of treatment failure, which are also the main points and difficulties of treatment for AML. However, the most effective regimen for refractory/relapsed AML has not been established. This review focuses on the progress of the regimens and major chemotherapy for refractory/relapsed AML(except M3).
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Leukemia, myeloid, acute; Refractory; Relapsed; Chemotherapy
Refractory (planetary science)
Regimen
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Hemorrhagic cystitis is a common stem cell transplantation-related complication. The incidence of early-onset hemorrhagic cystitis, which is related to the pretransplant conditioning regimen, has decreased with the concomitant use of mesna and hyperhydration. However, late-onset hemorrhagic cystitis, which is usually caused by the BK virus, continues to develop. Although the BK virus is the most common pathogenic microorganism of poststem cell transplantation late-onset hemorrhagic cystitis, pediatricians outside the hemato-oncology and nephrology specialties tend to be unfamiliar with hemorrhagic cystitis and the BK virus. Moreover, no standard guidelines for the early diagnosis and treatment of BK virus-associated hemorrhagic cystitis after stem cell transplantation have been established. Here, we briefly introduce poststem cell transplantation BK virus-associated hemorrhagic cystitis. Key words: Cystitis, Stem cell transplantation, BK virus, Child
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Nephrology
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