Huan Chen

Peking University People's Hospital, Peping, Beijing, China

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Publications (136)204.76 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Allogeneic hematopoietic stem cell transplantation (HSCT) is the most effective post-consolidation therapy and curative option for adult patients with Philadelphia chromosome-negative (Ph-negative) acute lymphoblastic leukemia (ALL) in first complete remission (CR1). A human leukocyte antigen (HLA)-haploidentical related donor (haplo-RD) is one of the most important alternative sources for those without HLA-identical sibling donor (ISD). The present study aimed to evaluate the outcomes of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in adult Ph-negative ALL CR1 patients (n=183). We produced an unmanipulated haplo-HSCT protocol including granulocyte colony stimulating factor (G-CSF) for all donors, intensive immune suppression, anti-thymocyte globulin, and combination of G-CSF-primed bone marrow harvest and G-CSF-mobilized peripheral blood stem cells harvest as the source of stem cell grafts. The median age for high-risk versus low-risk groups were 29 versus 23 years. Three-year incidences of relapse mortality and nonrelapse mortality for high-risk versus low-risk groups were 7.1% versus 11.1% (P = 0.498) and 18.0% versus 16.2% (P = 0.717), respectively. Three-year probabilities of disease-free survival and overall survival for high-risk versus low-risk groups were 67.6% versus 68.2% (P = 0.896) and 74.9% versus 72.7% (P = 0.981), respectively. Multivariate analysis showed that limited cGVHD and a lower pre-HSCT comorbidity burden were associated with better outcomes. In summary, comparable outcomes were observed among high- and low-risk Ph-negative ALL CR1 patients after haplo-HSCT. Haplo-RD could be considered for adults with Ph-negative ALL in CR1 as an important alternative source of donors in cases when no ISD is available. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 04/2015; 136(7). DOI:10.1002/ijc.29146 · 5.01 Impact Factor
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    ABSTRACT: We aimed to analyze the complications and survival associated with myeloablative haploidentical SCT in patients aged ≥50 years, and compare these results with a younger group population. In this case-control study, enrolled patients with leukemia were identified from 1262 patients between May 2002 and May 2013 at a single institution. Thirty-one patients were aged ≥50 years (the older group) and 165 patients were aged 18-49 years (the younger group). Of the older group, 20 out of 31 (64.5%) had a haematopoietic cell transplantation co-morbidity index (HCT-CI) of 0 or 2. Statistical analysis showed no significant differences in the incidences of grades II to IV acute GVHD, extensive chronic GVHD, and non-relapse mortality (NRM), or probability of relapse between the two groups. Furthermore, the 3-year overall survival (OS) and leukemia-free survival (LFS) were not significantly different between the older and younger groups: 67.0% ± 9.3% vs. 75.3 ± 3.4% (P = 0.406) and 60.5% ± 9.6% vs. 72.5% ± 3.5% (P = 0.183), respectively. Selected older patients aged ≥50 years with low HCT-CI and good performance status could safely undergo haploidentical SCT. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Transplantation 03/2015; DOI:10.1111/ctr.12545 · 1.49 Impact Factor
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    ABSTRACT: 86 adult inv(16) acute myeloid leukemia (AML) patients in the first complete remission (CR1) were serially monitored for CBFB-MYH11 transcript levels during the early courses of chemotherapy. 57 and 29 of them received chemotherapy/autologous SCT and allo-SCT after the second consolidation, respectively. For patients receiving chemotherapy/autologous SCT, the sole independent adverse prognostic factor for the cumulative incidence of relapse (CIR), disease-free survival (DFS) and overall survival (OS) was a CBFB-MYH11 level >0.2% after course 2 consolidation (p=0.003, 0.003 and 0.031), which was used to define a poor molecular response (MR). allo-SCT significantly decreased the 3-year CIR and increased the DFS and OS of patients with a poor MR (p<0.0001, 0.0001 and 0.045) but did not improve the outcome of good-MR patients (all p>0.05) compared with chemotherapy/autologous SCT. Therefore, allo-SCT could improve the outcome of adult inv(16) AML patient in CR1 with a poor MR during the early courses of chemotherapy.
    Leukemia & lymphoma 03/2015; DOI:10.3109/10428194.2015.1032964 · 2.61 Impact Factor
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    ABSTRACT: The role of haploidentical related allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) is not clear. We aimed to investigate the long-term survival of Ph+ ALL patients who underwent haploidentical donor (HID)-HSCT and to analyze the factors influencing relapse and survival after allo-HSCT. The study population included Ph+ ALL patients who underwent haploidentical related allo-HSCT. Additionally, Ph+ ALL patients who underwent human leukocyte antigen (HLA)-matched related donor (MRD) transplants during the same period were included to compare outcomes. BCR-ABL transcript levels were analyzed by using real-time quantitative reverse transcription polymerase chain reaction. Clinical data of 139 Ph+ ALL patients received allo-HSCT in our center was analyzed. Of these patients, 101 received HID transplants and 38 received MRD transplants. At a median follow-up of 36 months, the 5-year disease-free survival (DFS) and overall survival (OS) in the HID transplant group were 65.8% and 74.0%, respectively. The 5-year cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) for the HID transplant group were 20.3% and 15.6%, respectively. In addition, there were no differences in OS, DFS, CIR, and NRM between the HID and MRD groups. Multivariate analysis showed that imatinib resistance was a significant factor influencing DFS and CIR in HID transplant patients. Haploidentical HSCT for the treatment of Ph+ ALL achieves promising long-term survival, which is comparable to that of HLA-matched related HSCT. Imatinib resistance is a negative predictor of relapse and DFS after allo-HSCT. Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 02/2015; DOI:10.1016/j.bbmt.2015.02.009 · 3.35 Impact Factor
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    ABSTRACT: Acute graft-versus-host disease (aGVHD) is a major complication associated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Interleukin (IL)-35 is a novel anti-inflammatory cytokine that suppresses the immune response. This prospective study explored IL-35 plasma levels in 65 patients after HSCT. The results revealed that the peripheral blood of patients with grades III-IV aGVHD (23.46 ng/ml) had reduced IL-35 compared to transplanted patients with grades I-II aGVHD (40.26 ng/ml, p < 0.01) or patients without aGVHD (41.40 ng/ml, p < 0.05). Allografts, including granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood progenitor cell (PBPC) and G-CSF-primed bone marrow (GBM), from 38 patients were analyzed for IL-35 levels with respect to aGVHD. The patients who received lower levels of IL-35 cells in the GBM (28.0 ng/ml, p = 0.551) or lower levels of IL-35 in PBPC (53.46 ng/ml, p = 0.03) exhibited a higher incidence of aGVHD. Patients with aGVHD have increased platelet aggregation. IL-35 was added to patient blood in vitro, and platelet aggregation was inhibited by IL-35 in a dose-dependent manner. The markers of platelet activation (CD62P/PAC-1) can also be inhibited by IL-35. The results indicate that IL-35 may affect the development of aGVHD by inhibiting platelet activation and aggregation. Our data suggests that IL-35 represents a potentially effective therapeutic agent against aGVHD after allo-HSCT.
    Annals of Hematology 12/2014; DOI:10.1007/s00277-014-2278-7 · 2.40 Impact Factor
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    ABSTRACT: We examined the incidence, risk factors, treatment, and clinical outcomes of extramedullary relapse (EMR) in 961 acute leukemia patients undergoing human leukocyte antigen-haploidentical hematopoietic stem cell transplantation (haplo-HSCT) between 2002 and 2013. Multiple controls were selected at random from the same cohort and matched to EMR cases for diagnosis, disease status at HSCT, age at the time of the HSCT, and year of the HSCT. Forty patients exhibited EMR with a median time to EMR of 207 days. The cumulative incidence of EMR was 4.0% at 3 years, and the incidence was higher in acute lymphoblastic leukemia patients compared to acute myeloid leukemia patients (5.6% vs. 2.4%). In the multivariate analysis, non-complete remission (CR) status at HSCT (hazard ratio [HR]=4.6; P=0.018) and non-chronic graft-versus-host disease after HSCT (HR=3.2; P<0.001) were the independent risk factors for EMR after haplo-HSCT. A total of 27 patients received combination treatments, and the proportion of patients who achieved CR was higher than those who received single treatment. Multifocal involvement at EMR (HR=2.7; P=0.024) and non-CR after EMR treatments (HR=4.6; P<0.001) were the independent risk factors for poor survival rates among EMR patients. We found that graft-versus-leukemia effect may help to prevent EMR after haplo-HSCT.
    Biology of Blood and Marrow Transplantation 12/2014; DOI:10.1016/j.bbmt.2014.08.023 · 3.35 Impact Factor
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    ABSTRACT: In haploidentical hematopoietic stem cell transplantation (HSCT), the duration of graft-versus-host disease (GVHD) prophylaxis after modified donor lymphocyte infusion (DLI) was the only risk factor of DLI-associated grades 3-4 acute GVHD. However, the successful application of modified DLI depended not only on the reduction of severe GVHD, but also on the preservation of graft-versus-leukemia (GVL) effect. Therefore, this study was performed to compare the impact of prophylaxis for 6-8 weeks and prophylaxis for <6 weeks on GVL effect after modified DLI in haploidentical HSCT.
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    ABSTRACT: To investigate the impact of body mass index (BMI) before transplantation on clinical outcomes of haploidentical allogeneic stem cell transplantation (allo-HSCT). We performed a retrospective cohort study of 253 adult patients with acute or chronic leukemia who received haploidentical allo-HSCT from August 2008 to September 2011. All conditioning regimens were myeloablative and bulsufan based. Patients were stratified according to BMI values (low BMI group: <18 kg/m(2); normal BMI group: ≥ 18 and < 25 kg/m(2); overweight BMI group: ≥ 25 kg/m(2)). Other possible risk factors correlated with GVHD, relapse, transplant related mortality (TRM) and overall survival (OS) included age and gender of donor and recipient, HLA disparity, relationship between donor and recipient, diagnosis, status of disease, ATG dose in conditioning regime(10 mg/kg , 6 mg/kg), mononuclear cells (MNC), CD(+)34 and CD(+)3 cell amount from granulocyte colony-stimulating factor (G-CSF) primed bone marrow grafts (G-BM) and G-CSF mobilized peripheral blood grafts(G-PB). Cox regression analysis was used to determine the related risk factors. The median age of all 253 patients was 31 (18-56) years, including 128 cases with acute myeloid leukemia (AML), 95 cases with acute lymphocytic leukemia (ALL), and 30 cases with chronic myeloid leukemia (CML). According to primary diseases, 185 patients were classified in the standard -risk group and 68 cases in the high-risk group. Median follow-up time was 929 days (range: 48-1762 days) post-transplantation. Engraftment has been attainted 252 (99.6%) recipients with the median time of granulocyte and platelet recovery 12 days (ranging from 9 to 45 days) and 16 days (ranging from 7 to 180 days), respectively. Cumulative incidences of acute GVHD was 33.2% with median time of 25 days (range: 13-88 days) after transplant. Multivariate analysis identified that low BMI was associated with an increased risk of grade III-IV acute GVHD (HR = 5.736, 95%CI 1.779-18.491, P = 0.003). There was no significant impact of BMI to other manifestations of GVHD, TRM, relapse or OS in different groups. Our findings demonstrate a correlation between pre transplant BMI and clinical outcome post-transplant. Low BMI was associated with increased risk of severe acute GVHD in leukemia patients receiving haploidentical allo-HSCT. Meticulous supportive care pre-transplantation is required for low BMI patients.
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    ABSTRACT: To improve the understanding of treatment for graft failure by analyzing the efficacy of second transplantation for graft failure after first allogeneic stem cell transplantation (allo-HSCT).
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    ABSTRACT: Post-transplant lymphoproliferative disorder (PTLD) occurring after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare but severe. Risk factors including pre-HSCT exposure variables, conditioning regimens, transplant-related complications, and post-HSCT immune reconstitution were investigated in the development of PTLD after allo-HSCT.
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    ABSTRACT: Minimal residual disease (MRD)-directedmodified donor lymphocyte infusion (mDLI) is used to treat relapse after hematopoietic stem cell transplantation (HSCT). For patients who experience an unsatisfactory response tomDLI, relapse is usually inevitable. Therefore, we sought to evaluate the efficacy ofinterferon α therapy in these patients.
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    ABSTRACT: The best donor for a related donor for a HLA-haplotype-mismatched transplant for hematological neoplasms is controversial. We studied outcomes in 1210 consecutive transplant recipients treated on a uniform protocol. Younger donors and male donors were associated with less non-relapse-mortality (NRM; hazard ratio [(HR)=0.30; 95% confidence interval [CI] 0.01-0.39; P=0.008 and HR 0.65, 95% CI, 0.49-0.85; P=0.002) and better survival (HR=0.73; 95%CI, 0.54-0.97; P=0.033 and HR=0.73; 95%CI, 0.59-0.91; P=0.005). Father donors were associated with less NRM (HR=0.65; 95%CI, 0.45-0.95; P=0.02), acute graft-versus-host disease (GvHD) (HR=0.69; 95% CI, 0.55-0.86; P=0.001) and better survival (HR=0.66; 95%CI, 0.50-0.87; P=0.003) compared with mother donors. Children donors were associated with less acute GvHD than sibling donors (HR=0.57; 95% CI, 0.31-0.91; P=0.01). Older sister donors were inferior to father donors with regard to NRM (HR=1.87; 95%CI, 1.10-3.20; P=0.02) and survival (HR=1.59; 95%CI, 1.05-2.40; P=0.03). Non-inherited-maternal-antigen (NIMA)-mismatched sibling donors were associated with the lowest incidence of acute GvHD compared with parental donors and non-inherited-paternal-antigen (NIPA)-mismatched sibling donors. Specific HLA-disparities were not significantly correlated with transplant outcomes. Our data indicate which HLA-haplotype-mismatched related donors are associated with the best transplant outcomes in persons with hematological neoplasms.
    Blood 06/2014; DOI:10.1182/blood-2014-03-563130 · 9.78 Impact Factor
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    ABSTRACT: We compared total body irradiation (TBI,700 cGy)/cyclophosphamide (Cy,3.6g/m(2))/simustine (250mg/m(2)) plus anti-thymocyte globulin (ATG) (TBI/Cy plus ATG) with cytarabine (8 g/m(2))/intravenous busulfan (Bu,9.6mg/kg)/Cy (3.6g/m(2)) /simustine (250mg/m(2)) plus ATG (modified Bu/Cy plus ATG) as preparative therapy in T-cell-replete haploidentical hematopoietic stem cell transplantation (haplo-HSCT) for acute leukemia. From August 2009 to August 2013, 38 consecutive patients using TBI/Cy plus ATG regimen for T-cell-replete haplo-HSCT (TBI group) at our center were eligible, which contained 28 high-risk and 10 standard-risk patients. A nested case-control study was designed. Seventy-seven patients using modified Bu/Cy plus ATG regimen (Bu group) were randomly selected in a 1-3:1 ratio with matching for age, the disease and status, the year of HSCT (±2 years) and the length of follow-up. Only one graft failure occurred in TBI group. The incidence and time of neutrophil and platelet engraftment were comparable between the two groups. Severe grade III/IV GVHD was observed in 13.4% of Bu group and only 2.6% of TBI group (P=0.083). More toxicity of the liver (37.7% vs. 10.5%; P=0.002) and more hemorrhagic cystitis occured in Bu group (49.3% vs. 23.7% ,P=0.008). Diarrhea was more common in TBI group (44.7% vs. 22.1%; P= 0.031). There was no significant difference in the 2-year incidences of relapse (26.5 % for TBI group vs. 32.3 % for Bu group, P=0.742), the 1-year transplant-related mortality (12.6% vs. 16.2 %, P=0.862), the 2-year overall survial (60.2% vs. 57.0%, P=0.937) and the 2-year incidence of disease-free survial (57.9 % vs. 56.6 %, P=0.845) between the two groups.We conclude that the TBI/Cy plus ATG regimen seems to be feasible in T-cell-replete haplo-HSCT, with promotes stable engraftment,a lower incidence of liver toxicity and hemorrhagic cystitis.However, longer follow-up is necessary to determine the late relapse rate and late toxicity.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 04/2014; DOI:10.1016/j.bbmt.2014.04.012 · 3.35 Impact Factor
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    ABSTRACT: To compare the efficacy of haploidentical hematopoietic stem cell transplantation (HSCT) with chemotherapy alone in adult standard-risk acute lymphoblastic leukemia (ALL) in first complete remission (CR1). Consecutive 138 adult patients with standard-risk ALL in CR1 were retrospectively investigated. Out of these patients, 59 received chemotherapy alone (Group A), and 79 received unmanipulated haploidentical HSCT (Group B). Cumulative incidence of relapse at 5 years in Group A was significantly higher than Group B (66.3%vs.29.9%,P<0.0001). The OS and DFS in Group A were significantly inferior to Group B (P<0.0001). Moreover, multivariate analyses demonstrated that central nervous system leukemia (P=0.002), T-cell immunophenotype (P=0.044), expression of E2A-PBX1 (P=0.007) and minimal residual disease-positive after the 1(st) cycle of consolidation (P=0.004) were correlated with relapse. Patients with one of four risk factors were assigned to high-risk group. Otherwise, patients without risk factors were assigned to low-risk group. In high-risk group, HSCT had lower relapse rate and superior DFS compared with chemotherapy (P<0.05), but in low-risk group, there were no differences between HSCT and chemotherapy (P>0.05). This study is the first to demonstrate that, compared with chemotherapy alone, haploidentical HSCT is a better post-remission therapy in adult standard-risk ALL in CR1. Moreover, based on the four risk factors, the establishment of risk-stratification could identify the subgroup of patients with higher risk of relapse in adult standard-risk ALL in CR1. Furthermore, risk-stratification directed post-remission therapies using haploidentical HSCT or chemotherapy alone not only reduce relapse rate, but also avoid unnecessary treatment-related mortality and improve survival.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 04/2014; 20(9). DOI:10.1016/j.bbmt.2014.04.011 · 3.35 Impact Factor
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    ABSTRACT: To evaluate the molecular response and prognostic factors of patients with Philadelphia chromosome/BCR-ABL-positive acute lymphoblastic leukaemia (Ph⁺ ALL) treated by imatinib with chemotherapy. From May 2006 to July 2012, 82 adult Ph⁺ ALL patients were enrolled in the study. Forty-eight patients combined imatinib in, and 34 patients after induction therapy. Forty-nine patients underwent allogeneic hematopoietic stem cell transplant (allo-HSCT) after 3 to 5 cycles of consolidation therapy. The molecular response of BCR-ABL mRNA was evaluated by real-time quantitative PCR in every chemotherapy course ending. The complete remission (CR) rate after the first cycle of induction chemotherapy was 76.8% (63/82), with overall CR rate of 92.7% (76/82). The CR rate in the patients combined imatinib in was higher than of those combined imatinib after the first cycle of induction chemotherapy (93.8% vs 52.9%, P<0.001). 55.3% patients BCR-ABL decreased >1 log after induction therapy. Among 76 CR patients, cumulative incidence of relapse was 27.6%, the probabilities of disease-free survival (DFS) and overall survival (OS) at 3 years were 60.5% and 70.2%, respectively. allo-HSCT was an independent favorable factor for decrease of leukemia relapse (P<0.001). allo-HSCT, imatinib combined in the first cycle of induction therapy and female were independent favorable factors for DFS (P<0.01, 0.05 and 0.01, respectively), BCR-ABL mRNA reduction at least 1 log from baseline after the first induction therapy and allo-HSCT were independent favorable factors for OS (P=0.011 and 0.027, respectively). Imatinib combined in the first cycle of induction therapy, BCR-ABL mRNA reduction at least 1 log from baseline after the first induction therapy and allo-HSCT improved outcomes of Ph⁺ ALL patients.
    Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi 02/2014; 35(2):120-125. DOI:10.3760/cma.j.issn.0253-2727.2014.02.013
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    ABSTRACT: Cancer-testis (CT) antigen genes might promote the progression of multiple myeloma (MM). CT antigens may act as diagnostic and prognostic markers in MM, but their expression levels and clinical implications in this disease are not fully understood. This study measured the expression levels of four CT antigen genes in Chinese patients with MM and explored their clinical implications. Real-time quantitative polymerase chain reaction (qPCR) was used to quantify the expression of MAGE-C1/CT7, MAGE-A3, MAGE-C2/CT10 and SSX-2 mRNA in 256 bone marrow samples from 144 MM patients. In the newly diagnosed patients, the positive expression rates were 88.5% for MAGE-C1/CT7, 82.1% for MAGE-C2/CT10, 76.9% for MAGE-A3 and 25.6% for SSX-2. The expression levels and the number of co-expressed CT antigens correlated significantly with several clinical indicators, including the percentage of plasma cells infiltrating the bone marrow, abnormal chromosome karyotypes and the clinical course. MAGE-C1/CT7, MAGE-A3, MAGE-C2/CT10 and SSX-2 expression levels provide potentially effective clinical indicators for the auxiliary diagnosis and monitoring of treatment efficacy in MM.
    Molecular Cancer 02/2014; 13(1):25. DOI:10.1186/1476-4598-13-25 · 5.40 Impact Factor
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    ABSTRACT: To evaluate the efficacy and optimize the timing of allogeneic hematopoietic stem cell transplantation (allo-HSCT) from human leukocyte antigen (HLA)-identical siblings for myelodysplastic syndrome (MDS). From January 2003 to December 2012, 95 patients with MDS or secondary acute myeloid leukemia (AML) were treated with HLA-identical allo-HSCT in our hospital. The median age was 43 (21-59) years. Conditioning regimens including modified busulfan (Bu)/cyclophosphamide (Cy) or Bu/ fludarabine (Flu) were used. All patients received transfusion of donor stem cells mobilized by granulocyte colony-stimulating factor (G-CSF) from bone marrow and/or peripheral blood. Eleven patients had refractory anemia (RA) or RA with ringed sideroblasts, 53 of RA with excess blasts (RAEB), 15 of RAEB in transformation (RAEB-t), and 16 progressing to secondary AML. A total of 93 patients achieved sustained myeloid engraftment. The cumulative incidence of grade II-IV acute graft versus host disease (aGVHD) was 12.9% ± 3.5%. The 3-year cumulative incidence of chronic graft versus host disease (cGVHD) was 80.3% ± 4.9%. After a median follow-up of 28.7 months, 29 patients died. The 3-year estimated overall survival (OS) and disease-free survival (DFS) rates were 69.9% ± 5.0% and 58.0% ± 5.4% respectively. The cumulative relapse rate (RR) was 25.9% ± 4.7%, while non-relapse mortality (NRM) was 16.1% ± 4.0%. Multivariate analyses showed that non II-IV aGVHD and cGVHD were favorable factors associated with OS. Low DFS rate was correlated with high scores of international prognostic scoring system (IPSS). Patients with RAEB-t and AML (n = 31) were divided into 3 groups: no chemotherapy before HSCT (Group 1), chemotherapy but not achieving remission (Group 2) and chemotherapy and achieving remission (Group 3). The 3-year OS rate was 100.0% in Group 3, which was significantly higher than those of Groups 1 and 2 with 33.9%, 32.7% respectively (P < 0.05). The difference of DFS and RR in the three groups did not reach statistic difference. Allo-HSCT from HLA-identical siblings is effective for patients with MDS. IPSS is of prognostic value for post-transplantation outcome. For patients with progressive disease before transplantation, maximal control of blasts in bone marrow may improve the prognosis of advanced MDS.
    Zhonghua nei ke za zhi [Chinese journal of internal medicine] 02/2014; 53(2):89-93.
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    ABSTRACT: To compare the clinical characteristics and prognosis of acute graft-versus-host disease (aGVHD) between patients undergoing human leukocyte antigen (HLA)-identical and HLA-mismatched allogeneic hematopoietic stem cell transplantation (allo-HSCT). Cinical data of 544 patients receiving related allo-HSCT in Institute of Hematology of Peking University from January 2010 to December 2011 were retrospectively analyzed. The clinical features of aGVHD including manifestations and prognosis between HLA-identical and HLA-mismatched transplantation were compared. The cumulative incidence of aGVHD in related HLA-mismatched transplant was 50.2%, which was significantly higher than that of HLA-identical transplant (20.4%, P < 0.001). However, the cumulative incidence of grade III°-IV° aGVHD between the two groups was comparable (4.5% vs 6.8%, P = 0.066). Gut aGVHD accounted for 31.1% in HLA-identical transplant while cutaneous aGVHD was the dominant area in HLA-mismatched transplant (66.5%). The incidence of gut and liver aGVHD in HLA-mismatched patients was also lower than that in HLA-identical patients. The proportion of patients with aGVHD accompanied by fever was higher in HLA-mismatched patients than in HLA-identical patients (47.6% vs 28.9%, P = 0.028). The cure rate of aGVHD in identical transplant was lower than that in mismatched transplant, especially for grade III°-IV° aGVHD. The complete remission rate after second-line anti-GVHD therapies was lower than that of mismatched transplant (88.9% vs 98.8%, P = 0.006). More patients died of aGVHD in identical transplant compared with mismatched transplant (11.1% vs 2.4%, P = 0.024). More patients who received HLA-mismatched allo-HSCT develop into aGVHD compared with HLA-identical transplant. But the incidence of severe aGVHD between HLA-identical and -mismatched is comparable. The overall cure rate of HLA-mismatched transplant is significantly higher than that of HLA-identical transplant.
    Zhonghua nei ke za zhi [Chinese journal of internal medicine] 01/2014; 53(1):35-9.
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    ABSTRACT: The aim of this study was to develop and investigate the significance of a new multi-factor risk score system to predict the outcome of patients with hematological malignancies received allogeneic hematopoietic stem cell transplantation (allo-HSCT). The impact of pre-, peri-, and post-transplant factors on the outcome including overall survival (OS), disease-free survival (DFS), relapse and transplant-related mortality (TRM) after allo-HSCT were retrospectively analyzed in 122 patients with hematological malignancies at our center. A new risk score system based on the independent risk factors was established and tested. The results showed that absolute monocyte count at day 30 after transplantation (AMC-30, ≥ 536 cells/µl) [hazard ratio (HR) = 0.313, 95% confidencial interval (CI):0.156-0.63], WT1( ≥ 1.0%) (HR = 3.268, 95% CI:1.644-6.499), pre-transplant risk grouping (HR = 1.999, 95% CI = 0.993-4.023) were independent prognostic factors of OS and DFS. Patients were divided into 3 groups based on the risk scoring system:group A (no risk factor; score 0), group B (1 risk factor; score 1) and group C (2-3 risk factors; score 2-3). OS at 5 years were 95.1% ± 3.4%, 62.9% ± 6.6% and 36.1% ± 9.6%, respectively (P < 0.0001). DFS at 5 years were 92.6% ± 4.9%, 60.4% ± 6.8% and 15.4% ± 7.1%, respectively (P < 0.0001). The akaike information criterion(AIC) value of the new score system for OS was 331, less than those of AMC-30, WT1, and pre-transplant risk group (346, 343, 346), AIC value for DFS and relapse were 378 and 231, both less than the three single elements(417, 397, 411 and 268, 238, 257). It is concluded that the risk scoring system based on AMC-30, WT1, pre-transplant risk grouping is more highly predictive for clinical outcomes of allo-HSCT than any one of the three single elements.
    Zhongguo shi yan xue ye xue za zhi / Zhongguo bing li sheng li xue hui = Journal of experimental hematology / Chinese Association of Pathophysiology 01/2014; 22(1):117-24.

Publication Stats

775 Citations
204.76 Total Impact Points

Institutions

  • 2004–2015
    • Peking University People's Hospital
      Peping, Beijing, China
  • 2003–2015
    • Peking University
      • Institute of Hematology
      Peping, Beijing, China
  • 2010–2012
    • Beijing University of Technology
      Peping, Beijing, China
  • 2008
    • Linyi People's Hospital
      Yichow, Shandong Sheng, China
  • 2006
    • Medical College of Wisconsin
      Milwaukee, Wisconsin, United States