OBJECTIVE To study the long-term efficacy and safety of CD19 chimeric antigen receptor T cells (CAR-T) in the treatment of relapsed patients with B-cell acute lymphoblastic leukemia (ALL) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS A total of 7 patients with B-cell ALL relapsed after allo-HSCT were treated with CD19 CAR-T cells from September 2015 to March 2018. Among them, 6 had hematological recurrence and 1 had positive of MRD. They all were treated with a single infusion of CAR-T cells. FC chemotherapy regimen was administered before transfusion. The median number of CAR-T cells transfused was 6.0 (range 4.0-8.6) )×106/kg. Long-term efficacy and toxicity were evaluated. RESULTS Bone marrow examination performed at d 30 after CAR-T infusion showed that all 7 patients achieved complete remission and MRD negative, grade I CRS for 1 case and grade II CRS for 6 cases, two of them had mild neurotoxicity, which was controlled by treatment. Two patients presented grade VI intestinal GVHD after CAR-T infusion. The median follow-up time was 18 months (range 12-42). Follow-up showed that two patients relapsed at 9 months and 14 months after treatment, out of 2 patients one died of progressive disease and the other reachived the hematological remission, but MRD was positive after CD22 CAR-T cell therapy. At present, five patients are disease-free survival, moreover showed complete donor chimerism. One year after CAR-T cell therapy, the results of immune reconstitution showed that CD4 level was more than 300×106/L in 5 patients who disease-free survived. Among them, 3 patients had poor recovery of immunoglobulin and received gamma globulin replacement therapy. CONCLUSION All patients are followed up for at least one year. The preliminary efficacy and safety are satisfactory. CAR-T cell infusion is an effective method for the treatment of B-ALL recurrence after allo-HSCT.

Angiogenesis is important in pathophysiological processes, including the pathogenesis of acute monocytic leukemia (AML). MicroRNA‑21 (miR‑21) is overexpressed and exhibits oncogenic activity in cancer. However, the biological mechanism underlying the effect of miR‑21 in AML remains to be fully elucidated. In the present study, the expression levels of miR‑21 and vascular endothelial growth factor (VEGF) were determined in 26 patients with AML and 28 healthy individuals. The secretion of VEGF was also measured following the transfection of THP‑1 cells with miR‑21 mimic or inhibitor. The supernatants of the THP‑1 cells, which were transfected with miR‑21 mimic, inhibitor or small interfering RNA (si)VEGF, respectively, were used to incubate human umbilical vein endothelial cells (HUVECs), following which tube formation of the HUVECs was measured. miR‑21 targets were predicted using a biological target prediction website and confirmed using a luciferase assay. The effects of interleukin (IL)‑12 were investigated by examining the tube formation of HUVECs and the secretion of VEGF following recombinant human (rh) IL‑12 pretreatment. The results revealed that miR‑21 and VEGF expression was significantly increased in the peripheral blood monocytes of the patients, compared with the healthy controls. There was negative correlation between the expression of IL‑12 and miR‑21 in the serum of patients with AML. Furthermore, supernatant VEGF levels from the miR‑21 mimic‑transfected THP‑1 cells were increased, whereas a decreasing trend was observed in the miR‑21 inhibitor group. The angiogenic ability of the HUVECs pretreated with supernatant from the THP‑1 cells transfected with miR‑21 mimic was higher, and was lower in THP‑1 cells co‑transfected with miR‑21 mimic and siVEGF, compared with the miR‑21 mimic only group. A luciferase assay demonstrated that IL‑12 was the direct target of miR‑21, and the level of IL‑12 in the supernatant of THP‑1 cells transfected with miR‑21 mimic was increased. IL‑12 pretreatment increased VEGF expression and angiogenic ability in HUVECs. The inactivation of miR‑21 or activation of its target gene may be a potential therapeutic strategy in human AML.

Acute leukemia (AL) is the most popular malignant tumor in children. Currently little has been known about the relationship between childhood AL pathogenesis and whole-genome methylation level. As the polymorphism of DNA methyltransferase (DNMT) gene can affect DNA methylation level, we investigated the whole genome methylation level in childhood AL patients. Meanwhile, the relationship between DNMT1 gene polymorphism and susceptibility of childhood AL was also been investigated. A case-control study was performed recruiting childhood AL patients and age-matched healthy children (N=168 each). PCR-ligase detective response (PCR-LDR) typing method was used to study the genotype distribution of human DNMT1 gene at rs2228611 and rs10854076 loci. Pyrophosphate sequencing was used to measure LINE-1 methylation level. Allele frequency of two loci fits HardyWeinberg equilibrium (P>0.05). Significant difference of genotype and allele frequency existed at locus rs10854076 but not locus rs2228611 between patients and healthy people. Allele C was found to be a risk factor for AL. A significant difference of LINE-1 methylation level existed between the two groups, as AL patients had lower methylation level (P<0.05). Specifically, LINE-1 methylation level at locus rs10854076 but not at rs2228611 had significant difference between patients and controls. Polymorphism of DNMT1 gene at locus rs10854076 is related with children AL susceptibility, possibly via affecting LINE-1 methylation level.

AIMS:To investigate the association of several single nucleotide polymorphisms (SNPs) within vascular endothelial growth factor (VEGF) and vitamin D receptor (VDR) gene polymorphisms and additional gene- gene and gene- smoking interaction with multiple myeloma (MM) risk in Chinese population. METHODS:Generalized multifactor dimensionality reduction (GMDR) was used to screen the best interaction combination among SNPs and smoking. Logistic regression was performed to investigate association between 6 SNPs within VEGF and VDR gene, additional gene- gene and gene- smoking interaction on MM risk. RESULTS:MM risk is significantly higher in carriers with the rs699947- A allele within VEGF gene than those with CC genotype (CA+ AA versus CC), adjusted OR (95%CI) =1.72 (1.19-2.33), and higher in carriers with rs2228570- T allele within VDR gene than those with CC genotype (CT+ TT versus CC), adjusted OR (95%CI) = 1.68 (1.26-2.17). We also found a significant two-locus model (p=0.0010) involving rs699947 and rs2228570, and a significant two-locus model (p=0.0107) involving rs2228570 andsmoking. Participants with rs699947- CA+AA and rs2228570- CT+TT genotype had the highest MM risk, compared to participants with rs699947- CC and rs2228570- CC genotype, OR (95%CI) = 3.12 (1.82 -4.61). Smokers with rs2228570- CT+TT genotype had the highest MM risk, compared to never- smokers with rs2228570- CC genotype, OR (95%CI) = 3.27 (1.74-4.86). CONCLUSIONS:We found that the A allele of rs699947 within VEGF and T allele of rs2228570 within VDR gene, interaction between rs699947 and rs2228570, rs2228570 andsmoking were all associated with increased MM risk.

Objective To evaluate the efficacy of post-transplantation cyclophosphamide for tolerance induction in post-transplantation for severe aplastic anemia(SAA)and to observe the effects of cyclophosphamide on hematopoietic stem cells in animal experiments. Method 16 patients with severe aplastic anemia who underwent allo-HSCT were enrolled. All patients received fludarabine, CY, busulfan, and ATG as conditioning before allo-HSCT. On days 3 and 4 after transplantation combined with 50 mg/(kg·d) of cyclophosphamide. Animal experiments with three doses of 100,200,380 mg/kg respectively by intraperitoneal injection of cyclophosphamide BALB/c mice, and dynamic observe of the formation of CFU-GM and BFU-E between groups of mice.Result All patients, one case died of engraftment failure, the rest of the 15 patients all engraftment success. All mice survived in animal experiments, the experimental group and control group of BFU -E and CFU-GM colony formation of no significant difference (P>0.05), and had no obvious difference between the experimental group (P>0.05).Conclusion Use of cyclophosphamide induction of immune tolerance for SAA after transplantation is a feasible method, animal experiments cyclophosphamide has no damage effect on bone marrow hematopoietic stem cells in mice SAA cyclophosphamide induction of immune tolerance for clinical treatment.

The study was aimed to explore the efficacy and safety of allo-HSCT with high-dose cyclophosphamide-induced immune tolerance for SAA. In the present study, 20 cases (12 male, 8 female; average age = 17.8 years) received reduced-intensity conditioning allo-HSCT from August 2012 to August 2014 in the Beijing Military Region General Hospital. All were HLA mismatched and received CSA; 11 received ATG-intensive immune therapy. Donors underwent mobilization with cell colony-stimulating factor. The modified preconditioning regimen included reduced-strength fludarabine combined with Busulfex and cytarabine, cyclophosphamide. Cyclophosphamide (50 mg/kg/d) induced immune tolerance 3 days after transplantation and was combined with immunosuppressive agents, including CSA, MTX, and FK506, for GVHD prophylaxis and the management of observed toxicity, GVHD and DFS. Hematopoietic reconstitution was achieved in 17 cases and engraftment after a second transplantation in an additional three cases. The average times to engraftment were 17.4 and 21.3 days, respectively, with neutrophils ≥0.5 × 109/L and platelets ≥20 × 109/L. Engraftment was confirmed by the evidence of 100 % donor hematopoiesis; T lymphocyte subset counts also increased significantly after transplantation. During follow-up monitoring to April 2015 (median duration = 17.7 months), three patients died of complications, while the other 17 showed disease-free survival (DFS rate = 85 %; longest DFS period = 32 months). Reduced-intensity allo-HSCT with high-dose cyclophosphamide-induced immune tolerance treatment is effective for SAA and can be the key technology extensively used in clinic, but its efficacy needs to be confirmed further with prospective randomized study with increased sample size.

Objective To evaluate the relationship between the amount of grafted cells and the incidence of acute graft versus host disease (aGVHD) after haploid hematopoietic stem cell transplantation (haplo-HSCT). Methods Data of 68 patients who underwent haplo-HSCT from Jan 2009 to Dec 2013 were analyzed retrospectively. Influences of different factors on the incidence of Ⅲ-Ⅳ degree of aGVHD after HSCT were evaluated. Results 68 patients including 42 males and 26 females were 5/10-9/10 HLA match with 19 father donors, 24 mother donors, 16 sibling donors and 9 children donors. 51 patients not suffered Ⅲ-Ⅳdegree of aGVHD included 32 males and 19 females with the mean age of 20 years old (5-55 years old). 17 patients sufferedⅢ-Ⅳdegree of aGVHD including 10 males and 7 females with the mean age of 23 years old (5-54 years old). There were no significant differences in the amount of the grafted mononuclear cells (MNC) and CD34+cells, and the white blood cell counts (WBC) and platelet count (Plt) recovered time between two groups (P>0.05). However, MNC number was related to CD34+cell number (P<0.05) and WBC recover time (P<0.05), and the CD34+cells number was related to WBC and Plt recover time (P< 0.05). Conclusion The incidence of Ⅲ-Ⅳ degree of aGVHD is unrelated to the amount of grafted MNC, and CD34+cells.

OBJECTIVE:To evaluate the relationship between T lymphocyte subsets and the incidence of graft-versus-host disease (GVHD) and its clinical significance of monitoring the changes of T lymphocyte subsets dynamicly on 1, 3, 6, 12 month after allogeneic hematopoietic stem cell transplantation (allo-HSCT).METHODS:Twenty cases received allo-HSCT in Department of Hematology of General Hospital of Beijing Military Command from January 2013 to January 2014, including 10 males and 10 females with average age of 20.3 years (3-46 years old), among them 4 cases rectived HLA matched transplantation and 16 cases rectived HLA mismatched transplantation. The levels of T lymphocyte subsets including CD3(+), CD4(+), CD8(+), CD4(+)/CD8(+), CD4(+)CD25(high) FOXP3(+) in the peripheral blood were manitored with flow cytometry (FCM) on +1, +3, +6, +12 month after transplantation dynamicly.RESULTS:(1) Follow up to March 2015, the levers of CD3(+), CD4(+), CD8(+), CD4(+)/CD8(+), CD4(+) CD25(high) FOXP3(+) showed a different degree of recovery after transplantation for all cases and returned to the lever of pre-transplantation on 12 month basically, and CD8(+) T cells recovered earlier than CD4(+) T cells, while the decrease of CD4(+) T cells lasted more than 1 year; The proportion inversion of CD4(+)/CD8(+) also lasted for more than 1 year;(2) The level of CD4(+) CD25(high) FOXP3(+) in patients with acute GVHD was lower than that in patients without acute GVHD.CONCLUSION:The dynamic monitoring of the T lymphocyte subsets, especially CD4(+) CD25(high) FOXP3(+) after transplantation has importent clinical significance, it can forecast the incidence of acute GVHD before symptoms appeared; the dynamic monitoring of the T-lymphocyte subsets also can be used as reference indicator for prediction of GVHD, theraby it can reduce mortality of patients after transplantation.

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.

OBJECTIVE:To investigate the efficacy and safety of haploidentical allo-HSCT in combination of reduced intensity preconditioning combined with cyclophosphamid (CTX)-induced immune tolerance after transplanitation for treatment of severe aplastic anemia (SAA).METHODS:A total of 15 patients with SAA received the haploidentical allo-HSCT of reduced intensity preconditioning combined with CTX-induced immune tolerance after transplartation in the General hospital of Beijing military command of chinese PLA from June 2012 to December 2014. The reduced intensity preconditioning regimen consisted of CTX, fludarabine, busulfex and amti-lymphocyte immunoglobin; the immune tolerance was induced with CTX (50 mg/kg·d) on day 3 after transplantation; the HSC donors were father and mother of patients. The GVHD was prevented by inmunosuppression consisted of cyclosporine A(CsA), methotrexate and tacrolimus. The aduvese reaction and disease-free survival (DFS) were observed in all the patients.RESULTS:All the SAA patients achieved hematopoietic reconstitution with 100% donor hematopoiesis, and all the T lymphocyte subsets increased. Out of 15 patients, 3 cases died of complication, and the DFS rate was 80% with a median follow-up of 19.8 month (6-36 months).CONCLUSION:The haploidentical allo-HSCT of reduced intensity preconditioning combined with CTX-induced immune tolerance after transplantation is safet and effective for SAA patients, that may be applied to clinical therapy.

Objective To explore the clinical significance of the relationship between the immune function and the pathogenesis of aplastic anemia in children with aplastic anemia(AA),along with the incidence of graft versus host disease (GVHD)by monitoring the changes of T lymphocyte subsets dynamically in +1 ,+3,+6,+1 2 months for blood disease patients after allogeneic hematopoietic stem cell transplantation.Methods Twelve AA patients re-ceived allogeneic hematopoietic stem cell transplantation in Department of Hematology,the Affiliated General Hospital of Beijing Military Region of Anhui Medical University,from January 201 3 to January 201 4,including 4 male and 8 fe-male,with average age of 7.92 years old(3 -1 4 years old)with 5 cases of human leukocyte antigen(HLA)matched and 7 cases of HLA mismatched.The level of T lymphocyte subsets including CD3 +,CD4 +,CD8 +,CD4 +/CD8 +, CD56 +,CD4 +CD25 high +FOXP3 +were monitored with flow cytometry before transplantation and in +1 ,+3,+6,+1 2 months after transplantation dynamically in the peripheral blood.While in the same period the level of T lymphocyte subsets was monitored in 1 2 cases of healthy children at the same period as the healthy control group.Results Fol-lowed up to March 201 5,1 0 cases had abnormal cellular immunity (CD4 +/CD8 + ratio inversion)in the 1 2 AA pa-tients.Compared with the control group,in the AA group,CD3 + was slightly higher,(66.79 ±7.35)% and (62.74 ± 5.58)% respectively(P =0.043),CD4 + was decreased by (33.73 ±7.26)% and (39.54 ±3.46)% respectively (P =0.037),CD8 + was increased by (35.69 ±6.78)% and (25.34 ±4.36)%,respectively (P =0.000),CD4 +/CD8 + decreased by 1 .23 ±0.56 and 1 .78 ±0.34 respectively(P =0.001 )and CD56 + was decreased by (7.46 ± 2.80)% and (1 6.73 ±3.70)% respectively(P =0.000),CD4 +CD25 high +FOXP3 + was decreased by (3.3 ± 1 .5)% and (8.1 ±1 .3)% respectively (P =0.003),whose difference was statistically significant (P <0.05).The lever of CD3 +,CD4 +,CD8 +,CD4 +/CD8 +,CD56 +,CD4 +CD25 high +FOXP3 + had a different degree of recovery after transplantation for all cases and returned to normal in +1 2 months basically.In +1 ,+3,+6,+1 2 months after transplantation,the levels of CD4 +CD25 high +FOXP3 + in GVHD positive group and negative group were (0.4 ± 0.6)% and (1 .6 ±0.7)% respectively,(0.7 ±0.3)% and (2.7 ±0.4)% respectively,(1 .1 ±0.5 )% and (2.9 ±0.7)% respectively,(1 .4 ±0.3)% and (3.6 ±0.2)% respectively,which had statistical significance (P <0.05).Conclusions There was abnormal cell immune function in some cases with AA.After transplantation,the level of CD4 +CD25 high +FOXP3 + is closely related to the acute GVHD,which can be used to predict the occurrence of GVHD.

Objective: In this study, we performed an updated meta-analysis by summarizing all available relevant association studies to evaluate whether the murine double minute-2 (MDM2) T309G polymorphism is associated with risk of leukemia and to determine its prognostic effect. Material and Methods: Studies published in PubMed, Embase and the Cochrane Controlled Trial Register were searched till June 2014 using the search terms ‘MDM2', ‘polymorphism' and ‘leukemia'. Results: Eleven studies were included in this meta-analysis, with a total of 2,478 patients accrued. There were 8 studies providing data on single nucleotide polymorphism at position 309 (SNP309) and risk of leukemia and 7 studies providing data on SNP309 and overall survival. Our analysis showed that patients having G/G mutations had a significantly higher risk of developing leukemia (HR 1.90, 95% CI 1.56-2.31, p < 0.00001), while the association between G/T and leukemia was not significant (HR 1.18, 95% CI 0.96-1.45, p = 0.11). In addition, SNP309 was not significantly associated with patient survival (HR 1.29, 95% CI 0.79-2.13, p = 0.31). Conclusions: Our meta-analysis showed that the MDM2 T309G variation, especially homozygous G/G, might be associated with an increased risk of leukemia. Additional studies are needed to confirm the findings as well as to understand the underlying mechanisms.

Objective To explore the efficacy and safety of haplotype allogeneic stem cell transplantation (allo-HSCT) in the treatment of relapsed or refractory T cell lymphoma .Methods 6 patients with relapsed or refractory T cell lymphoma were treated with haplotype allo-HSCT.All patients received various chemotherapy regimens had not achieved remission or relapsed be -fore transplantation.Haplotype donors received granulocyte colony -stimulating facto mobilization,stem cell transplantation was col-lected from both peripheral blood and bone marrow .All patients were treated with pretreatment consisting of idarubicin 、fludara-bine、 busulfan、 ATG and total body irradiation, combined immunosuppressive agents were used for graft -versus-host disease (GVHD) prophylaxis,including cyclosporine A and amethopterin .Toxicities、GVHD and disease-free survival in patients after transplantation were observed.Results All of the patients achieved hematopoietic reconstitution ,the average time were 17.3 d and 20.3 d respectively with neutrophils ≥0.5 ×10 9 /L and platelets≥20 ×10 9 /L.Implantation was confirmed by the evidence to be 100% of donor hematopoiesis.Follow-up till November 2014,the median follow-up was 24.0 months (8 ~40 months),2 cases died of recurrence and the other 4 cases remained disease-free survival,disease-free survival rate was 66.7% and the longest dis-ease-free survival was 40 months.Conclusion Allo-HSCT for relapsed or refractory T cell lymphoma is effective and safe ,it can be used extensively in clinical.

Objective To compare the effects of HLA-haploidentical related donors (RD) and unrelated donors (URD) hematopoietic stem cell transplantations (HSCTs) for leukemia.Methods Ninety-three leukemia patients who underwent allogenic HSCT were divided into two groups including 51 cases of HLA-haploidentical RD-HSCT and 42 cases of URD-HSCT.In the RD-HSCT group, a preconditioning regimen with fludarabine (Flu)+busulfan (Bu)+cytosine arabinoside (Ara-C) was employed for 42 cases and total body irradiation (TBI)+Flu+Ara-C for the rest of the 9 cases.In the URD-HSCT group, the modified preconditioning regimen with Bu+cyclophosphamide (Cy) was employed in 35 cases, while the other 7 cases underwent the treatment of TBI+Flu.Results After transplantation, the mean time of reaching the neutrophil count of more than 0.5×109/L was 12.5 and 16.2 days, while the mean time of attaining platelet count of more than 20×109/L was 17.5 and 20.3 days in the RD-and URD-HSCT groups, respectively.The occurrence rates of grade Ⅱ-Ⅳ acute graft-versus-host disease (aGVHD) were 46.0 ％ (23/50) and 51.2 ％ (21/41) in the RD-and URD-HSCT groups, respectively, and the rates of chronic GVHD (cGVHD) were 46.0 ％ (23/50) and 63.4 ％ (26/41), respectively.Furthermore, the mortality rates of GVHD were 6.0 ％ (3/50) and 17.1％ (7/41) in the RD-and URD-HSCT groups, respectively.No significant difference in the occurrence of aGVHD (P =0.773), cGVHD (P =0.529) and mortality of GVHD (P =0.113) was detected between the two groups.The recurrence rate after transplantation, three-year survival rate and disease-free survival rate were 17.6 ％, (56.3±7.0) ％ and (63.1±5.8) ％ in HLA-haploidentical RD-HSCT group, and 11.9 ％, (48.2±7.7) ％ and (62.3±9.4) ％ in URD-HSCT group, respectively.There were no significant differences between the two groups (P =0.653, P =0.318 and P =0.661).Conclusion HLA-haploidentical RD-HSCT with enhanced preconditioning and administration of immunosuppressants shows the similar clinical efficacy to URD-HSCT in the battle against leukemia, without the risk of increasing infection and GVHD incidence.

Objective To explore efficacy and safety of haploid allogeneic hematopoietic stem cell transplantation (allo-HSCT) for the children with relapsed or refractory acute lymphoblastic leukemia.Methods 20 cases of childhood acute lymphoblastic leukemia treated with haploid allo-HSCT were collected in Beijing Military General Hospital Hematology from Jan 2010 to Jan 2013,including 12 males and 8 females,with median age 9 (1-14) years old.There were 14 cases of B-ALL and 6 cases of T-ALL.When transplation,10 cases were relapsed without remission,and 10 cases were relapsed after 2 or 3 times to obtain remission.6 cases received bone marrow plus peripheral blood stem cell transplantation,and 14 cases received peripheral blood stem cell transplantation.Pretreatment program mainly were busulfan (Bu),fludarabine (Flu),cyclophosphamide (CTX) and anti-thymocyte immunoglobulin (ATG),plus cytarabine,etoposide or semustine and total body irradiation in some patients.Graft-versus-host disease (GVHD) was prevented by cyclosporine (CsA),mycophenolate mofetil (MMF) and methotrexate (MTX) (+1,+3,+6,+11 day).After transplantation,adverse reactions,complications and disease-free survival were observed.Results The hematopoiesis in all of children were rebuilded,and 1 month after transplantation,donor cells chimeric rate was 100 ％.After transplantation,the median time of granulocyte plant alive was 12.5 d (9-23 d),and that of platelet plant alive was 15 d (12-40 d).Follow-up until Jun 2014,the median follow-up time was 25 months (2-50 months) with 8 cases of acute GVHD,11 cases of chronic GVHD,and 5 cases of death including GVHD in 2 cases,infection in 1 case and recurrence in 2 cases.The overall survival rate was 75 ％ (15/20).Conclusion Haploid allo-HSCT for children with recurrent refractory lymphocytic leukemia scheme is safe,which could improve the long-term survival rate without increasing the complications and recurrence rate after transplantation.

Objective To investigate the efficacy and safety of cyclophosphamide +pirarubicin + vindesine + dexamethasone (CVAD) regimen on multiple myeloma (MM).Methods Thirty patients with MM from January 2011 to January 2014 of the Beijing Military Region General Hospital were selected and randomly divided into the CVAD group (treatment group) and VAD (pirarubicin + vindesine + dexamethasone) group (control group) with 15 cases in each,including 18 males and 12 females,aged from 38 to 64 years old,and the mean age was 50.5 years old.Sequential therapy was performed over eight cycles of chemotherapy and clinical efficacy between the two groups was compared.Results The total effective rates of the treatment group and control group were 80.0 ％ and 66.7 ％,respectively.In treatment group,one patient died of complications,three cases progressed to refractory MM,and in control group,one patient died of complications,and eight cases progressed to refractory MM.The median follow-up were 22.5 months and 22.7 months,and overall survival (OS) rates were 86.7 ％ and 73.3 ％ in the treatment group and control group,respectively.Conclusion CVAD regimen could improve the clinical effect on MM and it is more effective than the VAD regimen.It is safe and worthy of clinical application.

Objective To observe the effect and toxicity of pegaspargase combined with EPOCH (P-EPOCH) regimen for patients with relapse and refractory non-Hodgkin' s T-cell lymphoma (T-NHL).Methods A total of 15 patients with pathologically diagnosed T-NHL from January 2010 to January 2014 of the Beijing Military Region General Hospital who had been treated with CHOP or CHOP-like regimens were relapse or refractory.They were treated by P-EPOCH regimen [VP16 50 mg/m2,E-ADM 12 mg/m2,VCR 0.4 mg/m2,dissolved in 500 ml saline sustained static drops 24 h on day 1 to 4;CTX 750 mg/m2,intravenous injection on day 5;pegaspargase 2 500 U ·m-2·d-1 given as intramuscular injection on day 6;oral prednisone 60 mg/m2 on day 1 to 6;21 days of a cycle].Results All the 15 patients were treated by P-EPOCH regimen.The response rate of the whole group was 66.7 ％,including CR 4 cases (26.7 ％) and PR 6 cases (40.0 ％).The median survival time was 20 months (5-30 months),and (2-year) overall survival rate was 46.6 ％.Main side effects were myelosuppression,liver dysfunction and disturbance of blood coagulation.Conclusion PEPOCH regimen is effective for patients with relapse and refractory T-NHL and has better tolerance,and worthy of clinical study.

This study was purposed to evaluate the curative efficacy of second allogeneic hematopoietic stem cell transplantation (allo-HSCT) after failure of the first allo-HSCT in aplastic anemia patients, the cause of implant failure after allo-HSCT and clinical data of 10 severe aplastic anemia (SAA) patients in the second allo-HSCT were retrospectively analyszed. The second HSCT conditioning programs include: cyclophosphamide (CTX) + fludarabine (FLU)+ anti-thymocyte globulin (ATG) combination chemotherapy for 3 cases; CTX + FLU + white busulfan (Bu) + ATG combination chemotherapy for 7 cases. The prevention regimen of graft-versus-host disease (GVHD) include cyclosporine (CsA), mycophenolate mofetil (MMF) and methotrexate (MTX). The median count of mononuclear cell infusion was 12.17 (5.99-18.12)×10(8)/kg. The CD34(+) cell count was 5.2 (3.8-10.9)×10(6)/kg. The results showed that 10 evaluable patients achieved hematopoietic reconstitution with absolute neutrophil >0.5×10(9)/L, platelets >20×10(9)/L at 15d (8-21d) and 17d (11-27d) after transplantation. The grade I aGVHD occurred in 2 case, grade II in 1 case, chronic GVHD in 3 cases. Transplant-related deaths occurred in 4 cases. The disease-free survival rate, transplant-related mortality, GVHD after transplantation were 60%, 40% and 50% respectively. It is concluded that the second allo-HSCT is an effective therapy for aplastic anemia after allo-HSCT implant failure.

This study was purposed to investigate the therapeutic efficacy of haploidentical allogeneic hemopoietic stem cell transplantation (allo-HSCT) for severe aplastic anemia (SAA), and evaluate the safety of this treatment by retrospective analysis. A total of 21 patients with SAA (13 cases of SAA-I, 8 cases of SAA-II) were treated with haploidentical allo-HSCT. Donors were the relatives of the patients (12 were the parents, 9 were the siblings). The conditioning regimen contained cyclophosphamide, fludarabine and antithymocyte globulin. Methylaminopterin, mycophenolate mofetil and cyclosporin A were used for preventing graft versus host disease (GVHD). The chimerism rate was monitored periodically after successful graft. The long survival rate, incidence and severity of complication, such as GVHD, infection, and so on were analyzed. The results showed that 15 out of 21 patients were survived for 16 (3-46) months, survival rate was 71.4%. Graft tailure happened in one case who died of mycetes septicemia at 43 days after allo-HSCT. Two patients died of pulmonary infection at 6 days and 10 days respectively after transplantation. Rejection happened in one case at 3 months who died of pulmonary infection at 17 days after the second transplantation with the same donor. Two patients died of IV grade intestinal GVHD at 35 days and 52 days. GVHD occurred in 14 of 21 patients, the accumulative incidence was 66.7%, 5 cases of them were severe. It is concluded that the therapeutic efficacy of haploidentical allo-HSCT is effective for SAA and with slighter complications.

Objective To investigate the change and the prognostic value of platelet-associated immunoglobulin (PAIg) level in idiopathic thrombocytopenic purpura (ITP).Methods From November 2010 to October 2012,a total of 90 ITP patients in The Military General Hospital of Beijing were collected into this study,as the study group (n=90),and 40 cases with non-ITP thrombocytopenic in the same period were included in the control group (n =40).The blood specimens from the study group and the control group were collected at the clinical laboratory.The immunological phenotypes of platelet were analyzed by flow cytometry (FCM).The clinical data of the two groups were retrospectively analyzed:The expression level of PAIgG,PAIgA,and PAIgM and the platelet count were contrasted between the two groups,and the study group before and after treatment.The relationship between the changes of the PAIg level and the platelet count was analyzed.Results ①There was no significant difference in platelet count between the study group before treatment and the control group (P＞0.05),but the expression level of PAIgG,PAIgA,and PAIgM was significantly higher in the study group before treatment than the control group(P＜0.01).②After the treatment,the platelet count in the study group was significantly elevated than before(P＜0.05),and the expression level of PAIgG,PAIgA,and PAIgM was significantly reduced than before(P＜0.01).③There was a significant negative correlation between the platelet count and the expression level of PAIgG,PAIgA,PAIgM in the study group(P＜0.05).Conclusions The expression level of PAIgG,PAIgA,and PAIgM can be used to evaluate the treatment efficacy and the prognosis of ITP.