Objective:To investigate the effect of decitabine maintenance treatment after transplantation of myelodysplastic syndrome(MDS).Methods:Seven patients with MDS after allogeneic hematopoietic stem cell transplantation in the First Affiliated Hospital of Zhengzhou University from April 2016 to October 2019 and received low-dose decitabine maintenance transplantation were included, 5 males and 2 females, aged 15 to 43 years. Seven patients were treated with decitabine or a combination of low-dose cytarabine, aclamycin, and granulocyte colony-stimulating factor regimens before transplantation, and they all achieved complete remission before transplantation, and decicabine was maintained for 56 (31~78) days after tranplantation. The treatment results were analyzed retrospectively.Results:None of the patients recurred after transplantation, 1 case died of acute intestinal graft-versus-host disease, six cases were followed-up to date, and 2 case of chronic mild liver graft-versus-host disease, with a median follow-up of 12 months (3~30 months) after transplantation.Conclusions:Low dose of decitabine could improve post-transplant survival in high-risk MDS patients, but further research is needed to confirm.

Objective To investigate the efficacy and safety of maintenance treatment with low-dose decitabine after allogeneic stem cell transplantation (allo-HSCT) for high-risk acute lymphoblastic leukemia (ALL). Methods The data of 10 patients with high-risk ALL who received maintenance therapy with low-dose decitabine after allo-HSCT in the First Affiliated Hospital of Zhengzhou University from July 2016 to March 2018 was collected. The incidence of post-transplant relapse and graft-versus-host disease (GVHD) and the safety of the treatment protocol were analyzed. The cumulative incidence of relapse (CIR) rate, disease-free survival (DFS) rate and overall survival (OS) rate were estimated by Kaplan-Meier method. Results Two patients relapsed and the median relapse time of these 10 patients was 575 days after transplantation. The 1-year CIR, OS and DSF rates were 16.7%, 100.0% and 83.3%, respectively. At the end of follow-up, the DFS time after transplantation of 2 patients with p53 mutation were 23 months and 11 months, respectively. There was no induction or alleviation of GVHD caused by decitabine treatment. Nine patients developed grade Ⅰ-Ⅱmyelosuppression. Three patients had unexplained thrombocytopenia after transplantation and their platelet counts recovered after decitabine treatment. Conclusion Maintenance therapy with low-dose decitabine has low hematologic toxicity without increasing GVHD, which could be a maintenance treatment option to prevent relapse after transplantation for patients with high-risk ALL.

Objective To observe the efficacy of maintenance treatment with decitabine and dasatinib after allogenic hematopoietic stem cell transplantation for myeloid sarcoma.Methods A 29-year-old male patient was diagnosed with abdominal myeloid sarcoma and acute myeloid leukemia with c-kit mutation and t(8;21).Allogeneic hematopoietic stem cell transplantation was performed after inducted remission.The conditioning regimen was decitabine + FLAG + modified Bu/Cy.Prophylaxis of GVHD was performed with cyclosporine mycophenolate mofetil and short-term methotrexate.The patient received 11.73 × 108 mononucleated cells/kg and 17.59 × 106CD34+ cells/kg from donor.At Day 13 post-transplantation,neutrophils reached 0.5 × 109/L and platelet count was 20 × 109/L.Decitabine was prescribed since Day 50 post-transplantation monthly for 5 courses.And dasatinib was offered orally since Day 100 for 4 months.Results It was followed up to 16 months post-transplantation.There were no obvious abnormalities of bone marrow cytology,AML/ETO fusion gene quantification,cerebrospinal fluid or abdominal enhanced computed tomography (CT).Conclusions Hematopoietic stem cell transplantation is an effective treatment for myeloid sarcoma.Decitabine has some efficacy for myeloid sarcoma and it may be used for maintenance treatment after transplantation.Tyrosine kinase inhibitors reduce recurrence in myeloid sarcoma with c-kit mutation.The treatment of decitabine and dasatinib after allogeneic hematopoietic stem cell transplantation yield excellent outcomes.This is the first report in domestic and foreign literatures.

Objective To discuss the efficacy of sirolimus in the treatment of refractory autoimmune cytopenias. Methods Clinical data of 6 patients with refractory autoimmune cytopenias admitted to the First Affiliated Hospital of Zhengzhou University from October 2017 to October 2018 were retrospectively analyzed. The 6 patients included 4 males and 2 females, with a median age of 38 (23-55) years old, disease duration of 4 months to 9 years. Three cases of the 6 patients had immune-related pancytopenia, 2 cases had Evans syndrome, and 1 case had immune thrombocytopenia. Six patients were treated by conventional treatment, but did not get good results, so that they were given sirolimus 0. 2 to 1. 0 mg/d orally;of them, 5 patients were treated with glucocorticoid or cyclosporine, and the dosages of hormones and cyclosporine were reduced after the blood loss increased. And the efficacy was analyzed. Results Among the 6 patients with refractory autoimmune cytopenias, 3 cases achieved complete remission, 2 cases had partial remission, and 1 case had ineffective result after oral treatment with sirolimus. Conclusions Sirolimus is effective and safe in the treatment of refractory autoimmune cytopenias, but its effect needs to be clinically validated by multi-center and large sample research. The treatment method has broad prospects for treatment of blood diseases.