Objective Through conducting a meta-analysis using the methodology of Cochrane review, to assess the effectiveness and safety of graft-versus-host disease (GVHD) prophylaxis with antithymocyte globulins (ATGs) in allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods Such databases as PubMed (1966 to March 2011), EMbase (1974 to March 2011), the Science Citation Index databases (1900 to March 2011), The Cochrane Library (1996 to March 2011), CBMdisc (1978 to March 2011), and CNKI (1979 to March 2011) were electronical1y searched. The references of all identified studies were retrieved for collecting more randomized controlled trials (RCTs) and non-RCTs. Two reviewers independently screened the trials according to inclusion and exclusion criteria, abstracted the data, and assessed the methodology quality of the included studies. Meta-analyses were performed using RevMan 5.0.2 software. Results Thirteen clinical trials were included, of which 2 were RCTs involving 310 patients and the other 11 were non-RCTs involving 1480 patients. The results of meta-analyses showed that compared with the Non-ATG group, the pooled risk ratio (RR) and 95%CI of the ATG group in acute GVHD II-IV incidence rate, acute GVHD III-IV incidence rate, chronic GVHD (limited plus extensive) incidence rate, chronic GVHD (extensive) incidence rate, overall survival (OS) rate, non-relapse mortality (NRM) rate, and relapse rate were 0.77 (0.67, 0.87), 0.54 (0.44, 0.68), 0.58 (0.51, 0.65), 0.35 (0.26, 0.46), 1.14 (1.04, 1.25), 0.81 (0.69, 0.93), and 1.24 (0.98, 1.57), respectively. Conclusion The addition of ATGs to GVHD prophylaxis can reduce the incidence of acute and chronic GVHD, decrease NRM, and increase OS, but has no obvious interference with relapse rate.
【摘要】 目的 分析异基因造血干细胞移植术（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后并发毛细血管渗漏综合征（capillary leak syndrome，CLS）的发生率、危险因素和结局，并探讨其防治措施。 方法 回顾性分析2005年6月-2011年2月住院的allo-HSCT术后14例并发CLS的临床资料。 结果 CLS发生率为9.2%（14/152）。年龄、性别、诊断、HLA配型、预处理、CD34+细胞量、粒细胞集落刺激因子（granulocyte colony-stimulating factor，G-CSF）用量、植入时间均不能认定为造血干细胞移植后CLS诱发因素。 结论 HSCT术后CLS诱因尚不清楚，采用限水、减量G-CSF、使用糖皮质激素和羟乙基淀粉等措施及时治疗，有助于控制CLS。【Abstract】 Objective To study the occurrence rate, risk factors and outcomes of capillary leak syndrome (CLS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and discuss its prevention and treatment. Methods We retrospectively analyzed the clinical records of 14 allo-HSCT recipients complicated with CLS from June 2005 to February 2011. Results Fourteen out of 152 patients developed CLS with a cumulative incidence of 9.2 %. None of the 8 clinical parameters including age, gender, underlying disease, donor type, conditioning regimen, CD34+ cell dose, granulocyte colony-stimulating factor (G-CSF) dosage, and days to neutrophil engraftment could be identified as risk factors for the occurrence of CLS. Conclusions Risk factors for CLS after allo-HSCT have not been fully established. Restriction of water intake, administration of corticosteroids and hydroxyethyl starch can be beneficial for patients with CLS.
【摘要】 目的 分析异基因造血干细胞移植术（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后出血性膀胱炎（hemorrhagic cystitis，HC）相关的危险因素，动态监测受者尿BK病毒（BK virus，BKV），分析其与HC发病的关系。 方法 回顾性分析2003年3月-2008年1月期间接受allo-HSCT的121例患者的资料，选择8个临床参数[年龄、性别、疾病类型、移植时疾病状态、供者类型、预处理方案、急性移植物抗宿主病（acute graft-versus-host disease，aGVHD）、aGVHD的预防方案]作COX回归分析。采用SYBR Green染料实时荧光定量聚合酶链反应法对2006年9月-2008年1月42例allo-HSCT患者尿BKV载量进行动态监测，分析被检查者尿液BKV基因载量与HC发生以及严重程度的关系。 结果 121例患者中有24例发生HC，发病时间为术后0~63 d，中位时间40 d；持续时间7~150 d，中位时间22 d。Ⅱ~Ⅳ度aGVHD为HC的独立危险因素[RR=8.304，95%CI（1.223，56.396），P=0.030]。allo-HSCT受者尿液中BKV检出率为100%（42/42）。与正常人及未发生HC的allo-HSCT受者相比，HC患者尿中BKV基因载量具有更高平均峰值。 结论 Ⅱ~Ⅳ度aGVHD，尿中BKV DNA高载量与HC的发生有相关性。【Abstract】 Objective To identify the risk factors for hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and define the quantitative relationship between BK virus (BKV) DNA load with HC. Methods The medical records of 121 patients undergoing allo-HSCT from March 2003 to January 2008 were retrospectively analyzed. Eight clinical parameters were selected for COX regression analysis, including age, sex, underlying disease, disease status at transplant, donor type, conditioning regimen, acute graft-versus-host disease (aGVHD), and GVHD prophylaxis. From September 2006 to January 2008, mid-stream urine samples were continuously collected from 42 patients with allo-HSCT. SYBR green real-time polymerase chain reaction, technique was utilized to define the quantitative relationship between BKV DNA load and HC. Results Twenty-four out of 121 patients developed HC. The median time of onset was 40 days after HSCT, ranged from 0 to 63 days. The disease lasted for 7 to 150 days, with a median duration of 22 days. Grade Ⅱ-Ⅳ aGVHD [RR=8.304, 95% CI (1.223,56.396); P=0.030] was identified as an independent risk factor for the occurrence of HC. BKV excretion was detected in 100% (42/42) of the recipients of allo-HSCT. When compared with asymptomatic patients and allo-HSCT recipients without HC, patients with HC had a significantly higher mean peak BKV DNA load. Conclusions Patients are at an increased risk of developing HC if they have grade Ⅱ-Ⅳ aGVHD. A correlation between the load of BKV and incidence of HC may exist.
目的 建立急性白血病（AL）患者八色流式免疫表型分析起始管方案。 方法 用胞膜CD3（CD3）、CD19、CD10、CD34、CD45、胞浆CD79a（cCD79a）、髓过氧化物酶（MPO)和胞浆CD3（cCD3）等8种抗体建立八色流式染色方案。膜表面抗体直接染色；膜内抗体经固定破膜，再染色后上机检测。将3个血小板减少患者骨髓标本分别进行抗体的单色染色和缺一色染色；最后对17例确诊的AL初发患者标本进行检测。 结果 用单色染色来确定染色方案中各抗体的检测电压及荧光补偿；缺一色染色中，阳性细胞群较单色染色变化均＜10%，表明方案中的各抗体相互作用小。17例AL初发患者中，6例急性B淋巴细胞白血病原始细胞均为CD34和CD19阳性，5例cCD79a阳性和4例CD10阳性；4例急性T淋巴细胞白血病患者均为cCD3阳性；6例急性髓细胞白血病均为CD34和MPO阳性；1例B+T混合表型AL患者CD34、cCD3、CD19、cCD79a及CD10均为阳性，MPO和CD3为阴性，此检测方案能够确定各类AL的细胞类型。 结论 建立了AL患者八色流式免疫表型分析起始管方案，操作简便快速，适用于临床检测。