Abstract: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the optimal treatment for pediatric patients with high-risk or intermediate-acute myeloid leukemia. Immunotherapies, such as CAR-T cellular therapy, have been rapidly developed, especially for refractory acute lymphoblastic leukemia. However, they are relatively expensive, limiting their widespread use. For patients lacking matched sibling donors, haploidentical donors are an option. This study analyzed the clinical outcomes of 119 pediatric acute leukemia patients who underwent haploidentical HSCT (n=68) or human leukocyte antigen (HLA)-matched HSCT (n=51). The 2-year overall survival (OS) and leukemia-free survival (LFS) in the haploidentical HSCT group were similar to those in the HLA-matched HSCT group (77.6% vs. 88.6%, P=0.076; 55.6% vs. 52.9%, P=0.497). The 3-year probability of total chronic graft-versus-host disease (GVHD) was 21.4% and 34.1% in the haploidentical and HLA-matched HSCT groups, respectively (P=0.526). Analysis of the 3-year cumulative recurrence rate suggested no significant difference between the haploidentical HSCT group and HLA-matched HSCT group (cumulative incidence, 32.7% vs. 31.2%, P=0.801). The cumulative incidence of acute GVHD, non-relapse mortality (NRM), and graft-versus-host relapse-free survival (GRFS) were similar in both groups. There was no difference in transplantation-related toxicity (TRT) in terms of infection, hepatic dysfunction, oral mucositis, and engraftment syndrome between the haploidentical HSCT and HLA-matched HSCT groups. The study suggests that haploidentical HSCT shows comparable OS, LFS, and GRFS to HLA-matched HSCT in pediatric patients with acceptable complications, and can therefore be recommended as an effective alternative for this population.
Abstract: Castleman disease (CD) is a rare and heterogeneous disease whose treatment options and prognosis vary with clinical types. Multicentric Castleman disease (MCD) is characterized by poor prognosis, and effective treatment options are still being explored. This study aimed to determine whether the E-COD (E: etoposide 50 mg/m2/d, d1–3; C: phosphoramide 750 mg/m2, d1, d3; O: vincristine 2 mg, d1; D: dexamethasone 10 mg/d, d1–5) regimen is effective in treating human herpesvirus-8 (HHV-8)-negative MCD. A group of patients diagnosed with MCD at Shengjing Hospital of China Medical University were treated with E-COD regimen. The effectiveness evaluation was conducted after four treatment cycles and follow-up for survival. A total of 101 patients were included in this study from January 2003 to December 2021, of whom 29 patients had HHV-8 negative MCD subtype. Seven HHV-8 negative MCD patients received four courses of E-COD chemotherapy. The complete response, partial response, and stable disease were 14.3%, 71.4%, and 14.3%, respectively. The follow-up ended on June 1, 2021. Two patients died, and five patients survived, with a survival period ranging from 2 to 11 years. This study suggests that the E-COD regimen is a safe, efficient, and affordable therapy option for HHV-8 negative MCD patients.
Abstract: Since 1993, alanine aminotransferase (ALT) testing has been mandatory for blood donor screening in China. This study aimed to evaluate the significance of ALT testing for transfusion safety. Between January 2012 and December 2018, 122236 blood donor samples were routinely screened by the enzyme-linked immunosorbent assay method for transfusion-transmitted disease markers (TTDM) and by the kinetics method for ALT. Out of 2705 (2.21%) seropositive donors, 291 (10.76%) tested positive for ALT alone and were categorized as ALT-only positive donors. Fourteen ALT-only positive donors who all tested negative in subsequent TTDM and nucleic acid testing (NAT) screening were followed up. The return rate for ALT-only positive donors was reduced by 4.1 times as compared with qualified blood donors (P<0.000). The results suggest that ALT testing does not make a significant contribution to reducing the risk of transfusion-transmitted diseases. Furthermore, being disqualified even once owing to elevated ALT levels has a significant impact on donors' return behavior. Therefore, a suitable cutoff value for ALT testing should be considered based on the evaluated risk in both blood safety and supply.