Dao-Pei Lu May 2010, Shanghai Hematopoietic Stem Cell Transplantation (HSCT) in China (2010)
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Transcript of Dao-Pei Lu May 2010, Shanghai Hematopoietic Stem Cell Transplantation (HSCT) in China (2010)
Dao-Pei LuMay 2010, Shanghai
Hematopoietic Stem Cell
Transplantation (HSCT) in
China (2010)
1CSBMT and Syn-HSCT
Establishment of CSBMT(Chinese Society of BMT)
20072007
20052005
20092009
Hangzhou, establishment of Chinese BMT Cooperation Group in APBMT and China BMT Group meeting
Beijing, establishment of CSBMT in ISH-APD & APBMT meeting
Hong-Kong, Chinese BMT Forum
1st CSBMT Conference (2009, Hong Kong)
1st CSBMT Conference (2009, Hong Kong)
CSBMT Newsletter
Syn-HSCT in Chinese--A report of 94 cases from 32
centers in CSBMT
Patient characteristics
CSBMT
AA
AML
large granular lymphocytosis
Neuroblastoma
lymphoma
MDS
CML
ALL n=94
OS of Syn-HSCT (n=94)
DFS of Syn-HSCT (n=94)
Follow-up the longest survivor of HSCT in the world
2Overview of HSCT in
China
HSCT Number in Different Cities in China
HSCT Number in Different Units in China
HSCT indications in China( 2009 )
A ML
A L LC ML
MDS
L ym phoidm alig nancy
MM
Other leukemia
Autoimmune diseaseSolid tumor
AA
Types of HSCT in China( 2009 )
Identicalsibling
Haplo
Unrelated
Auto
Syngeneic
GIAC Principle
Combined BM & PBC:
ATG A:
Immuno-suppression intensified and prolonged
I :
G-CSF mobilizationGG:
Haploidentical HSCT(Haplo-HSCT)
Lu et al. Blood 2006; 107: 3065
Haploidentical Blood and Marrow Transplantation in
Hematological Malignancies: A Single-
Center Report of 290 patients
Tong Wu, Dao-Pei Lu, et al.
Beijing Daopei Hospital, Beijing, China
August 2009
14th APBMT
Outstanding Oral Presentation Award
(Haplo-HSCT)
14th APBMT (August 2009, Korea)
20 40 60 80 1000
20
40
60
80
100II-IV aGVHD
III-IV aGVHD
Days after BMT
Per
cen
t
34.9%
16.0%
Acute GVHD of Haplo-HSCT (Beijing Daopei Hospital, n=290)
1 2 3 4 5 6 70
20
40
60
80
100standard risk
high risk
advanced
Years after BMT
LF
S
73.9%
51.0%
22.2%
P<0.0001
LFS of Haplo-HSCT (Beijing Daopei Hospital, n=290)
1 2 3 4 5 6 70
20
40
60
80
100standard risk
high risk
advanced
Years after BMT
OS
77.3%
58.1%
29.5%
P<0.0001
OS of Haplo-HSCT (Beijing Daopei Hospital, n=290)
Indications of Unrelated-HSCT (U-HSCT)
( Beijing Daopei Hospital, n=182)
Acute GVHD of U-HSCT (Beijing Daopei Hospital, n=182)
5yr-OS of U-HSCT (Beijing Daopei Hospital, n=182)
72.2%
5yr-DFS of U-HSCT (Beijing Daopei Hospital, n=182)
64.9%
U-HSCT with Haplo-BM (Beijing Daopei Hospital, n=182)
Successful Rescue of Refractory/Recurrent
Myelogenous Leukemia by Allogeneic HSCT and
Prophylactic Immunotherapy
Beijing & Shanghai Daopei Hospitals
Refractory/recurrent myelogenous leukemia by HSCT
and immunotherapy• 30 cases (AML 29 , CML-BC myeloid 1)
• Median blasts in BM 36 ( 20-87 )%
• Types of HSCT:
– Matched sibling 5
– Unrelated 7
– Haploidentical 18
• Median follow-up 17 (5 - 37) months
Conditioning• <40% blasts in BM
– Ara-C + BuCy 13
• >40% blasts in BM
– Chemotherapy + reduced BuCy 6
• Impaired organs:– Fludarabine substituted for Cy 11
Prophylaxis of Relapse
–Immunosuppressants were tapered off early post-HSCT
–Prophylactic immunotherapy if no GVHD
•Cellular: DLI, DC-CIK, NK cells
•Humoral: IL-2, IFN-a, thymosin
Refractory/recurrent myelogenous leukemia by HSCT
and immunotherapy
OS
EFS
3 Further application of
HSCT
A Special Neonatal Case of SCID cured by U-CBT
Dao-pei Hospital & Pediatric Hospital, Fu Dan University
Reconstitution
PLT
WBCN#L#
U-CBT 前
U-CBT 后 5 个月
Familial Hemophagocytic Lymphohistiocytosis (FHL)
treated by U-HSCT
Beijing Daopei Hospital
Patient Zhang x. 13 yr girl
• “Lymphoma” was diagnosed and treated in other hospitals.
• FHL was diagnosed on admission.
Zhang’s Family Tree
Diagnosed as FHL-2
MACPF 结 构 域 野 生 型 PRF1-168S
MACPF 结 构 域 突 变 型 PRF1-168N
MHD2 结构域 野生型 UNC13D-863G MHD2 结构域 突变型 UNC13D-863D
Protein conformation of PRF1 gene mutations
Paternal
Maternal
Perforin normalization post HSCT of Zhang Y.
-3 -2 -1 1 32 4
Month
--3 -2 --1 1 32 4
Autologous cord blood transplantation (Auto-
CBT) in children
Beijing Children’s Hospital (BCH)
Beijing Daopei Hospital (BDH)
Auto-CBT in ChildrenDate
of HSCT
Hospital Diagnosis Follow-up
(month)
Outcome
2009.4 BCH Neuroblastoma
2 CR
2010.1 BDH SAA 4 CR
2010.2 BDH SAA 3 CR
Auto-CBT for pediatric SAABeijing Daopei Hospital
Before HSCT
Summary
1 、 CSBMT must play an important role in HSCT continuously.
2 、 Large series of syn-HSCT show excellent outcome in both nonmalignant and malignant hematological diseases.
Summary3 、 HSCT in China has been developing
rapidly. The outcomes of Haplo-HSCT and U-HSCT have achieved top level in the world in experienced units.
4 、 DFS in refractory/recurrent myeloid leukemia treated by allo-HSCT and immunotherapy has been improved significantly.
Summary
5 、 More and more diseases could be treated by HSCT, such as allo-HSCT for inherited diseases (SCID, FHL) and auto-CBT for solid tumor and SAA.
Acknowledgment