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BACKGROUND: Allogeneic hematopoietic stem cell transplantation is an important treatment for malignant hematological diseases, and delayed postoperative platelet implantation is a common complication that seriously affects the quality of patient survival; however, there are no standard protocols to improve platelet implantation rates and prevent platelet implantation delays. OBJECTIVE: To compare the safety and efficacy of oral Herombopag Olamine versus subcutaneous recombinant human thrombopoietin for promoting platelet implantation in patients with malignant hematological diseases undergoing haploid hematopoietic stem cell transplantation. METHODS: Clinical data of 163 patients with malignant hematological diseases who underwent haploidentical hematopoietic stem cell transplantation from January 2016 to October 2022 were retrospectively analyzed. A total of 72 patients who started to subcutaneously inject recombinant human thrombopoietin at +2 days were categorized into the recombinant human thrombopoietin group; a total of 27 patients who started to orally take Herombopag Olamine at +2 days were categorized into the Herombopag Olamine group; and 64 patients who did not apply Herombopag Olamine or recombinant human thrombopoietin were categorized into the blank control group. The implantation status, incidence of acute graft-versus-host disease of degree II-IV within 100 days, 1-year survival rate, 1-year recurrence rate, and safety were analyzed in the three groups. RESULTS AND CONCLUSION: (1) The average follow-up time was 52(12-87) months. The implantation time of neutrophils in the blank control group, recombinant human thrombopoietin group, and Herombopag Olamine group was (12.95±3.88) days, (14.04±3.71) days, and (13.89±2.74) days, respectively, with no statistically significant difference (P=0.352); the implantation time of platelets was (15.16±6.27) days, (17.67±6.52) days, and (17.00±4.75) days, with no statistically significant difference (P=0.287). (2) The complete platelet implantation rate on day 60 was 64.06%, 90.28%, and 92.59%, respectively, and the difference was statistically significant (P < 0.001). The subgroup analysis showed that the difference between the blank control group and the recombinant human thrombopoietin group was statistically significant (P < 0.001), and the difference between the blank control group and the Herombopag Olamine group was statistically significant (P=0.004). The difference was not statistically significant between the recombinant human thrombopoietin group and Herombopag Olamine group (P=0.535). (3) 100-day II-IV degree acute graft-versus-host disease incidence in the blank control group, recombinant human thrombopoietin group, and Herombopag Olamine group were 25.00%, 30.56%, and 25.93%, respectively, and the difference was not statistically significant (P=0.752). (4) The incidence of cytomegalovirus anemia, cytomegalovirus pneumonia, and hepatic function injury had no statistical difference among the three groups (P > 0.05). (5) During the follow-up period, there was no thrombotic event in any of the three groups of patients. (6) The results showed that recombinant human thrombopoietin and Herombopag Olamine could improve the platelet implantation rate of malignant hematological disease patients after haploidentical hematopoietic stem cell transplantation, with comparable efficacy and good safety [ABSTRACT FROM AUTHOR]

BACKGROUND: HLA haploid allogeneic hematopoietic stem cell transplantation provides a chance of survival for patients with high-risk hematologic malignancies. In recent years, the research on the transplantation mode and graft selection of haploidentical transplantation is still ongoing. At present, the mixed transplantation model of non-extracorporeal T-cell removal bone marrow and peripheral blood stem cells established by the Hematology Research Center of Peking University is gradually becoming popular in China, but this model requires the collection of donor bone marrow fluid, which increases the pain and risk of the donor. OBJECTIVE: To explore the curative effect of infusion of umbilical cord mesenchymal stem cells replacing donor bone marrow cells in haploidentical peripheral blood hematopoietic stem cell transplantation for malignant hematological diseases. METHODS: Fifty hematological malignancies patients who underwent haploidentical hematopoietic stem cell transplantation from January 2019 to May 2022 were selected and randomly assigned to two study groups at a ratio of 2:3. Among them, 19 patients received umbilical cord mesenchymal stem cell combined with peripheral blood stem cell transplantation, and 31 patients were treated with bone marrow cells combined with peripheral blood stem cells. The study was approved by the Ethics Committee of Henan Provincial People’s Hospital. The recipients of umbilical cord mesenchymal stem cells were first transfused with third-party umbilical cord mesenchymal stem cells (1×106 /kg) on the day of transplantation, followed by peripheral blood hematopoietic stem cells 6 hours later. In the bone marrow group, donor bone marrow cells were transfused +1 day after transplantation and peripheral blood stem cells were transfused +2 days after transplantation. After transplantation, rabbit anti-human thymocyte immunoglobulin, cyclosporine A, mycophenolate mofetil, and a short-course methotrexate were used for graft-versus-host disease prophylaxis for all recipients. RESULTS AND CONCLUSION: No adverse events occurred during the reinfusion of umbilical cord mesenchymal stem cells. There were no significant differences between the mesenchymal stem cell group and the bone marrow group in the engraftment rate [100% (19/19) vs. 96.8%(30/31), P > 0.05], median duration for neutrophil engraftment (14 days vs.15 days, P > 0.05) and median duration for platelet engraftment (20 days vs.19 days, P > 0.05). The incidence of grade IIIV acute graft-versus-host disease in the mesenchymal stem cell group was significantly lower than in the bone marrow group [21.1% (4/19) vs. 58.1% (18/31), P = 0.01]. There were no significant differences between the two groups in the incidence of chronic graft-versus-host disease [21.1% (4/19) vs. 25.8% (8/31), P > 0.05], the relapse rates [15.8% (3/19) vs. 16.1% (5/31), P > 0.05] and the incidence of early cytomegalovirus viremia [42.1% (8/19) vs. 35.5% (11/31), P > 0.05], and the 2-year overall survival rate [68.4% (10/19) vs. 70.9% (16/31), P > 0.05]. It is indicated that umbilical cord mesenchymal stem cells replace donor bone marrow cells in haploidentical peripheral blood stem cell transplantation for malignant hematological diseases, which reduced the incidence of acute graft-versus-host disease after transplantation, did not increase the incidence of chronic graft-versus-host disease, recurrence rate and early cytomegalovirus viremia, and reduced the pain and risk of donor pulp extraction. [ABSTRACT FROM AUTHOR]

BACKGROUND: Haploidentical hematopoietic stem cell transplantation is associated with a higher rate of graft rejection and therefore often requires a higher CD34+ cell dose, but the findings reported in existing studies regarding the relationship between CD34+ cell dose and study endpoints after allogeneic hematopoietic stem cell transplantation are controversial. OBJECTIVE: To investigate the effect of CD34+ cell dose on clinical outcomes of haploidentical hematopoietic stem cell transplantation for malignant hematological diseases. METHODS: 135 patients who underwent haploidentical hematopoietic stem cell transplantation at Hematopoietic Stem Cell Transplantation Center, Department of Hematology, First Affiliated Hospital of Zhengzhou University between January 2019 and December 2021 were included. Combining the results of previous studies and our center’s experience, the cohort was divided into two groups using a CD34+ cell count of 5.0×106 /kg as the cut-off point. Clinical outcomes related to graft implantation, relapse incidence, non-relapse mortality, overall survival and progression-free survival were evaluated in both groups. RESULTS AND CONCLUSION: (1) CD34+ cell dose correlated with platelet engraftment, with platelets implanted earlier in the high-dose group than in the lowdose group (14 days vs. 16 days, P=0.013). (2) There was no significant difference in 3-year overall survival between the two groups (67.5% vs. 53.8%, P=0.257); nor was there a significant difference in progression-free survival between the two groups (65.6% vs. 44.2%, P=0.106), but stratified analysis based on disease risk index revealed an association with elevated 3-year progression-free survival in the high-dose group among low-risk patients (72.0% vs. 49.3%, P=0.036). (3) The cumulative 3-year relapse incidence was smaller in the high-dose group than in the low-dose group (16.0% vs. 33.5%, P=0.05). (4) The rate of non-relapse mortality within 100 days was greater in the high-dose group than in the low-dose group, but there was no significant difference (17.3% vs. 6.7%, P=0.070); stratified analysis revealed that non-relapse mortality within 100 days was significantly higher in the high-dose group than in the low-dose group (20.0% vs. 3.3%, P=0.046). (5) In conclusion, CD34+ cell doses >5.0×106 /kg promote early platelet implantation, improve 3-year progression-free survival in low-risk patients at transplantation and reduce the cumulative relapse incidence. However, in high-risk patients, high-dose CD34+ cells result in increased non-relapse mortality within 100 days after transplantation, which is considered to be possibly associated with an increased occurrence of severe acute graft versus host disease in the early post-transplantation period. Therefore, it is considered that graft versus host disease monitoring should be enhanced in patients who transfused highdose CD34+ cells. [ABSTRACT FROM AUTHOR]

BACKGROUND: A great progress has been achieved in the allogeneic hematopoietic stem cell transplantation for aplastic anemia. However, graft-versus-host disease and graft failure after transplantation are still the main causes of non-relapse death, which seriously affect the survival of patients. OBJECTIVE: To summarize the current status and progress of allogeneic hematopoietic cell transplantation in the treatment of aplastic anemia. METHODS: The first author retrieved PubMed, CNKI, WanFang and VIP databases for the articles concerning allogeneic hematopoietic stem cell transplantation for aplastic anemia published from January 1990 to September 2019. The keywords were "aplastic anemia, matched sibling donor hematopoietic stem cell transplantation, unrelated donor hematopoietic stem cell transplantation, haploidentical hematopoietic stem cell transplantation, cord blood transplantation" in Chinese and English, respectively. Finally 55 eligible articles were included for result analysis. RESULTS AND CONCLUSION: HLA-matched sibling donor allogeneic hematopoietic stem cell transplantation is the first choice. Unrelated donor hematopoietic stem cell transplantation may be an effective and feasible first-line therapy in pediatric severe aplastic anemia patients with no matched sibling donors. Haploidentical hematopoietic stem cell transplantation and cord blood transplantation can also be important transplantation methods for severe aplastic anemia when lack of HLA-matched donors. [ABSTRACT FROM AUTHOR]

BACKGROUND: Haploidentical hematopoietic stem cell transplantation is currently the mainstream mode of transplantation in China, but its widespread development is restricted by the higher incidence of graft-versus-host disease and implantation failure as compared with HLA identical hematopoietic stem cell transplantation. In order to solve these two problems, co-transplantation of mesenchymal stem cells and hematopoietic stem cells is used in some transplant centers to promote hematopoietic stem cell transplantation, and to reduce the incidence of graft-versus-host disease. Studies have shown that mesenchymal stem cells can promote the repair of liver cells in liver cirrhosis and hepatitis patients. It is unclear whether co-transplantation of mesenchymal stem cells and hematopoietic stem cells can prevent acute drug-induced liver injury. OBJECTIVE: To investigate the preventive and protective effects of infusion of umbilical cord blood mesenchymal stem cells on acute drug-induced liver injury after conditioning in haploidentical hematopoietic stem cell transplantation. METHODS: Clinical data of patients who underwent haploidentical hematopoietic stem cell transplantation from January 2010 to August 2017 was retrospectively analyzed. Eight cases were transfused with umbilical cord blood mesenchymal stem cells 1×106/kg within 4-6 hours before transfusion of hematopoietic stem cells. Seventeen-seven cases in the control group were not given umbilical cord blood mesenchymal stem cells. The changes of liver function indicators and treatment outcomes at 1 day, 2 weeks and 4 weeks after transplantation conditioning were observed. The study protocol was approved by the ethics committee of the First Affiliated Hospital of Xi’an Jiao Tong University with the approval No. 2016(20). Written informed consent was obtained prior to the initiation of the study. RESULTS AND CONCLUSION: (1) Patients in both groups had abnormalities in the biomedical indicators of liver function to different extent. These indicators peaked at 2 weeks post preconditioning, and then became normal after 4 weeks. (2) The levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, transglutaminase, and direct bilirubin were significantly lower in the observation group than the control group at 1 day and 2 weeks after transplantation conditioning (P < 0.05). (3) There were no adverse reactions such as fever, blood pressure increase/decrease, arrhythmia and hemolysis in the two groups during the infusion of hematopoietic stem cells and umbilical cord blood mesenchymal stem cells. These findings reveal that co-transfusion of umbilical cord blood mesenchymal stem cells during haploidentical hematopoietic stem cell transplantation may reduce acute drug-induced liver injury after transplantation conditioning, and it needs to be further investigated duo to limit numbers of patients. [ABSTRACT FROM AUTHOR]