Comparison of outcomes after human leukocyte antigen-matched and haploidentical hematopoietic stem-cell transplantation for multiple myeloma

Background:Allogeneic stem-cell transplantation (SCT) is a well-established immunotherapeutic strategy for multiple myeloma (MM) with a potent and often sustained graft-vs.-myeloma effect.This multicenter investigation aimed to analyze the complications and survival of haploidentical SCT in patients with MM,and compare the main outcomes with matched-related donors (MRDs).Methods:Haploidentical and MRD SCT was identified from a cohort of 97 patients with MM who received a myeloablative transplantation in 13 hospitals from May 2001 to December 2017.A matched-pair analysis was designed.For each haplo recipient,the recipients were randomly selected from the MRD group and were matched according to the following criteria:year of the hematopoietic SCT (±2 years),disease status at transplantation,and the length of follow-up.ults:Seventy cases received MRD and 27 received haploidendcal transplantation.The two groups showed no significant ifferences regarding age,gender,cytogenetic risk,and diagnostic stage.The cumulative incidences of non-relapse mortality (NRM) at1 and 3 years based on donor type were 20.5%(95% confidence interval [CI],10.90-30.10%) and 24.2%(95% CI,13.81-34.59%) for the MRD group and 16.80%(95% CI,1.71-31.89%) and 28.70%(95% CI,8.71-48.69%) for the haplo group,respectively.Cumulative incidence of NRM did not differ significantly between the two groups (x2 =0.031,P =0.861).The cumulative incidences of progression-free survival (PFS) and 1 year and 3 years by type of donors were 59.8 %(95 % CI,48.24-71.36 %) and 45.4 %(95 % CI,33.44-57.36%),and 65.6%(95% CI,47.18-84.02%) and 26.8%(95% CI,7.59-46.01%) for MRD and haploidentical donor,respectively.Cumulative incidence of PFS did not differ significantly between the two groups (x2 =0.182,P =0.670).In multivariate analyses,no statistically significant differences were observed between haploidentical and MRD for relapse,NRM,PFS,and overall survival.There were no statistically differences on main outcomes after haploidentical and MRD.Conclusion:Haploidentical SCT could be performed safely and feasibly for patients with MM in need.

Study of Clinical Practical Model of Urinary System Injury

Background： In order to improve the clinical treatment level of urinary system injury, it is necessary to build tip an animal model of urinary system wound, which is not only analogous to real clinical practice, but also simple and practical. Methods： We have developed the third generation of firearm fragment wound generator based on the first and the second producer. The best explosive charge of the blank cartridge was selected by gradient powder loading experiments. The firearm fragment injuries were made to the bulbous urethra of 10 New Zealand male rabbits. One week preoperatively and 2, 4 and 8 weeks postoperatively, all the animals underwent urethroscopy and urethrography. At 2, 4 and 8 weeks postoperatively, two animals were randomly selected and killed, and the urethra was cut off for pathological examination. Results： The shooting distance of the third generation of firearm fragment wound generator is 2 cm. The best explosive charge of the blank cartridge is 1 g ofnitrocotton. All rabbits survived the procedures and stayed alive until they were killed, h!juries were limited to bulbous urethra and distal urethra. Round damaged areas, 1-1.5 cm in length, on the ventral wall were observed. Ureteroscopy restdts showed that canal diameter gradually shrank by over 50% in 9 rabbits. The rate of success was 90%. Urethrography result noted that a 11.3 cm stricture was formed at the bulbous urethra. Histology results of injured stricture urethra showed that fibrous connective tissue hyperplasia and hyaline degeneration caused further stricture in the canal. Conclusions： The third generation of firearm fragment wound generator imitates the bullet firing process and is more accurate and repeatable. The corresponding rabbit model of traumatic complex urethral stricture simulates the real complex clinical conditions. This animal model provides a standardized platform for clinical researches on treating traumatic injuries to the urinary system.