Outcomes and prognostic factors of myelodysplastic syndrome patients with allogeneic hematopoietic stem cell transplantation

Objective To evaluate the outcomes and prognostic factors of myelodysplasia syndrome(MDS)patients who received allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods 165 cases of MDS who underwent allo-HSCT from Jan.2010 to Mar.2018 were analyzed retrospectively,focusing on the overall survival(OS),disease free survival(DFS),relapse,non-relapse mortality(NRM)and their related risk factors.Results Of all the 165 cases,105 were male and 60 were female.The 3-year OS and DFS rate were 72.5%(95%CI 64.9%-80.1%)and 67.4%(95%CI 59.17%-75.63%),respectively.The 3-year cumulative incidence of relapse and NRM were 12.11%(95%CI 7.03%-18.65%)and 20.44%(95%CI 14.15%-27.56%),respectively.HCT-comorbidity index(P=0.042,HR=2.094,95%CI 1.026-4.274)was identified as an independent risk factor for OS by the multivariate analysis.Intensive chemotherapy before HSCT or hypomethylation agents treatment had no effects on OS[(67.0±7.5)%vs(57.7±10.9)%,χ^2=0.025,P=0.874].Conclusion allo-HSCT is a promising means for MDS,and NRM is the major cause of treatment failure.MDS with refractory anemia with excess blasts and secondary acute myeloid leukemia patients may not benefit from intensive chemotherapy or hypomethylation agents treatment before HSCT.

Outcomes of splenectomy in relapsed/refractory autoimmune hemolytic anemia

Objective To evaluate the outcomes of splenectomy in the treatment of relapsed/refractory autoimmune hemolytic anemia(AIHA).Methods Retrospective analysis was performed in 30 cases with relapsed/refractory AIHA who were treated with splenectomy in our hospital.The pre-and post-operative blood routine indexes and responses were followed up.Results Among the 30 relapsed/refractory AIHA patients,20 were pure AIHA(including 13 patients with warm antibody AIHA,2 with warm-cold double antibody AIHA and 5 with Coombs negative AIHA)and 10 were Evans syndrome.The short-term response was evaluated 10-14 days after operation,and the overall response rate(ORR)of short-term response was 90%[12 cases in complete response(CR),6 cases in partial response(PR)]in 20 therapeutic evaluable cases.Among 13 patients with long-term follow-up data,except 3 patients with Evans syndrome died(2 cases were refractory to splenectomy,1 case relapsed after surgery),the ORR of 10 patients with relapsed/refractory pure AIHA at 6 months and 12 months were 90%(9/10)and 70%(7/10),respectively,with a median follow-up of 14(4-156)months.At the end of followup,3 cases had maintained CR for more than 3 years.Conclusion The short-term response of splenectomy as a second-line treatment for relapsed/refractory AIHA is satisfactory,and long-term outcome of splenectomy is up to 70%at 1 year.Approximately one-third of patients could maintain sustained remission.