Dao-Pei Lu May 2010, Shanghai Hematopoietic Stem Cell Transplantation (HSCT) in China (2010)
1 CSBMT and Syn-HSCT
Establishment of CSBMT (Chinese Society of BMT) 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
1 st 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
2 Overview of HSCT in China
HSCT Number in Different Cities in China
HSCT Number in Different Units in China
HSCT indications in China ( 2009 ) MM Other leukemia Autoimmune disease Solid tumor AA
Types of HSCT in China ( 2009 ) Identical sibling Haplo Unrelated Auto Syngeneic
GIAC Principle Combined BM & PB C:C: ATG A:A: Immuno-suppression intensified and prolonged I : G-CSF mobilization GG:GG:
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 th APBMT
Outstanding Oral Presentation Award (Haplo-HSCT) 14th APBMT (August 2009, Korea)
II-IV aGVHD III-IV aGVHD Days after BMT Percent 34.9% 16.0% Acute GVHD of Haplo-HSCT (Beijing Daopei Hospital, n=290)
standard risk high risk advanced Years after BMT LFS 73.9% 51.0% 22.2% P< LFS of Haplo-HSCT (Beijing Daopei Hospital, n=290)
standard risk high risk advanced Years after BMT OS 77.3% 58.1% 29.5% P< 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 ( )% Types of HSCT: –Matched sibling5 –Unrelated7 –Haploidentical18 Median follow-up 17 (5 - 37) months
Conditioning <40% blasts in BM –Ara-C + BuCy13 >40% blasts in BM –Chemotherapy + reduced BuCy 6 Impaired organs : –Fludarabine substituted for Cy11
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 WBC N# 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 PRF1-168SMACPF 结构域 突变型 PRF1-168N MHD2 结构域 野生型 UNC13D-863GMHD2 结构域 突变型 UNC13D-863D Protein conformation of PRF1 gene mutations Paternal Maternal
Perforin normalization post HSCT of Zhang Y Month
Autologous cord blood transplantation (Auto- CBT) in children Beijing Children’s Hospital (BCH) Beijing Daopei Hospital (BDH)
Auto-CBT in Children Date of HSCT HospitalDiagnosisFollow- up (month) Outcome BCHNeuroblas toma 2CR BDHSAA4CR BDHSAA3CR
Auto-CBT for pediatric SAA Beijing 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.
Summary 3 、 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