Jianpei Fang

Unrelated Umbilical Cord Blood Transplant for β‐thalassemia Major

A 5-year-old boy with beta-thalassemia major received an unrelated umbilical cord blood transplantation (URD-UCBT). The URD-UCB was six antigen HLA matched. The infused cell dose was 7.5 x 10(7)/kg nucleated cells. Conditioning included busulfan 20 mg/kg, cyclophosphamide 200 mg/kg, fludarabine 150 mg/kg, thiotepa 6 mg/kg, and antithymocyte globulin 90 mg/kg. The post transplant complications were mild hepatic veno-occlusive disease, acute GVHD grade III, and CMV interstitial pneumonia. The subject has been ex-thalassemic for more than 20 months post transplant. The chronic GVHD was limited and could be controlled by methylprednisolone combined with mycophenolate. This is the first successful report of an unrelated umbilical cord blood transplantation for beta-thalassemia major from China.

Panel reactive antibody in thalassemic serum inhibits proliferation and differentiation of cord blood CD34+ cells in vitro.

Thalassemic children are at a high risk of graft rejection in cord blood transplantation. To investigate this possible mechanism, the authors evaluated the effect of panel reactive antibody on the growth of CD34+ cells in vitro. On semisolid medium, CD34+ cells derived from cord blood were incubated with thalassemic serum, and colony-forming units were counted after 10 days of culture. After incubation with serum-specific panel reactive antibody, profound decreases were found in the numbers of CFU-GM, CFU-GEMM and BFU-E compared with controls. The results indicated that serum-specific panel reactive antibody might have an apparent inhibition effect on proliferation and differentiation of cord blood CD34+ cells.

Inhibition of autophagy potentiates anticancer property of 20(S)-ginsenoside Rh2 by promoting mitochondria-dependent apoptosis in human acute lymphoblastic leukaemia cells.

Acute lymphoblastic leukaemia (ALL) is the most prevalent childhood malignancy. Although most children with ALL are cured, there is still a group of patients for which therapy fails owing to severe toxicities and drug resistance. Ginsenoside Rh2 (GRh2), a major bioactive component isolated from Panax ginseng, has been shown to have a therapeutic effect on some tumors. However, the molecular mechanisms of cell death induced by 20(S)-GRh2 in ALL cells remains unclear. In this study, we showed that 20(S)-GRh2 inhibited the cell growth and induced mitochondria-dependent apoptosis and autophagy. But it has no cytotoxic effect on human normal blood cells. Furthermore, autophagy plays a protective role in 20(S)-GRh2-induced apoptosis in ALL cell lines and human primary ALL cells. We demonstrated that either genetic or pharmacologic inhibition of autophagy could be more effective in reducing viability and enhancing 20(S)-GRh2-induced toxicity than 20(S)-GRh2 treatment alone. In addition, inhibition of autophagy could aggravate mitochondrial ROS generation and mitochondrial damage, and then accelerate mitochondria-dependent apoptosis. Taken together, these results suggest that inhibition of autophagy can sensitize ALL cells towards 20(S)-GRh2. The appropriate inhibition of autophagy could provide a powerful strategy to increase the potency of 20(S)-GRh2 as a novel anticancer agent for ALL therapy.

Rituximab combined with autologous peripheral blood stem cell transplantation improve therapeutic effects of chemotherapy in pediatric patients with Burkitt's lymphoma.

We report on 2 children with Burkitts lymphoma accompanied by extensive extranodal involvement treated with chemotherapy and Rituximab in combination with autologous peripheral blood stem cell transplantation (Auto-PBSCT) regimens. No obvious side effects could be seen during the Rituximab therapy. Both children achieved complete remission with no relapse after being followed up for 4.3 and 4 years, respectively. Our limited experience show that Rituximab in combination with chemotherapy and Auto-PBSCT might have better therapeutic effects on Burkitts lymphoma of children and the side effects of Rituximab therapy is minimal and can be well tolerated.

Allogeneic peripheral blood stem cell transplantation in β-thalassemia

Six transfusion-dependent g -thalassemia major patients were treated with allogeneic peripheral blood stem cell (PBSC) transplant. The donors were HLA identical siblings except one donor who was a father with one-antigen mismatch of HLA-B loci. The donors were mobilized with G-CSF and PBSC was infused without manipulation. Engraftment was documented in all patients. Acute graft versus host disease (GvHD) was present in 4 patients but could be controlled with steroid or/and ATG. One patient died of hepatic veno-occlusive disease (HVOD) and survivors were all transfusion independent (ex-thalassemia). Chronic GvHD occurred in one patient. Allogeneic PBSC transplantation could achieve disease-free survival in g -thalassemia major patients.

Application of mesenchymal stromal cells in bone marrow transplantation for sensitized recipients.

Sensitized patients are at high risk for graft rejection during transplantation. It is of interest to investigate the effect of mesenchymal stromal cells (MSCs) in sensitized hematopoietic stem cell transplantation. MSCs were generated from bone marrow cells of BALB/c mice. The molecular markers of MSCs were detected by flow cytometry. MSCs labeled with green fluorescent dye were transplanted into nonsensitized and sensitized recipients, respectively. Homing of MSCs in vivo was monitored at different time points post-transplantation. Additionally, sensitized BALB/c mice under irradiation were transplanted with syngeneic MSCs and allogeneic bone marrow cells, and the rate of survival was monitored daily. The fourth passage of MSCs presented a typical spindle-shaped morphology and met the identification criteria of MSCs. Forty-eight hours post-transplantation, the homing of MSCs was found mainly in the bone morrow of nonsensitized recipients and the spleen of sensitized recipients, respectively. Moreover, all of the sensitized recipients died 12–16 days after receiving syngeneic MSCs and allogeneic bone marrow cells, with a median of 14 days. Our results suggest that the MSCs mainly homed to the spleen of sensitized recipients post-transplantation. MSCs could not enhance the engraftment of allogeneic bone marrow cells in sensitized recipients.