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Dao-Pei Lu May 2010, Shanghai Hematopoietic Stem Cell Transplantation (HSCT) in China (2010)

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Presentation on theme: "Dao-Pei Lu May 2010, Shanghai Hematopoietic Stem Cell Transplantation (HSCT) in China (2010)"— Presentation transcript:

1 Dao-Pei Lu May 2010, Shanghai Hematopoietic Stem Cell Transplantation (HSCT) in China (2010)

2 1 CSBMT and Syn-HSCT

3 Establishment of CSBMT (Chinese Society of BMT) 2007 2005 2009 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

4 1 st CSBMT Conference (2009, Hong Kong)

5

6 CSBMT Newsletter

7 Syn-HSCT in Chinese --A report of 94 cases from 32 centers in CSBMT

8 Patient characteristics CSBMT AA AML large granular lymphocytosis Neuroblastoma lymphoma MDS CML ALL n=94

9 OS of Syn-HSCT (n=94)

10 DFS of Syn-HSCT (n=94)

11 Follow-up the longest survivor of HSCT in the world

12 2 Overview of HSCT in China

13 HSCT Number in Different Cities in China

14 HSCT Number in Different Units in China

15 HSCT indications in China ( 2009 ) MM Other leukemia Autoimmune disease Solid tumor AA

16 Types of HSCT in China ( 2009 ) Identical sibling Haplo Unrelated Auto Syngeneic

17 GIAC Principle Combined BM & PB C:C: ATG A:A: Immuno-suppression intensified and prolonged I : G-CSF mobilization GG:GG:

18 Haploidentical HSCT (Haplo-HSCT) Lu et al. Blood 2006; 107: 3065

19 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 2009 14 th APBMT

20 Outstanding Oral Presentation Award (Haplo-HSCT) 14th APBMT (August 2009, Korea)

21 20406080100 0 20 40 60 80 100 II-IV aGVHD III-IV aGVHD Days after BMT Percent 34.9% 16.0% Acute GVHD of Haplo-HSCT (Beijing Daopei Hospital, n=290)

22 1234567 0 20 40 60 80 100 standard risk high risk advanced Years after BMT LFS 73.9% 51.0% 22.2% P<0.0001 LFS of Haplo-HSCT (Beijing Daopei Hospital, n=290)

23 1234567 0 20 40 60 80 100 standard risk high risk advanced Years after BMT OS 77.3% 58.1% 29.5% P<0.0001 OS of Haplo-HSCT (Beijing Daopei Hospital, n=290)

24 Indications of Unrelated-HSCT (U-HSCT) ( Beijing Daopei Hospital, n=182)

25 Acute GVHD of U-HSCT (Beijing Daopei Hospital, n=182)

26 5yr-OS of U-HSCT (Beijing Daopei Hospital, n=182) 72.2%

27 5yr-DFS of U-HSCT (Beijing Daopei Hospital, n=182) 64.9%

28 U-HSCT with Haplo-BM (Beijing Daopei Hospital, n=182)

29 Successful Rescue of Refractory/Recurrent Myelogenous Leukemia by Allogeneic HSCT and Prophylactic Immunotherapy Beijing & Shanghai Daopei Hospitals

30 Refractory/recurrent myelogenous leukemia by HSCT and immunotherapy 30 cases (AML 29 , CML-BC myeloid 1) Median blasts in BM 36 ( 20-87 )% Types of HSCT: –Matched sibling5 –Unrelated7 –Haploidentical18 Median follow-up 17 (5 - 37) months

31 Conditioning <40% blasts in BM –Ara-C + BuCy13 >40% blasts in BM –Chemotherapy + reduced BuCy 6 Impaired organs : –Fludarabine substituted for Cy11

32 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

33 Refractory/recurrent myelogenous leukemia by HSCT and immunotherapy OS EFS

34 3 Further application of HSCT

35 A Special Neonatal Case of SCID cured by U-CBT Dao-pei Hospital & Pediatric Hospital, Fu Dan University

36 Reconstitution PLT WBC N# L#

37 U-CBT 前

38 U-CBT 后 5 个月

39 Familial Hemophagocytic Lymphohistiocytosis (FHL) treated by U-HSCT Beijing Daopei Hospital

40 Patient Zhang x. 13 yr girl “Lymphoma” was diagnosed and treated in other hospitals. FHL was diagnosed on admission.

41

42

43 Zhang’s Family Tree Diagnosed as FHL-2

44 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

45 Perforin normalization post HSCT of Zhang Y. -3 -2 1 32 4 Month - -3-2 - -113 2 4

46 Autologous cord blood transplantation (Auto- CBT) in children Beijing Children’s Hospital (BCH) Beijing Daopei Hospital (BDH)

47 Auto-CBT in Children Date of HSCT HospitalDiagnosisFollow- up (month) Outcome 2009.4BCHNeuroblas toma 2CR 2010.1BDHSAA4CR 2010.2BDHSAA3CR

48 Auto-CBT for pediatric SAA Beijing Daopei Hospital Before HSCT

49

50 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.

51 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.

52 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.

53

54

55 Acknowledgment


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