[Comparison of haploidentical hematopoietic stem cell transplantation and matched-sibling donor transplantation for the treatment of paroxysmal nocturnal hemoglobinuria]

[Interpretation of the guidelines for diagnosing and treating paroxysmal nocturnal hemoglobinuria in China (2024)]

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal disorder of hematopoietic stem cells induced by PIG-A gene mutations. It is clinically manifested by hemolysis, bone marrow failure, and high-risk concurrent thrombosis, which are life-threatening in severe cases. Significant progress has been made in the pathogenesis research and clinical diagnosis and treatment of PNH in recent years. The Red Blood Cell Disease (Anemia) Group Chinese Society of Hematology, Chinese Medical Association, combined with the latest diagnosis and treatment progress of PNH, relevant foreign guidelines/consensus, and China's national conditions, jointly formulated the "Guidelines for the diagnosis and management of paroxysmal nocturnal hemoglobinuria (2024) " based on extensive solicitation of expert suggestions and opinions. This article discussed the key and difficult issues in PNH diagnosis and treatment, interpreted the updated part of the guidelines, and expanded the relevant recommendations of the guidelines according to the latest research progress at home and abroad, thereby providing more references for clinical practice.

[Clinical observation of allogeneic hematopoietic stem cell transplantation for treating five cases of classic paroxysmal nocturnal hemoglobinuria]

This study enrolled five patients with classic paroxysmal nocturnal hemoglobinuria (cPNH) who underwent allogeneic hematopoietic stem cell transplantation in our hospital from 2019 to 2023. All five patients were male, with a median age of 26 (range: 26-46) years. The median time from diagnosis to allo-HSCT was 5.5 (range: 3.6-18.0) years. The median PNH granulocyte clone size was 96.3% (ranged 90.0%-99.7%), and the median lactate dehydrogenase (LDH) level was 2 224 IU/L (8896-fold of the upper limit of normal). All patients were detected to have bone marrow hyperplasia by trephine biopsy. The stem cell source came from four haploidentical donors and one HLA-identical sibling donor. Among the five patients, three underwent myeloablative conditioning (MAC) and two underwent reduced-intensity conditioning (RIC) treatment. None of the patients experienced primary implantation failure. The neutrophil implantation time was 15 (range: 13-21) days, and the platelet implantation time was 24 (range: 13-60) days. The three patients developed grade II acute graft-versus-host disease (aGVHD). No patients developed grade Ⅲ/Ⅳ aGVHD. The two patients developed localized chronic GVHD (cGVHD), and no patients developed extensive cGVHD. PNH clones turned negative in all patients after 2 (range: 1-3) months of transplantation. At a median follow-up of 16 (range: 6-34) months, one patient died of relapse and infection, and the remaining four patients survived, of which two patients had discontinued all drugs.

[Guidelines for the diagnosis and management of paroxysmal nocturnal hemoglobinuria (2024)]

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired clonal disorder of hematopoietic stem cells characterized by intravascular hemolysis, bone marrow failure, and a high risk of thrombosis. Although PNH is a benign intravascular hemolytic disease, severe cases may be life-threatening. In recent years, remarkable progress has been made in the diagnosis and treatment of PNH, particularly in the field of complement inhibitor therapy. To further standardize and improve the diagnosis and treatment level of PNH in China, the Red Blood Cell Disease (Anemia) Group of the Chinese Society of Hematology updated the 2013 PNH Expert Consensus by combining the latest diagnosis and treatment progress of PNH, consulting relevant foreign guidelines/consensus and China's national conditions, and soliciting expert advice and opinions to formulate the Chinese Guidelines for the Diagnosis and Treatment of Paroxysmal Nocturnal Hemoglobinuria (2024) .