[Clinical analysis of six cases with the de novo glomerulitis after allogeneic hematopoietic stem cell transplantation]

目的

探讨异基因造血干细胞移植（allo-HSCT）后肾小球肾炎的发病、诊断及治疗情况。

方法

回顾性分析2008年1月至2016年12月河南省肿瘤医院allo-HSCT后肾小球肾炎患者的临床资料。

结果

478例allo-HSCT患者中6例（1.26%）发生肾小球肾炎，男3例，女3例，中位年龄22（12~36）岁；重型再生障碍性贫血（SAA）2例，急性髓系白血病（AML）4例，移植前均无明确的肾脏病病史，中位发生时间为移植后447（272~1 495）d。4例患者肾功能异常，5例尿潜血阳性，3例高血压，2例高血脂。5例患者曾发生急性GVHD，4例发病时伴有慢性GVHD。肾脏病理：微小病变型肾病1例，膜性肾病4例，系膜增生性肾小球肾炎伴缺血性损伤1例。肾脏免疫组化：IgG阳性4例，IgM阳性1例，C3阳性3例，C1q阳性1例。2例血清抗核抗体阳性，IgG和IgM升高各1例。仅1例患者糖皮质激素治疗有效。5例患者采用低剂量环磷酰胺联合霉酚酸酯治疗，2例完全有效，3例部分有效。4例患者生存良好，2例患者死于肺感染。

结论

allo-HSCT后肾小球肾炎的病理类型以膜性肾病为主，低剂量环磷酰胺联合霉酚酸酯可获得较好疗效。

[Effect of stopping tyrosine kinase inhibitors during pregnancy on disease status and reproductive outcomes among patients with chronic myeloid leukemia]

Objective: To explore the pregnancy outcome and disease status among patients with chronic myeloid leukemia (CML) treated with tyrosine kinase inhibitor (TKI) when they stopped TKI treatment during pregnancy. Methods: The clinical characteristics, reproductive outcomes and disease status of the patients who stopped TKI due to pregnancy between November 2004 to November 2017 were retrospectively collected. Results: A total of 14 CML patients in chronic phase (CML-CP), 12 patients were Sokal-low-risk. The median time of TKI treatment was 46.5 (15-123) months before the drug was stopped. The median age at the time of pregnancy was 29 (24-32) years. The median time of TKI exposure was 4 (0-9) weeks in 12 accidental pregnancies. Outcomes were available for 13 pregnancies, 9 cases (69.2%) delivered healthy babies, 1 case (7.7%) delivered polydactylia malformation baby, 3 cases (23.1%) had spontaneous abortion. The last one was still in pregnancy (no organ malformations were observed in color Doppler ultrasound). At the end of the follow up date, 10 children developed normal, the median age was 14 (0.7-65) months. Of the 14 patients who stopped TKI, 7 in complete molecular response (CMR), 3 in MR(4) (BCR-ABL(IS) <0.01%, ABL transcript >10 000), 2 in major molecular response (MMR), 2 in complete cytogenetic response (CCyR). The median time of TKI discontinuation during pregnancy was 33.5 (4-40) weeks. At the end of pregnancy, 4 cases were in CMR, 4 in MR(4), 1 in MMR and 4 in CCyR. No patients lost CCyR and complete hematologic remission. Conclusions: During the treatment of imatinib and Nilotinib, unplanned pregnancy may have a normal infant, but may lead to spontaneous abortion and congenital malformations. Female of CML-CP who had sustained and stable MMR at least 24 months and Sokal-low-risk had higher safety factor discontinued TKI during pregnancy, but still had a risk of increasing tumor load, so monitored the level of BCR-ABL of peripheral blood monthly during pregnancy is necessary.

[The efficacy analysis of interferon combined with imatinib in chronic myelogenous leukemia patients with ABL kinase domain mutations]

To retrospectively analyze the efficacy of interferon plus imatinib (IM) in patients with chronic-phase chronic myelogenous leukemia(CML-CP)and ABL kinase domain mutations. The mutation rates of ABL kinase region in patients with Sokal score low, medium and high risk CML-CP were statistically significant (6.25%, 9.42% and 47.06%, P<0.05). The response rates of interferon plus IM versus second-generation TKI in CML-CP with non-T315I ABL kinase domain mutations were comparable (61.11% vs 65.52%, P>0.05). When CML-CP patients with ABL kinase domain mutations were resistant to TKI or not accessible to second-generation TKI, interferon plus IM can be an alternative choice.