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From January 14th to 16th, 2022, the 2nd China Hematology Development Conference will be held online
.
With the theme of "Strengthening the Foundation, Emphasizing Clinical Practice, and Promoting Transformation—Building a New Ecology of Hematology Innovation and Development", many experts and colleagues in the field of hematology gathered together to exchange the cutting-edge progress of hematology and discuss the future development direction
.
At this conference, Professor Han Yue from the First Affiliated Hospital of Soochow University gave a keynote report on "Progress in Hematopoietic Stem Cell Transplantation and Thrombocytopenia Treatment".
Yimaitong organized the main contents as follows
.
At present, hematopoietic stem cell transplantation (HSCT) is the main method for the treatment of hematological malignancies.
Bleeding is an important complication after HSCT and is closely related to the prognosis of transplanted patients
.
Professor Han Yue said that post-transplant hemorrhage greatly affects the prognosis of patients, and its risk factors include: graft-versus-host disease (GVHD), infection, thrombocytopenia, use of anticoagulant drugs, endothelial cell damage,
etc.
The study found that patients who received allogeneic hematopoietic stem cell transplantation had 10 times the incidence of bleeding than patients who received chemotherapy
.
Professor Han Yue then introduced the pathogenesis of hemorrhage after HSCT
.
Any one or more abnormalities of platelets, coagulation factors, and vascular endothelium can lead to an imbalance in coagulation homeostasis, causing bleeding, and platelet levels directly affect the occurrence of bleeding
.
Thrombocytopenia is a common complication after transplantation, with an incidence of about 5% to 37%, and its incidence is significantly related to the type of transplantation, recipient and donor
.
Thrombocytopenia after HSCT can increase the patient's platelet transfusion volume, increase the chance of infection, increase the risk of bleeding, and even cause fatal bleeding
.
Furthermore, delayed platelet recovery after HSCT is closely associated with known mortality and poor prognosis
.
Definition of Thrombocytopenia After HSCT Thrombocytopenia after transplantation includes the following three
.
1) Poor platelet reconstitution: Refers to platelets less than 50×109/L 60 days after transplantation, and good granulocyte and erythroid reconstitution; 2) Secondary thrombocytopenia: refers to factors such as infection, GVHD, thrombotic microangiopathy, etc.
3) Refractory thrombocytopenia: refers to platelets below 30×109/L 60 days after transplantation, rhTPO, TPO receptor agonists and other routine measures (Glucocorticoids, gamma globulin, etc.
) treatment for one month is ineffective
.
The pathogenesis of thrombocytopenia after HSCT The pathogenesis of thrombocytopenia after HSCT mainly includes two aspects: reduced production of megakaryocytes and increased platelet destruction
.
The reasons for the reduction of megakaryocyte production include: insufficient stem cell infusion, implantation failure, disease recurrence, myelofibrosis, etc.
; the reasons for increased platelet destruction mainly include: GVHD, infection, drugs, transplantation-related thrombotic microangiopathy (TA-TMA)
.
Among them, the amount of stem cell infusion is the most important factor, especially the infusion amount of CD34+ cells is directly related to thrombocytopenia after transplantation
.
Different stem cell sources, especially umbilical cord blood and haploid transplantation sources are key risk factors for thrombocytopenia after transplantation
.
Platelet antibodies, especially donor-specific antibodies (DSAs), also play an important role in the thrombocytopenia process
.
The number and function of endothelial progenitor cells in the bone marrow microenvironment also have a certain impact on the reduction of platelets
.
Professor Han Yue said that through the study of the First Affiliated Hospital of Soochow University, it was found that compared with patients with normal platelets, the incidence of severe acute GVHD, extensive chronic GVHD and active infection increased in patients with thrombocytopenia
.
Platelet levels and prognosis after HSCT have shown that patients with long-term thrombocytopenia after transplantation have increased mortality, while patients with transient thrombocytopenia and non-thrombocytopenia patients have no difference in mortality, and patients with chronic GVHD, long-term thrombocytopenia The mortality rate of patients was significantly higher than that of patients with normal platelets
.
Professor Han Yue said that the research data of the First Affiliated Hospital of Soochow University also proved that patients with poor platelet remodeling have a poor prognosis
.
In addition, studies have shown that poor platelet engraftment increases the incidence of transplant-related complications, and thrombocytopenia after HSCT in patients with myelodysplastic syndrome (MDS) is an independent risk factor for overall survival (OS)
.
Treatment of thrombocytopenia after HSCT Treatment of thrombocytopenia after HSCT includes removal of possible triggers (including discontinuation of suspected drugs, control of infection, treatment of GVHD, etc.
), platelet transfusion, glucocorticoids, gamma globulin, stimulating factors (including TPO, romiprostim, eltrombopag), rituximab, plasma exchange, mesenchymal stem cell infusion, and novel treatments (eg, decitabine)
.
Professor Han Yue said that related research from Peking University has proved that the infusion of mesenchymal stem cells has a certain effectiveness in reducing the occurrence of thrombocytopenia after transplantation, and within 30 days after HSCT, 35 patients (100%) obtained hematopoietic reconstruction and hematopoietic reconstruction.
Full donor chimerism is maintained
.
In recent years, there have been relatively more studies on rhTPO and TPO receptor agonists, which can act on all stages of hematopoietic stem cells to differentiate into megakaryocytes by activating the downstream JAK/STAT and RAS pathways, and promote platelet production and release
.
Then Professor Han Yue introduced a number of studies, all of which showed that rhTPO and TPO receptor agonists can promote platelet engraftment
.
Platelet ineffective transfusion (PTR) PTR refers to patients who are still in a state of unresponsiveness after receiving sufficient doses of platelet transfusions for two consecutive times, with no improvement in clinical bleeding, and no significant increase in platelet count, but sometimes a decrease
.
It occurs in 7%-34% of patients with hematological diseases
.
Studies have shown that patients with PTR have significantly increased ICU admission after transplantation
.
Recombinant human coagulation factor VIIa can effectively and safely stop bleeding in patients with hematological malignancies bleeding with ineffective platelet transfusions
.
Professor Han Yue said that a prospective, randomized controlled study conducted by the First Affiliated Hospital of Soochow University showed that the use of low-dose decitabine in the treatment of persistent thrombocytopenia after transplantation can significantly benefit patients, and 28 days after treatment, The platelet reaction rates in the decitabine group and the control group were 73.
3% and 19.
4%, respectively
.
Conclusion Prof.
Yue Han finally concluded that thrombocytopenia is a common complication after transplantation, which can increase the risk of infection and bleeding, and has a negative impact on prognosis
.
The abnormal bone marrow microenvironment plays an important role in the occurrence of thrombocytopenia after transplantation
.
New treatment regimens (such as decitabine) have better efficacy and potential for thrombocytopenia after transplantation
.
Prof.
Han Yue Deputy Director, Second-level Professor, Doctoral Supervisor, Department of Hematology, The First Affiliated Hospital of Soochow University Member of Hematology Branch, Member of Leukemia Group Standing Member of Hematology Branch of Chinese Geriatrics Association Chairman of Jiangsu Society of Hematology and Immunology, Executive Director of Jiangsu Society of Immunology Member of Hematology Branch of China Anti-Cancer Association, Member of Cell Therapy and Transplantation Group China Hematology The editorial board of the magazine, the judges of J.
Thromb & Hemost.
, Thromb.
Res and other magazines Jiangsu Province "Key Medical Talents", "Six Peak Talents", "333 High-level Talents" presided over the first prize of Science and Technology Progress of the Ministry of Education, Jiangsu Province Science and Technology Progress first prize stamp "read the original text", we will progress together
.
With the theme of "Strengthening the Foundation, Emphasizing Clinical Practice, and Promoting Transformation—Building a New Ecology of Hematology Innovation and Development", many experts and colleagues in the field of hematology gathered together to exchange the cutting-edge progress of hematology and discuss the future development direction
.
At this conference, Professor Han Yue from the First Affiliated Hospital of Soochow University gave a keynote report on "Progress in Hematopoietic Stem Cell Transplantation and Thrombocytopenia Treatment".
Yimaitong organized the main contents as follows
.
At present, hematopoietic stem cell transplantation (HSCT) is the main method for the treatment of hematological malignancies.
Bleeding is an important complication after HSCT and is closely related to the prognosis of transplanted patients
.
Professor Han Yue said that post-transplant hemorrhage greatly affects the prognosis of patients, and its risk factors include: graft-versus-host disease (GVHD), infection, thrombocytopenia, use of anticoagulant drugs, endothelial cell damage,
etc.
The study found that patients who received allogeneic hematopoietic stem cell transplantation had 10 times the incidence of bleeding than patients who received chemotherapy
.
Professor Han Yue then introduced the pathogenesis of hemorrhage after HSCT
.
Any one or more abnormalities of platelets, coagulation factors, and vascular endothelium can lead to an imbalance in coagulation homeostasis, causing bleeding, and platelet levels directly affect the occurrence of bleeding
.
Thrombocytopenia is a common complication after transplantation, with an incidence of about 5% to 37%, and its incidence is significantly related to the type of transplantation, recipient and donor
.
Thrombocytopenia after HSCT can increase the patient's platelet transfusion volume, increase the chance of infection, increase the risk of bleeding, and even cause fatal bleeding
.
Furthermore, delayed platelet recovery after HSCT is closely associated with known mortality and poor prognosis
.
Definition of Thrombocytopenia After HSCT Thrombocytopenia after transplantation includes the following three
.
1) Poor platelet reconstitution: Refers to platelets less than 50×109/L 60 days after transplantation, and good granulocyte and erythroid reconstitution; 2) Secondary thrombocytopenia: refers to factors such as infection, GVHD, thrombotic microangiopathy, etc.
3) Refractory thrombocytopenia: refers to platelets below 30×109/L 60 days after transplantation, rhTPO, TPO receptor agonists and other routine measures (Glucocorticoids, gamma globulin, etc.
) treatment for one month is ineffective
.
The pathogenesis of thrombocytopenia after HSCT The pathogenesis of thrombocytopenia after HSCT mainly includes two aspects: reduced production of megakaryocytes and increased platelet destruction
.
The reasons for the reduction of megakaryocyte production include: insufficient stem cell infusion, implantation failure, disease recurrence, myelofibrosis, etc.
; the reasons for increased platelet destruction mainly include: GVHD, infection, drugs, transplantation-related thrombotic microangiopathy (TA-TMA)
.
Among them, the amount of stem cell infusion is the most important factor, especially the infusion amount of CD34+ cells is directly related to thrombocytopenia after transplantation
.
Different stem cell sources, especially umbilical cord blood and haploid transplantation sources are key risk factors for thrombocytopenia after transplantation
.
Platelet antibodies, especially donor-specific antibodies (DSAs), also play an important role in the thrombocytopenia process
.
The number and function of endothelial progenitor cells in the bone marrow microenvironment also have a certain impact on the reduction of platelets
.
Professor Han Yue said that through the study of the First Affiliated Hospital of Soochow University, it was found that compared with patients with normal platelets, the incidence of severe acute GVHD, extensive chronic GVHD and active infection increased in patients with thrombocytopenia
.
Platelet levels and prognosis after HSCT have shown that patients with long-term thrombocytopenia after transplantation have increased mortality, while patients with transient thrombocytopenia and non-thrombocytopenia patients have no difference in mortality, and patients with chronic GVHD, long-term thrombocytopenia The mortality rate of patients was significantly higher than that of patients with normal platelets
.
Professor Han Yue said that the research data of the First Affiliated Hospital of Soochow University also proved that patients with poor platelet remodeling have a poor prognosis
.
In addition, studies have shown that poor platelet engraftment increases the incidence of transplant-related complications, and thrombocytopenia after HSCT in patients with myelodysplastic syndrome (MDS) is an independent risk factor for overall survival (OS)
.
Treatment of thrombocytopenia after HSCT Treatment of thrombocytopenia after HSCT includes removal of possible triggers (including discontinuation of suspected drugs, control of infection, treatment of GVHD, etc.
), platelet transfusion, glucocorticoids, gamma globulin, stimulating factors (including TPO, romiprostim, eltrombopag), rituximab, plasma exchange, mesenchymal stem cell infusion, and novel treatments (eg, decitabine)
.
Professor Han Yue said that related research from Peking University has proved that the infusion of mesenchymal stem cells has a certain effectiveness in reducing the occurrence of thrombocytopenia after transplantation, and within 30 days after HSCT, 35 patients (100%) obtained hematopoietic reconstruction and hematopoietic reconstruction.
Full donor chimerism is maintained
.
In recent years, there have been relatively more studies on rhTPO and TPO receptor agonists, which can act on all stages of hematopoietic stem cells to differentiate into megakaryocytes by activating the downstream JAK/STAT and RAS pathways, and promote platelet production and release
.
Then Professor Han Yue introduced a number of studies, all of which showed that rhTPO and TPO receptor agonists can promote platelet engraftment
.
Platelet ineffective transfusion (PTR) PTR refers to patients who are still in a state of unresponsiveness after receiving sufficient doses of platelet transfusions for two consecutive times, with no improvement in clinical bleeding, and no significant increase in platelet count, but sometimes a decrease
.
It occurs in 7%-34% of patients with hematological diseases
.
Studies have shown that patients with PTR have significantly increased ICU admission after transplantation
.
Recombinant human coagulation factor VIIa can effectively and safely stop bleeding in patients with hematological malignancies bleeding with ineffective platelet transfusions
.
Professor Han Yue said that a prospective, randomized controlled study conducted by the First Affiliated Hospital of Soochow University showed that the use of low-dose decitabine in the treatment of persistent thrombocytopenia after transplantation can significantly benefit patients, and 28 days after treatment, The platelet reaction rates in the decitabine group and the control group were 73.
3% and 19.
4%, respectively
.
Conclusion Prof.
Yue Han finally concluded that thrombocytopenia is a common complication after transplantation, which can increase the risk of infection and bleeding, and has a negative impact on prognosis
.
The abnormal bone marrow microenvironment plays an important role in the occurrence of thrombocytopenia after transplantation
.
New treatment regimens (such as decitabine) have better efficacy and potential for thrombocytopenia after transplantation
.
Prof.
Han Yue Deputy Director, Second-level Professor, Doctoral Supervisor, Department of Hematology, The First Affiliated Hospital of Soochow University Member of Hematology Branch, Member of Leukemia Group Standing Member of Hematology Branch of Chinese Geriatrics Association Chairman of Jiangsu Society of Hematology and Immunology, Executive Director of Jiangsu Society of Immunology Member of Hematology Branch of China Anti-Cancer Association, Member of Cell Therapy and Transplantation Group China Hematology The editorial board of the magazine, the judges of J.
Thromb & Hemost.
, Thromb.
Res and other magazines Jiangsu Province "Key Medical Talents", "Six Peak Talents", "333 High-level Talents" presided over the first prize of Science and Technology Progress of the Ministry of Education, Jiangsu Province Science and Technology Progress first prize stamp "read the original text", we will progress together
