造血干细胞移植治疗白血病患者负性因素干预措施的护理研究

目的针对造血干细胞移植治疗白血病患者不同阶段存在负性因素的特点进行干预并观察其临床效果。方法对96例白血病患者在造血干细胞移植前期-预处理期-移植期-移植后期的不同阶段负性因素实施心理支持,全环境保护方案,并发症的预防、观察与处理,健康教育等干预措施。结果减轻或消除负性因素对患者的影响,减少了并发症的发生,缩短留住无菌层流室的时间,提高白血病患者移植后的生活质量。结论制定一整套合理的、规范的、系统的护理流程,使患者获得最佳护理方案,有效减轻负性因素对患者的影响。     

造血干细胞患儿移植初期的营养状况调查

目的：调查行造血干细胞移植的患儿移植初期的营养状况,为采取有效的营养支持措施提供临床参考。方法：以2013年10月—2014年10月在首都医科大学附属北京儿童医院血液肿瘤中心行骨髓移植的64例患儿为研究对象,观察患儿移植前及移植后30d体质量、血生化指标、人体成分变化及口腔黏膜炎发生率、感染发生率、移植物抗宿主病发生率、肝功能受损程度、造血重建时间并做营养评估。结果：移植后患儿体重较移植前下降明显,具有统计学意义。移植后血清白蛋白较移植前下降明显（t=5.4,P<0.01）,差异有统计学意义;移植前后血红蛋白变化不明显。移植后患儿人体成分4项指标（体脂肪率、蛋白质、去脂体重、肌肉量）较移植前均显著下降。结论：患儿移植后营养状况较移植前恶化,应组成营养支持团队针对患儿移植前后各个阶段做好营养筛查和评估,对有营养风险的患儿、营养不良的患儿予以指导和干预。     

造血干细胞移植条件对小鼠造血重建的影响

通过同种基因型小鼠构建造血干细胞移植模型,将预处理的全骨髓单个核细胞或c-Kit⁺造血干细胞移植至致死剂量照射的受体小鼠体内,动态监测移植2～16周后受体小鼠体内供体来源细胞造血重建以及嵌合情况,以期揭示不同群体的供体细胞以及预处理等因素对小鼠造血干细胞移植后造血重建的影响。实验结果显示,移植后早期(2周)全骨髓单个核细胞组髓系比例要高于c-Kit⁺细胞移植组,但全骨髓移植组受体小鼠呈现出较大的移植后不良反应,出现脱毛、食欲不振以及体重减轻的症状。c-Kit⁺细胞移植组在淋系重建上要早于全骨髓移植组,供体细胞的嵌合植入也早于全骨髓移植组,但两组实验组最终均能完成造血重建过程。实验结果表明c-Kit⁺细胞移植组在移植后能够较快地实现供体细胞植入,进而开始造血重建,且c-Kit⁺细胞移植组的不良反应要低于全骨髓移植组。结果说明在整体造血重建效果上c-Kit⁺细胞移植组要优于全骨髓移植组。     

间充质干细胞在造血干细胞移植中的应用

间充质干细胞(MSCs)是一种具有自我更新和多向分化潜能的成体干细胞,存在于骨髓、脂肪组织、脐血及多种胎儿组织.它可分泌多种细胞因子及生长因子,促进造血干细胞(HSC)的增殖与分化.MSCs还具有免疫调节、抗炎和组织修复作用,可减轻移植物抗宿主病(GVHD)及其他移植相关并发症.     

造血干细胞移植与捐献

造血干细胞移植技术在临床上的应用越来越广泛,是目前白血病等难治性疾病的重要治疗方法之一,给广大患者带来了福音,但目前造血干细胞来源不足制约了其在临床上的广泛应用。介绍了造血干细胞移植与捐献的相关知识,包括造血干细胞移植的种类、临床应用、采集的过程、捐献的流程及捐献对供体的安全性等,旨在提高对造血干细胞捐献的认识。     

胎肝造血干细胞的移植特性

胚胎发育中,肝脏是一个重要的造血器官。近年来胎肝移植的临床应用重新引起了人们的关注。本文应用染色体的 C-带染色法研究了小鼠骨髓和胎肝造血干细胞在照射受体小鼠中的增殖能力与相互间的竞争作用。实验结果表明胎肝造血干细胞在成年骨髓中的植入率比较同样条件下的成年骨髓造血干细胞低,但胎肝造血干细胞比较成年骨髓造血干细胞具有更强的自我更新或增殖能力。在同种胎肝造血干细胞移植中,为了降低同种移植抗力,提高移植的胎肝造血干细胞在受体中的耐受性,移植前对受体作适当的免疫抑制处理是必要的。因此,克服个体发育屏障和移植免疫屏障是提高同种胎肝造血干细胞移植效果中两个重要的研究课题。     

造血干细胞移植的风险

1.感染：患者接受造血干细胞移植后,由于免疫功能的抑制,发生感染的机会明显增加,发生率50％－80％。感染病变可能发生在身体的任何部位,可能来自移植操作的并发症、潜在的感染病原体激活、环境中接触的新病原体。引起感染的病原体包括细菌、真菌、病毒、寄生虫等。感染仍是目前影响移植个体长期存活的主要因素之一。     

造血干细胞移植治疗白血病的护理研究进展

造血干细胞移植（HSCT）是根治白血病的主要手段,治愈率达60％～80％。由于移植过程存在着影响治疗效果的各种负性因素,我们针对移植过程不同阶段负性因素的特点,实施心理支持,并发症的预防、观察与处理,全环境保护方案,健康教育等干预措施,以减轻或消除负性因素对患者的影响,促进患者身心早日康复,提高白血病患者移植后的生活质量。     

异基因造血干细胞移植中的树突状细胞

树突状细胞(DC)是目前已知的启动免疫反应最强大的抗原呈递细胞(APC),也是惟一能激活初始T细胞的APC。近年来,DC在移植免疫中的作用已成为研究的焦点。简要综述了DC在异基因造血干细胞移植中的研究进展。     

造血干细胞的研究进展

干细胞研究是一门新兴的学科。经过50多年的努力,造血干细胞的研究已经成为当今生物医学领域中发展最快的领域。介绍了造血干细胞的来源、分离纯化和检测方法以及“可塑性”等方面的研究情况,并详细说明了一些主要的造血干细胞表面标志以及造血干细胞在干细胞移植、细胞治疗和基因治疗等方面的临床应用和前景。     

Overview of nutritional approach in hematopoietic stem cell transplantation: COVID-19 update

The coronavirus disease 2019 (COVID-19) is caused by the newly discovered SARS-CoV-2. Hematopoietic stem cell transplantation (HSCT) is a high-risk procedure. The novelty of COVID-19 has created more uncertainty during all phases of HSCT. It is thought that HSCT patients taking immunosuppressive agents are more likely to contract COVID-19 than healthy individuals are. Appropriate care precautions should be taken with patients undergoing HSCT to minimize the risk of COVID-19, and appropriate treatment methods must be followed in patients infected with COVID-19. Malnutrition has become a significant problem in HSCT patients during the COVID-19 pandemic. The causes of malnutrition in HSCT patients are multifactorial. However, the most important reason is the decrease in energy and nutrient intake. The HSCT procedure can lead to many complications such as dysgeusia, mucositis, diarrhea, constipation, xerostomia and vomiting/nausea. Improving the nutritional status of HSCT patients by managing each of these special complications with an appropriate nutritional approach is essential for successful engraftment. This review aims to provide a comprehensive overview of the specific complications affecting the nutritional status of HSCT patients and their nutritional approach during the challenging COVID-19 pandemic.     

Mesenchymal stem cells in hematopoietic stem cell transplantation

Mesenchymal stromal/stem cells (MSC) of bone marrow (BM) origin not only provide the supportive microenvironmental niche for hematopoietic stem cells (HSC) but are capable of differentiating into various cell types of mesenchymal origin, such as bone, fat and cartilage. In vitro and in vivo data suggest that MSC have low inherent immunogenicity, modulate/suppress immunologic responses through interactions with immune cells, and home to damaged tissues to participate in regeneration processes through their diverse biologic properties. MSC derived from BM are being evaluated for a wide range of clinical applications, including disorders as diverse as myocardial infarction and newly diagnosed diabetes mellitus type 1. However, their use in HSC transplantation, either for enhancement of hematopoietic engraftment or for treatment/prevention of graft-versus-host disease, is far ahead of other indications. Ease of isolation and ex vivo expansion of MSC, combined with their intriguing immunomodulatory properties and their impressive record of safety in a wide variety of clinical trials, make these cells promising candidates for further investigation.     

DC homeostasis in hematopoietic stem cell transplantation

Hematopoietic stem cell transplantation is an important experimental tool and therapeutic modality. Its efficacy and toxicity are both linked to a GvH reaction that is initiated by donor T cells recognizing recipient APC, of which DC are the most potent. In most tissues recipient DC are replaced after transplantation because they turnover rapidly from BM-derived precursors. However, in a number of sites, notably the skin, recipient DC may persist and even self-renew for many months after transplantation. Understanding the homeostasis of different APC populations and how they are related to the induction of alloreactivity may help to improve the therapeutic benefit of transplantation.     

Role of HLA in hematopoietic stem cell transplantation

ABO blood group incompatibility is not a contraindication for allogeneic hematopoietic stem cell transplantation (allo-HSCT). An increasing number of ABO-incompatible HSCT (ABOi-HSCT) procedures have been performed along with advances in donor selection over the years. Currently, whether the recipient-donor ABO incompatibility has detrimental effects on post-HSCT outcomes is a matter of debate. Discrepancies across studies referring to various graft sources, donor types, conditioning regimens, and the use of immunomodulators complicate interpretations of the clinical outcomes of ABOi-HSCT, such as transfusion requirements, graft-versus-host disease (GVHD), disease relapse, overall survival (OS), and non-relapse mortality (NRM). Isohemagglutinins (ISO) targeting red blood cell (RBC) antigens are associated with post-HSCT immunohematological complications, including hemolysis, passenger lymphocyte syndrome (PLS), and pure red cell aplasia (PRCA). Immunohematological events occur frequently and are sometimes difficult to handle in clinical practice. Therefore, it is necessary to form a deeper understanding on the mechanism and a comprehensive management scheme for recipients of ABOi-HSCT. In this review, we summarized literature of the impact of ABO incompatibility on post-HSCT outcomes and outlined important immune-mediated hematological events.     

Plasticity after allogeneic hematopoietic stem cell transplantation

The postulated almost unlimited potential of transplanted hematopoietic stem cells (HSCs) to transdifferentiate into cell types that do not belong to the hematopoietic system denotes a complete paradigm shift of the hierarchical hemopoietic tree. In several studies during the last few years, donor cells have been identified in almost all recipient tissues after allogeneic HSC transplantation (HSCT), supporting the theory that any failing organ could be accessible to regenerative cell therapy. However, the putative potential ability of the stem cells to cross beyond lineage barriers has been questioned by other studies which suggest that hematopoietic cells might fuse with non-hematopoietic cells and mimic the appearance of transdifferentiation. Proof that HSCs have preserved the capacity to transdifferentiate into other cell types remains to be demonstrated. In this review, we focus mainly on clinical studies addressing plasticity in humans who underwent allogeneic HSCT. We summarize the published data on non-hematopoietic chimerism, donor cell contribution to tissue repair, the controversies related to the methods used to detect donor-derived non-hematopoietic cells and the functional impact of this phenomenon in diverse specific target tissues and organs.     

Autologous hematopoietic stem cell transplantation for systemic sclerosis

Systemic sclerosis is a rare disorder manifesting as skin and internal organ fibrosis, a diffuse vasculopathy, inflammation, and features of autoimmunity. Patients with diffuse cutaneous disease or internal organ involvement have a poor prognosis with high mortality. To date no therapy has been shown to reverse the natural course of the disease. Immune suppressive drugs are commonly utilized to treat patients, but randomized trials have generally failed to demonstrate any long-term benefit. In phase I/II trials, autologous hematopoietic stem cell transplantation (HSCT) has demonstrated impressive reversal of skin fibrosis, improved functionality and quality of life, and stabilization of internal organ function, but initial studies were complicated by significant treatment-related mortality. Treatment-related mortality was reduced by better pre-transplant evaluation to exclude patients with compromised cardiac function and by treating patients earlier in disease, allowing selected patients the option of autologous HSCT treatment. There are currently three ongoing randomized trials of autologous HSCT for systemic sclerosis: ASSIST (American Systemic Sclerosis Immune Suppression versus Transplant), SCOT (scleroderma cyclophosphamide versus Transplant), and ASTIS (Autologous Stem cell Transplantation International Scleroderma). The results from these trials should clarify the role of autologous HSCT in the currently limited therapeutic arsenal of severe systemic sclerosis.