Transplantation and Cellular Therapy最新文献

{"title":"High Melphalan Exposure Increases the Risk of Graft-versus-Host Disease in Pediatric Patients Undergoing Alpha-Beta T-Cell Depleted Haploidentical Transplantation.","authors":"Christopher C Dvorak, Soohee Cho, Gabriel Salinas Cisneros, Christine S Higham, Julia Chu, Lena E Winestone, William C Temple, Sandhya Kharbanda, Kristin A Shimano, Serine Avagyan, Philip T Pauerstein, James N Huang, Geoffrey Cheng, Nahal Lalefar, Paibel Aguayo-Hiraldo, Ron J Keizer, Michael A Pulsipher, Janel R Long-Boyle","doi":"10.1016/j.jtct.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.jtct.2025.03.020","url":null,"abstract":"<p><strong>Background: </strong>Melphalan is often used as the backbone agent for conditioning prior to A/B-T-cell depleted (A/B-TCD) hematopoietic cell transplant (HCT) due to lower rates of organ toxicity compared to busulfan or total-body irradiation, albeit with significant mucosal injury. Traditional dosing based on body-surface-area (BSA) may result in non-optimal melphalan exposure among certain patient subsets.</p><p><strong>Objectives: </strong>As mucosal injury is linked to initiation of alloreactivity, we hypothesized that high exposure of melphalan predicted via a pharmacokinetic (PK) model would be associated with an increased risk of acute graft-versus-host disease (aGVHD).</p><p><strong>Study design: </strong>We performed an analysis of 85 patients who underwent A/B-TCD haploidentical HCT on two prospective trials using melphalan-based conditioning for treatment of malignancy at three centers from 2015-2024. Most patients (61.2%) received a total dose of melphalan at 140 mg/m<sup>2</sup> using actual body weight; others received a dose adjusted for obesity or age <2 years. We analyzed outcomes based on whether melphalan exposure was above or below the median exposure for the group.</p><p><strong>Results: </strong>The 100-day cumulative incidences of engraftment syndrome (ES), grade II-IV aGVHD, and grade III-IV aGVHD were 34.2%, 24.8%, and 17.1%, respectively. The 3-year cumulative incidence of chronic GVHD (cGVHD), non-relapse mortality (NRM), and relapse were 17.5%, 8.7%, 21.8%, respectively. The 3-year cumulative incidence of disease-free survival (DFS) and severe GVHD-relapse-free survival (GRFS) were 71.4% and 55.6%, respectively. ES was significantly associated with the subsequent development of aGVHD, both grade II-IV (41.4% vs. 17.3% in those with and without ES, p=0.01) and grade III-IV (34.5% vs. 8.5% in those with and without ES; p=0.003). Chronic GVHD occurred at significantly higher rates in patients with prior Grade II-IV (66.7% vs. 0% for Grade 0-I; p<0.001) and Grade III-IV aGVHD (75% vs. 4.3% for Grade 0-II; p<0.001). Compared to non-obese patients, the PK model predicted lower melphalan exposure (p=0.02) in obese patients where adjusted ideal body weight was utilized, suggesting overcorrection of the dose. There was no impact of melphalan exposure on immunologic rejection. The median melphalan exposure was 6.81 mg*hr/L (range, 4.4-8.8). Compared to a melphalan exposure ≤6.8 mg*hr/L, a melphalan exposure >6.8 mg*hr/L was associated with a higher incidence of ES (48.8% vs. 19.1%; p=0.005), grade II-IV aGVHD (39.3% vs. 10.1%; p=0.002), and grade III-IV aGVHD (31.5% vs. 2.5%; p<0.001). The 3-year incidence of cGVHD was 27.2% in those with high predicted melphalan exposure compared to 7.4% for low exposure (p=0.03); with no difference in 3-year NRM incidence (9.2% vs. 7.7%; p=0.82) or 3-year relapse incidence (16.8% vs. 27.6%; p=0.31) for high compared to low exposure. However, GRFS was significantly worse in patients ","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simple, rapid, reproducible and biomarker-validated clinical grading system for murine models of xenogeneic graft-versus-host disease.","authors":"Allan Thiolat, Cécile Pivert, Romane Bariseel, Frédéric Charlotte, Christine Sedlik, Eliane Piaggio, Sébastien Maury, Mathieu Leclerc, Jimena Tosello, José L Cohen, Caroline Pilon","doi":"10.1016/j.jtct.2025.03.015","DOIUrl":"https://doi.org/10.1016/j.jtct.2025.03.015","url":null,"abstract":"<p><p>Experiment models of xenogeneic graft-versus-host disease (xeno-GVHD), in which human immune cells are injected into immunodeficient mice, are increasingly used to study human immune cell behavior in vivo and to test therapeutic approaches. Today, the main, and more commonly accepted clinical parameters used to characterize xeno-GVHD are weight loss and mortality. These criteria do not provide an accurate and subtle assessment of the disease intensity, nor do they reflect the great variability of xeno-GVHD, which depends on the donor. Relying on previous work in which we described an original clinical grading system for assessing GVHD in mice, we propose an adaptation of this system for xeno-GVHD models. This simple, solid, and reproducible scoring system of xeno-GVHD is constituted of the binary (yes or no) evaluation of four easy-to-evaluate parameters that reflect the complexity of the disease without the need to sacrifice the mice. This scoring system is consistent with the gold standard histological grading of human GVHD and with numerous biomarkers characteristic of the disease. We propose this new clinical grading system to evaluate and compare the results obtained with a common tool, regardless of the experimenters and laboratories where the experiments would have been carried out and whatever the therapeutic strategy evaluated.</p><p><strong>Background: </strong>Experiment models of xenogeneic graft-versus-host disease (xeno-GVHD), in which human immune cells are injected into immunodeficient mice, are increasingly used to study human immune cell behavior in vivo and to test therapeutic approaches. Today, the main, and more commonly accepted clinical parameters used to characterize xeno-GVHD are weight loss and mortality. These criteria do not provide an accurate and subtle assessment of the disease intensity, nor do they reflect the great variability of xeno-GVHD, which depends on the donor.</p><p><strong>Objective: </strong>Relying on previous work in which we described an original clinical grading system for assessing GVHD in mice, we propose an adaptation of this system for xeno-GVHD models.</p><p><strong>Study design: </strong>This simple, solid, and reproducible scoring system of xeno-GVHD is constituted of the binary (yes or no) evaluation of four easy-to-evaluate parameters that reflect the complexity of the disease without the need to sacrifice the mice.</p><p><strong>Results: </strong>This scoring system is consistent with the gold standard histological grading of human GVHD and with numerous biomarkers characteristic of the disease.</p><p><strong>Conclusion: </strong>We propose this new clinical grading system to evaluate and compare the results obtained with a common tool, regardless of the experimenters and laboratories where the experiments would have been carried out and whatever the therapeutic strategy evaluated.</p>","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Academic Writing: Who is the Audience and What is the Message?","authors":"Daniel Weisdorf","doi":"10.1016/j.jtct.2025.03.003","DOIUrl":"10.1016/j.jtct.2025.03.003","url":null,"abstract":"","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"31 4","pages":"Pages 187-189"},"PeriodicalIF":3.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143716060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolonged Neurologic Symptoms After CAR T Cell Therapy – What Is It?","authors":"Michael D. Jain","doi":"10.1016/j.jtct.2025.03.004","DOIUrl":"10.1016/j.jtct.2025.03.004","url":null,"abstract":"","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"31 4","pages":"Pages 190-191"},"PeriodicalIF":3.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143716061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Officers and Directors of ASTCT","authors":"","doi":"10.1016/S2666-6367(25)01072-3","DOIUrl":"10.1016/S2666-6367(25)01072-3","url":null,"abstract":"","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"31 4","pages":"Page A3"},"PeriodicalIF":3.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143716058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Masthead (Purpose and Scope)","authors":"","doi":"10.1016/S2666-6367(25)01070-X","DOIUrl":"10.1016/S2666-6367(25)01070-X","url":null,"abstract":"","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"31 4","pages":"Page A1"},"PeriodicalIF":3.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143716056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Melt the IKAROS Wings?","authors":"Sebastian Giebel","doi":"10.1016/j.jtct.2025.03.005","DOIUrl":"10.1016/j.jtct.2025.03.005","url":null,"abstract":"","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"31 4","pages":"Pages 192-193"},"PeriodicalIF":3.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143716062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Efficacy of Bendamustine Versus Fludarabine/Cyclophosphamide for Lymphodepletion before Chimeric Antigen Receptor T-Cell Therapy in Lymphoma.","authors":"Uttam K Rao, Navneet S Majhail, Betsy Blunk, Karin Abernathy, Carlos Bachier, Vikas Bhushan, Jose Carlos Cruz, Mohammed Elayan, Tara Gregory, Charles F LeMaistre, Shahbaz A Malik, Casey Martin, Meredith Mattlin, Gabrielle Blade, Michael B Maris, John Mathews, Luke Mountjoy, Jeremy M Pantin, Aravind Ramakrishnan, Paul Shaughnessy, Michael T Tees, Estil A Vance, Behyar Zoghi, Minoo Battiwalla","doi":"10.1016/j.jtct.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.jtct.2025.03.012","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chimeric antigen receptor T-cell (CAR-T) therapy represents a transformative advance in treating relapsed/refractory non-Hodgkin lymphomas (NHLs). Effective pre-infusion lymphodepleting chemotherapy (LDC) is essential for optimizing CAR-T outcomes. Traditionally, a combination of fludarabine and cyclophosphamide (Flu/Cy) have been used; however, a global fludarabine shortage has necessitated alternative regimens. This study compares the efficacy and safety of bendamustine versus Flu/Cy as LDC in NHL patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective analysis evaluated 265 NHL patients treated with FDA-approved CAR-T products from January 2018 to October 2023. Outcomes included cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), hematologic recovery, progression-free survival (PFS), overall survival (OS), and healthcare resource utilization. Kaplan-Meier survival analysis and multivariable Cox proportional hazards models were employed to adjust for CAR-T product type, infusion year, disease subtype, and dexamethasone prophylaxis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both LDC regimens effectively prepared patients for CAR-T therapy, with no significant differences in CRS, ICANS, OS, or PFS. At one year, OS was 71% for bendamustine versus 68% for Flu/Cy, and PFS was 68% versus 60% (p=0.3 and p=0.4, respectively). Bendamustine was associated with less severe hematologic toxicity; ANC levels did not fall below 0.5 K/µL in 71% of bendamustine recipients compared to 17% for Flu/Cy (p&lt;0.001). Multivariable analysis identified infusion year as a significant predictor of OS (HR 0.77, p=0.008) and PFS (HR 2.6, p&lt;0.001), reflecting improvements in CAR-T practices over time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Bendamustine is a viable alternative to Flu/Cy for LDC prior to CAR-T therapy in relapsed/refractory NHL, as it demonstrates comparable efficacy and safety. Its operational advantages, including reduced hospitalization rates and suitability for outpatient administration, underscore its potential in diverse clinical settings. Prospective studies are needed to confirm long-term outcomes and further optimize LDC strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chimeric antigen receptor T-cell (CAR-T) therapy represents a transformative advance in treating relapsed/refractory non-Hodgkin lymphomas (NHLs). Effective pre-infusion lymphodepleting chemotherapy (LDC) is essential for optimizing CAR-T outcomes. Traditionally, a combination of fludarabine and cyclophosphamide (Flu/Cy) have been used; however, a global fludarabine shortage has necessitated alternative regimens. This study compares the efficacy and safety of bendamustine versus Flu/Cy as LDC in NHL patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The purpose of this study was to compare the efficacy and safety of bendamustine versus Flu/Cy as LDC regimens in patients with relapsed/refractory NHL undergoing CAR-T therapy. We ","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Social Work Throughout the Hematopoietic Cell Transplantation Trajectory to Improve Patient and Caregiver Outcomes.","authors":"Jill Randall, Ana Gordon, Clair Boyle, Darah W Curran, Hailey Hassel, Jessie Russell, Ben Tweeten, Kristina Walker, Kate Zoll","doi":"10.1016/j.jtct.2025.03.013","DOIUrl":"10.1016/j.jtct.2025.03.013","url":null,"abstract":"<p><p>Clinical social workers possess a dual skillset of social care and mental health care and are the largest group of psychosocial care providers in oncology. Psychosocial care is an integral component of quality healthcare. The prevailing model of psychosocial care in oncology is a brief consultation for patients who screen positive for distress at a particular timepoint. This model is insufficient for hematopoietic cell transplantation (HCT). Patients and caregivers have evolving needs throughout the HCT process, and psychosocial care models should meet these needs. This white paper, a collaboration between the Association of Oncology Social Work's Blood Cancer/HCT Special Interest Group and the American Society for Transplantation and Cellular Therapy's Social Work Special Interest Group, presents a gold standard model for the integration of social work in HCT. The model structures social work visits in every phase of HCT and integrates social workers within the interdisciplinary team. In this model, social workers conduct assessments with all patients (autologous and allogeneic) at the initial HCT consultation and again during work-up. They subsequently follow all patients and caregivers as they progress through transplant. This ongoing management reduces the burden on other team members to identify and address psychosocial needs. It also creates many organic opportunities to implement interventions to improve outcomes. There is a need to build institutional capacity for psychosocial care. Strategies that centers can use to build capacity are presented. As a complex clinical intervention, the gold standard model is well-suited for implementation research within a quality improvement framework.</p>","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-myeloablative Allogeneic Haematopoietic Stem Cell Transplantation for Myelofibrosis. A Population-Based Study from Eastern Denmark.","authors":"Morten Orebo Holmström, Lia Minculescu, Katrine Nørgaard, Brian Thomas Kornblit, Ida Schjødt, Marietta Nygaard, Niels Smedegaard Andersen, Henrik Sengeløv, Helle Bruunsgaard, Søren Lykke Petersen, Mette Klarskov Andersen, Lone Smidstrup Friis","doi":"10.1016/j.jtct.2025.03.006","DOIUrl":"https://doi.org/10.1016/j.jtct.2025.03.006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Myeloablative conditioning (MAC) and reduced intensity conditioning (RIC) regimens are both used before allogeneic haematopoietic stem cell transplantation (allo-HCT) for myelofibrosis (MF). The median age of patients with MF treated with allo-HCT is increasing and a high non-relapse mortality (NRM), especially to MAC, has increased utilisation of lesser intense non-myeloablative (NMA) regimens. NMA is used as the standard conditioning regimen before allo-HCT for MF at all transplantation centres in Denmark.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To describe the outcomes of a highly homogenously treated, population derived cohort of MF-patients who received NMA conditioning prior to allo-HCT, and identify factors associated to transplantation outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;The study is a retrospective cohort study of MF-patients treated with NMA prior to allo-HCT at Copenhagen University Hospital, Rigshospitalet from 2007 to 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 70 patients with MF who were treated with allo-HCT for MF from 2007 to 2023, 67 patients received NMA conditioning with fludarabine 90 mg/m&lt;sup&gt;2&lt;/sup&gt; and total body irradiation of 2-4 Gray. These 67 patients had a median age of 61.1 years, 22 patients (33%) had a Karnofsky performance status below 90, and 28 patients (44%) had a haematopoietic-stem-cell-transplantation comorbidity index (HCT-CI) above 2. With a median follow-up time of 3.4 years (range 0.16-15.58 years), 39 patients (58%) were still alive. Eighteen patients (27%) relapsed and of the 28 patients (42%) that died during the study period, 12 (43%) died from relapse, and 16 (57%) from NRM. Median time to neutrophil engraftment, transfusion independency and platelet engraftment was 21 days (range 11 - 119 days), 69 days (range 0 - 470 days) and 17 days (range 0 - 308 days) respectively with primary graft failure identified in 13 patients (19.7%). Overall survival (OS) after 1, 3, and 5 years was 77%, 68%; 61% %, whereas the NRM was 15%, 15% and 21%. The cumulative incidence of relapse (CIR) was 24% after 1 year, 28 % after 3 years and 28% after 5 years. Multivariable analysis showed that male sex (HR= 5.43, p&lt;0.001), graft from unrelated donor (HR= 3.58, p=0.018) and HCT-CI above 2 (HR= 2.5, p=0.025) remained associated to OS, whereas for progression-free survival, only NRAS mutations remained as an independent factor (HR= 5.88, p=0.013). Both male sex (HR= 8.41, p=0.037) and graft from unrelated donor (HR= 3.15, p=0.043) were associated to NRM in multivariable analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;NMA conditioning in the form of low dose TBI and fludarabine before allo-HCT for MF is feasible. Patients show low 1-year NRM but a relatively high 1-year CIR. Differentiated conditioning with more intensive RIC regiments for younger and fit patients could be considered to reduce the early relapse rate without increasing NRM. In survival analysis, donor-patient relation, patient","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}