2023 CiteScore: 1.3
pISSN: 2008-3009
eISSN: 2008-2207
Editor-in-Chief:
Ardeshir Ghavamzadeh, MD.
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE).
Vol 2, No 2 (2005)
Articles
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Introduction: Idiopathic Thrombocytopenic Purpura is one of the most common causes of thrombocy-topenia with varius clinical courses and different responses to its treatment modalities. Therefore, we decided to evaluate the clinical course of this disease in our patients.
Methods: In this case series study, from March 1998 to March 2004, we evaluated 121 patients. As a first line of treatment, all of those patients received prednisolone (1mg/kg/day) for 6 weeks. Those who didn't respond or were refractory to prednisolone were candidates for splenectomy, and those who re¬fused these modalities or didn't respond to them were treated with Azathioprine.
Results: 99 patients (81.8%) were female and 22 (18.2%) were male, aged 11-73 years (mean; 28.6). Two patients had immune hemolytic anemia in addition to thrombocytopenia, 4 had systemic lupus erythematosus, and one was HIV positive. %44.6 of patients fully responded to prednisolone, 42 pa¬tients (%34.7) underwent splenectomy and %83.3 of them responsed to it.31 splenectomies were per¬formed in the first three months after diagnosis and 27 (87.1%) of them showed complete response, but 8 (72.7%) of the patients splenectomized after 3 months, had complete response. 14 patients were treated with Azathoprine, 2 of which (14.3%) platelet count normalized.
Conclusion: ITP is more common in females than males. Prednisolone is preferred as a non-invasive treatment with suitable response in comparison to other modalition responses to splenectomy, indicat¬ing that this modality of treatment is useful and effective, especially when performaed in the first 3 months of the diseases. -
Background: Induction Chemotherapy for Acute Lymphoblastic Leukemia achieves complete remis¬sion in over 90% of children. It is apparent therefore that many patients in clinical remission and with¬out residual disease detectable by conventional light microscopy of peripheral blood or bone marrow films still harbor viable cells of the original disease MRD analysis does have a useful role to play in the risk directed treatment of childhood ALL and this is currently being investigated in large prospective studies.
Methods: We have investigated MRD in bone marrow samples by three color flowcytometry approach in 63 pediatric B-precursor ALL patients treated according to BFM ALL 95 protocol. Bone marrow samples were collected from children at three different times including: Day 28th, At the beginning of intensified therapy and at the end of therapy .Cells with leukemia associated Immunophenotype were investigated by DNA analysis for evaluation of DNA content.
Results: Among 63 children with diagnosis of B-lineage ALL and quantified for post induction residual disease study .We observed that the mean number of blast cells have significant differences among these groups. The mean number of Leukemic blasts counted on day 28 was 2.7± 0.4, at the beginning of intensified therapy 1.7±0.4, and at the end of treatment 0.5±.2. These patients were in complete re¬mission in light microscopy examination. Relapse of ALL was demonstrated in six of 63 children (9.5%) whose MRD were more than one blast in 10-2 cells .Comparing this to light microscopic exami¬nation dill of these patients had 4-5% blasts vs. 1% for those who did not relapse.
Conclusion: MRD analysis does have a useful role in the risk directed treatment of child hood ALL and the investigation of levels and the dynamics of MRD by sensitive and quantitative flowcytometry and PCR methods reduce false negative results. However a good morphology is also valuable. -
Human mesenchymal stem cell (MSC) can be isolated from bone marrow (BM) and differentiated into multiple lineages. These properties make them promising tools in cell and gene therapy. Up to now, no definite therapeutic intervention for late stages of multiple sclerosis (MS) has been found. We decided to inject MS patients with autologous expanded MSC. Five patients participated in this ongoing study. Patients were injected intrathecally with the culture expanded BM MSCs. Patients were followed monthly for their clinical status and every 3 months re¬garding their magnetic resonance imaging. During 7 months follow up, one patient improved 1.5 EDSS, two patients improved by 1 and 2 scores, and two others remained unchanged till now. The first MRI findings of patients showed no change. We can claim that the injection of expanded MSC is a safe procedure. Three patients showed some de¬gree of improvement and the other two had no progression. Patients should be followed for at least one year and a larger sample is r quired in order to draw a definite conclusion.
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From 1365 to 1382, 205 cases of Acute lymphoblastic leukemia (ALL) were refered to our Center. 160 cases achived complete remission and entered our clinical trial of CNS relapse which were under consideration. The patients included 98 men and 62 women with an average age of 32 years (range 4-61 years). 160 of 205 cases had complete remission with a rate about 78%.The latter group was entered into our clinical trial. The patients were followed for 30 months after starting maintenance therapy. All patients underwent CNS prophelaxy by CNS Irradiation with 14 GY and Intratechal Methotrexate in¬jection for 6 weeks. 24 cases had relapsed. The age of CNS relapsed patients were between 9 to 58 years (Mean 31y). Patient Sex: 11 male of 91, 13 female of 69.
Results: 1 case showed CNS relapse after 4 months of starting maitenance therapy. 19 cases relapsed in the duration of 6-18 months after starting maintenance therapy. 2 cases relapsed within 24 & 28 months after starting maintenance therapy. The Statistic analysis are summarized as follows: 1-CNS relapse of ALLin the Females are more than Males (p=0.001). 2-CNS relapse of ALL in the age groupe older than 12 years were higher.
3-CNS relapse of ALL in those patients with bone marrow failure in responding to first period of treatment were higher (p=0.002).
4-CNS relapse of ALL in those patients with Leukocytosis more than 40.000/ul were higher (p=0.003). 5-The first Symptom of CNS relapse was severe headache (100%). 6-CNS relapse of ALL were in 18 months period of strating maintenance therapy. 7-CNS relapse of ALL in those patients with Type II ALL were more than Type I, with a rate of 18.7 % and 4.7% respectively. -
Background: Cisplatin-based chemotherapy is the standard treatment for advanced non-small cell lung cancer (NSCLC). Many novel drugs, including gemcitabine, vinorelbine, paclitaxel and docetaxel have been used in combination with cisplatin in this setting. Of these drugs, gemcitabine is reported to have a high response rate and acceptable toxicity. The aim of this study was to evaluate the efficacy and safety of gemcitabine & cisplatin combination.
Methods: Twenty-three patients with NSCLC, who met inclusion criteria, were enrolled from January 2001 till September 2003. All of them were confirmed by histology and were in advanced stages, i.e. stage IIIB or stage IV. Cisplatin with a dose of 70mg/m2 was given every 21 days, in combination with gemcitabine at a dose of 1250mg/m2 administered on days 1and 8 of a 21-day cycle.
Results: of the 23 patients, 1 showed complete remission, 5 achieved partial remission, 7 had stable disease and 2 patients showed progressive disease, while 8 patients were not evaluable for response. The overall response in 15 evaluable patients was 40% (95% CI), median survival was 13.5 months (95% CI, 3.5-27.4 months), and median progression free survival (PFS)was 11 months (95% CI, 1.04-20.9 months).
Hematological toxicities included WHO grade 3, 4 anemia, neutropenia and thrombocytopenia 10%, 7% and 2% respectively. Non-Hematological toxicities included nausea/vomiting WHO grade 1,2 & peripheral neuropathy WHO grade 1,2. Skin rashes were mild.Six patients developed grade 2 toxicity. Renal impairment was mild. One case developed Acute Respiratory distress syndrome (ARDS) after first dose of chemotherapy, another case developed transient acute psychosis under therapy.
Conclusions: The regimen of combined gemcitabine with cisplatin is safe and effective and well toler¬ated in patients. Some rare but important toxicity such as ARDS may occur occasionally. In this com¬bination, a lower dose of cisplatin seems to have an efficacy similar to that of in previous reports. -
Objective: To evaluate the potential advantages of imipenem/cilastatin in control of fever in neutro-penic HSCT recipients.Patients and Method: In this single-center study, 111 consecutive febrile episodes in 104 neutropenic HSCT recipients with a mean age of 26 years were randomized to treatment either with Imipenem/cilastatin 1 g, IV, q8h or cefepime (our standard regimen) 2 g, IV, q8h. If fever persisted, se¬quential antibiotics were added in 72-hour intervals: vancomycin, amikacin and amphotericin-B. The study population was at serious risk of a poor outcome, since 73.5% of febrile episodes occurred after allogeneic and 26.5% of febrile events occurred after autologous hematopoietic stem cell transplanta¬tion.
Results: The median total duration of neutropenia was 10 days, and the median leukocyte count at study inclusion was 0.16 × 109/l. The two patient groups were comparable in terms of Age, gender, un¬derlying disease, conditioning regimen, clinical and bacterial documentation, severity and duration of neutropenia and mucositis, GI decontamination and G-CSF administration. Bacteremia was found in 20.6%, other microscopically documented infections in 9.8%, clinically documented infections in 20.6% and fever of unknown origin in 49% of the febrile episodes. Most (102) febrile episodes were evaluable for response. No significant difference was found between imipenem/cilastatin and cefepime in terms of success rate (73.1% versus 62%), empirical addition of vancomycin (38% versus 26.2%) or median duration of antibiotic therapy (7 days in both).The difference between imipenem/cilastatin and cefepime was statistically significant for median duration of fever (1.5 versus 2 days) and median time of resolution of neutropenia (12 versus 14 days). The overall response rates to initial monotherapy was significantly higher for HSCT recipients with thalassemia, MM, lymphoma, AA, than recipients with ALL, AML, CML, CLL (P<0.001) and for episodes of fever of unknown origin than episodes of clini¬cally documented infections (87.8% versus 12.2%). In episodes of success without modification, the median duration of neutropenia before entry was longer than episodes when vancomycin was added (P<0.027).No patient died from the infection. Both antibiotic regimens were well tolerated. The study treatment being stopped only in 1 patient because of toxicity (cutaneous allergy to imipenem/cilastatin).
Conclusions: Imipenem/cilastatin and cefepime are effective and well tolerated when used as initial empirical treatment for HSCT recipient with prolonged neutropenia. But imipenem/cilastatin may be more effective than cefepime, as evidenced by a significantly better response in two outcome measures and in one subgroup of patients (AML). -
Mesenchyml stem cell (MSC) are receiving much attention in treatment of various diseases. The low frequency of MSCs in bone marrow (BM) necessitates their in vitro expansion prior to clinical use. We evaluated the effect of long term culture on the senescence of these cells. BM cells were taken from 11 transplant donors with mean age of 25 years. In different passages, MSC were examined for different aging indicators including: telomere length assay, differentiation ability, immunophenotyping of CD13, CD44 and CD34 antigens, determination of cumulative population dou¬blings (CPDs), and study of morphological characteristics of MSC cultures. The mean long term culture was 118 day and the mean passage number was 9. The average number of PD decreased from 7.7 to 1.2 in the 10th passage. The mean telomere length decreased from 9.19 Kbp to 8.7 kbp in the 9th passage. Differentiation potential dropped from the 6th passage on. The culture's morphological abnormalities were typical of the Hayflick model of cellular aging. We believe that MSC enter senescence almost undetectably from the moment of in vitro culturing. Si¬multaneously these cells are losing their stem cell characteristics. Therefore, it is much better to con¬sider them for cell and gene therapy early on.
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Introduction: Bone marrow transplantation is a good therapeutic modality for beta thalassemia. Liver complications are one of the major causes of morbidity and mortality following BMT. Determination of the factors of liver injury leads to earlier diagnosis after BMT and improves prognosis.
Method: We studied 113 major Beta thalassemic patients who have been transplanted from 1990- 2000 in bone marrow transplantation center of Shariati Hospital. 62 were male and 51 were female. 27 pa¬tients were class one, 56 were class two and 30 were class three. The median age of each class were 6.5, 6.3 and 8.7. Conditioning regimen consisted of busulfan (3.5-4mg/Kg) and cyclophophamide (40-50mg/Kg).For GVHD prophylaxis we gave cyclosporine ± metothoroxate. Grade of liver fibrosis de¬fined by biopsy in all patients before BMT. All patients and their donors tested for HBSAg, HBSAb, HCVAb, CMVAb with RIA method. We assessed causes of liver dysfunction before and after trans¬plantation and effect of high ferritin level on liver function.
Results: Hepatic dysfunction in first year after transplantation was seen in 86 (76%) patients. Causes of liver dysfunction were consisted of 53.1% GVHD, 15.93% cyclosporine hepatotoxicity, 7.07% condi¬tioning regimen hepatotoxicity and VOD. In all three classes hepatic GVHD, cyclosporine toxicity, death and normal liver function post BMT had significant relation with hepatic dysfunction before BMT (P=0.001). In patients with ferritin level more than 1000, there were significant hepatotoxicity with conditioning regimen (P=0.001). 17 (15.04%) of patients have been died.
Discussion: According to our study hepatic GVHD (%53.1) is the most common cause of hepatic dys¬function in all three classes.
