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 3, No 2 (2009)
Articles
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Introduction: The traditional goal of the treatment of Acute Myelogenous Leukemia is to produce and maintain a complete remission (CR).The difference in survival time was entirely attributable to the duration of time spent in CR .In this study, the outcome of AML patients with allogeneic HSCT in CR1 versus other than CR1 was compared.
Patients and Methods: Since March 1991 until November 2008, from 420 AML patients, 312 patients in CR1 with a median age of 28 years and 108 patients in other- than- CR1 with a median age of 27 years, have undergone allogeneic HSCT. The male/female ratio was 168/144 in the CR1 group and 55/53 in other- than- CR1. In totals 391 patients received Peripheral Blood, 27 patients Bone Marrow and 2 patients, Cord Blood as sources of HSCT.
Results: At present, 266 (85%) patients in CR1 and 73 (68%) patients in other- than-CR1 are living. The most common cause of death in CR1 group was Graft Versus Host Disease and in the other- than CR1 group was relapse. Median follow up time was 17 months (range: 1-158 months). Six month Disease Free Survival (DFS) and Overall Survival (OS) in CR1 was 86% and 91% (SE=2%). 2-years DFS and OS in CR1 was 78% (SE=3%) and 85% (SE=2%). Six month DFS and OS in other- than- CR1 was 64% (SE=5%) and 75% (SE=4%). In this groups 2 years DFS and OS was 50% and 64% (SE=5%). It is to be noted that six month DFS and OS in transplanted patients with CR1 was significantly higher than in other- than- CR1 (p<0.001). Furthermore, 2-years DFS and OS in patients with CR1 were better than the second group (P< 0.001).
Conclusion: Although the results of HSCT in other than first complete remission is not as good as in first complete remission, it seems that it is good enough to advise doing allogeneic HSCT for these patients. -
Introduction: The telomeric DNA together with its associated proteins protects the chromosome ends from degradation or aberrant recombination. Telomerase and telomere are closely associated with development of cancers. In this study we aim to investigate the significance of telomerase activity (TA) and telomere length (TL) in patients with acute promyelocytic leukemia (APL).
Methods: Peripheral blood samples were taken from 20 APL patients during the diagnosis and from 25 healthy normal individuals at different age ranges. Telomerase activity (TA) was assessed by TRAP-ELISA and –PAGE procedures. Genomic DNA isolated from patient mononuclear cells was digested with Rsa1 and Hinf1 restriction enzymes; electrophoresis was performed in 0.8% agarose gels, and telomere length (TL) was determined by southern analysis using a Chemiluminescence-based assay.
Results: As oppose to the normal individuals, telomerase activity was detected in peripheral blood mononuclear cells of all APL patients (P<0.001). Marked differences were observed in the sizes of the telomere length in the normal blood cells and APL leukemic cells. The leukemic cells of 18 of 20 (90%) patients with APL showed a significant reduction in the length of telomeric DNA, ranging from 2.3 to 6.7 kbp (median 3.5 kbp), while the telomere length in healthy normal individuals was 9.1 to 14.8 kbp (median 11.6 kbp) (P<0.000). In healthy individuals, the average TL was found to vary with age, and the rate of telomere shortening was age dependent.
Conclusions:Telomere length shortening and Telomerase up-regulation are closely associated with acute promyelocytic leukemia; therefore, they may be used as potential markers for diagnostic, prognostic and for therapeutic intervention in APL patients. -
Introduction: Drug Utilization Evaluation (DUE) studies are designed to assess drug usage appropriateness. DUEs have traditionally focused on drugs with high price tags, complicated dosage schedules, narrow therapeutic indices and regular side effects. The primary goal of the present study is to evaluate imipenem usage in Bone Marrow Transplantation (BMT) wards.
Methods: The study was a prospective DUE study, carried out in three BMT wards in Dr. Shariati hospital, Hematology- Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences. The study was performed from April 2008 to October 2008. NCCN Clinical Practice Guidelines in Oncology and AHFS recommended protocols were used for evaluation. For a statistical analysis, SPSS (version 16.0) was used.
Results: A total of 64 patients were evaluated during the study. In all patients, imipenem was started empirically. In thirty five (54.7%) patients, the antibiotic seemed to be effective. Twenty- two (35.9%) patients needed dosage adjustments due to low weight or renal failure, but no action in this regard was taken. In 51.6% of patients, the antibiotic therapy duration was not appropriate. Thirty seven (57.8%) patients experienced nausea.
Conclusion: Imipenem in febrile neutropenic patients is administered empirically. Imipenem induced nausea was observed in 57.8% of patients. This result may be due to rapid infusion of imipenem in the wards. The result of this study indicates the need for further education on dosage adjustment based on renal function and patients’ weight.
Improper duration of the treatment could result in resistance and thus should be noted.
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Introduction: Neuroblastoma is the most common extracranial solid tumor in children, accounting for 8% to 10% of all childhood cancers. Significantly, autologous transplantation appeared to have the largest impact on survival for the high risk subset of patients, such as those with N-MYC amplified metastatic disease diagnosed after age 2 years.
Patients and methods: This study includes high risk, relapse, or refractory patients with NBL who underwent SCT from 1998 up-to 2009. There were nine patients with NBL consisting of seven males and two females. Among nine neuroblastoma patients who received transplantation, eight patients received autologous transplantation and one patient received allogenic transplantation of full matched sibling. The main conditioning regimen was CEM; consist of Carboplatin (400 mg/m2 for 3 days), Etoposide (200 mg /m2 for 3 days), and Melphalan (75 mg /m2 for2 days). Patients transplanted after 2008 received 13-cis-retinoic-Acid 120-160 mg/m2/2weeks in month, as maintenance from days sixty after SCT until one year.
Results: Median age of recipients was 5.5 years (range: 4-8 years). All patients were in stage IV of NBL. The common pathological result was stromal poor. Primary involved site at diagnosis was adrenal gland in patients. The source of stem cells was Peripheral Blood in seven patients and Bone Marrow in two patients. The median duration required to achieving an Absolute Neutrophil Count (ANC) ≥ 500×109/µl was 11 days (range: 8-14 days). The median duration required to achieving a platelet count of ≥ 20×109/μl was 19 days (range 10-70 days). Six of nine recipients had relapsed. At present four patients are alive that one of them had relapse and three ones are in complete remission and all of them passed 250 days after SCT. Relapse was the only cause of death.
Conclusion: Regarding to the studies we can conclude in Neuroblastoma patients Stem Cell Transplantation is better than chemotherapy alone, the allogeneic Stem Cell Transplantation has no preference to autologous SCT and Peripheral Stem Cell Transplantation is significantly better than Bone Marrow. -
Introduction: Human Leukocyte Antigen (HLA) genes are the most polymorphic loci in the human genome. They predict the outcome of transplantation by detecting self from non-self antigens. The best use of HLA typing is to find a HLA-match donor for BMT candidate patients. Evidence suggests that matching unrelated donors and recipients for HLA-A, -B and -DRB1 loci is a prediction for an improved outcome.
Methods and materials: HLA-A and -B of six hundred Iranian cord blood samples were typed by PCR-SSP method and the frequency of loci were estimated.
Results: The most frequent alleles were A*02(18.16), A*24(16.41), B*35(21.66) and B*51(13.35), respectively.
Discussion: Our HLA typing data show similarity between neighbor and related countries and Caucasians. Identifying HLA alleles helps to find suitable donors for patients in need of hematopoietic stem cell transplantation. -
Introduction: Hematopoietic stem cells are always in a quiescence state. Since they need retroviral transduction to infect dividing cells, they are resistant to retrovirus transduction. They need to be pre-stimulated by a cytokine cocktail. For proliferation without maturation, we suggest MIP-1α as a novel factor.
Material and methods: Retroviral vector produced by PG13/LN C8 cells titter on Hela cells. Then, the CD34+ cells of cord blood can be pre-stimulated in a serum- free media supplemented with SCF, Flt3,TPO,IL6 in the presence and absence of 50 ng/ml MIP-1α. Transduction efficiency was assessed by a semi-quantitative PCR for the neomycin gene.
Results: A PCR analysis of the neomycin gene in CD34+ cells revealed an improved transduction of cord blood cells in the presence of MIP-1α 65%, in comparison to its absence: 40.7%.
Conclusion: the addition of MIP-1α to the cytokine cocktail improves the transduction efficiency of cord blood hematopoietic progenitor cells. Further studies are required to clarify its effect on the functional properties of CD34+ cells. -
Introduction: Chemotherapeutic drugs used to treat cancer may cause nausea and emesis by inducing the release of 5-hydroxytryptamine (5-HT) in the small intestine. Blockage of 5-HT3 receptors in the small intestine by 5-HT3 receptor antagonists might prevent the nausea and vomiting associated with chemotherapy for cancer. The aim of this study was to compare the efficacy and tolerability of the 5-HT3 receptor antagonists (granisetron) and granisetron plus dexamethasone in the treatment of acute chemotherapy induced digestive emesis and nausea.
Materials and Methods: Patients on their first course of emetic chemotherapy (cisplation or doxorubicin based regimen) were randomly placed into two treatment groups. Group A received a one-time administration of granisetron 3 mg, IV and group B received granisetron plus dexamethasone 8 mg IV. For each study the drug were administered one time, 30 minutes before infusion of chemotherapy emetic agent. For the efficacy assessment, response data were recorded every 6 hours for a total of 24 hours, after the start of the chemotherapy infusion.
Results: A total of 138 patients [86 males, 52 females with amean age of 48 (a range between 15-82 years)] were involved in the study . Of these, 125 were evaluable.
Discussion: The ability of granisetron plus dexamethason to prevent acute emesis was significantly better than, administering granisetron alone (66.7% vs 42.8% respectively) (p<0.001). The combination of granisetron and low-dose dexamethasone is superior to granisetron alone to control acute emetic episodes in patients receiving emetogenic chemotherapy. -
Castleman disease (CD) is a rare, lymphoproliferative disorder of uncertain etiology. We are reporting on two cases of Castleman disease. Both patients were female. This disease can be found wherever lymph nodes are present. We have reported two unusual cases of Castleman disease. A 29- year old woman was referred for evaluation because of a cervical lymph node, weight loss and night sweats. There was a history of Hodgkin’s disease. A 80- year old woman was referred to the oncology clinic because of progressive generalized pruritus and vertigo, weight loss, night sweats and fever. In two cases, a biopsy of the cervical lymph node revealed a plasma cell variant of Castleman disease. CD can present symptoms in patients. Therefore, clinical, hematological and histological features of lymph node revealed a plasma cell variant which can be suggestive of Castleman disease.
