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 4, No 3 (2010)
Articles
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Introduction: Arsenic has been used as an effective medicine in the treatment of severe promyelocytic leukemia in recurrence and resistance cases toward ATRA. In this study, it has been used as induction and maintenance therapy after remission.
Method & Material: We studied 31 patients diagnosed by APL. Arsenic was started at a dose of 0.15 mg/kg (daily) until patient’s bone marrow remission.(1) We started Arsenic as a consolidation therapy after 28 days rest and then we continued the treatment with Arsenic each 3-4 months during 2 years for 14 days.
Results: 4 patients died (12.9%) during the first 15 days of treatment. 27 patients (87%) went into remission. 2 patients refused the continuation of treatment regardless the remission. 25 patients received a long term treatment. The disease of 3 out of 25 patients recurred during follow -up period. 1 patient died during the treatment after recurrence and 3 others given ATRA & Arsenic went into remission. Now, It has been past 2 months since the end of their remission. The recurrence appeared in the form of full involvement of thoraco-lumbar which was observed as an extensive tumor on MRI and was found to cover the mentioned area. 1 patient faced CNS fungal infection during neutropenia period and then recovered after operation and proper treatment; however his vision was severely damaged. As 4 patients faced leukocytosis over 1000/000ml, we were obliged to discontinue arsenic for 3-4 days and chemotherapy by Danurobicine was prescribed for 2 days. The patient’s follow-up and the median survival time were 54 and 48 months, respectively. The overall survival was 80.6%.
Discussion: Arsenic as the first line therapy for APL is an effective treatment .Consistent long- term therapy with intervals will reduce the risk of disease recurrence. -
Introduction: Hypothyroidism is diagnosed by elevated thyroid stimulating hormone (TSH) and normal or decreased serum levels of T4 or T3, and is associated with a wide range of metabolic abnormalities, including anemia. This clinical study aimed to assess the improvement of anemia in patients with primary hypothyroidism following administration of levothyroxine in Iranian population.
Materials & Methods: The effect of levothyroxine in 70 patients with hypothyroidism was examined and the improvement of anemia in patients who had a poor or good response to levothyroxine was assessed during a 3 month follow-up.
Results: Three months after treatment, the levels of TSH in 64 patients with hypothyroidism (91.4%) significantly decreased to a normal limit (TSH< 2.5 IU/ml). Forty three out of 70 patients (61.4%) had a concurrent anemia. A significant difference was found in the levels of hematologic parameters between those who had a good response (TSH< 2.5 IU/ml) and those with poor responses to the treatment (TSH≤2.5 IU/ml) (p< 0.05).
Conclusions: Current study showed a high rate of association between anemia and hypothyroidism in Iranian population. Improvement in hypothyroidism and its associated anemia was observed in majority of patients (more than 90%), indicating a dual benefit for hypothyroidism treatment. Less than 10% of patients poorly responded to levothyroxine, with no clear reasons. -
Introduction: Infections in neutropenic patients are considered as major causes of mortality and emergence of drug resistant Gram positive bacterial infections are crucially important to be covered if indicated. Vancomycin is active against most Gram positive bacteria including methicillin resistant Staphylococcus aureus (MRSA). In this study, we evaluated the appropriate utilization of this agent.
Methods: We conducted a prospective observational study at bone marrow transplantation research center, Shariati teaching hospital in Tehran to evaluate the appropriateness of vancomycin utilization for our adult bone marrow transplantation (BMT) patients for a period of six months.
Results: The charts of a total of 117 patients were prospectively reviewed in 3 adult BMT wards. Seventy four patients (63.2%) received vancomycin treatment during their hospital stay. Most patients received allogienic versus autologous transplantation (62.2%, 18.9%). Majority of patients were under 50 years of age (91.9%). About 58% of cases were febrile neutropenic at the time of vancomycin initiation. Based on the criteria of appropriate indications, vancomycin utilization was justified in 59.5% of cases which 43.2% of those cases received appropriate initial doses.
Conclusion: Based on the results of this study, in the majority of our BMT patients vancomycin was utilized appropriately as a part of their empiric treatment. More attention in the time of initiation and also dose adjustment seems to be necessary to minimize treatment failure and the emergence of drug resistance. -
Introduction: The aim of this study was to evaluate the use of albumin in bone marrow transplanted patients and its possible economic repercussions from its inappropriate use.
Methods and materials: This was a retrospective study in which all patients receiving albumin ) from start to end of treatment( at three bone marrow transplantation wardswere assessed in two consecutive years .The clinical indications for albumin were evaluated on the basis of guidelines.The concomitant drugs that affected albumin levels were assessed.Characteristic data including age,gender,weight,body surface area(BSA),diagnosis, blood group,type of transplantation were recorded .All lab data which included serum creatinine ,alanine aminotransferase , aspartate aminotransferase, alkaline phosphatase, totalprotein, albumin, hematocrite, calcium before and after albuminuse were also recorded . Postconsumption data was in-hospital stay and mortality.
Results: During the study period, 104 patients received albumin at 3 wards (BMT1:36 patients, BMT2:11 patients, BMT3:57 patients). Patients received a mean number of 24.52 ± 20.86 vials. The mean treatment duration was 13.96 ± 9.14 days. Drugs decreasing albumin level did not significantly affect the use of albumin. Weight, total protein and calcium have been significantly altered after albumin use.
Conclusion: Drug Use Evaluation is an opportunity for clinical pharmacist to help improve therapy by designing strategies to reduce the medication error and cost or changing prescriber manners. -
Introduction: Breast cancers in the early phase frequently undergo distant metastasis and survival of patients is greatly dependent on distant metastasis. The occurrence of micrometastasis has been suggested to relate with prognostic features of breast cancer, such as lymph node metastasis and the presence of vascular invasion. The aim of this study was to examine the presence of keratin-19 mRNA of epithelial tumors in bone marrow aspirates obtained from breast cancer patients and its possible correlation with tumor staging and disease free survival.
Methods and materials: Bone marrow samples were obtained from 53 breast cancer patients at the time of adjuvant therapy after surgery. We separated the mononuclear fraction from the samples and carried out nested reverse transcriptase polymerase chain reaction (RT-PCR) .for the detection of keratin-19 mRNA with two different pairs of primers. After adjuvant therapy, patients undergoing Bone marrow aspiration and repeat separation the mononuclear fraction from the samples and carried out nested reverse transcriptase polymerase chain reaction (RT-PCR) for the detection of keratin-19 mRNA with two different pairs of primers, the patients were followed up at 3-month intervals.(1,2) We studied the possible correlation of the detection of keratin-19 mRNA with tumor size, nodal involvement, stage and recurrence rate, overall survival and disease -free survival.
Results: We studies 53 Breast cancer patients (Stage 1-11I) for presence of Bone marrow micrometastasis by nested-PCR for cytokeratin 19. Before adjuvant chemotherapy it was positive in 17 patients (32%). Presence of DTC was independent to clinical stage. We followed 15 out of 17 bone marrow positive, by the same methods for presence of micrometastasis after adjuvant chemotherapy and observed that 4 patients remained positive after adjuvant chemotherapy.
Conclusion: With a median follow up of 272 days three metastasis developed, in our cohort which all happened in bone marrow positive patients. Our study is ongoing to increase the number of patients, longer follow up and also to compare peripheral blood with bone marrow. -
Introduction: The secondary genetic changes other than the PML-RARA fusion gene may contribute to the acute promyelocytic leukemogenesis. Chromosomal alterations and mutation of FLT3 tyrosine kinase receptor are the frequent genetic alterations in acute myeloid leukemia (AML). However, the prognostic significance of FLT3 mutations in acute promyelocytic leukemia (APL) is not firmly established.
Patients & Methods: FLT3 ITD screening by fragment length analysis and FLT3 D835 mutation by melting curve analysis in 23 APL samples was screened in this study.
Results: About13% of the patients had FLT3 internal tandem duplications (ITDs), and 26% had D835 point mutation. FLT3 ITD mutation was associated with higher white blood cell (WBC) count at presentation and poor prognosis.
Conclusions: As the PML-RARA is not sufficient to develop APL, we assume FLT3 mutations and additional chromosomal alterations in this APL series may cooperate with PML-RARA in APL development. -
We describe a case of leishmaniasis in a 55-year-old male who presented with weakness, fever and anemia. The patient was born and lived all his life in Talaghan, a non-endemic region of kala-azar and there was no history of travel to endemic reigon for leishmania. In primary diagnosis, the patient suspect has been myelofibrosis and then lymphoma and underwent chemotherapy. His general condition worsened and bone marrow biopsy was performed again and leishmania promastigotes seen in the bone marrow. Specific identification of the parasite was done by RAPD-PCR. After two weeks of treatment, he was transferred to ICU due to heart attack and after 4 days he died due to aortic valve ABE.
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The hematological malignancies associated with nephrotic syndrome are mainly hodgkin’s and non-hodgkin’s lymphomas and chronic lymphocytic leukemia. Acute myelogenous leukemia (AML) has rarely been described in associated with nephritic syndrome. We report a rare case of acute myelogenous leukemia who presented with nephrotic syndrome. A previously healthy 62-year-old man was admitted in nephrology ward because of generalized developing pitting edema during last month. Simultaneously, he had generalized itching and urticaria, polyuria, polydypsia and low grade fever but had no history of weight loss, anorexia and sweating. In laboratory tests he had proteinuria above 3.5 gr/ day. Because of anemia, hematology consultation was done. In peripheral blood, there were myeloblast cells in the circulation at a ratio of 20%. Bone marrow aspiration confirmed a diagnosis of AML M2, showing hypercellular bone marrow with 80-90% leukemic cells, increased M/E ratio, myeloblast (immature cell, fine chromatin, cytoplasmic granule) and these abnormal elements: myeloblast >50% and mature cell about 20%. Unfortunately, we hadn’t renal biopsy as a consequent of patient illness and thrombocytopenia. He received induction chemotherapy, which led to a complete remission and decreasing urinary protein excretion during chemotherapy and no proteinurai at the end of it. Now the patient has received second course of consolidation therapy and remained in complete remission, with no physical and laboratory evidence of proteinuria. It can be concluded that nephrotic syndrome may be additionally associated with AML. In some cases, there is a direct causal effect of the leukemic process on renal function or even pathology, while in others it is exerted indirectly via other complications of the malignancy or the treatment.
