Introduction: Despite achievement to complete remission (CR) with current treatments and new multiple chemotherapeutic agents in Acute Lymphoblastic Leukemia (ALL) patients, the majority of them still relapse during long-term follow-up. The use of post- remission therapy will reduce early relapse in these cases, but the best option is still debatable.
Patients and Methods: In this retrospective review, we assessed the outcome of allogeneic hematopoietic stem cell Transplantation (HSCT) in ALL patients treated in our center. All cases received cyclophosphamide and busulfan as conditioning regimen, cyclosporine A and methotrexate for graft versus host disease prophylaxis (GVHD) and trimethoprim/sulfamethoxazole, acyclovir and fluconazol as prophylaxis of bacterial / viral and fungal infections.
Results: From March 1991 till August 2011, 446 ALL patients with a median age of 20 (range: 2 -53) years old underwent allogeneic HSCT. The male to female ratio was 300/146. At the time of transplantation 63 % of cases were in first CR, 23 % in second CR and 6% in third CR. Thirty eight (9%) patients were transplanted in primary induction failure or relapse. Sources of hematopoietic stem cell included peripheral blood (n=412, 92.3%), bone marrow (n=23, 5.1%), cord blood (n=8, 1.7%) and peripheral blood with bone marrow (n=3, 0.9%). Almost 93.2% of patients received stem cells from their HLA- identical siblings. HLA-mismatched sibling or other relatives, HLA-matched other relative and HLA-mismatched unrelated donors were 3.4%, 2% and 1.4%, respectively. Female patients received stem cells from 16% of female and 17% of male donors. Male patients received stem cells from 26% of female and 41% of male donors. The median time of neutrophil recovery was16 (range: 6-58) days and platelet recovery was 12 (range: 9-43) days. Relapses occurred in 106 (24%) patients. 18-month LFS and OS were 58.9% (SE: 2.6%) and 68.1% (SE: 2.5%), respectively.
Conclusion: According to these results, allogeneic HSCT as a post- remission therapy can improve OS and DFS in ALL patients with a reduction in relapse rate.

Objective: This study was conducted to evaluate serum trace elements level, selenium (Se), zinc (Zn), and copper (Cu) at the diagnosis of acute leukemia, and also if there is any difference in their serum levels among various subtypes of disease.
Subjects: Fifty newly-diagnosed acute leukemia patients before starting therapy and fifty healthy subjects were entered into the study.
Methods: Serum trace elements level was determined by atomic absorption spectrometry technique.
Results: Serum selenium and zinc levels were significantly lower in patients than in healthy subjects. The comparison of trace element levels in acute myeloid leukemia (AML) subtypes showed significant difference in Se levels between AML-M3 and AML-M5. There were no significant difference between Cu levels of patients and healthy subjects.
Conclusions: Low serum levels of Zn and Se in leukemia patients in this study can express the need for assessing the effect of improving trace elements status on patient`s overall survival. A difference in Se levels between subgroups of AML patients warrants further investigation with larger sample size.

Introduction: Patients referred to as having thalassemia major are usually those who come to medical attention in the first year of life and subsequently require regular transfusions to survive. Those who present later or who seldom need transfusions are said to have thalassemia intermediaHydroxyurea, an s-phase-specific and non-DNA-hypomethylating chemotherapeutic agents is capable of inducing HbF synthesis.
Patients & Methods: The study evaluated hydroxyurea complications in a cohort of 28 patients with major (n=20) and intermediate thalassemia (n=8). HU was started in a dose of 10 mg/kg daily and then increased by 5 mg/kg daily every 4-6 weeks until toxicity occurred or clinical response was achieved.
Results: We reviewed the records of 28 patients with intermediate and major b-thalassemia. The statistical analysis did not show a significant correlation between age at diagnosis, age of starting HU, duration of HU treatment, dose of HU and ethnicity.Side effects of HU have been recorded in 21 (75%) patients.Adverse effects were hair loss (n=8; 28.57%), hyper pigmentation (n=4; 14.28%), nausea and vomiting (n=2; 7.14%), abdominal pain (n=4; 14.28%), and increase in hepatic enzymes (n=2; 7.14%).Neurologic complications were headache (n=7; 25%), vertigo (n=1; 3.57%) and drowsiness (n=1; 3.57%).
Conclusion: According to the results of this and other studies, it seems that HU therapy in thalassemic patients can be safely used but can be started at low doses and increased slowly , monitoring the patient's response.

Background and Aim: Iron overload in patients with thalassemia major is one of the most important complications of this disease and its cardiac complications are the most important causes of death in these patients.MRI T2 is the perfect device to assess the amount of iron deposited in the heart of thalassemia patients, but it causes waste of time and also is an expensive diagnostic method. Tissue Doppler echocardiography is the newer method for this evaluation.Herein, this study was conducted to determine efficacy and specificity of tissue Doppler echocardiography in the assessment of heart iron overload in patients with thalassemia major.
Materials & Methods: It was a diagnostic power assessment research?? performed on 50 patients with thalassemia major aged ≥ 15 years old that had been visited in BoualiSina Hospital in sari, Iran. After the study was explained and patients agreed to participate, written informed consent was obtained. All the patients underwent MRI T2* and tissue Doppler echocardiography results were obtained. The collected data were processed with SPSS 16 and specificity and efficacy of tissue Doppler echocardiography were obtained. In all analysis, P value< 0.05 was considered statistically significant.
Result: Patients were divided into four groups: normal amount of iron in the heart tissue, mild, moderate and severe. There was a good compatibility between results of MRI T2* and tissue Doppler echocardiography.
Conclusion: we can offer that tissue Doppler echocardiography is a worthy method for evaluating cardiac complications of iron overload in patients with thalassemia major.

Introduction: Thalassemia is the most common genetic disorder, affecting around 200 million people worldwide. The etiology of this bone disease is multifactorial. Seemingly, in the setting of increased bone turnover which manifests by increased bone resorption and remodeling; bone density decreases. In this research, thalassaemia patients with osteoporosis were placed on oral alendronate therapy for one year and their pre-and post-study bone mineral densitometry were compared.
Method: Thalassaemia patients, comprising the major and intermedia types, in the range of 20 to 50 years old were included in the study. They were admitted to three different centers: Tehran Center of Thalassaemia, Iranian Blood Transfusion Organization and the Rheumatology Clinic of Rasool Akram(s) Hospital. First of all, osteoporotic patients diagnosed on the basis of densitometry were placed on oral regimen of 10mg of alendronate daily. After a year, their densitometries were repeated and compared for the changes in BMD(g/cm2) and T-score. Also, patient’s serum calcium, phosphorus and alkaline phosphatase levels were measured at the beginning and the end of the year and the results were compared.
Results: Ninety-six of 120 patients who underwent first and second bone density measurements showed an increase in BMD and T-score at the end of the study. BMD increased in patients who used their drugs regularly, while no increased BMD was found in patients who used drugs irregularly or essentially did not use any drug.
Conclusion:, we concluded that bisphosphonates like alendronate are highly effective at improving bone density of neck of femur and vertebral bones without having dangerous side effects. So, early diagnosis, treatment and prophylaxis of osteoporosis in this group of patients are highly recommended.

Background: One million people are diagnosed with gastric cancer (GC) annually and the prognosis for patients with advanced GC or gastroesophageal junction (GEJ) cancer is usually poor with a median survival time of 8 to 10 months. Recent reports have identified that anti HER2 target therapy improved the median survival rate in patients with HER2 positive GC; but a wide range of HER2 overexpression incidence has been reported in different studies. This study was conducted to determine the incidence of HER2 overexpression and its relationship to tumor characteristics.
Methods: All gastric or GEJ adenocarcinoma patients who underwent a curative surgical resection in Firoozgar Hospital, Tehran, Iran between 2010 and 2011 were entered into this cross-sectional study. The formalin-fixed and paraffin wax-embedded tissue blocks used in the present study were surgical resection specimens obtained from 115 patients. All tumor samples were examined for HER2 expression by an immunohistochemistry (IHC) assay and HER2 IHC score 3+ was considered positive.
Results: The study sample consisted of 115 subjects, 81 males and 34 females with a mean age of 61.01 years (30-85 years, SD=11.605). HER2 overexpression was detected in 13 (11.3%) of the patients. HER2 overexpression was significantly higher in tumors ≥5cm compared to those <5cm (P=0.01). But, there was no significant relationship between tumor histological subtype, GC stage or tumor location and HER2 overexpression (P=0.607, 0.745, 0.491).
Conclusion: The findings of the present study indicated that the incidence of HER2 overexpression in gastric adenocarcinoma was 11.3%. The higher incidence of HER2 overexpression in patients with tumors ≥5cm maybe indicate that anti HER2 target therapy administration for these patients could be more beneficial.

Ewing’s sarcoma is a round cell malignancy of bone and soft tissue that occurs predominately in adolescents and young adults.It is an uncommon malignancy, but is recognized as the second most prevalent primary bone tumor worldwide. Extraosseous Ewing’s sarcoma is extremely rare and can affect the skin, soft tissues, or viscera. Prognostic and therapeutic features of Ewing’s extraosseous tumors are similar to those of Ewing’s sarcoma. A primary Ewing’s sarcoma arising from the cervix is highly rare. Most of these patients presented with abnormal vaginal bleeding. We report a case of extraskeletal Ewing’s sarcoma arising in the cervix in a 25-year-old woman.

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