Tehran University of Medical Sciences International Journal of Hematology-Oncology and Stem Cell Research 2008-2207 14 3 2020 07 02 151 156 EN Amanda Rodrigues School of Medical Sciences, Pará State University, Belém – PA, Brazil Daniel do Nascimento School of Medical Sciences, Pará State University, Belém – PA, Brazil Josy de Lima Division of Hematology-Oncology and Stem Cell Transplantation, Ophir Loyola Hospital, Belém – PA, Brazil Marcos Laércio Reis Division of Hematology-Oncology and Stem Cell Transplantation, Ophir Loyola Hospital, Belém – PA, Brazil Lucyana Leão Division of Hematology-Oncology and Stem Cell Transplantation, Ophir Loyola Hospital, Belém – PA, Brazil Murilo Azavedo School of Medical Sciences, Federal University of Pará, Belém – PA, Brazil Samanta Muccini School of Medical Sciences, Federal University of Pará, Belém – PA, Brazil Polyana da Silva School of Medical Sciences, Federal University of Pará, Belém – PA, Brazil Thiago Carneiro Division of Hematology-Oncology and Stem Cell Transplantation, Ophir Loyola Hospital, Belém – PA, Brazil 2019 09 07 2020 03 26 Background: The attempt to manage patients with acute myeloid leukemia as outpatients has become increasingly common due to high hospitalization costs, low availability for beds and patient preference. Publications on the subject are scarce, especially in low-income regions and the safety in this population remains to be determined. The present study aims to assess the safety of consolidation with high dose cytarabine in the outpatient setting. Materials and Methods: We retrospectively analyzed 39 patients who underwent consolidation with high-dose cytarabine, between 2009 and 2018, at Ophir Loyola Hospital, in Belém, Brazil. Patients treated after 2015 were given high-dose cytarabine as outpatients due to the decision of medical staff. Results: 27 patients received 76 cycles of cytarabine as outpatients; males were 48.14% of the total population, with a median age of approximately 45 years. The occurrence of delay between cycles was significantly lower among outpatients (48.14% vs. 83.33%, p = 0.04). There was no difference between relapse rates, transfusion requirements and non-relapse mortality between both groups. Hospitalization was required in 40.74% of patients during outpatient cycles and 18.51% of blood cultures were positive for pathogens. Non-relapse mortality was significantly higher among patients above 50 years old and treated on an outpatient basis (44.4% vs. 5.60%, p = 0.03). Conclusion: High-dose cytarabine administration on an outpatient basis appears to be safe and effective in a low-income population at the Brazilian Amazon region, but toxicity seems to be increased for patients older than 50 years. https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1179 https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/download/1179/835

Tehran University of Medical Sciences International Journal of Hematology-Oncology and Stem Cell Research 2008-2207 14 3 2020 07 02 157 166 EN Mang Ngaih Ciin Centre of Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand Tanakorn Proungvitaya Centre of Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand Temduang Limpaiboon Centre of Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand. AND Cholangiocarcinoma Research Institute (CARI), Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand Ubon Cha’on Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand Sittiruk Roytrakul National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathumthani 12120, Thailand Siriporn Proungvitaya Centre of Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand. AND Cholangiocarcinoma Research Institute (CARI), Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand 2019 08 30 2020 01 26 Background: Cholangiocarcinoma (CCA) is the second most common primary hepatobiliary cancer. These patients have meager prognosis and short-term survival. Precise assessment of glomerular filtration rate is a fundamental aspect of clinical care in cancer patients. Cystatin C has been proposed to be superior to creatinine, a well-known marker of renal function. This study aimed to evaluate cystatin C as a marker of GFR calculation in CCA patients. Materials and Methods: One hundred thirty serum samples from CCA patients and 32 from controls were included in this study. Serum cystatin C was measured using immunoturbidity assay. Estimated glomerular filtration rate was calculated by three equations established by chronic kidney disease epidemiology collaboration (based on creatinine and/or cystatin C). Results: Serum cystatin C in CCA patients was higher than that of controls (p=0.0002). Cystatin C was positively correlated with BUN in CCA group (p=0.019). eGFR based on cystatin C and based on both cystatin C and creatinine in CCA was low with significantly different from those of control (p<0.001). Although there was no difference in eGFR using three equations in control, creatinine based eGFR was high with significantly different from eGFR based on cystatin C and on both creatinine and cystatin C in CCA (P=0.000).  Proportion in each eGFR stage by three equations showed a high sensitivity with significantly different in CCA (p<0.05). Conclusion: There was a high sensitivity of cys C with significant difference between creatinine and/or cystatin C based eGFR in CCA patients. It should take account into consideration of mild changes in eGFR by cystatin C which is important in managing drug dosage for CCA patients. https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1174 https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/download/1174/834

Tehran University of Medical Sciences International Journal of Hematology-Oncology and Stem Cell Research 2008-2207 14 3 2020 07 02 171 176 EN Mani Ramzi Hematology and Bone Marrow Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Nasrin Namdari Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran Shirin Haghighat Department of Hematology, Hematology Research Center, Medical Oncology and Stem Cell Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran Hourvash Haghighinejad Department of Family Medicine, Shiraz University of Medical Sciences, Shiraz, Iran 2019 06 29 2020 02 15 Background: Busulfan (BU) in combination with cyclophosphamide (CY) is used as an effective conditioning regimen in hematopoietic SCT. Busulfan, depletes glutathione level in liver and causes elevated levels of CY metabolites. Cyclophosphamide metabolites are highly toxic for sinusoidal endothelial cells and cause VOD/ SOS with high mortality rate. Materials and Methods: All adult patients with acute leukemia, who were candidates for myeloablative allogenic SCT admitted in Stem Cell Transplantation center of our center were enrolled in this prospective randomized clinical trial during 2 years. We tested the hypothesis that reverse administration from BU-CY (28 patients) to CY-BU group (27 patients) would reduce liver toxicity. Results: Liver function tests were significantly higher in BU-CY group between day -1 and +4 (p<0.05), but we do not have VOD/SOS in both groups. The incidence and severity of acute GVHD was higher in BU-CY group, but not statistically significant. Engraftment and mortality rate were not different. Conclusion: These data support the concept that CY-BU is associated with less liver toxicity, suggesting CY-BU is superior to BU-CY as conditioning. https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1152 https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/download/1152/829

Tehran University of Medical Sciences International Journal of Hematology-Oncology and Stem Cell Research 2008-2207 14 3 2020 07 02 181 187 Mozaffar Aznab Department of Internal Medicine, Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Seyed Majid Ahmadi School of Medicine, , Yasuj University of Medical Sciences, Yasuj, Iran Sedigheh Khazaei Molecular Pathology Research Center, Imam Reza University Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Seyed Mojtaba Ahmadi Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran Mansour Khazaei Taleghani University Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Hamid Hamdi Armi Hospital, Sanandaj, Kurdistan 2019 05 15 2020 02 12 Background: Thymidylate synthase is one of the target enzymes of 5-fluorouracil. However, the clinical and prognostic significance of TS expression in gastric cancer has remained controversial. In this study, the expression of thymidylate synthase was evaluated in gastric cancer patients treated with combinational chemotherapy; moreover, the association between TS expression and clinicopathologic characteristics and overall survival of the patients were also assessed. Materials and Methods: In this descriptive study, 89 pathological samples were gathered from patients at Kermanshah hospitals during 2008-2017. The survival status of patients was recorded and their overall survival was evaluated individually. Results: The average survival period for low and high thymidylate synthase groups was 54 and 50 months, respectively, meaning higher survival time in the lower thymidylate group. But this difference was not statistically significant (log Rank=0.88). In addition, sex, stage, recurrence, and survival had no significant difference between the low and high expression of thymidylate synthase groups (p=0.89). Conclusion: The results clearly indicated that the level of thymidylate synthase is not a significant modulator of 5- fluorouracil in gastric cancer patients. Nevertheless, evaluation of the level of the enzymes and markers, as well as their effects, is highly recommended for accurate selection of chemotherapeutical strategies. https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1133 https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/download/1133/833

Tehran University of Medical Sciences International Journal of Hematology-Oncology and Stem Cell Research 2008-2207 14 3 2020 07 02 188 199 Nadia Menshawy Clinical Pathology, Hematology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt Shaimaa Ashwah Clinical Hematology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt Mohamed Ebrahim Medical Oncology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt 2019 04 27 2020 05 07 Background: A trigger for initiation the clonal hematopoietic stem cells disorders could be short telomere length, probably due to chromosomal instability. The relationship between relative telomere length (RTL) and the two linked hematological stem cell disorders, myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML), is still unclear. Material and Methods: We evaluated the role of RTL in MDS (n=96) and AML (n=130) at the time of diagnosis using a real time quantitative polymerase chain reaction (RT-PCR) technique. The median value of RTL (1) was set as the cutoff for statistical comparison. Overall survival (OS) is defined as the time from diagnosis to death or last follow-up. Results: RTL was significantly longer in both MDS and AML cases versus control (p<0.0001) and was significantly longer in MDS versus AML cases (p =0.03). RTL correlated negatively with age in MDS (p <0.0001) but not in AML cases. RTL was also significantly shorter in MDS cases with pancytopenia and poor risk cytogenetics (p < 0.0001 for each) and short RTL was significantly associated with inferior survival (p = 0.007), while RTL showed no significant impact on OS in AML cases. Moreover, short RTL retained independent prognostic value in multivariate analysis (HR= 3.42 [95% CI, 8.97-19.35], p = 0.004). Conclusion: RTL showed an association with both AML and MDS; however, short RTL was an independent poor prognostic factor in MDS patients only. https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1124 https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/download/1124/832

Tehran University of Medical Sciences International Journal of Hematology-Oncology and Stem Cell Research 2008-2207 14 3 2020 07 02 200 212 Moloud Absalan Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran Mohammad Hossein Ghahremani Department of Pharmacology and Toxicology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Zahra Jabbarpour Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran Roya Karimi Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran. Shilan Shafei Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran Reza Heidari Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran Mostafa Akbariqomi Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran Gholamreza Tavoosidana Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran Marziyeh Asadizaker Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Mojtaba Jahanifar Shahid Chamran University of Ahvaz, Ahvaz, Iran 2019 12 06 2020 03 01 Background: Uncertainty leads to a stressful situation in patients with thalassemia major that can dramatically affect their psychosocial coping ability, treatment process and disease outcomes, and reduce patients' quality of life. As one of the important factors affecting the health of thalassemia patients, understanding the concept of uncertainty is of major importance to health care providers especially nurses as the first line of exposure to these patients. The present study aimed to explore the experiences of uncertainty in patients with thalassemia major. Materials and Methods: The present qualitative study was conducted through in-depth face-to-face semi-structured interviews held with 18 patients with major thalassemia selected through purposive sampling. Interviews continued until saturation of data. All interviews were recorded, transcribed and analyzed with conventional content analysis method of Landman and Graneheim using MAXQDA10 software. Results: Two main themes, including 'living in the shadow of anxiety' and 'coping with uncertainty' emerged from patients’ experiences of illness uncertainty of thalassemia. 'Living in the shadow of anxiety' included four categories of 'fear of complications', 'contradictory views on treatment', 'unknown future' and 'stigma'. 'Coping with uncertainty' included three categories of 'spiritual coping', 'psychosocial coping' and 'knowledge acquisition'. Conclusion: According to the results of this study, uncertainty is a major psychological stress in patients with thalassemia major. Healthcare providers should therefore consider the challenges and concerns faced by patients and, through utilizing appropriate training and communicational practices, plan interventions and strategies to empower patients for coping with uncertainty.   https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1219 https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/download/1219/865

Tehran University of Medical Sciences International Journal of Hematology-Oncology and Stem Cell Research 2008-2207 14 4 2020 10 07 248 256 EN Aysun Senturk Yikilmaz Department of Hematology, Yıldırım Beyazıt University, Ankara 06010, Turkey Sema Akinci Department of Hematology, Ataturk Training And Research Hospital, Ankara 06010, Turkey Sule Bakanay Department of Hematology, Yıldırım Beyazıt University, Ankara 06010, Turkey İmdat Dilek Department of Hematology, Yıldırım Beyazıt University, Ankara 06010, Turkey 2019 12 01 2020 02 25 Background: Complete response (CR) and very good partial response (VGPR) are targeted with pre-ASCT induction regimens in patients by diagnosed multiple myeloma (MM), who are candidates for ASCT. In this study, it was aimed to compare the response and survival evaluations of cases who underwent induction treatment by vincristine-doxorubicin-dexamethasone (VAD) protocol versus bortezomib containing regimens. Materials and Methods: The data of 96 ASCT eligible patients, retrospectively analyzed. P value> 0.05 was considered statistically significant. Results: While 66 cases had received bortezomib containing regimens as induction regimen, 30 cases had received VAD protocol. The total survival was 91.3 (st.s 6) months and 43 (st.s 7.9) months, respectively, when we compared the cases without ASCT and with ASCT (p = 0.001). The OS of patients who underwent ASCT after reaching at least VGPR was longer than the underwent ASCT without reaching VGPR (p=0.019).  Post-ASCT PFS (p=0.717) and OS (p = 0.126) analyzes were performed in 74 cases undergoing ASCT treatment, there was no significant statistical difference when patients with treated by VAD protochol and treated by bortezomib containing regimens as pre-ASCT induction regimens was compared to each other. Conclusion: Whatever the type of induction regimen is, the level of response achieved before ASCT is important. The survival of the myeloma patients are much more influenced with HDT-ASCT as well as post-transplantation strategies to keep the patients in remission. Even though it is outdated, we think that the VAD protocol may be an option in patients who are not responding with the new generation of agents in the following days. https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1216 https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/download/1216/866

Tehran University of Medical Sciences International Journal of Hematology-Oncology and Stem Cell Research 2008-2207 14 4 2020 10 07 257 264 Amirhosein Maali 1) Infection Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran 2) Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran 3) Student Research Committee, Babol University of Medical Sciences, Babol, Iran Elaheh Ferdosi-Shahandashti 1) Infection Diseases and Tropical Medicine Rese