International Journal of Hematology-Oncology and Stem Cell Research
Volume:4 Issue: 4, Oct 2010

This review reports the current results of hematopoietic stem cell transplantation (HSCT) in patients who had received transplantation in the Hematology-Oncology and SCT Research Center, Tehran, Iran. In Iran, from 1991 through 2010, a total of 3170 hematopoietic stem cell transplantation have been carried out. The male/female patient ratio was 1909/1261 with a median age of 23 years (range: 4 months-71 years). The most common transplanted disorders were acute myelogenous leukemia (799 patients; 25.2%), thalassemia major (500 patients; 15.8%) and acute lymphoblastic leukemia (447 patients; 14.1%). The donor types for 2147 allogeneic HSCT patients were 2007 (93.5%) human leukocyte antigen (HLA) matched-identical siblings, 66 (3.1%) HLA matched (other relatives), 52 (2.4%) HLA mismatched sibling/other relatives and 22 (1%) unrelated donors; also 16 (0.5%) of transplanted patients had syngeneic twins as donor. There were 2147 cases which had received allogeneic HSCT and 1007 cases which had received autologous HSCT. The number of allogeneic and autologous HSCT patients had increased during that time, but the allogeneic to autologous ratio remained constant. Out of 2147 allogeneic HSCT cases, there were 1730 (80.6%) cases of peripheral blood, 370 (17.2%) cases of bone marrow, and 13 (0.6%) combined peripheral blood and bone marrow cases and 34 (1.6%) cord blood cases as product types. Of the 1007 autologous patients with the first HSCT, 937 (93%) received peripheral blood, 65 (6.5%) bone marrow and 5 (0.5%) mixed bone marrow and peripheral blood as stem cell sources. Hematopoietic stem cell transplantation is a choice treatment for many malignant, nonmalignant and genetic diseases. In Iran, HSCT has been successfully adapted in routine clinical care. Recently, new methods have been used, for example double cord blood and haploidentical transplantation.

Acute Idiopathic Thrombocytopenic purpura (ITP) is an autoimmune bleeding disorder of childhood caused by production of auto antibodies against platelets. The aim of the present study was to compare the efficacy of intravenous immunoglobulin (IVIG) and intravenous anti-D(IV anti-D) in ITP treatment.Methods and materials: In a clinical trial, 43 children with acute ITP referred to Afzalipour Hospital, Kerman/ Iran during 2 years were studied. Children were randomly divided into two treatment groups of IVIG (n=27) and anti-D (n=16). Two groups were compared in regard to the time takes for platelets to increase, platelets count in the 10th post-treatment day and any drug side effects. Positive response to the treatment was observed in 70.4% (19 patients) of IVIG group and 68% (11 ones) of IV anti-D group. Mean response time was 2.9 days in anti-D and 2.8 days in IVIG groups (p=0.934). Platelets count on the 10th post-treatment day in anti-D and IVIG groups were respectively 202545/μl and 204857/μl (p=0.974). Four patients in IVIG group showed side effects, while the patients in anti-D group had no complication or acute hemoglobin decrease. In spite of no significant difference between IVIG and anti-D treatment groups in regard to the therapeutic outcomes, IV anti-D is suggested as the first-line treatment in acute ITP because of its lower price, more convenient administration and no need for hospitalization.

Breast cancer is the most common malignancy with more than one million new cases diagnosed annually all around the world. Its growth is mostly regulated by steroid hormones such as estrogen and peptide growth factors in interaction with epidermal growth factor 1 and 2.Methods and materials: In this study, 237 patients who had consulted the Oncology Clinic of Tabriz University of Medical Sciences with pathologic diagnosis of breast cancer (from 2003 to 2010) were involved. Data was extracted from medical records. From the total of 237 patients, 50.6% were ER+, 48.9% were PR+ and 37.1% were HER-2+. The greatest percentage of HER-2 positivity (51.6%) was detected in the age group of patients over 60 and the least in the group aged 31 to 40 yrs. The greatest percentage of HR+ (71%) patients were also over 60 and the least (50%) were less than 30. 35.5% of patients in pre- menstrual period were HER-2+. HR was positive in 64% of LN+ patients; HER- 2 and HR were positive in 35.4% and 65.4% while in LN- patients they were positive in 39% and 61.9% of cases, respectively. Acquired data showed reverse relation between the expression of epidermal growth factor II and hormone receptors in breast cancer. 40-55% of cases with epidermal growth factor expression lacked hormone receptors. Co-existence of hormone receptors and HER-2 expression in breast cancer are considered as important prognostic factors.

In Iran along with other countries, as transplant technology progresses and advances, the number of patients undergoing transplantation is rising steadily. In order to make Stem-Cell Transplantation (SCT) safer and more effective, psychological distress of patients must be taken in to account. Patients are facing challenges pre- and post-transplantation. This study attempts to measure and compare the levels of anxiety depression before and after SCT.Method and materials: The study includes 35 patients (21 male and 14 female; mean age 34.8, range 18-60 years, 10 Hodgkin's disease, 10 MM, 9 AML and 6 ALL) who met the inclusion criteria at the time of hospitalization were selected as candidates for SCT at Shariati Hospital-Tehran, Iran. Anxiety and depression were evaluated by Hospital Anxiety and Depression Scale (HADS). Questionnaires were filled out in two steps, once within 48 hours after hospitalization and the other one on the day of discharge. Level of anxiety and depression decreased from 8.64±3.42 to 6.09±2.84 and from 7.20±3.49 to 6.00±3.7, respectively (both p-values <0.001).Nobody has severe anxiety/depression pre- or post-SCT and only one patient had moderate anxiety/ depression before SCT that reduced to mild level thereafter. The level of anxiety and depression in transplant patients has been reduced. The findings suggest that psychological distress (anxiety, depression) should be evaluated in patients at frequent intervals. Therapeutic treatment procedure, pharmaceutical and non pharmaceutical treatment should be carried out based on the results obtained from patients under study.

The aim of our study is evaluation of response rate of VAD (Vincristin, Adriamycin and Dexamethason) regimen as initial treatment in 40 new cases of multiple myeloma. This is the first systemic and classic report of VAD regimen in Iranian population. All patients with at least stage 2 multiple myeloma or progressive disease after physical examination, para- clinical profile such as (Imaging, CBC, BUN, Creatinine, Ca, P, Alk Phos, protein eletrophoresis, immuno electrophoresis and B2 Microglobuline) entered to this study and investigation. All patients received VAD regimen (Vincristin 0.4mg/day 1-→4 days, Adriamycin 9mg/m2 1-→4 days and Dexamethasone 40 mg/day/1→4 (days), 9→12 (days), 17→20 (days)/cycle in outpatient therapy (24mg/morning and 16 mg evening) and repeated every 28 days for 4 cycles. The evaluation of response rate was with: decreased clinical manifestation, changes in para clinical profile and M- component and B2 microglubuline. Fourty (40) patients enrolled, 24 cases (60%) were female, 16 (40%) male, the mean age was 48 (25- 64), IgG myeloma was 80% (32), IgA myeloma 15% (6), and IgM myeloma 5% (2). 9 cases had thrombocytopenia in initiation of treatment and 7 cases during treatment protocol, and in the end of treatment, thrombocytopenia remained in 3 cases (total 16 cases) with mild thrombocytopenia (PLT= 100,000- 120,000), azotemia detected in 7 cases and in 2 cases resolved during treatment protocol. The over all response rate was 85%, median survival to now was 44.3 months. Toxicity was mild and acceptable. Our result revealed the high response rate of VAD regimen as initial therapy and good survival rate with minor and acceptable toxicity.

Acute myeloid leukemia (AML) is a clonal disease characterized by heterogeneous involvement of hematopoietic bone marrow cell populations. In AML patients, a variety of clinical and biologic parameters, including surface markers, have been examined for potential value in predicting treatment response and survival. By checking the myeloid, lymphoid and nonspecific markers on the blasts, we tested the hypothesis which the disease free survival and overall survival in AML could correlate with the expression of them. The immunophenotype was performed by multiparameter flow cytometry (FACS Caliber flow cytometry, Becton Dickinson). The prognostic significance of 16 antigens is taken separately in 207 adult AML patients. We applied statistical software of SPSS-13. In this analysis, we compared DFS and OS with each of the surface markers existence. We could just find significant correlation in 4 of these markers. Those patients possessed CD3 blasts, had better overall survival (P=0.027). In contrast in CD33 patients, this parameter was worse (P=0.002). Disease free survival in CD15 patients was higher (P=0.036) but in CD34 cases, it was significantly lower (P=0.001). This study suggests that dependent role of surface markers in the prognosis and response to treatment in AML is a fact which should be paid much more attention and applied it in the management of these patients.

Pulmonary Adenosquamous carcinoma is an uncommon histological variety of bronchogenic carcinoma, and has histologic areas differentiated as both squamous cell carcinoma and adenocarcinoma and has clinical behavior more like that of adenocarcinoma. Tumor Stage is higher at the time of diagnosis, and survival is poorer. We present a 65 years old woman with bulging in her left frontal site of the head. He also had a dyspnea and abnormal chest X-ray and Histopathological findings for the bronchoscopic biopsy specimen as well revealed bronchogenic adenosquamous carcinoma. Brain MRI with contrast showed a metastasis to skull that resulted in a lytic lesion in frontal bone and leakage of CSF from the skull. Metastasis of lung cancer to the skull is not a common manifestation of this tumor. However, as we showed, the only manifestation of lung cancer can be the metastatic complications of the tumor.

Multiple myeloma is a neoplasm of monoclonal plasmacells which may cause oral manifestations. We report a 50-year-old man with a mass burned out of a post extraction socket. He had recived an eight month period of chemotherapy and was supposed to be ready for hematopoetic stem cell transplantation. After clinical and histopathological examinations, the mass was diagnosed as a plasmacytoid cell proliferation. As the oral manifestations are an indicator of poorly controlled disease, the patient was refered to change his chemotherapeutic regimen. It seems that a team work, including oral medicine specialists may be a valuable opportunity in monitoring and promoting the quality of therapy.