International Journal of Hematology-Oncology and Stem Cell Research
Volume:4 Issue: 1, Jan 2010

Endometrial cancer is the most common pelvic malignancy in women. Approximately 7,000 women die from this disease every year. Although most patients can be treated with appropriate therapies, there is insufficient data regarding the choice of the best adjuvant therapy after a surgical procedure in advanced endometrial cancer cases. It seems that radiotherapy or chemotherapy alone don’t provide good survival. The aim of this study was to compare radiotherapy alone with chemotherapy-radiotherapy in the treatment of patients with stages II and III endometrial cancer. In this study, we selected 34 patients with stages II and III endometrial cancer who had undergone surgery. There were 22 patients in first group who received chemotherapy and 12 patients in second group who received chemotherapy and then radiotherapy with the same dosage as the first group. Mean survival rates and disease free survival rates during a 30-month period were evaluated. Local relapse was noted in 7 of the patients in the first group who had undergone radiotherapy alone, while no relapse was noted in the second group (p=0.03). Distant metastasis was observed in one patient from the first group. The disease free survival in first group was 22.4± 1.2 months. In the second group, whhad undergone radiotherapy after chemotherapy, no relapse or metastasis was observed. There was no significant difference regarding between the two groups serious adverse effects. This study showed that radiotherapy after chemotherapy is an effective method of treatment for patients with stages II and III endometrial cancer and is not associated with significant adverse effects.

Acute leukemia covers a broad spectrum of hematological clonal diseases originating from the malignant transformation of stem cells. Current chemotherapeutic methods result in an incomplete response to primary regimens in 30-40% of cases. 20 patients who had been diagnosed with acute leukemia and who had displayed defined criteria in order to enter our study, were assessed in a clinical trial. A combined chemotherapy regimen with Cladribine and Cytarabine was used in the evaluation of the response to treatment and other parameters between the two ALL (acute lymphoblastic leukemia) and AML (acute myeloid leukemia) groups. Average patient age was 32.5±11.3. 13 patients (65%) were male and 7 patients (35%) were female. The average blast count was 67.7% ±18.3% in the AML group while this count was 63.8±19.6% in the ALL group. 5 out of 11 (45.5%) AML patients and 4 out of 9 ALL patients (44.4%) died during our experiment with no significant statistical difference between the two groups (P=0.65). 4 of the AML patients (36.4%) showed complete response while 4 cases (36.4%) were refractory. In the ALL group, there were 3 patients (33.3%) with complete response and 5 (55.6%) were refractory cases. According to the results of the present study compared to other similar studies, a combined chemotherapy regimen of Cladribine and Cytarabine can be used in acute relapsed and refractory leukemia, however, with high toxicity and high early mortality. If factors are controlled, mortality can be reduced in some cases.

Polymorphism in genes involved in folate metabolism may cotribute to the susceptibility to acute lymphoblastic leukemia (ALL). Patients and To examine the influence of polymorphism in thymidylate synthase (TS 28-bp repeat) and methionine synthase (MS A2756G) genes on the susceptibility to ALL, 73 children with ALL and 128 age and gender matched, unrelated healthy individuals from Kermanshah Province were studied. Detection of TS 28-bp repeat and MS A2756G polymorphisms were performed by PCR and PCR-RFLP, respectively. The frequency of TS 2R allele in patients and controls were 41.5 and 38%, respectively (OR 1.4, 95%CI 0.76-2.56, P=0.27). The allelic frequency of G allele of MS was higher (25%) in patients compared with healthy subjects (23%) [OR 1.04, 95%CI 0.58-1.87, P=0.8]. Considering MS AA and TS 3R3R genotypes as references indication where that individuals with MS GG+TS 2R2R genotypes have 1.3-fold increase risk of ALL (OR 1.3, 95%CI 0.6-2.7, P=0.5). For the first time, our study has determined the frequency of polymorphism in two genes involved in the folate metabolism in a homogenous ethnic group of ALL patients. It seems that neither TS 28bp-repeat nor MS A2756G polymorphisms might be risk factors for susceptibility to ALL in western Iran.

Bronchiolitis Obliterans (BO) is one of the most important pulmonary complications of Hematopoietic Stem Cell Transplantation (HSCT). We decided to evaluate the prevalence and risk factors of BO in HSCT patients in the Shariati Hospital Oncology Research Center. Forty two patients, who had had HSCT for at least 6 months ago, completed the study. The diagnosis of BO was confirmed either by spirometry or inspiratory and expiratory views of HRCT with a FEV1/FVC lower than 75% or more than a 10% drop of FEV1/FVC from a baseline value and mosaic or air trapping on HRCT, respectively. Nineteen out of forty two patients were BO, with a prevalence of 45.2%; seventeen cases by HRCT and eleven by spirometry criteria. Identified risk factors for BO were acute and chronic GVHD, age 21-40 yrs. Female donor to male recipient and unmatched genders. There was a strong negative predictve value of symptoms under age 20. Young patients under 20, without respiratory symptoms, need no further evaluation. Acute and chronic GVHD are again the main risk factors regarding female donors to male recipients within the age group of 21-40.

Ifosfamide (IFO) is a potent drug that is used in cancer therapy. The major uses of IFO are: solid tumors especially, osteogenic sarcoma, other soft tissue sarcomas and hematologic malignancy, especially in lymphoma patients. The toxicity of IFO is very encompassing and includes: alopecia, nausea, vomiting, gastrointestinal, renal and neurological problems. Neuropsychiatric toxicities vary and include: fatigue, confusion, coma, and death. An early detection of the neurologic toxicities of IFO and discontinuation of the drug is the best way to manage these side effects. In a prospective study, on all admitted patients in our ward who had received Ifosfamide for chemotherapy and did not have any underlying disease. After a full physical examination and the performing of necessary paraclinical evaluations, information forms for all of the patients were filled out at admission and in follow up visits to be used in their final assessments. Neuropsychiatry examinations were performed with neuropsychiatric physician. The physician repeated their examinations at the end of treatment. If the patients had any symptoms or signs of neuropsychiatric problems the examinations were repeated examination and documented in their files. Sixty- six cases were male and 34 cases were female. The mean age was 36.4 years (18-49). The most common neuropsychiatric side effects were fatigue and delirium. Side effects were observed in 60% of the patients, and other toxicities included: somnolence (20%), confusion (10%), agitation (5%), extrapyramidal symptoms (5%), stupor (8%); and aphasia, seizures, mutism, coma, and death were not observed. All of the side effects ceased after 48- 120 hours cessation of treatment except fatigue which continued 7- 10 days after the cessation of therapy. Ifosfamide has the power potential to produce both mild and severe neuropsychiatric side effects. A careful physical examination and early detection of these side effects can prevent major neuropsychiatric problems and rule out the necessity for specific treatment of those side effects and discontinuation of drug.

The current study evaluated the value of red blood cell (RBC) indices and the corresponding cut- off points for β-thalassemia control programs in Iran. 1,150 individuals (575 couples) with low RBC indices and normal hemoglobin A2 who had been referred to the Genetic Centre of Isfahan, were tested during pre-marital screening analyses, in the 2 year period, 2006-2008. β-thalassemia mutations were evaluated. β-thalassemia was identified in 67.8% of the cases with both mean corpuscular volume (MCV) less than 78fl and mean corpuscular hemoglobin (MCH) less than 26 pg. However, 4.1% of the individuals with 78≤ MCV≤ 80 tested positive for thalassemia. MCV showed a higher diagnostic reliability than MCH. However, the accompaniment of MCH<26 with MCV<78 increased the risk of thalassemia 35 times. A significant association was found between the prevalence of minor β-thalassemia and educational levels, race and familial relationships. According to the results of this study, it seems that MCV=80fl can be used as a proper cut- off point for the screening of minor β-thalassemia. Although in the present study MCV was found to have a higher diagnostic reliability than MCH, MCH <26 along with MCV are very helpful indices for the counselor physician to estimate the risk of minor β-thalassemia more accurately.

The prevalence of rare bleeding disorders, including combined factor V+VIII deficiency are higher in Iran than in developed countries. There are only a few reports which have been written concerning kidney transplantation in the patients suffering from these disorders.Case report: A 22-year old girl, with a known case of combined factor V+VIII deficiency, a history of bladder stone surgery, postoperative bleeding and a need for hemodialysis due to renal failure was admitted for allograft kidney transplantation. The patient received fresh-frozen plasma and factor VIII, according to individualized protocol before, during and after the course of the transplantation. The function of the grafted kidney was very good nine months post-transplantation. Only heparin was used during hemodialysis. It has been shown that allograft kidney transplantation can be performed in rare bleeding disorders with good replacement therapy without any complications.

Primary adrenal insufficiency (Addison’s disease) is due to adrenocortical disease. This study is about a 40 year old man who had been referred to a hematologist who assessed him for anemia. He had been affected by a periodic paresthesia one month prior to his visit to the physician. According to the clinical presentation, macrocytic anemia and hypersegmentation of PMN in PBS, BMA/B was performed, which reported “megaloblastic anemia”.In 2001, his skin became mildly hyperpigmented, on the elbows, hands, groin and knees. In 2002, he felt weakness, had the sweats, arthralgia and myalgia. The patient was refered to a clinic and then to a hospital. But, his symptoms did not abate, therefore he was refered to the Imam-khomeini Hospital located in Tehran, and was admitted. At the hospital, new signs were detected: hypotension, hyponatremia (Na=100), raised ALT and TSH levels, and macrocytic anemia.The physician suspected primary adrenal insufficiency. More tests were performed and the diagnosis of Addison’s disease was confirmed. Noticing one of the rare features in Addison’s disease is megaloblastic anemia.