International Journal of Hematology-Oncology and Stem Cell Research
Volume:3 Issue: 3, Jul 2009

To evaluate the efficacy and safety of Carboplatin plus Paclitaxel in patients with advanced locoregional recurrence and metastatic endometrial cancer.Patient and 32 eligible patients (median age 62, range 41-72) with measurable endometrial cancer were treated with Carboplatin (AUC= 6) and Paclitaxel (175 mg/m3) every 4 weeks for 6 cycles, or, until disease progression or severe toxicity. The ORR was 54% (16 out of 30), CR in 4 and PR in 12.The median progression free survival was 8.2 months. The 6 months overall survival was seen in 80% of trhe patients. The toxicity was generally tolerable. The combination of Carboplatin plus Paclitaxel was well tolerated in this trial. This regimen demonstrated feasible success in curing advanced endometrial cancer compared to other combination therapies used before (in terms of RR and toxicity).

Autologous stem cells have greatly influenced the treatment of a variety of malignancies including Hodgkin/non-Hodgkins lymphoma and acute leukemias. This is a preliminary study comparing the time of engraftment, mortality rate and cost of treatment in outpatient versus inpatient autologous stem cell transplantation (SCT) in Ira.Patients and 11 outpatients (6 Hodgkin Lymphoma (HL), 3 Non-Hodgkin Lymphoma (NHL) and 2 Acute Myeloid Leukemia (AML)) were compared with 32 inpatients (15 HL, 8 NHL and 9 AML) from May, 2008 to December, 2008. All patients were in complete remission and without significant organ failure. They received conditioning regimen (CEAM for NHL and HL, Busulfan and Etoposide for AML) and stem cell infusion in hospital. The day after SCT, the outpatient group was discharged and followed up by an outpatient SCT team to be re-hospitalized, if indicated. For outpatients and inpatients, the median period to WBC engraftment was 11 and 12 days (p-value=0.03), the timeframe to PLT engraftment was 15 and 25 days (p-value=0.20) and the number of transfused single-donor PLT was 3 and 4.5 units (p-value=0.21). The duration of neutropenic fever was 6 and 9 days (p-value=0.001), the duration of hospitalization after SCT was 0 and 16 (p-value<0.001), respectively. All outpatients are alive but three inpatients died between days +35 and +100 following SCT due to transplantation complications. The cost of the drugs used for treatment of neutropenic fever was 6 times higher in the inpatient group. The outpatient autologous SCT in malignant hematological disorders is feasible and comparable to inpatient protocols in Iran.

Imatinib Mesylate is a selective inhibitor of TK and is considered now to be the frontline therapeutic agent during the chronic phase of CML. We have evaluated the efficacy of it on children with chronic-phase of CML.Patients and In a clinical trial study over the past 3 years, 14 patients (8 females and 6 males, 2.5-14 years old) were admitted with a diagnosis of CML. Seven patients who were in the early chronic-phase and seven who were in the late chronic-phase suffered from hematological relapse while being treated with conventional therapy. All of them had positive BCR-ABL in peripheral blood and bone marrow. Glivec was given as an oral dose of 300mg/m2/d. Then, regular monitoring was done for hematological and cytogenetic response, toxic effects, disease progression and survival. All seven patients with newly- diagnosed CML and five previously treated patients attained complete and sustained hematological and cytogenetic remission in a follow-up period over 2 to 30 months (the mean was 22.5). One patient was taken off study because of drug intolerance. One patient in each group relapsed after initial response and died from progressive disease. Overall survival was 86%. No major side effects were noted and there was no drug- related mortality. Glivec has proved to be effective in inducing prolonged complete hematological and cytogenetic remission in newly- diagnosed as well as previously treated children with CML. One major problem is prolonged, unlimited and continued therapy which results in poor compliance as time goes by. In addition, in developing countries, high cost and suboptimal accessibility would make its routine use quite difficult.

Zinc (Zn) deficiency can cause significant defects in cellular immunity. Hematopoietic stem cell transplantation (HSCT) patients usually experience serious deficiencies of all components of the immune system. Therefore, the maintenance of a normal Zn status may be important in this group of patients.Patients and Serum Zn levels were analyzed in 55 patients during the HSCT period. As Zn-related factors, serum copper (Cu) levels and alkaline phosphatase (ALP) activity were also measured. There was decrease in Zn values immediate post-transplant period (at day +10) when compared to pre-HSCT levels (P=0.06). In patients who developed hypozincemia, adverse events appeared to occur more frequently. This study suggests that maintaining a normal Zn status can be important in HSCT patients and Zn deficiency may be a risk factor causing adverse effects.

Hypoparathyroidism (HPT) is an irreversible but preventable disorder caused by an iron overload which can be considered a typical complication in patients with beta-thalassemia major.Patients and Parathyroid function was evaluated in 130 patients in Qom, Iran, who suffered from beta-thalassemia major. Their serum ferritin levels were checked for monitoring of chelation therapy effects. The prevalence of HPT was 14.6% (19/130). The median age of patients with HPT was significantly higher than of patients without HPT (18 vs. 15 years; P=0.03). Serum ferritin levels was not significantly different between the two groups (median: 2709 vs. 1512; P=0.95). The prevalence of cardiac diastolic dysfunction in patients with HPT was significantly higher than in normal thalassemic patients (3.1% vs. 15.8%, P=0.04). Patients with hypoparathyroidism demonstrated abnormal glucose metabolism (0% vs. 15.8%; P=0.003). the high prevalence of hypoparathyroidism demonstrated poor chelation therapy in these patients. Close monitoring of ferritin level was recommended. Also, the measurement of parathyroid hormone on a regular basis for all thalassemic patients was recommended.

Shark cartilage has been shown to have some inhibitory effects on angiogenesis, metastasis, cell adhesion and proteolysis. Patients and In this study, we evaluated the effect of shark cartilage on immune response in three treatment session of 3 weeks, 6 weeks and 12 weeks on stage III invasive ductal carcinoma patients (n=15) compared to patients treated with a starch placebo (n=15). The results indicated a significant increase after an initial 3 weeks treatment period in the level of IFNγ, but no significant decrease in the level of IL-4 before and after the treatment with shark cartilage. After 6 weeks, we noticed a significant increase (P<0.05) in the level of IFNγ, but no significant increase in the level of IL-4 was observed after the treatment with shark cartilage. After 12 weeks, a significant increase in the level of IFNγ and a significant decrease in the level of IL-4 after the treatment with shark cartilage was observed; while there was no significant difference in the levels of both IFNγ and IL-4 at 3, 6 and 12 weeks treatment in the placebo group. We also evaluated the lymphocytes proliferation in pre and post treatments with shark cartilage or a placebo. Our findings showed a significant increase in lymphocyte proliferation in the three-week treatment. It is concluded that shark cartilage can stimulate immune response in a short period of time after treatment with it and modulate immune response in longer treatment duration toward Th1 cytokine pattern.

Most of the hematologic malignancies are heterogenous with regard to morphology, immunophenotype, and genetic rearrangements. Multiple recurrent chromosomal aberrations have been identified by conventional cytogenetic analysis, which is now widely recognized as one of the most important diagnostic and prognostic determinants in these patients.Patients and Bone marrow samples were obtained from 80 patients with different hematologic malignancies. These consisted of 43 CML cases, 27 AML, 9 ALL and 1 MDS. In each case, cells were cultured and conventional cytogenetic analysis was performed. Among the 80 subjects, 53(66%) were abnormal and 27(34%) showed apparently normal karyotype. The various aberrations in abnormal cases were t(9;22)(q34;q11) in 43 CML (100%), Monosomy Y in 2 CML (4.6%), monosomy 7 in 1 CML (2.4%), trisomy 8 and t(15;17)(q22;q21) in 2 AML case(7.4%), t(8;21)(q22;q22) in 1 AML (3.7%) and complex karyotype in 2 CML, 1 AML, 1 ALL and 1 MDS (6%). Apart from these, some novel chromosomal abnormalities were observed in our study populatio. The difference in the frequency of clonal chromosomal aberrations is probably the result of the applied methods for chromosome preparation and often very poor morphologic chromosome appearance, making the identification of finer structural abnormalities more difficult. Furthermore, ongoing cytogenetic studies are warranted in larger groups of hematologic malignancies to identify newly acquired chromosomal aberrations that may aid in cloning novel genes involved in the neoplastic process, ultimately helping in the development of targeted therapeutic drugs.

The most important factor in donor-recipient matching for hematopoietic stem cell transplantation is their HLA typing.For many patients, we can not find a full-matched donor. In high risk patients, one locus mismatched related donors are suitable alternatives. (1, 2)Since the matching of patients and their siblings usually is based on low resolution HLA typing, the matching of one locus mismatched siblings is always prone to catastrophic errors. The following cases clearly demonstrate the possible pitfalls and highlight the importance of the HLA typing of parents in the matching of patients and their full-matched and one locus, mismatched siblings.