International Journal of Hematology-Oncology and Stem Cell Research
Volume:4 Issue: 2, Apr 2010

Conventional amphotericin B is one of the antifungal choices as prophylactic and empiric treatment against fungal infections in febrile neutropenic patients. However the time of initiation, dosing and monitoring of drug adverse effects must be justified to maximize the efficacy and minimize the toxicities of this antifungal agent. We conducted a prospective observational study at Shariati teaching hospital, Hematology – Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences to evaluate the appropriateness of amphotericin B utilization for our adult bone marrow transplant (BMT) patients for a period of six months. The charts of a total of 54 patients in 3 adult BMT wards were prospectively evaluated. Most patients underwent allogienic transplantation (61.1%). The mean duration of treatment with amphotericin was 9.3 days with 50% as prophylactic and 42.6% as empiric treatments. Appropriate dose was initiated in 70.4% of patients versus 22.2% unjustified initial doses. The use of amphotericin was appropriate in 92.6% of cases versus 7.4% unjustified uses. Based on the results of this study, in the majority of our BMT patients amphotericin B was utilized appropriately either as prophylactic or empiric treatment. More attention in dose adjustment seems to be necessary to minimize nephrotoxicity and other adverse effects of this agent.

MicroRNAs (miRNA) are small non-coding RNAs that have a distinguished role in post- transcriptional gene expression. It’s estimated that 10-30% of human mRNAs are regulated by miRNAs. Many miRNAs profiles change during normal erythropoiesis in which some of them are stage specific.mir-155 was downregulated 200 fold in erythropoiesis. K562cells were grown in RPMI1640 and viability tested by trypan blue. microRNA 155Inhibitor and its scramble were purchased from exiqon. K562 cells were transfected using transfection kit according to manufacture manual. After RNA extraction and cDNA synthesis, miRNA downregulation confirmed by miRNA Real time PCR, then alpha- and zeta- chain expression was investigated by RT and QRT-PCR. The viability of cells before transfection was 99% and the efficiency of mir-155 inhibitor transfection was 90%. By relative Q-PCR the zeta chain expression was increased 3.4 fold and alpha chain was increased 8.3 fold in comparison to untransfected cells. This study showed that mir-155 downregulation has a distinguished role in alpha chain hemoglobin mRNA expression level. The expression of alpha chain was more than zeta chain that may be result of adult source of K562 cells. Differentiation induction by miRNA regulation without adding any growth factor can be considered as a new strategy in gene therapy and tissue engineering.

JAK2 is a nonreceptor tyrosine kinase that plays a major role in myeloid disorders. JAK2V617F mutation is characterized by a G to T transverse at nucleotide 1849 in exon 12 of the JAK2 gene, located on the chromosome 9p, leading to a substitution of valine to phenylalanine at amino acid position 617 in the JAK2 protein. In this study we compared two molecular methods namely ARMS-PCR and AS-PCR for the evaluation of JAK2V617F mutation in patients with myeloproliferative neoplasms. In this study we evaluated JAK2 mutation in 89 patients with Myeloproliferativeneoplasm (MPNs) by simple randomized sampling. The mutation was detected by ARMS-PCR and AS-PCR in patients.Three DNA samples were sequenced for conformation of the above techniques. The JAK2 V617F mutation was detected in 86.6% (26/30) of patients with polycythemia vera and 61.5% (8/13) of patients with idiopathic myelofibrosis. None of 31 CML patients were detected by ARMS-PCR and AS-PCR. In essential thrombocythemia using ARMS-PCR and AS-PCR 46.6% (7/15) and 53% (8/15) of patients were positive, respectively. The mutation was confirmed by sequencing. The results of the study showed that similarity with other studies by two techniques and detection of the JAK2V617F mutation may depend on the molecular technique used. Also, JAK2 mutation detection is an appropriate tool for differential diagnosis of non-CML myeloproliferative neoplasms from benign condition like reactive erytrocytosis and thrombocytosis.

Candida dubliniensis and C. albicans are very similar in morphology and phenotypic characteristics. Approximation of this yeast species has caused major problems in identifying these two correctly. To distinguish among sixty yeast clinical isolates from patients with cancer, polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) was done. PCR-RFLP of the ITS region showed different patterns between Candida dubliniensis and C. albicans after digestion with enzymes BlnI. All of the Clinical isolates were diagnosed as C. albicans. The results were confirmed by sequencing and RAPD-PCR. PCR-RFLP would be a useful and applicable technique in clinical laboratories for discrimination of C. albicans and C. dubliniensis.

The majority of leukemia patients are acute leukemia patients, so that about 70.8% lymphoblastic leukemia were acute lymphoblastic leukemia (ALL) patients and 66.4 % of myeloid leukemia patients were acute myeloid leukemia (AML) in Tehran metropolitan. During the last two decades, intensification of therapy by the use of high-dose Cytarabine allogeneic stem cell transplantation in selected cases, paralleled by improvement in supportive care may have contributed to the impotent. In this article we use parametric survival models for recognizing prognostic factors in acute leukemia patients.Patients and Data on patients who underwent bone marrow or peripheral blood transplantation were obtained from the Hematology- Oncology and bone marrow transplantation research center at Shariati hospital, Tehran, Iran. Transplantations were performed between Oct. 17, 1993 to Jan. 31, 2007. Written informed consents for hematopoietic cell collection and transplantation were obtained from patients and donors. The study included patients 2 to 56 years of age who had received either an HLA-matched marrow transplant or a marrow transplant with a single HLA mismatch from an unrelated donor. The mean follow- up period was about 2 years after transplantation. Five hundred and seven patients were included in the study. There were 301 with acute myeloid leukemia (AML) and 206 with acute lymphoblastic leukemia (ALL). The median ages of the AML and ALL patients were 27 (2-55) and 20 years (2-52), respectively. In ALL patients, Prior viral exposure- cytomegalovirus antibody was positive in 143 patients and negative in 30 patients. In AML patients’ Prior viral exposure- cytomegalovirus antibody was positive in 220 patients and negative in 41patients. Table- 1 shows the characteristics of 507 patients who included in the study. In spite of no significant difference in follow-up time, serological status (CMV), donor-recipients sex match, bone marrow cell dose(WBC, CD34, MNC), donor type, source of stem cell, graft type, and conditioning regimen, (Busulfan- Oral, Cyclophosphamide, ALG/AIS/ATG, Stoposide)(Table- 1) in both AML and ALL patients, generalized gamma distribution shows that the mean of SBMT in AML patients is 2.52 times of ALL patients.

Invasive aspergillosis is a major cause of morbidity and mortality in hematologic malignant patients which have received intensive cytotoxic therapy or undergone blood and marrow transplantation (BMT). Early clinical and radiological diagnosis of IA is almost impossible and so mortality is very high. The main purpose of our study was to assay the diagnostic value of serum galactomannan (a fungal antigen found in the sera of infected patients) level in early diagnosis of invasive aspergillosis in patients with hematologic malignancies and BMT.Method and materials: During 2009and2010, 70 adult patients with neutropenic fever of unknown origin in Shariati and Imam Khomeini centers of cancer and BMT were tested for galactomannan serum level on the 7th day of fever or before starting antifungal treatment. The OD index of 0.5 or more was taken as positive result. Tissue biopsy from lung or sinus was performed in 8 patients and there were 7 positive results for aspergillus species. Galactomannan EIA test result was positive in 26 cases (37.1%). There were 7 cases of proven IA with positive tissue (lung or sinus) biopsy and 20 cases of probable IA. Overall, 27 cases were positive for IA (gold standard= proven IA+pobable IA). The study yields a sensitivity and specificity of 77.8% and 88.4% for this test, respectively. Positive and negative predictive value of the test with confidence interval of 95% was 80.8 % (60-92.7%) and 86.4 %(72.0-94.3%), respectively. Considering these results, galactomannan EIA test results must be interpreted cautiously as an alternative test to prove IA, and it doesn’t eliminate the need for other diagnostic criteria such as clinical symptoms, biopsy, imaging, etc. However, the test is substantially helpful in recognizing true cases of the disease.

Primary cardiac lymphoma is a rare disease which mainly found in elderly men. It is usually a B-Cell non-Hodgkin’s lymphoma which primarily located in the heart and may involve the pericardium. The common presentations include massive pericardial effusion and heart failure. Clinical diagnosis is often delayed in these patients and prognosis is dismal. We report a case of a 70-year-old man presented with congestive cardiac failure and constitutional symptoms. A computed tomography of the chest showed two large right and left atrial masses. Echocardiographic study demonstrated that the tumour was in both atria with infiltration into the left ventricle. The diagnosis was confirmed by lymph node excision. The patient was started on chemotherapeutic agents but unfortunately succumbed to the disease 18 days later. Although, the prognosis of primary cardiac lymphoma remains poor, early diagnosis may alter the clinical course.

Myelodysplastic syndromes (MDS) are a group of hematological disorders ranging from chronic refractory anemia to leukemia. There are some reports about association of MDS with autoimmune disorders and vasculitis. In this study we describe a patient with MDS and vasculitis presenting with central nervous system (CNS) involvement. A clinical response to immunosuppressive therapy was also observed in the patient.