Iranian Journal of Blood and Cancer
Volume:5 Issue: 1, Autumn 2012

Chemotherapy-induced neutropenia as a major toxicity of systemic chemotherapy is commonly associated with substantial mortality and morbidity, and thus identifying its determinants is necessary. This study was undertaken to identify main risk factors of severe neutropenia following adjuvant chemotherapy treatment in a community-based population of patients with cancer in Semnan, Iran. This prospective study included 828 consecutive patients with histologically proven primary or metastatic solid tumors who received chemotherapy. Demographics data, disease characteristics, and co-morbidities (including current smoking and diabetes) were collected by face to face interviews with the patients and also by referring to their laboratory data and files. Patients underwent complete blood count a week after the first chemotherapy course. Based on the nadir value of the absolute neutrophil count (ANC), 30 patients (3.6%) had severe neutropenia. Multivariable logistic regression analysis showed that advanced age (OR = 5.262, p = 0.012), and the presence of diabetes mellitus (OR = 8.126, p = 0.015) were the main determinants for the appearance of severe neutropenia with the presence of demographics and studied co-morbidities as confounders. We identified advanced age and the presence of diabetes as the main determinants of high-grade neutropenia in solid tumor patients receiving adjuvant chemotherapy in our study population. Keywords: Neutropenia, solid tumor, chemotherapy.

Pain is described as the fifth vital sign, and inadequate pain management is linked to numerous immediate and long-term negative outcomes. Venipuncture is one of the most painful medical procedures in children. Distraction is one of the most effective ways to relieve pain. Reducing patients’ pain is important for all nurses for many reasons. Unnecessary pain can damage the nurse-patient relationship, whereas knowledge of alternative techniques can improve patient care and satisfaction. The purpose of this quasi-experimental study was to test the analgesic effect of distraction during venipuncture in children with thalassemia. Forty patients (6–12 years) who were suffering from major thalassemia and required venipuncture were randomized into distraction group (n = 20, regular breathing exercise) and control group (n = 20, without any intervention). The pediatric pain behavioral symptoms and numeric pain rating scale were used to assess pain caused by venipuncture. The mean pain score based on the numerical scale was 5.60 ± 3.13 in the control group and 1.85 ± 1.42 in the breathing exercise group (p=0.0001), and the mean score of behavioral pain symptoms was 3.80 ± 2.80 in the control group and 0.96 ± 0.75 in the breathing exercise group (p=0.0001). Distraction was demonstrated to be effective in reducing pain among children undergoing venipuncture. This intervention requires minimum effort and time and is a convenient nursing intervention that might be used in clinical settings. Keywords: Pain, Thalassemia, Distraction, Children.

Transcranial Doppler ultrasonography results have not been previously studied in among Iranian sickle cell anemia patients. The present study was performed to evaluate the pattern of intracranial flow velocities among Iranian children with sickle cell anemia and the hematological parameters that can affect the time-averaged mean of maximum velocity in major intracranial arteries. A total of 34 patients with sickle cell anemia aged 2-16 years (Mean: 9.5 ±4.1 years) were enrolled in this cross sectional study. A special pediatric Doppler transducer was used to study intracranial vessels such as left and right middle cerebral arteries and the time-averaged mean maximum velocity was determined for major intracranial arteries on each side. The results of transcranial Doppler were studied according to the Stroke Prevention Trial in Sickle Cell Anemia criteria. In total a relatively high transcranial Doppler value was found in 9 patients (26.4%) on either right or left side. Out of these 5 patients (14.7%) were in low risk zone (140-169 cm/sec), 3 patients (8.8%) in conditional zone (170 to 200 cm/sec), and one patient (2.9%) in high risk zone (>200cm/sec). Time averaged mean of maximum velocity on the right side and the left side had inversely significant correlation with Hb F (p=0.03) and Hb S (p=0.02). Transcranial Doppler parameters in patients with sickle cell anemia in our study indicated about one forth of patients to have degrees of increased intracranial flow velocity. In contrast to most other studies the cerebral blood flow velocities among our patients were not significantly correlated with most haematological parameters except for Hb F and Hb S. Key Words: Sickle cell anemia, transcranial, Doppler, children, Iran.

Methotrexate has an important role in treatment of acute leukemia. We measured methotrexate level in CSF and blood of children with acute lymphoblastic leukemia to determine complications and outcomes. One hundred and twenty patients (73 male, 47 female), with mean age at diagnosis of 6.1 years (11mo_15years) entered the study. Patients were divided into two groups receiving consolidation therapy of medium-dose MTX 2g/m2/24hrs, or high- dose MTX 5g/m2/24hrs respectively. Clinical features, concentration and pharmacokinetic parameters of MTX, as well as serum creatinine were assessed. The mean serum MTX levels (24 hours after therapy) was 8.9_ 9.8 µmol/L after 4 courses. The mean serum MTX level 48 hours after therapy was 0.3-0.42 µmol/L after 4 courses. The mean CSF MTX levels after therapy was 0.22 µmol/L. The mean serum creatinine before and after MTX therapy were not different between two groups. Mucositis was observed as grade 0; in 65.8%, grade 1 in 15%, grade 2in 15%, grade 3 in 3.3% and grade 4 in 0.8% of patients. CNS relapse was observed in 20.8% patients. The mean MTX level after 24 hours in patients with CNS relapse were lower than the mean MTX level in patients with no CNS relapse. Mortality in patients with severe mucositis was higher than patients with mild mucositis (P value <.001). Mortality in patients with CNS relapse was greater than patients without CNS relapse. Routine assessment of the serum MTX levels for medium dose MTX is not necessary, however, careful clinical monitoring of these patient is mandatory. Monitoring the plasma concentration of MTX is necessary in high dose MTX therapy. Keywords: Leukemia, treatment, side effect, methotrexate

Methotrexate is an anti-rheumatic agent used as a first-line tretment for rheumatoid arthritis. Hematological malignancies like lymphoma or acute myeloid leukemia have been reported to be secondary to treatment with Methotrexate, but are very uncommon. We report here the first Moroccan case of RA patient on low dose MTX, who developed AML. We also reviewed all similar cases.