TET2, DNMT3A, IDH1, and JAK2 Mutation in Myeloproliferative Neoplasms in southern Iran

BACKGROUND

Five epigenetic regulator mutations are considered in myeloproliferative neoplasms (MPN) that have prognostic and therapeutic values.

OBJECTIVE

We aimed to evaluate these mutations in MPNs among the Iranian population.

METHODS

We selected 5 mutations in 4 epigenetic regulatory genes [TET2, DNMT3A, IDH1 (rs147001633&rs121913499), and JAK2)] and evaluated 130 patients with MPNs including 78 Philadelphia chromosome negative (49 ETs, 20 PVs, and 9 PMFs) and 52 Philadelphia chromosome-positive patients as well as 51 healthy controls.

RESULTS

Eight patients (6.5%) carried the DNMT3A mutation, 35 (27%) were positive for TET2 mutation and 64 (49.3%) had the JAK2V617F mutation. In the healthy controls, 16 (31.4%) cases had the TET2 mutation (15 Heterozygote + 1 Homozygote) and one had heterozygote JAK2 mutation. There was no statistically significant difference between patient groups for any of these mutations, except for JAK2. The JAK2 mutation rate was 18 (90%), 25 (51%), 7 (77.8%), 14 (26.9%) in polycythemia vera, essential thrombocythemia, primary myelofibrosis, and chronic myelocytic leukemia, respectively. Patients aged 60 and older were more likely to carry the TET2 mutation (23% vs. 39% in younger and older than 60 years old individuals, p=0.025). IDH1 was not detected at all and PV had the highest TET2 mutation 7(35%). Two PMF patients had a history of bone marrow transplantation that were negative for IDH1and DNMT3A and one was positive for TET2 mutation.

CONCLUSION

In the normal Iranian population, the heterozygote form of TET2 mutation is significant, especially in the elderly. No association was found between JAK2 and TET2 mutations. Both of them are more prevalent in the age group of 60 years and older. DNMT3A mutation has a low prevalence and occurs in both positive and negative MPNs.

Dysregulated Expression of CD28 and CTLA-4 Molecules in Patients with Acute Myeloid Leukemia and Possible Association with Development of Graft versus Host Disease after Hematopoietic Stem Cell Transplantation

BACKGROUND

Dysregulated expression of co-stimulatory molecules is one of the immune escape mechanisms employed in hematologic malignancies like acute myeloid leukemia (AML).

OBJECTIVES

To evaluate the expression of the CD28 and CTLA-4 molecules in 62 adults with de novo AML and its correlation with the development of acute graft vs host disease (GVHD) after hematopoietic stem-cell transplantation.

METHODS

The relative expression of CD28 and CTLA-4 was measured by quantitative SYBR Green real-time PCR method in a group of patients and controls as well as different risk groups (high, intermediate and favorite risk), M3 vs non-M3 and GVHD vs non-GVHD patients.

RESULTS

The mRNA expression of CD28 (7.9-fold) and CTLA-4 (5.7-fold) was significantly increased in AML patients compared with healthy controls (p=0.006 and 0.02, respectively). Although the mean expression of both CD28 and CTLA-4 was increased in high-risk group compared with low-risk and intermediate-risk groups, the difference was not statistically significant. Also, the mean expression of the CTLA-4, but not CD28, was significantly higher in M3 patients compared with non-M3 ones (p<0.001). The expression of CD28 was upregulated in GVHD patients, while the expression of CTLA-4 was slightly lower in GVHD patients compared with non-GVHD patients, though the difference was not statistically significant. There was no significant correlation between the expression of CD28 and CTLA-4 and laboratory parameters like white blood cells and platelets counts, and hemoglobin and lactate dehydrogenase level in AML patients.

CONCLUSIONS

CD28 and CTLA-4 molecules are aberrantly expressed in peripheral blood leukocytes of AML patients and might contribute to the development of aGVHD after hematopoietic stem cell transplantation.

Intrathecal Autologous Bone Marrow-Derived Hematopoietic Stem Cell Therapy in Neurological Diseases

BACKGROUND

Cellular transplantation is a promising treatment strategy for neurological diseases.

OBJECTIVE

To report the results of intrathecal hematopoietic stem cell therapy in different neurological diseases in the past 6 years in a single center.

METHODS

From October 2011 to September 2018, 220 patients with various neurological diseases were transplanted intrathecally by their bone marrow stem cells. To have a longer follow up, we only reported the first 80 patients, transplanted up to July 2015-10 patients had spinal cord injuries and paralysis, 12 had advanced Parkinson's disease, 28 had cerebral palsy, 7 had hypoxic brain damage, 2 had autism, 4 had multiple sclerosis, 5 had progressive cerebellar atrophy, and 12 had other neurological diseases. The patients were admitted to the Bone Marrow Transplant Unit. On the first day, 50-200 (median 100) mL bone marrow was aspirated from the patients' posterior iliac crests, mixed with 120 mL culture media (RPMI), and 12 mL heparin. The samples were then transferred to immunology lab in cold box. Mononuclear cells (MNCs) were separated by a Ficoll-Hypaque gradient, washed, and suspended in ringers. Cell viability was assessed with trypan blue viability test. Transplantation was performed 3-4 hours after bone marrow collection. 5-10 mL of the cerebrospinal fluids were aspirated and about 20 mL MNCs (containing stem cells) in ringers were injected intrathecally (IT). The patients were laid down on their back for 4-5 hours. The median number of MNCs was 4×10⁷ (range 1-450×10⁷). The median viability of the cells was 90% (range 60%-98%). The patients received intravenous ceftriaxone every 12 hours and were discharged from the hospital few days after autologous stem cell therapy.

RESULTS

We noted clinical improvements in 9 of 12 patients with Parkinson's disease, 20 of 28 patients with cerebral palsy, 6 of 7 patients with hypoxic brain damage, 2 of 4 patients with multiple sclerosis, and 4 of 5 patients with cerebellar atrophy. The improvements were noted after 2-4 weeks of cell therapy. There were no improvements in patients with spinal cord injury and complete paralysis and those with autism. There were variable improvements in other patients treated.

CONCLUSION

Most patients with advanced Parkinson's disease, cerebral palsy, hypoxic brain damage, progressive cerebellar atrophy, and kernicterus neuropathy reported clinical effects of this safe intervention resulting in better functioning and an increased quality of life.

First report of pediatric hematopoietic stem cell transplantation activities in the eastern mediterranean region from 1984 to 2011: on behalf of the pediatric cancer working committee of the eastern mediterranean blood and marrow transplantation group

To describe the hematopoietic stem cell transplantation (HSCT) activities for children in the Eastern Mediterranean (EM) region, data on transplants performed for children less than 18 years of age between 1984 and 2011 in eight EM countries (Egypt, Iran, Jordan, Lebanon, Oman, Pakistan, Saudi Arabia and Tunisia) were collected. A total of 5187 transplants were performed, of which 4513 (87%) were allogeneic and 674 (13%) were autologous. Overall, the indications for transplantation were malignant diseases in 1736 (38.5%) and non-malignant in 2777 (61.5%) patients. A myeloablative conditioning regimen was used in 88% of the allografts. Bone marrow (BM) was the most frequent source of stem cells (56.2%), although an increasing use of PBSC was observed in the last decade. The stem cell source of autologous HSCT has shifted over time from BM to PBSC, and 80.9% of autologous HSCTs were from PBSCs. The donors for allogeneic transplants were matched-related in 94.5% of the cases, and unrelated transplants, mainly cord blood (99%) in 239 (5.5%) cases. This is the first report to describe the pediatric HSCT activities in EM countries. Non-malignant disorders are the main indication for allogeneic transplantation. Frequency of alternate donor transplantation is low.

Breakthrough curves of oil adsorption on novel amorphous carbon thin film

A novel amorphous carbon thin film (ACTF) was prepared by hydrolyzing wood sawdust and delignificating the residue to obtain cellulose mass that was subjected to react with cobalt silicate nanoparticle as a catalyst under the influence of sudden concentrated sulfuric acid addition at 23 °C. The novel ACTF was obtained in the form of thin films like graphene sheets having winding surface. The prepared ACTF was characterized by Fourier-transform infrared spectrometer, transmission electron microscope (TEM), and Brunauer-Emmett-Teller (BET). The adsorption capacity of ACTF to remove oil from synthetic produced water was evaluated using the incorporation of Thomas and Yoon-Nelson models. The performance study is described through the breakthrough curves concept under relevant operating conditions such as column bed heights (3.8, 5 and 11 mm) and flow rate (0.5, 1 and 1.5 mL.min(-1)). It was found that the oil uptake mechanism is favoring higher bed height. Also, the highest bed capacity of 700 mg oil/g ACTF was achieved at 5 mm bed height, and 0.5 mL.min(-1) flow rate. The results of breakthrough curve for oil adsorption was best described using the Yoon-Nelson model. Finally, the results illustrate that ACTF could be utilized effectively for oil removal from synthetic produced water in a fixed-bed column system.

Colonization Rate and Risk Factors of Vancomycin-Resistant Enterococci among Patients Received Hematopoietic Stem Cell Transplantation in Shiraz, Southern Iran

BACKGROUND

Infections caused by antimicrobial-resistant bacteria are associated with increased mortality and health care costs. Enterococci have been recognized as a clinically important pathogen in hospitalized patients. Vancomycin-resistant enterococci (VRE) infections cause significant morbidity and mortality among patients undergoing transplantation.

OBJECTIVE

To identify epidemiology of VRE colonization and related risk factors among patients with hematological malignancies after hematopoietic stem cell transplantation (HSCT).

METHODS

This cross-sectional study was performed on 42 patients who underwent bone-marrow transplantation between July 2013 and March 2014. A stool sample was taken from each patient 3-5 days after transplantation and cultured on appropriate media. Suspected colonies of enterococci were detected to species level by their culture characteristics, biochemical reactions and molecular features. VRE were confirmed via phenotypic and genotypic methods.

RESULTS

VRE were detected in 14 (33%) of studied samples. 10 (71%) of the detected VRE isolates were identified as high level vancomycin-resistant E. faecium with minimum inhibitory concentration (MIC) of ≥256 μg/mL of vancomycin; 3 isolates were E. galinarum and 1 was E. casseliflavus with an MIC of 8-16 μg/mL. VanA was dominant phenotype and all VRE isolates with high-level of vancomycin resistance had vanA gene. VRE isolation was mostly observed in patients with acute lymphoblastic leukemia (ALL) than other diseases. Moreover, antibiotic prophylaxis and hospitalization were independent risk factors for acquisition of VRE after transplantation.

CONCLUSION

We found high level of vancomycin-resistance in E. faecium isolates obtained from HSCT patients. The vancomycin-resistant isolates of E.faecium had vanA and/or simultaneously vanB genes.

Human Bone Marrow-derived Mesenchymal Stem Cell: A Source for Cell-Based Therapy

BACKGROUND

The ability of mesenchymal stem cells (MSCs) to differentiate into many cell types, and modulate immune responses, makes them an attractive therapeutic tool for cell transplantation and tissue engineering.

OBJECTIVE

This project was designed for isolation, culture, and characterization of human marrow-derived MSCs based on the immunophenotypic markers and the differentiation potential.

METHODS

Bone marrow of healthy donors was aspirated from the iliac crest. Mononuclear cells were layered over the Ficoll-Paque density-gradient and plated in tissue cultures dish. The adherent cells expanded rapidly and maintained with periodic passages until a relatively homogeneous population was established. The identification of adherent cells and the immune-surface markers was performed by flow cytometric analysis at the third passage. The in vitro differentiation of MSCs into osteoblast and adipocytes was also achieved.

RESULTS

The MSCs were CD11b (CR3), CD45, CD34, CD31 (PCAM-1), CD40, CD80 (B7-1), and HLA-class II negative because antigen expression was less than 5%, while they showed a high expression of CD90, and CD73. The differentiation of osteoblasts, is determined by deposition of a mineralized extracellular matrix in the culture plates that can be detected with Alizarin Red. Adipocytes were easily identified by their morphology and staining with Oil Red.

CONCLUSION

MSCs can be isolated and expanded from most healthy donors, providing for a source of cell-based therapy.

Molecular impact and inducible factors associated with adenovirus infection in hematopoietic stem [corrected] cell transplant patients

BACKGROUND AND PURPOSE OF STUDY

Latent and active adenovirus infections are detected in 5% to 20% of hematopoietic stem cell transplant (HSCT) patients. In addition to the significant role of adenoviral infection in the pathogenesis of late-onset hemorrhagic cystitis in HSCT patients, adenovirus infections may have possible roles in undefined posttransplant clinical complications. Therefore, pre- and posttransplantation we studied the prevalence and role of adenoviral infections among HSCT clinical syndromes using molecular methods.

MATERIALS AND METHODS

In this cross-sectional study between 2005 and 2008. We collected 470 EDTA-treated blood samples from 125 HSCT recipients, including 70 (56%) men and 55 (44%) women. The 52 (41.6%) HSCT patients underwent autologous grafts and the other 73 (58.4%), from related donors. One EDTA-treated blood sample was collected from all recipients pretransplantation. Also once per week for 3 months we were collected blood samples from HSCT patients to evaluate the prevalence of adenovirus DNA infection by a qualitative in house polymerase chain reaction method.

RESULTS

The adenovirus genome was diagnosed in 2/75 (2.7%) HSCT patient samples pretransplantation. There were 28/395 (7.1%) plasma samples of transplant patients infected with adenovirus DNA. Graft-versus-host disease (GVHD) clinical complications were observed in six adenovirus-infected transplant recipients; there was a significant correlation between these viral infections and GVHD clinical presentation.

CONCLUSION

The high prevalence of adenovirus infection in HSCT recipients pre- and posttransplantation, was significantly related to GVHD symptoms, enforcing the important pathogenic role of these viral infections in clinical complications post-HSCT.

Anemia and iron deficiency in adolescent school girls in kavar urban area, southern iran

BACKGROUND

Anemia is one of the most common public health problems especially in developing countries. We investigated the prevalence of anemia, iron deficiency anemia and related risk factors in adolescent school girls in Kavar urban area in southern Iran.

METHODS

A total of 363 adolescent school girls were evaluated by a cross sectional study. Socioeconomic, demographic and related risk factors were obtained by a questionnaire. Hematological parameters and serum iron indices were measured.

RESULTS

There were 21 cases of anemia (5.8%), 31 (8.5%) iron deficiency and 6 (1.7%) iron deficiency anemia.  Most of anemic girls (85.7%) had mild anemia.  MCV, TIBC, age, and BMI had statistically significant relationship with hemoglobin. Only parasites infestation in the last three months had a 6.83 times more risk of anemia than those without this history (95% CI, 1.66-28.11).

CONCLUSION

The prevalence of anemia and iron deficiency anemia in this study were substantially less than what reported in many other regions of Iran as well as other developing countries. It seems that related implemented strategies in the recent years have been successful. More especial attention to prevention of parasite infestation should be considered in this area.

Impact of human cytomegalovirus infection UL55-nested polymerase chain reaction method in hematopoietic stem cell transplant donors and recipients

Human cytomegalovirus (HCMV) is one of the most important and critical viral causes of graft rejection among hematopoietic stem cell transplant (HSCT) recipients. Monitoring of this viral infection has a critical role in the management of HSCT clinical complications. In this retrospective cohort, blood (plasma and buffy coat) and urine samples were collected from 110 HSCT patients and 95 donors pretransplantation and weekly for 100 days posttransplantation. An HCMV-optimized UL55-nested polymerase chain reaction (PCR) method was used to detect HCMV infection. Genotyping of the HCMV UL55 gene was performed for all UL55-nested, PCR-positive samples. HSCT donor and recipient laboratory and clinical data were statistically analyzed using SPSS version 15 software. UL55-nested, PCR-positive results were obtained in 3540/4950 (71.5%), 3634/4950 (73.4%), and 3292/4950 (66.5%) of these plasma, buffy coat, and urine samples, respectively. Twenty-five percent of transplant donors were infected with HCMV. An increase in HCMV infection was observed from pre- to post-HSCT conditions. Detection of the gB2 UL55 genotype in most transplant patient samples suggested the need to examine the possible impact of HCMV UL55 genotypes and HCMV infections among stem cell transplant recipients.

Molecular detection of invasive aspergillosis in hematologic malignancies

BACKGROUND

Aspergillus species are the most frequent causes of invasive mold infections in immunocompromised patients, particularly those who underwent chemotherapy for hematologic malignancies. The aim of this study was to determine the incidence and efficiency of the PCR-enzyme linked immunosorbent assay method (PCR-ELISA) for early detection of Aspergillus species in patients with hematologic malignancies.

PATIENTS AND METHODS

From 2004 to 2006, 194 patients with hematologic malignancies (who received chemotherapy) were evaluated for invasive aspergillosis (IA) in Shiraz, southern Iran. Ethylenediaminetetraacetic acid anticoagulant whole blood samples were collected prospectively once a week and stored at -20 degrees C until examination. All collected blood samples were assayed for the presence of the bands on ethidium bromide stained gel and for hybridization.

RESULTS

The female-to-male ratio was 61:133, the mean age of patients was 33.7 years, and mean of hospitalization period was 21.2 days. PCR-ELISA was positive in 14 (7.2%) patients who exhibited clinical and radiologic signs of IA. The etiologic agents were Aspergillus flavus (11 cases) and Aspergillus fumigatus (three cases). The mean time of positivity of PCR-ELISA in the blood before the appearance of clinical signs was 12.6 days. PCR was found to be the earliest indicator of IA preceding nonspecific clinical and radiologic findings. The sensitivity, specificity, positive, and negative predictive values of PCR-ELISA to detect DNA-specific for Aspergillus species in patients with proven and probable IA were 66%, 96%, 62.5%, and 97%, respectively. In case patients were treated with antifungal drugs, and the treatment was successful, fungal PCR assay became negative after 14 days and if the treatment failed, assay was positive until death.

CONCLUSIONS

We demonstrated, in the present study, the incidence of IA in leukemic patients and the usefulness of molecular assay for early diagnosis and monitoring of the treatment of IA.

Long term follow up after treatment of hairy cell leukemia with 2-CdA

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Background: Hairy cell leukemia (HCL) is a chronic B cell disorder that follows an indolent but progressive course. The ability of new purine analogue deoxyadenosine to induce long lasting complete remission in patients with hairy cell leukemia has revolutionized the treatment of this disease. We report the long term outcomes of patients with HCL treated in Shiraz, in south of Iran,with this drug. Methods: Between October 1993 till April 2004, 79 patients with classic symptomatic hairy cell leukemia were treated with 2-cholorodeoxy adenosine (2-CdA) with dose of 0.1 mg/kg of body weight per day by continuous intravenous infusion for 7 days. Results: sixty nine (87%) of patients achieved an initial complete response and 10 (12.6) a partial response with an overall median duration of response follow up of 78 months. Five patients had relapsed at a median of 43 months. All of 5 patients after relapse treated with second courses of 2-CdA, 4 (80%) achieved second complete responses and one (20%) partial response. In our study we had not any case of second malignancy after treatment with 2-CdA with median follow up of 82.5 months. Conclusion: This study confirms single course of 2-CdA induced long lasting complete response in the vast majority of patients. Relapse rate for complete responders were low. Patients who relapse can be successfully retreated with this drug, so we conclude 2-CdA had high efficacy and a favorable acute and long term toxicity profile in our patients in south of Iran, without any increase in risk of second malignancy.

No significant financial relationships to disclose.

Bone Marrow Transplantation in Thalassemia Major Patients Using “Short” Anti-Thymocyte Globulin Therapy in Shiraz, Southern Iran

Allogeneic bone marrow transplantation (BMT) was performed on 113 Iranian transfusion-dependent thalassemia major patients from May 1993 through September 2003. To have at least 2 years follow-up, we report BMT on 90 patients transplanted up to December 2001. The donors were human leukocyte antigen (HLA)-identical, mixed lymphocyte culture (MLC)-nonreactive siblings (n = 74) on parents (n = 6); HLA-identical MLC-reactive siblings (n = 5) or parents (n = 1); and one HLA antigen-mismatched sibling (n = 4). The induction regimen in 11 patients was oral busulfan (BU) (14 mg/kg) and IV cyclophosphamide (CY; 200 mg/kg); in fifteen patients it was BU (15 mg/kg) and cyclophosphamide (CY; 200 mg/kg); in 47 patients, BU (15 mg/kg), CY (200 mg/kg), and short course of anti-thymocyte globulin (ATG, horse; 40 mg/kg including 10 mg/kg on days -2, -1, +1, +2); and in 15 patients, BU (15 mg/kg) CY (200 mg/kg), and ATG (60 to 100 mg/kg; 10 mg/kg at 3 to 5 days before and after BMT). Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and prednisolone. The group who received BU (14 mg/kg) and CY (200 mg/kg), as compared to the group receiving BU (15 mg/kg) and CY (200 mg/kg), was of younger age and lower risk; median age 7 versus 10 years, and 46% versus 7% in Lucarelli's risk group class I (the best prognostic group), respectively. These patients showed a lower disease-free survival (DFS), namely 64% versus 73%, with a follow up of 2 to 10.5 years. Thus from 9.5 years ago, our standard protocol for BU has been 15 mg/kg. The group who received "short" ATG (40 mg/kg), BU (15 mg/kg), and CY (200 mg/kg) showed almost the same outcome as the group who received a higher dose of ATG (60 to 100 mg/kg), namely DFS 72% versus 73%, respectively, despite the fact that half of both groups were included in the Lucarelli's risk group class III (the worst prognostic group) 49% versus 53%. We showed the same DFS for the patients who received BU (15 mg/kg), CY (200 mg/kg), and no ATG compared with the ATG group (73% vs 72%), but 27% of the group without ATG developed grade IV acute GVHD and 54% developed chronic GVHD. In the group with short ATG, 15% and 17% of patients developed grade IV acute and chronic GVHD, respectively. There was no significant difference for falls in platelets and white blood cell or engraftment days and the number of packed red blood cell transfusions among the groups. The median hospital stay was longer for the group with BU (15 mg/kg), CY (200 mg/kg) namely 81 versus 61 to 65 days. Second bone marrow infusions were needed in 6% and 20% of patients who received ATG doses of (40 versus 60 to 100 mg/kg; respectively (1 to 2 month post-BMT). BU at a dose of 15 mg/kg was more effective than 14 mg/kg BU for its myeloablative properties. By adding "short" ATG course to the conditioning regimen, the incidence of grade IV acute and chronic GVHD was reduced in thalassemic patients, especially when an HLA disparity was present.

Comparative analysis of a double primer PCR assay with plasma, leukocytes and antigenemia for diagnosis of active human cytomegalovirus infection in bone marrow transplant patients

The aim of the study was to determine the prognostic value of a double primer PCR assay to detect human cytomegalovirus (HCMV) infection or disease in bone marrow transplant (BMT) recipients. A total of 209 blood samples including peripheral blood mononuclear cells (PBMN), polymorphonuclear (PMN) leukocytes and plasma from 26 BMT recipients were tested by PCR assay. To discriminate between latent and active HCMV infection, 177 blood samples were also tested by a quantitative antigenemia assay. HCMV serology status of donors and recipients was determined before transplantation by an enzyme immunosorbent assay method. Using the double primer PCR assay, the number of positive samples increased by an average of 11.6%. Symptomatic active HCMV infection was diagnosed in 14 (53.8%) out of 26 BMT patients. There was a good association between double primer PCR assay of PMN leukocytes and antigenemia assays for detection of active HCMV infection in all patients. Detection of HCMV DNA in PMN leukocytes of BMT patients by double primer PCR assay can be an alternative method for antigenemia assay. However, quantitative PCR methods will be necessary for monitoring antiviral treatment.

Hematopoietic stem cell transplantation for β-thalassemia major: Experience in south of Iran

INTRODUCTION

Allogeneic stem cell transplantation as a curative treatment for thalassemia major was established in Shiraz in 1993. In this article we describe our results of 10 years experience with allogeneic bone marrow transplantation for thalassemia major.

METHODS

From June 1993 to January 2003, 112 cases of beta-thalassemia major underwent allogeneic marrow transplantation from HLA-identical or one antigen-mismatched related donors. Conditioning chemotherapy included busulfan (14 to 15 mg/kg), cyclophosphamide (200 mg/kg), and antithymocyte globulin (ATG; 40 mg/kg). Prophylaxis for graft-versus-host disease consisted of cyclosporine, prednisolone, and methotrexate.

RESULTS

One hundred twelve patients with a diagnosis of beta-thalassemia major underwent allogeneic marrow transplantation during this period. The mean age of the patients was 9.5 years with the range of 2 to 20 years. The distribution of cases according to the Lucarelli classification were: 27 cases class I, 38 cases class II, and 47 cases class III. Eighty-seven of 112 patients (77.6%) with diagnosis of beta-thalassemia major are living with full engraftment at a median follow-up of 6 years (range 2 to 119 months).

CONCLUSION

Allogeneic bone marrow transplantation has changed the outcome of disease dramatically. According to our results stem cell transplantation is the treatment of choice for class I and II (Lucarelli risk groups). Also, we recommend transplantation as a curative method for treatment of class III beta-thalassemic patients.

Qualitative detection of human cytomegalovirus DNA in the plasma of bone marrow transplant recipients: value as a predictor of disease progression

OBJECTIVE

The aim of this prospective study was to determine whether human cytomegalovirus (HCMV)-DNA detected by polymerase chain reaction (PCR) analysis in the plasma of bone marrow transplant (BMT) patients is a predictor of HCMV disease progression.

METHODS

Plasma samples were collected from 15 patients who received allogenic BMTs. Each individual was sampled 1 week before and then weekly for 17 weeks after transplantation. The 270 plasma specimens were processed with a PCR method for detecting HCMV-DNA. Patients were also physically examined for signs or symptoms of HCMV-related disease.

RESULTS

Eight (53.5%) of the 15 patients tested positive for HCMV-DNA. Two (25%) of these 8 individuals also had positive PCR findings before transplantation. Six (75%) of the 8 HCMV-DNA-positive patients had positive plasma-PCR results a week before clinical symptoms developed. The other 2 (25%) remained asymptomatic throughout their hospital stay. All 6 symptomatic cases were treated with ganciclovir, and 4 converted to negative plasma-PCR status at a median of 21 days. There was a significant correlation between PCR-detection of HCMVDNA in plasma and presence of HCMV-related symptoms (P < 0.01).

CONCLUSION

Qualitative plasma-PCR analysis before and after bone marrow transplantation is a valuable way to screen for HCMV infection in BMT patients. Plasma-PCR monitoring of HCMV activity in this patient group might make it possible to administer an antiviral drug and thus reduce mortality. However, quantitative PCR is still considered the best way to accurately identify active HCMV infection and monitor treatment.

Bone marrow transplantation for hematological disorders--Shiraz experience

OBJECTIVE

In the past 8 years, 120 cases of hematological disorders were transplanted from the HLA identical donors.

METHOD

Using chemotherapy based conditioning regimen with cyclophosphamide 200 mg/kg and busulfan 15-16 mg/kg, 80 cases of beta-thalassemia major and 35 cases of leukemia and five patients with aplastic anemia had received bone marrow transplantation.

RESULT

The five-year-survival in thalassemic group was 72%, for leukemic group (acute and chronic) was 58%, and also for aplastic anemia 65%. Transplantation related mortality was the cause of death in 29 cases. The two major causes of death were acute graft versus host disease and poor medical condition of patients before marrow transplantation.

CONCLUSION

At the present time, allogenic marrow transplantation is curative mode of treatment for many hematological diseases.

Bone marrow transplantation in thalassaemia patients in Shiraz, Islamic Republic of Iran

We report the results of allogeneic bone marrow transplantation in 26 female and 37 male patients with beta-thalassaemia major (age range: 2-17 years), performed at Namazi Hospital over the period 1992-99. In all cases, standard conditioning and immunosuppressive regimens were employed. Currently, 50 patients remain thalassaemia-free, 9 of whom have developed chronic graft-versus-host disease. There were 8 deaths among the 13 unsuccessful transplant cases: 4 due to acute uncontrollable graft-versus-host disease, and 4 to non-transplant-related causes such as hypoglycaemia, hypersensitivity reactions and advanced disease. We conclude that allogeneic bone marrow transplantation is an effective therapy for the treatment of beta-thalassaemia major, particularly for patients classified as classes I and II.

On the occurrence of ternary complexes in agarose gels as studied by the contrast variation method

The contrast variation method by isotopic labelling as used in small-angle neutron scattering experiments is applied to the case of agarose systems (sol and gels) in order to cast some light on the occurrence of complexes (crystallosolvates). This approach proves to be helpful for giving further support to the existence of ternary complexes in agarose/water/DMSO gels and in agarose/DMSO sols. The results are discussed in the light of temperature-composition phase diagrams established previously.

Acute graft-versus-host disease in thalassaemic marrow transplantation with low-dose antithymocyte globulin

Our unit performed transplantations on 21 classes II and III thalassaemic patients [class II patients had either hepatomegaly or portal fibrosis and class III patients had both]. We used busulfan [15 mg/kg]and cyclophosphamide [200 mg/kg]. Graft-versus-host disease [GVHD]prophylaxis was cyclosporin, prednisolone and low-dose antithymocyte globulin. Our patient data showed a low incidence of acute GVHD following transplantation. We offer this regimen as an acceptable therapy for thalassaemic patients undergoing allogeneic marrow transplantation as a safe clinical procedure, irrespective of the class of patient

Acute graft-versus-host disease in thalassaemic marrow transplantation with low-dose antithymocyte globulin

Our unit performed transplantations on 21 classes II and III thalassaemic patients (class II patients had either hepatomegaly or portal fibrosis and class III patients had both). We used busulfan (15 mg/kg) and cyclophosphamide (200 mg/kg). Graft-versus-host disease (GVHD) prophylaxis was cyclosporin, prednisolone and low-dose antithymocyte globulin. Our patient data showed a low incidence of acute GVHD following transplantation. We offer this regimen as an acceptable therapy for thalassaemic patients undergoing allogeneic marrow transplantation as a safe clinical procedure, irrespective of the class of patient.