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Dehghani M, Kashkooe A, Namdari N, Majidi R, Karimi M, Haghighat S, Rezvani A, Safari N. Long-term follow-up of patients with hairy cell leukemia in the south of Iran. Expert Rev Hematol 2023; 16:289-295. [PMID: 36709461 DOI: 10.1080/17474086.2023.2174520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Hairy cell leukemia (HCL) is an indolent chronic lymphoproliferative disorder and first-line treatment with either intravenous or subcutaneous cladribine generally leads to long-lasting remissions. METHOD All 131 patients with hairy-cell leukemia (HCL) were analyzed, with a median follow-up of 91 months. Data is from 2007 to 2020. We evaluated the response rate to cladribine as the first line and the response rate to cladribine with or without rituximab in relapsed patients. Further, we assessed relapse-free survival, complications, and secondary malignancy. RESULTS After a median follow-up of 91 months, the recurrence rate was 24%. The 5-year and 10-year RFS rates were 85% and 66%, respectively. Adding rituximab to 2-CDA leads to a better response rate than just cladribine (90% vs. 27.3%, p-value = 0.002) in the relapsed patients. CONCLUSION HCL patients have long-term survival when cladribine is the first line of treatment. Furthermore, adding rituximab to cladribine leads to a higher response rate.
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Affiliation(s)
- Mehdi Dehghani
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Kashkooe
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Namdari
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Majidi
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Karimi
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shirin Haghighat
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rezvani
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negar Safari
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
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Ramzi M, Haghighat S, Namdari N, Haghighinejad H. Combination of Low-Dose, Short-Course Mycophenolate Mofetil With Cyclosporine and Methotrexate for Graft-Versus-Host Disease Prophylaxis in Allogeneic Stem Cell Transplant. EXP CLIN TRANSPLANT 2020; 19:1328-1333. [PMID: 32778017 DOI: 10.6002/ect.2020.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES With the standard regimen for graft-versushost disease prophylaxis in allogeneic stem cell transplant with human leukocyte antigen-matched donor, grade II-IV acute graft-versus-host disease occurs in 30% to 50% of sibling and up to 80% of unrelated recipients. Studies with limited patient numbers have shown efficacy and safety of mycophenolate mofetil for graft-versus-host disease prophylaxis. We investigated the effect of low-dose mycophenolate mofetil added to a standardized prophylaxis regimen for graft-versus-host disease in related human leukocyte antigen-matched allogeneic stem cell transplant. MATERIALS AND METHODS In this prospective randomized clinical trial, we compared cyclosporine and methotrexate versus the combination of cyclosporine, methotrexate, and mycophenolate mofetil in all patients who underwent human leukocyte antigencompatible related donor allogeneic stem cell transplant for acute leukemia during 3 years at the Bone Marrow Transplant Unit at Namazi Hospital, Shiraz University of Medical Sciences (Shiraz, Iran). RESULTS All 134 patients in both groups underwent successful engraftment. Recovery times for neutrophils and platelets were not significantly different between groups (P < .05). Incidence of acute graft-versus-host disease in the cyclosporine, methotrexate, and mycophenolate mofetil group was less than in the cyclosporine and methotrexate group (21.6% vs 40.9%; P = .041). Incidence of grade II-IV acute graftversus-host disease in the mycophenolate mofetil group was 15.2% versus the control group at 33% (P = .045). CONCLUSIONS Our single-center study suggests the combination of mycophenolate mofetil, cyclosporine, and methotrexate is superior to the standard regimen of cyclosporine and methotrexate for graft-versushost disease prophylaxis after human leukocyte antigen-matched related donor allogeneic stem cell transplant.
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Affiliation(s)
- Mani Ramzi
- From the Hematology Research Center and Bone Marrow Transplantation Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Ramzi M, Namdari N, Haghighat S, Haghighinejad H. Evaluation of Reversed Administration Order of Busulfan (BU) and Cyclophosphamide (CY) as Conditioning on Liver Toxicity in Allogenic Hematopoietic Stem Cell Transplantation (ALL-HSCT). Int J Hematol Oncol Stem Cell Res 2020; 14:171-176. [PMID: 33024523 PMCID: PMC7521389 DOI: 10.18502/ijhoscr.v14i3.3725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Busulfan (BU) in combination with cyclophosphamide (CY) is used as an effective conditioning regimen in hematopoietic SCT. Busulfan, depletes glutathione level in liver and causes elevated levels of CY metabolites. Cyclophosphamide metabolites are highly toxic for sinusoidal endothelial cells and cause VOD/ SOS with high mortality rate. Materials and Methods: Between September 2013 and September 2015, all adult patients with acute leukemia who were candidates for myeloablative allogenic SCT and were admitted to Stem Cell Transplantation center were enrolled in this prospective randomized clinical trial. We tested the hypothesis that reverse administration from BU-CY (n=28) to CY-BU group (n=27) would reduce liver toxicity. Results: Liver function tests were significantly higher in the BU-CY group between day -1 and +4 (p<0.05), but VOD/SOS was not diagnosed in both groups. The incidence and severity of acute GVHD was higher in the BU-CY group, but not statistically significant. Engraftment and mortality rate were not different. Conclusion: These data support the concept that CY-BU is associated with less liver toxicity, suggesting CY-BU is superior to BU-CY as conditioning.
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Affiliation(s)
- Mani Ramzi
- Hematology and Bone Marrow Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Namdari
- Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shirin Haghighat
- Department of Hematology, Hematology Research Center, Medical Oncology and Stem Cell Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran
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Dehghani M, Jangjoo S, Monabati A, Masoomi Bandari D, Namdari N. An Unusual Case Report: Occurrence of Renal Cell Carcinoma, Basal Cell Carcinoma and Chronic Lymphocytic Leukemia in a Case of Papillary Thyroid Carcinoma Treated with Radioactive Iodine. Iran J Med Sci 2018; 43:659-663. [PMID: 30510343 PMCID: PMC6230934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The standard therapy for thyroid cancer is total or near total thyroidectomy, followed by the administration of radioactive iodine for remnant ablation or residual disease. Patients with radioiodine therapy are predisposed to second malignant neoplasms in organs such as central nervous system (CNS), breast, prostate, kidney, bone marrow, salivary gland, and digestive tract. Exposure to carcinogen including occupational and therapy related hazard, aging and genetic susceptibility are other causes of second primary cancers. The second primary malignancies are not uncommon and, nowadays, the prevalence of it is mildly increasing due to the increasing survival of cancer patients and advances in early diagnosis and therapeutic modalities. Here, we present a fifty-one-year-old man with papillary thyroid carcinoma (PTC), who developed chronic lymphocytic leukemia (CLL), renal cell carcinoma (RCC), and basal cell carcinoma (BCC) in 15-20 years after radioactive iodine therapy. Second primary tumors are increasing and environmental, genetic susceptibility and increase in survival of cancer patients are the major risk factors.
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Affiliation(s)
- Mehdi Dehghani
- Department of Hematology and Medical Oncology, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saranaz Jangjoo
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Monabati
- Department of Pathology, Hematopathology and Molecular Pathology, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dena Masoomi Bandari
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Namdari
- Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
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Zakerinia M, Kamgarpour A, Nemati H, Zare HR, Ghasemfar M, Rezvani AR, Karimi M, Nourani Khojasteh H, Dehghani M, Vojdani R, Haghighat S, Namdari N, Rekabpoor J, Tavazo M, Amirghofran S, Amirghofran Z, Yosefipour GA, Ramzi M. Intrathecal Autologous Bone Marrow-Derived Hematopoietic Stem Cell Therapy in Neurological Diseases. Int J Organ Transplant Med 2018; 9:157-167. [PMID: 30863518 PMCID: PMC6409093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- M. Zakerinia
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Maryam Zakerinia, MD, Professor of Internal Medicine, Hematologist-Oncologist, Hematology Research Center, Department of Internal Medicine, School of Medicine, Shiraz. University of Medical Sciences, Shiraz, Iran Tel: +98-71-3647-4301, E-mail:
| | - A. Kamgarpour
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H. Nemati
- Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H. R. Zare
- Department of Immunology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Ghasemfar
- Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A. R. Rezvani
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Karimi
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H. Nourani Khojasteh
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Dehghani
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - R. Vojdani
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S. Haghighat
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - N. Namdari
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - J. Rekabpoor
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Tavazo
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S. Amirghofran
- The International Branch, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Z. Amirghofran
- Department of Immunology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - G. A. Yosefipour
- Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Ramzi
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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