Management of refractory/relapsed acute leukemia with heart limitation by anthracycline-free chemotherapy regimens in pediatric patients: New hypothesis and new approach

Background: Anthracycline therapy for acute leukemia may be associated with significant morbidity and mortality in children or elderly patients that have a degree of heart failure. Patients with prior anthracycline exposure, those with pre-existing heart disease, or who have received the total anthracycline dose present an increased risk for cardiotoxicity. Therefore, new chemotherapy regimens in these situations would be life saving for leukemia patients. We have conducted a systematic review of possible strategies for rescue regimens without anthracycline in refractory acute leukemia patients. Methods: We gathered the data from 5 creation databases and relevant website until August 2016. We selected randomized clinical trials or other studies that used anthracycline-free chemotherapy regimens to treat acute refractory leukemia in children and adults. The quality of the studies was evaluated according to the Cochrane risk of the polarization tool. All stages of the review were independently conducted by two authors. We obtained data from 75 main clinical trials. Results: There were 75 trials included from which 4 were considered to be at low risk for bias. Most trials showed that the improvement did not reach statistical significance. Conclusion: Evidence existed to support the use of the combination of fludarabine, cytarabine, and filgrastim, ICE-rituximab chemotherapy regimens, or monoclonal antibodies such as tyrosine kinase inhibitors (Sorafenib) useful for acute refractory/relapsed leukemia.These drugs are used as first salvage regimens or clofarabine and cladribine for acute myeloid leukemia in patients for whom combined anthracycline chemotherapy is inappropriate. © 2018, Shiraz University of Medical Sciences. All rights reserved

Management of refractory/relapsed acute leukemia with heart limitation by anthracycline-free chemotherapy regimens in pediatric patients: New hypothesis and new approach

Background: Anthracycline therapy for acute leukemia may be associated with significant morbidity and mortality in children or elderly patients that have a degree of heart failure. Patients with prior anthracycline exposure, those with pre-existing heart disease, or who have received the total anthracycline dose present an increased risk for cardiotoxicity. Therefore, new chemotherapy regimens in these situations would be life saving for leukemia patients. We have conducted a systematic review of possible strategies for rescue regimens without anthracycline in refractory acute leukemia patients. Methods: We gathered the data from 5 creation databases and relevant website until August 2016. We selected randomized clinical trials or other studies that used anthracycline-free chemotherapy regimens to treat acute refractory leukemia in children and adults. The quality of the studies was evaluated according to the Cochrane risk of the polarization tool. All stages of the review were independently conducted by two authors. We obtained data from 75 main clinical trials. Results: There were 75 trials included from which 4 were considered to be at low risk for bias. Most trials showed that the improvement did not reach statistical significance. Conclusion: Evidence existed to support the use of the combination of fludarabine, cytarabine, and filgrastim, ICE-rituximab chemotherapy regimens, or monoclonal antibodies such as tyrosine kinase inhibitors (Sorafenib) useful for acute refractory/relapsed leukemia.These drugs are used as first salvage regimens or clofarabine and cladribine for acute myeloid leukemia in patients for whom combined anthracycline chemotherapy is inappropriate. © 2018, Shiraz University of Medical Sciences. All rights reserved

Metronomic maintenance therapy in refractory acute myeloblastic leukemia with monosomy 7

Patients with acute myeloblastic leukemia (AML) with monosomy 7 are a group of patients with refractory AML who have a very poor prognosis. Therefore, rationally designed new therapies, including metronomic chemotherapy regimen with histidine deacetylase inhibitors (Valporic acid, ATRA) are being investigated as potential treatments for the population of refractory cases of AML. Herein, we report a patient with primary refractory AML who was treated with oral low-dose chemotherapy after standard systemic chemotherapy. © 2015, Iranian Pediatric Hematology and Oncology Society. All rights reserved

Resolving Multiphase Flow through Packed Bed of Solid Particles Using eXtended Discrete Element Method with Porosity Calculation

Multiphase flow reactors such as trickle bed reactors are frequently used reactors in many industries. Understanding the fluid dynamics of these kinds of reactors is necessary to design and optimize them. The pressure drop and liquid saturation are the most important hydrodynamic parameters in these reactors, which depend highly on the porosity distribution inside the bed. The eXtended Discrete Element Method (XDEM) was applied as a numerical approach to model multiphase flow through packed beds of solid particles. This method has the ability to be coupled with Computational Fluid Dynamics (CFD) through interphase momentum transfer which makes it suitable for many Eulerian− Lagrangian systems. The XDEM also calculates the porosity distribution along the bed, which not only eliminates the empirical correlations but also makes it possible to investigate the maldistribution of liquid saturation inside the bed. The results for the hydrodynamics parameters were compared with experimental data, and satisfactory agreement was achieved

Reducing pain in children with cancer: Methodology for the development of a clinical practice guideline

Although pain is one of the most prevalent and bothersome symptoms children with cancer experience, evidence-based guidance regarding assessment and management is lacking. With 44 international, multidisciplinary healthcare professionals and nine patient representatives, we aimed to develop a clinical practice guideline (following GRADE methodology), addressing assessment and pharmacological, psychological, and physical management of tumor-, treatment-, and procedure-related pain in children with cancer. In this paper, we present our thorough methodology for this development, including the challenges we faced and how we approached these. This lays the foundation for our clinical practice guideline, for which there is a high clinical demand