A Precisely Calculated Neutrophil to Lymphocyte Ratio could Predict Overall Survival in Multiple Myeloma Patients

Background: Neutrophil to lymphocyte ratio was initially used as a low cost prognostic marker in a group of solid tumors and subsequently hypothesized to have a role in multiple myeloma. This retrospective analysis aimed to report the prognostic importance of the neutrophil to lymphocyte ratio in multiple myeloma. Methods: Between November 2003 and February 2016, we included 175 patients from two centers in this study. CBC differentials were primarily checked by a Sysmex analyzer in both centers. In one center, differentials were rechecked by light microscopy. Analysis of survival was performed using a Kaplan-Meier estimate and we assessed the effects of prognostic factors by Cox proportional hazards model. Results: Patients had a mean age of 63.22±10.89 years. Although mean lymphocyte percent did not differ between the two centers, mean neutrophil percent and mean neutrophil to lymphocyte ratio were higher at the center that manually checked the CBC differentials. After adjustments for age and gender, we noted that the hazard ratio for elevated neutrophil to lymphocyte ratio when stratified for the centers was 1.07 (95% CI: 1.01–1.15, P=0.034). Conclusion: A precisely checked neutrophil to lymphocyte ratio could act as a potentially inexpensive, accessible prognostic factor for multiple myeloma patients

Low Level of Microsatellite Instability Correlates with Poor Clinical Prognosis in Stage II Colorectal Cancer Patients

The influence of microsatellite instability (MSI) on the prognosis of colorectal cancer (CRC) requires more investigation. We assessed the role of MSI status in survival of individuals diagnosed with primary colorectal cancer. In this retrospective crosssectional study the MSI status was determined in 158 formalin-fixed paraffin-embedded tumors and their matched normal tissues from patients who underwent curative surgery. Cox proportional hazard modeling was performed to assess the clinical prognostic significance. In this study we found that MSI-H tumors were predominantly located in the colon versus rectum ( = 0.03), associated with poorer differentiation ( = 0.003) and TNM stage II/III of tumors ( = 0.02). In CRC patients with stage II, MSI-L cases showed significantly poorer survival compared with patients who had MSI-H or MSS tumors ( = 0.04). This study indicates that MSI-L tumors correlate with poorer clinical outcome in patients with stage II tumors ( = 0.04) or in tumors located in the colon ( = 0.02). MSI-L characterizes a distinct subgroup of CRC patients who have a poorer outcome. This study suggests that MSI status in CRC, as a clinical prognostic marker, is dependent on other factors, such as tumor stage and location

The Role of ATRA Followed by Chemotherapy in the Treatment of Acute Promyelocytic Leukemia

There are different treatment protocols available for acute promyelocytic leukemia (APL) such as all-trans retinoic acid (ATRA) plus chemotherapy or arsenic trioxide (ATO) based regimens. In this study, we focused on the role of ATRA followed by an anthracycline-containing chemotherapy regimen. This study reported the outcome of APL patients at 501 army hospital; Tehran, Iran. Seventy-three patients were included between 1995 and 2015. Treatment in our center for the majority of cases included induction with ATRA followed by Cytarabine (AraC) and an anthracycline agent (daunorubicin), and then three cycles of consolidation chemotherapy. Maintenance consisted of a 2-year period of medication with ATRA, Methotrexate (MTX) and 6-mercaptopurine (6-MP). Relapsed cases were treated with ATRA and a combination of etoposide, mitoxantrone, and cytarabine. Kaplan-Meier estimate was used to calculate survival rates. We detected 5- and 10-year overall and disease-free survival rates of 51.6% and 50.2% respectively. For those patients who survived induction deaths and received ATRA-based chemotherapy the 5-year OS and DFS rates were 68.8% and 66.5%, respectively. Hematologic complete remission (CR) was observed in all but three patients, and relapse occurred in 12 cases. The cardinal causes of induction death were disseminated intravascular coagulation (DIC) and infection. Up to the end of the follow-up time, 31 patients died including 11 cases of the relapsed disease. The combination of ATRA and chemotherapy could lead to an acceptable CR rate and relapse incidences in newly diagnosed APL patients, but more effective strategies need to be developed for screening and treatment of relapse

Immunosuppressive Therapy in Patients with Aplastic Anemia: A Single-Center Retrospective Study

<div><p>Background</p><p>Aplastic anemia (AA) is a rare disease in which hematopoietic stem cells are severely diminished resulting in hypocellular bone marrow and pancytopenia. Etiology of AA includes auto immunity, toxins, infection, ionizing radiation, drugs and rare genetic disorders, but in the majority of cases no cause can be identified. In the present study we assessed response rate, survival, relapse and clonal evolution in patients with AA treated with immunosuppressive therapy.</p><p>Methods</p><p>Patients with AA who received immunosuppressive therapy between May 1998 and September 2013 were included in this study. Patients with non-severe AA (NSAA) were treated with cyclosporine (CsA) and danazol while patients with severe AA (SAA) as well as patients with NSAA who progressed to SAA after beginning of the treatment, were candidates for receiving antithymocyte globulin in addition to CsA and danazol.</p><p>Results</p><p>Among the 63 studied patients, 29 (46%) had NSAA and 34 (54%) had SAA. Three months after treatment, overall response was 58.6% in NSAA and 12.9% in patients with SAA. Survival of all patients at 5, 10 and 15 years were 73%, 55% and 49%, respectively. Survival rates were significantly higher in patients with NSAA compared to patients with SAA as well as in patients who responded at 6 months compared to non-responders. The relapse risk was 39.7% at 10 years. Relapse occurred in patients who discontinued the therapy more than those who continued taking CsA (p value<0.01). The risk of clonal evolution was 9.9% at 10 years and 22.8% at 15 years after treatment.</p><p>Conclusion</p><p>This long-term retrospective study indicated that immunosuppressive therapy should be recommended to patients with AA. Also, our experience indicated that immunosuppressive therapy should not be discontinued after response to therapy in patients with both NSAA and SAA due to high risk of relapse. Low dose of CsA should be continued indefinitely.</p></div

Response to treatment and death at 3, 6 and 12 months after treatment.

<p>Data are presented as n (%)</p><p>NSAA non-severe aplastic anemia, SAA severe aplastic anemia</p><p>Response to treatment and death at 3, 6 and 12 months after treatment.</p

Overall survival curves for patients with SAA and NSAA

<p>Overall survival curves for patients with SAA and NSAA</p

Overall survival curves for patients with AA who responded at 3 months and non responders.

<p>Overall survival curves for patients with AA who responded at 3 months and non responders.</p

Cumulative incidence of relapse for patients with SAA and NSAA.

<p>Cumulative incidence of relapse for patients with SAA and NSAA.</p

Low Level of Microsatellite Instability Correlates with Poor Clinical Prognosis in Stage II Colorectal Cancer Patients

The influence of microsatellite instability (MSI) on the prognosis of colorectal cancer (CRC) requires more investigation. We assessed the role of MSI status in survival of individuals diagnosed with primary colorectal cancer. In this retrospective cross-sectional study the MSI status was determined in 158 formalin-fixed paraffin-embedded tumors and their matched normal tissues from patients who underwent curative surgery. Cox proportional hazard modeling was performed to assess the clinical prognostic significance. In this study we found that MSI-H tumors were predominantly located in the colon versus rectum (p=0.03), associated with poorer differentiation (p=0.003) and TNM stage II/III of tumors (p=0.02). In CRC patients with stage II, MSI-L cases showed significantly poorer survival compared with patients who had MSI-H or MSS tumors (p=0.04). This study indicates that MSI-L tumors correlate with poorer clinical outcome in patients with stage II tumors (p=0.04) or in tumors located in the colon (p=0.02). MSI-L characterizes a distinct subgroup of CRC patients who have a poorer outcome. This study suggests that MSI status in CRC, as a clinical prognostic marker, is dependent on other factors, such as tumor stage and location