Dose-modified lenalidomide induces sustained hematological response in patients with intermediate to high risk myelodysplasia

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A retrospective analysis of the effect of filgrastim compared to pegfilgrastim on neutrophil recovery during the treatment of acute leukaemias

Objectives:The rate of neutrophil recovery is a crucial parameter for successful treatment of acute leukaemias. Traditionally, filgrastim, which is a short acting Granulocyte Colony Stimulating Factor (G-CSF ) is used to reduce the period of post-chemotherapy neutropenia. It needs daily administration. The recently developed pegfilgrastim is a long acting G-CSF that has decreased renal clearance allowing for single injection dosing. The objective was to compare the effect of Filgrastim to Pegfilgrastim on post chemotherapy neutrophil recovery.Methods: We retrospectively analysed the outcome of 103 episodes of chemotherapy in 33 patients who received induction and consolidation therapy for acute leukaemias with supporting G-CSF during the period from 2007 to 2009 at a single institution. 24 patients were treated for AML and 9 for ALL/lymphoblastic lymphoma. G-CSF was commenced according to body weight (filgrastin 5mcg/kg daily, pegfilgrastin 6mg, single dose) one day after completion of the chemotherapy. The time required for neutrophil recovery > 0.5x 10 9/l and > 1.0x 10 9/l were analysed for each patient for every treatment cycle. The study also incorporated other factors that may influence neutrophil recovery such as ECOG status of the patient, type of chemotherapy and the presence of febrile neutropaenia or sepsis.Results: Patients who were treated with filgrastim (18 patients) had a neutrophil recovery >0.5/nl with a mean of 11 days compared to 12 days with pegfilgrastin, while neutrophil recovery >1.0/nl was observed on a mean of 12.5 days for both groups. There was no significant difference between the two groups with a p-value of 0.7 and 0.9 respectively. Further sub-analysis of induction and consolidation chemotherapies did not reveal a significant difference between the two cytokines, however it was noted that a prolonged neutropaenia occurred during induction- compared to consolidation chemotherapy in both treatment groups. Furthermore cost of the total course of filgrastim was three times the cost of a single dose of pegfilgrastim.Conclusions: During the treatment of acute leukaemia, pegfilgrastim results in a comparable effect with filgrastim with decreased cost and less injections

In vitro oslobađanje hidrofilnih i hidrofobnih ljekovitih tvari iz liposomskih disperzija i gelova

A method for determining the rate of hydrophilic and hydrophobic drug entities release from different types of liposomal dispersions and gels using a dialysis method is described. Dibucaine base and 5-fluorouracil were used as model drugs for a hydrophobic and hydrophilic drug, respectively. A dialysis technique was employed. Release rates were affected by the rate of rotation of the paddles of the tablet dissolution tester, temperature, and volume of release medium. The method was used to evaluate the in vitro drug release from hydrophilic and hydrophobic drug entities from liposomal dispersions and gels. The in vitro release study of dibucaine base showed no burst effect, while the in vitro release study of 5-fluorouracil showed a clear burst effect with an initial fast release phase followed by a sustained release phase.Opisana je metoda za određivanje brzine oslobađanja hidrofilnih i hidrofobnih ljekovitih tvari iz različitih vrsta liposomskih disperzija i gelova koristeći dijalizu. Dibukain baza i 5-fluorouracil upotrebljeni su kao modeli hidrofobnog, odnosno hidrofilnog lijeka. Na brzinu oslobađanja utjecala je brzina rotacije lopatica u aparatu u koje je pokus izvođen, temperatura i volumem medija za oslobađanje. Metoda je upotrebljena in vitro praćenje oslobađanja ljekovite tvari iz liposomskih disperzija i gelova. In vitro oslobađanje dibukain baze ne pokazuje učinak naglog oslobađanja, a 5-fluorouracila pokazuje, s brzim inicijalnim oslobađanjem iza kojeg slijedi usporeno oslobađanje

Quality of Life Assessment in Multiple Myeloma Patients Undergoing Dose-Reduced Tandem Autologous Stem Cell Transplantation

Few studies exist that consider health-related quality of life (HR-QoL) in patients with multiple myeloma (MM) undergoing tandem autologous stem cell transplantation (TASCT). Eighteen patients with advanced MM who underwent dose-modified TASCT were enrolled in this study between March 2006 and March 2008. Patients <60 year old (10) received conditioning with melphalan 140 mg/m2 and patients who were ≥60 years (8) received 100 mg/m2. The median age was 57.5 years (range 35–69). We conducted the European Organization of Research and Treatment of Cancer (EORTC) QLQ-C30 and the QLQ-MY24 questionnaires via interviews at presentation, after each ASCT and thereafter every 3 months for 24 months. Mean global health measure improved from 3.44 before transplant to 4.50 (1=very poor, 7=excellent) at the second and subsequent follow-up visits (P<0.001) and the mean global quality of life score improved from 3.61 to 4.71 (P<0.001). Pain symptoms were reduced (P=0.001), and physical functioning improved (P<0.001) throughout the period of post-transplant follow-up. Our study showed that dose-reduced TASCT is well tolerated with low toxicity albeit the transient reduction in QoL during both transplants. Post-transplant follow-up showed significant improvement in overall HR-QoL that reflects positively on the overall disease-outcome. Furthermore, a sole focus on patient-survival does not adequately provide indication regarding the tolerability and effectiveness of a proposed treatment on the patient’s perceived quality of life. As clinicians, our primary concern should be toward patient-welfare as well as survival. Therefore, we should employ the tools of QoL in conjunction with overall survival in order to deliver the best possible patient outcomes. The EORTC-QLQ-MY24 is a practical tool in measuring QoL in myeloma patients

An Unusual Presentation of Desmoplastic Small Round Cell Tumour of the Abdomen: Morphological, Immunohistochemical, Ultrastructural, and Molecular Studies

Desmoplastic small round cell tumour (DSRCT) is an aggressive and a rare neoplasm. We report on a 34-year-old male who had abdominal discomfort with a large intraperitoneal mass. Histological examination of the tumour biopsy revealed sheets of small round cells. The cells were positive with vimentin and desmin (with occasional dot positivity) and negative for WT1 and CD 99 with immunohistochemistry. Cytogenetics showed a translocation disrupting the EWSR 1 gene on 22 q 12 consistent with DSRCT. Electron microscopic examination showed sparse cytoplasmic organelles. The patient succumbed 34 months from disease presentation after multiple chemotherapies and thereafter radiotherapy. In summary, our case exemplifies that it is crucial to combine clinical, histological, and molecular aspects in diagnosing DSRCT especially when characteristic dot positivity with desmin is weak along with deficient marking of WT1 and CD99 by immunohistochemistry. Histology was also less clear than published examples of this entity with a poor desmoplastic response. A multidisciplinary approach including early referral to specialised centres is recommended in these cases as tertiary referral centres will be required to substantiate the diagnosis

Iron deficiency anaemia in pregnancy and postpartum: pathophysiology and effect of oral versus intravenous iron therapy

Nutritional iron-deficiency anaemia (IDA) is the most common disorder in the world, affecting more than two billion people. The World Health Organization&apos;s global database on anaemia has estimated a prevalence of 14% based on a regression-based analysis. Recent data show that the prevalence of IDA in pregnant women in industrialized countries is 17.4% while the incidence of IDA in developing countries increases significantly up to 56%. Although oral iron supplementation is widely used for the treatment of IDA, not all patients respond adequately to oral iron therapy. This is due to several factors including the side effects of oral iron which lead to poor compliance and lack of efficacy. The side effects, predominantly gastrointestinal discomfort, occur in a large cohort of patients taking oral iron preparations. Previously, the use of intravenous iron had been associated with undesirable and sometimes serious side effects and therefore was underutilised. However, in recent years, new type II and III iron complexes have been developed, which offer better compliance and toleration as well as high efficacy with a good safety profile. In summary, intravenous iron can be used safely for a rapid repletion of iron stores and correction of anaemia during and after pregnancy

Different methods of bacterial inoculation on the yield of chamomile blossoms and essential oil

Chamomile is one of the most wide spread medicinal plant cultivated in Egypt. This work aimed at enhancement of blossoms and oil production of chamomile plants via biofertilization with PGPRs under organic farming system. In this study, 6 bacterial strains were applied using two different inoculation techniques. The first application method was throughout soaking the roots of seedlings in the bacterial suspension before transplanting. The second technique was by adding the bacterial inocula to soil 2 weeks after transplantation. The results showed that root dipping method displayed high impact on the yield of chamomile blossoms and essential oil percentage. Furthermore, the soil application of the bacterial inocula didn’t show any significant impact in this respect. Where Paenibacillus polymyxa, Bacillus subtilis, Serratia plymuthica and Streptomyces subrutilus increased the dry weight of chamomile blossoms compared to the control, essential oil content increased significantly in case of Serratia plymuthica, Stenotrophomonas rhizophyla and Bacillus subtilis. The current results also indicated that bacterial strains produced the highest indole-3-acetic acid and gibberellic acid resulted in the highest yield of both flowers and essential oil