Comparison of Intensive Chemotherapy and Hypomethylating Agents before Allogeneic Stem Cell Transplantation for Advanced Myelodysplastic Syndromes

The European Society for Blood and Marrow Transplant Research data set was used to retrospectively analyze the outcomes of hypomethylating therapy (HMA) compared with those of conventional chemotherapy (CC) before hematopoietic stem cell transplantation (HSCT) in 209 patients with advanced myelodysplastic syndromes. Median follow-up was 22.1 months and the median age of the group was 57.6 years with 37% of the population older than > 60 years. The majority of patients (59%) received reduced-intensity conditioning and 34% and 27% had intermediate-2 and high international prognostic scoring system (IPSS) scores. At time of HSCT, 32% of patients did not achieve complete remission (CR) and 13% had primary refractory disease. On univariate analysis, outcomes at 3 years were not significantly different between HMA and CC for overall survival (OS), relapse-free survival (RFS), cumulative incidence of relapse (CIR), and nonrelapse mortality (NRM): OS (42% versus 35%), RFS (29% versus 31%), CIR (45% versus 40%), and NRM (26% versus 28%). Comparing characteristics of the groups, there were more patients < 55 years old, more patients in CR (68% versus 32%), and fewer patients with primary refractory disease in the CC group than in the HMA group (10% versus 19%, P < .001). Patients with primary refractory disease had worse outcomes than those in CR with regard to OS (hazard ratio [HR], 2.42; 95% confidence interval [CI], 1.41 to 4.13; P = .001), RFS (HR, 2.27; 95% CI, 1.37 to 3.76; P = .001), and NRM (HR, 2.49; 95% CI, 1.18 to 5.26; P = .016). In addition, an adverse effect of IPSS-R cytogenetic risk group was evident for RFS. In summary, outcomes after HSCT are similar for patients receiving HMA compared with those receiving CC, despite the higher proportion of patients with primary refractory disease in the HMA group

Screening of traditionally used Tanzanian medicinal plants for antifungal activity

Kisangau DP, Hosea KM, Lyaruu HVM, et al. Screening of traditionally used Tanzanian medicinal plants for antifungal activity. PHARMACEUTICAL BIOLOGY. 2009;47(8):708-716.Fungal infections represent a significant cause of morbidity and mortality especially in immunocompromised patients in the world today. Dichloromethane (DM) and aqueous (W) extracts of nine plants used traditionally for the treatment of fungal infections in Bukoba rural district in Tanzania were screened for antifungal activity against Candida albicans, Cryptococcus neoformans, and Aspergillus niger using agar well and disk diffusion methods. Dichloromethane extracts of Capparis erythrocorpos [CE] Isert (Capparaceae), Cussonia arborea [CA] Hochst. Ex A. Rich (Araliaceae), Drocaena steudneri [DS] Engl. (Dracaenaceae), Lannea schimperi [LS] (A. Rich) Engl. (Anacardiaceae), Rouvolfia vomitoria [RV] Afz (Apocynaceae), and Sapium ellipticum [SE] (Krauss) Pax (Euphorbiaceae) showed activity against all three fungi. Extracts of Rumex usambarensis [RU] (Dammer) Dammer (Polygonaceae) and Zehneria scabro [ZS] (L.f.) Sond. (Cucurbitaceae) had an activity limited to only one or two of the test organisms. Rhoicissus tridentata [RT] (L.Q Wild & Drum (Vitaceae) was the only plant without activity. Fractions of the active extracts CE, CA, DS, LS, and SE exhibited higher antifungal activity against one or more of the three fungi. Four compounds isolated from S. ellipticum also exhibited antifungal activity against one or more of the three fungi. The minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs), determined using the microplate assay method, ranged between 0.4 and 50.0 mu g/mL for crude extracts, 1.6 and 50.0 mu g/mL for semi-purified fractions, and 0.12 and 1.0 mu g/mL for pure compounds, as compared to 0.016-1.5 mu g/mL for fluconazole. We confirm the potential of traditionally used plants as a source of new drugs for treatment of fungal infections