16 month survey of cyclosporine utilization evaluation in allogeneic hematopoietic stem cell transplant recipients

Objectives: Graft versus host disease [GVHD] is a life threatening reaction in the stem cell transplantation process. Nowadays Cyclosporine is the most commonly utilized agent for GVHD prophylaxis and it has a major role in successful transplantation. Cyclosporine has been applied for many years in this field but it could be stated that currently no general consensus is available for its optimal method of administration. Conditions related to cyclosporine administration and possible related adverse reactions observed closely in our patients with the aim of constructing a comprehensive practice guideline in the future

Patients and Methods: Allogeneic stem cell transplant recipients who have been taking cyclosporine were monitored during and after their hospitalization while recording all observations on predefined questionnaires on the basis of periodic clinical and laboratory examinations for a 16 month period

Results: Mean recorded duration of infusions was 1.44 +/- 0.68 h and by twice daily administration, means intravenous and oral dose was 101.85 +/- 22.03 mg and 219.28 +/- 63.9 mg, respectively. A mean CsA trough level after about 12 h of specified unique doses was 223 +/- 65 ng/mL. We found hypertension, nephrotoxicity, neurotoxicity, hypertension, and dyslipidemia in about 14, 20, 48, and 94 percent of patients

Conclusions: This study proposed that permanent guidance of healthcare team according to a fixed and standard method of cyclosporine administration routine with using efficient facilities and protocols would be helpful considerably for an optimal pharmacotherapy

Plerixafor in the treatment of stem cell mobilization failure; first experience in Iran

High-dose chemotherapy and autologous stem cell transplantation [SCT] have become an effective care for many patients with hematological malignancies. Harvesting the stem cells is one the most important parts of SCT. The two most commonly used mobilization regimens are the use of granulocyte colony-stimulating factor [G-CSF] or G-CSF plus chemotherapy. However, about 10-30% of patients are unable to collect enough cells to support HSCT due to previous chemotherapies, radiation, marrow involvement or fibrosis. In multiple myeloma patients, it is hard to collect enough stem cells when the bone marrow is extensively involved. Plerixafor has emerged as a novel mobilizing agent and its efficacy has been shown in two phase III studies. Considering the importance of autologous SCT in patients with multiple myeloma, we report the first successful Iranian experience at Tehran Taleghani bone marrow transplantation center using plerixafor to mobilize stem cells in a patient with refractory multiple myeloma with extensive bone marrow involvement who failed mobilization with G-CSF

Osteogenic inhibition in multiple Myeloma

Multiple myeloma [MM] is a plasma cell malignancy where plasma cells are increased in the bone marrow [BM] and usually do not enter peripheral blood, but produce harmful factors creating problems in these patients [e.g. malignant plasma cells over activate osteoclasts and inhibit osteoblasts with factors like RANKL and DKK]. These factors are a main cause of bone lesion in MM patients. Recently SOST gene which responsible to encodes the sclerostin protein was identify. This protein specifically inhibits Wnt signaling in osteoblasts [inhibition of osteoblast differentiation and proliferation] and decrease bone formation and can also cause bone lesion in MM patients. In this experimental study, human myeloma cell lines [U266 b1] were purchased from Pasteur Institute of Iran. Samples consisted of BM aspirates from the iliac crest of MM patients. BM with more than 70% plasma cell were selected for our study [6 patients] and one healthy donor. RNA extraction was done with Qiagen kit. was undertaken on mRNA of samples and cell lines. Also we purchased unrestricted somatic stem cells from Bonyakhte Company to evaluate the effect of soluble factors from myeloma cell lines on osteogenic differentiation medium. Our results showed that SOST is expressed significantly in primary myeloma cells derived from MM patients and myeloma cell lines. In other words, patients with more bone problems, express SOST in their plasma cells at a higher level. In addition, myeloma cells inhibit osteoblast differentiation in progenitor cells from umbilical cord blood stem cell [UCSC] in osteogenic inducing medium. There are many osteoblast maturation inhibitory factors such as DKK, Sfrp and Sclerostin that inhibit maturation of osteoblast in bone. Among osteoblast inhibitory agents [DKK, Sfrp, Sclerostin] sclerostin has the highest specificity and therefore will have less side effect versus non-specific inhibitory agents. Our results also show that based on SOST expression in MM, there is a potential to inhibit sclerostin with antibody or alternative methods and prevent bone lesion in MM patients with the least side effect

In-patient satisfaction and its related factors in Taleghani University Hospital, Tehran, Iran

Patient satisfaction survey is an instrumental component in hospital's quality of care monitoring in relation to cost and services. This study was conducted to evaluate patient satisfaction and its related factors. A cross sectional study was performed between April 2006 and August 2006. Sample size was determined as 476 from 5021 by randomized sampling in several phases according to the proportion of hospitalized patient. Participants were interviewed privately face to face in the hospital at discharge time. Interviews were conducted by trained interviewers using pre tested questionnaires. Correlation between variables was estimated by using Pearson's Correlation. The majority, 83% of patient was quite satisfied with their care and 1% was dissatisfied. About 91% of patients were most satisfied with physician communication and treatment. Only 27% of patients were satisfied with nutrition status. There was no relationship between age, education and total satisfaction. Percentage of patient faithfulness and recommendation for this hospital to their friends was 66% and 65% respectively. Both male and female patients whose hospital stay was between 11-15 days were more satisfied with the service provided. In general, patients were quite satisfied with their hospital care. More studies such as this survey are required to improve the quality of care and overall health cares outcome

Analysis of HLA-G gene expression in b-lymphocytes from chronic lymphocytic leukemia patients

The human leukocyte antigen G [HLA-G] molecule exhibits limited tissue distribution, low polymorphism and alternative splicings that generate seven HLA-G isoforms. HLA-G exerts multiple immunoregulatory functions. Recent studies indicate an ectopic up-regulation in tumor cells that may favor their escape from anti-tumor immune responses. This study it is an effort to clarify the presence of HLA-G in B-cell chronic lymphocytic leukemia [B-CLL] patients. HLA-G mRNA expression was studied in a pilot study in circulating B-CLL and also healthy controls by reverse transcription [RT]-PCR using a set of pan-HLA-G primers. RT-PCR was performed on B-cells from 74 B-CLL patients and 12 healthy controls. The data showed HLA-G gene expression in 20% of the B-CLL patients. No expression of HLA-G could be detected in the healthy control group. These data suggest that HLA-G is expressed at the gene level in B cells from B-CLL patients but not in B cells from healthy controls. Further study is required to clarify the role of HLA-G as a regulatory factor that could affect immune response in B-CLL patients

Increase of CXCR4 expression on expanded non-enriched cord blood CD34+cells using MSCs

A number of potential cell adhesion molecules, which mediate essential cell-to-cell or cell-to-matrix interactions, are expressed on the surface of CD34+ hematopoietic progenitor cells [HPCs], including integrins, CD44, and CXCR4. These molecules are essential for homing process. In this study, we compared the changes of expression of CD44 and CXCR4 on the CD34+ hematopoietic progenitor cells expanded on MSCs in the presence of cytokines. Cord blood CD34+ cells were expanded using human bone marrow mesenchymal stem cells and cytokines [TPO, SCF, FLt-3, IL-6, and IL-3], and then expression of CD44 and CXCR4 on CD34+ cells were evaluated by flow cytometric analysis. After 2 weeks of serum free culture of CD34+ cells in the presence of cytokines, the expression of CXCR4 on CD34+ cells was decreased 3.4 fold [p<0.05]. In contrast, the expression of CXCR4 on CD34+ cells expanded on hMSCs was increased [p<0.05]. The expression of CD44 on expanded CD34+ cells in both methods did not differ significantly. Our results indicated that co-culture of cord blood stem cells on hMSCs significantly increased CXCR4 expression on cord blood CD34+ cells