Stem cell transplantation in hematological disorders: a developing country experience-impact of cost considerations

To describe the experience in setting up a bone marrow transplant program at Ain Shams University, Cairo, Egypt. Sixteen patients were transplanted at Ain Shams University Bone Marrow Transplantation unit from March 2005 to January 2008. Sixteen patients were transplanted with a median age of 25 years. Indications for transplantation were chronic myeloid leukemia, acute myeloid leukemia, aplastic anemia, acute lymphoblastic leukemia, and aggressive lymphoma. Seven donors and 6 patients were positive for cytomegalovirus immunoglobulin G [IgG] antibody [Ab] pretransplant. Only one patient was positive for toxoplasma IgG Ab and another had a high titre for toxoplasma IgM Ab pretransplant. Two donors and 2 recipients were positive for hepatitis B antibody markers; however, none were positive for hepatitis B virus DNA by polymerase chain reaction [PCR]. None of the patients or donors were positive for hepatitis C virus via PCR pre-transplant. Acute graft versus host disease [GVHD] was seen in 3 patients, while chronic GVHD was seen in 5 patients. Primary cause of death was recurrence in 2 patients and graft failure in one patient. Thirteen are alive and disease free with a median follow-up of 20 months. Although our unit is a relatively new unit, these results are comparable to those achieved in the Western world and cost a mean of US$250,000

Serum levels of IL-10, TNF-alpha and neopterin in chronic hepatitis c virus infection and their relation to viral load

Hepatitis C virus [HCV] has been shown to be an etioligic agent responsible for chronic liver disease with eventual progress to cirrhosis in 20% of patients. While the immunologic mechanisms in chronic HCV infection have not been clearly defined, it is believed that cytokines are involved. In this study, the serum levels of IL-10 [by ELISA], TNF-alpha [by ELISA] and neopterin [by RIA] in patients with chronic hepatitis C [n = 40] were measured. They were compared with biochemical [ALT, AST, GGT] and viral [serum levels of HCV-RNA] indicators of infection. In addition, serum autoantibodies [anti-LKM, ANA, ASMA and APCA] were done by the indirect immunofluorescence technique. Also, twenty healthy subjects were enrolled as a control group. Serum levels of IL-10, TNF-alpha and neopterin were significantly increased in HCV infected patients versus normal control group [P<0.001]. There was significant positive correlation between serum level of IL-10 and serum level of HCV-RNA [P < 0.001]. There was also a significant negative correlation between serum level of TNF-alpha and both of serum level of HCV-RNA [P < 0.05] and IL-10 [P < 0.001]. ANA was detected in 7.5%, ASMA in 37.5% and APCA in 2.5% in these patients. In summary HCV patients have an altered immune reactivity that may play a role in the pathogenesis of chronic HCV. An activated T cell response is present in these patients as manifested by increased circulating cytokine levels and presence of serum autoantibodies. Proper understanding of the immune response in HCV patients should make it possible to design future treatment strategies for HCV infection