Fluorescence in situ hybridization in conjunction with karyotyping in detection of cytogenetic abnormalities in B-cell chronic lymphocytic leukemia and its prognostic value

Routine cytogenetic analysis frequently fails to identify an abnormal clone in B-cell lymphocytic leukemia [B-CLL] due to poor response to mitogen stimulation. Fluorescence in situ hybridization [FISH] suggest that chromosomal abnormalities occur more frequently, most commonly trisomy 12, retinoblastoma gene deletion [Rb 1 gene] and P53 gene deletion. 30 patients with B-CLL were enrolled in the trial from 2 centers in Cairo, Egypt during the period May 2000 to January 2002. Karyotyping and FISH assessment for possible chromosomal abnormalities [trisomy 12, Rh 1 gene and P53 gene] were done at initial diagnosis. Results of cytogenetic abnormalities were correlated with clinical picture and survival. The median age was 57.4 years [range 40-75]. Karyotyping technique showed that no metaphase could be detected in 30%, metaphase with normal karyotyping was observed in 63% and cytogenetic abnormalities were detected in 2 cases [1 trisomy 12 and 1 deletion in chromosome 13]. FISH examination of interphase and metaphase nuclei revealed cytogenetic abnormalities in 15 cases [50%], trisomy 12 in 9 [30%], Rb 1 gene deletion in 5 [17%] and P53 gene deletion in 1. At diagnosis, patients with trisomy 12 were significantly associated with advanced stage and absolute lymphocyte count of >/= 30,000/mm[3]. Univariate analysis showed that absolute lymphocyte count >/= 30,000/mm[3] [p=0.004] and trisomy 12 [p=.024] were associated with poor progression free survival. Interphase and metaphase FISH studies improve the cytogenetic diagnosis of chromosomal abnormalities in B-CLL. Lymphocytosis and trisomy 12 might be a good indicator of poor prognosis

Role of adiation therapy in the treartment of malignant pleural mesothelioma based on treatment ouctcome of 54 patients

This is a retrospective study that included 54 patients with malignant pleural mesothelioma presenting to NEMROCK from 1999 to 2001. Twenty- six patients [group I] were treated with platinol-adriamycin, 16 patients [group II] were treated with holoxan-adriamycin and 12 patients [group III] were treated with external beam radiation therapy. The overall response rate in the three treatment groups were 38.5%, 43.8% and 25%, respectively. The median overall survival of cases of the whole study was 7.5 months. Eighteen patients from groups I and II received salvage radiation therapy when they progressed. Their response rate to radiation therapy was 33.3%. The overall median survival of these patients was 10.5 months. So, radiation therapy gave a survival advantage when given as bimodality treatment following chemotherapy. The local recurrence rate was 16.6% with no cases of local recurrence encountered in patients receiving local radiation therapy. So, prophylactic radiation therapy to scar regions can reduce local recurrence. Age <50 years and epithelial pathology were significant predictors of treatment response

Use of temozolomide in the management of high grade gliomas at relapse.

This study was done at NEMROCK and other private as well as official governmental oncology centers, where 30 patients with residual or relapsed high grade gliomas received temozolomide at a dose of 200 mg/m2/day for five successive days to be recycled on day 21 for a total of six courses. Drug administration was quite safe with accepted toxicity profiles. The response parameters, including partial response, stationary disease and progressive neoplastic process, were documented in 33%, 45% and 22%, respectively

Cisplatin and paclitaxel concomitant with radiotherapy in locally recurrent cancer cervix

Twenty-three eligible patients with locally recurrent cervical carcinoma after radical hysterectomy were treated with concomitant cisplatin/paclitaxel and radiation. Thechemotherapy regimen consisted of cisplatin [20 mg/m2] and paclitaxel [45 mg/m2 therapy] that were given every other week concomitantly with 65-70 Gy local pelvic irradiation over 7 weeks. Eight patients [34.8%] experienced grade 3-4 acute toxicity during treatment. Late morbidity was reported in 4 patients [17.4%]. The chemotherapy related morbidity included mainly hematological toxicity, nausea and vomiting and neurotoxicity. The radiation related morbidity included mainly skin reaction, prostatitis and cystitis. Objective response was achieved in 69.7% ofpatients [34.8% complete response and 34.8% partial response]. The median duration of follow up for whole group was 17.1 months. Sex patients [26.9%] were alive with no evidence of disease with a median survival of 30.6 months. The 2 year overall survival was 26.9%. Five patients [21.7%] developed distant metastases. There was a tendency towards better results for earlier initial stage of the disease, patients older than 50 years old, squamous cell carcinoma tumors, tumors < 5 cm, central pelvis tumors and disease free interval from initial surgery more than 1 year. The study concluded that concomitant cisplatin/paclitaxel and radiation is a safe and tolerable treatment with reasonable response rate and satisfying survival for locally recurrent cancer cervix. However, this regimen must be run on a larger number of patients with a longer follow up period to get significant predictors of the response and survival and to guide in identifying the subset of patients that may benefit from more aggressive therapy