[Does multiple myeloma response induction therapy depending on plasma cell il6 receptor gene expression]

Interleukine 6 [IL-6] is the most important cytokine involved in malignant plasma cells growth and survival. To analyse bone marrow plasma cells IL6 receptor gene expression in both multiple myeloma patients at diagnosis and healthy bone marrow donors. Clinical and biological patients' features and responses to Dexamethasone-Thalidomide induction therapy were gathered. 47 patients and 16 case controls were analyzed: Bone marrow plasma cells were isolated; and IL6 receptor gene expression was quantified using Taqman quantitative PCr technology and 2-DELTA CT formula. Quantitative and qualitative IL6 receptor gene expression were negatively correlated with the degree of response to therapy [p= 0.02]. In this study, plasma cells IL6 receptor gene expression seems to be decisive in predicting the response to treatment. Understanding the mechanisms involved in plasma cells IL6 receptor gene expression may offer a better appreciation of the physiopathologic and anti-oncogenic ways of drug resistance in multiple myeloma and consequently the discovery of new specific drugs

Hematopoietic stem cell transplantation in the eastern mediterranean region [EMRO] 2008-2009: report on behalf of the eastern mediterranean bone marrow transplantation [EMBMT] group

The Eastern Mediterranean Bone Marrow Transplantation [EMBMT] Group has accumulated over 25 years of data and experience in hematopoietic stem cell transplantation [HSCT], most particularly in he-moglobinopathies, severe aplastic anemia [SAA], and inherited metabolic and immune disorders, in addition to hematologic malignancies peculiar to the region and where recent updates in trends in activities are warranted. To study trends in HSCT activities in the World Health Organization-Eastern Mediterranean [EM] region surveyed by EMBMT between 2008 and 2009. STUDY DESIGN: Retrospective analysis of the survey data, mainly of the cumulative number of transplants, types of transplants [autologous vs. allogeneic], types of conditioning as myeloablative [MAC] vs. reduced intensity conditioning [RIC] and trends in leukemias, hemo-globinopathies, SAA, inherited bone marrow failure syndromes amongst others. Fourteen teams from ten Eastern Mediterranean Region Organization [EMRO] countries reported their data [100% return rate] to the EMBMT for the years 2008-2009 with a total of 2608 first HSCT [1286 in 2008; 1322 in 2009]. Allogeneic HSCT represented the majority [63%] in both years. The main indications for allogeneic HSCT were acute leukemias [732; 44%], bone marrow failure syndromes [331, 20%], hemoglobinopathies [255; 15%] and immune deficiencies [90; 5%]. There was a progressive increase in the proportions of chronic myeloid leukemia [CML] cases transplanted beyond the first chronic phase [3; 7% of all CML cases in 2008 vs 13; 29% in 2009]. The main indications for autologous transplants were plasma cell disorders [345; 36%] Hodgkin disease [256; 27%], non-Hodgkin lymphoma [207; 22%] and solid tumors [83; 9%]. RIC continued to show a progressive increase over the years [7% in 2007, 11% in 2008 and 13% in 2009], yet remained relatively low compared to contemporary practices in Europe published by EBMT. The vast majority [95%] of allo-HSCT sources were from sibling donors with a continued dominance of peripheral blood [PB] [1076; 63%], while cord blood transplant [CBT] increased to 83 [5% of allo-HSCT], matched unrelated donor [MUD] remained underutilized [1; 0%] and there were no haploidentical transplants reported. Large centers with >50 HSCT/year showed a plateau of the total number of allo-HSCT over the last 5 years that may be related to capacity issues and needs further study. There is an overall increased rate of HSCT in the EMRO region with a significant increase in utilization of CBT and allogeneic PB-HSCT as a valuable source. However, further research on outcome data and development of regional donor banks [CB and MUD] may help facilitate future planning to satisfy the regional needs and increase collaboration within the group and globally

High-Dose therapy and autologous stem cell transplantation for Hodgkin's Lymphoma in relapse or failure after initial chemotherapy: results of the centre National de Greffe de Moelle osseuse de Tunis

In the present study we report the clinical outcome of 27 patients with refractory or relapsed Hodgkin's lymphoma [HL] undergoing autologous peripheral stem-cell transplantation [ASCT]. On transplant, 18 patients had sensitive disease [SD] and 9 resistant disease [RD]. The median time between diagnosis and ASCT was 18 months [range, 7 to 96 months]. The conditioning consisted of BEAM regimen. The 100-day mortality rate was 3%. Three months after transplant, 12 patients transplanted with SD were in complete remission [CR] and only one of the 9 patients transplanted with RD achieved CR. Overall survival and disease-free survival after 3 years were 68% and 60%, respectively. The present results confirm the efficacy and safety of the ASCT in refractory or relapsed HL patients with SD. Other strategies should be investigated for patients with RD

[Autologous stem cell transplantation in multiple mayeloma: first experience of the "centre national de greffe de moelle osseuse" and review of therapeutic strategies]

Alkylating agents administered with prednrisone have been the standard therapy for myeloma over the last three decades. Intensive treatment with autologous hematopoietic support has become the treatment of choice for multiple myeloma patients up to 60 years of age. From march 1999 to January 2000, seven patients with multiple myeloma [stage III] with a median age of 43 years [34-56] received an outologous stem cell transplantation. The myeloablative treatment regimen consisted of high-dose melphalan. All patients had sustained engraftment. The median duration of neutropenia [<500/mm3] was 12 days [11-140] and the median duration of thrombocytopenia[<20000/mm3] was 13 days [11-110]. One patient had a complete remission, one a very good partial remission, and 5 patients had a partial remission. With a median follow- up of 8 months [2-12], all patients are alive, without relapse

[Indications and complications of central venous catheters in oncohematology: a report of 81 cases]

From February 1998 to July 1999, 81 central venous catheters were placed in 41 patients 28 years old [5 to 51 years]. We used the subclavicular anatomic way [Aubaniac] in all cases. The total duration of catheter placement was 2905 days [median of 31 days, range 1 to 165 days]. We observed 1 pneumothorax [1,2%], 3 venous thrombosis [3,7%] and 1 arterial puncture [1,2%]. Catheter-related infections were seen in 8 catheters [2,7 per 1000 catheter-days]. Candida was encountered in 4 cases [50%], Gram-positive cocci in 2 cases [25%], and Gram-negative bacilli in 2 cases [25%]. The improvment of preventive ways, diagnosis techniques [simultaneous quantitative cultures, differential positivity time], and therapeutic methods [treatment without removal of the catheter, antibiotic lock technique, catheter exchange by guidewire] should allow a better treatment of catheter-related infections

Greffe de moelle osseuse allogenique complications. 2 eme partie

Bone marrow transplantation increase the chances of cure of many hemetologie and allso neoplasmes cancers. The procedure is however a cause of expected mortality and morbidity. The complications are represented by mucocutaeous, toxicaty graft versus host disease, veno-occlusive desease and mort importanlly injections consequences all this complications needs to be prevented and treated considering the risk associated to the moderling immunosuppression