1[st] line antimicrobial therapy for febrile neutropenic cancer patients

Empiric antibiotic regimens used in febrile neutropenic patients often include an extended spectrum cephalosporin, but the response of therapy in Gram positive coccal bacteremia has been unsatisfactory, thus new antibiotic with better activity against Gram positive bacteria should be tested. Antipseudomonal penicillins including piperacillin are effective against many Gram positive and Gram negative organisms. The aim of this work is to compare combination therapy with piperacillin-tazobactam plus amikacin versus ceftazidime plus amikacin as first line in treatment of febrile neutropenic cancer patients. This study is a single center, prospective and randomized trial performed in pediatric branch wards, of the National Cancer Institute, Cairo University. All patients were subjected to full clinical and laboratory evaluation including microbiological study. Doses were given according to the International Antimicrobial Therapy Cooperative Group [IATCG] of the European Organization for the Research and Treatment of Cancer [EORTC]. 164 febrile neutropenic episodes were enrolled on this study. 82 patients with 105 [64%] high risk febrile granulocytopenic episodes were considered eligible. 53 were treated with piperacillin-tazobactam plus amikacin [group A], and 52 were treated with ceftazidime plus amikacin [group B]. The overall success in group A was higher than group B, yet, the difference was statistically insignificant with a p value=0.2. Time of defervecence was significantly shorter in piperacillin-tazobactam group [p=0.001]. There was no infection related mortality in this study. Side effects were encountered in 3 [5.6%] cases receiving piperacillin-tazobactam in the form of mild skin reaction. 55.7% of positive cultures yielded Gram positive organisms. Staphylococcus species were the most common organism in both groups. Both Gram positive and negative organisms showed higher sensitivity to pipercillin-tazobactam compared to ceftazidime with a significant p value=0.05. Piperacillin-tazobactam is safe and more effective than ceftazidime in febrile neutropenia in pediatric cancer patients

Aberrant p15 promotor methylation in acute leukaemia

The p15 gene is one of the tumour suppressorgenes located on chromosome 9p21. In acute leukemias alterations involving the p15 gene have been reported. Commonly, these alterations involve the c[p]g islands that are commonly aberrantly methylated and result in the transcriptional loss of this gene. To detect this aberrant methylation, we used methylation specific pcr which is a novel method of pcr that can rapidly assess the methylation status of virtually any c[p]g island. The study included 30 patients: 17 cases of the novo all and 13 cases of de novo aml. Aberrant p15 gene mehylation was detected in 47.1% of cases of all and in 69.2% of casaes of AML. There was no statistically significant difference between methylated and unmethylated cases regarding the clinical and haematological data other than the peripheral blood blast cell count. On following up the patients to detect the response to therapy, there was a statistically significant difference in the response to therapy between methylated and unmethylated cases [p< 0.05]. Methylated case had a higher incidence of relapse or death [in all methylated cases 35.4% of the studied cases relapsed and 61.6% in aml patients] while the inidence of remission was 11.7% for all methylated cases and 7.7% for aml cases. Unmethylated all cases achieved remission in 41.2% of the studied group and unmethylated cases of AML reached remission in 61.6%. Aberrant p15 methylation may have important prognostic implications for clinical monitoing. And risk assessment. Also it opens new strategies of treatment using demethylating agents that can reverse this epigenetic change