Geographic heterogeneity of cytogenetic characteristics of acute myeloid leukemia in the early detection: a comparative study of Iranian and Indian adult patients

Acute Meyloid Leukemia [AML] in adults is known to be a heterogeneous disease with diverse chromosome abnormalities. Some of these chromosome abnormalities are found with a high incidence in populations from specific geographical areas and ethnic societies. Therefore, we studied the cytogenetic features of AML cases in contrasting societies of Iran and India. Cytogenetic investigation was performed in various subtypes of AML with unstimulated short-term culture and High Resolution Cell Synchronization with some modification. Cytogenetically, Iranian M3 displayed a higher frequency of t[15;17] than Indian M3 [33.8% vs 19.3%] followed by M2 [t[8;21] [27.7% vs 16.2%]] and M1 [t[9;22] [16.0% vs 11.3%]]; whereas, inv[16]11q23 and numerical chromosomal aberrations in chromosome 5,7,8 occurred more frequently in Indian than Iranian. These findings represented different cytogenetic characteristics of t[15;17] between the two populations. This is the first systematic cytogenetic study of an ethnic Iranian population. Extensive biological studies of AML in Iran and India and various countries to be needed to clarify the role of genetic as well as geographic heterogeneity in the pathogenesis of AML

[Primary plasma cell leukemia: effective treatment with intermediate dose melphalan]

Primary Plasma cell Leukemia [PCL] is a rare disease with no standard treatment, although, combination chemotherapy, BMT and intermediate dose melphalan have been shown to be effective, in some case reports. Patients usually present with anemia, thrombocytopenia, hypercalcemia, and renal failure. Diagnosis is confirmed by peripheral and bone marrow examination. We recently had a case in our department. A 43 years old gentleman presented with history of fatigue, weakness, weight loss, dyspnea and bone pain. Diagnosis of PCL was confirmed by PBS and bone marrow exam. The patient was treated using single intermediate dose melphalan [60 mg/m2/ IV] plus Dexamethasone with G-CSF support; after 3 weeks, complete remission was achieved. In the last visit, done 9 months after treatment, he was doing well clinically and his Lab data were normal. This case report confirmed the efficacy of intermediate dose of melphalan in the management of plasma cell leukemia

[Evaluation of therapeutic effects of dexamethasone, high-dose cytosine arabinoside and cisplatin regimen on patients with relapsed lymphoma]

Recurrence of hematologic malignancies are one of the main problems after early management of these diseases. Due to the poor survival, several salvage regimens have been suggested. To evaluate the efficacy and safety of DHAP regimen in relapsed lymphoma, we conducted this prospective trial. Sixthy patients with progressive relapsed lymphoma were treated with a combination of Cisplatin 100 mg/m[2] [continuous IV infusion over 24 hours] followed by Cytosine Arabinoside in two pulses [each at a dose of 2 g/m[2] given 12 hours apart]. Dexamethasone [40mg IV] was given on days 1 through 4. Vigorous hydration was reinforced by routine use of mannitol. Cycles were repeated at 3-4 weeks interval for six courses. The primary aim was to evaluate the response after six cycles. Patients had a median age of 42 years old [15-70 years]. They all had relapsed during or less than one year after first line chemotherapy. Out of 60 patients, 19 [32%] achieved complete remission, whereas 17 [28%] experienced partial remission. Eleven patients [18%] expired during treatment. The mean survival of patients after 2 years of follow up was 53%. Organomegaly, lymphomadenopathy, the underlying disease and serum LDH were important prognostic factors and the most frequent complication of DHAP regimen was neutropenia [55%]. Having acceptable complications, the DHAP regimen was proved to be effective for patients with relapsed or refractory lymphoma. For stronger recommendation of this regimen larger scale trials are needed