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

Circulating soluble tumour necrosis factor receptors in rheumatoid arthritis

Two types of tumur necrosis factor receptors, TNF-RI and TNF-RII, have been identified. It has been suggested that levels of soluble TNF receptors in the serum can serve as markers of disease activity in rheumatoid arthritis [RA]. This work was designed to measure the soluble TNF-RI and RII in serum of RA patients during disease activity and to find out if their levels reflect clinical response in these patients after methotrexate therapy for 24 weeks. This study was conducted on 30 patients with active RA and 16 healthy controls. The soluble TNF receptors were assayed before and after methotrexate therapy using ELISA technique. Our study revealed that the concentrations of soluble TNF-RI [P55] and RII [P75] were significantly higher in RA patients during disease activity compared to healthy controls [P<0.001 for each receptor]. After methotrexate therapy, a significant decrease in P55 sTNF-R concentration was associated with clinical improvement [P<0.001] while the decrease in P75 sTNFR concentration was found to be insignificant. We conclude that sTNF receptors [P55 and P75] serve as markers of disease activity in RA and we can consider P55 sTNF- R as a marker of clinical response and drug efficacy