Risk Factors of anemia in head and neck cancer patients undergoing chemotherapy with high-dose cisplatin.

Cisplatin is well-known for its effectiveness against cancer, as well as its toxicity to human tissues. Of several documented side effects, anemia was reported to have significant association with decreased quality of life. This study was conducted to investigate development of cisplatin-induced anemia, and to identify independent factors contributing to anemia. Clinical data from head and neck cancer patients treated with high-dose cisplatin between December 2002 and December 2005 were obtained in this study. Incidence and risk factors of anemia were assessed in a model including age, sex, baseline hemoglobin level, baseline creatinine clearance, and occurrence of distant metastases. Multivariate logistic regression was used to define independent predictors of anemia. Among 86 eligible patients, 26 (30.2%) developed anemia, defined as Hb level lower than 11 g/dL. Age > 55 years old (RR = 2.2, 95% CI, 1.2-4.0), female sex (RR = 2.0, 95% CI, 1.2-3.8), baseline Hb ≤ 13 g/dL (RR = 4.2, 95% CI, 1.9-9.4) and baseline CrCl < 50 mL/min (RR = 2.9, 95% CI, 1.7-5.1) were significantly correlated with incidence of anemia (P < 0.05). In multivariate analysis, baseline Hb and baseline CrCl were identified as independent risk factors for anemia. However, considerable confounding was observed in baseline CrCl after stratified by age (aRR = 2.2, 95% CI, 1.1-4.7). Thus, baseline Hb level was the strongest predictor of anemia. The findings suggested that baseline Hb and CrCl were useful to recognize cisplatin-treated patients at risk for anemia who might benefits from preventive measures.

Non secretory multiple myeloma – a case report.

A rare variant of multiple mieloma, non-secretory multiple myeloma (NSM), is reported. Diagnosis of NSM is made by presentations of lytic bone lesions with bone pain, anemia, slight hypercalcemia, good renal function, negative results of protein and immunoelectrophoresis detecting monoclonal gammopathy, and positive clonal proliferation of plasma cells and atypical plasma cells in bone marrow biopsy. Immunophenotypic study resulted negative pan-B cell antigens and positive CD 79a. Patient condition was improved after institution of combination chemotherapy and 1 year afterward.

Morphological characteristics of leukemia cells in acute myeloblastic leukemia with t(8;21)(q22;q22): possible predictability of t(8;21).

The laboratory systems for chromosomal analysis or the detection of fusion genes are generally not available in Indonesia. Therefore, bone marrow (BM) morphological analysis should be developed and applied to get an accurate diagnosis. In this study the BM smears of eight (8) cases of acute myeloblastic leukemia (AML) which had already been known to have t(8;21)(q22;q22), were morphologically evaluated in order to find out the characteristics, which might be used to predict t(8;21)(q22;q22) or the presence of AML1-ETO(MTG8) fusion gene. All of the cases belonged to AML-M2. The morphological characteristics, indicative of t(8;21) were pink colored cytoplasm in mature neutrophil (75%), neutrophilic myelocytes or metamyelocytes without granules or with scarce granules (2.3%), eosinophilia (eosinophilic myelocytes and metamyelocytes) (above 5%), myelocytes with abundant granules 8.5%, and low percentage of type I blasts (below 10%). These characteristics were not observed in AML-M2 cases without t(8;21) or AML1-ETO(MTG8). The myelocytes with abundant granules have not been described so far, while other characteristics were in line with the findings of Nakamura et al (Leukemia 1997;11:651-55).

Fibrinogen and plasminogen activator inhibitor-1 level in peripheral arterial disease of type 2 diabetes patients.

AIM: To determine association of fibrinogen and plasminogen activator inhibitor-1 with peripheral arterial disease (PAD) in type 2 diabetes patients. METHODS: This is a cross-sectional study with 52 type 2 diabetes patients of 41-74 years old. The subjects were divided into two groups, those who were diagnosed with PAD (16) and without PAD (36). Diagnosis of PAD was based on the ankle brachial index (ABI) measurement. Fibrinogen and plasminogen activator inhibitor-1 (PAI-1) level were evaluated as hemostatic factors. The two groups were compared for age, sex, smoking, plasma fasting glucose, total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglyceride concentrations, diabetes duration, systolic blood pressure and diastolic blood pressure level. Statistical analyse were conducted to check the significance of differences between variables in the two groups as well as interrelationship between hemostatic factors and other parameters. RESULTS: Fibrinogen was similar in both group (402.42 +/- 74.44 mg/dl in PAD group and 322.45 +/- 101.05 mg/dl in non-PAD group) (p= 0.259). PAI-1 was also similar in both group (8.93 +/- 11.02 IU/ml in PAD group and 7.06 +/- 7.32 IU/ml in non-PAD group) (p=0.721). Hyperfibrinogenemia was more prevalent in PAD group (68.8%) than in non-PAD group (25%) (p= 0.005). CONCLUSION: Our data showed that fibrinogen and PAI-1 level were similar in both groups. As a risk factor hyperfibrinogenemia was more prevalent in PAD group.

Epstein-barr nuclear antigen-1 (EBNA-1) in diffuse large B-cell lymphoma and its relationship to the bcl-2 protein.

AIM: To determine EBNA-1 expression in the tissue of patients with diffuse large B-cell lymphoma and its relationship to bcl-2 expression. METHODS: Paraffin-embedded tissue from 24 cases of diffuse large B-cell lymphoma were stained immunohisto chemically with monoclonal antibody anti-EBNA-1 and anti-bcl-2 using Streptavidin Biotin Complex method. The bcl-2 expression was measured as negative (no staining), positive 1 (weak staining), and positive 2 (moderate to strong staining). The relationship between the immunohisto chemistry results was examined. RESULTS: From the 24 samples, 12 (50%) were EBNA-1 positive and 14 (58.3%) showed expression of bcl-2. Eleven of the 14 samples (90%) showed expression of bcl-2 were EBNA-1 positive, while only 3 of these samples (10%) were EBNA-1 negative. The relationship between bcl-2 expression and EBNA-1 was statistically significant (Chi square-uncorrected 11.2571, p= 0.0036). CONCLUSION: Our results showed that 50% of diffuse large B-cell lymphoma were EBNA-1 positive. Furthermore, EBNA-1 seemed to be correlated with bcl-2 expression.

The efficacy of granisetron for cancer patients undergoing platinum-based chemotherapy: comparison of 1 miligram versus 3 miligram doses in preventing nausea and vomiting.

AIM: To compare the efficacy of anti-emetic and prophylactic effects of 1 milligram (mg) versus 3 mg granisetron in cancer patients. METHODS: In this double blind, randomized, parallel study, 2-dose regimens of intra venous (IV) granisetron were evaluated in 39 cancer patients who were treated with platinum-based chemotherapy. Patients who met the inclusion criteria were randomized to receive granisetron 1 mg IV plus dexamethasone 20 mg (group A) or granisetron 3 mg iv plus dexamethasone 20 mg (group B). A questionnaire was used to evaluate the anti-emetic effects of granisetron. RESULTS: Subjects consisted of 31 men and 8 women. In group A (19 patients) 57.9% showed complete response from vomiting, 10.5% of major response, and 31.6% of failure to anti-emetic therapy. There were 47.4% of patients free from nausea and 52.6% complained of nausea (mild, moderate, and severe nausea). Among group B (20 patients), 90% showed complete response from vomiting, 5% of major response, and 5% of failure to anti-emetic therapy. Eighty percent of patients were free from nausea, while 15% complained of mild nausea and 5% of moderate nausea. The differences were statistically significant for vomiting (p = 0.02) as well as for nausea (p = 0.03). CONCLUSION: Intravenous granisetron 3 mg has better efficacy than granisetron 1 mg in preventing cisplatin- induced acute emesis.