[Determination of clinical prevalence and predominant pattern of RBCs alloimmunization among transfusion dependent thalassemic patients in Ahvaz]

The mainstay of management of severe beta-thalassemia remains lifelong blood transfusion. The development of one or more alloantibody against specific red cell minor antigens is a common complication of chronic transfusion therapy. Delayed hemolytic transfusion reactions are due to alloantibodies cause increased blood requirement in transfusiondependent beta-thalassemia patients. This study was performed to detect the frequency and predominant pattern of alloimmunization in the target population. This is a cross-sectional study carried out on 133 transfusion- dependent beta-thalassemia patients referring to Shafa hospital-Ahvaz. Antibody screening and identification technique employed was tube method. All panel test phases were done at immunohematology laboratory of Iranian Blood Transfusion Organization. Among the selected patients, 66 were males [49.1%] and 67 were females [50.9%], with a mean age of 17.63 years [SD +/- 7.6]. The antibody screening panel was positive in 42 patients [31.57%], of whom 25 patients [59.52%] had alloantibody and 17 patients [40.50%] additionally had autoantibody. The predominant patterns of alloimmunization were anti-Rh [55%] and anti-Kell [33%]. Frequency of alloimmunization were significant with increasing duration of transfusion [P=0.01], history of splenectomy [P=0.03] and beta-thalassemia intermedia [P=0.02]. Alloimmunization was a common complication in our transfusion-dependent beta-thalassemia patients. It's recommended that before embarking on transfusion therapy, patients should have extended red cell antigen typing that includes at least Rh and Kell blood grouping, in order to help reduce the likelihood of development of immunological responses later

Results of chemotherapy by UKCCSG protocol in children with acute lymphoblastic leukemia: clinical characteristics and outcome

Acute lymphoblastic leukemia [ALL] represents a clonal expansion and arrest of normal lymphoid hematopoiesis. ALL remains the most common malignancy in children. The survival rate of the patients is significantly increased since the 1960s. This study was undertaken to evaluate the 5- year overall survival [OS] rates of patients with ALL in a single center in Iran. A total of 220 children with ALL up to 15 years old who had been treated by UKCCSG protocol at the Oncology Department in Shafa Hospital from March 1997 to October 2004 were evaluated for their age, gender, as well as FAB types, presenting features, outcomes of therapy and relapse. The mean age of the patients was 6.69 years [SD= 3.8, median 6 years]. In this series, 123 patients [55.9%] were male. There was a complete remission induction rate of 85.5% during first induction course of therapy. Five-year overall survival was 60.9% and it was better [p=0.006] in standard risk group. Relapse rate after first remission was 23.6% and death due to relapse was more in high risk group, but it was not significant [p=0.053]. There were 59[68.6%] of total deaths in induction period and 18[20.9%] after relapse. Overall infections [69.4%] were major cause of deaths in induction period. OS was better in boys, age group between [1-10 yo] and initial white blood cells count [10,000-50,000x10[3]/mm[3]] but there were not significant [p=0.39, p=0.30, p=0.202, respectively]. Five-year overall survival was 60.9% of the children with new ALL who were undergoing chemotherapy by UKCCSG protocol. High mortality rate in induction period was mainly due to infections which decreased five-year overall survival in this study

Results of chemotherapy with BFM-87 protocol in children with acute myeloid leukemia at a referral center in the southwest of iran: clinical characteristics and outcome

Leukemia is the most common malignancy in childhood, and acute myeloid leukemia [AML] is the second most common leukemia. AML still accounts for more than 30% of deaths from leukemia. AML is classified into several subgroups from M0 to M7 with different presentations, clinical features, and outcomes. Between March 1996 and October 2003, 47 children with acute myeloid leukemia were treated with intensive chemotherapy using BFM-87 protocol after remission at Shafa hospital, Ahwaz, Iran. We compared the presenting features and outcomes of therapy in these children based on age, initial White Blood Cells [WBC] count, Central Nervous System involvement, FAB system types, and response to first induction treatment. Younger children were more likely to have favourable risks and less likely to have induction deaths [p=0.03] and lower relapse risks [p=0.001]. FAB types M2 and M4 showed a better first remission rate [p=0.01, p=0.02, respectively], regardless of age and gender. Two major risk factors for relapse after first remission were initial high WBC counts [p=0.01] and older age at the time of diagnosis [p=0.02]. Overall survival [p=0.001], event-free survival [p=0.001], and disease-free survival were better [p<0.001] in younger children due to lower relapse rates [p=0.001]. Overall survival was 53% in the children with new AML who were on intensive chemotherapy with a median follow-up time of 5 years in our study. Relapse risk after first remission for the children who were on intensive chemotherapy alone was 34% in our study. Because of the potential morbidity and mortality usually related to allogeneic HSCT and also problems due to lack of sufficient HSCT possibility for some patients, several cooperative group trials now do not recommend HSCT for good- or standard- risk patients in their first remission. Results of our study were compatible with BFM, AML 10 and AML 12 groups trials in terms of overall survival, or relapse risk, or induction death risk factors