عنوان : بررسي اهميت باليني تظاهر آنتي ژن CD₃₄ بر روي سلول هاي جوان ( ميلوبلاستها ) در بيماران مبتلا به لوسمي حاد ميلوئيدي

نويسندگان : دكتر غلامرضا توگه ، دكتر منوچهر كيهاني ، خانم دكتر ناهيد عابديني

نشاني : تهران ، انتهاي بلوار كشاورز ، بيمارستان امام خميني ( ره ) ، مجتمع ولي عصر ، بخش خون ، تلفن : 925629

مقدمه و اهداف :

مطالعات متعددي اهميت باليني وجود CD₃₄ را در سلولهاي ميلوبلاست مبتلايان به AML نشان داده اند .

روش اجرا :

جهت ارزيابي خصوصيات باليني و پاسخ به شيمي درماني در بيماران AML كه داراي اين آنتي ژن مي باشند107 مورد بيمار AML بستري شده دربخش خون بيمارستان امام خميني بين سالهاي 1377 لغايت 1379 كه تحت شيمي درماني قرار گرفته بودند مطالعه شدند . 81 مورد داراي ارزيابي فلوسيتومتري بوده اند . خصوصيات باليني و پاسخ به درمان به صورت رميسيون كامل و يا مقاومت در نظر گرفته شد .

يافته هاي پژوهشي :

64% از مواردCD₃₄ مثبت و 68% از موارد CD₃₄ منفي به رميسيون كامل دست يافتند كه تفاوت معني داري را نشان نداد . در ساير خصوصيات باليني و آزمايشگاهي هم تفاوت معني داري بين اين دو گروه مشاهده نشد .

بحث و نتيجه گيري :

همانطور كه ملاحظه مي كنيد اين يافته هاي آماري پيش فرض ها را تائيد ننموده و ارتباط CD₃₄ با ميزان پاسخ درماني بيماران را مورد ترديد قرار مي دهد . البته بر پايه مطالعات پيشين اين تعداد بيماران جهت بررسي آماري دقيق كافي نبوده و ما بر آنيم كه مطالعه را تا رسيدن به سطح نمونه كافي جهت مطالعه آماري دقيق ادامه دهيم . در آينده اي نه جندان دور توانائي پاسخ قطعي به اين سوال را خواهيم داشت كه آيا CD₃₄ ارزش تعيين پيش آگهي در بيماران مبتلا به لوسمي حاد ميلوئيدي را دارد يا خير .

Title of Article : The aspects of Arsenic trioxide in treatment of Acute promyelocytic leukemia

Author(s) : Dr.Alimoghaddam Kamran Ghavamzadeh , A(1) ; Alimoghaddam , K(1) ; Aghdami,N (1) ; Rastegarpanah , M (1) ; Shalchian ,M(2) ; Tavassoli ,P(1); Jahani , M(1); Khodabandeh , A(1) ; Baibordi,E(1)

Address : Tehran University of medical sciences Hematology – Oncology and BMT Research Center Karegar Ave . (2) Aboreihan Co . , Pharmacology , Tehran , Iran ;

Background :

Recently it has been shown that Arsenic compounds including Arsenic Trioxide (As 203) and Arsenic Disulfide , two components used in some traditional Chinese remedies , are very effective and relatively safe drug in APL treatment .

Methods and Materials :

Fourteen patients with refractory/relapsed and newly APL were treated with Arsenic Tirioxide . The diagnosis of APL was established on the basis of clinical presentation , morphological criteria of the French American-British (FAB) classification .

The following protocol was used : 10 mg As203 ( 10ml,0.1% aqua solution ) for 6 weeks duration . Those patients who failed to reach CR after 2 courses were considered as nonresponders (NR) and were treated with chemotherapy .

Results :

Of 14 patients in the current study , despite two cases of intolerance to therapy and one case of sudden death , 11 patients showed somplete remission in full criteria . Intention to treat analysis shows the overall complete remission rate was 78.6% ( conf.95% , 49.2-95.3) . Which was 6/8 (75% ) for newly diagnosed patients and 5/6 (83.3 % ) for refractory or relapsed group respectively .

One patient with relapsed APL and another newly diagnosed patient were excluded on day 12 and 10 of therapy because of the adverse effect of AT. Another newly diagnosed patient died due to on cardiac arrest on day 32 while she was experiencing good response . The median duration of therapy after excluding the three above patients was 31 days ( range 22-34 days ) .

Adverse effects consisted of elevated liver enzyme(s) ( five time above normal limit ) 9 OF 14,ATRA symdrome 5 OF 14 , lecukocytosis 5 OF 14 , and pericardial effusion , 2 OF 14 . The median follow up duration was 100 days ( range 30-359 days ) .

Discussion :

In summation we concluded that using AT in treatment of patients with APL has better efficacy and outcome in comparison with other previous therapies .

Title of Article : Hepatotoxicity and leukocytosis in patients with acute promyelocyte leukemia treated with Arsenic Trioxide (AT )

Author(s) : Aimoghaddam , K(1) ; Rastegarpanah ,M(1) ; Aghdami , N (1) ; Shalchian , M (2) ; Khoein ,B(1) ; Jahani ,M(1) ; Irvani,M(1) ; Ghavamzadeh ,A(1) ; Tavassoli, P(1) ; Ahmadi , I(1) ;

Address :1)Tehran University of Medical Sciences Hemotology – Oncology and BMT Research Center , Shariati Hospital . 2) Aboreihan Co . Pharmacology , Tehran , Iran ;

Background :

Results of the clinical trials using Arsenic Trioxide , demonstrated that a significant numger of patients with APL were able to achieve a complete remission , of a disappearance of all visible leukemic cells . Although most adverse effects due to AT therapy were tolerable , but sever tocicities related to AT might be observed , including hepatic damage , cardiac arrhythmia and leukocytosis .

Methods and Materials :

Thirteen patients with new , relapsed or refractory APL were treated with 10 mg AT daily until visible leukemic cells were eliminated from the bone marrow .

Results :

Eleven patients (84.6% ) entered into CR and the median time to obtain CR was 31 days ( range 22 to 44 days ) . Hepatic toxicity occurred in 8 of 13 patients 61.5% (Conf 95% , 31.6-86.1 ) with elevation of the serum glutamic pyruvic transaminase (SGPT) ranging from 114 to 940 IU/L (median 174 IU/L , normal rang 7 to 23 IU/L ) and serum glutamic oxaloacetic transaminase (SGOT ) ranging from 50 to 365 IU/L ( median 95 IU/L , normal rang 7 to 32 IU/L ) . all patients recovered without any interruption to their regiment except one (SGOT 365 IU/L , SGPT 940 IU/L and Total Bill 3.3 mmol/L .

Hyperleukocytosis ( WBC >10 109/L ) developed in 4 of the 13 , (30.8% ) patients . The median baseline leukocyte count for patients with leukocytosis ( 10.800 109 ) was higher ( p=0.04) than for patients who did not develop leukocytosis ( 1.100 109/L). the leukocytosis resolved in all cases .

Conclusion :

Although most of adverse effects of AT like hepatic toxicities and leukocytosis are reversible , but watchful monitoring of the patients should be done .