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Article
Evaluation of Fludarabine, and granulocyte colony

Author: Alaa Fadhil Alwan*, Adil siwan Alaqabi**,Azher Al-zubaidi**
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2012 Volume: 8 Issue: 2 Pages: 69-74
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Refractory/relapsed acute leukemia has always been a challenging problem for hematologist. Over the past decade emphasis has been made in the development of regimens containing fludarabine, combined with cytosine arabinoside for the treatment of refractory/relapsed acute leukemias. The aim of this study is to evaluate the efficacy and toxicity of the combination of fludarabine, high dose cytarabine, and granulocyte colony stimulating factor in refractory relapsed cases of acute leukaemia,Methods: a prospective study is being conducted at the national center of hematology and hematology unit /Baghdad teaching hospital from July 2008 to July 2010.Twenty Patients with refractory/relapsed acute leukemia were treated with fludarabine 30mg/m2 and cytosine arabinoside (AraC) 2 g/m2 for 5 days, and granulocyte colony stimulating factor G-CSF 300 microgram/day from day 0 till neutrophil recovery (ANC >1.0 x 109/l).Response was evaluated by bone marrow examination on day 30-post chemotherapy.Results: Patients included were refractory acute lymphoblastic leukemia (ALL) (n=5), relapsed ALL (n=4), refractory acute myeloid leukemia (AML) (n=8), relapsed AML (n=3). Complete remission (CR) was achieved in 9(45%) patients, 3 (15%) patients got partial remission. Three (15%) patients died of post chemotherapy complications and 5(25%) patient failed to achieve remission. Major complications encountered were: anemia, fever, bleeding, mucositis and bacterial infections.Conclusion: FLAG protocol is well tolerated and effective regimen in relapsed / refractory acute leukemias. The toxicity is acceptable, enabling most patients to receive further treatment, including transplantation proceduresKey words: FLAG, refractory acute leukemia, relapsed acute leukemia


Article
Hypolipoproteinemia as Biological Marker in Acute Leukemia

Authors: Azher Sabih Zubaidy --- Adil Siwan Aqabi --- Majid Hameed AL Maini
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 4 Pages: 456-459
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Acute leukemia is a clonal hematopoietic malignant disease that arises from malignant transformation of an early hematopoietic stem cells .Seeking for biochemical markers that are associated with acute leukemia may help us for better understanding of the leukemic process &improve our lines of management.Hypolipoproteinemia is one of these markers&it is the target of this study.OBJECTIVE:To study the association between the hypolipoproteinemia &acute leukemia &the ability of using hypolipoproteinemia as a biological marker that is helpful in follow up of acute leukemia.PATIENT&METHODS:A total of fifty patients with acute leukemia diagnosed by blood film&bone marrow examination were compared with control group of twenty healthy persons regarding fasting lipid profile(TC total cholesterol,LDL low density lipoprotein,HDL high density lipoprotein,TG triglyceride).RESULTS:In this study there is close association between hypolipoproteinemia&acute leukemia. The mean values of lipoproteins were significantly lower in patient with acute leukemia compared to control group(P value is 0.0001 for total cholesterol&0.045 for triglyceride).CONCLUSION:These data suggest that hypolipoproteinemia could be useful as a marker for follow up of acute leukemia.


Article
Serum Lactate Dehydrogenase Level in Acute Leukemias

Author: Mutaz Fawzi Hussain
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2007 Volume: 49 Issue: 4 Pages: 369-374
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Acute leukemias are clonal neoplastic proliferations of immature cells of the hemopoietic system. They are divided into acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL) and acute undifferentiated leukemia (AUL). LDH has been suggested as a possible non-specific tumor marker for many years, and total serum LDH is frequently elevated in neoplastic diseases. The aims of the study are to evaluate the significance of increased serum LDH levels in patients with acute leukemia and to determine the importance of serum LDH level in the follow up and assessment of treatment responses. Patients, Materials and Methods: This study was conducted at Baghdad Teaching Hospital in Medical City during the period of October 2003 till October 2004. It included 108 patients with acute leukemias. The patient groups were compared with 21 apparently healthy control subjects. All patients had full medical history, complete physical examination, and routine investigations and other specific investigations e.g. BM aspiration and biopsy. Serum lactate dehydrogenase LDH level was estimated in all patients serially during diagnosis and after chemotherapy as well as in control subjects. Results: Total serum LDH levels were significantly higher among patients with acute leukemias compared to that of the controls. Comparing the three types of leukemic patients, no significant difference was observed in total serum LDH levels between AML, ALL and AUL patients. Regarding treatment, levels of total serum LDH were significantly decreased in both remitter and non-remitter patients with acute leukemia with no significant difference between them. Conclusion: Although total serum LDH is higher in all acute leukemic patients, it is hardly discriminator between subsets of acute leukemia and is of little value in the prognosis and prediction of treatment response and outcome.

Keywords

LDH --- acute leukemia.


Article
Hypolipoproteinemia as Biological Marker in Acute Leukemia

Authors: Majid Hameed AL Maini --- Adil Siwan Aqabi --- Azher Sabih Zubaidy
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 4 Pages: 456-459
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Acute leukemia is a clonal hematopoietic malignant disease that arises from malignant transformationof an early hematopoietic stem cells .Seeking for biochemical markers that are associated with acuteleukemia may help us for better understanding of the leukemic process &improve our lines ofmanagement.Hypolipoproteinemia is one of these markers&it is the target of this study.OBJECTIVE:To study the association between the hypolipoproteinemia &acute leukemia &the ability of usinghypolipoproteinemia as a biological marker that is helpful in follow up of acute leukemia.PATIENT&METHODS:A total of fifty patients with acute leukemia diagnosed by blood film&bone marrow examination werecompared with control group of twenty healthy persons regarding fasting lipid profile(TC totalcholesterol,LDL low density lipoprotein,HDL high density lipoprotein,TG triglyceride).RESULTS:In this study there is close association between hypolipoproteinemia&acute leukemia. The mean valuesof lipoproteins were significantly lower in patient with acute leukemia compared to control group(Pvalue is 0.0001 for total cholesterol&0.045 for triglyceride).CONCLUSION:These data suggest that hypolipoproteinemia could be useful as a marker for follow up of acuteleukemia.


Article
The Clinical& Radiological Respiratory Features in Acute Leukemia At Presentation: A Descriptive Study of 118 Iraqi Adult Patients

Author: Adil Siwan Al-Aqabi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 1 Pages: 57-61
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Acute leukemia is a hematological malignancy characterized by an uncontrolled proliferation ofhemopietic primitive cells. Presenting features of acute leukemia include fever, anemia, pallor;hepatosplenomegaly &lymphadenopathy, bleeding tendency, bone pain&gum hypertrophy.Intrathoracic manifestations of acute leukemia include infection,mediastinal widening , hemorrhage,infiltration, embolism, edema, pericarditis &acute respiratory distress syndrome.OBJECTIVE:To describe the clinical &radiological respiratory features of acute leukemia at presentation,beforestarting chemotherapy.PATIENTS AND METHODS:Patients with acute leukemia of age ranged from 15-75 years were incorporated in this study, patientswere excluded from the study if they had previous malignancy, lung disease, or if received cytotoxictreatment. Every patient had a detailed history of pulmonary symptoms & chest examination,chest xrayexamination, sputum samples & pleural aspirates for relevant patients.RESULTS:Of 118 patients with actue leukemia at presentation, 60% of patients were males& 40% werefemales. Respiratory symptoms including cough,dyspnea&chest pain were found in27.7% of patients(cough 24.4% ,dyspnea 2.5%,chest pain 0.8%) . Respiratory signs including crepitations ,decreasedair entry & bronchial breathing were found in 12.5% of patients(crepitation 3.3%, decreased air entryin 6.7%, bronchial breathing in 2.5%). Chest X-ray abnormalities were found in 14.3% of patients,these include mediastinal widening in 5.9% of patients .Pleural effusion in 4.2% & parenchymalinfiltrates in 4.2% of patientsCONCLUSION:The chest findings in patient with actue leukemia at presentation were not uncommon. mediastinalwidening was the commonest, pleural effusion&parenchymal infiltrates were less common findings


Article
Pancytopenia Adult Patients At Baghdad Teaching Hospital

Authors: Khudair Abbas Al-Khalisi --- Azher Sebieh Al-Zubaidy --- Majid Rhaima***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 4 Pages: 441-448
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:pancytopnia is a triad of findings caused by different diseases affecting bone marrow primarily or secondarily, causing manifestations of anemia, thrombocytopenia, and/ or leucopeniaOBJECTIVE:To identify causes, and presenting symptoms of pancytopnia in patients attending Baghdad teaching hospital.PATIENTS AND METHODS:One hundred and five patients, found on complete blood count having Pancytopenia were included, excluding patients that had been exposed to chemotherapy, and/or radiotherapyRESULTS:Causes in decreasing frequency were acute leukemia (30.47%), aplastic anemia (17.14%), megaloblastic anemia (13.33%), NHL (14.47%), MDS (8.57%), PNH (4.76%), TB, SLE, HD (2.58%) for each, and kalazar, and MM and HCL (1.9%) for each.Manifestations were fatigability (67.6%), bleeding tendency (55.8%), and fever (48%).CONCLUSION:Incidence of Pancytopenia may vary according to geographical, and genetic factors, and depending on parameters, and criteria of inclusion and exclusion. Acute leukemia was found the most common cause, followed by megaloblastic anemia.


Article
Pancytopenia Adult Patients At Baghdad Teaching Hospital

Authors: Khudair Abbas Al-Khalisi --- Azher Sebieh Al-Zubaidy --- Majid Rhaima
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 4 Pages: 441-448
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:pancytopnia is a triad of findings caused by different diseases affecting bone marrow primarily orsecondarily, causing manifestations of anemia, thrombocytopenia, and/ or leucopeniaOBJECTIVE:To identify causes, and presenting symptoms of pancytopnia in patients attending Baghdad teachinghospital.PATIENTS AND METHODS:One hundred and five patients, found on complete blood count having Pancytopenia were included,excluding patients that had been exposed to chemotherapy, and/or radiotherapyRESULTS:Causes in decreasing frequency were acute leukemia (30.47%), aplastic anemia (17.14%),megaloblastic anemia (13.33%), NHL (14.47%), MDS (8.57%), PNH (4.76%), TB, SLE, HD(2.58%) for each, and kalazar, and MM and HCL (1.9%) for each.Manifestations were fatigability (67.6%), bleeding tendency (55.8%), and fever (48%).CONCLUSION:Incidence of Pancytopenia may vary according to geographical, and genetic factors, and dependingon parameters, and criteria of inclusion and exclusion. Acute leukemia was found the most commoncause, followed by megaloblastic anemia.


Article
The constitution of the Family in Childhood Leukemia
تركيبة عائلة الطفل المصاب بسرطان الدم الحاد

Author: Mouroge H. Abdullah Al_Ani, د.مروج العاني
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2008 Volume: 21 Issue: 1 Pages: 79-83
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

AbstractBackground: There is evidence that leukemia in general is higher among children whose mothers had previous abortions, knowing that there are many other factors which participate in increasing incidence of leukemia among certain families.Objective: To find out the relationship between the consanguineous marriage and the history of family cancer with the number of maternal abortions and the birth order of the leukemic child. Patient & Method: one hundred twenty children with acute leukemia and 150 children as a control attending out patient clinic in Central teaching Hospital for Children for the period 1st Dec 2002- 1st May2003 were randomly selected . Questionnaire about family history of any type of cancer, number of maternal fetal loss, birth order of the leukemic child and the consanguinity between the parents in both patients and control had been obtained Results: Forty three (43%) of acute leukemia in this study have positive consanguineous marriage while the control group is (40%). For maternal history of abortions 33.3% of the leukemic mothers had history of abortion (28 mother had one abortion, 3mother had 2 abortion, 7 had 3 abortion, and2 more than 3), while in the control there is 30%. Family history of cancer is positive in 25 (20.8%) family of leukemic children and as such,11 leukemia,1 lymphoma, 3 CA breast, 1 brain tumor ,3renal , 1 uterine, and 5 unknown. While family history of malignancy among control group is 22 (14.3%) and most of them were of solid tumor like CA stomach, larynx, prostate.Children after 1st child and before the last one had higher incidence of leukemia in the family setting and constitute 61.6%. Conclusion: Family history of cancer was statically higher in leukemic families with more incidence of leukemia than in the control group. Regarding history of no. of abortion there is no significance difference. Being of consanguineous marriage there is no significant difference from the control knowing that there is frequent consanguineous marriage among Iraqi people. Birth order seems to involve those follow 1st child and before last one. This explains the viral theory and other postnatal genetic alteration behind etiology of leukemia. Key wards: acute leukemia, risk factors, children.

في اغلب الحالات السبب الحقيقي للسرطان في الاطفال غير معروفة مع هذا هناك ترابط بين بعض المتلازمات مثل فقر دم فانكوني ومرض ابيضاض الدم.مرض ابيضاض الدم هو اعلى لدى الامهات اللاتي عندهن اسقاطات متكررة ,واشقاء الاطفال المصابين بهذا المرض يعانون من 2-3 مرة اكثر خطورة من السرطان وكذالك هي اعلى في الاشقاءالتؤام.الهدف من الدراسة هو ايجاد العلاقة بين زواج الاقارب وتاريخ العاائلةبمرض السرطان وعدد الاسقاطات لدىالام مع تسلسل الطفل المصاب بين اخوانه.اخذ (120) طفل مصاب بابيضاض الدم الحاد مع(150)طفل سليم ممن يراجعوا العيادة الخارجية في مستشفى الطفل المركزي التعليمي للاطفال وبصورة عشوائية,تم الاستجواب عن عدد الاسقاطات والتاريخ العئلي لاي نوع من السرطان عند الوالدين او اقرباء الدرجة الاولى وتسلسل الطفل المريض في العائلة مع وجود زواج الاقارب لكلا الفئتين ام لا .كان 43%من مرضى ابيضاض الدم هم لزواج الاقارب بينما40%من الاصحاء هم لزواج الاقارب,الاجهاضات لدى امهات المرضى كانت33,3%(28 ام لديها اسقاط واحد,3امهات لديهن2 اسقاطات,و7 امهات لديهن3 اسقاطات,و2لديهن اكثر من 3اسقاطات).التاريخ العائلي للسرطان كان موجبافي20,8%(11 ابيضاض دم ,ليمفوما واحد,3سرطان ثدي ,واحد ورم دماغ ,3 ورم كلى ,واحد ورم رحم ,و5سرطانات غير مشخصة),بينما عند امهات الاصحاء النسبة كانت 14,3% معضمهم سرطان صلب مثل ورم المعدة اوالبروستات او الحنجرة. الاطفال بعد الطفل الاول وقبل الاخيرهم الاكبر بين المرضى.نستنتج ان تاريخ السرطان العائلي كان احصائيا اعلى لدى عوائل مرضى الدم ومن نوع ابيضاض الدم ,وعن التجهاضات لايوجد فرق واضح بين الفئتين,وكان زواج الاقارب متقارب فى الفئتين,بينما تسلسل الطفل المريض كان يشكل النسبة الاكبرما بين الطفل الاول والاخير,مما يعزز نظرية العدوى بالفيروسات المرضية ومتغيرات اخرى وراثية لحدوث المرض.


Article
DNA Quantitation in Pediatric Acute Leukemia

Authors: Najiha A. Ameen --- Safa A. Faraj --- Hasanein H. Ghali
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2015 Volume: 8 Issue: 2 Pages: 2229-2234
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Deoxyribose Nucleic Acid (DNA) ploidy, and immunophenotyping are now established as prognostic markers, however provide vulnerable information regarding long term outcome of acute leukemia.Aims of study: To establish a histochemical quantitation of nuclear DNA content of acute leukemia patients by Microspectrophotometry (MSP).Patients and methods: Prospective study on (55) patients with newly diagnosed acute leukemia from Children Welfare Teaching Hospital / Medical City Complex during the period from October 2002 to June 2003 and (10) patients with viral lymphocytosis as control group. MSP technique was used to determine the DNA content in leukemia blasts nuclei. Data were tabulated using SPSS (Statistical package for the social sciences) version 18.0 for windows. P-values equal or less than 0.05 were considered significant.Results: DNA cytochemical quantitation was studied after applying Feulgen stain. The amount of DNA per nucleus were expressed as means optical density × 10-3. The results showed that the mean DNA value was (0.545) while that of control group was (0.418). The ALL group was shown to have significantly higher mean OD compared to other groups.The frequency distribution of the different groups shows that there is homogeneous population of the mean OD of Feulgen stained nuclei for the control, AML, and AUL groups while it shows a heterogeneous population for ALL group. In comparison with the range of OD of nuclei of the control group, leukemia cases can be differentiated into diploid and aneuploidy classes. DNA aneuploidies were identified in (12/55) cases analyzed, thus accounting for (21.8%). For the ALL group, the mean OD readings in (18) patients (60%) were within the diploid region while (12) were outside the range (aneuploidy type) (40%).Conclusions: DNA quantitation determined by MSP may represent an additional factor to improve the definition of risk groups of acute leukemia, it will continue to be a valuable tool for understanding tumor growth heterogeneity.


Article
Polymorphisms and haplotypes in multidrug resistance 1 (MDR1) gene and their association with clinical outcome of some Iraqi patients with acute leukemia.

Author: Kifah Jabbar Alyaqubi 1 , Abdul Hussein M. AL-Faisal 2 , Khalid Tobal 3
Journal: Iraqi Journal of Biotechnology المجلة العراقية للتقانات الحياتية ISSN: 18154794 Year: 2017 Volume: 16 Issue: 3 Pages: 200-208
Publisher: Baghdad University جامعة بغداد

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Abstract

The human multidrug resistance (MDR1, ABCB1) gene encodes P-glycoprotein (P-gp), which affects the pharmacokinetics of many drugs. Polymorphisms in ABCB1 might contribute to cancer risk and therapeutic response. Here, we investigated whether common MDR1 single nucleotide polymorphisms (SNPs) (C1236T, C3435T, and G2677T/A) and their expressed levels associated with clinical outcome of acute leukemia. Genotyping was performed in 46 patients with acute leukemia (AL) by direct sequencing analysis resulting in a total of 31 AML and 15 ALL cases matched with 10 samples healthy control. There was a high significant difference in the heterozygous haplotype B (CTGTCT) of MDR1 associated with high level of MDR1 mRNA expression (p=0.0017**: 3.21 ± 0.24) in non-responder (NR) patients with AML patients. While a mutant homozygous C (TTT) haplotype was found to be associated in both NR and CR ALL patients (p=0.0428* and 0.0336*) respectively, with high level of MDR1 gene expression (1.14 ± 0.05 and 1.25 ± 0.03). We conclude that B haplotype of MDR1 associated with poor prognosis of AML, while the C mutant haplotype of MDR1 was associated with ALL but there was no significant differences with clinical outcomes.

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