Our aim was to determine the impact of cytogenetics and remission status on outcome of AML or MDS pts treated with allogeneic stem cell transplantation (alloSCT) conditioned with busulfan (Bu) based regimens. We reviewed retrospectively all pts who received alloSCT at MD Anderson Cancer Center for AML or MDS between 1990 and 2007 conditioned with Bu (1 mg/kg IV q 6h ×4 days) and cyclophosphamide (60 mg/kg IV x 2 days), Bu and fludarabine (Flu) in myeloablative (Bu 130 mg/m2 ×4 days and Flu 40 mg/m2 ×4 days) or reduced intensity doses. Pts in first or subsequent remission and those achieving morphologic remission after initial induction treatment but without platelet recovery to >100,000/mcl (marrow remission) were included in the analysis. Pts were categorized according to the Dana-Farber cytogenetics classification. Cox's regression analysis was used to evaluate prognostic factors for disease progression, overall survival (OS) and progression free survival (PFS). Among 265 pts (median age 45 [5–69]) diagnoses were AML (n = 217), MDS (n = 17) and AML evolving from MDS (n = 31). Disease status at alloSCT was; first complete remission (CR) (n = 129), advanced remission (beyond first CR) (n = 93) and marrow remission (n = 43). Majority of the donors were matched related (n = 152) or matched unrelated (n = 94). Stem cell source was bone marrow (n = 108), peripheral blood (n = 153) or cord blood (n = 4). Median follow-up time of surviving pts was 39 months (1.6–189). The 3 years actuarial probability of OS was 55% and PFS 49%. On univariate analysis, adverse cytogenetics were associated with higher disease progression rate (p<0.05). There was also a trend for worse OS (p = 0.09) and PFS (p = 0.098) for adverse cytogenetics. In addition pts in "marrow remission" compared to those who were in CR with full platelet recovery prior to transplant had a significantly higher rate of disease progression (p = 0.001) and poorer 3 years OS (37% vs 59%, p = 0.001) and PFS (30% vs 53%, p = 0.001). Outcomes were comparable for pts in first and advanced remissions. Pts with de novo AML had more favorable OS (p = 0.02) and PFS (p = 0.05). On multivariate analysis, pts who were in "marrow remission" and had adverse cytogenetics had a significantly higher rate of disease progression (p<0.001), lower OS (p<0.001), and lower PFS (p<0.001). De novo AML was associated with a significantly better OS and PFS. Cytogenetics and remission status are significant predictors for outcomes after alloSCT in pts with AML or MDS.
Intrathecal treatment with methotrexate, an essential chemotherapeutic for both prophylaxis and treatment of central nervous system involvement of leukemia, may be associated with local neurotoxicity and/or systemic toxicity. Signs of acute neurotoxicity include confusion, disorientation, seizures, aphasia, ataxia, dysarthria, paresis and even paraly- sis. Presented here is a case of a 58 year old patient with acute lymphoblastic leukemia who developed acute neuro- toxicity after her 13th dose of intrathecal methotrexate. Available treatment options are also discussed.
European LeukemiaNet (ELN) expert panel updated the 2006 CML management recommendations in Blood with minor modifications in Journal of Clinical Oncology. The most important criticism about this update is the preservation of the ambiguous concept “suboptimal response to imatinib”. This gray-zone concept has been generated without long-term follow-up data on imatinib and in the absence of second generation TKIs in 2006. Latest evidences indicated that the outcome of “imatinibsuboptimal responders” is very similar and as worse as “imatinib-failure patients”. Furthermore, in the Table 7, “Continue imatinib same dose; or test high dose imatinib..” was also recommended as a treatment for “imatinib-suboptimal responders”. High dose imatinib, which had inferior efficacy when compared to dasatinib and nilotinib, is not superior to standard dose imatinib too. Removal of the misleading concept “suboptimal response to imatinib” could also simplify Table 6 of the manuscript. Adherences of physicians and patients to previous ELN-CML recommendations are not so high. Simplification of recommendations may also increase the compliances and the response to treatment.
Iron deficiency anemia (IDA) is the most frequent type of anemia.The use of biochemical markers is a challenging way of diagnosis in case of inflammation and functional iron deficiency.The role of bone marrow aspirate iron staining is criticized because it is an invasive method and has no accurate standardization.This study was planned to find the value of bone marrow iron staining in diagnosis of iron deficiency.Four hundred and seven cases who had bone marrow aspirate iron staining and simultaneous serum iron tests have been reviewed retrospectively and 47 such cases were evaluated prospectively.Bone marrow iron was negative in 125 (%30.7)cases in retrospective cohort.There was significant differences in serum iron, ferritin, transferrin saturation between bone marrow iron negative and positive cohorts (p< 0.001).Low serum transferrin saturation (<15%) and ferritin (<15 ng/ml) levels are consistent with iron deficiency.On this standard, in both retrospective and prospective cohorts, rates for specificiy (85.5% and 90.4%, respectively) and negative predictivity (97.5% and 100%, respectively) of bone marrow iron staining were relatively high compared with the sensitivity and positive predictivity of the same test.The results of this study show that the evaluation of bone marrow iron staining is a more reliable test for the elimination of IDA rather than its diagnosis.
