12th Congress of the European Hematology ... - Haematologica

posed, was: DF = (CD43%+FMC7%+CD79b% + CD38%)
/(CD23%+CD11c%). The percentages refer to CD19 positive B cell gate.
DF values greater than 5 were observedin MCL and the t(14q32) disorder
but not in the atypical B-CLL diagnostic groups. Its discriminating
value is attributed to the increased CD11c% values in atypical B-CLL and
the icreased CD38% values in MCL (Table 1). Conclusions. The proposed
function is simple, is based on commonly used antigens and It can be
combined with the common Catovsky score to discriminate B-CLL from
MCL. The newly recognized CD5+ chronic lymphoproliferative disorder
t(14q32) however, cannot be discriminated from MCL by both methods.
Table 1.
1239
GEMCITABINE IN THE TREATMENT OF RELAPSED AND REFRACTORY HODGKIN’S
DISEASE
V. Milosevic, M. Petrovic, B. Mihaljevic, S. Jankovic, R. Jancic
Nedeljkov, D. Boskovic
Institute og hematology, BELGRADE, Serbia
Background. Patients with refractory Hodgkin’s disease or relapsing
after high-dose therapy and autografting have a poor prognosis. Here,
we present our experiences with gemcitabine in this setting. Aims. This
study’s objective was to determine the efficacy and safety of gemcitabine
in patients with relapsed or chemotherapy-refractory Hodgkin’s lymphoma
(HL). Patients and Methods. We treated 10 patients /70% patients
were male/ with relapsed or refractory Hodgkin’s disease with gemcitabine.
The median age was 43 years (range, 20-76). 4 patient had stage
IIB disease, 2 patients had stage IIIB disease and 4 patients had stage IVB
disease. 6 patients had mediastinal lokalisation of disease. 6 patients
received BEACOPP regimen in first line of therapy, while 4 patients
received ABVD. 7 patients had received radiotherapy. 80% of patients
had early relapse of disease. 5 patients had an Eastern Cooperative
Oncology Group performance status (PS) of 0, 4 patients had a PS of 1.
Gemcitabine was administered at a starting dose of 1250mg m2 on days
1,8 and 15 every 3 weeks in combination with steroids. All patients had
received at least 2 cycles of Gemcitabine (range, 2-6). Results. The median
follow-up period was 6 months. Hematological toxicity grade 3-4
occurred in 7 patients leading to dose reductions. No other non-hematological
toxicities were observed. The response rate was 30% with 1
patients achieving complete remission (CR) and 2 patients partial remission
(PR). 7 patients have discontinued treatment because of disease progression.
The median time to treatment failure was 4.5 months, and survival
was 11 months. Responses were seen in patients refractory to previous
treatment. The so far longest responder has been in CR for over
40 months. Conclusions. Gemcitabine is potentially effective treatment for
Hodgkin’s disease. According to our results and results of other investigators,
studies on great number of patients is needed. Heavily pretreated
patients often require dose reductions. Diagnostic groups were
defined according to immunophenotypic, FISH, histological and clinical
findings as follows: MCL (n=29), B-CLL (n=106), 9 cases with IgH
rearrangement, excluding those with t(14;18) ? t(11;14). Whenever cyto-
12 th Congress of the European Hematology Association
genetic anomalies coexisted, hierarchical diagnostic criteria were set as
following t(11;14)>t(14q32)>17p->11q->+12>13q-. B-CLL without positive
FISH findings was assigned as B-CLL (-).
1240
LOW DOSE THALIDOMIDE PLUS VALPROIC ACID COMBINATION THERAPY SHOWS
HIGHER HEMATOLOGIC IMPROVEMENT THAN SINGLE AGENT THERAPY
IN MYELODYSPLASTIC SYNDROME CANNOT BE CANDIDATE TO INTENSIVE TREATMENT
S. Ho-Jin, J.S. Chung, G.J. Cho, Y.J. Choi
Pusan National University Hospital, BUSAN, South-Korea
Background. Thalidomide is a potentially useful drug for myelodysplastic
syndrome (MDS) because of its immune-modulatory effect with
anti-cytokine and anti-angiogenic effects. Valproic acid (VPA) inhibits
histone deacetylase activity and can induce differentiation as well as
apoptosis in leukemic cell lines in vitro. Aims. This study is investigated
whether thalidomide plus VPA combination therapy has more potent
therapeutic effect than single agent therapy. Methods. Twenty-six patients
with MDS and chronic myelomonocytic leukemia (CMML) were treated
with thalidomide combined with VPA therapy. Thalidomide was
administered orally at a dose of 50 mg fixed dose per day and VPA was
administered to reach serum concentrations between 50 and 100 ug/mL
in two or three divided doses per day. Bone marrow biopsy and aspirates
specimens were taken at diagnosis and at the end of the study (three
months later). Weekly or biweekly complete blood counts with differentials
were obtained, and upon completion of 12 weeks of therapy. In
patient of any evidence of response, stable disease or hematologic
improvements, thalidomide and VPA were continued until response disappeared.
Results. 10 patients have completed at least 12 weeks of therapy
and five patients discontinued therapy within 12 weeks due to intolerable
side effects and death of disease aggravation. Of the 9 male and
6 female (median age, 68 years), 3 had refractory anemia (RA), 2 had RA
with ringed sideroblasts, 5 had RA with excess blasts-1, 4 had hypoplastic
MDS, and one had CMML. No complete response was seen, but one
patients who had hypoplastic MDS showed partial response. 73.3% of
patients (11 out of 15) showed hematologic improvement (9 patients
with erythroid improvement, 6 with platelet improvement, and 4 with
neutrophil improvement). The median response duration was 8.5 weeks
(range, 2-23 weeks). Conclusions. Thalidomide combined with valproic
acid therapy is more effective than thalidomide single agent in improving
cytopenias of MDS patients.
1241
UNRELATED UMBILICAL CORD BLOOD TRANSPLANTATION FOR HEMATOLOGICAL MALIG-
NANCIES IN A SINGLE CENTER IN BRAZIL
A. Ribeiro, N. Hamerschlak, J. Kutner, E. Ferreira, N. Strachman Bacal,
M. Rodrigues, C. Vogel, C. Toledo Andrade
Hospital Albert Einstein, SAO PAULO, Brazil
Background. A number of hematological malignancies can be cured by
allogeneic stem cell transplantation but only approximately 35% of
Brazilians have a suitable histocompatible related donor. For those
patients in need of an allogeneic transplant, but for whom a suitable
matched related or unrelated adult donor cannot be found, the use of
banked unrelated umbilical cord blood has emerged as a potential option.
Aims. The aim of this study was to define the feasibility of allogeneic
stem cell transplantation using single unrelated cord blood units in a
cohort of adults and children with poor prognosis leukaemia in a single
institution in Brazil. Methods.Twenty patients, 13 children and 7 adults,
with hematological malignancies: 9 with acute lymphoblastic leukaemia,
8 with acute myeloid leukemia, 3 with chronic myeloid leukemia
received transplants of cryopreserved cord blood. Seven patients had
active disease at time of the transplant. The conditioning therapy were
high-dose cyclophosphamide and total body irradiation; Bulssufan with
high-dose cyclophosphamide or Mephalan and antithymocyte globulin.
Patients were given post-transplant immunosuppression with
cyclosporin and methylprednisolone. Results. Patients had a median age
of 8 years (range: 8m to 51y). Cord blood units contained a median
3,83×107 nucleated cells/kg recipient body weight and were matched for
four (8 cases);five (9 cases) or 6 (2 cases) major histocompatibility complex
class 1 and 2 antigens. Two patients did not engraft and three recovered
with disease. In 15 evaluable patients, the neutrophil recovery to
0.5×109 /L was seen by median day 20 after transplant and platelet recovery
to 20×109 /L occurred by median day 57. With a median follow-up
of 24 months (1,5-130 months), 8 patients were alive, five of them without
evidence of relapse. The causes of death were infection in 6 patients,
haematologica/the hematology journal | 2007; 92(s1) | 451