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

12 th Congress of the European Hematology Association
underlying disease in 3, graft versus host disease (GVHD) in two and
multiple organ failure in one. Infection was the most common complication
(90%). The agents of infection in the patients who died were: S.
aureus and acinetobacter; aspergillus; candida sp, cytomegalovirus and
adenovirus. Acute GVHD grades II-IV was seen in 7 of 15 (46,6%) who
survived more than 30 days and limited chronic GVHD was seen 1 in 9
patients who survived more than 100 days post-transplant. Conclusions.
Unrelated cord blood transplantation is feasible in patients with highrisk
malignancy in Brazil with infection relating to immunosuppression
being the major limitation.
1242
SIGNIFICANCE OF PLATELET-DERIVED MICROPARTICLES IN PATIENTS WITH RECUR-
RENT FETAL LOSSES
K. Kaptan, C. Beyan, I. Ifran, A. Pekel, A. Sengul
Gulhane Military Medical Academy, ANKARA, Turkey
Background. Platelet-derived microparticles (PMP) have procoagulant
activity and are produced by platelet activation or physiological stimulation.
PMP are associated with various prothrombotic states. One of the
proposed causes of recurrent fetal losses is uteroplacental thrombosis
and PMP may be associated with it. The aim of this study was to investigate
the significance of PMP in women with recurrent fetal losses.
Methods. The platelet CD62P as a platelet activation marker and CD42b +
microparticles as PMP were measured by flow cytometry. Measurements
by flow cytometry were done in whole blood of 13 women with
recurrent fetal losses and 11 age-matched healthy women controls with
no previous history of fetal loss. Results. PMP levels in patients group
were higher than in normal subjects (4.13±1.09% vs 2.54±1.47%,
p0.05). Conclusions.
Our findings, increased levels of PMP in patients group, suggest
that PMP might have a role of pathogenesis of recurrent fetal losses.
1243
EFFICACY OF MICAFUNGIN IN PROPHYLAXIS AGAINST INVASIVE FUNGAL INFECTIONS
IN PATIENTS UNDERGOING ALLOGENEIC HEMATOPOIETIC STEM CELL
TRANSPLANTATION
S. Hashino, K. Kahata, M. Onozawa, T. Kondo, H. Kanamori,
S. Takahashi, M. Asaka
Hokkaido University, SAPPORO, Japan
Background. Allogeneic hematopoietic stem cell transplantation
(HSCT) recipients usually receive fluconazole (FCZ) or amphotericin B
(AMPH-B) for standard antifungal prophylaxis. However, invasive fungal
infections (IFI) have become an important problem in patients undergoing
allogeneic HSCT, especially in aged or severely immunosuppressed
recipients. Because of fungal resistance and lack of anti-
Aspergillus activity with FCZ and renal toxicity with AMPH-B, alternative
prophylactic regimens have become necessary. Since many antifungal
drugs have recently become clinically available, the optimal strategy
for prophylactic antifungal therapy has not yet to be determined.
Aims. To resolve this issue, we therefore conducted a prospective study
to compare the effectiveness and safety of recently available micafungin
(MCFG) with those of FCZ in preventing IFI during the first 100
days after allogeneic HSCT. Methods. Patients undergoing allogeneic
marrow, peripheral blood stem cell, or cord blood stem cell transplantation
were eligible for the study. Patients undergoing allogeneic HSCT
received MCFG at 100 mg/day intravenously beginning 14 days prior to
HSCT and continuing until engraftment. To evaluate the efficacy and
safety of MCFG, data for patients undergoing allogeneic HSCT who
received FCZ at 400 mg/day orally or intravenously were analyzed retrospectively.
After obtaining engraftment, patients in both groups
received FCZ at 200 mg/day orally until cessation of administration of
immunosuppressants for prophylaxis or treatment of GVHD. IFI were
diagnosed by using criteria published by the European Organization for
Research and Treatment of Cancer. Treatment of high-dose AMPH-B
(0.5-1.0 mg/kg/day intravenously), MCFG (150-300 mg/day intravenously),
or voriconazole (400 mg/day intravenously or orally) was
started for patients with suspected or proven IFI. Drug-associated toxicity
was evaluated, and proven, probable, or possible IFI were analyzed.
Mortality from fungal infection and overall mortality were also determined.
Results. From December 2003 to June 2006, a total of 31 patients
were enrolled in the trial. Two patients were excluded because of discontinuation
of MCFG treatment due to drug eruption and because of
early death due to capillary leak syndrome. Data for 29 patients who had
452 | haematologica/the hematology journal | 2007; 92(s1)
undergone allogeneic HSCT with FCZ for prophylactic IFI from May
2000 to October 2003 were also retrospectively analyzed for comparison.
The incidences of proven IFI in the two groups were not significantly
different (0% in the MCFG group and 7% in the FCZ group, p=0.491).
The total incidences of proven, probable or possible IFI were also not significantly
different (34% in the MCFG group and 45% in the FCZ group,
p=0.592). The survival rates at 100 days post-transplantation were similar
in the two groups (86% in the MCFG group and 76% in the FCZ
group, p=0.504). Rates of death attributable to IFI were similar in the two
groups (0% in the MCFG group and 7% in the FCZ group, p=0.491).
MCFG was well tolerated. Conclusions. We conclude that MCFG is as
effective as FCZ in prophylaxis against IFI during immunosuppression
in patients undergoing allogeneic HSCT.
1244
CHILDHOOD NON HODGKIN LYMPHOMA IN DEVELOPING COUNTRIES; CAN INTENSIVE
CHEMOTHERAPEUTIC REGIMENS BE APPLIED?
F. Bazzeh, M. Jarrar, M. Tawfiq, F. Madanat
King Hussein Cancer Center, AMMAN, Jordan
Background. Non Hodgkin Lymphoma (NHL) is the third most common
childhood cancer. It is divided further into subtypes that differ in
their clinical, histopathological and management aspects. Using multi
agent intensive chemotherapy significantly improved the outcome of
high-risk patients. Decreasing the treatment intensity in low risk patients
maintained their superior outcome while reducing the long-term toxicity
of the treatment. Aims. To retrospectively evaluate the outcome of
children diagnosed with NHL and treated at King Hussein Cancer Center
(KHCC) using the multi-agent intensive protocols developed by the
European and North American cooperative groups and to compare the
treatment outcome at KHCC to the treatment outcome in Europe and
North America using the same protocols. Methods. Between January
2004 and December 2006, 54 children were treated at KHCC for NHL.
Median age was 8.6 years (range 11 months-18 years). Male to female
ratio was 4.4:1. Of those, 30 patients (55.5%) had Burkitt’s Lymphoma
(BL), 8 patients (14.8%) had Diffuse Large B cell Lymphoma (DLBL)
with 5 of them having primary Mediastinal disease, 11 patients (20%)
had Lymphoblastic Lymphoma (LL), 4 patients (7.4%) had Anaplastic
Large Cell Lymphoma (ALCL) and 1 patient (1.8%) had Large T Cell
Lymphoma. BL and DLBL patients were treated on LMB 96 protocol; LL
patients were treated on BFM 95 protocol and ALCL with 2 different
protocols (POG and BFM). Results. 30 patients had BL. With a median
follow up of 23.5 months (2-37 months), 26 patients (86.6%) were alive
in complete response (CR). 2 patients died in CR secondary to treatment
related complications, one died with progressive disease and one
alive patient progressed while on therapy. 8 patients had DLBL, of those
5 (62.5%) are alive in remission with a median follow up of 27 months
(2-36 months), 3 patients with primary mediastinal disease died due to
disease progression. 6 patients had T-Cell LL, 3 patients had precursor
B LL and 2 patients had LL with unknown phenotype. All LL patients
are alive in CR with a median follow up of 24 months (2-37 months).
Two patients with ALCL were treated according to BFM 90 protocol and
two patients with ALCL were treated on POG 8615 protocol (standard
arm). All ALCL patients are alive in CR with a median follow up of 18
months (7-28 months). Conclusions. Adopting intensive treatment protocols
such as LMB, POG and BFM is feasible in countries with limited
resources like Jordan if adequate supportive care can be provided. The
outcome of our patients is comparable to the outcome reported in Western
countries. The poor outcome of DLBL patients with mediastinal disease
makes it necessary to explore more novel therapies.
1245
CONSECUTIVE DETECTION OF MLL REARRANGEMENTS IN INFANTS ACUTE
LYMPHOBLASTIC LEUKEMIA DURING TREATMENT WITH ALL-TRANS RETINOIC ACID
IN COMBINATION WITH CONVENTIONAL CHEMOTHERAPY
G. Tsaur, 1 E. Semenikhina, 2 L. Saveliev, 3 L. Fechina2 1 Research Institute of Cells Technologies, EKATERINBURG; 2 Regional Children’s
Hospital, EKATERINBURG; 3 Ural State Medical Academy, EKATER-
INBURG, Russian Federation
Background. Despite of many attempts worldwide, treatment results
and prognosis of infant leukemia with MLL rearrangements are rather
dismal. Recently new treatment approach with all-trans retinoic acid
(ATRA) for such patients has been applied in our clinic. It is based on
combination of conventional chemotherapy and simultaneous pulses
of ATRA. ATRA is a natural provitamin A. It has been approved for the