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

12 th Congress of the European Hematology Association
(59,5%) and infection (19%). The cariotype of bone marrow cells was
detected in 36 children. It was normal in 65,7%, monosomy 7 - 14,3%;
the transiocation (8;21)-5,7%, the transiocation (9;11)-2,9%; +14-5,7%;
the del 9, inv 9, inv 1, del 13, del 16 in other cases. 57, 4% patients were
transformed in acute leukemia. The transformation period lasted from
3 to 27 months (the median age was 7,2 months). The median of transformation
was 14 months at RA and 4,6 months at RAEB. The survival
rate of children with MDS was 39,4%, a median of survival - 32 months.
1477
GEMCITABINE, DEXAMETHASONE, HIGH DOSE CYTARABINE AND PLATINUM (G-DHAP)
IS AN EFFECTIVE SALVAGE IN RELAPSED AND REFRACTORY LYMPHOMA
M.B. Rassam, S. Gupta, M. Thanigaikumar, M.E. Hill
Kent Cancer Centre, KENT, United Kingdom
DHAP is a standard regimen in relapsed and refractory lymphoma but
is associated with a low response rate of around 10-20% in relapsed
refractory disease. Gemcitabine (G) has been recently found to be an
active agent in this setting. Combining these drugs has theoretical attractions
beyond the simple additive effect of the two regimens. Platinum
increases the cytotoxicity of Cytarabine. It is well recognized in the treatment
of acute leukaemia that purine analogues have synergistic properties
with regard to cytotoxicity. We report here three sequential cases
with primary refractory and DHAP refractory relapsed disease treated
with G-DHAP. Case 1: 35 year old female presented with Stage III B lymphocyte
rich Hodgkin lymphoma. She progressed through 4 courses of
ABVD to stage IVB histiocytic rich diffuse large B-cell lymphoma with
bulky abdominal disease, bone marrow involvement and pathological
fracture of the acetabulum. She received R-CHOP (Rituximab, cyclophosphamide,
Adriamycin, Vincristine and Prednisolone) achieving a partial
response after 4 courses but progressed after 3 more and remained avidly
PET positive. She received ESHAP as salvage without any response.
Gemcitabine (1 gm/m2 day 1, 8), Cisplatin (100 mg/m2 day 1-2) and
Cytarabine (4 gm/m2 day3) along with Dexamethasone (40 mg/d days 1-
4) was started as salvage with a very good partial response on CT and
only one small PET positive site in the liver after one course. Case 2: 32
year old male with stage III B nodular sclerosing Hodgkin lymphoma
achieved partial response with 5 courses of ABVD with significant residual
PET positive disease. He had 4 cycles of G-DHAP with Rituximab as
salvage chemotherapy with complete CT and PET response after 2. He
relapsed 8 months later and received 2 further courses of the same with
complete remission. He underwent high dose therapy and autologous
stem cell rescue and remains in remission 2 years later. Case 3: 46 year
old male with stage IV B mixed cellularity Hodgkin’s lymphoma progressed
through ABVD and received 7 cycles of escalated BEACOPP
chemotherapy having achieved remission after 2. He relapsed 3 years later
with stage IVB disease. DHAP as salvage failed but he responded to
the addition of Gemcitabine and Rituximab with a complete radiological
response and minimal residual PET positivity after one course. He
received one more cycle of RG-DHAP followed by BEAM Campath allogeneic
stem cell transplant from his sister and is in remission 3 years later.
Informed consent was obtained from all patients. The treatment causes
grade 3-4 myelosuppression and requires GCSF support and transfusions.
Case 2 had a successful peripheral blood stem cell harvest with G-
CSF at the back of G-DHAP. We conclude that the addition of Gemcitabine
with or without Rituximab to DHAP is an effective salvage of
relapsed lymphoma even in cases refractory to DHAP. Further work in
the form of a formal Phase II study and subsequent randomized trial will
be required to confirm this important finding.
1478
CYCLOOXYGENASE-2 AND TRANSFORMING GROWTH FACTOR-β1 EXPRESSION IN HCV
INDUCED CHRONIC LIVER DISEASE: RELEVANCE TO OUTCOME
E.I. El-Bassiouni, M.K. Zoheiry, M.F. Nosseir, E.G. El-Ahwany, R.I.
Atta, A.E. I. El Bassiouny
Theodor Bilharz Research Institute, GIZA, Egypt
Background. Cyclooygenase-2 (COX-2) and transforming growth factor-β1
(TGF-β1) were modulated in a variety of viral infections, but there
is a paucity of data about the role of these factors in the pathological
process of fibrosis and carcinogenesis in HCV infection. Aims. This study
aimed to analyze hepatic tissue expression of COX-2 and TGF-β1 in
chronic hepatitis C liver disease, and its sequel of cirrhosis and/or hepatocellular
carcinoma, in a trial to assess the role of these factors in the
multi-step process of fibrosis/carcinogenesis. Methods. Hepatic expression
of COX-2 and TGF-β1 was assessed using immunoperoxidase
526 | haematologica/the hematology journal | 2007; 92(s1)
staining of liver biopsy specimens of 110 HCV-infected patients, of
whom 50, 30 and 30 subjects had chronic active hepatitis (CAH), liver
cirrhosis (LC) and hepatocellular carcinoma (HCC), respectively. Histologically-normal
livers (n=10) were also assessed as controls. Results.
Immunoperoxidase staining of normal hepatic tissue revealed faint
COX-2 and TGF- β1 immunoreactivity (