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

12 th Congress of the European Hematology Association
define the relevance of ANG-2 for prediction of prognosis in CLL. Supported
by research project MZO 00179906 from Ministry of Health,
Czech Republic.
1488
ALEMTUZUMAB TREATMENT IN REFRACTORY LYMPHOPROLIFERATIVE DISORDERS
A. Müller, 1 A. Soyano, 2 A.E. Soyano, 3 M. Di Stefano, 1 M.A. Torres, 4
M. Morales, 1 G. Acquatella, 1 R. Somoza1 1 Inst. of Hematology & Oncology (MS-UCV), CARACAS; 2 Venezuelan Inst.
for Scient. Research, CARACAS; 3 Luis Razetti Medical School (UCV), CARA-
CAS; 4 Clinica Santa Sofia, CARACAS, Venezuela
Background. CAMPATH-1H is a human immunoglobulin G1 (IgG1)
anti-CD52 monoclonal antibody (MAb) that binds to nearly all B- and
T-cell lymphomas and leukemias A number of clinical trials have demonstrated
the clinical activity of Campath in chronic lymphocytic leukemia
(CLL), T-cell malignancies such as T-prolymphocytic leukemia (T-PLL)
and cutaneous T-cell lymphoma (CTCL). Methods. Fifteen patients wth
lymphoproliferative disorders refractory to different chemotherapies or
with advanced disease were treated as induction with CHOP-CAM-
PATH-1H or ATT-Campath-1H for a maximum of 6 cycles, and one
patient with CAMPATH-H for 18 weeks and local radiotherapy. The
patients who entered only in partial remission were treated with CAM-
PATH-1H as maintenance treatment. Two patients with CLL, 4 patients
with Mycosis fungoide( MF)/ Sesary Syndrome (SS), and 9 patients with
Peripheral T Cell Lymphomas were treated The CD4 was measured.
RESULTS: Seven patients (46,66%) entered in a complete remission (CR)
for 1 year up today (4 NHL, 1 CLL, 1 SS), 6 patients (40%) achieved a
partial remission (50-75% PR) (4 LNH, 1 CLL, 3 MF) and one patient did
not respond. The most pronounced effects in CLL patient were noted
in blood, bone marrow, and spleen in one of the patients with advanced
and chemotherapy-resistant CLL. The other patient 82 years old with
CLL entered in complete remision after 3 dosis of Campath-1H. Three
patients had severe infections : 1 ocular cytomegalovirus, one cristoporidium
diarrhea (in these cases Campath-1H was discontinued) and
one Herpez zozter. Another patient with NHL died after 3 cycles of
CHOP-CAMPATH-1H due to severe pulmonary hypertension. The level
of CD4 falled after Campath-1H treatment. Conclusions. CAMPATH-
1H had significant activity in patients with lymphoproliferative disorders
refractories to different chemotherapies so CAMPATH improve
survival although it can cause severe infections due partially to CD4 cell
count drop, the majority of them can be clinically manageable. One
patient died in CR due to severe pulmonary hypertention probably as a
complication of Campath treatment.
1489
IMATINIB DOSE IN INDIAN PATIENTS WITH PH+ CML
Tapan K Saikia, N. Hazarika, B.N. Dhabhar
Prince Aly Khan Hospital, MUMBAI, India
Background. It has been often discussed that the standard dose of 400
mg daily imatinib mesylate (IM) is poorly tolerated by many Asian
patients. However, it has remained undocumented. Aim: To study the
dose of IM tolerated by the Indian patients with Ph + CML-CP. Methods.
A cohort of 182 adult Indian patients (>18 yrs of age) with Ph + CML-CP
(newly diagnosed or late-CP) and on regular follow-up was included in
the analysis. The starting dose of IM was 400 mg daily. The IM dose
ingested by the patients (on their own i.e. compliance or on physician’s
advice) was recorded over the subsequent months. Physicians’ recommendations
for dose modification was based on hematologic (neutropenia
and/or thrombocytopenia, but not anemia) or some severe nonhematologic
toxicities (myalgia, muscle cramps, mucositis, GI symptoms
or skin rash). Results. The consistent IM doses received were - daily
300 mg by 15 patients (8%), 400 mg by 136 (75%), 600 mg by 27
(15%) and 800 mg by 4 (2%). Most patients (except by 3 due to GI intolerance
or myalgia/cramps) on a higher dose (raised due to poor response
to 400 mg daily) did not reduce the dose and were fully compliant. However,
attempts to raise the dose from 300 mg to 400 mg or higher was
unsuccessful due both either to hemtologic and non-hematologic toxicities.
Non-compliance as regard to 300 mg daily was documented in
~20%of patients (1.1% of the study cohort) receiving this dose. The
median dose among these patients was 230 mg daily. This happened as
patients were often apprehensive of non-hematologic toxicity of excessive
flatulence, nausea, myalgia, mucositis and cramps. Patients who
continued with the standard dose of 400 mg, the mean daily dose was
380 mg (IRIS cohort 382±52 mg). Our analysis suggests that Indian
530 | haematologica/the hematology journal | 2007; 92(s1)
patients do tolerate the standard dose of IM as documented in the IRIS
study (N Engl J Med 2006; 355: 2408). In reality, in our cohort more
patients (6% in the IRIS study) received a higher dose of 600 mg daily.
This could be explained by the fact that patients with late CML-CP not
responding to 400 mg were advised a higher dose. Conclusions. This
prospective analysis shows that most Indian patients can tolerate the
standard 400 mg daily dose of IM. However, who usually tolerate only
300 mg daily, a good number (~20%) tend to remain somewhat noncompliant
and this might have an impact on long-term outcome in them.
1490
THE INFECTION OF CYTOMEGALOVIRUS IN CHILDREN WITH NEUTROPENIAS
N. Finogenova, E.A. Mamedova, T.V. Polovtseva
Federal Clinical Research Center of Pedi, MOSCOW, Russian Federation
Background. Cytomegaloviruses (CMV) don’t only show activity under
the condition of immunodeficiency, but they also have an immunesuppressive
effect on the human organism. The pinacle of the diagnostics
of neutropenias falls on the early childhooh age, which is the most vulnerable
for development of cytomegalovirus infection (CMVI), while
during some neutropenic states there is a lack of adequate immune
response not only to bacterial agents, but also to virus ones. Aim. To
find out to which extent children with neutropenias are infected with
CMV. Methods. A screening examination took place for CMV with the
help of the three-phase enzyme immunoassay of blood serum of 269
children in the age 0 to 14 years during their primary visit to the Moscow
Hematology Center in the Morozov Child’s City Clinical Hospital. The
purpose of the assay was to find antibodies of the classes IgM and IgG.
The received data were analyzed in 4 age groups: group 1-0 to 6 months
(71 children), group 2-6 to 12 months (101 children), group 3-1 to 3 years
(97 children), group 4-3 to 14 years (29 children). Results. Serologic markers
were found in 153 children (51.3%). The percentage of serologically
positive children in groups 1,2 , 3 and 4 was 63.4%, 51.3%, 58.8%
and 37.9% respectively. The biggest number of presence of the specibic
IgM antibodies, which tell about infection prosses activity was noted in
children with neutropenias in the age less, than 6 months (12,7% of all
the examenees in this age group). Conclusion. The high rate of CMV
infection in children with neutropenias indicates that there is necessity
to examine patients of the group in question for CMVI. The biggest
number of the infected was found among children with a debut of neutropenia
in the age 6 months to 3 years. This shows that CMV influences
the development of neutropenia in children of early age.
1491
RESULTS OF IMATINIB MESYLATE THERAPY IN CHRONIC MYELOID LEUKEMIA:
EXPERIENCE OF A SINGLE CENTER
S. Pasa, 1 T. Boyraz, 1 C. Beyaz, 1 S. Sayar, 2 Y. Atayan1 1 Dicle University Medical Faculty, DIYARBAKIR, Turkey; 2 Dicle University,
Medical Faculty, DIYARBAKIR, Turkey
Background. Imatinib mesylate, spesific bcr-abl tirosine kinase
inhibitor, have been used widely in treatment of chronic myeloid
leukemia (CML) recently. Hematologic, cytogenetic and even molecular
remission can be achieved by imatinib in the dose of 400 mg/day in
chronic phase. Dose adjustment is 600-800 mg/day in accelerated or
blastic phase. Aim. To evaluated the effectiveness of the imatinib mesylate
treatment. Material and method. Eighty-seven patients with CML
whose followed regularly by department of hematology of Dicle University,
Medicine Faculty were included to study. Thirty-nine patients
with 44.1 years mean age were female (45%) and 67 patients with 55.2
median age were male (55%). Bcr-abl was detected regulary in every 6
months by PCR. Results. Complete hematologic response rate was 82/87
(94.2%). Primary resistance to 400 mg/day imatinib was observed in 5
patients. Dosage increased to 600 mg and subsequently to 800 mg/day.
One of 5 resistant patient respond to 800 mg. An another patient who
was in blastic phase in 6th months of therapy responsed to 800 mg and
regressed to chronic phase. Complete molecular remission achieved in
one patient. Superficial edema, vomiting, and grade 3-4 neutropenia or
thrombocytopenia were detected in 34 (39%), 37 (42%), and 10 (11%)
patients in chronic phase. Myalgia and osteoalgia were observed in 8
patients. Treatment was discontinued in patients with hematologic
adverse effects, and subsequent to the recovery of these effects, imatinib
mesylate restarted with a dose of 300 mg/day. Conclusions. Hematologic
response to imatinib mesylate therapy was founded in 94% of
patients. Patients should follow regulary for effectiveness of treatment
and for the possible advers effects which may be serious.