Palonosetron and dexamethasone for the prevention of nausea and vomiting in patients receiving allogeneic hematopoietic stem cell transplantation.

PURPOSE: The primary aim of this study was to evaluate the efficacy of palonosetron combined with dexamethasone in the prevention of vomiting, and especially nausea, in patients receiving allogeneic stem cell transplantation. METHODS: Palonosetron 0.25 mg was given to 27 patients receiving allogeneic transplantation on the first day of conditioning, and then every other day during the entire conditioning period. Dexamethasone was given daily also during conditioning. Vomiting and nausea were recorded daily according to CTCAE version 4.0 from the start of conditioning to Day 7 after transplantation. In addition, MASCC antiemetic tool (MAT) was also used in parallel to evaluate the intensity of nausea. RESULTS: The treatment was well tolerated; 25.9 and 40.7 % of the patients had grade 2/3 vomiting and nausea respectively during conditioning. The incidences of grade 2/3 vomiting and nausea were even higher in the first week after transplantation (40.7 and 51.8 %, respectively). The score of MAT correlated well with the grade of CTCAE. However, the difference in the mean intensity of nausea between period of conditioning and the first week after HSCT was significant only by using MAT (0.96 ± 1.829 vs. 3.81 ± 3.386, p=0.001) but not CTCAE (1.26 ± 0.903 vs. 1.63 ±0.967, p=0.152). CONCLUSION: Palonosetron combined with dexamethasone is effective in preventing vomiting during conditioning. However, more effort should be made to alleviate nausea during conditioning and both nausea and vomiting in the first week after transplantation. Furthermore, MAT has a higher discriminant power than CTCAE in assessing the intensity of nausea in patients receiving allogeneic transplantation.

Association of cyclooxygenase 2 single-nucleotide polymorphisms and hepatocellular carcinoma in Taiwan.

Hepatocellular carcinoma (HCC) is a worldwide neoplasm for which early diagnosis is difficult and the prognosis is usually poor. Overexpression of cyclooxygenase 2 (COX-2) has been suggested to be associated with hepatocarcinogenesis. Although several COX-2 inhibitors have been used in hepatoma therapy, the genetic background between COX-2 and HCC remains largely unknown. In this study, the association of genotypic polymorphisms in COX-2 with HCC was investigated. 298 patients with HCC and 298 healthy controls recruited from the China Medical Hospital in Taiwan were genotyped by a PCR-RFLP method. We have investigated six polymorphic variants of COX-2, including A-1195G, G- 765C, T+8473C, and variants in introns 1, 5 and 6, and analyzed the association of specific genotype(s) with susceptibility to HCC. The results showed that, for each of the six genotypes, no differences un distribution between the HCC and control groups were found. There was neither obvious joint effect of COX-2 G-765C/intron 6 haplotype nor its genotypes with smoking or alcohol consumption on HCC risk. Environmental factors, other than smoking and alcohol drinking, may affect the post-natal expression of COX-2 in the etiology of HCC, which is an outcome of complex genetic and environmental interactions. Moreover , our immunohistochemistrical results indicated that the COX-2 protein was significantly over-expressed in well-differentiated HCC, but not significantly increased in expression in poorly-differentiated HCC. We suggest that COX-2 may be a determinant of the differentiation grade of HCC.

Interaction of CCND1 genotype and smoking habit in Taiwan lung cancer patients.

AIM: Cyclin D1 (CCND1) is critical in the transition of the cell cycle from G1 to S phase and unbalanced cell cycle regulation is a hallmark of carcinogenesis. The study aimed at investigating the association of CCND1 genotypes with lung cancer risk in Taiwan and examining the interaction between CCND1 genotype and smoking habit. PATIENTS AND METHODS: CCND1 A870G (rs9344) and C1722G (rs678653) genotypes were determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis of DNA from the blood of 358 lung cancer patients and 716 cancer-free healthy controls. RESULTS: The results showed that there were significant differences between lung cancer and control groups in the distribution of the genotypes (p=0.0003) and allelic frequency (p=0.0007) in the CCND1 rs9344 genotype. Individuals who carried AG or GG genotype had 0.59- and 0.52-fold risk, respectively, of developing lung cancer compared to those who carried the AA genotype (95% CI=0.44-0.78 and 0.35-0.79, respectively). There was also an obvious interaction of CCND1 rs9344 genotype with personal smoking habit on lung cancer risk (p=0.0009). CONCLUSION: These findings support the conclusion that cell cycle regulation may play a role in lung cancer development and that CCND1 rs9344 polymorphism together with smoking habit maybe a useful biomarker for lung cancer prediction.

A unique finding on gallium-67 scintigraphy: widespread fatal skin manifestations of Pseudomonas sepsis.

We report a case of a 25-year-old woman presented with neutropenic fever after chemotherapy for the relapse of acute biphenotypic leukemia. Gallium-67 scintigraphy for the detection of infectious foci demonstrated a unique pattern of numerous foci with intense and varying-sized radioactivity spreading throughout the body. The subsequent skin biopsy and culture proved Pseudomonas infection. Therefore, this unique image, in combination with clinical information, was compatible with cutaneous manifestations of Pseudomonas sepsis. Eventually, the patient died of uncontrolled systemic infection despite the aggressive antibiotic treatment. This case reminded clinicians and nuclear medicine physicians to notice the potentially fatal finding on gallium-67 scan.

Reversible abnormal functional neuroimaging presentations in polycythemia vera with chorea.

We report a case of polycythemia vera with chorea in which the brain metabolism and dopamine system were investigated using 2-[(18)F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) and (99m)Tc-labeled tropane dopamine transporter ((99m)Tc-TRODAT-1) single photon emission computed tomography (SPECT). Along with normalization of the hematocrit and clinical symptoms after consecutive phlebotomies, the FDG PET scan and (99m)Tc-TRODAT-1 SPECT images returned towards normal. It is hypothesized that the development of polycythemia chorea is associated with a reversible alteration in the corticobasal ganglia metabolism and disturbed dopaminergic function.

Unexpected findings on gallium-67 scintigraphy: detection of undifferentiated endometrial stromal sarcoma.

We reported an extremely rare case of undifferentiated endometrial stromal sarcoma imaged with gallium-67 scintigraphy. This previously healthy 32-year-old woman presented with cough and dyspnea for days. Unexpectedly, the pathology of the opacity in the right pulmonary hilar region demonstrated metastatic high-grade epithelioid sarcoma. Gallium scintigraphy performed to detect possible origin showed abnormal uptake in the right supraclavicular region, chest region and pelvic region. Computed tomography-guided biopsy of the pelvic mass revealed undifferentiated endometrial stromal sarcoma. This case demonstrated the usefulness of gallium-67 scintigraphy in the detection of the primary disease and the evaluation of the metastatic disease.

Association of cyclooxygenase 2 polymorphic genotypes with prostate cancer in taiwan.

UNLABELLED: The aim of this study was to evaluate the association of polymorphic genotypes in the cyclooxygenase 2 gene (COX2), which is reported to be overexpressed in prostate tumors, with Taiwan prostate cancer patients. MATERIALS AND METHODS: Six polymorphic variants of COX2 were analyzed for their association with prostate cancer susceptibility. A total of 218 patients with prostate cancer and 436 healthy controls in central Taiwan were enrolled in this investigation. P-values and odds ratios with 95% confidence intervals were used to assess the strength of the association. RESULTS: Among the six polymorphic sites examined, only the Cox-2 promoter G-765C (rs14133) genotypes were distributed differently between the prostate cancer and control groups. The COX2 -765GG genotype was associated with higher prostate cancer risk than -765GC. CONCLUSION: These findings provide evidence that the G allele of COX2 promoter G-765C may be associated with the development of prostate cancer and may be a useful marker for early detection of prostate cancer.

Esophageal squamous cell carcinoma with a solitary phalangeal metastasis.

A patient with pathologically proven acrometastasis of his left thumb presented 3 months after esophagectomy for esophageal squamous cell carcinoma. Interestingly, there was indeed a faint uptake in his left thumb that was initially considered an artifact in the whole body bone scan taken before esophagectomy. Physicians must be aware of the possibility of acrometastasis, even if there is no other concomitant metastatic area.