Factors Associated with Absolute Neutrophil Count Dynamics and Docetaxel-Adryamicin-Cyclophosphamide (TAC) Chemotherapy Induced Neutropenia During Extended Filgrastim Administration in Breast Cancer Patients.

BACKGROUND: Myelosuppressive effects of chemotherapy for breast cancer treatment may trigger chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN). Filgrastim has been widely used as prophylaxis against CIN and FN. However despite filgrastim administration, some study showed FN still occur and cause patient vulnerability to infection. This study aims to evaluate factors associated with Absolute Neutrophil Count (ANC) dynamics and Docetaxel-Adryamicin-Cyclophosphamide (TAC) CIN during extended filgrastim administration in breast cancer patients. METHODS: Patients were selected among breast cancer in-patients who fulfilled the eligibility criteria. Patient characteristics data and ANC were collected. The entire patients received 5µg/kg/day filgrastim by subcutaneous injection 24 hours post-chemotherapy. ANC was monitored daily and filgrastim administration was stopped when ANC reached >10000/mm3 or 14 days of administration. Kruskall-Wallis test and Spearman Correlation test was performed to analyze ANC dynamics and CIN-related factors. RESULTS: This study included 42 breast cancer patients. Patient age median was 52 (31-70) years old. ANC nadir could be observed around 5-7 days after chemotherapy and FN occurred in two out of 38 grade 4 neutropenia patients (4.8%). Critical ANC lasted for 1 day, 2 days, and 3 days respectively in 9 (23.7%), 25 (65.8%) and 4 (10.5%) patients. There was no correlation between neutropenia and age. ANC slope and recovery duration did not show a significant difference. However, depth of nadir is inversely correlated with the duration of ANC recovery (>10000/mm3) and the duration during the peak on the 2nd day until reaching nadir both with fair strength, r = -0.489 and r = -0.438 (p <0.05), respectively. No sepsis incidence had manifested. CONCLUSION: CIN still occured in breast cancer patient receiving filgrastim primary prophylaxis regardless of age and neutropenia severity. Nadir as the lowest point of ANC should be noted as a pivotal milestone for ANC slope and recovery evaluation.

Profile of BCR-ABL transcript levels based on Sokal prognostic score in chronic myeloid leukemia patients treated with imatinib.

AIM: to elucidate the pattern of molecular response assessed by logarithmic reduction in BCR-ABL transcription levels based on Sokal prognostic score in chronic phase chronic myeloid leukemia (CML) patients receiving Imatinib treatment. METHODS: cross-sectional study was conducted in the Hematologic Outpatient Clinic, Dr. Soetomo Hospital Surabaya in all chronic phase CML patients from June 2008 to June 2012. Data on subject characteristics (age and sex), complete blood count with differential and spleen size were collected. Patients were stratified according to Sokal score at diagnosis. Real-time quantitative PCR (RT-qPCR) were used to monitor BCR-ABL levels in patients who fulfilled study. Proportion difference of complete molecular response (MR) was analyzed by chi-square test, while differences of BCR-ABL transcript level among Sokal prognostic scole subgroups was analyzed by Kruskal-Wallis test. RESULTS: 40 subjects finished the study. After 18 months of Imatinib treatment, the undetected BCR-ABL transcript level (complete MR) were 7(70%), 8(66.7%), and 9(50%) in low-, intermediate-, and high risk group patients, respectively (p=0.417). Although proportion of subjects with complete MR is higher in sokal low risk group compared to in sokal high risk groups (70% v.s. 50%), but this difference is not statistically significant (p=0.557). Kruskal-Wallis test showed that there was no significant difference of BCR-ABL transcript level among Sokal prognostic score subgroup (p=0.734). CONCLUSION: there was no difference of BCR-ABL transcript level among sokal prognostic score risk groups in chronic phase CML patients treated with Imatinib.

How to prioritize treatment in dual malignancy: A case report of patient with non-Hodgkin lymphoma and breast cancer.

Introduction: Clinicians often encounter dilemma upon treating multiple primary malignancies. Case presentation: We report a case of a female patient, 72, complained of a lump under her left eye since January 2019. Patient was diagnosed with infiltrating ductal carcinoma grade III of the right breast in June 2018 with ER+, PR+, and HER2-, treated with hormonal treatment. Histopathology examination of the lump revealed Non Hodgkin Lymphoma (NHL), B cell type, high grade. Patients received rituximab, cyclophosphamide, epirubicin, vincristin, and prednisone (RHCOP) for 6 cycles to overcome lymphoma then received hormonal therapy afterwards. Clinical discussion: According to earlier published case reports, it's advised to start hormonal therapy after RHCOP. The survival time was 21 months (5.1-114.7 months) with 5-year overall survival 29. Conclusion: Unfortunately, we could not have a follow-up on the patient after finishing 6 cycles of RHCOP due to the COVID-19 pandemic situation.

Markers of Renal Complications in Beta Thalassemia Patients with Iron Overload Receiving Chelation Agent Therapy: A Systematic Review.

Objective: The emerging renal complications in beta-thalassemia patients have raised the global exchange of views. Despite better survival due to blood transfusion and iron chelation therapy, the previously unrecognized renal complication remain a burden of disease affecting this population -the primary concern on how iron overload and chelation therapy correlated with renal impairment is still controversial. Early detection and diagnosis is crucial in preventing further kidney damage. Therefore, a systematic review was performed to identify markers of kidney complications in beta thalassemia patients with iron overload receiving chelation therapy. Methods: Searches of PubMed, Scopus, Science Direct, and Web of Science were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to identify studies of literature reporting renal outcome in ß-TM patients with iron overload and receiving chelation therapy. The eligible 17 studies were obtained. Results: uNGAL/NGAL, uNAG/NAG, uKIM-1 are markers that can be used as predictor of renal tubular damage in early renal complications, while Cystatin C and uß2MG showed further damage at the glomerular level. Discussion and Conclusion: The renal complication in beta-thalassemia patients with iron overload receiving chelating agent therapy may progress to kidney disease. Early detection using accurate biological markers is a substantial issue that deserves further evaluation to determine prevention and management.

Polymorphism C3435T of the MDR-1 gene predict response to preoperative chemotherapy in locally advanced breast cancer with Her2/neu expression.

AIM: to reveal the role of polymorphism C3435T of MDR-1 gene in the response to preoperative chemotherapy in locally advance breast cancer. METHODS: the analytical observational research in nineteen patients diagnosed between January and December 2005 with locally advanced breast cancer treated by preoperative Anthracycline chemotherapy to evaluate its predictive outcome was performed. On all samples Immunohistochemistry, PCR, and sequencing methodology of the MDR1 target gene were performed. RESULTS: the polymorphism of MDR1 gene at cDNA position 3435 located in exon 26 has been shown to be correlated with clinical response to Anthracycline chemotherapy in breast cancer patients, without being affected by the positive or negative Her-2 expression. Patient with T/T genotype developed clinical response, while patient with C/T genotype did not develop clinical response. CONCLUSION: breast cancer patients with positive Her-2 expression do not always respond to Anthracycline, it means that only patients with T/T genotype at position 3435 located in exon 26 of MDR1 gene have clinical response, while patients have C/T genotype do not show clinical response. MDR-1 polymorphism C3435T in exon 26 may co-determine resistance to chemotherapy and provide useful information to individual therapy.