Hematopoietic stem cell transplantation in qatar: One-year anniversary.

Hematopoietic stem cell transplantation (HSCT) offers potentially curative therapy for many hematologic and nonhematologic conditions. As a successful outcome of Qatar's National Cancer Strategy, the HSCT program was started in the National Center for Cancer Care and Research (NCCCR) in October 2015. The HSCT program in NCCCR is the only transplant program in Qatar and self-sufficient with all three core components: the stem cell collection facility, the stem cell processing facility, and the clinical program, which are locally available at Hamad Medical Corporation. In this paper, we report on the outcomes of the first 16 patients who underwent autologous stem cell transplantations (ASCTs) in our center. A total of 17 ASCT have been performed for 16 adult (≥14years) patients. Thirteen of the 16 patients were eligible for disease evaluation at Day 100 post-ASCT. Among these patients, the overall response rate on Day 100 was 92% (complete remission, 61%; very good partial remission/partial remission, 31%) and stable disease occurred in 6%. The procedure was very well tolerated by all patients. At the time of writing this report, all patients are alive; however, one patient (6%) had disease relapse. The Day 100 post-ASCT nonrelapse mortality rate was 0%. Launching the HSCT program represents a historic milestone in the development of the health-care sector in Qatar. The 1st year of this program was very fruitful with the accomplishment of 17 successful transplants. We are in the process of starting the allogenic HSCT early next year. This would represent the next significant milestone for cancer care in Qatar.

Primary Breast Lymphoma in a Woman: A Case Report and Review of the Literature.

BACKGROUND: Primary breast lymphoma (PBL) is an unusual clinical entity accounting for 0.4-0.5% of all breast neoplasms. The usual presentation includes a painless palpable mass similar to that of breast carcinoma. Diffuse large B-cell lymphoma (DLBCL) is the most common identifiable type of PBL based on the histopathological examination. CASE REPORT: We report an unusual case of a 43-year-old Indonesian woman who presented with a 7-month history of a painless mass in the left breast. A core needle biopsy revealed diffuse infiltration of large atypical lymphoid cells. The immuno-histochemical biomarkers confirmed the diagnosis of a DLBCL. A bone scan showed no evidence of bone metastasis. It was treated non-surgically, based on the decision of the breast multidisciplinary team (MDT). The patient was treated with 4 cycles of combination chemotherapy with R-CODOX/IVAC. A follow-up PET scan revealed non-significant mild F-18 fluorodeoxyglucose (FDG) uptake at the periphery of the residual left breast mass, indicating a radiologically favorable response. CONCLUSIONS: Early and accurate diagnosis of PBL is crucial for selecting the appropriate MDT treatment strategies to avert potentially harmful surgical interventions.

Osteoblastic and vascular endothelial niches, their control on normal hematopoietic stem cells, and their consequences on the development of leukemia.

Stem cell self-renewal is regulated by intrinsic mechanisms and extrinsic signals mediated via specialized microenvironments called "niches." The best-characterized stem cell is the hematopoietic stem cell (HSC). Self-renewal and differentiation ability of HSC are regulated by two major elements: endosteal and vascular regulatory elements. The osteoblastic niche localized at the inner surface of the bone cavity might serve as a reservoir for long-term HSC storage in a quiescent state. Whereas the vascular niche, which consists of sinusoidal endothelial cell lining blood vessel, provides an environment for short-term HSC proliferation and differentiation. Both niches act together to maintain hematopoietic homeostasis. In this paper, we provide some principles applying to the hematopoietic niches, which will be useful in the study and understanding of other stem cell niches. We will discuss altered microenvironment signaling leading to myeloid lineage disease. And finally, we will review some data on the development of acute myeloid leukemia from a subpopulation called leukemia-initiating cells (LIC), and we will discuss on the emerging evidences supporting the influence of the microenvironment on chemotherapy resistance.

Fatal Strongyloides stercoralis hyper-infection in a patient with multiple myeloma

Strongyloides stercoralis (S.S.) is a human intestinal parasite, which may lead to complicated strongyloidiasis. We report a case of disseminated strongyloidiasis following the treatment of myeloma. The patient developed skin lesions, respiratory distress, aseptic meningitis and bacterial and fungal sepsis. The diagnosis of strongyloidiasis was established through endotracheal tube secretions. Despite the treatment with Ivermectin and Albendazole, the outcome was fatal. The value of screening for strongyloidiasis is unclear but may be of benefit in patients with hematological malignancies from high endemic areas.

Two Ocular Infections during Conventional Chemotherapy in a Patient with Acute Lymphoblastic Leukemia: A Case Report.

Viral retinitis due to cytomegalovirus (CMV) infection is rare in patients with acute leukemia who did not receive hematopoietic stem cell transplantation. We report a case of CMV retinitis that developed in a 49-year-old patient with acute lymphoblastic leukemia. The patient was treated with salvage chemotherapy using a hyper-CVAD regimen and did not receive hematopoietic stem cell transplantation. The incidence of CMV retinitis in this subgroup of patients is not described in literature. He had a very complicated course during chemotherapy but was successfully treated, with preservation of visual acuity, and to date he is in complete remission. Interestingly, prior to CMV retinitis, the patient had been diagnosed with and treated for candida retinitis. This case shows the importance of eye examination and care in patients diagnosed with hematological malignancies.

Fatal Strongyloides stercoralis hyper-infection in a patient with multiple myeloma.

Strongyloides stercoralis (S.S.) is a human intestinal parasite, which may lead to complicated strongyloidiasis. We report a case of disseminated strongyloidiasis following the treatment of myeloma. The patient developed skin lesions, respiratory distress, aseptic meningitis and bacterial and fungal sepsis. The diagnosis of strongyloidiasis was established through endotracheal tube secretions. Despite the treatment with Ivermectin and Albendazole, the outcome was fatal. The value of screening for strongyloidiasis is unclear but may be of benefit in patients with hematological malignancies from high endemic areas.