A Survey of Infection in Allogenic Hematopoietic Stem Cell Transplantation in Patients with Acute Myeloid Leukemia.

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially cure for acute myeloid leukemia (AML). Patients who undergone HSCT are at increased risk of infection due to impaired immunity. OBJECTIVE: To evaluate the rate of bacterial, viral and fungal infection and its relationship with 2-year overall survival of AML patients who had undergone HSCT. METHODS: This was a retrospective cross-sectional study of 49 patients who underwent allogenic bone marrow transplantation (BMT) from full-matched donors at BMT Center, Imam Khomeini Hospital Complex, Tehran, Iran, from 2006 to 2013. All autologous transplantations and promyelocytic leukemia (PML) transplantations were excluded. RESULTS: All patients, except for one, had fever for a mean of 7 days post-transplantation and received broad-spectrum antibiotic. The rate of severe sepsis was 6.1%. None of the patients developed fungal infection during admission. The rate of admission due to sepsis after discharge was 27% in the alive group (mean onset of 54 days), and 73% in the deceased group (mean onset of 52 days) (p<0.05). The most common site of infection was lung (70%). The rate of cytomegalovirus (CMV) antigenemia (positive PP65) was 20% during the 2-year period after HSCT. CONCLUSION: The rate of infection was a negative prognostic factor for 2-year overall survival. The rate of CMV antigenemia is less than similar studies (51%), which could be due to full-matched donor-recipients requiring less immunosuppression.

Self-reported versus proxy reported quality of life for breast cancer patients in the Islamic Republic of Iran.

Since quality of life (QoL) is subjective, self-reported QoL is the main source of assessment; however, in some situations the patient cannot evaluate his/her own status. In this cross-sectional study, 148 patients with breast cancer referred to the Cancer Institute of the Islamic Republic of Iran and their caregivers were selected through the consecutive sampling method. Five oncologists from this centre also evaluated the QoL of these patients. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was completed by these 3 groups and the results compared. The patient-caregiver intra-class correlation coefficient (ICC) for all 15 QLQ.C30 domains was moderate to good (ICC = 0.41-0.76). Agreements between QoL scores of patients and those of oncologists were moderate to good, except in the 4 domains. In the patient-caregiver comparison there was 55% exact agreement, and for the patient-physician comparison agreement was 45%. The findings can be used in the patients' decision-making process and care planning when patients with breast cancer are unable to self-report the QoL.

Self-reported versus proxy reported quality of life for breast cancer patients in the Islamic Republic of Iran

Since quality of life [QoL] is subjective, self-reported QoL is the main source of assessment; however, in some situations the patient cannot evaluate his/her own status. In this cross-sectional study, 148 patients with breast cancer referred to the Cancer Institute of the Islamic Republic of Iran and their caregivers were selected through the consecutive sampling method. Five oncologists from this centre also evaluated the QoL of these patients. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was completed by these 3 groups and the results compared. The patient-caregiver intra-class correlation coefficient [ICC] for all 15 QLQ.C30 domains was moderate to good [ICC = 0.41-0.76]. Agreements between QoL scores of patients and those of oncologists were moderate to good, except in the 4 domains. In the patient-caregiver comparison there was 55% exact agreement, and for the patient-physician comparison agreement was 45%. The findings can be used in the patients' decision-making process and care planning when patients with breast cancer are unable to self-report the QoL

La qualité de vie étant de nature subjective, l'auto-évaluation constitue l'instrument de choix pour la mesure de celle-ci. Pour autant, dans certaines circonstances, le patient n'est pas capable d'évaluer sa situation. Au cours de cette étude transversale, 148 patients adressés à l'Institut du Cancer de République islamique d'Iran pour un cancer du sein ont été sélectionnés avec leurs aidants à l'aide d'une méthode d'échantillonnage consécutif. Cinq oncologues travaillant dans ce centre ont également évalué la qualité de vie de ces patients. Le questionnaire Qualité de vie [QLQ] de l'Organisation européenne pour la Recherche et le Traitement du Cancer a été rempli par ces trois groupes et les résultats ont fait l'objet d'une comparaison. Le coefficient intra-classe [CIC] patient-aidant pour les 15 domaines du QLQ-C30 allait de modéré à bon [CIC= 0,41-0,76]. La concordance entre les scores des patients portant sur la qualité de vie et ceux des oncologues étaient compris entre [ modéré ] et [ bon ], excepté dans quatre domaines. La comparaison patient-aidant donnait une concordance exacte dans 55%, et la comparaison patient-médecin une concordance de 45%. Les résultats peuvent être utilisés au cours du processus de décision clinique et de planification des soins quand les patients atteints d'un cancer du sein ne sont pas en mesure d'évaluer eux-mêmes leur niveau de qualité de vie

Hepatocytes of donor origin in recipient liver after hematopoietic SCT in beta-thalassemia major patients.

BM and circulating cells contain stem cells with the potential to differentiate into mature cells of various organs. We determined whether stem cells transformed into hepatocytes. Biopsy specimens from liver were obtained from 11 patients who had undergone transplantation of hematopoietic stem cells from peripheral blood (eight patients) or BM (three patients). Four female patients had received transplants from a male donor and seven male patients had received transplants from a female donor. All patients had beta-thalassemia major and fibrosis in biopsy specimens from the liver before hematopoietic SCT. Hematopoietic stem cell engraftment was verified by STR analysis. The biopsies were studied for the presence of donor-derived hepatocytes using FISH of interphase nuclei and immunohistochemical staining for CD45 (leukocyte common Ag), and a hepatocyte-specific Ag. All 11 recipients of sex-mismatched transplants showed evidence of complete hematopoietic donor chimerism. XY-positive hepatocytes accounted for 4-6.7% of cells in histological sections of the biopsy specimens of female patients and XX-positive hepatocytes accounted for 3-7% of cells in histological sections of the biopsy specimens of male patients. These cells were detected in liver tissue as early as 1 year and as late as 8.5 years after hematopoietic SCT. BM and circulating stem cells can differentiate into mature hepatocytes in beta-thalassemia major patients who had undergone hematopoietic SCT.