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Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma
Ahmed Elhemaly,
Ahmed Fathalla,
Mahmed Elhusseny,
Mohamed Fawzy
Issue:
Volume 9, Issue 2, June 2021
Pages:
85-91
Received:
13 March 2021
Accepted:
27 March 2021
Published:
7 April 2021
Abstract: Background: High-risk Neuroblastoma (N. B) patients have a poor outcome with 5-year survival rates of 50%. Patients with stage 4 disease or MYC-N amplification showed post-progression 5y O. S. of 7% to 8%. Other studies proved the same dismal outcome in high-risk relapsed patients. This study aimed to detect the O. S. and EFS of N. B patients post-progression. Secondary to explore, if initial prognostic factors, high-intensity salvage therapy and other treatment modalities could improve the outcome of progressive /refractory disease. Methods: Seventy patients of high-risk Neuroblastoma needed salvage therapy, either due to refractory/progressive disease or irresectability of the primary tumor. Initial prognostic factors and different treatment strategies were collected and correlated with the outcome. Results: Fifty-seven (57 /70) patients died from progressive disease with a median survival of 20.6 months with three y EFS and O. S. of 9.5% and 35.7%, respectively. Objective response (CR/VGPR/PR) post-induction, consolidation by HSCT, radiotherapy, and maintenance therapy; affected survival significantly post salvage therapy. Multivariate analysis revealed that the only independent factor that significantly affected O. S was maintenance therapy. The independent factors that affected the EFS negatively were the presence of liver metastases, poor response post-induction, and not administering radiotherapy. Conclusion: Response to induction had a significant impact on the outcome post salvage. Salvage therapy did not improve the outcome for those with inadequate induction response. Initial front-line targeted therapy like antiGD2 is needed to improve the outcome, especially for chemo-resistant ones.
Abstract: Background: High-risk Neuroblastoma (N. B) patients have a poor outcome with 5-year survival rates of 50%. Patients with stage 4 disease or MYC-N amplification showed post-progression 5y O. S. of 7% to 8%. Other studies proved the same dismal outcome in high-risk relapsed patients. This study aimed to detect the O. S. and EFS of N. B patients post-...
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Risk Factors and Molecular Study of Vimentin Gene (VIM), Associated with Female Breast Cancer in Khartoum, Sudan
Hala Abdalgader Khairalseed Abas,
Hind Abdelaziz Elnasri,
Mona Abdelrahman Mohmed Khaier
Issue:
Volume 9, Issue 2, June 2021
Pages:
92-97
Received:
31 May 2020
Accepted:
4 July 2020
Published:
8 May 2021
Abstract: Background: The aim of this study was to investigate the possible risk factors and mutations in VIM gene among Sudanese’s breast cancer women in Khartoum State. Methods: This case-control study involved 45 patients with breast cancer and 45controls. It was conducted across three hospitals and two laboratories in Khartoum State. A structural questionnaire was used to obtain data regarding age, family history, menarche, marriage, menopause, pregnancy, nulliparous and parous women, breast-feeding, use of fertility or contraceptive drugs and grade of the disease. DNA from patient and control tissues was extracted using extraction kits. PCR was conducted to amplify VIM gene using specific primers. PCR products were sequenced in order to detect the mutation in VIM gene. Data was analyzed using Pearson’s Chi-square tests to identify risk factors associated with breast cancer. Results: The study showed that the main risk factors associated with breast cancer were family history with first degree relative, menarche, irregularity of menarche, reproductive factors such as pregnancy, breast-feeding and nulliparous. DNA sequencing revealed no mutations in VIM gene associated with breast cancer in Sudanese women in Khartoum State. Conclusion: The association of other risk factors such as menopausal status, age of menopausal, oral contraceptive birth control and fertility hormones needs more illumination and further work. Other genes associated with breast cancer can be investigated.
Abstract: Background: The aim of this study was to investigate the possible risk factors and mutations in VIM gene among Sudanese’s breast cancer women in Khartoum State. Methods: This case-control study involved 45 patients with breast cancer and 45controls. It was conducted across three hospitals and two laboratories in Khartoum State. A structural questio...
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Outcome of Sentinel Lymph Node Biopsy with Methylene Blue Dye in Early-stage Breast Cancer
Khandakar A. B. M. Abdullah Al Hasan,
A. F. M. Anowar Hossain,
Md Ashiqur Rahman,
Sabiha Sultana
Issue:
Volume 9, Issue 2, June 2021
Pages:
98-105
Received:
3 April 2021
Accepted:
21 April 2021
Published:
14 May 2021
Abstract: Background: Axillary staging is the standard of care for all breast cancers amenable to curative treatment. Sentinel lymph node biopsy (SLNB) has been established as the gold standard for axillary staging and has supplanted axillary lymph node dissection (ALND) as a means of regional nodal staging in clinically node-negative breast cancer. Different blue dyes like isosulfan blue dye, patent blue, sulfan blue, radio labeled substances, and methylene blue dye (MBD) have been evaluated for the sentinel node procedure. Aim of the study: The aim of this study was to assess the efficacy of sentinel lymph node biopsy with methylene blue dye in clinically axillary node negative early-stage breast carcinoma as well as to observe the early postoperative outcome of SLN procedure. Method: Between November 2015 to October2017, a total of 18 female patients of 18 years and above, with diagnosis of early-stage (T1/T2) breast carcinoma with clinically negative ipsilateral axillary lymph nodes were studied in the department of surgical oncology, NICRH. Written informed consents were obtained from all patients. Results: In this study, the highest population was in 31-50 years age group with a mean age of 46(SD 12). Out of 18 cases, SLN(s) was identified in 15 cases by using MBD. The identification rate was 83.3%. In frozen section biopsy all SLNs were found positive for malignant cells. Two or more SLNs were positive in 12(66.6%) cases where SLNB was extended to ALND. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 100, 50, 80 and 100, respectively. Postoperative morbidity was significantly high in ALND group. Conclusion: This study showed that SLNB is a safe procedure and efficacy of this procedure was very significant. It lowers the unnecessary extended surgery (ALND) which has troublesome postoperative complications. Multicenter studies are required to extract more relevant information in this regard.
Abstract: Background: Axillary staging is the standard of care for all breast cancers amenable to curative treatment. Sentinel lymph node biopsy (SLNB) has been established as the gold standard for axillary staging and has supplanted axillary lymph node dissection (ALND) as a means of regional nodal staging in clinically node-negative breast cancer. Differen...
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Expression of HER2 in Gastric Carcinoma According to Tumor Location
Monoar Hossain,
Miranur Rahman,
Mohammad Sahajadul Alam,
Monzurul Islam
Issue:
Volume 9, Issue 2, June 2021
Pages:
106-110
Received:
22 April 2021
Accepted:
31 May 2021
Published:
7 June 2021
Abstract: Introduction: HER2/neu (c-erbB-2) is an oncogene that encodes a transmembrane glycoprotein with tyrosine kinase activity known as 185 kDa. This 185 kDa belongs to the epidermal growth factor receptor. Though HER-2 expression has been extensively found in advanced gastric cancer, few recent studies have evaluated the same in early gastric cancers. HER-2 overexpression is considered one of the poorest prognostic variables after nodal status in early gastric cancers too. Aim of the study: To find out the expression of HER2 in gastric carcinoma according to tumor location. Material & Methods: This cross-sectional study was conducted in the Department of Surgical Oncology of National Institute of Cancer, Research and Hospital, Mohakhali, Dhaka. The study period was from March 2014 to April 2015. A total of 80 patients were included in the study. After receiving the gastrectomy specimen, it was fixed in 10% formaldehyde. Statistical analysis was carried out using a computer-based software package for social science (SPSS 16.1). Ethical clearance was taken from the ethical committee of NICRH. Results: The highest patients were from the 61-70 years age group and the lowest were from 71-80 years. The mean age of the patients was 59.71 (±10.19) years. The female to male ratio in this study was 1: 2.48. The leading number of patients presented with abdominal pain where the vague abdominal discomfort was also included. They were 75%. This clinical condition was followed by vomiting which coined 58.75% of respondents. Out of 80 patients, 27 (33.75%) patients bore A +ve blood group whereas 23 (28.75%) patients had B+ve blood group. Most of the tumors were located in the distal (Noncardiac) part of the stomach (75%). Regarding staging 79 (98.75%) patients were in the advanced stage of the disease. Most of the tumors were located in the distal part of the stomach (11.67%). Conclusion: We reported a 12.5% of positive HER2 expression (IHC=3+ & 2+) in a series of 80 surgical specimens of gastric cancer patients. We also observed that positive HER2 expression varied depending on the histology and the primary tumor localization.
Abstract: Introduction: HER2/neu (c-erbB-2) is an oncogene that encodes a transmembrane glycoprotein with tyrosine kinase activity known as 185 kDa. This 185 kDa belongs to the epidermal growth factor receptor. Though HER-2 expression has been extensively found in advanced gastric cancer, few recent studies have evaluated the same in early gastric cancers. H...
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Pathosphysiology of Chronic Myeloid Leukemia, Prognistic Factors and Emerging Treatment Options in a Low Resource Economy
Patrick Olanrewaju Osho,
Okunnuga Ndidi,
Ojo Matilda,
Odunlade Olufunke
Issue:
Volume 9, Issue 2, June 2021
Pages:
111-121
Received:
21 April 2021
Accepted:
17 May 2021
Published:
25 June 2021
Abstract: Chronic myeloid leukemia (CML) is a triphasic clonal myeloproliferative disorder characterized by the presence of Philadelphi a chromosome (Ph) in over 95% of cases alongside excessive accumulation of clonal myeloid cells in hematopoietic tissues. This occurs as a result of reciprocal translocation between the long arms of chromosome 9 and 22 t (9;22) (q34; q11) creating the fusion oncogene BCR–ABL1 which exhibits constitutive tyrosine kinase activity. It is one of the commonest haematological malignancies in low economies around the world including Nigeria. The clinical features of CML are often described in 3 phases namely the chronic phase (CP), accelerated phase (AP), and blastic phase (BP) while CP is the most common stage with progression to AP and BP occurring later. Despite that, prognosis of CML is dependent on phase of disease, age, and response to therapy, the only curative approach in use currently is hematopoietic stem cell transplantation with other drugs being used for cytogenetic responses. This study focuses on the aetiopathophysiology, cytogenetics, molecular biology, clinical/laboratory features and treatment options of CML. Rigorous review of literature on the study was retrieved from relevant oncology journals and textbooks abstracted and indexed in PubMed, Google Scholar, ProQuest, CINAHL, and Science Direct. The study discovered that, resistance of CML to imatinib has been reported with research having reached the advanced stage on the use of alternative drugs (e.g., Nilotinib and Desatinib). There are also potentials for these new drugs to become the treatment choice and first line drugs for the treatment of CML.
Abstract: Chronic myeloid leukemia (CML) is a triphasic clonal myeloproliferative disorder characterized by the presence of Philadelphi a chromosome (Ph) in over 95% of cases alongside excessive accumulation of clonal myeloid cells in hematopoietic tissues. This occurs as a result of reciprocal translocation between the long arms of chromosome 9 and 22 t (9;...
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The Landscape of Checkpoint Inhibition in the Management of Hematological Malignancies
Shukaib Arslan,
Alex Herrera,
Monzr Al Malki
Issue:
Volume 9, Issue 2, June 2021
Pages:
122-130
Received:
25 May 2021
Accepted:
8 June 2021
Published:
30 June 2021
Abstract: The programmed-death 1 (PD-1) and cytotoxic T-lymphocyte associated protein 4 (CTLA-4) pathways are inhibitory immune checkpoints involved in the escape of cancer cells from the immune system. Inhibition of these immune checkpoints can lead to the induction of body’s immune response to these cancer cells. To activate the immune system against the tumor cells, various monoclonal antibodies targeting these pathways have been developed. Many of such antibodies have been approved for therapy in solid tumor malignancies and now some hematological malignancies. Here, we review the available data regarding the response to PD-1 and CTLA-4 pathway blockade in hematological malignancies including Hodgin lymphoma, non-Hodgkin lymhoma, multiple myeloma and myeloid neoplasms as well as before and after hematopoietic cell transplantation. We also discuss the specific concerns and differences related to their use in hematological malignancies (HMs) as compared to solid tumors.
Abstract: The programmed-death 1 (PD-1) and cytotoxic T-lymphocyte associated protein 4 (CTLA-4) pathways are inhibitory immune checkpoints involved in the escape of cancer cells from the immune system. Inhibition of these immune checkpoints can lead to the induction of body’s immune response to these cancer cells. To activate the immune system against the t...
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