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Combination therapy of Fludarabine and Cyclophosphamide(FC) Combination Regimen in advance stage of Chronic Lymphocytic Leukemia

Background: the exposure of  chronic lymphocytic leukemia (CLL) cells to fludarabine and cyclophosphamide resulted in an increased, synergistic cytotoxicity . DNA repair mechanisms in CLL cells, which are initiated in response to cyclophosphamide exposition, are inhibited by fludarabine. This observation was later translated into clinical trials evaluating the combination of fludarabine plus cyclophosphamide (FC) showed promising efficacy with response rates exceeding 90% in previously untreated and pretreated patient

Aim of  this study: To assess the efficacy and safety of combination therapy of fludarabine plus cyclophosphamide in  Iraqi adults patients with advance stage of chronic lymphocytic leukemia (CLL) in both previously treated and untreated patients and to assess the treatment free  and  overall survival in CLL patient who are receiving FC regimen therapy.

Patients and methods: Single arm study was done between February 2005 and fabruary2009.This study included 64 Iraqi patients aged between 39-77years old with advanced stage CLL .All patients  received FC combination Therapy(fludarabine25mg/m2 plus cyclophosphamide 250mg/m2 for 3 days intravenously, repeated every 28 days). Treatment was administered for 4-6 courses. Forty eight(75%) patients were treatment naive(N) and 16(25%)were previously treated(Y) with alkylating agent.

Results: This combination chemotherapy resulted in 39.1% complete remission rate(CR) and 39.1%partial remission(PR) rate with overall response rated78.2%.The  2years median treatment-free survival was 90% with the median duration of response was 18months. Also  there was a significant difference(p value <0.005) between different stage group(C&B) and degree of response, with better response rate  in those with stage C than those with stage B, as the overall response rate was 88.3% and 65.5%  respectively.

By common toxicity criteria (CTC) grading, the major toxicity(grade 3-4) in  patients who treated by FC regimen were  nausea and vomiting while the myelosuppression was prominent complication  of grade 1&2 as leucopenia  and neutropenia occur in 19%, 14% respectively however this is not increased the number of severe infections.

Conclusion: Fludarabine and cyclophosphamide combination regimen is an effective therapy for patients with advance CLL with high response and complete remission rate in those untreated and pretreated CLL patients, with good tolerability to this combination

 

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Publication Date
Mon Jul 01 2013
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Immunohistochemical analysis of CD34 to evaluate angiogenesis in chronic lymphocytic leukemia

Background: Chronic lymphocytic leukemia (CLL) results from a progressive accumulation of long-lived, functionally incompetent, nonproliferating lymphocytes.
Angiogenesis is defined as the formation of new capillaries from pre-existing blood vessels and plays an important role in the progression of solid tumors as well as several hematologic malignancies like CLL.
Patients and methods: A retrospective cross-sectional study done on 68 patients with CLL compared with 15 control individuals (anemic patients), all recruited at the Medical City Teaching Laboratories from January 2005 to December 2008. The bone marrow biopsy (BMB) of each was re-examined histologically. Immunohistochemical (IHC) technique was performed on BMB sections ut

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Publication Date
Sun Jul 01 2012
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Outcome of 49 Iraqi adult patients with Chronic Lymphocytic Leukemia treated with oral alkylating agent:

Background: Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with an extremely variable course. Survival after diagnosis can range from months to decades and wide variability exists in the rate of disease progression and the incidence of disease-related complications among patients with CLL. Staging helps to define prognosis and to decide when to initiate therapy.
Objective: To asses response to oral alkylating therapy and to evaluate the adverse events that can complicate the disease itself or the treatment, including infections, autoimmune and other complications. The survival events are also been assessed.
Patients and methods: Forty nine Iraqi CLL patients, their age ranged between 40-90 years were followed with me

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Publication Date
Wed Jan 02 2013
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Evaluation of Bcl 2 and Ki 67 expression in Chronic Lymphocytic Leukemia .

Background :Chronic lymphocytic leukemia (CLL) is a low-grade B-lineage lymphoid malignancy. Both  Ki-67 which is a large nuclear protein associated with cell proliferation and Bcl-2 which is an anti-apoptotic protein which is associated with dysregulation of the intrinsic apoptotic pathway , were thoroughly investigated in many cancer patients particularly in hemopoietic malignancies .

Patients, materials and methods: This retrospective study was conducted from November 2009 to May 2010 , on fifty formaline fixed paraffin embedded blocks of CLL cases retrieved from Medical City Teaching Hospital ; their age range was 39-75 years along with twenty control cases with benign r

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Publication Date
Sun Jul 01 2012
Journal Name
Journal Of The Faculty Of Medicine Baghdad
mRNA in situ hybridization analysis of MMP-9 in chronic lymphocytic leukemia

Background: Several factors render chronic lymphocytic leukemia (CLL) an interesting subject for study by researchers. These include marked progress in understanding the molecular biology of normal and neoplastic lymphocytes and recent advances in molecular genetics techniques. Among molecular markers, matrix metalloproteinase-9 (MMP-9), have been widely studied.
Objectives: The aim of the study is to evaluate the role of MMP-9 in the pathogenesis of CLL and to assess its prognostic role.
Patients and methods: A retrospective cross-sectional study done on 60 patients with chronic lymphocytic leukemia compared with 20 controls (anemic patients), all recruited at the Medical City Teaching Hospital laboratories from January 2004 to De

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Publication Date
Mon Jul 01 2013
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Mutant P53 expression in chronic myeloid leukemia

Background: Chronic Myeloid Leukemia (CML) occurs due to malignant transformation of a pluripotent stem cell.  Progression is insidious from chronic to aggressive accelerated or blastic phases. Studies revealed a significant role of the tumor suppressor gene P53 in disease progression.

Objectives: To evaluate the immunohistochemical expression of mutant P53 protein in CML at different clinical phases.

J Fac Med Baghdad

2013; Vol.55, No .3

Received Nov .2012

Accepted July.2013

 

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Publication Date
Wed Apr 01 2015
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Immunohistochemical study of p-53 protein expression in chronic lymphocytic leukemia and its correlation with clinicopathological factors

Background: several factors render chronic lymphocytic leukemia an interesting subject for study by researchers. These include marked progress in understanding the molecular biology of normal and neoplastic lymphoid cells and recent advances in molecular genetics techniques. Among molecular markers, p-53 cancer suppressor gene has been widely studied.
Objectives: is to correlate p-53 protein expression in chronic lymphocytic leukemia, as examined by immunohistochemical method, with some pathological and clinical parameters.
Patients and methods: this is a retrospective study; whereby archival paraffin-embedded bone marrow tissue blocks along with the clinical and hematological records of fifty patients (35 males and 15 females), wi

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Publication Date
Sun Oct 02 2011
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Bone Marrow Fibrosis in Chronic myeloid leukemia (CML) and other Myeloproliferative Disorders Evaluated by Using Special Histochemical Stains for Collagen.

Background: It is still difficult to give a final diagnosis in chronic myeloproliferative disorders (CMPDs) because of the overlap of the common pathological and clinical features of these disorders like bone marrow fibrosis which is considered important because it affects the normal function of the bone marrow. The collagen fibers are of different types, but in the bone marrow, the two main types are: collagen I, which is the most abundant type and collagen III (reticular) which is often associated with type I.
Objectives:To study bone marrow fibrosis (BMF) in samples of bone marrow biopsies (BMB) of chronic myeloid leukemia (CML) and other chronic myeloproliferative disorders using histochemical stains to establish the grade of fibr

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Publication Date
Sun Jul 03 2011
Journal Name
Journal Of The Faculty Of Medicine Baghdad
mRNA in situ hybridization analysis of VEGF in chronic lymphocytic leukemia

Background: Several factors render chronic lymphocytic leukemia (CLL) an interesting subject for study by researchers. These include marked progress in understanding the molecular biology of normal and neoplastic lymphocytes and recent advances in molecular genetics techniques. Among molecular markers, vascular endothelial growth factor (VEGF), have been widely studied.
Objective: The aim of the study is to evaluate the role of VEGF in the pathogenesis of CLL and its role in disease progression.
Patients, materials and methods: A retrospective cross-sectional study was done on 60 patients with chronic lymphocytic leukemia (45 males & 15 females) compared with 20 controls (anemic patients), all recr

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Publication Date
Tue Dec 06 2022
Journal Name
Iraqi National Journal Of Nursing Specialties
Quality of Life of Children age from (8- lessthan13) years with Acute Lymphocytic Leukemia Undergoing Chemotherapy at Hematology Center in Medical City

Objective (s): To assess the QoL of children age from (8- lessthan13) years with acute lymphocytic leukemia undergoing chemotherapy and to find out the relationship between the QoL of children with acute lymphocytic leukemia and their illness history.

Methodology:  A descriptive study included (40) children with acute lymphocytic leukemia who were ranged between (8 - less than 13 years) at the Hematology Center in Medical City for the period from 4th March 2021 to 1st September 2021. The sample was non-probability (purposive) sample of children (male and female). A questionnaire designed with 2 main parts was used. The first part focused on sociodemographic characterist

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Publication Date
Sun Jan 04 2015
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Association between Leukemia and Exon 2 CD19 Gene Variants in a sample of Iraqi Patients

Background: The human CD19 (Cluster Differentiation) antigen is a 95 kd transmembrane glycoprotein belonging to the immunoglobulin superfamily. CD19 gene located on the short arm of chromosome 16p11.2 (P: petit). CD19 is a member of the Ig immunoglobulin superfamily expressed on the surface of B lymphocytes, and may play a pivotal role in B-cell differentiation and activation. Research suggests that mutations in a gene CD19 leads to a lack of expression of CD19 membrane and result in an antibody deficiency syndrome.
Objective: The aim of this work is to study the mutations in Exon 2 CD19gene in leukemia patients in Baghdad/Iraq.
Patients and Methods: This cross sectional study was performed in the National

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