Background: The present study was conducted considering the increased number of patients with BMT, and the increasing sensitivity of the patients, due to taking immunosuppressive drugs against CMV which is an organism of the Herps family, and it's following complications. The patients may survive under prompt and timely treatment if they are diagnosed to be infected by CMV. The present study is one of the rare studies conducted here. Unfortunately, no access was found to the previous literature. The study is prospective, preformed on 145 patients who were in bed at BMT Ward at Shariati Hospital here in Tehran, Iran.Generally, the clinical diagnosis of CMV infection is really hard, while its diagnosis is impossible in some cases and the presence of the virus or its antigens have to be traced with laboratory equipment. The best method is virus culture in specific environment. However, the basis study was identifying the infection of the polymorphonuclar cells to Protein PP65, which is a phosphoprotein in the lower matrix of the CMV virus and is considered as a basic antigen in virus reproduction.Materials & Methods: The method of the study is immuno-fluorescence. The cells infected with PP65 antigen were dyed using monoclonal antibodies and were seen under immuno-fluorescence microscope. For the announcement of the results, 3x104 WBCs were analyzed and the results were announced using semi-quantifiable method (the number of the cells positive for CMV in 50000 cells). The positive cells of the homogenous nuclei were yellow-green, while the negative cells were colorless. It should be noted that along with the patient samples, the positive and negative controls with kits were used as well. The, results of the present study were reported only by "positive" or "negative". All patients were under treatment through immunosuppressive drugs. The study was conducted weekly (during the first month after transplantation), while it was repeated monthly (for 12 consecutive months). The age of the patients ranged between 3-71, and the test repetition was asked upon the physician's request. The study was done using the CMV Brite turbo kits made at IQ Products Factory, and was tested at a private hospital.Findings: Of 145 patients who were under BMT at different ages and for different reasons, 60 cases showed positive antigens for PP65 (41.4%, 37 males & 23 females). In people with autologous BMT (15.4%) and in cases with allogenic BMT a frequency distribution of 47% was found, showing an increase in the CMV antigenemia in allogenic BMT cases.Conclusion: Considering the high rate of the patients under BMT, and regarding the importance of the prompt diagnosis and treatment in patients with CMV infection, it is suggested that this test be performed before and after BMT in all patients with BMT or those using immunosuppressive drugs. The comparison among other diagnostic methods, such as virus culture and PCR is also recommended. The frequency distribution of CMV infection among the apparently healthy donors is also suggested. The study of the antigenemy prevalence with clinical severity and the study of the PP65 predictive value with the amount of the semiquantifiability value as well as comparative studies in the transplantation of other argans such as the kidney, or the bone marrow are well suggested.

The increasing incidence of aspergillosis emphasizes to improve the diagnostic tools. Aspergillus fumigatus is associated with a high rate of mortality among patients receiving Bone Marrow Transplantation (BMT).Diagnosis in the early stages of invasive aspergillosis (IA) is very difficult, as clinical and radiological sings are nonspecific. In this study, we used nested PCR technique to diagnose IA in BMT recipients.

Hematopoietic stem cell transplantation (HSCT) has been practiced for more than 30 years. Hematological malignancies are the main indications for this treatment. However, its indications in adults are different from children. Advances in chemotherapy and target therapy have improved treatment outcome of some of the very high risk cancers, and changed indications of HSCT in children. Multi-center clinical trials evaluating outcome of childhood cancers using different therapeutic protocols are needed to precisely define the role of HSCT. A review on the current literature about HSCT indications in pediatric cancers is presented in this manuscript.

Background: Thrombocytopenia is a frequent complication after hematopoietic stem cell transplantation (HSCT). Although platelet transfusion is the most used treatment for severe thrombocytopenia, it is associated with well-established risks. High-intensity interval exercise (HIIE) results in thrombocytosis. Therefore, this study aimed to reduce thrombocytopenia by increasing platelet count through exercise. Materials and Methods: Twenty lymphoma and multiple myeloma patients were divided into HIIE and control groups. To determine the maximal exercise capacity, patients in the HIIE group performed a graded exercise test. All patients received granulocyte colony-stimulating factor for 5 days, followed by a HIIE trial. After 5 min warm up at 10 to 20% of peak power, patients in the HIIE group performed an HIIE protocol that included 12 intervals of one-minute work at 100% peak power interspersed by one-minute active rest at 20% of peak power. Patients in the control group were seated for the same duration without any physical activity. Two blood samples were taken before and immediately after the trials and were analyzed for measuring complete blood count. Results: Platelet count on the day of platelet engraftment in the HIIE group was significantly higher than in the control group (P=0.02). Single-donor platelet transfusion was significantly lower in the HIIE group than in the control group (P=0.05). Conclusion: Based on the findings of the present study, a short bout of HIIE had a positive effect on platelet engraftment through thrombocytosis and reduced platelet transfusion and its complications, which could be a useful strategy for HSCT patients.

Introduction: Krabbe disease (KD) is an autosomal recessive disorder caused by mutations in the galactocerebrosidase (GALC) gene resulting in neuro-inflammation and defective myelination in the central and peripheral nervous systems. Most infantile patients present with clinical features before six months of age and die before two years of age. The only treatment available for presymptomatic or mildly affected individuals is hematopoietic stem cell transplantation (HSCT). In the animal models, combining bone marrow transplantation (BMT) with gene therapy has shown the best results in disease outcome. In this study, we examine the outcome of gene therapy alone. Methods: Twitcher (twi) mice used in the study, have a W339X mutation in the GALC gene. Genotype identification of the mice was performed shortly after birth or post-natal day 1 (PND1), using polymerase chain reaction on the toe clips followed by restriction enzyme digestion and electrophoresis. Eight or nine-day-old affected mice were used for gene therapy treatment alone or combined with BMT. While iv injection of 4 × 1013 gc/kg of body weight of viral vector was used originally, different viral titers were also used without BMT to evaluate their outcomes. Results: When the standard viral dose was increased four-and ten-fold (4X and 10X) without BMT, the lifespans were increased significantly. Without BMT the affected mice were fertile, had the same weight and appearance as wild type mice and had normal strength and gait. The brains showed no staining for CD68, a marker for activated microglia/macrophages, and less astrogliosis than untreated twi mice. Conclusion: Our results demonstrate that, it may be possible to treat human KD patients with high dose AAVrh10 without blood stem cell transplantation which would eliminate the side effects of HSCT.

Introduction: BCR/ABL fusions in hematopoeitic cells are known to induce resistance to apoptosis and cell changes in response to cell-cell and cell-matrix interactions, on the other hand, patients with TEL/AML1 gene fusions respond differently to treatment, depending on therapeutic protocols.Aims: We conducted a prospective cohort study to investigate how these translocations affect a person’s quality of life, and to evaluate their responses to bone marrow transplantation therapy.Methods and Materials: TEL, AML1, ABL and BCR probes were applied to cells during interphase, using cytogenetic techniques and FISH analysis to obtain the karyotype of 100 patients, which included genes involved in fusion, signal distributions, age, sex, positive familial background, and responses to therapies. After BMT was performed in 25 patients, all of the above data was collected once again and the results were compared.Results: In our study, 46% of child patients demonstrated an abnormal FISH pattern (23% with fused ABL/AML1, 3% with deletion, 7% with a gain in TEL gene, and 3% and 10% with deletion and a gain in AML1 genes, respectively. In adults, 27% had an abnormal FISH pattern, while 3% had fused TEL/AML1 genes and other abnormalities, as was evident in children. A gain in gene copy occured twice as often as a loss in gene copy, except for child ALL patients with t(12;21), where in 58% of cases, lost TEL gene children with  t(12;21) had longer survival periods, while adults with t(9;22) had shorter ones. Post BMT revealed that 65% of BM cells karyotyped normal, compared to 24% pre-BMT. WBC count increased positively with the onset of ALL, although an increase in WBC count decreased survival time. A relationship between positive familial background and ALL was also seen.Conclusion: FISH is the better method for diagnosing genetic disorders in ALL patients compared to other methods.

Introduction: Invasive aspergillosis is a major cause of morbidity and mortality in hematologic malignant patients which have received intensive cytotoxic therapy or undergone blood and marrow transplantation (BMT). Early clinical and radiological diagnosis of IA is almost impossible and so mortality is very high. The main purpose of our study was to assay the diagnostic value of serum galactomannan (a fungal antigen found in the sera of infected patients) level in early diagnosis of invasive aspergillosis in patients with hematologic malignancies and BMT.Method and materials: During 2009and2010, 70 adult patients with neutropenic fever of unknown origin in Shariati and Imam Khomeini centers of cancer and BMT were tested for galactomannan serum level on the 7th day of fever or before starting antifungal treatment. The OD index of 0.5 or more was taken as positive result. Tissue biopsy from lung or sinus was performed in 8 patients and there were 7 positive results for aspergillus species.Galactomannan EIA test result was positive in 26 cases (37.1%). There were 7 cases of proven IA with positive tissue (lung or sinus) biopsy and 20 cases of probable IA. Overall, 27 cases were positive for IA (gold standard=proven IA+pobable IA).Results: The study yields a sensitivity and specificity of 77.8% and 88.4% for this test, respectively. Positive and negative predictive value of the test with confidence interval of 95% was 80.8 % (60-92.7%) and 86.4 % (72.0-94.3%), respectively.Conclusion: Considering these results, galactomannan EIA test results must be interpreted cautiously as an alternative test to prove IA, and it doesn’t eliminate the need for other diagnostic criteria such as clinical symptoms, biopsy, imaging, etc. However, the test is substantially helpful in recognizing true cases of the disease.