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2022
Elnahass, Y. H., H. A. Nader, S. Sabet, H. A. Nooh, H. Bassiony, M. Kamel, M. O. H. A. M. E. D. A. Samra, H. K. Mahmoud, W. H. ElMetnawy, and F. A. Elrefaey, "High Frequency of ASXL1 and IDH Mutations in Young Acute Myeloid Leukemia Egyptian Patients.", Asian Pacific journal of cancer prevention : APJCP, vol. 23, issue 3, pp. 977-984, 2022. Abstracthigh_frequency_of_asxl1_and_idh_mutations_in_young_acute_myeloid_leukemia_egyptianpatients.pdf

BACKGROUND: Prognostication of AML patients depends on association of genetic and epigenetic abnormalities. We aimed to evaluate the frequency and prognostic significance of Additional Sex comb's Like1 (ASXL1), Isocitrate Dehydrogenase (IDH) and Casitas B- lineage Lymphoma (CBL) mutations in AML assessing their association with different cytogenetic risk category.

METHODS: We used High Resolution Melting (HRM) technology that detects small differences in PCR amplified sequences by direct melting using EvaGreen saturating dye to analyze epigenetic mutations in 70 denovo AML patients.

RESULTS: Median age of AML patients was 39.5 years (18-75). ASXL1, IDH and CBL mutations were detected in 14 (20%), 10 (14%) and 5 (7%) patients, respectively. Mean age of ASXL1 and IDH mutants vs. wild type was 35.9±14.6 years and 42.9±14.4 years (p=0.114) and 46.7±15.2 years vs. 40.6±14.5 years (p=0.290), respectively. AML cytogenetic risk groups included low (25/70, 36%), intermediate (33/70, 47%) and high-risk (12/70, 17%). Nine/14 (64%) ASXL1 and 8/10 (80%) IDH mutants were classified as intermediate risk and 9 ASXL1 positive (64%) were adolescent and young adults (AYA). Overall survival (OS) of mutant ASXL1 vs. wild type was 1.1 years (95% CI 0.83-1.4) vs. 1.9 years (95% CI 0.71-7.51), respectively (p=0.056). OS of mutant IDH vs. wild type was 1.25 years (95% CI 0.85-1.6) vs. 1.8 years (95% CI 1.2-6.7), respectively (p=0.020). In intermediate risk cytogenetic group, ASXL1 and IDH mutants had shorter OS than wild type; 1.1 years (95% CI 0.97-1.2) vs. 2.1 years (95% CI 0.14-10.8) (p=0.002) and 1.8 years (95% CI 0.69-3.15) vs. 2.3 years (95% CI 1.1-5.5) (p=0.05), respectively.

CONCLUSION: ASXL1 and IDH mutations occur at a high incidence among young Egyptian AML patients with intermediate risk cytogenetics and confer a poorer outcome. Integration of mutations into risk profiling may predict outcome and impact therapeutic approach of young AML patient with uncertain prognosis.

Kamel, A. M., N. M. El Sharkawy, E. Z. Kandeel, M. Hanafi, M. Samra, and R. A. Osman, "Leukemia Stem Cell Frequency at Diagnosis Correlates With Measurable/Minimal Residual Disease and Impacts Survival in Adult Acute Myeloid Leukemia.", Frontiers in oncology, vol. 12, pp. 867684, 2022. Abstractleukemia_stem_cell_frequency_at_diagnosis.pdf

Acute myeloid leukemia (AML) is a heterogenous disease in which the initiation and maintenance of the malignant clone is blamed on a rare population of leukemia stem cells (LSCs). The persistence of such a malignant population is referred to as measurable/minimal residual disease (MRD). Evaluation of MRD is the gold standard for follow-up of therapy and constitutes an independent prognostic parameter. As LSCs are the main contributor to the persistence of MRD, then MRD should correlate with the bulk of LSCs at the individual case level. MRD is measured at defined time points during therapy. However, LSCs can be evaluated at diagnosis, which ensures the advantage of early prediction of high-risk patients and allows for early therapeutic decisions. Using two simple four-color monoclonal antibody combinations (CD38/CD123/CD34/CD45 and CD90/CD133/CD45/CD33) and the prism function of the Coulter Navios flow cytometer, the frequency of LSC subsets was evaluated in 84 newly diagnosed adult AML patients. For each panel, 16 possible combinations were detected. Our results showed that there was extreme variability in the percentage of the LSC fraction between different cases, as well as at the individual case level. For each LSC subset, the median value was used to divide cases into low and high expressors. LSC subsets that showed an impact on overall survival (OS) and disease-free survival (DFS) included CD123+, CD 123+/CD34-, CD34-/CD38+/CD123+, CD34+/CD38-/CD123+, CD133+, and CD133+/CD33-. On multivariate analysis, only CD123 (p ≤ 0.001, SE = 0.266, HR = 2.8, 95% CI = 1.74.7) and CD133+/CD33- (p = 0.017, SE = 0.263, HR = 1.9, 95% CI = 1.1-3.1) retained their significance for OS. Likewise, only CD34+/CD38-/CD123+ (p ≤ 0.001, HR 2.3, SE: 0.499, 95% CI: 2.4-17.4) and CD133 (p = 0.015, HR 2.3, SE 0.34, 95% CI: 1.2-4.4) retained their statistical significance for DFS. The LSC frequency at diagnosis showed a moderate to strong correlation with MRD status at day 14 and day 28. In conclusion, the level of LSCs at diagnosis correlated with MRD status at day 14 and day 28 in AML patients and had a deleterious impact on OS and DFS. It may be used as an early marker for high-risk patients allowing for early therapeutic decisions.

2021
Kandeel, E. Z., L. Refaat, R. Abdel-Fatah, M. Samra, A. Bayoumi, M. S. Abdellateif, H. Abdel-Hady, M. Ali, and medhat khafagy, "Could COVID-19 induce remission of acute leukemia?", Hematology (Amsterdam, Netherlands), vol. 26, issue 1, pp. 870-873, 2021. Abstract

BACKGROUND: COVID-19 viral pandemic caused many mortalities in cancer patients especially those with hematological malignancies. The immunological response to COVID-19 infection is responsible for the outcome of cases whether mild, severe or critical.

CASE PRESENTATION: Two cases presented with moderate COVID-19 viral infection, concomitant with acute myeloid leukemia and T acute lymphoblastic leukemia, respectively. Surprisingly, after the administration of COVID-19 supportive therapy, the cases showed disease remission after a follow-up period of 12 and 5 months, respectively. Additionally, the blast cells dropped to only 3% and 0% in the bone marrow aspirates of those two cases, respectively, after it was 30% in both cases at diagnosis.

CONCLUSION: The immune response that emerged against COVID-19 infection could potentially produce anti-tumor immunity in some patients, or the virus may act as an oncolytic virus. However, further investigations are required to explain this phenomenon, which may help in finding a possible new targeted therapy for these cases.

Abdelfattah, N. M., M. E. L. Maadawy, O. A. Fahmy, A. Elhaddad, M. O. H. A. M. E. D. A. Samra, R. Abdel Fattah, and G. E. D. M. Fathy, "The Impact of CD34+ Cell Dose on the Outcome of Allo-HSCT in Adult SAA Patients Conditioned with a Non-ATG-Based Regimen with Post- Transplantation Cyclophosphamide from Fully Matched-Sibling Donors.", Proceedings of the Society of Hematologic Oncology (SOHO) 2021 Annual Meeting, Houston, Texas, USA, Clin Lymph Myel Leuk. September 2021. 21(Suppl. 1): Page S446: Poster CT-037., pp. S446, 2021.
Nooh, H. A., M. S. Abdellateif, L. Refaat, E. Z. Kandeel, A. Bayoumi, M. Samra, and medhat khafagy, "The role of inflammatory indices in the outcome of COVID-19 cancer patients.", Medical oncology (Northwood, London, England), vol. 39, issue 1, pp. 6, 2021. Abstract

To assess the prognostic role of different inflammatory indices on the outcome of cancer patients with COVID-19. Sixty-two adults and 22 pediatric cancer patients with COVID-19 infection were assessed for the prognostic value of certain inflammatory indices including the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), derived NLR (dNLR), systemic inflammation index (SII), mean platelet volume to platelet ratio (MPR), C-reactive protein to lymphocyte ratio (CRP/L), aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIRI), and neutrophil to lymphocyte, platelet ratio (NLPR). Data were correlated to patients' outcome regarding ICU admission, and incidence of mortality. Increased CRP/L ratio in adult COVID-19 cancer patients was significantly associated with inferior survival [152 (19-2253) in non-survivors, compared to 27.4 (0.8-681) in survivors (P = 0.033)]. It achieved a sensitivity (60%) and a specificity (90.2%) at a cut-off 152, while it achieved a sensitivity of 60% and specificity 95.1% at a cut-off 252 (AUC 0.795, P = 0.033). When combining both CRP/L and NLPR for the prediction of poor outcome in adult cancer patients with COVID19, the sensitivity increased to 80% and the specificity was 70.7% (AUC 0.805, P = 0.027). Increased incidence of ICU admission in pediatric cancer patients associated significantly with the severity of covid19 infection, decreased mean corpuscular hemoglobin (MCH) < 28.3, increased red cell distribution width (RDW) > 16, lymphopenia < 1.04, pseudo Pelger-Huet appearance, and PLR < 196.4 (P = 0.004, P = 0.040, P = 0.029, P = 0. 0.039, P = 0.050, and P = 0.040; respectively). The mean corpuscular volume (MCV), MCH, and RDW could be useful prognostic markers for poor outcome in COVID-19 pediatric cancer patients (P < 0.05 for all). Increased both CRP/L and NLPR associated significantly with poor survival in adult COVID-19 cancer patients, while PLR associated significantly with ICU admission in pediatric COVID-19 cancer patients.

2020
Elsisi, G. H., J. L. Carapinha, R. Afify, M. A. Elmoty, and M. Khalaf, "A budget impact analysis of lenalidomide in multiple myeloma Egyptian patients.", Journal of medical economics, pp. 1-8, 2020. Abstracta_budget_impact_analysis_of_lenalidomide_in_multiple_myeloma_egyptian_patients.pdf

INTRODUCTION: The aim of this study was to estimate the budget impact of lenalidomide and dexamethasone (RD) versus bortezomib, cyclophosphamide and dexamethasone (VCD) in newly diagnosed multiple myeloma (NDMM) and relapsed refractory (RR) MM patients, from the perspective of the Egyptian Ministry of health (MoH).

METHODS: Two budget impact dynamic models were conducted to assess the budget impact of RD entry over a 3-year period. The clinical data for the modeled cohorts were based on published articles. Total annual medical costs associated with non-progression and progression disease states included the sum of estimated costs for adverse effects management, concomitant treatments, hospitalization and the follow up were measured. Deterministic sensitivity analyses were performed.

RESULTS: The target population in a given year was estimated to include 245 patients with RRMM and 291 patients with NDMM receiving RD versus VCD. In RRMM, the annual budget savings of lenalidomide entry were estimated at EGP -1,103,969, -3,362,793 and -5,949,228 at year 1, year 2 and year 3, respectively. In NDMM, the annual budget savings of lenalidomide entry were estimated at EGP869,415, -1,779,776 and -2,139,311 at year 1, year 2 and year 3, respectively, to the payer after lenalidomide entry. The model results in RRMM were most sensitive to variations in patients eligible to transplantation in RRMM. In NDMM, the model results were most sensitive to the market share of VCD in the first year.

CONCLUSION: The results of our BI models suggest that not only does RD treatment have an effect on the budget, but also has major cost savings in other areas which are very important while considering the total costs of MM treatment. This study results provided evidence-based information to the MoH that will help in decision making of whether to implement RD as a treatment intervention or not.

Mahmoud, H. K., G. M. Fathy, A. Elhaddad, O. Fahmy, M. Abdel-Mooti, R. Abdelfattah, and M. Bokhary, "Hematopoietic Stem Cell Transplantation in Egypt: Challenges and Opportunities.", Mediterranean journal of hematology and infectious diseases, vol. 12, issue 1, pp. e2020023, 2020. Abstract5._hematopoietic_stem_cell_transplantation_in_egypt-_challenges_and_opportunities.pdf

Hematopoietic stem cell transplantation (HSCT) is now an established treatment modality with definitive indications for many hematological disorders. However, HSCT requires tremendous resources, and it is increasingly challenging for transplantation experts to practice in the developing world and to reach a compromise between requirements and available resources. Based on 30 years of experience and 4256 transplants (60% allogeneic and 40% autologous), this article focuses on the challenges our HSCT program encountered since it started in 1989 and what opportunities we see to solve them. Since 1997, HSCT procedures increased dramatically with the opening of 15 HSCT units distributed all over Egypt.

Alnagar, A., A. Mahmoud, M. Elgammal, N. Hamdy, and M. Samra, "Outcome of Core Binding Factor Acute Myeloid Leukemia by Receptor Tyrosine Kinase Mutation.", Clinical lymphoma, myeloma & leukemia, 2020. Abstract

BACKGROUND: Core binding factor acute myeloid leukemia (CBF-AML) encodes 2 recurrent cytogenetic abnormalities, t(8;21) and inv(16), which carries an overall good prognosis. However, some patients will develop a relapse. We sought define the unfavorable group of CBF-AML by analysis of (c-KIT and FLT3-ITD) and to correlate them with treatment outcome.

PATIENTS AND METHODS: We performed a prospective study of 70 patients with CBF-AML diagnosed and managed at the medical oncology department of the (National Cancer Institute), Cairo University, with analysis of c-KIT and FLT3 mutations. All patients had received "3 + 7" induction, followed by 3 to 4 courses of high-dose cytarabine consolidation. The institutional review board approved the present study.

RESULTS: The median patient age was 31 years (range, 18-60 years), with a male/female ratio of 4:3. Of the 70 patients, 42 (60%) had t(8;21) and 28 had inv(16) (40%). c-KIT mutations (exons 8 and 17) were detected in 10 of 52 tested patients, and FLT3-ITD was detected in 3 of 70 patients. Patients with inv(16) experienced more lymphadenopathy and splenomegaly, had a higher median initial leukocyte count. Hepatitis C antibody positivity (8 of 42) was exclusively present in patients with t(8;21). The median overall survival (OS) was 19.5 months, and the median disease-free survival (DFS) was not reached. Patients with inv(16) had near-significant (P = .07) better DFS than patients with t(8;21). c-KIT mutations had no significant effect on OS or DFS. However, reverse tyrosine kinase mutations had a negative effect on DFS but not OS (P = .04).

CONCLUSION: CBF-AML with reverse tyrosine kinase mutation conveys a worse prognosis. Hepatitis C virus antibody positivity might be associated with t(8;21) AML and inv(16) with more extramedullary disease.

AlDawsari, G., A. Elhaddad, R. El Fakih, T. Ben Othman, P. Ahmed, A. Ghavamzadeh, A. Bazarbachi, M. J. Dasouki, G. Fathy, H. Alzahrani, et al., "Outcome of hematopoietic stem cell transplantation (HCT) from HLA-matched related donor for Fanconi anemia (FA) in adolescents and adults: a retrospective study by Eastern Mediterranean Blood and Marrow Transplantation Group (EMBMT).", Bone marrow transplantation, 2020. Abstractoutcome_of_hct_from_hla-matched_related_donor_for_fa_in_adolescents_and_adults.pdf

Hematopoietic Stem Cell Transplantation (HSCT) is the only potentially curative treatment option for the hematologic complications that occur in patients with Fanconi anemia (FA). In this study, we present a retrospective multicenter analysis from the Eastern Mediterranean Blood and Marrow Transplantation Group (EMBMT) of matched related donor HSCT for FA in adolescents and adults transplanted between 1988 and 2015. Forty-five patients received HSCT with a median age at transplant of 18 years, the interquartile range (IQR) (15-23.5); 25 (55.6%) patients were females and 20 (44.4%) were males. Conditioning regimen was fludarabine-based in 29 (64.4%) patients, irradiation-based in five (11.1%) patients, and the remaining patients received other combinations. Indication for HSCT was bone marrow failure in 39 (86.7%) and myelodysplastic syndrome in six (13.3%) patients. Stem cell source was bone marrow in 22 (48.9%), peripheral blood in 20 (44.4%), umbilical cord blood in one (2.2%), and combination of bone marrow and cord blood in two (4.4%) patients. Twenty-seven (60%) patients engrafted and five (11.1%) had primary engraftment failure. The median time to neutrophil engraftment was 14 days (range 10-21 days); median time for platelet engraftment was 17 days (10-33 days). The probability of developing grade II-IV acute GVHD for all patients was 7.0% and chronic GVHD 36.6%. No new malignancies were reported. The OS probability was 53.6% (95% CI, 38.3-68.9%) with a median follow-up of 13 months (95% CI, 1-240). Our HLA-matched related HSCT results in AYA patients with FA compare favorably with other reported international registry data.

M., D., S. S., S. M., E. - N. Y., and A. E., "Prognostic Impact of Multiple Myeloma Cytogenetic Abnormalities on Outcome of Autologous Bone Marrow Transplantation: A Single-Center Experience", Society of Hematologic Oncology (SOHO) 2020 Annual Meeting, Houston Tx, USA, Clin Lymph Mye Leuk. September 2020. 20 (Suppl. 1): Page S309: Abst no MM375., pp. S309: Abst no MM375, 2020. prognostic_impact_of_mm_cytogenetic_abnormalities_on_outcome_of_asct-a_single-center_experience.pdf
kandeel, E., N. El Sharkawy, M. Hanafi, M. Samra, and A. Kamel, "Tracing Leukemia Stem Cells and Their Influence on Clinical Course of Adult Acute Myeloid Leukemia.", Clinical lymphoma, myeloma & leukemia, 2020. Abstract

BACKGROUND: Acute myeloid leukemia (AML) evolves from neoplastic transformation of stem cell disease termed "leukemia stem cells" (LSCs). An unsatisfactory response to AML therapy is determined by the presence of minimal residual disease (MRD). The predominance of LSCs might anticipate sustained MRD results. The present study aimed to demonstrate the effect of LSCs on MRD at induction days 14 and 28 on overall survival (OS) and disease-free survival (DFS) and to compare LSC expression with MRD status.

PATIENTS AND METHODS: A total of 84 patients with de novo adult AML underwent testing using LSC panels for CD38/CD123/CD34/CD45 and CD90/CD133/CD45/CD33 and different regular MRD panels.

RESULTS: At day 14 after induction, the high expression of CD123 and CD133 had adverse effects on both OS and DFS (P = .004 and P ≤ .001 and P ≤ .001 and P ≤ .001, respectively). Greater expression of CD34/CD38/CD123 resulted in unfavorable OS and DFS (P ≤ .001 for both). Both CD34/CD38/CD123 and CD34/CD38/CD123 expression at day 14 after induction had an adverse effect on DFS only (P < .001 and P = .029, respectively). On multivariate analysis, CD133 expression and MRD status were independent prognostic parameters (hazard ratio [HR], 2.3; 95% confidence interval [CI], 1.2-4.4; P = .015; and HR, 2.9; 95% CI, 1.0-7.9; P = .041). At day 28 after induction, MRD and increased CD123/CD34, CD34/CD38/CD123, CD133/CD33 expression were associated with inferior OS (P = .016, P = .0035, P = .0.002, and P = .002, respectively). MRD and high expression of CD34CD123, CD133/CD33, CD34/CD38/CD123 were associated with inferior DFS (P < .001, P = .002, P < .001, P < .001, respectively). On multivariate analysis, only CD133/CD33 expression was the independent prognostic factor (HR, 3.1; 95% CI, 1.5-6.7; P = .003).

CONCLUSIONS: Estimation of LSC expression is a sensitive indicator of the response to therapy in adult patients with AML and might be a better prognosticator than the findings from regular MRD panels.

Mahmoud, H. K., G. M. Fathy, A. Elhaddad, O. A. Fahmy, M. Abdel-Mooti, R. Abdel Fattah, and M. Bokhary, "The Use of Post-transplantation Cyclophosphamide in Peripheral Blood HLA-matched Stem Cell Transplantation as GVHD Prophylaxis in Patients With Malignant or Non-malignant Hematologic Disorders", Clinical lymphoma, myeloma & leukemia, 2020. Abstract1._the_use_of_post-transplantation_cyclophosphamide_in_peripheral_blood_hla-matched_stem_cell_transplantation_as_graft_versus_host_disease_prophylaxis_in_patients.pdf

INTRODUCTION: Studies addressing the utilization of post-transplant cyclophosphamide (CY) as graft-versus-host disease (GVHD) prophylaxis in allogeneic hemopoietic stem cell transplantation from matched sibling donors are limited and with controversial results. Chronic GVHD incidence necessitating systemic treatment is around 35% in peripheral blood stem cell transplantation (PBSCT) from human leukocyte antigen-matched sibling donors.

PATIENTS AND METHODS: In this study, high-dose CY was added to PBSCT aiming to reduce the incidence of GVHD to reach a lower figure compared with standard GVHD prophylaxis. Fifty-two patients with either benign or malignant hematologic disorders who underwent stem cell transplantation at Nasser Institute Hospital in Egypt from November 2017 to October 2018 were enrolled in this study. Fifty patients had fully human leukocyte antigen-matched siblings, whereas the remaining 2 patients had 1 locus class I mismatched donors. Pre-transplant conditioning regimen was fludarabine and busulfan (FLU/BU) in malignant cases (73.1%) and FLU/CY in benign hematologic disorders (26.9%) and 1 patient with hypocellular myelodysplastic syndrome. For GVHD prophylaxis, CY was given at a dose of 50 mg/kg/day on days 3 and 4 post-transplantation, and cyclosporine (CSA) starting day 5 in 96.1% of patients. For the 1-locus mismatched patients, both CSA and mycophenolate mofetil were administered starting day 5.

RESULTS: The 1-year incidence of acute GVHD (aGVHD) was 15.3% and for chronic GVHD (cGVHD) was 13.4%. Historical data of GVHD prophylaxis at our center using CSA and methotrexate showed an incidence of 37% for aGVHD and 33.9% for cGVHD.

CONCLUSIONS: Post-transplant CY GVHD prophylaxis led to significantly less aGVHD (P = .03) and cGVHD (P = .04).

2019
Wong, R., I. Yavaşoğlu, M. A. D. Yassin, P. Tarkun, S. Yoon, M. A. Samra, P. Angchaisuksiri, V. Pilipovic, and J. H. Jang, "Assessment of Eltrombopag in Patients with Chronic Immune Thrombocytopenia under Routine Clinical Practice in the Middle East, Turkey, Asia, And Australia.", 24th Congress of the European Hematology Association, June 2019, Abst. PF701 (Poster Presentation). , Amsterdam, The Netherlands, HemaSphere 2019, 3 (S1), pp. 305, 2019. assessment_of_eltrombopag_in_patients_with_chronic.pdf
Elbogdady, M., S. Shamaa, E. Azmy, T. Abozeid, M. AbdElmoety, and Z. Emara, "BCR-ABL1/ABL reduction ratio superiority over EMR and halving time as a predictor for outcome in Egyptian chronic phase chronic myeloid leukemia patients treated with tyrosine kinase inhibitors.", 24th Congress of the European Hematology Association, June 2019: Abst. PB1927, Amsterdam, The Netherlands , HemaSphere 2019, 3 (S1), pp. 876, 2019. bcr-abl1abl_reduction_ratio_superiority_over_emr_and_halving_time...._eha_library._elbogdady_m._may_16_2019_267896.pdf
Hanafi, M. M., A. M. Kamel, N. M. El Sharkawy, E. Z. Kandeel, and M. A. Samra, "CD34+CD38–CD123+ leukemia stem cells in acute myeloid leukaemia; a promising phenotype for minimal residual disease detection. ", Pan Arab Conference for Bleeding Disorders 2019: Abst. A-022., Riyadh, Saudi Arabia, Journal of Applied Hematology. 10 (Suppl. 1)., pp. S8, 2019. cd34cd38-cd123_leukemia_stem_cells_in_acute_myeloid_leukaemia_a_promising_phenotype_for_minimal_residual_disease_detection.pdf
Fathy, G., H. Mahmoud, A. Elhaddad, O. Fahmy, R. Abdel Fattah, and M. Abdelmooti, "HLA-Matched Sibling Stem Cell Transplantation Using Post-Transplantation Cyclophosphamide as Graft-Versus-Host Disease Prophylaxis: A Single Center Experience. ", Sosiety of Hematooncology: Clinical Lymphoma Myeloma and Leukemia., pp. S262, 2019.
Kamel, A. M., N. M. El Sharkawy, E. K. Abdelfattah, R. Abdel Fattah, M. A. Samra, P. Wallace, and H. K. Mahmoud, "IL12 and IFNγ secretion by donor mononuclear cells in response to host antigens may predict acute GVHD after HSCT.", Immunobiology, 2019. Abstract

One persistent problem of allogeneic hematopoietic stem cell transplantation (HSCT) is acute graft versus host disease (GVHD). The role of cytokines in the pathogenesis of GVHD has been acknowledged. We aimed, in the current study, to investigate the possibility of prediction of acute GVHD through investigating the pattern of interleukin 12 (IL12) and interferon gamma (IFNγ) production of both patients' origin and donors' origin. A total of 45 patients, receiving allogeneic peripheral blood (PB) stem cells from an identical sibling, were included in the study. Patients' plasma was collected after conditioning, during aplastic phase (representing patients' origin) and after engraftment (representing donors' origin). In addition an aliquot from the graft was used as responders in mixed lymphocyte culture (MLC) for 3 days with patients' mitomycin-treated mononuclear cells as stimulators. Culture supernatant was used for detection of IL12 and IFNγ of donors' origin. Fourteen patients developed acute GVHD. In culture supernatant, IL12 was detectable in 7/14 cases with and in none of 31 cases without acute GVHD (p= <0.001). The corresponding figures for IFNγ were 10/14 and 3/31 with significantly higher IFNγ level in cases with than in cases without acute GVHD (p = 0.001). At engraftment the corresponding figures were 7/14 and 5/31 for IL12 and 11/14 and 7/31 for IFNγ with significantly higher cytokine levels in cases with acute GVHD (p = 0.008 and p = 0.001 respectively). At a cutoff of 0.89 pg/ml, IL12 in culture supernatant may predict acute GVHD with absolute specificity of 100% and a sensitivity of 50%. In conclusion, IL12 and IFNγ of donors' origin not of patients' origin may predict the occurrence of acute GVHD. The MLC model may allow prediction of acute GVHD upfront before conditioning of the patient or mobilization of the donor.

Maher, M., M. Samra, R. Abdel Fattah, M. ElGammal, and hossam kamel, "Imatinib Generic in Newly Diagnosed Patients with Chronic Myeloid Leukemia in Chronic Phase: Egyptian National Cancer Institute Experience.", Society of Hematooncology, Houston, USA, Clinical Lymphoma Myeloma and Leukemia, pp. S296-S297, 2019. cml-246_imatinib_generic_in_newly_diagnosed_patients_with_chronic_myeloid_leukemia_in_chronic_phase.pdf
Elbogdady, M., S. Shamaa, M. AbdElmoeti, E. Azmy, T. AboZeid, and Z. Emara, "Kinetics of QPCR Decrease in Newly Diagnosed Chronic Phase Egyptian CML Patients: Do we have a Better Prognostic Tool?", Society of Hematooncology, Society of Hematooncology (SOHO), Clinical Lymphoma Myeloma and Leukemia, pp. S301, 2019. cml-386_kinetics_of_qpcr_decrease_in_newly_diagnosed_chronic_phase_egyptian_cml_patients.pdf
Eldeweny, S., H. Ibrahim, G. Elsayed, and M. Samra, "MPL W515 L/K mutations in myeloproliferative neoplasms", Egypt J Med Hum Genet, vol. 20, issue 1, pp. 1-7, 2019. mpl_w515_lk_mutations_in_myeloproliferative_neoplasms.pdf
Elgammal, M., A. Mahmoud, M. Samra, A. Elnagar, and N. El-Shakankiry, "Outcome of core binding factor acute myeloid leukemia in adult patients.", 24th Congress of the European Hematology Association, June 2019 : Abst. PB1727., Amsterdam, The Netherlands , HemaSphere 2019, 3 (S1), pp. 794, 2019. pb1727_outcome_of_core_binding_factor_acute_myeloid_leukemia_in_adult_patients.pdf
Fathy, G., H. Mahmoud, A. Elhaddad, R. Abdel Fattah, M. Abdelmooti, and O. Fahmy, "Outcome of Hematopoietic Stem Cell Transplantation in Resource Limited Setting: Thirty Years’ Experience in Egypt.", Society of Hematooncology, Houston, USA, Clinical Lymphoma Myeloma and Leukemia., pp. S263, 2019. ct-050_outcome_of_hematopoietic_stem_cell_transplantation_in_resource_limited_setting_-thirty_years_experience_in_egypt.pdf
Elrefaey, F., M. Samra, hossam kamel, H. Sayed, and yasser el nahass, "Philadelphia Negative Adult Acute Lymphoblastic Leukemia Patients with CRLF2 Rearrangement Show an Inferior Survival and Represent a High-Risk Category", Society of Hematooncology (SOHO), Houston, USA, Clinical Lymphoma Myeloma and Leukemia., pp. S182, 2019. all-106_philadelphia_negative_adult_all_patients_with_crlf2.pdf
Elmahgoub, I. R., H. M. Gouda, M. A. Samra, IAShaheen, and A. H. ElMaraashly, "Polymorphisms of xeroderma pigmentosum genes (XPC, XPD and XPG) and susceptibility to acute leukemia among a sample of Egyptian patients", Pan Arab Conference for Bleeding Disorders 2019: Abst. A-080, Riyadh, Saudi Arabia. , Journal of Applied Hematology, 10 (Suppl. 1), 2019, pp. S36, 2019. polymorphisms_of_xeroderma_pigmentosum_genes_xpc_xpd_and_xpg_and_susceptibility_to_acute_leukemia_among_a_sample_of_egyptian_patients.pdf
El Gammal, M. M., H. M. Owaidat, R. A. Rashed, R. A. Fatah, and M. O. H. A. M. E. D. A. Samra, "Prognostic and Therapeutic Value of Day 14 Bone Marrow Aspiration in Adult Acute Myeloid Leukemia Patients.", Clinical lymphoma, myeloma & leukemia, vol. 19, issue 7, pp. e406-e413, 2019. Abstract

BACKGROUND: Early blast clearance to induction chemotherapy in acute myeloid leukemia (AML) is an important prognostic indicator of treatment outcome in addition to genetics and molecular genetics. We evaluated the prognostic value of bone marrow aspiration (BMA) at day 14 (D14) and impact on outcome to asses the timing of a second induction.

PATIENTS AND METHODS: This retrospective study included 303 adult AML patients managed at the National Cancer Institute, Cairo University, from the beginning of 2010 to the end of 2014.

RESULTS: Median age was 34 years (range, 18-67 years). Sixty-six percent had early blast clearance with < 5% blasts and 34% had ≥ 5% blasts at BMA D14; 38 patients died early during or shortly after induction. Initial blast load (bone marrow and peripheral blood) and initial platelet count were significantly higher in those with disease that did not respond to therapy compared to those whose disease did respond to therapy at D14 (P < .001, .035, and .006, respectively). The median disease-free survival for early blast clearance at D14 was 18.5 months, versus 18.7 months for those with late response to therapy (day 28), and was only 1.3 months for patients who received immediate second-line therapy on the basis of BMA D14 (P < .001). The median overall survival for early blast clearance was 13.6 months, versus 7.2 months for those with late response to therapy, and only 1.3 months for patients who received immediate second-line therapy on the basis of BMA D14 (P < .001).

CONCLUSION: BMA D14 has a significant prognostic impact on the therapeutic outcome of AML patients (complete remission, disease-free survival, and overall survival); however, a second induction in patients with BMA D14 blasts > 5% should be delayed until neutrophil recovery to minimize death in aplasia.

2018
Bahnassy, A. A., M. M. Saber, M. G. Mahmoud, M. S. Abdellateif, M. Abd El-Mooti Samra, R. M. Abd El-Fatah, A. - R. N. Zekri, and S. E. Salem, "The role of circulating tumor cells in metastatic breast cancer: prognostic and predictive value.", Molecular biology reports, 2018 Sep 18. Abstractthe_role_of_circulating_tumor_cells_in_metastatic_breast_cancer.pdf

The aim of the current study was to assess the prognostic value of circulating tumor cells (CTCs) and their related markers at different points of chemotherapy regimens in metastatic breast cancer (MBC) patients. The impact of CTCs on progression free survival (PFS) and overall survival (OS) rates were also assessed. Peripheral blood samples were obtained from 66 female patients with MBC at different time intervals for evaluation of CTCs by flow cytometry (FC). cytokeratin 19 (CK19), mammaglobin, prolactin inducible peptide (PIP), aldehyde dehydrogenase 1 (ALDH1) and human chorionic gonadotropin (hCG) were also assessed by qRT-PCR. Analysis of different CTC levels (at 4, 5, and 6 cells/7 ml), showed statistically significant values at 4 cells/7 ml blood. The presence of baseline CTCs < 4 cells/7 ml, associated significantly with higher PFS (P value = 0.03). Patients showing a decrease in the CTCs level after treatment had significantly prolonged median PFS and OS rates compared to those whose CTCs level increased (P = 0.007 and P = 0.014; respectively). Mammaglobin, CK19, PIP, ALDH1 and hCG expression did not affect PFS or OS. However, patients with CTCs ≥ 4 at diagnosis had higher rates of progression compared to those with CTCs < 4 (1.9 times, P = 0.07), and who metastasized before 4 years showed a worse decrease outcomes (they were 2.4 time more progressed than those who metastasized after 4 years; P = 0.029). CTCs could be an independent prognostic and predictive biomarker for MBC patients' outcomes. Although none of the assessed genes (mammaglobin, CK19, PIP, ALDH1 and hCG) showed correlation with PFS or OS rates, further studies on a larger number of patients are required to validate the current results.

Shams-EL-Din, A. A., N. A. El-Desoukey, D. G. Tawadrous, N. M. Fouad, M. A. Abdelmooti, and S. F. Hotar, "The potential association of CMV-specific CD8+ T lymphocyte reconstitution with the risk of CMV reactivation and persistency in post allogeneic stem cell transplant patients.", Hematology (Amsterdam, Netherlands), vol. 23, issue 8, pp. 463-469, 2018 Sep. Abstractthe_potential_association_of_cmv_specific_cd8_t_lymphocyte_reconstitution.pdf

OBJECTIVES: development of cytomegalovirus (CMV)-specific CD8+ T cell response is crucial in preventing symptomatic CMV infection specially, in stem cell transplant (SCT) patients. The aim of this study was to evaluate CMV-specific CD8+ T cell reconstitution in allogeneic SCT recipients and to study the possible association between CMV-specific CD8+ T cell recovery with protection from CMV reactivation and persistency.

METHODS: Human leuKocyte antigen (HLA)-tetramers were used for CMV-specific CD8+ cell quantitation by Flow cytometry in twenty post-allogeneic SCT patients.

RESULTS: Nine patients (45%) developed rapid recovery of CMV-specific CD8+ cells, among them; 7 patients (78%) had no CMV reactivation in the first 95 days post-transplant. Five patients had developed persistent CMV viremia; all of them had not developed CMV-specific CD8+ recovery till day 95 post-transplant. Patients with persistent CMV viremia had a statistically significant lower means of CMV-specific CD8+ percent and absolute count compared to those without persistent viremia (p = .001, .015), respectively.

DISCUSSION: The incidence of CMV reactivation and persistency was higher among patients with delayed CMV-specific CD8+ reconstitution in the first 95 days post-transplant.

CONCLUSION: CMV-specific CD8+ cells can help in categorizing patients into risk groups: (early recovery/low risk) and (delayed recovery/increased risk), this tool may guide clinicians in the selection of patients who may profit from prophylactic antiviral therapy and frequent viral monitoring.

Elnahass, Y. H., H. K. Mahmoud, M. M. Mattar, O. A. Fahmy, M. A. Samra, R. M. Abdelfattah, F. A. Elrefaey, H. M. Fahmy, G. M. Fathy, A. Abdulgawad, et al., "MPN10 score and survival of molecularly annotated myeloproliferative neoplasm patients.", Leukemia & lymphoma, vol. 59, issue 4, pp. 844-854, 2018 04. Abstractmpn10_score_and_survival_of_molecularly_annotated_mpn_patients.pdf

JAK2, CALR, MPL and triple-negative mutational status has a direct impact on symptom severity and disease burden assessed by MPN10 score in myeloproliferative neoplasms (MPNs). Among 93 patients; median MPN10 score was 48 (5-76) in JAK2 mutants versus 25 (4-80) in JAK2 negative (p < .001); 22.5 (4-65) in CALR mutants versus 35 (5-80) in CALR negative (p < .050) and 21 (10-48) in triple negative versus 40 (4-80) in JAK2/CALR/MPL mutants (p < .001). At three years, progression free and overall survival of JAK2-positive versus JAK2-negative patients were 62% versus 100% (p < .001); 85% versus 100% (p = .011) and were 100% versus 78% (p = .067); 100% versus 92% (p = .197) in CALR-positive versus CALR-negative patients and 100% versus 75% (p = .004); 100% versus 90% (p = .015) in triple negative versus mutant patients, respectively. MPN10 score in association with driver gene mutations can be used as a predictor of survival in MPN patients.

Maher, M., A. Elhaddad, M. Samra, R. Abdelfatah, M. Elgammal, and H. Kamel, "Egyptian Experience in Haploidentical Hematopoietic Stem Cell Transplantation", Clin Lymph Myel Leuk., vol. 18, issue Supplement 1, pp. S304–S305: SCT-024, 2018. egyptian_experience_in_haploidentical_hsct.pdf
Elnahass, Y. H., O. A. Fahmy, M. A. Samra, F. A. Elrefaey, M. T. Bokhary, H. Elsherif, and H. H. Afifi, "Poor Outcome of CRLF2 Rearranged Philadelphia Negative Acute Lymphoblastic Leukemia Adults Patients", Blood, vol. 132 , issue Suppl 1 , pp. Abst. 5290, 2018.
2017
Hussein, A. A., A. A. Hamidieh, A. Elhaddad, M. Ramzi, T. B. Othman, F. Hussain, D. Dennison, P. Ahmed, M. Abboud, A. Al-Ahmari, et al., "First report of pediatric hematopoietic stem cell transplantation activities in the eastern mediterranean region from 1984 to 2011: on behalf of the pediatric cancer working committee of the eastern mediterranean blood and marrow transplantation group.", Bone marrow transplantation, vol. 52, issue 1, pp. 120-125, 2017 Jan. Abstract

To describe the hematopoietic stem cell transplantation (HSCT) activities for children in the Eastern Mediterranean (EM) region, data on transplants performed for children less than 18 years of age between 1984 and 2011 in eight EM countries (Egypt, Iran, Jordan, Lebanon, Oman, Pakistan, Saudi Arabia and Tunisia) were collected. A total of 5187 transplants were performed, of which 4513 (87%) were allogeneic and 674 (13%) were autologous. Overall, the indications for transplantation were malignant diseases in 1736 (38.5%) and non-malignant in 2777 (61.5%) patients. A myeloablative conditioning regimen was used in 88% of the allografts. Bone marrow (BM) was the most frequent source of stem cells (56.2%), although an increasing use of PBSC was observed in the last decade. The stem cell source of autologous HSCT has shifted over time from BM to PBSC, and 80.9% of autologous HSCTs were from PBSCs. The donors for allogeneic transplants were matched-related in 94.5% of the cases, and unrelated transplants, mainly cord blood (99%) in 239 (5.5%) cases. This is the first report to describe the pediatric HSCT activities in EM countries. Non-malignant disorders are the main indication for allogeneic transplantation. Frequency of alternate donor transplantation is low.

Aboelhassan, R., H. A. Ali, A. Mohammed, A. mousa, M. E. Hassan, M. A. M. Samra, and R. Abdel Fattah, "Management of Hard Palatine Fistula Caused by Granulocytic Sarcoma: Case Report.", The Gulf journal of oncology, vol. 1, issue 23, pp. 72-76, 2017 Jan. Abstract

Granulocytic Sarcoma (GS) is a rare condition with a wide list of differential diagnosis and debatable guidelines of treatment in different cancer centers. Most of literature recommended systemic chemotherapy with or without radiation therapy and small role of surgery. One of the rarest sites for myeloid sarcoma is hard palate, which usually worsen the quality of life of the patient due to difficulty in feeding, drinking and speaking. We are reporting a case of hard palatine fistula caused by granulocytic sarcoma, in which we tried to get local control of disease with 3 dimension conformal radiation therapy 3DCRT and surgery with systemic control with chemotherapy using recommendation of multidisciplinary team and targeting mainly patient quality of life.

FATHY, G., A. El-Haddad, H. Mahmoud, O. Fahmy, R. Abdelfattah, M. Abdel-Mooti, M. Bokhary, and S. Ibrahim, "ATG Based Conditioning Regimen in Stem Cells Transplantation of Fanconi Anemia: A Single Center Experience of 63 Patients.", Annals of Bone Marrow Research, vol. 2, issue 1, pp. 8-12, 2017. atg_based_conditioning_regimen_in_stem_cells_transplantation_of_fanconi_anemia-_a_single_center_experience_of_63_patients.pdf
FATHY, G., Y. Elnahass, O. Fahmy, M. Samra, R. AbdelelFattah, A. Elhaddad, A. Sobhy, S. Mohamed, M. Bokhary, and H. Mahmoud, "Non-TBI Based Conditioning Regimen in Peripheral Blood Stem Cell Transplantation (PBSCT) for Adult Acute Lymphoblastic Leukemia Patients: A Single Center Experience", Blood, vol. 130, issue Suppl 1 , pp. Abst. 5474, 2017.
Elmahgoub, I. R., H. M. Gouda, M. A. Samra, IAShaheen, and A. H. ElMaraashly, "Polymorphisms of xeroderma pigmentosum genes (XPC, XPD, and XPG) and susceptibility to acute leukemia among a sample of Egyptian patients", Journal of Hematopathology, vol. 10, issue 1, pp. 3-7, 2017. polymorphisms_of_xeroderma_pigmentosum_genes.pdf
yasser el nahass, H. K. Mahmoud, M. Mattar, O. Fahmy, M. A. E. Moaty, R. Abdelfattah, F. Elrefaey, and W. Elmetenawy, "MPN10 score and survival of molecularly annotated myeloproliferative neoplasms (MPNs) Patients; A First Report on an Egyptian Cohort", 22nd Congress of the European Hematology Association (EHA), Madrid, Spain, Haematologica, 102 (suppl. 2): 767: Abst. PB2052., pp. 767, 2017.
2016
Mahmoud, H. K., M. A. Samra, and G. M. Fathy, "Hematologic malignancies during pregnancy: A review.", Journal of advanced research, vol. 7, issue 4, pp. 589-96, 2016 Jul. Abstract

Malignancy is the second most common cause of mortality in the reproductive period and it complicates up to one out of every 1000 pregnancies. When cancer is diagnosed during pregnancy, the management approach must take into consideration both the mother and her fetus. Hematologic cancers diagnosed in pregnancy are not common, resulting in paucity of randomized controlled trials. Diagnosis of such malignancies may be missed or delayed, as their symptoms are similar to those encountered during normal pregnancy. Also, many imaging studies may be hazardous during pregnancy. Management of these malignancies during pregnancy induces many treatment-related risks for mother and baby and should consider patient's preferences for pregnancy continuation. In this article, hematologic malignancies diagnosed in pregnant patients including acute leukemias, chronic myeloid leukemia, lymphomas, multiple myeloma and myeloproliferative neoplasms, will be reviewed, including diagnostic and management strategies and their impact on the pregnant patient and the developing fetus.

Sallam, Y. A., M. A. Samra, and A. A. Gaber, "Exploring the Clinicopathological Parameters Affecting the Outcome in Egyptian Patients with Multiple Myeloma.", The Gulf journal of oncology, vol. 1, issue 20, pp. 51-63, 2016 Jan. Abstract

BACKGROUND: Multiple myeloma (MM) is a plasma-cell neoplasm in which the interplay of several clinical, pathological and genetic parameters affects the patient's prognosis and response to treatment and survival.

AIM: The aim of this study was to evaluate the different clinicopathological parameters of MM patients in correlation with response to therapy, progressionfree survival (PFS) and overall survival (OS).

METHODS: This retrospective study was performed on 60 MM patients diagnosed at NCI, Cairo University from January 2005 to December 2008. The patients were evaluated for different clinicopathological parameters which were correlated to their response to treatment, OS and PFS.

RESULTS: Sixty patients were followed up for a median period of 21 months wherein about 90% received 1st line treatment: 34 VAD, 17 MP and 3 dexamethasone. Six patients (10%) were referred for BSC. CR was achieved by 15%, 11.7% achieved good PR, 6.7% achieved PR, 22.1% have stable disease, 35% experienced disease progression. ECOG PS-I patients have 39 months median survival compared to 12 months for patients with PS ECOG-II (P 0.005). Patients with multiple skeletal lesions (≥3) have median OS of 19 months (P 0.03). Patients who presented with plasmacytoma have better OS than those without (38 months versus 14 months) (P<0.05). Patients <60 years old have a better median OS compared to patients <60 years (37 months versus 12 months) (P 0.001). OS was 39 months in female patients versus 14 months in male patients (P0.025). Median OS was 9 months for patients with comorbidities versus 27 months for those without (P0.01), 39 months for patients with non-detected paraproteinuria versus 18 months for those with paraproteinuria (P 0.045), 18 months for stage II disease versus 12 months for stage III disease (P0.001), 12 months for patients with elevated serum LDH versus 39 months for those with normal levels (P 0.001), 27 months for patients with normal serum creatinine level versus 13 months for those with elevated levels (>1.4 mg/dl) (P 0.005), 27 months for patients with normal serum calcium levels versus 10 months for those with hypercalcemia (P 0.03).

CONCLUSION: Besides FISH-guided molecular cytogenetic classification of myeloma abnormality, a specific risk-stratification model based upon the patient's age, sex, performance status, lytic bone lesions, plasma cells labeling index, serum creatinine, calcium, LDH, B2M and paraproteins in serum and urine, can depict the response to treatment, OS and PFS of patients with MM.

FATHY, G., A. El-Haddad, M. Abdel-Mooti, R. Abdelfattah, O. Fahmy, A. Sobhy, and H. Mahmoud, "Impact of HCV on the outcome of transplant of Fully Matched Sibling Donor PBSCs Transplantation for B- Thalassemia Major a single- center experience with 152 patients", BMT, vol. 51, issue S1, pp. S264– S265, 2016.
Fahmy, O., G. Fathy, A. M. Elhaddad, A. M. Sultan, S. Ibrahim, M. Bokhary, yasser el nahass, M. Talaat, R. M. S. Abdelfattah, M. Samra, et al., "The Impact of HCV Viremia on the Tempo of Engraftment and the Incidence of Acute and Chronic Graft Versus Host Disease (GVHD) As Well As Sinusoidal Obstruction Syndrome (SOS): A Single Centre Experience of 332 Patients Following Allogeneic PBSCT", American Society of Hematology (ASH) 2016 Annual Meeting, San Diego, California, American Society of Hematology (ASH), pp. Abst. 5785, 2016.
Hassanein, S. M., Z. M. Elsayed, and M. A. Samra, "Lived experience among patients with allogeneic stem cell transplantation: A single center experience", Journal of Nursing and Health Science, vol. 5, issue 1, pp. 16-26, 2016. lived_experience_among_patients_with_allogeneic_stem_cell_transplantation.pdf
Osman, N. F., W. M. Alzobary, M. A. Samra, H. H. Alsaid, and I. A. Eltounsi, "Lower Fas-associated phosphatase-1 expression predicted poor outcome in acute myeloid leukemia patients.", Egyptian Journal of Haematology, vol. 41, issue 3, pp. 111-115, 2016.
yasser el nahass, H. Mahmoud, M. Mattar, O. Fahmy, M. Samra, R. Abdelfattah, H. Fahmy, and A. Abdelha, "Triple Negative Myeloproliferative Neoplasms (MPNs) Patients Show Low MPN10 Score and Lower Grades of Bone Marrow Fibrosis", Blood 2016, vol. 128, issue 22, pp. Abst. 5477, 2016.
Darwish A, S. M, A. N, and G. O, "Adult biphenotypic acute leukemia: the Egyptian national cancer institute experience. ", The 21st Congress of the European Hematology Association (EHA) , Denmark, Haematologica, 101:p 680-681: Abst. PB1666. , pp. 680-681, 2016.
HK, M., E. A, F. O, S. M, A. R, E. Y, F. G, E. A. H, and E. F, "Comparable Outcome of Allogeneic Versus Autologous Hematopoietic Peripheral Blood Stem Cell Transplantation in Acute Myeloid Leukemia with Normal Karyotype and Flt3-ITD Negative. ", The 21st Congress of the European Hematology Association, Denmark, Haematologica 2016; 101(s1): Abst. PB2190 , pp. 866, 2016.
El-Beih, E., R. Abdel Fattah, M. Samra, H. Kamel, A. Elhaddad, O. Fahmy, G. Ebid, G. Fathy, E. Radwan, and A. Kamel, "Cyclosporine (CsA) Pharmacogenetics Post HLA-Matched Sibling Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Myeloid Leukemia: Value of CYP3A4 Gene Polymorphism.", with Myeloid Leukemia. Proceedings of the Society , Houston, Texas, USA, Clin Leukem Lymph Myeloma, 2016, 16 (Suppl 2): Abst. RES-117: S123–S124. , pp. S123–S124, 2016.
M, S. M., E. - B. E, A. - F. R, K. H, E. - H. A, F. O, S. M, F. G, E. G, R. E, et al., "Impact of the GSTA1 Gene Polymorphism on Clinical Outcomes of HLA-Matched Sibling Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Myeloid Leukemia", Society of Hematologic Oncology 2016 Annual Meeting, Houston, Texas, USA, Clin Leuk Lymph Myel. September 2016, 16(Supplement 2); S118–S119, pp. S118–S119, 2016.
Eisa, N., S. Shaimaa, K. M, E. Azmy, A. Agm, M. Samra, and Z. Emarah, "Kinetics of WT1 Overexpression in Acute Myeloid Leukemia Patients Who Received
 Standard Chemotherapy or Underwent Allogeneic Stem Cell Transplantation", The 21st Congress of the European Hematology Association, Denmark, Haematologica. June 2016. 101:681-681: Abst. PB1668, pp. 681, 2016.
Beih, E. E., R. A. El-Fattah, H. Kamel, M. Samra, A. El-Haddad, O. Fahmy, G. Fathy, G. Ebid, E. Radwan, and A. Kamel, "Role of the Methylenetetrahydrofolate Reductase (MTHFR) A1982C Gene Polymorphism in Predicting Clinical Outcomes of HLA-Matched Sibling Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Myeloid Leukemia", Society of Hematologic Oncology 2016 Annual Meeting, Houston, Texas, USA, Clin Leuk Lymph Myeloma, 16 (Suppl 2): Abst. AML-003: S22. , pp. S22, 2016.
2015
Mahmoud, H. K., A. M. Elhaddad, O. A. Fahmy, M. Samra, R. M. Abdelfattah, Y. H. El-Nahass, G. M. Fathy, and M. S. Abdelhady, "Allogeneic hematopoietic stem cell transplantation for non-malignant hematological disorders.", Journal of advanced research, vol. 6, issue 3, pp. 449-58, 2015 May. Abstractallogeneic_hematopoietic_stem_cell_transplantation_for_non-malignant_hematological_disorders.pdf

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) from a geno-identical matched sibling (MSD) is one of the most successful therapies in patients with non-malignant hematological disorders. This study included 273 patients with severe aplastic anemia (SAA), 152 patients with B-Thalassemia major (BTM), 31 patients with Fanconi's anemia (FA), 20 patients with congenital immunodeficiency diseases (ID), and 13 patients with inherited metabolic disorders (IMD) allografted from a MSD. In SAA, the 8-year overall survival (OS) of the whole group patients was 74%. OS was significantly better in patients conditioned with fludarabine and cyclophosphamide (Flu/Cy) than in those who received cyclophosphamide and antithymocyte globulin (Cy/ATG) (p = 0.021). Acute graft-versus-host disease (aGVHD) grade II-IV occurred in 15% while chronic GVHD (cGVHD) occurred in 28%. In BTM, the 12-year disease-free survival (DFS) of the whole group of BTM patients was 72.4%. DFS was 74% for peripheral blood stem cell (PBSC) group compared to 64% in the BM stem cell group. The incidence of graft rejection was significantly lower in patients who received PBSC than in those who received BM (9% vs 25%) (p = 0.036). AGVHD grade II-IV and cGVHD occurred in 15% and 12% of the whole group of BTM patients respectively. In FA, the 5-year OS was 64.5%. Graft rejection occurred in 10% of patients. Grade II-IV aGVHD occurred in 16% while cGVHD occurred in 4%. In ID, the 5-year OS was 62%. Graft rejection occurred in two (10%) patients. Three patients (15%) developed grade II-IV aGVHD, 2 of them progressed to secondary cGVHD. In IMD, OS was 46% at 5 years. Graft rejection occurred in 8% of patients. AGVHD grade II-IV occurred in 15% while cGVHD occurred in 14%. In conclusion, Allo-HSCT provides a higher DFS rate over conventional therapies for patients with non-malignant hematological disorders with prolonged survival.

Sallam, Y. A., M. A. Samra, A. A. Shaheen, and M. E. Ahmed, "Chemotherapy induced ovarian failure after adjuvant treatment for early breast cancer: National Cancer Institute experience.", Clinical Cancer Investigation 2015, 4 (S1): p, vol. 4, issue S1, pp. S29: Abst P26, 2015.
2014
Elnahass, Y. H., M. M. Mattar, M. M. El-Kasas, A. M. Abdelhameed, M. H. Elazzazi, M. A. Samra, H. N. Elleithy, and W. H. Elmetnawy, "Impact of multidrug resistance gene 1 (MDR1) C3435T polymorphism on chronic myeloid leukemia response to tyrosine kinase inhibitors", Journal of Egyptian Society of Haematology and Research, vol. 10, issue 2, pp. 39-44, 2014.
Samra, M. A., Y. Sallam, A. A. Gaber, and M. M. Saber, "Prognostic Factors in Multiple Myeloma: National Cancer Institute Experience", The Medical Journal of Cairo University, vol. 82, issue 1, pp. 505-515, 2014.
FATHY, G., R. Abdelfattah, A. Sobhy, M. Abdel-Mooti, O. Fahmy, and H. Mahmoud, "A Single Center Experience of Matched Sibling Donors PBSC Bone Marrow Transplantation for 31 Cases of Fanconi Anemia Using Low Dose Cyclophosphamide.", BMT, vol. 49, issue S1, pp. S195: Abst. PH- P198, 2014.
2013
Samra, M. A., H. K. Mahmoud, T. M. Abdelhamid, N. M. El Sharkawy, Y. H. Elnahass, M. Elgammal, R. M. Abdelfattah, S. Eid, F. M. Ghaleb, and A. M. Kamel, "The prognostic significance of minimal residual disease in adult Egyptian patients with precursor acute lymphoblastic leukemia.", Journal of the Egyptian National Cancer Institute, vol. 25, issue 3, pp. 135-42, 2013 Sep. Abstract

BACKGROUND: Minimal residual disease (MRD) studies in adult acute lymphoblastic leukemia (ALL) give highly significant prognostic information superior to other standard criteria as age, gender and total leucocytic count (TLC) in distinguishing patients at high and low risk of relapse.

OBJECTIVES: We aimed to determine the value of MRD monitoring by flowcytometry (FCM) in predicting outcome in adult Precursor ALL patients.

PATIENTS AND METHODS: Bone marrow (BM) samples were analyzed by 4-color FCM collected at diagnosis and after induction therapy (MRD1) to correlate MRD positivity with disease free survival (DFS) and overall survival (OS).

RESULTS: Study included 57 adult ALL patients (44 males and 13 females) with a median age of 22 years (18-49). DFS showed no significant difference with age, gender and initial TLC (p=0.838, 0.888 and 0.743, respectively). Cumulative DFS at 2 years was 34% for B-lineage ALL (n: 35) and 57% for T-lineage ALL (n: 18) (p = 0.057). Cumulative DFS at 2 years was 7% for MRD1 positive (high risk, HR) versus 57% for MRD1 negative patients (Low risk, LR) (p < 0.001). Cumulative DFS at 2 years was 29% for HR patients (n: 26) versus 55% for LR (n: 27) according to GMALL classification (p = 0.064). Cumulative OS did not differ according to age, gender and TLC (p = 0.526, 0.594 and 0.513, respectively). Cumulative OS at 2 years was 36% for B ALL (n: 39) versus 77% for TALL (n: 18) (p = 0.016) and was 49% for Philadelphia chromosome (Ph) negative patients versus 0% for Ph-positive patients (p < 0.001). Regarding MRD1, OS at 2 years was 18% for MRD1 HR (n: 17) versus 65% for MRD1 LR (n: 38) (p < 0.001). OS was 35% for high-risk patients (n: 30) and 62% for low-risk patients (n: 27) classified according to GMALL risk stratification (p = 0.017).

CONCLUSION: MRD by FCM is a strong independent predictor of outcome in terms of DFS and OS and is a powerful informative parameter in guiding individual treatment in ALL patients.

El-Metnawy, W. H., M. M. Mervat, Y. H. El-Nahass, M. A. Samra, H. M. Abd El Hamid, R. M. Abdlfattah, and A. R. Hamed, "Predictive Value of Pretreatment BCR-ABL(IS) Transcript level on Response to Imatinib Therapy in Egyptian Patients with Chronic Phase Chronic Myeloid Leukemia (CPCML).", International journal of biomedical science : IJBS, vol. 9, issue 1, pp. 48-53, 2013 Mar. Abstract

BACKGROUND: A wide range of responses of patients with CPCML to IM has been reported. Several factors were proposed to predict response including molecular response at 3 and 6 months.

PURPOSE: To study the impact of pretreatment BCR-ABL transcript level on molecular response to IM, and to assess the value of the milestone ; ≤10% transcript at 3 months on PFS and OS.

PATIENTS AND METHODS: Fifty five adult CP-CML patients receiving daily dose of 400 mg IM were subjected to molecular and cytogenetic analysis at diagnosis and at regular time intervals. Median follow up period was 36 months (15-48). Hematologic, cytogenetic, and molecular responses were rated according to ELN.

RESULTS: Two Patient groups were distinguished regarding response to IM therapy. A group of 22/55 patients (40%) having pretreatment BCR-ABL(IS) level ≤200% and a second patient group 33/55 (60%) having transcript level >200%. The ≤10% milestone was achieved by 15/22 patients (68%) versus 7/33 patients (21%), p=0.04 in favor of the first group. Optimal responders in first group were 14/22 (64%) compared to 13/33 (39%) in second group, p=0.02. Achievement of 10% transcript level significantly correlated with longer PFS. The median BCR-ABL(IS) transcripts levels in optimal responders at 3, 6 and 18 months was 10%, 2% and 0.1%, respectively compared to 100%, 65% and 10%, in suboptimal/resistant patients p=0.001. Resistance in 11 patients was correlated with identifiable ABL Kinase mutations.

CONCLUSIONS: The Pretreatment 200% cutoff and the 3 month BCR-ABL(IS) ≤10% transcript levels proved strong predictors of response to IM and significantly correlated with probability of CCyR, MMR and PFS.

Saber, M. M., A. A. Zeeneldin, M. A. Samra, and S. A. Farag, "Primary gastrointestinal lymphoma in an Egyptian district: a study using a population-based cancer registry.", Journal of the Egyptian National Cancer Institute, vol. 25, issue 2, pp. 95-101, 2013 Jun. Abstract

INTRODUCTION: Gastrointestinal lymphoma (GIL) is the most common extranodal form of non-Hodgkin's lymphoma (NHL) with geographical and age variation of its various subtypes.

AIM: To study GIL in Gharbiah, Egypt and to recognize the treatments employed and their outcomes including survival.

METHODS: This is a retrospective study. Between 2000 and 2002, 40 adult patients with GIL were identified in the Gharbiah population based cancer registry (GPBCR); 26 cases of whom were treated at Tanta Cancer Center (TCC).

RESULTS: GIL in Gharbiah, Egypt represented 6.2% of all GIT cancers. The median age was 47 years with slight male predominance. The commonest primary site was the stomach followed by the colon/rectum then the small intestine (67.5%, 25% and 7.5%, respectively). The commonest histological subtypes were the diffuse large B-cell (41.5%) followed by marginal zone B-cell (39%). The commonest symptoms were abdominal pains followed by vomiting. Only 18% of GILs were surgically resected. Most patients (77%) received chemotherapy with a 60% complete response (CR) rate. Once in CR, relapses are occasional. The median overall survival (OS) and progression free survival (PFS) were 31 and 14 months (95% CI, 13.2-48.7 and 6.4-21.6 months, respectively). Gastric primary site and diffuse large B cell subtype carry a non-significant worse OS and PFS than those of other sites and subtypes.

CONCLUSIONS: GILs in Gharbiah, Egypt are characterized by predominance of male gender, gastric site and marginal zone histology. Survival is worse for gastric and diffuse large B-cell GILs compared to other sites and histologies.

Mossallam, G., and M. Samra, "CTLA-4 polymorphism and clinical outcome post allogeneic hematopoietic stem cell transplantation.", Human immunology, vol. 74, issue 12, pp. 1643-8, 2013 Dec. Abstract

CTLA-4 inhibitory molecule plays an important role in regulating T cell activation. It is considered a crucial element in keeping the immune balance and has been implicated in cancer, autoimmunity and transplantation immunology. Inconsistent observations are reported regarding its association with hematopoietic stem cell transplantation (HSCT). Genotyping of CTLA-4 was performed in recipients and their HLA-matched donors for +49A/G and CT60 polymorphisms (80 and 94 pairs, respectively) using PCR-RFLP. No association was encountered between both polymorphisms in patients and donors and acute or chronic graft versus host disease. Significant association was observed between recipient +49A/G G allele and lower disease-free survival and overall survival compared to AA genotype (HR: 2.17, p = 0.03, 95% CI: 1.05-4.48 and HR: 2.54, p = 0.01, 95% CI: 1.16-5.54), respectively. Our results suggest that CTLA-4 genotyping may predict outcome in patients post HSCT. To validate our results, further studies on a larger cohort are needed.

Elnahass, Y. H., H. K. Mahmoud, F. T. Ali, M. R. MOHAMED, M. M. Said, M. A. Samra, M. A. Ali, A. Salem, and W. H. Elmetnawy, "Abl Kinase Domain Mutations in Imatinib-treated Egyptian Patients with Chronic Myeloid Leukemia", Journal of Leukemia, vol. 1, issue 1, 2013.
Talaat, A., N. Khattab, A. Tabl, and M. Samra, "Acute Myeloid Leukemia (AML) Malignant Clone Disorder of Immature Hematopoietic Cells", Journal of Engineering Technology, vol. 1, pp. 32-41, 2013.
Kamel, A. M., G. I. Mossallam, S. S. Meshaal, D. Labib, R. Abdelfattah, M. A. Samra, M. Sherif, and O. Goher, "BCL-XL Expression as a Potential Prognostic Parameter In Chronic Myeloid Leukemia.", Haematologica, vol. 98, issue S1, pp. 548: Abst. B1348, 2013.
Abdulla, S., T. Eladl, T. Talaat, N. Khattab, A. Tabl, M. Samra, and Y. Elnahas, "Clinical Applications of PML-RAR-α Transcript in Acute Promyelocytic Leukemic Adult Egyptians", Journal of American Science, vol. 9, issue 2, pp. 247-255, 2013.
Kamel, A. M., N. M. El-Sharkawy, S. S. Meshaal, D. A. Labib, M. M. Kamel, M. A. Samra, M. M. Sherif, and A. Omaima, "Expression of Phosphorylated STAT5 in chronic myeloid leukemia: relation to disease stages", Journal of the Egyptian Society of Hematology and Research, vol. 9, issue 1, pp. 17-23, 2013.
Kamel, A. M., N. M. El-Sharkawy, E. M. AbdEl-Fattah, R. M. Abd El-Fattah, M. A. Samra, P. K. Wallace, and H. K. Mahmoud, "Interferon Gamma/IL10 Ratio Production in Response to Host Antigens may Predict Acute Graft Versus Host Disease after Allogeneic Stem Cell Transplantation from a Sibling.", Journal of Leukemia, vol. 1, issue 2, 2013.
Saber, M. M., A. A. Bahnasy, H. M. El-Zawahry, N. M. Allahloubi, M. A. El-Moetii, R. M. ABDELFATAH, said, and M. Ghareeb, "Assessment of circulating tumor cells (CTC) by RT/PCR as a surrogate marker for PFS in metastatic breast cancer (MBC)", Cancer Res , vol. 73, issue 24 Suppl., pp. Abst. P1-04-10., 2013.
2012
2011
Abdelhamid, T., M. Samra, H. Ramadan, M. Mehessin, and N. Mokhtar, "Clinical prognostic factors of diffuse large B cell non-Hodgkin lymphoma: a retrospective study.", Journal of the Egyptian National Cancer Institute, vol. 23, issue 1, pp. 17-24, 2011 Mar. Abstract

BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of NHL in Egypt. It represents about 49% of NHL presenting to the National Cancer Institute (NCI), Cairo University. CHOP regimen is the standard treatment used for NHL since the 1970s with only 30-40% overall survival. Recently, integration of Rituximab became a standard of care for patients with DLBCL. However, its widespread use in developing countries is still limited by the lack of financial coverage. Clinical prognostic factors, as well as the pathological markers, are mandatory to individualize treatment.

AIM: The aim of the study was to evaluate the clinical risk stratification models including the age adjusted International prognostic index (aaIPI), patients profile and dose intensity (DI) of Cyclophosphamide and Doxorubicin as effective tools for predicting the outcome and prognosis of our DLBCL patients treated with first line CHOP regimen.

PATIENTS AND METHODS: This retrospective study included 224 patients with diffuse large B cell lymphoma who were treated with 3-8 cycles of CHOP regimen at the Medical Oncology Department, NCI, Cairo University during the time period from 1999 to 2006.

RESULTS: One hundred and seventy-eight patients (79.5%) achieved CR after the CHOP regimen with an observation period of 51 months. The median survival time was 12 months. The OS and DFS at 2 years were 82% and 68.8%, respectively. The univariate analysis of predictive factors for response to treatment showed that the CR rate was significantly affected by aa-IPI and its elements (performance status, stage & LDH), extranodal lesions and DI of Cyclophosphamide and Doxorubicin. The CR rate was 96.9%, 91.2%, 73.9% and 55.6% in cases with aa-IPI 0, 1, 2 and 3, respectively (p<0.001) and it was 82.4%, 81.9% versus 50% in cases with no extranodal site, one extranodal site and two extranodal sites, respectively (p=0.01). As regard DI of Cyclophosphamide, with DI below or equal to the median (249 mg/m(2)/week) the CR rate was 69%, while with DI above the median the CR rate was 87.7% (p=0.001). For Doxorubicin, the CR rate was 72.3% with DI below or equal to the median (16.5 mg/m(2)/week), however, it was 86.6% with DI above the median (p=0.008). The OS rate was significantly affected by aa-IPI as it was 89.8% in cases of aa-IPI 0+1 versus 75.8% in those of aa-IPI 2+3 (p=0.03). DI of Cyclophosphamide and Doxorubicin significantly influenced the OS. The OS rate was 74% with DI of Doxorubicin below or equal to the median versus 96% in cases with DI above the median (p=0.02). For Cyclophosphamide the OS rate was 72.7% with DI below or equal to the median versus 96.3% in cases with DI above the median (p=0.01). The tumor bulk (with a median tumor size of 5 cm) affected the OS, which was 91.23% versus 86.8% in the tumor bulk less than and more than or equal to the median, respectively (p=0.05). By multivariate analysis of predictive factors for response to treatment, the CR rate was significantly affected by the number of extranodal sites and the clinical staging of diffuse large B cell lymphoma. However, OS rate was strongly associated with the bulk of the tumor and the clinical staging of diffuse large B cell lymphoma.

CONCLUSION: DI of Cyclophosphamide and Doxorubicin is important in the future treatment regimen plan for DLBCL especially in high risk cases. In addition to aa-IPI and its elements, extra nodal sites and bulk of the tumor proved to be significant predictors and prognostic factors for DLBCL treatment outcome.

Khorshid, O., A. Diaa, M. A. E. Moaty, R. A. E. Fatah, I. E. Dessouki, M. A. E. Hamid, E. Elnoshokaty, G. E. Saied, T. Fouad, and S. Ramadan, "Clinical features and treatment outcome of acute promyelocytic leukemia patients treated at cairo national cancer institute in egypt.", Mediterranean journal of hematology and infectious diseases, vol. 3, issue 1, pp. e2011060, 2011. Abstract

The current study reports the clinical features and treatment outcome of 67 patients with acute promyelocytic leukemia (APL) treated at National Cancer Institute (NCI-Cairo), in Egypt from January 2007 to January 2011. The median age at presentation was 29 years. Bleeding was the most common presenting symptom (79%). Most patients had an intermediate risk Sanz score (49%) and 34% had a high risk score. The median follow-up time was 36 months. All evaluable patients were treated for induction with the simultaneous administration of all-trans retinoic acid (ATRA) and an anthracycline. The original AIDA treatment protocol was modified due to resource limitations at the NCI-Cairo by replacing of idarubicin with daunorubicin or doxorubicin in most of the cases and the inclusion of cytarabine during the consolidation phase only in pediatric patients. All patients who achieved molecular complete remission after consolidation received two-year maintenance treatment with low dose chemotherapy composed of 6 mercaptopurine, methotrexate and intermittent ATRA courses. Five patients died before treatment initiation due to bleeding, three died during induction chemotherapy due to infectious complications (n=2) and bleeding (n=1) and one patient died during consolidation therapy due to infection. The main therapeutic complications during the induction phase were febrile neutropenia (42%), bleeding (18%) and differentiation syndrome (11%). All patients achieved molecular CR at end of consolidation therapy at a median time of 100 days. The 3-year OS was 89%. Two patients relapsed at 13 and 24 months, respectively. Adapting standard AIDA treatment protocols to limited resources by reducing dose-intensity during consolidation, using ATRA in the consolidation phase and alternative anthracyclin (doxorubicin) may be a valid treatment option for APL in developing countries. In spite of the increased incidence of high and intermediate risk disease in our cohort, we reported an acceptable CR rate, toxicity and OS.

AM, K., M. G, M. SS, L. D. A, A. RM, S. MA, and S. MM, "Bcl-xL expression as a potential prognostic parameter in chronic myeloid leukemia", CML–ESH-iCMLf 15th International Conference on Chronic Myeloid Leukemia: Biology and Therapy, Estoril, Portugal, 2011.
Kamel, A., N. El-Sharkawy, S. Meshaal, D. Labib, M. Kamel, R. Abdelfattah, M. Samra, M. Sherif, and O. Gohar, "Expression of Phosphorylated STAT5 In Chronic Myeloid Leukemia: Relation to Disease Stages.", Haematologica, vol. 96, issue S2, pp. 496: Abst. 1202, 2011.
2010
Mossallam, G., A. M. Kamel, S. S. Meshaal, D. A. Labib, R. M. Abdelfattah, M. A. Samra, M. M. Sherif, and O. A. Gohar, "Bcl-xL expression as a potential prognostic parameter in Chronic myeloid Leukemia.", The Journal of the Egyptian Society of Haematology and Research, vol. 6, issue 10, pp. 17-22, 2010.
Khairy, T., H. Elhossieny, and M. Abd Moaty, "A study evaluating the impact of nerve preserving surgery and adjuvant pelvic irradiation for rectal cancer on quality of life.", Chinese-German Journal of Clinical Oncology, vol. 9, issue 8, pp. 459-465., 2010.
2009
Mahmoud, H., Y. El Nahas, M. Abdel Moaty, R. Abdel Fattah, M. El Emary, and W. El Metnawy, "Kinetics of BCR-ABL Transcripts in Imatinib Mesylate treated Chronic Phase CML (CPCML), A Predictor of Response and Progression Free Survival.", International journal of biomedical science : IJBS, vol. 5, issue 3, pp. 223-8, 2009 Sep. Abstract

PURPOSE: To assess the kinetics of molecular response to Imatinib Mesylate (IM) therapy in predicting progression free survival (PFS), sustained hematological, and cytogenetic responses in CPCML.

METHODS: Ninety five newly diagnosed CPCML Egyptian patients were treated with IM 400 mg daily dose. Cytogenetic analysis was performed at diagnosis and every 6 months. Molecular monitoring by RT-QPCR was performed at diagnosis and every 3 months during a median follow-up period (FUp) of 26 months. Mutation detection of ABL domain was performed by ASO-PCR.

RESULTS: Hematological response was 98% after three months of IM therapy. Out of 95 patients 59 showed 2 log reduction of BCR-ABL/ABL ratio after 6 months of whom 49 (83%) had complete cytogenetic response (CCyR) and 42 (71%) had major molecular response (MMR) at 12 months. BCR-ABL transcripts remained undetectable in 22 patients (39%) at 26 months. Among the remaining 34 patients not achieving 2 log reduction at 6 months only 5 (15%) had CCyR and MMR by 12 months. ABL domain mutations were detected in 11/15 (73%) resistant and suboptimal responding patients. Achieving 2 log reduction after 6 months of IM therapy significantly correlated with sustained cytogenetic and molecular responses (p<0.0001), with PFS at 2 years (p<0.03) and inversely with ABL gene mutations (p<0.001).

DISCUSSION: These data demonstrated the predictive value of early molecular response to IM in CPCML regarding disease course and PFS. A 2 log reduction at 6 months of IM treatment could be a cut off level predicting resistance, CCyR, or suggesting IM dose modification.

Mahmoud, H. K., Y. H. El Nahas, M. A. Samra, R. M. Abdelfattah, M. A. ElEmary, and W. H. El-Metnawy, "Kinetics Of BCR-ABL Transcripts In Patients with Chronic Phase CML (CML-CP) Treated With Imatinib Mesylate (Im): A Predictor Of Response And Progression Free Survival (PFS)", Haematologica, vol. 94, issue S2, pp. 573: Abst 1473., 2009.
Samra, M., M. Kamel, M. Elsharkawy, M. AbdElFatah, M. Ghaleb, M. Kamel, T. Abdel Hamid, and M. Elemary, "The Prognostic Significance of Minimal Residual Disease in Adult Patients with Acute Lymphoblastic Leukemia.", Haematologica, vol. 94, issue Suppl.2, pp. 564: Abst. 1445, 2009.
H.K., M., A. M. Elhadad, O. Fahmy, M. Elemary, M. Abdel-Mooti, R. Abdelfattah, A. Sobhy, Y. El-Nahass, and G. FATHY, "Therapeutic choices in patients with Ph-positive CML: SCT Vs TKI?", Pan Arab Journal of Oncology, vol. 2, issue 2, pp. 35-36: Abst. A10., 2009.
2008
Abdelsalam, M., A. El Sissy, M. A. Samra, S. Ibrahim, D. El Markaby, and F. Gadallah, "The impact of trisomy 12, retinoblastoma gene and P53 in prognosis of B-cell chronic lymphocytic leukemia.", Hematology (Amsterdam, Netherlands), vol. 13, issue 3, pp. 147-53, 2008 Jun. Abstract

PURPOSE: Routine cytogenetic analysis frequently fails to identify an abnormal clone in B-cell lymphocytic leukaemia (B-CLL) due to poor response to mitogen stimulation. Fluorescence in situ hybridization (FISH) suggest that chromosomal abnormalities occur more frequently, most commonly trisomy 12, retinoblastoma gene deletion (Rb1 gene) and P53 gene deletion.

PATIENTS AND METHODS: 30 patients with B-CLL were enrolled in the trial from two centers in Cairo, Egypt during the period May 2000 to January 2002. Karyotyping and FISH assessment for possible chromosomal abnormalities (trisomy 12, Rb1 gene and P53 gene) were done at initial diagnosis. Results of cytogenetic abnormalities were correlated with clinical picture and survival.

RESULTS: The median age was 57.4 years (range 40-75). Karyotyping technique showed that no metaphase could be detected in 30%, metaphase with normal karyotyping was observed in 63% and cytogenetic abnormalities were detected in two cases (one trisomy 12 and one deletion in chromosome 13). FISH examination of interphase and metaphase nuclei revealed cytogenetic abnormalities in 15 cases (50%), trisomy 12 in 9 (30%), Rb1 gene deletion in 5 (17%) and P53 gene deletion in 3. At diagnosis, patients with trisomy 12 were significantly associated with advanced stage and absolute lymphocyte count of >or=30,000/mm(3). Univariate analysis showed that absolute lymphocyte count >or=30,000/mm(3) (p=0.004) and trisomy 12 (p=0.024) were associated with poor progression free survival.

CONCLUSION: Interphase and metaphase FISH studies improve the cytogenetic diagnosis of chromosomal abnormalities in B-CLL. Lymphocytosis and trisomy 12 may be a good indicator of poor prognosis.

Mahmoud, H. K., A. El-Haddad, O. Fahmy, M. El-Emary, A. Nassar, M. Abdel-Mooti, A. Sobhy, and A. Sultan, "Hematopoietic stem cell transplantation in Egypt.", Bone marrow transplantation, vol. 42 Suppl 1, pp. S76-S80, 2008 Aug. Abstract

Hematopoietic SCT is now an established treatment modality with definitive indications for many hematological disorders. However, this line of treatment requires tremendous resources, and it becomes increasingly difficult for transplanters practicing in the developing world to reconcile the difference between what is possible and what is available. On the basis of 18 years of experience and more than 1300 transplants, this article will focus on special issues, which we think are important for hematopoietic SCT practices in developing countries, taking the program in Egypt as an example that may be applicable to other countries in the developing world. The SCT program in Egypt started in 1989 on a narrow scale. In 1997, the transplant rate increased dramatically with the opening of the SCT unit at the Nasser Institute. Our team is registered in the Center for International Blood and Marrow Transplant Research. The total number of transplants performed till June 2007 is 1362; 80% of the cases are allogeneic and 20% autologous. There are seven other centers in Egypt performing mainly autologous transplants.

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