Ahmad Antar - Academia.edu (original) (raw)

Papers by Ahmad Antar

Frontiers in Oncology, Aug 20, 2023

Editorial on the Research Topic Case reports in hematological malignancies: 2022 Hematological ma... more Editorial on the Research Topic Case reports in hematological malignancies: 2022 Hematological malignancies are tumors of the hematopoietic and lymphoid tissues, referring to a group of cancers that affect the blood, lymph nodes, and bone marrow. They include leukemias, myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPNs), lymphomas, plasma cell neoplasms, and other rare bone marrow diseases like histiocytic or dendritic cell tumors. The most recent World Health Organization (WHO) classification of hematolymphoid tumors (5 th edition) was released in August 2022 (1). The aim of this Research Topic entitled "Case reports in hematological malignancies" was to collect articles that highlight rare cases with typical features, frequent cases with atypical features, or cases with a convincing clinical response to new off-label use therapy. Such cases may provide valuable insights into the pathomechanism of the disease. They can also serve as a basis for creating hypotheses for future research. A total of seventy-three manuscripts were submitted, of which thirty-three have been accepted for publication: a 45% acceptance rate. Eleven of the accepted manuscripts are cases of acute leukemia. Long et al. reported a case of acute myeloid leukemia (AML) treated with a lower dose of venetoclax (100 mg once daily) with the combination of grapefruit juice (a strong CYP3A4 inhibitor, 200 ml 3 times daily), and azacitidine 75 mg/m2 on days 1-7 of each 28-day cycle (2, 3). The patient achieved complete remission (CR) with the venetoclax Cmax within the effective concentration range at 7 and 14 days of treatment and maintained remission with manageable side effects. This case highlights the importance of drug-food interaction combinations in reducing the dose and cost of venetoclax, especially in low to middleincome countries. A case of concurrent Langerhans cell histiocytosis (LCH) and AML which shared driver mutations in an 84-year-old female patient was reported by Kazama et al. The diagnosis was based on biopsy where LCH was primarily identified in the skin, lymph nodes, and bone marrow, while AML was predominantly present in the bone marrow and peripheral blood. Only a few numbers of cases of LCH and AML diagnosis at the same time have been reported, the majority of which included generalized LCH, and monocytic leukemia, and was associated with dismal prognosis (4, 5

Gene Reports, Sep 1, 2016

Hepatitis C virus (HCV) is a common chronic infection worldwide affecting approximately 170 milli... more Hepatitis C virus (HCV) is a common chronic infection worldwide affecting approximately 170 million people. 80% of acutely infected people fail to eliminate the virus and develop into the chronic phase. Some studies propose that activating KIRs have an important role in the clearance of some viruses including HCV and HIV, however, they might increase the risk of acquiring autoimmune diseases. Aim: The aim of this study is to investigate any possible association between HCV and some KIR genotypes. Methods: KIR genotype was analyzed for 47 HCV patients and 120 healthy Lebanese individuals using the KIR Genotyping SSP kit. Results: Among HCV patients, the AA, AB, and BB genotypes frequencies were, respectively, 34.05%, 42.55% and 23.40% with an A:B ratio of 1.24:1. As for the controls, the AA, AB, and BB genotypes frequencies were, respectively, 39.17%, 50%, and 10.83% with an A:B ratio of 1.79:1. KIR 2DL3 and KIR 2DS4*001/002 were found to be significantly more prevalent among HCV patients as compared to controls in addition to an increase in the B haplotype. Conclusion: In this first pilot prevalence study in the Mediterranean area studying KIR genotyping in HCV patients, the interesting results warrant further clinical and translational research to assess the protective or predisposing role of KIR genotypes in HCV.

Journal of Cardiothoracic Surgery

Background Giant cell tumor (GCT) is a relatively common and locally aggressive benign bone tumor... more Background Giant cell tumor (GCT) is a relatively common and locally aggressive benign bone tumor that rarely affects the sternum. Case presentation We report a case of giant cell tumor of the sternum in a 28-year-old Saudi with painful swelling at the lower part of the sternum. Subtotal sternectomy and reconstruction with a neosternum using two layers of proline mesh, a methyl methacrylate prosthesis, and bilateral pectoralis muscle advancement flaps were performed. Conclusions Giant cell tumor of the sternum is a rare diagnosis. Surgical resection with negative margins is the ideal management. To avoid defects or instability of the chest wall, reconstruction of the chest wall with neosternum should be considered.

Journal of Multidisciplinary Healthcare

Background: Pulmonary complications after thoracic surgery are common and are associated with pro... more Background: Pulmonary complications after thoracic surgery are common and are associated with prolonged hospital stay, higher costs, and increased mortality. This study aimed to evaluate the value of The Assess Respiratory risk in Surgical Patients in Catalonia (ARISCAT) risk index in predicting pulmonary complications after thoracic surgery. Methods: This retrospective study was conducted at Almoosa Specialist Hospital, Saudi Arabia, from August 2016 to August 2019 and included 108 patients who underwent thoracic surgery during the study period. Demographic data, ARISCAT risk index score, length of hospital stay, time of chest tube removal, postoperative complications, and time of discharge were recorded. Results: The study involved 108 patients who met the inclusion criteria. Their mean age was 42.5 ± 18.9 years, and most of them were men (67.6%). Comorbid diseases were present in 53.7%, including mainly type 2 diabetes mellitus and hypertension. FEV1% was measured in 58 patients, with a mean of 71.1 ± 7.3%. The mean ARISCAT score was 39.3 ± 12.4 and ranged from 24 to 76, with more than one-third (35.2%) having a high score grade. The most common surgical procedures were thoracotomy in 47.2%, video-assisted thoracoscopic surgery (VATS) in 28.7%, and mediastinoscopy in 17.6%. Postoperative pulmonary complications (PPCs) occurred in 22 patients (20.4%), mainly pneumonia and atelectasis (9.2%). PPCs occurred most frequently during thoracotomy (68.2%), followed by VATS (13.6%), and mediastinoscopy (9.1%). Multinomial logistic regression of significant risk factors showed that lower FEV1% (OR = 0.88 [0.79-0.98]; p=0.017), longer ICU length of stay (OR = 1.53 [1.04-2.25]; p=0.033), a higher ARISCAT score (OR = 1.22 [1.02-1.47]; p=0.040), and a high ARISCAT grade (OR = 2.77 [1.06-7.21]; p=0.037) were significant predictors of the occurrence of postoperative complications. Conclusion: ARISCAT scoring system, lower FEV1% score, and longer ICU stay were significant predictors of postoperative complications. In addition, thoracotomy was also found to be associated with PPCs.

A 66-year-old woman was admitted to the gastroenterology department with epigastric pain, nausea,... more A 66-year-old woman was admitted to the gastroenterology department with epigastric pain, nausea, and subicterus. Her complaints had begun 6 h earlier. Her abdomen was soft and flat, with localized tenderness on palpation in the right subcostal area. Laboratory studies revealed a white cell count of 17.9x10 9 /L, hemoglobin concentration of 14.4 g/dL, and platelet count of 48x10 9 /L, and they were notable for elevated serum cholestatic enzymes. The abdominal ultrasound was remarkable for cholangitis. The patient received broad-spectrum antibiotics. A peripheral blood smear examination, performed to evaluate thrombocytopenia, revealed the presence of blue intracytoplasmic inclusions in neutrophils (Figures 1A-C). On the 11 th day of treatment, her blood smear was examined once again and the Döhle body-like inclusions were resolved (Figure 1D). May-Hegglin anomaly is an uncommon autosomal dominant abnormality characterized by large, basophilic inclusion bodies (resembling Döhle bodie...

Gastrointestinal metastasis from invasive lobular breast cancer (ILC) is relatively rare. Simulta... more Gastrointestinal metastasis from invasive lobular breast cancer (ILC) is relatively rare. Simultaneous gastric and colonic metastases are extremely rare. Its presentation is typically vague; therefore, early recognition using clinical, radiological, endoscopic and histopathologic investigations is critical to distinguish it from primary gastric carcinoma. We report a 62-year-old woman who presented initially with atypical gastrointestinal symptoms and was diagnosed with de novo metastatic ILC with synchronous gastric and colonic involvement. She had excellent clinical response after 4 weeks of medical treatment. To our best knowledge, this is the first case of synchronous spread to stomach and colon as the first presentation of de novo metastatic breast cancer.

SSRN Electronic Journal, 2022

Bone Marrow Transplantation, 2016

FMS-like tyrosine kinase 3 (FLT3) is one of the most commonly mutated genes in AML. FLT3 is mutat... more FMS-like tyrosine kinase 3 (FLT3) is one of the most commonly mutated genes in AML. FLT3 is mutated in~30% of patients with AML, either by internal tandem duplications (FLT3-ITD) of the juxta-membrane domain or by a point mutation, usually involving the tyrosine kinase domain. Several FLT3 tyrosine kinase inhibitors are being evaluated in multiple studies aiming at improving outcomes. The most widely used is sorafenib, a potent multikinase inhibitor approved for hepatocellular carcinoma and renal cell carcinoma. Sorafenib monotherapy or in combination with conventional chemotherapy, has been evaluated in various settings in AML, including front-line, relapsed or refractory disease including post-allograft failures and, more recently, as post-transplant maintenance therapy. Encouraging data have emerged with several other agents like lestaurtinib, midostaurin, crenolanib, gilteritinib and quizartinib. Although transient responses to FLT3 inhibitors are often observed in case of disease relapse, the most promising approach is the use of FLT3 inhibitors either in combination with induction chemotherapy or as consolidation/ maintenance therapy after allogeneic hematopoietic cell transplantation. In this review, we summarize the clinical data on sorafenib and other FLT3 inhibitors in AML.

European Journal of Gynaecological Oncology, 2019

SSRN Electronic Journal, 2021

Background: Inferior vena cava (IVC) filter can be used for patients with venous thromboembolism ... more Background: Inferior vena cava (IVC) filter can be used for patients with venous thromboembolism (VTE) with any of the following conditions: contraindications for anticoagulants, recurrent pulmonary embolism (PE) despite anticoagulants, or anticoagulants-related complications, and poor cardiopulmonary reserve. This study aimed to assess indications, efficacy, and outcome of IVC filter insertion for patients with VTE. Methods: This retrospective study was performed at Almoosa Hospital, Alhasa, Saudi Arabia, from August 2017 to August 2020 and met the inclusion criteria. All adult patients who received an IVC filter insertion were included. Results: The study included 1350 cases. We divided the patients into two groups, group 1: 1310 patients who had VTE without need for IVC filter insertion, and group 2: 40 patients, 39 who had VTE, and IVC filter insertion was needed and one poly-trauma patient and IVC filter were inserted prophylactically. A total of 40 IVC filters were inserted....

Blood

Background The optimal stem cell mobilization regimen for multiple myeloma (MM) is undefined. Mos... more Background The optimal stem cell mobilization regimen for multiple myeloma (MM) is undefined. Most centers use either granulocyte-colony stimulating factor (G-CSF) alone (steady state strategy) or cyclophosphamide (CY) followed by G-CSF (chemo-mobilizing strategy). However, the impact of CY dose on stem cell yield and subsequent engraftment, and toxicity is unknown. We retrospectively analyzed our experience using fractionated high-dose CY and G-CSF as our preferred chemo-mobilization strategy in MM patients (pts) and its impact on the mobilization outcomes, engraftment and the observed toxicity. Methods Between 01/2000 and 12/2012, 220 chemo-mobilization attempts were undertaken. Among these, 62 pts (M=37, F=25) had MM (1st-line=54, relapsed=8) and all received high-dose CY and G-CSF. Median age was 56 (37-75) yrs. ISS stage was I (n=34), II (n=16), and III (n=12). Pre-transplant induction consisted of VAD or VAD-like chemotherapy (n=26), bortezomib(bor)/dexamethasone (dex) (n=15),...

Blood

Background: 5-Azacidine (5-AZA) is a DNA hypomethylating agent with proven clinical activity in m... more Background: 5-Azacidine (5-AZA) is a DNA hypomethylating agent with proven clinical activity in myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). A recent non-randomized study reported promising results with the use of lower doses of 5-AZA as maintenance therapy after hematopoietic stem cell transplantation (HSCT). It is important to note that 5-AZA has an immunomodulatory effect and might enhance the graft-versus-leukemia (GVL) effect. Here, we report the successful use of 5-AZA maintenance following allogeneic HSCT in patients with high risk AML and MDS. Patients and methods: Nine patients (M=6, F=3; median age=49 (36-65) years ) with high-risk AML (n=6 including 2 abnormal karyotypes) or MDS (n=3 including 1 abnormal karyotype) received 5-AZA as post-transplant maintenance at a dose of 32mg/m2 daily for 5 days every 4 weeks starting at a median time of 100 (30-210) days post-transplant. All patients were in complete remission at initiation of 5-AZA. A median of 12...

Blood

Introduction: Despite allogeneic hematopoietic stem cell transplantation (HSCT), prognosis of fms... more Introduction: Despite allogeneic hematopoietic stem cell transplantation (HSCT), prognosis of fms-like tyrosine kinase 3 (FLT3) mutated acute myeloid leukemia (AML) remains poor due to the high risk of relapse. Sorafenib, a multikinase inhibitor active on FLT3, has shown encouraging results in these patients. Patients and methods: Here, we report the use of sorafenib as a maintenance agent after HSCT in 28 adults with FLT3 positive AML treated in three hematologic departments. Results: A total of 18 males and 10 females were included. All but one patient (pt) underwent their first HSCT between 2012-2016. Median age at HSCT was 45 years (range 16-57). A normal karyotype was detected in all but 5 pts. Ten pts showed FLT3-ITD as sole molecular abnormality, thirteen with concomitant NPM-1 mutation, associated to WT1 overexpression in 1 case and to CEBP-α double mutated in two. Association of FLT3 and WT1 overexpression was observed in 3 pts. Two more pts presented a FLT3-TKD with concom...

Blood

Introduction: The optimal stem cell mobilization regimen for patients with multiple myeloma (MM) ... more Introduction: The optimal stem cell mobilization regimen for patients with multiple myeloma (MM) remains undefined. Most transplant centers use either a chemo-mobilization strategy using cyclophosphamide (CY) and granulocyte-colony stimulating factor (G-CSF) or a steady state strategy using G-CSF alone or with plerixafor in case of mobilization failure. However, very few studies compared efficacy, toxicity and cost-effectiveness of stem cell mobilization with cyclophosphamide (CY) and G-CSF versus G-CSF with preemptive plerixafor. In this study, we retrospectively compared our single center experience at the American University of Beirut in 89 MM patients using fractionated high-dose CY and G-CSF as our past preferred chemo-mobilization strategy in MM patients with our new mobilization strategy using G-CSF plus preemptive plerixafor. The change in practice was implemented when plerixafor became available, in order to avoid CY associated toxicity. Patients and methods: Patients in th...

Turkish Journal of Hematology

Cancer, Jan 7, 2017

Sorafenib has shown encouraging results in patients with Fms-like tyrosine kinase 3 (FLT3)-positi... more Sorafenib has shown encouraging results in patients with Fms-like tyrosine kinase 3 (FLT3)-positive acute myeloid leukemia. Its role after allogeneic stem cell transplantation (HSCT) has been reported in a few cases with encouraging results. The authors describe the use of sorafenib as a maintenance agent after HSCT in 27 patients with FLT3-positive acute myeloid leukemia. The median age of the patients was 46 years (range, 15-57 years). Sorafenib was introduced at a median of 70 days (range, 29-337 days) after HSCT. The median treatment duration was 8.4 months (range, 0.2-46 months). Eleven patients experienced treatment toxicities, mainly of grade 1 to 2 (graded according to the National Cancer Institute Common Toxicity Criteria [version 4.0]). Dose reduction or withdrawal was required in 4 patients and 4 patients, respectively. The persistence of toxicity prompted treatment withdrawal in 1 patient. Clinical improvement followed dose modifications. Thirteen patients experienced ch...

Gastrointestinal Cancer Research Gcr, 2013

Frontiers in Oncology, Aug 20, 2023

Editorial on the Research Topic Case reports in hematological malignancies: 2022 Hematological ma... more Editorial on the Research Topic Case reports in hematological malignancies: 2022 Hematological malignancies are tumors of the hematopoietic and lymphoid tissues, referring to a group of cancers that affect the blood, lymph nodes, and bone marrow. They include leukemias, myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPNs), lymphomas, plasma cell neoplasms, and other rare bone marrow diseases like histiocytic or dendritic cell tumors. The most recent World Health Organization (WHO) classification of hematolymphoid tumors (5 th edition) was released in August 2022 (1). The aim of this Research Topic entitled "Case reports in hematological malignancies" was to collect articles that highlight rare cases with typical features, frequent cases with atypical features, or cases with a convincing clinical response to new off-label use therapy. Such cases may provide valuable insights into the pathomechanism of the disease. They can also serve as a basis for creating hypotheses for future research. A total of seventy-three manuscripts were submitted, of which thirty-three have been accepted for publication: a 45% acceptance rate. Eleven of the accepted manuscripts are cases of acute leukemia. Long et al. reported a case of acute myeloid leukemia (AML) treated with a lower dose of venetoclax (100 mg once daily) with the combination of grapefruit juice (a strong CYP3A4 inhibitor, 200 ml 3 times daily), and azacitidine 75 mg/m2 on days 1-7 of each 28-day cycle (2, 3). The patient achieved complete remission (CR) with the venetoclax Cmax within the effective concentration range at 7 and 14 days of treatment and maintained remission with manageable side effects. This case highlights the importance of drug-food interaction combinations in reducing the dose and cost of venetoclax, especially in low to middleincome countries. A case of concurrent Langerhans cell histiocytosis (LCH) and AML which shared driver mutations in an 84-year-old female patient was reported by Kazama et al. The diagnosis was based on biopsy where LCH was primarily identified in the skin, lymph nodes, and bone marrow, while AML was predominantly present in the bone marrow and peripheral blood. Only a few numbers of cases of LCH and AML diagnosis at the same time have been reported, the majority of which included generalized LCH, and monocytic leukemia, and was associated with dismal prognosis (4, 5

Gene Reports, Sep 1, 2016

Hepatitis C virus (HCV) is a common chronic infection worldwide affecting approximately 170 milli... more Hepatitis C virus (HCV) is a common chronic infection worldwide affecting approximately 170 million people. 80% of acutely infected people fail to eliminate the virus and develop into the chronic phase. Some studies propose that activating KIRs have an important role in the clearance of some viruses including HCV and HIV, however, they might increase the risk of acquiring autoimmune diseases. Aim: The aim of this study is to investigate any possible association between HCV and some KIR genotypes. Methods: KIR genotype was analyzed for 47 HCV patients and 120 healthy Lebanese individuals using the KIR Genotyping SSP kit. Results: Among HCV patients, the AA, AB, and BB genotypes frequencies were, respectively, 34.05%, 42.55% and 23.40% with an A:B ratio of 1.24:1. As for the controls, the AA, AB, and BB genotypes frequencies were, respectively, 39.17%, 50%, and 10.83% with an A:B ratio of 1.79:1. KIR 2DL3 and KIR 2DS4*001/002 were found to be significantly more prevalent among HCV patients as compared to controls in addition to an increase in the B haplotype. Conclusion: In this first pilot prevalence study in the Mediterranean area studying KIR genotyping in HCV patients, the interesting results warrant further clinical and translational research to assess the protective or predisposing role of KIR genotypes in HCV.

Journal of Cardiothoracic Surgery

Background Giant cell tumor (GCT) is a relatively common and locally aggressive benign bone tumor... more Background Giant cell tumor (GCT) is a relatively common and locally aggressive benign bone tumor that rarely affects the sternum. Case presentation We report a case of giant cell tumor of the sternum in a 28-year-old Saudi with painful swelling at the lower part of the sternum. Subtotal sternectomy and reconstruction with a neosternum using two layers of proline mesh, a methyl methacrylate prosthesis, and bilateral pectoralis muscle advancement flaps were performed. Conclusions Giant cell tumor of the sternum is a rare diagnosis. Surgical resection with negative margins is the ideal management. To avoid defects or instability of the chest wall, reconstruction of the chest wall with neosternum should be considered.

Journal of Multidisciplinary Healthcare

Background: Pulmonary complications after thoracic surgery are common and are associated with pro... more Background: Pulmonary complications after thoracic surgery are common and are associated with prolonged hospital stay, higher costs, and increased mortality. This study aimed to evaluate the value of The Assess Respiratory risk in Surgical Patients in Catalonia (ARISCAT) risk index in predicting pulmonary complications after thoracic surgery. Methods: This retrospective study was conducted at Almoosa Specialist Hospital, Saudi Arabia, from August 2016 to August 2019 and included 108 patients who underwent thoracic surgery during the study period. Demographic data, ARISCAT risk index score, length of hospital stay, time of chest tube removal, postoperative complications, and time of discharge were recorded. Results: The study involved 108 patients who met the inclusion criteria. Their mean age was 42.5 ± 18.9 years, and most of them were men (67.6%). Comorbid diseases were present in 53.7%, including mainly type 2 diabetes mellitus and hypertension. FEV1% was measured in 58 patients, with a mean of 71.1 ± 7.3%. The mean ARISCAT score was 39.3 ± 12.4 and ranged from 24 to 76, with more than one-third (35.2%) having a high score grade. The most common surgical procedures were thoracotomy in 47.2%, video-assisted thoracoscopic surgery (VATS) in 28.7%, and mediastinoscopy in 17.6%. Postoperative pulmonary complications (PPCs) occurred in 22 patients (20.4%), mainly pneumonia and atelectasis (9.2%). PPCs occurred most frequently during thoracotomy (68.2%), followed by VATS (13.6%), and mediastinoscopy (9.1%). Multinomial logistic regression of significant risk factors showed that lower FEV1% (OR = 0.88 [0.79-0.98]; p=0.017), longer ICU length of stay (OR = 1.53 [1.04-2.25]; p=0.033), a higher ARISCAT score (OR = 1.22 [1.02-1.47]; p=0.040), and a high ARISCAT grade (OR = 2.77 [1.06-7.21]; p=0.037) were significant predictors of the occurrence of postoperative complications. Conclusion: ARISCAT scoring system, lower FEV1% score, and longer ICU stay were significant predictors of postoperative complications. In addition, thoracotomy was also found to be associated with PPCs.

A 66-year-old woman was admitted to the gastroenterology department with epigastric pain, nausea,... more A 66-year-old woman was admitted to the gastroenterology department with epigastric pain, nausea, and subicterus. Her complaints had begun 6 h earlier. Her abdomen was soft and flat, with localized tenderness on palpation in the right subcostal area. Laboratory studies revealed a white cell count of 17.9x10 9 /L, hemoglobin concentration of 14.4 g/dL, and platelet count of 48x10 9 /L, and they were notable for elevated serum cholestatic enzymes. The abdominal ultrasound was remarkable for cholangitis. The patient received broad-spectrum antibiotics. A peripheral blood smear examination, performed to evaluate thrombocytopenia, revealed the presence of blue intracytoplasmic inclusions in neutrophils (Figures 1A-C). On the 11 th day of treatment, her blood smear was examined once again and the Döhle body-like inclusions were resolved (Figure 1D). May-Hegglin anomaly is an uncommon autosomal dominant abnormality characterized by large, basophilic inclusion bodies (resembling Döhle bodie...

Gastrointestinal metastasis from invasive lobular breast cancer (ILC) is relatively rare. Simulta... more Gastrointestinal metastasis from invasive lobular breast cancer (ILC) is relatively rare. Simultaneous gastric and colonic metastases are extremely rare. Its presentation is typically vague; therefore, early recognition using clinical, radiological, endoscopic and histopathologic investigations is critical to distinguish it from primary gastric carcinoma. We report a 62-year-old woman who presented initially with atypical gastrointestinal symptoms and was diagnosed with de novo metastatic ILC with synchronous gastric and colonic involvement. She had excellent clinical response after 4 weeks of medical treatment. To our best knowledge, this is the first case of synchronous spread to stomach and colon as the first presentation of de novo metastatic breast cancer.

SSRN Electronic Journal, 2022

Bone Marrow Transplantation, 2016

FMS-like tyrosine kinase 3 (FLT3) is one of the most commonly mutated genes in AML. FLT3 is mutat... more FMS-like tyrosine kinase 3 (FLT3) is one of the most commonly mutated genes in AML. FLT3 is mutated in~30% of patients with AML, either by internal tandem duplications (FLT3-ITD) of the juxta-membrane domain or by a point mutation, usually involving the tyrosine kinase domain. Several FLT3 tyrosine kinase inhibitors are being evaluated in multiple studies aiming at improving outcomes. The most widely used is sorafenib, a potent multikinase inhibitor approved for hepatocellular carcinoma and renal cell carcinoma. Sorafenib monotherapy or in combination with conventional chemotherapy, has been evaluated in various settings in AML, including front-line, relapsed or refractory disease including post-allograft failures and, more recently, as post-transplant maintenance therapy. Encouraging data have emerged with several other agents like lestaurtinib, midostaurin, crenolanib, gilteritinib and quizartinib. Although transient responses to FLT3 inhibitors are often observed in case of disease relapse, the most promising approach is the use of FLT3 inhibitors either in combination with induction chemotherapy or as consolidation/ maintenance therapy after allogeneic hematopoietic cell transplantation. In this review, we summarize the clinical data on sorafenib and other FLT3 inhibitors in AML.

European Journal of Gynaecological Oncology, 2019

SSRN Electronic Journal, 2021

Background: Inferior vena cava (IVC) filter can be used for patients with venous thromboembolism ... more Background: Inferior vena cava (IVC) filter can be used for patients with venous thromboembolism (VTE) with any of the following conditions: contraindications for anticoagulants, recurrent pulmonary embolism (PE) despite anticoagulants, or anticoagulants-related complications, and poor cardiopulmonary reserve. This study aimed to assess indications, efficacy, and outcome of IVC filter insertion for patients with VTE. Methods: This retrospective study was performed at Almoosa Hospital, Alhasa, Saudi Arabia, from August 2017 to August 2020 and met the inclusion criteria. All adult patients who received an IVC filter insertion were included. Results: The study included 1350 cases. We divided the patients into two groups, group 1: 1310 patients who had VTE without need for IVC filter insertion, and group 2: 40 patients, 39 who had VTE, and IVC filter insertion was needed and one poly-trauma patient and IVC filter were inserted prophylactically. A total of 40 IVC filters were inserted....

Blood

Background The optimal stem cell mobilization regimen for multiple myeloma (MM) is undefined. Mos... more Background The optimal stem cell mobilization regimen for multiple myeloma (MM) is undefined. Most centers use either granulocyte-colony stimulating factor (G-CSF) alone (steady state strategy) or cyclophosphamide (CY) followed by G-CSF (chemo-mobilizing strategy). However, the impact of CY dose on stem cell yield and subsequent engraftment, and toxicity is unknown. We retrospectively analyzed our experience using fractionated high-dose CY and G-CSF as our preferred chemo-mobilization strategy in MM patients (pts) and its impact on the mobilization outcomes, engraftment and the observed toxicity. Methods Between 01/2000 and 12/2012, 220 chemo-mobilization attempts were undertaken. Among these, 62 pts (M=37, F=25) had MM (1st-line=54, relapsed=8) and all received high-dose CY and G-CSF. Median age was 56 (37-75) yrs. ISS stage was I (n=34), II (n=16), and III (n=12). Pre-transplant induction consisted of VAD or VAD-like chemotherapy (n=26), bortezomib(bor)/dexamethasone (dex) (n=15),...

Blood

Background: 5-Azacidine (5-AZA) is a DNA hypomethylating agent with proven clinical activity in m... more Background: 5-Azacidine (5-AZA) is a DNA hypomethylating agent with proven clinical activity in myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). A recent non-randomized study reported promising results with the use of lower doses of 5-AZA as maintenance therapy after hematopoietic stem cell transplantation (HSCT). It is important to note that 5-AZA has an immunomodulatory effect and might enhance the graft-versus-leukemia (GVL) effect. Here, we report the successful use of 5-AZA maintenance following allogeneic HSCT in patients with high risk AML and MDS. Patients and methods: Nine patients (M=6, F=3; median age=49 (36-65) years ) with high-risk AML (n=6 including 2 abnormal karyotypes) or MDS (n=3 including 1 abnormal karyotype) received 5-AZA as post-transplant maintenance at a dose of 32mg/m2 daily for 5 days every 4 weeks starting at a median time of 100 (30-210) days post-transplant. All patients were in complete remission at initiation of 5-AZA. A median of 12...

Blood

Introduction: Despite allogeneic hematopoietic stem cell transplantation (HSCT), prognosis of fms... more Introduction: Despite allogeneic hematopoietic stem cell transplantation (HSCT), prognosis of fms-like tyrosine kinase 3 (FLT3) mutated acute myeloid leukemia (AML) remains poor due to the high risk of relapse. Sorafenib, a multikinase inhibitor active on FLT3, has shown encouraging results in these patients. Patients and methods: Here, we report the use of sorafenib as a maintenance agent after HSCT in 28 adults with FLT3 positive AML treated in three hematologic departments. Results: A total of 18 males and 10 females were included. All but one patient (pt) underwent their first HSCT between 2012-2016. Median age at HSCT was 45 years (range 16-57). A normal karyotype was detected in all but 5 pts. Ten pts showed FLT3-ITD as sole molecular abnormality, thirteen with concomitant NPM-1 mutation, associated to WT1 overexpression in 1 case and to CEBP-α double mutated in two. Association of FLT3 and WT1 overexpression was observed in 3 pts. Two more pts presented a FLT3-TKD with concom...

Blood

Introduction: The optimal stem cell mobilization regimen for patients with multiple myeloma (MM) ... more Introduction: The optimal stem cell mobilization regimen for patients with multiple myeloma (MM) remains undefined. Most transplant centers use either a chemo-mobilization strategy using cyclophosphamide (CY) and granulocyte-colony stimulating factor (G-CSF) or a steady state strategy using G-CSF alone or with plerixafor in case of mobilization failure. However, very few studies compared efficacy, toxicity and cost-effectiveness of stem cell mobilization with cyclophosphamide (CY) and G-CSF versus G-CSF with preemptive plerixafor. In this study, we retrospectively compared our single center experience at the American University of Beirut in 89 MM patients using fractionated high-dose CY and G-CSF as our past preferred chemo-mobilization strategy in MM patients with our new mobilization strategy using G-CSF plus preemptive plerixafor. The change in practice was implemented when plerixafor became available, in order to avoid CY associated toxicity. Patients and methods: Patients in th...

Turkish Journal of Hematology

Cancer, Jan 7, 2017

Sorafenib has shown encouraging results in patients with Fms-like tyrosine kinase 3 (FLT3)-positi... more Sorafenib has shown encouraging results in patients with Fms-like tyrosine kinase 3 (FLT3)-positive acute myeloid leukemia. Its role after allogeneic stem cell transplantation (HSCT) has been reported in a few cases with encouraging results. The authors describe the use of sorafenib as a maintenance agent after HSCT in 27 patients with FLT3-positive acute myeloid leukemia. The median age of the patients was 46 years (range, 15-57 years). Sorafenib was introduced at a median of 70 days (range, 29-337 days) after HSCT. The median treatment duration was 8.4 months (range, 0.2-46 months). Eleven patients experienced treatment toxicities, mainly of grade 1 to 2 (graded according to the National Cancer Institute Common Toxicity Criteria [version 4.0]). Dose reduction or withdrawal was required in 4 patients and 4 patients, respectively. The persistence of toxicity prompted treatment withdrawal in 1 patient. Clinical improvement followed dose modifications. Thirteen patients experienced ch...

Gastrointestinal Cancer Research Gcr, 2013