REAL WORLD MULTIPLE MYELOMA REGISTRY FROM JORDAN, A DEVELOPING COUNTRY.

Abstract Background and objective: Very scanty reports from the middle east and north Africa (MENA) region have been published on multiple myeloma (MM). Multiple myeloma registry has been established at Jordan University Hospital (JUH) since 2009. In this work we aim to review Multiple Myeloma registry with data from 113 patients who were diagnosed with MM at JUH and analyze their management and course. Methods: This is a non-interventional, and retrospective analysis of MM registry from 2009-2016 involving 113 patients at JUH. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS). Overall survival (OS) was analyzed with the Kaplan-Meier method. P value was considered significant if it was (<0.05). Results: We found no gender difference in this registry. The median age is 62 years. Most patients are ISS stage II and III (36.28% for each). Immunoglobulin type G Kappa is the dominant subtype. Bone pain is the most common presenting symptom. The most common laboratory finding is anemia (45.6%). Most of our patients (85.2%) had received thalidomide and dexamethasone, while only 14.8% received bortezomib, thalidomide, and dexamethasone. The mean overall survival (OS) in our patients was 74 months, and the median survival was 38 months. Median OS for ISS stage I, II, and III were 96, 46, and 16 months respectively. Conclusion: MM in a developing country presents a challenging disease compared with that in industrial countries in both the epidemiology and management. An improved road map in the care of MM in these countries is needed. The use of three or four drug combination upfront is warranted. However, this is limited because of the high cost of these drugs. We expect the following decade to show better survival and quality of life for MM patients once these drugs are widely used.   KEYWORDS: MYELOMA, DEVELOPING COUNTRIES, JORDAN, NEW THERAPIES, THERAPY COST

KRAS and NRAS mutational gene profile of metastatic colorectal cancer patients in Jordan.

BACKGROUND:A constitutively active RAS protein in the absence of stimulation of the epidermal growth factor receptor (EGFR) is the result of mutations in KRAS and NRAS genes. Mutations in the KRAS exon 2 and outside exon 2 have been found to predict the resistance to anti-EGFR monoclonal therapy. A substantial proportion of metastatic colorectal cancer cases (mCRC) exhibit RAS mutations outside KRAS exon 2, particularly in KRAS exon 3 and 4 and NRAS exons 2 and 3. No data about RAS mutations outside KRAS exon 2 are available for Jordanian patients with mCRC. We aim to study the molecular spectrum, frequency, and distribution pattern of KRAS and NRAS mutations in Jordanian patients with mCRC. METHODS:A cohort of 190 Jordanian metastatic colorectal cancer patients were enrolled in the trial. We detected mutations in exon 2 of the KRAS and NRAS gene as well as mutations outside of exon 2 using the StripAssay technique. The KRAS StripAssay covered 29 mutations and 22 NRAS mutations. RESULTS:Mutations were observed in 92 (48.42%) cases, and KRAS exon 2 mutations accounted for 76 cases (83.69%). KRAS G12D was the most common mutation, occurring in 18 cases, followed by KRAS G12A in 16 cases, and G12T in 13 cases. Mutations outside of KRAS exon 2 represented 16.3% of the mutated cases. Among those, 6 cases (6.48%) carried mutations in NRAS exon 2 and 3, and 10 cases (10.87%) in KRAS exon 3 and 4. CONCLUSION:The frequency of NRAS and KRAS mutations outside of exon 2 appears to be higher in Jordanian patients in comparison with patients from western countries. KRAS mutations outside of exon 2 should be tested routinely to identify patients who should not be treated with anti-EGFR antibodies

KRAS and NRAS mutational gene profile of metastatic colorectal cancer patients in Jordan: Molecular spectrum, frequency and distribution pattern

Abstract Background A constitutively active RAS protein in the absence of stimulation of the epidermal growth factor receptor (EGFR) is the result of mutations in KRAS and NRAS genes. Mutations in the KRAS exon 2 and outside exon 2 have been found to predict the resistance to anti-EGFR monoclonal therapy. A substantial proportion of metastatic colorectal cancer cases (mCRC) exhibit RAS mutations outside KRAS exon 2, particularly in KRAS exon 3 and 4 and NRAS exons 2, 3. No data about RAS mutations outside KRAS exon 2 are available for Jordanian patients with mCRC. We aim to study the molecular spectrum, frequency, and distribution pattern of KRAS and NRAS mutations in Jordanian patients with mCRC. Methods A cohort of 190 Jordanian metastatic colorectal cancer patients were enrolled in the trial. We detected mutations in exon 2 of the KRAS and NRAS gene as well as mutations outside of exon 2 using the StripAssay technique. The KRAS StripAssay covered 29 mutations and 22 NRAS mutations. Results Mutations were observed in 92 (48.42%) cases, and KRAS exon 2 accounted for 76 cases (83.69%). KRAS G12D was the most common mutation, occurring in 18 cases, followed by KRAS G12A in 16 cases, and G12T in 13 cases. Mutations outside of KRAS exon 2 represented 16.3% of the mutated cases. Among those, 6 cases (6.48%) carried mutations in NRAS exon 2, 3 and 10 cases (10.87%) in KRAS exon 3 and 4. Conclusion The frequency of NRAS and KRAS mutations outside of exon 2 appears to be higher in Jordanian patients in comparison with patients from western countries. KRAS mutations outside of exon 2 should be tested routinely to identify patients who should not be treated with anti-EGFR antibodies.</jats:p

REAL WORLD MULTIPLE MYELOMA REGISTRY FROM JORDAN, A DEVELOPING COUNTRY.

Abstract Background and objective: Very scanty reports from the middle east and north Africa (MENA) region have been published on multiple myeloma (MM). Multiple myeloma registry has been established at Jordan University Hospital (JUH) since 2009. In this work we aim to review Multiple Myeloma registry with data from 113 patients who were diagnosed with MM at JUH and analyze their management and course. Methods: This is a non-interventional, and retrospective analysis of MM registry from 2009-2016 involving 113 patients at JUH. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS). Overall survival (OS) was analyzed with the Kaplan-Meier method. P value was considered significant if it was (&lt;0.05). Results: We found no gender difference in this registry. The median age is 62 years. Most patients are ISS stage II and III (36.28% for each). Immunoglobulin type G Kappa is the dominant subtype. Bone pain is the most common presenting symptom. The most common laboratory finding is anemia (45.6%). Most of our patients (85.2%) had received thalidomide and dexamethasone, while only 14.8% received bortezomib, thalidomide, and dexamethasone. The mean overall survival (OS) in our patients was 74 months, and the median survival was 38 months. Median OS for ISS stage I, II, and III were 96, 46, and 16 months respectively. Conclusion: MM in a developing country presents a challenging disease compared with that in industrial countries in both the epidemiology and management. An improved road map in the care of MM in these countries is needed. The use of three or four drug combination upfront is warranted. However, this is limited because of the high cost of these drugs. We expect the following decade to show better survival and quality of life for MM patients once these drugs are widely used.   KEYWORDS: MYELOMA, DEVELOPING COUNTRIES, JORDAN, NEW THERAPIES, THERAPY COST.</jats:p

Characteristics of the 190 patients.

Characteristics of the 190 patients.</p

Mutational status and detailed mutation classes found.

Mutational status and detailed mutation classes found.</p

Myelodysplastic Syndromes and Myelodysplastic Syndromes/Myeloproliferative Neoplasms: A Real-World Experience From a Developing Country

PURPOSEMyelodysplastic syndromes (MDS) include a heterogeneous group of clonal bone marrow disorders characterized by ineffective hematopoiesis. They manifest as dysplasia in bone marrow hemopoietic elements associated with peripheral cytopenias with variable risk of AML transformation.PATIENTS AND METHODSWe analyzed retrospectively registry data collected prospectively from patients with primary MDS and patients with MDS/myeloproliferative neoplasm (MPN) in the Jordan University Hospital between January 2007 and September 2021. The registry captured epidemiologic information such as date of diagnosis, age, gender, date of AML transformation, cytogenetics, MDS subtype, risk group according to Revised International Prognostic Scoring System, and survival. The registry also captured baseline ferritin, B12, and lactate dehydrogenase levels.RESULTSA total of 112 patients with MDS and MDS/MPN were included in the registry. Median age at diagnosis was 59 years. The male-to-female ratio was about 1.2. In a multivariate cox regression model, baseline serum ferritin significantly affected survival as patients with levels exceeding 1,000 μg/L had a risk of death three times higher compared with those with <1,000 μg/L levels (P < .05).CONCLUSIONTo our knowledge, our study is the first comprehensive study examining the epidemiology and prognostic factors in patients with MDS and patients with MDS/MPN in Jordan. Our results show that MDS and MDS/MPN epidemiology in Jordan is different compared with Western countries. Our results also show that baseline serum ferritin levels can be used as a prognostic marker for patients with MDS

A retrospective analysis of post-transplant lymphoproliferative disorder following liver transplantation

OBJECTIVE: To evaluate response rates and survival in adults developing post-transplant lymphoproliferative disorder (PTLD) following liver transplantation.METHODS: Patients were identified retrospectively and data collected through local liver and haematology electronic databases and pharmacy records.RESULTS: Forty-five patients were identified. The median age at first transplant and at development of PTLD was 48 and 54 years, respectively, with the median time from transplant to PTLD diagnosis of 56 months. The majority of cases (76%) were monomorphic B-cell lymphomas, and 36% of tumours were EBV positive. Treatment involved reduction in immune-suppression (RIS) in 30 (67%) with RIS the only treatment in 3. Ten (22%) patients were treated with rituximab alone, 13 (29%) with chemotherapy alone and 14 (31%) patients were treated with rituximab and chemotherapy. Twenty-six (58%) patients achieved a complete response (CR). At a median follow-up of 27 months, the median overall survival (OS) was 50 months. Response and OS were not associated with clinical factors or the use of rituximab.CONCLUSION: Outcomes reported in this study are favourable and comparable to those reported previously. The addition of rituximab did not appear to have improved outcomes in this series, although a significant proportion of patients were able to avoid chemotherapy.</p