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Biomedical subjects

Sherif Farag

Publications and source records attributed to Sherif Farag.

5 recordsLinked to original sources
PubMed2006

Long-term outcome of Hodgkin disease patients following high-dose busulfan, etoposide, cyclophosphamide, and autologous stem cell transplantation.

Busulfan (Bu)-based preparative regimens have not been extensively investigated in Hodgkin disease (HD). The purposes of this study were to investigate the toxicity and efficacy of a novel preparative regimen of Bu 14 mg/kg, etoposide 50-60 mg/kg, and cyclophosphamide 120 mg/kg in patients with primary refractory and relapsed HD. One hundred twenty-seven patients with a median age of 33 years (range, 14-67 years) underwent transplantation. The regimen was well tolerated, with 5.5% treatment-related mortality at 100 days after transplantation. With a median follow up of 6.7 years, the 5-year progression-free survival was 48 +/- 5%, and the 5-year overall survival was 51 +/- 5%. A Cox proportional hazards model identified refractory disease at time of transplantation as the only significant factor affecting relapse and overall survival, whereas disease bulk >10 cm affected overall survival. Five patients died between 5.3 and 9.3 years of late complications, including secondary myelodysplasia or acute myeloid leukemia, secondary solid malignancies, and pulmonary toxicity. This novel Bu regimen is comparable to other radiation-free preparative regimens in its effectiveness in the control of HD and with a low-risk of early treatment-related mortality.

Adolescent↗
PubMed2004

Long-term follow-up after liver transplantation in Egyptians transplanted abroad.

OBJECTIVE: To study the long-term outcome after liver transplantation (LT) in Egyptian patients who underwent LT outside Egypt. METHODS: Between May 1993 and February 2004, over 150 Egyptians underwent LT outside Egypt. Data of 67 recipients were collected in Egypt through personal communications with the Overseas Liver Transplant Centers and through the records of the Egyptian Liver Transplant Association. RESULTS: Most patients underwent LT in Europe (73.1%), few in the United State of America (17.9%) and in Japan (9%). Sixty-one patients underwent cadaveric LT and the remaining 6 patients underwent living related liver transplantation (LDLT). The male to female ratio was 58:9. Median age was 45 (3-63 years). Hepatitis C virus (HCV) cirrhosis whether alone or mixed with schistosomiasis was the main indication for LT. Out of those 67 recipients, 52 (77.6%) survived after a median follow-up period of 4.6 years (rang 1-10.5 years). Deaths were due to primary non-function in 3 patients, postoperative bleeding in one patient, recurrent hepatitis C virus (HCV) in 10 patients, and chronic rejection in one patient. CONCLUSION: Egyptians underwent LT abroad showed a good long-term outcome. Due to the high prevalence of HCV, we expect a growing need for LT in Egypt. Although LDLT has been introduced recently in Egypt, cadaveric liver donation is still not legalized by the government. Efforts should be directed to expanding LDLT, legalizing cadaveric LT and also to the prevention and control of HCV infection in Egypt in order to avoid its devastating effect on the society as well as its enormous negative impact on Egypt's economy and future development.

Adolescent↗
PubMed2002

Leukocytoreduction for acute leukemia.

Both in children and adults, acute leukemia may present with extremely high blast counts; a phenomenon known as hyperleukocytosis. Respiratory failure, intracranial bleeding, and severe metabolic abnormalities frequently occur in acute hyperleukocytic leukemias (AHLs) and are the primary determinants of the high early mortality (20% to 40%) observed. The process leading to these complications has long been known as leukostasis, but the biological mechanisms underlying its development and progression have remained unclear. Traditionally, leukostasis has been attributed to overcrowding of leukemic blasts in the microcirculation, and its treatment has focused on prompt leukocytoreduction. However, it is becoming increasingly evident that leukostasis results from the adhesive interactions between leukemic blasts and the endothelium; a mechanism that none of the current therapies directly addresses. The endothelial damage associated with leukostasis is likely to be mediated by cytokines released in situ and by subsequent migration of leukemic blasts in the perivascular space. The adhesion molecules displayed by the leukemic blasts and their chemotactic response to the cytokines in the vascular microenvironment are probably more important in causing leukostasis than the cell number. This may explain why leukostasis may develop in some patients with AHL and not in others, and why some patients with acute leukemia without hyperleukocytosis (<50,000 blasts/mm(3)) develop leukostasis and respond to leukocytoreduction. Leukapheresis effectively reduces the blast count in many patients with AHL and is routinely used for immediate leukocytoreduction. However, the most appropriate use of leukapheresis in acute leukemia remains unclear, and the procedure may not prevent early death more efficiently than fluid therapy, hydroxyurea, and prompt induction chemotherapy. The use of cranial irradiation remains very controversial and is not generally recommended. The identification of the adhesion molecules, soluble cytokines, and chemotactic ligand-receptor pairs mediating endothelial cell damage in AHL should become a priority if better outcomes are desired.

Acute Disease↗
PubMed2002

Chronic lymphocytic leukemia.

This update of early stage B-cell chronic lymphocytic leukemia (B-CLL) embraces current information on the diagnosis, biology, and intervention required to more fully develop algorithms for management of this disease. Emphasis on early stage is based on the rapid advancement in our understanding of the disease parameters and our increasing ability to predict for a given early stage patient whether there is a need for more aggressive management. In Section I, Dr. Terry Hamblin addresses the nature of the disease, accurate diagnostic procedures, evidence for an early "preclinical" phase, the use of newer prognostic features to distinguish who will be likely to progress or not, and whether it is best to watch or treat early stage disease. In Section II, Dr. Neil Kay and colleagues address the biologic aspects of the disease and how they may relate to disease progression. Review of the newer insights into gene expression, recurring genetic defects, role of cytokines/autocrine pathways, and the interaction of the CLL B cell with the microenvironment are emphasized. The relationship of these events to both trigger disease progression and as opportunities for future therapeutic intervention even in early stage disease is also considered. In Section III, Dr. John Byrd and colleagues review the historical and now current approaches to management of the previously untreated progressive B-CLL patient. They discuss what decision tree could be used in the initial decision to treat a given patient. The use of single agents versus newer combination approaches such as chemoimmunotherapy are discussed here. In addition, the place of marrow transplant and some of the newer antibodies available for treatment of B-CLL are considered. Finally, a challenge to utilize our growing knowledge of the biology of B-CLL in the early stage B-CLL is proffered.

Antineoplastic Agents↗