Hematology - Oncology and BMT Research Center

 

BMT Wards
Hematology Wards

Clinics

Laboratory

Research Office

BMT Data

SHARIATI  HOSPITAL

December 2002

 




The Hematology Oncology & BMT Research Center (HORC) of Tehran Medical University of medical sciences , which is located in Shariati Hospital, has been established since 1991. It gradually expanded till it was moved to a new fully equipped four storied 4800 m2 infrastructure consisting of 4 wards with 32 beds for transplantation and two blood wards each consisting of 12 beds.We also have a research laboratory and computer center.

This center is one of the largest BMT centers in the world and  is one of the remarkable international BMT centers due to its performing a great number of successful transplantations.

It should also be mentioned that HORC is able to train five fellowships as Hematologist and Oncologist annually. 

 

 The Goals of HORC

  1. Promoting the knowledge of students, fellowships, and specialists, in the field of hematology & oncology.

  2. Promotion and development of the basic & practical research in hematology and oncology.

  3. Improvement of society’s health status.

  4. Assisting in planning education research and treatment programs in order of importance depending on our country’s health policy.

  5. Expanding communications with other research centers in order to exchange and update knowledge.

 

 The missions of HORC  

  1. Performing the practical & basic research in order to assess our present cure method and also offering the newest and latest protocol of treatment in hematology and oncology diseases.

  2. Providing the best facilities to absorb more students seeking a career in research in the field of hematology and relevant diseases.

  3. Cooperation with other research centers for performing national , regional and universal research projects.

  4. Issuing and publishing the reports of HORC in the form of articles, bulletins and booklets.

  5. Raising funds with the help of celebrities, in order to reach the goals of the center.   

  6. Educational planning in order to train assistants and fellows for our territory according to Ministry of Health policy.

In order to achieve the above goals and missions, HORC has a staff consisting of approximately 25  professors and specialists in different fields (hematology, oncology, pathology, clinical pharmacology, immunology, statistics, epidemiology) and also 116 nurses and employees.

This center has the honor to be a pioneer in providing the services listed below:

  1. Performed the first HSCT in Iran in 1991 by A. Ghavamzadeh, et al and carrying out this treatment for different kinds of cancers and hematologic disorders.

  2. Performing successful cord blood transplantation for the first time in Iran since 1998.

  3. Successfully performing BMT as a treatment for Thalassemia, which made Iran rank second for performing BMT worldwide

  4. Providing Platelets needed for BMT by using the single donor method, which has been carried out by the research lab.

  5. Non – myeloablative Transplantation (LIC)

  6. Donor Lymphocyt Infusion ( DLI)

  7. Freezing possibility for stem cells

  8. Fish technique.

  9. RT-PCR

  10. Cell- Culture.

Before the opening of our center, Iranian candidates for BMT had to deal with a lot of financial problems to go abroad and receive treatment. It caused not only financial losses for our country, but also it added a lot of psychological problems to the patients. After the establishment of our BMT center, not only have we been treating related patients, but also decreasing extra expenditure. Now our knowledge and experience is sufficiently developed so that at the moment we have the approved technology of our own. We have been performing  about 200 Transplantations annually and we are the pioneers of this procedure in our territory. This is proved by the fact that our results are concordant with those of one of the  largest  BMT centers in the world ,which has  32 beds.



BMT Wards

 One of the most important activities of our Hematology- Oncology & BMT Center is performing and developing BMT as a new treatment for curing special types of cancer. Since 1991 (when the first BMT was carried out in Iran), 602 cases have been transplanted in our center, which had one ward with 6 beds and gradually expanded so that we have now four wards, with 32 active beds. Therefore the compliance of BMT center has been significantly increased. The patients are completely isolated and sterilization is carefully done. The building has appropriate air conditioning systems with positive air pressure, full fresh air and HEPA filters. Each ward has its own CSR room and also its own operating room in order to avoid unnecessary movement, which might be hazardous to the patients.

The facilities available for researchers are:

-Study and gaining knowledge concerning BMT.

-Study & retrospective research in various fields relating to patients’ files.

-Prospective co-operating research projects on BMT, hematology and oncology

disorders with other research centers.   

Needless to say, there are certain rules to which the members should comply.  


 

 

Hematology Wards

There are two Hematology wards. Each ward consists of 12 beds in 5 double rooms and two single rooms. Only patients over 14 years old are admitted. The duration of admission is about one month; therefore we are able to admit 300 patients annually.

Patients with Hematological diseases are admitted through the hematology Clinic or emergency room based on the diagnosis made by their own Hematologist or Oncologist.

 There are enough facilities for researchers as below:

- Studying in the field of every Hematology or Oncology disease relating to the various patients’

- Studying and analyzing the patient’s data.

- The ability of performing common projects with the other Hematology and Oncology centers.

 




Clinics Wards

Patients are initially examined and followed up by Hematologists, Oncologists and BMT specialists in the clinic. In order to cope with the number of referred patients, the clinics have been active daily since the spring of 2000. Besides these, there are also specialized Clinics in the afternoon. Also, BMT clinics are run separately to follow up the BMT patients and to consult with BMT candidates. There is also a separate hall with 9 beds next to the clinic for outpatient chemotherapy.

 

The facilities for researchers are as the following:

- Study in the field of Hematology or Oncology diseases in referred patients

- Studying and analyzing patient’s data.

- The ability of performing common projects with other Hematology and Oncology centers.

 





Laboratory

HORC’s laboratory has been active since 1991. It was relocated  to new and modern facilities last year providing enough space and facilities. Its main role is preparing Transplantation patients, performing special tests and research projects. 

 This laboratory has seven separate areas as below:

 

1- Cell Separator

It is equipped with 3 Cobe and 2 Fresenius for the following performances.

-  Providing platelets from single donors.

-  Capturing stem cells from HLA-identical donors. (PBSC)

-  Performing DLI for patients.

-  Performing Mini Transplantation

-  Cell Culture

At the time of transplantation each PBSC, Cord blood and BM is cultured due to determination of GM-CSF ratio and in vitro control.

Long-term culture and stem cell expansion .

3- BMT Lab

BMT lab prepares the operating instruments for the sampling of BM, provides the equipment and the facilities necessary for taking Cord blood, and also separates RBC from Cord blood and Bone marrow for both culturing and homogenous ABO.

4- Hematological Lab

Performs daily CBC for patients in transplant wards, Hematology- Oncology wards  and special staining to rule out differential diagnoses.

5- Freezing Lab
Duties are as below:
- Freezing the stem cells taken from Cord blood and the PBSC of autologous in order to preserve until the time of Transplantation.
- Cord blood storage in frozen form.
- Providing stem cell bank.

6- Radiation Ward  
Radiates all blood products, which are used in transplant patients. Radiation may also be a device in other related fields of research.

7- Genetic & Molecular Lab, Immunologic Lab:

  • Performing RT-PCR for AML patients.

  • HLA typing by serologic and molecular methods.

  • Assessing Chimerism by PCR.

  • Assessing Multiple Drug Resistance by Flowcytometry.

  • Developing a DNA bank in Transplanted and non – transplanted patients.

8- Educational Classes  
These are held every week with the subject of Gene therapy, Immunotherapy, and cell culture.
As a summary the lab facilities and services are as the following:

- Platelet collection
- Peripheral blood stem cell collection (PBSC)
- Plasma exchange
- Blood products irradiation
- Stem cell culture
- Cryopreservation of stem cells
- Preparation of condition medium from cell line 5637
- RBC deletion from BM and Cord blood
- Bone marrow collection in operation room
- Complete blood count (CBC)
- Peripheral Blood Smear (PBS)
- Specialy staining
- Fish technique
- RT-PCR

 It should be mentioned that Hematology-Oncology and BMT research center is equipped with the latest laboratory devices according to world standards. At the moment its facilities are as below:

- Performing clinical and basic lab tests in the field of hematology and oncology.

- Performing shared research projects with other centers in related fields regarding our framework rules.




Research Office

HORC has a research office : A section for data management consist of  gathering the BMT data of BMT wards ,checking Reports for completeness of data and identifying missing data, reporting missing fields and after completing them, entering Report Form data into the computer database program for statistical analysis and prepration of statistical reports, and finally sending them to IBMTR and EBMT.This center is also responsible for quality control of data entry processes and training  patients, BMT and data management staff. Another section for organizing conferences, research projects, editing HORC news and other scientific activities . It’s current activities and the list of research projects are as follows:

Current Activities

 HORC has had many scientific/educational activities even before its registration as an independent organization. These include providing  more than 200 scientific-research essays to international congress and journals and offering more than 100 academic thesis supervised by professors. HORC has always been in communication with other remarkable centers i.e.:  

 

1. IBMTR

International BMT Registry

  2. EBMT European BMT
  3. APCC Asian Pacific Cancer Congress
  4. ESO European Society of Oncology
  5. ASCO American Society of Clinical Oncology
  6. ASBMT American Society of BMT
  7. ASH American Society of Hematology
  8. ESMO European Society of Medical Oncology
  9. EHA   European Hematology Association



At present HORC is involved in the following projects, their necessity was approved in the current year.

  Forming student research groups. Admitting and performing 7 research projects as academic thesis.

  Study in the opening of a cord blood bank in Iran according to world standards.

  Study in the opening of a genetic laboratory for gene therapy center in Iran.

  Performing DLI (Donor Lymphocyte Infusion) projects to increase the success rate of BMT.

  Performing NST (Non-myeloablative Stem Cell Transplantation) to increase the success rate of BMT.

  Performing shared research projects with internal and external research centers.

 

Research projects are as follows:

  1. Three years survival of multimodality therapy versus surgery alone in esophageal squamus cell carcinoma.

  2. A clonality study on hematopoiesis in acute myelocytic leukemia in female patients at diagnosis and during remission.

  3. Effect of intratumoral injection of shark cartilage extract on growth local invasion & metastasis of osteosarcoma in rabbits

  4. A comparison study of BMT patients in Shariati hospital with EBMT & IBMTR centers.

  5. Descriptive evaluation of risk factors, clinical course of the patients with Ovarian carcinoma admitted in cancer institute, Shariatie Hospital, Mirza Koochak Khan hospital, Arash Hospital and Vali-e-Asr Hospital during the past ten years (1990-2000)

  6. Incidence of chronic graft versus host disease and its risk factors in patients undergone bone marrow transplantation at Hematology-Oncology & BMT Research Center of Shariati Hospital between 1369-1379

  7. The evaluation of side effects and efficacy of interferon in CML patients.

  8. Descriptive study of clinical and paraclinical specifications, clinical course and therapeutic side effects in breast cancer patients treated by protocol 7904 referred to Shariati hospital from June 2000 to June 2002.

  9. Evaluation of 6 different media for EX vivo expansion of cord blood hematiopoietic stem cells

  10. Determination of chimerism status after BMT using STR-PCR method

  11. Survey the effect of patient training for decreasing chemotherapy side effect in patient with lymphoma, getting ABVD treatment protocol.

  12. HLA & risk of GVHD in BMT from HLA identical sibling at Shariati Hospital during 1991-99

  13. A study on the feasibility & effectiveness of MIXED CHIMERISM as a choice treatment in high risk patients with a hematological malignancy   

  14. Efficacy of arsenic tri oxide in remission induction of patients with APL

  15. Descriptive study on clinical manifestation & distribution of the risk in patients with non-Hodgkin lymphoma hospitalized in Tehran Shariati & IMAM hospital during 1372-1379 a companied by it’s data bank

  16. Survey of epidemiologic, clinical & treatment in record of myeloma patient who have been hospitalized in Shariati & Imam hospitals during 1991-2000 & forming a data base of the obtained information

  17. Survey of the relation between bone marrow vascular density & therapeutic response in related studies

  18. Comparative study of 2 regimens plan for patient with multiple myeloma in Imam hospital in 3 years

  19. Evaluation of relapse after detection of MRD by PCR in patient with adult acute lymphoblastic leukemia

  20. Phase I/II trial of arsenic trioxide in patient with relapsed/refractory hematologic malignancies

  21. The evaluation of side effects & efficacy of interferon in CML patients Forming a data bank of ALL & gathering all the related information of the HORC admitted during the last 10 years

  22. Forming a data bank of AML & gathering all the related information of the HORC admitted during the last 10 years

  23. Forming a data bank of CML & gathering all the related information of the HORC admitted during the last 10 years

  24. Forming a data bank of Gastric cancer patients & gathering all the related information of the HORC admitted during the last 10 years

  25. A comparative study of the efficacy & side effects of two regimens in ALL

  26. Estimation of Quality of life after hematopoietic stem cell and bone marrow transplantation: a case control study

  27. Estimation of Quality of life after hematopoietic stem cell and bone marrow transplantation: a case control study

  28. Descriptive study on clinical manifestation and of the risk factors in patients with Hodgkin’s lymphoma hospitalized in Shariati and Imam centers during 1993-2000. accompanied by it’s data bank

  29. Follow up of leukocyte and reticulocyte counts for prediction of engraftment after hematopoietic stem cell and bone marrow transplantation by Flowcytometry

  30. Descriptive study on clinical manifestation and of the risk factors in patients with Esophagus cancer hospitalized in Shariati and Imam centers during 1993-2000 accompanied by it’s data bank

  31. Descriptive study on clinical manifestation and of the risk factors in patients with Colon cancer hospitalized in Shariati and Imam centers during 1993-2000. accompanied by it’s data bank

  32. Rituximab and CHOP in patients with diffuse mixed, diffused large cell and immunoblastic large cell histology Non-Hodgkin's lymphoma

  33. Follow up of leucocyte and reticulocyte counts for prediction of engraftment after hematopoietic stem cell and bone marrow transplantation by Flow cytometry

  34. Study of Gemzar effects in patients with Non small cell lung cancer

  35. Use of two methods for evaluation of Multi-Drug resistance in patients with Multiple Myeloma, Myeloblastic and Lymphoblastic leukemia

  36. Evaluation of MIP1α effects on transduction rate of GaLV oncoretrovirus in cord blood stem cells LTC-IC.

  37. Assessment of two different methods of preemptive therapy based on directly observing Antigen and PCR in reducing the incidence of CMV diseases of bone marrow transplanted patients in Shariati Hospital

  38. Study of patients with acute promyelocytic leukemia using reverse transcription polymerase chain reaction at the time of diagnosis and follow up

  39. The assessment of Metronidazole on improving of Cyclosporine induced Gingival Hyperplasia in patients admitting to Shariati Hospital in 1380

  40. Assessing of time sequential high dose chemotherapy (TSHDC) in cytarabin+ Idarubicin regimen on adult patients with primary AML (except M3) admitted in Shariati hospital

  41. Determination of CBFb/MYH11 و CBFa/ETO1 و PML/RARA Frequency in AML patients who  have been referred to shariati hospital

  42. Study on effects of infusion desmopressine and management of factor VIII an van Willibrand in mild and moderate Hemophilia A and VWD type I

  43. Study on effects of infusion desmopressine and management of factor VIII an van Willibrand in mild and moderate Hemophilia A and VWD type I

  44. Evaluation of IL-6 and TNF-a in neutropenic patients who have fever (low risk, High risk) and comparison of Ofloxacin vs. conventional therapy in low risk patient

  45. Comparative study on the effect of treatment with Fe and Zn supplements with merely Fe supplement in Iron deficiency anemia women ahead 20-45 referring to Shariati hospital

  46. Assessment of Cytarabin + Idarubicin Combination Therapy in the Elderly with AML

  47. Variation of the frequency of peripheral blood haematopoietic stem cell preserved at 4 oC by eight days after sample collection

  48. Purification of Dendritic cells from Human Blood

  49. Comparison of allogeneic T cell proliferation stimulated by cord blood and Adult Blood Dendritic cells

  50. Survey of anti-sense oligodendritic inhibitor of telomerase on matrix metaloproteinase secretion by human prostate cancer cells(LNCAP)

  51. Survey of the relation of the change in bone marrow vascular density(before and after BMT)with relapse and GVHD rates

  52. Detection of IL-18 and IL-2 receptor as  aGVHD predictor after BMT

  53. Comparison of apoptosis induction of cord blood and adult blood dendritic cells

  54. Identification of myeloid and lymphoid subsets in dendritic cells derived from cord blood and peripheral adult blood

  55. Comparison of IL-4 and IFN-γ production from T-cells stimulated by cord blood and peripheral adult blood dendritic cells

  56. Comparison of nitric oxide production of cord blood and adult blood dendritic cells

  57. The effect of Idarubicin and Busulfan as conditioning regimen to autologous stem cell transplantation in acute myeloid leukemia

  58. Evaluation of epidemiologic and laboratory characteristics of patients with hereditary function disorders in Imam khomeini hospital from 1979  to 2002

  59. Study of effects of Arsenic trioxide in reduction of morphologic and molecular remission in acute promylocitic leukemia  with t(15,17)

  60. Immunosuppressive therapy of severe acquired  aplastic anemia with adaptation of AT6 and cyclosporin

  61. Survey  of the relation of the changes in bone marrow vascular density(before and after BMT)with relapse and GVHD rates

  62. Study of mouth epithelial cells chimerism after allogeneic hematopoitic stem cell transplantation in human

  63. Invitro study ofMDR1-Antisense oligoneucleotides of acute myeloblastic leukemia patients cells study of drug resistance due to P-glycoprotein expression and detoriation of sensitivity of blast cells to chemotherapeutic agents in acute myeloblastic leukemia patients

  64. Study of nlslac gene presentation in dendritic cells derived from CD+34 cells contaminated with retrovirus

  65. Study of the effect of dendritic cells pulsed exvivo by antigenic in treatment of acute adult leukemia

  66. Study of microorganism producing fever neutropenic patients in hematology ward in Imam Khomeini hospital




BMT Data

 

Bone marrow=252

Peripheral blood=397

Cord blood=5

BM+PB=2

Allogeneic= 487

Autologus =169

Female =278

Male=378

HLA-identical sibling = 470

Syngeneic=5

Other related=12

Thalassemia: 196

Bone marrow=115

Peripheral blood=76

Cord blood=5

Disease free survival in thalassemia major

 

 

 

 

ã 2004 TUMS