Rare types of cancer are often not effectively treated by approaches such as chemotherapy and radio-therapy, although their side-effects persist. Immunotherapy has been gaining attention worldwide with growing examples of its anticancer activity demonstrated in vivo. This case report describes a 35-year-old male who suffered from advanced epithelioid sarcoma and underwent 18 cycles of chemotherapy without any significant response, who suffered adverse effects that caused lung collapse. A notable response was observed following the administration of autologous immune enhancement therapy (AIET), which involves a process of isolation, activation and expansion of natural killer (NK) and T cells, which were obtained from the patient’s own (autologous) peripheral blood. With the present data and the response of the patient to AIET, it may be proposed that AIET is beneficial for patients suffering from advanced epithelioid sarcoma without producing adverse effects.

Current modalities of cancer treatment, including surgery, chemotherapy and radiotherapy, show marginal therapeutic responses in cancer patients. In adoptive immunotherapy, interleukin-2 (IL-2) activated immune cells demonstrated notable results in patients with advanced malignant disease. The present study reports the efficacy and safety of repetitive infusions of autologous immune enhancement therapy (AIET) in a stage IV colonic cancer patient who had already received first-line chemotherapeutic drugs. Peripheral blood was aspirated from the patient. Specifically, natural killer (NK) cells and T-lymphocytes were isolated from the peripheral blood mononuclear cells (PBMCs). These cells were activated and expanded ex vivo for 14 days and were transfused intravenously to the patient. After six infusions of AIET, the carcinoembryonic antigen (CEA) level was decreased from 901 to 437 U/ml, regression of lesions was noted and there were no adverse reactions during the course of this therapy. Thus, AIET may be a promising anticancer approach to eradicate tumor cells with other conventional therapies.

Immune cell-based therapies using natural killer (NK) cells and cytotoxic T cells are under constant scrutiny, with the aim to design an effective and reduced-toxicity therapy, which will benefit patients via improved quality of life and improved prognosis. Four patients with stage IV colon cancer were administered 1, 3, 5 and 6 effector cell intravenous infusions, respectively. Peripheral blood was collected from the patients and the activation and expansion of NK and T cells was performed in Good Manufacturing Practice-certified clean rooms for ~12-15 days. Immunophenotypic analysis of the peripheral blood mononuclear cells (PBMCs) and expanded NK and T cells was conducted using flow cytometry and the patients were followed up. On average, 4.8×10 initial PBMCs and 2.7×10 total expanded cells were obtained. The intravenous infusions of the expanded cells were not accompanied by adverse reactions. Improved prognosis, reflected by a considerable decrease in the cancer markers, accompanied by an improved quality of life in the patients were observed. In conclusion, potential strategies are currently under development for the large-scale production of effectors cells; therefore, autologous immune enhancement therapy (AIET) may be considered as a viable approach to cancer treatment.

Human albumin solution (HAS) which is available in government hospitals in Malaysia, mostly are supplied by the National Blood Centre, Ministry of Health (MOH) Malaysia. Due to the high usage of HAS, it is a strain to meet the demands nationwide. Moreover, HAS is very expensive. This study was a retrospective observational study evaluating drug utilisation of HAS in Hospital Tawau, Sabah. A name list of 61 patients who had received HAS between 6 months from 1 January to 30 June 2019 was sent for medical records tracing. Forty-eight prescriptions of HAS were evaluated and later categorised as ‘proven indications’ or ‘unproven indications’ with the aid of an internally prepared guideline. The result of this study indicates that 12 (25%) out of 48 prescriptions were for ‘unproven indications’. Possible wastage due to ‘unproven indications’ was 29 vials which were 20% of the total HAS usage in this study, estimated to cost RM7,804 (USD1,880). Major surgery with a serum albumin level of 20 g/L and above (55.2%), paracentesis with ascitic fluid removed of less than 5 L (24.1%) and hypoalbuminemia without justified comorbid or diagnosis (20.6%) being reasons for possible wastage of HAS in this study. The percentage of possible wastage of HAS reflected in this study was not as high as other published research done in other countries, mainly due to additional steps required for prescribing HAS in our facility (filling Blood Plasma Product Request Form) and also the need to obtain approval from the Director-General of MOH Malaysia if it was prescribed for other than the approved indications.