Objective: Investigate epidemiology of leukemia in Karbala province of Iraq, compare and identify possible changes with other populations. Methods: This was retrospective descriptive study for more than 400 leukemia patients in Karbala province from November 2011 to May 2018 with evaluation of age, gender distribution, types distribution and frequency distribution types of leukemia according to age and gender.Result: About 402 patients with leukemia were retrospectively enrolled in this study at median age of 30 years. Males accounted for a higher proportion of leukemia patients, 58.2 % compared to 41.8% females, with a male to female ratio of nearly 1.4:1. Acute lymphoblastic leukemia (ALL) was the most prevalent in the study group, contributing 41% (median age 10 years), followed by chronic myeloid leukemia (CML) 24.1% (median age 42 years), acute myeloid leukemia (AML) 19.2% (median age 36 years) and chronic lymphocytic leukemia(CLL) of less frequent type which contributed only 15.7% (median age 60 years). Conclusion: This is the first statistical study of leukemia in Karbala. It can be used as basic information to investigate epidemiological characteristics, to evaluate progress in recent years and to develop future leukemia strategies. More statistical leukemia analyses in Iraq are needed.

Background: Second line treatment of chronic myeloid leukemia (CML) is crucial after imatinib therapy failure. In Iraq, nilotinib is the only available second line tyrosine kinase inhibitors (TKIs), making management of CML patients with failure response to 1st generation TKIs as a great challenge to the health system. Objectives: Our study tries to evaluate nilotinib safety and efficacy among CML patients in Karbala province of Iraq as the only drug available as second line treatment for CML patients post imatinib failure. Materials & Methods: This research was carried out in Al-Hussein cancer center in Karbala province of Iraq between January 2012 & December 2020. Nilotinib was used as a second-line treatment for 30 CML patients and their response were assessed by the level of BCR-ABL1 transcription in peripheral blood at 3 months, 6 months and 12 months from starting treatments. Results: The median age was 42.5 years, included 16 males and 14 females with male to female ratio 1.14. According to Sokal score 15 patients were high risk, 11 patients were intermediate risk and 4 patients were low risk. More than 66% of our patients achieved major molecular response (MMR) after starting nilotinib as second line. The BCR- ABL transcription level had a significant reduction from baseline at 3 months, 6 months and 12 months respectively (P value <0.05). Male patients and those who received imatinib for ≥ 24 months were better survival. Conclusion: Nilotinib is effective and safe drugs as second line treatment among Iraqi patients.

Objectives: To evaluate the pathological patterns & luminal subtypes of breast cancer patients in the Middle Euphrates region of Iraq. Methods: A retrospective descriptive study was conducted at Al-Hussein Cancer Center in Karbala province of Iraq between January 2012 and August 2020. Results: There were 920 female patients with breast cancer. At the time of diagnosis, the mean age was 50.20 ±11.74 years. The most frequent pathological subtype was invasive ductal carcinoma in 91.85%, and 50.32% of tumors were grade II. Of luminal subtypes, Luminal A was the most prevalent subtype in 53.69%. Conclusion: Our results were similar to middle eastern patterns but significantly differed from western patterns.

Background: Multiple myeloma (MM) is a B cells neoplasm characterized by plasma cells clonal proliferation. Aims: The aim of this study was to evaluate incidence, prevalence and pattern of multiple myeloma (MM) in Middle Euphrates region of Iraq. Materials and Methods: A retrospective descriptive conducted at Al-Hussein center in Karbala province of Iraq between February 2012 and February 2020. Results: A total of 78 patients with MM were included in this study, median age at presentation was 59.8 years, M:F ratio was 0.85:1. The most frequent presenting complain was bony lesions in 87.18% of patients, IgG was the most frequent paraprotient in 61.53% and VRD was the most common used protocol in 37.18% . Survival rate was higher in younger & female patients, while there was no correlation between myeloma defining events and early death in our study. Conclusion: MM presenting age in our region was close to other parts of Iraq and neighboring countries but younger than western countries with female predominance. Giving that the majority of the patients presented with advance stage disease, therefore raising awareness of early symptoms is recommended for early diagnosis and proper management.