ALBERT

Description: Introduction: The incidence of chronic lymphocytic leukemia (CLL) is believed to be low in India. Furthermore, there is no information on the incidence and outcome of autoimmune cytopenias. The incidence of autoimmune cytopenias is 5-10% at any point of the course of CLL. This diagnosis can have an important impact on therapeutic decisions. The prognostic significance of these autoimmune cytopenias in CLL continues to be a topic of debate. Methods: This was a retrospective study done at a tertiary level referral center in North India. Patient records of all CLL patients visiting the hematology clinic for the period 1994-2014 (20 years) were analyzed. Diagnosis of autoimmune hemolytic anemia (AIHA), autoimmune thrombocytopenia (ITP) and pure red cell aplasia (PRCA) was made according to standard criteria. The initial treatment options were categorized as prednisone, chlorambucil and observation. Responses were categorized as overall response rate (ORR) including CR+PR+SD and progressive disease (PD). Time to progression (TTP) was also calculated for each of the treatments and autoimmune cytopenias. Result: Out of a total of 412 CLL patients registered and following up at our clinic, a total of 62 patients (15.0%) developed autoimmune cytopenias. AIHA was seen in 21 patients (5.09%), ITP in 19 patients (4.6%) and PRCA in 22 (5.3%) patients. Autoimmune cytopenia at diagnosis was present in 44 and at follow-up in 18 patients. The median age of the patients was 63 years (SD±10.4). The median hemoglobin of patients with AIHA and PRCA was 70g/l (SD±28) and 60g/L (SD±16) respectively and median platelet count of patients with ITP was 81x109/L (SD±78.3). The best response to steroids was seen in patients with AIHA (ORR=71.4%) and ITP (ORR=80%), while only 40% PRCA patients show response to steroids. The response to chlorambucil was best for ITP (71.4%) followed by PRCA (33.3%) and AIHA (28.5%). The median time to progression of ITP, AIHA and PRCA patients on the above treatment options was 12, 6 and 0 months respectively (p

Description: Background Morbidity and mortality in tumor lysis syndrome (TLS) remains high despite increasing efforts for prevention, early detection and treatment in recent years. The current risk stratification system and treatment guidelines are largely consensus based without strong evidence. There is paucity of data on the in-hospital mortality and predictors of poor clinical outcome in this population. Methods We used the 2009-2011 Nationwide Inpatient Sample database to identify hospitalizations in patients ≥18 years with a diagnosis of TLS (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 277.88). Nationwide Inpatient Sample is the largest all-payer publicly available inpatient care database in the US. It contains data from five to eight million hospital stays from about 1,000 hospitals across the country and approximates a 20% sample of all US hospitals. The interval 2009-2011 was selected as ICD-9-CM code 277.88 for TLS was only introduced from the year 2009 onwards. Univariate and multivariate logistic regression were used to determine the independent predictors of in-hospital mortality. Data analysis was done using STATA version 13.0 (College Station, TX). Results Among the 997 admissions (mean age ± SD 67.58±3.33, 62.6 % males, and 80.4 % white) with TLS, in-hospital mortality was 14.44 %. Based on the results of univariate analyses (table 1), we used obesity, coronary artery disease, cardiac dysrhythmias, acute kidney injury and sepsis in the final regression model. We found that cardiac dysrhythmias (OR 4.79; 95% CI, 1.67-13.77; p=0.004) and sepsis (OR 19.70; 95% CI, 5.33-72.78; p

Description: Introduction: There are evidence based guidelines for the prophylaxis and management of infections in hematopoietic stem cell transplant recipients. However, the infection profile of transplant centers differs from center to center even in different regions of the same country. The reported incidence of bacterial, fungal and viral infections ranges widely from 13-60%, 4-30% and 2-16% respectively across the world. Here we report the infection profile in our transplant center. Methods: This was a retrospective study done at a tertiary care referral center in India. Data of hematopoietic stem cell transplants from 2004 –2014 was analyzed. All recipients received trimethoprim-sulphamethoxazole, levofloxacin, fluconazole and acyclovir prophylaxis. Voriconazole was used in allogeneic transplants after 2011. Definite bacterial infections were defined as any positive cultures from blood, urine, sputum, pus. Definite infective diarrhea was defined as stool culture or Clostridium difficile toxin positivity. Definite fungal infection required confirmation by culture or histopathology. Probable fungal infection required one each of host factors, clinical features and mycological evidence. Possible fungal infection required any one of the above three factors. Antifungals were started on day 3-5 as per the febrile neutropenia guidelines. CMV was monitored by RQ-PCR weekly till 100 days post transplant. All recipients were nursed in HEPA (high efficiency particulate air) filtered rooms till the resolution of infection or engraftment whichever was later. Results: Data of first 100 (36 allogeneic and 64 autologous) transplants was analyzed. All patients except 3 developed fever requiring antibiotics. There were 68 documented bacterial infections in 47 transplant recipients (47%). Gram negative were the most frequent isolates 49/68 (72.1%) followed by Gram positive organisms 19/68 (27.9%). Polymicrobial infections were seen in 11 patients (16.1%). Infections were significantly more common in allogeneic (26/36) than autologous transplant recipients (34/64) (p=0.005). Diarrhea was seen in 59 patients. Clostridium difficile toxin positivity was seen in 7 cases (11.8%). CMV infection was seen in 9 allogeneic HSCT recipients (25%). All patients had ongoing GVHD at the time of CMV reactivation and were on additional immunosuppression with corticosteroids. The diagnosis of fungal infection was made in 54 patients (54%). It was categorized as probable in 10 and possible in 44. Definite fungal infections could not be documented in any case. Antifungals were used for a median duration of 4.5 days (SD ±6.9). Infection attributed mortality was 9%. The median duration of antimicrobial usage was 13 days (SD±9.2). The median duration of total hospital stay was 38 days (SD±31.7). The median day of neutrophil engraftment was 12 days (SD±3.5). Multiple regression analysis revealed duration of antimicrobial use to be associated with hospital stay (p

Description: Introduction: The clinical behaviour and disease prognosis of AYA-CML is much different from adult CML. The outcome of this group of patients in resource constraints setting is not known where patients are seen in late chronic phase. Objectives: To study the survival pattern of AYA-CML in resource constraint settings. Methodology: It is a retrospective observational study wherein the data of all patients of AYA-CML managed at tertiary care centre in North India over last 14 years were analysed. All case records of the AYA-CML were perused, digitalised and their survival statistics derived. Results: Amongst a total of 1815 CML case records, 431 (23.74%) were AYA-CML. AYA-CML cases with complete data (n-225) were analysed for overall survival. The mean age of the patients was 23.08 ± 4.325 years (range 12-29). Males constituted 60.9% (n-137) and females, 39.1% (n-88) of AYA-CML. Of these 117 (52%) were single and 108 (48%) were married. Sixty one percentage of patients were educated upto 10th grade and 22.7% upto 5th grade and 8% received no formal education. Only 22.7% were educated beyond 12th grade. The mean monthly income was $75 (range $5-493). Ninety four percentage of patients had at least 12 months of follow up and 85.3% patients had at least 24 months of follow-up. The median delay in CML diagnosis from symptom onset was 62 days (range 0-2568). The details of therapy and complete haematological remission achieved in patients are described in table 1. The cumulative overall survival (OS) was 84% with no statistical difference in males and females (83.2%, 85.2% respectively) (Fig 1A, B). Survival rate at 1, 3, 5 and 8 years was 94.2%, 86.5% 78% and 74.2% respectively. Median OS was 1034 days (range 0-4788). OS was significantly better in patients receiving free drugs under Novartis Oncology Access (NOA) Program (p