India has the second largest population of any country in the world. c India has a high patient load: the total number of registered people with hemophilia is 18 353. c Treatment for hemophilia is unaffordable for many. Less than 20% of the country's population is covered by health insurance. c India has a diverse geography. c Many facilities that diagnose hemophilia are of poor quality. c Care is suboptimal because many treatment facilities are of poor quality. c Indians with hemophilia have a high rate of complications and disabilities. Objective Our aim is to study disease indications, the factors used for treatment, and the outcome of patients treated with CFCs. A subgroup analysis of patients with hemophilia A and hemophilia B was performed. Methodology This study used a retrospective, single-institution design. The study period was from April 1, 2017, to March 31, 2018. Included in the study were any patients with hemophilia A or B who received CFCs from the Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh.
Background & objectives: Both innovator and generic imatinib are approved for the treatment of Chronic Myeloid Leukaemia-Chronic phase (CML-CP). Currently, there are no studies on the feasibility of treatment-free remission (TFR) with generic imatinib. This study attempted to determine the feasibility and efficacy of TFR in patients on generic Imatinib. Methods: In this single-centre prospective Generic Imatinib-Free Trial-in-CML-CP study, twenty six patients on generic imatinib for ≥3 yr and in sustained deep molecular response (BCR ABL IS ≤0.01% for more than two years) were included. After treatment discontinuation, patients were monitored with complete blood count and BCR ABL IS by real-time quantitative PCR monthly for one year and three monthly thereafter. Generic imatinib was restarted at single documented loss of major molecular response (BCR ABL IS >0.1%). Results: At a median follow up of 33 months (interquartile range 18.7-35), 42.3 per cent patients (n=11) continued to be in TFR. Estimated TFR at one year was 44 per cent. All patients restarted on generic imatinib regained major molecular response. On multivariate analysis, attainment of molecularly undetectable leukaemia (>MR 5 ) prior to TFR was predictive of TFR [ P =0.022, HR 0.284 (0.096-0.837)]. Interpretation & conclusions: The study adds to the growing literature that generic imatinib is effective and can be safely discontinued in CML-CP patients who are in deep molecular remission.
Diffuse large B-cell lymphoma (DLBCL) is the commonest sub-type of non-Hodgkin lymphoma. However, lung consolidation is a rare presentation of DLBCL. Moreover, in view of poor general condition, it poses clinical dilemma of when to start chemotherapy and whether chemotherapy should be given at full dose or truncated doses till improvement in general condition. A 48-years-old lady was admitted with complaints of non-productive cough for 2 months duration. She was febrile and hypoxemic requiring oxygen supplementation. She had bilateral axillary lymphadenopathy, and bronchial breath sounds on chest auscultation. Chest X-ray showed non-homogenous opacities involving bilateral lower zones. A diagnosis of DLBCL was confirmed on lymph node biopsy and Immunohistochemistry. She received chemotherapy, following which a gradual, improvement in her breathlessness and cough was noted over ensuing week and she got discharged from the hospital and received rest of her chemotherapy on outpatient basis. In a case of DLBCL with lung consolidation, a high index of suspicion can clinch the diagnosis of secondary lymphomatous involvement. Presence of respiratory failure at presentation doesn't necessarily warrants truncation of chemotherapy doses.
Introduction: Cytogenetic assessment is an essential test in patients with Acute Lymphoblastic Leukaemia (ALL), as it is required for diagnosis, treatment and to know the prognosis. Although these tests are done as standard of care in most of the institutes, there are limited publications from India describing karyotypic abnormalities in ALL patients. Aim: To assess the various cytogenetic abnormalities encountered in patients suffering from ALL and to know the pattern of chromosomal abnormalities. Materials and Methods: The present study was a retrospective cross-sectional study done at a tertiary care teaching hospital in Karnataka, India. Patients who were diagnosed with ALL based on flow cytometry between January 2017 and June 2021 were included in the present study and total 61 patients were evaluated for the cytogenetic findings. The medical records of these 61 patients were reviewed to collect their details like age, sex, immunophenotype and cytogenetic findings. Results: During flow cytometry analysis, side scatter vs CD45 expression strategy was applied. Events with low side scatter and dim CD45 expression (blast gate) were gated. Leukaemias expressing precursor markers (CD34/HLA-DR) along with cytoplasmic/surface CD3 were diagnosed as T-ALL. Leukaemias with precursor markers along with any two out of three B-cell markers i.e CD19, CD79a or CD10 were diagnosed as B-ALL. In this study 13 patients out of 35 had normal karyotype and this was the most common cytogenetic finding. The most common cytogenetic abnormality in B-ALL patients was hypodiploidy, but t(9;22) (q34;q11.2) was the most common cytogenetic abnormality in adult patients with B-ALL. Among the patients with T-ALL, only 2 (15.38%) patients had chromosomal abnormalities. Conclusion: The present study highlights the role of cytogenetics in patients undergoing treatment for ALL. Chromosomal abnormalities like t(9;12) (q13;p11.2), t(X;1) (q13;p36.1) and t(9;15) (p13;q11.2) are novel chromosomal abnormalities which were found in the present study. Long-term follow-up is necessary to identify prognostic implications of such chromosomal abnormalities.
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