Background There is scarcity of data on outcome of COVID-19 in patients with hematological malignancies. Primary objective of study was to analyse the 14-day and 28-day mortality. Secondary objectives were to correlate age, comorbidities and remission status with outcome. Methods Retrospective multicentre observational study conducted in 11 centres across India. Total 130 patients with hematological malignancies and COVID-19 were enrolled. Results Fever and cough were commonest presentation. Eleven % patients were incidentally detected. Median age of our cohort was 49.5 years. Most of our patients had a lymphoid malignancy ( n = 91). One-half patients (52%) had mild infection, while moderate and severe infections contributed to one-fourth each. Sixty seven patients (52%) needed oxygen For treatment of COVID-19 infection, half( n = 66) received antivirals. Median time to RT-PCR COVID-19 negativity was 17 days (7–49 days). Nearly three-fourth ( n = 95) of our patients were on anticancer treatment at time of infection, of which nearly two-third ( n = 59;64%) had a delay in chemotherapy. Overall, 20% ( n = 26) patients succumbed. 14-day survival and 28-day survival for whole cohort was 85.4% and 80%, respectively. One patient succumbed outside the study period on day 39. Importantly, death rate at 1 month was 50% and 60% in relapse/refractory and severe disease cohorts, respectively. Elderly patients(age ≥ 60)( p = 0.009), and severe COVID-19 infection ( p = 0.000) had a poor 14-day survival. The 28-day survival was significantly better for patients in remission ( p = 0.04), non-severe infection (p = 0.00), and age < 60 years ( p = 0.05). Conclusions Elderly patients with hematological malignancy and severe covid-19 have worst outcomes specially when disease is not in remission.

Heparin induced thrombocytopenia (HIT) is a serious adverse drug reaction caused by transient antibodies against platelet factor 4 (PF4)/heparin complexes, resulting in platelet activation and potentially fatal arterial and/or venous thrombosis. Most cases of HIT respond to cessation of heparin and administration of an alternative non-heparin anticoagulant, but there are cases of persisting HIT, defined as thrombocytopenia due to platelet activation/consumption for greater than seven days despite standard therapy. These patients remain at high risk for thrombotic events, which may result in limb-loss and mortality. Intravenous immunoglobulin (IVIg) has been proposed as an adjunct therapy for these refractory cases based on its ability to saturate FcγRIIa receptors on platelets, thus preventing HIT antibody binding and platelet activation. We describe 2 cases of persisting HIT (strongly positive antigen and functional assays, and persisting thrombocytopenia >7 days) with rapid clinical response to IVIg. We performed in-vitro experiments to support IVIg response. Healthy donor platelets (1 × 10e6) were treated with PF4 (3.75 μg/mL) for 20 min followed by 1-hour incubation with patients' sera. Platelet activation with and without addition of IVIg (levels equivalent to those reached in a patient after treatment with 2 gm/Kg) was evaluated in the PF4-dependent P-selectin expression assay (PEA). A significantly decreased platelet activation was demonstrated after the addition of IVIg to both patient samples, which correlated well with the rapid clinical response that each patient experienced. Thus, our study supports the use of IVIg as an adjunct therapy for persisting HIT.

Summary:body irradiation (TBI). [3][4][5][6] The anti-leukemic activity of HDA in patients refractory to standard therapy was first demonstrated by Herzig et al 7 in 1983. Over a 9-year period Seventy-three patients with hematological cancers undergoing allogeneic bone marrow transplantation from September 1983 to October 1992, we transplanted 73 patients with hematologic disease at the University of Flor-(BMT) were evaluated for event-free survival (EFS) and toxicity. All received 36 g/m 2 cytosine arabinoside ida using a uniform regimen of HDA and fractionated TBI. This paper reports the results of a retrospective analysis of (HDA) and 1200 cGy fractionated total body irradiation (TBI). We assessed the association of EFS and toxicities these patients in terms of their survival and major organ toxicity. We make proposals for further clinical research. with the following risk factors: age, gender, diagnosis, initial relapse risk and patient-donor histocompatibility. The EFS probability is 33% at 800 days post-BMT. Twenty-six patients (36%) died of toxicity within Materials and methods 100 days and 14 (19%) have relapsed. EFS was inversely associated with age (P Ͻ 0.0001) and initialConditioning regimen and nursing care relapse risk (P = 0.007). The risk of pulmonary (P = Seventy-three patients aged 2-55 years received a con-0.023) and hepatic toxicity (P = 0.011) increased with ditioning regimen of HDA 3 g/m 2 intravenously over 1 h age. Diagnosis other than acute lymphoblastic leukemia every 12 h on days −10 to −5 (total 36 g/m 2 ), plus TBI in (ALL) was a risk factor (P = 0.015) for graft-versustwice-daily 200 cGy fractions on days −4 to −2. Male host disease (GVHD); and fewer ALL patients died patients also received testicular irradiation (200 cGy/day from toxicity (P = 0.014). The probability of sepsis for 5 days). Bone marrow was infused on day 0. All within 100 days post-BMT correlated (P = 0.007) with patients were nursed in laminar air-flow rooms during the initial relapse risk. We conclude: (1) the lower EFS and neutropenic phase, and received intravenous broadgreater pulmonary and hepatic toxicity associated with spectrum antibiotics and antifungal drugs for fever spikes. increasing age indicate a need for less toxic regimens Corticosteroid eye drops were used to lessen conjunctivitis, that maintain high antileukemic efficacy for older as well as hyperalimentation and irradiated blood products patients; (2) the high GVHD and sepsis rates seen in as clinically indicated. certain categories of patients indicate a need for careful definition of eligibility criteria for this still highly GVHD prophylaxis: Varying regimens were used. In gentoxic treatment.eral, prior to 1987, prednisone only or prednisone and

In an increasingly globalised world, where medical tourism is common, data from developing countries regarding cost and outcome of CMV infections in AHSCT patients are of relevance.

Cytarabine, a pyramidine analog, is used for treating various hematological malignancies such as acute leukemias and lymphomas. Side effects of cytarabine are dose dependent and include bone marrow suppression, fever, cerebellar toxicity, cardiomyopathy, hepato-renal insufficiency, necrotizing enterocolitis, pancreatitis, acute respiratory distress, corneal toxicity and dermatological side effects. The dermatological side effects can be immediate or due to delayed hypersensitivity reactions. They have been attributed largely to release of cytokines. We present three such cases of delayed hypersensitivity to cytarabine affecting the ears bilaterally.