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.

Background:Pancytopenia is a relatively common hematological condition, the etiological factors of which vary widely in different geographic location. Determining the specific etiology is of immense importance for appropriate management.Aims and Objectives:The present study was undertaken to delineate etiological factors leading to pancytopenia in a Tertiary Care Hospital of West Bengal from Eastern Region of India.Materials and Methods:A prospective study was conducted for a period of 2 years in which 248 patients were included. After obtaining a relevant clinical history, physical examination was done followed by complete blood count including peripheral blood smears examination, relevant biochemical, and radiological investigations. Afterward, bone marrow aspiration and biopsy were performed and microscopically examined.Results:Among 248 patients studied, 156 (62.9%) were males and 92 (37.09%) were females. The mean age of the patients was 33 years. Aplastic anemia was the most common cause of pancytopenia that was observed in 83 cases (33.47%) followed by megaloblastic anemia in 52 cases (20.97%), leishmaniasis in 34 patients (13.71%), hypersplenism also in 34 patients (13.71%), and tuberculosis and other connective tissue disorders in 18 cases (7.26%). The occurrence of aplastic anemia was statistically significant in pediatric (≤15 years) age group.Conclusion:Aplastic anemia was found to be the most common cause of pancytopenia in this study, which is in contrast to studies conducted from other regions of India. Delineation of etiologies of pancytopenia in various regions can help in defining diagnostic and therapeutic strategies, which is expected to contribute toward the better management of such patients.

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Non-Hodgkin lymphoma associated with pregnancy is rare. Rituximab based chemotherapy is now considered the standard of care and considered safe for the treatment of diffuse large B-cell lymphoma (DLBCL) during pregnancy but little is known about its safety profile on the fetus. A 32 y primigravida was diagnosed as DLBCL at 20 wk of gestation. She received rituximab containing chemotherapy with successful pregnancy outcome. Though the baby was absolutely healthy, B-cell was totally absent in the cord blood.

BackgroundBurkholderia cepacia, an aerobic gram-negative bacillus, is a frequent colonizer of fluids used in the hospital ward. It poses little risk of infection to healthy people; however it is a known important opportunistic pathogen causing morbidity and mortality due to its intrinsic resistance to most of the antibiotics in hospitalized patients. Small hospital outbreaks are frequent. B. cepacia may occur as an opportunistic infection in hemato-oncology patients. Here we present an outbreak of Burkholderia cepacia infection in hematology ward of our institute.MethodsFebrile episodes as defined by IDSA guideline, 2010 were followed, and blood for culture and sensitivity was sent in all the events. The culture was done by an automated method using Bactalert 3d Biomeriux & sensitivity pattern by Microscan Siemens method and subsequently detected by PCR based method.ResultsDuring September 2016 to February 2017 (six months), a total of 498 blood cultures were sent during febrile episodes. Out of which 60 (12%) came out to be positive for different microorganisms. Out of all positive cultures, Burkholderia cepacia was detected in 29 (48%) patients, which reduced drastically following the change in antibiotic administration practice. All isolates showed sensitivity to pipercillin+tazobactum, cefoperazone+sulbactum, fluoroquinolones, cotrimoxazole and carbapenems and resistance to polymyxin B and colistin. With timely intervention by appropriate intravenous antibiotics as per culture sensitivity result and change in antibiotic preparation practice, overall mortality was low 1 (4%) out of 29 culture positive episodes.ConclusionChange of antibiotic preparation practice was the key to control this outbreak, and overall mortality was low.

There is paucity of information from eastern India with regard to observed dominant micro-organisms causing febrile neutropenia (FN) in patients with haematological malignancies. To identify the prevalence of pathogenic microorganisms associated with FN. A total number of 268 episodes of FN were analysed from September'2010 to October'2013. The blood samples were inoculated into brain heart infusion broth, glucose broth, Hicombi dual performance media (Himedia, LQ-12) at 37° C for 168 h and Bactec method was also performed for these samples. Blood agar, chocolate agar, MacConkey's agar and cystine lactose electrolyte deficient agar were used for isolation of the microorganisms. A total number of 78 (29.10 %) episodes revealed positive growths. Gram negative bacilli and Gram positive cocci were isolated in 61.53 and 34.61 % cases respectively. The eight commonest isolates were Pseudomonas aeruginosa (14.10 %), methicillin resistant Staphylococcus aureus (MRSA-12.82 %), Acinetobacter sps (11.53 %), coagulase negative Staphylococcus (10.25 %), Klebsiella pneumoniae (8.97 %), Escherichia coli (8.97 %), ESBL E. coli (6.41 %), methicillin sensitive S. aureus (MSSA-6.41 %). Amongst other less common isolates were Citrobacter kosseri (3.84 %), Citrobacter freundii (2.56 %), Ralstonia paucula (2.56 %), Cedecia neteri (1.28 %), methicillin resistant coagulase negative Staphylococcus (2.56 %). Candida spp. including two cases of Candida non-albicans was isolated in 3.84 % of cases. P. aeruginosa was the commonest pathogenic isolates in FN patients associated with haematological malignancies in this study. Gram negative bacteria were the commonest isolates in FN including significant numbers of rare opportunistic micro-organisms.

Chronic myelogenous leukemia (CML) is a clonal myeloproliferative neoplasm (MPN) characterized by dysregulated and uncontrolled proliferation of mature and maturing granulocytes with normal differentiation. A genetic hallmark of CML is the presence of the fusion gene product BCR-ABL. Bleeding diathesis in CML patients is rare (<10%) and primarily caused by acquired platelet dysfunction. We report a rare case of an adult CML chronic phase patient who presented with spontaneous muscle hematoma due to acquired Glanzmann’s thrombasthenia (GT). On laboratory workup, a GT was confirmed along with the diagnosis of CML in chronic phase. The muscle hematoma was completely resolved following imatinib therapy. The present case demonstrates that bleeding is a complication of MPNs and highlights the importance of both acquired GT diagnosis to determine the cause of bleeding in CML and of prompt treatment with imatinib to reverse this condition.

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