There is limited data on the impact of treatment interruptions due to nonadherence in patients with chronic phase chronic myeloid leukemia (CP-CML) treated with Imatinib. We looked at factors (including adherence to therapy) affecting the outcome in a large cohort of patients with CP-CML. All the 516 patients received Imatinib free-of-cost through a company sponsored scheme, which mandated regular three monthly visits for drug procurement. Data regarding the disease characteristics, adherence to treatment and outcomes, were obtained from patients records. Unwarranted interruption of treatment for more than 1 week was defined as nonadherence. With a median follow-up of 39 months, the estimated 5-year event free survival (EFS) was 70.8% (95%, CI 5 63.3-78.3). Nearly one-third of the patients (29.6%) were found to be nonadherent at some point during their treatment. On univariate analysis, the factors adversely affecting the EFS were prolonged symptom duration before diagnosis, treatment with hydroxyurea for more than 1 month before start of Imatinib, and nonadherence to therapy. Only nonadherence was significant in multivariate analysis (HR1.6; P 5 0.048). The 5-year EFS in adherent and nonadherent patients was 76.7% and 59.8% respectively (P 5 0.011, log rank test). Nonadherent patients were less likely to achieve complete cytogenetic responses (26% versus 44%; P 5 0.004; v 2 test) at any point. A significant proportion of patients with CP-CML have drug interruptions due to nonadherence during therapy and this compromises the EFS. Adherence to therapy must be included as an important evaluation parameter in all future studies of CML. Am. J. Hematol. 86:471-474, 2011. V

The overall QOL in younger patients with breast cancer appeared to be good. The QOL and sexual function were marginally worse in the breast conservation group when compared to mastectomy group.

BACKGROUND:Primary mediastinal malignancies are uncommon. They can originate from any mediastinal organ or tissue but most commonly arise from thymic, neurogenic, lymphatic, germinal or mesenchymal tissues.OBJECTIVES:The aim of this study was to review the clinical presentations, diagnostic methods adopted, the histologies and the treatment outcomes of this rare subset of tumors.MATERIALS AND METHODS:Case records of 91 patients in the period 1993-2006 at our institute were retrospectively analyzed. Patients with primary mediastinal mass and supraclavicular nodes were included for the analysis. Patients with primary, extrathoracic disease of the lung and peripheral adenopathy were excluded. Actuarial method was used for calculating the disease-free survival and overall survival.RESULTS:Primary mediastinal tumors were seen commonly in males with mean age of 37.48 ± 17.04 years. As many as 97% of patients were symptomatic at presentation. Superior venacaval obstruction (SVCO) was seen in 28% of the patients. As many as 50% of the patients were diagnosed by a fine-needle aspiration or Trucut biopsy, while 28% of the patients required thoracotomy for a diagnosis. Majority of the tumors had anterior mediastinal presentation. Pleural effusion was seen in 20% of the patients, but diagnosis was obtained in only 1%. In adults, thymoma (39%), lymphoma (30%) and germ cell tumor (15%) were the common tumors. In the pediatric population, lymphoma, PNET and neuroblastoma were the common tumors. The 5-year DFS and OS are 50% and 55%, respectively.CONCLUSION:Primary mediastinal tumors are a challenge to the treating physician because of their unique presentation in the form of medical emergencies, like superior venacaval obstruction and stridor. Diagnosis may require invasive procedures like thoracotomy. Treatment and outcome depend on the histologic subtypes.

Primary renal lymphoma is very rare. Lymphomatous involvement of the kidney is often seen as a part of disseminated disease. The prognosis is usually poor with median survival less than a year. It is essential to differentiate between renal cell carcinoma and renal lymphoma in patients presenting with solitary renal masses. We present a 52-year-old lady who presented with a solitary renal mass and was diagnosed to have primary lymphoma of the kidney and discuss briefly about primary renal lymphoma.

The outcome of metastatic GIST patients has definitely improved from a virtually incurable state to a disease where median OS has reached 60 months. The genotype of Indian patients with GIST may be different from the western population which needs to be confirmed in a larger study.

Anemia in tuberculosis is usually anemia of chronic disease. Severe hemolytic anemia is exceedingly rare in tuberculosis patients. We report a patient diagnosed with tubercular lymphadenitis complicated by Coomb's positive hemolytic anemia. Patient responded well to antituberculous treatment. Hematological parameters improved after initiation of antituberculosis treatment. To the best of our knowledge, this is the first case from India of an adult patient with tuberculous lymphadenitis presenting with Coomb's positive hemolytic anemia.

The incidence of eosinophilia in Hodgkin lymphoma is approximately 15%. Both peripheral and tissue eosinophilia have been noted in Hodgkin lymphoma. Eosinophils have important role in pathobiology of Hodgkin lymphoma. The mechanism of eosinophilia remains unknown though various mediators like IL-5 and GM-CSF have been implicated. We present a case who was diagnosed to have Hodgkin lymphoma and hypereosinophilia. Keywords Hypereosinophilia · Hodgkin lymphoma Case reportA 9-year-old child presented to our institution with swelling in the left side of neck and intermittent fever of three months duration. No history of bleeding manifestations. He had dry cough. Physical examination revealed generalized lymphadenopathy and hepatosplenomegaly. He also had features of superior venacaval obstruction (SVCO). His investigations revealed Hemoglobin of 9.4g/dl, total count of 1.8 lakhs/mm 3 and platelets of 2.94 lakhs/mm 3 . Differential count showed Neutrophils 9%, Lymphocytes12% and Eosinophils 79%. ESR was 50 mm/hr. Chest X ray showed mediastinal widening, diffuse pulmonary infi ltrates. Bone marrow examination revealed hypercellular marrow with marked eosinophilic proliferation. Superior mediastinal adenopathy, bilateral pleural effusion and patchy bilateral pulmonary infi ltrates were seen in CT thorax. CT Abdomen showed large retroperitoneal adenopathy.Lymph node biopsy after immunohistochemical correlation was diagnostic of Hodgkin lymphoma -mixed cellularity. Patient was initiated on ABVD chemotherapy. The total count normalised to 9000/mm 3 and Eosinophilia decreased to 20% after the very fi rst cycle of chemotherapy. Patient is being continued on treatment. DiscussionThe incidence of eosinophilia in Hodgkin's disease is around 15% [1]. Hodgkin lymphoma in paediatric population, especially in the fi rst decade is very rare. Among these patients male preponderence has been noticed. The most common histology noticed is mixed cellularity in the younger population [2].

EP-EMA was highly effective for the primary management of very-high-risk GTN.