Assessing the value of diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) in normal bone marrow (BM) tissue as well as in benign and malignant hematological diseases in comparison with BM histopathologic report. A cohort cross-sectional study performed from October 2016 till December 2017 in Al-Imamian Al-Khadimain Medical City. Forty patients were enrolled and segregated equally into two main groups (benign and malignant hematological disorders with another 20 healthy volunteers (control group). Hematology data were recorded for all patients in addition to DWI-MRI and ADC mapping in comparison with bone marrow report for the group of malignant hematological disease in terms of blast cell percentage. Conventional MRI reveals abnormal signal intensity in 85% of the malignant cases with different pattern. While 95% of the benign and 100% of control group had normal signal intensity with P value (P = 0.001). Application of DWI-ADC on three groups of sample reveals a variable range of ADC values which is higher in malignant (225-875 × 10 −6 mm 2 \s) than benign (275-600 × 10 −6 mm 2 \s) and control cases (205-560 × 10 −6 mm 2 \s) with a cut-off value of 550 × 10 −6 mm 2 \s. There was a positive correlation between ADC values and blast % in bone marrow histopathological report with correlation coefficient of 0.75 and P value of 0.05. Both DWI-MRI and ADC are useful in BM assessment. The latter is a quantitative assay for the diffusion and can reflect a functional assessment in correlation with blast cell percentage.
Pure white cell aplasia (PWCA) is a rare acquired cause of agranulocytosis characterized by absence of all myeloid lineages in bone marrow with intact erythropoiesis and megakaryopoiesis. Reported cases were associated with autoimmune conditions, thymomas, chronic lymphocytic leukemia, infections, and as an adverse drug reaction. Presentation ranges from asymptomatic severe neutropenia to fatal sepsis. Several medications were tried along with treatment of the underlying cause if identified. Steroids, immunoglobulin, azathioprine, cyclosporine, rutiximab, GCSF and bone marrow transplant were all tried with variable response. Here we report a case of PWCA in middle age male, who responded to cyclosporine.
Objectives: In Iraq, leukemia is the 4 th most common cancer, and acute promyelocytic leukemia contributes to 2.83% and 3.18% of leukemia in Iraqi males and females respectively. The aim of this study is to review the presentation and management outcome of patients with acute promyelocytic leukemia in Iraq. Methods: A hospital-based cross-sectional study was conducted over the period of 15 months in different hematology centers. A total of 58 patients with acute promyelocytic leukemia were enrolled in this study (53 newly diagnosed and 5 relapsed cases). Diagnosis was based on morphology with or without cytogenetic study. Results: The mean age was 33.1±13.8 years, with slight female predominance. Most cases presented at winter season (39.7%). Sanz severity scoring classification of patients as (25.9%) with low risk, (53.4%) intermediate risk, and (20.6%) high risk disease. Induction protocol consist of chemotherapy plus ATRA in (58%), while (36.2%) received only ATRA plus ATO. At the end of induction, (86.2%) of patients had complete remission, while only 13.8% had failure of induction and death. Induction mortality was higher in those who had received chemotherapy-based regimens. At relapse, a second complete remission had been achieved in 4 out of 5 cases (80%).
Conclusion:There is a predilection of acute promyelocytic leukemia to young age group and winter season presentation. The choice of non-chemotherapy regimens, especially for the low and intermediate risk group, showed no drawback in complete remission rate. Disease outcome in Iraq has improved over several years due to increasing experience with using different regimen.
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