Pediatric and adolescent chronic myeloid leukemia: A follow-up study in Western India

Background: Chronic myeloid leukemia (CML) is relatively rare in pediatric and adolescent age groups. The purpose of this study was to evaluate the clinical, hematopathological, and biochemical parameters of CML in pediatric and adolescent age groups, along with an assessment of the treatment response with first-line tyrosine kinase inhibitors (TKI) and its correlation with the prognostic scoring systems of adults. Materials and Methods: A retrospective study of 44 Breakpoint Cluster Region-Abelson leukemia virus (BCR-ABL1)-positive pediatric and adolescent CML cases registered at our hospital was done. The clinical and laboratory parameters were evaluated using hospital software. The treatment response was monitored and scoring was performed using mathematical calculations. Results: The mean age was 11.6 (±4.7) years. The median hemoglobin was 8.4 g/dL and 63.6% of the cases showed white blood cell (WBC) counts >250,000/?L. The average follow-up was 21 months. A total of 97.7 and 78.1% cases achieved complete hematological response (CHR) and molecular response, respectively, during the treatment course. The maximum number of patients had low Sokal and European treatment and Outcomes Study (EUTOS) scores. Seventy-five per cent of the cases achieved CHR at 3 months, while 73.6 and 78.6% CML-Chronic phase (CP) cases with low Sokal and EUTOS scores achieved CHR at 3 months, respectively. Conclusion: This study revealed that the CML cases in pediatric and adolescent age groups are normally present with higher WBC counts at the time of diagnosis. The association of the prognostic scoring system with treatment response was statistically insignificant. However, a larger cohort study is needed to determine the treatment response of TKI in children and adolescent CML and its correlation with the prognostic scoring systems.

A Record Based Study on Various Factors Affecting The Choice Of Intra-Uterine Contraceptive Device In Ahmedabad City

Background:Unplanned pregnancy may be the reason of many neonatal and maternal adverse effects. The objective is to study various factors affecting IUCD (temporary contraceptive method) preference. Material And Methods:A record based study of data of 483 couples selecting IUCD, during the one year period was collected with permission from tertiary care hospital. Result:The most common group preferring IUCD was 21-30 years (mean age-females-26 years and males-30 years).Majority having 2 children opted for IUCD while only 1 couple opted for IUCD without any child. Out of the total, 42% opted PPIUCD, 42% interval IUCD and 16% PAIUCD. Among lower age and up to primary educated groups, majority opted for PPIUCD. Among higher age and educated groups, majority opted for interval IUCD. PAIUCD proportion was higher in less educated females. Majority ofMuslims preferred PPIUCD while Hindus, interval IUCD. The association of type of IUCD with age, number of children and religion was found significant while with education, it was in-significant. Conclusion:The use and type of IUCD preferred depends on various factors such as age of male and female, number of children and religion of couples.

A Record Based Study On Various Factors Affecting The Choice Of Intra-Uterine Contraceptive Device In Ahmedabad City

Background:Unplanned pregnancy may be the reason of many neonatal and maternal adverse effects. The objective is to study various factors affecting IUCD (temporary contraceptive method) preference. Material And Methods:A record based study of data of 483 couples selecting IUCD, during the one year period was collected with permission from tertiary care hospital. Result:The most common group preferring IUCD was 21-30 years (mean age-females-26 years and males-30 years).Majority having 2 children opted for IUCD while only 1 couple opted for IUCD without any child. Out of the total, 42% opted PPIUCD, 42% interval IUCD and 16% PAIUCD. Among lower age and up to primary educated groups, majority opted for PPIUCD. Among higher age and educated groups, majority opted for interval IUCD. PAIUCD proportion was higher in less educated females. Majority ofMuslims preferred PPIUCD while Hindus, interval IUCD. The association of type of IUCD with age, number of children and religion was found significant while with education, it was in-significant. Conclusion:The use and type of IUCD preferred depends on various factors such as age of male and female, number of children and religion of couples

Gemcitabine in brief versus prolonged low-dose infusion, both combined with carboplatin for advanced non-small cell lung cancer.

Purpose: Gemcitabine in low-dose prolonged infusion is a treatment with documented activity against a variety of tumors. The present study was conducted to evaluate the efficacy and safety of the combination of gemcitabine at a low-dose prolonged infusion in comparison with standard dose gemcitabine with carboplatin in chemonaive patients with advanced non-small cell lung cancer (NSCLC). Materials and Methods: Sixty chemonaive patients with stage IIIB or IV NSCLC were included. Patients were randomly assigned 1:1 to receive 350mg/m 2 gemcitabine in a 6-h infusion on days 1 and 8 and carboplatin area under the serum concentration time curve (AUC) 5 on day 1 versus gemcitabine 1000mg/m 2 on days 1 and 8 and carboplatin AUC 5 on day 1 (3-week cycle both). A total of 118 chemotherapy cycles, with a median of 4 cycles per patient (range 2-6), and 134 chemotherapy cycles, with a median of 4.47 cycles per patient (range 3-6) were administered in standard and low infusional dose arm, respectively. Results: Among patients in the standard arm, 40% had overall response rate (ORR), 33.3% had stable disease and 26.6% had progressive disease, while in low-dose infusional arm, 36.6% had ORR, 36.3% had stable disease and 26.6% had progressive disease (P = 0.992). Median progression-free survival was 5.5 months and 5.4 months, median overall survival was 9.7 months and 10.7 months, and 1-year survival was 33.7% and 36.6% in standard arm and low-dose infusion arm, respectively. Grade 3/4 toxicity was rare. Conclusion: In NSCLC, gemcitabine low-dose prolonged infusion with carboplatin has low toxicity, especially thrombocytopenia, and has an activity comparable with gemcitabine given in higher dose in standard infusion.

Management of primary and metastatic triple negative breast cancer: Perceptions of oncologists from India.

Background: In order to document the understanding of current evidence for the management of triple negative breast cancer and application of this knowledge in daily practice, we conducted an interactive survey of practicing Indian oncologists. Materials and Methods: A core group of academic oncologists devised two hypothetical triple negative cases (metastatic and early breast cancer, respectively) and multiple choice options under different clinical circumstances. The respondents were practicing oncologists in different Indian cities who participated in either an online survey or a meeting. The participants electronically chose their preferred option based on their everyday practice. Results: A total of 152 oncologists participated. Just over half (53.8%) preferred taxane based chemotherapy as first-line chemotherapy in the metastatic setting. In the adjuvant setting, a taxane regimen was chosen by 61%. Over half of respondents (52.6%) underestimated the baseline survival of a patient with node positive triple-negative tumor and 18.9% overestimated this survival compared to the estimate of the Adjuvant! program. Discussion: This data offers insight into the perceptions and practice of a diverse cross-section of practicing oncologists in India with respect to their therapeutic choices in metastatic and adjuvant settings in triple negative breast cancer.

Recombinant alpha-interferon therapy in multiple myeloma.

Three patients with multiple myeloma were treated with recombinant alpha-interferon (r IFN-alpha 2b Intron AR) along with combination chemotherapy i.e. melphelan and prednisolone. In one case it was given as an initial therapy, while the other two patients had refractory and relapsing disease respectively. IFN-alpha 2b was given in the dose of 2 x 10(6) Mu/m2 by subcutaneous injection thrice in a week for six months in two patients and for three months in one patient. All three patients experienced improvement in bone pains; partial response with reduction in the paraprotein level was seen in one patient; while there was no radiological, biochemical or haematological improvement in two patients. Side effects noted were flu like syndrome in all three patients and urticaria in one patient. They were treated symptomatically and did not require cessation of interferon therapy.