Therapeutic outcomes of older patients with acute myeloid leukemia

To evaluate the therapeutic outcomes of acute myeloid leukemia [AML] in elderly patients. This study was conducted at the Aga Khan University Hospital, Karachi, Pakistan over 11 years from January 1997 to August 2008. This was a descriptive case series study. We investigated the impact of disease biology and various treatment protocols on the outcome in this population. A total of 55 evaluable patients [>60 years of age] were diagnosed with AML including 34 [61.8%] males and 21 [38.2%] females. The median age was 67 years [range 60-86 years] at the time of presentation. The AML was preceded by myelodysplastic syndrome in 15 [27.2%] patients. High-risk cytogenetics were observed in 3 [5.4%] patients. Forty patients received palliative treatment while only 15 received chemotherapy. Of the last group with primary AML [n=10], there were 2 remitters, one showed resistant disease while 8 had induction death. The overall mean survival was 75.1 days [95% confidence interval: 46.7-103.5 days] in all patients. There was no survival advantage in patients treated with chemotherapy versus those conservatively treated. We found high mortality among aged patients with AML in our setting. Patients receiving chemotherapy were extremely intolerant to toxic drugs and succumbed earlier than patients receiving palliative care only

Significance of cytogenetic abnormalities in acute myeloid leukaemia

To evaluate the role of karyotype in acute myeloid leukaemia [AML] as a predictor of response to induction chemotherapy. A cross-sectional study was carried out at the department of Pathology and Oncology, Aga Khan University Karachi from January 2003 to January 2005. Newly diagnosed patients with denovo AML admitted to the hospital were included in the study. Diagnosis of AML was based on FAB criteria, immunophenotyping and cytogenetic studies. They were treated according to standard protocols [combination of anthracycline and cytarabine -3+7] and those who had acute promyelocytic leukaemia additionally received all- trans retinoic acid [ATRA]. A total of 56 patients were enrolled, 4 were excluded due to inadequate cytogenetic analysis and the remaining patients entered the study protocol. There were 32 males and 20 females with mean age of 31.3 years [range 9 months to 73 years]. Thirty-five [67.3%] patients had normal karyotype while 17 [32.7%] were found to have cytogenetic abnormalities. Eleven patients did not receive treatment at our hospital. Half of the [51.2%] patients out of remaining 41 achieved complete remission on bone marrow examination after receiving induction chemotherapy. In favourable risk group 3/3 [100%] achieved complete remission [CR] while 15/32 [46.9%] in intermediate risk group and 3/6 [50%] in unfavourable risk group. There was low CR rate in patients with high white cell counts. The frequency of cytogenetic abnormalities in AML and response to induction chemotherapy was low when compared with international data possibly due to the small sample size. However, there was a clear difference in CR rates between favourable and unfavourable risk groups

Role of ICT malaria immunochromatographic test for rapid diagnosis of malaria

To evaluate the sensitivity and specificity of immunochromatographic test [ICT] malaria p.f/p.v using microscopy as the gold standard diagnosis. Five hundred and sixty patients of both sexes and all age groups with clinical suspicion of malaria were studied. Venous blood was collected for microscopy and ICT. Thick and thin films prepared and stained with Leishman's stain were examined. ICT malaria test was performed and interpreted according to manufacturer's instructions. Data was analyzed using Epi-6. A total of 560 cases were studied, 339 males and 221 females with age ranges between 2 to 73 years. Seventy two [12.85%] cases had parasitaemia [with or without sexual forms]. On microscopy 65 [11.6%] cases had asexual-stage parasitaemia and 7 [1.25%] cases had P. falciparum gametocytes only. Thirty two cases were infected with P. falciparum, 29 with P. vivax and 4 had mixed infection. For P. falciparum the ICT was 97.0% sensitive, 98.3% specific, with positive predictive value [PPV] of 78.0% and a negative predictive value [NPV] of 99.8%. For P. vivax the sensitivity was only 89.7%, specificity 97.9%, PPV was 70.3% and NPV 99.4%. Our results are in concordance with previous studies. Rapid tests though expensive are simple to perform and effective diagnostic tools of malaria. They can be used selectively, though microscopy remains the gold standard diagnosis, economical and accurate if performed by skilled technologists

Hairy Cell Leukemia: clinical presentation and long term follow up after treatment with 2-Chlorodeoxyadenosine [2-CdA]

The aim of the study was to the clinical features and long term follow up after treatment with Cladarbine in a tertiary care hospital. Seven patients with hairy cell leukemia were diagnosed between January 1990 till December 2003. Diagnosis in all the patients was established by bone marrow aspirates and trephine biopsy along with TRAP. In two patients the diagnosis was supplemented by flowcytometry and in another two patients by splenectomy. Six patients were male while one was female. Mean age was 47.7 years [range 36-64]. Most common presenting features were pallor and weakness [n=5]. All patients had splenomegaly. Blood count at presentation revealed that one patient had bicytopenia, two had isolated thrombocytopenia, and three had pancytopenia. Treatment responses were evaluable in seven patients. Complete response was seen in six patients [85.7%]. One patient died after two months due to sepsis while 3 [50%] patients relapsed. Those who relapsed received another course of CDA and have maintained remission with a median duration of response of 48 months [20-48]. From this small series we can conclude that CDA is an effective treatment for HCL and even it works very well in relapsed cases.

Anaphylactic reaction after Intramuscular injection of Cyanocobalamin [Vitamin B12]: a case report

report a case of anaphylactic reaction to intramuscular injection of cyanocobalamin. This 52-year-old lady was diagnosed as a case of megaloblastic anemia secondary to dietary vitamin B12 deficiency. She had severe anaphylactic reaction after the parenteral administration of cyanocobalamine. Later she received oral vitamin B12 with no adverse effects. The purpose of this case report is to draw attention to the hypersensitive reaction to injectable vitamin B12, which is rarely seen. This could be due to sensitization to the vitamin B12 molecule itself or an IgE mediated reaction. We concluded that anaphylactic reaction to vitamin B12 is a rare but serious side effect and it should be kept in mind while the drug is being administered to the patient, especially via the parenteral route

Frequency of irregular red cell alloantibodies in patients with thalassemia major: a bicenter study

To provide frequency and distribution pattern of various types of irregular red cell alloantibodies in patients with thalassemia major. This is a descriptive study conducted at two centers from January to December 2001. Purposive sampling was done and all patients diagnosed to have thalassemia major were included in the study. Antibody identification was carried out on serum employing commercial two-cell panel using standardized blood bank methods. If patients were found to have an irregular red cell alloantibody then the antibody identification was performed using 16 panel cells. A total of ninety-seven patients were included in the study. Fifty-three patients were males and 44 females. Mean age was 10.6 years. Irregular red cell alloantibodies were found in 9 [9.2%]. Mean age of patients who developed red cell alloantibody was 11.9 years. Three [33.3%] patients developed anti-K while two [22.2%] had non-specific antibody. One patient each developed anti-D [11.1%] and anti-E [11.1%]. Two had anti-D [11.1%] and anti-C while the other one [11.1%] developed anti-E and anti-K. We concluded that there is relatively high rate of alloimmunization in our set of patients when compared to data from our region. We also suggest that red cell alloimmunization should not be overlooked in patients receiving regular blood transfusions