Clinical characteristics, outcome and early induction deaths in patients with acute promyelocytic leukaemia: a five-year experience at a tertiary care centre

<p><b>INTRODUCTION</b>Acute promyelocytic leukaemia (APL) is a distinct clinical and biological subtype of acute myeloid leukaemia. APL is notorious for causing early death during induction therapy, resulting in induction failure. The aim of our study was to report the clinical characteristics, outcome and early induction deaths with regard to patients with APL seen at our hospital.</p><p><b>METHODS</b>This was a retrospective study carried out at Aga Khan University Hospital, Karachi, Pakistan. Patients aged > 15 years diagnosed with APL within the period September 2007-September 2012 were included in the study.</p><p><b>RESULTS</b>Within the study period, 26 patients were diagnosed with APL based on morphology and the detection of t(15;17)(q24.1;q21.1) and promyelocytic leukaemia-retinoic acid receptor alpha (PML-RARA). The male to female ratio was 1:1. The median age of the patients was 41 (range 16-72) years. In all, there were 13 (50.0%) high-risk patients, and early induction death rate was 61.5%. Causes of early induction deaths (n = 16) included haemorrhage in 7 (43.8%) patients, differentiation (ATRA) syndrome in 7 (43.8%) and infection in 2 (12.5%). The survival rate among patients who survived the early period was 70% at 42 months. The relapse rate was 30%.</p><p><b>CONCLUSION</b>Early induction death rate was very high in patients with APL. The most common cause of early induction death in our study was haemorrhage. Outcome among patients with APL was found to be better among those who survived the initial period.</p>

Freequency of FAB subtypes i acute myeloid leukemia patients at Aga Khan University Hospital Karachi

Acute myeloid leukemia [AML] is a heterogeneous disease. Therefore, various parameters are needed to classify this disease into subtypes, so that specific treatment approaches can be utilized effectively. The commonly used method for diagnosis and classification is based on FAB criteria using morphology and cytochemical stains. For sonic of the categories, imnninophenotyping is necessary. The aim of present study is to determine the frequency of various sub types in acute myeloid leukemia using FAB criteria in our population. This will aid in the correct diagnosis of acute leukemia and hence proper management of the patients. Materials and This is descriptive case control study conducted at Aga Khan University Hospital from January 1999 to December 2000. The total number of subjects was 116 that included both adults and children. The patients were diagnosed on the basis of bone marrow morphology using FAB classification. Cytochemistry was done in all cases, while immunophenotyping was considered only in those cases that were found to be problematic. Among 116 patients, 70 were males and 46 were females with male to female ratio 1.5:1. The age ranged between 6 months to 85 years with a mean age of 32 years. AML-M4 was the predominant French American-British [FAB] subtype [36.2%] followed by M2 [30.25%], M3 [10.4%], M1 [7.7%]. M5a [3.5%], M5b [2.5%] and M6 [0.8%]. Conclusions: The most common FAB subtype observed in our study was Acute myclomonocytic leukemia [M4] which is in accordance with studies reported from Saudia Arabia and a previous study reported from our institution. However, other national and international studies have reported Myeloblastic Leukemia with maturation [M2] as the predominant subtype of AML

Use of norethisterone oenanthate and predisposition to thrombosis

To observe the effects of progestin-only hormonal contraceptives in our population. Design: Cohort study. Place and Duration of Study: Department of Pharmacology, Ziauddin Medical University, Karachi and Department of Pathology, Faculty of Health Sciences, The Aga Khan University, Karachi from October 2002 to September 2003. Patients and The study comprised of 50 women of reproductive age group, divided into two equal and matched groups of 25 each, namely, a group of users of progestin-only injectable hormonal contraceptive Norethisterone oenanthate [NET EN] 200 mg used as a 2-monthly injection and a control group not using any hormonal contraception. Complete blood counts, prothrombin time [PT] and international normalized ratio [INR] as well as activated partial thromboplastin time [APTT] were monitored. APTT and prothrombin time were not significantly different in both the groups. Menstrual irregularities were found out by more frequent in users of injectable hormonal contraceptives than in non-users [p= 0.001]. Hemoglobin [p= 0.029] and hematocrit were slightly better preserved in the same group. Use of Norethisterone oenanthate does not predispose to thrombogenesis in current dose for contraception