ABSTRACT
Objectives: To evaluate the impact of myeloid antigen expression on complete remission [CR], event-free survival [EFS], and overall survival [OS] in patients with T-cell acute lymphoblastic leukemia [T-ALL] treated with intensive chemotherapy
Methods: We retrospectively reviewed consecutive patients diagnosed with T-ALL and treated in Sultan Qaboos University Hospital and Royal Hospital in Oman between 2004 and 2010. The diagnosis of T-ALL was established using French-American-British classification or World Health Organization criteria. Patients were considered having myeloid antigen expression if they expressed CD13, CD33, or both [My+ and My-]
Results: Of the 39 patients, 38 were included in the study [25 patients with My- and median age of 18.4 years, 13 patients with My+ and median age of 22.0 years]. Median follow-up was 12 months. Thirty-two out of the total cohort were eligible for response-rate assessment. Twenty-nine patients [90.6%] achieved CR with one or two courses of chemotherapy with similar CR rates between the two groups [p = 0.880]. Twenty-five percent [5/20] of the patients with My- required two courses of induction, whereas 58.3% [7/12] of My+ required two courses of induction and the difference was statistically significant [p = 0.040]. In the multivariable analysis; age, gender, initial white blood cell count, central nervous system disease, and myeloid antigen expression were not statistically significant predictors of CR. The EFS and OS were similar between the My+ and My- groups p = 0.180 and p = 0.440, respectively
Conclusions: Patients with T-ALL with myeloid antigen expression need more courses of induction; however, rates of CR, EFS, and OS are not different from those without myeloid antigen expression. Larger prospective studies are required to confirm these findings
ABSTRACT
Objectives: We sought to study the occurrence of portal vein thrombosis [PVT] in adult Omani patients
Methods: We conducted a retrospective cross-sectional study in patients diagnosed with PVT, which was confirmed by radiological imaging, from two tertiary hospitals over a 10-year period
Results: Amongst the 39 patients enrolled in the study, 15 [38.4%] had cirrhosis of the liver, and 24 [61.5%] were non-cirrhotic. In the non-cirrhotic PVT patients, 15 [62.5%] had acute PVT, whereas nine [37.5%] had chronic PVT. PVT was more common in males than females, [25 [64.1%] vs. 14 [35.8%], respectively, p = 0.020]. The three most common clinical symptoms were abdominal pain [n = 25, 64.1%] followed by nausea [n = 12, 30.7%] and fever [n = 8, 20.5%] patients. Causative risk factors included prothrombotic states [17.9-28.2%] and local factors [20.5%] such as cholecystitis, cholangitis, and liver abscess. Complications were found in 23.0% of patients with PVT, namely variceal bleeding in seven patients [17.9%] patients and bowel ischemia in two patients [5.1%]. Management with sclerotherapy was performed in all patients with variceal bleeding. Thrombectomy was done for one patient complicated with intestinal ischemia, but as it failed, he was treated with warfarin anticoagulation
Conclusions: This is the first study reflecting a real-life practice in PVT with possibly underlying inherited and acquired prothrombotic conditions as well as complications due to local and malignant conditions from Oman. We studied the prevalence, clinical presentation, underlying possible etiological factors, treatment, and outcomes. Since causative factors were found in 36 patients [92.3%], etiological screening seems worthwhile in every case with PVT, but thrombophilia screening may not be cost-effective
ABSTRACT
To assess the response rate and duration of response in patients with chronic immune thrombocytopenia [ITP] receiving rituximab. We retrospectively analyzed 32 consecutive patients with chronic ITP who were treated in two tertiary centers in Oman. Response assessment was based on the American Society of Hematology criteria. Nineteen patients [59%] had an initial response. However, six of the 19 patients lost their response leaving 13 patients with long-lasting remissions. The median age at diagnosis was 25 years [range 14-58]. The median time from diagnosis to rituximab therapy was 21 months. The median follow-up after starting rituximab was 26 months. The overall cumulative response rate was 59% [complete response 44%, partial response 15%] and the median time to respond was 30 days with a response rate of 44% at four weeks. In all responders, the cumulative rate of loss of response was 32% with a median time to lose response of 54 months. The use of rituximab in ITP achieves high response rate and long remission duration. Our study was limited by the small sample size and further larger prospective studies are recommended