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Background: Worldwide, diffuse large B-cell lymphoma (DLBCL) represents the most common subtype of non-Hodgkin lymphoma (NHL), accounting for 30%-40% of all newly diagnosed cases. The response rate to currently available chemotherapy in DLBCL is much unsatisfactory. Dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA-EPOCH) was developed in an effort to improve outcome in patients with diffuse large B-cell lymphoma. To assess the efficacy and safety of DA-EPOCH chemotherapy in patients with diffuse large B-cell lymphomas.Material & Methods:This quasi experimental study was conducted in the department of Hematology, DMCH, from January 2016 to December 2017. 20 patients with diffuse large B-cell lymphomas were treated with etoposide, vincristine, and doxorubicin for 96 hours with bolus doses of cyclophosphamide and oral prednisone (DA-EPOCH chemotherapy). The doses of etoposide, doxorubicin and cyclophosphamide were adjusted to achieve a nadir absolute neutrophil count below 0.5× 109/L. Cycles were repeated after 21 days. After 3rd and 6th cycle patients were evaluated for interim analysis and response evaluation respectively. Evaluation was done in aspect of clinical parameter (lymph node size, physical complaint), laboratory parameter (CBC) and radiological imaging (CT scan of chest and abdomen). The median age of the patient was 46.5 years (range, 25-62 years); 20% were older than 50 years; and 25% were at high-intermediate risk according to International Prognostic Index (IPI) criteria. The statistical analyses were done by appropriate methods.Results:There was a complete response in 73.7% of patients and partial response 10.5% of patients, which were evidenced by significant reduction of size of the lymph nodes after chemotherapy. The mean Serum LDH was also significantly lower after chemotherapy in comparison to before chemotherapy in those patients who achieved complete or partial response. Moreover, size of the liver and spleen were significantly lower after chemotherapy in response group patients who had either hepatomegaly or splenomegaly or both. Doses were escalated in 12.50% cycles and toxicity levels were acceptable.Conclusion:DA-EPOCH chemotherapy is an effective regimen for treatment of diffuse large B-cell lymphoma patients.
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Background: Multiple myeloma is a plasma cell neoplasm with acquired genetic abnormalities of clinical and prognostic importance, with survival duration ranging from a few months to more than 10 years. Cytogenetic abnormalities (CA) detected by fluorescence in situ hybridization (FISH) are of major prognostic significance since e.g. patients with del(17p), t(4;14) or gain 1q21 show dismal outcome. Objective: To evaluate the cytogenetic patterns by fluorescence in situ hybridization (FISH) of clinically diagnosed cases of multiple myeloma.Methods:This cross-sectional study was conducted in Department of Haematology, Dhaka Medical College Hospital, Dhaka, from January 2018 to December 2018. A total number of 30 patients with multiple myeloma were analyzed cytogenetically by interphase fluorescence in situ hybridization (iFISH). The collected data were analyzed by using the Statistical Package for Social Science (SPSS-24) for windows version 10.0.Results:Out of 30 diagnosed Multiple Myeloma cases the mean age was 56.37�.38 years and male to female ratio was almost 3:1. Sixteen (56.7%) of 30 patients. Among 30 cases of 8 cases were thyrogenicity positive of 7(23.3%) patients was detected del 13q positive. Isolated del 13q was found in 4 cases. 2 cases were found coexistence of del 13q and del 17p positive ;1 case was found coexistence of del 13q and t(4;14) positive and rest of 1 case had del 17 p positive. There was no detectable t (11; 14) and t(14;16) in any of 30 cases.Conclusion:FISH panel for Multiple Myeloma including del (13q); t(11;14); t(4;14), del(17p), t(14;16) is very important molecular test for the prognosis , risk stratification, treatment modality of the patient. On the basis of cytogenetic abnormality Multiple Myeloma risk stratification is modified now a day. This Revised International Staging system R-ISS is a simple and powerful prognostic staging system.
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Nested reverse-transcriptase polymerase chain reaction (rt-PCR) was performed on 58 leukemia patients at BIRDEM Laboratory, as a pioneering work in Bangladesh. Thirty of themwere examined for the presence of BCR-ABL being clinically and morphologically diagnosed as chronic myeloid leukemia (CML) and 28 for PML-RARalpha fusion transcripts being clinically and morphologically diagnosed as acute promyelocytic leukemia (APL/ AML M3). The cases were selected for targeted therapy with imatinib mesylate and all-Trans retinoic acid (ATRA) to treat CML and APL respectively. Samples were received either before commencement or during therapy. In the positive cases, amplified DNA products were visible after gel electrophoresis and were reported accordingly. In case of BCR-ABL, positive results were found for five out of six (83.33%) untreated cases and 11 out of 24 (45.83%) treated cases. Positive results for PML-RARalpha were found for 12 out of 14 (85.70%) untreated cases and 11 out of 16 (68.75%) treated cases. A strong positive correlation was found between duration of treatment and negativity of PCR results in both the cases. In present times, the detection of minimal residual disease in patients undergoing treatment for hematological malignancies has become an important goal, not only to monitor the effectiveness of therapy but also to detect an impending relapse. This is the first time in Bangladesh that rt-PCR method is being employed to detect or monitor the presence of abnormal fusion genes in hematological malignancies.