Indian Journal of Hematology and Blood Transfusion最新文献

Acute lymphoblastic leukemia (ALL) is one of the most common pediatric malignancies, with vincristine (VCR) being a key chemotherapeutic agent in its treatment. The present review aims to assess the risk factors, clinical manifestations, and management strategies of VCR-induced neurotoxicity in patients with ALL. A systematic search of the literature was performed using PubMed, Scopus, and CINAHL Ultimate. Inclusion criteria encompassed studies involving ALL patients treated with VCR, reporting neurotoxicity outcomes. The study was conducted following the PRISMA guidelines. From 4310 articles screened, 109 studies met the inclusion criteria. Neurotoxicity was predominantly characterized by peripheral neuropathy, cranial nerve involvement, and autonomic dysfunction. The severity of neurotoxicity was associated with cumulative vincristine exposure, with doses exceeding 25 mg/m² frequently linked to severe neuropathy. Age was a key factor, with older children and adolescents showing greater susceptibility. Genetic polymorphisms, particularly CEP72 rs924607 TT and ABCB1 variants, were identified as significant risk factors. Concurrent methotrexate use was found to exacerbate VCR-induced neurotoxicity. Sensory disturbances, motor impairment, and gastrointestinal autonomic dysfunction, including constipation and ileus, were among the most frequently reported symptoms. Management strategies primarily involved dose adjustments, drug discontinuation, and symptomatic treatments, including pyridoxine and pyridostigmine, though their efficacy remained inconsistent. Emerging strategies such as altered infusion methods showed promise in reducing toxicity severity. VCR-induced neurotoxicity remains a significant challenge in ALL therapy. Standardized neurotoxicity assessment tools and prospective studies are needed to improve early detection and optimize management strategies, ultimately balancing treatment efficacy with minimizing neurological morbidity.

This case-control study, which was performed at a tertiary care center in India, involved sixty children between the ages of 5 and 18 who were already being treated as case of beta thalassemia major. All participants underwent routine biochemical investigations encompassing complete hemogram, viral markers, LFT, KFT, serum ferritin as per treating unit protocol, and specific tests including a 12-hour fasting lipid profile, carotid artery intima thickness (CIMT), and serum apelin levels. Appropriate Statistical Analysis were performed and p value was calculated and set at < 0.05 for it to be statistically significant. The index study showed that children with beta thalassemia had significantly lower serum cholesterol, LDL and HDL levels when contrasted with age matched controls and were also found to have mean CIMT and serum apelin levels significantly higher with p value < 0.001. Children living with beta thalassemia major are more likely to develop early sub-clinical atherosclerosis, and measures of serum apelin level and carotid artery intima thickness can be used in addition to routine lab parameters to determine the early stages of atherosclerosis in these patients.

Isolated central nervous system (CNS) relapse in patients of acute myeloid leukemia (AML) post-transplant is a rare clinical scenario. We present a case of intermediate-risk AML diagnosed five years ago who underwent matched sibling allogeneic hematopoietic stem cell transplantation (HSCT) following standard induction chemotherapy. He presented with symptoms suggestive of cerebellar dysfunction, and imaging studies revealed a large homogeneously enhancing lesion along the tentorium cerebelli. Flow cytometric immunophenotyping (FCM IPT) and cytomorphology of cerebrospinal fluid (CSF) clinched the diagnosis of isolated CNS relapse as bone marrow was uninvolved. This case highlights the necessity for surveillance of CNS symptoms following transplantation, even in AML. Clinical Trial Registration Not applicable.

Approximately 30% of patients with Hodgkin lymphoma experience relapse or are refractory to first-line chemotherapy. For these patients, immunotherapy has emerged as an effective option. Current treatments include anti-CD30 (Brentuximab-Vedotin) and PD-1 inhibitors (Nivolumab or Pembrolizumab), often in combination with Autologous Stem Cell Transplantation (ASCT). This study aims to evaluate clinical outcomes in a cohort of patients with relapsed/refractory Hodgkin lymphoma (R/R HL) undergoing treatment with immunotherapy combined with ASCT. This is an open-label, single-arm clinical trial involving patients diagnosed with R/R HL who were treated with Brentuximab-Vedotin (BV) combined with a PD-1 inhibitor, followed by consolidation with ASCT and maintenance therapy using BV and a PD-1 inhibitor. An intention-to-treat analysis was performed. The primary endpoints were complete remission rate (CRR), progression-free survival (PFS), overall survival (OS), and the occurrence of severe adverse events. Fifteen patients were included in the study (8 men and 7 women). The median age was 27 years, with an interquartile range (IQR) of 23-37 years. The median follow-up period for the entire cohort was 41.3 months. The pre-transplant CRR was 80%, and the PFS was also 80%. OS at the last follow-up was 100%. No severe adverse events were observed. ASCT was performed in 60% of the patients. This treatment strategy demonstrates high OS and PFS with no serious adverse effects, suggesting that it could be a clinically beneficial approach for patients with R/R HL. Further studies are needed to validate these findings in larger cohorts. The study is registered at ClinicalTrials.gov under the identifier NCT05595447.

This study aimed to determine whether p190 and p210 isoforms of BCR::ABL1 in adult patients with Ph + ALL are associated with different survival outcomes and to compare these two groups in terms of prognostic factors. This retrospective multicenter study included adult patients (aged ≥ 18 years) with de novo Ph + B-cell ALL patients. Results of the routine tests specific for this group of patients were retrieved from hospital records. p190 and p210 groups were compared for overall survival (OS), progression-free survival (PFS) and prognostic factors such as age, white blood cell count, response to treatment, relapse after induction therapy, need for transplantation, relapse after transplantation, and mortality rate. Among 44 patients, 59.1% had p190 and 40.9% had p210 isoform. The groups were comparable in terms of the characteristics at diagnosis, and response to treatment and molecular relapse rate. Overall mortality rate was 56.8% and infection was the leading cause of death in both groups. Patients with p190 and p210 isoforms were followed for a median of 20.37 months and 26.5 months, respectively. In patients with p190 and p210 isoforms, the 2-year OS rates were 48.6% and 70.5%, respectively and the 5-year OS rates were 33.3% and 47.0%, respectively; the 2-year PFS rates were 38.2% and 65.3%, respectively and the 5-year PFS rates were 31.9% and 42.3%, respectively. Our results suggest that p190 and p210 isoforms of BCR::ABL1 oncogene in adult pH + B-ALL patients were not significantly different in terms of prognostic parameters and survival outcomes.

This study aimed to investigate the factors that influence chemotherapy-induced nausea, vomiting, and alterations in taste experienced by non-Hodgkin lymphoma. This cross-sectional study recruited 133 non-Hodgkin lymphomas from January 2022 to December 2023. Patients completed the Chemotherapy Induced Taste Alteration Scale (CITAS) and Rhodes Index of Nausea, Vomiting, and Retching (RINVR). A multiple linear regression model was used to investigate the factors that influence taste alterations in chemotherapy-induced nausea and vomiting. The factors influencing the subgroups of CITAS and RINVR were identified using ANOVA and multinomial logistic regression analyses. The regression model established to determine the effect of basic taste alteration, loss of appetite symptoms, nausea vomiting, age, and vomiting distress was statistically significant and explained 84.1% of the change. Via multiple linear regression analysis, we identified substantial factors in basic taste alteration associated with loss of appetite symptoms [(95%CI: 0.083-0.123); P = 0.000], nausea-vomiting[(95%CI: 0.001-0.096); P = 0.045], age [(95%CI: - 0.101-0.027); P = 0.001], vomiting distress [(95%CI: - 2.114-0.865); P = 0.001]. According to the model, a 1-unit change in basic taste alteration caused a 0.189-unit change in nausea and vomiting.Taste alteration statistically significantly affected symptoms of loss of appetite, nausea and vomiting, age, and vomiting distress. The results will provide deep insights into developing effective intervention strategies to address this common issue of non-Hodgkin lymphoma.

Cancer Therapy Related Cardiac Dysfunction is a significant challenge in the field of pediatric hemato-oncology and is often under-recognized. The study reports the role of levosimendan as a cardio-protective agent in pediatric onco-critical care. A retrospective study was performed in children up to 18 years of age undergoing chemotherapy for malignant disorders and those undergoing hematopoietic stem cell transplantation (HSCT) from January 2020 to December 2023. The primary objective was to assess the efficacy and safety of levosimendan in pediatric hemato-oncology and HSCT patients with severe cardiac dysfunction. The secondary objective was to study the effectiveness of levosimendan as both first- and second-line cardiac support drug. We administered levosimendan as a first line agent in children with known cardiac dysfunction and second line in children with shock with cardiac dysfunction after other short-acting inotropes. The study included 62 children with 85% overall response rate and a mean improvement in ejection fraction from 50 to 58%. The mean Vasoactive-Inotropic Score (VIS) reduction was 3.2. A follow up ECHO after four weeks demonstrated normal heart function in all children. Levosimendan is a safe and effective agent in the treatment of acute heart failure in hemato-oncology patients who maintain normal or high blood pressure. The results have helped tailor supportive critical care in pediatric hemto-oncology patients with cardiac dysfunction.

To evaluate the incidence, clinical characteristics and outcomes of second primary malignancies (SPM) in Multiple myeloma patients post autologous stem-cell transplant (ASCT). This is a report of myeloma patients from a prospectively maintained database who underwent ASCT between 1st March, 2007 to 31st December, 2022. Baseline characteristics, details of induction, transplant and post-transplant maintenance therapy of these patients were retrieved. Details of treatment received for SPM, and outcomes were also obtained. In total,178 patients underwent 192 ASCTs (14 patients with two ASCTs). Of 178 patients, six patients (3.3%) developed SPM [3-solid (1.6%) and 3-haematological (1.6%)] at a median follow-up post-ASCT of 8.7 years. Median follow-up of entire cohort (n = 178) post-ASCT was 51 months. Median time from diagnosis and transplant to second malignancy was 9.0 years (5.4-13.5 years) and 8.2 years (4.0-12.3 years), respectively. Median duration of lenalidomide exposure from diagnosis to second malignancy in these six patients was 25.8 months (Range: 15-40 months). Amongst our six patients with SPM, three patients (50%) are alive. At a median follow-up of more than 8 years post-ASCT, the incidence of SPM was 3.3% in our cohort. This highlights the need for life-long surveillance for SPM in myeloma patients post-ASCT.