A case series of post-infectious chikungunya myeloradiculoneuropathy.

Chikungunya fever is an arboviral illness caused by chikungunya virus (CHIKV) and transmitted by the bite of Aedes aegypti and Aedes albopictus. It is an RNA virus belonging to the genus Alphavirus and family Togaviridae. We present a case series of three patients with chikungunya illness developing para/post-infectious myeloradiculoneuropathy.These patients developed neurological symptoms in the form of bilateral lower limb weakness with sensory and bowel involvement after the recovery from the initial acute episode of chikungunya fever. Clinical examination findings suggested myeloradiculoneuropathy with normal Magnetic Resonance Imaging of the Spine, with the nerve conduction study showing sensorimotor axonal polyneuropathy. All the patients were treated with 1 g of methylprednisolone once a day for five days, and case 2 was given intravenous immunoglobulin also. In the follow-up, cases 1 and 2 showed complete recovery without recurrence, and case 3 did not show improvement at one month.

Efficacy, safety, and quality of life of generic and innovator ibrutinib in Indian CLL patients.

To report the efficacy, safety, and quality of life (QoL) on generic and innovator ibrutinib in Indian CLL patients. This was a single centre, prospective study of treatment-naive (TN), and relapsed/refractory (R/R) CLL patients receiving ibrutinib in India. The choice of innovator or generic ibrutinib was as per patient discretion. Response and adverse events were recorded as per the 2018 iwCLL guidelines and CTCAEv4.0. QoL was assessed using the EORTC QLQ-C30 and CLL17 questionnaires. A total of 32 CLL patients (TN, n = 7 and R/R, n = 25) received ibrutinib from 2016-2019. The median age was 60 years (37-84). All TN patients attained partial response without any grade 3/4 adverse events (AE). Ibrutinib was less tolerated in the R/R setting, with 52% patients developing grade 3/4 AE and required dose reduction. Eleven patients (44%) died during follow-up. Grade 3-5 infections were seen in 44% of R/R CLL patients. Generic ibrutinib (n = 8) was comparable to innovator ibrutinib (n = 17) in terms of efficacy, safety, and QoL. Ibrutinib is less well tolerated in Indian R/R CLL patients. Infections are a common cause of morbidity and mortality. This study affirms the safety and efficacy of generic ibrutinib.

Quality of life in patients of chronic lymphocytic leukemia using the EORTC QLQ-C30 and QLQ-CLL17 questionnaire.

INTRODUCTION: The quality of life (QoL) analysis is likely to differ by region, ethnicity, and questionnaires in comparison with age-matched healthy controls. METHODS: The EORTC QLQ-C30 and QLQ-CLL17 questionnaire validated in regional languages were administered to 127 consecutive CLL and 100 age-matched, healthy controls at a single center from 2018 to 2019. RESULTS: All groups of CLL patients either on wait and watch (W&W) or on treatment had significantly impaired QoL in all functional domains including global health compared to controls (P < .0001). CLL patients had significantly higher symptom scores than controls in most domains (P < .0001, 0.03 for diarrhea). There was no difference in the QoL by age or gender. Lower socioeconomic status patients had higher financial difficulty (P = .02). Patients on CIT had the worst global health (OR 12.21 compared to patients on W&W) (P = .03). Patients on ibrutinib had less worries/fears about health and functioning than patients who were on CIT (P = .04). CONCLUSIONS: Quality of life is severely affected in CLL patients on W&W. Global health status and worries about future health and functioning were major concerns. Socioeconomic status but not age or gender impacted QoL. Patients on ibrutinib had better QoL than on CIT.