ABSTRACT
This retrospective study was aimed to understand the clinical, laboratory, radiological parameters and the outcome of COVID-19 patients with underlying haematological disease. All patients with known haematological disease admitted with COVID-19-positive status from April to August 2020 in the COVID-19 facility of a tertiary care centre in north India, were included. Their medical records were analyzed for outcome and mortality risk factors. Fifty four patients, 37 males, were included in the study. Of these, 36 patients had haematological malignancy and 18 had benign disorder. Fever (95.5%), cough (59.2%) and dyspnoea (31.4%) were the most common symptoms. Nine patients had severe disease at diagnosis, mostly malignant disorders. Overall mortality rate was 37.0 per cent, with high mortality seen in patients with aplastic anaemia (50.0%), acute myeloid (46.7%) and lymphoblastic leukaemia (40.0%). On univariate analysis, Eastern Cooperative Oncology Group performance status >2 [odd ratio (OR) 11.6], COVID-19 severity (OR 8.2), dyspnoea (OR 5.7) and blood product transfusion (OR 6.4) were the predictors of mortality. However, the presence of moderate or severe COVID-19 (OR 16.6, confidence interval 3.8-72.8) was found significant on multivariate analysis. The results showed that patients with haematological malignancies and aplastic anaemia might be at increased risk of getting severe COVID-19 infection and mortality as compared to the general population
ABSTRACT
Aberrant regulation of DNA methylation plays a crucial causative role in haematological malignancies (HMs). Targeted therapy, aiming for DNA methylation, is an effective mainstay of modern medicine; however, many issues remain to be addressed. The progress of epigenetic studies and the proposed theory of "state-target medicine" have provided conditions to form a new treatment paradigm that combines the "body state adjustment" of CM with targeted therapy. We discussed the correlation between Chinese medicine (CM) syndromes/states and DNA methylation in this paper. Additionally, the latest research findings on the intervention and regulation of DNA methylation in HMs, including the core targets, therapy status, CM compounds and active components of the Chinese materia medica were concisely summarized to establish a theoretical foundation of "state-target synchronous conditioning" pattern of integrative medicine for HMs, simultaneously leading a new perspective in clinical diagnosis and therapy.
Subject(s)
Humans , DNA Methylation/genetics , Drugs, Chinese Herbal , Hematologic Neoplasms/genetics , Materia Medica , Medicine, Chinese TraditionalABSTRACT
RESUMEN Objetivo: analizar las características epidemiológicas, clínicas y bacteriológicas que influyen en la supervivencia de los pacientes con neoplasias hematológicas que desarrollaron neutropenia febril posterior a quimioterapia. Materiales y métodos: estudio de corte transversal que incluyó adultos con diagnóstico de neoplasias hematológicas que presentaron neutropenia febril durante la hospitalización en 2014 en las sedes de Oncólogos de Occidente en Pereira, Manizales y Armenia (Colombia). Se realizaron análisis univariados y multivariados; la supervivencia se estableció según el método de Kaplan-Meier. Se estableció un valor de p <0.05. Se usó el software STATA. Se tuvo aval de bioética de la Universidad Tecnológica de Pereira. Resultados: se incluyó a 55 pacientes. La mediana de edad fue de 48 años (31-63), 27(49 %) fueron hombres. Los diagnósticos oncológicos más frecuentes fueron el linfoma no Ho-dgkin (29 %), leucemia mieloide aguda (24%) y leucemia linfoblástica aguda (20 %). La mayor letalidad se presentó en los días 21, 32 y 48. La mortalidad general fue del 9 % y la mortalidad por neutropenia profunda fue del 18 %. Conclusión: el número de neutropenias febriles, mayor tiempo de duración de la neutropenia febril, índice de Charlson y el antecedente de ingreso a UCI son factores de riesgo para mortalidad, mientras que el uso de piperacilina-tazobactam y el incremento en la puntuación del índice de MASCC son factores protectores.
ABSTRACT Objective: analyze the epidemiological, clinical and bacteriological characteristics that influence the survival of patients with haematological malignancies who developed febrile neutropenia after chemotherapy. Materials and methods: cross-sectional study of adult patients diagnosed with hema-tologic malignancies who presented febrile neutropenia during hospitalization in 2014 at Oncólogos de Occidente in Pereira, Manizales and Armenia (Colombia). Univariate and multivariate analyzes were performed. The survival analysis was established according to the Kaplan-Meier method. A value of p<0.05 was established for it. The STATA software was used. This study was endorsed by the bioethics committee of the Universidad Tecnológica de Pereira. Results: 55 patients were included. The median age was 48 years (31-63), 27 (49%) were men. The most frequent oncological diagnoses were non-Hodgkin's lymphoma (29 %), acute myeloid leukemia (24 %) and acute lymphoblastic leukemia (20 %). The highest lethality occurred on days 21, 32 and 48. Overall mortality was 9 %, mortality due to deep neutro-penia was 18 %. Conclusion: the number of febrile neutropenia, longer duration of febrile neutropenia, Charlson index and the history of admission to the ICU are risk factors for mortality, while the use of piperacillin-tazobactam and the increase in the score of the MASCC index are protective factors.
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Introduction: Immunosuppressive state due to haematological malignancies and chemotherapy may cause disruption to wound healing despite optimum conventional treatment and standard wound dressing. Non-healing wounds are predisposed to infection whereas chemotherapy dose reductions or interruptions are associated with poor survival. Background: Mononuclear cells contain progenitor cells including haematopoietic and mesenchymal stem cells, endothelial progenitor cells and fibroblasts which facilitate wound healing through cytokines, growth factor secretions, cell-cell interactions and provision of extracellular matrix scaffolding. Clinical applications of autologous mononuclear cells therapy in wound healing in non-malignant patients with critical limb ischaemia have been reported with remarkable outcome. Methods: We report three patients with haematological malignancies undergoing chemotherapy, who received autologous mononuclear cells implantation to treat non-healing wound after optimum conventional wound care. The sources of mononuclear cells (MNC) were from bone marrow (BM), peripheral blood (PB) and mobilised PB cells (mPB-MNC) using granulocyte colony stimulating factor (G-CSF). The cells were directly implanted into wound and below epidermis. Wound sizes and adverse effects from implantation were assessed at regular intervals. Results: All patients achieved wound healing within three months following autologous mononuclear cells implantation. No implantation adverse effects were observed. Conclusions: Autologous mononuclear cells therapy is a feasible alternative to conventional wound care to promote complete healing in non-healing wounds compounded by morbid factors such as haematological malignancies, chemotherapy, diabetes mellitus (DM), infections and prolonged immobility.
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Background: The pattern and distribution of haematological malignancies vary depending on age, sex and geographical location. Studies on the association between haematological cancers and ABO blood types have been largely conflicting. Aim: To determine the frequency and distribution of ABO blood groups among a cohort of patients with haematological cancers. Methods: This was a retrospective descriptive cross-sectional study involving the review of records of patients with various haematological cancers, their demographic characteristics and ABO blood group distribution over a 5 year period. Results: The record of 132 patients with haematological malignancies over a 5 year period were reviewed. The mean age of the patients was 47.93 ± 17.9 years. The peak age incidence for the various haematological cancer was the fourth and fifth decades of life. The male to female sex ratio was 2:1. NHL was the commonest haematological cancer among the patients. Majority of the patients were of the O-blood type, the different blood group distribution among the patients was statistically not different from that of the general population. Also, there was no significant association between haematological cancers and ABO blood type of the patients. Conclusion: The distribution, age and sex ratio of haematological malignancies in our study was comparable to those reported by other authors with NHL being the most common haematological cancer in our environment. Majority of the patients were of the O-blood type, comparable to the general population. There was no significant association between haematological cancers and ABO blood type of the patients.
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Background: The paper examined the quality of life of haematological cancer patients according to their socio-demographic profiles and clinical diagnoses. Methods: This cross-sectional study was conducted at the tertiary referral centre of Ampang Hospital, Kuala Lumpur, involving 105 patients. The European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) questionnaire was used to measure their quality of life. Results: The study involved patients diagnosed with all types of haematological cancer, including non-Hodgkin lymphoma (NHL), acute myelogenous leukaemia (AML), acute lymphoblastic leukaemia (ALL), Hodgkin lymphoma (HL), and multiple myeloma (MM), with a response rate of 83.3%. The patients with ALL, HL, without NHL, and without MM were younger than other patients. There were significant differences in quality of life scores in different socio-demographic groups and types of cancer diagnosis. The global quality of life of the female patients was much better than that of the male patients. Patients who were 40 years old or younger had a better global quality of life and physical functioning, as well as fewer symptoms of constipation, nausea, and vomiting. Employed patients were in less pain but showed greater impairments of cognitive function than did unemployed patients. Patients who earned a monthly wage of RM1000 or less had reduced physical function, more symptoms of pain, and more financial difficulties compared with patients who earned more. Patients with AML tended to have better physical functioning than did patients with MM, whose physical functioning was impaired. Comparatively, more symptoms of dyspnoea were found in ALL and HL patients than in other types of lymphoma. Compared with other patients, those with ALL had a greater loss of appetite, and other lymphoma patients had fewer symptoms of pain. Patients with NHL had impaired role functioning and more constipation compared with other patients. The results were all statistically significant (P < 0.05). Conclusion: The quality of life of haematological cancer patients is affected by sociodemographic factors and clinical diagnoses. Efforts should be made to improve the overall quality of life of these patients.