Short-course Venetoclax With Standard Chemotherapy Is Effective in Early T-cell Precursor Acute Lymphoblastic Leukemia.

BACKGROUND: Early T-cell precursor acute lymphoblastic leukemia (ETP ALL) is a high-risk subgroup of acute lymphoblastic leukemia characterized by unique immune phenotype and disease biology. ETP ALL cells share similarities with hematopoietic stem cells and myeloid progenitor cells. These patients have lower rates of complete remission and overall survival. High BCL2 expression is the main rationale for using venetoclax in ETP ALL. RESULTS: We report the treatment outcomes of 2 patients with ETP ALL who achieved minimal residual disease negative remission with the short course of venetoclax. CONCLUSIONS: Combination therapy of short-course venetoclax with Berlin-Frankfurt-Meunster 95 regimen is an effective regimen for treating patients with ETP ALL.

Practical Approach to the Interpretation of Complete Blood Count Reports and Histograms.

Improvement in technology and inclusion of new parameters in automated hematology analyzers allows for better and faster detection of anemias. These parameters along with histograms provide details and clues that help to diagnose the etiology of anemia and help bridge the time lag in detection and treatment. Timely and expert interpretation of complete blood counts should not be limited to the pathologist but should also interest the clinician to allow for efficient patient care.

Innovator Filgrastim versus Generic Filgrastim in Hematopoietic Stem Cell Transplantation Mobilization.

Methods This is a retrospective study. G-CSF was administered in the dose of 10 µg/kg subcutaneous as a single dose for 4 days. On day 5, peripheral blood stem cell (PBSC) apheresis was performed using Haemonetics MCS plus or COBE Spectra apheresis machine through a double-lumen central venous catheter. Primary outcome parameters were the total number of CD34+ HSCs/kg of recipient weight mobilized in peripheral blood and the number of days required for neutrophil and platelets engraftment, respectively. Objective We compared the effectiveness and safety of innovator filgrastim versus generic filgrastim in patients who underwent hematopoietic stem cell transplantation (HSCT). Results A total of 91 stem cell mobilizations was analyzed. There were 58 normal healthy donors for allogeneic HSCT and 33 patients for autologous HSCT. There was no statistically significant difference among groups in terms of total collected CD34+ cells value ( p = 0.609). The mean time to neutrophil engraftment was 13.7 days in the innovator group and 13.2 days in the Grafeel group ( p = 0.518). The mean time to platelet engraftment was 16.2 days in the innovator group and 14.8 days in the generic group ( p = 0.435). The patient who received generic filgrastim had more febrile episodes during the course of transplantation ( p = 0.020). Conclusion Generic filgrastim was found to be comparable to original filgrastim for peripheral blood stem cell mobilization in normal healthy donors for allogeneic HSCT and patients for autologous HSCT.

Daratumumab for pure red cell aplasia post ABO incompatible allogeneic hematopoietic stem cell transplant for aplastic anemia.

Pure red cell aplasia is a known complication after ABO incompatible stem cell transplant. Due to rarity of disease, no established treatment guidelines are available for PRCA. Daratumumab is a monoclonal antibody against CD38 expressed by plasma cells. In this report we present our experience of successfully managing a patient of post-transplant PRCA with daratumumab. Our patient had failed multiple lines of therapy prior to receiving daratumumab. Response was seen after the 3rd weekly dose of daratumumab.

Adequate Engraftment With Lower Hematopoietic Stem Cell Dose.

BACKGROUND: Adequate hematopoietic stem cell dose is required to proceed with autologous stem cell transplantation (ASCT). PATIENTS AND METHODS: We conducted a retrospective analysis of 108 patients with multiple myeloma and lymphoma who underwent ASCT with noncryopreserved stem cells at our center. Data were compared for patients who received stem cell dose < 2 × 106/kg with those who received a higher dose. RESULTS: The median CD34 dose collected in the lesser dose group was 1.76 × 106/kg (1.22 to 1.97 × 106/kg). Mean CD34 dose of the whole group was 4.96 ± 4.2 × 106/kg. Neutrophil engraftment was similar in both groups (12 vs. 11 days) (P = .065). Similarly, platelet engraftment occurred in 12 versus 11 days in both groups (P = .017). Length of hospital stay was similar in both groups. There was no significant difference in the incidence of proven bacterial infections between the 2 groups. There was no transplant-related mortality in lower dose group. CONCLUSION: ASCT can be safely performed with lower hematopoietic stem cell dose in noncryopreserved setting.

Tandem Autologous Hematopoietic Stem Cell Transplantation in Very Young Patients with Multiple Myeloma.

Introduction Multiple myeloma (MM) in very young patients is uncommon, and no treatment guidelines exist for these patients. Patients and Methods We performed a retrospective analysis of five very young myeloma patients who underwent tandem autologous hematopoietic stem cell transplantation (HSCT). Results The median age was 37 years (range = 34-40 years). A median of two leukapheresis was performed (range = 1-4). The median number of hematopoietic stem cells collected was 5.4 × 10 6 /kg (4.4-8.2 × 10 6 /kg). During first transplant, four patients received melphalan of 200 mg/m 2 and one patient received melphalan of 140 mg/m 2 (due to renal failure) as conditioning regimen. Second transplant conditioning was melphalan of 200 mg/m 2 for one patient and melphalan of 140 mg/m 2 for remaining four patients. Two patients were in complete remission, and two were in very good partial remission and one patient progressed to active disease at the time of tandem autologous bone marrow transplant. All patients developed significant mucositis. Neutrophil and platelet recovery was longer in tandem autologous hematopoietic stem cell transplant. More viral infections were seen in tandem transplant. Day 30 and day 100 mortality was nil. Conclusion We present data on tandem autologous HSCTs in very young patients with MM in India. Responses continued to improve in this small series.

Clinical utility of procalcitonin in bacterial infections in patients undergoing hematopoietic stem cell transplantation.

BACKGROUND: Infections are major contributor to morbidity and mortality in patients undergoing bone marrow transplant (BMT). OBJECTIVE: To assess role of serum procalcitonin (PCT) as a useful biomarker for the infections and outcomes in these patients. METHODS: Retrospective observational study. RESULTS: Total 47 patients with febrile episodes were enrolled. Twenty patients underwent autologous BMT and 27 underwent allogeneic BMT. Bacterial infections were documented in 18/47 (38%) patients. Forty patients were neutropenic. The median fever duration was 10 days (range 3-30 days) in positive procalcitonin level group whereas it was 4 days (range 1-18) in negative group. This was statistically significant (P=0.000). Procalcitonin levels were high in 8/9 episodes of sepsis (P=0.029). Intensive care unit transfers and death were significantly higher in PCT positive group as compared to PCT negative group. CONCLUSION: Serum procalcitonin levels provide prognostic information of worse outcome in patients undergoing HSCT.

Hematogone Hyperplasia Masquerading as Acute Lymphoblastic Leukemia With Concurrent Hypercupremia.

Alterations in copper homeostasis is an uncommon cause for hematologic alterations frequently presenting with dysplastic features in the bone marrow. Most of these alterations have been documented in adult patients with copper deficiency. Rare cases show hematogone hyperplasia in these patients. Effects of mild copper excess have not been documented in literature. We are describing a pediatric patient who presented with pancytopenia associated with hypercupraemia (excess of copper). Bone marrow examination showed hematogone hyperplasia. Interestingly, correction of serum copper levels with zinc therapy lead to complete improvement in pancytopenia. Hematogones had also reduced in subsequent marrow biopsy after therapy.

Paroxysmal Cold Hemoglobinuria in a 4-year-old Child.

Paroxysmal Cold Hemoglobinuria is a rare cause of intravascular hemolysis presenting in children following an acute viral illness. It is usually self-limiting in nature. We present the details of a 4-year-old boy who presented with rapid onset intravascular hemolysis. Donath Landsteiner antibody test was positive and hemolysis resolved within two weeks of onset.

Granulomatous reaction in a patient with lung cancer: should we treat it?

In TB endemic regions, granulomatous inflammation in the samples from a tumour in the lung or in the draining lymph nodes will not be sufficient to diagnose TB as granulomas can also arise as a reaction to tumour cells http://ow.ly/tOTm30kSFAY.

Single Versus Dual Platform Analysis for Hematopoietic Stem Cell Enumeration Using ISHAGE Protocol.

Hematopoietic stem cell transplantation is curative therapy in benign and malignant diseases. Adequate stem cell dose is one of the most important marker of engraftment. Several methods have been developed to enumerate CD34+ cells. We present our data on 147 samples analysis. There was a clear linear correlation between two methods. Both methods were effective. Both single vs dual platform analysis yield similar results. Single platform analysis is easier to perform. In terms of cost reduction dual platform analysis is better.