Department Of Hematology Research Articles

Fertility preservation counselling and practice among women with lymphomas: a retrospective study

Background Research on fertility preservation among women diagnosed with lymphoma is very limited. We aimed to assess the receipt of fertility preservation information and use of fertility preservation among women diagnosed with lymphoma. Methods This was a retrospective, single-centre study. Patients with Hodgkin and non-Hodgkin lymphoma were screened from the electronic medical records of individuals who attended the Haematology Department at the study site between 2000 and 2018 and were followed-up for obstetric outcomes and onset of menopause until December 2023. Results Forty-three patients had available electronic health records. Overall, 13 (36.1%) of the 36 patients ≤45 years old received fertility preservation counselling; it was more frequent among nulliparous women (11/23, 47.8%), women aged ≤35 years (11/26, 42.3%), and those diagnosed in the latest study period from 2015 to 2018 (9/16, 56.3%). Of the 13 patients who were informed about fertility preservation, 2 patients refused this intervention, and fertility preservation was contraindicated for 3 patients, leading to a total of eight women who underwent fertility preservation strategies: six underwent ovarian cortex cryopreservation, and two underwent oocyte vitrification. Among the participants aged ≤45 years, 10 (27.8%) had at least one live birth after diagnosis. Fifteen (34.9%) of the 43 participants exhibited amenorrhoea after the initiation of chemotherapy, including 4 women ≤35 years of age. The median (range) age at menopause in this series was 45 (27-50) years. Conclusion Even though the situation appears to have improved in recent years, we are far from reaching the target of all women with lymphoma who are of reproductive age receiving fertility preservation counselling before initiating chemotherapy.

Outbreak of Norovirus Infection in the Hematology Department of a Children's Multidisciplinary Hospital

Relevance. Noroviruses are currently considered the most common cause of sporadic cases and community-acquired outbreaks of acute gastroenteritis (AGE) worldwide [1]. However, outbreaks of healthcare-associated infections (HAI) are also often caused by norovirus etiology [2], including in the Russian Federation [3].Aim. Analysis of key aspects of prevention and anti-epidemic measures against norovirus infection (NVI) in the hematology department.Materials and methods. The following epidemiological research methods were used: descriptive (intensity, dynamics, spatial characteristics of the NVI outbreak); analytical – longitudinal cohort study of the epidemic process of HAI – assessment of hypotheses about the causes and conditions, risk factors and routes of transmission of norovirus among patients and caregivers in the oncohematology department of the children's multidisciplinary hospital.Results and discussion. An outbreak of acute norovirus gastroenteritis of an imported nature was identified in the oncohematology department of a children's multidisciplinary hospital in February 2023, an analysis of the spread of NVI was carried out: the presumed source and mechanism of transmission of norovirus infection was established; the chronology of the spread of norovirus among patients and their caregivers is shown, a list of anti-epidemic measures taken to stop the outbreak is presented, and the difficulties of verifying the epidemiological diagnosis of HAI are reflected (based on the efficiency of laboratory testing of material from patients).Conclusion. Based on the results of the activities carried out, recommendations were proposed for improving preventive and anti-epidemic measures for acute gastroenteritis (AGE) in children's oncohematology departments.

Outcomes in patients with acute myeloid leukemia older than 70 years within the last 30 years, a single center experience.

As median age of patients with acute myeloid leukemia is 72 years, older patients continue to be a vulnerable cohort representing significant challenges in clinical practice. Patient-specific comorbidities as well as leukemia-specific unfavorable molecular- and cytogenetics confer even poorer outcomes. Treatment of AML therefore needs to be less toxic to prevent harm while lowering or eradicating leukemic burden to prolong survival. In this retrospective analysis we included 365 older AML patients from the Düsseldorf registry who were diagnosed and treated in our department of hematology over a period of 31 years. Most patients were treated with HMA (37.3%) followed by 35.3% of patients who received either low dose chemotherapy or BSC. 9% of patients were treated with induction chemotherapy while 8.5% of patients received a combination of HMA with venetoclax. 4.1% of patients underwent allografting. At the time of last follow up, 35 patients (9.6%) were still alive. Of those patients who were treated with induction chemotherapy or HMA + venetoclax, 18.2% and 29.0% were still alive, whereas 60% of the patients who underwent allogeneic stem cell transplantation were still alive (p < 0.001). Median overall survival of the entire patient population was 6 months. Longest survival was observed in patients who underwent aHSCT with an unreached median overall survival followed by patients who were treated with induction chemotherapy (21 months) or HMA plus venetoclax (11 months). The implementation of HMA + venetoclax and increasing numbers of aHSCT improved prognosis and survival even in older AML patients.

Assessment of serum soluble transferrin receptor in adult Egyptian aplastic anemia patients

Aplastic Anemia (AA) is one of the life-threatening bone marrow failure syndromes. One of the main pathologies of AA is reduced erythropoietic activity evidenced by decreased soluble transferrin receptor (sTfR) levels which results in minimal iron utilization and accumulation of iron in tissues in the form of ferritin. This study aimed to measure serum level of sTfR in adult AA patients and correlate it with the severity of the disease and the response to treatment. The study included 35 randomly selected AA patients recruited from the Hematology Department, aged from 17 to 66 years and 27 normal controls of matched age and sex. The level of sTfR was measured by using an enzyme linked immunoassay. The median level of sTfR was significantly lower in AA cases than in controls (17.9 nmol/l, ranged 9.87–30.42 nmol/l vs. 52.2 nmol/l; ranged 29.74–86.84 nmol/l, (p&lt;0.001). The concentration of sTfR was significantly lower in the Very Severe Aplastic Anemia (VSAA) patients in comparison to Severe Aplastic Anemia (SAA) 34.27 nmol/l (ranged 31.05 – 45.41 nmol/l) vs. 55.15 nmol/l (ranged 48.78–63.88 nmol/l), respectively, p= 0.004). The level of sTfR in responders to immunosuppressive treatment did not show any difference in comparison to non-responders [55.15 nmol/l (ranged 47.36 – 65.35 nmol/l) vs. 48.26 nmol/l (ranged 34.62 – 60.39 nmol/l), (p=0.808). In conclusion, sTfR level was significantly lower in AA cases than controls. The sTfR concentration expresses the erythropoietic activity in AA patients and can be an indicator of severity of bone marrow failure.

A case report of macrophage activation syndrome of infectious origin in the clinical haematology department of the Ignace Deen University Hospital, Conakry, Guinea

Background: Macrophage activation syndrome (MAS) is a rare but often fatal condition. It is linked to inappropriate stimulation of macrophages leading to abnormal phagocytosis of the formed elements of the blood and the release of pro-inflammatory cytokines. The aim of this study is to report a case of MAS of infective origin, and call the attention of medical practitioners to this potential life-threatening condition.Case presentation: This was a 45-year-old male patient, admitted on account of febrile pancytopenia (anaemia, leukopaenia and thrombocytopaenia) of chronic course. No particularly significant past medical history of the patient. Clinical and paraclinical examinations showed that the MAS was due to tuberculosis Conclusion: MAS is a life-threatening condition often associated with infections such as tuberculosis as described in this case.

THE FIRST SUCCESSFUL EXPERIENCE OF HIGH-DOSE CHEMOTHERAPY FOLLOWING AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION FOR HODGKIN LYMPHOMA IN A PATIENT WITH HIV INFECTION AT THE PIROGOV NATIONAL MEDICAL AND SURGICAL CENTER

The risk of developing Hodgkin Lymphoma (HL) is 5 to 26 times higher in HIV-infected patients compared to the general population. HL can develop even with moderate immune suppression and treatment with antiretroviral medicines. This article reviews the current treatment strategy for HL in HIV-infected patients and describes the first successful experience of high-dose chemotherapy following autologous hematopoietic stem cell transplantation (autoHSCT) in an HIV-infected patient at the Hematology Department of the Pirogov National Medical and Surgical Center. This clinical case demonstrates the efficacy and safety of autoHSCT for treatment of relapsed and refractory HL in patients with HIV infection.

To Assess the Relationship Between Reticulocyte Hemoglobin Content and Iron Status in Hemodialysis-Dependent Patients

Objectives: This study aims to evaluate the diagnostic utility of reticulocyte hemoglobin content (RET-He) and its correlation with transferrin saturation (TSAT) and other iron markers for identifying iron deficiency anemia in hemodialysis patients. Methods: The study was conducted at Hematology Department of Shaikh Zayed Hospital in Lahore, from March 2022- April 2023. Total 120 patients with chronic kidney disease on hemodialysis were enrolled in this study. Ferritin was determined by chemiluminescence immunoassay. Flow cytometry and spectrophotometry was performed to determine RET-He and iron status including serum iron and Total iron binding capacity (TIBC). Patients of both genders, aged 18-80 and those on hemodialysis for 3 months or more were selected. Patients excluded were those with bleeding from any site in last three months, received oral or parenteral iron supplementation in one month. Results: In this study, 120 hemodialysis dependent chronic kidney disease patients were enrolled. Among them, 65 (54.2%) were males, while 55 (45.8%) were females; 18 years to 80 years was the age range, with 53.48 ± 13.782 years being mean age. Mean RET-He was 29.439 ± 3.51 pg/cell, while mean serum iron was 68.96 ± 38.63 µg/dl, mean TIBC was 224.41 ± 55.109 µg/dl, serum ferritin mean value being 386.91 ± 357.51 ng/ml and mean TSAT was 31.93 ± 18.52%. Sensitivity (Se) was 56.0%, specificity (Sp) was 74.6%, positive predictive value (PPV) 36.8%, negative predictive value (NPV) 86.6% and accuracy of RET-He in diagnosing Iron deficiency anemia was 70.8% respectively. Conclusion: Reticulocyte hemoglobin content is highly effective in diagnosing iron deficiency anemia in chronic kidney disease patients. Its lower cost compared to traditional markers makes it a valuable tool for clinical practice.

Clinical and splenectomy-based treatment outcomes in 40 cases of hepatosplenic T-cell lymphoma: a comprehensive analysis

Background/aimThis research study was conducted to examine the clinical characteristics and post-splenectomy survival outcomes of patients diagnosed with hepatosplenic T-cell lymphoma (HSTCL).Materials and methodsA total of 10 cases of HSTCL patients admitted to the Hematology Department of Fudan University Affiliated Huadong Hospital between January 2012 and December 2021 were included. In addition, we also included 30 other cases reported from domestic and international sources. All pathological specimens were stained with hematoxylin and eosin (H&E) and immunohistochemistry, with color development using DAB staining. Survival analysis was conducted using Kaplan-Meier curves and log-rank tests.ResultsIn the 10 HSTCL patients, Epstein-Barr virus (EBV) infection was confirmed. Six patients had died, with 5 of them within 1 year of disease onset. Survival analysis showed poorer prognosis in patients with hemophagocytic syndrome and thrombocytopenia. Patients who underwent splenectomy followed by chemotherapy had a higher median and average survival time compared to those who only received chemotherapy. The study included a total of 40 HSTCL patients, with 29 males and 11 females, and an average age of onset at 42.3 years. All patients presented with fever, with some exhibiting emaciation and/or hemophagocytic syndrome. Splenomegaly, hepatomegaly, lymphadenopathy, and bone marrow involvement were found in the patients. Common laboratory findings included leukopenia, anemia, and thrombocytopenia. All patients exhibited elevated ferritin levels and decreased blood calcium levels.ConclusionThose patients suffering from hemophagocytic syndrome at the onset of this disease face greater treatment-related difficulties and a higher risk of mortality. Combined chemotherapy after splenectomy may improve HSTCL patient survival.

Addressing Treatment Abandonment in Pediatric Oncology: The Role of Missed Appointment Call-Back Systems in a Pakistani Setting

Objective: To evaluate the effectiveness of a missed appointment call-back system in reducing treatment abandonment rates at a tertiary care hospital in Pakistan. Methods: This cross-sectional study was conducted in the Pediatric Hematology and Oncology Department of Indus Hospital and Health Network from April to September 2023. The study included children aged 1 month to 16 years diagnosed with cancer and receiving curative treatment. A call-back system was introduced, contacting patients within 48 hours of a missed appointment to address their absence and reschedule. Treatment abandonment was defined as missing clinic visits for 4 weeks. Results: Of 389 children, the mean age was 6.8 ±4.0 years. There were 258 (66.3%) males and 131 (33.6%) females. Treatment abandonment was observed in 26 (6.7%) patients. The likelihood of treatment abandonment was 6 times significantly higher in children who did not respond to the call than those who did respond (cOR 6.27, 95% CI 2.69 to 14.59, p-value &lt;0.001). Similarly, children who missed rescheduled appointments had 8 times higher chances of treatment abandonment than those who attended (cOR 8.11, 95% CI 3.30 to 19.92, p-value &lt;0.001). Among 26 treatment abandonment children, the most common reason of missed appointment was financial issue 10 (38.5%) followed by forget appointment 7 (26.9%), attending school 6 (23.1%), and long distance 3 (11.5%). Conclusion: Treatment abandonment was low as 6.7%. Children who did not respond to call-backs or missed rescheduled appointments were significantly more likely to abandon treatment. The call-back system is effective in reducing abandonment rates in pediatric oncology.

Clinical characteristics of cytokine release syndrome after haploidentical hematopoietic stem cell transplantation for thalassemia major

To investigate the clinical characteristics of cytokine release syndrome (CRS) in children with thalassemia major (TM) after haploidentical hematopoietic stem cell transplantation (haplo-HSCT) and their prognosis. A retrospective analysis was performed for the clinical data of 280 children with TM who underwent haplo-HSCT in the Department of Hematology and Oncology, Shenzhen Children's Hospital, from January 2019 to December 2021. According to the CRS criteria, they were divided into two groups: CRS grade <3 (260 children) and CRS grade ≥3 (20 children). The children with TM were analyzed in terms of clinical characteristics of CRS after haplo-HSCT and their prognosis. There were significant differences between the two groups in neutrophil engraftment time, clinical manifestations of CRS, and the rate of use of glucocorticoids within 4 days after haplo-HSCT (P=0.012, 0.040, and <0.001 respectively). For the CRS grade <3 group, the incidence rate of acute graft-versus-host disease (aGVHD) was 9.6% within 3 months after transplantation, while no aGVHD was observed in the CRS grade ≥3 group within 3 months after transplantation, but there was no significant difference in the incidence of aGVHD between the two groups within 3 months after transplantation (P=0.146). No transplantation-related death was observed in either group within 3 months after haplo-HSCT. The children with CRS grade≥3 have an early neutrophil engraftment time, severe and diverse clinical manifestations of CRS, and a high rate of use of glucocorticoids within 4 days after haplo-HSCT. For these children, early use of low-dose glucocorticoids after transplantation may alleviate CRS response and reduce the incidence of aGVHD, thereby bringing more benefits to the children. CRS after haplo-HSCT has no significant impact on the prognosis of the children.

The Role of the Lawton Instrumental Activities of Daily Living (IADL) Scale in Predicting Adverse Events and Outcomes of R-CHOP Treatment in Elderly Patients with Diffuse Large B-Cell Lymphomas (DLBCLs) or Mantle Cell Lymphomas (MCLs): A Prospective Single-Center Study.

The prognostic value of the comprehensive geriatric assessment (CGA) is recognized by many in hematology. However, there is no consensus on the utilization of alternative abbreviated methods to assess disabilities in elderly patients with B-cell non-Hodgkin's lymphomas (B-NHLs). The aim of this study was to prospectively analyze the prognostic value of selected CGA tools in predicting adverse events (AEs) and outcomes of R-CHOP or R-CHOP-like treatment in elderly patients with diffuse large B-cell lymphomas (DLBCLs) or mantle cell lymphomas (MCLs). All patients who participated in this study underwent the Katz Index of Independence in Activities of Daily Living (ADL), the Lawton Instrumental Activities of Daily Living (iADL) scale, the Vulnerable Elders Survey-13 (VES-13), the Groningen Frailty Index (GFI), and the Mini Nutritional Assessment Short Form (MNA-SF) before starting anticancer treatment. Selected clinical predictors were also included in the study. A total of 62 patients with newly diagnosed DLBCLs or MCLs, treated with R-CHOP in the Department of Hematology, Blood Neoplasm and Bone Marrow Transplantation of Wroclaw University Hospital between 1 July 2018, and 1 July 2020, were included in the study. The median age upon initiation of the treatment was 72 years (range: 61-68). Multinomial logistic regression and Cox proportional hazard regression analysis demonstrated that the iADL scale was significantly associated with response to treatment (OR = 1.21, 95% CI: 1.02-1.44, p = 0.03), was inversely related to non-hematological AEs (OR = 0.81, 95% CI: 0.71-0.92, p = 0.001), and was a statistically significant predictor of longer overall survival (OS) (HR = 0.83, 95% CI: 0.79-0.89, p < 0.001) and longer progression-free survival (PFS) (HR = 0.91, 95% CI: 0.83-0.99, p = 0.03). These results underscore the effectiveness of the iADL scale as a quick, easy-to-use, and universal CGA tool for evaluating crucial functional status before treatment in elderly hematological patients with DLBCLs or MCLs.

Health Related Quality of Life in Patients With Hodgkin’s Lymphoma Receiving Brentuximab Vedotin in University Hospital Establishment of Oran (Uheo) - Algeria.

For patients with Hodgkin’s lymphoma (HL) treated with Brentuximab vedotin (BV), quality of life (QoL) depends primarily on the effectiveness of treatment, side effects management, the psychological impact of diagnosis and treatment, and how the constraints associated with drug delivery affect their daily lives. The main objective is to evaluate Qol using the Europeen Organization For Research and Treatment of Cancer questionnaire in HL patients under BV at the UHEO to improve overall patient management and optimize therapeutic outcomes throughout their treatment path care. Materials and methods. The study included patients from different regions of Algeria who had been treated at the UHEO’s hematology department with HL under BV since January 2024. Questionnaires assessing various aspects such as potentially quality of life, were completed by the patients themselves. Results. In total 28 patients were included, 57.15% were women. The average age of the population was 33+/-17 years with extremes of 15 and 72. A statistically significant difference was found between the items of the QLQ-HL27 as well as for the items of the QLQ-C30 according to age, gender, region and stage of disease (p&lt;0.05). No influence of age was found on diarrhea (p=0.10), nor any statistical difference between pain (p=0.78) and financial impact (p=0.63) compared to gender. Conclusion. A statistical difference of the majority of items in QLQ-C30 and QLQ-HL27 compared to age, gender, region and stage of disease in LH patients treated with BV.

Outcomes of patients with complement-mediated thrombotic microangiopathy

Objective: Complement-mediated thrombotic microangiopathy (CM-TMA)) is a rare, progressive and life-threatening type of thrombotic microangiopathy (TMA) characterized by microangiopathic hemolytic anemia, thrombocytopenia and associated acute kidney disease (AKI) caused by dysregulation of the alternative complement pathway. The aim of this study was to retrospectively analyze the clinical features, follow-up, treatment and mortality of patients with CM-TMA. Materials and methods: This was a retrospective study evaluating 13 patients diagnosed with CM-TMA who were followed retrospectively from 2024. Data were collected through a comprehensive review of electronic medical records of patients diagnosed with CM-TMA and receiving Eculizumab in the Department of Hematology and Nephrology. Results: Thirteen patients with a mean age at diagnosis of 36.0 ± 17.8 years were included. Age at disease onset ranged from 17 to 66 years. Only 3 (23.1%) patients were over 50 years of age. All patients were female. The mean follow-up period was 78.6±34.6 months. After an increase in GFR with eculizumab treatment, 76.9% of patients were weaned from dialysis. Conclusion: CM-TMA was found to be predominant in young women. Eculizumab treatment provided significant improvements in clinical and laboratory values of the patients.

Primary Thyroid Diffuse Large B-Cell Lymphoma: A Case Report.

Primary thyroid lymphoma is rare. Hashimoto's disease is usually found as a risk factor. Among thyroid lymphoma, diffuse large B-cell lymphoma (DLBCL) is the most aggressive and frequent one. A 56-year-old man with a medical history of Hashimoto's disease presented with a neck mass and dysphonia. A computed tomography scan revealed a large thyroid mass. Fine-needle aspiration cytology (FNAC) was consistent with lymphoma, confirmed by a core needle as a DLBCL. The patient was transferred to the Department of Hematology and Oncology for chemotherapy with good results. Primary thyroid lymphoma accounts for less than 5% of all thyroid gland malignancies and less than 2% of extranodal lymphomas. It frequently affects women in the sixth or seventh decade. Hashimoto's disease is a major risk factor. DLBCL is the most common histological subtype with aggressive evolution. Radiology and FNAC are not usually very precise and a biopsy is needed. Treatment includes surgery, radiotherapy, chemotherapy, and targeted therapy.

Treatment of elderly patients with acute myeloid leukemia: personal experience

Background. Acute myeloid leukemia (AML) is an aggressive malignancy of the hematopoietic system. Most patients with newly diagnosed AML are 65 years of age or older. Treatment of this cohort of patients is difficult due to the comorbidity of elderly patients and the genetic characteristics of hemoblastosis, which prevents the achievement of significant progress in treatment, in contrast to younger patients with AML. As domestic and foreign studies have shown, age is an independent universal prognosis factor for AML. In the era of targeted drugs, successful treatment of AML is becoming possible.Aim. To assess overall survival in elderly patients with AML, tolerability and effectiveness of various treatment regimens in patients with AML ≥65 years.Materials and methods. This paper presents our own experience in the treatment of elderly patients with AML in the hematology departments of the City Clinical Hospital No. 52. The study included patients over 65 years of age with AML from April 2022 to September 2023. A total of 40 patients were analyzed. To determine the risk factors for death, univariate and multivariate regression analyzes were performed using the logistic regression method. Variables that showed statistical significance on univariate analysis were included in the multivariate analysis. An analysis of 12‑month overall survival was also carried out using the Kaplan–Meier method with the construction of survival curves and calculation of median survival. A comparative analysis of two groups of patients treated with the AZA + EN and LdaraC regimens was carried out.Results. 63 % (n = 25) are men, 37 % (n = 15) are women. The median age was 75 years; all patients had complicated premorbid background. 53 % (n = 21) of patients were in the age range from 65 to 69 years, 47 % (n = 19) were over 70. Antitumor treatment was received by 88 % (n = 35) of patients. The remaining 5 underwent: best accompanying (n = 2), cytoreductive (early death at this stage) (n = 3) therapy. Complete remission after two cycles of therapy was achieved in 46 % (n = 16) of patients, and in 29 % (n = 10) it was maintained at the time of analysis. Early relapse occurred in 14 % (n = 5). Early mortality was recorded in 9 % (n = 3). Death was reported in 40 % (n = 16) of patients. 20 % (n = 7) of patients were refractory to first-line therapy, of which 36 % (n = 5) were treated with low doses of cytarabine (LdaraC), the rest to a combination of azacitidine (AZA) with venetoclax (EN). The number of relapses among patients on AZA + EN and LdaraC therapy was comparable.Conclusion. AZA + EN is the first-line treatment of choice in older patients with AML. The possibility of conducting this course in an outpatient setting makes it most convenient for both hematologists and patients. An important aspect in the treatment of AML in elderly patients is improving and maintaining quality of life.

Inhibition of Acute Myeloid Leukaemia Development by Bittersweet Based on miR-let-7a Regulating Vascular Endothelial Growth Factor A Resistance Mechanism

Acute myeloid leukaemia (AML) is closely related to regulation of miR-let-7a and vascular endothelial growth factor A (VEGFA). Picrasidine is a traditional Chinese medicine extract with antitumour effects, but its mechanism of action in AML is unclear. This study investigated picloram’s effect on AML and its relationship with miR-let-7a regulation of VEGFA resistance mechanism. Bone marrow samples from leukaemia patients in the Department of Haematology of our hospital were collected, and RT-PCR detected miR-let-7a and VEGFA expression in the bone marrow of healthy individuals and leukaemia patients. At the same time, cell culture of AML-resistant cell line K562/ADM was performed, which was divided into NC group, Picrasidine L group, Picrasidine M group, Picrasidine H group, si-NC group, Picrasidine H+miR-let-7a inhibitor group, Picrasidine H+miR-let-7a mimic group, miR-let-7a mimic+hVEGF-IN-1 group, miR-let-7a inhibitor+hVEGF-IN-1 group, and Picrasidine H+miR-let-7a mimic+hVEGF-IN-1 group. Cell proliferation and apoptosis was detected and correlation between miR-let-7a and VEGFA was analyzed by clinical samples. Picrasidine had a significant ameliorative effect on acute myeloid leukaemia in a dose-dependent manner. miR-let-7a was lowly expressed and VEGFA was highly expressed in AML patients. miR-let-7a and VEGFA showed significant correlation in human AML disease staging, and there was a statistically significant difference (p &lt;0.05). That is to say, picloram promotes miR-let-7a expression, thus achieving inhibition of VEGFA, which in turn promotes apoptosis of AML drug-resistant cell line K562/ADM and inhibits its proliferation. The ameliorative effect of Picrasidine on acute myeloid leukaemia was achieved by upregulating miR-let-7a and downregulating VEGFA.

Clinical characteristics and prognostic analysis of prolonged cytopenia after CAR-T cell therapy in LBCL patients

Objective: To investigate the clinical features and prognosis of prolonged cytopenia (PC) in patients with large B-cell lymphoma (LBCL) undergoing anti-CD19 chimeric antigen receptor T (CAR-T) cell therapy. Methods: A retrospective case series study was conducted on LBCL patients who received CAR-T cell therapy with a survival time of over one month at the Hematology Department of Peking Union Medical College Hospital from March 2019 to December 2023. Statistical analyses were performed on hematologic changes at 1, 3, 6, and 12 months post-CAR-T infusion, as well as on the progression-free survival (PFS) and post-treatment adverse events, including infections. Patients were categorized into the PC and non-PC groups based on the occurrence of cytopenia at 90 days post-infusion. Differences between groups were compared, and univariate logistic regression analysis was used to identify risk factors. Results: The median age of 27 LBCL patients receiving CAR-T cell therapy was 58 years (range 27-69 years), with 18 males. Among the 27 LBCL patients who received CAR-T cell therapy, PC was observed in 19 patients (70.4%), with instances of neutropenia (48.1%, 13 cases), anemia (37.0%, 10 cases), and thrombocytopenia (22.2%, 6 cases). Univariate logistic regression analysis revealed that prior chemotherapy sensitivity (OR=18.00, 95%CI 1.56-207.45, P=0.020) and bone marrow suppression (OR=18.00, 95%CI 1.38-235.69, P=0.028) were associated with PC. The median follow-up time was 13.5 months. The PC group exhibited a higher risk of infection within 3 months (9/19 vs. 1/8) and a shorter mean PFS (19.3 months vs. 24.4 months), although the difference was not statistically significant (both P>0.05). Conclusions: PC is common following CAR-T cell therapy and is associated with an increased risk of infection and poorer prognosis. Prior treatment sensitivity and bone marrow suppression may serve as indicators of PC.

Unusual Presentation of Oral DLBCL Resembling a Canine Fossa Abscess.

This report aims to describe a unique case of diffuse large B-cell lymphoma originating from the oral cavity, which presented with symptoms mimicking a canine fossa abscess. It emphasizes the importance of accurate differential diagnosis and appropriate treatment. A 64-year-old female patient visited the authors' clinic with a painful swelling in the left anterior region of the maxilla, persisting for 1 month. Initially, an abscess drainage procedure was performed, accompanied by extraction of the maxillary left canine and parenteral antibiotherapy. However, no improvement was observed during the follow-up appointment after 3 days. An incisional biopsy was then conducted under local anesthesia, leading to a histopathologic diagnosis of diffuse large B-cell lymphoma. The patient is currently under the care of the hematology department and receiving maintenance chemotherapy. Lymphomas occurring in the oral cavity are uncommon and may exhibit non-specific clinical features that resemble benign oral and dental conditions. Therefore, a comprehensive clinical evaluation is necessary to achieve an early and accurate diagnosis, with histopathologic examination being essential for suspicious lesions.

Risk factors of asparaginase-associated pancreatitis in children with acute lymphoblastic leukaemia

Background: Acute lymphoblastic leukaemia (ALL) is the top childhood cancer, with survival rates of 80–85%. Attention now focuses on treatment complications. Pancreatitis, linked to Asparaginase in ALL therapy, remains poorly understood despite its recognition. The main objective of the study was to identify the risk factors of pancreatitis in children with acute lymphoblastic leukemia receiving L-Asparaginase during induction chemotherapy. Methods: A prospective observational study was conducted at BSMMU's Paediatric Haematology and Oncology Department from March 2018 to February 2019. Newly diagnosed ALL cases in children aged 1 to 17.9 years were included, excluding those &lt;1 or &gt;18 years, with prior pancreatitis, or relapsed cases. Informed consent was obtained from parents/legal guardians. Diagnosis relied on clinical, CBC, bone marrow and immunophenotyping. Induction chemotherapy followed the UK ALL 2003 protocol for 35 days, with regular follow-ups monitoring abdominal symptoms and laboratory markers. USG of the abdomen was performed if pancreatitis symptoms or elevated serum amylase/lipase occurred post-L-asparaginase administration. Results: Among 80 patients, pancreatitis affected 3 (3.8%) after the 2nd, 3rd and 7th doses of L-asparaginase, independent of individual or cumulative dosing, induction phase or concomitant medications. Age, sex, initial WBC count, ALL lineage, treatment regimen and CNS status were not statistically linked to pancreatitis incidence. Clinical manifestations included abdominal pain, tenderness, nausea, vomiting and fever, alongside elevated serum amylase and lipase levels, supported by consistent ultrasonographic findings. Despite these symptoms, no pancreatitis-related mortalities were observed, however, overall mortality during induction therapy reached 20%, unrelated to pancreatic complications. Conclusions: In this study no significant risk factor could be identified for developing pancreatitis in ALL patients treated with asparaginase. Further studies with large sample size are required to predict who will develop pancreatic toxicity from asparaginase.

Knowledge, attitude, and practice toward family-based treatment among parents of children with leukemia.

To investigate the KAP toward family-based treatment among parents of children with leukemia. This cross-sectional study was conducted between December, 2022 and July, 2023 in the Pediatric hematologic oncology department of West China Second University Hospital, Sichuan University. The study population consisted of parents of children diagnosed with leukemia. Their demographic characteristics and KAP toward family-based treatment for leukemia were collected by self-administered questionnaires. A total of 482 parents participated, including 379 (78.63%) females, with an average age of 35.83 ± 6.40 years. The mean scores for KAP were 7.28 ± 1.13 (possible range: 0-10), 37.82 ± 4.38 (possible range: 9-45), and 40.09 ± 4.17 (possible range: 9-45), respectively. Multivariate logistic regression analysis indicated that the knowledge score (OR = 1.48, 95% CI: [1.08-2.05], P = 0.016), attitude score (OR = 1.31, 95% CI: [1.18-1.46], P < 0.001), education of junior college and above (OR = 11.28, 95% CI: [1.94-65.65], P = 0.007), and monthly income of 5,000-10,000 Yuan (OR = 10.88, 95% CI: [1.15-102.98], P = 0.037) were independently associated with a proactive practice. Structural equation modeling (SEM) results highlighted the significant direct impact of knowledge on attitude (β = 0.72, P = 0.002), attitude on practice (β = 0.57, P < 0.001), and knowledge on practice (β = 0.81, P < 0.001). Parents of children with leukemia demonstrated inadequate knowledge, but positive attitudes and proactive practices toward family-based treatment for leukemia. Future interventions should not only prioritize augmenting parental knowledge through educational initiatives but also focus on fostering positive attitudes and providing support for both knowledge and practical parenting skills to facilitate proactive involvement.