Diagnosis Of Hematological Malignancies Research Articles

Venous thromboembolism in critically ill adult patients with hematologic malignancy: a population-based cohort study.

The aim of this study was to describe the incidence of venous thromboembolism (VTE) and major bleeding among hospitalized patients with hematologic malignancy, assessing its association with critical illness and other baseline characteristics. We conducted a population-based cohort study of hospitalized adults with a new diagnosis of hematologic malignancy in Ontario, Canada, between 2006 and 2017. The primary outcome was VTE (pulmonary embolism or deep venous thrombosis). Secondary outcomes were major bleeding and in-hospital mortality. We compared the incidence of VTE between intensive care unit (ICU) and non-ICU patients and described the association of other baseline characteristics and VTE. Among 76,803 eligible patients (mean age 67years [standard deviation, SD, 15]), 20,524 had at least one ICU admission. The incidence of VTE was 3.7% in ICU patients compared to 1.2% in non-ICU patients (odds ratio [OR] 3.08; 95% confidence interval [CI] 2.77-3.42). The incidence of major bleeding was 7.6% and 2.4% (OR 3.33; 95% CI 3.09-3.58), respectively. The association of critical illness and VTE remained significant after adjusting for potential confounders (OR 2.92; 95% CI 2.62-3.25). We observed a higher incidence of VTE among specific subtypes of hematologic malignancy and patients with prior VTE (OR 6.64; 95% CI 5.42-8.14). Admission more than 1year after diagnosis of hematologic malignancy (OR 0.64; 95% CI 0.56-0.74) and platelet count ≤ 50 × 109/L at the time of hospitalization (OR 0.63; 95% CI 0.48-0.84) were associated with a lower incidence of VTE. Among patients with hematologic malignancy, critical illness and certain baseline characteristics were associated with a higher incidence of VTE.

Deciphering Disease: The Critical Role of Bone Marrow Aspirate and Biopsy in Diagnostic Medicine

Background: Haematological malignancies, such as non-Hodgkin lymphomas and multiple myeloma, present diagnostic challenges due to the heterogeneity and complexity of their presentation. The importance of accurate diagnostic methods, like bone marrow aspirate (BMA) and bone marrow biopsy (BMB), is paramount for patient prognosis and therapeutic decisions. Objective: This manuscript aims to critically evaluate the role of bone marrow aspiration and its efficacy with bone marrow biopsy in diagnosing and assessing different medical conditions, offering an in-depth understanding of their individual and combined implications. Methods: Diverse studies exploring on lymphomas, Leukaemia and research on multiple myeloma were analysed. The emphasis was on the diagnostic discrepancies and complementarities between BMA and BMB. Additionally, the evolving role of advanced tools like PET-CT, flow cytometry, and their integration with traditional methodologies were examined. Results: While BMA and BMB both play crucial roles in the diagnostic paradigm, there exists a tendency for BMA to underestimate plasma cell involvement in certain cases. Additionally, PET-CT scans and flow cytometry, when combined with conventional techniques, enhance diagnostic accuracy. However, the application of these techniques should be individualized based on specific clinical scenarios, with considerations for costeffectiveness and practical implications. Conclusion: The multifaceted diagnosis of haematological malignancies mandates a holistic approach, integrating both traditional and advanced methodologies. An interdisciplinary approach, prioritizing patient-specific nuances, ensures precise diagnoses, laying the groundwork for optimal therapeutic outcomes. Future research endeavours should focus on refining these diagnostic algorithms to align with the rapidly progressing field of haematology

Immunocytochemistry on frozen-embedded cell block for the diagnosis of hematolymphoid cytology specimen: a straightforward alternative to the conventional cell block.

Agarose-based cell block (CB) technique can be modified to be combined with the frozen section technique for the preparation of a high-quality frozen-embedded CB (F-CB) from an effusion or fine-needle aspiration (FNA) cytology sample. This combined technique can be effectively used for the immunocharacterization of the hematolymphoid cells on F-CB. To demonstrate the applicability of performing diagnostic ICC on F-CB, we have analyzed the immunophenotype of the hematolymphoid cells in a series of eight cases of effusions and eight cases of FNA cytology specimens by using CB-ICC on sections cut from frozen-embedded CBs. The SurePathTM residue or cytologic material scraped off from the FNA cytology smear that was diagnostic for or suspicious of hematolymphoid malignancy was pelleted and pre-embedded in agarose. Half of the agarose-embedded pellet was frozen-embedded in OCT compound for the preparation of F-CB, while the other half was processed for the preparation of paraffin-embedded CB. Sections cut from the F-CB and P-CB were used for CB-ICC. Panels of ICC on the F-CBs could enable the immunocytochemical differential diagnosis of large cell hematologic malignancies that encompass anaplastic large cell lymphoma and other forms of large-cell hematolymphoid malignancies such as large B-cell lymphomas, anaplastic plasma cell myeloma, myeloid sarcoma, and T-lymphoblastic lymphoma. It also appeared that the small B-cell lymphomas in the effusions or FNAs could be differentially diagnosed with the aid of CB-ICC on the F-CB. A modified agarose-based CB technique can be combined with the frozen-embedded CB method for the preparation of F-CB that can be directly used for the immunocytochemical differential diagnosis of hematolymphoid cytology samples.

An Attempt to Determine Hematological Malignancies in Selected Patients: A Cytogenetical Approach

Diagnosis and treatment of hematological malignancies, a diverse category of tumors that begin in the blood and bone marrow, are extremely difficult. Our knowledge of these conditions has been revolutionized by the development of cytogenetics, the study of chromosomes and genetic abnormalities. A total of 180 patients with benign and malignant hematological malignancy had peripheral bone marrow or blood samples obtained using the standard G-banding procedure. Fifty-one percent of patients had normal karyotypes. In addition, thirty individuals (15%) had a complicated karyotype whereas eighty-five percent (85%) had a normal one. Three-hundred and three percent of patients were diagnosed with Pre-B Acute Lymphoblastic Leukemia (Pre-B ALL), followed by twenty percent with Chronic Myelogenous Leukemia (CML), and fourteen percent with Acute Lymphocytic Leukemia.

Memorial lecture to the 100th anniversary of the birth of Professor Yu.I. Lorie

In 2022, the 100th anniversary of the birth of Professor Yu.I. Lorie was celebrated. Yuri Ivanovich Lorie is a talented Russian internal medicine specialist and hematologist, a wonderful teacher, and a person of great personal charm. Yu.I. Lorie is the founder of a new direction of hematology in Russia – oncohematology – and the establisher of a school based on deep knowledge and understanding of the oncological principles of hematological malignancies. Yuri Ivanovich Lorie lived a short (only 54 years) but bright life, utterly devoted to Russian medicine. He left a great legacy – a modern, rapidly developing direction in Russian medicine and a school of students who successfully continued the work he started. Looking back at the scientific and practical activities of Yu.I. Lorie and those emotional scientific debates that his colleagues and students remember, it becomes clear how many modern trends in the understanding of oncogenesis, diagnosis and treatment of hematological malignancies this legendary scientist established.

Analytic Validation of Optical Genome Mapping in Hematological Malignancies.

Structural variations (SVs) play a key role in the pathogenicity of hematological malignancies. Standard-of-care (SOC) methods such as karyotyping and fluorescence in situ hybridization (FISH), which have been employed globally for the past three decades, have significant limitations in terms of resolution and the number of recurrent aberrations that can be simultaneously assessed, respectively. Next-generation sequencing (NGS)-based technologies are now widely used to detect clinically significant sequence variants but are limited in their ability to accurately detect SVs. Optical genome mapping (OGM) is an emerging technology enabling the genome-wide detection of all classes of SVs at a significantly higher resolution than karyotyping and FISH. OGM requires neither cultured cells nor amplification of DNA, addressing the limitations of culture and amplification biases. This study reports the clinical validation of OGM as a laboratory-developed test (LDT) according to stringent regulatory (CAP/CLIA) guidelines for genome-wide SV detection in different hematological malignancies. In total, 60 cases with hematological malignancies (of various subtypes), 18 controls, and 2 cancer cell lines were used for this study. Ultra-high-molecular-weight DNA was extracted from the samples, fluorescently labeled, and run on the Bionano Saphyr system. A total of 215 datasets, Inc.luding replicates, were generated, and analyzed successfully. Sample data were then analyzed using either disease-specific or pan-cancer-specific BED files to prioritize calls that are known to be diagnostically or prognostically relevant. Sensitivity, specificity, and reproducibility were 100%, 100%, and 96%, respectively. Following the validation, 14 cases and 10 controls were run and analyzed using OGM at three outside laboratories showing reproducibility of 96.4%. OGM found more clinically relevant SVs compared to SOC testing due to its ability to detect all classes of SVs at higher resolution. The results of this validation study demonstrate the superiority of OGM over traditional SOC methods for the detection of SVs for the accurate diagnosis of various hematological malignancies.

Evaluation of Platelet and Clotting Parameters in Hematologic Malignancies and Hematopoietic Stem Cell Transplantation Patients with Candidemia

1.Backgroud In recent years, the number and proportion of deaths from fungal infections have increased year by year. The fatality rate of fungemia is about 0.4 per 100 000 [Pfaller MA, et al. Clin Microbiol Rev. 2007]. Chemotherapy can effectively treat hematological malignancies. Data from multi-center studies in China show that the overall mortality rate of patients receiving chemotherapy for hematological malignancies is only 1.5%, and the mortality rate of patients with clinically diagnosed invasive fungi is as high as 11.7% [ Sun Y, et al. Tumor Biol, 2015]. The surveillance data of China Hospital Invasive Fungal Disease Surveillance Network from 2015 to 2017 showed that Candida albicans was the most common pathogen among 4 010 Candida strains isolated from patients with candidemia from 77 hospitals in China [Xiao M, et al. J Infect Dis, 2020]. 2.Methods We conducted a retrospective study that collected relevant clinical information from 34 hematologic malignancies and hematopoietic stem cell transplantation (HSCT) patients with candidemia between 2017 to 2022 in Hematology Hospital, Chinese Academy of Medical Sciences. The blood specimens of patients suspected to have candidemia were collected and cultured. After diagnosis, they were regarded as the candidemia group, and 107 healthy people were selected as the control group. Candidemia is classified as invasive or non-invasive according to whether it involves tissues or organs damage. Blood routine and clotting related tests were performed at the Clinical Laboratory Center of Hematology Hospital, Chinese Academy of Medical Sciences. 3.Results 3.1 General Characteristics of the Study Subjects A total of 34 hematologic malignancies and HSCT patients with candidemia were recruited. Of these 34 patients, 28 were male and 6 were female. Meanwhile, 107 healthy people were recruited as control group. The characteristics of two groups are presented in Table 1. 3.2 Hematologic malignancies and HSCT patients with abnormal blood routine are at increased risk of candidemia Hematologic malignancies and HSCT patients with candidemia present as lower white blood cell count, lower red blood cell count, higher lymphocyte ratio, lower lymphocyte count, lower monocyte count, lower neutrophil count and ratio, and lower NEU/PLT compared with control group. 3.3 Candidemia cause platelet activation in hematologic malignancies and HSCT patients The PLT and PCT of hematologic malignancies and HSCT patients with candidemia were significantly lower than control group. Meanwhile, MPV and P-LCR were higher than control group. It revealed that hematologic malignancies and HSCT patients with candidemia may present with platelet activation, while PLT and PCT level were low in this group. 3.4 Invasive candidemia can cause a decrease in platelets and an increase in MPV/PLT Furthermore, we found that PLT level was lower and MPV/PLT level was higher in hematologic malignancies and HSCT patients with invasive candidemia than hematologic malignancies and HSCT patients with non-invasive candidemia. 3.5 Candidemia can cause coagulation dysfunction in hematologic malignancies and HSCT patients Hematologic malignancies and HSCT patients with candidemia had coagulation dysfunction symptoms such as prolonged PT and APTT, reduced antithrombin III activity, and high INR. 3.6 Candidemia can cause hyperfibrinolysis in hematologic malignancies and HSCT patients Meanwhile, hematologic malignancies and HSCT patients with candidemia showed reduced TT, increasing fibrinogen, fibrinogen degradation products, and D-Dimer. 4.Conclusion In conclusion, we demonstrated for the first time that decreasing platelet count and activated platelet function in hematologic malignancies and HSCT patients with candidemia. Invasive candidemia may cause lower platelet count and more activated platelet function in hematologic malignancies and HSCT patients. At the same time, we found that candidemia can cause coagulation dysfunction and hyperfibrinolysis in hematologic malignancies and HSCT patients. We hope that our study can provide a new perspective on the cognition and diagnosis of hematologic malignancies and HSCT patients with candidemia.

Social Determinants of Health (SDoH) Scores for Adolescent and Young Adults (AYAs) at a Public Safety-Net Teaching Hospital: A Retrospective Cohort Analysis

Introduction The majority of AYAs, ages 15-39, are treated outside of major academic centers and recent data suggests inferior outcomes for these patients. Social determinants of health play an important role in the outcomes for AYAs due to longer duration of survival, less established social networks, diminished support systems, and financial toxicity. Here we report SDoH data from self-reported screening questionnaires in the EPIC electronic medical record (EMR). The purpose of this study was to examine differences in SDoH between AYAs and older adults from diagnosis of hematological malignancy through 5 years at a nonprofit public safety-net health system in Cleveland, Ohio. Methods Using a retrospective cohort design, patients with hematological malignancies (acute/chronic leukemia, lymphoma, myelodysplastic syndrome, myeloproliferative neoplasms, etc.) identified in the EMR by ICD code, were assigned two groups, AYAs (15-39) and older adults (>39 years of age). Social determinants of health data screenings for Alcohol Use, Depression, Financial Resource Strain, Food Insecurity, and Transportation Needs were evaluated beginning at malignancy diagnosis through 5 years. Scores for each item rated from 0 to 3 based on 3 questions pertaining to each item. Data was stratified by low scores (0 to 1) and high scores (2 to 3) and cumulative incidence was obtained at timepoints of diagnosis (-7 to +7 days), and annually through year 5 from diagnosis. Statistical significance was performed using Kruskal-Wallis chi square analysis and odds ratios (OR). Results A total of 1710 patients with 11010 screens were identified from days 7 prior to diagnosis to 12070 after diagnosis. Any positive score (score of 1 to 3) was obtained in 93% of AYA screens and 95% of >39 years of age screens. To further investigate the degree of positivity of SDoH screen, scores were stratified by low (0 to 1) and high (2 to 3). At initial diagnosis, no statistical difference between AYAs and >39 years was found (x 2=0.97, p=0.3251). A statistical difference was seen for cumulative incidence at all timepoints after diagnosis: 1 year x 2=9.23, p=.0024; 2 years x 2=15.86, p=0.0001; 3 years x 2=18.58, p<0.00001; 4 years x 2=25.47, p<0.00001; 5 years x 2=25.32, p<0.00001 (table 1). Odds ratios (with 95% CI) were statistically significant at all timepoints after diagnosis: 1 year 2.06 (1.28-3.13), p=0.0029; 2 years 1.77 (1.21-2.58), p=0.0031; 3 years 1.97 (1.44-2.69), p=<0.0001; 4 years 2.07 (1.55-2.76), p=<0.0001; 5 years 1.94 (1.49-2.53), p=<0.0001, (figure 1). Most prominently positive were self-reported depression screens in AYAs at 1 year (x 2=6.54, p=0.0105), 2 years (x 2=16.35, p=.0001), 3 years (x 2=21.42, p<0.00001), 4 years (x 2=19.09, p<0.00001), 5 years (x 2=26.86, p<0.00001). Lastly, we assessed annual incidences for total SDoH screens which showed significance at 1 year (x 2=8.73, p=.0031), 3 years (x 2=11.04, p=.0009), and 4 years (x 2=7.96, p=.0048) but not at 2 or 5 years (x 2=1.17, p=0.2798 and x 2=1.40, p=0.2373, respectively). Conclusions Within a highly vulnerable population at a public safety-net hospital, AYAs with hematological malignancies had a statistically significant higher proportion of self-reported Alcohol Use, Depression, Financial Resource Strain, Food Insecurity, and Transportation Needs versus older adults. While no statistical difference existed at time of diagnosis, a larger proportion of high-risk scores were seen beginning at 1 year after diagnosis through 5 years after diagnosis. In addition, odds ratios were most prominent at 1 year and 4 years after diagnosis possibly suggesting a higher social toxicity seen by AYAs in active treatment and survivorship. Specific attention should be given to mental health services for AYAs throughout treatment and prospective observation studies should be done in order to confirm the observed results. In addition, further research is needed to assess the role of hospital setting type (academic, county, community) and presence of an AYA program on social determinants of health for AYAs as well as implementation of social interventions that may mitigate these outcomes.

Patterns of prescription opioid use and opioid-related harms among adult patients with hematologic malignancies.

Treatment advances for hematologic malignancies (HM) have dramatically improved life expectancy, necessitating greater focus on long-term cancer pain management. This study explored real-world patterns of opioid use among patients with HM. This retrospective cohort study identified adults diagnosed with HM from January 1, 2013 through December 31, 2019 using the Truven MarketScan Commercial Claims and Encounters database. Across several HM types, we described rates of high-risk opioid use (based on Pharmacy Quality Alliance measures) and opioid-related harms, including incident opioid use disorder (OUD) diagnoses and opioid-related hospitalizations or emergency department (ED) visits. We used multivariable Cox regression to generate adjusted hazard ratios and 95% confidence intervals comparing the risk of opioid-related harms between patients with versus without high-risk opioid use. Our sample included 43,190 patients with HM. Median age at HM diagnosis was 54 years (interquartile range = 44-60). Most patients (61.9%) were diagnosed with lymphoma. Approximately half (49.2%) had an opioid dispensed in the follow-up period. Among all patients, 20.0% met criteria for high-risk opioid use, 0.9% had an OUD diagnosis, and 0.3% experienced an opioid-related hospitalization/ED visit in follow-up. High-risk opioid use increased the risk of an OUD diagnosis by 3.3 times (p < 0.0001) and an opioid-related hospitalization/ED visit 4.2 times (p < 0.0001). High-risk opioid use was prevalent among patients with HM and significantly increased the risk of opioid-related harms. However, rates of opioid-related harms were low. These findings highlight the importance of continually monitoring pain and opioid use throughout HM survivorship to provide safe, effective HM pain management.

Cancer Predisposition Genetic Testing Among Children with Hematologic Malignancies

Introduction: There is growing recognition of germline cancer predisposition syndromes (CPS) that increase risk of hematologic malignancies including leukemias, lymphomas, bone marrow failure syndromes and myeloproliferative diseases. Somatic (tumor) testing can identify potential germline variants based on multiple factors including variant allele fraction, sequence characteristics, and other findings; however, subsequent germline testing is required to characterize the lesion. Paired tumor and germline testing (T/N testing) is more accurate to diagnose CPS and may mitigate loss to follow-up, reduce time to CPS diagnosis, and possibly alleviate unnecessary anxiety due to suspected but ultimately disproved germline conditions. Previously, our center performed tumor-only diagnostic testing for patients with newly diagnosed hematologic malignancies. In 2020 we transitioned to paired T/N testing for all new hematologic malignancy diagnoses with patient/caregiver consent. Here we report the frequency of CPS diagnoses suggested by tumor-only testing and subsequently confirmed with germline testing, as well as CPS diagnoses identified from the outset by T/N testing. Methods: Data was automatically abstracted from the Children's Hospital of Philadelphia (CHOP) Diagnostic Genomics Database (FileMaker and Nexus) for 1057 pediatric, adolescent, and young adult patients who underwent testing with the CHOP Comprehensive Hematologic Malignancy panel between 2016 and 2023. This panel interrogates 117 genes for single nucleotide variants, insertions, deletions, and copy number variants. Of those tested, 932 patients underwent tumor-only testing, and 125 patients underwent paired T/N testing. Characteristics of patients with possible pre-established genetic syndromes (e.g. Trisomy 21) were cross-checked via manual chart review. Results: Schematic representation of patient testing is summarized in Figure 1. Among 932 patients who underwent tumor-only testing, 98 were identified to have potential or previously established germline pathogenic variants. Of these, 9 had known genetic syndromes and 8 had non-cancer related genetic diagnoses (e.g. Usher syndrome). Of the 81 patients with a suspected CPS, 26 were referred from an outside hospital with unavailable follow-up data. Among suspected germline patients from our center (n=55), 34 (62%) did not undergo confirmatory testing. Of the 21 (38%) who underwent confirmatory testing, 2 (10%) were diagnosed with a CPS. For patients with T/N testing, 16 of 125 (7%) were identified to have germline conditions; 8 were pre-established diagnoses and 4 were non-cancer related genetic diagnoses. Thus, 4 (3%) of patients with T/N testing were newly diagnosed with a CPS. New CPS diagnoses included: ETV6 thrombocytopenia and leukemia predisposition syndrome, CBL syndrome, GATA2 MDS/AML predisposition syndrome, Noonan syndrome, and CEBPA AML predisposition syndrome. Conclusion: At our center, 62% of patients with suspected germline conditions on tumor-only testing had no follow up testing documented in the available medical record. These data suggest that paired T/N testing at the time of hematologic malignancy diagnosis assists in mitigating loss-to-follow up for patients with possible CPS. Additionally, T/N testing may streamline result interpretation, reduce time to diagnosis, aid in treatment decisions, and guide cascade testing for potentially affected family members. When possible, genetic testing decisions and results should be discussed with a trained genetic counselor. Over time, increasing utilization of paired T/N testing may also enhance understanding of CPS-associated genes that increase risk of hematologic malignancies.

Clonal Hematopoiesis and Venous Thromboembolism in the UK Biobank

Background: Patients with myeloid malignancies have an increased risk of thrombosis, but less is known about the risk of thrombosis in clonal hematopoiesis of indeterminate potential (CHIP). We evaluated genotype-specific associations between CHIP and both prevalent and incident venous thromboembolism (VTE) in the largest such analysis to date of the UK Biobank. Methods: We examined 425,573 individuals without a prevalent hematologic malignancy diagnosis from the UK Biobank. Whole exome sequencing and single nucleotide polymorphism array data were analyzed to identify individuals with CHIP and/or mosaic chromosomal alterations (mCA), respectively. Prevalent and incident VTE cases were ascertained with respect to the time of DNA sampling. VTE events were identified based on ICD10 codes, including but not limited to, pulmonary embolism, phlebitis/thrombophlebitis of deep veins of lower veins, portal vein thrombosis, and Budd Chiari syndrome. Median follow-up time for incident VTE was 11.8 years. Associations of CHIP and VTE were assessed using logistic regression for prevalent analyses and Cox proportional hazards for incident analyses. The association analyses were adjusted for age at the time of DNA sampling, sex, Caucasian ancestry, genetic principal components, ever smoked status, and body mass index (BMI) as covariates. Results: Prevalent VTE and CHIP: While CHIP overall was not associated with an increased risk of prevalent VTE (odds ratio (OR) 1.06; 95% CI 0.87-1.28, P= 0.56) (Figure 1), JAK2-mutant CHIP and JAK2 CHIP with loss of heterozygosity at the JAK2 locus (LOH 9p) were powerfully associated with increased risk of thrombosis, OR = 7.49 (95% CI 3.02-18.56, P=1.41e-05) and 6.74 (95% CI 1.62-28.08; P=8.71e-03). Having both CHIP and autosomal mCA was associated with a nominally increased risk of VTE (OR 1.76; 95% CI 1.02-3.06, P= 0.04). Otherwise, non- JAK2 CHIP , ASXL1 CHIP , TET2 CHIP , DNMT3A CHIP were not associated with increased prevalent VTE, regardless of clone size. Incident VTE and CHIP: CHIP was modestly associated with incident VTE with a hazard ratio of 1.15 (1.03-1.28; P=0.01), and CHIP with a larger clone size (VAF &amp;gt; 10%) was associated with a hazard ratio of 1.22 (95% CI 1.08-1.39; P= 0.001) (Figure 2). Consistent with our analysis of prevalent VTE, JAK2-CHIP and JAK2-CHIP with LOH 9p were strongly associated with incident VTE with hazard ratios of 3.76 (95% CI 1.79-7.9, P= 0.0004) and 4.89 (95% CI 1.84-13.04; P=0.0015). Other associations, including overall CHIP, CHIP with VAF &amp;gt;10%, CHIP together with autosomal mCA, autosomal mCA, non- JAK2 CHIP, TET2 CHIP with VAF &amp;gt;10%, showed modest increased hazard ratios between 1 and 2. Conclusions: In this study of risk of thrombosis in the UK Biobank, CHIP was not significantly associated with prevalent VTE and was modestly associated incident VTE. Among CHIP genotypes analyzed, only JAK2 mutations were significantly associated with both prevalent and incident VTE risk (OR 7.49 and HR 3.76, respectively). JAK2-mutant CHIP may be an undetected contributor to cases of VTE and may have therapeutic implications.

Retrospective analysis of respiratory virus infections in adults with hematologic malignancies.

The study aimed to evaluate respiratory virus infections in adult patients with hematological malignancies (HM). The medical records of patients who were followed up by the hematology clinic at Başakşehir Çam and Sakura City Hospital between March 2021 and March 2023 with a diagnosis of HM and who underwent real-time polymerase chain reaction (RT-PCR) testing for nasopharyngeal/oropharyngeal specimens taken with suspected respiratory tract infection constituted the study data. Infections were symptomatic in 64.56% of patients, and the most common symptoms were fever (48.10%) and cough (18.99%). The mortality rate was 25.32% over a two-year period. When the samples were examined, positive test frequency was 43.04%, and the three most common pathogens were Influenza A (10.13%), SARS-CoV-2 (8.86%), and rhinovirus/enterovirus (7.59%). The frequency of positive tests from HMs was highest in patients with AML (p=0.042). Respiratory PCR kit positivity was higher in patients who had any symptoms (p=0.002) and cough (p=0.003). Test positivity was higher in patients with any pathological radiological finding (p=0.039) and ground glass appearance (p=0.010). The risk of death was found to be 5.848 times higher in patients with dyspnea compared to those without (OR: 5.848, 95% CI: 1.143-29.915, p=0.034). Respiratory tract virus panel PCR test positivity is more common in patients with HM presenting with respiratory tract infection symptoms in the presence of AML diagnosis, symptomatic infection, cough, radiological findings, and ground glass appearance. Mortality risk is high in HM patients with respiratory tract virus infection who have shortness of breath.

Retracted: Application of Dynamic Enhanced Magnetic Resonance Imaging in the Diagnosis of Hematological Malignancies.

[This retracts the article DOI: 10.1155/2021/4623850.].

Morphological diagnosis of hematologic malignancy using feature fusion-based deep convolutional neural network

Leukemia is a cancer of white blood cells characterized by immature lymphocytes. Due to blood cancer, many people die every year. Hence, the early detection of these blast cells is necessary for avoiding blood cancer. A novel deep convolutional neural network (CNN) 3SNet that has depth-wise convolution blocks to reduce the computation costs has been developed to aid the diagnosis of leukemia cells. The proposed method includes three inputs to the deep CNN model. These inputs are grayscale and their corresponding histogram of gradient (HOG) and local binary pattern (LBP) images. The HOG image finds the local shape, and the LBP image describes the leukaemia cell's texture pattern. The suggested model was trained and tested with images from the AML-Cytomorphology_LMU dataset. The mean average precision (MAP) for the cell with less than 100 images in the dataset was 84%, whereas for cells with more than 100 images in the dataset was 93.83%. In addition, the ROC curve area for these cells is more than 98%. This confirmed proposed model could be an adjunct tool to provide a second opinion to a doctor.

A study protocol for clinico-pathological diagnosis of hematological malignancies in a tertiary care hospital in central India

There is a paucity of a relevant national registry or any individual center study on clinico-pathological profiles of acute/chronic leukemias and multiple myeloma from central India. The proposed observational, prospective, longitudinal study in a rural tertiary center hospital in central India therefore intends to combine diagnostic techniques like peripheral blood smears, immunophenotyping via flow cytometry, bone marrow aspiration, and cytogenetic studies along with World Health Organisation and French-American-British classification for sub-typing, to accurately diagnose acute/chronic leukaemia and multiple myeloma. A total of 55 patients with any clinical suspicion of leukaemia and myeloma will be followed-up for a one-year period post diagnosis to ascertain if the patient is in complete or partial remission, or in a relapsed disease state. Furthermore, these diagnostic techniques will be compared in terms of their effectiveness and if these could substitute or complement each other keeping the limitations of Indian health settings in mind.

Hema-seq reveals genomic aberrations in a rare simultaneous occurrence of hematological malignancies

Co-occurrence of multiple myeloma and acute myelogenous leukemia is rare, with both malignancies often tracing back to multipotent hematopoietic stem cells. Cytogenetic techniques are the established baseline for diagnosis and characterization of complex hematological malignancies. In this study, we develop a workflow called Hema-seq to delineate clonal changes across various hematopoietic lineages through the integration of whole-genome sequencing, copy-number variations, cell morphology, and cytogenetic aberrations. In Hema-seq, cells are selected from Wright-stained slides and fluorescent probe-stained slides for sequencing. This technique therefore enables direct linking of whole-genome sequences to cytogenetic profiles. Through this method, we mapped sequential clonal alterations within the hematopoietic lineage, identifying critical shifts leading to myeloma and acute myeloid leukemia (AML) cell formations. By synthesizing data from each cell lineage, we provided insights into the hematopoietic tree's clonal evolution. Overall, this study highlights Hema-seq's capability in deciphering genomic heterogeneity in complex hematological malignancies, which can enable better diagnosis and treatment strategies.

In the management of febrile neutropenia; evaluation of the factors affecting the lenght of hospital stay

Aim: Febrile neutropenia (FEN) is one of the most serious and commonly seen complications of patients receiving chemotherapy for a diagnosis of hematological malignancy. FEN is an emergency condition with mortality rates reaching 40% because of an increase in antimicrobial-resistant pathogens in particular. In a situation with such high mortality rates, parameters that can predict prognosis play an important role in the approach to the patient. The aim of this study was to investigate the parameters that could affect prognosis in the follow-up of FEN. Material and Methods: The study included 58 patients hospitalised in the Hematology Clinic with a diagnosis of FEN. The patients were evaluated in respect of the recorded demographic characteristics, blood group, MASCC score, hemogram, procalcitonin, C-reactive protein (CRP), Interleukin-6 (IL-6), D-dimer, fibrinogen, pre-albumin, albumin, HbA1c, anthropometric measurements and length of stay in hospital. Results: According to the statistical analysis results, patients with a length of hospital stay of ≥14 days were determined to have a significant decrease in the MASCC score and thrombocyte count and the procalcitonin, Il-6, D-dimer values and the number of antibiotics used were higher. No significant difference was determined between the groups in respect of the other parameters. Conclusion: In the management of febrile neutropenia, the most important points are the establishment of indications for hospitalisation, rapid and early recognition of a worsening status and intervention made in the right place at the right time. Parameters with prognostic benefit will help the clinician in decision-making.

Mortality and clinical outcomes following SARS-CoV-2 infection among individuals with haematological malignancies: A Danish population-based cohort study.

We aimed to quantify the risk of death following a positive test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among individuals with haematological malignancies, stratified by virus variants and type of malignancy. Using the Danish nationwide registries, we conducted a population-based cohort study among individuals who received a discharge diagnosis of haematological malignancies during the 5 years prior to testing positive for SARS-CoV-2 (February 2020-April 2023). All individuals were followed for 30 days after a positive test, and overall and time-stratified case fatality risks (CFR) were estimated. We identified 7154 individuals with a history of haematological malignancies who tested positive for SARS-CoV-2. Among these, we observed 223 deaths, yielding a CFR of 3.1%. The CFR was highest at the beginning of the pandemic (10%) and gradually declined to 1.9% during the period of Omicron BA1/BA2 predominance. The highest CFR was observed among individuals with acute leukaemia (CFR 6.2%, adjusted relative risk 1.95, 95% confidence interval 1.33-2.88) compared to individuals with lymphoma (CFR 3%). We observed a reduction in the CFR over time, which may be attributed to new treatments, COVID-19 vaccination and the emergence of less aggressive variants.

Quiz case: Abnormal haematopoietic cells in pleural effusion.

This case was presented because of the number of plasmablasts in a patient with a medical history of multiple myeloma. Flow cytometry is a "gold standard" technique for the diagnosis of haematological malignancies. This technique works for all fluids and should be performed in effusions (pleural, pericardial, ascites) in cases of suspected haematological malignancy. Alternatively, immunohistochemistry using appropriate markers could be performed if flow cytometry is not available. This case illustrates a pleural infiltration by plasmablasts. Myelomatous cells were characterised by immunocytochemistry and flow cytometry.

The impact of infertility and physical late effects on psycho-social well-being of long-term childhood cancer survivors: A cross-sectional study

IntroductionDescribe how physical late effects, and particularly fertility, impact on the psycho-social well-being (anxiety, depression and perception of HRQoL) in a cohort of childhood cancer survivors (CCS). MethodsEligibility criteria: a) cancer diagnosis at age < 18 years; b) off-therapy > 5 years; c) age at the time of the study > 18 years and < 35 years. CCS with severe cognitive impairment, psychiatric disorders, or conditions otherwise hampering the participation to the study were excluded. Psychological evaluation included Hamilton Rating Scale for Anxiety (HAM-A), Montgomery-Asberg Depression Scale (MADRS), Satisfaction-Profile (SAT-P) and Short Form Health Survey (SF-36). Late effects have been grouped using the St Jude Lifetime Cohort Study-modified version of the National Cancer Institute’s CTCAE version 4.03. Results205 CCS were included (response rate: 80.08%; 58.05% male, 40.00% between 18 and 24 years at the time of the study, 74.36% diagnosis of hematologic malignancies). Moderate or severe anxiety was found in only 3,90% of CCS. More than 35% reported depressive symptoms. The prevalence of any grade of anxiety or depression increases with the increasing of the number of late effects (from 4.08% to 17.14% and from 24.49% to 42.86%, respectively). At least mild depressive symptoms have been reported by 56.33% of CCS affected by reproductive/genital late effects. Reproductive/genital late effect (p = 0.001) and female gender (p = 0.002) significantly predict the risk of depression. CCS with 2 or more late effects and those with reproductive/genital late effects reported a reduced satisfaction in psychological and physical function. DiscussionCCS globally show a satisfactory psychological health, but infertility or a high number of physical late effects enhance the risk of depression and impaired HRQoL.