Anemia Grade Research Articles

Pegylated liposomal doxorubicin for relapsed epithelial ovarian cancer.

Pegylated liposomal doxorubicin for relapsed epithelial ovarian cancer.

Homozygous delta beta-thalassemia: A rare case report

Delta Beta (δβ) thalassemia is a rare autosomal recessive hemoglobinopathy. This is caused by either reduced production of δ and β genes (heterozygous state) or complete absence (homozygous state). High-performance liquid chromatography (HPLC) is an important screening and diagnostic tool, to be supported by molecular data and parental studies. A 40-year-old male (propositus), with mild anemia presented in the outpatient department. There were no other definitive causes of anemia with adequate nutritional status and no response after the treatment with nutritional supplements. HPLC was advised to look for any qualitative/quantitative defects. HPLC findings reveal 96% fetal hemoglobin (HbF), a very small quantity of adult hemoglobin (HbA), and an absent HbA2. In view of this data, followed up with parental studies. Both parents had elevated HbF and similar grades of anemia. These supported the presence of a heterozygous state of δβ-thalassemia in parents and homozygous δβ thalassemia in propositus. In δβ-thalassemia, there is a deletion of the δ and β genes on Chromosome 11. Expression of the gamma gene increases to compensate, causing increased production of gamma globulin for HbF (α2 β2). On HPLC or electrophoresis, heterozygosity shows as normal HbA2 and elevated HbF, and as absent HbA2 with almost 100% HbF for homozygous individuals. Screening of hemoglobinopathies by HPLC is that can be further subjected to parental screening for a more definitive diagnosis and narrow down the differentials as compared to molecular testing considering the cost, limited availability, and higher turnaround time.

Assessment of peripheral nerve conduction in iron deficiency anemia patients in Indian rural adult population attending a tertiary care hospital

Background: Iron deficiency anemia (IDA) is the most common nutritional deficiency anemia in India. Peripheral neuropathy can result due to iron deficiency as it disrupts myelination and neuronal energetics in neuronal functioning. Nerve conduction studies (NCS) can quantitatively detect peripheral nerve dysfunction. This study was conducted to observe effect of IDA on peripheral nerve conduction velocity in adults using neuroelectrophysiological techniques with the aim to recommend Complete Blood Count for serologic evaluation of patients with peripheral neuropathy in Indian population. Objectives: This study aims to compare motor and sensory nerve conduction study parameters between controls and IDA patients and evaluate the effect of various grades of IDA on motor and sensory nerves. Methodology: 30 newly diagnosed patients of IDA in age group of 20-45 yrs and 30 healthy controls in same age group were recruited in this study. NCS was conducted on bilateral motor and sensory median and ulnar nerves in Neurophysiology laboratory using Neurosoft machine. Neuroelectrophysiological data of both the groups was evaluated and analysed using Student’s unpaired t test. Also, patients were categorised as mild, moderate and severe anemia cases and one way ANOVA was used for comparison among patients with various grades of anemia. Results: CMAP (compound muscle action potential), SNAP (sensory nerve action potential) and nerve conduction velocity (NCV) of bilateral median and ulnar nerves was reduced and DL (distal latency) was increased in bilateral median and ulnar nerves in patients with IDA compared to controls. The results were statistically significant (p=0.001). A highly significant difference between motor and sensory nerve conduction values between mild, moderate and severe IDA patients was also observed (p=0.001). Conclusion: The results of the study confirmed peripheral nerves involvement in IDA patients. As severity of anemia increases, peripheral neuropathy worsens. These results can be extrapolated for screening patients with peripheral neuropathy for iron deficiency as a routine part of diagnostic approach for peripheral neuropathy.

Population pharmacokinetic and exposure-response safety analyses of mecbotamab vedotin (BA3011) in patients with advanced solid tumors.

e15010 Background: Mecbotamab vedotin (BA3011) is antibody-drug conjugate (ADC) consisting of a conditionally active biologic (CAB) anti-AXL humanized (IgG1) monoclonal antibody conjugated to monomethyl auristatin E (MMAE) using a cleavable linker. BA3011 is being developed for the treatment patients with advanced solid tumors including sarcoma with AXL expression. Methods: As of data cutoff date 19 April 2022, BA3011 was administered by intravenous infusion to 67 patients, with doses ranged from 0.3 to 3 mg/kg once every three weeks (Q3W), 1.2 to 1.8 mg/kg once every two weeks (Q2W) and 1.8 mg/kg twice every three weeks (2Q3W). Population pharmacokinetics (popPK) analysis was performed using sequential modeling approach, where a PK model was first developed for BA3011 ADC alone, and then an integrated model was developed for BA3011 ADC and MMAE. The popPK base model for BA3011 ADC and MMAE was used to generate empirical Bayes estimates of PK parameters for patients in Study BA3011-001 and used for the exposure-response (E-R) safety analysis. E-R time-to-event models were developed to characterize the relationship between BA3011 ADC or MMAE exposure and the time to first incidence of adverse events (AEs). Results: A popPK model with two-compartment disposition and parallel linear and nonlinear elimination of BA3011 ADC, formation of MMAE from ADC, and two-compartment disposition and linear elimination of MMAE, adequately described the PK profiles of BA3011 ADC and MMAE in patients based on model evaluation using prediction-corrected visual predictive checks. Key PK parameter estimates are summarized in the table below. In the E-R safety analysis, statistically significant correlations were demonstrated between BA3011 ADC exposure and all safety endpoints explored (TEAE Grade ≥3, neutropenia Grade ≥3, increase in AST or ALT Grade ≥1, anemia Grade ≥2, and peripheral neuropathy Grade ≥1). Correlations were statistically significant between MMAE exposure and TEAE Grade ≥3, neutropenia Grade ≥3, increase in AST or ALT Grade ≥1, but not anemia Grade ≥2 or peripheral neuropathy Grade ≥1. Time-varying Cmax was selected as the most appropriate exposure metric for each model developed, calculated over the past 24 hours, 1 week, or 3 weeks, depending on the model. Conclusions: The popPK relationship between ADC and MMAE were adequately characterized using a sequential modeling approach. BA3011 ADC exposure was correlated with all safety endpoints evaluated whereas MMAE exposure did not demonstrate correlations with anemia or peripheral neuropathy. These models are essential to generate predictions of exposure and safety for dosing regimens to be evaluated in a planned Phase 2 clinical trial. Clinical trial information: NCT03425279 . [Table: see text]

Phase 1 first-in-human study of PF-07257876, a novel CD47/PD-L1 bispecific checkpoint inhibitor, in patients with PD-1/PD-L1-refractory and -naïve advanced solid tumors.

2529 Background: Tumor expression of the antiphagocytic protein CD47 (integrin associated protein) may lead to immunotherapy resistance (IO-R). PF-07257876 is a novel, IgG1, Fc-active, bispecific antibody targeting CD47 and PD-L1 designed to reverse IO-R, decrease anemia risk, and eliminate a priming dose. We report a Phase 1 dose escalation study (NCT04881045) in patients (pts) with advanced solid tumors, both IO-refractory and IO-naïve. Methods: The study enrolled pts ≥18 yrs with advanced non–small-cell lung carcinoma (NSCLC) and squamous cell carcinoma of the head and neck (SCCHN) with PD-L1 expression >1% post anti-PD-1/PD-L1 therapy. Pts with other PD-L1+ tumors known to express CD47 were included (prior IO not required). Pts received PF-07257876 at escalating dose levels in 28-day cycles. Primary objectives were safety (dose-limiting toxicity [DLT] rate), tolerability, and determination of Recommended Phase 2 Dose (RP2D). Secondary and exploratory objectives included pharmacokinetics (PK), blood receptor occupancy (RO), CD47 levels by immunohistochemistry (IHC), tissue biopsy findings, and objective response rate (ORR) per RECIST v.1.1. Results: As of 20OCT2022, 18 pts were enrolled (NSCLC: n = 6; SCCHN: n = 4; other: n = 8). Median (range) age 68 (46–79) yrs. PF-07257876 was given at ascending doses, 150-2400 mg by subcutaneous (SC) injection or SC infusion every 2 weeks. 16 (89%) pts had treatment-related adverse events (TRAEs): Grades 1/2: n = 12 (67%); Grade 3: n = 1 (6%); Grade 4: n = 3 (17%); no Grade 5. Most common TRAEs: injection site reaction/erythema (n = 13, 72%), thrombocytopenia (n = 6, 33%), anemia (n = 5, 28%), and nausea (n = 4, 22%). DLTs occurred in 2 of 3 pts at the highest tested dose (Grade 4 neutropenia and thrombocytopenia, n = 1; Grade 4 thrombocytopenia, n = 1; both pts recovered). One pt with IO-R SCCHN had a confirmed partial response (duration of response 16 wks). ORR was 5.6% (1/18). Drug exposure increase after 1st dose was not dose proportional. Blood RO was > 95% for PD-L1 and > 70% for CD47 with drug exposure. All pts’ baseline CD47 IHC levels were moderate to high. Pharmacodynamics cytokine profiling showed notable dose-response increases of IFNg, TNFa, CXCL9/10, CCL3/4, without IL-6 increase. Conclusions: PF-07257876 was well tolerated with manageable toxicity. Incidence and grade of anemia or thrombocytopenia were manageable. Target engagement of CD47 and PD-L1 in peripheral blood was high. Innate and adaptive cytokine modulation was observed. Antitumor activity was modest. Expansion is ongoing at 1800 mg. Clinical trial information: NCT04881045 .

Nutritional status of reproductive age group women: A community-based study.

Anemia continues to be a major public health problem worldwide, particularly among females of reproductive age in developing country settings. The prevalence of anemia in South Asia is among the highest in the world, mirroring overall high rates of malnutrition. 1) To estimate the prevalence of anemia and undernutrition among reproductive age group females. 2) To study factors associated with anemia and undernutrition among reproductive age group females. This was cross-sectional study, which was carried out from June 2011 to December 2012 at Nanded City in Maharashtra state among nonpregnant ever-married women of 15-49 years age with a sample size of 750 selected using probability proportional to size sampling technique. Percentage, Chi-square test, analysis of variance (ANOVA) test, and Student's t test were used for analyzing the data. The prevalence of anemia among reproductive age group women was 554 (73.9%). 20.8% of women were undernourished and 4.1% were obese. There was a significant difference in the hemoglobin percentage of study subjects in relation to their age at marriage, weight, and body mass index (BMI). Mean BMI increases significantly as the age of women and duration of marriage increases. Nutritional status has a significant effect on the grade of anemia. Women of reproductive age groups are affected by anemia irrespective of age and parity.

A phase I study of bintrafusp alfa and NHS-IL12 (M9241) alone and in combination with stereotactic body radiation therapy (SBRT) in patients with metastatic genitourinary (GU) malignancies.

4571 Background: Bintrafusp alfa is a novel bifunctional fusion protein targeting PD-L1 and TGF-β which has demonstrated clinical efficacy in some tumor types and a manageable safety profile. M9241 is an immunocytokine that allows targeting of the pro-inflammatory IL-12 cytokine to exposed DNA in necrotic portions of tumors. SBRT can help promote anti-tumor responses and may potentially synergize with immunotherapy by inducing DNA damage. Methods: This is an open label, non-randomized, three arm phase I trial of bintrafusp alfa and M9241 combination therapy administered alone (Arm 1), or with either sequential (Arm 2), or concurrent (Arm 3) SBRT. Eligible patients must have metastatic non-prostate GU cancers with measurable disease. Bintrafusp alfa was used at a flat dose of 1200mg (q2w) for arms 1-3 and a fixed dose of SBRT (24Gy in 3 fractions) was used for arms 2-3. M9241 was administered at 16.8mcg/kg (q4w) for Arm 1 and decreased if side effects occur. Arm 1 used bintrafusp alfa and M9241 alone, with the maximum tolerated dose (MTD) of M9241 being dose level 1 (DL1) for Arm 2. Arm 2 used SBRT followed by bintrafusp alfa and M9241, with the MTD of M9241 being DL1 for Arm 3. Arm 3 used concurrent SBRT with bintrafusp alfa and M9241. The primary objective was to determine the safety and highest tolerable doses of each arm. Secondary objectives include objective response rate (ORR), progression free survival (PFS), and overall survival (OS). Results: Study enrollment began in 12/2019, with interim safety analyses performed quarterly. A total of 16 patients have enrolled, 12 in Arm 1, three in Arm 2, and one in Arm 3 at data cutoff 1/2/23. The first six patients enrolled in Arm 1 had no DLTs allowing Arm 2 to open, Arm 2 had no DLTs after 3 patients enrolled allowing Arm 3 to open. At data cut off four of 16 patients remained on treatment. The median age was 63 and 19% were female. The most frequent TRAEs were fatigue (grade 2, 38%), lipase increase (grade 2+3, 31%), and anemia (grade 2+3, 31%). Grade 3 hematuria occurred in 2 patients (13%); a grade 4 creatinine increase occurred in one (8%). There were no grade 5 TRAEs. Two (13%) patients had treatment discontinued and 5 (31%) had dose reductions due to AEs. Of the 16 patients enrolled on study, 11 were evaluable at data cutoff. Currently three patients (38%) on Arm 1 and one patient (50%) in Arm 2 had objective responses, corresponding to an ORR of 36.4% (4/11). All responses have been partial responses. On Arm 1 the responding patients included one with small cell carcinoma of the renal pelvis, one with Leydig cell tumor, and one with urothelial carcinoma. On Arm 2 the responding patient had a Sertoli cell tumor. Conclusions: The use of bintrafusp alfa and M9241 either alone or in combination with sequential or concurrent SBRT has shown clinical activity in pts with GU tumors and has not been associated with any DLTs. Clinical trial information: NCT04235777 .

Ruptured Ectopic Pregnancy at Tertiary Care Centre: A Cross-sectional Study

Objectives: Ectopic pregnancy (EP) is the leading cause of early pregnancy accounting for 10-15% of pregnancy-related deaths. It is life-threatening condition where the majority of them present late. This study aims to evaluate the incidence, risk factors, clinical features, diagnosis, and management of EP in the tertiary care center. Materials and Methods: This study conducted a retrospective analysis of electronic medical records from June 2015 to June 2020, focusing on participants in the age group of 18 to 45 years, to examine the occurrence of EP. The data were analysed with simple descriptive statistics and presented in frequency tables and charts of age group, parity, anemia grades, risk factors and presenting symptoms. Results: The incidence of EP in the current study was 0.38%. In the present study, 73.8% of women were of 20–30-year-old. In this study, 54.1% of women had a history of pelvic inflammatory disease (PID). Prior EP was seen in 19.7 % of cases. 16.4% of participants had a prior history of tubectomy and 19.7% had a previous history of infertility treatment, and 21.3% had a previous history of lower segment caesarean section (LSCS). In the present study, 65.5% of women presented with amenorrhea of 4-8 week, and 95% had abdominal pain. In the present study, common site was the right fallopian tube in 73.9% of cases. In this study, all cases need surgical management most common procedure carried out was salpingectomy. intensive care unit (ICU) admission was needed in 26.2% of cases, and no mortality was seen in our study. Conclusions: EP is a serious and potentially life-threatening condition. Early diagnosis and prompt management are crucial in reducing maternal mortality and morbidity rates.

A Study to Assess Anemia Level among Hearing Impaired School Students in Special School, Palakkad

A descriptive study was conducted to assess anemia among hearing impaired school children in a special school in Palakkad. The objective of the study is to assess hemoglobin level among hearing impaired children. The sample size is 30 and purposive sampling technique is used. In data collection procedure, hemoglobin level of school children was assessed and grade of anemia was analyzed. The study findings is that normal haemoglobin leve1 is 6 (53.33%), mild anemia includes 12 (40%), moderate anemia zero and severe anemia includes 2 (6.67%). After the research and analysis, the study subjects were administered with iron supplementation.

COMPARATIVE EVALUATION OF EFFICACY AND SAFETY OF INTRAVENOUS FERRIC CARBOXYMALTOSE VERSUS IRON SUCROSE COMPLEX FOR THE TREATMENT OF MODERATE GRADE ANEMIA IN POST CAESAREAN SECTION WOMEN: A RANDOMIZED AND PROSPECTIVE STUDY

Objective: Iron deficiency anemia is common in postpartum women in India. The present study is aimed at comparing the safety and efficacy ofintravenous ferric carboxymaltose (FCM) with intravenous iron sucrose complex (ISC) in patients who underwent cesarean section and havingmoderate grade anemia in postpartum period.Methods: A prospective and comparative study was carried out in 100 post-cesarean section women with moderate grade anemia hemoglobin (Hb7–9 g%) in Gajra Raja Medical College, Gwalior (M.P.) from February 2019 to August 2020. Subjects were randomly allocated to two groups, namely,FCM and ICS, 50 patients in each group. In group FCM, patients were infused with 1000 mg of FCM in a single dose on 4th post-operative day. Patients inISC group were infused with ISC 200 mg in 100 mL normal saline on 3 alternate days on 4th, 6th, and 8th post-operative day. Mean, Hb mean corpuscularvolume (MCV), mean corpuscular Hb (MCH), and MCH concentration (MCHC) were recorded before start of therapy and 15 days after treatment in allstudy subjects. Mean reticulocyte count was recorded before start of treatment and 2 days after completion of treatment that is on 6th and 10th postcesarean day in FCM and ICS group, respectively. Adverse drug reactions were recorded during the study period. Statistical analysis was done usingStatistical Package for the Social Sciences software.Results: Mean Hb increased by 27% in FCM and by 19% in ISC group and is significant (*p<0.05) from baseline values. FCM showed significantly(**p<0.01) better response, than ISC group. Mean reticulocyte percent showed significant increase by 120% and 73% in FCM and ISC group,respectively, from the baseline and change in mean reticulocyte in FCM was significant (***p<0.001) as compared to ISC. The mean rise in MCV was12% and 5% and MCH was by 10% and 1% in FCM and ISC group, respectively. FCM groups showed significantly better response (p<0.05) than ISC.However, in MCHC, there were 7% and 4% increase in FCM and ISC group, respectively, and on inter group comparison was not significant (p>0.05).Adverse effects noted during the study were mild and responded to symptomatic treatment. Sixteen percentage of FCM cases and 26% of ISC casesunderwent adverse drug reactions that included nausea, vomiting, giddiness, and injection site reactions.Conclusion: FCM is more efficacious and safer than ISC, making it the first line of management in postpartum iron deficiency anemia.

Lipid Profile in Anemic Patients: A Cross Sectional Study

Introduction: Anemia is a common disorder in India, although there are plenty of reasons attributable to Anemia. Studies are reporting the beneficial effect of Anemia on lipid profile. Aim: This research was conducted to study the pattern of lipid profiles in anemic patients. Material and Method: Present hospital-based cross-sectional study was conducted among patients more than 18yrs of age attending the OPD or admitted to the medicine department National Institute of Medical Sciences and Research, Jaipur, with diagnosed Anemia. The study was done over a period of two years on patients with proven cases of Anemia. After informed & written consent from the patients, detailed history, clinical assessment & laboratory investigation was done. Results: In the present study a total of 280 patients fulfilling inclusion criteria are included in the study. The mean age of the patients was found to be 39.44±14.92yrs; among them, 60% were female, and 40% were male patients with female preponderance. There was significant positive strength of association of hemoglobin with the lipid profile, which included the total cholesterol, LDL, HDL, triglycerides, and VLDL cholesterol l(p<0.05). Conclusion: The present study showed a significant strength of association between the hemoglobin level and the lipid profile parameters. Also, the lower mean level of lipid parameters with the severity of grade of Anemia.

Neoadjuvant chemoradiation in elderly Irish patients with esophageal cancer: A review of the clinical outcomes and toxicity.

335 Background: In locally advanced esophageal cancer, neoadjuvant chemo-radiotherapy improves survival compared with surgery alone. In the Chemo-Radiotherapy for Oesophageal cancer followed by Surgery Study (CROSS), the median age was 60. However, 1/3 of patients diagnosed with esophageal cancer are over 70 years. The CROSS outcomes are therefore limited in its application to older patients. The objective of this study is to report and compare the outcomes and tolerability in elderly patients (≥70 years), who underwent neoadjuvant chemo-radiation for esophageal cancer with younger patients < 70 years. Methods: A retrospective analysis of patients treated with neoadjuvant chemo-radiation for esophageal cancer between 1st January 2015 and 1st January 2021 was completed. Baseline characteristics and haematological toxicities were reported. Pathological response was reported. Survival was estimated using the Kaplan-Meier method. Results: In total 105 patients were included; 35 (33%) were ≥ 70 years and 70 (67%) patients were < 70 years. In the elderly cohort, the median age was 75 (70-86) and the younger cohort median age was 60 (29-69). 73% of patients in each cohort were male. 31 (89%) of older adults experienced any grade of anaemia compared with 45 (64%) of the younger cohort. Only one patient experienced ≥ grade 3 anaemia in each cohort. 18(51%) and 33(47%) of older and younger patients respectively experienced any grade of neutropenia. 5(14%) older and 7(10%) younger patients experienced ≥ grade 3 neutropenia. 15(43%) and 43(61%) of older and younger patients experienced any grade of thrombocytopenia. No patients experienced ≥ grade 3 thrombocytopenia. 80% of the older and 86% of the younger cohort proceeded to surgery. 3(11%) and 17(29%) of the older and younger cohorts respectively who underwent surgery achieved a complete pathological response. There was no difference in overall survival (OS) between the cohorts (p=0.48). There was also no difference in progression free survival (PFS) between the cohorts. Conclusions: In conclusion, we confirm that neoadjuvant chemo-radiation is tolerable in patients ≥ 70 when compared with patients < 70 years. Both OS and PFS is similar in both cohorts. We recommend the use of neoadjuvant therapy in appropriately selected patients ≥ 70 years.

Comparison of first-line treatments for elderly patients with diffuse large B-cell lymphoma: A systematic review and network meta-analysis.

The incidence of DLBCL in elderly patients has been gradually increased. Considering their comorbidities and performance status, the first-line standard treatment hasn't been determined for the elderly. We performed a systemic review and network meta-analysis to compare the efficacy and safety of all eligible regimens as first line treatment for elderly patients with DLBCL. We searched PubMed, Cochrane Library, and Embase Library proceedings up to March 2022. Our search yielded thirteen trials including 1839 patients. R2CHOP21 showed the best PFS with a statistical difference and the most favorable OS without a statistical difference. RCOMP showed the most clinical benefits in EFS, CR and OR with no significant difference. The point estimate was in favored improved DFS with RCHOP14 than RCHOP21, although this was not statistically significant. In a subgroup analysis concerning 3-4 grade AEs revealed R-COMP was associated with a decrease in grade III/IV neutropenia and cardiac toxic events; RminiCEOP was associated with the lower rates of 3-4 grade anemia, thrombocytopenia and infection; RCHOP21 had the lowest rate of 3-4 grade AE of neurotoxicity. The findings of our meta-analysis indicated that R2CHOP21 provided the best disease control in PFS and represented an optimal first-line treatment option in the elderly with DLBCL. Furthermore, RCOMP, RminiCEOP and RCHOP21 exhibited lower rates in different 3-4 grade AEs and might be reasonable treatment options in the elderly with poor general conditions.

Phase Ib study of HSP90 inhibitor, onalespib (AT13387), in combination with paclitaxel in patients with advanced triple-negative breast cancer.

Heat shock protein 90 (HSP90) is a molecular chaperone required for stabilization of client proteins over-activated in triple-negative breast cancer (TNBC). Over-expression of HSP90 client proteins has been implicated in paclitaxel resistance. Onalespib (AT13387) is a potent inhibitor of HSP90 that could improve paclitaxel efficacy when administered in combination. This phase Ib trial administered onalespib with paclitaxel in patients with advanced TNBC to assess safety and establish a recommended phase II dose (RP2D). The primary objectives were determining the dose-limiting toxicities and maximum tolerated dose of combination therapy. Secondary objectives included pharmacokinetic (PK) analysis and determination of overall response rate (ORR), duration of response (DOR), and progression-free survival (PFS). Patients with advanced TNBC were treated with standard dose intravenous paclitaxel in combination with intravenous onalespib at doses ranging from 120 to 260 mg/m2 administered on days 1, 8, and 15 of a 28-day cycle using a standard 3 + 3 design. A total of 15 patients were enrolled to dose expansion cohort at RP2D to confirm safety profile. Thirty-one patients were enrolled in the study, of which over 90% had received prior taxane therapy. Paclitaxel was given for metastatic disease in 23% of patients. Adverse events (AEs) included anemia (grade 3: 20%), lymphopenia (grade 3: 17%), and neutropenia (grade 3: 33%, grade 4: 4%). The most frequent grade ⩾3 non-hematologic AE was diarrhea (7%). The established RP2D was 260 mg/m2 onalespib when given with paclitaxel at 80 mg/m2. PK analysis revealed a modest drug interaction profile for onalespib in the combination regimen. ORR was 20%. Three patients achieved complete responses, all of whom had received prior taxane therapy. Median DOR was 5.6 months; median PFS was 2.9 months. Combination treatment with onalespib and paclitaxel had an acceptable toxicity profile and RP2D was determined to be 260 mg/m2 of onalespib. Combination therapy showed antitumor activity in patients with advanced TNBC. Onalespib and paclitaxel in treating patients with advanced TNBC https://clinicaltrials.gov/ct2/show/NCT02474173.

Effect of nutritional-deficiency anemia on peripapillary retinal nerve fiber layer: A North Indian study.

The purpose of this study was to evaluate the effect of nutritional-deficiency anemia (NDA) on peripapillary retinal nerve fiber layer thickness (PPRNFLT) using spectral-domain optical coherence tomography and to determine any correlation arising thereof. This was a single-center, cross-sectional, observational study. A total 115 eyes of 115 NDA patients (50 of each with iron-deficiency anemia [IDA] and Vitamin B12-deficiency anemia [BDA], and 15 with folic acid-deficiency anemia [FDA]) aged 18-65 years were compared with a total 100 eyes of 50 age- and sex-matched healthy controls. All subjects underwent comprehensive clinical, ophthalmic, and hematological evaluation, followed by PPRNFLT assessment for the mean total, superior, inferior, nasal, and temporal quadrants. PPRNFLT for the mean total and all four quadrants in IDA patients, for the mean total, inferior, nasal, and temporal quadrants in BDA patients, and for the mean total, inferior, and nasal quadrants, in FDA patients, was significantly lower as compared to the controls (P < 0.05). The mean total PPRNFLT of all NDA patients correlated significantly (P < 0.05) with their relevant hematological parameters with Pearson's coefficient (r) value of 0.613, 0.610, 0.336, 0.295, 0.337, 0.374, and - 0.509, respectively, for serum haemoglobin (Hb), iron, ferritin, mean corpuscular volume (MCV), mean cell hemoglobin, mean corpuscular hemoglobin concentration, and total iron binding capacity in IDA; 0.310, 0.435, and - 0.386, respectively, for serum Hb%, Vitamin B12, and MCV in BDA; and 0.557, 0.358, and - 0.294 for Hb%, folate, and MCV, respectively, in FDA cases. Mean total retinal nerve fiber layer thinning of all NDA patients showed progression with the increasing severity grades of anemia, except in very severe BDA where an inverse relationship was documented. Our study revealed that PPRNFLT is significantly thinner in all NDA patients (total and all four quadrants in IDA; total, inferior, nasal, and temporal in BDA; and total, inferior, and nasal in FDA) correlating well with their relevant hematological parameters. Early detection of this may be crucial in preventing potential blinding sequelae and differentiating glaucomatous and other neuro-ophthalmic disorders.

The Prevalence of Anaemia and Haematological Parameters in Children and Adolescents; A Hospital Based Study

Introduction: Anemia is a common health problem worldwide. It is an important cause of morbidity and mortality of young and growing children in rural areas of developing countries. Young growing anemic children have various clinical symptoms including, pallor, Jaundice, fever, cough, breathlessness, hyper-pigmentation, tremors, and hepatosplenomegaly. Aim of the Study: Aim of the study was to evaluate the clinical manifestations, and grades of anaemia in different age groups. Methods: This retrospective observational study was conducted in the Department of Paediatrics at Dhaka Shishu Hospital, Dhaka, Bangladesh. A total of 95 patients were enrolled and analyzed in this study from July 2021 to December 2021. Result: In the present study of the prevalence of anemia and hematological parameters in children aged 1-18 years 10(10.53%) children were &lt;1 year, 37(38.95%) were between 1-5 years, 28(29.47%) were aged between 6-10 years, and 11(11.58%) were between 11-15 years. Types of anemia were 46.32% had iron deficiency, 29(30.53%) had thalassemia. The clinical manifestation included 95 (100%) pallor, 79(83.16%) weakness and fatigability, 35(36.84%) fever, 25(26.32%) Icterus, 19(20.00%) shortness of breath, 17(17.80%) hepatomegaly. According to grade of anemia, 21.05% of patients had mild, 46.32% of patients had moderate anemia, and 32.63% had a severe grade of anemia. Conclusion: Besides haematological investigations for typing of anemia, Haemoglobin electrophoresis establishes the disease in haemoglobinopathies. Adequate health and healthy nutritional habits and prescription of Iron supplements are of great importance in the prevention and management of anemia in children assisted by public health services.

Clinico-Haematological Profile of Geriatric Anaemia (A Study of 300 Cases)

Introduction: Anaemia in the elderly patients is associated with increased morbidity and poor health relatedquality of life. It is an emerging global health problem for 21st century which negatively impacts quality of life.Aims and Objectives: The aim of this study is to know clinico-haematological patterns and morphological typesof anaemia in elderly.Material and Methodology: The present study is a descriptive cross-sectional study, which was conducted inPathology Department of P.D.U. Government Medical College, Rajkot in which all the indoor patients of 60 yearsand above and clinically diagnosed as anaemic were included. Haematological investigations, factors like age,gender, symptoms and signs, peripheral blood smear, cause and grade of anaemia were utilized in this.Result: Total 300 cases were studied; anaemia of chronic disease in age group 60-65 years was most common.Males were affected more than females. Smoking was the most common associated factor. Mostly respiratorysystem involved. Normochromic normocytic anaemia mostly seen. Grade-1 (mild) anaemia was most common.Conclusion: Geriatric anaemia being under-reported and inadequately investigated, especially when mild, thereis need of evaluation of even mild cases. Further studies with larger population and wider parameters should beencouraged.

Hubungan Antara Frekuensi Minum Teh, Siklus Dan Lama ‎Menstruasi Dengan Kejadian Anemia Remaja Putri Kelas 7 Di Mtsn 2 Pandeglang Tahun 2022‎

Introduction: Observations made at MTSN 2 Pandeglang as many as 15-20 young women consume tea every day in the form of cold and hot drinks. All types of packaged teas and teabags contain tannins derived from tea extracts that can inhibit the absorption of iron nutrients. If drinking tea occurs continuously, it is certainly not good for the health of young women, especially since young women experience menstrual bleeding every month. Based on these problems, it is necessary to conduct research on the relationship between the frequency of drinking tea, cycles, and menstrual length with the incidence of anemia of grade 7 adolescent girls in MTSN 2 Pandeglang. Methods: This study uses a descriptive-analytical method with a Cross-Sectional study design. With a total sample of 59 people, the sampling technique was carried out by purposive sampling. Data analysis was carried out by means of univariate and bivariate analysis using the chi-square test. Results: There is a relationship between the frequency of drinking tea (p-value = 0,000 and OR = 0,030), menstrual cycle (p-value = 0,001 and OR = 0,101), with the incidence of tea drinking in young women and there is no relationship between menstrual length (P-value = 1,000 and OR = 1,367) with the incidence of anemia in adolescent girls grade 7 in MTSN 2 Pandeglang in 2022. Discussion: There is a relationship between the frequency of drinking tea, and the menstrual cycle with the incidence of anemia in young women, and there is no relationship between the length of menstruation and the incidence of anemia in adolescents in grade 7 MTSN 2 Pandeglang 2022.

Cytopenias following anti-CD19 chimeric antigen receptor (CAR) T cell therapy: a systematic analysis for contributing factors

Background Cytopenia is one of the most common adverse events following the CAR-T cell infusion, affecting the quality of life and potentially leading to life-threatening bleeding and infection. This study aimed to systematically review the cytopenias following anti-CD19 CAR-T therapy and further analyse the contributing factors. Methods Databases including PubMed, MEDLINE, Embase and Cochrane were systematically searched on 8 May 2022. A random-effect meta-analysis was used to estimate the incidence of cytopenia, and subgroup analyses were applied to explore heterogeneity. Results A total of 68 studies involving 2950 patients were included in this study. The overall incidence of all grade anaemia, thrombocytopenia, neutropenia, leukopoenia, lymphocytopenia and febrile neutropenia was 65%, 55%, 78%, 62%, 70% and 27%, respectively, and the corresponding cytopenias of grade 3 or worse were 33%, 31%, 61%, 45%, 46%, and 21%, respectively. Subgroup analysis showed increased incidence of cytopenias in subgroups with lower median age, proportion of males (<65%) and proportion of bridging therapy (<80%) and in the subgroup with a median line of prior therapy ≥3. In terms of disease and therapeutic target, cytopenias were more frequent in ALL patients and in dual-target CAR-T therapies (targeting CD19 in combination with other targets). Furthermore, CAR-T products manufactured by lentiviral vectors and those with the costimulatory domain of CD28 were more likely to cause haematological toxicity. No significant differences were observed in cytopenia between patients treated with CAR-T products with murine and humanized scFv. Conclusion In conclusion, neutropenia is the most frequent cytopenia after CAR-T therapy, both in all grades or grade ≥3. The incidence of cytopenias following CAR-T therapy is influenced by the age, sex, disease and number of prior therapy lines of the patients, as well as the target and costimulatory domain of CAR-T cells, and viral vectors used for manufacturing. KEY MESSAGES Neutropenia is the most frequent cytopenia after CAR-T therapy. The clinical characteristics of the patients, the design of CAR-T cells and the protocol of CAR-T treatment can influence the occurrence of cytopenias following the CAR-T therapy.

Baseline anemia predicts a poor prognosis in patients with non-small cell lung cancer with epidermal growth factor receptor mutations: a retrospective study

BackgroundAnemia is relatively common in cancer patients, and baseline anemia is associated with poor survival in patients with non-small cell lung cancer (NSCLC). However, there is a lack of large-sample studies of patients with NSCLC with epidermal growth factor receptor (EGFR) mutations.MethodsWe retrospectively analyzed anemia‑related data for patients with NSCLC and EGFR mutations who were admitted to Zhejiang Cancer Hospital from January 2013 to June 2019 and treated with targeted therapy. The patients’ clinicopathological features were evaluated by χ2 tests and the relationships between clinical characteristics and prognosis were investigated using Kaplan–Meier and multivariate Cox regression analyses.ResultsA total of 2,029 patients treated with EGFR-tyrosine kinase inhibitors (TKIs) were finally enrolled in this study, of whom 24.6% had baseline anemia. Patients without baseline anemia had longer median overall survival (OS) than patients with baseline anemia (36.10 vs. 29.10 months, P = 0.001), and patients with grade < 2 anemia had longer median OS than those with grade ≥ 2 anemia (35.00 vs. 25.10 months, P < 0.001). Multivariate analyses identified baseline anemia as a factor predicting a poor prognosis in terms of OS in patients with EGFR mutations.ConclusionsBaseline anemia is a significant factor predicting a poor prognosis in terms of OS in patients with NSCLC and EGFR mutations treated with targeted therapy. A higher grade of baseline anemia may also be related to shorter OS. And a higher risk of EGFR-mutated patients who had received targeted therapy could also be observed.