Hospital Kuala Lumpur Research Articles

39. The prevalence of intestinal neuronal dysplasia hirschsprung’s disease patients in Malaysia

Background Hirschsprung’s disease (HD) is due to malfunction of neural crest cell migration to the distal bowel, resulting in colonic aganglionosis. Hypoganglionosis and intestinal neuronal dysplasia (IND) are other neuronal causes of paediatric intestinal obstruction. These two entities have been reported to occur concurrently with HD. Their occurrence in the Malaysian HD population remains unknown. This knowledge is important to avoid the diagnostic pitfalls of transition zone evaluation, especially in intraoperative frozen section procedure. Aim To investigate the prevalence of hypoganglionosis and IND in resected bowel specimens for HD. Methods Thirty-nine resected bowel specimens from HD cases were retrieved from the archives of Pathology Department, Hospital Kuala Lumpur. The H&E stained sections from these cases were reviewed for the neuronal abnormalities stated above. Results Demographically, 79.4% of the patients were male. The age at operation ranged from 11 weeks to 4.9 years. Culturally, 66% were Malays, 17% Chinese, 12.8% indigenous Borneo ethnic group and 2.5% Indian. All of the cases had recto-sigmoid disease. Giant ganglia and hypoganglionosis were seen in 7 (17%) and 4 (10.3%) cases, respectively. In addition, an excess of small ganglions were present within the transtition zone of 24 cases (61.5%), while ectopic ganglia were observed in 2 cases. Conclusion IND is not uncommon in HD patients in Malaysia. This is important to appreciate, especially in the assessment of resection margins of HD.

Enterococci: Emerging Drug Resistant Bacteria In Hospital Acquired Infections At Hospital Kuala Lumpur, Malaysia

Enterococci are the most common pathogens in hospital acquired infections. Some of them are resistant to Vancomycin(VRE) and some are susceptible to Vancomycin (VSE). The present study was carried out to identify enterococci from clinical cases and to illustrate their clinical features and drug resistance characteristics. Antibiotics susceptibility of the identified bacteria was determined by disk diffusion method and E-test. Drug resistance properties were evaluated against ampicillin, gentamicin, vancomycin, teicoplanin and linezolid. Relating to clinical features, 244 cases of enterococci infected patients were identified at hospital Kuala Lumpur (HKL) Malaysia based on clinical information from the hospital. Of the patients 21% had history of urinary tract infections, 17.2% end stage renal disease, 12.2% sepsis, 8.4% malignancy, 12.2% had head injury and neurological problems, 4.2% diabetes mellitus and other clinical manifestations .In case of Vancomycin resistant enterococci infection, the clinical features of the patients were: end stage renal failure 3/6 (50%) and others with diabetes mellitus, interstitial lung disease and nephrotic syndrome. The patients of the enterococci infections were more prevalent in nephrology-urology unit (39%) and medical wards (including ICU, 23%) The findings would serve as an alert to the clinicians of the emergence of infections by enterococci and encourage implementation of appropriate infection control measures in order to curb further rise in prevalence.

Molecular Characterization of Nosocomial Methicillin Resistant Staphylococci aureus by Rep-PCR

Nosocomial methicillin-resistance Staphylococcus aureus (MRSA) poses problem to clinicians and hospital administrators for its management. In the present study isolation, identification molecular characterizations of methicillin-resistance Staphylococcus aureus were performed at Hospital Kuala Lumpur, Malaysia during December 2005 to April 2007. Twenty seven MRSA positive samples were identified based on cultural, biochemical and antibiotic sensitivity assay. These were, 51% from blood samples, 33.3% from tracheal aspirate and 11,1% from nasal swab and pus. Molecular method rep-PCR was used to characterize the MRSA positive strains. Results of rep-PCR showed 5 different pattern of bands based on their genomic nature. Thus, rep-PCR was proved to be potential tool to determine genomic differences of nosocomial MRSA in resource limited setting.

Comparative Efficacy Sensitivity and Specificity of the Tests used for the Diagnosis of Helicobacter pylori

Abstract: A total number of 157 samples were examined by 4 different tests-In-house rapid urease (iRUT), Culture, Histopathology and Immunochromatography (Immuno CardSTAT) for the detection of Helicobacter pylori from the patients reported to Hospital Kuala Lumpur, Malaysia during 2007 to 2008. Out of the samples examined 47 (29.9%) were positive for H. pylori by the tests used in the laboratory. Efficacy of detection of the bacteria by the tests- In-house rapid urease, Culture, Histopathology and Immuno CardSTAT were 31.8, 13.9, 30.3 and 32.8%, respectively. However, sensitivity and specificity of the iRUT were 91.5 and 93.6%, respectively and the Positive Predictive Value (PPV) was 86% and the Negative Predictive Value (NPV) was 96.3%. The sensitivity for Immuno CardSTAT rapid test was 100% and the specificity was 79.3%. The PPV was 50% and the NPV was 100%. Convenient methods to the authors were 'In house rapid urease test and Immunochromatography though variability of specificities were observed.

Cardiac Magnetic Resonance of Acute Myocarditis in an Human Immunodeficiency Virus Patient Presenting With Acute Chest Pain Syndrome

A 34-year-old woman of Afro Caribbean origin presented to the HIV clinic with a few days’ history of chest pain, chills, and malaise. The chest pain was intermittent, severe, central, radiating to the left arm, worse on lying down, and better on sitting forward. This was preceded by an episode of collapse after palpitations a week earlier. On examination, she had a regular pulse of 84 bpm, blood pressure of 131/71 mm Hg, respiratory rate of 20, temperature of 38°C, and oxygen saturation of 99% on air. Cardiovascular, respiratory, abdominal, and neurological examinations were normal. ECG demonstrated anterolateral ischemic changes (Figure 1). Chest radiograph was normal. Figure 1. ECG showing anterolateral ischemic changes. Biochemical profile was as follows: C-reactive protein, 296 mg/dL; troponin, 3.8 ng/mL; CD4 count, 459; viral load, <50; and hemoglobin, 9.1 g/dL. Her antistreptolysin O titer was 1 in 40, and no antistreptolysin antibodies were detected. Viral titers were negative for cytomegalovirus, adenovirus, Coxiella burnetii , chlamydia (group) and Mycoplasma pneumoniae , enterovirus (including echoviruses, coxsackie …

Determinants of Early Postpartum Psychological Reaction among Mothers in Kuala Lumpur Hospital

Introduction: Maternal psychological well-being determines early mother-infant relationship and baby’s health. Paying attention on this aspect is essential particularly in early postpartum period. This study aimed to determine early psychological reactions toward socioeconomic profiles, delivery methods and delivery outcomes among postpartum mothers in Kuala Lumpur Hospital. Materials and Methods: A total of 150 twoweek-postpartum mothers participated in this cross sectional study and their psychological perspective was measured by using the Depressive, Anxiety and Stress Scale (DASS). Results: 4%, 16% and 4.7% of respondents had significant depressive, anxiety and stress levels respectively. Conclusion: Socioeconomic variables such household income, level of education and presence of medical illness were statistically significant to determine early postpartum psychological reactions but not the modes or outcomes of delivery.

Identification of novel large genomic rearrangements at the BRCA1 locus in Malaysian women with breast cancer

Background: The incidence of breast cancer has been on the rise in Malaysia. It is suggested that a subset of breast cancer cases were associated with germline mutation in breast cancer susceptibility ( BRCA) genes. Most of the BRCA mutations reported in Malaysia were point mutations, small deletions and insertions. Here we report the first study of BRCA large genomic rearrangements (LGRs) in Malaysia. We aimed to detect the presence of LGRs in the BRCA genes of Malaysian patients with breast cancer. Methods: Multiplex ligation-dependent probe amplification (MLPA) for BRCA LGRs was carried out on 100 patients (60 were high-risk breast cancer patients previously tested negative/positive for BRCA1 and BRCA2 mutations, and 40 were sporadic breast cancer patients), recruited from three major referral centres, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Hospital Kuala Lumpur (HKL) and Hospital Putrajaya (HPJ). Results: Two novel BRCA1 rearrangements were detected in patients with sporadic breast cancer; both results were confirmed by quantitative PCR. No LGRs were found in patients with high-risk breast cancer. The two large genomic rearrangements detected were genomic amplifications of exon 3 and exon 10. No BRCA2 genomic rearrangement was found in both high-risk and sporadic breast cancer patients. Conclusion: These results will be helpful to understand the mutation spectrum of BRCA1 and BRCA2 genes in Malaysian patients with breast cancer. Further studies involving larger samples are required to establish a genetic screening strategy for both high-risk and sporadic breast cancer patients.

Nutritional Status and the Risk for Colorectal Adenomas: A Case-Control Study in Hospital Kuala Lumpur, Malaysia

The most important and possible risk factor of colorectal adenomas is the individual’s nutritional status. The role of nutritional status in the aetiology of colorectal adenomas remains an area of active investigation, as the exact relationship between nutritional status and colorectal adenomas remains unclear. The objective of this case-control was to determine the nutritional status of subjects with colorectal adenomas as compared with healthy subjects at Hospital Kuala Lumpur over a period of one year. A total of 118 subjects were recruited (n case = 59 and n control = 59). A pre-tested questionnaire was used to collect socio-demographic information and dietary intake. Lipid profile was determined using standard Roche diagnostic kits. The data were analyzed using SPSS version 12.0. The intake of beta-carotene, alphacarotene, lycopene, vitamin A and crude fiber found to be significantly different between the groups (p<0.05), while beta-carotene, alpha-carotene, lycopene, vitamin C, vitamin D, vitamin E and crude fiber significantly reduced the risk. Although the percentages intake of nutrient achieved according to RNI were below the recommended value, percentages of RNI achieved for vitamin C, D, E and folate were found to be significantly different between male subjects (p<0.05). Our results support the notion that certain nutritional factors are of importance for the development of these pre-cancerous lesions. Identification of risk factors through this case-control study should be able to supplement the available data in order to develop an intervention package that focuses on multiple risk factors to reduce the chances for developing colorectal adenomas or colorectal cancer.

Neonatal tumours in Malaysia: a call for heightened awareness

Neonatal neoplasms are rare tumours notorious for their atypical presentation and unpredictable behaviour. Their optimal treatment remains uncertain, a dilemma compounded by the deleterious effects of adjuvant chemo- or radiotherapy during this vulnerable period of growth. This paper examined the relatively high incidence of these tumours and its impact on paediatric surgery in Malaysia. Neonatal tumours treated at the Department of Paediatric Surgery, Kuala Lumpur Hospital over an 8-year period were retrospectively analysed. Besides data pertaining to patient demographics, distribution of tumour types and survival rates, morbidity from disease as well as treatment was emphasised in particular. The 28 neonatal tumours, majority of which were sacrococcygeal teratoma, constituted 7% of all tumours treated by the unit. Surgical excision remained the mainstay of treatment. Mortality and morbidity from disease and treatment were not insignificant, at 7 and 29%, respectively. The outcome of neonatal tumours treated in Malaysia appeared to be influenced by indigenous factors unique to the local healthcare setting. Several solutions were expounded, chief among these are strategies of improved and earlier detection, in addition to the centralisation of expertise for this group of tumours.

Fatal Lightning Strikes in Malaysia

Lightning strike is a natural phenomenon with potentially devastating effects and represents one of the important causes of deaths from environmental phenomena. Almost every organ system may be affected as lightning current passes through the human body taking the shortest pathways between the contact points. A 10 years retrospective study (1996-2005) was conducted at University Hospital Kuala Lumpur (20 cases) also including cases during last 3 years from Hospital Tengku Ampuan Rahimah, Klang (7 cases) from the autopsy reports at Forensic Pathology Units of these 2 hospitals. Both these hospitals are attached to University of Malaya. There were 27 fatal cases of lightning strike with male preponderance(92.59%) and male to female ratio of 12.5:1. Majority of victims of lightning strike were from the age group between 30 and 39 years old. Most of the victims were foreign workers. Indonesians workers contributed to 59.26% of overall cases. Majority of them were construction workers who attributed i.e.11 of 27 cases (40.74%). Most of the victims were brought in dead (37.04%). In majority of the cases the lightning incidence occurred in the evenings, with the frequency of 15 of 27 cases (62.5%). The month of December represented with the highest number of cases (5 cases of 23 cases); 2004 had the highest incidence of lightning strike which was 5 (19.23%). Lightning strike incidence occurred when victims had taken shelter (25.9%) under trees or shades. Lightning strike in open areas occurred in 10 of 27 cases (37.0%). Head and neck were the most commonly affected sites with the incidence of 77.78% and 74% respectively in all the victims. Only 29.63% of the cases presented with ear bleeding.

Late presentation of retinoblastoma in Malaysia

The aims of this study were to review the presenting features, treatment and outcome for Malaysian children with retinoblastoma currently. This was a prospective study, conducted at the General Hospital Kuala Lumpur from August 2001 until October 2007. Clinical data were collected at presentation and follow-up. One hundred five children were diagnosed to have retinoblastoma. There were 55 males and 50 females, ranging in age from 1 month to 14 years (median 20 months). Seventy-six children were Malay in ethnic origin (73%), 14 Chinese (13%), 12 Indian (11%), and other races (3%). Sixty-four children presented with leukocoria (61%), followed by 23 with proptosis (22%), 13 with squint (12%), and 3 with orbital cellulitis (3%). Thirty-three children (31%) deferred treatment for 6 months or more. Overall, 56 children had extraocular disease (55%), 52 at presentation, 4 later. Seventy-one children (68%) underwent primary enucleation, 76 received chemotherapy (72%), and 23 radiotherapy (22%). Fifty-seven children are alive (54%), of whom 3 are blind (5%). Twenty-seven children were lost to follow-up (26%) and 21 have died (20%). Retinoblastoma in Malaysia is still characterized by predominantly extraocular disease due to late presentation and high rates of abandonment.

Pediatric Cancer Deaths: Curative or Palliative?

The aims of this study were to review the deaths of Malaysian pediatric oncology patients in order to determine the major causes and the proportion of patients who received palliative care. This was a retrospective review from 2001-2007 of deaths at the Pediatric Institute, General Hospital Kuala Lumpur. Clinical data such as age, gender, disease, cause, and place of death were collected. The patients were divided into two groups: those who received palliative care and those who received curative treatment. Two hundred forty-seven patients were included. There were 148 males and 99 females. The age ranged from 2 months to 22 years (median, 4 years). One hundred thirty cases (53%) were still in the curative phase of treatment at the time of death. The most common cause of death was septicemia (62%), followed by hemorrhage (18%) and underlying cancer (14%). One hundred seventeen cases (47%) were in the palliative phase at the time of death. All palliative care deaths occurred in the oncology ward with one exception. Nearly half of all inpatient pediatric cancer deaths were palliative in nature. Septicemia and hemorrhage were the major causes of death in the others.

Outcome study of first-episode schizophrenia in a developing country: quality of life and antipsychotics

Quality of life has recently been emphasized in the management of schizophrenia, yet data from developing country is lacking. We explored the differences in subjective quality of life between conventional antipsychotics (CAs) and atypical antipsychotics (AAs). This is a naturalistic study conducted in Kuala Lumpur, Malaysia. Patients with first-episode schizophrenia and related psychosis were recruited from Kuala Lumpur Hospital. WHOQOL-BREF, side effects of medications and other variables were assessed after 1 year of treatment in routine clinical situation. The study comprised 120 adults. There were no significant statistical differences between groups concerning subjective quality of life, extrapyramidal side effects and employment. Significant less benzhexol usage was reported among AAs (P<0.001) compared to CAs and sulpiride. Patients treated with CAs, sulpiride or AAs experienced similar quality of life, clinical and health outcomes after 1 year commencing treatment. Overall, the results are in line with other major pragmatic clinical trials. This study also found sulpiride cost-effective.

A Prospective Study to Determine the Effect of Intermittent Pneumatic Foot and Calf Compression on Popliteal Artery Peak Systolic Blood Flow

Objective This study investigated the effects of posture and also intermittent foot and calf compression on peak systolic flow of the popliteal artery in a normal population. Methods This was a prospective study carried out in normal subjects at the Vascular Laboratory, Department of Surgery, Hospital Kuala Lumpur, from March 2006 to September 2006. The study compared the popliteal artery blood flow during change of posture from the horizontal (supine) to the sitting position and the effect of intermittent pneumatic compression (IPC) of the foot and calf on popliteal artery blood flow immediately and 10 minutes after cessation of compression. Results A total of 15 subjects involving 30 limbs were examined in this study. On comparing flows between the horizontal and sitting position, there was a mean reduction in blood flow of 23% ( p <0.005). Immediately after compression of the foot and calf, there was an increase in blood flow of between 4% and 35% with a mean of 15% ( p <0.05). Peak systolic flows at 10 minutes postcompression were 536 ±95 mL/min, which was still significantly higher than precompression measurements. Conclusion There is a significant reduction in popliteal artery blood flow on changing from the supine to the sitting position. Popliteal artery blood flow is higher than baseline after 15 minutes of intermittent pneumatic foot and calf compression. The increase in popliteal artery blood flow is still present 10 minutes after cessation of IPC.

Serum Lipoprotein(a) Levels in Patients with Atherosclerotic Peripheral Vascular Disease in Hospital Kuala Lumpur

The objective of this study was to determine the proportion of patients with atherosclerotic peripheral vascular disease (PVD) who had elevated lipoprotein(a) [Lp(a)] levels, as well as to determine the latter's significance as a risk factor for PVD in the local population. This case-controlled study was conducted between June and October 2004 in the Department of Surgery, Kuala Lumpur Hospital. A total of 100 patients were recruited and divided into control and PVD groups. Patients were defined as having PVD if they were symptomatic, with ankle-brachial systolic index < 0.90, or by radiological evidence. Lp(a) concentrations were determined using immunoturbidometry. Absorbance of reaction precipitate was measured by spectrophotometry to give Lp(a) concentration in grams per litre (g/L). The reference value for normal Lp(a) levels was < or = 0.36 g/L. Mean Lp(a) levels for control and PVD groups were 0.29 g/L and 0.56 g/L, and median values were 0.17 g/L and 0.48 g/L, respectively. Elevated Lp(a) levels in the control group was 26% compared to 58% in the PVD group. Analysis with Pearson's chi-squared test achieved a significant p value of 0.001. Multivariate analysis showed that elevated Lp(a) levels contributed significantly to the probability of having PVD with an odds ratio of 7.69. Elevated serum Lp(a) has a significant role as a risk factor for atherosclerotic PVD in the local population.

Patient Satisfaction as An Indicator of Service Quality In Malaysian Public Hospitals

The Ministry of Health (MOH) is the major healthcare provider in Malaysia, although the service is also being complemented by the private sector which constitutes about 35% of overall healthcare services. Public hospitals in the country are organised into national level, state level and district level. The national level hospital is Hospital Kuala Lumpur, which serves as the National Referral Centre. It is the largest hospital in the country with 2500 beds, providing a comprehensive range of tertiary care services. The state level hospitals provide a comprehensive range of secondary care services and are located in the state capital of each of the thirteen federal states in the country. These are also large hospitals with bed capacity ranging from 800‐1200. The district level hospitals on the other hand, provide basic impatient care services. For those with resident specialist, some secondary level speciality services are also provided. District hospitals without specialities are generally smaller with beds ranging from 30 to 150, while those with specialists may have beds ranging from 200 to 500.

Tuberculous Meningitis: Neuroimaging Features, Clinical Staging and Outcome

Forty-two patients diagnosed with tuberculous meningitis in Kuala Lumpur Hospital based on clinical criteria, cerebrospinal fluid analysis and response to antituberculous treatment over a seven year period were included in this study. Relevant information was obtained from patients' medical case notes and neuroimaging findings were evaluated. The clinical presentation of patients was staged according to Medical Research Council for tuberculous meningitis. Fisher's Exact Test was used to determine the correlation between the neuroimaging features, clinical staging and outcome of patients. 52.4% of patients had stage 2 disease, 28.6% stage 3 and the remainder stage 1 disease. 95.2% of patients had various neuroimaging abnormalities and only 4.8% had normal neuroimaging findings. The commonest neuroimaging findings were hydrocephalus and meningeal enhancement. 47.6% of patients survived without any complication. 23.8% developed morbidity either with minor or major neurological deficit and 28.6% had died at the end of the study period. Among patients with negative neuroimaging findings, one died and another one survived without any complication. Among patients with abnormal neuroimaging findings, 25% developed morbidity, 27.5% died and 47.5% survived without complication. The only neuroimaging feature significantly correlated with clinical outcome was the presence of hydrocephalus. Therefore, hydrocephalus is important in the prognosis of the disease and should be considered an indicator of poor clinical outcome. There was no significant correlation between clinical staging and clinical outcome, nor was there a significant correlation between clinical staging and individual neuroimaging features.

P1739 Looking for evidence of Chlamydia pneumoniae presence in atherosclerotic and non-atherosclerotic segments of arteries obtained from autopsies at a forensic unit in a Kuala Lumpur hospital, by both rtPCR to detect omp A VD4 base sequences and immunohistoch

P1739 Looking for evidence of Chlamydia pneumoniae presence in atherosclerotic and non-atherosclerotic segments of arteries obtained from autopsies at a forensic unit in a Kuala Lumpur hospital, by both rtPCR to detect omp A VD4 base sequences and immunohistoch

Toxoplasmosis: A Silent Opportunistic Disease in HIV/AIDS Patients

A total of 693 HIV/AIDS patients were recruited in this retrospective and descriptive study during April 2003 to December 2004, Hospital Kuala Lumpur, Malaysia. It was found that both genders were shown to be within the same range of age (M = 18-79 vs F = 18-73), while a median age was slightly higher in male (36 years) than female (31 years). The majority of both genders were significantly shown in the age group of 25 to 34 years, but a higher rate was evident in females (42) (p = 0.001). It was even observed that male patients were mainly Chinese (44.7) and single (57.3) (p = 0.001), while the females were Chinese (40.6) and married (83.3) (p = 0.000). However, the highest numbers of both genders were manifested to be heterosexuals (M = 47.6 vs F = 86.2), followed by intravenous drug users (M = 39.3 vs F = 6.5) (p = 0.000). The range of CD4 cell count was 0 to 1799 with a median of 230 cells/mm3. The level of CD4 cell count of < 200 cells/mm3 was significantly found in males (48.5) and between 200 to 499 and �500 cells/mm3 were 36.2 and 26.8 in females, respectively (p = 0.001). Overall, the Toxoplasma seroprevalence was 43.85 where seropositive of anti-Toxoplasma antibody relatively higher in males (50) than in females (37.7) (p = 0.015). Toxoplasma seropositivity was thoroughly evident among Malays (168; 51.1), Intravenous Drug Users (IDUs) and patients with toxoplasmic encephalitis (TE) (p = 0.001). Furthermore, anti-retroviral therapy including HAART was more significantly found in patients with 9 seropositive Toxoplasma when compared to 2 seronegative and unknown serostatus patients (p = 0.025). Seventeen AIDS-related toxoplasmic encephalitis patients were diagnosed at the time of this study, depicting hemiparesis as the most common neurological manifestation in 11 (64.7) patients, followed by headache and seizure in 6 (35.3) and 3 (17.7) patients, respectively. Interestingly, CT scan finding showed mass like structure with multiple (58.8), ring enhancing lesions (100), in parietal region (58.8) and edema (29.4) in these patients. Overall, the treatment outcome showed that 13 (76.5) patients had completed treatment with maintenance, whereas, 3 (17.6) patients were lost to follow up and 1 (6) patient was transferred to another hospital. No relapse or death case was reported during the time of this study.

Incidence and Outcome of T-Cell Lymphomas in Malaysia.

The T- and NK-cell neoplasms are a heterogenous group and are relatively uncommon. From the International Non-Hodgkin's Lymphoma classification study, precursor T-lymphoblastic lymphoma and the mature T- and NK-cell lymphomas account for 1.7% and 12% of all NHLs. T-NHL are in general more common in Asia. The outcome of this disease is poorer with a 5-y overall survival of 20% (excluding anaplastic NHL). Hospital Kuala Lumpur is the major hematology referral centre in Malaysia. A total of 414 new cases of lymphoma was seen during 2000–2005. The majority were DLBCL 46% and follicular grade I/II lymphomas 15.8%. Only 48 cases (12%) were T-NHL. These were PTCL 19 (5%), anaplastic T-NHL 9 (2.2%), cutaneous T-NHL Stage IV 9 (2.2%), T/NK-NHL 5 (1.2%) and angioimmunoblastic NHL 3 (0.7%). Between 2002–2005, 15 patients were treated with HyperCVAD regimen alternating with Mtx/Ara-C. Three had T-lymphoblastic lymphoma, 7 had PTCL and 5 had T/NK cell. The complete remission was 40% with two proceeding to stem cell transplant. One received local DXT. The median duration of remission was 18.5mths(10–30mths) with median follow-up of 30mths(25–35mths). Alemtuzumab(Campth-1H) is a humanised monoclonal antibody that targets the CD 52 antigen including the T-cell. We combined HyperCVAD with Alemtuzumab 30mg sc on day 1 of every chemotherapy cycle. Four patients with relapsed/refractory T-ALL and 1 patient with T/NK NHL were treated. Two patients, one who relapsed six months after chemotherapy and the other after allogeneic transplant achieved complete remission. The patient with T/NK who had progressive disease with enlarging hepatosplenomegaly after 1 pair of HyperCVAD achieved remission after the addition of Campath. The median duration between each chemotherapy cycle was 25 days(23–26d). One patient had CMV reactivation with no evidence of disease. All patients are still undergoing treatment. The addition of Campath 30mg on day 1 of each chemotherapy cycle appears to be a viable option to try to improve the results in aggressive T-NHL. In view of these preliminary findings, we are starting a study protocol using Campath plus HyperCVAD in aggressive T-cell disease.