Acute promyelocytic leukaemia (APL) characterized by t (15;17) leading to formation of fusion protein PML-RARA is an acute leukaemia with highest mortality. A remarkable improvement in the outcomes has been witnessed due to evolution of highly effective targeted therapies replacing the traditional chemotherapy is most patients. However limited data is available regarding treatment outcomes of APL using various novel regimens from developing countries like Pakistan.This was a retrospective descriptive study which included APL patients treated at AFBMTC Rawalpindi from 2005 to 2020. It included a total of 51 eligible patients with a diagnosis of de novo APL confirmed by the presence of PML-RARA transcript or presence of t (15;17) by cytogenetics or FISH analysis. The protocols used for treatment included the UKAML MRC 12, the LPA-99/LPA-2005 PETHEMA, the APML4 and non-chemotherapy based ATO-ATRA protocol.The study included 51 patients in which 31 (60.78%) were male and 20 (39.2%) were female. The median age at diagnosis was 30 years (range 5-70). The commonest symptom was fever seen in 43 (84.3%) patients and bruising was the commonest physical finding present in 44 (86.3%) patients. High-risk patients were 23 (46.1%), 18 (35.3%) were intermediate risk and 10 (19.6%) were low risk. The LPA99/LPA2005 was most frequently employed protocol being used in 36 (72%) patients. There were 2 deaths during induction and 44 (86.3%) achieved CR post induction. The median follow up time was 32 months (range 1 to 190 months) with an overall survival (OS) of 76.5% and a relapse free survival (RFS) of 66.7.Our study shows APL is a highly curable malignancy and outcomes have improved with newer non chemotherapy based therapies. It can also be concluded that outcomes of APL gradually improved over the past 2 decades due to improvement in supportive care, provision of blood products and use of newer protocols. The prognosis remains less favourable in high risk patients.
Objective: To determine the outcome of beta thalassemia major (BTM) patients undergoing haematopoietic stem cells (HSCT), with fully matched parents as donors vs. matched sibling donors (MSD).
Objective: To determine CMV reactivation in hematopoietic stem cell transplant patients with haploidentical versus fully HLA matched donors Methodology: Retrospective Observational study was conducted at Armed Forces Bone Marrow Transplant Centre (AFBMTC) between March 2019 and October 2022. We enrolled a total of 60 consecutive patients.CMV DNA PCR analysis was carried out every week from day +14 to day +100 in order to monitor CMV reactivation during the 100-day post-transplantation period. The SaMag viral nucleic acid extraction kit (Sacace Biotechnologies, Como, Italy) was used to extract the DNA from two millilitres of blood collected in EDTA tubes. The kit's lower limit of detection for blood and serum was 5 copies/mL, while for other body fluids it was 500 copies/mL. An Applied Biosystems 7500 real-time PCR machine (Thermo Fisher Scientific, Waltham, MA) was used to conduct the PCR analysis. Result: The age range from 0.6 to 53 years ago was a median of 15±10.6. 39 patients had CMV reactivation (65%). With a range of 13 to 66 days, the median time to CMV DNAemia was 19.25 days.. Only two (3.3%) of the 39 patients received ganciclovir, while 26 (43.3%) received valganciclovir. Patients with aplastic anaemia had the highest rate of CMV infection (41%), followed by those with ALL (20.5%), AML (12.8%), and primary immunodeficiency (10.2%). A statistically significant connection between the underlying diagnosis and CMV infection. CMV infection was higher in haplo identical transplant recipients (66.6%) than in completely matched recipients (33.3%) and was statistically significantly. Sadly, 14 people passed away, yielding a mortality rate of 23.3%. Primary graft failure was the most frequent cause of mortality, resulting in neutropenic sepsis in 6 patients (42.85%), but 3 of these patients also had CMV reactivation. The rate of overall survival (OS) was found to be 76.7%. The rate of disease-free survival (DFS) was estimated at 71.7%. Notably, neither OS nor DFS in our analysis showed a statistically significant connection with CMV infection. Conclusion: The findings demonstrated a statistically significant association between haploidentical transplantation and CMV reactivation, with higher rates observed in the haploidentical group compared to fully matched recipients. Various factors, including underlying diagnosis, conditioning regimen, and GVHD prophylaxis, were also found to be correlated with CMV reactivation. However, while CMV reactivation was associated with specific factors, it did not impact overall survival or disease-free survival in the study population.
Objective: Retrospective analysis to evaluate overall response and outcome of various therapeutic regimens given in patients with non acute promyelocytic acute myeloid leukaemia (non APL AML).
Study Design: Retrospective study.
Place and Duration of Study: Armed Forces Bone Marrow Transplant centre/ National Institute of Blood and Marrow Transplant (AFBMTC/NIBMT), Rawalpindi.
Methodology: Patients of non APL AML managed at Armed Forces Bone Marrow Transplant Centre between Jul 2001 and Dec 2014 were evaluated. These patients included cases of denovo (n=103) and relapsed (n=18) AML cases. After baseline investigations bone marrow examination was carried out in all cases and cytogenetics and immunophenotyping in some cases. Informed written consent was taken before starting chemotherapy. The chemotherapy regimens used were D3A7, ADE, ICE, MAE, FLAG & FLAG-IDA and HiDAC. Majority of patients received induction with daunorubicin/cytarabine based chemotherapy. Post remission chemotherapy included either second course of D3A7/ADE combination or FLAG-Ida/ICE chemotherapy in relapsed AML followed by one to two courses of HiDAC (high dose cytarabine). Bone marrow examination was carried out after each course of chemotherapy to assess remission status.
Results: Total 121 cases were evaluated. Median age of patients was 28 years with 68% males and 32% females. Sixty four (53%) patients were of AML-M2 subtype. All 121 cases received induction chemotherapy including 103 denovo and 18 relapsed patients. Anthracycline based chemotherapy was given to majority of denovo cases (68%) while most of the relapsed AML patients received FLAG-Ida regimen. Hematological complete remission (CR) was achieved in 37% of denovo and 58% of relapsed patients after first course. Twenty nine (24%) patients failed to respond 11% had partial remission while 19 (15%) died within four weeks post induction and 9% discontinued the treatment. Out of eighty patients who received second course of chemotherapy 60 (75%) achieved CR. Only 62 patients including 52 denovo and 10 relapsed cases completed four courses of chemotherapy and were followed for a period of one to five years after completion of treatment. Out of these 62 patients 31 (50%) achieved CR, six of these 31 subsequently relapsed and two are alive on palliation. Overall and disease free survival in patients who completed chemotherapy was 43% and 40% respectively.
Conclusion: A significant number of patients with AML can be saved provided proper risk adapted chemotherapy is given. Standard induction with daunorubicin/cytarabine chemotherapy followed by two to three courses of high dose cytarabine is associated with overall and disease free survival in a significant proportion of cases.
Background Cutaneous leishmaniasis (CL) is endemic in various regions of Khyber Pakhtunkhwa (KPK) province and Federally Administered Areas (FATA). Troops deployed in these regions are at an increased risk of acquiring the disease as compared to the native population. Objective To determine clinical and epidemiological pattern of CL in armed forces personnel serving in endemic areas of CL in KPK and FATA. Patients and Method This observational/descriptive study was conducted at CMH, Peshawar from January, 2010 to June, 2010. All patients of any age reporting in skin outdoor with clinical diagnosis of CL were enrolled in the study and all were subjected to skin slit smears for L eishman-Donovan (LD) bodies and skin biopsies were also taken in all cases to observe histopathological features. Patients in whom clinical diagnosis was not supported by laboratory diagnosis, were excluded. Clinical and epidemiological data was recorded and finally analyzed by using descriptive statistics. Results Out of 172 initially enrolled cases, 2 were excluded from the study as their clinical diagnosis was not supported by laboratory findings. All patients were young males (deployed armed forces personnel). Their ages ranged from 18 to 43 (mean age: 27.4 years). Number of lesions ranged from 1-11. Multiple lesions were seen in 41.2% cases only. Size of lesions ranged from 1-13 cm. 70.6% of lesions were seen on upper and lower limbs followed by head and neck region 27.6%, and trunk and abdomen 1.8%. Morphological patterns seen were crusted plaques, psoriasiform plaques, nonhealing ulcers, erythematous infiltrated nodules and papules. Majority of the cases were from the regular army units deployed in the areas in recent past (71.8%) as compared to 28.2% of native troops of Frontier Corps (FC): 3% deployment of regular troops against 0.5% of FC troops. Conclusion CL is common in soldiers serving in KPK province and FATA regions of Pakistan. Armed forces personnel who moved from central Punjab and deployed in these areas for operations against terrorists are at much higher risk of acquiring the disease as compared to the native troops. This risk can be decreased by implementing effective precautionary measures and education of the soldiers.
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