Syed Kamran Mehmood

National University of Medical Sciences

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Mehreen Ali Khan

Armed Forces Institute of Pathology

Tariq Mehmood Satti

National University of Medical Sciences

Nighat Shahbaz

Armed Forces Institute of Pathology

Parvez Ahmed

Shahid Beheshti University of Medical Sciences

Humayyun Satti

National University of Medical Sciences

Qamar Un Nisa Chaudhary

Armed Forces Institute of Pathology

Qamar Un Nisa Chaudhry

Armed Forces Institute of Pathology

Nadeem Paracha

Combined Military Hospital

Raheel Iftikhar

Armed Forces Institute of Pathology

Shahid Raza

RISE Research Institutes of Sweden

Cooperative Institutions

National University of Medical Sciences

Armed Forces Institute of Pathology

Combined Military Hospital

National Institute Of Blood Disease and Bone Marrow Transplantation

Shifa International Hospital

Unity Health System

Military Hospital

GTx (United States)

Dow University of Health Sciences

All India Institute of Medical Sciences

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OUTCOME OF CHEMOTHERAPY IN NON ACUTE PROMYELOCYTIC ACUTE MYELOID LEUKAEMIA

DOAJ (DOAJ: Directory of Open Access Journals) (2020)

Nighat Shahbaz Parvez Ahmed Tariq Mehmood Satti Nadeem Paracha Syed Kamran Mehmood

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.

Myeloid leukaemia

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Relapsed diffuse large B-cell lymphoma treated by reduced-intensity allogeneic stem cell transplantation with donor lymphocyte infusion.

PubMed (2010)

Qamar-Un-Nisa Chaudhry Parvez Ahmed Khalil Ullah Tariq Mehmood Satti Shahid Raza

A 42 years old male with relapsed diffuse large B-cell lymphoma was given second-line chemotherapy followed by reduced intensity allogeneic stem cell transplantation from HLA matched brother. Twelve weeks posttransplant, his disease relapsed evidenced by the appearance of lymphoma cells in the peripheral blood and declining donor chimerism. Donor lymphocyte infusion was given that induced complete lymphoma remission. The patient is well 3 years posttransplant with his disease in complete remission.

Donor lymphocyte infusion

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Outcomes of Allogeneic Stem Cell Transplant in Chronic Myeloid Leukaemia - A Single-Centre Experience from Pakistan

Pakistan Armed Forces Medical Journal (2023)

Jehanzeb ur Rehman Fayyaz Hussain Qamar Un Nisa Chaudhry Syed Kamran Mehmood Mehreen Ali Khan

Objective: To determine indications and outcomes of stem cell transplant in Chronic Myeloid Leukemia in a tertiary care centre in Pakistan. Study Design: Retrospective longitudinal study Place and Duration of Study: Armed Forces Bone Marrow Transplant Center, Rawalpindi Pakistan, from Jan 2002 to Jan 2019. Methodology: Retrospective analysis of all the patients who had undergone transplants for chronic myeloid leukaemia at our centre from 2002 to 2019 was done. Cases enrolled included patients of both genders and any age for whom data related to disease status and follow-up post-transplant was available. Patients with incomplete records and follow-ups were excluded from the study. Results: Out of 73 patients, data from 53 patients was analyzed. At a median follow-up of 40 months, overall survival was 72%. Survival in patients <40 years was better (78%) compared to the >40 years (50%). Among the three conditioning regimens, Bu16Cy120 was the most commonly used (n=35, 66%) and had better overall survival (n=29, 83%) though statistical significance could not be established (p=0.172). Conclusion: In addition to the established indications of resistance or intolerance to tyrosine kinase inhibitors for bone marrow transplant in CML, the non-availability/ affordability, young age, and lack of access to novel drugs can be included in underdeveloped countries like Pakistan.

Chronic myeloid leukaemia

Bone marrow transplant

10.51253/pafmj.v73i4.6857

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RESPONSE TO IMMUNOSUPPRESSIVE THERAPY IN PATIENTS OF ACQUIRED APLASTIC ANAEMIA: A SINGLE CENTER EXPERIENCE FROM A DEVELOPING COUNTRY

Journal of Ayub Medical College Abbottabad (2022)

Maryam Khan Raheel Iftikhar Qamar Un Nisa Chaudhry Syed Kamran Mehmood Tehniat Faraz

Background: Aplastic Anaemia (AA) is characterized by pancytopenia and hypocellular marrow. Immunosuppressive therapy (IST) SHOWS impressive haematological response; however, risk of relapse and clonal evolution persists. The objective of the study is to assess response to IST in patients with aplastic anaemia. Methods: A retrospective single centre study at AFBMTC / NIBMT for patients of acquired AA was conducted from January 2005 to December 2019.Inclusion criteria included diagnosed cases of acquired AA receiving IST for at least 12 weeks and age >2 years. IST included cyclosporine (CsA) alone, CsA + androgens, CsA + rabbit anti thymocyte globulin (rATG), CsA + horse anti thymocyte globulin (hATG). Primary outcome measure was response to IST; secondary outcome measure was overall survival (OS). Results: A total of 513 patients received IST. Median age was 23 years (range 2-97 years). In study cohort, 155 (30.2%) patients responded to the IST, 63 (12.3%) achieved complete response (CR) while 92 (17.9%) achieved partial response (PR). The ORR of CsA in NSAA, SAA and VSAA was 52.6%, 28.10% and 10% respectively; whereas ORR of CsA + rATG in NSAA, SAA and VSAA was 50%, 35.1% and 22.5% respectively. OS was 38% at a median follow up of 36 months. There was a significant difference in the survival distributions of different treatment modalities (p=0.016). Median survival time 60 months (CsA), 9 months (CsA+ androgens) and 39 months (CsA+ rATG/hATG.) Conclusion: In resource constrained settings, single agent CsA remains a reasonable alternative with modest activity and acceptable side effect profile.

Anti-thymocyte globulin

Thymoglobulin

Aplastic anemia

Single Center

Immunosuppression

Regimen

10.55519/jamc-04-s4-9885

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HIGH ALTITUDE AND VENOUS THROMBOSIS: FREQUENCY AND RISK FACTORS

Pakistan Armed Forces Medical Journal (2021)

Qamar Un-Nisa Choudry Raheel Iftikhar Manzur Qadir Tariq Mehmood Satti Ghassan Omair

Objective: To determine the effect of high altitude on frequency and risk factors of venous thrombosis inindividuals ascending to high altitude Study Design: Cross-sectional analytical study. Place and Duration of Study: Armed Forces Bone Marrow Transplant Centre, Combined Military HospitalSkardu, from Apr 2015 to Aug 2018. Methodology: High Altitude was taken as height equal to or more than 8000 feet. Polycythemia as hemoglobin>16.5 g/dl OR hematocrit >49%. Medical records of all patients evacuated from high altitude through CombinedMilitary Hospital Skardu were analyzed retrospectively. A proforma was designed to include necessary variables. Results: We evaluated medical records of 539 individuals and found frequency of 86 (15.9%) for venous thromboembolism (VTE) at high altitude. Cerebral venous sinus thrombosis (CVST) was most common thrombotic complication seen in 39 patients (46%). Majority of thrombotic episodes occurred at >18000 feet (likelihood ratio (LR) 5.99, p-value 0.009). Majority of thrombotic episodes 34 (39%) occurred within first 45 days of ascent to high altitude. Thrombosis was linked to smoking 47 (55%) (likelihood ratio 21.3 and p-value <0.001) and use of melted snow as a source of drinking water 56 (65%) (likelihood ratio 57.6 and p-value <0.001). Conclusion: This study showed a very high frequency of thrombotic complications at high altitude. There isa need for a robust prospective study covering epidemiology, clinical information and diagnostics in order todevelop appropriate standard operating procedures and guidelines for prevention of thrombosis at HA

Medical record

10.51253/pafmj.v71i1.3173

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OUTCOME OF CHEMOTHERAPY IN NON ACUTE PROMYELOCYTIC ACUTE MYELOID LEUKAEMIA

DOAJ (DOAJ: Directory of Open Access Journals) (2020)

Nighat Shahbaz Parvez Ahmed Tariq Mehmood Satti Nadeem Paracha Syed Kamran Mehmood

Myeloid leukaemia

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