International Blood Research & Reviews

Response to Tyrosine Kinase Inhibitors in Patients with BCR-ABL1 Positive Chronic Myeloid Leukemia; 13.5 Years’ Experience at Patan Hospital, Nepal

A. Adhikari — 2023-03-04

Background: Since the advent of Tyrosine Kinase Inhibitor (TKI), well controlled studies in developed world have shown that the life expectancy of patients with CML is comparable to normal people without the disease. But long-term follow up studies are lacking in resource poor setting.

Methods: This is a retrospective follow up study looking at the molecular response and resistance to Tyrosine Kinase Inhibitors (TKI) in patients enrolled in the Max Access Program since February 2003 till March 2017. Patients with two or more BCR-ABL1 levels by Karyotyping/ fluorescent in situ hybridization (FISH) / reverse transcriptase polymerase chain reaction (RT-PCR) were included. At baseline, complete blood count (CBC), renal function test (RFT), and liver function test (LFT) were evaluated. Bone marrow aspiration and biopsy for morphology, cytogenetic analysis by Karyotyping/FISH and/or molecular analysis by RT-PCR were also done if these tests were not performed earlier. FISH or RT-PCR was done on peripheral blood every 3–12 months as necessary if the patient could afford. Patients with warning response/failure underwent BCR-ABL1 Resistance Mutation Analysis (IRMA).

Results: Three hundred and forty six (346) patients had two or more BCR-ABL1 monitoring tests done. Optimal response was seen in 49.42%. Similarly, suboptimal response and failure were seen in 16.5% and 34% respectively. Overall Survival is 89.6% (at 1.8 -165 months, mean 62 months) . If only CML related events is considered survival is 95.9%. Seventy seven (77) patients with a total of 80 BCR-ABL1 domain Imatinib Resistance Mutation Analyses (IRMA) showed 19 different types of mutations with the most common being T315I mutation (8 and 19.5%). About 22.25% of the total patients showed resistance to Glivec out of which 10.98% showed mutations. Nine patients underwent trial for treatment free response (TFR) and 5 of them relapsed between 2-8 months.

Conclusions: Despite all the odds of having financial problem, accessibility problem due to distances, transportation, etc. and difficulty monitoring with routine BCR-ABL1 and IRMA, our findings show that the outcome of TKI therapy in our CML patients is comparable to well controlled studies done elsewhere. Overall survival, molecular and cytogenetic responses and mutations in our patients who developed resistance as well as TFR are also similar to other studies. The resistance rate of 22.25% is slightly higher compared to other studies in developed world. This is mainly because of poor monitoring due to unavailability of the test including IRMA in our country and affordability until 2012. It proves that TKI is very effective in CML even in a resource-poor, developing country.

Convalescent Plasma Infusion in Italian Hospitalized Patients with Severe COVID 19 Pneumonia: Evaluation of Late Mortality Associated Factors

Gianluca Gessoni — 2023-03-17

Background: This was a single center prospective study about factors related with mortality in hospitalized patients with severe COVID-19 pneumonia treated with convalescent plasma (CCP) infusion in Venice Prefecture.

Methods: In this study were enrolled all the (376) consecutive hospitalized patients with severe COVID-19 pneumonia treated with CCP observed from 30/04/2020 to 31/10/2021. At hospital admission, in order to evaluate correlation with prognosis, study recorded demographic data, clinical data, presence of co morbidities, Rx findings, laboratory results. The endpoint was mortality at 30 days.

Results: Using multivariate analysis, considering demographic data and co morbidities four variables emerged as significant independent predictors of 30-day mortality: age>70 years, tobacco smoke, obesity (BMI>30), Diabetes. Considering Patients’ clinical characteristics at hospital admission two variables emerged as significant independent predictors of 30-day mortality in this cohort of hospitalized patients with severe COVID-19 Pneumonia: PaO2/FiO2 ratio under 200 and lungs imaging with a score >3.

Discussion: Late mortality was investigated in a series of consecutive, hospitalized, patients with severe COVID-19. We therefore believe that any influence linked to the level of expertise of the clinical staff and available technology was minimal. Furthermore, we also tried to reduce, as much as possible, the variables related CCP infusion using plasma with a neutralizing antibody titer> 80 and a standardized dose: a 200 mL unit per day for three consecutive days. Moreover, using both a univariate and multivariate analytical approach, numerous demographic variables were considered, relating to comorbidities, all clinical characteristics, to laboratory data; correlating them with mortality at 30 days.

Heamatological Parameters in Type 2 Diabetic Patients Attending Igbinedion University Teaching Hospital Okada, Edo State, Nigeria

Olley Mitsan — 2023-03-20

Diabetes is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period, and if untreated could lead to complications. This study, carried out at the Igbinedion university teaching hospital Okada to ascertain some hematological parameters, using 69 known diabetes patients who enrolled as an Out-patient in the General Out- Patient Department and 69 non- diabetes apparently healthy individuals as control. Thirty- nine of these diabetic individuals were female, while thirty were male individuals. For the non- diabetic individuals, thirty- seven were female, and thirty-two were male representing 53.6% and 46.4% respectively. Ethical approval from the institution was sought prior to commencement of study and quality control of reagents was strictly maintained. Five millilitres of whole blood was collected into an Ethylene Diamine Tetra-Acetic acid (EDTA) anticoagulated bottle, and haematological parameters including PCV, HB, WBC, RBC,MCV, MCH, MCHC and platelet count were conducted for all individuals. Result obtained for Diabetic individuals showed a mean value of 34.63, 11.24, 4.41, 7.20 and 204.27 for PCV, Hb, RBC, WBC and platelets counts respectively, while for non-diabetic individuals, a mean value of 35.04, 10.09, 3.99, 7.07 and 262.56 respectively.Hb concentration and RBC count were statistically significant (p < 0.05). The Red cell indices, MCV and MCHC, were statistically significant. This study showed a statistically significant variation in some hematological parameters of diabetic patients compared to control group .Low platelet count and alteration to red cell morphology as indicated in values of MCV and MCHC among diabetic patients are indicators of thrombotic potential. Hence, routine screening of hematological parameters should be considered for proper management of diabetic patients.

Detection of Schistosma heamatobium among Orphanage Children Attending Jarma UK Orphanage Home and Bakin Gulbi Primary School Sokoto

Kabiru Mohammed — 2023-03-20

Urinary schistosomiasis or Bilharzia caused by fluke worm Schistosoma haematobium (S. haematobium) is one of the seventeen (17) neglected tropical diseases associated with serious health problems and morbidities. It affects over 200 million people globally with an estimated death rate of more than 200, 000 annually and very common in Sub-Saharan African countries. The aim of the study was to determine the prevalence and associated risk factors of S. haematobium and provide epidemiological data in part of Nigeria. This cross-sectional study was carried out on 202 consenting participants, using both male and female attending Jarma Uk Orphanage home and Bakin Gulbi primary school. Detection and evaluation were done using Gold Standard Microscopy and commercially available Rapid Detection Test strips. Statistical analysis was carried out using a statistical package (SPSS version 26). A prevalence of 34(16.8%) among 202 from gold standard microscopy and 13(6.4%) circulating cathodic antigen (CCA) were obtained. High infection risk was observed among participant on swimming as a recreational activity 32(15.8%) at p<0.046 A gender prevalence of 26 (12.87%) and 8 (3.96%) at p<0.067 from male and female respectively were obtained. Female at the age group 11-15 had 27 (13.36%), and those with agriculture as recreational activity had the least infection risk 2(0.99%). This study showed that CCA has a less sensitivity and specificity than gold standard microscopy.

Convalescent Plasma Infusion does not Appear to Change the Prognosis in Italian Patients Hospitalized with Sars-Cov-2 Pneumonia

Gianluca Gessoni — 2023-03-23

Aims: This case-control prospective study aimed to describe the effects of COVID convalescent plasma (CCP) on late mortality in hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia.

Study Design: In this study were enrolled 214 consecutive patients with moderate to severe COVID-19 pneumonia hospitalized during the fourth trimester of 2020 in Venice Prefecture (North-East Italy). admitted to COVID-19 Hospitals of our district were enrolled.

Methodology: Confirmation of SARS-CoV-2 infection was made through reverse transcription-polymerase chain reaction test in nasopharyngeal swabs. The severity of each patient’s clinical condition was determined considering the Berlin score radiological findings and ventilatory data. Clinical data, risk factors and comorbidity, laboratory test reports and imaging diagnosis of all patients were recorded at hospitalization. In Italy, during the fourth trimester 2020 standard therapy for COVID-19 Pneumonia was: NSAIDs, ventilator support, LMWH, steroids, antibiotics and antiviral drugs; 108 patients received standard therapy alone and 106 received standard therapy in combination with CCP. The endpoint was mortality at 30 days.

Results: Patients series were comparable for gender, age, comorbidity and risk factors, Berlin score, PaO2/FiO2. Data concerning radiological findings and data concerning ventilatory support suggested a higher severity of patients treated with standard therapy plus CCP. Mortality rate at 30 days was 30.6% among subjects treated with standard therapy versus 30.2% among subjects treated with standard therapy plus CCP. The mortality observed in the two groups did not differ significantly. In the present study, however, we observed a higher mortality than reported in the literature. This result may be attributable to the greater severity of the patients considered.

Conclusions: This case-control prospective study showed that in a cohort of hospitalized patients suffering from severe 19 pneumonia, the addition of CCP to the standard therapy did not impact the mortality rate at 30 days. However, we believe that further studies are needed to evaluate the effectiveness of convalescent plasma therapy.