1.Impact of timely BCR-ABL1 monitoring before allogeneic stem cell transplantation among patients with BCR-ABL1-positive B-acute lymphoblastic leukemia
Siew Lian CHONG ; Asral Wirda AHMAD ASNAWI ; Tze Shin LEONG ; Jenq Tzong TAN ; Kian Boon LAW ; Siong Leng HON ; Rui Jeat FANN ; Sen Mui TAN
Blood Research 2021;56(3):175-183
Background:
With the emergence of tyrosine kinase inhibitors and the incorporation of stringent measurable residual disease (MRD) monitoring, risk stratification for BCR-ABL1-positive acute lymphoblastic leukemia (ALL) patients has changed significantly. However, whether this monitoring can replace conventional risk factors in determining whether patients need allogeneic stem cell transplantation is still unclear. This study aimed to determine the impact of BCR-ABL1 monitoring on the outcome of patients with BCR-ABL1-positive ALL after allogeneic stem cell transplantation.
Methods:
We retrospectively analyzed the survival outcome of patients with BCR-ABL1-positive ALL based on the quantification of BCR-ABL1 at 3 timepoints: the end of induction (timepoint 1), post-consolidation week 16 (timepoint 2), and the end of treatment for patients who were either transplant-eligible or non-transplant eligible (timepoint 3).
Results:
From 2006 to 2018, a total of 96 patients newly diagnosed with BCR-ABL1-positive ALL were treated with chemotherapy and tyrosine kinase inhibitors. Thirty-eight (41.3%) patients achieved complete remission, and 33 patients underwent allogeneic stem cell transplantation. Our data showed that pre-transplant MRD monitoring by real-time quantitative polymerase chain reaction had the highest correlation with survival in patients with BCR-ABL1-positive ALL, especially for those who underwent allogeneic stem cell transplantation.
Conclusion
Patients without MRD pre-transplantation had superior survival compared with those who had MRD, and they had excellent long-term outcomes after allogeneic stem cell transplantation.
2.Impact of timely BCR-ABL1 monitoring before allogeneic stem cell transplantation among patients with BCR-ABL1-positive B-acute lymphoblastic leukemia
Siew Lian CHONG ; Asral Wirda AHMAD ASNAWI ; Tze Shin LEONG ; Jenq Tzong TAN ; Kian Boon LAW ; Siong Leng HON ; Rui Jeat FANN ; Sen Mui TAN
Blood Research 2021;56(3):175-183
Background:
With the emergence of tyrosine kinase inhibitors and the incorporation of stringent measurable residual disease (MRD) monitoring, risk stratification for BCR-ABL1-positive acute lymphoblastic leukemia (ALL) patients has changed significantly. However, whether this monitoring can replace conventional risk factors in determining whether patients need allogeneic stem cell transplantation is still unclear. This study aimed to determine the impact of BCR-ABL1 monitoring on the outcome of patients with BCR-ABL1-positive ALL after allogeneic stem cell transplantation.
Methods:
We retrospectively analyzed the survival outcome of patients with BCR-ABL1-positive ALL based on the quantification of BCR-ABL1 at 3 timepoints: the end of induction (timepoint 1), post-consolidation week 16 (timepoint 2), and the end of treatment for patients who were either transplant-eligible or non-transplant eligible (timepoint 3).
Results:
From 2006 to 2018, a total of 96 patients newly diagnosed with BCR-ABL1-positive ALL were treated with chemotherapy and tyrosine kinase inhibitors. Thirty-eight (41.3%) patients achieved complete remission, and 33 patients underwent allogeneic stem cell transplantation. Our data showed that pre-transplant MRD monitoring by real-time quantitative polymerase chain reaction had the highest correlation with survival in patients with BCR-ABL1-positive ALL, especially for those who underwent allogeneic stem cell transplantation.
Conclusion
Patients without MRD pre-transplantation had superior survival compared with those who had MRD, and they had excellent long-term outcomes after allogeneic stem cell transplantation.
3.Clinical presentations and predictors of mortality for leptospirosis - A study from suburban area in Malaysia
Rui Jeat Fann ; Vidya Rubini Rani ; Huey Ee Chong ; Indralingam Vaithlingam ; Christopher Wai Seong Chan
The Medical Journal of Malaysia 2020;75(1):52-56
Introduction: Malaysia is endemic for leptospirosis with
increasing incidence recorded over the years. Perak has
recorded one of the highest incidence and mortality of
leptospirosis since 2004.
Methods: This is a retrospective study of confirmed
leptospirosis cases in Larut, Matang and Selama (LMS)
district in Perak reported in 2016. The demographic, clinical
presentation, laboratory result and clinical outcomes data
were analysed and presented.
Results: Forty-two patients with confirmed diagnosis of
leptospirosis were included into the study. Majority of
patients were males and Malays. The case fatality rate was
14.3%. Patients with leptospirosis present with variable
clinical presentations and are commonly seen with coinfection. Patients 70-year-old and older, have clinical
presentations suggestive of organ dysfunction and require
intensive care are associated with higher mortality.
Conclusion: Leptospirosis is endemic in LMS district of
Perak with high incidence and case fatality rate. The clinical
presentation of leptospirosis is variable. Co-infection of
leptospirosis with other acute febrile illness is common.
Patients presenting with symptoms and signs of organ
dysfunctions or require intensive care are associated with
an increased odds of death.
4.Haemophilia care and outcome in a major haemophilia treatment centre in Malaysia
Yang Liang Boo ; Christopher Chin Keong Liam ; Kar Ying Yong ; Rui Jeat Fann ; Grace Wan Chieng Lee ; Gilbert Wilfred ; Jameela Sathar
The Medical Journal of Malaysia 2021;76(1):46-50
Introduction/Objective: The management of potential
treatment-related complications and bleeding events in
haemophilia is challenging in developing countries.
Providing optimal care among these patients improve their
quality of life (QOL) and life expectancy. This study explores
the demographic characteristics and treatment outcome in a
major haemophilia treatment centre in Malaysia.
Materials and Methods: A total of 260 patients were recruited
in this retrospective cross-sectional analysis. Clinical data,
including treatment regimens and outcome, were collected
and analysed.
Results: A total of 211 patients were diagnosed with
haemophilia A (HA) (severe disease, 72.5%) and 49 patients
had haemophilia B (HB) (severe disease, 65.3%). The median
age was 31 (IQR;2-84) years. Majority of the patients had at
least one episode of musculoskeletal bleeding since
diagnosis. The mean annual bleeding event (ABE) was 4.91
(SD±6.07) in 2018. Target joints were identified in 80.4% of
the patients. Chronic arthropathy and synovitis collectively
accounted for more than half of the musculoskeletal
complications. 30.1% of the patients had contracted
hepatitis C with less than half received treatment. Thirty-one
patients (16.8%) with severe haemophilia developed
inhibitor and 12 patients successfully underwent immune
tolerance induction. More than three-quarters of the severe
haemophilia patients were treated with factor concentrate
prophylaxis. The mean prophylaxis dose for HA and HB were
41.3 (SD±19.1) and 48.6 (SD±21.5) IU/kg/week, respectively.
In patients with severe disease, prophylaxis significantly
reduced the ABE (5.45,9.03;p=0.005).
Conclusion: The importance of utilising a low to moderate
dose regimen as prophylaxis in haemophilic patients is
highlighted in our study. Future studies should include QOL
assessment will further improve the management in
haemophilia.