Publications by authors named "Parameswaran Anoop"

48 Publications

Refractory Autoimmune Hematological Presentations of Undiagnosed Tuberculosis.

J Assoc Physicians India 2021 Sep;69(9):11-12

Pulmonology, Apollo Hospitals, Bangalore, Karnataka.

Four patients who presented with autoimmune cytopenias as the sole manifestation of undiagnosed tuberculosis are described here. These were refractory to conventional immunosuppressive therapy and responded dramatically to treatment of the infection. The potential association between tuberculosis and immune hematological conditions is highlighted. Literature is reviewed with respect to possible pathogenetic mechanisms. Clinicians need to be aware of this type of unusual presentation of tuberculosis and must consider this chronic bacterial infection as a potential cause for refractory cytopenias.
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September 2021

Halving Time of BCR-ABL1 in Chronic Myeloid Leukemia: Is It Better Than Day-90 Value-A Multicenter Study From South India.

Clin Lymphoma Myeloma Leuk 2020 05 30;20(5):e205-e211. Epub 2019 Sep 30.

Madras Cancer Care Foundation, Chennai, India.

Background: The 90-day BCR-ABL1 (breakpoint cluster region-Abelson 1) level has been one of the accepted milestones for predicting the molecular response in patients with chronic myeloid leukemia (CML). The rate of decline in BCR-ABL1 has been considered a better predictor of the response but has not been uniformly accepted. A paucity of evidence is available to predict the accuracy of the rate of decline in the Indian context. Therefore, we tested the accuracy of the rate of decline of BCR-ABL1 in predicting the molecular response compared with the single 90-day values in a retrospective cohort study of selected cancer centers in south India.

Methods And Materials: Patients with chronic-phase CML diagnosed from January 2013 to December 2018, the serial BCR-ABL1 levels were estimated at 0, 45, and 90 days, 6 months, and 1 year. Data on patient demographics, risk stratification assessed using the Sokal and EUTOS (European Treatment and Outcome Study) scores were extracted using a mobile-based data capture tool from the medical records of the enrolled patients. The halving time, determined by log reduction, was compared with the 90-day BCR-ABL1 values using the receiver operating characteristic curve for the major and complete molecular response at 6 months and 1 year as standards. Accuracy was determined from the area under the curve. The cutoff for the halving time was chosen to balance the sensitivity and specificity.

Results: The rate of decline had more predictive accuracy compared with the 90-day BCR-ABL1 values (area under the curve for rate of decline, 0.83; 90-day, 0.80). A halving time of < 20 days identified 95% of the patients who had achieved major molecular response at 12 months compared with 80% using the single 90-day BCR-ABL1 response.

Conclusions: The halving time of BCR-ABL1 appears promising as a predictor of the outcomes for patients with CML.
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http://dx.doi.org/10.1016/j.clml.2019.09.606DOI Listing
May 2020

Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence.

J Glob Oncol 2019 11;5:1-13

International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.

Purpose: Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) improves overall survival (OS) in patients with Hodgkin lymphoma (HL) relative to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. However, the associated higher cost and toxicity discourage clinicians from prescribing it. Identifying high-risk patients and administering escalated BEACOPP remains an effective strategy. We assessed the significance of interim positron emission tomography (iPET) scan after 2 cycles (iPET2) in identifying this high-risk subset.

Patients And Methods: This cohort study used secondary data from 12 tertiary care centers in South India gathered over 10 years (2008-2018). OS, event-free survival (EFS), determinants of EFS, and complete response (CR) in iPET2 were assessed.

Results: The study included 409 patients with HL (mean age, 34.5 years; male/female ratio, 1.4:1). The median duration of follow-up was 2.8 years. Of 409 patients, 63% underwent PET-based staging and 37% underwent computerized tomography (CT) staging. Stage IV (28.9%) and bone involvement (9.2%) were seen more often with PET than with CT staging (9.2% and 2%, respectively). Among 171 patients with iPET2 results, 24% did not achieve CR, and no factors were significantly associated. The 5-year EFS and OS rates of the entire cohort were 78% and 97%, respectively. The 5-year EFS and OS rates of patients with CR on iPET2 were 90% and 99%, respectively, whereas these were 65% and 100%, respectively, for patients not achieving CR. On univariable analysis, sex, stage, and iPET2 response significantly predicted inferior EFS. On multivariate analysis, only iPET2 response significantly predicted EFS ( < .000).

Conclusion: Our study supports the use of PET for staging and iPET2 for response assessment. Nonachievement of CR on iPET2 indicates unfavorable outcome, and such patients may benefit from more intensive treatment.
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http://dx.doi.org/10.1200/JGO.19.00179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939745PMC
November 2019

Bone marrow limited diffuse large B-cell lymphoma following prolonged immunosuppressive therapy with methotrexate and corticosteroids.

South Asian J Cancer 2018 Jul-Sep;7(3):192

Department of Medical oncology and Hematology, Apollo Hospitals, Bengaluru, Karnataka, India.

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http://dx.doi.org/10.4103/sajc.sajc_90_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069334PMC
August 2018

Intracranial granulocytic sarcoma as the first presentation of chronic myeloid leukemia in chronic phase.

J Neurooncol 2017 Sep 30;134(2):473-474. Epub 2017 Jun 30.

Department of Neurosurgery, Apollo Hospitals, Bangalore, India.

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http://dx.doi.org/10.1007/s11060-017-2541-6DOI Listing
September 2017

Transesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA)-Pushing the boundaries in the diagnosis.

Pediatr Pulmonol 2017 Nov 25;52(11):E91-E93. Epub 2017 Apr 25.

Apollo Hospitals, Bengaluru, India.

Isolated mediastinal adenopathy is a diagnostic challenge in the paediatric population, often requiring invasive surgical procedures for diagnosis. We describe a novel minimally invasive modality in a 20 month toddler-transesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA). This is the youngest reported use of this modality, highlighting feasibility, technical issues, safety, and rapid diagnosis leading to expedited treatment.
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http://dx.doi.org/10.1002/ppul.23709DOI Listing
November 2017

Sensorineural deafness: An uncommon irreversible adverse effect of bortezomib.

Indian J Cancer 2016 Jul-Sep;53(3):459

Department of ENT, Apollo Hospitals, Bengaluru, Karnataka, India.

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http://dx.doi.org/10.4103/0019-509X.200675DOI Listing
September 2018

Successful penile reconstruction following prior arteriovenous loop thrombosis due to undiagnosed protein-S deficiency and exogenous testosterone.

Indian J Plast Surg 2016 May-Aug;49(2):268-270

Department of Plastic Surgery, Apollo Hospitals, Bengaluru, Karnataka, India.

Flap failure from microvascular thrombotic occlusion is a rare but significant cause for unsuccessful reconstructive surgery. We encountered thrombosis of arteriovenous loop in a patient undergoing phallus reconstruction. Further investigations revealed underlying previously asymptomatic hypercoagulable state due to protein-S deficiency in addition to long-term exogenous testosterone administration. Role of thrombophilia testing, thrombogenic potential of testosterone and the need for therapeutic perioperative anti-coagulation in such situations are described here.
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http://dx.doi.org/10.4103/0970-0358.191307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053005PMC
November 2016

Screening assays for primary haemophagocytic lymphohistiocytosis in children presenting with suspected macrophage activation syndrome.

Pediatr Rheumatol Online J 2015 Nov 16;12 Suppl 1:48. Epub 2015 Nov 16.

Departments of Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK.

Background: Primary haemophagocytic lymphohistiocytosis (HLH) screening assays are increasingly being performed in patients presenting with macrophage activation syndrome (MAS). The objective of this study was to describe their diagnostic and prognostic relevance in children who had presented to paediatric rheumatology and had undergone investigative work up for MAS.

Methods: Data was obtained retrospectively from an existing protein screening assay database and patient records. Assays included: intracellular expression of perforin in CD56+ Natural Killer (NK) cells; CD107a Granule Release Assay (GRA) in response to PHA in NK cells, or anti-CD3 stimulation of CD8 lymphocytes; in males Signal Lymphocyte Activating Molecule Associated Protein (SAP), and X-linked Inhibitor of Apoptosis Protein (XIAP) expression. All assays, requested by paediatric rheumatology, of children who had undergone investigative work up for MAS over a 5-year period (2007-2011) were included.

Results: Twenty-one patients (15 female), median age 6.5 years (range 0.6-16) with follow-up of 16 months (range 1-51), were retrospectively identified. At presentation, 3/21 (14 %) fulfilled HLH-2004 diagnostic criteria. At least one screening test result was available for all 21 patients; 7/21 (33 %) had at least one persistent screening test abnormality. Of this group 4/7 (57 %) died or required haematopoietic stem cell transplantation (HSCT), compared to 1/14 (7 %) with no screening test abnormality (p = 0.025). 3/21 (14 %) ultimately had a diagnosis of primary HLH (two confirmed genetically; XIAP, familial HLH type 3, and one confirmed clinically). Of the six patients with abnormal GRA 5/6 had negative routine genetic results.

Conclusions: Screening for primary HLH is warranted for children whose first rheumatological presentation is with MAS, since overall 14 % had an eventual diagnosis of primary HLH. A persistently abnormal GRA in patients presenting with MAS defines a high-risk group with poor outcome (mortality or HSCT), possibly due to as yet unidentified genetic cause.
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http://dx.doi.org/10.1186/s12969-015-0043-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4647814PMC
November 2015

Acquired alpha thalassemia associated with erythroleukemia.

Am J Hematol 2014 Jan 1;89(1):114. Epub 2013 Aug 1.

Department of Hematology, Apollo Hospital, Bangalore, India.

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http://dx.doi.org/10.1002/ajh.23514DOI Listing
January 2014

Distribution of dyssynchrony in subjects with no known cardiac disease and comparison of velocity vector imaging to color-coded tissue Doppler imaging.

Echocardiography 2013 Feb;30(2):180-9

St. John's Health System, Springfield, MO, USA.

Data on the distribution of dyssynchrony in subjects with normal ejection fraction (EF) and normal QRS are scarce. We studied 100 subjects with no known cardiac disease (52% male, mean age 60 ± 17 years) using velocity vector imaging (VVI). Seventeen percent had septal to lateral (S-L) wall longitudinal delay >75 msec, 63% of subjects had S-L wall radial delay >75 msec, and 25% had a circumferential opposing wall delay >100 msec. Those with circumferential opposing wall delay of >100 msec had a lower EF (57 ± 5% vs. 62 ± 5%, P < 0.05). In an additional group of 33 patients, we compared the longitudinal dyssynchrony parameters as assessed by VVI and tissue Doppler imaging (TDI) and found them to be comparable. In conclusion, we find significant variation in time to peak velocities in subjects with no known cardiac disease, who had a normal left ventricular ejection fraction and QRS duration. VVI is comparable to TDI.
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http://dx.doi.org/10.1111/echo.12028DOI Listing
February 2013

Prominent megakaryocytic dysplasia after regression of transient abnormal myelopoiesis associated with GATA-1 mutation.

J Pediatr Hematol Oncol 2012 Nov;34(8):640

Department of Pediatric Hemato-Oncology, Royal Marsden Hospital, Surrey, UK.

About a quarter of children with Down syndrome and transient abnormal myelopoiesis (TAM) progress to acute megakaryoblastic leukemia (AMKL). We describe isolated dysmegakaryopoiesis despite complete resolution of TAM in an 18-month-old girl, who developed AMKL 6 months later.
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http://dx.doi.org/10.1097/MPH.0b013e31826e7dbaDOI Listing
November 2012

Giant left atrial myxoma everything is bigger in Texas.

Tex Heart Inst J 2012 ;39(2):286-7

Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384026PMC
November 2012

Tiger heart: a variant of isolated left ventricular noncompaction?

Tex Heart Inst J 2012 ;39(3):444-5

Departments of Radiology and Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3368445PMC
October 2012

Hepatic subcapsular hematoma: two neonates with disparate presentations.

Pediatr Neonatol 2012 Apr 2;53(2):144-6. Epub 2012 Mar 2.

Department of Paediatrics, Great Ormond Street Hospital, London, UK.

Subcapsular hematoma of the liver rarely occurs in neonates and the diagnosis is often missed or delayed. We report two babies who had this uncommon condition in the early neonatal period. In the first baby, the hematoma was associated with ventouse delivery and presented with abdominal distension and worsening jaundice. In contrast, the other baby was relatively well, with progressive pallor as the only clinical finding. The former had no other identifiable risk factors, whereas the latter was confirmed as having classical hemophilia. The literature is briefly reviewed with regards to incidence, etiology, diagnosis and management. Awareness of this unusual entity coupled with a high index of suspicion is essential for early identification and stabilization of such babies.
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http://dx.doi.org/10.1016/j.pedneo.2012.01.013DOI Listing
April 2012

Outcome of childhood relapsed or refractory mature B-cell non-Hodgkin lymphoma and acute lymphoblastic leukemia.

Leuk Lymphoma 2012 Oct 23;53(10):1882-8. Epub 2012 Apr 23.

Department of Paediatric Haemato-Oncology, Royal Marsden Hospital NHS Foundation Trust, Sutton, Surrey, UK.

Patients with childhood relapsed and refractory mature B-cell non-Hodgkin lymphoma (B-NHL) and acute lymphoblastic leukemia (B-ALL) are rare and have a dismal prognosis. The previous UK national analysis of 26 children over a 7-year period prior to 1996 had highlighted the poor outcome, with only three survivors. This 10-year multicenter study evaluated recent data, since 2000. Of 33 children, nine survived (27.3%), with a median follow-up of 4.3 years. On exclusion of six children treated with palliative intent, the survival was one-third (nine of 27; 33.3%). All patients with primary refractory disease (n = 7) and all except one with early relapse (n = 11) died. Administration of four doses of 375 mg/m(2) of rituximab was associated with a longer survival (p = 0.006). Response to reinduction (p < 0.001) and autologous hematopoietic stem cell transplant (auto-HSCT) (p = 0.003) were significant on multivariate analysis. Patients with a time to relapse of at least 6 months are potentially curable and must be offered intensive treatment with salvage chemotherapy, rituximab and auto-HSCT.
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http://dx.doi.org/10.3109/10428194.2012.677534DOI Listing
October 2012

A rare combination of two rare diseases: left ventricular noncompaction and hypertrophic cardiomyopathy.

J Am Coll Cardiol 2011 Nov;58(20):e37

Clinical Institute of Radiology, University Medical Centre, Ljubljana, Slovenia.

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http://dx.doi.org/10.1016/j.jacc.2011.03.075DOI Listing
November 2011

Osteolytic presentation of pediatric acute megakaryoblastic leukemia.

Pediatr Hematol Oncol 2011 Sep 25;28(6):526-8. Epub 2011 Jul 25.

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http://dx.doi.org/10.3109/08880018.2011.584608DOI Listing
September 2011

Clinical profile and outcome of urotheliotropic viral haemorrhagic cystitis following haematopoietic stem cell transplantation: a 7-year tertiary centre analysis.

Hematology 2011 Jul;16(4):213-20

Department of Haematology, Royal Marsden Hospital NHS Foundation Trust, Sutton, Surrey, UK.

Viral haemorrhagic cystitis (HC) is a significant complication after haematopoietic stem cell transplantation (HSCT), with a potential for major morbidity. The aim of this 7-year analysis of 1160 HSCT patients was to evaluate risk factors for the incidence, severity, toxicity of therapy, clinical course, and outcome of this condition. The overall incidence of HC was 5·8%, with most cases occurring after allogeneic HSCT. Unrelated donors (P = 0·001), non-peripheral blood stem cell source (P = 0·005), myeloablative conditioning (P<0·001), use of alemtuzumab in conditioning (P = 0·001), and severe acute graft versus host disease (P<0·001) were independent risk factors for an increased incidence of HC post-allogeneic transplant on multivariate analysis. Severe forms of HC were associated with grades II-IV acute graft versus host disease and a longer duration of haematuria. Contrary to previous studies which were carried out on smaller patient populations, busulphan, cyclophosphamide, anti-thymocyte globulin, and total body irradiation were not found to independently increase the risk of viral HC, unless used in a myeloablative combination. Neither duration of viriuria nor peak viral load in urine influenced the severity of HC on multivariate analysis. Severe HC contributed to the deaths of two patients. Overall survival was not statistically different between patient subgroups with non-severe and severe HC.
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http://dx.doi.org/10.1179/102453311X13025568941763DOI Listing
July 2011

Rheumatologic manifestations of benign and malignant haematological disorders.

Clin Rheumatol 2011 Sep 23;30(9):1143-9. Epub 2011 Jun 23.

Department of Rheumatology, MES Medical College, Perinthalmanna, Kerala, India.

Diseases of blood and lymphoreticular system can have multisystem manifestations. Rheumatologic involvement has been reported in association with many benign and malignant haematological disorders; these patients are equally likely to present to both clinical rheumatologists and haematologists. This review focuses on the well-described rheumatologic features, other occasionally reported rheumatologic manifestations and unusual musculoskeletal complications related to the treatment in patients with underlying haematological conditions. The aim of this review is to help increase the awareness of rheumatologic manifestations seen in the blood disorders and to highlight the potential diagnostic pitfalls.
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http://dx.doi.org/10.1007/s10067-011-1799-xDOI Listing
September 2011

First report of fatal human infections with the cactophilic yeast Sporopachydermia cereana.

J Infect 2011 Apr 3;62(4):311-3. Epub 2011 Mar 3.

Department of Haematology, Royal Marsden Hospital NHS Foundation Trust, Downs Road, Sutton, Surrey SM25PT, United Kingdom.

Sporopachydermia cereana is a cactophilic yeast, which is not recognised as a human pathogen. We describe two fatal infections with this fungus in profoundly neutropenic patients. S. cereana escapes detection by conventional mycological identification methods. This organism may be an under-recognised cause of fatal fungal sepsis among immunocompromised patients.
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http://dx.doi.org/10.1016/j.jinf.2011.02.008DOI Listing
April 2011

Dyssynchrony in obese subjects without a history of cardiac disease using velocity vector imaging.

J Am Soc Echocardiogr 2011 Jan 13;24(1):98-106. Epub 2010 Nov 13.

Einstein Institute for Heart and Vascular Health, Albert Einstein Medical Center and Jefferson Medical College, Philadelphia, Pennsylvania 19141, USA.

Background: The aim of this study was to examine the occurrence of intra-left ventricular (LV) dyssynchrony in obese versus nonobese subjects without known cardiac disease using Velocity Vector Imaging (VVI).

Methods: One hundred ninety consecutive subjects with no known cardiac disease had their echocardiograms analyzed using VVI after excluding subjects with QRS durations>120 msec or LV ejection fractions<55%. Study subjects were divided into two groups on the basis of body mass index: obese (>30 kg/m2) and nonobese (<30 kg/m2).

Results: The final cohort included 136 subjects (74 obese; 32% women; mean age, 55±16 years). The occurrence of intra-LV dyssynchrony was higher in the obese group compared with the nonobese group.

Conclusions: There was an increased prevalence of intra-LV dyssynchrony in obese subjects, especially longitudinal and radial dyssynchrony. This dyssynchrony may signal a mechanism by which obesity predisposes to the development of heart failure.
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http://dx.doi.org/10.1016/j.echo.2010.10.003DOI Listing
January 2011

The feasibility of plerixafor as a second-line stem cell mobilizing agent in children.

J Pediatr Hematol Oncol 2011 Jan;33(1):65-7

Department of Pediatric Hemato-Oncology, Royal Marsden Hospital NHS Foundation Trust, Sutton, UK.

In patients heavily pretreated with myelosuppressive chemotherapy or irradiation, Granulocyte colony stimulating factor (G-CSF) may fail to mobilize stem cells from the bone marrow. Plerixafor is emerging as a reliable alternate option in such situations in adult patients. Robust data in support of the high efficacy and safety of plerixafor are available in adults. Very little evidence is available on the usefulness of this drug among children. We report our experience with plerixafor usage on 5 occasions in pediatric patients, with a success rate of 60%. No significant side effects were encountered in any patient.
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http://dx.doi.org/10.1097/MPH.0b013e3181e9e4c2DOI Listing
January 2011

Epstein-Barr virus infections after allogeneic stem cell transplantation: a comparison between non-malignant and malignant hematological disorders.

Hematology 2010 Oct;15(5):344-50

Department of Hematology, St George's Hospital, London, UK.

Hematological cancers and non-malignant hematological disorders are biologically diverse conditions and are treated differently. We compared the pattern of EBV infections following allogeneic stem cell transplantation between the above two groups of hematological disorders. Eighty-three transplants were evaluated over a consecutive 7-year period at a single center. No difference was found in the incidence of post-transplant EBV infections between the two groups, though a higher median peak viral load was noted in the non-malignant group (P=0·04). Pre-transplant immunosuppressive therapy with antithymocyte globulin (ATG) significantly increased the risk of post-transplant EBV infections (P=0·04) in the non-malignant group patients. No significance was found for prior cytotoxic chemotherapy among the malignant group of patients. Alemtuzumab based conditioning was not associated with an increased risk for EBV infections in either of the groups. Treatment with two or more courses of ATG was found to be significantly associated with post-transplant EBV-related PTLD (P=0·01). Post-transplant EBV infections did not influence overall survival (non-malignant, P=0·66; malignant, P=0·41) in either of the subgroups. There were no deaths directly attributable to EBV infections.
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http://dx.doi.org/10.1179/102453310X12647083621047DOI Listing
October 2010

Synchronous mantle cell lymphoma, chronic lymphocytic leukaemia and melanoma in a single lymph node.

Acta Haematol 2010 17;123(3):194-6. Epub 2010 Mar 17.

Department of Haemato-Oncology, Royal Marsden NHS Foundation Trust, Institute of Cancer Research, London, UK.

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http://dx.doi.org/10.1159/000297525DOI Listing
April 2010

Images in hematology. Transient erythrocyte changes caused by infiltration of liver by plasma cell leukemia.

Am J Hematol 2011 Jan 8;86(1):67-8. Epub 2010 Feb 8.

Department of Hematology, St George's Hospital, London, United Kingdom.

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http://dx.doi.org/10.1002/ajh.21669DOI Listing
January 2011

Carcinomatous infiltration of cerebrospinal fluid with reactive lymphocytosis and granulocytosis.

Am J Hematol 2010 Oct;85(10):791

Department of Hematology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom.

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http://dx.doi.org/10.1002/ajh.21652DOI Listing
October 2010

Early cytomegalovirus infections following allogeneic stem cell transplantation: a comparison between non-malignant and malignant haematological disorders.

Hematology 2010 Feb;15(1):4-10

Department of Haematology, St George's Hospital, London, UK.

The haematological indications for allogeneic stem cell transplantation can be broadly divided into non-malignant and malignant disorders. We compared the incidence and risk factors for post-transplant cytomegalovirus (CMV) infections between these two biologically diverse subgroups of haematological conditions. Out of 105 allogeneic transplants, 64 and 41 were for underlying non-malignant and malignant indications respectively. CMV infections were significantly more frequent (P=0.016) in the malignant subgroup. Pre-transplant recipient CMV seropositivity in both subgroups (negative versus positive; non-malignant,P=0.023; malignant, p<0.001), donor seropositivity (P=0.002) and acute graft-versus-host disease (GVHD) (P=0.02) in the non-malignant subgroup and > or =3 courses of previous cytotoxic therapy (P=0.023) in the malignant subgroup were found to be associated with an increased risk of CMV infections. On multivariate analysis, donor seropositivity in the non-malignant patients (negative versus positive,P=0.022; odds ratio: 0.18) and recipient seropositivity in patients with malignancies (negative versus positive; P=0.001, odds ratio: 0.01) were identified to be significant factors for risk of CMV infection.
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http://dx.doi.org/10.1179/102453310X12583347009612DOI Listing
February 2010
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