CAR-T Therapy, the End of a Chapter or the Beginning of a New One?

Chimeric antigen receptor-T (CAR-T) therapy targeting CD19 has revolutionised the treatment of advanced acute lymphoblastic leukaemia (ALL) and diffuse large B-cell lymphoma (DLBCL). The ability to specifically target the cancer cells has shown high positive results as reported in the registration studies. The success of CAR-T therapy in the first two indications led to the initiation of a large number of studies testing CAR-T therapy in different haematologic tumours such as acute myelogenous leukaemia (AML), Hodgkin’s disease (HD), chronic lymphocytic leukaemia (CLL), multiple myeloma (MM), as well as different solid tumours. Unfortunately, relapses occurred in patients treated with CAR-T therapy, calling for the development of effective subsequent therapies. Likewise, this novel mechanism of action was also accompanied by a different toxicity profile, such as cytokine release syndrome (CRS). Patients’ access to the treatment is still limited by its cost. Notwithstanding, this did not prohibit further development of this new therapy to treat other malignancies. This research activity of CAR-T therapy moves it from being used as an end-stage treatment for ALL and DLBCL to a new therapeutic option for a wide range of patients with different haematologic and solid tumours.

Correlation of Bone Marrow Morphology and Immunophenotyping in Acute Leukaemia Patients

Background: Acute leukaemia (AL) is a malignant disorder of the blood that is characterized by blocked or impaired differentiation of haemopoietic stem cells, resulting in abnormal accumulation of immature precursors and suppression of growth and maturation of cells in vivo. Objective: To find out correlation between morphological and immunophenotypic study of bone marrow among acute leukaemia patient. Methods/Procedure: This is a comparative cross sectional study of diagnosis of leukaemia by bone marrow study and immunophenotyping from bone marrow sample with bone marrow alone of suspected cases of leukaemia treated in the department of haematology in Dhaka Medical College Hospital (DMCH)from March 2013 to August 2013 .Bone marrow examination and immunophenotyping was done simultaneously but having bone marrow morphology report we have compared with flow report. Results: Out of 50 patients according to Bone marrow study (BMS) 25(50.0%) of the patients had acute myelogenous leukaemia, 24(48.0%) had acute lymphoblastic leukaemia and 1(2.0%) had acute leukaemia. On the other hand, in immunophenotyping 28(56.0%) patients had acute lymphoblastic leukaemia, 20(40.0%) had acute myelogenous leukaemia and 2(4.0%) mixed cell immunophenotyping. Discordance of diagnosis was found in 3(6%) is diagnose as AML which was ALL on flow and one acute leukaemia and one AML was subsequently diagnose as mixed cellular leukaemia. Conclusion: Subjective variation in the accuracy of diagnosis of leukaemia on the basis of bone marrow study alone may occur. Inclusion of immunophenotyping with bone marrow study improves accuracy of leukaemia.

Diagnostic Role of Bone Marrow Examination in Detecting Haematological and Nonhaematological Disorders

Introduction: Bone marrow study has wide application in clinical medicine. It is important test not only for diagnosis of haematological diseases but also for various systemic illnesses. The aim of this study is to determine the indications, the spectrum of haemotological and non haematological disorders diagnosed by using this procedure. Materials & Methods: It was a prospective study comprising 152 patients who underwent bone marrow examination for evaluation of haematological and nonhaematological disorders in the Department of Haematology, Enam Medical College Hospital during the period of 2012 to 2017. Results: In our study male to female ratio was 1.6:1 and common age group was >45years (n-65, 42.76%). Most common indications for bone marrow examination were pancytopenia (26.97%, n-41) and diagnosis of leukaemia/myeloproliferative neoplasm (25.66%, n-38). 90.13% (n-137) marrows were pathological. Non-malignant conditions were 40.79% (n-62) and malignant conditions were 49.43% (n-75). Non malignant haematological condition were 33.55% (n-51), malignant haematological conditions were 47.37% (n-72). Most common nonmalignant haematological conditions were aplastic anaemia (15.13%, n-23) and immune thrombocytopenic purpura (9.87%, n-15). Visceral leishmaniasis was found 3.29% (n-5). Acute myelogenous leukaemia (14.47%, n-22) and multiple myloma (11.18%, n-17) were the most common malignant haematological condition. Secondary deposit was found 1.97% (n-3). Conclusion: Bone marrow examination is a simple invasive procedure for diagnosis of both haematological and nonhaematological diseases when routine investigations failed to reach the final diagnosis. Medicine Today 2019 Vol.31(1): 15-18