Correlation of amniotic fluid index with fetomaternal outcome

Background: Amniotic fluid acts like a protective cover around the baby. Advances in ultrasound have increased early detection of abnormal amniotic fluid volumes. Any variation in the amniotic fluid volume warrants antenatal foetal surveillance.Methods: 300 pregnant women between 37 to 40 weeks of gestation were included in the study. A detailed history, examination and ultrasound was done. Pregnant women were divided into 3 groups’ i.e. normal liquor, oligohydramios and polyhydramnios. All the women were closely monitored during labour and puerperium. Follow-up was done till 7 days post-delivery. Maternal and neonatal data were collected.Results: 300 pregnant women were included in the study, out of which 221 had normal amniotic fluid index (AFI), 64 had oligohydramnios and 15 had polyhydramnios. All baseline characteristics were comparable between the groups except body mass index (BMI). Incidence of meconium stained liquor was significantly higher in oligohydramnios compared to normal AFI and polyhydramnios groups (34.4% versus 10.5% versus 13.3%; p=0.0001). Caesarean section rates were significantly higher in polyhydramnios and oligohydramnios compared to normal AFI group (73.3% versus 70.3% versus 19.9%; p=0.0001). Higher cases of low birth weight were recorded in oligohydramnios group compared to normal AFI and polyhydramnios group group (32.8% versus 18.6% versus 13.3%; p=0.011). Neonatal intensive care unit (NICU) admissions were higher in oligohydramnios (35.9%) and polyhydramnios (33.3%) compared to normal AFI group (35.9% versus 33.3% versus 12.7%; p=0.0001).Conclusions: Abnormal liquor volumes are associated with increased caesarean section rates, NICU admissions and neonatal mortality. Careful assessment of pregnant women is imperative for proper counselling and management

Clonal Evolution of B-Cell Acute Lymphoblastic Leukemia with del(9)(p13p21) into Mixed Phenotype Acute Leukemia Presenting as an Isolated Testicular Relapse

Lineage switch in acute leukemias is a well-reported occurrence; however, most of these cases involve a switch from either lymphoid to myeloid or myeloid to lymphoid lineage. Here, we report a case of a 14-year-old male with B-cell acute lymphoblastic leukemia (B-ALL) who initially responded well to standard chemotherapy but then later developed mixed phenotype acute leukemia (MPAL) at relapse, likely reflecting a clonal evolution of the original leukemia with a partial phenotypic shift. The patient had a del(9)(p13p21) in his leukemia blasts at diagnosis, and the deletion persisted at relapse along with multiple additional cytogenetic aberrations. Interestingly, the patient presented with an isolated testicular lesion at relapse, which on further analysis revealed both a lymphoid and myeloid component. Unfortunately, the patient did not respond well to treatment at relapse and eventually succumbed to his disease. To our knowledge, an isolated extramedullary MPAL at relapse in a patient with previously diagnosed B-ALL has not been reported in the literature before

Obesity-induced galectin-9 is a therapeutic target in B-cell acute lymphoblastic leukemia

The incidence of obesity is rising with greater than 40% of the world’s population expected to be overweight or suffering from obesity by 2030. This is alarming because obesity increases mortality rates in patients with various cancer subtypes including leukemia. The survival differences between lean patients and patients with obesity are largely attributed to altered drug pharmacokinetics in patients receiving chemotherapy; whereas, the direct impact of an adipocyte-enriched microenvironment on cancer cells is rarely considered. Here we show that the adipocyte secretome upregulates the surface expression of Galectin-9 (GAL-9) on human B-acute lymphoblastic leukemia cells (B-ALL) which promotes chemoresistance. Antibody-mediated targeting of GAL-9 on B-ALL cells induces DNA damage, alters cell cycle progression, and promotes apoptosis in vitro and significantly extends the survival of obese but not lean mice with aggressive B-ALL. Our studies reveal that adipocyte-mediated upregulation of GAL-9 on B-ALL cells can be targeted with antibody-based therapies to overcome obesity-induced chemoresistance

Significance of minimal residual disease in pediatric mixed phenotype acute leukemia: a multicenter cohort study

© 2020, The Author(s), under exclusive licence to Springer Nature Limited. The rarity of mixed phenotype acute leukemia (MPAL) has precluded adequate data to incorporate minimal residual disease (MRD) monitoring into therapy. Fluidity in MPAL classification systems further complicates understanding its biology and outcomes; this includes uncertainty surrounding the impact of shifting diagnostic requirements even between iterations of the World Health Organization (WHO) classification. Our primary objective was to address these knowledge gaps. To do so, we analyzed clinicopathologic features, therapy, MRD, and survival in a centrally-reviewed, multicenter cohort of MPAL uniformly diagnosed by the WHO classification and treated with acute lymphoblastic leukemia (ALL) regimens. ALL induction therapy achieved an EOI MRD negative (\u3c0.01%) remission in most patients (70%). EOI MRD positivity was predictive of 5-year EFS (HR = 6.00, p \u3c 0.001) and OS (HR = 9.57, p = 0.003). Patients who cleared MRD by EOC had worse survival compared with those EOI MRD negative. In contrast to adults with MPAL, ALL therapy without transplantation was adequate to treat most pediatric patients. Earlier MRD clearance was associated with better treatment success and survival. Prospective trials are now necessary to validate and refine MRD thresholds within the pediatric MPAL population and to identify salvage strategies for those with poor predicted survival

Significance of minimal residual disease in pediatric mixed phenotype acute leukemia: a multicenter cohort study.

© 2020, The Author(s), under exclusive licence to Springer Nature Limited. The rarity of mixed phenotype acute leukemia (MPAL) has precluded adequate data to incorporate minimal residual disease (MRD) monitoring into therapy. Fluidity in MPAL classification systems further complicates understanding its biology and outcomes; this includes uncertainty surrounding the impact of shifting diagnostic requirements even between iterations of the World Health Organization (WHO) classification. Our primary objective was to address these knowledge gaps. To do so, we analyzed clinicopathologic features, therapy, MRD, and survival in a centrally-reviewed, multicenter cohort of MPAL uniformly diagnosed by the WHO classification and treated with acute lymphoblastic leukemia (ALL) regimens. ALL induction therapy achieved an EOI MRD negative (\u3c0.01%) remission in most patients (70%). EOI MRD positivity was predictive of 5-year EFS (HR = 6.00, p \u3c 0.001) and OS (HR = 9.57, p = 0.003). Patients who cleared MRD by EOC had worse survival compared with those EOI MRD negative. In contrast to adults with MPAL, ALL therapy without transplantation was adequate to treat most pediatric patients. Earlier MRD clearance was associated with better treatment success and survival. Prospective trials are now necessary to validate and refine MRD thresholds within the pediatric MPAL population and to identify salvage strategies for those with poor predicted survival