Primary plasma cell leukemia (pPCL) is an aggressive and rare form of plasma cell dyscrasia, requiring early detection and rapid intervention and is characterized by presence of 5

Waldenström macroglobulinemia (WM) is a rare indolent neoplasm characterized by presence of ≥ 10

Anti BCMA bispecific antibodies (BsAb) have changed the treatment landscape of relapsed-refractory multiple myeloma (RRMM). However, these drugs are associated with high rates of infections. This is a retrospective analysis of patients of RRMM who received either Elranatamab or Teclistamab from January, 2023 to September, 2025. The primary objective was to assess response rates, whereas the secondary objectives were to assess OS, PFS, haematological toxicities and non-hematological toxicities. Nine patients received Anti BCMA BsAb (four patients received Elranatamab and five patients received Teclistamab). Median age was 63 years (Range 30-67 years). 77.8

Solitary plasmacytomas (SP) are rare neoplasm of localised proliferation of clonal plasma cells. It can be classified based on site of involvement and bone marrow involvement. It is an indolent disease in the majority of patients. Primary modality of treatment is radiotherapy and surgical excision. This was a retrospective audit of SP who were treated and followed up at a tertiary care center in eastern India from December 2000 to December 2025. Patients who have solitary plasmaSBP_SEPcytoma with more than 10

Fungal infections are common and serious complications in patients undergoing bone marrow transplantation (BMT). Despite the use of prophylactic antifungal therapy, breakthrough infections can occur and lead to significant morbidity and mortality. In this retrospective observational study, we attempted to understand the clinico-epidemiological patterns of breakthrough invasive fungal infections (bIFI) in BMT patients of a tertiary cancer care hospital of eastern India. Cases were included between 2011 and 2021. European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC MSG 2020) criteria were used for diagnosis of invasive fungal infection, and European Confederation of Medical Mycology (ECMM) definition was used to diagnose bIFI. Incidence of bIFI was found to be 5.1

Background There is limited information on outcomes of allogeneic hematopoietic stem cell transplantation (alloHSCT) in adults with acute lymphoblastic leukemia (ALL) from India. Aims 1. To evaluate 4-year event-free survival (EFS) and overall survival (OS) after alloHSCT in adults with ALL. 2. To assess the impact of donor type [Matched related donor (MRD), haploidentical donor (haplo), matched unrelated donor (MUD)], disease status, and graft-versus-host disease (GVHD) on outcomes. 3. To estimate the cumulative incidences (CI) of relapse and non-relapse mortality (NRM) considering competing risks. Methods This multicenter, registry-based study included adult patients (≥18 years) diagnosed with ALL who underwent alloHSCT between January 2012 and June 2024 across 21 centers registered under the Indian Society of Blood and Marrow Transplantation (ISBMT). The data analysis was performed up to the cut-off date of December 31, 2024. Survival probabilities were estimated using Kaplan–Meier methods and compared using the log-rank test. Cumulative incidence analyses were conducted for relapse and non-relapse mortality (NRM), considering deaths without relapse and relapse as competing events, respectively. Results A total of 445 patients were analyzed (median age: 29 years, range 18–62; M: F = 2.6:1). Transplants included MRD 53.4% (n=238), haplo 37.5% (n=167), and MUD 8.9% (n=40). Over half (55%) underwent alloHSCT in CR1, and 44% in non-CR1. Myeloablative TBI conditioning was used in 49.6% (n=221) of cases, with peripheral blood as primary stem cell source (99.5%). Acute GVHD occurred in 32.8%, and chronic GVHD in 23.8% patients. Median follow-up for survivors was 47 months (range: 6.05-146.4). Overall, 55.9% (n=249) died, and 44.2% (n=197) were alive. Relapse/progression occurred in 39% at a median of 6 months, with a 4-year CI of 38.8% (95% CI: 34.2–43.3%). NRM occurred at a median of 2.7 months with a 4-year incidence of 20.6% (95% CI: 16.8–24.4%) (Figure 1f).The 4-year EFS and OS were 36.3% and 39.1%, respectively (Figures 1b, 1a). EFS did not differ between MAC and RIC (39.8% vs 45.5%, p=0.33) (Figure 1c), or between TBI, non-TBI–based regimens, and RIC (39.1%, 46.6%, and 47%, p=0.48). Patients transplanted in CR1 had significantly better EFS (47.6% vs 22%, p<0.001). MRD transplants showed superior 4-year EFS (47.6%) compared with MUD (26.5%) and haplo (30.1%) (p<0.001) (Figure 1d). Acute GVHD did not influence survival (40.2% vs 33.8%, p=0.28), whereas chronic GVHD was associated with improved EFS (65.9% vs 26.9%, p<0.001) (Figure 1e). Conclusions MRD transplants and transplantation in CR1 confer the best survival advantage. Conditioning intensity and donor type (MUD vs. haplo) showed comparable outcomes, while chronic GVHD was associated with significantly improved long-term survival rates.

Measurable residual disease (MRD) monitoring has dramatically improved outcomes in pediatric acute lymphoblastic leukemia (ALL) patients while, the prognosis in adult B-ALL remains poor. Biological heterogeneity, therapy-related toxicity, and inconsistent MRD-integration contribute to this disparity. This study evaluates the early prognostic value of MRD by flow cytometry in high-risk adult B-ALL patients. METHODS:The present study included 47 high-risk adult B-ALL patients stratified by cytogenetic-risk groups (Age range: 18 - 66 years) and treated between January 2020 and December 2024 at Tata Medical Center, Kolkata. MRD was assessed using an 11-color flow cytometry panel at end-of-induction (EOI) and end-of-consolidation (EOC) timepoints. Patient details including demographics, cytogenetic risk profiles, treatment protocols, and survival outcomes were collected. Statistical analysis was performed using univariable, multivariable (MANNOVA) and multivariable cox-regression tests. Kaplan-Meier analysis was performed for survival at 18-months. RESULTS:At EOI time point, 27 patients were MRD-negative, while 20 had detectable MRD (4 low-level <0.01%, 16 high-level ≥0.01%). MRD positivity at EOI significantly correlated with inferior survival at 18 months (log-rank p = 0.004). On univariable cox regression, EOI MRD positive patients demonstrated an approximately six-fold higher hazard of relapse or death compared with MRD-negative patients (HR = 6.33; 95% CI, 0.39-103.07). Multivariable and cox-regression analysis confirmed EOI MRD positivity as an independent predictor of OS (p = 0.004). Additionally, Day 8 prednisone response showed prognostic significance with survival (cox-regression p-value = 0.003; MANNOVA p ≈ 0.05). CONCLUSIONS:The EOI MRD positivity, is a robust independent predictor of 18m-survival in high-risk adult B-ALL patients. Additionally, a longitudinal MRD monitoring enhances risk stratification and informs therapeutic decisions. Therefore, incorporating MRD assessment into routine clinical practice is essential for dynamic risk stratification and optimizing outcomes in High-risk adult B-ALL.

Background Waldenström macroglobulinemia (WM) is a clonal B-cell lymphoproliferative disorder characterized by the presence of monoclonal IgM paraprotein. The traditional treatment approach was chemotherapy in combination with an anti-CD20 antibody. However, the treatment approach underwent a paradigm shift with the approval of Bruton tyrosine kinase inhibitors (BTKis). This retrospective analysis aims to highlight the efficacy and safety of BTKis in WM. Methodology Medical records of patients with WM who received BTKis were retrospectively reviewed. Relevant details regarding demographics, clinical and laboratory investigations, imaging reports, treatment, post-treatment response, adverse events, and infection were extracted from electronic medical records. Descriptive statistics and categorical variables were presented as frequencies and percentages. Survival outcomes were estimated by the Kaplan-Meier method. Results In total, 22 patients received BTKis. Of these, 12 patients received ibrutinib, whereas 10 patients received acalabrutinib. The median age was 64 years. MYD88 L265P positivity was seen in 19 (90.5%) cases, whereas CXCR4 mutations were seen in two (13.3%) cases. The most common indication for treatment with BTKis was anemia (n = 11, 50%). Overall response rate was seen in 18 (81.8%) cases, whereas major response rates were seen in 14 (63.7%) cases. At a median follow-up of 30 months, overall survival and progression-free survival were 91% (95% confidence interval (CI) = 0.87-0.95) and 82% (95% CI = 0.77-0.87), respectively. Neutropenia and thrombocytopenia were seen in 6 (27.3%) and 7 (31.8%) cases, respectively. Bleeding, arrhythmias, and infections were seen in 2 (9.1%), 3 (13.6%), and 18 (81.8%) cases, respectively. Conclusions BTKis are effective in WM but are associated with high rates of hematologic and non-hematologic side effects.

Introduction: Sepsis in acute myeloid leukemia (AML) induction remains a leading cause of morbidity and mortality. This study aimed to evaluate the impact of prophylactic buffy coat–derived granulocyte transfusions in AML induction. Methods: This ambispective, single-center study included newly diagnosed AML patients aged > 18 years who underwent intensive chemotherapy and received prophylactic buffy coat–derived granulocyte transfusions from October 2021 to October 2023. Primary endpoints included ICU admissions, ICU and hospital stay duration, and transfusion support requirements (PRBCs, RDPs, and SDPs). Secondary endpoints included transfusion-related adverse events, duration of antibiotic therapy, and infection-related mortality. Outcomes were compared with matched historical controls. Results: Fifty-one patients (n = 51) received prophylactic granulocyte transfusions and were compared with 51 controls. The median age was 41 years (range 20–58) versus 40 years (18–67). Granulocyte transfusions were given for a median of 5 days (range 1–13), with a median of 30 units per patient (range 6–71). Primary prophylaxis accounted for 78.4

Blast phase (BP) transformation in chronic myeloid leukemia (CML) represents a progression to an aggressive clinical state with dismal outcomes. While most cases exhibit myeloid lineage, rare transformations to megakaryoblastic, mixed phenotype, or undifferentiated forms pose significant diagnostic and therapeutic challenges. In this case series we describe the clinicopathological, immunophenotypic, and molecular features of three rare CML-BP cases and emphasize the role of integrated diagnostics in identifying atypical blast phenotypes. Three adult CML patients presenting in BP were evaluated using peripheral smear morphology, bone marrow examination, immunohistochemistry, multiparameter flow cytometry, and molecular analysis for BCR::ABL1 transcript variants. The first case demonstrated megakaryoblastic transformation with CD41/CD61 positivity. The second case presented as acute undifferentiated leukemia, with blasts lacking definitive lineage markers. The third case exhibited a mixed B/monocytic phenotype consistent with MPAL-B/M, confirmed by dual-lineage antigen expression. All cases expressed the p210 BCR::ABL1 transcript, supporting a diagnosis of CMLrelated secondary blast crisis. Outcomes varied, with one patient achieving molecular remission post-transplant, while others experienced treatment-related complications or succumbed to disease. Atypical phenotypes in CML-BP require a high index of suspicion. Timely integration of flowcytometry and molecular diagnostics is critical to distinguish secondary blast transformation from de novo leukemia and to guide appropriate management strategies.

Cytomegalovirus (CMV) reactivation is a major complication in allogeneic hematopoietic stem cell transplantation (HSCT), increasing nonrelapse mortality (NRM) and transplant-related complications. Letermovir, a CMV deoxyribonucleic acid (DNA) terminase inhibitor, has demonstrated efficacy in reducing CMV reactivation without the hematologic toxicity associated with traditional antivirals. We report two HSCT cases, one with a T-cell receptor (TCR) alpha/beta-depleted haploidentical transplant and another haploidentical (6/10 HLA-matched) stem cell transplant, both at significant risk for CMV reactivation. Letermovir prophylaxis was initiated early post-transplant and continued for 100-200 days, depending on risk factors. Both patients remained free of CMV reactivation throughout follow-up (beyond Day +140), with no breakthrough CMV infection or drug-related adverse effects. This case series highlights the first real-world use of letermovir, India's bioequivalent letermovir, in haploidentical transplant recipients, supporting its clinical effectiveness in a resource-limited setting. Real-world outcomes were consistent with previously reported clinical trial data. While outcomes were favorable, the small sample size and single-center experience represent limitations. Nonetheless, the findings highlight the potential benefit of extended prophylaxis beyond Day 100 and the need for individualized CMV prevention strategies in immunosuppressed populations.

Acute promyelocytic leukemia (APL) is defined by the PML-RARα fusion gene, which serves as a key biomarker for pathogenesis, diagnosis, and measurable residual disease (MRD) monitoring. The incorporation of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) has markedly transformed treatment outcomes. However, treatment-related toxicities frequently lead to treatment interruptions that may lead to persistent MRD post-induction therapy. This study investigates whether variations in doses are associated with persistent MRD. Additionally, statistical modelling is utilized to find the ideal dose and duration of ATRA for induction, to balance drug toxicity and response. A retrospective cohort of APL patients treated at Tata Medical Centre, Kolkata, between January 2019 and July 2024 was analysed. All patients received ATRA-ATO–based induction regimens, with chemotherapy added as per risk stratification. Post-induction MRD status was assessed via digital droplet PCR for PML-RARα on bone-marrow samples. Cumulative ATRA dose, body surface area (BSA) and treatment duration were calculated, considering variations in dose and exposure duration. Binary logistic regression and receiver operating characteristic (ROC) analysis were used to identify dose thresholds predictive of MRD negativity. Of Thirty-seven patients, 54

Chronic myeloid leukemia is a myeloproliferative neoplasm defined by translocation t(9;22)(q34;q11), leading to the BCR::ABL1 fusion gene, which drives unchecked tyrosine kinase activity. Tyrosine kinase inhibitors (TKI) have revolutionised the management of CML offering patients near-normal life expectancy. However, prolonged TKI use poses adverse effects and financial burden. Treatment-free remission (TFR) has emerged as a therapeutic goal, allowing safe discontinuation of TKIs while maintaining remission. However, the cost and logistics of frequent monitoring is yet another problem in resource-limited setting. We evaluated 16 CML patients initiated on TFR at our centre. Out of which eleven patients maintained remission, with a median TKI duration of eight years and a median deep molecular remission of three years, followed over a duration of 66 months. The probability of survival without molecular relapse (SWMR) stabilized at 67

Allogeneic haematopoietic stem cell transplantation (HSCT) is currently indicated in Chronic Myeloid Leukemia (CML) patients who are intolerant or resistant to 2 or more Tyrosine Kinase Inhibitors (TKIs) or in patients with advanced stage disease. This study reports the use of ponatinib as a salvage option in patients who are either ineligible or cannot afford an allogenic transplant. CML patients treated with ponatinib at our centre between 1st January 2019 to 28th February 2025 were assessed retrospectively. The study included 40 patients [35 CML chronic phase (CP) and 5 CML- accelerated phase (AP) patients]. RQPCR data was available for 25 patients at three and twelve months, respectively. At 3 months, a total of 16 patients (64

The aim of this study is to analyze the profile of patients receiving daratumumab and their presentation to the transfusion laboratory by looking at the different pre-transfusion policies and the risk of erythrocyte alloimmunization. Patients receiving daratumumab from 2018 to 2023 were reviewed. They were divided into two groups: Group I, presented before administration of daratumumab, and Group II, presented after drug administration. Appropriate strategies were applied to mitigate the drug interference, and the transfusion outcome was analyzed by following up with the patients for six months. A total of 48 patients were studied. The antibody screen was negative in patients who presented before the administration of daratumumab (n = 35). Extended phenotyping was done for 31 patients. Blood group genotyping was done for 4 patients. The patients who presented after daratumumab administration (n = 13) had a positive antibody screen that became negative with dithiothreitol-treated cells. A total of 261 red cell units were transfused to these patients (mean 5.55 units per patient). None of the patients developed antibodies during the follow-up period. The transfusion services must frame policies and protocols to mitigate drug interference. Good communication between transfusion services and clinical hematologists is a must to ensure safe transfusions.

Melphalan-induced encephalopathy is a rare complication observed in patients undergoing autologous stem cell transplantation (ASCT) and is characterized by symptoms ranging from drowsiness to seizures.Previous reports have described similar cases, including a review of a large cohort of patients in whom melphalanassociated encephalopathy was identified in 2% of the patients undergoing ASCT.We describe the case of a 63year-old male with Multiple Myeloma and underlying chronic kidney disease (CKD) who underwent ASCT with a reduced dose of melphalan due to renal dysfunction in complete remission following induction therapy and subsequent neurological deterioration, which necessitated an extensive evaluation of several neurological and infective etiologies.In this report, we highlight that melphalan-associated encephalopathy is a distinct entity complicating ASCT in patients with myeloma, especially in those with preexisting renal insufficiency, and consider its management.