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Fulltext Enteropathy-associated T-cell lymphoma: An extremely rare cause of chronic diarrhoea

Liong CC, Ravindran S, Gnana Kumar G, Chin EF, Koh PS, Chan WK

Med J Malaysia, 2016 04;71(2):88-90.
PMID: 27326953 MyJurnal

Chronic diarrhoea in tropical countries may be due to a myriad of causes from infective to non-infective. This case report illustrates the challenges faced in the investigation of a middle-age Chinese gentleman who presented with chronic diarrhoea and weight loss. The diagnosis of type II enteropathy-associated T-cell lymphoma (EATL) was finally made. The diagnosis of EATL was least suspected as the condition is almost unheard of in this part of the world. The epidemiology, presentation, diagnosis, management and prognosis of this rare condition are discussed.
Nonalcoholic Wernicke Encephalopathy: An Entity Not to Be Missed!

Liong CC, Rahmat K, Mah JS, Lim SY, Tan AH

Can J Neurol Sci, 2016 Sep;43(5):719-20.
PMID: 27670213 DOI: 10.1017/cjn.2016.269
Fulltext Treatment Pattern and Outcome of Newly Diagnosed Multiple Myeloma Patients in a Resource-Limited Setting

Cheong CS, Tengku K Aziz TAH, Anuar NA, Bee PC, Chin EFM, Khairullah S, et al.

Asian Pac J Cancer Prev, 2024 Feb 01;25(2):595-601.
PMID: 38415546 DOI: 10.31557/APJCP.2024.25.2.595

BACKGROUND: Multiple myeloma is the third most common hematologic malignancy in Malaysia. The introduction of novel agents over the past decades has improved patient outcome and survival substantially. However, these agents incur significant economic burden, thus leading to limited use in less developed countries. This study aims to report on the real-world treatment pattern and outcome of newly diagnosed multiple myeloma (NDMM) patients from a resource-constraint setting.
METHODS: This is a retrospective study on NDMM patients diagnosed between 1 January 2008 and 31 December 2022 in a single academic center. Patients' demographic and treatment details were included for analysis of progression free survival (PFS) and overall survival (OS).
RESULTS: One hundred and thirty-six NDMM patients with a median age of 64.0 years (ranged from 38 to 87 years old) were included. Bortezomib-containing regimens were the most commonly used induction agent, followed by thalidomide. Almost half of the patients (47.1%) achieved very good partial response (VGPR) or complete remission (CR), while 31.6% achieved partial response (PR). Bortezomib containing regimen was associated with significantly deeper and more rapid response, (p=0.001 and p=0.017, respectively) when compared to other agents. Only 22.8% of these patients proceeded to upfront autologous haematopoietic stem cell transplantation. The median OS and PFS were 60.0 months and 25.0 months, respectively. Best initial response and upfront autologous stem cell transplantation (ASCT) were significantly associated with better PFS.
CONCLUSION: Achieving at least a VGPR significantly associated with better outcome in NDMM patients. In a resource constrain country, we recommend incorporating bortezomib in the induction therapy followed with an upfront ASCT.
CMV Infection Post Allogeneic Hematopoietic Stem Cell Transplantation in a Resource Limited Country

Sulaiman NY, Anuar NA, Arshad N, Cheong CS, Liong CC, Khairullah S, et al.

Indian J Hematol Blood Transfus, 2024 Jan;40(1):97-102.
PMID: 38312192 DOI: 10.1007/s12288-023-01655-0

Cytomegalovirus (CMV) infection is one of the common complications which can lead to significant morbidity and mortality in patients after allogeneic hematopoietic stem cell transplantation (HSCT). As the seroprevalence of CMV infection in Malaysia is high, this study aims to determine the prevalence of CMV infection in patients post HSCT and to evaluate the associated risk factors. Patients who underwent allogeneic HSCT in adult ward from 2008 to 2020 at a tertiary teaching hospital in Kuala Lumpur, Malaysia were studied retrospectively. They were followed up for a minimum of 100 days post-HSCT to determine the incidence of CMV infection. CMV infection was defined according to CMV Drug Development Forum 2014. Risk factors such as type of transplant, serostatus of donor and patients, age, gender, race, presence of graft versus host disease (GVHD) and underlying disease were included for analysis. A total of 112 patients were included. Forty (35.7%) patients had CMV infection with median of onset recorded as 40 days (range 13-95 days). Only haplo-identical HSCT and presence of GVHD were identified as significant risk factors. Patients who had CMV infection had a lower median survival time although this was not statistically significant. The CMV infection rate was comparable with previous reports in Asia and as expected, higher than the western countries. Therefore, vigilant monitoring of CMV infection should be implemented especially in patients who had haplo-identical HSCT and acute GVHD.
Incidence and Risk Factors for Invasive Fungal Infection in Patients with Hematological Malignancies at a Tertiary Hospital in Malaysia

Cheong CS, Iyadorai T, Tay ST, Liong CC, Hussein N, Samudi C, et al.

Asian Pac J Cancer Prev, 2025 Mar 01;26(3):839-845.
PMID: 40156400 DOI: 10.31557/APJCP.2025.26.3.839

OBJECTIVE: This study aims to describe the incidence and risk factors of invasive fungal infection (IFI) among patients with haematological malignancies (HM) in a tertiary hospital from Malaysia.
METHODS: This was a cross-sectional study in a teaching hospital involving HM patients, admitted for chemotherapy or haematopoietic stem cell transplantation (HSCT). Each admission for either chemotherapy or HSCT was considered as a separate event. Patients were followed up for development of IFI from the time of each admission to time of discharge or time of death. Outcomes of patients with IFI upon discharge were recorded. Clinical and mycological data during each admission were collected and analysed.
RESULTS: Eighty-three patients with mean age of 58.8±15.5 years were recruited. Acute myeloid leukemia (AML) was the most common diagnosis (45.8%). A total of 132 admissions were analysed from these 83 patients. Antifungal prophylaxes were prescribed in 94.7% of admissions with fluconazole being the most common agent used (88.6%). The incidence of proven and probable IFI was 7.6%. Candida tropicalis was the most common fungi isolated from these patients (22.7%), followed by Candida krusei (13.6%). The mortality rate due to IFI was 17.6%. Patients with AML and those with concomitant bacteraemia were associated with higher risk of IFI (odds ratio [OR] 3.69, 95% confidence interval [CI] 1.16-11.71, p=0.029 and OR 4.17, 95% CI 1.37-12.66, p=0.009, respectively), while the use of antifungal prophylaxis was associated with lower IFI risk (OR 0.17, 95% CI 0.03-0.83, p=0.045). After multivariate analysis, the use of antifungal prophylaxis remains significantly associated with lower risk of IFI (OR 0.54, 95% CI 0.01-0.62, p=0.019).
CONCLUSION: IFI remains one of serious complications of HM patients undergoing chemotherapy and HSCT, most commonly due to non-albicans Candida spp. Appropriate antifungal prophylaxis is therefore crucial in the prevention of breakthrough IFI.