Treatment option of Haematological malignancies has expanded over the last decade. The outcome of treatment is expected to be better compare to previously. However, study of treatment outcome for haematological malignancies has not been carried out in Malaysia. The goal of this study is to measure the treatment outcome in patients with haematological malignancy.
The aims of this study were to determine the types of cancers and hematological disorders in patients attending a pediatric hematology-oncology clinic. This was a prospective study at the Pediatric Institute, General Hospital Kuala Lumpur, Malaysia from June 2005-November 2006. During the 18-month study, 803 patients attended the clinic, 730 had oncological problems and 73 had hematological problems. The age range was from 2 months to 28 years (median 6 years). The patients were Malay (66%), Chinese (23%), Indian (10%) and other races (1%). Of the oncological patients, 51% had either leukemia (n=293) or lymphoma (n=77). The other most common diagnoses were retinoblastoma, followed by Wilm's tumor and germ cell tumors. Six patients (0.8%) developed a second malignant neoplasm. Of the hematological patients, 60% had platelet disorders, most commonly chronic immune thrombocytopenic purpura. Twenty-four per cent had bone marrow failure and 16% had red cell disorders.
Study site: Pediatric Institute, General Hospital Kuala Lumpur
Although classified as an AIDS-defining illness, several reports show histoplasmosis also affects patients living with cancers including haematological malignancies and solid tumours. However, reviews describing cases of histoplasmosis in malignancies are lacking in the literature. We identified a total of thirty-four cases with twenty (58.8 %) cases reported from the USA, four from Brazil (11.8 %), three from India (8.8 %), and one each from Singapore (2.9 %), France (2.9 %), Netherlands (2.9 %), Colombia (2.9 %), Canada (2.9 %), Morocco (2.9 %), and Malaysia (2.9 %). 82.4 % (n = 28) of the cases were adults. Presenting symptoms were majorly fever (61.7 %), lymphadenopathy (50.0 %) and weight loss (29.4 %). Essential haematologic findings were pancytopaenia (n = 7, 20.6 %), neutropenia (n = 2, 5.9 %) and anaemia (n = 5, 14.7 %). The associated cancers were predominantly haematological and comprised 73.5 % (n = 25) of all cases. The diagnosis of histoplasmosis was via histopathology (n = 23, 67.6%), culture (n = 13, 38.2%), Histoplasma antigen assay (n = 13, 38.2%), anti-Histoplasma antibody assay (n = 5, 14.7%), PCR and sequencing (n = 2, 5.9%), peripheral blood film/direct microscopy (n = 4, 11.8%) and cytology (n = 1, 2.9%). Of the thirty-four cases, twenty-four (70.6%) had favourable outcomes, eight (23.5%) died, one (2.9%) was lost to follow-up and in one (2.9%) case, the outcome was not stated. Histoplasmosis is not an uncommon opportunistic disease complicating malignancies but is paradoxically underdiagnosed in Africa given the huge burden of cancers in that region. Besides following chemotherapy and the use of steroids, tumour necrosis factor-α antagonists therapy, hematopoietic stem cell transplantation and environmental exposure were factors associated with Histoplasma infection in patients with malignancies. A resolution to promptly screen suspected or confirmed cases of malignancies for histoplasmosis will improve diagnosis and clinical outcomes.