To the Editor: ZNF384 (zinc finger protein 384) rearrangements are recently recognized cytogenetic abnormalities. Forty-eight percent of mixedphenotype acute leukaemia (MPAL), B/myeloid 1 and 4% of B-cell precursor acute lymphoblastic leukaemia (BCP-ALL) 2 show this rearrangement. Several fusion partners of ZNF384 have been described, the most common being TCF3 and EP300, but also include ESWR1, TAF15, CREBBP, ARID1B, SYNRG and BMP2K. 1-3 We report a challenging case with TCF3-ZNF384 rearrangement that initially presented as BCP-ALL but showed the emergence of a large myeloid blast subset following 1 week of high-dose steroid therapy. A 2-year-old female presented with fever and pallor of 1 week duration. Examination revealed mild hepatomegaly and splenomegaly. The haemoglobin was 46 g/L, platelet count 14.0 × 10 9 /L and total leukocyte count 14.7 × 10 9 /L. Peripheral blood film showed 62% blasts (Figure 1A,B). Bone marrow aspiration revealed 82% blasts without Auer rods but with cytochemical myeloperoxidase (MPO) positivity in 2% of the blasts. On flow cytometry, the blasts expressed bright CD19, cytoplasmic CD79a, cytoplasmic CD22 and CD33, along with dim expression of CD10 and CD13 (Figure S1). However, cytoplasmic myeloperoxidase (anti-MPO) expression was absent. Fluorescent in situ hybridisation (FISH) testing with dual-colour dual-fusion probes for BCR-ABL1 and ETV6-RUNX1, and dual-colour break-apart probes for KMT2A and TCF3 (CytoTest Inc. Rockville, MD, USA) revealed presence of TCF3 translocation in 80% of cells (Figure 1E). TCF3-PBX1 and TCF3-HLF translocations were excluded using a tri-colour probe (Cytocell Ltd, Cambridge). In view of absence of metaphase, further FISH testing was performed using a commercially available dual-colour break-apart probe (ZytoVision GmbH, Germany) that confirmed rearrangement of ZNF384 (Figure 1G). A diagnosis of BCP-ALL with TCF3-ZNF384 [t(12;19)(p13;p13)] rearrangement was rendered, following which the child was initiated on the standard-risk BCP-ALL protocol of the Indian Childhood Collaborative Leukaemia Group (ICiCLe), comprising a prephase of prednisolone 60 mg/m 2 /day in three divided doses. 4

Background: This study was conducted to determine if oral antibiotics started at presentation reduce the duration of acute exacerbations of bronchial asthma by comparing the durations of mild to moderate exacerbations of asthma managed with or without antibiotics in children below 12 years.Methods:In this systematic trial, we allocated the eligible children to antibiotic group (who also received standard of care and control (the standard of care) group (n=40 in each group) and compared the duration of acute asthma exacerbation between the two groups.Results: The mean difference of duration of mild and moderate exacerbations between the antibiotic and control group was 4.76 hours (95% Confidence Interval (CI) of -36.76 to 28.84) which was found not to be statistically significant (p value- 0.482).Conclusions:There was no significant reduction in the duration of mild to moderate exacerbations of asthma in children below 12 years by the administration of empirical antibiotics.

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