Angioimmunoblastic T cell lymphoma (AITL) is a common subtype of mature peripheral T cell lymphoma (PTCL). As per the 2016 World Health Organization classification, AITL is now considered as a subtype of nodal T cell lymphoma with follicular helper T cells. The diagnosis is challenging and requires a constellation of clinical, laboratory and histopathological findings. Significant progress in the molecular pathophysiology of AITL has been achieved in the past two decades. Characteristic genomic features have been recognized that could provide a potential platform for better diagnosis and future prognostic models. Frontline therapy for AITL was mainly depending on chemotherapy and the management of relapsed or refractory AITL is still unsatisfactory with a very poor prognosis. Upfront transplantation offers better survival. Novel agents have been introduced recently with promising outcomes. Several clinical trials of combinations using novel agents are underway. Herein, we briefly review recent advances in AITL diagnosis and the evolving treatment landscape.

Introduction A positive direct antiglobulin test (DAT) with or without autoimmune hemolytic anemia is a frequent finding in chronic lymphocytic leukemia (CLL). The heterogenic clinical course of CLL mainly depends on different pathogenetic mechanisms which appears in a form of variable biological and clinical features. These features allow stratification of patients into subsets with different outcomes. Patients and Methods We evaluated the DAT as a prognostic marker in 120 CLL patients treated with chemoimmunotherapy. Clinical and laboratory features, treatment response, and survival outcomes of CLL patients were assessed in relation to their DAT test status. Additionally, the English literature was extensively reviewed regarding the prognostic impact of a positive DAT in CLL. Results DAT positivity was detected in 36 patients (30%) and was associated advanced disease staging ( P = 0.03). No correlations were found with other clinical, laboratory, or biological factors such as ZAP-70 or CD38. Both a positive DAT and an Eastern Cooperative Oncology Group performance status >2 were predictors for non-response to first-line treatment in the multivariate analysis (OR = 0.3, 95% CI: 0.12–0.8 and OR = 0.2, 95% CI: 0.08–0.8, respectively). The five-year progression-free survival was significantly lower in the DAT-positive group ( P = 0.004). No significant association was found with overall survival ( P = 0.2). Sixteen reports analyzing more than 11,000 patients were identified in our review. Conclusion In conclusion, DAT positivity in CLL patients is associated with poor response to treatment and disease progression.

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Thrombocytopenia is a well-known relative contraindication for the initiation of antiviral therapy in HCV-infected patients and may also result in the postponement of many invasive procedures that chronic liver disease (CLD) patients may need to undergo, such as percutaneous, transjugular, or laparoscopic liver biopsy; paracentesis; thoracentesis; radiofrequency ablation; or partial hepatectomy for hepatocellular carcinoma. The latter group of patients may also need to undergo splenectomy, especially if the platelet counts are ,50,000/mm3(Cacoub et al.,2000). Different therapeutic strategies have been suggested and tried for the treatment of HCV-related thrombocytopenia in different studies with variable success (generally disappointing). However, the recent introduction of second-generation thrombopoietinreceptor agonists (TPO-RAs) has opened up a novel way to treat thrombocytopenia. In 2008, the US Food and Drug Administration approved two TPO-RAseltrombopag and romiplostim for use in chronic immune thrombocytopenic purpura(CITP) patients refractory to at least one standard treatment (Nurden et al.,2009). Background: Thrombocytopenia is a common hematological abnormality observed in patients infected with hepatitis C virus (HCV). Thrombocytopenia is a well-known relative contraindication for the initiation of antiviral therapy in HCV-infected patients and may also result in the postponement of many invasive procedures that chronic liver disease (CLD) patients may need to undergo. This study aiming to determine the platelet response to eltrombopag and side effects of eltrombopag therapy in patients with HCV-associated thrombocytopenia. Patients and methods: This prospective study was carried out on 30 patients with chronic HCVassociated thrombocytopenia (<50,000×109/L) thatprecludes the initiation of HCV therapy. Eltrombopag was initiated at a dose of 25 mg once daily; the dose was adjusted with 25 mg increments every 2 weeks to achieve the target platelet count. The primary end point was to achieve stable target platelet count(>100,000×109/L) required to initiate antiviral therapy and any surgical intervention. Results: Treatment response was achieved in 29 (96.7%) patients. This prospective study showed That when the dependent variable was the increased platelet count at second week of treatment while the independent variables are: age, albumin level, gender, platelet count before treatment, AST, and WBC count. The only significant positive predictive factor was the platelet count before treatment. Conclusion:Eltrombopag causes significant elevation of platelet count in patients with HCV related thrombocytopenia, so that Eltrombopag could be used prior to and during treatment with antiviral therapy when thrombocytopenia become confronting problem as well as before surgical interventions.

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