A double-blind, randomised, placebo-controlled, phase 2b study evaluating sorafenib in combination with paclitaxel as a first-line therapy in patients with HER2-negative advanced breast cancer

BACKGROUND

We conducted a phase 2b, randomised, double-blind, placebo-controlled screening trial to evaluate the addition of the multikinase inhibitor sorafenib (antiproliferative/antiangiogenic) to first-line paclitaxel for human epidermal growth factor receptor 2 (HER2)-negative locally recurrent/metastatic breast cancer.

METHODS

Patients were randomised to paclitaxel (90mg/m(2), weekly, intravenously, 3 weeks on/1 week off) plus sorafenib (400mg, orally, twice daily) or placebo. The primary endpoint was progression-free survival (PFS). A sample size of 220 patients was planned with relative risk ≤ 0.82 (1-sided α=0.14) after 120 events supporting a treatment effect.

FINDINGS

Patients were randomised in India (n=170), the United States (n=52) and Brazil (n=15). Median PFS was 6.9 months for sorafenib versus 5.6 months for placebo (hazard ratio (HR)=0.788; 95% confidence interval (CI), 0.558-1.112; P=0.1715 [1-sided P=0.0857]). The addition of sorafenib increased time to progression (median, 8.1 versus 5.6 months; HR=0.674; 95% CI 0.465-0.975; P=0.0343) and improved overall response (67% versus 54%; P=0.0468). Overall survival did not statistically differ (median, 16.8 versus 17.4 months; HR=1.022; 95% CI 0.715-1.461; P=0.904). Grade 3/4 toxicities (sorafenib versus placebo) included hand-foot skin reaction (31% versus 3%), neutropenia (13% versus 7%) and anaemia (11% versus 6%). Two treatment-related deaths occurred (malaria and liver dysfunction) in the sorafenib arm.

INTERPRETATION

The addition of sorafenib to paclitaxel improved disease control but did not significantly improve PFS to support a phase 3 trial of similar design. Toxicity of the combination was manageable with dose reductions.

Dasatinib in chronic myeloid leukemia: a limited Indian experience

AIM

To report our experience of the use of dasatinib in various phases of chronic myeloid leukemia (CML).

METHODS

Ten patients in various phases of CML, not responding to imatinib and started on dasatinib, were included and analyzed. The baseline characteristics of the patients and their salient features including the duration and response to initial therapy as well as to dasatinib, were noted.

RESULTS

Before starting dasatinib three patients were in chronic phase of CML while seven others were in the progressive phase (accelerated and blast phase) of CML. Half the patients developed transient grade 3 and 4 toxicities to dasatinib. Overall, the tolerability of the drug in all 10 patients was acceptable and none discontinued treatment. Three patients died due to progressive disease while the remaining seven are continuing the drug with the disease still under cytogenetic or hematological remission. Of the 10 patients, seven achieved complete hematological response and two of the accelerated phase/blast crisis patients achieved complete cytogenetic response. Overall, dasatinib was able to control disease for a median of 20.6 months.

CONCLUSION

Despite small sample size and insufficient information on mutational analysis, dasatinib is effective in CML in India. Cost limits the use of second-generation tyrosine kinase inhibitors in India. Our observation is not suitable for survival analysis but the difference made by dasatinib in progressive disease and its tolerability needs to be acknowledged.

Gastric Cancer: a retrospective analysis from AIIMS, New Delhi

Carcinoma of stomach is the leading cause of cancer related death in the last century worldwide. However in many parts of the world, the incidence has gradually decreased due to changes in food habit and the environment. The proximal gastric and gastro-esophageal junction (GE junction) cancer has markedly increased in the last three decades. The only proven curative treatment is surgery, but due to high recurrence rate, efforts are still going on regarding better systemic and regional adjuvant therapies. The present study is a retrospective analysis of all the post-operative (post-op) cases of carcinoma stomach and the GE junction being registered and treated in our department from June 1995 to February 2008. The total number (no.) of patients (pts) were 69 (54 stomach, 15 GE junction), males 49, females 20, KPS 50-90 (median 80), length of the lesion was <5cm in 28 pts, transmural infiltration along with serosa involvement was found in 40 pts. Histologically, adenocarcinoma was detected in 61 pts and metastatic spread in 50 pts. Thirty-six pts had surgery in another center prior to registration. Forty-nine pts had subtotal gastrectomy, while lymph nodes dissection was done in 64 pts. Chemo-radiotherapy (CRT) was given in 49 pts, and 54 pts received >30 Gy dose of radiation. Macdonald's regimen was used in 49 pts. Treatment compliance was found in 53 pts, but only 05 pts were hospitalized for supportive management. Pts were followed up from 01-69 months (median 12 months) and the recurrence was found in 13 pts (median 14 months). The multimodality intervention is better treatment option in the management of carcinoma of stomach.

Clinical and pathological response rates of docetaxel-based neoadjuvant chemotherapy in locally advanced breast cancer and comparison with anthracycline-based chemotherapies: eight-year experience from single centre

INTRODUCTION

The administration of neoadjuvant chemotherapy (NACT) prior to local therapy is advantageous for women with locally advanced breast cancer (LABC), since it can render inoperable tumors resectable and can increase rates of breast conservative surgeries.

MATERIALS AND METHODS

We retrospectively analyzed LABC patients who received NACT from January 2000 to December 2007. Out of 3000 case records screened, 570 (19%) were LABC and 110/570 (19%) treatment-naïve patients started on NACT were analyzed. Ninety-one (37 docetaxel [D], 54 anthracycline [A]) patients were eligible for response and survival analysis. Pathological complete remission (pCR) was defined as no evidence of malignancy in both breast and axilla.

RESULTS

Median age of the whole cohort was 45 years (range 25-68 years). Premenopausal were 42% and estrogen receptor + 49.5%. Most (90%) were T4 tumors and 70% were Stage IIIB. Median numbers of preoperative cycles were six and three in the D and A group respectively. Overall clinical response rates for breast primary were 74.3% and 53.7% (CR 28.6% vs. 16.7%, P=0.58) while for axilla ORR were 75.7% vs. 54.8% (51.4% vs. 40.4% CR, P=0.77) respectively for D and A. Corresponding pCR rates were 19% vs. 13% respectively. There was no significant difference in disease-free (three-year 56.84% vs. 61.16%, P=0.80) and overall survival (three-year 70% vs. 78.5%, P=0.86) between the two groups.

CONCLUSIONS

Although pCR rates were higher with docetaxel-based NACT, it did not translate into superior disease-free survival / overall survival compared to anthracycline-based chemotherapies.

Assessment of 285 cases of chronic lymphocytic leukemia seen at single large tertiary center in Northern India

Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the West accounting for about 30% of leukemias, but about 2-4% in India. There is no large series reported from India, and hence we decided to undertake this study. We assessed the clinicohematological profiles and treatment outcomes in 285 patients seen over 11 years at our center (median age 59 years, 209 males). Sixty-three patients (22%) were asymptomatic and diagnosed incidentally. The median total leukocyte count at presentation was 50 × 10(9)/L. Rai stage distribution was: stage 0, 10%; stage I, 16%; stage II, 33%; stage III, 20%; and stage IV, 21%. Fifty percent of patients required treatment at presentation. Ninety-six patients received chlorambucil-based (overall response rate [ORR] 69%, complete remission [CR] 3%) and 27 patients received fludarabine-based (ORR 89%, CR 44%) chemotherapy. With a median follow-up of 2.9 years, the median overall survival (OS) and event-free survival (EFS) were 5.1 and 4.6 years, respectively. Fludarabine was more toxic, as half of the patients developed febrile neutropenia and various infections. The majority of patients presented with advanced stage disease. Fludarabine was less commonly used as first-line therapy. Advanced clinical stage (Rai III and IV) was associated with poor OS (hazard ratio [HR] 2.46, 95% confidence interval [CI] 1.19-5.11, p = 0.001) and EFS.

Plasmacytoma: 10 years experience at a tertiary care center in India

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Background: To evaluate the clinical features, diagnoses, prognostic factors, progression to MM of the patients of solitary plasmacytoma (SP) treated at AIIMS in last 10 years(2001-2010). Methods: From 2001-2010, we identified 57 patients with SP. OS, EFS, progression to myeloma were calculated using the Kaplan-Meier method and log rank test. Results: Out of 57 patients; 48 patients were evaluable. The M:F ratio was 3.5:1 with the median age of 49 years. The primary site was osseous(SBP) in 49 patients, extramedullary(EMP) in 8; 5 lesions were located in the upper respiratory passages, ie nasal cavity and maxillary sinus and rest of the 3 were one each in bronchus, gluteal region and intracranial. 43.8% of the lesions involved the vertebral column. The thoracic spine was the single most commonly involved site (12/57 patients). Out of 25 patients with lesions in vertebral column, 12 presented with paraparesis. Monoclonal protein was present in 48% patients and Urine M- Band in additional 2 patients. Treatment consisted of RT [45 Gy (8-50 Gy)] alone in 27, excision in 2 and excision and RT(n=9) and combined modality(n=10). The median follow-up was 28 months(range 3-160 months). Local control was achieved in 41(85%) while progressive disease was seen in 4. Serum M protein became undetectable after treatment in 60% patients. 17(41%) patients progressed to MM after initial response. The median duration of progression to MM was 21 months. Even though there was a trend towards a better EFS and OS for EMP than SBP, in univariate analysis this was not statistically significant. Patients having vertebral lesion showed trend towards progression to MM (p=.057). 5 yr EFS & OS were 44.4% and 89 % respectively. Median EFS and OS were 38 and 122 months respectively. 5 yr survival rate in patients who developed MM and those who did not were 81% and 100% respectively. None of the baseline characteristics were predictive of survival. Conclusions: Out of 1129 patients of plasma cell dyscrasias registered between 2001-2010; 5% were of SP. Bone was the most common site. Attainment of local control is the predictor of significant EFS (p<0.0001) and OS (p<0.05). Progression to MM is the commonest pattern of failure. Vertebrae involvement was predictor for disease progression to MM.

Analysis of regulatory T cells in patients of NSCLC with malignant pleural effusion

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Background: Enrichment of regulatory T (Treg) cells at the affected anatomic site in cancer may suppress the anti-tumor immune response influencing the cancer progression. Understanding of the clinical relevance of Treg mediated suppression of anti-tumor immune response and mechanisms underlying their preferential trafficking to the affected anatomic site is still limited. The aim of this study was to enumerate the frequencies of Treg cells in malignant pleural effusion and peripheral blood of patients with advanced NSCLC and it’s trend after treatment. Methods: Treg frequencies were evaluated in pleural effusion and peripheral blood of the patients with advanced NSCLC (n=27) using flowcytometry and compared with peripheral blood of age and sex matched healthy controls (n=15) and tubercular pleural effusions (n=10). The Treg cells were characterized as CD4+CD25+Foxp3+ T cells gated on CD4+CD25+ T cells. We assessed the effect of treatment response on Treg frequency. We have also looked for the expression of chemokine receptors CCR4 and CCR6 on the Tregs in pleural effusion and peripheral blood of the patients. Results: Compared to healthy controls, frequency of CD4+CD25+Foxp3+ Tregs was significantly increased in peripheral blood of patients with NSCLC (p=0.0036). In pleural effusion of patients, Treg frequency was higher than their corresponding peripheral blood (p=0.025). As compared to tubercular pleural effusion Treg frequency was higher in malignant effusion (p<0.0001). We had 12 patients who completed treatment and in whom response evaluation was available. Treg frequency reduced at the time of response (PR or SD) and increased again at disease progression. Surface expression of CCR4 and CCR6 was higher on Treg cells as compared to non Treg CD4 cells among the patients (p=0.0001; p=0.001 respectively). However, there was no difference in expression of these chemokine receptors on Tregs in pleural fluid and peripheral blood. Conclusions: Tregs are increased in patients of NSCLC, both at disease site and in systemic circulation. This increase may be chemokine receptors mediated. Treg frequency changes with treatment and response. Modulation of Tregs may have therapeutic implication in the management of advanced NSCLC.

Prognostic and predictive significance of smudge cell percentage on routine blood smear in chronic lymphocytic leukemia patients: A single center study from northern India

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Background: Smudge cells are ruptured lymphocytes seen on routine blood smears of chronic lymphocytic leukemia (CLL) patients. We evaluated prognostic and predictive significance of smudge cells percentage on a blood smear in CLL patients. Methods: We calculated smudge cell percentages (ratio of smudged to intact cells plus smudged lymphocyte) on archived blood smears of 185 untreated CLL patients registered at I.R.C.H, AIIMS, New Delhi over a period of 11 years. Results: There were 135 males and 50 females. The median age was 60 years (28-89). Median absolute lymphocyte count was 42 X109/L. Clinical Rai stage distribution was: stage 0 - 10%, stage I - 15%, stage II - 40%, stage III -15 % and stage IV - 20%. The median smudge cells percentage was 27% (4% to 76%). There was no correlation of proportion of smudge cells with age, sex, lymphocyte count, organomegaly, ZAP 70 + or CD 38 + CLL patients, but there was significant correlation with stage of disease. Median smudge cell percentage in stage 0 & I -33% (12-76), stage II- 31% (12-61) and stage III&IV-21% (4-51) [ p=<0.001]. One third of early stage (0, I &II) patients required treatment during follow up, at the end of 5 years of follow up 55% required treatment with smudge cell < 30%, against 24% patients requiring treatment with smudge cells > 30% [p=0.01]. The percentage of smudge cells as a continuous variable correlated with OS [HR 0.96, p< 0.001]. The 5-year survival rate was 51% for patients with 30% or less smudge cells compared with 81% for patients with more than 30% of smudge cells. Thirty percent of patients died during follow up. Median OS was 5 years with median follow up period of 3.9 years. Smudge cells percentage (<30% vs. >30%) had significant association with OS [HR 0.47, 95%CI (0.32-0.71), p=0.001)]. Conclusions: Simple and inexpensive detection of smudge cells on blood smears on routine diagnostic test useful in predicting progression free and OS in CLL patients and may be beneficial in countries with limited recourses.

Outcome in different molecular subtypes of diffuse large B-cell lymphoma: Indian experience

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Background: DLBCL has emerged as a heterogeneous disease and gene expression profiling has divided it into distinct molecular subtypes of Germinal center B-Cell (GCB) and Non-GCB- cell origin. These subtypes are reported to vary in the treatment responses and outcome. Methods: We analysed 97 consecutive patients of DLBCL who had satisfactory paraffin block of baseline biopsy. After reviewing diagnosis of DLBCL, sequential immunohistochemical staining with CD10, bcl6 and MUM1 was performed in all the cases. Using these markers the cases were sub-classified into GCB and non-GCB types as per Hans’ algorithm. Baseline presentation, stage, international prognostic score and treatment outcome were recorded. Survival was assessed by Kaplan-Meier survival curves and results were compared using log-rank test. Results: Thirty-three (34%) patients were classified in GCB group while 64(66%) patients in non-GCB group. Median age in both the groups was 50 years. High IPI score2-5 (GCB-34%, non GCB-72%;p 0.005) and stage 3,4 (GCB-39%,nonGCB-61%;p 0.04) were higher in non-GCB group. All the patients were treated with 6-8 cycles of CHOP based regimen and involved field radiotherapy wherever required. Complete remission rate (GCB-52%, nonGCB-27%; p0.02) was higher in GCB group. Three year overall survival, 75% and 63 %( p0.04), and event free survival was 63% and 43 %( p0.02) in GCB and non GCB subtypes, respectively. There was no difference in between two groups for performance status, LDH level and age. Conclusions: In our study, GCB-DLBCL patients had better response rate, EFS and OS in comparison to non GCB subtype. There were higher number of patients with advanced stage and high IPI score in non-GCB subtype which might have contributed to the poorer outcome.

Clinicopathologic and survival analysis of patients with lung cancer treated at a tertiary care centre in India

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Background: Lung cancer ranks among the most common and lethal malignancies worldwide and also in India. There are geographic and ethnic variations in incidences, clinical and pathological profile of lung cancer. There is paucity of data of changing trend of pathological and clinical profile from this part of the world. Methods: A total of 434 patients with lung cancer were analyzed who were registered at All India Institute of Medical Sciences, over a 3 year period, from July 2008 till June2011, based on information in hospital records. Survival analysis was performed on 310 patients who have received at least one modality of treatment. Results: Median age of the whole cohort was 55 years (23-84 years). There were 357 (82.26%) males and 77 (17.74%) females, 295(69.91%) smokers and 127 (30.09%) non smokers. 370 (85.25%) patients had NSCLC and 64 (14.74%) had SCLC. Among NSCLC, adenocarcinoma was the commonest histology (45.41%) followed by squamous cell carcinoma (29.46%) and unclassified NSCLC (20.54%). Majority (66.13%) of the diagnosis were based on biopsy (needle or bronchoscopic). Among NSCLC, 26.3% patients were of stage 1-3A and 73.7% were of stage 3B and 4. Among SCLC 25% patients were of limited stage and 75% patients were of extensive stage. 73.18% of NSCLC patients received chemotherapy, 19.15% received TKI and 5.75% received RT as first line treatment modality. Among SCLC 93.88% received chemotherapy and 6.12% received RT as first line treatment. Median PFS and OS of patients with NSCLC were 7.8 months and 13.2 months respectively while that of SCLC were 6.1 months and 9.2 months respectively. Conclusions: Pathological profile of lung cancer has changed in India. Adenocarcinoma has become the commonest histology, contrary to the older reports when squamous cell carcinoma was more common. Majority of the patients are diagnosed in advanced stage and survival of these patients remains poor.

Young patients with breast cancer (< 35 years): Single-institution study of 194 patients from India

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Background: Breast cancer in young women ( < 35 years) is uncommon and accounts for 1-2 % of all breast cancer in the West .There is paucity of data on young breast cancer from India. The aim of our study was to assess clinical and pathological parameters and outcome in young breast cancer patients. Methods: Annually we register approximately 350 new cases of breast cancer of whom young patients constitute a small fraction. This analysis was carried out in 194 patients with aged 35 years or less, who were registered in our clinic between 2000-2009, this constituted about 5.5 % of all new cases. Patients records were analysed from computer database using ICD code (C-50) Results: The median age was 31 years (range 21-35). The median duration of symptoms was 11.8 months (range 0.5-40). Breast lump was the commonest (93%) presenting symptom (left >right side). Ninety percent of patients were married and median age at first child birth was 23 years. Positive family history was elicited in 8 patients, and 3 patients presented with synchronous malignancy. The TNM (7th edition) stage distribution was stage I was 3 %, stage II- 20%, stage III- 55%, and stage IV- 22%. The median clinical tumour size was 5.9 cm. Modified Radical mastectomy was the commonest surgical procedure and this was done in 81 % of cases. The histopathological analysis showed 94% had infiltrating ductal carcinoma. Sixty percent of tumours were high grade and 56% had pathological node positive disease. ER/PR status and Her2 Neu status was available in 65% and 50% respectively. Out of these patients ER and her2neu positivity was 40% and 37% respectively. Triple negative breast cancer (TNBC) constituted 31%. A combination of anthracyclines and taxanes were used in the vast majority of patients and herceptin was used only in 5 %. With a median follow up of 30 months, three years event free (EFS) and overall survival (OS) was 50% and 60%. Higher Nodal stage, tumour size (>5 c.m ), negative ER/PR status and visceral metastasis at baseline predicted poor outcome. Conclusions: Young women constituted 5.5% cases with higher proportion of triple negativity, this is higher than the western population reflecting younger age of our population of breast cancer in general with a resultant poorer outcome.

Acute promyelocytic leukemia: an experience from a tertiary care centre in north India

BACKGROUND

There are very limited data reported about acute promyelocytic leukemia (APL) from developing countries. We reviewed the clinical course and treatment outcome of APL patients treated at our center.

MATERIALS AND METHODS

Between January 1997 and December 2007, 33 patients with APL received induction therapy using ATRA + daunorubicin (n = 26), As = 26), As2O3 (n = 4) or daunorubicin + cytosar ( n = 3).

RESULTS

Median age was 30 years with a male to female ratio of 1.68. Twenty seven patients (82%) achieved CR. Complications during induction therapy were febrile neutropenia (33%), ATRA syndrome (30%), bleeding (58%), and diarrhea in (6%) patients. During induction and follow up, 8 (24.24%) patients died, 6 (18.18%) during induction, 1 (3%) during maintenance, and 1 (3%) after relapse. Median OS is 128 months while median EFS is 61 months. Four patients relapsed at a median time of 61 months. At the time of censoring, 25 patients were alive at a median follow up of 13 months (range 0.6 -127 months); 21 in CR1, 3 in CR2, 1 in CR3. Comparisons among the risk groups (CR and relapse rate and survival statistics) were not statistically significant.

CONCLUSIONS

APL is a highly curable malignancy. Our results confirm the findings of the published literature from larger cooperative studies from the West. We may further improve outcome with quicker diagnosis and more efficient supportive care system.

A prospective audit of transfusion requests in a tertiary care hospital for the use of fresh frozen plasma

Aims and Background:

Like any other drug, therapeutic use of fresh frozen plasma (FFP) has its own side effects, adverse reactions and risks involved. Overall use of FFP has been on the increase in most tertiary care hospitals. Since the guidelines for FFP use in a clinical setting are not well defined, the present study aims at defining the appropriateness of use of FFP in the light of its risks and benefits as a drug.

Materials and Methods:

We carried out a prospective survey of 821 transfusion orders for 2,915 units of fresh frozen plasma components in our hospital over a 4-month period and recorded indication for transfusion and the number of components requested.

Results:

Five hundred seventy-three (69.8%) of transfusion requests affecting 2,202 (75.54%) units of FFP were appropriately indicated, while 248 (30.2%) of FFP requests were inappropriately indicated. The majority of fresh frozen plasma requests used were for surgical bleeding (22.77%) because of the deranged coagulation profile before surgery in most of the patients. It was followed by liver disease and transplantation (12.54%). Out of 821 patients, 586 were male and 235 were female.

Conclusion:

Inappropriate requests accounted for 30.2% of the total FFP requests in patients who had normal coagulation parameters. Regular audits, appropriate training of medical staff, conducting regular CMEs are the measures being incorporated in our hospital to rationalize the use of blood components.

Role of platelet transfusion in the management of dengue patients in a tertiary care hospital

Background and Objective:

While medical fraternity globally recognizes the role of platelet transfusion in the management of hospitalized dengue patients the exact indications and situations in which these are to be transfused may vary. Since there is inherent risk associated with the transfusion of blood/blood-component, it is imperative for each institution (or country) to lay their own criteria for transfusion of these blood components. The present study was conducted to lay precise criteria and transfusion trigger for platelet transfusion in our set-up.

Materials and Methods:

The present study was conducted on 225 serologically confirmed dengue patients admitted at Indraprastha Apollo Hospitals between 1^st of August to 30^th of November 2005. Clinical data, reports of hematological investigation, platelets requirements and data obtained from daily follow-up were analyzed. The clinicians followed the guidelines issued by the Directorate of Health services, NCT of Delhi.

Results:

In the serologically confirmed cases, the prevalence of thrombocytopenia (count less than 100,000/cumm) was 84.88% on admission and bleeding was recorded in 22 (9.7%) patients. About 96 (42.6%) patients of dengue cases received platelet transfusion. Among them 47 (20.88%) patients had a platelet count < 20,000/cumm, 43 (19.11%) had a platelet count in the range of 21-40,000/cumm while 6 (2.66%) patients had the platelet count in between 41 and 50,000/cumm. Out of 49 patients with a platelet count >20,000/cumm, 18 patients had haemorrhagic manifestations such as petechiae, gum-bleeding, epistaxis, etc., which necessitates the use of platelet transfusion. However, 31 patients received inappropriate platelet transfusion.

Conclusion:

This study suggests that bleeding occurs more often in patients with severe thrombocytopenia. High-risk patients having platelet count < 20,000/cumm and risk of bleeding require urgent platelet transfusion. Patients with platelet count 21-40,000/cumm are in moderate risk and require platelet transfusion only if they have any haemorrhagic manifestations and other superadded conditions.

Testicular germ cell tumor fungating through anterior abdominal wall

Retroperitoneal lymph node metastases from testicular germ cell tumor are common, but fungation of such mass through the anterior abdominal wall is extremely rare. We report such a case which had a favorable response to chemotherapy.

Prevalence and associations of hepatitis C viremia in hemodialysis patients at a tertiary care hospital

Hepatitis C virus (HCV) infection in hemodialysis (HD) is a significant problem. We evaluated the prevalence and associations of HCV viremia in our HD patients. All patients undergoing maintenance HD at our center were tested for HCV RNA by PCR after written informed consent. Detailed history regarding age, sex, and duration of dialysis, frequency of dialysis, blood transfusions in one year, number of dialysis centers, dialyzer reuse/fresh use, and recent laboratory data was recorded. A total of 119 patients (77 males and 42 females) were tested for HCV RNA. Thirty three (27.7%) tested positive. Duration of dialysis was significantly longer in HCV RNA positive group (P = 0.001). 45.2% of patients with duration of dialysis more than 16 months were HCV RNA positive while only 7.4% of patients with dialysis duration ≤16 months were HCV RNA positive (P < 0.001). In univariate analysis, in HCV RNA group patients, ALT, AST, and GGTP were significantly elevated and albumin was significantly lower. 39% of patients who had dialysis at more than one center were HCV RNA positive as compared to 20% for patients undergoing dialysis at single center (P = 0.024). Binary logistic regression analysis showed albumin, duration of dialysis, and serum ALT to be significant variables. Sensitivity and specificity of anti-HCV ELISA was 72.7 and 97.7%, respectively. Prevalence of HCV RNA in the HD population is 27.7%. Duration of dialysis, getting dialysis at more than one center, elevated transaminase levels, and low serum albumin are important associations for HCV RNA positivity.