We waited 9 months since DM with no word from the Vancouver office, until we heard back from the Call Centre that my wife's medical results have expired. Vancouver has sent my wife's file to Mississauga to get an extension on medical results. If Mississauga approves, then my wife's file goes back to Vancouver, where I
hope they expedite the landing appointment process. If Mississauga doesn't approve, then my wife has to do her medical tests again, which further delays the process by several months.
Make sure your medical results have not expired! That could be the problem. I kept calling the Call Centre to see if everything was ok for the past several months, and they said "no problem, the Vancouver office is just busy...". It's only in the 9th month (after I called 100 times) that they finally discovered the problem that my wife's medical results have expired.
I hope this helps.