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Roy Moulik N, Keerthivasagam S, Velagala SV, Gollamudi VRM, Agiwale J, Dhamne C, Chichra A, Srinivasan S, Shetty D, Jain H, Subramanian PG, Tembhare P, Chatterjee G, Patkar N, Narula G, Banavali S. Treating relapsed B cell-precursor ALL in children with a setting-adapted mitoxantrone-based intensive chemotherapy protocol (TMH rALL-18 PROTOCOL) - experience from Tata Memorial Hospital, India. Ann Hematol 2023; 102:2835-2844. [PMID: 37479890 DOI: 10.1007/s00277-023-05351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
The outlook of relapsed ALL in low- and middle-income countries (LMICs) is dismal due to high treatment-related toxicities and inadequate resources. We report our experience of using a locally adapted mitoxantrone-based protocol for non-high risk (HR) relapsed B-ALL (rALL). A retrospective cum prospective study of standard and intermediate risk (SR and IR) rALL patients treated on TMH rALL-18 protocol (adapted from COG/UKALLR3/Int-Re-ALL protocols) between November 2018 and January 2021 was analyzed. The protocol comprising of 7 blocks of multi-agent chemotherapy including mitoxantrone in induction followed by local irradiation and maintenance, underwent serial modifications based on our experience with initial patients. Eighty-two patients (SR rALL, 3; IR rALL, 79) were treated on TMH rALL-18 protocol. Of 321 grade 3/4 reported toxicities, around 43% (138 toxicities) were noted during induction. Induction chemotherapy was outpatient-based; however, 68 patients (82.9%) required supportive care admissions. Twelve out of 19 patients with gram negative bacilli sepsis (included 7 MDRO) died during reinduction. Five remission deaths were seen during block 3 after which cytarabine was dose reduced (3 g to 2 g/m2). Post-reinduction minimal residual disease was negative in 54 (80.6%) out of 67 evaluable patients. At a median follow-up of 24 months (95% CI 22-27), the estimated 2-year event-free and overall survival of the entire cohort was 58% (95% CI 48.1-69.9) and 60.3% (95% CI 50.5-72). Until the time, targeted therapies are freely accessible in LMICs, strengthening supportive care as well as local adaptation of protocols that strike a fine balance between efficacy and tolerability are mandated.
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Affiliation(s)
| | | | | | | | - Jayesh Agiwale
- Pediatric Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Chetan Dhamne
- Pediatric Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | | | - Dhanlaxmi Shetty
- Cancer Cytogenetics, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Hemani Jain
- Cancer Cytogenetics, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | | | | | - Nikhil Patkar
- Hematopathology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Gaurav Narula
- Pediatric Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
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Sexual Dimorphism in Children and Adolescents With Acute Lymphoblastic Leukemia: Influence on Incidence and Survival. J Pediatr Hematol Oncol 2020; 42:e293-e298. [PMID: 31725540 DOI: 10.1097/mph.0000000000001665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute lymphoblastic leukemia (ALL) incidence and poor prognosis are higher in male individuals. There is a lack of studies assessing the influence of sex in ALL. We documented this influence in a homogenous cohort. Three hundred three ALL Hispanic patients 1 to 20 years of age diagnosed over 10 years at a university hospital were evaluated. Patients were divided by sex and stratified by age. Survival rates were assessed by the Kaplan-Meier method, and the Cox model was used for univariate and multivariate analysis. The median age for female individuals was 6 years versus 9 years for male individuals (P=0.002). In the whole cohort, there was a male preponderance (P=0.025), with a 1.3 male-to-female ratio. For male individuals, the 5-year relapse-free survival was 46%; for female individuals, it reached 58.7%, (P=0.009). Male individuals 1-9 years of age had a lower 5-year relapse-free survival than female individuals, 51.5% versus 66.7% (95% confidence interval, 65.35-68.01; P=0.020); this was not the case for overall survival (P=0.660). The male-to-female ratio in the 10 to 15 years' group was 1.59, and 2.35 in the 16 to 20 years' group. Incidence and relapse of ALL were higher in male individuals. A skewed distribution in the 10 to 20 years' age group disproportionately affected male individuals, suggesting a hormonal influence.
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Jayakrishnan T, Shaikh H, Samhouri Y, Sandhu A, Fazal S. Isolated testicular recurrence of B cell acute lymphoblastic leukaemia in an adult: rare case. BMJ Case Rep 2019; 12:12/10/e232286. [PMID: 31676503 DOI: 10.1136/bcr-2019-232286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 80-year-old man who was previously diagnosed with Philadelphia+ B cell-acute lymphoblastic leukaemia (B-ALL) in remission post-allogeneic matched unrelated donor peripheral blood stem cell transplant. Five years later, he was found to have unilateral testicular relapse of Philadelphia+ B-ALL proven by pathology after radical orchiectomy. Bone marrow aspirate and biopsy did not show evidence of leukaemia. Patient was treated with adjuvant radiation therapy and started on dasatinib 50 mg daily. Given his age and absence of disseminated acutelymphoblastic leukaemia (ALL), no adjuvant chemotherapy was utilised. He is monitored with monthly PCR studies. At 1-year follow-up, no findings suggestive of recurrence of ALL have been identified and the patient is maintained on the dasatinib. Although isolated testicular recurrence is common among paediatric population, it is a rare event among adults as it is considered an immunological sanctuary for cancer cells.
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Affiliation(s)
| | - Hira Shaikh
- Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Yazan Samhouri
- Medical Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Ariel Sandhu
- Pathology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Salman Fazal
- Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Roy P, Islam R, Saha D, Gogoi M, Mishra DK, Arora N, Parihar M, Krishnan S, Saha V. Efficacy and safety of a bortezomib and reduced-intensity cytarabine-based protocol, TMC ALLR1, for relapsed childhood ALL in India. Br J Haematol 2019; 186:861-865. [PMID: 31168836 PMCID: PMC6785345 DOI: 10.1111/bjh.16005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/23/2019] [Indexed: 12/17/2022]
Abstract
The feasibility of bortezomib (BZB) in induction and reduced cytarabine doses in intensification was evaluated in children with relapsed acute lymphoblastic leukaemia (rALL) at a single centre in India. Of 55 children with rALL, 23 received supportive care and 7 refused treatment, with a median survival of 2 (interquartile range 1-6) months. Twenty-two (88%) of 25 children who were treated achieved second remission and 9 (69%) of 13 had end-of-induction minimal residual disease of <10-4 . The lower cytarabine dose was associated with decreased hospitalisation. One-year event-free and overall survival for the treated group was 74·7% (95% confidence interval 52-88) and 79·6% (58-91) respectively.
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Affiliation(s)
- Prakriti Roy
- Tata Translational Cancer Research Centre and Department of Paediatric Haematology Oncology, Tata Medical Center, Kolkata, India
| | - Rubina Islam
- Tata Translational Cancer Research Centre and Department of Paediatric Haematology Oncology, Tata Medical Center, Kolkata, India
| | - Debparna Saha
- Tata Translational Cancer Research Centre and Department of Paediatric Haematology Oncology, Tata Medical Center, Kolkata, India
| | - Manash Gogoi
- Tata Translational Cancer Research Centre and Department of Paediatric Haematology Oncology, Tata Medical Center, Kolkata, India
| | - Deepak Kumar Mishra
- Department of Cytogenetics and Lab Haematology, Tata Medical Center, Kolkata, India
| | - Neeraj Arora
- Department of Cytogenetics and Lab Haematology, Tata Medical Center, Kolkata, India
| | - Mayur Parihar
- Department of Cytogenetics and Lab Haematology, Tata Medical Center, Kolkata, India
| | - Shekhar Krishnan
- Tata Translational Cancer Research Centre and Department of Paediatric Haematology Oncology, Tata Medical Center, Kolkata, India
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Vaskar Saha
- Tata Translational Cancer Research Centre and Department of Paediatric Haematology Oncology, Tata Medical Center, Kolkata, India
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Abstract
OBJECTIVE The purpose of this review is to evaluate the current role of percutaneous testicular biopsy in the diagnosis of focal testicular lesions. CONCLUSION Percutaneous testicular biopsy can be either fine needle aspiration biopsy or trucut core needle biopsy. It is a well-tolerated and effective procedure useful in small testicular lesions, multifocal lesions, hematological malignancies, and focal lesions in single testis.
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Affiliation(s)
- Subramaniyan Ramanathan
- Department of Radiology, Al-Wakra Hospital, Hamad Medical Corporation, PO Box 82228, Doha, Qatar.
- Department of Radiology, Weil Cornell Medical College, Doha, Qatar.
| | - Vikram Dogra
- Department of Imaging Science, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
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Bourne AE, Wayment RO, Tarter TH, Hemmer P. Isolated relapse of acute lymphoblastic leukemia in the epididymis: a rare sanctuary site. J Clin Oncol 2010; 28:e327-8. [PMID: 20008636 DOI: 10.1200/jco.2009.23.8014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrew E Bourne
- Division of Urology, Southern Illinois University, Springfield, IL, USA
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