1
|
Arora S, Setia R, Sharma S, Dua S, Dogra M, Radhakrishnan N, Bakliwal A. Survey-based assessment of hematopoietic stem cell graft manipulation (minimal) by cell therapy labs supporting hematopoietic stem cell transplants in India. Cytotherapy 2024; 26:96-102. [PMID: 37943203 DOI: 10.1016/j.jcyt.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND AIMS Hematopoietic stem cell transplants (HSCTs) are increasingly being offered to patients in India for various conditions. The Indian Stem Cell Transplant Registry shows that a total of 2533 transplants were done in India in 2019. METHODS An epidemiological descriptive cross-sectional survey (55 questions) of centers providing HSCT in India was planned to analyze variations in policies and practices regarding HSCT graft manipulation (i.e., plasma reduction, red blood cell [RBC] depletion and cryopreservation). A total of 63 of 102 centers responded to the survey (response rate, 61.7%), mostly from the northern part of India (27 of 63 [42.8%]). RESULTS The majority of responding centers reported performing >50 HSCTs annually (n = 24 [38%]), and 92% (58 of 63) performed stem cell collections from a pediatric donor/patient (age <18 years). A total of 56 of 63 responding centers indicated that they did product manipulations involving cryopreservation (n = 45), plasma reduction (n = 42) and RBC depletion (n = 28). Cryopreservation was primarily done by blood centers (27 of 45 [60%]), with dimethyl sulfoxide (DMSO) being the primary constituent, used most commonly at a concentration of 5-10% (28 of 45 centers). Dump freezing was most commonly used (27 of 45) with a -80°C deep freezer. A 7-aminoactinomycin D based viability assessment was also most commonly used (30 of 45). Thawing of the product was done mainly at the bedside (30 of 45) using a wet-type thawer (36 of 45), and washing of DMSO was done by a few centers (seven of 45). Plasma reduction and RBC depletion were primarily done for ABO incompatibility at blood centers. CONCLUSIONS This survey demonstrates the lack of standardization and uniformity in the minimal manipulation of hematopoietic stem cell grafts in centers supporting HSCT in India. This work also highlights the need for more studies and country-specific recommendations to establish best practices.
Collapse
Affiliation(s)
- Satyam Arora
- Department of Transfusion Medicine, Post Graduate Institute of Child Health, Noida, India.
| | - Rasika Setia
- Department of Transfusion Medicine, Max-BLK Hospital, New Delhi, India
| | - Sanjeev Sharma
- Department of Hematology, Venkateshwar Hospital, New Delhi, India
| | - Seema Dua
- Department of Transfusion Medicine, Post Graduate Institute of Child Health, Noida, India
| | - Mitu Dogra
- Department of Transfusion Medicine, Max-BLK Hospital, New Delhi, India
| | - Nita Radhakrishnan
- Department of Pediatric Hematology-Oncology, Post Graduate Institute of Child Health, Noida, India
| | - Anamika Bakliwal
- Department of Hematology, Venkateshwar Hospital, New Delhi, India
| |
Collapse
|
2
|
Bandyopadhyay A, Palepu S, Dhamija P, Nath UK, Chetia R, Bakliwal A, Vaniyath S, Chattopadhyay D, Handu S. Safety and efficacy of Vitamin D 3 supplementation with Imatinib in Chronic Phase- Chronic Myeloid Leukaemia: an Exploratory Randomized Controlled Trial. BMJ Open 2023; 13:e066361. [PMID: 37643857 PMCID: PMC10465917 DOI: 10.1136/bmjopen-2022-066361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/11/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES The study aimed to compare early molecular response (EMR) rates at 3 months of imatinib therapy with and without vitamin D3 supplementation in patients newly diagnosed with chronic-phase chronic myeloid leukaemia (CML-CP). The secondary objective was to assess the effects of vitamin D3 on complete haematological response (CHR) and its safety. DESIGN Double-blind, placebo-controlled, exploratory randomised trial. SETTING Tertiary care hospital in northern India. PARTICIPANTS Treatment-naive patients with chronic phase chronic myeloid leukaemia (n=62) aged >12 years were recruited from January 2020 to January 2021. Patients with progressive disease, pregnancy and hypercalcaemia were excluded. INTERVENTION Oral vitamin D3 supplementation (60 000 IU) or matched placebo was given once weekly for an initial 8 weeks along with imatinib after randomisation with 1:1 allocation ratio. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was to compare EMR (defined as BCR-ABL1 transcript level ≤10%, international scale) at 3 months. The secondary outcomes were to compare effect of the intervention on CHR, correlation of 25(OH)2D3 levels with treatment response and safety according to Common Terminology Criteria for Adverse Events (CTCAE) version 5. RESULTS At baseline, 14.5% of the patients had normal vitamin D3 levels. EMR at 3 months was attained in 24 patients (82.7%) of the vitamin D3 group and 21 (75%) of the placebo group (OR 1.6, 95% CI 0.37 to 7.37, p=0.4). A significant difference in vitamin D3 levels from baseline to the end of study was observed. Patients with vitamin D3 supplementation did not achieve higher CHR in comparison with placebo (OR 1.3, 95% CI 0.25 to 7.23, p=1.0). Vitamin D3 levels were not significantly correlated with BCR-ABL1 levels. No dose-limiting toxicities were observed. CONCLUSION Vitamin D3 levels were low among patients with CML-CP in this study. Vitamin D3 supplementation with imatinib therapy did not have significant effect on EMR or CHR. Further clinical trials could be undertaken to assess the effective dosage and duration of vitamin D3 supplementation in these patients. TRIAL REGISTRATION NUMBER CTRI/2019/09/021164.
Collapse
Affiliation(s)
- Arkapal Bandyopadhyay
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sarika Palepu
- Community Medicine and Family Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Puneet Dhamija
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Uttam Kumar Nath
- Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rituparna Chetia
- Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anamika Bakliwal
- Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sudeep Vaniyath
- Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Debranjani Chattopadhyay
- Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shailendra Handu
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
3
|
Kumari N, Bakliwal A, Singh M, Dhingra G, Gupta A, Nath UK. B-lymphoblastic lymphoma presenting as acute pancreatitis: a rare mimicker. Hematol Transfus Cell Ther 2023; 45:102-105. [PMID: 34303652 PMCID: PMC9938471 DOI: 10.1016/j.htct.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/31/2021] [Accepted: 02/18/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
| | | | - Monika Singh
- All India Institute of Medical Science Rishikesh (AIIMS), Rishikesh, India.
| | | | | | | |
Collapse
|
4
|
Mamgain G, Naithani M, Patra P, Mamgain M, Morang S, Nayak J, Kumar K, Singh S, Bakliwal A, Rajoreya A, Vaniyath S, Chattopadhyay D, Chetia R, Gupta A, Dhingra G, Sundriyal D, Nath UK. Next-Generation Sequencing Highlights of Diffuse Large B-cell Lymphoma in a Tertiary Care Hospital in North India. Cureus 2022; 14:e28241. [PMID: 36158348 PMCID: PMC9489829 DOI: 10.7759/cureus.28241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: Next-generation sequencing (NGS) elucidates the diffuse large B-cell lymphoma (DLBCL) genetic characteristics by finding recurrent and novel somatic mutations. This observational study attempted to create an NGS panel with a focus on identifying novel somatic mutations which could have potential clinical and therapeutic implications. This panel was created to look for mutations in 133 genes chosen on basis of a literature review and it was used to sequence the tumor DNA of 20 DLBCL patients after a centralized histopathologic review. Methods: The study included 20 patients having DLBCL. The quality and quantity of tumor cells were accessed by H&E staining and correlated with histopathology and Immunohistochemistry (IHC) status. Patients were grouped as ABC (activated B-cell), PMBL (primary mediastinal large B-cell lymphoma), and other or unclassified subtypes. The lymphoma panel of 133 was designed on targeted sequencing of multiple genes for the coding regions through NGS. The libraries were prepared and sequenced using the Illumina platform. The alignment of obtained sequences was performed using Burrows-Wheeler Aligner and identification of somatic mutations was done using LoFreq (version 2) variant caller. The mutations were annotated using an annotation pipeline (VariMAT). Previously published literature and databases were used for the annotation of clinically relevant mutations. The common variants were filtered for reporting based on the presence in various population databases (1000G, ExAC, EVS, 1000Japanese, dbSNP, UK10K, MedVarDb). A custom read-depth-based algorithm was used to determine CNV (Copy Number Variants) from targeted sequencing experiments. Rare CNVs were detected using a comparison of the test data read-depths with the matched reference dataset. Reportable mutations were prioritized and prepared based on AMP-ASCO-CAP (Association for Molecular Pathology-American Society of Clinical Oncology-College of American Pathologists), WHO guidelines, and also based on annotation metrics from OncoMD (a knowledge base of genomic alterations). Results: The informativity of the panel was 95 percent. NOTCH 1 was the most frequently mutated gene in 16.1% of patients followed by 12.9% who had ARID1A mutations. MYD88 and TP53 mutations were detected in 9.6% of the patient while 6.4% of patients had CSF3R mutations. NOTCH 1 and TP 53 are the most frequently reported gene in the middle age group (40-60). Mutation in MYD88 is reported in every age group. MYD88 (51%) is the most common mutation in ABC subtypes of DLBCL, followed by NOTCH 1 (44%) and SOCS 1 (33%) according to our findings. NOTCH 1 mutations are frequent in ABC and PMBL subtypes. Closer investigation reveals missense mutation is the most frequent mutation observed in the total cohort targeting 68.4% followed by frameshift deletion reported in 26.3%. Six novel variants have been discovered in this study. Conclusions: This study demonstrates the high yield of information in DLBCL using the NGS Lymphoma panel. Results also highlight the molecular heterogeneity of DLBCL subtypes which indicates the need for further studies to make the results of the NGS more clinically relevant.
Collapse
|
5
|
Sundriyal D, Nath UK, Kumar P, Gupta S, Joseph D, Vaniyath S, Chetia R, Bakliwal A, Chattopadhyay D, Dhingra G, Sehrawat A. Audit of In-Hospital Mortality from a Medical Oncology and Hemato-Oncology Center with the Emphasis on Best Supportive Care. South Asian J Cancer 2022; 11:156-159. [PMID: 36466983 PMCID: PMC9718601 DOI: 10.1055/s-0041-1739042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Deepak SundriyalBackground and Objectives The newly established medical oncology and hemato-oncology center at the All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India, provided us an opportunity to audit in-hospital mortalities with a vision that the audit will serve as a standard for ceaseless improvement. Aim of the study was to initiate a vigorous process for the evaluation of all-cause mortality in patients suffering from cancer. Methods An audit of all in-hospital deaths that occurred during the year 2019 was performed, and comprehensive scrutiny of various parameters (demographic, clinico-pathological, therapeutic, causes of death) was done. Reviews from two independent observers sharpened the infallibility of the audit. The lacunae in the existing practices and the scope for further improvement were noted. Results Forty-five in-hospital deaths were registered during the study period (January-December 2019). The majority of the deaths occurred in patients with advanced stage of malignancy ([ n = 31] 68.8%). Most common causes of death were progressive disease, neutropenic, and non-neutropenic sepsis. Chemotherapeutic agents, growth factors, blood components, and antibiotics were found to be used judiciously as per institutional policy. The reviewers emphasized on the use of comorbidity indexes in the treatment planning and avoiding intensive care unit referrals for patients receiving best supportive care (BSC). Emphasis was put on providing only BSC to the patients with a very limited life expectancy. Emphasis was also laid down on record of out of the hospital deaths. Interpretation and Conclusion The audit disclosed areas of care which require further improvement. The mortality audit exercise should become a regular part of evaluation and training for the ongoing and future quality commitment. This should impact the clinical decision making in an oncology center providing quality care to the terminally ill patients.
Collapse
Affiliation(s)
- Deepak Sundriyal
- Department of Medical Oncology, Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Address for correspondence Deepak Sundriyal, DNB Department of Medical Oncology, Hematology, All India Institute of Medical SciencesRishikesh, Uttarakhand, 249203India
| | - Uttam Kumar Nath
- Department of Medical Oncology, Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Parmod Kumar
- Department of Medical Oncology, Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sweety Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Deepa Joseph
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sudeep Vaniyath
- Department of Medical Oncology, Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rituparna Chetia
- Department of Medical Oncology, Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anamika Bakliwal
- Department of Medical Oncology, Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Debranjini Chattopadhyay
- Department of Medical Oncology, Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Gaurav Dhingra
- Department of Medical Oncology, Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Amit Sehrawat
- Department of Medical Oncology, Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
6
|
Bakliwal A, Nath UK, Mohanty A, Gupta P. Life-Threatening Cryptosporidium Diarrhea in a Child on Induction Chemotherapy for Acute Lymphoblastic Leukemia. Cureus 2021; 13:e18340. [PMID: 34722091 PMCID: PMC8551933 DOI: 10.7759/cureus.18340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/05/2022] Open
Abstract
Cryptosporidium infection is usually self-limiting but can be life-threatening in immunocompromised patients. It has emerged as an important cause of diarrhea in such patients worldwide. In this report, we describe a case of Cryptosporidium diarrhea in a child on induction therapy for acute lymphoblastic leukemia (ALL); timely diagnosis using multiplex polymerase chain reaction (PCR) led to definitive treatment and a favorable outcome in our patient.
Collapse
Affiliation(s)
- Anamika Bakliwal
- Medical Oncology and Haematology, All India Institute of Medical Science Rishikesh, Rishikesh, IND
| | - Uttam Kumar Nath
- Medical Oncology and Haematology, All India Institute of Medical Science Rishikesh, Rishikesh, IND
| | - Aroop Mohanty
- Clinical Microbiology, All India Institute of Medical Science Gorakhpur, Gorakhpur, IND
| | - Pratima Gupta
- Clinical Microbiology, All India Institute of Medical Science Rishikesh, Rishikesh, IND
| |
Collapse
|
7
|
Mohanty A, Meena S, Nath UK, Bakliwal A, Kaistha N, Gupta P. Trichosporon dohaense causing life-threatening fungemia in acute leukemia: First case report from India. INDIAN J PATHOL MICR 2021; 64:619-621. [PMID: 34341294 DOI: 10.4103/ijpm.ijpm_185_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Aroop Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - Suneeta Meena
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Uttam Kumar Nath
- Department of Medical Oncology and Haematology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - Anamika Bakliwal
- Department of Medical Oncology and Haematology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - Neelam Kaistha
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - Pratima Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| |
Collapse
|
8
|
Basu G, Anthony ML, Bakliwal A, Chattopadhyay D, Joshi PP, Arora RK, Mittal RS, Nath UK. Primary anaplastic lymphoma kinase-negative anaplastic large cell lymphoma of cervical spine presenting with quadriplegia: A case report and literature review. Surg Neurol Int 2020; 11:373. [PMID: 33408907 PMCID: PMC7771492 DOI: 10.25259/sni_634_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background: An anaplastic large cell lymphoma (ALCL) involving the cervical spine and leading to quadriplegia is very rare. Case Description: A 48-year-old immunocompetent male presented with quadriplegia that warranted an anterior cervical corpectomy/fusion. He was previously being presumptively treated for cervical disease attributed to tuberculosis. The histopathology and immunohistochemistry revealed an ALCL that was anaplastic lymphoma kinase (ALK) negative. The patient had a favorable response to surgery followed by CHOEP (cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisolone) chemotherapy. Conclusion: ALK-negative ALCL presenting with quadriplegia due to primary involvement of cervical spine is extremely rare, but must be diagnosed and appropriately managed.
Collapse
Affiliation(s)
- Garga Basu
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Michael L Anthony
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anamika Bakliwal
- Department of Medical oncology-Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Debranjani Chattopadhyay
- Department of Medical oncology-Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prashant P Joshi
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajnish Kumar Arora
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Radhey Shyam Mittal
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Uttam Kumar Nath
- Department of Medical oncology-Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
9
|
Setia RD, Arora S, Handoo A, Dadu T, Choudhary D, Sharma SK, Kharya G, Khandelwal V, Sachdeva P, Doval D, Bakliwal A, Kapoor M, Bajaj S, Bachchas V, Singh P. Comparison of Amicus and COBE Spectra for allogenic peripheral blood stem cell harvest: Study from tertiary care centre in India. Transfus Apher Sci 2017; 56:439-444. [DOI: 10.1016/j.transci.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/07/2017] [Accepted: 04/08/2017] [Indexed: 10/19/2022]
|
10
|
Bakliwal A, Kharya G, Khandelwal V, Doval D, Sharma SK, Chaudhary D, Handoo A, Setia R, Dadu T, Dhamija G, Arora S. Hematopoietic stem cell transplant for Hurler’s disease: A Case Report. Pediatric Hematology Oncology Journal 2016. [DOI: 10.1016/j.phoj.2016.10.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|