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Srinivasan S, Dhamne C, Patkar N, Chatterjee G, Moulik NR, Chichra A, Pallath A, Tembhare P, Shetty D, Subramanian PG, Narula G, Banavali S. KIT exon 17 mutations are predictive of inferior outcome in pediatric acute myeloid leukemia with RUNX1::RUNX1T1. Pediatr Blood Cancer 2024; 71:e30791. [PMID: 38014874 DOI: 10.1002/pbc.30791] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/24/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Pediatric core binding factor acute myeloid leukemia (CBF-AML), although considered a favorable risk subtype, exhibits variable outcomes primarily driven by additional genetic abnormalities, such as KIT mutations. PROCEDURE In this study, we examined the prognostic impact of KIT mutations in 130 pediatric patients with CBF-AML, treated uniformly at a single center over 4 years (2017-2021). KIT mutations were detected via next-generation sequencing using a myeloid panel comprising 52 genes for most patients. RESULTS Our findings revealed that KIT mutations were present in 31% of CBF-AML cases. Exon 17 KIT mutation was most commonly (72%) seen with notable occurrences at the D816 and N822 residue in 48% and 39% of cases, respectively. The 3-year cumulative incidence of relapse (CIR) and overall survival (OS) for patients with exon 17 KIT mutation were 36% and 40%, respectively, and was significantly worse in comparison to other site KIT mutations (3-year CIR: 11%; OS: 64%) and without KIT mutation (3-year CIR: 13%; OS:71%). Notably, the prognostic impact of KIT mutations was prominent in patients with RUNX1::RUNX1T1, but not in those with CBFB::MYH11 fusion. Additionally, a high KIT variant-allele frequency (VAF) (>33%) predicted for a higher disease relapse; 3-year CIR of 40% for VAF greater than 33% versus 7% for VAF less than 33%. When adjusted for site of KIT mutation and end-of-induction measurable residual disease, VAF greater than 33% correlated with poor OS (hazard ratio [HR]: 4.4 [95% CI: 1.2-17.2], p = .034). CONCLUSION Exon 17 KIT mutations serve as an important predictor of relapse in RUNX1::RUNX1T1 pediatric AML. In addition, a high KIT VAF may predict poor outcomes in these patients. These results emphasize the need to incorporate KIT mutational analysis into risk stratification for pediatric CBF-AML.
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Affiliation(s)
- Shyam Srinivasan
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Chetan Dhamne
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nikhil Patkar
- Department of Hematopathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gaurav Chatterjee
- Department of Hematopathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nirmalya Roy Moulik
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Akanksha Chichra
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Aneeta Pallath
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prashant Tembhare
- Department of Hematopathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dhanalaxmi Shetty
- Department of Cancer Cytogenetics, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - P G Subramanian
- Department of Hematopathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Srinivasan S, Dhamne C, Moulik NR, Chichra A, Tembhare P, Patkar N, Subramanian PG, Shetty D, Narula G, Banavali S. Treatment of Pediatric Acute Promyelocytic Leukemia with Retinoic Acid and Arsenic Trioxide along with Chemotherapy. Indian J Pediatr 2023:10.1007/s12098-023-04689-4. [PMID: 37380920 DOI: 10.1007/s12098-023-04689-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/16/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES Outcomes of childhood acute promyelocytic leukemia (APL) have exceeded 90% in the era of differentiating agents. In resource-limited settings, early mortality secondary to coagulopathy remains a significant challenge. Differentiation syndrome is a unique complication of APL therapy that requires a high degree of suspicion for timely initiation of therapy. METHODS A retrospective study of children ≤15 y of age with APL diagnosed between January-2013 and June-2019 treated at a tertiary cancer centre was conducted. Patients with a total leukocyte count ≥10,000/µL were risk stratified as high-risk. Treatment included differentiating agents, all-trans retinoic acid and arsenic trioxide along with chemotherapy. Baseline demographics, clinical complications and outcomes were analysed. RESULTS Out of 90 patients treated, 48 (53%) had high-risk APL and 25 (28%) presented with significant bleeding manifestations. Response to therapy was excellent with 96% of evaluable patients achieving molecular remission by the end of consolidation phase. Differentiation syndrome occurred in 23 (25%) patients of which two expired. Early mortality rate was 5.5% and was due to severe hemorrhage most often at the time of presentation. The 3-y overall survival of the entire cohort was 91% (95% CI: 85-97%). Two of 4 patients with relapse of disease could be salvaged with only differentiating agents followed by autologous transplantation. CONCLUSIONS Long-term outcomes of Indian children with APL are excellent. Timely management of coagulopathy and prompt initiation of differentiating agents along with appropriate cytoreductive measures is critical. Efforts to build academic-community partnerships to ensure timely diagnosis and emergency care in order to reduce early mortality are needed.
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Affiliation(s)
- Shyam Srinivasan
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Chetan Dhamne
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India.
| | - Nirmalya Roy Moulik
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Akanksha Chichra
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Prashant Tembhare
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
| | - Nikhil Patkar
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
| | - P G Subramanian
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
| | - Dhanlaxmi Shetty
- Department of Cancer Cytogenetics, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
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Shetty D, Talker E, Dhamne C, Mohanty P, Chaubal K, Tembhare P, Patkar N, Subramanian PG, Moulik NR, Narula G, Banavali S. Copy number gain of JAK2 on marker chromosome in a case of relapsed pediatric B-ALL. Pediatr Blood Cancer 2022; 69:e29658. [PMID: 35373889 DOI: 10.1002/pbc.29658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/19/2022] [Accepted: 02/27/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Dhanlaxmi Shetty
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - Elizabeth Talker
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Chetan Dhamne
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - Purvi Mohanty
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Kruti Chaubal
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Prashant Tembhare
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - Nikhil Patkar
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - P G Subramanian
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - Nirmalya Roy Moulik
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - Gaurav Narula
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
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Narasimhan M, Khamkar V, Tilwani S, Dalal SN, Shetty D, Subramanian PG, Gupta S, Govekar R. Atypical activation of signaling downstream of inactivated Bcr-Abl mediates chemoresistance in chronic myeloid leukemia. J Cell Commun Signal 2021; 16:207-222. [PMID: 34596797 DOI: 10.1007/s12079-021-00647-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022] Open
Abstract
Chronic myeloid leukemia (CML) epitomises successful targeted therapy, where inhibition of tyrosine kinase activity of oncoprotein Bcr-Abl1 by imatinib, induces remission in 86% patients in initial chronic phase (CP). However, in acute phase of blast crisis, 80% patients show resistance, 40% among them despite inhibition of Bcr-Abl1 activity. This implies activation of either Bcr-Abl1- independent signalling pathways or restoration of signalling downstream of inactive Bcr-Abl1. In the present study, mass spectrometry and subsequent in silico pathway analysis of differentiators in resistant CML-CP cells identified key differentiators, 14-3-3ε and p38 MAPK, which belong to Bcr-Abl1 pathway. Their levels and activity respectively, indicated active Bcr-Abl1 pathway in CML-BC resistant cells, though Bcr-Abl1 is inhibited by imatinib. Further, contribution of these components to resistance was demonstrated by inhibition of Bcr-Abl1 down-stream signalling by knocking-out of 14-3-3ε and inhibition of p38 MAPK activity. The observations merit clinical validation to explore their translational potential.
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Affiliation(s)
- Mythreyi Narasimhan
- Rukmini Lab, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410210, India.,Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai, 400094, India
| | - Vaishnavi Khamkar
- Rukmini Lab, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410210, India
| | - Sarika Tilwani
- Sorab Lab, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410210, India.,Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai, 400094, India
| | - Sorab N Dalal
- Sorab Lab, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410210, India.,Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai, 400094, India
| | - Dhanlaxmi Shetty
- Department of Cancer Cytogenetics, , ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410210, India
| | - P G Subramanian
- Hematopathology Lab, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410210, India.,Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai, 400094, India
| | - Sanjay Gupta
- Gupta Lab, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410210, India.,Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai, 400094, India
| | - Rukmini Govekar
- Rukmini Lab, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410210, India. .,Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai, 400094, India.
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Shetty D, Jain H, Rohil Y, Khattry N, Sengar M, Bagal B, Jain H, Gokarn A, Punatar S, Avinash Bonda VN, Subramanian PG. Role of cytogenetic abnormalities detected by fluorescence in situ hybridization as a prognostic marker: Pathogenesis & clinical course in patients with B-chronic lymphocytic leukaemia. Indian J Med Res 2021; 153:475-483. [PMID: 34380794 PMCID: PMC8354055 DOI: 10.4103/ijmr.ijmr_2257_18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background & objectives: B-cell chronic lymphocytic leukaemia (B-CLL) is one of the most common forms of adult leukaemia, with a highly variable clinical course. Specific chromosomal and genetic aberrations are used clinically to predict prognosis, independent from conventional clinical markers. Molecular cytogenetic methods such as fluorescence in situ hybridization (FISH) detect aberrations in up to 80 per cent B-CLL patients. This study was conducted to score the frequencies of recurrent aberrations, i.e., del(13q14), trisomy 12, del(11q22), del(17p13), del(6q21) and IgH (immunoglobulin heavy chain) translocations and to understand their role in prognostication and risk stratification. Methods: FISH studies were performed on bone marrow aspirate or peripheral blood of 280 patients using commercially available disease-specific probe set. The data were correlated with clinical and haematological parameters such as low haemoglobin, splenomegaly and lymphadenopathy. Results: Chromosomal aberrations were detected in 79 per cent of patients, with del(13q14) (57%) as the most common cytogenetic aberration, followed by trisomy 12 (27%), del(11q22) (22%), t(14q32) (19%), del(17p13) (18%) and del(6q21) (9%). Single or in coexistence with other aberration del(13q14) had a favourable outcome in comparison to del(11q22), t(14q32), del(17p13) and del(6q21) which were associated with advanced stages of the disease. Trisomy 12 had a variable clinical course. Interpretation & conclusions: FISH was found to be a sensitive and efficient technique in detecting the prevalence of recurrent cytogenetic abnormalities. Each of these aberrations is an important independent predictor of disease progression and survival which aids in designing risk-adapted treatment strategies for better disease management.
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Affiliation(s)
- Dhanlaxmi Shetty
- Department of Cancer Cytogenetics, Advanced Centre for Training, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Mumbai, Maharashtra, India
| | - Hemani Jain
- Department of Cancer Cytogenetics, Advanced Centre for Training, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Mumbai, Maharashtra, India
| | - Yogita Rohil
- Department of Cancer Cytogenetics, Advanced Centre for Training, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Mumbai, Maharashtra, India
| | - Navin Khattry
- Department of Medical Oncology, Advanced Centre for Training, Research & Education in Cancer, Tata Memorial Centre, Kharghar; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Anant Gokarn
- Department of Medical Oncology, Advanced Centre for Training, Research & Education in Cancer, Tata Memorial Centre, Kharghar; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Sachin Punatar
- Department of Medical Oncology, Advanced Centre for Training, Research & Education in Cancer, Tata Memorial Centre, Kharghar; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Venkata Naga Avinash Bonda
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - P G Subramanian
- Department of Hematopathology, Advanced Centre for Training, Research & Education in Cancer, Tata Memorial Centre, Kharghar; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
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Nathany S, Chatterjee G, Ghai S, Moulik NR, Shetty D, Subramanian PG, Tembhare P, Gujral S, Dhamne C, Banavali S, Narula G, Patkar N. Mutational landscape of Juvenile Myelomonocytic Leukemia (JMML)-A real-world context. Int J Lab Hematol 2021; 43:1531-1538. [PMID: 34387930 DOI: 10.1111/ijlh.13680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/22/2021] [Accepted: 07/31/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Juvenile myelomonocytic leukemia (JMML) is a rare childhood neoplasm (<5% cases), which has been categorized under myelodysplastic/myeloproliferative neoplasms (MDS/MPN) in the recent classification by the World Health Organization. METHODS We developed a 51-gene (151.5kB) low-cost targeted myeloid panel based on single-molecule molecular inversion probes to comprehensively evaluate the genomic profile of Juvenile myelomonocytic leukemia (JMML). RESULTS A total of 50 children with clinical and pathological features of JMML were sequenced at high coverage. Among the 50 patients, 44(88%) harbored mutations in one of the RAS/MAPK-pathway genes, most frequently in NRAS (32%), followed by PTPN11 (28%) and NF1 (22%). One-fifth of children had more than one mutation, with 5 cases harboring two RAS pathway mutations. Monosomy 7 was detected in 32% (16) patients, and five of these did not harbor any RAS pathway mutations. Children with monosomy 7 showed shorter overall survival compared with their wild-type counterparts (P = .02). CONCLUSION Our study highlights that comprehensive genomic profiling identifies at least one mutation in almost 90% of JMML patients. Performing genomic analysis at baseline might help in triaging children with JMML for allogenic stem cell transplant in resource-constrained settings.
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Affiliation(s)
- Shrinidhi Nathany
- Department of Hematopathology, Advanced Centre for Treatment and Research in Cancer, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Gaurav Chatterjee
- Department of Hematopathology, Advanced Centre for Treatment and Research in Cancer, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shruti Ghai
- Department of Hematopathology, Advanced Centre for Treatment and Research in Cancer, Tata Memorial Centre, Mumbai, India
| | - Nirmalya Roy Moulik
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Pediatric Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Dhanalaxmi Shetty
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Department of Cancer Cytogenetics, Advanced Centre for treatment and research in cancer, Tata Memorial Centre, Mumbai, India
| | - P G Subramanian
- Department of Hematopathology, Advanced Centre for Treatment and Research in Cancer, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Prashant Tembhare
- Department of Hematopathology, Advanced Centre for Treatment and Research in Cancer, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sumeet Gujral
- Department of Hematopathology, Advanced Centre for Treatment and Research in Cancer, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Chetan Dhamne
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Pediatric Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Sripad Banavali
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Pediatric Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Gaurav Narula
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Pediatric Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Nikhil Patkar
- Department of Hematopathology, Advanced Centre for Treatment and Research in Cancer, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
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Jain H, Shetty D, Roy Moulik N, Narula G, Subramanian PG, Banavali S. A novel case of intrachromosomal amplification and insertion of RUNX1 on derivative chromosome 2 in pediatric AML. Cancer Genet 2021; 254-255:65-69. [PMID: 33647813 DOI: 10.1016/j.cancergen.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/21/2020] [Revised: 01/15/2021] [Accepted: 02/08/2021] [Indexed: 11/18/2022]
Abstract
Intrachromosomal amplification of RUNX1 gene on chromosome 21 (iAMP21) is a rare occurrence in acute myeloid leukemia (AML). Herein, we describe a case of AML with amplification of RUNX1 and its insertion on chromosome 2 detected by conventional karyotyping and confirmed by metaphase FISH. A six-year-old female was diagnosed as acute myeloid leukemia with monocytic differentiation. The patient's bone marrow revealed 74% blasts which were MPO negative. Conventional karyotyping revealed a complex karyotype, with rearrangements in chromosomes 1, 2, 7, 8 and hsr(21). FISH on interphase cells with LSI RUNX1-RUNX1T1 dual colour dual fusion translocation probe showed 6-7 copies of RUNX1 signal. Metaphase FISH with LSI RUNX1-RUNX1T1 probe confirmed amplification of RUNX1 and insertion of amplified RUNX1 sequences on long arm of chromosome 2. Induction chemotherapy was initiated, however, the patient died within one month of diagnosis suggesting poor outcome associated with this novel finding. Insertion of amplified RUNX1 on another chromosome has not yet been reported so far.
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Affiliation(s)
- Hemani Jain
- Cancer Cytogenetics Department, Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Sector-22, Kharghar, Navi Mumbai 410210, India.
| | - Dhanlaxmi Shetty
- Cancer Cytogenetics Department, Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Sector-22, Kharghar, Navi Mumbai 410210, India.
| | - Nirmalya Roy Moulik
- Department of Pediatric Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel. Mumbai 400012, India; Cancer Cytogenetics Department, Room No. 6, CCE building, Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Tata Memorial Centre, Sector-22, Kharghar, Navi Mumbai 410210 India.
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel. Mumbai 400012, India; Cancer Cytogenetics Department, Room No. 6, CCE building, Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Tata Memorial Centre, Sector-22, Kharghar, Navi Mumbai 410210 India.
| | - P G Subramanian
- Hematopathology Department, CCE building, Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Tata Memorial Centre, Sector-22, Kharghar, Navi Mumbai 410210, India; Cancer Cytogenetics Department, Room No. 6, CCE building, Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Tata Memorial Centre, Sector-22, Kharghar, Navi Mumbai 410210 India.
| | - Sripad Banavali
- Department of Pediatric Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel. Mumbai 400012, India; Cancer Cytogenetics Department, Room No. 6, CCE building, Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Tata Memorial Centre, Sector-22, Kharghar, Navi Mumbai 410210 India.
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Mirgh S, Gokarn A, Punatar S, Chichra A, Singh A, Rajendra A, Babu Goli V, Trivedi B, Joshi A, Patkar N, Tembhare P, Subramanian PG, Shetty N, Chavan P, Bhat V, Gupta S, Khattry N. Clinical course of severe COVID19 treated with tocilizumab and antivirals post-allogeneic stem cell transplant with extensive chronic GVHD. Transpl Infect Dis 2021; 23:e13576. [PMID: 33523551 PMCID: PMC7994986 DOI: 10.1111/tid.13576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/30/2020] [Revised: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 12/15/2022]
Abstract
Recipients of allogeneic hematopoietic stem cell transplantation (allo‐HSCT) are an immunocompromised group who are likely to develop severe complications and mortality because of coronavirus disease 2019 (COVID‐19). We report here a 61‐year‐old male patient of primary myelofibrosis who underwent an allo‐HSCT 6 years earlier, had chronic graft‐versus‐host disease (cGVHD) involving the liver, lung, eyes, and skin, (with recurrent episodes of pulmonary infections) who developed severe COVID‐19. The patient was treated with tocilizumab, and a combination of lopinavir/ritonavir, ribavirin, interferon‐β1b. He was discharged after 31 days with full recovery. Tocilizumab, a humanized monoclonal antibody against IL6, has been shown to benefit respiratory manifestations in severe COVID19. However, this is first report, to our knowledge, of its use and benefit in a post HSCT recipient.
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Affiliation(s)
- Sumeet Mirgh
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anant Gokarn
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sachin Punatar
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Akanksha Chichra
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuj Singh
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Akhil Rajendra
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vasu Babu Goli
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bhakti Trivedi
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Anaesthesiology, Pain and Critical Care Medicine, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nikhil Patkar
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Hemato-Pathology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Prashant Tembhare
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Hemato-Pathology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - P G Subramanian
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Hemato-Pathology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Nitin Shetty
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Radiodiagnosis, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Preeti Chavan
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Laboratory Medicine, ACTREC - Tata Memorial Centre, ACTREC, Navi Mumbai, Maharashtra, India.,Department of Microbiology, ACTREC - Tata Memorial Centre, ACTREC, Navi Mumbai, Maharashtra, India
| | - Vivek Bhat
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Microbiology, ACTREC - Tata Memorial Centre, ACTREC, Navi Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Navin Khattry
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
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9
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Shetty D, Amare PK, Mohanty P, Talker E, Chaubal K, Jain H, Tembhare P, Patkar N, Chaturvedi A, Subramanian PG, Moulik N, Dhamne C, Jain H, Bagal B, Narula G, Sengar M, Khattry N, Banavali S. Investigating the clinical, hematological and cytogenetic profile of endoreduplicated hypodiploids in BCP-ALL. Blood Cells Mol Dis 2020; 85:102465. [PMID: 32693366 DOI: 10.1016/j.bcmd.2020.102465] [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] [Received: 06/30/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
Ploidy, besides known translocations in lymphoblasts, is a strong predictor of prognosis in B- cell progenitor acute lymphoblastic leukemia (BCP-ALL). While hyperdiploidy with >50 chromosomes shows a favourable outcome, hypodiploidy with <45 chromosomes have a dismal clinical outcome. However, there exists a small subset where both the hypodiploid and hyperdiploid clones are apparent either by cytogenetics or flow cytometry and are defined partially masked hypodiploids or mosaics based on the percentage of clonal population. These patients are essentially hypodiploids, and show the hyperdiploid clone as a consequence of endoreduplication of the primary hypodiploid clone- A phenomenon of successive replication of genome without mitosis (cytokinesis) resulting in increased ploidy. In the current study, we present the complete clinical, hematological and cytogenetic profile of 11 such newly diagnosed mosaics or partially masked hypodiploid BCP-ALL cases.
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Affiliation(s)
- Dhanlaxmi Shetty
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai, India.
| | - Pratibha Kadam Amare
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai, India
| | - Purvi Mohanty
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai, India
| | - Elizabeth Talker
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai, India
| | - Kruti Chaubal
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai, India
| | - Hemani Jain
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai, India
| | - Prashant Tembhare
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Nikhil Patkar
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Anumeha Chaturvedi
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai, India
| | - P G Subramanian
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Nirmalya Moulik
- Department of Medical Oncology, Tata Memorial Hospital (TMH), Parel, Mumbai, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Chetan Dhamne
- Department of Medical Oncology, Tata Memorial Hospital (TMH), Parel, Mumbai, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Hospital (TMH), Parel, Mumbai, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Hospital (TMH), Parel, Mumbai, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Gaurav Narula
- Department of Medical Oncology, Tata Memorial Hospital (TMH), Parel, Mumbai, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Hospital (TMH), Parel, Mumbai, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Navin Khattry
- Department of Medical Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital (TMH), Parel, Mumbai, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
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10
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Patkar N, Bhanshe P, Rajpal S, Joshi S, Chaudhary S, Chatterjee G, Tembhare P, Dhamne C, Prasad M, Moulik NR, Shetty D, Gokarn A, Bonda A, Nayak L, Punatkar S, Bagal B, Sengar M, Narula G, Khattry N, Banavali S, Subramanian PG, Gujral S. NARASIMHA: Novel Assay based on Targeted RNA Sequencing to Identify ChiMeric Gene Fusions in Hematological Malignancies. Blood Cancer J 2020; 10:50. [PMID: 32372024 PMCID: PMC7200652 DOI: 10.1038/s41408-020-0313-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/31/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nikhil Patkar
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India. .,Homi Bhabha National Institute (HBNI), Mumbai, India.
| | - Prasanna Bhanshe
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Sweta Rajpal
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Swapnali Joshi
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Shruti Chaudhary
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Gaurav Chatterjee
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Prashant Tembhare
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Chetan Dhamne
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Pediatric Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Maya Prasad
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Pediatric Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Nirmalya Roy Moulik
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Pediatric Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Dhanalaxmi Shetty
- Department of Cytogenetics, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Anant Gokarn
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Adult Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Avinash Bonda
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Adult Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Lingaraj Nayak
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Adult Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Sachin Punatkar
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Adult Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Bhausaheb Bagal
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Adult Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Manju Sengar
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Adult Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Gaurav Narula
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Pediatric Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Navin Khattry
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Adult Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Shripad Banavali
- Homi Bhabha National Institute (HBNI), Mumbai, India.,Pediatric Haematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - P G Subramanian
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sumeet Gujral
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
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11
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Jain H, Shetty D, Narula G, Moulik NR, Tembhare P, Patkar N, Subramanian PG, Banavali S. Cytogenetic profile and outcome of a pediatric acute promyelocytic leukemia patient presenting with isolated isochromosome 17q in absence of RARA rearrangement. Blood Cells Mol Dis 2020; 88:102443. [PMID: 32414556 DOI: 10.1016/j.bcmd.2020.102443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Hemani Jain
- Cancer Cytogenetic Department, Room No. 6, CCE Building, Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Tata Memorial Centre, Sector-22, Kharghar, Navi Mumbai 410210, India
| | - Dhanlaxmi Shetty
- Cancer Cytogenetic Department, Room No. 6, CCE Building, Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Tata Memorial Centre, Sector-22, Kharghar, Navi Mumbai 410210, India.
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai 400012, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai 400094, India
| | - Nirmalya Roy Moulik
- Department of Pediatric Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai 400012, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai 400094, India
| | - Prashant Tembhare
- Haematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai 400094, India
| | - Nikhil Patkar
- Haematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai 400094, India
| | - P G Subramanian
- Haematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai 400094, India
| | - Sripad Banavali
- Department of Pediatric Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai 400012, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai 400094, India
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12
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Rabade N, Subramanian PG, Kodgule R, Raval G, Joshi S, Chaudhary S, Mascarenhas R, Tembhare P, Gujral S, Patkar N. Molecular genetics of BCR-ABL1 negative myeloproliferative neoplasms in India. INDIAN J PATHOL MICR 2018; 61:209-213. [PMID: 29676359 DOI: 10.4103/ijpm.ijpm_223_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/04/2022] Open
Abstract
Introduction Over the past decade, we have moved on from a predominantly morphological and clinical classification of myeloproliferative neoplasms (MPN) to a more evolved classification that accounts for the molecular heterogeneity that is unique to this subgroup of hematological malignancies. This usually incorporates mutations in Janus kinase 2 (JAK2), MPL, and calreticulin (CALR) genes. In this manuscript, we report the frequency of these mutations in a cohort of Indian patients at a tertiary cancer center. Materials and Methods One hundred and thirty cases of MPN were included in this study. These cases were diagnosed and classified based on the World Health Organization 2008 criteria. JAK2 and MPL mutations were detected using high sensitivity allele-specific polymerase chain reaction using fluorescent labeled primers followed by capillary electrophoresis. A subset of JAK2 and CALR mutations were assessed using a fragment length assay. Results Among the MPN, we had 20 cases of polycythemia vera (PV), 34 cases of essential thrombocythemia (ET), and 59 of myelofibrosis (MF). JAK2, MPL, and CALR mutations were mutually exclusive of each other. Seventeen cases were categorized as MPN unclassifiable (MPN-U). JAK2p.V617F and MPL mutations were present in 60% (78 of 130) and 5.3% (7 of 130) of all MPN. All the PV cases harbored the JAK2 p.V617F mutation. A total of 23.8% (31 of 130) of patients harbored CALR mutations. CALR exon 9 mutations were detected in 60.8% (14 of 23) and 50% (5 of 10) of JAK2 and MPL negative MF and ET cases, respectively. MPN-U cases included three JAK2 p.V617F positive, two MPL p.W515 L, and 12 CALR positive cases. Ten different types of CALR indels (8 deletions and 2 insertions) were detected of which Type I and Type II mutations were the most common, occurring at a frequency of 45.1% (14 of 31) and 22.5% (7 of 31), respectively. Discussion and Conclusion We report frequencies of JAK2 p. V617F, MPL exon 10 and CALR mutations in 130 patients similar to those reported in western literature. These mutations carry not only diagnostic but also prognostic relevance.
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Affiliation(s)
- Nikhil Rabade
- Tata Memorial Centre, Hematopathology Laboratory, Mumbai, Maharashtra, India
| | - P G Subramanian
- Tata Memorial Centre, Hematopathology Laboratory, Mumbai, Maharashtra, India
| | - Rohan Kodgule
- Tata Memorial Centre, Hematopathology Laboratory, Mumbai, Maharashtra, India
| | - Goutham Raval
- Tata Memorial Centre, Hematopathology Laboratory, Mumbai, Maharashtra, India
| | - Swapnali Joshi
- Tata Memorial Centre, Hematopathology Laboratory, Mumbai, Maharashtra, India
| | - Shruti Chaudhary
- Tata Memorial Centre, Hematopathology Laboratory, Mumbai, Maharashtra, India
| | - Russel Mascarenhas
- Tata Memorial Centre, Hematopathology Laboratory, Mumbai, Maharashtra, India
| | - Prashant Tembhare
- Tata Memorial Centre, Hematopathology Laboratory, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Tata Memorial Centre, Hematopathology Laboratory, Mumbai, Maharashtra, India
| | - Nikhil Patkar
- Tata Memorial Centre, Hematopathology Laboratory, Mumbai, Maharashtra, India
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13
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Jain H, Shetty D, Jain H, Sengar M, Khattry N, Subramanian PG. A rare case of hepatosplenic γδ T-cell lymphoma expressing CD19 with ring chromosome 7 and trisomy 8. Cancer Genet 2018; 228-229:17-20. [PMID: 30553467 DOI: 10.1016/j.cancergen.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
Hepatosplenic T-cell lymphoma (HSTL) is a rare subtype of peripheral T-cell lymphoma predominantly seen in young males. This disease presents with isolated hepatosplenomegaly and thrombocytopenia with sinusoidal infiltration of liver and sinusal infiltration of spleen. Immunophenotype shows positivity for CD3, CD7, TCRγδ or TCRαβ, CD38 and double negative for CD4, CD8, TdT, CD5, and CD56. Isochromosome 7q with or without trisomy 8 is seen in HSTL. Recently, ring chromosome 7 has also been identified as a new abnormality. We describe the clinical, immunophenotypic and cytogenetic analysis in a 24-year-old woman. We present an unusual case of TCRγδ positive T-cell lymphoma with aberrant expression of CD19, which is a B-cell lymphoid marker, with amplification of 7q region and subsequent formation of ring chromosome 7 and trisomy 8. This is the second case of HSTL, positive for CD19 and first case presenting with ring chromosome 7 and trisomy 8 in a CD19 positive HSTL which is a rare finding in T-cell lymphoma and needs to be explored further.
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Affiliation(s)
- Hemani Jain
- Cancer Cytogenetic Department, Tata Memorial Centre, Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Sector-22, Room No. 6, CCE building, Kharghar, Navi Mumbai 410210, India.
| | - Dhanlaxmi Shetty
- Cancer Cytogenetic Department, Tata Memorial Centre, Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Sector-22, Room No. 6, CCE building, Kharghar, Navi Mumbai 410210, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - Navin Khattry
- Department of Medical Oncology, Tata Memorial Centre, Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Sector-22, Kharghar, Navi Mumbai 410210, India
| | - P G Subramanian
- Hematopathology Department, Tata Memorial Centre, Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Sector-22, Kharghar, CCE building, Navi Mumbai 410210, India
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14
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Modkharkar S, Navale P, Amare PK, Chougule A, Patkar N, Tembhare P, Menon H, Sengar M, Khattry N, Banavali S, Arora B, Narula G, Laskar S, Khanna N, Muckaden MA, Rangarajan V, Agrawal A, Shet T, Epari S, Subramanian PG, Gujral S. Applicability of 2008 World Health Organization classification system of hematolymphoid neoplasms: Learning experiences. INDIAN J PATHOL MICR 2018; 61:58-65. [PMID: 29567885 DOI: 10.4103/ijpm.ijpm_56_17] [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: 11/04/2022] Open
Abstract
Background 2008 World Health Organization (WHO) classification of hematolymphoid neoplasms (HLN) has classified them based on morphology, results of various ancillary techniques, and clinical features.[1] There are no studies looking at the applicability of WHO classification. Aims The aim of the study was to calculate proportions of all HLN subtypes seen during 1-year period based on 2008 WHO classification of HLN and study applicability and also shortcomings of practices in a tertiary care center in India. Materials and Methods This was a 1-year retrospective study (January 1st, to December 31st, 2010) where cases were identified using hospital/laboratory electronic records. Old follow-up and referral cases were excluded from the study. Only newly diagnosed cases classified into categories laid down by 2008 WHO classification of HLN included. Results Out of 2118 newly diagnosed classifiable cases, 1602 (75.6%) cases were of lymphoid neoplasms, 489 (23.1%) cases of myeloid neoplasms, 16 (0.8%) cases of histiocytic and dendritic cell neoplasms, and 11 (0.5%) cases of acute leukemias of ambiguous lineage. Overall, most common HLN subtype was diffuse large B-cell lymphoma (n = 361, 17.0%). Precursor B-lymphoblastic leukaemia/lymphoma (n = 177, 48.2%) was the most common subtype within pediatric age group. Conclusions All major subtypes of HLN were seen at our center and showed trends almost similar to those seen in other Indian studies. Molecular/cytogenetic studies could not be performed on a significant number of cases owing to logistic reasons (unavailability of complete panels and also cost-related issues) and such cases could not be classified as per the WHO classification system.
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Affiliation(s)
- Sushil Modkharkar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pooja Navale
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pratibha Kadam Amare
- Department of Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anuradha Chougule
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nikhil Patkar
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prashant Tembhare
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Hari Menon
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Navin Khattry
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Brijesh Arora
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gaurav Narula
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mary Ann Muckaden
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Radiology and Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Radiology and Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - P G Subramanian
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital; Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
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15
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Patkar N, Subramanian PG, Tembhare P, Mandalia S, Chaterjee G, Rabade N, Kodgule R, Chopra K, Bibi A, Joshi S, Chaudhary S, Mascerhenas R, Kadam-Amare P, Narula G, Arora B, Banavali S, Gujral S. An integrated genomic profile that includes copy number alterations is highly predictive of minimal residual disease status in childhood precursor B-lineage acute lymphoblastic leukemia. INDIAN J PATHOL MICR 2018. [PMID: 28631637 DOI: 10.4103/ijpm.ijpm_466_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Copy number alterations (CNA) have been described in childhood precursor B-lineage acute lymphoblastic leukemia (B-ALL) which in conjunction with chromosomal abnormalities drive leukemogenesis. There is no consensus on the clinical incorporation of CNA in B-ALL. An integrated genomic classification (IGC) has been proposed which includes CNA and cytogenetics. METHODS We correlated this IGC with immunophenotypic minimal residual disease (MRD) as well as other standard criteria for 245 patients of B-ALL such as National Cancer Institute (NCI) risk, D+8 prednisolone response, cytogenetics, and ploidy status. RESULTS MRD was detectable in 81 patients (33.1%). The most common abnormalities were seen in CDKN2A/B (25.7%) followed by PAX5(20%), ETV6(16.7%), IKZF1(15.5%), Rb1(5.3%), BTG (3.3%), EBF1(2.0%), and PAR1(0.8%). On integrating CNA into the IGC, 170 patients (69.4%) were classified into good genomic risk (GEN-GR) whereas 75 (30.6%) belonged to the poor genomic risk (GEN-PR) category. The IGC showed a significant correlation with MRD and NCI risk. The presence of CNA predicted MRD clearance in intermediate cytogenetics group. CONCLUSION These data seem to indicate that in addition to cytogenetics, CNA should be incorporated into routine clinical testing and risk algorithms for B-ALL. The IGC is of prognostic relevance and offers an additional avenue for prognostication and risk-adapted therapy.
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Affiliation(s)
- Nikhil Patkar
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - P G Subramanian
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Prashant Tembhare
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sneha Mandalia
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Gaurav Chaterjee
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Nikhil Rabade
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Rohan Kodgule
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Karishma Chopra
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Asma Bibi
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Swapnali Joshi
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Shruti Chaudhary
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Russel Mascerhenas
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Pratibha Kadam-Amare
- Department of Cancer Cytogenetics, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Gaurav Narula
- Department of Medical Oncology, Pediatric Haemato-lymphoid Disease Management Group, Mumbai, Maharashtra, India
| | - Brijesh Arora
- Department of Medical Oncology, Pediatric Haemato-lymphoid Disease Management Group, Mumbai, Maharashtra, India
| | - Shripad Banavali
- Department of Medical Oncology, Pediatric Haemato-lymphoid Disease Management Group, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
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Khattry N, Laskar S, Sengar M, Rangarajan V, Shet T, Subramanian PG, Epari S, Bagal B, Goda JS, Agarwal A, Jain H, Tembhare P, Patkar N, Khanna N, Punatar S, Gokarn A, Shetty D, Jain H, Bonda A, Gota V, Hasan S, Kode J, Dutt S, Kulkarni S, Shetty N, Sable N, Deodhar J, Jadhav S, Pawaskar P, Mathew L, Menon H, Nair R, Kannan S, Chiplunkar S, Gujral S. Long term clinical outcomes of adult hematolymphoid malignancies treated at Tata Memorial Hospital: An institutional audit. Indian J Cancer 2018; 55:9-15. [PMID: 30147087 DOI: 10.4103/ijc.ijc_656_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 02/05/2023]
Abstract
INTRODUCTION There is paucity of data from India about the outcomes of patients with various hematological malignancies. Since its formation in 2009, the adult hematolymphoid disease management group of the Tata Memorial Centre is dedicated to the treatment of hematological malignancies alone. In this report, we present the outcomes of patients treated at our centre over a 5 year period for various haematological malignancies in both transplant and non-transplant setting. METHODS This is a retrospective analysis of all patients registered in adult hematolymphoid disease management group between 1st January 2010 to 31st December 2014. Patients not treated at our centre were excluded from survival analysis. The cut off date for survival analysis was 31st January 2016. RESULTS Overall, 1869, 3633 and 544 patients with acute leukemias, various lymphomas and myeloma respectively were registered at our centre from 1st January 2010 to 31st December 2014. Of these, 1178 (63%), 3091 (85%) and 454 (83%) respectively received treatment at our centre. The cumulative probability of 5 year overall survival for patients with acute leukemias, Hodgkin's lymphoma, non-Hodgkin lymphoma and myeloma treated at our centre is 40%, 85%, 78% and 40% respectively. Four hundred and fifteen stem cell transplants were done between 14th November 2007 to 31st December 2014 with 46% being allogeneic and 54% being autologous. The 5 year overall survival of patients with allogenic and autologous transplant was 52% and 63% respectively. CONCLUSIONS This is the largest single centre data on outcomes of various haematological malignancies from India. This real world data identifies areas which need further attention to improve outcomes.
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Affiliation(s)
- Navin Khattry
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - P G Subramanian
- Department of Hematopathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jayant Sastri Goda
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Archi Agarwal
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prashant Tembhare
- Department of Hematopathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Nikhil Patkar
- Department of Hematopathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sachin Punatar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anant Gokarn
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Dhanlakshmi Shetty
- Department of Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Hemani Jain
- Department of Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Avinash Bonda
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Tata Memorial Centre, Mumbai, Maharashtra, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai, Maharashtra, India
| | - Syed Hasan
- Cancer Research Institute, Tata Memorial Centre, Mumbai, Maharashtra, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai, Maharashtra, India
| | - Jyoti Kode
- Cancer Research Institute, Tata Memorial Centre, Mumbai, Maharashtra, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai, Maharashtra, India
| | - Shilpee Dutt
- Cancer Research Institute, Tata Memorial Centre, Mumbai, Maharashtra, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai, Maharashtra, India
| | - Suyash Kulkarni
- Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nitin Shetty
- Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilesh Sable
- Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jayita Deodhar
- Department of Psychiatry and Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sunita Jadhav
- Social Welfare, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Preeti Pawaskar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Libin Mathew
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Hari Menon
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Reena Nair
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sadhana Kannan
- Department of Biostatistics, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Shubhadha Chiplunkar
- Cancer Research Institute, Tata Memorial Centre, Mumbai, Maharashtra, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Malhotra H, Agarwal M, Chakarborti P, Varma N, Mathews V, Bhattacharyya J, Seth T, Gyathri K, Menon H, Subramanian PG, Sharma A, Bhattacharyya M, Mehta J, Shah S, Gogoi PK, Nair R, Agarwal U, Varma S, Prasad SVVS, Mishra D. Revised myeloproliferative neoplasms working group consensus recommendations for diagnosis and management of primary myelofibrosis, polycythemia vera, and essential thrombocythemia. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_88_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Ghodke K, Tembhare P, Patkar N, Subramanian PG, Arora B, Gujral S. A Rare Extramedullary and Extralymphoid Presentation of Mixed Phenotypic Blastic Hematolymphoid Neoplasm: A Study of Two Cases. Indian J Med Paediatr Oncol 2017; 38:394-397. [PMID: 29200701 PMCID: PMC5686994 DOI: 10.4103/ijmpo.ijmpo_94_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 11/04/2022] Open
Abstract
Mixed phenotype acute leukemia (MPAL) is a rare hematolymphoid neoplasm, representing only 3%-5% of acute leukemia. Although MPAL has been sufficiently described in the literature, its extramedullary presentation as a solitary lesion without leukemic (bone marrow [BM]) involvement is rarely described. We are presenting two cases of mixed phenotypic blastic hematolymphoid neoplasms without leukemic involvement at disease presentation in 8-year-old female and 21-year-old male patients. Both the cases had extralymphatic bone involvement in the form of solitary bone lesion. Initially, there was no leukemic involvement in both the cases, but the second case progressed to acute leukemia during the course of the disease. On immunophenotypic evaluation, both the cases revealed blasts showing unequivocal evidence of myeloid and B-lymphoid lineage commitment. These cases were difficult to categorize either into MPAL as the BM was not involved or into lymphoblastic lymphoma due to coexpression of myeloid differentiation. Therefore, we chose to classify them as a bi/mixed phenotypic blastic hematolymphoid neoplasm. Detailed immunophenotypic analysis either by immunohistochemistry or flow cytometric immunophenotyping is important for the diagnosis of such cases as they have a poor prognosis.
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Affiliation(s)
- Kiran Ghodke
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Prashant Tembhare
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Nikhil Patkar
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - P G Subramanian
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Brijesh Arora
- Department of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Kadam Amare PS, Jain H, Nikalje S, Sengar M, Menon H, Inamdar N, Subramanian PG, Gujral S, Shet T, Epari S, Nair R. Observation on frequency & clinico-pathological significance of various cytogenetic risk groups in multiple myeloma: an experience from India. Indian J Med Res 2017; 144:536-543. [PMID: 28256461 PMCID: PMC5345299 DOI: 10.4103/0971-5916.200890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background & objectives: Multiple myeloma (MM) is a plasma cell malignancy characterized by cytogenetic heterogeneity. In comparison with conventional karyotyping, fluorescence in situ hybridization (FISH) can efficiently detect various genetic changes in non-cycling plasma cells in 50-90 per cent of MM cases. The present study was undertaken in MM patients to evaluate the frequency and clinico-pathological significance of various cytogenetic abnormalities in the Indian population. Methods: Interphase FISH was applied on purified plasma cells of 475 patients with MM using specific probes. Interphase FISH for 1q gain/1q amplification was performed on a separate group of 250 newly diagnosed MM patients. Results: Low frequency of Δ13 [-13/del(13q)] (32%) and t(11;14) (5%) was observed in our 475 patients probably due to ethnic diversity. Clustering of Δ13, del(17) (p13.1) and IgH translocations in non-hyperdiploidy confirmed prognostic significance of ploidy in MM. t(4;14) and del(17) (p13.1) were high-risk groups due to correlation with high serum β2-microglobulin, increased plasma cells and advanced disease. Hyperdiploidy and t(14;16) were associated with higher age group. In a separate group of 250 patients, 1q amplification [amp(1q)] in combination with Δ13 and/or del(17p) with t(4;14) revealed association with adverse clinico-laboratory features, which confirmed progressive role of amp(1q) with adverse prognostic impact. Amp(1q) was clustered at 1q21 and 1q25 loci. Interpretation & conclusions: Based on our findings, it appears that comprehensive analysis of various cytogenetic aberrations by interphase FISH is a powerful strategy being adapted for risk stratification of MM.
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Affiliation(s)
| | - Hemani Jain
- Department of Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, India
| | - Shraddha Nikalje
- Department of Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Hari Menon
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Nitin Inamdar
- Department of Biochemistry, Tata Memorial Hospital, Mumbai, India
| | - P G Subramanian
- Department of Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Reena Nair
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
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20
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Patkar N, Rabade N, Kadam PA, Mishra F, Muranjan A, Tembhare P, Chaudhary S, Joshi S, Jain H, Dangi U, Bagal B, Khattry N, Menon H, Gujral S, Sengar M, Subramanian PG. Immunogenetics of chronic lymphocytic leukemia. INDIAN J PATHOL MICR 2017; 60:38-42. [PMID: 28195089 DOI: 10.4103/0377-4929.200051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cytogenetic aberrations as well as presence of IGVH mutations are the underlying reason for clinical heterogeneity in Chronic Lymphocytic Leukemia (CLL). The presence of IGVH mutations as well as the predominant gene usage shows geographical variations. However, there is no study from India addressing immunogenetics of CLL. In a first Indian study we document the immunogenetics of CLL in a large tertiary hospital. METHODS We analyzed IGVH mutation status, VH gene usage, cytogenetic abnormalities using FISH, immunophenotyping data and correlated them with standard clinical variables in 84 patients of CLL. RESULTS Advanced Rai stage (Stage 3/4) was seen in 45% of our patients, where as 13q deletion was the commonest clonal cytogenetic abnormality detected in 48.4% of the cases. IGVH unmutated cases (55.2%) showed higher proportion expressing CD38 and CD49d, a preferential usage for VH1 and VH3 families (55.2%), presentation at an advanced Rai stage (52.8%) as well as more frequent presence of p53 deletions. As compared to the IGVH mutated cases greater proportion of IGVH unmutated patients (70%) required treatment. However, there was no significant difference in the time to treatment between mutated and unmutated cases which can be attributed to relatively short median follow up of 10 months. CONCLUSION To summarize, we have seen a higher proportion of IGVH unmutated patients in our cohort (55.2%). The commonly used VH genes in the Indian population are IGVH 2-5, IGVH 1-2 and IGVH 1-69. Longer clinical follow up and a larger cohort is necessary to confirm the prognostic value of IGVH mutation analysis in Indian Patients with CLL.
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Affiliation(s)
- Nikhil Patkar
- Hematopathology Laboratory, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Nikhil Rabade
- Hematopathology Laboratory, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Pratibha Amare Kadam
- Department of Cancer Cytogenetics, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Falguni Mishra
- Hematopathology Laboratory, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Aditi Muranjan
- Hematopathology Laboratory, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Prashant Tembhare
- Hematopathology Laboratory, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Shruti Chaudhary
- Hematopathology Laboratory, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Swapnali Joshi
- Hematopathology Laboratory, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Uma Dangi
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Navin Khattry
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Hari Menon
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Hematopathology Laboratory, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - P G Subramanian
- Hematopathology Laboratory, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
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21
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Rabade N, Tembhare P, Patkar N, Amare P, Arora B, Subramanian PG, Gujral S. 'Childhood systemic mastocytosis associated with t (8; 21) (q22; q22) acute myeloid leukemia'. INDIAN J PATHOL MICR 2017; 59:407-9. [PMID: 27510692 DOI: 10.4103/0377-4929.188140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Systemic mastocytosis (SM) with associated clonal nonmast cell lineage disease is seen in up to 20% cases of SM. SM is uncommon in the pediatric population. T (8; 21) (q22; q22) is a good prognostic factor in acute myeloid leukemia (AML). However, the presence of SM confers poor prognosis in t (8; 21) (q22; q22) associated AML. We report the case of a child with t (8; 21) (q22; q22) associated AML with SM and her minimal residual disease status over the course of her treatment. In our case, the abnormal mast cells, showing co-expression of CD25 and CD2, persisted even after the marrow showed no evidence of residual AML.
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Affiliation(s)
- Nikhil Rabade
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prashant Tembhare
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nikhil Patkar
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pratibha Amare
- Department of Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Brijesh Arora
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - P G Subramanian
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
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22
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Ghodke KA, Patkar NV, Subramanian PG, Gujral S, Kadam PA, Tembhare PR. Biclonal chronic lymphocytic leukemia: A study of two cases and review of literature. INDIAN J PATHOL MICR 2017; 60:84-86. [PMID: 28195098 DOI: 10.4103/0377-4929.200019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a common, immunophenotypically well-defined mature B-cell neoplasm. Demonstration of more than 5000/μL CD5+ B-cell population with co-expression of CD23, weak expression of CD20, and one type of immunoglobin light chain (either kappa or lambda) is necessary for the diagnosis of CLL. However, CLL with two populations of B-cells expressing both kappa as well as lambda (biclonal) light chains are extremely rare and has not been reported from India. We report two cases of biclonal CLL presented with leukocytosis, typical morphological features, and distinct immunophenotype of CLL. These cases are also an example which suggests that careful attention to the morphology of the blood smear and the entire immunophenotype panel is a must and will aid the proper diagnosis as only light chain ratios can be misguiding.
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Affiliation(s)
- Kiran Ashok Ghodke
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Nikhil V Patkar
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - P G Subramanian
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Pratibha Aamre Kadam
- Department of Cancer Cytogenetics, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Prashant R Tembhare
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Centre, Mumbai, Maharashtra, India
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23
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Rabade N, Bibi A, Ghodke K, Patkar N, Tembhare P, Amare P, Subramanian PG, Gujral S. Lymphoblastic leukemia with surface light chain restriction: A diagnostic dilemma. INDIAN J PATHOL MICR 2016; 59:410-2. [PMID: 27510693 DOI: 10.4103/0377-4929.188129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Surface light chain expression is a feature of mature B-cell neoplasms. Light chain restriction in precursor B acute lymphoblastic leukemia is infrequently seen. We report a case of a 28-year-old female with non-FAB L3 morphology blasts and immunophenotypic features showing overlap between a precursor and mature B-cell neoplasm.
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Affiliation(s)
- Nikhil Rabade
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Asma Bibi
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kiran Ghodke
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nikhil Patkar
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prashant Tembhare
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pratibha Amare
- Department of Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - P G Subramanian
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Department of Pathology, Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Patkar N, Joshi S, Chaudhary S, Mascerhenas R, Doshi H, Tembhare P, Gujral S, Subramanian PG. Development of a cost-effective 'duplexed' real-time PCR assay for minimal residual disease monitoring of chronic myeloid leukemia using locked nucleic acid probes. Int J Lab Hematol 2016; 38:e102-e106. [PMID: 27461906 DOI: 10.1111/ijlh.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Patkar
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - S Joshi
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - S Chaudhary
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - R Mascerhenas
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - H Doshi
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - P Tembhare
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - S Gujral
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - P G Subramanian
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
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25
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Ghodke K, Bibi A, Rabade N, Patkar N, Subramanian PG, Kadam PA, Badrinath Y, Ghogale S, Gujral S, Tembhare P. CD19 negative precursor B acute lymphoblastic leukemia (B-ALL)-Immunophenotypic challenges in diagnosis and monitoring: A study of three cases. Cytometry B Clin Cytom 2016; 92:315-318. [PMID: 27018867 DOI: 10.1002/cyto.b.21373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 03/11/2016] [Accepted: 03/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND CD19 is a B-cell specific marker, expressed on all stages of B-lymphocytes including plasma cells. It is widely used in the flow cytometric immunophenotyping (FCI) of B-cell and plasma cell malignancies. The analysis approach of FCI for the diagnosis and monitoring of B-cell acute lymphoblastic leukemia (B-ALL) is totally based on the CD19-based primary gating strategy and it would be challenging to study B-ALL without CD19 expression. Since CD19 negative B-ALL are extremely rare, we report three cases of B-ALL with negative expression of CD19 and discussed its implication in the diagnosis, residual disease monitoring and future targeted therapy. METHODS Peripheral blood (PB) and bone marrow (BM) samples from three cases suspicious of acute leukemia were studied for morphology, cytochemistry, immunophenotyping and cytogenetics. FCI was performed using a comprehensive six to eight-color multiparametric assay. The cytogenetic studies for standard recurrent genetic translocations were performed by FISH & Karyotyping. RESULTS The three cases studied were diagnosed as B-ALL based on the expression of CD10, CD20, CD22, CD34, and CD79a by leukemic blasts. CD19 was studied using two different clones (i.e. J3-119 & HIB-19) and found to be severely down regulated in all three cases. There were no significant differentiating features in morphology. Cytogenetic studies were negative for recurrent translocations. CONCLUSION We report three cases of extremely rare CD19 negative B-ALL. Lack of awareness of negative CD19 expression in B-ALL can leads to incorrect immunophenotypic diagnosis and monitoring of B-ALL, especially in laboratories using limited markers. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- Kiran Ghodke
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Asma Bibi
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Nikhil Rabade
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Nikhil Patkar
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - P G Subramanian
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | | | - Y Badrinath
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Sitaram Ghogale
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Sumeet Gujral
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Prashant Tembhare
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
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Amare PSK, Jain H, Kabre S, Walke D, Menon H, Sengar M, Khatri N, Bagal B, Dangi U, Jain H, Subramanian PG, Gujral S. Characterization of Genomic Events Other than Ph and Evaluation of Prognostic Influence on Imatinib in Chronic Myeloid Leukemia (CML): A Study on 1449 Patients from India. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jct.2016.74030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Amare PSK, Jain H, Kabre S, Deshpande Y, Pawar P, Banavali S, Menon H, Sengar M, Arora B, Khattry N, Narula G, Sarang D, Kaskar S, Bagal B, Jain H, Dangi U, Subramanian PG, Gujral S. Cytogenetic Profile in 7209 Indian Patients with <i>de novo</i> Acute Leukemia: A Single Centre Study from India. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jct.2016.77056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tembhare P, Badrinath Y, Ghogale S, Patkar N, Dhole N, Dalavi P, Kunder N, Kumar A, Gujral S, Subramanian PG. A novel and easy FxCycle™ violet based flow cytometric method for simultaneous assessment of DNA ploidy and six-color immunophenotyping. Cytometry A 2015; 89:281-91. [PMID: 26671309 DOI: 10.1002/cyto.a.22803] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/07/2015] [Accepted: 11/13/2015] [Indexed: 01/19/2023]
Abstract
Abnormal DNA ploidy is a valuable prognostic factor in many neoplasms, especially in hematological neoplasms like B-cell acute lymphoblastic leukemia (B-ALL) and multiple myeloma (MM). Current methods of flow-cytometric (FC) DNA-ploidy evaluation are either technically difficult or limited to three- to four-color immunophenotyping and hence, challenging to evaluate DNA-ploidy in minute tumor population with background rich of its normal counterpart cells and other hematopoietic cells. We standardized a novel sensitive and easy method of simultaneous evaluation of six- to seven-color immunophenotyping and DNA-ploidy using a dye-FxCycle Violet (FCV). Linearity, resolution, and coefficient of variation (CV) for FCV were studied using chicken erythrocyte nuclei. Ploidy results of FCV were compared with Propidium iodide (PI) in 20 samples and intra-assay variation for FCV was studied. Using this six-color immunophenotyping & FCV-protocol DNA-ploidy was determined in bone-marrow samples from 124 B-ALL & 50 MM patients. Dilution experiment was also conducted to determine the sensitivity in detection of aneuploidy in minute tumor population. FCV revealed high linearity and resolution in 450/50 channel. On comparison with PI, CV of Go/G1-peak with FCV (mean-CV 4.1%) was slightly higher than PI (mean-CV 2.9%) but had complete agreement in ploidy results. Dilution experiment showed that aneuploidy could be accurately detected up to the limit of 0.01% tumor cells. Intra-assay variation was very low with CV of 0.005%. In B-ALL, hypodiploidy was noted in 4%, hyperdiploidy in 24%, near-hyperdiploidy in 13% and remaining 59% were diploid. In MM, hypodiploidy was in 2%, hyperdiploidy in 58%, near-hyperdiploidy in 8% and remaining 30% were diploid. FCV-based DNA-ploidy method is a sensitive and easy method for simultaneous evaluation of six-color immunophenotyping and DNA analysis. It is useful in DNA-ploidy evaluation of minute tumor population in cases like minimal residual disease and MM precursor conditions.
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Affiliation(s)
- Prashant Tembhare
- Hematopathology Laboratory, Tata Memorial Center Hospital, Parel, Mumbai, 400012, India
| | - Yajamanam Badrinath
- Hematopathology Laboratory, Tata Memorial Center Hospital, Parel, Mumbai, 400012, India
| | - Sitaram Ghogale
- Hematopathology Laboratory, Tata Memorial Center Hospital, Parel, Mumbai, 400012, India
| | - Nikhil Patkar
- Hematopathology Laboratory, Tata Memorial Center Hospital, Parel, Mumbai, 400012, India
| | - Nilesh Dhole
- Hematopathology Laboratory, Tata Memorial Center Hospital, Parel, Mumbai, 400012, India
| | - Pooja Dalavi
- Hematopathology Laboratory, Tata Memorial Center Hospital, Parel, Mumbai, 400012, India
| | - Nikesh Kunder
- Hematopathology Laboratory, Tata Memorial Center Hospital, Parel, Mumbai, 400012, India
| | - Ashok Kumar
- Hematopathology Laboratory, Tata Memorial Center Hospital, Parel, Mumbai, 400012, India
| | - Sumeet Gujral
- Hematopathology Laboratory, Tata Memorial Center Hospital, Parel, Mumbai, 400012, India
| | - P G Subramanian
- Hematopathology Laboratory, Tata Memorial Center Hospital, Parel, Mumbai, 400012, India
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Agarwal MB, Malhotra H, Chakrabarti P, Varma N, Mathews V, Bhattacharyya J, Seth T, Gayathri K, Menon H, Subramanian PG, Sharma A, Bhattacharyya M, Mehta J, Vaid AK, Shah S, Aggarwal S, Gogoi PK, Nair R, Agarwal U, Varma S, Prasad SVSS, Manipadam MT. Myeloproliferative neoplasms working group consensus recommendations for diagnosis and management of primary myelofibrosis, polycythemia vera, and essential thrombocythemia. Indian J Med Paediatr Oncol 2015; 36:3-16. [PMID: 25810569 PMCID: PMC4363847 DOI: 10.4103/0971-5851.151770] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Indexed: 01/14/2023] Open
Abstract
According to the 2008 revision of the World Health Organization (WHO) classification of myeloid malignancies, philadelphia chromosome (Ph)-negative myeloproliferative neoplasms (MPNs) include clonal, hematologic disorders such as polycythemia vera, primary myelofibrosis, and essential thrombocythemia. Recent years have witnessed major advances in the understanding of the molecular pathophysiology of these rare subgroups of chronic, myeloproliferative disorders. Identification of somatic mutations in genes associated with pathogenesis and evolution of these myeloproliferative conditions (Janus Kinase 2; myeloproliferative leukemia virus gene; calreticulin) led to substantial changes in the international guidelines for diagnosis and treatment of Ph-negative MPN during the last few years. The MPN-Working Group (MPN-WG), a panel of hematologists with expertise in MPN diagnosis and treatment from various parts of India, examined applicability of this latest clinical and scientific evidence in the context of hematology practice in India. This manuscript summarizes the consensus recommendations formulated by the MPN-WG that can be followed as a guideline for management of patients with Ph-negative MPN in the context of clinical practice in India.
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Affiliation(s)
- M B Agarwal
- Department of Hematology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Hemant Malhotra
- Division of Medical Oncology, RK Birla Cancer Center, SMS Medical College Hospital, Jaipur, Rajasthan, India
| | | | - Neelam Varma
- Department of Hematology and Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikram Mathews
- Department of Hematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jina Bhattacharyya
- Department of Clinical Hematology, Guwahati Medical College and Hospital, Assam, India
| | - Tulika Seth
- Department of Hematology, All India Institute of Medical Sciences, Delhi Cantonment, India
| | - K Gayathri
- Department of Hematopathology, Lifeline Tapadia Diagnostic Centre, Hyderabad, Telangana, India
| | - Hari Menon
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - P G Subramanian
- Department of Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ajay Sharma
- Hematology and Center for Stem Cell Transplantation and Research, Army Research and Referral Hospital, Delhi Cantonment, India
| | - Maitreyee Bhattacharyya
- Institute of Hematology and Transfusion Medicine, Medical College, Kolkata, West Bengal, India
| | - Jay Mehta
- Centre of Excellence in Histopathology, SRL Diagnostics, Mumbai, Maharashtra, India
| | - A K Vaid
- Cancer Institute-Division of Medical Oncology and Haemotology, Medanta-The Medicity, New Delhi, India
| | - Sandeep Shah
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Shyam Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - P K Gogoi
- East India Hematological Centre, Rajgarh Road, Guwahati, Assam, India
| | - Reena Nair
- Department of Clinical Hematology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Usha Agarwal
- Ashirwad Hematology Centre, Dadar, Mumbai, Maharashtra, India
| | - Subhash Varma
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - S V S S Prasad
- Division of Medical Oncology, Apollo Cancer Hospitals, Hyderabad, Telangana, India
| | - Marie Therese Manipadam
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Dharmani P, Mittal N, Subramanian PG, Galani K, Badrinath Y, Amare P, Gujral S. Blastic plasmacytoid dendritic cell neoplasm: Report of two pediatric cases. INDIAN J PATHOL MICR 2015; 58:72-6. [DOI: 10.4103/0377-4929.151193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Patkar N, Subramanian PG, Deshpande P, Ghodke K, Tembhare P, Mascarenhas R, Muranjan A, Chaudhary S, Bagal B, Gujral S, Sengar M, Menon H. MYD88 mutant lymphoplasmacytic lymphoma/Waldenström macroglobulinemia has distinct clinical and pathological features as compared to its mutation negative counterpart. Leuk Lymphoma 2014; 56:420-5. [PMID: 24828863 DOI: 10.3109/10428194.2014.924123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 11/13/2022]
Abstract
In a first series from India, we report 32 cases of lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (LPL/WM) over 7 years. Here, we analyzed 32 patients with LPL/WM for MYD88 L265P mutation and correlated mutation staus with hematological and biochemical parameters and also with the International Prognostic Scoring System (ISSWM) and treatment response. Twenty-seven out of 32 cases of LPL/WM (84.3%) harbored the MYD88 L265P mutation. MYD88 wild-type WM was associated with a lower number of tumor cells (p<0.01) and older age (p=0.02) and a lower ISSWM score at presentation (p=0.03) as compared to mutated LPL/WM. On evaluation of response (n=23), 44.4% of patients with MYD88 mutated LPL/WM had progressive disease, whereas no patient in the MYD88 unmutated group changed their baseline status. We confirm the high frequency of MYD88 mutations in LPL/WM. Although the number of MYD88 wild-type cases was limited, our data indicate that MYD88 may represent an adverse prognostic marker for LPL/WM.
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Affiliation(s)
- Nikhil Patkar
- Hematopathology Laboratory, Tata Memorial Centre , Mumbai , India
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Gujral S, Galani K, Gadage V, Epari S, Subramanian PG, Ghogale S. Anaplastic lymphoma kinase-positive large B-cell lymphoma: Unusual clinical and immunophenotypic features. Indian J Dermatopathol Diagn Dermatol 2014. [DOI: 10.4103/2349-6029.147298] [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: 11/04/2022] Open
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Rahman K, Subramanian PG, Kadam PA, Gadage V, Galani K, Mittal N, Ghogale S, Badrinath Y, Ansari R, Kushte S, Nair R, Sengar M, Menon H, Gujral S. Morphological spectrum of leukemic mantle cell lymphoma. INDIAN J PATHOL MICR 2012; 55:66-71. [PMID: 22499304 DOI: 10.4103/0377-4929.94860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Leukemic involvement in mantle cell lymphoma (MCL) is common, and can be secondary to nodal or extranodal disease or can be de-novo. There is paucity of literature that describes the morphological spectrum. AIM This study was aimed at studying the morphological spectrum of leukemic MCL and to correlate the morphology with other features. MATERIALS AND METHODS Twenty six such cases diagnosed over a period of four years were studied. Peripheral blood and bone marrow aspiration smears stained with Wrights stain were examined by three hematopathologists. Immunophenotyping was done using multicolor flow cytometry. Fluorescence in situ hybridization (FISH) done in 12 cases showed t(11;14)(q13:q32). RESULTS Six cases had de-novo leukemic involvement; while 20 cases had secondary involvement. Morphologically, the cells were small (less than twice the size of red blood cell) or large. Small cell morphology in turn showed irregular nuclear border (n=13) or round nuclear contour (n=6). Large cells had blastic morphology (n=5) or had central prominent nucleoli resembling prolymhphocytes (n=2). Twenty cases showed characteristic immunophenotype of CD5+/CD19+/CD20+/FMC7+/CD10-/CD23- and light chain restrictions. Three cases expressed CD23 and two cases were negative for FMC7. Five out of 12 cases, where FISH was done, showed cytogenetic abnormalities in addition to t(11;14)(q13;q32). CONCLUSION Morphological spectrum of leukemic MCL ranges from small cells resembling chronic lymphocytic leukemia (CLL) or follicular lymphoma (FL) to large cell mimicking prolymphocytic leukemia (PLL) or acute leukemia. Large cell morphology was associated with more frequent additional cytogenetic abnormality as well as a poorer outcome.
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Affiliation(s)
- Khaliqur Rahman
- Hematopathologist, Rajiv Gandhi Cancer Institute and Research, New Delhi, India.
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Galani KS, Subramanian PG, Gadage VS, Rahman K, Ashok Kumar MS, Shinde S, Mahadik S, Ansari R, Sengar M, Menon H, Nair R, Gujral S. Clinico-pathological profile of Hairy cell leukemia: critical insights gained at a tertiary care cancer hospital. INDIAN J PATHOL MICR 2012; 55:61-5. [PMID: 22499303 DOI: 10.4103/0377-4929.94858] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Hairy cell leukemia (HCL) is a rare, low grade, B-cell neoplasm with a characteristic morphologic and immunophenotypic profile. It has to be distinguished from chronic lymphoproliferative disorders because of different treatment protocol and clinical course. AIMS To evaluate clinicopathological features including immunophenotypic analysis of cases diagnosed as HCL. MATERIALS AND METHODS The present study included 28 cases diagnosed over a period of nine years (2002-2010). Clinical presentation, complete blood count, bone marrow aspirate, and flow cytometric analysis of cases were reviewed. Treatment and follow-up details (ranging from 3-90 months) were noted. RESULTS This study revealed 28 cases (referrals-7, indoor-21), aged 26-69 years with a median age of 47 years, with a male predominance (M:F=6:1). The presenting complaints were weakness (80%) followed by fever (56%) and abdominal pain. Physical examination revealed splenomegaly in most patients (92%) and hepatomegaly in a minority (28%). The common laboratory features were anemia in 23 cases, pancytopenia in 14 cases, while two patients had leukocytosis and three patients had normal WBC count. Dry tap was observed in 84% of the cases where hairy cells constituted 16-97% of non-erythroid nucleated cells. Tartarte resistant acid phosphate staining was positive in all the eight cases where it was done. CD5 was negative in all the cases, while CD10 was expressed in three cases (13%) and CD23 in five cases (19%). CONCLUSIONS Though pancytopenia is common, occasional patient can present with normal blood counts or leukocytosis. Few unusual findings include presence of lymphadenopathy, absence of palpable splenomegaly, and expression of CD23 and CD10 by the leukemic cells.
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Affiliation(s)
- Komal S Galani
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Affiliation(s)
- P G Subramanian
- Hematopathology Laboratory, Tata Memorial Hospital, Parel, Mumbai 400 012, India.
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Gupta S, Bagel B, Gujral S, Subramanian PG, Khattry N, Menon H, Nair R. Parenthood in patients with acute promyelocytic leukemia after treatment with arsenic trioxide: a case series. Leuk Lymphoma 2012; 53:2192-4. [DOI: 10.3109/10428194.2012.679936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gujral S, Lad P, Subramanian PG, Shet TM, Epari S, Laskar S, Muckaden M, Menon H, Sengar M, Nair R. Histopathological audit of splenectomies received at a cancer hospital. INDIAN J PATHOL MICR 2012; 54:487-96. [PMID: 21934208 DOI: 10.4103/0377-4929.85080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There are few studies in the literature studying the yield of the diagnostic splenectomy in a suspicious lymphoma case. Moreover, their relevance is limited owing to low number of cases, the use of selection criteria, and the lack of modern ancillary studies. We present a histopathological review of splenectomy specimens referred as a case of lymphoma to our center. MATERIALS AND METHODS The medical charts and laboratory data on all patients of all splenectomy specimens between the years 2003 and 2008 were reviewed. Morphological and immunohistochemical features were analyzed and the lymphomas were sub-typed in accordance to 2008 WHO Classification of Hematolymphoid Neoplasms. Flow cytometry immunophenotyping available in few cases was correlated. RESULTS A total of 46 cases studied included splenic marginal zone lymphoma (SMZL) (19 cases), splenic diffuse large B-cell lymphoma (DLBCL) (14 cases), splenic diffuse red pulp B-cell lymphoma (DRP) (five cases), follicular lymphoma (three cases), hairy cell leukemia (HCL) (two cases), HCL variant (HCLv) (1 case), 1 case of hepatosplenic gamma delta T-cell lymphoma (TCL), and 1 cases of TCL (not otherwise specified). CONCLUSIONS Predominantly splenic lymphoma is a biologically heterogeneous entity, ranging from low-grade SMZL to high-grade DLBCLs. TCLs constituted only 4% of all our cases. DRP, HCL, and HCLv have similar diffuse red pulp patterns of splenic involvement and are differentiated based on flow cytometric immunophenotyping. We had a large number of splenic DLBCL and none of these involved bone marrow (BM), while all other lymphoma subtypes had BM involvement (stage IV disease). Morphological and immunophenotypic (immunohistochemistry and flow cytometry) features of BM and splenectomy specimen need to be correlated to differentiate these rare though similar-looking entities with overlapping features.
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Affiliation(s)
- Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, India.
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Gadage VS, Subramanian PG, Galani KS, Sehgal KK, Johari SP, Ghogale VS, Badrinath Y, Ashok K, Gujral S. Leukemic phase of anaplastic lymphoma kinase positive, anaplastic large cell lymphoma. INDIAN J PATHOL MICR 2012; 54:599-602. [PMID: 21934233 DOI: 10.4103/0377-4929.85108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Anaplastic large cell lymphoma (ALCL) is a distinct type of CD30+ T/null-cell non-Hodgkin's lymphoma that frequently involves nodal and extranodal sites. The presence of leukemic phase in ALCL is extremely rare and occurs exclusively with ALK1-positive ALCL. We describe two patients with ALK1-positive ALCL who developed a leukemic phase with rapid progression of the disease. Immunophenotypic pattern assessed on peripheral blood by flow cytometry revealed CD45, CD30, and CD25 positivity in both cases but NPM-ALK1 was expressed in only one case. Both patients developed leukemic phase as a terminal event of the disease and we share the immunophenotypic features of both cases.
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Affiliation(s)
- Vijaya S Gadage
- Hematopathology of Laboratory, Tata Memorial Hospital, Mumbai, India
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Gujral S, Gandhi JS, Valsangkar S, Shet TM, Epari S, Subramanian PG. Study of the morphological patterns and association of Epstein-Barr virus and human herpes virus 8 in acquired immunodeficiency deficiency syndrome-related reactive lymphadenopathy. INDIAN J PATHOL MICR 2011; 53:723-8. [PMID: 21045401 DOI: 10.4103/0377-4929.72055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS Study of the morphological patterns of acquired immunodeficiency syndrome (AIDS)-related lymphadenopathy. SETTINGS AND DESIGN We retrospectively selected cases of AIDS-related benign lymphadenopathy. Cases with lymphomas, frank granulomas and necrosis were excluded. We analyzed different morphological patterns and correlated these with immunophenotypic markers along with viral markers human herpesvirus 8-latency-associated nuclear antigen (HHV8-LANA), and Epstein-Barr virus-encoded ribonucleic acid (EBER) studies via in situ hybridization (EBER-ISH). MATERIALS AND METHODS We present the morphological patterns of 13 cases of human immunodeficiency virus (HIV)-reactive lymph nodes and their clinical, hematological, biochemical and radiological parameters with special emphasis on the presence or absence of viral markers, including HHV8 and EBV. RESULTS Common patterns included follicular hyperplasia only (five cases), mixed pattern of follicular hyperplasia with burnt-out germinal centres (four cases), completely atretic follicle (two cases), folliculolysis (11 cases), dumbbell-shaped follicles (three each), progressive transformation of germinal centers (four cases), T-zone expansion (two cases), Reed Sternberg (RS) cells like immunoblasts (two cases), Castleman's-like features with lollipop-like follicles (three cases) and a spindle cell prominence (one case). CD8+ T-cells were predominant in 12 cases. CD8+ T-cells were prominent in germinal centers (eight cases). Plasmablasts were seen in four cases within the perigerminal center area. Immunohistochemistry for HHV8, i.e. HHV8-LANA were negative in all cases while EBER was detected in 11 cases in the centrocyte-like B cells. Two cases of multicentric Castleman's disease expressed EBER; however, they did not express HHV8. CONCLUSION The wide spectrum of histological changes in HIV-associated lymphadenopathy requires recognition. The histological changes can mimic those of other infective lymphadenitis, follicular lymphoma, Castleman's disease, progressive transformation of germinal center, Hodgkin's disease and spindle cell neoplasms. Presence of EBV is common while HHV8 was not seen.
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Affiliation(s)
- S Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, India.
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Bal M, Gujral S, Gandhi J, Shet T, Epari S, Subramanian PG. Angioimmunoblastic T-Cell lymphoma: a critical analysis of clinical, morphologic and immunophenotypic features. INDIAN J PATHOL MICR 2011; 53:640-5. [PMID: 21045384 DOI: 10.4103/0377-4929.72010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Angioimmunoblastic T-cell lymphoma (AITL), a subtype of peripheral T-cell lymphoma (PTCL), is characterized by unique clinical and biological features. Its diagnosis remains a challenge as clinical presentation as well as pathologic findings are frequently misleading. MATERIAL AND METHODS We retrospectively analyzed the clinical, morphological and immunophenotypic spectrum of 17 cases of histologically proven AITL. RESULT The mean age was 54 years and male to female ratio was 2.4. Common clinical features included generalized lymphadenopathy (60%), hepatomegaly (70%), splenomegaly (50%), anemia (80%) and polyclonal hypergammaglobulinemia (100%). Microscopically, three architectural patterns; pattern I (6%), pattern II (41%) and pattern III (53%) were observed. Bone marrow infiltration was seen in 60% cases and 30% cases revealed plasmacytosis. Absence of follicles, polymorphous infiltrate, extra-follicular follicular dendritic cell (FDC) proliferation, high endothelial venules (HEV) prominence and neoplastic T-cells were the diagnostic features of AITL. CD10 positivity (47%), clear cells in the background (59%) admixture with large size CD20+ B-immunoblasts (35%) and bone marrow plasmacytosis (50%) were common observations. CONCLUSION Awareness of various morphological and immunophenotypic complexities of AITL and distinction from reactive adenopathies and other types of lymphomas that mimic AITL is underscored in this study.
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Affiliation(s)
- Munita Bal
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
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Gujral S, Tembhare P, Subramanian PG, Sehgal K, Yajamanam B, Kumar A, Gadge V, Inamdar N. Immunophenotypic profile of plasma cell leukemia: A retrospective study in a reference cancer center in India and review of literature. INDIAN J PATHOL MICR 2011; 54:294-8. [DOI: 10.4103/0377-4929.81603] [Citation(s) in RCA: 8] [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] [Indexed: 11/04/2022] Open
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Viswanathan S, Kunal S, Subramanian PG, Gujral S, Gadage V. Parvovirus B19 presenting with persistent pancytopenia in a patient of T-ALL post induction chemotherapy diagnosed on bone marrow examination. INDIAN J PATHOL MICR 2011; 54:603-5. [DOI: 10.4103/0377-4929.85109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sehgal K, Badrinath Y, Tembhare P, Subramanian PG, Talole S, Kumar A, Gadage V, Mahadik S, Ghogale S, Gujral S. Comparison of platelet counts by CellDyn Sapphire (Abbot Diagnostics), LH750 (Beckman Coulter), ReaPanThrombo immunoplatelet method (ReaMetrix), and the international flow reference method, in thrombocytopenic blood samples. Cytometry 2010; 78:279-85. [DOI: 10.1002/cyto.b.20515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gujral S, Polampalli S, Badrinath Y, Kumar A, Subramanian PG, Nair R, Sengar M, Nair C. Immunophenotyping of mature T/NK cell neoplasm presenting as leukemia. Indian J Cancer 2010; 47:189-93. [DOI: 10.4103/0019-509x.63020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gujral S, Dongre K, Bhindare S, Subramanian PG, Narayan HKV, Mahajan A, Batura R, Hingnekar C, Chabbria M, Nair CN. Activity-based costing methodology as tool for costing in hematopathology laboratory. INDIAN J PATHOL MICR 2010; 53:68-74. [PMID: 20090226 DOI: 10.4103/0377-4929.59187] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sable MN, Sehgal K, Gadage VS, Subramanian PG, Gujral S. Megakaryocytic emperipolesis: a histological finding in myelodysplastic syndrome. INDIAN J PATHOL MICR 2009; 52:599-600. [PMID: 19805998 DOI: 10.4103/0377-4929.56153] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tembhare PR, Subramanian PG, Sehgal K, Yajamanam B, Kumar A, Gujral S. Hypergranular precursor B-cell acute lymphoblastic leukemia in a 16-year-old boy. INDIAN J PATHOL MICR 2009; 52:421-3. [PMID: 19679981 DOI: 10.4103/0377-4929.55014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Presence of cytoplasmic granules in the blasts is a well known feature of myeloid leukemia. ALL presenting with the numerous cytoplasmic granules in blasts is a rarity and may be misdiagnosed as acute myeloid leukemia. We describe a rare case of hypergranular precursor B-cell acute lymphoblastic leukemia (ALL) in an adolescent male expressing CD10, CD19, CytoCD22, CD34, as well as CD13 and CD117. The blasts were cytochemically negative for myeloperoxidase (MPO), and acid phosphatase (ACP) but were positive for non-specific esterase (NSE). In centers where immunophenotypic panel is usually decided on the basis of morphology with limited antibodies may result in an erroneous typing of such rare diseases. Hence it is important to be aware of this rare entity and to confirm the lineage of acute leukemia by using a comprehensive panel of antibodies for immunophenotypic analysis.
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Gujral S, Badrinath Y, Kumar A, Subramanian PG, Raje G, Jain H, Pais A, Amre Kadam PS, Banavali SD, Arora B, Kumar P, Hari Menon VG, Kurkure PA, Parikh PM, Mahadik S, Chogule AB, Shinde SC, Nair CN. Immunophenotypic profile of acute leukemia: critical analysis and insights gained at a tertiary care center in India. Cytometry B Clin Cytom 2009; 76:199-205. [PMID: 18803279 DOI: 10.1002/cyto.b.20451] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To analyze the spectrum of various types and subtypes of acute leukemia. METHODS Two thousand five hundred and eleven consecutive new referral cases of acute leukemia (AL) were evaluated based on WHO classification. RESULTS It included 1,471 cases (58%) of acute lymphoblastic leukemia (ALL), 964 cases (38%) of acute myeloid leukemia (AML), 45 cases (1.8%) of chronic myelogenous leukemia in blast crisis (CMLBC), 37 cases (1.5%) of biphenotypic acute leukemia (BAL), 1 case of Triphenotypic AL, and 2 cases of acute undifferentiated leukemia (AUL). Common subtypes of ALL were B-cell ALL (76%), which comprised of intermediate stage/CALLA positive (73%), early precursor/proBALL (3%). T-cell ALL constituted 24% (351 cases) of ALL. Common subtypes of AML included AMLM2 (27%), AMLM5 (15%), AMLM0 (12%), AMLM1 (12%), APML (11%), and AML t(8;21) (9%). CMLBC was commonly of myeloid blast crisis subtype (40 cases). CONCLUSION B-cell ALL was the commonest subtype in children and AML in adults. Overall incidence of AML in adults was low (53% only). CD13 was most sensitive and CD117 most specific for determining myeloid lineage. A minimal primary panel of nine antibodies consisting of three myeloid markers (CD13, CD33, and CD117), B-cell lymphoid marker (CD19), T-cell marker (CD7), with CD45, CD10, CD34, and HLADR could assign lineage to 92% of AL. Cytogenetics findings lead to a change in the diagnostic subtype of myeloid malignancy in 38 (1.5%) cases.
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Affiliation(s)
- S Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, India.
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Gujral S, Agarwal A, Gota V, Nair R, Gupta S, Pai SK, Sanger M, Shet T, Subramanian PG, Muckaden M, Laskar S. A clinicopathologic study of mantle cell lymphoma in a single center study in India. INDIAN J PATHOL MICR 2009; 51:315-22. [PMID: 18723950 DOI: 10.4103/0377-4929.42503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present clinical features, histopathology and results of treatment in cases of mantle cell lymphoma (MCL) at our hospital. We had 93 cases (2.1%) of MCL out of total 4301 cases of non-Hodgkin's lymphoma (NHL) in a 4-year period. It included 68 cases (1.7%) of MCL from 3987 cases of NHL diagnosed on histopathology. Remaining 25 cases (7.9%) diagnosed solely on peripheral blood examination were excluded. Thirty-six (85%) patients had advanced-stage disease. Sixty-three were nodal and five were extranodal (all gastrointestinal tract). Common patterns were diffuse (64%), nodular (25%) and mantle zone type (11%). Sixty-two cases had lymphocytic while six had blastic morphology (all nodal). Tumor cells expressed CD20 (100%), CD43 (94%), CD5 (89%) and cyclin D1 (85%). Bone marrow was involved in 25 (59%) cases. Thirty-two patients could be treated. Median recurrence-free survival was 22.23 months. Diffuse pattern of nodal involvement had a lower overall survival.
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Affiliation(s)
- S Gujral
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India.
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