1
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Brown A, Batra S. Rare Hematologic Malignancies and Pre-Leukemic Entities in Children and Adolescents Young Adults. Cancers (Basel) 2024; 16:997. [PMID: 38473358 DOI: 10.3390/cancers16050997] [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: 02/05/2024] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
There are a variety of rare hematologic malignancies and germline predispositions syndromes that occur in children and adolescent young adults (AYAs). These entities are important to recognize, as an accurate diagnosis is essential for risk assessment, prognostication, and treatment. This descriptive review summarizes rare hematologic malignancies, myelodysplastic neoplasms, and germline predispositions syndromes that occur in children and AYAs. We discuss the unique biology, characteristic genomic aberrations, rare presentations, diagnostic challenges, novel treatments, and outcomes associated with these rare entities.
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Affiliation(s)
- Amber Brown
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA
| | - Sandeep Batra
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA
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2
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Sahoo TP, Desai C, Agarwal S, Rauthan A, Dhabhar B, Biswas G, Batra S, Saha R, Philip A, Agarwal V, Dattatreya PS, Mohapatra PN, Deshmukh C, Bhagat S, Patil S, Barkate H. ExPert ConsEnsus on the management of Advanced clear-cell RenaL celL carcinoma: INDIAn Perspective (PEARL-INDIA). BMC Cancer 2023; 23:737. [PMID: 37558975 PMCID: PMC10413514 DOI: 10.1186/s12885-023-11237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/29/2023] [Indexed: 08/11/2023] Open
Abstract
In advanced Renal Cell Carcinoma (aRCC), systemic therapy is the mainstay of treatment, with no or little role for surgery in these patients. Tyrosine kinase inhibitors (TKIs) and immune-oncological (IOs) therapies, either alone or in combination, are recommended in these patients depending on patient and tumour factors. The sequencing of therapies is critical in RCC because the choice of subsequent line therapy is heavily dependent on the response and duration of the previous treatment. There are additional barriers to RCC treatment in India. Immunotherapy is the cornerstone of treatment in ccRCC, but it is prohibitively expensive and not always reimbursed, effectively putting it out of reach for the vast majority of eligible patients in India. Furthermore, in advanced RCC (particularly the clear cell variety), Indian oncologists consider the disease burden of the patients, which is particularly dependent on the quantum of the disease load, clinical symptoms, and performance status of the patient, before deciding on treatment. There are no India-specific guidelines for clear cell RCC (ccRCC) treatment or the positioning and sequencing of molecules in the management of advanced ccRCC that take these country-specific issues into account. The current consensus article provides expert recommendations and treatment algorithms based on existing clinical evidence, which will be useful to specialists managing advanced ccRCC.
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Affiliation(s)
| | - Chirag Desai
- Medical Oncology & Director Hemato-Oncology Clinic Vedanta, Ahmedabad, Ahmedabad, India
| | - Shyam Agarwal
- Medical Oncology, Sir Gangaram Hospital, Delhi, India
| | - Amit Rauthan
- Medical Oncology, Manipal Hospital, Bangalore, India
| | - Boman Dhabhar
- Medical & Hemat-Oncology, BND Onco Center, Mumbai, India
| | | | - Sandeep Batra
- Medical Oncology, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Rajat Saha
- Medical Oncology, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Arun Philip
- Medical Oncology Amrita Institute of Medical Sciences, Cochin, India
| | - Vijay Agarwal
- Medical Oncology Aster, CMI Hospital, Bangalore, India
| | | | | | - Chetan Deshmukh
- Medical Oncology, Deenanath Mangeshkar Hospital, Pune, India
| | - Sagar Bhagat
- DGM, Global Medical Affairs, Glenmark Pharmaceutical Limited, B D Sawant Marg, Chakala, Andheri East, Maharashtra, 400099, Mumbai, India.
| | - Saiprasad Patil
- GM, Global Medical Affairs, Glenmark Pharmaceutical Limited, Mumbai, India
| | - Hanmant Barkate
- Medical Affairs, Glenmark Pharmaceutical Limited, Mumbai, India
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3
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Begum R, Thota S, Batra S. Interplay between proteasome function and inflammatory responses in e-cig vapor condensate-challenged lung epithelial cells. Arch Toxicol 2023; 97:2193-2208. [PMID: 37344694 DOI: 10.1007/s00204-023-03504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/20/2023] [Indexed: 06/23/2023]
Abstract
Exposure to cigarettes and other nicotine-based products results in persistent inflammation in the lung. In recent years, electronic cigarettes (e-cigs) have become extremely popular among adults and youth alike. E-cigarette vapor-induced oxidative stress promotes protein breakdown, DNA damage and cell death, culminating in a variety of respiratory diseases. The proteasome, a multi-catalytic protease, superintends protein degradation within the cell. When cells are stimulated with inflammatory cytokines such as IFN-γ and TNF-α, the constitutive catalytic proteasome subunits are replaced by the inducible subunits-low-molecular mass polypeptide (LMP)2 (β1i), multi-catalytic endopeptidase complex-like (MECL)1 (β2i), and LMP7 (β5i), which are required for the production of certain MHC class I-restricted T-cell epitopes. In this study, we used human alveolar epithelial cells (A549) and exposed them to filtered air or (1%) tobacco-flavored (TF) electronic cigarette vapor condensate (ECVC) ± nicotine (6 mg/ml) (TF-ECVC ± N) for 24 h. We observed an increase in the levels of IFN-γ, TNF-α, and inducible proteasome subunits (LMP7/PSMB8, LMP2/PSMB9, MECL1/PSMB10), and a reduced expression of constitutive proteasome subunits (β1/PSMB6 and β2/PSMB7) in challenged A549 cells. Interestingly, knockdown of the inducible proteasome subunit LMP7 reversed ECVC-induced expression of NADPH oxidase and immunoproteasome subunits in A549 cells. In addition, pre-exposure to an LMP7 inhibitor (ONX-0914) abrogated the mRNA expression of several NOX subunits and rescued the excessive production/release of inflammatory cytokines/chemokines (IL-6, IL-8, CCL2, and CCL5) in ECVC-challenged cells. Our findings suggest an important role of LMP7 in regulating the expression of inflammatory mediators during ECVC exposure. Overall, our results provide evidence for proteasome-dependent ROS-mediated inflammation in ECVC-challenged cells.
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Affiliation(s)
- R Begum
- Laboratory of Pulmonary Immunotoxicology, Department of Environmental Toxicology, Southern University and A&M College, 129 Health Research Center, Baton Rouge, Louisiana, 70813, USA
| | - S Thota
- Laboratory of Pulmonary Immunotoxicology, Department of Environmental Toxicology, Southern University and A&M College, 129 Health Research Center, Baton Rouge, Louisiana, 70813, USA
| | - S Batra
- Laboratory of Pulmonary Immunotoxicology, Department of Environmental Toxicology, Southern University and A&M College, 129 Health Research Center, Baton Rouge, Louisiana, 70813, USA.
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4
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Elitzur S, Vora A, Burkhardt B, Inaba H, Attarbaschi A, Baruchel A, Escherich G, Gibson B, Liu HC, Loh M, Moorman AV, Möricke A, Pieters R, Uyttebroeck A, Baird S, Bartram J, Barzilai-Birenboim S, Batra S, Ben-Harosh M, Bertrand Y, Buitenkamp T, Caldwell K, Drut R, Geerlinks AV, Gilad G, Grainger J, Haouy S, Heaney N, Huang M, Ingham D, Krenova Z, Kuhlen M, Lehrnbecher T, Manabe A, Niggli F, Paris C, Revel-Vilk S, Rohrlich P, Sinno MG, Szczepanski T, Tamesberger M, Warrier R, Wolfl M, Nirel R, Izraeli S, Borkhardt A, Schmiegelow K. EBV-driven lymphoid neoplasms associated with pediatric ALL maintenance therapy. Blood 2023; 141:743-755. [PMID: 36332176 DOI: 10.1182/blood.2022016975] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/19/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
Abstract
The development of a second malignancy after the diagnosis of childhood acute lymphoblastic leukemia (ALL) is a rare event. Certain second malignancies have been linked with specific elements of leukemia therapy, yet the etiology of most second neoplasms remains obscure and their optimal management strategies are unclear. This is a first comprehensive report of non-Hodgkin lymphomas (NHLs) following pediatric ALL therapy, excluding stem-cell transplantation. We analyzed data of patients who developed NHL following ALL diagnosis and were enrolled in 12 collaborative pediatric ALL trials between 1980-2018. Eighty-five patients developed NHL, with mature B-cell lymphoproliferations as the dominant subtype (56 of 85 cases). Forty-six of these 56 cases (82%) occurred during or within 6 months of maintenance therapy. The majority exhibited histopathological characteristics associated with immunodeficiency (65%), predominantly evidence of Epstein-Barr virus-driven lymphoproliferation. We investigated 66 cases of post-ALL immunodeficiency-associated lymphoid neoplasms, 52 from our study and 14 additional cases from a literature search. With a median follow-up of 4.9 years, the 5-year overall survival for the 66 patients with immunodeficiency-associated lymphoid neoplasms was 67.4% (95% confidence interval [CI], 56-81). Five-year cumulative risks of lymphoid neoplasm- and leukemia-related mortality were 20% (95% CI, 10.2-30) and 12.4% (95% CI, 2.7-22), respectively. Concurrent hemophagocytic lymphohistiocytosis was associated with increased mortality (hazard ratio, 7.32; 95% CI, 1.62-32.98; P = .01). A large proportion of post-ALL lymphoid neoplasms are associated with an immunodeficient state, likely precipitated by ALL maintenance therapy. Awareness of this underrecognized entity and pertinent diagnostic tests are crucial for early diagnosis and optimal therapy.
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Affiliation(s)
- Sarah Elitzur
- Department of Pediatric Hematology and Oncology, Schneider Children's Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ajay Vora
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, United Kingdom
| | - Birgit Burkhardt
- Pediatric Hematology and Oncology, University Hospital Münster, Münster, Germany
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Andre Baruchel
- Department of Pediatric Hematology, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncoogy, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
| | - Brenda Gibson
- Department of Paediatric Haematology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Hsi-Che Liu
- Division of Pediatric Hematology/Oncology, Mackay Children's Hospital and Mackay Medical College, Taipei, Taiwan
| | - Mignon Loh
- Division of Pediatric Hematology, Oncology, Bone Marrow Transplant and Cellular Therapy, Seattle Children's Hospital and the Ben Towne Center for Childhood Cancer Research, University of Washington, Seattle, WA
| | - Anthony V Moorman
- Leukaemia Research Cytogenetics Group, Wolfson Childhood Cancer Centre, Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anja Möricke
- Department of Pediatrics, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Rob Pieters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Anne Uyttebroeck
- Department of Paediatric Haematology and Oncology, University Hospital Leuven, Leuven, Leuven, Belgium
| | - Susan Baird
- Department of Haematology, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
| | - Jack Bartram
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, United Kingdom
| | - Shlomit Barzilai-Birenboim
- Department of Pediatric Hematology and Oncology, Schneider Children's Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sandeep Batra
- Pediatric Hematology/Oncology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Miriam Ben-Harosh
- Department of Pediatric Hemato-Oncology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yves Bertrand
- Institut d'Hematologie et d'Oncologie Pediatrique, Hospices Civils de Lyon, Lyon, France
| | - Trudy Buitenkamp
- Amsterdam Academic Medical Center, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Kenneth Caldwell
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, FL
| | - Ricardo Drut
- Department of Pathology, School of Medicine, La Plata National University, La Plata, Argentina
| | | | - Gil Gilad
- Department of Pediatric Hematology and Oncology, Schneider Children's Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - John Grainger
- Faculty of Medical & Human Sciences, University of Manchester and Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Stephanie Haouy
- Department of Pediatric Oncology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Nicholas Heaney
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Mary Huang
- Department of Pediatric Hematology Oncology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
| | - Danielle Ingham
- Paediatric Oncology, Leeds Children's Hospital, Leeds, United Kingdom
| | - Zdenka Krenova
- Department of Pediatric Oncology and Department of Pediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michaela Kuhlen
- Pediatrics and Adolescent Medicine, University of Augsburg, Augsburg, Germany
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Felix Niggli
- Department of Pediatric Oncology, University Children's Hospital, Zurich, Switzerland
| | - Claudia Paris
- Department of Pediatric Oncology and Hematology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Shoshana Revel-Vilk
- Shaare Zedek Medical Centre and The Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | | | - Mohamad G Sinno
- Phoenix Children's Hospital, Center for Cancer and Blood Disorders, Phoenix, AZ
| | - Tomasz Szczepanski
- Department of Pediatric Hematology and Oncology, Zabrze and Medical University of Silesia, Katowice, Poland
| | - Melanie Tamesberger
- Department of Pediatrics and Adolescent Medicine, Kepler University Clinic, Linz, Austria
| | | | - Matthias Wolfl
- Pediatric Oncology, Hematology and Stem Cell Transplantation Program, University Children's Hospital Würzburg, Würzburg, Germany
| | - Ronit Nirel
- Department of Statistics and Data Science, Hebrew University, Jerusalem, Israel
| | - Shai Izraeli
- Department of Pediatric Hematology and Oncology, Schneider Children's Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Arndt Borkhardt
- Department of Paediatric Oncology, Haematology and Clinical Immunology, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, The University Hospital, Rigshospitalet, and Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
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5
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Jones SR, Patel RB, Rahim MQ, Althouse SK, Batra S. Venous Thromboembolic Events in Adolescent and Young Adult Patients with Acute Lymphoblastic Leukemia. J Adolesc Young Adult Oncol 2022; 11:600-604. [PMID: 35108120 DOI: 10.1089/jayao.2021.0136] [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: 12/16/2022] Open
Abstract
Acute venous thromboembolisms (VTEs) are serious complications that occur during acute lymphoblastic leukemia (ALL) chemotherapy. The data elucidating risk factors for developing VTEs are limited in adolescent and young adult patients being treated per pediatric ALL protocols. In a cohort of 66 patients, 14 (21%) experienced VTEs. The majority of VTEs occurred during induction chemotherapy after the first dose of asparaginase, and in the upper extremities. Five-year relapse-free and overall survival were not impacted by VTEs. Contrary to VTEs in adults, hypoalbuminemia and increased body mass index were not associated with an elevated risk of VTE.
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Affiliation(s)
- Sandra R Jones
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Roshni B Patel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mahvish Q Rahim
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Sandra K Althouse
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, SA
| | - Sandeep Batra
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA.,Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
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6
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Halbrook CJ, Thurston G, Boyer S, Anaraki C, Jiménez JA, McCarthy A, Steele NG, Kerk SA, Hong HS, Lin L, Law FV, Felton C, Scipioni L, Sajjakulnukit P, Andren A, Beutel AK, Singh R, Nelson BS, Van Den Bergh F, Krall AS, Mullen PJ, Zhang L, Batra S, Morton JP, Stanger BZ, Christofk HR, Digman MA, Beard DA, Viale A, Zhang J, Crawford HC, Pasca di Magliano M, Jorgensen C, Lyssiotis CA. Differential integrated stress response and asparagine production drive symbiosis and therapy resistance of pancreatic adenocarcinoma cells. Nat Cancer 2022; 3:1386-1403. [PMID: 36411320 PMCID: PMC9701142 DOI: 10.1038/s43018-022-00463-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/12/2022] [Indexed: 11/22/2022]
Abstract
The pancreatic tumor microenvironment drives deregulated nutrient availability. Accordingly, pancreatic cancer cells require metabolic adaptations to survive and proliferate. Pancreatic cancer subtypes have been characterized by transcriptional and functional differences, with subtypes reported to exist within the same tumor. However, it remains unclear if this diversity extends to metabolic programming. Here, using metabolomic profiling and functional interrogation of metabolic dependencies, we identify two distinct metabolic subclasses among neoplastic populations within individual human and mouse tumors. Furthermore, these populations are poised for metabolic cross-talk, and in examining this, we find an unexpected role for asparagine supporting proliferation during limited respiration. Constitutive GCN2 activation permits ATF4 signaling in one subtype, driving excess asparagine production. Asparagine release provides resistance during impaired respiration, enabling symbiosis. Functionally, availability of exogenous asparagine during limited respiration indirectly supports maintenance of aspartate pools, a rate-limiting biosynthetic precursor. Conversely, depletion of extracellular asparagine with PEG-asparaginase sensitizes tumors to mitochondrial targeting with phenformin.
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Affiliation(s)
- Christopher J Halbrook
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, USA.
- University of California Irvine Chao Family Comprehensive Cancer Center, Orange, CA, USA.
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA.
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, USA.
| | - Galloway Thurston
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Seth Boyer
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Cecily Anaraki
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, USA
| | - Jennifer A Jiménez
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Amy McCarthy
- Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
| | - Nina G Steele
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Samuel A Kerk
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Hanna S Hong
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Lin Lin
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Fiona V Law
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, USA
| | - Catherine Felton
- Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
| | - Lorenzo Scipioni
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Peter Sajjakulnukit
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Anthony Andren
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Alica K Beutel
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, USA
| | - Rima Singh
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, USA
| | - Barbara S Nelson
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Fran Van Den Bergh
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Abigail S Krall
- Department of Biological Chemistry, University of California Los Angeles, Los Angeles, CA, USA
| | - Peter J Mullen
- Department of Biological Chemistry, University of California Los Angeles, Los Angeles, CA, USA
| | - Li Zhang
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Sandeep Batra
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Jennifer P Morton
- Cancer Research UK Beatson Institute and Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Ben Z Stanger
- Gastroenterology Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Heather R Christofk
- Department of Biological Chemistry, University of California Los Angeles, Los Angeles, CA, USA
| | - Michelle A Digman
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Daniel A Beard
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Andrea Viale
- Department of Genomic Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ji Zhang
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Howard C Crawford
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Marina Pasca di Magliano
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Claus Jorgensen
- Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
| | - Costas A Lyssiotis
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA.
- University of Michigan Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
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7
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Srivastava S, Jiang J, Misra J, Seim G, Staschke KA, Zhong M, Zhou L, Liu Y, Chen C, Davé U, Kapur R, Batra S, Zhang C, Zhou J, Fan J, Wek RC, Zhang J. Asparagine bioavailability regulates the translation of MYC oncogene. Oncogene 2022; 41:4855-4865. [PMID: 36182969 PMCID: PMC9617787 DOI: 10.1038/s41388-022-02474-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 12/15/2022]
Abstract
Amino acid restriction has recently emerged as a compelling strategy to inhibit tumor growth. Recent work suggests that amino acids can regulate cellular signaling in addition to their role as biosynthetic substrates. Using lymphoid cancer cells as a model, we found that asparagine depletion acutely reduces the expression of c-MYC protein without changing its mRNA expression. Furthermore, asparagine depletion inhibits the translation of MYC mRNA without altering the rate of MYC protein degradation. Of interest, the inhibitory effect on MYC mRNA translation during asparagine depletion is not due to the activation of the general controlled nonderepressible 2 (GCN2) pathway and is not a consequence of the inhibition of global protein synthesis. In addition, both the 5' and 3' untranslated regions (UTRs) of MYC mRNA are not required for this inhibitory effect. Finally, using a MYC-driven mouse B cell lymphoma model, we found that shRNA inhibition of asparagine synthetase (ASNS) or pharmacological inhibition of asparagine production can significantly reduce the MYC protein expression and tumor growth when environmental asparagine becomes limiting. Since MYC is a critical oncogene, our results uncover a molecular connection between MYC mRNA translation and asparagine bioavailability and shed light on a potential to target MYC oncogene post-transcriptionally through asparagine restriction.
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Affiliation(s)
- Sankalp Srivastava
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Jie Jiang
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Jagannath Misra
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Gretchen Seim
- Morgridge Institute for Research and Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, 53715, USA
| | - Kirk A Staschke
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Minghua Zhong
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Leonardo Zhou
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Yu Liu
- Department of Hematology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610000, China
| | - Chong Chen
- Department of Hematology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610000, China
| | - Utpal Davé
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Reuben Kapur
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Sandeep Batra
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, 46202, USA
| | - Chi Zhang
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Jiehao Zhou
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Jing Fan
- Morgridge Institute for Research and Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, 53715, USA
| | - Ronald C Wek
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Ji Zhang
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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8
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Rahim MQ, Jones SR, Patel RB, Rupenthal J, Althouse SK, Vik T, Batra S. Early Discharge of Adolescent and Young Adult Patients During Induction Chemotherapy for Newly Diagnosed Acute Lymphoblastic Leukemia: Is It Safe? J Adolesc Young Adult Oncol 2022; 12:271-274. [PMID: 35852828 DOI: 10.1089/jayao.2022.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There is a lack of consensus for safely discharging adolescent and young adults (AYA) with newly diagnosed acute lymphoblastic leukemia. From 2017 to 2019 we evaluated predefined early discharge criteria for 41 AYA patients during induction chemotherapy. Only 17% (7/41) of patients met criteria for early discharge. Two (29%) patients who were discharged early were readmitted, but not to the pediatric intensive care unit (PICU). This outcome was compared to a historic cohort at our institution of 73 patients who were discharged without predefined discharge criteria. Twenty-seven (37%, p = 0.7) patients were readmitted, but 13 (48%) were readmitted to the PICU (p = 0.004).
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Affiliation(s)
- Mahvish Q. Rahim
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Section of Pediatric Hematology-Oncology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sandra R. Jones
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Roshni B. Patel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joy Rupenthal
- Section of Pediatric Hematology-Oncology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sandra K. Althouse
- Department of Biostatistics and Data Health Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Terry Vik
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Section of Pediatric Hematology-Oncology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sandeep Batra
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Section of Pediatric Hematology-Oncology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
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9
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Underwood JS, Sharaf N, O'Brien ARW, Batra S, Konig H, Skiles JL. Differences Between Pediatric and Adult Protocols and Medical Centers in the Treatment of Acute Myeloid Leukemia in the United States. J Adolesc Young Adult Oncol 2022; 12:147-150. [PMID: 35834614 DOI: 10.1089/jayao.2021.0231] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- John S Underwood
- Department of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nematullah Sharaf
- Internal Medicine/Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew R W O'Brien
- Department of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sandeep Batra
- Pediatric Hematology/Oncology, Riley Hospital for Children at Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Heiko Konig
- Department of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jodi L Skiles
- Pediatric Hematology/Oncology, Riley Hospital for Children at Indiana University School of Medicine, Indianapolis, Indiana, USA
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10
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Mittal A, Rangaraju RR, Agarwal A, Chandragouda D, Batra S, Qureshi S. Estimating the Risk of Chemotherapy Toxicity in Indian Geriatric Patient Population and Utility of Chemotherapy Risk Assessment Scale for High Age Patients (CRASH) Score. South Asian J Cancer 2021; 10:161-166. [PMID: 34938678 PMCID: PMC8687865 DOI: 10.1055/s-0041-1729447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background
Aging is a heterogeneous process, and elderly population is diverse in health status and functional reserve. The present study was undertaken to predict severe chemotherapy toxicity using the Chemotherapy Risk Assessment Scale for High-Age Patients’ (CRASH) score.
Materials and Methods
Elderly patients (age ≥65 years) with malignancy, who were planned to be treated with a new course of cytotoxic chemotherapy, were enrolled. The CRASH score was calculated, and patients were stratified into four categories, that is, low (0–3), intermediate (Int)-low (4–6), Int-high (7–9), and high (<9). Patients developing grade 3/4/5 nonhematologic (NH) or grade 4/5 hematologic (H) toxicity were taken as the development of severe toxicity.
Results
Of 100 enrolled patients, 64 (64%) were able to complete their prescribed treatment. Forty-four percent of patients (44 patients) of our study cohort experienced grade-4 H or grade 3/4 NH toxicity. The highest score in each category (heme/nonheme/CRASH) predicts nearly 100% toxicity risk. At a critical value of CRASH ≥ 6.5, the sensitivity is calculated as 100%, while specificity is 89.09%. The accuracy of prediction is 93.88%. The median time taken to develop toxicity was 39.5 days.
Conclusion
CRASH score utilizes clinical assessment and basic laboratory values. Yet, it accurately predicts severe chemotherapy toxicity above a critical value of 6.5. Based on the above study, the first 30 days are crucial as 45% of patients experienced toxicity in this time frame. With the help of these clinical predictive markers, the care of elderly will be optimized.
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Affiliation(s)
- Aditi Mittal
- Department of Medical Oncology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Ranga R Rangaraju
- Department of Medical Oncology, Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India
| | - Amit Agarwal
- Department of Medical Oncology, B.L. Kapur Super Speciality Hospital, Rajendra Place, New Delhi, India
| | - D Chandragouda
- Department of Medical Oncology, B.L. Kapur Super Speciality Hospital, Rajendra Place, New Delhi, India
| | - Sandeep Batra
- Department of Medical Oncology, Max Super Speciality Hospital, Saket, Delhi, India
| | - Suhail Qureshi
- Department of Medical Oncology, B.L. Kapur Super Speciality Hospital, Rajendra Place, New Delhi, India
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11
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Belsky JA, Batra S, Stanek JR, O'Brien SH. Secondary impacts of constipation in acute lymphoblastic leukemia in U.S. children's hospitals. Pediatr Blood Cancer 2021; 68:e29336. [PMID: 34490990 DOI: 10.1002/pbc.29336] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/04/2021] [Accepted: 08/22/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Childrenwith acute lymphoblastic leukemia (ALL) suffer a litany of chemotherapy-induced side effects. Constipation secondary to vinca alkaloids, psychological stressors, and opioid use are common issues for children newly diagnosed with leukemia. This study investigated the morbidity associated with constipation including infections, mucositis, and healthcare utilization in hospitalized children with ALL receiving induction chemotherapy. METHODS We analyzed data from 48 children's hospitals in the Pediatric Health Information System, extracting patients 1-21 years of age with ALL, hospitalized for induction from October 2015 through December 2019. Data were analyzed using nonparametric statistics, and comparisons of outcomes between those with and without constipation were presented as adjusted odds ratios (aOR). RESULTS We identified 2586 (56%) patients with constipation out of a total of 4622 unique ALL patients in induction. Compared to patients without constipation during induction, patients with constipation were significantly more likely to have mucositis (aOR = 2.30; p = 0.0010), perirectal issues (aOR = 3.21; p = 0.0092), or abdominal radiograph exposure (aOR = 2.40; p < 0.0001). The median length of induction hospitalization was significantly greater in those with constipation compared to those without constipation (10 days vs. 8 days; p < 0.0001). CONCLUSIONS Children with ALL suffering from constipation during induction therapy have increased length of stay, mucositis, imaging, and overall healthcare utilization compared to children without constipation. Further research should explore the causative relationship between constipation and infections. Increased attention should be given to constipation management in patients with ALL at the start of induction therapy, particularly in patients with complications or prolonged hospitalizations.
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Affiliation(s)
- Jennifer A Belsky
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Sandeep Batra
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Joseph R Stanek
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sarah H O'Brien
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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12
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Lin Y, Qureshi M, Batra S, Truong M, Mak K. Consecutive Daily vs. Every Other Day SBRT Scheduling for Stage I NSCLC. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Jiang J, Batra S, Zhang J. Asparagine: A Metabolite to Be Targeted in Cancers. Metabolites 2021; 11:metabo11060402. [PMID: 34205460 PMCID: PMC8234323 DOI: 10.3390/metabo11060402] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 01/18/2023] Open
Abstract
Amino acids play central roles in cancer progression beyond their function as building blocks for protein synthesis. Thus, targeting amino acid acquisition and utilization has been proved to be therapeutically beneficial in various pre-clinical models. In this regard, depletion of circulating asparagine, a nonessential amino acid, by L-asparaginase has been used in treating pediatric acute lymphoblastic leukemia (ALL) for decades. Of interest, unlike most solid tumor cells, ALL cells lack the ability to synthesize their own asparagine de novo effectively. However, only until recently, growing evidence suggests that solid tumor cells strive to acquire adequate amounts of asparagine to support tumor progression. This process is subjected to the regulation at various levels, including oncogenic signal, tumor-niche interaction, intratumor heterogeneity and dietary accessibility. We will review the literature on L-asparaginase-based therapy as well as recent understanding of asparagine metabolism in solid tumor progression, with the hope of shedding light into a broader cancer therapeutic strategy by perturbing its acquisition and utilization.
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Affiliation(s)
- Jie Jiang
- Herman B Wells Center for Pediatric Research, School of Medicine, Indiana University, Indianapolis, IN 46202, USA;
| | - Sandeep Batra
- Riley Hospital for Children at Indiana University Health; Indianapolis, IN 46202, USA
- Correspondence: (S.B.); (J.Z.)
| | - Ji Zhang
- Herman B Wells Center for Pediatric Research, School of Medicine, Indiana University, Indianapolis, IN 46202, USA;
- Department of Biochemistry and Molecular Biology, School of Medicine, Indiana University; Indianapolis, IN 46202, USA
- Correspondence: (S.B.); (J.Z.)
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14
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Carlson S, Batra S, Billow M, El-Nashar S, Chapman G. Perioperative Complications of Laparoscopic Versus Open Surgery for Pelvic Inflammatory Disease. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Bijangi-Vishehsaraei K, Pandya P, Lijun C, Shan T, Sinn A, Trowbridge M, Coy K, Hemenway C, Bailey B, Shannon H, Ding J, Dobrota E, Saadatzadeh MR, Elmi A, Shultz J, Murray M, Marshall M, Ferguson M, Bertrand T, Wurtz LD, Batra S, Li L, Renbarger J, Pollok K. Abstract 450: Systems biology approach provides rationale for dual-targeted inhibition of BET and CHK1 in aggressive pediatric osteosarcoma. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Patients with aggressive osteosarcoma (OS) have poor prognosis due in part to copy number variations (CNVs) that contribute to dysregulation of gene expression (GE) and therapeutic resistance. The objective of the present study was to utilize the TARGET database to integrate CNV and corresponding GE with poor prognosis in pediatric OS (n=85) followed by functional validation of prioritized targets. Cox regression analysis indicated that CNVs in 2642 genes correlated with relapse risk in pediatric OS. Furthermore, the top 10 genes with CNVs significantly associated with increased risk for relapse were present on chromosome 8. The MYC and RAD21 copy number gain (MYC-RAD21 CNV+) located on chromosome 8q correlated with increased GE and poor survival in >90% of the relapsed patients. Based on network analysis, the MYC-RAD21 CNV+ was prioritized for development of targeted therapy. MYC, an oncogenic driver of OS growth, can be indirectly inhibited by bromodomain and extra-terminal domain inhibitors (BETi). RAD21 expression has been associated with increased sensitivity to cell cycle checkpoint kinase 1 inhibitors (CHK1i) in melanoma. Additionally, mechanistic links exist between MYC and CHK1, especially during replication stress. Our hypothesis was that the MYC-RAD21 CNV+ serves as a biomarker of poor prognosis and therapeutic response to BETi+CHK1i therapy. Cell growth response to BETi and CHK1i was evaluated in MYC-RAD21 CNV+ pediatric OS cell lines and a patient-derived xenograft (PDX)-derived xenoline (TT2-77). OS lines (G292, MG63, U2OS, and TT2-77) were highly sensitive to single agent BETi/OTX-015, CHK1i/ SRA737 or CHK1i/LY2606368 at clinically relevant concentrations. Combination index and Bliss independence analysis indicated that BETi+CHK1i did not result in synergistic or additive inhibition of growth at clinically relevant concentrations. However, in OS lines Saos2 and Saos2-LM7 BETi+CHK1i resulted in additive to synergistic inhibition of growth at multiple dose-ratios and at clinically relevant concentrations. In the TT2-77 PDX, whole genome sequencing indicated that the original OS biopsy and the TT2-77 PDX generated from a resection sample harbor the MYC-RAD21 CNV+ (4 copies/amplicon). PDX tumor fragments were implanted into the flank of immunodeficient NOD/SCID/IL2Rγ mice. Once tumor volumes reached 100-150 mm3, mice were randomized and treated with four 5-day cycles of BETi/OTX-015 and/or CHK1i/SRA737. BETi+CHK1i significantly decreased TT2-77 growth, increased probability of survival, and was well tolerated. BETi+CHK1i is a promising therapeutic approach for treatment of relapsed pediatric MYC-RAD21 CNV+ OS. It is possible that MYC, BETs, RAD21 and CHK1 protein levels could dictate sensitivity to combination BETi+CHK1i independent of MYC-RAD2 CNV+ status. Studies are in progress to identify responder versus non-responder signatures in OS.
Citation Format: Khadijeh Bijangi-Vishehsaraei, Pankita Pandya, Cheng Lijun, Tang Shan, Anthony Sinn, Melissa Trowbridge, Kathy Coy, Courtney Hemenway, Barbara Bailey, Harlan Shannon, Jixin Ding, Erika Dobrota, M. Reza Saadatzadeh, Adily Elmi, Jeremiah Shultz, Mary Murray, Mark Marshall, Michael Ferguson, Todd Bertrand, L. Daniel Wurtz, Sandeep Batra, Lang Li, Jamie Renbarger, Karen Pollok. Systems biology approach provides rationale for dual-targeted inhibition of BET and CHK1 in aggressive pediatric osteosarcoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 450.
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Affiliation(s)
| | | | | | - Tang Shan
- 2Ohio State University, Columbus, OH
| | | | | | - Kathy Coy
- 1Indiana University, Indianapolis, IN
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lang Li
- 2Ohio State University, Columbus, OH
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16
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Lange CS, Rahrig A, Althouse SK, Nelson RP, Batra S. Hypogammaglobulinemia in Adolescents and Young Adults with Acute Lymphoblastic Leukemia. J Adolesc Young Adult Oncol 2020; 9:687-692. [PMID: 32668180 DOI: 10.1089/jayao.2020.0060] [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] [Indexed: 11/13/2022] Open
Abstract
Hypogammaglobulinemia is a poorly described complication of chemotherapy in adolescents and young adults (AYAs, 15-39 years) with acute lymphoblastic leukemia (ALL). The majority of AYAs treated on a Berlin-Frankfurt-Munster-based ALL regimen experienced hypogammaglobulinemia (65.0% [13/20]). Febrile neutropenia episodes (throughout the treatment course) and infectious events during maintenance occurred more frequently in hypogammaglobulinemic patients compared with patients with normal immunoglobulin G levels (n = 7) (median 1.0 vs. 0.0, p = 0.02; 7.0 vs. 3.0, p = 0.02, respectively). Hypogammaglobulinemia did not impact overall or event-free survival. Further studies are needed to elucidate the etiology of hypogammaglobulinemia and to establish criteria for immunoglobulin replacement in these patients.
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Affiliation(s)
| | - April Rahrig
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Pediatric Hematology and Oncology, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Sandra K Althouse
- Department of Biostatistics and Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert P Nelson
- Department of Pediatric Hematology and Oncology, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sandeep Batra
- Department of Pediatric Hematology and Oncology, Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
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17
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Batra S, Jha SK, Bahl A, Chaturvedi H, Taneja S. Outcome of FOLFOX based chemotherapy in advanced pancreatobiliary cancers presenting with hyperbilirubinemia. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16605 Background: Treatment of pancreatobiliary cancer patients with severe liver dysfunction including hyperbilirubinemia secondary to liver metastasis or biliary obstruction is challenging. A significant number of patients at presentation are in advanced/ locally advanced stage thus severely limiting chemotherapy options. FOLFOX (5 FU, Leucovorin, Oxaliplatin) represents a feasible option considering the pharmacokinetics. Clinical data on the dosage and tolerability of chemotherapy is limited and no recommendations are available to treat such patients in upfront setting with persistent hyperbilirubinemia. This observational study was done to find out safety and efficacy of FOLFOX based chemotherapy in these patients. Methods: Patients with advanced pancreatobiliary cancers with hyperbilirubinemia were treated with mFOLFOX6 based chemotherapy. Patients were treated till progression or 6 months or death (whichever occurred ealy) and assessed for toxicity and survival. Results: Only 13 out of 40 patients were able to complete all 12 cycle of chemotherapy. 12 patients were able to receive 2nd line chemotherapy of physician choice and 2 patients were able to received 3rd line chemotherapy. Total bilirubin of patients at start of chemotherapy ranged from 3 to 39.4 mg/dl with a mean value of 9.17±6.67 mg/dl and a median value of 7.5 mg/dl. Median progression free survival (PFS) of mFOLFOX6 was 5.97 months whereas median overall survival (OS) was 8.2 months. 6 patients were able to receive only one cycle of chemotherapy. 2 patients were able to receive only 2 cycles of chemotherapy. 26 patients completed 6 cycles of chemotherapy. Objective response rate was 45% after 6 cycles of chemotherapy. Of these 26 patients response assessment revealed progressive disease in 7 patients. 2 patient had complete metabolic response of which one of them had locally advanced disease. On laparotomy of this patient there were an extensive peritoneal disease curative surgery was not feasible. One patient successfully underwent Whipple’s procedure after 6 cycles of chemotherapy followed by adjuvant radiotherapy. Conclusions: FOLFOX based chemotherapy is a feasible option and a hope for patients of advanced pancreatobiliary cancers presenting with hyperbilirubinemia with a tolerable toxicity profile and providing comparable PFS and OS to other chemotherapy drugs/ regimens used in non hyperbilirubinemic patients.
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18
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Carlson S, Taylor R, Griebel L, Batra S, El-Nashar S, Billow M. 61: Patient predictors of compliance rates after implementation of an enhanced recovery protocol. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.101] [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: 11/30/2022]
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19
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Mittal A, Agrawal A, Batra S, Dodagoudar C, Qureshi S. Chemotherapy Toxicity in Elderly Population ≥65 Years: A Tertiary Care Hospital Experience from India. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_62_18] [Citation(s) in RCA: 1] [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: 12/16/2022] Open
Abstract
Abstract
Context: Trials in the elderly have established that older individuals may benefit from chemotherapy to the same extent as younger individuals. Although the elderly patient is a prototype for cancer, very few clinical trials focus on the therapeutic decisions most directly facing older adults. Aims: This study was undertaken to study the chemotherapy-induced severe toxicity among elderly. Settings and Design: This study was a prospective, observational cohort study. The study commenced in October 2014 after obtaining clearance from the hospital ethics and protocol committee. Subjects and Methods: A total of 100 patients were included in the study. All patients were of age ≥65 years, had malignancy, and were planned to start with chemotherapy. Development of Grade 3/4/5 nonhematologic (NH) or Grade 4/5 hematologic (H) toxicities was taken as the development of severe toxicity. Statistical Analysis Used: The quantitative variables were expressed as a mean ± standard deviation and compared using unpaired t-test. P < 0.05 was considered statistically significant. Results: Overall, 64 (64%) patients were able to complete their prescribed treatment. Forty-four patients (44%) of our study cohort experienced Grade 4 H or Grade 3/4 NH toxicity. The most common H Grade 4 toxicities were neutropenia (6%) and thrombocytopenia (5%). The most common NH toxicities were fatigue (18%), infection (10%), and cardiac abnormalities (4%). Conclusions: Less than 50% of elderly patients experience severe chemotherapy-related toxicity. First 30 days are most important for toxicity assessment as 45% of patients experienced toxicity in this time frame.
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Affiliation(s)
- Aditi Mittal
- Department of Medical Oncology, Dr. BL Kapur Memorial Hospital, New Delhi, India
| | - Amit Agrawal
- Department of Medical Oncology, Dr. BL Kapur Memorial Hospital, New Delhi, India
| | - Sandeep Batra
- Department of Medical Oncology, MAX Super Specialty Hospital, New Delhi, India
| | | | - Suhail Qureshi
- Department of Medical Oncology, Dr. BL Kapur Memorial Hospital, New Delhi, India
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20
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Sonthwal N, Hussain SM, Arya D, Batra S, Chaturvedi HK, Gupta A. Addition of docetaxel or abiraterone to androgen deprivation therapy in metastatic castration-naive prostate cancer in South Asian population. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16514] [Citation(s) in RCA: 1] [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: 11/20/2022] Open
Abstract
e16514 Background: Clinical trials have shown that addition of Docetaxel or Abiraterone to androgen deprivation therapy (ADT) achieves superior survival outcome in metastatic castration naive prostate cancer (mCNPC) in predominantly western population. We sought to evaluate treatment outcomes of adding Docetaxel or Abiraterone to ADT in South Asian population. Methods: 90 mCNPC patients who received treatment between January 2015 and June 2018 were prospectively followed. Diagnosis was established by TRUS guided prostate biopsy and staging was done by Ga68 PSMA PET CT scan in all patients. Patients who were unfit for combination therapy received ADT alone. Patients diagnosed before June 2017 & fit to receive chemo-hormonal therapy, received ADT+Docetaxel. Patients diagnosed after June 2017 and fit to receive combination were offered ADT+Docetaxel or ADT+Abiraterone and therapy selected based on patient’s choice. Monthly clinical evaluation and PSA measurement was done. Outcome measures analyzed included PSA decline > 90%, serological complete response (PSA < 0.2 ng/ml) and progression to CRPC. 76 patients with atleast 6 months follow-up were included in outcome analysis. Results: Patients received ADT alone (N = 37) or ADT+Docetaxel (N = 31) or ADT+Abiraterone (N = 22). Median age was 72, 64 & 70 years, median PSA was 88, 95 & 38 ng/ml, Gleason score was ≥8 in 57%, 71% & 77% patients in ADT alone, ADT+Docetaxel & ADT+Abiraterone group, respectively. Bone & visceral metastasis were present in 62% & 24%, 74% & 26%, 68% & 23% patients in ADT alone, ADT+Docetaxel & ADT+Abiraterone group, respectively. Outcome analysis in 76 evaluable patients is shown in Table. Conclusions: ADT+Docetaxel & ADT+Abiraterone achieve deeper serological response and reduced progression to CRPC compared to ADT alone in metastatic castration naive prostate cancer patients with South Asian ethnicity. Longer follow up is required to comment on overall survival and also to determine which combination (ADT+Docetaxel or ADT+Abiraterone) is superior to other, if at all.[Table: see text]
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Affiliation(s)
- Neha Sonthwal
- Max Institute of Cancer Care, Max Super Specialty Hospital, New Delhi, India
| | | | | | | | | | - Alok Gupta
- Max Institute of Cancer Care, max Super Speciality Hospital, New Delhi, India
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21
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Mittal A, Agarwal A, Rangaraju R, Batra S, Gouda D C, Qureshi S. Can we estimate the risk of chemotherapy toxicity in Indian geriatric patient population and utility of CRASH (chemotherapy risk assessment scale for high age patients) score? Ann Oncol 2018. [DOI: 10.1093/annonc/mdy444.028] [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: 11/13/2022] Open
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22
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Warrick K, Althouse SK, Rahrig A, Rupenthal J, Batra S. Factors associated with a prolonged hospital stay during induction chemotherapy in newly diagnosed high risk pediatric acute lymphoblastic leukemia. Leuk Res 2018; 71:36-42. [PMID: 30005182 DOI: 10.1016/j.leukres.2018.06.013] [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: 04/18/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND High Risk (HR) or Very High Risk (VHR) acute lymphoblastic leukemia (ALL) treated with 4 drug induction chemotherapy is often associated with adverse events. The aim of this study was to identify risk factors associated with a prolonged inpatient length of stay LOS during induction chemotherapy. PROCEDURE Data from patients (N = 73) (age<21 years) was collected through a retrospective chart review. Univariable and multivariable logistic regression was used to test for statistical significance. The overall survival and disease (leukemia)-free survival were analyzed using the Kaplan-Meier method and log-rank test. RESULTS Of the 73 patients, 42 (57%) patients were discharged on day 4 of induction (short LOS, group A), while 31 (43%) patients (group B) experienced a prolonged LOS or an ICU stay (16 ± 27.7 days, median hospital stay = 8 days vs 4 days (group A), p = 0.02) due to organ dysfunction, infectious or metabolic complications. Group B patients were more likely to have a lower platelet count, serum bicarbonate, and a higher blood urea nitrogen (BUN) on day 4 of treatment (OR = 4.52, 8.21, and 3.02, respectively, p < 0.05). Multivariable analysis identified low serum bicarbonate (p = 0.002) and a platelet count<20,000/μL (p = 0.02) on day 4 of induction to be predictive of a prolonged LOS. Twenty six (group A (n = 16, 36%) and B (n = 11, 35%), p = 0.8) patients experienced unplanned admissions, within 30 days of discharge. CONCLUSIONS A significant proportion of newly diagnosed HR or VHR pediatric ALL patients experience a prolonged LOS and unplanned re-admissions. Aggressive discharge planning and close follow up is indicated in this cohort of patients.
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Affiliation(s)
- Kasper Warrick
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sandra K Althouse
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - April Rahrig
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, United States; Section of Pediatric Hematology Oncology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Joy Rupenthal
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sandeep Batra
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, United States; Section of Pediatric Hematology Oncology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, United States; Indiana University Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States.
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Rangarao R, Smruti BK, Singh K, Gupta A, Batra S, Choudhary RK, Gupta A, Sahani S, Kabra V, Parikh PM, Aggarwal S. Practical consensus recommendations on management of triple-negative metastatic breast cancer. South Asian J Cancer 2018; 7:127-131. [PMID: 29721479 PMCID: PMC5909290 DOI: 10.4103/sajc.sajc_118_18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Patients with breast cancer along with metastatic estrogen and progesterone receptor (ER/PR)- and human epidermal growth factor receptor 2 (HER2)-negative tumors are referred to as having metastatic triple-negative breast cancer (mTNBC) disease. Resistance to current standard therapies such as anthracyclines or taxanes limits the available options for previously treated patients with metastatic TNBC to a small number of non-cross-resistant regimens, and there is currently no preferred standard chemotherapy. Clinical experience suggests that many women with triple-negative metastatic breast cancer (MBC) relapse quickly. Expert oncologist discussed about new chemotherapeutic strategies and agents used in treatment of mTNBC and the expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- R. Rangarao
- Department of Medical Oncology, Max Hospital, New Delhi, India
| | - B. K. Smruti
- Dept of Medical Oncology, Bombay Hospital, Mumbai, Maharashtra, India
| | - K. Singh
- Department of Radiation Oncology, MAMC, New Delhi, India
| | - A. Gupta
- Department of Radiation Oncology, Safdarjung Hospital, New Delhi, India
| | - S. Batra
- Department of Medical Oncology, Max Hospital, New Delhi, India
| | - R. K. Choudhary
- Department of Medical Oncology, Metro Cancer Center, New Delhi, India
| | - A. Gupta
- Department of Radiation Oncology, GMC, Jammu and Kashmir, India
| | - S. Sahani
- Department of Surgical Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Vedant Kabra
- Department of Surgical Oncology, Manipal Super Specialty Hospital, Gurugram, Haryana, India
| | - Purvish M. Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S. Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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Bhardwwaj P, Batra S, Dhopte S, Das T. Fibroid Degeneration - Myriad Presentation and Laparoscopic Management. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.566] [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: 11/30/2022]
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Jackson C, Stagg HR, Doshi A, Pan D, Sinha A, Batra R, Batra S, Abubakar I, Lipman M. Tuberculosis treatment outcomes among disadvantaged patients in India. Public Health Action 2017; 7:134-140. [PMID: 28695087 PMCID: PMC5493095 DOI: 10.5588/pha.16.0107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/09/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Urban slums and poor rural areas in India, 2012-2014. Objective: To describe the characteristics of tuberculosis (TB) patients enrolled in treatment through Operation ASHA, a non-governmental organisation serving disadvantaged populations in India, and to identify risk factors for unfavourable treatment outcomes. Design: This was a retrospective cohort study. Patient characteristics were assessed for their relationship with treatment outcomes using mixed effects logistic regression, adjusting for clustering by treatment centre and Indian state. Outcomes were considered favourable (cured/treatment completed) or unfavourable (treatment failure, loss to follow-up, death, switch to multidrug-resistant TB treatment, transfer out). Results: Of 8415 patients, 7148 (84.9%) had a favourable outcome. On multivariable analysis, unfavourable outcomes were more common among men (OR 1.31, 95%CI 1.15-1.51), older patients (OR 1.12, 95%CI 1.04-1.21) and previously treated patients (OR 2.05, 95%CI 1.79-2.36). Compared to pulmonary smear-negative patients, those with extra-pulmonary disease were less likely to have unfavourable outcomes (OR 0.72, 95%CI 0.60-0.87), while smear-positive pulmonary patients were more likely to have unfavourable outcomes (OR 1.38, 95%CI 1.15-1.66 for low [scanty/1+] and OR 1.71, 95%CI 1.44-2.04 for high [2+/3+] positive smears). Conclusion: The treatment success rate within Operation ASHA is comparable to that reported nationally for India. Men, older patients, retreatment cases and smear-positive pulmonary TB patients may need additional interventions to ensure a favourable outcome.
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Affiliation(s)
- C Jackson
- Institute for Global Health, University College London (UCL), London, UK
| | - H R Stagg
- Institute for Global Health, University College London (UCL), London, UK
| | - A Doshi
- Operation ASHA, New Delhi, India
| | - D Pan
- Medical School, Imperial College London, London, UK
| | - A Sinha
- Operation ASHA, New Delhi, India
| | - R Batra
- Operation ASHA, New Delhi, India
| | - S Batra
- Operation ASHA, New Delhi, India
| | - I Abubakar
- Institute for Global Health, University College London (UCL), London, UK.,Public Health England, London, UK
| | - M Lipman
- UCL Respiratory, Division of Medicine, UCL, London, UK.,Royal Free London National Health Service Foundation Trust, London, UK
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Deep A, Bhatia R, Kaur R, Kumar S, Jain U, Singh H, Batra S, Kaushik D, Deb P. Imidazo[1,2-a]pyridine Scaffold as Prospective Therapeutic Agents. Curr Top Med Chem 2016; 17:238-250. [DOI: 10.2174/1568026616666160530153233] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 02/18/2016] [Accepted: 02/29/2016] [Indexed: 11/22/2022]
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Sharma A, Chhabra HS, Chabra T, Mahajan R, Batra S, Sangondimath G. Demographics of tuberculosis of spine and factors affecting neurological improvement in patients suffering from tuberculosis of spine: a retrospective analysis of 312 cases. Spinal Cord 2016; 55:59-63. [PMID: 27241442 DOI: 10.1038/sc.2016.85] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/20/2016] [Accepted: 04/25/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The purpose of the study was to study demographics of tuberculosis of spine and analyze factors that might affect neurological improvement in such patients. METHODS Of the 638 suspected cases of spinal tuberculosis, 312 cases with confirmed diagnosis with at least 1-year follow-up were selected for retrospective analysis. Two hundred cases who presented with neurological deficit were further divided into three groups-completely improved, partially improved and no improvement according to American Spinal Injury Association impairment scale (AIS) grading. All continuous variables and categorical variables were compared across groups. RESULTS A total of 209 (66.99%) patients had typical clinical presentation. A total of 264 (84.62%) had typical magnetic resonance imaging (MRI) presentation. Among 356 involved vertebrae, thoracic levels (T1-10) were most commonly affected in 163 (45.78%) followed by thoracolumbar (T11-L2) vertebrae in 98 (27.52%). In 250 patients (80.12%), disease was restricted to one or two adjoining vertebrae. At presentation, 112 (35.89%) patients were neurologically intact, whereas 97 (31%) were AIS D, 65 (20.83%) were AIS C, 8 (2.5%) were AIS B and 30 (9.61%) were AIS A. On statistical analysis, although three groups of patients with complete improvement, partial improvement and no improvement were similar in age, sex, radiological presentation, and co-morbidities and the presence of pulmonary tuberculosis, they were significantly different with regard to the levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration. CONCLUSIONS In management of patients suffering from tuberculosis of spine, levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration significantly affect the final neurological improvement.
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Affiliation(s)
- A Sharma
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India.,Department of Orthopedic and Spine Surgery, Dr B R Ambedkar Central Railway Hospital, Mumbai, India
| | - H S Chhabra
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India
| | - T Chabra
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India
| | - R Mahajan
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India
| | - S Batra
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India
| | - G Sangondimath
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India
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Affiliation(s)
- Sandeep Batra
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Riley Hospital for Children, University of Indianapolis, Indianapolis, Indiana
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Abstract
We present a rare case of acute promyelocytic leukemia (APL) presenting as pulmonary thromboembolism being misdiagnosed as community-acquired pneumonia. Thrombotic phenomenon in APL are poorly understood and grossly underreported. In our case, following no response to standard antibiotic treatment, the patient was further investigated and detected to have an acute pulmonary thromboembolism following right lower limb deep vein thrombosis (DVT). Though, complete blood picture revealed only mild hyperleukocytosis, bone marrow biopsy and aspiration revealed 60% blasts and a positive t (15,17)(q22,12) and PML retinoic acid receptor alpha (RARA) fusion protein on molecular cytogenetics. He was diagnosed as APL and received treatment with all-transretinoic acid (ATRA) and arsenic trioxide (ATO) and therapeutic anticoagulation
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Affiliation(s)
- Ashok K Vaid
- Department of Medical Oncology, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Sandeep Batra
- Department of Medical Oncology, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Suman S Karanth
- Department of Medical Oncology, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Sachin Gupta
- Department of Medical Oncology, Max Superspeciality Hospital, Mohali, Punjab, India
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Pan D, Lee E, Lock L, Batra R, Abubakar I, Batra S, Lipman M. P254 Utilising community empowerment and biometrics to improve tuberculosis treatment outcomes in Delhi’s slum population: the Op ASHA model. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.390] [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]
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Batra S, Bhushan R. Synthesis of three strong UV-absorbing Naproxen-based chiral derivatizing agents and their application for enantioseparation of Baclofen by RP-HPLC. ACTA CHROMATOGR 2015. [DOI: 10.1556/achrom.27.2015.2.5] [Citation(s) in RCA: 3] [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: 11/19/2022]
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Abstract
Spitzoid melanomas (SM) and atypical Spitz tumors (AST) are rare pediatric neoplasms. We performed a retrospective, single-institution review and report our institutional experience. We identified 10 patients (median age: 12.5 years). A sentinel node biopsy (SNB) was performed in 8/10 (80%) patients, and interestingly 7/8 (87.5%) were found to be positive for malignant cells. A complete regional lymphadenectomy was performed in all SNB-positive patients, but only 2/8 (25%) were found to have additional lymph node spread. Adjuvant therapy was administered in 5/8 SLNB-positive and 2/2 (100%) regional LN-positive cases. All patients had excellent long-term outcomes (100% survival). This report highlights the excellent outcomes associated with SNB + pediatric SM and AST.
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Affiliation(s)
- Sandeep Batra
- Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA.,Division of Pediatric Hematology-Oncology, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA.,Hematopoiesis, Hematologic Malignancies & Immunology, Indiana University Melvin & Bren Simon Cancer Center, 535 Barnhill Drive, Indianapolis, IN 46202, USA.,Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA
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Fang P, Batra S, Hollander AB, Lin A, Hill-Kayser CE, Levin LM, Mupparapu M, Thompson RF. Development and evaluation of a standardized method and atlas for contouring primary and permanent dentition. Dentomaxillofac Radiol 2015; 44:20150034. [PMID: 25812046 DOI: 10.1259/dmfr.20150034] [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: 11/05/2022] Open
Abstract
OBJECTIVES Radiation toxicity of the dentition may present significant treatment-related morbidity in the paediatric head and neck cancer population. However, clear dose-effect relationships remain undetermined and must be predicated upon accurate structure delineation and dosimetry at the individual tooth level. Radiation oncologists generally have limited familiarity or experience with relevant dental anatomy. METHODS We therefore developed a detailed CT atlas of permanent and primary dentition. After studying this atlas, five radiation oncology clinicians delineated all teeth for each of eight different cases (selected for breadth of dental maturity and anatomical variability). They were asked to record confidence in their contours on a per-tooth basis as well as the duration of time required per case. Contour accuracy and interclinician variability were assessed by Hausdorff distance and Dice similarity coefficient. All analyses were performed using R v. 3.1.1 and the RadOnc v. 1.0.9 package. RESULTS Participating clinicians delineated teeth with varying degrees of completeness and accuracy, stratified primarily by the age of the subject. On a per-tooth basis, delineation of permanent dentition was feasible for incisors, canines, premolars and first molars among all subjects, even at the youngest ages. However, delineation of second and third molars was less consistent, commensurate with approximate timing of tooth development. Within each tooth contour, uncertainty was the greatest at the level of the dental roots. CONCLUSIONS Delineation of individual teeth is feasible and serves as a necessary precursor for dental dose assessment and avoidance. Among the paediatric radiation oncology community in particular, this atlas may serve as a useful tool and reference.
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Affiliation(s)
- P Fang
- 1 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - S Batra
- 1 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - A B Hollander
- 1 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - A Lin
- 1 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - C E Hill-Kayser
- 1 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - L M Levin
- 2 Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - M Mupparapu
- 3 Department of Oral and Maxillofacial Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - R F Thompson
- 1 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
We report a rare case of a 35-year-old man who presented with a 1-week history of retrosternal chest pain of moderate intensity. A positron emission tomography CT (PET-CT) showed a large fluorodeoxy-glucose (FDG)-avid heterogeneously enhancing necrotic mass in the anterosuperior mediastinum with a focal FDG-avid thrombosis of the superior vena cava (SVC) suggestive of tumour thrombus and vascular invasion. α-Fetoprotein levels were raised (5690 IU/L). Image guided biopsy of the mediastinal mass was suggestive of non-seminomatous germ cell tumour (NSGCT). The patient received four cycles of BEP (bleomycin, etoposide and cisplatin) along with therapeutic anticoagulation with low-molecular-weight heparin. Follow-up whole body PET-CT revealed complete resolution of mediastinal mass and SVC tumour thrombosis. The documentation of FDG-PET-avid tumour thrombus resolving with chemotherapy supports the concept of circulating tumour cells being important not only in common solid tumours such as breast and colon cancer but also in relatively less common tumours such as NSGCT. The detection of circulating tumour cells could help deploy aggressive regimens upfront.
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Affiliation(s)
- Suman S Karanth
- Department of Medical Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Ashok K Vaid
- Department of Medical Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Sandeep Batra
- Department of Medical Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Devender Sharma
- Department of Medical Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
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Goldberg DS, Batra S, Sahay S, Kawut SM, Fallon MB. MELD exceptions for portopulmonary hypertension: current policy and future implementation. Am J Transplant 2014; 14:2081-7. [PMID: 24984921 PMCID: PMC4340069 DOI: 10.1111/ajt.12783] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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: 03/04/2014] [Revised: 03/26/2014] [Accepted: 04/13/2014] [Indexed: 01/25/2023]
Abstract
Since 2006, waitlist candidates with portopulmonary hypertension (POPH) have been eligible for standardized Model for End-Stage Liver Disease (MELD) exception points. However, there are no data evaluating the current POPH exception policy and its implementation. We used Organ Procurement and Transplantation Network (OPTN) data to compare outcomes of patients with approved POPH MELD exceptions from 2006 to 2012 to all nonexception waitlist candidates during this period. Since 2006, 155 waitlist candidates had approved POPH MELD exceptions, with only 73 (47.1%) meeting the formal OPTN exception criteria. Furthermore, over one-third of those with approved POPH exceptions either did not fulfill hemodynamic criteria consistent with POPH or had missing data, with 80% of such patients receiving a transplant based on receiving exception points. In multivariable multistate survival models, waitlist candidates with POPH MELD exceptions had an increased risk of death compared to nonexception waitlist candidates, regardless of whether they did (hazard ratio [HR]: 2.46, 95% confidence interval [CI]: 1.73-3.52; n = 100) or did not (HR: 1.60, 95% CI: 1.04-2.47; n = 55) have hemodynamic criteria consistent with POPH. These data highlight the need for OPTN/UNOS to reconsider not only the policy for POPH MELD exceptions, but also the process by which such points are awarded.
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Affiliation(s)
- D. S. Goldberg
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Corresponding author: David Goldberg,
| | - S. Batra
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX
| | - S. Sahay
- Division of Pulmonary, Critical Care and Sleep Medicine, The University of Texas Health Science Center at Houston, Houston, TX
| | - S. M. Kawut
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M. B. Fallon
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX
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Thompson R, Fang P, Hollander A, Batra S, Lin A, Hill-Kayser C. PO-0784: Quantifying variability among clinician-delineated structures. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30902-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- S Batra
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Batra S, Teo K, Vennarini S, Lin L, Freedman G. An Analysis of 3-Dimensional Breast Motion During Normal Respiration: What CTV to PTV Margin Is Needed? Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lin L, Vennarini S, Dimofte A, Batra S, Both S, Dionisi F, Freedman G. Proton Beam Versus Photon Beam Dose to the Heart and Left Anterior Descending Artery for Left-Sided Breast Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Background: To identify the socio-demographic differences between a sample of women who present for first-trimester and second-trimester abortion. Aim: To determine whether women presenting late (in the second trimester) for abortion differ socio-demographically from those presenting early (in the first trimester). Materials and Methods: Data over 4 years for women presenting for second-trimester abortion were collected from the records of Family Planning Clinic at a public tertiary level teaching hospital in India. Eighty-four cases were analysed. The case presenting for first-trimester abortion after each second-trimester abortion was included for comparison. Information was gathered concerning age, parity, educational background, employment status, educational background of the husband, family expenditure and religion. Data were statistically analysed and significance determined using logistic regression analysis. Results: Second-trimester abortions represented 2% (84/4254) of all abortions in the study period. More women of higher age (P = 0.03) and parity (P = 0.02) and higher educational status (P = 0.04) presented for second-trimester abortion as compared to first-trimester abortion. The occupational status of the woman, husband's educational background, monthly family expenditure per person and religion did not significantly influence the time of presentation for abortion. Conclusion: Second-trimester abortions are associated with both increasing age and parity and higher education. This group of educated, older and multiparous women should be one of those targeted for counseling to reduce the risks associated with second trimester abortion.
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Affiliation(s)
- P Aggarwal
- Department of Obstetrics and Gynaecology, Safdarjang Hospital and Vardhman Mahavir Medical College, New Delhi, India
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Abstract
A 47-year-old woman presented with ascites. There was history of large volume paracentesis and the drained ascitic fluid was found to be positive for malignant cells. Clinical examination revealed a soft tissue nodule over the skin of right iliac fossa and a small umbilical nodule besides presence of ascites. In addition, the patient had a breast lump of 2×2 cm in upper quadrant of right breast. Biopsy from the abdominal wall nodule revealed a malignant tumour with dense desmoplastic response. The tumour cells were pancytokeratin, CA125, WT1 positive and CDX2, CD10, villin, calretinin negative; thus immunohistochemically suggesting a primary tumor arising from ovary. Biopsy from breast lump showed malignant epithelial cells present in sheets with stromal dysplasia. Immunohistochemically tumour cells were positive for CK7. CA125, WT1, thus favouring a metastatic carcinoma to breast with possible primary arising from ovary.
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Affiliation(s)
- Sandeep Batra
- Department of Medical Oncology, Medanta, The Medicity, Gurgaon, Haryana, India.
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Abstract
A 50-year-old man was diagnosed as classical Hodgkin's lymphoma stage III B. He had been a reformed smoker and has had a coronary artery disease as his comorbidity. He was started on adriamycin, bleomycin, vinblastine, dacarbazine (ABVD)-based chemotherapy. An interim disease evaluation was suggestive of metabolic complete response after four cycles of ABVD. After completion of his sixth cycle, he presented with low-grade fever, dry cough, generalised malaise and increasing dyspnoea on exertion. FDG (18 fluoro-deoxyglucose) positron emission tomography (PET)-CT revealed intensely FDG avid diffuse activity in mid and lower zone both lung fields. He was started on intravenous steroids along with broad spectrum antibiotic and antifungal cover. Clinical, radiological and laboratory assays did not reveal any infective pathology. He was diagnosed as bleomycin-induced pulmonary toxicity (BIP). Despite best supportive care, his pulmonary functions deteriorated and he developed cardiac arrhythmias. He finally succumbed to the irreversible chemotherapy toxicity of a curable malignancy.
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Affiliation(s)
- Sandeep Batra
- Department of Medical Oncology, Medanta, The Medicity, Gurgaon, Haryana, India.
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Hite M, Nevah M, Batra S, Fallon M, Machicao V, Liaw J, Kyriakides P, Cohen A. Predictors of ninety day mortality in post TIPS patients. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.376] [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: 11/17/2022] Open
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Abstract
No case of a primary renal parenchymal squamous cell carcinoma (SCC) has been reported previously in the literature although renal pelvic SCCs are well known. We report an unusual case in a 60-year-old lady who presented with significant weight loss. She was found to have a mid and lower pole left renal tumor with enlarged para-aortic nodes. A left radical nephrectomy and nodal dissection was performed and the pathological stage was T4N1M0. No adjuvant therapy was given. She is alive at 13 months post-surgery.
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Affiliation(s)
- P Kulshreshtha
- Department of Surgical Oncology, Army Hospital, Delhi, India
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Abstract
This is a case of acute splenic and bilateral renal infarction in a patient with non-small cell lung carcinoma during chemotherapy with gemcitabine and cisplatin. Till date, bilateral renal infarction following gemcitabine and cisplatin has been reported only once in the past. The case that is being reported has had acute splenic and bilateral renal infarct and has not been reported previously. Splenic and renal infarction should be considered in the differential diagnosis of excruciating abdominal pain and backache in a patient on gemcitabine-based and cisplatin-based chemotherapy.
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Affiliation(s)
- Sandeep Batra
- Department of Medical Oncology, Medanta, The Medicity, Gurgaon, Haryana, India.
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Kannan N, Bhardwaj R, Batra S, Kulshreshtha P. Authors′ reply. INDIAN J PATHOL MICR 2013. [DOI: 10.4103/0377-4929.116161] [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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Moningi S, Guss Z, Batra S, Cohen K, Jallo G, Wharam M, Terezakis S. The Role of Adjuvant Therapy in the Management of Low-Grade Pediatric Spinal Tumors. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1691] [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: 11/16/2022]
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Popper L, Batra S. Muscarinic acetylcholine and histamine-receptor mediated calcium mobilization and cell-growth in human ovarian-cancer cells. Int J Oncol 2012; 4:453-9. [PMID: 21566946 DOI: 10.3892/ijo.4.2.453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The effects of carbachol and histamine on changes in cytosolic-free calcium ([Ca2+]i) and cell proliferation have been characterized in human ovarian cancer cells (OVCAR-3) and non-tumourigenic Chinese hamster ovary cells (CHO). The muscarinic agonist carbachol increased [Ca2+]i significantly with a rapid biphasic response due to both influx of extracellular calcium and release of calcium from intracellular stores. None of these effects were however seen in CHO cells. The increase in cellular calcium by carbachol was also confirmed by calcium uptake experiments using Ca-45. Carbachol increased Ca-45 uptake by 25% in OVCAR-3 cells but had no effect in CHO cells. Histamine also stimulated calcium mobilization in OVCAR-3 cells but had no effect in CHO cells. The response to histamine was also biphasic although the calcium increase was smaller than with carbachol. Data obtained with selective histamine antagonists showed that the response to histamine was mediated by H-1 histaminergic receptors. Both carbachol and histamine also stimulated cell growth of OVCAR-3 cells but were without effect on CHO cells. The cell proliferating effect of carbachol and of histamine on OVCAR-3 cells as well as the increase in [Ca2+], was totally blocked by atropine and selective H-1 histaminergic receptor antagonist pyrilamine, respectively. Fetal calf serum (FCS) which increased [Ca2+]i in both cell lines also caused a substantial increase in cell growth in the two cell lines. Verapamil partially and TMB-8 totally blocked carbachol stimulated release of calcium from intracellular stores, whereas prenylamine had only a minor inhibitory effect on calcium influx. The effect of verapamil and TMB-8 were most likely resulted from their inhibition of cholinergic receptors rather than a direct inhibition of intracellular calcium release. The carbachol induced effects on calcium transients were also partially inhibited by pertussis toxin and the phorbol ester PMA. Our data suggest that the mitogenic action of carbachol occurs through an increase in [Ca2+]i which promote DNA synthesis and cell growth. These data also indicate the involvement of both a pertussis toxin sensitive and insensitive G-protein as well as protein kinase C in the signal transduction pathway induced by carbachol.
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Affiliation(s)
- L Popper
- LUND UNIV,DEPT OBSTET & GYNECOL,S-22101 LUND,SWEDEN. LUND UNIV,DEPT PHARMACOL,S-22101 LUND,SWEDEN. KABI PHARM THERAPEUT AB,LUND,SWEDEN
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