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Tembhare PR, Sriram H, Khanka T, Gawai S, Bagal B, Ghogale SG, Deshpande N, Girase K, Patil J, Hasan SK, Shetty D, Ghosh K, Chatterjee G, Rajpal S, Patkar NV, Jain H, Punatar S, Gokarn A, Nayak L, Mirgh S, Jindal N, Sengar M, Khattry N, Subramanian PG, Gujral S. Circulating tumor plasma cells and peripheral blood measurable residual disease assessment in multiple myeloma patients not planned for upfront transplant. Hemasphere 2024; 8:e63. [PMID: 38566804 PMCID: PMC10983024 DOI: 10.1002/hem3.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/16/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Circulating tumor plasma cells (CTPCs) provide a noninvasive alternative for measuring tumor burden in newly diagnosed multiple myeloma (NDMM). Moreover, measurable residual disease (MRD) assessment in peripheral blood (PBMRD) can provide an ideal alternative to bone marrow MRD, which is limited by its painful nature and technical challenges. However, the clinical significance of PBMRD in NDMM still remains uncertain. Additionally, data on CTPC in NDMM patients not treated with transplant are scarce. We prospectively studied CTPC and PBMRD in 141 NDMM patients using highly sensitive multicolor flow cytometry (HS-MFC). PBMRD was monitored at the end of three cycles (PBMRD1) and six cycles (PBMRD2) of chemotherapy in patients with detectable baseline CTPC. Patients received bortezomib-based triplet therapy and were not planned for an upfront transplant. Among baseline risk factors, CTPC ≥ 0.01% was independently associated with poor progression-free survival (PFS) (hazard ratio [HR] = 2.77; p = 0.0047) and overall survival (OS) (HR = 2.9; p = 0.023) on multivariate analysis. In patients with detectable baseline CTPC, undetectable PBMRD at both subsequent time points was associated with longer PFS (HR = 0.46; p = 0.0037), whereas detectable PBMRD at any time point was associated with short OS (HR = 3.25; p = 0.004). Undetectable combined PBMRD (PBMRD1 and PBMRD2) outperformed the serum-immunofixation-based response. On multivariate analysis, detectable PBMRD at any time point was independently associated with poor PFS (HR = 2.0; p = 0.025) and OS (HR = 3.97; p = 0.013). Thus, our findings showed that CTPC and PBMRD assessment using HS-MFC provides a robust, noninvasive biomarker for NDMM patients not planned for an upfront transplant. Sequential PBMRD monitoring has great potential to improve the impact of the existing risk stratification and response assessment models.
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Affiliation(s)
- Prashant R. Tembhare
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Harshini Sriram
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Twinkle Khanka
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Sanghamitra Gawai
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial CentreHBNI UniversityMumbaiMaharashtraIndia
| | - Sitaram G. Ghogale
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Nilesh Deshpande
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Karishma Girase
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Jagruti Patil
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Syed Khaizer Hasan
- Hasan Laboratory, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Dhanalaxmi Shetty
- Department of Cancer Cytogenetics, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Kinjalka Ghosh
- Department of Biochemistry, Tata Memorial CentreHBNI UniversityMumbaiMaharashtraIndia
| | - Gaurav Chatterjee
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Sweta Rajpal
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Nikhil V. Patkar
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial CentreHBNI UniversityMumbaiMaharashtraIndia
| | - Sachin Punatar
- Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Anant Gokarn
- Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Lingaraj Nayak
- Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Sumeet Mirgh
- Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Nishant Jindal
- Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial CentreHBNI UniversityMumbaiMaharashtraIndia
| | - Navin Khattry
- Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Papagudi G. Subramanian
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital, Tata Memorial CentreHBNI UniversityMumbaiMaharashtraIndia
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Jindal N, C M, Mathew LJ, Kumbhalwar K, Patel K, Garg M, Mirgh S, Chichra A, Nayak L, Bonda A, Gokarn A, Punatar S, Bagal B, Khattry N. Fertility outcomes in patients desiring conception following autologous stem cell transplantation for hodgkin lymphoma using LACE conditioning. Bone Marrow Transplant 2024; 59:417-418. [PMID: 38102211 DOI: 10.1038/s41409-023-02179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Nishant Jindal
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Muralidaran C
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Libin Jacob Mathew
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Komal Kumbhalwar
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Kaumil Patel
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Malini Garg
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Sumeet Mirgh
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Akanksha Chichra
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Lingaraj Nayak
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Avinash Bonda
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Anant Gokarn
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Sachin Punatar
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Navin Khattry
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India.
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Gupta SK, Gohil D, Momin MB, Yadav S, Chichra A, Punatar S, Gokarn A, Mirgh S, Jindal N, Nayak L, Hingorani L, Khattry N, Gota V. Withania Somnifera Extract Mitigates Experimental Acute Graft versus Host Disease Without Abrogating Graft Versus Leukemia Effect. Cell Transplant 2024; 33:9636897241226573. [PMID: 38258793 PMCID: PMC10807391 DOI: 10.1177/09636897241226573] [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: 11/07/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
Acute graft versus host disease (aGvHD) is the major contributor of nonrelapse mortality in alloHSCT. It is associated with an inflammatory immune response manifesting as cytokine storm with ensuing damage to target organs such as liver, gut, and skin. Prevention of aGvHD while retaining the beneficial graft versus leukemia (GvL) effect remains a major challenge. Withania somnifera extract (WSE) is known for its anti-inflammatory, immune-modulatory, and anticancer properties, which are appealing in the context of aGvHD. Herein, we demonstrated that prophylactic and therapeutic use of WSE in experimental model of alloHSCT mitigates aGvHD-associated morbidity and mortality. In the prophylaxis study, a dose of 75 mg/kg of WSE offered greatest protection against death due to aGvHD (hazard ratio [HR] = 0.15 [0.03-0.68], P ≤ .01), whereas 250 mg/kg was most effective for the treatment of aGvHD (HR = 0.16 [0.05-0.5], P ≤ .01). WSE treatment protected liver, gut, and skin from damage by inhibiting cytokine storm and lymphocytic infiltration to aGvHD target organs. In addition, WSE did not compromise the GvL effect, as alloHSCT with or without WSE did not allow the leukemic A20 cells to grow. In fact, WSE showed marginal antileukemic effect in vivo. WSE is currently under clinical investigation for the prevention and treatment of aGvHD.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Dievya Gohil
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Mohd Bashar Momin
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Subhash Yadav
- Homi Bhabha National Institute, Mumbai, India
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Akanksha Chichra
- Homi Bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Sachin Punatar
- Homi Bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Anant Gokarn
- Homi Bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Sumeet Mirgh
- Homi Bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Nishant Jindal
- Homi Bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Lingaraj Nayak
- Homi Bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | | | - Navin Khattry
- Homi Bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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Chichra A, Nayak L, Kothari R, Kalantri S, Bonda A, Gokarn A, Punatar S, Mirgh S, Jindal N, Bagal B, Kannan S, Mathew L, Khattry N. Fludarabine melphalan versus fludarabine treosulfan for reduced intensity conditioning regimen in allogeneic hematopoietic stem cell transplantation: a retrospective analysis. Int J Hematol 2024; 119:71-79. [PMID: 37952243 DOI: 10.1007/s12185-023-03674-z] [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: 04/06/2023] [Revised: 10/02/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
Various reduced-intensity conditioning (RIC) regimens are used to decrease toxicity while providing comparable outcomes to myeloablative regimens. We compared toxicity and outcomes between two RIC regimens, fludarabine with melphalan (Flu-Mel) and fludarabine with treosulfan (Flu-Treo), retrospectively over a 10-year period in two donor groups, matched related donor (MRD)/matched unrelated donor (MUD) and haploidentical (Haplo) transplants. The study included 138 patients, of which 105 received MRD/MUD (Flu-Mel: 94, Flu-Treo: 11) and 33 Haplo (Flu-Mel: 17, Flu-Treo: 16) transplants. In the MRD/MUD group, 44 (47%) of patients who received Flu-Mel had grade 3/4 oral mucositis compared to 1 (9%) who received Flu-Treo (P = 0.02). Corresponding numbers in the Haplo group were 7 (41%) and 1 (6%). Grade 3/4 diarrhoea was more frequent with Flu-Mel than Flu-Treo in the Haplo group (41% vs 6%; P = 0.039), but not the MRD/MUD group. Median follow-up time for all patients was 4.8 years. Five-year OS in the MRD/MUD group was 62% with Flu-Mel versus 53% with Flu-Treo (P = 0.0694). Similarly, 5-year OS was 41% with Flu-Mel and 28% with Flu-Treo (P = 0.770) in the Haplo group. Severe mucositis and diarrhoea were significantly less frequent with Flu-Treo than Flu-Mel. Flu-Treo provided comparable outcomes to Flu-Mel in all donor transplants.
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Affiliation(s)
- Akanksha Chichra
- Stem Cell Transplant Unit, Department of Medical Oncology, Room 211, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410201, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Lingaraj Nayak
- Stem Cell Transplant Unit, Department of Medical Oncology, Room 211, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410201, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Rushabh Kothari
- Stem Cell Transplant Unit, Department of Medical Oncology, Room 211, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410201, India
| | - Siddhesh Kalantri
- Stem Cell Transplant Unit, Department of Medical Oncology, Room 211, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410201, India
| | - Avinash Bonda
- Stem Cell Transplant Unit, Department of Medical Oncology, Room 211, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410201, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Anant Gokarn
- Stem Cell Transplant Unit, Department of Medical Oncology, Room 211, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410201, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Sachin Punatar
- Stem Cell Transplant Unit, Department of Medical Oncology, Room 211, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410201, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Sumeet Mirgh
- Stem Cell Transplant Unit, Department of Medical Oncology, Room 211, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410201, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Nishant Jindal
- Stem Cell Transplant Unit, Department of Medical Oncology, Room 211, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410201, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Bhausaheb Bagal
- Stem Cell Transplant Unit, Department of Medical Oncology, Room 211, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410201, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Sadhana Kannan
- Department of Biostatistics, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Libin Mathew
- Stem Cell Transplant Unit, Department of Medical Oncology, Room 211, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410201, India
| | - Navin Khattry
- Stem Cell Transplant Unit, Department of Medical Oncology, Room 211, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410201, India.
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India.
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Kandekar S, Punatar S, Khattry N, Gokarn A, Jindal N, Mirgh S, Chichra A, Tembhare P, Rane P, Gawde J, Mathew L, Patil A, Chiplunkar S, Kode J. Low levels of CD26 on certain cellular subtypes of donor harvest is associated with better clinical outcomes post allogeneic stem cell transplantation through regulation of NF-κB pathway and pro-inflammatory cytokines. Int Immunopharmacol 2023; 125:111054. [PMID: 37890379 DOI: 10.1016/j.intimp.2023.111054] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND We had previously reported significant association of immunoectoenzyme CD26 expression on donor harvest with acute Graft-versus-Host-Disease (aGVHD) in allogeneic stem cell transplantation (ASCT) patients. The current study was aimed at analysing CD26 signaling pathway molecules and understanding their impact on immune reconstitution and clinical outcomes post-ASCT. SUBJECTS AND METHODOLOGY The study cohort included 26 transplant donors/patients who underwent reduced intensity (n = 21), myeloablative (n = 4) and non-myeloablative (n = 1) ASCT for hematological malignancies. Donors were matched related donors (n = 19) and haploidentical donors (n = 7). Surface expression of CD26, CD73 and ADA, and various immune cell subtypes were assessed by multicolour-flow cytometry. Soluble CD26 (sCD26) and cytokine levels were measured in plasma samples by ELISA and Multiplex Luminex assay, respectively. Immune cells from healthy individuals were stimulated with phytohemagglutinin (PHA) in the presence or absence of CD26 inhibitor. Effect of CD26 inhibition on NF-κB localization in PHA stimulated cells was analysed by immunofluorescence and confocal microscopy. Pro-inflammatory cytokines from the culture supernatants were detected with Cytometric bead array flow cytometry. Association of all measured markers with clinical outcomes was evaluated using appropriate statistical tests. RESULTS CD26 surface expression on PBSC donor harvest cells showed increased risk of chronic GVHD (cGVHD, p = 0.055). Amongst the various immune cell subtypes, decreased B cells in harvest showed significant association with aGVHD (p = 0.022) whereas increased myeloid dendritic cells and CD3+T cells at Day100 in peripheral blood of transplant recipients correlated with cGVHD (p = 0.046) and aGVHD (p = 0.035), respectively. Further, high sCD26 in transplant recipients at Day100 exhibited association with reduced event-free survival (EFS) (p = 0.011). Higher CD26 expression on more & less mature NK cells, naïve & post-switched memory B cells and Treg cells in the donor harvest (p < 0.05) led to lower EFS in transplant recipients. Mechanistically, CD26 inhibitor caused dose-dependent reduction in CD26 enzyme activity and in pro-inflammatory cytokine production in post mitogen-stimulated T cell cultures. CONCLUSION Our study has implicated that lower CD26 expression on immune cell subtypes of the donor stem cell harvest is associated with reduced risk of GVHD and better survival. The underlying mechanism was found to be through NF-κB pathway and pro-inflammatory cytokines. Based on these observations, chemically designed or natural resources-based CD26 inhibitors can be explored further in clinical trials for improving ASCT outcomes.
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Affiliation(s)
- Shruti Kandekar
- Kode Lab, Tumor Immunology & Immunotherapy Group, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Sachin Punatar
- Stem Cell Transplant Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Navin Khattry
- Stem Cell Transplant Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Anant Gokarn
- Stem Cell Transplant Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Nishant Jindal
- Stem Cell Transplant Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Sumeet Mirgh
- Stem Cell Transplant Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Akanksha Chichra
- Stem Cell Transplant Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Prashant Tembhare
- Hematopathology Lab, Clinical Research Centre, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Pallavi Rane
- Clinical Research Secretariat, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India
| | - Jitendra Gawde
- Clinical Research Secretariat, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India
| | - Libin Mathew
- Stem Cell Transplant Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India
| | - Anand Patil
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Shubhada Chiplunkar
- Chiplunkar Lab, Tumor Immunology & Immunotherapy Group, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Jyoti Kode
- Kode Lab, Tumor Immunology & Immunotherapy Group, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India; Homi Bhabha National Institute (HBNI), Training School Complex, Anushakti Nagar, Mumbai 400094, India.
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6
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Gokarn A, Tembhare PR, Syed H, Sanyal I, Kumar R, Parab S, Khanka T, Punatar S, Kedia S, Ghogale SG, Deshpande N, Nikam Y, Girase K, Mirgh S, Jindal N, Bagal B, Chichra A, Nayak L, Bonda A, Rath S, Hiregoudar S, Poojary M, Saha S, Ojha S, Subramanian PG, Khattry N. Long-Term Cryopreservation of Peripheral Blood Stem Cell Harvest Using Low Concentration (4.35%) Dimethyl Sulfoxide with Methyl Cellulose and Uncontrolled Rate Freezing at -80 °C: An Effective Option in Resource-Limited Settings. Transplant Cell Ther 2023; 29:777.e1-777.e8. [PMID: 37678607 DOI: 10.1016/j.jtct.2023.08.032] [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: 07/02/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
Long-term cryopreservation of peripheral blood stem cells (PBSCs) is highly useful in the setting of tandem/multiple transplantations or treatment of relapse in the autologous hematopoietic stem cell transplantation (HSCT) setting. Even in allogeneic HSCT, donor lymphocyte infusions may be stored for months to years if excess stem cells are collected from donors. Cryopreservation is a delicate, complex, and costly procedure, and higher concentrations of dimethyl sulfoxide (DMSO), a commonly used cryoprotectant, can be toxic to cells and cause adverse effects in the recipient during infusions. In this study, we examined the effect of long-term cryopreservation using 4.35% DMSO (as final concentration) with methyl cellulose and uncontrolled rate freezing in a mechanical freezer (-80 °C) on the viability and colony-forming ability of CD34+ human PBSCs. For patients undergoing autologous HSCT, PBSCs were cryopreserved using DMSO (final concentration of 4.35%) with methyl cellulose. The post-thaw viability of PBSCs was determined using Trypan blue exclusion and flow cytometry-based 7-amino-actinomycin-D (FC-7AAD) methods. Concentrations of CD34+ stem cells and immune cell subsets in post-thaw PBSC harvest samples were assessed using multicolor flow cytometry, and the clonogenic potential of post-thaw stem cells was studied using a colony-forming unit (CFU) assay. CD34+ stem cell levels were correlated with the prestorage CD34 levels using the Pearson correlation test. The viability results in the Trypan blue dye exclusion method and the flow cytometry-based method were compared using Bland-Altman plots. We studied 26 PBSC harvest samples with a median cryopreservation duration of 6.6 years (range, 3.8 to 11.5 years). The median viability of post-thaw PBSCs was >80% using both methods, with a weak agreement between them (r = .03; P = .5). The median CD34+ stem cell count in the post-thaw samples was 9.13 × 106/kg (range, .44 to 26.27 × 106/kg). The CFU assay yielded a good proliferation and differentiation potential in post-thaw PBSCs, with a weak correlation between granulocyte macrophage CFU and CD34+ stem cell levels (r = .4; P = .05). Two samples that had been cryopreserved for >8 years showed low viability. Cryopreservation of PBSCs using 4.35% DMSO with methyl cellulose and uncontrolled freezing in a mechanical freezer at -80 °C allows the maintenance of long-term viability of PBSC for up to 8 years.
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Affiliation(s)
- Anant Gokarn
- Department of Medical Oncology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - Prashant R Tembhare
- Homi Bhabha National Institute, Mumbai, India; Hematopathology Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Hasan Syed
- Homi Bhabha National Institute, Mumbai, India; Hasan Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Isha Sanyal
- Hematopathology Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Rohit Kumar
- Hasan Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Sarika Parab
- Department of Transfusion Medicine, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Twinkle Khanka
- Hematopathology Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Sachin Punatar
- Department of Medical Oncology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - Shweta Kedia
- Hematopathology Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Sitaram G Ghogale
- Hematopathology Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Nilesh Deshpande
- Hematopathology Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Yuvraj Nikam
- Hasan Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Karishma Girase
- Hematopathology Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Sumeet Mirgh
- Department of Medical Oncology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - Nishant Jindal
- Department of Medical Oncology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - Akanksha Chichra
- Department of Medical Oncology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - Lingaraj Nayak
- Department of Medical Oncology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - Avinash Bonda
- Department of Medical Oncology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - Sushmita Rath
- Department of Medical Oncology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - Sumathi Hiregoudar
- Homi Bhabha National Institute, Mumbai, India; Department of Transfusion Medicine, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Minal Poojary
- Homi Bhabha National Institute, Mumbai, India; Department of Transfusion Medicine, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Suryatapa Saha
- Homi Bhabha National Institute, Mumbai, India; Department of Transfusion Medicine, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Shashank Ojha
- Homi Bhabha National Institute, Mumbai, India; Department of Transfusion Medicine, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Papagudi G Subramanian
- Homi Bhabha National Institute, Mumbai, India; Hematopathology Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India
| | - Navin Khattry
- Department of Medical Oncology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Center, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India
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Jindal N, Saroha M, Mirgh S, Chichra A, Nayak L, Bonda A, Gokarn A, Punatar S, Bagal B, Chavan P, Mathew LJ, Kannan S, Khattry N. Relevance of vitamin D in patients undergoing HLA matched allogeneic stem cell transplant for acute leukemia. Transpl Immunol 2023; 81:101925. [PMID: 37648032 DOI: 10.1016/j.trim.2023.101925] [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: 07/02/2023] [Revised: 08/20/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND In hematopoietic stem cell transplant (HSCT), vitamin D deficiency has been variably associated with increased complications, primarily graft versus host disease (GvHD), with a potential impact on survival. Results from various studies however, have not been consistent. This analysis was conducted to study the impact of peri-transplant vitamin D levels on transplant outcomes in patients with acute leukemia (AL) who underwent HLA matched (related/unrelated) HSCT. METHODS This was a single center retrospective study. Patients of AL including Acute Lymphoblastic Leukemia (ALL), Acute Myeloid Leukemia (AML) or Mixed Phenotypic Acute Leukemia (MPAL) who underwent fully matched or 9/10 transplants (related/unrelated) between 2008 and 2019 were included. Vitamin D deficiency was defined as serum 25-hydroxy vitamin D3 levels ≤20 ng/ml. Those with deficiency received replacement with oral vitamin D at a dose of 60,000 IU weekly for 8 weeks followed by maintenance with daily vitamin D (800 IU/day). Vitamin D levels were repeated at 4 months from start of replacement. For patients who received correction, repeat levels >20 ng/ml were considered replete. Based on vitamin D levels in the peri-transplant period (within 120 days of transplant), patients were categorised as either vitamin D replete (> 20 ng/ml) or deplete (≤ 20 ng/ml). Peri-transplant vitamin D status was correlated with transplant outcomes. RESULTS Of the 133 patients included, 31 were deplete (median vitamin D 15.0 ng/ml) and 102 were replete (median vitamin D 34 ng/ml) at time of transplant. Both groups were matched for age, diagnosis, EBMT score and disease risk index (DRI). There were no differences in time to neutrophil or platelet engraftment, CMV reactivation, acute GvHD (aGvHD) or chronic GvHD (cGvHD) between the two groups. Relapse rate, Progression Free Survival (PFS) and Overall Survival (OS) were also comparable between the 2 groups. CONCLUSION The incidence of vitamin D deficiency was high in our patient cohort. Patients who were vitamin D deficient at the time of transplant did not have inferior outcomes, suggesting a limited role of vitamin D in influencing transplant outcomes.
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Affiliation(s)
- Nishant Jindal
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Megha Saroha
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Sumeet Mirgh
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Akanksha Chichra
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Lingaraj Nayak
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Avinash Bonda
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Anant Gokarn
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Sachin Punatar
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Preeti Chavan
- Composite Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Libin Jacob Mathew
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Sadhana Kannan
- Department of Biostatistics, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Navin Khattry
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India.
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Kumbhalwar K, Punatar S, Gokarn A, Nayak L, Chichra A, Mirgh S, Jindal N, Mathew L, Khattry N. Lenalidomide with or without dexamethasone for relapsed or refractory Hodgkin lymphoma post autologous stem cell transplant. Blood Cell Ther 2023; 6:95-103. [PMID: 38146353 PMCID: PMC10749212 DOI: 10.31547/bct-2023-009] [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] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/06/2023] [Indexed: 12/27/2023]
Abstract
Background The prognosis of Hodgkin lymphoma (HL) relapsing post autologous transplant (AuSCT) is poor. Even with novel therapies, only approximately 20%-25% of patients attain complete remissions, with a median progression-free survival (PFS) of approximately 5-15 months. Lenalidomide has been shown to have activity in relapsed HL. We retrospectively analyzed the outcomes of patients with relapsed HL post AuSCT treated with lenalidomide alone or in combination with dexamethasone at our center. Patients and methods Records of 143 patients transplanted from November 2007 to October 2021 were reviewed. Of these patients, 41 (28%) relapsed, and 16 (39%) received lenalidomide alone or in combination with dexamethasone. Data collected included demographic, pathological, staging, and prior therapy details. Lenalidomide was administered at 10-25 mg/day on an intermittent or continuous schedule alone or in combination with dexamethasone (20-40 mg weekly). Response was assessed using PET-CT scan in accordance with Lugano criteria. Standard definitions were used for response, PFS, and overall survival (OS). Toxicities were graded using Common Terminology Criteria for Adverse Events version 5.0. Statistical analysis was done using SPSS Version 21. Results The median age of the patients was 25.5 years, and 10 were males. Eleven (69%) had advanced disease, and 7 (44%) were refractory to last systemic therapy. Nine patients received lenalidomide alone and 7 with dexamethasone. Four (25%) had complete response, and another four (25%) had partial response, with an overall response rate of 50%. The 3-year PFS and OS were 31% and 38%, respectively. Grade III/IV toxicities were only hematological, neutropenia and thrombocytopenia in four and three patients, respectively. No therapy-related deaths were recorded. Conclusions Lenalidomide alone or in combination with dexamethasone is a safe and effective therapy for relapsed HL post AuSCT and results in durable response and long-term survival in approximately one-third of the patients. However, these results needs verification in larger prospective studies.
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Affiliation(s)
- Komal Kumbhalwar
- Stem Cell Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Sachin Punatar
- Stem Cell Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Anant Gokarn
- Stem Cell Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Lingaraj Nayak
- Stem Cell Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Akanksha Chichra
- Stem Cell Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Sumeet Mirgh
- Stem Cell Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Nishant Jindal
- Stem Cell Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
| | - Libin Mathew
- Stem Cell Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Navin Khattry
- Stem Cell Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai, India
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Kumar Gupta S, Gohil D, Dutta D, Panigrahi GC, Gupta P, Dalvi K, Khanka T, Yadav S, Kumar Kaushal R, Chichra A, Punatar S, Gokarn A, Mirgh S, Jindal N, Nayak L, Tembhare PR, Khizer Hasan S, Kumar Sandur S, Hingorani L, Khattry N, Gota V. Withaferin-A alleviates acute graft versus host disease without compromising graft versus leukemia effect. Int Immunopharmacol 2023; 121:110437. [PMID: 37311352 DOI: 10.1016/j.intimp.2023.110437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/20/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023]
Abstract
Acute graft versus host disease (aGvHD) contributes to a significant proportion of non-relapse mortality and morbidity in patients undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT). Withaferin-A (WA), a phytomolecule obtained from Withania somnifera (Ashwagandha), is known to have anti-inflammatory, anti-proliferative and immunomodulatory properties. The efficacy of WA for the prevention and treatment of aGvHD was evaluated using a murine model of alloHSCT. Prophylactic administration of WA to mice mitigated the clinical symptoms of aGvHD and improved survival significantly compared to the GvHD control [HR = 0.07 (0.01-0.35); P < 0.001]. Furthermore, WA group had better overall survival compared to standard prophylactic regimen of CSA + MTX [HR = 0.19 (0.03-1.1), P < 0.05]. At the same time, WA did not compromise the beneficial GvL effect. In addition, WA administered to animals after the onset of aGvHD could reverse the clinical severity and improved survival, thus establishing its therapeutic potential. Our findings suggest that WA reduced the systemic levels of Th1, Th2 and Th17 inflammatory cytokine and increased the anti-inflammatory cytokine IL-10 levels significantly (P < 0.05). WA also inhibited lymphocytes migration to gut, liver, skin and lung and protected these organs from damage. Ex-vivo, WA inhibited proliferation of human peripheral blood mononuclear cells (hPBMCs), modulated immune cell phenotype and decreased cytokine release. In addition, WA inhibited pJAK2 and pSTAT3 protein levels in mouse splenocytes and hPBMCs. In conclusion, our study demonstrates the utility of WA for the prevention and treatment of aGvHD, which should be further evaluated in a clinical setting.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Dievya Gohil
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Deepshikha Dutta
- Cell and Tumor Biology Group, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Girish Ch Panigrahi
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Puja Gupta
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India
| | - Kajal Dalvi
- Hematopathology Laboratory, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India
| | - Twinkle Khanka
- Hematopathology Laboratory, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India
| | - Subhash Yadav
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Rajiv Kumar Kaushal
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Akanksha Chichra
- Department of Medical Oncology, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Sachin Punatar
- Department of Medical Oncology, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Anant Gokarn
- Department of Medical Oncology, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Sumeet Mirgh
- Department of Medical Oncology, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Nishant Jindal
- Department of Medical Oncology, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Lingaraj Nayak
- Department of Medical Oncology, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Prashant R Tembhare
- Hematopathology Laboratory, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Syed Khizer Hasan
- Cell and Tumor Biology Group, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Santosh Kumar Sandur
- Radiation Biology and Health Science Division, Bio-science Group, Bhabha Atomic Research Centre, Mumbai 400094, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Lal Hingorani
- Pharmanza Herbal Pvt. Ltd., Anand 388435, Gujarat, India
| | - Navin Khattry
- Department of Medical Oncology, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Vikram Gota
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India; Homi Bhabha National Institute, BARC Training School Complex, Anushakti Nagar, Mumbai 400094, Maharashtra, India.
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Kamtalwar S, Mirgh S, More A, Gokarn A, Dhumal S, Sharma P, Lall S, Patkar N, Shetty N, Chatterjee G, Rajpal S, Bhat V, Khattry N, Gupta S. Triple Trouble: Disseminated Penicilliosis in a Cancer patient with COVID-19. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
AbstractPenicilliosis is a fungal infection caused by the fungus Penicillium marneffei or Talaromyces marneffei. Penicillosis is commonly seen in immunocompromised patients such as in HIV(AIDS). Herein, we present a case of penicilliosis in an oral cavity cancer patient who was admitted for the management of SARS-CoV-2 infection at our hospital. A 50-year-old male patient operated on for squamous cell carcinoma of the oral cavity who completed his adjuvant chemoradiation 2 months ago, presented to our hospital with dry cough for more than 3 weeks. His nasopharyngeal swab was positive for the severe acute respiratory distress syndrome (SARS-CoV-2). During his hospital stay for SARS-CoV-2 infection, he was diagnosed with disseminated penicilliosis. The patient was treated with intravenous antifungals caspofungin and voriconazole. However, he succumbed to disseminated fungal sepsis. This case highlights the need to consider penicilliosis as a possible opportunistic pathogen, especially in immunocompromised patients such as cancer.
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Das S, Bagal B, Jain H, Kashyap L, Anbarasan S, Abhishek S, Bondili S, Nayak L, Thorat J, Mirgh S, Gokarn A, Punatar S, Ayushi S, Epari S, Tembhare P, Shetty P, Khanna N, Goda J, Aliasgar M, Gupta T, Sengar M, Khattry N, Laskar S, Menon H. Demographics, Pattern of Care & Outcomes of Primary CNS Lymphoma- Experience from a Tertiary Care Cancer Center in India. Indian J Hematol Blood Transfus 2023; 39:57-70. [PMID: 36699441 PMCID: PMC9868032 DOI: 10.1007/s12288-022-01557-7] [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: 02/07/2022] [Accepted: 07/04/2022] [Indexed: 01/28/2023] Open
Abstract
Primary CNS lymphoma (PCNSL) is a rare subtype of non-Hodgkin lymphoma with the worst outcomes amongst all extranodal lymphomas. There is a scarcity of data on real-world outcomes of primary CNS lymphoma (PCNSL) owing to the rarity of the disease. This study analyzed the demographic patterns, risk stratification, treatment regimens used, & outcomes of patients treated at Tata Memorial Center Mumbai, India. This is a retrospective analysis of newly diagnosed primary CNS lymphoma patients treated at our centre over seven years from January 2013 to December 2019. A total of 142 patients with PCNSL were diagnosed during this period. Thirty (21.1%) patients were deemed ineligible for any systemic or local therapies,ten patients were referred to other hospitals, two patients had relapsed disease, and one was excluded because age less than 18 years. Finally 99 patients were included in the final analysis. Among these 99 patients,72 patients (72.7%) were < 60 years,70 (70.7%) patients had Eastern cooperative oncology group (ECOG) performance status (PS) less than equal to 2. DLBCL was the most common histology (86.4%) while rests were high grade B cell NHL NOS (11.4%),Burkitt's Lymphoma(1%),Peripheral T-cell Lymphoma NOS (1.2%). Only one of 99 patients was positive for HIV serology. Multiple intracranial lesions were found in 59.5%. Surgical resection was performed in 28.4% of patients. Out of 63 patients in whom the International extranodal lymphoma study group (IELSG) score is available, 34(54%) were IELSG high-risk groups. As per Memorial Sloan Kettering Cancer Center (MSKCC) risk grouping, patients were almost equally distributed in all the risk groups, with 32(32.3%) patients in risk group 1 (age < 50 years), 36(36.4%) patients in risk group 2 (age > 50 years, KPS > = 70), and 31(31.3%) patients in risk group 3 age > 50 years, KPS < 70). First-line treatment with high dose methotrexate (HD-MTX) based regimens was administered to 92 (92.9%) patients, and 72.8% of these patients received rituximab. Of these 92 patients, 59 (64.1%) patients could complete induction, and 52 patients received consolidation. Thirty-one patients received high dose cytarabine based chemo consolidation, one patient underwent high dose chemotherapy followed by autologous stem cell transplantation (ACST), and 19 patients received whole-brain radiotherapy (WBRT) and 1 patient received temozolomide as consolidation regimen. Thus only 52 patients completed the entire course of induction with consolidation therapy. The response to treatment was assessed using International PCNSL Collaborative Group Criteria. Post completion of consolidation, 49(94.2%) patients had a complete response. With a median follow-up duration of 39.2 months, the median progression-free survival (PFS) and the median overall survival (OS) of the patients taken into the analysis (N = 99) were 21 and 37 months respectively. On multivariate analysis, age < 60 yrs, > = 5 HD-MTX cycles received & the use of rituximab predicted better OS.Outcomes of patients with PCNSL treated with HD-MTX based therapy are comparable to reported literature however a large proportion of patients do not undergo required treatment despite the curable nature of disease. Supplementary Information The online version supplementary material available at 10.1007/s12288-022-01557-7.
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Affiliation(s)
- Shasanka Das
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Lakhan Kashyap
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Sekar Anbarasan
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Sharma Abhishek
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Suresh Bondili
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Lingraj Nayak
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Jayshree Thorat
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Sumeet Mirgh
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Anant Gokarn
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Sachin Punatar
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Sahay Ayushi
- Homi Bhabha National Institute, Mumbai, India
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Sridhar Epari
- Homi Bhabha National Institute, Mumbai, India
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Prashant Tembhare
- Homi Bhabha National Institute, Mumbai, India
- Department of Hemato-pathology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Prakash Shetty
- Homi Bhabha National Institute, Mumbai, India
- Department of Neurosurgery, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Nehal Khanna
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Jayant Goda
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Moiyadi Aliasgar
- Homi Bhabha National Institute, Mumbai, India
- Department of Neurosurgery, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Tejpal Gupta
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Navin Khattry
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Siddhartha Laskar
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Hari Menon
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Department of Hematology and Medical Oncology, St John's Medical College Hospital, Bengaluru, India
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12
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Punatar S, Murugaiyan V, Kumbhalwar K, Gokarn A, Chichra A, Mirgh S, Nayak L, Bonda A, Jindal N, Shirure V, Bagal B, Mathew L, Kannan S, Saikia T, Khattry N. Comparison of Outcomes of Donor Lymphocyte Infusions With or Without Lenalidomide in Patients with Hematological Malignancies Post Allogeneic HSCT. Indian J Hematol Blood Transfus 2023; 39:40-49. [PMID: 36699432 PMCID: PMC9868208 DOI: 10.1007/s12288-022-01545-x] [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: 12/25/2021] [Accepted: 04/26/2022] [Indexed: 01/28/2023] Open
Abstract
Outcomes with DLI alone for post-transplant relapsed hematological malignancies are poor especially in acute leukemias. Addition of immunomodulatory drugs to DLI may augment GVL effect. Use of lenalidomide with DLI to augment GVL has not been previously reported. This retrospective analysis was to compare the outcomes of DLI with or without lenalidomide. All consecutive patients who received DLI from 01/2010 through 01/2020 were included. DLIs were given without any immunosuppression. Lenalidomide, when used, was given continuously, starting with 1st or subsequent DLI. Patients who received lenalidomide were compared with those who did not. Event (hematological relapse or death) free survival (EFS) and overall survival (OS) were calculated from 1st DLI. Primary objective was to compare OS. Secondary objectives were EFS, CR rates, acute GVHD, lenalidomide toxicities and DLI related mortality (TRM). Total 61 patients received DLI-43 without and 18 with lenalidomide; all outcomes in the 2 groups were similar. There were 26 patients with HLA-A*24 and/or HLA-B*40. Among these, trend towards improvement in OS (median OS not reached vs. 8 months, 4 year OS was 62% vs. 32%, p = 0.1) and EFS (median 9 vs. 1 month, 4 year EFS 50% vs. 22%, p = 0.1) was seen with lenalidomide. Overall, there was no improvement in outcomes by adding lenalidomide to DLI. However, among patients with HLA*24 or B*40, there was a trend to improved survival with lenalidomide. Use of lenalidomide to augment the GVL effect of DLI warrants further exploration.
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Affiliation(s)
- Sachin Punatar
- Stem Cell Transplantation Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Room 211, Paymaster Shodhika, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Vinodhini Murugaiyan
- Stem Cell Transplantation Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Room 211, Paymaster Shodhika, Navi Mumbai, India
| | - Komal Kumbhalwar
- Stem Cell Transplantation Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Room 211, Paymaster Shodhika, Navi Mumbai, India
| | - Anant Gokarn
- Stem Cell Transplantation Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Room 211, Paymaster Shodhika, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Akanksha Chichra
- Stem Cell Transplantation Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Room 211, Paymaster Shodhika, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Sumeet Mirgh
- Stem Cell Transplantation Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Room 211, Paymaster Shodhika, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Lingaraj Nayak
- Stem Cell Transplantation Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Room 211, Paymaster Shodhika, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Avinash Bonda
- Stem Cell Transplantation Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Room 211, Paymaster Shodhika, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Nishant Jindal
- Stem Cell Transplantation Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Room 211, Paymaster Shodhika, Navi Mumbai, India
| | - Vijay Shirure
- Stem Cell Transplantation Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Room 211, Paymaster Shodhika, Navi Mumbai, India
| | - Bhausaheb Bagal
- Stem Cell Transplantation Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Room 211, Paymaster Shodhika, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Libin Mathew
- Stem Cell Transplantation Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Room 211, Paymaster Shodhika, Navi Mumbai, India
| | - Sadhana Kannan
- Department of Biostatistics, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, India
| | | | - Navin Khattry
- Stem Cell Transplantation Unit, Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Room 211, Paymaster Shodhika, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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13
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Dhumal S, Patil A, More A, Kamtalwar S, Joshi A, Gokarn A, Mirgh S, Thatikonda P, Bhat P, Murthy V, Chavan P, Oak A, Gore S, Bhattacharjee A, Patkar N, Kannan S, Shetty N, Rawat A, Achrekar M, Trivedi B, Laskar S, Chaturvedi P, Badwe R, Khattry N, Gupta S. SARS-COV-2 reinfection after previous infection and vaccine breakthrough infection through the second wave of pandemic in India: An observational study. Int J Infect Dis 2022; 118:95-103. [PMID: 35192951 PMCID: PMC8857778 DOI: 10.1016/j.ijid.2022.02.037] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background There are sparse longitudinal data on SARS-CoV-2 infection after previous infection and after partial or full vaccination. Methods This study of a cohort of healthcare workers used Kaplan-Meier analysis with appropriate definition of events and censoring and used Cox models to assess outcomes, with data cut-off on June 18, 2021. Results A total of 1806 individuals with median age of 32 (18-64) years, 1483 (82.1%) with at least one vaccine dose, 1085 (60.1%) with 2 vaccine doses, 408 (22.6%) with at least one episode of SARS-CoV-2 infection, and 6 (1.47%) with 2 episodes of infection were included in the analysis. At median follow-up of 38.4 weeks after first SARS-CoV-2 infection (n=408), the 52-week probability of reinfection was 2.2% (95% CI, 1.0-4.91%); and at median follow-up of 13.3 weeks after second dose, the 16-week probability of breakthrough infection was 5.6% (95% CI, 4.33-7.23%), which was significantly higher among those without previous SARS-CoV-2 infection versus with previous infection (6.4% vs 1.8%, p=0.016, adjusted Cox HR=3.49, 95% CI, 1.09-11.20, p=0.036) and females versus males (7.9% vs 3.8%, p=0.007, adjusted Cox HR=2.06, 95% CI 1.19-3.56, p=0.01). Conclusions There was low probability of reinfection after previous SARS-CoV-2 infection and higher vaccine breakthrough infections among females and those without previous infection.
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Affiliation(s)
- Sachin Dhumal
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Amar Patil
- Department of Medical Administration, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Ashwini More
- Department of Medicine, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Sujeet Kamtalwar
- Department of Medicine, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Anant Gokarn
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Sumeet Mirgh
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Puneeth Thatikonda
- Department of Medical Administration, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Prasanth Bhat
- Department of Medical Administration, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Preeti Chavan
- Department of Composite Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Amey Oak
- Centre for Cancer Epidemiology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Suvarna Gore
- Centre for Cancer Epidemiology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Atanu Bhattacharjee
- Centre for Cancer Epidemiology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Nikhil Patkar
- Department of Hematopathology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Sadhana Kannan
- Department of Biostatistics, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Nitin Shetty
- Department of Radiodiagnosis, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Anjali Rawat
- Department of Nursing, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Meera Achrekar
- Department of Nursing, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Bhakti Trivedi
- Department of Anaesthesiology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Pankaj Chaturvedi
- Centre for Cancer Epidemiology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India; Department of Surgical Oncology, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Rajendra Badwe
- Department of Surgical Oncology, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Navin Khattry
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India.
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14
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Shetty A, Chatterjee G, Rajpal S, Srivastava T, Gardi N, Mirgh S, Gokarn A, Punatar S, Shetty N, Joshi A, Nair S, Murthy V, Khattry N, Tembhare P, Dikshit R, Chaturvedi P, More A, Kamtalwar S, Chavan P, Bhat V, Patil A, Dhumal S, Bhat P, Subramanian P, Gujral S, Badwe R, Patkar N, Gupta S. Genomic Analysis of AZD1222 (ChAdOx1) Vaccine Breakthrough Infections in the City of Mumbai. Int J Clin Pract 2022; 2022:2449068. [PMID: 35685574 PMCID: PMC9159196 DOI: 10.1155/2022/2449068] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This manuscript describes the genetic features of SARS-CoV-2 mutations, prevalent phylogenetic lineages, and the disease severity amongst COVID-19-vaccinated individuals in a tertiary cancer hospital during the second wave of the pandemic in Mumbai, India. METHODS This observational study included 159 COVID-19 patients during the second wave of the pandemic from 17th March to 1st June 2021 at a tertiary cancer care centre in Mumbai. The cohort comprised of healthcare workers, staff relatives, cancer patients, and patient relatives. For comparison, 700 SARS-CoV-2 genomes sequenced during the first wave (23rd April to 25th September 2020) at the same centre were also analysed. Patients were assigned to nonvaccinated (no vaccination or <14 days from the 1st dose, n = 92), dose 1(≥14 days from the 1st dose to <14 days from the 2nd dose, n = 29), and dose 2 (≥14 days from the 2nd dose, n = 38) groups. Primary measure was the prevalence of SARS-CoV-2 genomic lineages among different groups. In addition, severity of COVID-19 was assessed according to clinical and genomic variables. RESULTS Kappa B.1.1671.1 and delta B.1.617.2 variants contributed to an overwhelming majority of sequenced genomes (unvaccinated: 40/92, 43.5% kappa, 46/92, 50% delta; dose 1: 14/29, 48.3% kappa, 15/29, 51.7% delta; and dose 2: 23/38, 60.5% kappa, 14/38 36.8% delta). The proportion of the kappa and delta variants did not differ significantly across the unvaccinated, dose 1, and dose 2 groups (p = 0.27). There was no occurrence of severe COVID-19 in the dose 2 group (0/38, 0% vs. 14/121, 11.6%; p = 0.02). SARS-CoV-2 genomes from all three severe COVID-19 patients in the vaccinated group belonged to the delta lineage (3/28, 10.7% vs. 0/39, 0.0%, p = 0.04). CONCLUSIONS Sequencing analysis of SARS-COV-2 genomes from Mumbai during the second wave of COVID-19 suggests the prevalence of the kappa B.1.617.1 and the delta B.1.627.2 variants among both vaccinated and unvaccinated individuals. Continued evaluation of genomic sequencing data from breakthrough COVID-19 is necessary for monitoring the properties of evolving variants of concern and formulating appropriate immune response boosting and therapeutic strategies.
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Affiliation(s)
- Arusha Shetty
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Gaurav Chatterjee
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sweta Rajpal
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Tuhina Srivastava
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Nilesh Gardi
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Sumeet Mirgh
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Anant Gokarn
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Sachin Punatar
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Nitin Shetty
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India
| | - Amit Joshi
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Sudhir Nair
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Vedang Murthy
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Navin Khattry
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Prashant Tembhare
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rajesh Dikshit
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Centre for Cancer Epidemiology, Tata Memorial Centre, Navi Mumbai, India
| | - Pankaj Chaturvedi
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Ashwini More
- Department of General Medicine, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Sujeet Kamtalwar
- Department of General Medicine, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Preeti Chavan
- Department of Laboratory Medicine, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Vivek Bhat
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Microbiology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Amar Patil
- Department of General Medicine, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Sachin Dhumal
- Department of General Medicine, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Prashant Bhat
- Department of General Medicine, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Papagudi Subramanian
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sumeet Gujral
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rajendra Badwe
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Nikhil Patkar
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sudeep Gupta
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
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15
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Punatar S, Gokarn A, Nayak L, Bonda A, Chichra A, Mirgh S, Bagal B, Tembhare P, Subramanian P, Khattry N. Long term outcome of a patient with relapsed refractory early thymic precursor acute lymphoblastic leukemia treated with daratumumab. Am J Blood Res 2021; 11:528-533. [PMID: 34824885 PMCID: PMC8610796] [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] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
The prognosis of patients with relapsed Early Thymic Precursor acute lymphoblastic leukemia (ETP-ALL) remains poor. Unlike B cell Precursor-ALL (BCP-ALL), there are no approved targeted therapies for ETP-ALL. Recent studies have identified a consistent expression of CD38 on the blasts of patients with T-ALL (both ETP-ALL and non ETP-ALL). Pre-clinical studies indicate that CD38 expression persists on the blasts of T-ALL even after receipt of conventional chemotherapy. These findings make CD38 an attractive targetable surface protein for patients with relapsed refractory T-ALL. We were the first to describe the clinical use of daratumumab in a patient of ETP-ALL, with relapsed disease post allogeneic transplant. We describe here the long term outcome of this patient more than 3 years after starting single agent daratumumab.
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Affiliation(s)
- Sachin Punatar
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, ACTRECKharghar, Navi Mumbai 410210, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai, India
| | - Anant Gokarn
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, ACTRECKharghar, Navi Mumbai 410210, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai, India
| | - Lingaraj Nayak
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, ACTRECKharghar, Navi Mumbai 410210, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai, India
| | - Avinash Bonda
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, ACTRECKharghar, Navi Mumbai 410210, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai, India
| | - Akanksha Chichra
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, ACTRECKharghar, Navi Mumbai 410210, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai, India
| | - Sumeet Mirgh
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, ACTRECKharghar, Navi Mumbai 410210, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai, India
| | - Bhausaheb Bagal
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, ACTRECKharghar, Navi Mumbai 410210, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai, India
| | - Prashant Tembhare
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai, India
- Department of Hematopathology, Tata Memorial Centre, ACTRECKharghar, Navi Mumbai 410210, India
| | - Papagudi Subramanian
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai, India
- Department of Hematopathology, Tata Memorial Centre, ACTRECKharghar, Navi Mumbai 410210, India
| | - Navin Khattry
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, ACTRECKharghar, Navi Mumbai 410210, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai, India
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Punatar S, Gokarn A, Nayak L, Bonda A, Mirgh S, Chichra A, Singh M, D’silva S, Khattry N. Human leukocyte antigen (HLA) alleles as predictive factors for benefit from lenalidomide in acute myeloid leukemia (AML). Am J Blood Res 2021; 11:564-570. [PMID: 34824888 PMCID: PMC8610794] [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] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Lenalidomide is an active agent in acute myeloid leukemia (AML); response rates are about 15-30%. There are no well-defined predictive factors for benefit from lenalidomide in AML. One of the mechanisms of lenalidomide is natural killer (NK) cell activation; hence human leukocyte antigen (HLA) class I alleles (serving as killer immunoglobulin-like receptor ligands) could play a predictive role. We here evaluate the same when lenalidomide was used as a bridge to transplant. METHODS Consecutive AML patients started on lenalidomide as bridge to transplant between Aug-2013 to Aug-2018 were included in this single centre retrospective analysis. The starting dose and schedule of lenalidomide were at the discretion of the treating clinician. Lenalidomide was scheduled to be stopped about 2-4 weeks prior to planned transplant admission (or was stopped earlier if there was intolerance). For this study, event was defined as progression/relapse while on lenalidomide or within 4 weeks of stopping the drug. The primary endpoint was event free survival (EFS). Those who underwent transplant without an event were censored on the day of transplant. Toxicities and post-transplant outcomes were secondary endpoints. RESULTS Twelve patients (8 males, median age 29 years) were included. At start of lenalidomide, 7 had complete remission (CR)-1 (measurable residual disease or MRD by flow cytometry was positive in 3, negative in 3, and 1 unknown), 4 CR-2 (all MRD negative) and 1 active disease. In the whole cohort, median EFS was not reached with projected 3 year EFS being 80%. There was a significantly reduced risk of event with HLA A*24 (0% vs 75%, P=0.018) or with HLA B*40 (0% vs 60%, P=0.045). Only 1 patient needed discontinuation due to toxicities (cytopenias). Among patients who underwent transplant, grade II-IV acute graft versus host disease (GVHD) was seen in 83%. CONCLUSIONS This is first study to show that HLA alleles may have a bearing on the effect of lenalidomide in AML and could serve as predictive biomarkers. These findings need to be confirmed in larger prospective studies.
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Affiliation(s)
- Sachin Punatar
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, HSCT Unit, ACTRECKharghar, Navi Mumbai 410210, Maharashtra, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai 410210, India
| | - Anant Gokarn
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, HSCT Unit, ACTRECKharghar, Navi Mumbai 410210, Maharashtra, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai 410210, India
| | - Lingaraj Nayak
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, HSCT Unit, ACTRECKharghar, Navi Mumbai 410210, Maharashtra, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai 410210, India
| | - Avinash Bonda
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, HSCT Unit, ACTRECKharghar, Navi Mumbai 410210, Maharashtra, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai 410210, India
| | - Sumeet Mirgh
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, HSCT Unit, ACTRECKharghar, Navi Mumbai 410210, Maharashtra, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai 410210, India
| | - Akanksha Chichra
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, HSCT Unit, ACTRECKharghar, Navi Mumbai 410210, Maharashtra, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai 410210, India
| | - Meenakshi Singh
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai 410210, India
- Transplant Immunology and Immunogenetics, ACTREC, Tata Memorial CentreMumbai 410210, India
| | - Selma D’silva
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai 410210, India
- Transplant Immunology and Immunogenetics, ACTREC, Tata Memorial CentreMumbai 410210, India
| | - Navin Khattry
- HSCT Unit, Department of Medical Oncology Tata Memorial Centre, HSCT Unit, ACTRECKharghar, Navi Mumbai 410210, Maharashtra, India
- Homi Bhabha National Institute (HBNI)Anushakti Nagar, Mumbai 410210, India
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17
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Tembhare PR, Sriram H, Chatterjee G, Khanka T, Gokarn A, Mirgh S, Rajendra A, Chaturvedi A, Ghogale SG, Deshpande N, Girase K, Dalvi K, Rajpal S, Patkar N, Trivedi B, Joshi A, Murthy V, Shetty N, Nair S, More A, Kamtalwar S, Chavan P, Bhat V, Bhat P, Subramanian PG, Gupta S, Khattry N. Comprehensive immune cell profiling depicts an early immune response associated with severe coronavirus disease 2019 in cancer patients. Immunol Cell Biol 2021; 100:61-73. [PMID: 34582592 PMCID: PMC8652640 DOI: 10.1111/imcb.12504] [Citation(s) in RCA: 6] [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: 06/04/2021] [Revised: 08/22/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022]
Abstract
Recent studies have highlighted multiple immune perturbations related to severe acute respiratory syndrome coronavirus 2 infection-associated respiratory disease [coronavirus disease 2019 (COVID-19)]. Some of them were associated with immunopathogenesis of severe COVID-19. However, reports on immunological indicators of severe COVID-19 in the early phase of infection in patients with comorbidities such as cancer are scarce. We prospectively studied about 200 immune response parameters, including a comprehensive immune-cell profile, inflammatory cytokines and other parameters, in 95 patients with COVID-19 (37 cancer patients without active disease and intensive chemo/immunotherapy, 58 patients without cancer) and 21 healthy donors. Of 95 patients, 41 had severe disease, and the remaining 54 were categorized as having a nonsevere disease. We evaluated the association of immune response parameters with severe COVID-19. By principal component analysis, three immune signatures defining characteristic immune responses in COVID-19 patients were found. Immune cell perturbations, in particular, decreased levels of circulating dendritic cells (DCs) along with reduced levels of CD4 T-cell subsets such as regulatory T cells (Tregs ), type 1 T helper (Th1) and Th9; additionally, relative expansion of effector natural killer (NK) cells were significantly associated with severe COVID-19. Compared with patients without cancer, the levels of terminal effector CD4 T cells, Tregs , Th9, effector NK cells, B cells, intermediate-type monocytes and myeloid DCs were significantly lower in cancer patients with mild and severe COVID-19. We concluded that severely depleted circulating myeloid DCs and helper T subsets in the initial phase of infection were strongly associated with severe COVID-19 independent of age, type of comorbidity and other parameters. Thus, our study describes the early immune response associated with severe COVID-19 in cancer patients without intensive chemo/immunotherapy.
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Affiliation(s)
- Prashant R Tembhare
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Harshini Sriram
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Gaurav Chatterjee
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Twinkle Khanka
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Anant Gokarn
- Department of Medical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Sumeet Mirgh
- Department of Medical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Akhil Rajendra
- Department of Medical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Anumeha Chaturvedi
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Sitaram G Ghogale
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Nilesh Deshpande
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Karishma Girase
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Kajal Dalvi
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Sweta Rajpal
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Nikhil Patkar
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Bhakti Trivedi
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Center, HBNI University, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Nitin Shetty
- Department of Radio-Diagnosis, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Ashwini More
- Department of Medicine, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Sujeet Kamtalwar
- Department of Medicine, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Preeti Chavan
- Composite Laboratory and Microbiology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Vivek Bhat
- Composite Laboratory and Microbiology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Prashant Bhat
- Medical Administration, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Papagudi G Subramanian
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Navin Khattry
- Department of Medical Oncology, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
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18
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Patkar N, Rajpal S, Shetty N, Gokarn A, Mirgh S, Munipally S, Nair S, Joshi A, Murthy V, Khattry N, Gupta S. Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is influenced by the type of transport medium: Implications for diagnosis and monitoring. Int J Clin Pract 2021; 75:e14311. [PMID: 33932309 PMCID: PMC8236963 DOI: 10.1111/ijcp.14311] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/28/2021] [Indexed: 01/08/2023] Open
Abstract
It is unclear if the use of a molecular transport medium (MTM) containing guanidine isothiocyanate (GITC) would be advantageous over the CDC recommended, commonly used viral transport medium (VTM). We retested 70 SARS-CoV2 cases by RT-PCR in varying stages of follow-up using MTM and VTM in parallel and found discrepant results of RNase P, E and N genes. Majority (81%) patients tested positive with MTM as compared with VTM (27.1%). Even patients who were sampled 3 weeks after diagnosis demonstrated a significant discrepancy in the positivity rates between MTM vs VTM raising concerns about the clinical utility of VTM.
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19
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Mirgh S, Sharma A, Folbs B, Khushoo V, Kapoor J, Tejwani N, Ahmed R, Agrawal N, Choudhary PS, Mehta P, Bhurani D. Daratumumab-based therapy after prior Azacytidine-Venetoclax in an octagenerian female with BPDCN (blastic plasmacytoid dendritic cell neoplasm) - a new perspective. Leuk Lymphoma 2021; 62:3039-3042. [PMID: 34151693 DOI: 10.1080/10428194.2021.1941938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Sumeet Mirgh
- Adult Hematolymphoid and BMT unit, Tata Memorial Centre, ACTREC (Advanced Centre for Treatment, Research, and Education in Cancer), Navi Mumbai, India (Present Affiliation); Homi Bhabha National Institute, Mumbai, India (Present Affiliation); Department of Hematology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Archana Sharma
- Department of Hematology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Bhaarat Folbs
- Department of Hematology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Vishvdeep Khushoo
- Department of Hematology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Jyotsna Kapoor
- Department of Hematology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Narender Tejwani
- Department of Hematology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rayaz Ahmed
- Department of Hematology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Narendra Agrawal
- Department of Hematology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Partha S Choudhary
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Pallavi Mehta
- Department of Hematology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Dinesh Bhurani
- Department of Hematology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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20
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Mirgh S, Sharma A, Shaikh MRMA, Kadian K, Agrawal N, Khushoo V, Mehta P, Ahmed R, Bhurani D. Hypomethylating agents+venetoclax induction therapy in acute myeloid leukemia unfit for intensive chemotherapy - novel avenues for lesser venetoclax duration and patients with baseline infections from a developing country. Am J Blood Res 2021; 11:290-302. [PMID: 34322294 PMCID: PMC8303019] [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] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
Both elderly acute myeloid leukemia (AML) patients and those with baseline infections, when treated with intensive chemotherapy, are associated with high induction mortality. We report 24 patients (16-newly-diagnosed, 8-relapsed/refractory) with AML deemed unfit for intensive chemotherapy (by virtue of age >60 years, ECOG-PS 3-4, or those with non-resolving infections at baseline), treated with azacytidine-venetoclax combination as induction chemotherapy. Median follow-up of the study group was 8 months. The overall complete remission (CR)+CR with incomplete count recovery (CRi) rate was 58.3%. 1-year progression-free survival and overall survival of the whole cohort was 44.4% and 55.8%, respectively. On subgroup analysis, newly-diagnosed AML (p=0.05), intermediate-risk cytogenetics (p=0.007), and HMA-naïve (p=0.05) patients had a significantly better outcome. AML patients with baseline infections (versus without infections) treated with azacytidine-venetoclax induction, have lesser induction mortality (compared with historic intensive chemotherapy) with equivalent response rates. A detailed analysis amongst cohorts with different venetoclax durations revealed that, shorter duration (<21 days) venetoclax (versus 21-28 days duration) in induction therapy leads to similar response rates and similar severity of myelosuppression, however, with early count recovery and lesser duration of intravenous antibiotics.
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Affiliation(s)
- Sumeet Mirgh
- Present address: Department of Medical Oncology, Tata Memorial Centre, ACTREC, Mumbai and Homi Bhabha National InstituteMumbai, India
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21
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Mirgh S, Gokarn A, Punatar S, Chichra A, Singh A, Rajendra A, Babu Goli V, Trivedi B, Joshi A, Patkar N, Tembhare P, Subramanian PG, Shetty N, Chavan P, Bhat V, Gupta S, Khattry N. Clinical course of severe COVID19 treated with tocilizumab and antivirals post-allogeneic stem cell transplant with extensive chronic GVHD. Transpl Infect Dis 2021; 23:e13576. [PMID: 33523551 PMCID: PMC7994986 DOI: 10.1111/tid.13576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 12/15/2022]
Abstract
Recipients of allogeneic hematopoietic stem cell transplantation (allo‐HSCT) are an immunocompromised group who are likely to develop severe complications and mortality because of coronavirus disease 2019 (COVID‐19). We report here a 61‐year‐old male patient of primary myelofibrosis who underwent an allo‐HSCT 6 years earlier, had chronic graft‐versus‐host disease (cGVHD) involving the liver, lung, eyes, and skin, (with recurrent episodes of pulmonary infections) who developed severe COVID‐19. The patient was treated with tocilizumab, and a combination of lopinavir/ritonavir, ribavirin, interferon‐β1b. He was discharged after 31 days with full recovery. Tocilizumab, a humanized monoclonal antibody against IL6, has been shown to benefit respiratory manifestations in severe COVID19. However, this is first report, to our knowledge, of its use and benefit in a post HSCT recipient.
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Affiliation(s)
- Sumeet Mirgh
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anant Gokarn
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sachin Punatar
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Akanksha Chichra
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuj Singh
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Akhil Rajendra
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vasu Babu Goli
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bhakti Trivedi
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Anaesthesiology, Pain and Critical Care Medicine, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nikhil Patkar
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Hemato-Pathology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Prashant Tembhare
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Hemato-Pathology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - P G Subramanian
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Hemato-Pathology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Nitin Shetty
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Radiodiagnosis, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Preeti Chavan
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Laboratory Medicine, ACTREC - Tata Memorial Centre, ACTREC, Navi Mumbai, Maharashtra, India.,Department of Microbiology, ACTREC - Tata Memorial Centre, ACTREC, Navi Mumbai, Maharashtra, India
| | - Vivek Bhat
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Microbiology, ACTREC - Tata Memorial Centre, ACTREC, Navi Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Navin Khattry
- Department of Medical Oncology, ACTREC - Tata Memorial Centre, Navi Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
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22
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Borah P, Mirgh S, Sharma SK, Bansal S, Dixit A, Dolai TK, Lunkad S, Gupta N, Singh G, Jain A, Bansal D, Choudhary D, Khandelwal V, Doval D, Kumar M, Bhargava R, Chakrabarti A, Kalashetty M, Rauthan A, Kazi B, Mandal PK, Jeyaraman P, Naithani R. Effect of age, comorbidity and remission status on outcome of COVID-19 in patients with hematological malignancies. Blood Cells Mol Dis 2020; 87:102525. [PMID: 33338697 PMCID: PMC7723067 DOI: 10.1016/j.bcmd.2020.102525] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is scarcity of data on outcome of COVID-19 in patients with hematological malignancies. Primary objective of study was to analyse the 14-day and 28-day mortality. Secondary objectives were to correlate age, comorbidities and remission status with outcome. METHODS Retrospective multicentre observational study conducted in 11 centres across India. Total 130 patients with hematological malignancies and COVID-19 were enrolled. RESULTS Fever and cough were commonest presentation. Eleven percent patients were incidentally detected. Median age of our cohort was 49.5 years. Most of our patients had a lymphoid malignancy (n = 91). One-half patients (52%) had mild infection, while moderate and severe infections contributed to one-fourth each. Sixty seven patients (52%) needed oxygen For treatment of COVID-19 infection, half(n = 66) received antivirals. Median time to RT-PCR COVID-19 negativity was 17 days (7-49 days). Nearly three-fourth (n = 95) of our patients were on anticancer treatment at time of infection, of which nearly two-third (n = 59;64%) had a delay in chemotherapy. Overall, 20% (n = 26) patients succumbed. 14-day survival and 28-day survival for whole cohort was 85.4% and 80%, respectively. One patient succumbed outside the study period on day 39. Importantly, death rate at 1 month was 50% and 60% in relapse/refractory and severe disease cohorts, respectively. Elderly patients(age ≥ 60) (p = 0.009), and severe COVID-19 infection (p = 0.000) had a poor 14-day survival. The 28-day survival was significantly better for patients in remission (p = 0.04), non-severe infection (p = 0.00), and age < 60 years (p = 0.05). CONCLUSIONS Elderly patients with hematological malignancy and severe covid-19 have worst outcomes specially when disease is not in remission.
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Affiliation(s)
| | | | | | | | | | | | | | - Naveen Gupta
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Gurmeet Singh
- Jawahar Lal Nehru Hospital & Research Centre, Bhilai, India
| | | | | | | | | | - Divya Doval
- BLK Superspeciality Hospital, New Delhi, India
| | - Meet Kumar
- Fortis Memorial Hospital, Gurugram, India
| | | | | | | | | | - Bilal Kazi
- NRS Medical College and Hospital, Kolkata, India
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23
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Kapoor J, Mirgh S, Agrawal N, Khushoo V, Garg A, Bhurani D, Ahmed R. Treading a Difficult Path: Granulocyte Colony Stimulating Factor Induced Mobilization of Stem Cells in Pregnancy. Indian J Hematol Blood Transfus 2020; 36:406-407. [PMID: 32425400 DOI: 10.1007/s12288-019-01198-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/25/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- Jyotsna Kapoor
- Department of Hemato-Oncology and Bone Marrow Transplantation Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, Delhi 110085 India
| | - Sumeet Mirgh
- Department of Hemato-Oncology and Bone Marrow Transplantation Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, Delhi 110085 India
| | - Narendra Agrawal
- Department of Hemato-Oncology and Bone Marrow Transplantation Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, Delhi 110085 India
| | - Vishvdeep Khushoo
- Department of Hemato-Oncology and Bone Marrow Transplantation Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, Delhi 110085 India
| | - Ambar Garg
- Department of Hemato-Oncology and Bone Marrow Transplantation Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, Delhi 110085 India
| | - Dinesh Bhurani
- Department of Hemato-Oncology and Bone Marrow Transplantation Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, Delhi 110085 India
| | - Rayaz Ahmed
- Department of Hemato-Oncology and Bone Marrow Transplantation Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, Delhi 110085 India
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Bothra SJ, Bhandari P, Agrawal N, Tejwani N, Ahmed R, Khushoo V, Mirgh S, Bhurani D. Extranodal NK-T Cell Lymphoma, Nasal Type: Retrospective Analysis of Real-World Data. Indian J Hematol Blood Transfus 2019; 36:260-266. [PMID: 32425375 DOI: 10.1007/s12288-019-01195-6] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
Peripheral T cell lymphomas constitute nearly 15% of all cases on non-Hodgkin lymphoma. Of these, NK-T cell lymphoma nasal type is a rare and aggressive form. We present our experience of 16 patients of NK/T cell lymphoma which constituted approximately 1% of all lymphoma (N = 1590) cases treated at our center. Male to female ratio was 4.3:1. Median age of presentation was 42 years. Early Stage patients (n = 11) were treated with DeVIC regimen (n = 10) and SMILE (n = 1) chemotherapy and RT to all the patients. Advanced stage patients were treated with SMILE regimen (n = 4) and ICE and local RT (n = 1) with one treatment related mortality. The presence of B-symptoms adversely affected survival. The estimated median PFS and OS were 39 and 49 months respectively. Overall survival was not reached in Limited Stage patients (stage 1 and 2) and 8 months in patients with advanced stage (stage IV) (p = 0.001). According to the new CSWOG staging (retrospectively applied), comparing the Limited versus Extensive Stage, the earlier group has a significantly better estimated PFS (p = 0.020) and OS (p = 0.007). ENKTL is a rare malignancy with aggressive course. B-symptoms portend a poor prognosis to patients with this aggressive lymphoma. The new staging system helps estimate survival better.
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Affiliation(s)
- Sneha J Bothra
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Pragya Bhandari
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Narendra Agrawal
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Narender Tejwani
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Rayaz Ahmed
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Vishvdeep Khushoo
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Sumeet Mirgh
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Dinesh Bhurani
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
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Mirgh S, Ahmed R, Agrawal N, Khushoo V, Garg A, Francis S, Tejwani N, Singh N, Bhurani D. Will Daratumumab be the next game changer in early thymic precursor‐acute lymphoblastic leukaemia? Br J Haematol 2019; 187:e33-e35. [DOI: 10.1111/bjh.16154] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sumeet Mirgh
- Department of Haematology and BMT Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Rayaz Ahmed
- Department of Haematology and BMT Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Narendra Agrawal
- Department of Haematology and BMT Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Vishvdeep Khushoo
- Department of Haematology and BMT Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Ambar Garg
- Department of Haematology and BMT Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Shinto Francis
- Department of Haematology and BMT Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Narender Tejwani
- Department of Haematology and BMT Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Neha Singh
- Department of Haematology and BMT Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Dinesh Bhurani
- Department of Haematology and BMT Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
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Aggarwal M, Mirgh S. Hepatic and Cardiac Iron Overload - Revising the Role of Deferiprone. Indian Pediatr 2018; 55:557-558. [PMID: 30129534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Mukul Aggarwal
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sumeet Mirgh
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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Mirgh S, Chauhan R, Tyagi S, Mishra P, Seth T, Mahapatra M, Pati H, Saxena R. Expect the unexpected – Loss of surface CD3 on flow cytometry in hepatosplenic T-cell lymphoma: An eye opener. INDIAN J PATHOL MICR 2018; 61:275-277. [DOI: 10.4103/ijpm.ijpm_442_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Harbada RK, Sorabjee JS, Surya N, Jadhav KA, Mirgh S. Cerebellar Toxoplasmosis in an Immunocompetent Patient with G6PD Deficiency. J Assoc Physicians India 2016; 64:79-82. [PMID: 27762116] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We report a case of an immunocompetent patient who presented with a short history of unilateral cerebellar lesion later proven as toxoplasmosis on histopathology. The case highlights that patients with G6PD deficiency are more prone to develop fatal toxoplasma infections than those individuals with normal G6PD activity.
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Affiliation(s)
| | | | - Nirmal Surya
- Neurologist, Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra
| | - Kishor A Jadhav
- Neurologist, Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra
| | - Sumeet Mirgh
- Senior Resident, Department of Clinical Hematology, All India Institute of Medical Sciences, New Delhi
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Mishra V, Sorabjee J, Mirgh S, Mishra M. Tophaceous gout in thalassemia intermedia: a rare association. Oxf Med Case Reports 2016; 2016:105-6. [PMID: 27168938 PMCID: PMC4860522 DOI: 10.1093/omcr/omw030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/22/2016] [Accepted: 03/25/2016] [Indexed: 11/21/2022] Open
Affiliation(s)
- Vikas Mishra
- Department of Medicine , Bombay Hospital Institute of Medical Sciences , Mumbai , India
| | - Jehangir Sorabjee
- Department of Medicine , Bombay Hospital Institute of Medical Sciences , Mumbai , India
| | - Sumeet Mirgh
- Bombay Hospital Institute of Medical Sciences , Mumbai , India
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