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Srinivasan S, Dhamne C, Moulik NR, Chichra A, Tembhare P, Patkar N, Subramanian PG, Shetty D, Narula G, Banavali S. Treatment of Pediatric Acute Promyelocytic Leukemia with Retinoic Acid and Arsenic Trioxide along with Chemotherapy. Indian J Pediatr 2024; 91:564-570. [PMID: 37380920 DOI: 10.1007/s12098-023-04689-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/16/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES Outcomes of childhood acute promyelocytic leukemia (APL) have exceeded 90% in the era of differentiating agents. In resource-limited settings, early mortality secondary to coagulopathy remains a significant challenge. Differentiation syndrome is a unique complication of APL therapy that requires a high degree of suspicion for timely initiation of therapy. METHODS A retrospective study of children ≤15 y of age with APL diagnosed between January-2013 and June-2019 treated at a tertiary cancer centre was conducted. Patients with a total leukocyte count ≥10,000/µL were risk stratified as high-risk. Treatment included differentiating agents, all-trans retinoic acid and arsenic trioxide along with chemotherapy. Baseline demographics, clinical complications and outcomes were analysed. RESULTS Out of 90 patients treated, 48 (53%) had high-risk APL and 25 (28%) presented with significant bleeding manifestations. Response to therapy was excellent with 96% of evaluable patients achieving molecular remission by the end of consolidation phase. Differentiation syndrome occurred in 23 (25%) patients of which two expired. Early mortality rate was 5.5% and was due to severe hemorrhage most often at the time of presentation. The 3-y overall survival of the entire cohort was 91% (95% CI: 85-97%). Two of 4 patients with relapse of disease could be salvaged with only differentiating agents followed by autologous transplantation. CONCLUSIONS Long-term outcomes of Indian children with APL are excellent. Timely management of coagulopathy and prompt initiation of differentiating agents along with appropriate cytoreductive measures is critical. Efforts to build academic-community partnerships to ensure timely diagnosis and emergency care in order to reduce early mortality are needed.
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Affiliation(s)
- Shyam Srinivasan
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Chetan Dhamne
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India.
| | - Nirmalya Roy Moulik
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Akanksha Chichra
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Prashant Tembhare
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
| | - Nikhil Patkar
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
| | - P G Subramanian
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
| | - Dhanlaxmi Shetty
- Department of Cancer Cytogenetics, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
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Kumar A, Sonkusare L, Noronha V, Deodhar J, Rao AR, Kumar S, Castellino R, Gattani S, Dhekale R, Krishnamurthy J, Mahajan S, Daptadar A, Ansari N, Vagal M, Gota V, Mahajan P, Nookala M, Chitre A, Banavali S, Prabhash K, Badwe R, Ramaswamy A. An analysis of psychological problems in older Indian patients with cancer. J Geriatr Oncol 2024; 15:101744. [PMID: 38538494 DOI: 10.1016/j.jgo.2024.101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/18/2024] [Accepted: 03/06/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Anita Kumar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai 400 012, India
| | - Lekhika Sonkusare
- Department of Psychiatry & Psycho Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai 400 012, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai 400 012, India
| | - Jayita Deodhar
- Department of Psychiatry & Psycho Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai 400 012, India
| | | | - Sharath Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, India
| | - Renita Castellino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, India
| | - Shreya Gattani
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai 400 012, India
| | - Ratan Dhekale
- Professor Emeritus, Ex-Director, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 4000012, India
| | - Jyoti Krishnamurthy
- Professor Emeritus, Ex-Director, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 4000012, India
| | - Sarika Mahajan
- Department of PhysioTherapy Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai 400 012, India
| | - Anuradha Daptadar
- Department of PhysioTherapy Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai 400 012, India
| | - Nabila Ansari
- Department of Occupational therapy Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai - 400 012, India
| | - Manusha Vagal
- Department of Occupational therapy Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai - 400 012, India
| | - Vikram Gota
- Department of Clinical Pharmacology Advanced Centre for treatment Research and Education in Cancer TATA Memorial Centre, Mumbai, India
| | - Purabi Mahajan
- Department of Digestive diseases and Clinical nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjunath Nookala
- Department of Clinical Pharmacology Advanced Centre for treatment Research and Education in Cancer TATA Memorial Centre, Mumbai, India
| | - Ankita Chitre
- Department of Physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai 400 012, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai 400 012, India
| | - Rajendra Badwe
- Professor Emeritus, Ex-Director, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 4000012, India.
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai 400 012, India.
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Roy Moulik N, Keerthivasagam S, Pandey A, Agiwale J, Hegde K, Chatterjee G, Dhamne C, Prasad M, Chichra A, Srinivasan S, Mohanty P, Jain H, Shetty D, Tembhare P, Patkar N, Narula G, Subramanian PG, Banavali S. Treatment and follow-up of children with chronic myeloid leukaemia in chronic phase (CML-CP) in the tyrosine kinase inhibitor (TKI) era-Two decades of experience from the Tata Memorial Hospital paediatric CML (pCML) cohort. Br J Haematol 2024; 204:1249-1261. [PMID: 38098201 DOI: 10.1111/bjh.19251] [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: 09/21/2023] [Revised: 11/04/2023] [Accepted: 11/28/2023] [Indexed: 04/11/2024]
Abstract
Tyrosine kinase inhibitors (TKIs) have drastically improved the outcomes of pCML (paediatric CML) but data on long-term off-target toxicities of TKIs in children are scarce. In this single-centre, retrospective cum prospective study of pCML in chronic phase, we report our experience of treating 173 children with imatinib and following them for long-term toxicities. Mean (SD) time to attain CHR, CCyR and MMR were 3.05 (2.1), 10.6 (8.4) and 43.4 (31.8) months respectively. DMR was not attained in 59 (34%) patients at last follow-up. Ten patients were switched to second-generation TKIs (2G-TKIs; nilotinib = 1/dasatinib = 9) due to poor/loss in response, of which seven had kinase domain mutations. Three patients progressed to the blastic phase. At a median follow-up of 84 (3-261) months, the 5-year EFS and OS for the entire cohort were 96.9% (95% CI: 93.4-100) and 98.7% (95% CI: 96.9-100) respectively. Screening for long-term toxicities revealed low bone density and hypovitaminosis D in 70% and 80% respectively. Other late effects included short stature (27%), delayed puberty (15%), poor sperm quality (43%) and miscellaneous endocrinopathies (8%). Children younger than 5 years at diagnosis were more susceptible to growth and endocrine toxicities (p = 0.009). Regular monitoring for long-term toxicities, timely intervention and trial of discontinuation whenever feasible are likely to improve the long-term outlook of pCML.
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Affiliation(s)
- Nirmalya Roy Moulik
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | | | - Ankita Pandey
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Jayesh Agiwale
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Kriti Hegde
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Chatterjee
- Homi Bhabha National Institute, Mumbai, India
- Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Chetan Dhamne
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Maya Prasad
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Akanksha Chichra
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Shyam Srinivasan
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Purvi Mohanty
- Homi Bhabha National Institute, Mumbai, India
- Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, India
| | - Hemani Jain
- Homi Bhabha National Institute, Mumbai, India
- Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, India
| | - Dhanlaxmi Shetty
- Homi Bhabha National Institute, Mumbai, India
- Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, India
| | - Prashant Tembhare
- Homi Bhabha National Institute, Mumbai, India
- Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Nikhil Patkar
- Homi Bhabha National Institute, Mumbai, India
- Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Gaurav Narula
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Papagudi G Subramanian
- Homi Bhabha National Institute, Mumbai, India
- Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Shripad Banavali
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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Rao AR, Noronha V, Ramaswamy A, Kumar A, Pillai A, Gattani S, Sehgal A, Kumar S, Castelino R, Pearce J, Dhekale R, Jagtap P, Tripathi V, Satamkar S, Krishnamurthy J, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nookala M, Chitre A, Kapoor A, Gota V, Banavali S, Badwe RA, Prabhash K. Assessing frailty in older Indian patients before cancer treatment: Comparative analysis of three scales and their implications for overall survival. J Geriatr Oncol 2024; 15:101736. [PMID: 38428186 DOI: 10.1016/j.jgo.2024.101736] [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: 12/07/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Frailty, characterized by ageing-related vulnerability, influences outcomes in older adults. Our study aimed to investigate the relationship between frailty and clinical outcomes in older Indian patients with cancer. MATERIALS AND METHODS Our observational single-centre study, conducted at Tata Memorial Hospital from February 2020 to July 2022, enrolled participants aged 60 years and above with cancer. Frailty was assessed using the Clinical Frailty Scale (CFS), G8, and Vulnerable Elders Survey (VES)-13. The primary objective was to explore the correlation between baseline frailty and overall survival. Statistical analyses include Kaplan-Meier, Cox proportional hazards, and Harrell's C test. RESULTS A total of 1,177 patients (median age 68, 76.9% male) were evaluated in the geriatric oncology clinic. Common malignancies included lung (40.0%), gastrointestinal (35.8%), urological (11.9%), and head and neck (9.0%), with 56.5% having metastatic disease. Using CFS, G8, and VES-13 scales, 28.5%, 86.4%, and 38.0% were identified as frail, respectively. Median follow-up was 11.6 months, with 43.3% deaths. Patients fit on CFS (CFS 1-2) had a median survival of 28.02 months, pre-frail (CFS 3-4) 13.24 months, and frail (CFS ≥5) 7.79 months (p < 0.001). Abnormal G8 (≤14) and VES-13 (≥3) were associated with significantly lower median survival (p < 0.001). Multivariate analysis confirmed CFS's predictive power for mortality (p < 0.001), with hazard ratios [HRs] for pre-frail at 1.61(95% confidence interval [CI] 1.25 to 2.06) and frail at 2.31 (95%CI 1.74 to 3.05). G8 ≤ 14 had HR 2.00 (95%CI 1.42 to 2.83), and abnormal VES-13 had HR 1.36 (95%CI 1.11-1.67). In the likelihood ratio test, CFS significantly improved the model fit (p < 0.001). Harrell's C index for survival prediction was 0.62 for CFS, 0.54 for G8, and 0.58 for VES-13. DISCUSSION In conclusion, our study highlights varying frailty prevalence and prognostic implications in older Indian patients with cancer, emphasizing the need for personalized care in oncology for this aging population. We would recommend using CFS as a tool to screen for frailty for older Indian patients with cancer.
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Affiliation(s)
- Abhijith R Rao
- Department of Geriatric Medicine, All India Institute of Medical Science, New Delhi, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anita Kumar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anupa Pillai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shreya Gattani
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Arshiya Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Sharath Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Renita Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Jessica Pearce
- NIHR Acaemic Clinical Fellow in Medical Oncology, Leeds Institute of Medical Research at St James', University of Leeds, United Kingdom
| | - Ratan Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Pravin Jagtap
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vinod Tripathi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sunita Satamkar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jyoti Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sarika Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anuradha Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Lekhika Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jayita Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nabila Ansari
- Department of Occupational therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjusha Vagal
- Department of Occupational therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Purabi Mahajan
- Department of Digestive diseases and Clinical nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shivshankar Timmanpyati
- Department of Digestive diseases and Clinical nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjunath Nookala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Ankita Chitre
- Department of physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Akhil Kapoor
- Department of Medical oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rajendra A Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
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Arun B, Joshi M, Kakkar AK, Madki S, Ivaturi V, Chinnaswamy G, Banavali S, Gota V. Bioequivalence study followed by model-informed dose optimization of a powder for oral suspension of 6-mercaptopurine. Pediatr Blood Cancer 2024; 71:e30813. [PMID: 38110844 DOI: 10.1002/pbc.30813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/15/2023] [Accepted: 11/23/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND 6-Mercaptopurine (6MP) is the mainstay chemotherapy for acute lymphoblastic leukemia (ALL) and is conventionally available as 50 mg tablets. A new 6MP powder for oral suspension (PFOS 10 mg/mL) was developed recently by IDRS Labs, India, intended for pediatric use. A comparative pharmacokinetics of PFOS with T. mercaptopurine was conducted to determine the dose equivalence. METHODS An open-label, randomized, two-treatment, two-period, two-sequence, single oral dose, crossover, bioequivalence study was conducted on 51 healthy adult subjects. Post hoc, a population pharmacokinetic (PopPK) model was developed using the healthy volunteer data to perform simulations with various PFOS doses and select a bioequivalent dose. Further, to confirm the safety of PFOS in pediatrics, a simulation of 6MP and 6-thioguanine exposures was performed by incorporating the formulation-specific parameters derived from the healthy volunteer study into the PopPK model in childhood ALL available in literature. RESULTS The 6MP PFOS had 47% higher oral bioavailability compared to the reference product. Simulations using a two-compartmental PopPK model with dissolution and transit compartments showed that 40 mg of PFOS was found to be equivalent to 50 mg tablets. The simulated 6-thioguanine nucleotide concentrations in children using the dose adjusted for PFOS were between 114 and 703.6 pmol/8 × 108 RBC, which was within the range reported in pediatric ALL studies. CONCLUSION 6MP PFOS 10 mg/mL should be administered at a 20% lower dose than the tablet to achieve comparable exposure. 6MP PFOS addresses an unmet medical need for a liquid formulation of 6MP in the Indian subcontinent.
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Affiliation(s)
- Bhavatharini Arun
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | | | | | | | | | - Girish Chinnaswamy
- Department of Paediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Anushakthinagar, Mumbai, Maharashtra, India
| | - Shripad Banavali
- Department of Paediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Anushakthinagar, Mumbai, Maharashtra, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Anushakthinagar, Mumbai, Maharashtra, India
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Noronha V, Kapu V, Joshi A, Menon N, Singh A, Prakash G, Menon S, Sable N, Murthy V, Pal M, Arora A, Kumar S, Banavali S, Prabhash K. Clinical Profile and Outcomes of Carcinoma Penis Patients Receiving Systemic Therapy at an Indian tertiary care Center: A Retrospective Observational Study. Clin Genitourin Cancer 2024; 22:102053. [PMID: 38442451 DOI: 10.1016/j.clgc.2024.02.004] [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: 12/28/2023] [Accepted: 02/03/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Penile cancer is a rare malignancy with scant data on the impact of systemic therapy on outcomes. METHODS Retrospective observational study of patients with a histological diagnosis of carcinoma penis treated with systemic therapy at the Tata Memorial Centre (Mumbai, India) between August 2010 and February 2018. Primary objective was overall survival (OS); secondary objectives included assessment of clinical characteristics, treatment approaches, and toxicity profiles. RESULTS We included 91 patients with penile carcinoma who received systemic therapy at our center. Intent of therapy was curative in 71 patients (78%), and palliative in 20 (22%). Median age was 57 years (interquartile range [IQR], 50-65.5) for curatively treated patients and 58.5 years (IQR, 44-65.2) for those with advanced disease. Common presenting symptoms were lumps (70%), and pain (57%). Neoadjuvant chemotherapy (NACT) with paclitaxel + platinum was administered to 19 patients (20.9%), of which 7 (37%) attained complete or partial response. Six patients (31.5%) underwent R0 surgery post-NACT. All 71 patients underwent primary surgery; 47 (66.2%) undergoing partial penectomy. Of the 20 patients treated with palliative first-line chemotherapy, 4(20%) attained a partial response. Median OS of patients treated in curative and palliative settings was 33.8 months (95% CI, 17.2-not recorded) and 11.4 months (95% CI, 9.53-23.3), respectively. CONCLUSIONS Patients with penile cancer treated with systemic therapy have poor outcomes. Little over a third of the patients respond to neoadjuvant chemotherapy and those with advanced disease have poor survival despite systemic therapy, emphasizing the need for early detection and optimum management of primary and nodal disease.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Venkatesh Kapu
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Ajaykumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Gagan Prakash
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Nilesh Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Mahendra Pal
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Amandeep Arora
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Sravan Kumar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India.
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7
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Srinivasan S, Dhamne C, Patkar N, Chatterjee G, Moulik NR, Chichra A, Pallath A, Tembhare P, Shetty D, Subramanian PG, Narula G, Banavali S. KIT exon 17 mutations are predictive of inferior outcome in pediatric acute myeloid leukemia with RUNX1::RUNX1T1. Pediatr Blood Cancer 2024; 71:e30791. [PMID: 38014874 DOI: 10.1002/pbc.30791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/24/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Pediatric core binding factor acute myeloid leukemia (CBF-AML), although considered a favorable risk subtype, exhibits variable outcomes primarily driven by additional genetic abnormalities, such as KIT mutations. PROCEDURE In this study, we examined the prognostic impact of KIT mutations in 130 pediatric patients with CBF-AML, treated uniformly at a single center over 4 years (2017-2021). KIT mutations were detected via next-generation sequencing using a myeloid panel comprising 52 genes for most patients. RESULTS Our findings revealed that KIT mutations were present in 31% of CBF-AML cases. Exon 17 KIT mutation was most commonly (72%) seen with notable occurrences at the D816 and N822 residue in 48% and 39% of cases, respectively. The 3-year cumulative incidence of relapse (CIR) and overall survival (OS) for patients with exon 17 KIT mutation were 36% and 40%, respectively, and was significantly worse in comparison to other site KIT mutations (3-year CIR: 11%; OS: 64%) and without KIT mutation (3-year CIR: 13%; OS:71%). Notably, the prognostic impact of KIT mutations was prominent in patients with RUNX1::RUNX1T1, but not in those with CBFB::MYH11 fusion. Additionally, a high KIT variant-allele frequency (VAF) (>33%) predicted for a higher disease relapse; 3-year CIR of 40% for VAF greater than 33% versus 7% for VAF less than 33%. When adjusted for site of KIT mutation and end-of-induction measurable residual disease, VAF greater than 33% correlated with poor OS (hazard ratio [HR]: 4.4 [95% CI: 1.2-17.2], p = .034). CONCLUSION Exon 17 KIT mutations serve as an important predictor of relapse in RUNX1::RUNX1T1 pediatric AML. In addition, a high KIT VAF may predict poor outcomes in these patients. These results emphasize the need to incorporate KIT mutational analysis into risk stratification for pediatric CBF-AML.
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Affiliation(s)
- Shyam Srinivasan
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Chetan Dhamne
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nikhil Patkar
- Department of Hematopathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gaurav Chatterjee
- Department of Hematopathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nirmalya Roy Moulik
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Akanksha Chichra
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Aneeta Pallath
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prashant Tembhare
- Department of Hematopathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dhanalaxmi Shetty
- Department of Cancer Cytogenetics, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - P G Subramanian
- Department of Hematopathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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8
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Bajpai J, Kapu V, Rath S, Kumar S, Sekar A, Patil P, Siddiqui A, Anne S, Pawar A, Srinivas S, Bhargava P, Gulia S, Noronha V, Joshi A, Prabhash K, Banavali S, Sarin R, Badwe R, Gupta S. Low-dose versus standard-dose olanzapine with triple antiemetic therapy for prevention of highly emetogenic chemotherapy-induced nausea and vomiting in patients with solid tumours: a single-centre, open-label, non-inferiority, randomised, controlled, phase 3 trial. Lancet Oncol 2024; 25:246-254. [PMID: 38224701 DOI: 10.1016/s1470-2045(23)00628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Olanzapine is an effective antiemetic agent but it results in substantial daytime somnolence when administered at the standard dose. Our aim was to compare the efficacy of low-dose versus standard-dose olanzapine after highly emetogenic chemotherapy in patients with solid tumours. METHODS This was a single-centre, open-label, non-inferiority, randomised, controlled, phase 3 trial done in a tertiary care referral centre in India (Tata Memorial Centre, Homi Bhabha National Institute, Mumbai). Patients aged 13-75 years with an Eastern Cooperative Oncology Group performance status of 0-2, who were receiving doxorubicin-cyclophosphamide or high-dose cisplatin for a solid tumour were eligible. Patients were randomly assigned (1:1), with block randomisation (block sizes of 2 or 4) and stratified by sex, age (≥55 or <55 years), and chemotherapy regimen, to receive low-dose (2·5 mg) oral olanzapine or standard-dose (10·0 mg) oral olanzapine daily for 4 days, in combination with a triple antiemetic regimen. Study staff were masked to treatment allocation but patients were aware of their group assignment. The primary endpoint was complete control, defined as no emetic episodes, no rescue medications, and no or mild nausea in the overall phase (0-120 hours), assessed in the modified intention-to-treat (mITT) population (ie, all eligible patients who received protocol-specified treatment, excluding those who had eligibility violations and who withdrew consent after randomisation). Daytime somnolence was the safety endpoint of interest. Non-inferiority was shown if the upper limit of the one-sided 95% CI for the difference in the complete control proportions between the treatment groups excluded the non-inferiority margin of 10%. This study is registered with the Clinical Trial Registry India, CTRI/2021/01/030233, is closed to accrual, and this is the final data analysis. RESULTS Between Feb 9, 2021, and May 30, 2023, 356 patients were pre-screened for eligibility, of whom 275 patients were enrolled and randomly assigned (134 to the 2·5 mg olanzapine group and 141 to the 10·0 mg olanzapine group). 267 patients (132 in the 2·5 mg group and 135 in the 10·0 mg group) were included in the mITT population, of whom 252 (94%) were female, 15 (6%) were male, and 242 (91%) had breast cancer. 59 (45%) of 132 patients in the 2·5 mg olanzapine group had complete control in the overall phase versus 59 (44%) of 135 in the 10·0 mg olanzapine group (difference -1·0% [one-sided 95% CI -100·0 to 9·0]; p=0·87). In the overall phase, there were significantly fewer patients in the 2·5 mg olanzapine group than in the 10·0 mg olanzapine group with daytime somnolence of any grade (86 [65%] of 132 vs 121 [90%] of 135; p<0·0001) and of severe grade on day 1 (six]5%] vs 54 [40%]; p<0·0001). INTERPRETATION Our findings suggest that olanzapine 2·5 mg is non-inferior to 10·0 mg in antiemetic efficacy and results in reduced occurrence of daytime somnolence among patients receiving highly emetic chemotherapy and should be considered as a new standard of care. FUNDING Progressive Ladies Welfare Association.
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Affiliation(s)
- Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - Venkatesh Kapu
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sushmita Rath
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sravan Kumar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anbarasan Sekar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Priyanka Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Altaf Siddiqui
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Srikanth Anne
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Akash Pawar
- Department of Biostatistics, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sujay Srinivas
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Prabhat Bhargava
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rajiv Sarin
- Department of Radiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rajendra Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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9
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Sharma S, Dhamne C, Bhosale S, Parambil B, Divatia J, Chinnaswamy G, Patil V, Joshi R, Epari S, Mahadevan A, Vaidya S, Kulkarni S, Kulkarni A, Patil V, Srinivasan S, Gollamudi VRM, Roy Moulik N, Prasad M, Narula G, Banavali S. Epilepsia Partialis Continua as a Sequelae of Measles Infection in Children With Hematolymphoid Malignancies. JCO Glob Oncol 2024; 10:e2300399. [PMID: 38422460 PMCID: PMC10914244 DOI: 10.1200/go.23.00399] [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: 10/23/2023] [Revised: 11/27/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE To share our clinical experience with the diagnosis and management of children with hematolymphoid malignancies presenting with epilepsia partialis continua (EPC) as a sequelae of measles infection. MATERIALS AND METHODS In December 2022, a series of children in our hemato-oncology unit presented with focal status epilepticus with no conclusive evidence pointing toward any underlying etiology. One such child had a typical measles rash a few weeks before the onset of this focal status epilepticus. After a series of cases with a similar presentation, a clinical pattern suspicious for measles became evident. cerebrospinal fluid polymerase chain reaction was positive for measles virus with measles immunoglobin M detected in the serum. This led to the diagnosis of measles inclusion-body encephalitis in a series of children who presented with EPC over a period of 3 months. EPC is a rare manifestation of measles that is seen only in immunocompromised patients. RESULTS Among the 18 children reported in this series, only 10 had a history of rashes. The rash was mostly transient and elicited only on retrospective history taking. Five of the 18 children who did not lose consciousness during the prolonged seizure episode survived the disease but had residual neurologic sequelae. Among the 18 children, two were unimmunized and immunization status could not be confirmed in three other children. CONCLUSION This case series highlights the threats posed by measles infection in children with cancer who are immunosuppressed because of the underlying disease and ongoing chemotherapy. Loss of herd immunity because of declining measles immunization rates secondary to vaccine hesitancy and COVID-19 lockdown pose a greater risk of measles infection and its complications for patients with deficient immune systems.
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Affiliation(s)
- Sudivya Sharma
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Chetan Dhamne
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shilpushp Bhosale
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Badira Parambil
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jigeeshu Divatia
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vasundhara Patil
- Department of Radiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Sridhar Epari
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sunil Vaidya
- Virus Registry and Virus Repository, National Institute of Virology, Pune, India
| | - Shilpa Kulkarni
- Department of Neurology, Wadia Children's Hospital, Mumbai, India
| | - Atul Kulkarni
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vijaya Patil
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shyam Srinivasan
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Nirmalya Roy Moulik
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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10
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Kumar S, Castelino R, Rao A, Gattani S, Kumar A, Pillai A, Sehgal A, Rane P, Ramaswamy A, Dhekale R, Krishnamurthy J, Banavali S, Badwe R, Prabhash K, Noronha V, Gota V. Performance of potentially inappropriate medications assessment tools in older Indian patients with cancer. Cancer Med 2024; 13:e6797. [PMID: 38183404 PMCID: PMC10807583 DOI: 10.1002/cam4.6797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medication (PIM) use are common problems in older adults. Safe prescription practices are a necessity. The tools employed for the identification of PIM sometimes do not concur with each other. METHODS A retrospective analysis of patients ≥60 years who visited the Geriatric Oncology Clinic of the Tata Memorial Hospital, Mumbai, India from 2018 to 2021 was performed. Beer's-2015, STOPP/START criteria v2, PRISCUS-2010, Fit fOR The Aged (FORTA)-2018, and the EU(7)-PIM list-2015 were the tools used to assess PIM. Every patient was assigned a standardized PIM value (SPV) for each scale, which represented the ratio of the number of PIMs identified by a given scale to the total number of medications taken. The median SPV of all five tools was considered the reference standard for each patient. Bland-Altman plots were utilized to determine agreement between each scale and the reference. Association between baseline variables and PIM use was determined using multiple logistic regression analysis. RESULTS Of the 467 patients included in this analysis, there were 372 (79.66%) males and 95 (20.34%) females with an average age of 70 ± 5.91 years. The EU(7)-PIM list was found to have the highest level of agreement given by a bias estimate of 0.010, the lowest compared to any other scale. The 95% CI of the bias was in the narrow range of -0.001 to 0.022, demonstrating the precision of the estimate. In comparison, the bias (95%) CI of Beer's criteria, STOPP/START criteria, PRISCUS list, and FORTA list were -0.039 (-0.053 to -0.025), 0.076 (0.060 to 0.092), 0.035 (0.021 to 0.049), and -0.148 (-0.165 to -0.130), respectively. Patients on polypharmacy had significantly higher PIM use compared to those without (OR = 1.47 (1.33-1.63), p = <0.001). CONCLUSIONS The EU(7)-PIM list was found to have the least bias and hence can be considered the most reliable among all other tools studied.
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Affiliation(s)
- Sharath Kumar
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Renita Castelino
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Abhijith Rao
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Shreya Gattani
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Anita Kumar
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Anupa Pillai
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Arshiya Sehgal
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Pallavi Rane
- Department of StatisticsAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Anant Ramaswamy
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Ratan Dhekale
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | | | - Shripad Banavali
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Rajendra Badwe
- Homi Bhabha National InstituteMumbaiIndia
- Department of Surgical OncologyTata Memorial HospitalMumbaiMaharashtraIndia
| | - Kumar Prabhash
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Vanita Noronha
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Vikram Gota
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
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11
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Chatterjee G, Dhende P, Raj S, Shetty V, Ghogale S, Deshpande N, Girase K, Patil J, Kalra A, Narula G, Dalvi K, Dhamne C, Moulik NR, Rajpal S, Patkar NV, Banavali S, Gujral S, Subramanian PG, Tembhare PR. 15-color highly sensitive flow cytometry assay for post anti-CD19 targeted therapy (anti-CD19-CAR-T and blinatumomab) measurable residual disease assessment in B-lymphoblastic leukemia/lymphoma: Real-world applicability and challenges. Eur J Haematol 2024; 112:122-136. [PMID: 37706583 DOI: 10.1111/ejh.14102] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES Measurable residual disease (MRD) is the most relevant predictor of disease-free survival in B-cell acute lymphoblastic leukemia (B-ALL). We aimed to establish a highly sensitive flow cytometry (MFC)-based B-ALL-MRD (BMRD) assay for patients receiving anti-CD19 immunotherapy with an alternate gating approach and to document the prevalence and immunophenotype of recurrently occurring low-level mimics and confounding populations. METHODS We standardized a 15-color highly-sensitive BMRD assay with an alternate CD19-free gating approach. The study included 137 MRD samples from 43 relapsed/refractory B-ALL patients considered for anti-CD19 immunotherapy. RESULTS The 15-color BMRD assay with CD22/CD24/CD81/CD33-based gating approach was routinely applicable in 137 BM samples and could achieve a sensitivity of 0.0005%. MRD was detected in 29.9% (41/137) samples with 31.7% (13/41) of them showing <.01% MRD. Recurrently occurring low-level cells that showed immunophenotypic overlap with leukemic B-blasts included: (a) CD19+CD10+CD34+CD22+CD24+CD81+CD123+CD304+ plasmacytoid dendritic cells, (b) CD73bright/CD304bright/CD81bright mesenchymal stromal/stem cells (CD10+) and endothelial cells (CD34+CD24+), (c) CD22dim/CD34+/CD38dim/CD81dim/CD19-/CD10-/CD24- early lymphoid progenitor/precursor type-1 cells (ELP-1) and (d) CD22+/CD34+/CD10heterogeneous/CD38moderate/CD81moderate/CD19-/CD24- stage-0 B-cell precursors or ELP-2 cells. CONCLUSIONS We standardized a highly sensitive 15-color BMRD assay with a non-CD19-based gating strategy for patients receiving anti-CD19 immunotherapy. We also described the immunophenotypes of recurrently occurring low-level populations that can be misinterpreted as MRD in real-world practice.
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Affiliation(s)
- Gaurav Chatterjee
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Priyanka Dhende
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Simpy Raj
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Vruksha Shetty
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Sitaram Ghogale
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Nilesh Deshpande
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Karishma Girase
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Jagruti Patil
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Aastha Kalra
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Center, Mumbai, Mumbai, Maharashtra, India
| | - Kajal Dalvi
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Chetan Dhamne
- Department of Pediatric Oncology, Tata Memorial Center, Mumbai, Mumbai, Maharashtra, India
| | - Nirmalya Roy Moulik
- Department of Pediatric Oncology, Tata Memorial Center, Mumbai, Mumbai, Maharashtra, India
| | - Sweta Rajpal
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Nikhil V Patkar
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Center, Mumbai, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Mumbai, Maharashtra, India
| | - Papagudi G Subramanian
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Prashant R Tembhare
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
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12
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Rao AR, Noronha V, Ramaswamy A, Kumar A, Pillai A, Gattani S, Sehgal A, Kumar S, Castelino R, Dhekale R, Krishnamurthy J, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nookala M, Chitre A, Kapoor A, Gota V, Banavali S, Badwe RA, Prabhash K. Correlation of the Geriatric Assessment with Overall Survival in Older Patients with Cancer. Clin Oncol (R Coll Radiol) 2024; 36:e61-e71. [PMID: 37953073 DOI: 10.1016/j.clon.2023.11.003] [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: 07/18/2023] [Revised: 10/09/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
AIMS Global guidelines recommend that all older patients with cancer receiving chemotherapy should undergo a geriatric assessment. However, utilisation of the geriatric assessment is often constrained by its time-intensive nature, which limits its adoption in settings with limited resources and high demand. There is a lack of evidence correlating the results of the geriatric assessment with survival from the Indian subcontinent. Therefore, the aims of the present study were to assess the impact of the geriatric assessment on survival in older Indian patients with cancer and to identify the factors associated with survival in these older patients. MATERIALS AND METHODS This was an observational study, conducted in the geriatric oncology clinic of the Tata Memorial Hospital (Mumbai, India). Patients aged 60 years and older with cancer who underwent a geriatric assessment were enrolled. We assessed the non-oncological geriatric domains of function and falls, nutrition, comorbidities, cognition, psychology, social support and medications. Patients exhibiting impairment in two or more domains were classified as frail. RESULTS Between June 2018 and January 2022, we enrolled 897 patients. The median age was 69 (interquartile range 65-73) years. The common malignancies were lung (40.5%), oesophagus (31.9%) and genitourinary (12.1%); 54.6% had metastatic disease. Based on the results of the geriatric assessment, 767 (85.4%) patients were frail. The estimated median overall survival in fit patients was 24.3 (95% confidence interval 18.2-not reached) months, compared with 11.2 (10.1-12.8) months in frail patients (hazard ratio 0.54; 95% confidence interval 0.41-0.72, P < 0.001). This difference in overall survival remained significant after adjusting for age, sex, primary tumour and metastatic status (hazard ratio 0.56; 95% confidence interval 0.41-0.74, P < 0.001). In the patients with a performance status of 0 or 1 (n = 454), 365 (80.4%) were frail; the median overall survival in the performance status 0-1 group was 33.0 months (95% confidence interval 24.31-not reached) in the fit group versus 14.4 months (95% confidence interval 12.25-18.73) in the frail patients (hazard ratio 0.50; 95% confidence interval 0.34-0.74, P = 0.001). In the multivariate analysis, the geriatric assessment domains that were predictive of survival were function (hazard ratio 0.68; 95% confidence interval 0.52-0.88; P = 0.003), nutrition (hazard ratio 0.64; 95% confidence interval 0.48-0.85, P = 0.002) and cognition (hazard ratio 0.67; 95% confidence interval 0.49-0.91, P = 0.011). DISCUSSION The geriatric assessment is a powerful prognostic tool for survival among older Indian patients with cancer. The geriatric assessment is prognostic even in the cohort of patients thought to be the fittest, i.e. performance status 0 and 1. Our study re-emphasises the critical importance of the geriatric assessment in all older patients planned for cancer-directed therapy.
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Affiliation(s)
- A R Rao
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Kumar
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Pillai
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S Gattani
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - S Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - R Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - R Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - J Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - L Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - N Ansari
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Vagal
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Mahajan
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Timmanpyati
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Nookala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - A Chitre
- Department of Physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - A Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - V Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - S Banavali
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - R A Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India.
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13
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Dhariwal N, Roy Moulik N, Smriti V, Dhamne C, Chichra A, Srinivasan S, Narula G, Banavali S. Clinico-radiological profile, management and follow-up of methotrexate induced neurotoxicity in children with acute lymphoblastic leukemia. Leuk Lymphoma 2023; 64:1971-1980. [PMID: 37565568 DOI: 10.1080/10428194.2023.2245093] [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: 11/14/2022] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
Methotrexate-induced neurotoxicity is a well-defined side-effect of high-dose and intrathecal methotrexate with characteristic clinico-radiological findings and transient nature. Our experience in managing this entity in children with acute lymphoblastic leukemia(ALL) is reported here. All children with de novo ALLregistered from January 2016 through December 2021 who developed methotrexate-induced neurotoxicity were included. Of children with ALL treated during the study period, thirty-three experienced methotrexate induced neurotoxicity with an incidence of 1.25%. Stroke-like symptoms(36.36%; 12/33) were the most common clinical manifestation followed by seizures(30.3%, 10/33). Twenty-three patients had radiological features consistent with methotrexate-induced leukoencephalopathy. With emerging evidence, thirty-one patients were re-challenged with methotrexate (IV/IT), of whom 4 patients had recurrence of symptoms. No long-term neurological sequalae were noted in our cohort, despite rechallenging. Therefore in our study, methotrexate induced neurotoxicity is a self-limiting toxicity and methotrexate can be re-challenged safely without compromising theintensity of CNS-directed therapy.
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Affiliation(s)
- Nidhi Dhariwal
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Nirmalya Roy Moulik
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Vasundhara Smriti
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Chetan Dhamne
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Akanksha Chichra
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Shyam Srinivasan
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Narula
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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14
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Dhariwal N, Roy Moulik N, Bhat V, Smriti V, Kakoti S, Choudhury S, Sridhar E, Gujral S, Dhamne C, Shah S, Narula G, Banavali S. Intracranial disease in pediatric Hodgkin lymphoma-case report and review of literature. Am J Blood Res 2023; 13:162-167. [PMID: 38023415 PMCID: PMC10658030] [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: 05/05/2023] [Accepted: 08/31/2023] [Indexed: 12/01/2023]
Abstract
Central nervous system (CNS) involvement in Hodgkin lymphoma (HL) is an extremely rare presentation with dismal outcomes according to reported literature. An 8-year-old girl presented to us with complaints of on-off fever, right cervical swelling and bilateral ptosis. Positron emission tomography (PET) showed intracranial extra-axial soft tissue masses in right infero-lateral temporal lobe, sella and bilateral parasellar region along with cervical, mediastinal, axillary, abdominal and inguino-pelvic nodes, liver lesions and extensive marrow lesions involving the axial and appendicular skeleton. Histopathology of the cervical lymph node revealed a diagnosis of classical Hodgkin lymphoma. Child received 2 cycles of OEPA and 4 cycles of COPP followed by radiotherapy to bulky cervical lymph nodes and intracranial lesion. The child has been disease-free for 44 months with no neurological sequalae. Intracranial spread is rare in Hodgkin lymphoma and is associated with inferior outcomes. Due to its rarity, there are no specific treatment guidelines for this entity. The choice of ideal chemotherapeutic agents and role of whole-brain radiotherapy needs further evaluation.
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Affiliation(s)
- Nidhi Dhariwal
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial HospitalMumbai 400012, Maharashtra, India
- Homi Bhabha National InstituteAnushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Nirmalya Roy Moulik
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial HospitalMumbai 400012, Maharashtra, India
- Homi Bhabha National InstituteAnushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Vasudeva Bhat
- Homi Bhabha National InstituteAnushakti Nagar, Mumbai 400094, Maharashtra, India
- Department of Pediatric Hematology and Oncology, Manipal Academy of Higher EducationManipal 576104, Karnataka, India
| | - Vasundhara Smriti
- Homi Bhabha National InstituteAnushakti Nagar, Mumbai 400094, Maharashtra, India
- Department of Radiodiagnosis, Tata Memorial HospitalMumbai 400012, Maharashtra, India
| | - Sangeeta Kakoti
- Homi Bhabha National InstituteAnushakti Nagar, Mumbai 400094, Maharashtra, India
- Department of Radiotherapy, Tata Memorial HospitalMumbai 400012, Maharashtra, India
| | - Sayak Choudhury
- Homi Bhabha National InstituteAnushakti Nagar, Mumbai 400094, Maharashtra, India
- Department of Nuclear Medicine, Tata Memorial HospitalMumbai 400012, Maharashtra, India
| | - Epari Sridhar
- Homi Bhabha National InstituteAnushakti Nagar, Mumbai 400094, Maharashtra, India
- Department of Pathology, Tata Memorial HospitalMumbai 400012, Maharashtra, India
| | - Sumeet Gujral
- Homi Bhabha National InstituteAnushakti Nagar, Mumbai 400094, Maharashtra, India
- Department of Pathology, Tata Memorial HospitalMumbai 400012, Maharashtra, India
| | - Chetan Dhamne
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial HospitalMumbai 400012, Maharashtra, India
- Homi Bhabha National InstituteAnushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Sneha Shah
- Homi Bhabha National InstituteAnushakti Nagar, Mumbai 400094, Maharashtra, India
- Department of Nuclear Medicine, Tata Memorial HospitalMumbai 400012, Maharashtra, India
| | - Gaurav Narula
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial HospitalMumbai 400012, Maharashtra, India
- Homi Bhabha National InstituteAnushakti Nagar, Mumbai 400094, Maharashtra, India
| | - Shripad Banavali
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial HospitalMumbai 400012, Maharashtra, India
- Homi Bhabha National InstituteAnushakti Nagar, Mumbai 400094, Maharashtra, India
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15
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Roy Moulik N, Keerthivasagam S, Velagala SV, Gollamudi VRM, Agiwale J, Dhamne C, Chichra A, Srinivasan S, Shetty D, Jain H, Subramanian PG, Tembhare P, Chatterjee G, Patkar N, Narula G, Banavali S. Treating relapsed B cell-precursor ALL in children with a setting-adapted mitoxantrone-based intensive chemotherapy protocol (TMH rALL-18 PROTOCOL) - experience from Tata Memorial Hospital, India. Ann Hematol 2023; 102:2835-2844. [PMID: 37479890 DOI: 10.1007/s00277-023-05351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 03/24/2023] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
The outlook of relapsed ALL in low- and middle-income countries (LMICs) is dismal due to high treatment-related toxicities and inadequate resources. We report our experience of using a locally adapted mitoxantrone-based protocol for non-high risk (HR) relapsed B-ALL (rALL). A retrospective cum prospective study of standard and intermediate risk (SR and IR) rALL patients treated on TMH rALL-18 protocol (adapted from COG/UKALLR3/Int-Re-ALL protocols) between November 2018 and January 2021 was analyzed. The protocol comprising of 7 blocks of multi-agent chemotherapy including mitoxantrone in induction followed by local irradiation and maintenance, underwent serial modifications based on our experience with initial patients. Eighty-two patients (SR rALL, 3; IR rALL, 79) were treated on TMH rALL-18 protocol. Of 321 grade 3/4 reported toxicities, around 43% (138 toxicities) were noted during induction. Induction chemotherapy was outpatient-based; however, 68 patients (82.9%) required supportive care admissions. Twelve out of 19 patients with gram negative bacilli sepsis (included 7 MDRO) died during reinduction. Five remission deaths were seen during block 3 after which cytarabine was dose reduced (3 g to 2 g/m2). Post-reinduction minimal residual disease was negative in 54 (80.6%) out of 67 evaluable patients. At a median follow-up of 24 months (95% CI 22-27), the estimated 2-year event-free and overall survival of the entire cohort was 58% (95% CI 48.1-69.9) and 60.3% (95% CI 50.5-72). Until the time, targeted therapies are freely accessible in LMICs, strengthening supportive care as well as local adaptation of protocols that strike a fine balance between efficacy and tolerability are mandated.
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Affiliation(s)
| | | | | | | | - Jayesh Agiwale
- Pediatric Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Chetan Dhamne
- Pediatric Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | | | - Dhanlaxmi Shetty
- Cancer Cytogenetics, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Hemani Jain
- Cancer Cytogenetics, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | | | | | - Nikhil Patkar
- Hematopathology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Gaurav Narula
- Pediatric Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
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16
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Noronha V, Sekar A, Rajendra A, Mokal S, Patil V, Menon N, Chopade S, Singh AK, Kaushal RK, Mahajan A, Janu A, Purandare N, Dikshit R, Banavali S, Prabhash K, Badwe R. Epidemiological Trend of Esophageal Cancer at a Tertiary Cancer Center in Mumbai, India, Over the Past 15 Years. J Gastrointest Cancer 2023; 54:903-912. [PMID: 36418768 DOI: 10.1007/s12029-022-00887-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] [Accepted: 11/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In developed countries, there has been a definite change in the histopathological spectrum of esophageal cancer towards adenocarcinoma. There are limited data from India regarding the histopathological profile of patients with esophageal cancer. MATERIALS AND METHODS We retrospectively evaluated patients with histologically proven esophageal cancer who were registered at the Tata Memorial Hospital (Mumbai, India) between 2003 and 2018. The primary aim of the study was to analyze the time-trend of the histological pattern of esophageal cancer. Our secondary objectives included evaluating whether there was any correlation between the histology of the esophageal cancer and the age, sex, socioeconomic status (the paying ability of the patient, which was reflected in the treatment category of the patient, i.e., private [full payment], general [subsidized payment], or no charge), comorbidities, and a history of substance abuse. RESULTS Among 7874 patients with esophageal cancer, 5092 (64.7%) were men, with a male-to-female ratio of 1.8:1. The median age was 57 years (IQR, 50-65). Of the 4912 patients in whom a history of tobacco or alcohol use had been elicited, 1360 (27.7%) had no history of substance abuse. A majority of the tumors (2942, 37.4%) originated in the middle-third of the esophagus. Squamous cell carcinoma was the predominant histological type, noted in 6413 (81.4%) patients and remained the most common histologic type consistently through the study with no evidence of a time-trend in the histological pattern. On the multivariate analysis, female sex and a history of substance abuse were associated with higher odds of squamous cell carcinoma, while the presence of comorbidities and lower esophageal/gastroesophageal junction primaries were associated with higher odds of adenocarcinoma. CONCLUSIONS There is no evidence of an epidemiological shift in the histopathologic spectrum of esophageal cancer in India over the last two decades. Four out of five Indian patients with esophageal cancer have squamous cell histology, with the commonest site of origin being the middle third. This is important to recognize, given the varying molecular spectrum and efficacy of therapeutic modalities based on histopathology.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Anbarasan Sekar
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Akhil Rajendra
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Smruti Mokal
- Department of Biostatistics, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Sunil Chopade
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Ajay Kumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Rajiv Kumar Kaushal
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Amit Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Rajesh Dikshit
- Department of Epidemiology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India.
| | - Rajendra Badwe
- Department of Surgical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
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17
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Noronha V, Rao AR, Ramaswamy A, Kumar A, Pillai A, Dhekale R, Krishnamurthy J, Kapoor A, Gattani S, Sehgal A, Kumar S, Castelino R, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nookala M, Chitre A, Narasimhan PN, Banerjee J, Gota V, Banavali S, Badwe RA, Prabhash K. The current status of geriatric oncology in India. Ecancermedicalscience 2023; 17:1595. [PMID: 37799956 PMCID: PMC10550294 DOI: 10.3332/ecancer.2023.1595] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 10/07/2023] Open
Abstract
Geriatric oncology in India is relatively new. The number of older persons with cancer is increasing exponentially; at our institution, 34% of patients registered are 60 years and over. Apart from the Tata Memorial Hospital in Mumbai, there are currently no other Indian centers that have a dedicated geriatric oncology unit. Geriatric assessments (GAs) are done sporadically, and older patients with cancer are usually assessed and treated based on clinical judgement. Challenges to increasing the uptake of GA include a lack of training/time/interest or knowledge of the importance of the GA. Other challenges include a lack of trained personnel with expertise in geriatric oncology, and a paucity of research studies that seek to advance the outcomes in older Indian patients with cancer. We anticipate that over the next 10 years, along with the inevitable increase in the number of older persons with cancer in India, there will be a commensurate increase in the number of skilled personnel to care for them. Key goals for the future include increased research output, increased number of dedicated geriatric oncology units across the country, India-specific geriatric oncology guidelines, geriatric oncology training programs, and a focus on collaborative work across India and with global partners. In this narrative review, we provide a broad overview of the status of geriatric oncology in India, along with a description of the work done at our center. We hope to spark interest and provide inspiration to readers to consider developing geriatric oncology services in other settings.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Abhijith Rajaram Rao
- Department of Geriatric Medicine, All India Institute of Medical Science, New Delhi 110023, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Anita Kumar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Anupa Pillai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Ratan Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Jyoti Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Akhil Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi 221005, India
| | - Shreya Gattani
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Arshiya Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Sharath Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Renita Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Sarika Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Anuradha Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Lekhika Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Jayita Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Nabila Ansari
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Manjusha Vagal
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Purabi Mahajan
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Shivshankar Timmanpyati
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Manjunath Nookala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Ankita Chitre
- Department of Physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi 400012, India
| | | | - Joyita Banerjee
- Venu Geriatric Care Centre, Venu Charitable Society, New Delhi 110017, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Rajendra A Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
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18
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Budukh A, Bagal S, Thakur JS, Khanna D, Sancheti S, Banavali S. Pediatric Cancer Burden in Different Regions of India: Analysis of Published Data From 33 Population-Based Cancer Registries. Indian Pediatr 2023; 60:541-545. [PMID: 37078481] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To provide the regional pediatric cancer (age-group 0-14 years) burden and pattern in India utilizing published data of population-based cancer registries established under the National Cancer Registry Programme and Tata Memorial Centre, Mumbai. METHODS Based on the geographic locations, the population-based cancer registries were categorized into six regions. The age-specific incidence rate was calculated using the number of pediatric cancer cases and population in the respective age-group. Age-standardized incidence rate per million and 95% CI were calculated. RESULTS In India, 2% of all cases were pediatric cancer. The age-standardized incidence rate (95% CI) for boys and girls is 95.1 (94.3-95.9) and 65.5 (64.8-66.2) per million population, respectively. Registries from northern India reported the highest rate; while the lowest rate was in northeastern India. CONCLUSIONS There is a need to establish pediatric cancer registries in different regions of India to know the accurate pediatric cancer burden.
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Affiliation(s)
- Atul Budukh
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC),Navi Mumbai, Maharashtra and Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, Maharashtra. Correspondence to: DrAtul Madhukar Budukh, Professor, Epidemiology Centre for Cancer Epidemiology,Tata Memorial Centre, Homi Bhabha National Institute, Maharashtra.
| | - Sonali Bagal
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC),Navi Mumbai, Maharashtra
| | - Jarnail Singh Thakur
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
| | - Divya Khanna
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC), Tata Memorial Centre (TMC), Varanasi, Uttar Pradesh
| | - Sankalp Sancheti
- Department of Pathology, Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centre (TMC), Sangrur, Punjab
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre (TMC), Mumbai, Maharashtra and Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, Maharashtra
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19
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Keerthivasagam S, Srinivasan S, Navkudkar A, Chichra A, Moulik NR, Dhamne C, Narula G, Desai P, Chinnaswamy G, Banavali S. Does granulocyte transfusion help pediatric cancer patients with sepsis? Pediatr Blood Cancer 2023:e30547. [PMID: 37409841 DOI: 10.1002/pbc.30547] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/03/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023]
Abstract
Sepsis-related mortality continues to be a major concern while treating pediatric cancer patients, more so with the rise in the incidence of multidrug-resistant organisms (MDRO). In this retrospective study conducted between January 2021 and December 2022 at a tertiary cancer center in India, granulocyte transfusion was offered in addition to standard antimicrobial therapy to 64 children with hematolymphoid malignancy who developed 75 episodes of severe sepsis following intensive chemotherapy. Forty-four (83%) of 53 blood culture proven sepsis was caused by MDROs. Thirty-seven (70%) patients with blood culture proven sepsis cleared the organism after granulocyte transfusion. Thirty-day mortality was 25% for the entire study cohort and 32% for patients with MDRO sepsis.
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Affiliation(s)
- Swaminathan Keerthivasagam
- Division of Pediatric oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shyam Srinivasan
- Division of Pediatric oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anisha Navkudkar
- Department of Immunohematology and Blood Transfusion, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Akanksha Chichra
- Division of Pediatric oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nirmalya Roy Moulik
- Division of Pediatric oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Chetan Dhamne
- Division of Pediatric oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gaurav Narula
- Division of Pediatric oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Priti Desai
- Department of Immunohematology and Blood Transfusion, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Division of Pediatric oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shripad Banavali
- Division of Pediatric oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Shenoy R, Rao AR, Rane PP, Noronha V, Kumar A, Pillai A, Pathak S, Gattani S, Sehgal A, Kumar S, Castelino R, Dhekale R, Krishnamurthy J, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nokala M, Chitre A, Kapoor A, Gota V, Banavali S, Prabhash K, Ramaswamy A. Validation of the Onco-MPI in predicting short-term mortality in older Indian patients with cancer. J Geriatr Oncol 2023; 14:101550. [PMID: 37327761 DOI: 10.1016/j.jgo.2023.101550] [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: 01/24/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The number of older patients with cancer is increasing exponentially worldwide, and a similar trend has also been noted in India. The Multidimensional Prognostic Index (MPI) strongly correlates the presence of individual comorbidities with mortality, and the Onco-MPI prognosticates patients accurately for overall mortality. However, limited studies have evaluated this index in patient populations beyond Italy. We evaluated the performance of the Onco-MPI index in predicting mortality in older Indian patients with cancer. MATERIALS AND METHODS This observational study was conducted between October 2019 and November 2021 in the Geriatric Oncology Clinic at Tata Memorial Hospital in Mumbai, India. The data of patients aged ≥60 years with solid tumors who underwent a comprehensive geriatric assessment was analysed. The study's primary aim was to calculate the Onco-MPI for patients in the study and correlate it with one-year mortality. RESULTS A total of 576 patients aged ≥60 years were included in the study. The median age (range) of the population was 68 (60-90) years, and 429 (74.5%) were male. After a median follow-up of 19.2 months, 366 (63.7%) patients had died. The proportion of patients classified as low risk (0-0.46), moderate risk (0.47-0.63) and high risk (0.64-1.0) were 38% (219 patients), 37% (211 patients) and 25% (145 patients), respectively. There was a significant difference in one-year mortality rates between the low-risk patients compared to medium and high-risk patients (40.6% vs 53.1% vs 71.7%; p < 0.001). DISCUSSION The current study validates the Onco-MPI as a predictive tool for estimating short-term mortality in older Indian patients with cancer. Further prospective studies need to build on this index to obtain a score with greater discrimination in the Indian population.
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Affiliation(s)
- Ramnath Shenoy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Abhijith Rajaram Rao
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anita Kumar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anupa Pillai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shruti Pathak
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shreya Gattani
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Arshiya Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Sharath Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Renita Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Ratan Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jyoti Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sarika Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anuradha Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Lekhika Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jayita Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nabila Ansari
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjusha Vagal
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Purbi Mahajan
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shivshankar Timmanpyati
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjunath Nokala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Ankita Chitre
- Department of Physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Akhil Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
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21
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Patil V, Noronha V, Menon N, Mathrudev V, Bhattacharjee A, Nawale K, Parekh D, Banavali S, Prabhash K. Metronomic adjuvant chemotherapy evaluation in locally advanced head and neck cancers post radical chemoradiation - a randomised trial. Lancet Reg Health Southeast Asia 2023; 12:100162. [PMID: 37384061 PMCID: PMC10305911 DOI: 10.1016/j.lansea.2023.100162] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 06/30/2023]
Abstract
Background Locally advanced head and neck cancers treated with radical chemoradiation have unsatisfactory outcomes. Oral metronomic chemotherapy improves outcomes in comparison to maximum tolerated dose chemotherapy in the palliative setting. Limited evidence suggests that it may do so in an adjuvant setting. Hence this randomized study was conducted. Methods Patients of head and neck (HN) cancer with primary in oropharynx, larynx or hypopharynx, with PS 0-2 post radical chemoradiation with documented complete response were randomized 1:1 to either observation or oral metronomic adjuvant chemotherapy (MAC) for 18 months. MAC consisted of weekly oral methotrexate (15 mg/m2) and celecoxib (200 mg PO BD). The primary endpoint was OS and the overall sample size was 1038. The study had 3 planned interim analyses for efficacy and futility. Trial registration- Clinical Trials Registry- India (CTRI): CTRI/2016/09/007315 [Registered on: 28/09/2016] Trial Registered Prospectively. Findings 137 patients were recruited and an interim analysis was done. The 3 year PFS was 68.7% (95% CI 55.1-79.0) versus 60.8% (95% CI 47.9-71.4) in the observation and metronomic arm respectively (P value = 0.230). The hazard ratio was 1.42 (95% CI 0.80-2.51; P value = 0.231). The 3 year OS was 79.4% (95% CI 66.3-87.9) versus 62.4% (95% CI 49.5-72.8) in the observation and metronomic arm respectively (P value = 0.047). The hazard ratio was 1.83 (95% CI 1.0-3.36; P value = 0.051). Interpretation In this phase 3 randomized study, oral metronomic combinations of weekly methotrexate and daily celecoxib failed to improve the PFS or OS. Hence observation post-complete response post radical chemoradiation remains the standard of care. Funding ICON funded this study.
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Affiliation(s)
- Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Deevyashali Parekh
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
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22
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Ramanathan S, Prasad M, Vora T, Badira CP, Kembhavi S, Ramadwar M, Khanna N, Laskar S, Muckaden MA, Qureshi S, Banavali S, Chinnaswamy G. Outcomes of relapsed/refractory extracranial germ cell tumors treated on conventional salvage chemotherapy without stem cell rescue: Experience from a tertiary cancer center. Pediatr Blood Cancer 2023; 70:e30179. [PMID: 36645132 DOI: 10.1002/pbc.30179] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/14/2022] [Accepted: 12/06/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Data on the outcome and prognostic indicators in extracranial relapsed/refractory germ cell tumors (rel/ref-GCTs) in children are limited to a few studies. This study looks at remission rates and outcomes of rel/ref-GCTs treated with conventional salvage chemotherapy (SC) regimens without stem cell rescue at a single center in the developing world. METHODS Patients treated at our center from January 2009 to December 2018 were included. Risk at primary presentation was stratified as all completely excised teratomas and stage I gonadal tumors being low risk (LR); stage IV ovarian, stage III-IV extragonadal GCTs as high risk (HR), and the remaining as intermediate risk (IR). SC regimens were: vinblastine-ifosfamide-cisplatin/carboplatin or paclitaxel-ifosfamide-cisplatin/carboplatin, or cisplatin/carboplatin-etoposide-bleomycin. Local therapy was either surgery and/or radiotherapy. RESULTS The analyzable cohort comprised 50 patients (44 = rel-GCTs; 6 = ref-GCTs) with a median age of 3.8 years and male:female ratio of 1.27:1. Primary location was ovary in 16 (32%), testicular in 10 (20%), and extragonadal in the rest (48%). Local, metastatic, and combined progression was noted in 28 (56%), 14 (28%), and eight (16%) patients, respectively, at a median time of 8.5 months. At a median follow-up of 60 months, the 5-year event-free survival (EFS) and overall survival (OS) of the entire cohort (n = 50) were 42.4% and 50.0%, respectively. In patients previously exposed to platinum analogs (n = 38), 5-year-EFS and OS were 27.7% and 31.7%, respectively. Local relapses did better when compared to metastatic and combined relapses (5-year EFS: 64% vs. 23% vs. 0%; p = .009). LR and IR tumors did better compared to HR (5-year EFS: 81.5% vs. 49.3% vs. 6.5%; p = .002). Patients with normalization of tumor markers after two cycles had a superior EFS (57.6% vs. 0%; p < .001). Relapsed tumors fared better than primary refractory GCTs (5-year EFS: 48.6% vs. 0%; p < .001). CONCLUSIONS Primary refractory GCTs, extragonadal rel-GCTs, and rel/ref-GCTs with a poor biochemical response did poorly with conventional SC and need alternative treatment strategies. The rel/ref-testicular GCTs had the best chance of salvage despite a second recurrence (5-year EFS and OS: 28.60% and 42.90%, respectively).
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Affiliation(s)
- Subramaniam Ramanathan
- Department of Paediatric Oncology, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, Tyne and Wear, UK
| | - Maya Prasad
- Department of Paediatric Oncology, Tata Memorial hospital, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tushar Vora
- Department of Paediatric Oncology, SickKids Hospital, Toronto, Ontario, Canada
| | - Cheriyalinkal Parambil Badira
- Department of Paediatric Oncology, Tata Memorial hospital, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Seema Kembhavi
- Department of Radiology, Mackay Hospital and Health Services, Mackay, Queensland, Australia
| | - Mukta Ramadwar
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nehal Khanna
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mary Ann Muckaden
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sajid Qureshi
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Paediatric Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shripad Banavali
- Department of Paediatric Oncology, Tata Memorial hospital, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Department of Paediatric Oncology, Tata Memorial hospital, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
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23
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Dwivedi P, Kapse A, Bangurwar C, Tamhane A, Banavali S. Metronomic Chemotherapy for Burkitt Lymphoma in a Patient With HIV: Case Report. J Pediatr Hematol Oncol 2023; 45:78-81. [PMID: 36161878 DOI: 10.1097/mph.0000000000002547] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/16/2022] [Indexed: 11/25/2022]
Abstract
Burkitt lymphoma (BL) is an aggressive type of non-Hodgkin lymphoma (NHL). With high-dose combination chemotherapy, cure rates are excellent. Treatment for HIV-positive BL is similar to that for HIV-negative BL. Offering long-term intensive chemotherapy is difficult in resource-limited settings. Oral metronomic chemotherapy, though in vogue as a treatment modality, has limited evidence of its efficacy in HIV-positive BL. Here, we present the case of a child who was diagnosed with BL and HIV and administered metronomic chemotherapy, and also review the literature on the role of metronomic chemotherapy in non-Hodgkin lymphoma with and without HIV.
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Affiliation(s)
| | | | | | | | - Shripad Banavali
- Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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24
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Patil VM, Noronha V, Menon N, Rai R, Bhattacharjee A, Singh A, Nawale K, Jogdhankar S, Tambe R, Dhumal S, Sawant R, Alone M, Karla D, Peelay Z, Pathak S, Balaji A, Kumar S, Purandare N, Agarwal A, Puranik A, Mahajan A, Janu A, Kumar Singh G, Mittal N, Yadav S, Banavali S, Prabhash K. Low-Dose Immunotherapy in Head and Neck Cancer: A Randomized Study. J Clin Oncol 2023; 41:222-232. [PMID: 36265101 DOI: 10.1200/jco.22.01015] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The regimens approved for the treatment of advanced head and neck squamous cell carcinoma are accessible to only 1%-3% of patients in low- and middle-income countries because of their cost. In our previous study, metronomic chemotherapy improved survival in this setting. Retrospective data suggest that a low dose of nivolumab may be efficacious. Hence, we aimed to assess whether the addition of low-dose nivolumab to triple metronomic chemotherapy (TMC) improved overall survival (OS). METHODS This was a randomized phase III superiority study. Adult patients with recurrent or newly diagnosed advanced head and neck squamous cell carcinoma being treated with palliative intent with an Eastern Cooperative Oncology Group performance status of 0-1 were eligible. Patients were randomly assigned 1:1 to TMC consisting of oral methotrexate 9 mg/m2 once a week, celecoxib 200 mg twice daily, and erlotinib 150 mg once daily, or TMC with intravenous nivolumab (TMC-I) 20 mg flat dose once every 3 weeks. The primary end point was 1-year OS. RESULTS One hundred fifty-one patients were randomly assigned, 75 in TMC and 76 in the TMC-I arm. The addition of low-dose nivolumab led to an improvement in the 1-year OS from 16.3% (95% CI, 8.0 to 27.4) to 43.4% (95% CI, 30.8 to 55.3; hazard ratio, 0.545; 95% CI, 0.362 to 0.820; P = .0036). The median OS in TMC and TMC-I arms was 6.7 months (95% CI, 5.8 to 8.1) and 10.1 months (95% CI, 7.4 to 12.6), respectively (P = .0052). The rate of grade 3 and above adverse events was 50% and 46.1% in TMC and TMC-I arms, respectively (P = .744). CONCLUSION To our knowledge, this is the first-ever randomized study to demonstrate that the addition of low-dose nivolumab to metronomic chemotherapy improved OS and is an alternative standard of care for those who cannot access full-dose checkpoint inhibitors.
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Affiliation(s)
- Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rahul Rai
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Atanu Bhattacharjee
- Section of Biostatistics, Center for Cancer Epidemiology, Tata Memorial Center, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ajay Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shweta Jogdhankar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rupali Tambe
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Riddhi Sawant
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Mitali Alone
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Devanshi Karla
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Zoya Peelay
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shruti Pathak
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Arun Balaji
- Department of Speech and Therapy, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Suman Kumar
- Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Archi Agarwal
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ameya Puranik
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Abhishek Mahajan
- Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Janu
- Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Gunjesh Kumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Subhash Yadav
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
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Bajpai J, Simha V, Anne S, Bhargava P, Srinivas S, Khanna N, Rekhi B, Noronha V, Patil V, Laskar S, Prabhash K, Gupta S, Banavali S. 431P Alveolar soft part sarcomas: A tertiary care Indian centre experience. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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26
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Shetty D, Mohanty P, Jain H, Tembhare P, Patkar N, Subramanian P, Thorat J, Nayak L, Gokarn A, Punatar S, Jain H, Bagal B, Srinivasan S, Chichra A, Roy N, Dhamne C, Sengar M, Khattry N, Narula G, Banavali S. 2. Clinical, cytogenetic and genomic profiling of B-Other Acute Lymphoblastic Leukemia: An Indian cohort study. Cancer Genet 2022. [DOI: 10.1016/j.cancergen.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Johnson S, Dhamne C, Sankaran H, Gandhi KA, Rane P, Moulik NR, Jadhav SM, Gurjar M, Narula G, Banavali S, Gota V. A prospective, open-label, randomised, parallel design study of 4 generic formulations of intramuscular L-asparaginase in childhood precursor B-cell acute lymphoblastic leukaemia (ALL). Cancer Chemother Pharmacol 2022; 90:445-453. [PMID: 36251032 DOI: 10.1007/s00280-022-04482-8] [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: 02/16/2022] [Accepted: 10/05/2022] [Indexed: 11/27/2022]
Abstract
AIMS L-asparaginase is an essential medicine for childhood ALL. The quality of generic L-asparaginase available in India is a matter of concern. We compared four commonly used generic formulations of L-asparaginase in India. MATERIALS AND METHODS We conducted a prospective, open-label, randomised trial of four generic formulations of asparaginase for the treatment of patients with newly diagnosed intermediate-risk B-ALL. Patients were randomly assigned in a 1:1:1:1 ratio to receive generic asparaginase at a dose of at 10,000 IU/m 2 on days 9, 12, 15, and 18 of a 35-day cycle (Induction treatment). The primary end points were to determine the difference in the asparaginase activity and asparagine depletion. Historical patients who received L-asparaginase Medac (innovator) served as controls. RESULTS A total of 48 patients underwent randomization; 12 patients each in the four arms. Failure to achieve predefined activity threshold of 100 IU/L was observed in 9/40 samples of Generic A (22·5%), 23/40 of Generic B (57·5%), and 43/44 (98%) each of Generic C and D. All 27 samples from seven historical patients who were administered Medac had activity > 100 IU/L. The average activity was significantly higher for Genericm A, 154 (70·3, 285·4) IU/L followed by Generic B 84·5(44·2, 289·1) IU/L, Generic C 45(14·4, 58·4) IU/L, and Generic D 20·4(13, 35) IU/L. Only 6 patients had asparaginase activity > 100 IU/L on each of the four occasions (Generic A = 5; Generic B = 1), and none of them developed Anti-Asparaginase Antibodies (AAA). On the other hand, AAA was observed in 12/36 patients who had at least one level < 100 IU/L (P < 0·05): Generic A 3/5, Generic B = 3/9, Generic D (4/11), and Generic C (5/11). CONCLUSION Generic A and B had better trough asparaginase activity compared to Generic D and C. Overall, generic formulations had lower asparaginase activity which raises serious clinical concerns regarding their quality. Until strict regulatory enforcement improves the quality of these generics, dose adaptive approaches coupled with therapeutic drug monitoring need to be considered.
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Affiliation(s)
- Suja Johnson
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, 410210, India
| | - Chetan Dhamne
- Department of Paediatric Oncology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400094, India
| | - Hari Sankaran
- Department of Paediatric Oncology, Tata Memorial Centre, Mumbai, India
| | - Khushboo A Gandhi
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, 410210, India
| | - Pallavi Rane
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, 410210, India
| | - Nirmaly Roy Moulik
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, 410210, India
- Department of Paediatric Oncology, Tata Memorial Centre, Mumbai, India
| | - Shraddha Mahesh Jadhav
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, 410210, India
| | - Murari Gurjar
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, 410210, India
| | - Gaurav Narula
- Department of Paediatric Oncology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400094, India
| | - Shripad Banavali
- Department of Paediatric Oncology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400094, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, 410210, India.
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400094, India.
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Shetty D, Talker E, Dhamne C, Mohanty P, Chaubal K, Tembhare P, Patkar N, Subramanian PG, Moulik NR, Narula G, Banavali S. Copy number gain of JAK2 on marker chromosome in a case of relapsed pediatric B-ALL. Pediatr Blood Cancer 2022; 69:e29658. [PMID: 35373889 DOI: 10.1002/pbc.29658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/19/2022] [Accepted: 02/27/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Dhanlaxmi Shetty
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - Elizabeth Talker
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Chetan Dhamne
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - Purvi Mohanty
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Kruti Chaubal
- Cancer Cytogenetics Department, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Prashant Tembhare
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - Nikhil Patkar
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - P G Subramanian
- Department of Hematopathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - Nirmalya Roy Moulik
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - Gaurav Narula
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI), Training School Complex, Mumbai, India
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Noronha V, Chougule A, Chandrani P, Kaushal RK, Patil VM, Menon N, Kapoor A, Chopade S, Singh A, Shetty O, Dutt A, Banavali S, Prabhash K. Lung cancer with dual EGFR and ALK driver alterations at baseline: a retrospective observational cohort study. Acta Oncol 2022; 61:1143-1147. [PMID: 35972844 DOI: 10.1080/0284186x.2022.2109426] [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] [Indexed: 11/01/2022]
Affiliation(s)
- Vanita Noronha
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | | | - Pratik Chandrani
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Nandini Menon
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | | | - Sunil Chopade
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Ajaykumar Singh
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Omshree Shetty
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Amit Dutt
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
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Bajpai J, Mailankody S, Budukh A, Swaminathan R, Dikshit R, Perera S, Dhimal M, Tshomo U, Bagal S, Bhise M, Banavali S, Gupta S, Chaturvedi P, Badwe R, Trama A. 1336P Epidemiology of rare cancers in South Asian Association for Regional Cooperation (SAARC) countries: Remembering the forgotten. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ramanathan S, Subramani V, Kembhavi S, Prasad M, Roy Moulik N, Dhamne C, Narula G, Banavali S. Clinical features, predictors and outcome of posterior reversible encephalopathy syndrome (PRES) in children with hematolymphoid malignancies. Childs Nerv Syst 2022; 38:1689-1698. [PMID: 35614149 DOI: 10.1007/s00381-022-05557-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 05/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological syndrome characterized by a neurotoxic state with vasogenic edema. We studied the clinical profile, predisposing factors, imaging features, and outcome of PRES in children receiving treatment for hematolymphoid malignancies. METHODS Retrospective analysis of the clinical data and radiological features of patients with PRES diagnosed between June 2014 and December 2019. RESULTS Fifty-two patients (boy: girl = 3:1) were diagnosed with PRES during the study period with a median age of 11 (range:1-15) years. Primary diagnoses were acute leukemias (n = 42), non-Hodgkin lymphoma (n = 8), Hodgkin lymphoma (n = 1), and Langerhan's cell histiocytosis (n = 1). Most common presenting symptoms were seizures (n = 52), altered sensorium (n = 42), headache (n = 39), and visual disturbances (n = 8). Hypertension at time of diagnosis was noted in 50 (96%) patients. Classic hyper-intense lesions on FLAIR and diffusion weighed (DW) images were noted in parieto-occipital region in 39 patients (75%). Central PRES involving basal ganglia was seen in 3 (6%) patients. A subsequent neuro-imaging was done in 18 patients (MRI: 13; CT: 5) at a median interval of 16.2 weeks. Neurological sequelae were observed in 10 (19%) patients, whereas 1 succumbed due to PRES. CONCLUSIONS PRES is an important clinico-radiological syndrome in patients undergoing chemotherapy for hematological malignancies. High index of suspicion, early diffusion-weighted images on MRI in children with classic symptoms help in early diagnosis. A small minority of patients may develop long-term sequelae.
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Affiliation(s)
| | - Vignesh Subramani
- Department Of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
| | - Seema Kembhavi
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Maya Prasad
- Department Of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Chetan Dhamne
- Department Of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.
| | - Gaurav Narula
- Department Of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
| | - Shripad Banavali
- Department Of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
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Ramanathan S, Prasad M, Vora T, Parambil BC, Kembhavi S, Ramadwar M, Khanna N, Laskar S, Kurkure P, Qureshi S, Banavali S, Chinnaswamy G. Outcomes and prognostic variables of extracranial germ cell tumors in children and adolescents treated over a decade: A developing world perspective. Pediatr Blood Cancer 2022; 69:e29765. [PMID: 35561025 DOI: 10.1002/pbc.29765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this single-center study was to analyze the outcomes of extracranial germ cell tumors (GCTs) in children treated on a multimodality regimen. METHODS Retrospective study of children (<18 years) with a histopathologically confirmed diagnosis of extracranial GCT over a period of 10 years (January 2009 to December 2018) treated on a uniform institution-based protocol consisting of both cisplatin- and carboplatin-based regimens. All completely excised teratomas and stage I gonadal tumors received no further therapy (low risk [LR]); stage IV ovarian, stage III-IV extragonadal GCTs received six cycles of chemotherapy (high risk [HR]), and the remaining received four cycles of chemotherapy (intermediate risk [IR]). RESULTS A total of 297 children were treated with a female:male ratio of 1.72:1 and median age of 4 years. Forty-three children had pure teratomas. Gonadal GCTs (N = 180) were more common than extragonadal GCTs (N = 117) with ovary as primary site in 128 children (43%) and sacrococcygeal site being the commonest extragonadal location (N = 41; 14%). LR, IR, and HR disease were noted in 60 (20.2%), 125 (42%), and 112 (37.8%) patients, respectively. Three-fourths of ovarian tumors and half of testicular tumors operated prior to presentation needed upstaging. Forty-one patients relapsed and 43 children expired (disease-related: 33; toxic deaths: 9; unknown: 1). The 5-year event-free survival (EFS)/overall survival (OS) of malignant GCT (n = 254) was 72.50%/82.70%, respectively, with gonadal site (p = .001), LR and IR (p = .001) and nonmetastatic disease (p = .001) being favorable prognostic variables. CONCLUSIONS The LR and IR GCTs in our cohort had an excellent outcome. A significant proportion of IR gonadal GCTs can be spared of systemic chemotherapy by adhering to strict surgical guidelines. In HR GCTs however, intensifying therapies to improve outcomes must be balanced against the risk of cumulative toxicity, more so in a resource-limited setting.
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Affiliation(s)
| | - Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tushar Vora
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Badira C Parambil
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Seema Kembhavi
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Purna Kurkure
- Department of Pediatric Hematology/Oncology, SRCC Children's Hospital, Mumbai, Maharashtra, India
| | - Sajid Qureshi
- Department of Pediatric Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Patil VM, Menon N, Chatterjee A, Tonse R, Choudhari A, Mahajan A, Puranik AD, Epari S, Jadhav M, Pathak S, Peelay Z, Walavalkar R, Muthuluri HK, Ravi Krishna M, Chandrasekharan A, Pande N, Gupta T, Banavali S, Jalali R. Mebendazole plus lomustine or temozolomide in patients with recurrent glioblastoma: A randomised open-label phase II trial. EClinicalMedicine 2022; 49:101449. [PMID: 35747192 PMCID: PMC9156991 DOI: 10.1016/j.eclinm.2022.101449] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Recurrent glioblastoma (GBM) has dismal outcomes and limited treatment options. Mebendazole (MBZ) has activity in glioma both in-vivo and in-vitro, and is well tolerated in combination with lomustine (CCNU) and temozolomide (TMZ). In this study, we sought to determine whether the addition of MBZ to CCNU or TMZ would improve overall survival (OS) in recurrent GBM. METHODS In this phase II randomized open-label trial, adult patients with ECOG PS 0-3, with recurrent GBM who were not eligible for re-radiation, were randomized 1:1 to the CCNU-MBZ and TMZ-MBZ arms. CCNU was administered at 110 mg/m2 every 6 weeks with MBZ 800 mg thrice daily and TMZ was administered at 200 mg/m2 once daily on days 1-5 of a 28 days cycle with MBZ 1600 mg thrice daily. The primary endpoint was OS at 9 months. A 9-month OS of 55% or more in any arm was hypothesized to warrant further evaluation and a value below 35% was too low to warrant further investigation. OS was analyzed using intention to treat (ITT) and per-protocol (PP) analyses. Per-protocol analysis was used for safety analysis. Clinical Trials Registry-India number, CTRI/2018/01/011542. FINDINGS Participants were recruited from 14th March 2019 to 18th June 2021, 44 patients were randomised on each arm. At 17.4 months, 68 events for OS analysis had occurred, 33 in the TMZ-MBZ and 35 in the CCNU-MBZ arm. The 9-month OS was 36.6% (95% CI 22.3-51.0) and 45% (95% CI 29.6-59.2) in the TMZ-MBZ and CCNU-MBZ arms respectively, in the ITT population. ECOG PS was the only independent prognostic factor impacting OS (HR-0.48, 95% CI 0.27-0.85; P = 0.012). Grade 3-5 adverse events were seen in 8 (18.6%; n = 43) and 4 (9.5%; n = 42) patients in the TMZ-MBZ and CCNU-MBZ arms respectively. There were no treatment related deaths. INTERPRETATION The addition of MBZ to TMZ or CCNU failed to achieve the pre-set benchmark of 55% 9-month OS. This was probably due to 28.6% of patients having poor PS of 2-3. FUNDING Brain Tumor Foundation (BTF) of India, Indian Cooperative Oncology Network (ICON), and India Cancer Research Consortium (ICRC) under ICMR (Indian Council of Medical Research).
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Affiliation(s)
- Vijay M. Patil
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Corresponding author at: Department of Medical Oncology, Tata Memorial Hospital, 1110, Homi Bhabha Block, Parel, Mumbai, India.
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Abhishek Chatterjee
- Department of Radiation Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Raees Tonse
- Department of Radiation Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Choudhari
- Department of Radiology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Abhishek Mahajan
- Department of Radiology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ameya D. Puranik
- Department of Nuclear Medicine, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Monica Jadhav
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shruti Pathak
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Zoya Peelay
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rutuja Walavalkar
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Hemanth K. Muthuluri
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Madala Ravi Krishna
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Arun Chandrasekharan
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nikhil Pande
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rakesh Jalali
- Department of Radiation Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
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Roy Moulik N, Bhat V, Yadav R, Narula G, Challinor J, Banavali S. Development and impact of a novel hospital to home-away-from-home infection control outreach nursing program in Mumbai: Tata Memorial Hospital experience. Pediatr Blood Cancer 2022; 69:e29449. [PMID: 34767282 DOI: 10.1002/pbc.29449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Nirmalya Roy Moulik
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vasudeva Bhat
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rajeshree Yadav
- Department of Nursing, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Narula
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Julia Challinor
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Shripad Banavali
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Patil V, Noronha V, Joshi A, Menon N, Mathrudev V, Bhattacharjee A, Chandrasekharan A, Vallathol D, Dsouza H, Srinivas S, Mandal T, Chaturvedi P, Chaukar D, Pai P, Nair S, Thiagrajan S, Laskar S, Nawale K, Babanrao Dhumal S, Tambe R, Banavali S, Prabhash K. RMAC study: A randomized study for evaluation of metronomic adjuvant chemotherapy in recurrent head and neck cancers post salvage surgical resection in those who are ineligible for re-irradiation. Oral Oncol 2022; 128:105816. [DOI: 10.1016/j.oraloncology.2022.105816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
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Dhanawat A, Noronha V, Ramaswamy A, Gattani S, Castelino R, Dhekale R, Mahajan S, Patil V, Menon N, Daptardar A, Gota V, Banavali S, Badwe R, Prabhash K. The prevalence of cognitive impairment in older Indian persons with cancer and brain metastases. Ecancermedicalscience 2022; 16:1372. [PMID: 35702404 PMCID: PMC9117002 DOI: 10.3332/ecancer.2022.1372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background Older patients with cancer are more vulnerable to the effects of cognitive impairment affecting their functional status, quality of life, compliance to treatment and ultimately survival. Cancer-related cognitive impairment may be due to the cancer itself or due to the treatment of cancer. There are no data regarding the prevalence of cognitive impairment in older persons with cancer and brain metastasis. Methods This retrospective analysis was conducted on a prospectively collected data set of patients who attended the geriatric oncology clinic at a tertiary care comprehensive cancer centre in India from June 2018 to July 2021. Patients aged 60 years and above with malignancy were included. Cognition was assessed with the mini-mental status examination (MMSE); the Hindi MMSE was used for illiterate patients. A score of ≤23 on the MMSE was considered abnormal. Correlation between the presence of cognitive impairment and brain metastasis was tested using the chi-square test. Results A total of 597 patients were included, of which 462 (77.4%) were male. The median age was 69 years (range: 60–100 years). All patients had solid tumours; 244 (40.9%) had lung, 189 (31.7%) had gastrointestinal and 75 (12.6%) had head and neck malignancies. Forty-one (6.9%) patients had brain metastases, of which 10 (24.4%) had solitary, 30 (73.2%) had multiple lesions and 1 (2.4%) had leptomeningeal metastases. Cognitive impairment was noted in 11 (26.8%) of the 41 patients with brain metastases and 91 (16.4%) of the 556 patients without brain metastases. There was no significant correlation between the presence of brain metastases and cognitive impairment, p = 0.086. Conclusion Older persons with cancer and brain metastases were not found to have a higher occurrence of cognitive impairment than those without brain metastases in this study. The next step is to understand whether older persons with brain metastases are at a higher risk for cognitive decline as a result of therapeutic interventions such as cranial radiotherapy and chemotherapy.
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Affiliation(s)
- Aditya Dhanawat
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Shreya Gattani
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Renita Castelino
- Department of Clinical Pharmacology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Ratan Dhekale
- Utsaah Foundation, Parel, Mumbai, Maharashtra 400012, India
| | - Sarika Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Anuradha Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Rajendra Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
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Behel V, Choughule A, Noronha V, Patil V, Menon N, Singh A, Kumar S, Kumar R, Shah S, More S, Banavali S, Chandrani P, Prabhash K. Clinical utility of liquid biopsy (cell-free DNA) based EGFR mutation detection post treatment initiation as a disease monitoring tool in patients with advanced EGFR-mutant NSCLC. Clin Lung Cancer 2022; 23:410-418. [DOI: 10.1016/j.cllc.2022.04.002] [Citation(s) in RCA: 1] [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] [Received: 01/19/2022] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 12/15/2022]
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Mande R, Roy Moulik N, Shet T, Narula G, Prasad M, Dhamne C, Bhat V, Cheriyalinkal Parambil B, Shah S, Shridhar E, Gujral S, Banavali S. Clinicopathologic Profile and Treatment Outcomes of Children With Diffuse Large B-cell Lymphomas: Experience From a Tertiary Cancer Center in India. J Pediatr Hematol Oncol 2022; 44:e760-e764. [PMID: 35129150 DOI: 10.1097/mph.0000000000002378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/30/2021] [Indexed: 11/25/2022]
Abstract
Clinicopathologic profile and outcome of 15 children (15 years or above) with diffuse large B-cell lymphoma treated with MCP-842 protocol are reported. Eleven of 15 presented with advanced (stage-III/IV) disease. Post-2 cycles of chemotherapy, complete metabolic and morphologic response was documented in 10 (66%) and rest 5 (33%) with partial response achieved complete metabolic remission by end of treatment. At a median follow-up of 44 months (range: 16 to 79 mo), the 3-year event-free survival and overall-survival were 77.1%±11.7% and 85.7%±9.4%, respectively. Though majority of our patients had advanced disease, outcome on MCP-842 protocol was satisfactory.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sneha Shah
- Nuclear Medicine, Tata Memorial Hospital, Parel, Mumbai, India
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Shah M, Noronha V, Ramaswamy A, Gattani S, Mokal S, Joshi A, Patil V, Menon N, Banavali S, Badwe R, Prabhash K. G8 and VES-13 as screening tools for geriatric assessment and predictors of survival in older Indian patients with cancer. J Geriatr Oncol 2022; 13:720-730. [DOI: 10.1016/j.jgo.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 12/29/2021] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
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Moulik NR, Pandey A, Chatterjee G, Dhamne C, Chichra A, Shetty D, Tembhare P, Subramanian P, Patkar N, Narula G, Banavali S. Treatment and long-term follow-up of children with Chronic Myeloid Leukemia (CML) in Chronic Phase (CP): Experience from the Tata Memorial Hospital pediatric CML cohort over 2 decades. Pediatric Hematology Oncology Journal 2022. [DOI: 10.1016/j.phoj.2022.10.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Tandon S, Khanna N, Chivate R, Dey S, Gulia A, Narula G, Shah S, Rane S, Banavali S, Laskar S. Solitary Bone Plasmacytoma of Humerus Presenting as a Nonhealing Fracture in a Child: A Rare Entity. J Pediatr Hematol Oncol 2022; 44:e233-e236. [PMID: 34654755 DOI: 10.1097/mph.0000000000002332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022]
Abstract
Solitary bone plasmacytoma is an extremely rare entity and is characterized by localized proliferation of monoclonal plasma cells. Plasmacytomas are extremely rare in the pediatric population. The median age at diagnosis is usually the fifth or sixth decade, with axial skeleton being more commonly involved than appendicular. We hereby, report the case of a 13-year-old boy with solitary bone plasmacytoma of the right humerus. Though extremely rare in the pediatric age group, plasmacytomas may be considered as one of the remote differentials in children presenting with solitary bone tumors.
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Affiliation(s)
- Sneha Tandon
- Division of Paediatric Oncology, The Royal London Hospital, Barts Health NHS Trust, London
| | | | | | | | | | | | | | - Swapnil Rane
- Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Prabhash K, Noronha V, Rao A, Gattani S, Ramaswamy A, Kumar A, Kumar S, Castelino R, Dhekale R, Krishnamurthy J, Pawar A, Mahajan S, Daptardar A, Sonsukare L, Deodhar J, Ansari N, Vagal M, Gota V, Banavali S, Badwe R. Impact of the geriatric assessment on cancer-directed systemic therapy in older Indian persons with cancer: An observational study. Cancer Res Stat Treat 2022. [DOI: 10.4103/crst.crst_298_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Prabhash K, Rao A, Kumar S, Dhekale R, Krishnamurthy J, Mahajan S, Daptardar A, Ramaswamy A, Noronha V, Gota V, Banavali S. Timed Up and Go as a predictor of mortality in older Indian patients with cancer: An observational study. Cancer Res Stat Treat 2022. [DOI: 10.4103/crst.crst_79_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ramaswamy A, Gattani S, Noronha V, Castelino R, Kumar S, Rao A, Dhekale R, Krishnamurthy J, Kannan S, Gota V, Prabhash K, Banavali S, Badwe R. ECOG performance status as a representative of deficits in older Indian patients with cancer: A cross-sectional analysis from a large cohort study. Cancer Res Stat Treat 2022. [DOI: 10.4103/crst.crst_127_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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45
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Keerthivasagam S, Roy Moulik N, Pandey A, Gala K, Patil V, Dhamne C, Chatterjee G, Patkar N, Narula G, Banavali S. Imatinib-induced retroperitoneal fibrosis in a child with chronic myeloid leukemia: a case report. Am J Blood Res 2021; 11:600-604. [PMID: 35103114 PMCID: PMC8784644] [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: 06/15/2021] [Accepted: 11/17/2021] [Indexed: 06/14/2023]
Abstract
A 12 year old boy with chronic myeloid leukemia (CML) presenting with bilateral pitting pedal edema and abdominal distension after about 41 months of imatinib therapy and was diagnosed to have retroperitoneal fibrosis (RPF) based on imaging and biopsy findings. He was found to have bilateral hydroureteronephrosis needing double-J stenting to the more severely affected right ureter. Imatinib was briefly interrupted and restarted later due to rising transcript levels and unavailability of other alternatives at that time which was later substituted by dasatinib once generic versions became available. Child remains asymptomatic after 18 months of DJ stenting. RPF is a rare complication of imatinib this being the second case reported in the literature.
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Affiliation(s)
| | | | - Ankita Pandey
- Tata Memorial Centre, Homi Bhaba National Instituite Mumbai, India
| | - Kunal Gala
- Tata Memorial Centre, Homi Bhaba National Instituite Mumbai, India
| | - Vasundhara Patil
- Tata Memorial Centre, Homi Bhaba National Instituite Mumbai, India
| | - Chetan Dhamne
- Tata Memorial Centre, Homi Bhaba National Instituite Mumbai, India
| | | | - Nikhil Patkar
- Tata Memorial Centre, Homi Bhaba National Instituite Mumbai, India
| | - Gaurav Narula
- Tata Memorial Centre, Homi Bhaba National Instituite Mumbai, India
| | - Shripad Banavali
- Tata Memorial Centre, Homi Bhaba National Instituite Mumbai, India
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Noronha V, Gattani S, Ramaswamy A, Castelino R, Dhekle R, Krishnamurthy J, Gota V, Banavali S, Badwe R, Prabhash K. Patients’ expectations from therapy and disclosure of diagnosis/ prognosis in older adults with cancer: A retrospective cohort study. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bajpai J, Abraham G, Saklani AP, Agarwal A, Das S, Chatterjee A, Kapoor A, Eaga P, Mondal PK, Chandrasekharan A, Bhargava PG, Srinivas S, Turkar S, Rekhi B, Khanna N, Janu AK, Bal M, Ostwal VS, Ramaswamy A, Rohila J, Desouza AL, Guha A, Kumar R, Menon NS, Rath S, Patil VM, Noronha VM, Joshi AP, Laskar S, Rangarajan V, Prabhash K, Gupta S, Banavali S. Demographics, Pattern of Care, and Outcome Analysis of Malignant Melanomas - Experience From a Tertiary Cancer Centre in India. Front Oncol 2021; 11:710585. [PMID: 34568037 PMCID: PMC8456006 DOI: 10.3389/fonc.2021.710585] [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: 05/16/2021] [Accepted: 07/30/2021] [Indexed: 12/19/2022] Open
Abstract
Background Treatment of malignant melanoma has undergone a paradigm shift with the advent of immune checkpoint inhibitors (ICI) and targeted therapies. However, access to ICI is limited in low-middle income countries (LMICs). Patients and Methods Histologically confirmed malignant melanoma cases registered from 2013 to 2019 were analysed for pattern of care, safety, and efficacy of systemic therapies (ST). Results There were 659 patients with a median age of 53 (range 44–63) years; 58.9% were males; 55.2% were mucosal melanomas. Most common primary sites were extremities (36.6%) and anorectum (31.4%). Nearly 10.8% of the metastatic cohort were BRAF mutated. Among 368 non-metastatic patients (172 prior treated, 185 de novo, and 11 unresectable), with a median follow-up of 26 months (0–83 months), median EFS and OS were 29.5 (95% CI: 22–40) and 33.3 (95% CI: 29.5–41.2) months, respectively. In the metastatic cohort, with a median follow up of 24 (0–85) months, the median EFS for BSC was 3.1 (95% CI 1.9–4.8) months versus 3.98 (95% CI 3.2–4.7) months with any ST (HR: 0.69, 95% CI: 0.52–0.92; P = 0.011). The median OS was 3.9 (95% CI 3.3–6.4) months for BSC alone versus 12.0 (95% CI 10.5–15.1) months in any ST (HR: 0.38, 95% CI: 0.28–0.50; P < 0.001). The disease control rate was 51.55%. Commonest grade 3–4 toxicity was anemia with chemotherapy (9.5%) and ICI (8.8%). In multivariate analysis, any ST received had a better prognostic impact in the metastatic cohort. Conclusions Large real-world data reflects the treatment patterns adopted in LMIC for melanomas and poor access to expensive, standard of care therapies. Other systemic therapies provide meaningful clinical benefit and are worth exploring especially when the standard therapies are challenging to administer.
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Affiliation(s)
- Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - George Abraham
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Avanish P Saklani
- Department of Surgical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Anshul Agarwal
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Sashanka Das
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Ambarish Chatterjee
- Department of Surgical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Akhil Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Prathyusha Eaga
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Pradip Kumar Mondal
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Arun Chandrasekharan
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | | | - Sujay Srinivas
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Siddharth Turkar
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Amit Kumar Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Munita Bal
- Department of Surgical Pathology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Vikas Sureshchand Ostwal
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Jitender Rohila
- Department of Surgical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Ashwin L Desouza
- Department of Surgical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Amrita Guha
- Department of Radiodiagnosis, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Rajiv Kumar
- Department of Surgical Pathology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Nandini Sharrel Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Sushmita Rath
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Vanita Maria Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Amit Prakashchandra Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Homibhabha National Institute, Mumbai, India
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Chatterjee G, Sriram H, Ghogale S, Deshpande N, Khanka T, Girase K, Verma S, Arolkar G, Dasgupta N, Narula G, Shetty D, Dhamne C, Moulik NR, Rajpal S, Patkar NV, Banavali S, Gujral S, Subramanian PG, Tembhare PR. Mimics and artefacts of measurable residual disease in a highly sensitive multicolour flow cytometry assay for B-lymphoblastic leukaemia/lymphoma: critical consideration for analysis of measurable residual disease. Br J Haematol 2021; 196:374-379. [PMID: 34476808 DOI: 10.1111/bjh.17801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/13/2021] [Indexed: 01/08/2023]
Abstract
High-sensitivity multicolour flow cytometry (MFC)-based B-lymphoblastic leukaemia (B-ALL) measurable residual disease (BMRD) assay is increasingly being used in clinical practice. Herein, we describe six consistently present low-level populations immunophenotypically mimicking abnormal B-ALL blasts in 441 BMRD samples from 301 children. These included CD19+ CD123+ plasmacytoid dendritic cells differentiating from lymphoid precursors, CD10+ transitional B cells with CD10+ /CD38dim-to-negative/CD20bright/CD45bright phenotype, CD19+ natural killer (NK) cells, CD73bright/CD10+ mesenchymal stromal/stem cells, CD73bright/CD34+ endothelial cells, and a CD34+ CD38dim-to-negative/CD10- /CD20bright/CD45bright subset of mature B cells. We provide the proportions, comprehensive immunophenotype, and practical clues for proper identification of these low-level populations. Knowledge regarding the presence and immunophenotype of these mimics is essential for accurate interpretation in high-sensitivity MFC-BMRD analysis.
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Affiliation(s)
- Gaurav Chatterjee
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Harshini Sriram
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Sitaram Ghogale
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Nilesh Deshpande
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Twinkle Khanka
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Karishma Girase
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Shefali Verma
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Gauri Arolkar
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Niharika Dasgupta
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Hospital, Tata Memorial Centre, HBNI University, Mumbai, India
| | - Dhanalaxmi Shetty
- Department of Cancer Cytogenetics, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Chetan Dhamne
- Department of Pediatric Oncology, Tata Memorial Hospital, Tata Memorial Centre, HBNI University, Mumbai, India
| | - Nirmalya R Moulik
- Department of Pediatric Oncology, Tata Memorial Hospital, Tata Memorial Centre, HBNI University, Mumbai, India
| | - Sweta Rajpal
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Nikhil V Patkar
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Hospital, Tata Memorial Centre, HBNI University, Mumbai, India
| | - Sumeet Gujral
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Papagudi G Subramanian
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
| | - Prashant R Tembhare
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, HBNI University, Navi Mumbai, India
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Gattani S, Noronha V, Castelino R, Dhekle R, Mahajan S, Daptardar A, Menon N, Patil V, Gota V, Banavali S, Prabhash K. 1705P The correlation of the ECOG performance status with vulnerabilities in the geriatric assessment: A retrospective cohort study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Prasad M, Tandon S, Gala R, Kannan S, Chinnaswamy G, Narula G, Vora T, Banavali S, Mehta S, Paradkar A, Goswami S, Ghadge M, Jagiasi D, Sharma S, Fernandes L, Manglani M, Jadhav A, Barr R, Ladas E. Efficacy of ready-to-use therapeutic food in malnourished children with cancer: Results of a randomized, open-label phase 3 trial. Pediatr Blood Cancer 2021; 68:e29197. [PMID: 34212474 DOI: 10.1002/pbc.29197] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The adverse influence of undernutrition in children with cancer may be remediated by early nutritional intervention. This study assessed the efficacy of ready-to-use therapeutic food (RUTF) in improving nutritional status and reducing treatment-related toxicities (TRTs) in such children. METHODS In a randomized controlled phase-3 open-label trial, severely and moderately undernourished children with cancer were randomized 1:1 to receive standard nutritional therapy (SNT) or SNT+RUTF for 6 weeks. The primary outcome (weight gain >10%) and secondary outcomes (improved/maintained nutritional status, improved body composition) were assessed after 6 weeks. TRTs were assessed over 6 months. RESULTS Between July 2015 and March 2018, 260 subjects were enrolled, 126 were analyzable in both arms at 6 weeks. More children on RUTF had weight gain (98 [77.8%] vs. 81 [64.2%], p = .025) with a greater increase in fat mass as a percentage of body mass (median 2% [IQR -0.12 to 4.9] vs. 0.5% [IQR -1.45 to 2.27, p = .005]) but a greater loss of lean mass (median -1.86% [IQR -4.4 to 0.50] vs. -0.4% [IQR -2.4 to 1.4, p = .007]) compared to the SNT arm. Fewer subjects on the RUTF arm had episodes of severe infection (10.6% vs. 31%, p < .0001), treatment delays (17.7% vs. 39%, p < .0001), and severe mucositis (11% vs. 23.8%, p = .006) compared to the SNT arm. The odds of developing TRTs on the RUTF arm were lower even after adjusting for improvement in nutritional status. CONCLUSIONS RUTF is efficacious in improving weight gain and nutritional status in undernourished children with cancer and decreases TRTs. Incorporating RUTF into a healthy, balanced diet should be considered in undernourished children with cancer.
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Affiliation(s)
- Maya Prasad
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Sneha Tandon
- Division of Paediatric Oncology, Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rajul Gala
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sadhna Kannan
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Biostatistics, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Gaurav Narula
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Tushar Vora
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Shripad Banavali
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Medical Oncology, Tata Memorial Centre Parel, Mumbai, Maharashtra, India
| | - Shaesta Mehta
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Digestive Disease and Clinical Nutrition, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Amey Paradkar
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Savita Goswami
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Psycho-Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Meera Ghadge
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Biochemistry, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Sujata Sharma
- Department of Pediatrics, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Lavina Fernandes
- Department of Pediatrics and Nutrition Rehabilitation Research and Training Centre, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Mamta Manglani
- Paediatric Haematoology Oncology, Comprehensive Thalassemia Care and Bone Marrow Transplant Centre, Mumbai, Maharashtra, India
| | - Alka Jadhav
- Department of Pediatrics and Nutrition Rehabilitation Research and Training Centre, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Ronald Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elena Ladas
- Division of Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
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