Bendamustine in combination with ifosfamide, etoposide, and vinorelbine (VIBE) is an effective salvage regimen for heavily pre-treated patients with relapsed or refractory Hodgkin lymphoma: a single-center experience

Gaurav Prakash,Arihant Jain,Kamalkant Sahu,Amanjit Bal,Charanpreet Singh,Rajender Basher,Harmandeep Singh,Kundan Mishra,Aditya Jandial,Deepesh Lad,Alka Khadwal,Radhika Srinivasan,Ashim Das,Neelam Varm 대한혈액학회 2021 Blood Research Vol.56 No.3

Background This study evaluated the outcomes of patients with refractory/relapsed Hodgkin lymphoma (RRHL) treated with a bendamustine-based regimen in combination with ifosfamide, etoposide, and vinorelbine (VIBE). Methods Consecutive RRHL patients who were treated with the VIBE regimen were identified and studied for clinicopathologic characteristics, response to VIBE regimen, event-free survival (EFS), and feasibility of an autologous stem-cell transplant (autoSCT). Results In total, 24 patients received the VIBE regimen, and a median of 3 cycles were administered. In this cohort, 80% of the patients had received ≥2 prior lines of therapy. The overall and complete response rates with VIBE were 79% and 42%, respectively. After a median follow-up (following VIBE regimen) of 14 months (range, 3‒76), the 3-year EFS and OS were 46% and 74%, respectively. Of the eligible patients, 92% underwent successful AutoSCT. The mean CD34+ cell count in the autograft was 5.5×106 /kg (SD 2.07). Neutropenia was the commonest hematologic toxicity and it was observed in 42% of the patients. However, only 9% of the patients developed grade III/IV febrile neutropenia. Chemotherapy-induced nausea and vomiting were the second most common grade III/IV toxicities in our cohort of patients. Conclusion In this retrospective analysis, the combination regimen, VIBE, has shown good efficacy in heavily pre-treated patients with RRHL without compromising stem cell collection. These encouraging results provide a rationale for further development of this regimen.

Energy management in multi stage evaporator through a steady and dynamic state analysis

Om Prakash Verma,Gaurav Manik,Toufiq Haji Mohammed 한국화학공학회 2017 Korean Journal of Chemical Engineering Vol.34 No.10

Increasing energy demand, high cost of energy and global warming issues across the globe require energyintensive industries, such as paper mills to improve energy efficiency. Multi-stage evaporators used to concentrate the black liquor in such mills form its most energy consuming unit and require a strong understanding of steady and unsteady state behavior to ensure energy savings. The modeling of nonlinear heptads’ effect system yielded a set of complex nonlinear algebraic and differential equations that are analyzed using Interior-point method and state space representation. Dynamic response of product concentration and system vapor temperatures along with system stability and controllability have been explored by disturbing the flow rate, concentration and temperature of feed, and fresh steam flow rate. Simulations predict that steam flow rate, feed flow rate and its concentration invariably are major controlling factors (in decreasing order) of vapor temperature and product concentration. The interactive behavior between different effects translates into slower responses of the effects with increasing separation from disturbance source. This steady state and transient study opens many new explanations to this relatively less explored area and helps to propose and implement industrial PID controllers to reduce steam consumption and control product quality.

Combinatorial and geometric optimization of a parabolic trough solar collector

Anubhav Goel,Gaurav Manik,Om Prakash Verma 한국화학공학회 2022 Korean Journal of Chemical Engineering Vol.39 No.2

The current investigation reveals the need for combinatorial and geometric optimization for parabolic trough solar collectors (PTSCs) and proposes methods to perform them. An analytical model of PTSC was drafted, which emerged to be quite accurate when exhaustively validated using experimental results. The analysis reveals that superior properties of design components (solar selective absorber coatings (SSACs), heat transfer fluids (HTFs), etc.) cannot guarantee better performance, as there are many interacting factors. Also, a particular combination of components can perform better at a certain temperature while lagging at another. To acquire an optimal combination of components, combinatorial optimization is introduced and carried out for PTSCs, using genetic algorithm (GA). Six SSACs, three absorber materials, and five HTFs are considered, significant efficiency improvements of 8% at 150 oC and 6% at 300 oC are observed. This study discloses that geometrical parameters (length and width of collector, focal length, etc.) possess positive as well negative impacts on efficiency. By varying these in a reasonable range, optimal values that lead to improved efficiency can be obtained. Particle swarm optimization (PSO) is used to attain this geometric optimization, and improvement of 3% in efficiency is noticed by only ±5% variation in dimensions.

A weeping ulcer that vanished with a 'SMILE'

Ankur Jain,Gaurav Prakash,Amanjit Bal,Pankaj Malhotra,Subhash Varma 대한혈액학회 2018 Blood Research Vol.53 No.1

Comparison of propofol alone and in combination with ketamine or fentanyl for sedation in endoscopic ultrasonography

Shweta A Singh,Kelika Prakash,Sandeep Sharma,Gaurav Dhakate,Vikram Bhatia 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.1

Background: We evaluated whether the addition of a small dose of ketamine or fentanyl would lead to a reduction in the total dose of propofol consumed without compromising the safety and recovery of patients having endoscopic ultrasonography (EUS). Methods: A total of 210 adult patients undergoing elective EUS under sedation were included in the study. Patients were randomized into three groups. Patients were premedicated intravenously with normal saline in group 1, 50 μg fentanyl in group 2, and 0.5 mg/kg ketamine in group 3. All patients received intravenous propofol for sedation. Propofol consumption in mg/kg/h was noted. The incidence of hypotension, bradycardia, desaturation, and coughing was noted. The time to achieve a Post Anesthesia Discharge Score (PADS) of 10 was also noted. Results: There were 68 patients in group 1, 70 in group 2, and 72 in group 3. The amount of propofol consumed was significantly higher in group 1 (9.25 [7.3–13.2]) than in group 2 (8.8 [6.8–12.2]) and group 3 (7.6 [5.7–9.8]). Patient hemodynamics and oxygenation were well maintained and comparable in all groups. The time to achieve a PADS of 10 was significantly higher in group 3 compared to the other two groups. Conclusions: The use of 50 μg fentanyl or 0.5 mg/kg ketamine in a single dose during EUS reduces the dose of propofol required for sedation. However, unlike the addition of fentanyl, the addition of ketamine increased the time to recovery. Thus, 50 μg fentanyl is a good additive to propofol infusion for sedation during EUS to reduce the requirement for propofol without affecting the time to recovery.

Electronic structure of the PLD grown mixed phase MoS2/GaN interface and its thermal annealing effect

Arun Barvat,Nisha Prakash,Gaurav Kumar,Dilip K. Singh,Anjana Dogra,Suraj P. Khanna,Prabir Pal 한국물리학회 2018 Current Applied Physics Vol.18 No.2

We report the electronic structure of Molybdenum disulfide (MoS2) ultrathin 2D films grown by pulsed laser deposition (PLD) on top of GaN/c-Al2O3 (0001) substrates annealed up to 550 C in an ultrahigh vacuum. Our X-ray photoemission spectroscopy (XPS) study shows that the grown films are mixed phase character with semiconducting 2H and metallic 1T phases. After ultrahigh vacuum (UHV) annealing, the 1T/2H phase ratio is significantly modified and film-substrate bonding becomes the leading factor influencing variation of mixed phase compositions. The semiconducting phase is partially transformed to metallic phase by thermal annealing; suggesting that the metallic phase observed here may indeed have more stability compared to the semiconducting phase. The notable enhancement of the 1T/2H ratio induces significant changes in Ga 3d core level spectra taken from bare GaN and MoS2/GaN sample. The impact of S and/or Mo atoms on the Ga core level spectra is further pronounced with the thermal annealing of grown films. The analysis shows that an enhancement of 1T metallic phase with thermal annealing in MoS2 layers is manifested by the occurrence of new spectral component in the Ga 3d core level spectra with the formation of Ga-S adlayer interaction through the Ga bonding in defect assisted GaN structure.

Epitrochlear lymphadenopathy

( Ashok Kumar Pannu ),( Gaurav Prakash ),( Aditya Jandial ),( Chirag Rajkumar Kopp ),( Savita Kumari ) 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.6

Comparable outcomes with low-dose and standard-dose horse anti-thymocyte globulin in the treatment of severe aplastic anemia

Arihant Jain,Aditya Jandial,Thenmozhi Mani,Kamal Kishore,Charanpreet Singh,Deepesh Lad,Gaurav Prakash,Alka Khadwal,Reena Das,Neelam Varma,Subhash Varma,Pankaj Malhotra 대한혈액학회 2024 Blood Research Vol.59 No.1

Background The standard dose (SD) of horse anti-thymocyte globulin (hATG) ATGAM (Pfizer, USA) or its biosimilar thymogam (Bharat Serum, India) for the treatment of Aplastic Anemia (AA) is 40 mg/kg/day for 4 days in combination with cyclosporine. Data on the impact of hATG dose on long-term outcomes are limited. Here, we describe our comparative experience using 25 mg/kg/day (low-dose [LD]) hATG for 4 days with SD for the treatment of AA. Methods We retrospectively studied patients with AA (age > 12 years) who received two doses of hATG combined with cyclosporine. Among 93 AA patients who received hATG, 62 (66.7%) and 31 (33.3%) patients received LD and SD hATG with cyclosporine, respectively. Among these,seventeen(18.2%) patients also received eltrombopag with hATG and cyclosporine. Overall response rates [complete response (CR) and partial response (PR)] of LD and SD hATG groups at 3 months (50% vs. 48.4%; p = 0.88), 6 months (63.8% vs. 71.4%; p = 0.67), and 12 months (69.6% vs. 79.2%; p = 0.167) were comparable. The mean (Standard Deviation) 5-year Kaplan–Meier estimate of overall survival and event-free survival was 82.1 (4.6)% and 70.9 (5.5)% for the study population. The mean (standard deviation) 5-year Kaplan–Meier estimate of overall survival and event-free survival of those who received LD hATG versus SD hATG dose was 82.9 (5·3)% versus 74.8 (10·3)% (P = 0·439), and 75.2 (6.2)% versus 61.4(11.2)% (P = 0·441). Conclusion Our study revealed that the response rates of patients with AA and LD were similar to those of patients with SD to hATG combined with cyclosporine in a real-world setting.

The Diagnostic Dilemma of Neurolymphomatosis

Ritu Shree,Manoj Kumar Goyal,Manish Modi,Balan Louis Gaspar,Bishan Dass Radotra,Chirag Kamal Ahuja,Bhagwant Rai Mittal,Gaurav Prakash 대한신경과학회 2016 Journal of Clinical Neurology Vol.12 No.3

Neurolymphomatosis (NL) defned as infltration of the central nervous system or the peripheral nervous system (PNS) by malignant lymphoma cells is a rare clinical entity. However, the increasing use of fuorodeoxyglucose positron-emission tomography (FDG-PET) and magnetic resonance imaging in evaluating PNS disorders is resulting in; this condition being recognized more frequently. Here; we report fve NL patients and review the current literature. We report five patients with non-Hodgkin’s lymphoma (NHL) and NL, all of whom were men aged 47–69 years. Te clinical presentation varied from symmetrical peripheral neuropathy to mononeuropathy. Peripheral neuropathy was the presenting manifestation of a systemic lymphoma in two patients (40%). Neuroimaging as well as whole-body FDG-PET helped in determining the correct diagnosis in all of the patients. NL is an unusual presentation of NHL resulting from infltration of the PNS by malignant lymphomatous cells. While evaluating peripheral neuropathy, a high degree of suspicion of NL is required since the presenting symptoms vary, conventional radiology has only modest sensitivity, and a pathological diagnosis is ofen difcult. FDG-PET helps in the early diagnosis and treatment of this condition.

Plasma cell leukemia in North India: retrospective analysis of a distinct clinicohematological entity from a tertiary care center and review of literature

Karthik Bommannan,Man Updesh Singh Sachdeva,Pankaj Malhotra,Narender Kumar,Prashant Sharma,Shano Naseem,Jasmina Ahluwalia,Reena Das,Neelam Varma,Gaurav Prakash,Alka Khadwal,Radhika Srinivasan,Subhash 대한혈액학회 2016 Blood Research Vol.51 No.1

BackgroundPlasma cell leukemia (PCL) is a rare and aggressive plasma cell neoplasm. In PCL, clonal plasma cells comprise ≥20% of the peripheral blood (PB) leukocytes and/or the absolute clonal PB plasma cell count is ≥2×109/L. Primary PCL (PPCL) originates de novo, whereas, secondary PCL (SPCL) evolves from pre-existing multiple myeloma.MethodsClinicohematological features, immunophenotypic profile, and survival of PCL patients were analyzed retrospectively.ResultsBetween January 2007 and December 2014, ten PPCL and four SPCL patients were inves-tigated (8 PPCLs and 3 SPCLs had complete clinical data). All were North Indians, sharing common geography and ethnicity. Our cohort showed less frequent renal failure, more frequent hepatomegaly, and non-secretory type disease. In contrast to western literature, flow cytometric immunophenotyping of our cohort revealed altered expression of CD138 (67%), CD56 (33%), and CD20 (0%). With novel therapeutic agents, these PPCL patients had a median overall survival of 15 months.ConclusionWe highlight that our PPCL patients from North India had distinct clinicohematological and immunophenotypic profiles. The significance of our findings must be tested in a larger patient cohort and must be supported by molecular and cytogenetic investigations to un-mask possible significant effects on pathogenesis.