FACTORS AFFECTING INITIAL CYCLOSPORINE A LEVEL AND ITS CORRELATION WITH CLINI...Alok Gupta
FACTORS AFFECTING INITIAL CYCLOSPORINE A LEVEL AND ITS CORRELATION WITH CLINICAL OUTCOME INACUTE LEUKEMIA PATIENTS UNDERGOING ALLOGENEIC STEM CELL TRANSPLANTATION
Hepatitis B infection in Stem cell transplant patients and role of lamivudine...Alok Gupta
The presentation describes Hepatitis B infection in Stem cell transplant patients and role of lamivudine prophylaxis in prevention.
The presentation was made at annual meeting of Mumbai Hematology Group held at ACTREC, Mumbai in 2014.
Describes the changes made over years in the management of advanced renal cell carcinoma with special focus on re-empowering of the concept of immunotherapy
FACTORS AFFECTING INITIAL CYCLOSPORINE A LEVEL AND ITS CORRELATION WITH CLINI...Alok Gupta
FACTORS AFFECTING INITIAL CYCLOSPORINE A LEVEL AND ITS CORRELATION WITH CLINICAL OUTCOME INACUTE LEUKEMIA PATIENTS UNDERGOING ALLOGENEIC STEM CELL TRANSPLANTATION
Hepatitis B infection in Stem cell transplant patients and role of lamivudine...Alok Gupta
The presentation describes Hepatitis B infection in Stem cell transplant patients and role of lamivudine prophylaxis in prevention.
The presentation was made at annual meeting of Mumbai Hematology Group held at ACTREC, Mumbai in 2014.
Describes the changes made over years in the management of advanced renal cell carcinoma with special focus on re-empowering of the concept of immunotherapy
Join Dr. Emily Chan presentation on the latest research and treatments for colorectal cancer patients presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.
Enhancing MRD Testing in Hematologic Malignancies: When Negativity is a Posit...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This expert CME-approved slide deck, presented by Noopur Raje, MD, Director of the Center for Multiple Myeloma at Massachusetts General Cancer Center, will explore the current and emerging roles of MRD testing in hematologic malignancies. She presents the ongoing questions and latest data regarding the clinical utility of MRD testing in prognosis and treatment.
STATEMENT OF NEED
Measurable residual disease (MRD) is defined as the persistence of cancer cells at levels below morphologic detection after treatment. For patients with hematologic malignancies, MRD testing is increasingly being used to predict disease progression, monitor disease status, and evaluate treatment options (Dekker et al, 2023). Questions about current and future roles of MRD testing abound, including validation of assays, such as next-generation sequencing, machine learning, and flow cytometry; standardization of collection methods and modalities; considerations for clinical trial design and statistical analyses; and improved understanding of the roles of MRD status and depth of response across hematologic malignancies (Dekker et al, 2023; Baines et al, 2023). It is critical for members of the multidisciplinary cancer care team to stay up-to-date on the latest data regarding the clinical utility of MRD testing in prognosis and treatment. In this CME-approved activity, Noopur Raje, MD, Director of the Center for Multiple Myeloma at Massachusetts General Cancer Center, will explore the current and emerging roles of MRD testing in hematologic malignancies.
TARGET AUDIENCE
Medical oncologists, hematologists, pathologists, and other health care professionals involved in the treatment of patients with hematologic malignancies.
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to:
Distinguish the advantages and limitations of current MRD detection methods
Evaluate consensus recommendations on indications for MRD testing in hematologic malignancies
Explain the current and potential roles of MRD status and depth of response as a biomarker in clinical trials
Describe mechanisms of drug resistance/loss of response to BCMA-directed therapies
Assess the clinical utility of MRD in prognosis and treatment of selected hematologic malignancies, including acute lymphoblastic leukemia, chronic lymphocytic leukemia, and multiple myeloma
Recent advancement in prevention and management of GVHD.pptxroysudip900
advances in prevention of GVHD by different investigational and approved methods of graft modulating, drugs, chemotherapy, analysis of published data, improved survival, future direction. different sources of stem cell and strategies to prevent mortality and morbidity
Join Dr. Emily Chan presentation on the latest research and treatments for colorectal cancer patients presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.
Enhancing MRD Testing in Hematologic Malignancies: When Negativity is a Posit...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This expert CME-approved slide deck, presented by Noopur Raje, MD, Director of the Center for Multiple Myeloma at Massachusetts General Cancer Center, will explore the current and emerging roles of MRD testing in hematologic malignancies. She presents the ongoing questions and latest data regarding the clinical utility of MRD testing in prognosis and treatment.
STATEMENT OF NEED
Measurable residual disease (MRD) is defined as the persistence of cancer cells at levels below morphologic detection after treatment. For patients with hematologic malignancies, MRD testing is increasingly being used to predict disease progression, monitor disease status, and evaluate treatment options (Dekker et al, 2023). Questions about current and future roles of MRD testing abound, including validation of assays, such as next-generation sequencing, machine learning, and flow cytometry; standardization of collection methods and modalities; considerations for clinical trial design and statistical analyses; and improved understanding of the roles of MRD status and depth of response across hematologic malignancies (Dekker et al, 2023; Baines et al, 2023). It is critical for members of the multidisciplinary cancer care team to stay up-to-date on the latest data regarding the clinical utility of MRD testing in prognosis and treatment. In this CME-approved activity, Noopur Raje, MD, Director of the Center for Multiple Myeloma at Massachusetts General Cancer Center, will explore the current and emerging roles of MRD testing in hematologic malignancies.
TARGET AUDIENCE
Medical oncologists, hematologists, pathologists, and other health care professionals involved in the treatment of patients with hematologic malignancies.
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to:
Distinguish the advantages and limitations of current MRD detection methods
Evaluate consensus recommendations on indications for MRD testing in hematologic malignancies
Explain the current and potential roles of MRD status and depth of response as a biomarker in clinical trials
Describe mechanisms of drug resistance/loss of response to BCMA-directed therapies
Assess the clinical utility of MRD in prognosis and treatment of selected hematologic malignancies, including acute lymphoblastic leukemia, chronic lymphocytic leukemia, and multiple myeloma
Recent advancement in prevention and management of GVHD.pptxroysudip900
advances in prevention of GVHD by different investigational and approved methods of graft modulating, drugs, chemotherapy, analysis of published data, improved survival, future direction. different sources of stem cell and strategies to prevent mortality and morbidity
The presentation describes various facts about breast and cervical cancer including burden of disease, survival outcomes, need for early diagnosis and screening recommendations.
Cancer screening - Evidence, Expected benefits, Methods and Current Recommend...Alok Gupta
The presentation discusses about Cancer screening - Evidence, Expected benefits, Methods and Current Recommendations.
The was presented in HEALTH CONNECT meeting at Max Hospital, Saket, new Delhi in 2016.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
4. Known risk factors and impact on
outcomes
• Older age of patient or donor
• Female donor to male recepient
• Mismatched or unrelated donor
• PBSC versus BM
• Acute GVHD
• Malignant vs Non-malignant disorders
• Improves DFS
5. However….
• Paucity of Indian data
• Acute leukemia pts
• Impact on Overall Survival
• Infectious complications and impact on
mortality in Indian subcontinent
6. PATIENTS AND METHODS
• Single centre retrospective analysis
• All patients undergoing allo HSCT for acute
leukemia
• January 2008 – March 2013
7. • Conditioning regimen
– Full intensity (TBI-Cy or Bu-Cy)
– Reduced intensity (Fludarabine based)
• Standard GVHD prophylaxis
– CsA + MTX (CsA 1.5 mg/kg BD from D-1, MTX 15
mg/m2 D+1, 10 mg/m2 D+3, D+6, D+11)
– CsA + MMF (CsA as above, MMF 600 mg/m2 BD)
8. • Rabbit ATG
– Unrelated transplants
– Related transplants with 8/10 or 9/10 match
• Chronic GVHD
– Extensive stage
– Limited stage
9. TREATMENT OF cGVHD
• Topical steroids
– Budesonide gargles for oral GVHD
– Budesonide nebulization for lung GVHD
– Topical steroid and tacrolimus for skin GVHD
– CsA and steroid eye drops for ocular GVHD
– Oral budesonide for gut GVHD
• Additional for lung GVHD
– Azithromycin – immune modulator
– Imatinib – decrease fibrosis
– Montelukast – mast cell stabilizer
10. TREATMENT OF cGVHD
• Systemic steroids
– Visceral GVHD
– Not responding to topical steroids
• CsA or MMF – as steroid sparing agents in
patients whose GVHD flared up as steroids
were tapered or when GVHD did not respond
to steroids
11. RISK FACTORS ANALYSED
• Patient and donor age
• Diagnosis
• Gender mismatch
• Disease status at transplant
• Stem cell source
• Use of ATG
• GVHD prophylaxis
• Degree of HLA match
• CD3 and CD34 cells infused
• Acute GVHD
12. OUTCOME MEASURES
• Overall Survival
• Relapse Free Survival
• Incidence of relapse
• Slippage of chimerism
• Transplant related mortality
• Infective complications
13. STATISTICAL METHODS
• Categorical data – Chi square test
• Continuous data – Mann Whitney test
• Multivariate analysis – Logistic regression
• P values – 2 sided
• Survival analysis – Kaplan-Meier method
14. RESULTS – PATIENT CHARACTERISTICS
No of transplants 77
Median age 30 (5-61) years
Males, n (%) 52 (68%)
Diagnosis
AML
ALL
Biphenotypic leukemia
52 (67.5%)
23 (29.9%)
2 (2.6%)
Stem cell source
PBSC
Cord blood
Marrow
70 (91%)
2 (2.5%)
5 (6.5%)
Fully matched transplants 61 (79%)
15. RESULTS – INCIDENCE AND PATTERN
Incidence of cGVHD, n(%) 40 (52%)
Extensive stage
Limited stage
60%
40%
Median time to onset 5 months
Thrombocytopenia at onset 6 (15%)
De novo chronic GVHD, n(%) 19 (47%)
Systemic steroids, n(%) 23 (58%)
Median duration of steroids 5 months
16. ALL- HR- High Risk (TLC > 100 x 109 /L at baseline or poor risk cytogenetics or not achieving CR after induction or persistent disease at transplant or > CR-2 ), SR- Standard Risk (according to
cytogenetics)
AML- PR- Poor Risk (TLC > 100 x 109 /L at baseline or poor cytogenetics or not achieving CR after induction or persistent disease at transplant or > CR-2) , IR- Intermediate Risk (according to
cytogenetics), GR- Good Risk (according to cytogenetics)
NK- Not Known
M
68%
F
32%
Gender
ALL
30%
AML
67%
Biphenoty
pic
Leukemia
3%
Diagnosis
Biphenotypic Leukemia (3%)
CR1
55%CR2
26%
19%
Disease status at transplant
Relapse/Refractory
Baseline Characteristics (n = 77)
Percent
GR
IR
PR
0
20
40
60
80
100
ALL AML
4 10
74
40
22
8
42 NK
HR
SR
19. cGVHD (n=40) No cGVHD
(n=37)
P VALUE
Median age, y 29 31 0.575
Males, n(%) 28 (70%) 24 (64.9%) 0.631
Diagnosis
Acute Lymphoid Leukemia (ALL), n (%)
Acute Myeloid Leukemia (AML), n (%)
Biphenotypic leukemia, n (%)
17 (42.5%)
23 (57.5%)
0 (0)
6 (16.2%)
29 (78.4%)
2 (5.4%)
0.020
Baseline Risk*, n
Good (or standard) Risk
Intermediate Risk
Poor Risk
Not known
2
7
25
6
4
14
14
5
0.138
Relapse/Refractory disease at transplant 12.5% 27.0% 0.231
Univariate analysis of risk factors –
Patient related
ALL – Standard risk or Poor risk
20. Univariate analysis of risk factors –
donor related
cGVHD (n=40) No cGVHD
(n=37)
P VALUE
Median donor age, y 31.5 33 0.860
Gender mismatch transplant 62.5% 40.5% 0.054
Female donor to male recipient 42.5% 16.2% 0.012
ABO mismatch 20 (50%) 12 (32.4) 0.118
Stem cell source
Bone Marrow
Umbilical Cord
Peripheral blood stem cells
2 (5.0)
1 (2.5)
37 (92.5)
3 (8.1)
1 (2.7)
33 (89.2)
0.855
Degree of HLA matching
Full matched (6/6 or 10/10)
1 mismatched (5/6 or 9/10)
Haplo-identical transplant
34 (85)
6 (15)
0 (0)
27 (73.0)
5 (13.5)
5 (13.5)
0.121
21. Univariate analysis of risk factors –
transplant related
cGVHD (n=40) No cGVHD
(n=37)
P VALUE
Type of transplant, n (%)
Matched Related transplant
Matched Unrelated transplant
Haplo-indentical transplant
35 (87.5)
5 (12.5)
0 (0)
30 (81.1)
5 (13.5)
2 (5.4)
0.321
Total body irradiation used, n (%) 20 (50.0) 12 (32.4) 0.118
ATG used, n (%) 5 (12.5) 7 (18.9) 0.438
Graft versus Host disease prophylaxis, n (%)
Cyclosporine + Methotrexate
Cyclosporine + Mycophenolate mofetil
30 (75.0)
10 (25.0)
23 (62.2)
14 (37.8)
0.224
Prior acute GVHD, any grade, n (%) 21 (52.5) 13 (35.1) 0.630
Prior acute GVHD, grade II-IV, n(%) 9 (22.5%) 5 (13.5%) 0.307
CD 34 cell dose x 106/kg 5.11 5.12 0.899
CD 3 cell dose x 106/kg 147.80 177.65 0.039
22. Multivariate analysis of risk factors
Risk factors HR 95% CI P value
Diagnosis of ALL 3.977 0.997 - 15.86 0.050
Female donor to male recipient transplant 4.776 1.35 – 16.86 0.015
CD 3 cell dose infused 0.995 0.989 – 1.001 0.082
24. RELAPSE FREE SURVIVAL
MEDIAN RFS
cGVHD 37.7 months
No cGVHD 9.3 months
P <0.001
PROJECTED 3 YR RFS
cGVHD 55%
No cGVHD 29%
P = 0.021
25. OUTCOME MEASURES
cGVHD (n=40) No cGVHD (n=37) P value
Incidence of relapse 17.5% 51.4% 0.002
Slippage of
chimerism
15.0% 43.2% 0.006
Transplant related
mortality
7.5% 2.72% 0.342
26. INFECTIVE COMPLICATIONS
cGVHD (n=40) No cGVHD
(n=37)
P value
CMV reactivation, n(%) 29 (72.5%) 20 (54%) 0.09
Median no of episodes of CMV
reactivation
2 1.5 0.75
Adenoviral reactivation, n(%) 11 (27.5%) 5 (13.5%) 0.13
BKV reactivation, n(%) 7 (17.5%) 6 (16.2%) 0.88
EBV reactivation, n(%) 2 (5%) 3 (8.1%) 0.58
Fungal infections, n(%) 5 (12.5%) 6 (16.2%) 0.63
27. CONCLUSIONS
• Incidence of chronic GVHD is approximately
50% of our patients with acute leukemia
• About 60% of them have extensive cGVHD
• Occurs after a median of 5 months
• Oral cavity is the commonest site involved
30. CONCLUSIONS
• No increase in TRM in patients with chronic
GVHD
• Though CMV reactivation was somewhat
higher in those with cGVHD, there was no
increase in other infections.