Naresh Jadhav - Academia.edu (original) (raw)

Papers by Naresh Jadhav

Supportive Care in Cancer, 2019

Background Anemia is a common finding and important cause of morbidity in patients with acute lym... more Background Anemia is a common finding and important cause of morbidity in patients with acute lymphoblastic leukemia (ALL) at diagnosis or during the course of its protracted treatment. We studied profile of anemia in ALL patients on maintenance therapy and evaluated specific micronutrients as cause of this anemia. Patients and methods ALL patients who were on maintenance therapy and had grade ≥ 2 anemia were recruited for the study. Serum iron studies, folate, and vitamin B12 were done to identify micronutrient deficiency and to initiate supplementation with specific components if found to be deficient. Toxicities, improvement of anemia, micronutrient levels, and disease outcome were studied after 3 months. Results From March 2015 to September 2016, 105 ALL patients were found to be on maintenance fulfilling the inclusion criteria. Overall, the proportion of anemia was 80%(N = 84). Majority had normocytic normochromic anemia (71%). Macrocytic anemia was seen in 18% and microcytic hypochromic in 9.5%. In patients with anemia of grade ≥ 2 (N = 84), 38 patients (45%) had biochemical deficiency of serum folate, and 7 (8%) had vitamin B12 deficiency. No biochemical evidence of iron deficiency was found. Supplementation of deficient micronutrients improved anemia: mean hemoglobin significantly increased from 8.06 ± 1.63 to 10.78 ± 1.53 (p < 0.001) at 3 months; and reduced treatment toxicities, mean number of febrile neutropenia episodes (p = 0.007), and treatment interruptions of > 2 weeks (p = 0.002) were lowered. Patients with anemia had significantly more relapses (N = 14,64%) compared to patients without anemia (N = 8,36%), (p = 0.040). Conclusion Timely identification and correction of micronutrient deficiencies causing anemia in ALL patients on maintenance can enhance treatment outcomes.

Transfusion Medicine, 2019

Dear Sir, The most common toxicities for autologous stem cell transplantation (ASCT) in multiple ... more Dear Sir, The most common toxicities for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) are gastrointestinal and mucositis. Mortality is lower than 5% in well-selected patients. Engraftment syndrome (ES) is a common complication of ASCT, whereas transplant-associated thrombotic microangiopathy (TA-TMA) and hemophagocytic syndrome (HPS) are very rare, mostly occurring after allogeneic transplants, and often have a fulminant course. We describe a case of MM where the post-ASCT course was marked by ES, life-threatening TA-TMA and secondary HPS occurring concomitantly. A 55-year-old lady with MM stage IIIA received six cycles of induction chemotherapy with cyclophosphamide, bortezomib and dexamethasone (Reeder et al., 2010) and had very good partial response. In March 2017, she underwent ASCT by peripheral blood stem cell harvest performed using granulocyte-colony stimulating factor (G-CSF) mobilisation. CD34 was 2.01 × 10 6 kg −1. Melphalan was given at 200 mg m −2 on D−1.G-CSF 5 μg kg −1 was started from D+1. Antibiotics were added on D+2 for febrile neutropenia and changed to meropenem, linezolid and liposomal amphotericin B for recurrent fever on D+8. Work-up for infection was negative. She developed grade 2 mucositis and diarrhoea. Neutrophil engrafted on D+10, and the platelet count was 20 × 10 9 L −1 with support. On D+11, fever recurred, with worsening of diarrhoea, weight gain (4% of baseline), mild dyspnoea, no skin rashes, new chest infiltrates and elevated creatinine and bilirubin over the next 48 h. Repeat work-up for infection was negative. ES was diagnosed, and G-CSF was discontinued. Diuretics and steroids (prednisone-1 mg kg −1 day −1 for 5 days) were initiated, colistin was added, and supportive treatment continued, to which she showed initial response. From D+17 to D+21, she deteriorated with recurring high fever, worsening diarrhoea, dyspnoea, tachypnoea, tachycardia, mild hypertension initially, mild gum/oral bleeding, persistent thrombocytopenia even with support, declining leucocyte count, anaemia, rising bilirubin and an episode of haemoptysis, haematuria and hypotension on D+21. Inotropes were initiated with the continuation of antibiotics and antifungals (liposomal amphotericin B), and steroids were restarted. Non-invasive ventilator (NIV) support was required

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 17, 2018

Beta lactams are standard empirical therapy for febrile neutropenia (FN). The aim of this study w... more Beta lactams are standard empirical therapy for febrile neutropenia (FN). The aim of this study was to evaluate the efficacy and safety of cefepime monotherapy compared with cefoperazone/sulbactam plus amikacin (CS + A) for empirical treatment of high risk FN. One hundred seventy-five patients with 336 FN episodes were randomized to receive either cefepime (2 g q8h for adults and 50 mg/kg q8h for children) or CS (2 g q8h for adults and 50 mg/kg q8h for children) plus amikacin (15 mg/kg once a day). Positive response was defined as afebrile within 72 h of starting antibiotics, persistent afebrile status more than 48 h and no requirement of second-line antibiotics and antifungal agents. Three hundred thirty-six episodes were assessable for efficacy (168 cefepime, 168 CS + A). The positive response to antibiotics was identical for cefepime (53%) and CS + A (53%). Positive response was similar in MDI (microbiologically documented infection), 50 vs. 35% (p = 0.248), CDI (clinically docum...

Cureus, 2017

The radiation recall dermatitis (RRD) phenomenon is defined as the "recalling" of the skin follow... more The radiation recall dermatitis (RRD) phenomenon is defined as the "recalling" of the skin following the administration of drugs; this induces a response or flare-like reaction over the skin that is exposed to radiation. In this case report, a young female developed RRD on Day 18 after the completion of cranial radiotherapy, that is, four days after the restart of the chemotherapy with doxorubicin. It is a self-limiting condition with supportive care as the treatment. When encountered in hematological malignancies, undue treatment breaks can delay definitive treatment and can eventually cause a relapse.

Indian Journal of Hematology and Blood Transfusion, 2020

The study aimed at identifying the profile of gut colonization of patients with acute leukemia wh... more The study aimed at identifying the profile of gut colonization of patients with acute leukemia who underwent induction chemotherapy and its association with induction events and outcome. Baseline bacterial stool culture with resistance pattern of isolates were recorded. Multi-drug resistance was defined as resistance to at least two antibiotic classes including beta lactam and fluoroquinolones. During induction chemotherapy, blood and clinically indicated cultures were taken during febrile neutropenic episodes. Association studies were done between gut colonization and induction events/outcome. Among 109 patients enrolled, 71 (65.13%) patients undergoing induction chemotherapy were colonized with bacteria, with nearly 50% of colonizers harboring multidrug resistant bacteria. Organisms isolated from stool preinduction were mostly gram negative (98%), with Escherichia coli and Klebsiella pneumoniae being the commonest. 65.13% patients developed febrile neutropenia. Overall multi-drug resistant positivity during febrile neutropenia was 70.14%. Concordance of 8.45% was observed between isolates from stool and organisms isolated from cultures during febrile neutropenia. There were significant proportion of gut colonized gram-negative multi-drug resistance bacteria among patients with acute leukemia. There was a low concordance rate between baseline stool isolates and subsequent cultures during the induction. There was no significant association between gut colonization and induction events/outcomes studied.

Supportive Care in Cancer, 2019

Background Anemia is a common finding and important cause of morbidity in patients with acute lym... more Background Anemia is a common finding and important cause of morbidity in patients with acute lymphoblastic leukemia (ALL) at diagnosis or during the course of its protracted treatment. We studied profile of anemia in ALL patients on maintenance therapy and evaluated specific micronutrients as cause of this anemia. Patients and methods ALL patients who were on maintenance therapy and had grade ≥ 2 anemia were recruited for the study. Serum iron studies, folate, and vitamin B12 were done to identify micronutrient deficiency and to initiate supplementation with specific components if found to be deficient. Toxicities, improvement of anemia, micronutrient levels, and disease outcome were studied after 3 months. Results From March 2015 to September 2016, 105 ALL patients were found to be on maintenance fulfilling the inclusion criteria. Overall, the proportion of anemia was 80%(N = 84). Majority had normocytic normochromic anemia (71%). Macrocytic anemia was seen in 18% and microcytic hypochromic in 9.5%. In patients with anemia of grade ≥ 2 (N = 84), 38 patients (45%) had biochemical deficiency of serum folate, and 7 (8%) had vitamin B12 deficiency. No biochemical evidence of iron deficiency was found. Supplementation of deficient micronutrients improved anemia: mean hemoglobin significantly increased from 8.06 ± 1.63 to 10.78 ± 1.53 (p < 0.001) at 3 months; and reduced treatment toxicities, mean number of febrile neutropenia episodes (p = 0.007), and treatment interruptions of > 2 weeks (p = 0.002) were lowered. Patients with anemia had significantly more relapses (N = 14,64%) compared to patients without anemia (N = 8,36%), (p = 0.040). Conclusion Timely identification and correction of micronutrient deficiencies causing anemia in ALL patients on maintenance can enhance treatment outcomes.

Transfusion Medicine, 2019

Dear Sir, The most common toxicities for autologous stem cell transplantation (ASCT) in multiple ... more Dear Sir, The most common toxicities for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) are gastrointestinal and mucositis. Mortality is lower than 5% in well-selected patients. Engraftment syndrome (ES) is a common complication of ASCT, whereas transplant-associated thrombotic microangiopathy (TA-TMA) and hemophagocytic syndrome (HPS) are very rare, mostly occurring after allogeneic transplants, and often have a fulminant course. We describe a case of MM where the post-ASCT course was marked by ES, life-threatening TA-TMA and secondary HPS occurring concomitantly. A 55-year-old lady with MM stage IIIA received six cycles of induction chemotherapy with cyclophosphamide, bortezomib and dexamethasone (Reeder et al., 2010) and had very good partial response. In March 2017, she underwent ASCT by peripheral blood stem cell harvest performed using granulocyte-colony stimulating factor (G-CSF) mobilisation. CD34 was 2.01 × 10 6 kg −1. Melphalan was given at 200 mg m −2 on D−1.G-CSF 5 μg kg −1 was started from D+1. Antibiotics were added on D+2 for febrile neutropenia and changed to meropenem, linezolid and liposomal amphotericin B for recurrent fever on D+8. Work-up for infection was negative. She developed grade 2 mucositis and diarrhoea. Neutrophil engrafted on D+10, and the platelet count was 20 × 10 9 L −1 with support. On D+11, fever recurred, with worsening of diarrhoea, weight gain (4% of baseline), mild dyspnoea, no skin rashes, new chest infiltrates and elevated creatinine and bilirubin over the next 48 h. Repeat work-up for infection was negative. ES was diagnosed, and G-CSF was discontinued. Diuretics and steroids (prednisone-1 mg kg −1 day −1 for 5 days) were initiated, colistin was added, and supportive treatment continued, to which she showed initial response. From D+17 to D+21, she deteriorated with recurring high fever, worsening diarrhoea, dyspnoea, tachypnoea, tachycardia, mild hypertension initially, mild gum/oral bleeding, persistent thrombocytopenia even with support, declining leucocyte count, anaemia, rising bilirubin and an episode of haemoptysis, haematuria and hypotension on D+21. Inotropes were initiated with the continuation of antibiotics and antifungals (liposomal amphotericin B), and steroids were restarted. Non-invasive ventilator (NIV) support was required

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 17, 2018

Beta lactams are standard empirical therapy for febrile neutropenia (FN). The aim of this study w... more Beta lactams are standard empirical therapy for febrile neutropenia (FN). The aim of this study was to evaluate the efficacy and safety of cefepime monotherapy compared with cefoperazone/sulbactam plus amikacin (CS + A) for empirical treatment of high risk FN. One hundred seventy-five patients with 336 FN episodes were randomized to receive either cefepime (2 g q8h for adults and 50 mg/kg q8h for children) or CS (2 g q8h for adults and 50 mg/kg q8h for children) plus amikacin (15 mg/kg once a day). Positive response was defined as afebrile within 72 h of starting antibiotics, persistent afebrile status more than 48 h and no requirement of second-line antibiotics and antifungal agents. Three hundred thirty-six episodes were assessable for efficacy (168 cefepime, 168 CS + A). The positive response to antibiotics was identical for cefepime (53%) and CS + A (53%). Positive response was similar in MDI (microbiologically documented infection), 50 vs. 35% (p = 0.248), CDI (clinically docum...

Cureus, 2017

The radiation recall dermatitis (RRD) phenomenon is defined as the "recalling" of the skin follow... more The radiation recall dermatitis (RRD) phenomenon is defined as the "recalling" of the skin following the administration of drugs; this induces a response or flare-like reaction over the skin that is exposed to radiation. In this case report, a young female developed RRD on Day 18 after the completion of cranial radiotherapy, that is, four days after the restart of the chemotherapy with doxorubicin. It is a self-limiting condition with supportive care as the treatment. When encountered in hematological malignancies, undue treatment breaks can delay definitive treatment and can eventually cause a relapse.

Indian Journal of Hematology and Blood Transfusion, 2020

The study aimed at identifying the profile of gut colonization of patients with acute leukemia wh... more The study aimed at identifying the profile of gut colonization of patients with acute leukemia who underwent induction chemotherapy and its association with induction events and outcome. Baseline bacterial stool culture with resistance pattern of isolates were recorded. Multi-drug resistance was defined as resistance to at least two antibiotic classes including beta lactam and fluoroquinolones. During induction chemotherapy, blood and clinically indicated cultures were taken during febrile neutropenic episodes. Association studies were done between gut colonization and induction events/outcome. Among 109 patients enrolled, 71 (65.13%) patients undergoing induction chemotherapy were colonized with bacteria, with nearly 50% of colonizers harboring multidrug resistant bacteria. Organisms isolated from stool preinduction were mostly gram negative (98%), with Escherichia coli and Klebsiella pneumoniae being the commonest. 65.13% patients developed febrile neutropenia. Overall multi-drug resistant positivity during febrile neutropenia was 70.14%. Concordance of 8.45% was observed between isolates from stool and organisms isolated from cultures during febrile neutropenia. There were significant proportion of gut colonized gram-negative multi-drug resistance bacteria among patients with acute leukemia. There was a low concordance rate between baseline stool isolates and subsequent cultures during the induction. There was no significant association between gut colonization and induction events/outcomes studied.