Biomedical subjects
T G Sagar
Publications and source records attributed to T G Sagar.
Neutrophil function tests in disseminated malignancies.
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Lithium and leukaemia--causal or coincidental?
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A review of Hodgkin's disease at the Cancer Institute, Madras.
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Report of an International Network of Cancer Treatment and Research workshop on non-Hodgkin's lymphoma in developing countries.
The International Network of Cancer Treatment and Research (INCTR) recently organized a workshop on non-Hodgkin lymphomas (NHLs) in selected developing countries with the purpose of examining existing information relating to the pathology and management of these neoplasms, and identifying potential areas for research. This report provides a summary of the information presented and is focused primarily on the pathology of NHLs in children and adults. In most countries, the WHO classification of lymphomas was used and most participating centers included immunohistochemistry using a wide array of lymphoid antibodies as part of routine diagnosis. Some of the series had been reviewed by an external panel of experts. B-cell lymphomas accounted for 82-88% of all NHLs. The proportions of chronic lymphatic leukemia (4-6%), mantle cell lymphoma (MCL, 3-5%), and plasmacytoma (2-4%) were similar in the series presented. However, there was a significant variation in the proportion of follicular lymphoma (FL), which accounted for 15% and 11% in India and Kuwait, but less than 5% in Pakistan and Egypt. All of these frequencies are significantly lower than those reported in Western series. Diffuse large B-cell lymphoma accounted for about 35% of cases in India but for more 50% in other countries, but this difference was not accounted for by an increased incidence in a single lymphoma subtype in India, but rather an apparent paucity of several subtypes (such as mantle cell and marginal zone lymphomas (MZL)) in other series. There were relatively high frequencies of Burkitt lymphoma in Egypt (7%) and precursor T-cell lymphoblastic lymphoma in India (6-7%). Peripheral T-cell lymphomas (PTCLs) (not otherwise specified and angioimmunoblastic subtypes) accounted for 3-5% of NHLs, and extranodal lymphoma of T/NK cell type was rare (<1%). These differences in the relative proportions of NHL subtypes among developing countries and between developing countries and the rest of the world presumably arise from differences in environmental and genetic factors that influence lymphomagenesis and strongly suggest that more research in developing countries would provide valuable insights into the pathogenesis of lymphoid neoplasms.
Paucity of hematological neoplasia after treatment of Hodgkin disease: observation after long-term follow-up at Cancer Institute, Chennai, south India.
The purpose of the study was to evaluate the incidence of second malignancies in childhood Hodgkin disease treated with COPP and COPP/ABV (replacing mechlorethamine by cyclophosphamide) chemotherapy. In 212 children with Hodgkin disease who were under 14 years of age and treated at Cancer Institute during the 25-year period of 1970-1994, the occurrence of second malignant neoplasms was analyzed as on 31 December 1999. Eighty-two percent attained complete response. The 5- and 10-year overall survival rate was 91 and 83%, respectively. In this interm report 5 cases of second malignancies were documented. All 5 were solid tumors: one each of soft tissue sarcoma, dermatofibrosarcoma, micropapillary carcinoma of thyroid, malignant phylloides tumor of breast, and chondrosarcoma of ilium. All patients had received combination chemotherapy and radiotherapy. Interestingly, all were splenectomized. All these patients had advanced stage of cancer and were 7-14 years of age at the time of diagnosis of first primary Hodgkin disease. It is significant that there were no secondary hematological malignancies. COPP and COPP/ABV are effective therapeutic regimens. The paucity of secondary hematological malignancies is unique in this series and may be attributed to the substitution of nitrogen mustard with cyclophosphamide in the chemotherapy combination. This is an initial observation, and further follow-up is needed for a firm conclusion.
Prognostic variables and survival in pediatric acute lymphoblastic leukemias: cancer institute experience.
This presentation is an analysis of front-end prognostic variables in achieving a complete response, a continuous complete remission, and disease-free survival in pediatric acute lymphoblastic leukemia at the Cancer Institute, Madras, India between 1983 and 1988. The clinical characteristics at presentation showed that virtually 100% of patients belong to the poor risk category, age < 3 years of > 6 years 72.2%, WBC > 10,000/mm3 59.8%, blast count > 50% 39.2%, organomegaly 91.8%, and L2 morphology 66.0%. All patients had more than one risk factor. Between 1983 and 1988, 97 children were treated on a pilot protocol designed in collaboration with the Lymphoma Biology Division of the Pediatric Oncology Branch of the National Cancer Institute, Bethesda, Maryland. The protocol was designed for a poor prognostic group. The significance of implicated poor prognostic factors was analyzed using the Cox proportional hazard model. Age at presentation was the only variable that emerged as an independent risk factor, and sex appeared to be a modifier. No other variables attained significance. Survival data were calculated by the Kaplan-Meier method. The relapse-free and event-free survivals up to 10 years were 50.7% and 38.1%, and compare reasonably well with results reported for similar groups elsewhere for the same period.
Impact of high-dose cytosine arabinoside in poor-prognosis acute lymphoblastic leukemia: Cancer Institute experience, Chennai, India.
High-dose cytosine arabinoside (HD-AraC) has been used in relapsed and refractory cases of acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL). Sixty-two poor-prognosis ALL patients were treated with HD-AraC between 1983 and 1995 at the Cancer Institute, Chennai, India. Of them, 37 had experienced a relapse, 16 were partial responders (refractory) to the induction regimen, and 9 were high risk due to central nervous system or testicular involvement or total counts above 200,000/mm3 at presentation. Of the 37 patients with relapses, 22 (59.5%) achieved complete remission (CR) and 10 had no evidence of disease (NED); of the 16 refractory group patients, 10 achieved CR and 2 had NED; and of the 9 high-risk patients, 5 had NED at the end of the study. The 5-year event-free survival (EFS) values of relapsed, refractory and high-risk group categories were 21.7%, 12.5%, and 55.6%, with a mean duration of 41 months, 18 months, and 85 months, respectively. Total alopecia and grade IV myelosuppression were the predominant toxicities. HD-AraC is an effective drug in the treatment of relapsed and refractory acute leukemias and can overcome relative drug resistance in high concentrations.
Bone marrow involvement in a primary mediastinal extragonadal non-seminomatous germ cell tumour.
A case of primary mediastinal extragonadal germ cell tumour with involvement of bone marrow, a rare finding, is reported with a review of literature.
Primary esophageal T-cell non-Hodgkin's lymphoma.
Primary non-Hodgkin's lymphoma of the esophagus is a rare disease. We report a 52-year-old man who had a polypoid mass in the esophagus at endoscopy. Histology was suggestive of non-Hodgkin's lymphoma; immunohistochemistry was positive for CD3, CD45 RO, LCA. He was treated with 6 cycles of CHOP and is disease-free 14 months later.
Antibiotics in febrile neutropenia: a randomized prospective comparison of two combinations.
BACKGROUND: Problems of initial empirical antibiotic therapy in febrile neutropenia are further complicated by other factors such as cost and the pattern of infective organisms in a particular institution. We, therefore, conducted a randomized study comparing the efficacy of two sets of antibiotics which differed in their spectrum of action, availability and price. METHODS: Sixty episodes of febrile neutropenia in 40 patients who were not on any prophylactic antibiotics were randomized into one of two arms--cefotaxime and gentamicin or ciprofloxacin and gentamicin. Depending upon the response by 72 hours, they were crossed over to the other arm or continued with the same combination. Empirical antifungal therapy was added in those who did not become afebrile. RESULTS: Infection was documented either clinically, bacteriologically or radiologically in 42% of the febrile episodes. The commonest organism isolated was Klebsiella and the commonest organism producing bacteraemia was the Staphylococcus. The temperature was reduced to normal without cross-over in 53% of the febrile episodes with cefotaxime and gentamicin and in 60% with ciprofloxacin and gentamicin (p > 0.05). After cross-over the temperature came down in 30% of the episodes with cefotaxime and gentamicin (initial combination) and 40% with ciprofloxacin and gentamicin (initial combination; p > 0.05). The overall response rate without empirical antifungal therapy was 83% in the patients on cefotaxime and gentamicin (initial combination; p > 0.05). While both the arms of the study had a 100% response rate, there was no significant difference between the efficacy of the antibiotic combinations. The ciprofloxacin-gentamicin combination is one-third as expensive as cefotaxime-gentamicin and is more readily available. CONCLUSION: We recommend the use of ciprofloxacin and gentamicin as the initial drug combination and cefotaxime and gentamicin only when the former is not effective.