Publications by authors named "Dhwanee Thakkar"

16 Publications

  • Page 1 of 1

Successful Allogeneic Hematopoietic Stem Cell Transplant for CARMIL2 Deficiency.

J Pediatr Hematol Oncol 2021 Sep 6. Epub 2021 Sep 6.

Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Medanta The Medicity, Gurgaon, Haryana, India.

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http://dx.doi.org/10.1097/MPH.0000000000002311DOI Listing
September 2021

Wilms tumor with Mulibrey Nanism: A case report and review of literature.

Cancer Rep (Hoboken) 2021 Jul 26:e1512. Epub 2021 Jul 26.

Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Cancer Institute, Medanta The Medicity Hospital, Gurgaon, Haryana, India.

Background: Mulibrey-Nanism (Muscle-liver-brain-eye Nanism = dwarfism; MUL) is a rare genetic syndrome. The underlying TRIM37 mutation predisposes these children to develop tumors frequently. In the largest published series of MUL, 8% patients were reported to develop Wilms tumor (WT). The published literature lacks data regarding the best treatment protocol and outcome of this cohort of children with WT and MUL. We report here a 2-year-old boy with WT and MUL and present a review of literature on WT in MUL.

Case: Our patient had associated cardiac problems of atrial septal defect, atrial flutter and an episode of sudden cardiac arrest. We managed him successfully with chemotherapy, surgery and multi-speciality care. He is alive and in remission at follow-up of 6 months.

Conclusion: A total of 14 cases (including present case) of WT have been reported in MUL and treatment details were available for six cases. They were managed primarily with surgery, chemotherapy with/without radiotherapy, and all achieved remission. The outcome data is available only for two cases, one has been followed up till 15 years post treatment for WT and other is our patient.
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http://dx.doi.org/10.1002/cnr2.1512DOI Listing
July 2021

Dengue virus transmission from donor to recipient during haploidentical stem cell transplantation.

IDCases 2021 7;25:e01220. Epub 2021 Jul 7.

Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Cancer Institute, Medanta The Medicity Hospital, Gurgaon, Haryana, 122001, India.

Dengue fever is endemic in tropical and subtropical countries. Dengue virus transmission through hematopoietic stem cells is very rare and just two such cases have been reported previously. We report here only third case of dengue virus transmission in a 2-year-old child with thalassemia major who underwent hematopoietic stem cell transplant (HSCT) from a haploidentical related donor. One week after HSCT, the recipient developed fever, pancytopenia and signs of capillary leak. On day 10, his dengue NS1 antigen test was positive which confirmed diagnosis of dengue fever. Donor also had fever few days prior to stem cell donation which was later diagnosed to be due to dengue fever. Child had a severe clinical course of dengue leading to primary graft failure. However, he had autologous recovery of his own bone marrow and is alive and well on day+200 post HSCT. Our report highlights the transmission of dengue virus from donor to recipient through hematopoietic stem cell graft although rare but possible. We suggest that in tropical and subtropical countries where dengue is endemic, hematopoietic stem cell donors should be screened for it.
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http://dx.doi.org/10.1016/j.idcr.2021.e01220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282947PMC
July 2021

Peripheral blood stem cell mobilization with pegylated granulocyte colony stimulating factor in children.

Cancer Rep (Hoboken) 2021 Jul 10:e1408. Epub 2021 Jul 10.

Department of Pediatric Hematology Oncology and BMT, Medanta The Medicity, Gurgaon, India.

Background And Aim: We report here our experience of using pegylated granulocyte colony stimulating factor (peg-GCSF) for peripheral blood stem cell (PBSC) mobilization in children.

Methods And Results: A total of nine children suffering from high-risk/relapsed solid tumors were mobilized with chemotherapy and peg-GCSF (100 microgram/kg single dose). Mean age was 7.7 years (range 2-15 years).The mean time from peg-GCSF administration to PBSC harvest was 9.7 days. Adequate stem cells (median dose 26.9 million/kg) could be harvested in all children by a single apheresis procedure. No major adverse events observed.

Conclusion: It is feasible and safe to mobilize PBSC with peg-GCSF in children with cancer.
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http://dx.doi.org/10.1002/cnr2.1408DOI Listing
July 2021

COVID-19 reinfection in two children with cancer.

Pediatr Hematol Oncol 2021 05 24;38(4):403-405. Epub 2021 Feb 24.

Department of Microbiology, Medanta The Medicity, Gurgaon, Haryana, India.

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http://dx.doi.org/10.1080/08880018.2020.1855276DOI Listing
May 2021

Upfront Haploidentical Stem Cell Transplant With Posttransplant Cyclophosphamide in Children With Severe Aplastic Anemia.

J Pediatr Hematol Oncol 2020 11;42(8):500

Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Cancer Institute Medanta The Medicity Hospital, Gurgaon Haryana, India.

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http://dx.doi.org/10.1097/MPH.0000000000001957DOI Listing
November 2020

Successful Haploidentical Stem Cell Transplant With Posttransplant Cyclophosphamide for Isolated Central Nervous System Blast Crisis in a Child With Chronic Myeloid Leukemia.

J Pediatr Hematol Oncol 2021 01;43(1):e146-e147

Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Cancer Institute, Medanta The Medicity Hospital, Gurgaon, Haryana, India.

Chronic myelogenous leukemia (CML) is a myeloproliferative disorder. The extramedullary blast crisis (BC) is a known complication of CML, but it usually accompanies a systemic disease. However, an isolated central nervous system (CNS) BC at relapse is very rare and has a very poor prognosis. Salvage is even more difficult for patients who relapse with a CNS BC after an allogeneic stem cell transplant (SCT). Here, we report successful treatment of an isolated CNS BC of CML in a 14-year-old boy who relapsed with isolated a CNS BC after matched sibling donor SCT by haploidentical SCT with posttransplant cyclophosphamide.
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http://dx.doi.org/10.1097/MPH.0000000000001675DOI Listing
January 2021

Successful Haploidentical Stem Cell Transplant With Posttransplant Cyclophosphamide for Hemophagocytic Lymphohistiocytosis.

J Pediatr Hematol Oncol 2019 Apr;41(3):e158-e160

Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Fortis Memorial Research Institute.

Allogeneic hematopoietic stem cell transplant (HSCT) has been known to be a curative therapy for patients with hemophagocytic lymphohistiocytosis (HLH) but donor availability is an issue. Haploidentical HSCT with posttransplant cyclophosphamide (PTCy) has been investigated as a feasible option for various malignant and nonmalignant conditions with reduced incidence of acute graft versus host disease (GVHD) and graft rejection. However, its use has not been described in children with HLH and here we describe 2 boys who underwent successful haploidentical HSCT with PTCy. None had acute GVHD and 1 had limited chronic GVHD. Both are alive and disease-free at follow-up of 912 and 239 days, respectively. Haploidentical HSCT with PTCy is a feasible option for children with HLH lacking a matched sibling donor.
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http://dx.doi.org/10.1097/MPH.0000000000001265DOI Listing
April 2019

Skin involvement in Burkitt's lymphoma.

Hematol Oncol Stem Cell Ther 2018 Dec 2;11(4):251-252. Epub 2018 Feb 2.

Department of Pediatric Hematology Oncology & BMT, Medanta The Medicity Hospital, Gurgaon 122001, India. Electronic address:

Skin involvement in Burkitt's lymphoma (BL) is rare, more so in the pediatric age group. There are very few cases of BL involving skin either at presentation or relapse reported in literature. We report a case of a 9-years old boy with stage 4 Burkitt's lymphoma with skin involvement who tested negative for human immune-deficiency virus.
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http://dx.doi.org/10.1016/j.hemonc.2018.01.002DOI Listing
December 2018

Successful Nonmyeloablative Allogeneic Stem Cell Transplant in a Child With Emberger Syndrome and GATA2 Mutation.

J Pediatr Hematol Oncol 2018 08;40(6):e383-e388

Department of Pediatrics, Pediatric Hematology Oncology & Bone Marrow Transplant Unit.

Emberger syndrome with underlying guanine-adenine-thymine-adenine 2 (GATA2) mutation is a rare disorder and very few successful nonmyeloablative allogeneic hematopoietic stem cell transplants (HSCTs) have been reported. We report a case of Emberger syndrome with GATA2 mutation in a 9-year-old girl who presented with congenital sensorineural deafness, warts, lymphedema, and Myelodysplastic syndrome. Her sister had died of a similar illness. She underwent a nonmyeloablative matched related donor peripheral blood HSCT with rabbit antithymoglobulin (5 mg/kg), fludarabine (160 mg/m), cyclophophamide (29 mg/kg), and total body irradiation (2 Gray). Graft versus host disease prophylaxis consisted of tacrolimus and mycophenolate moefetil. She had neutrophil engraftment on day+15 and fully donor chimerism by day+30. She developed limited chronic skin graft versus host disease on tapering off immunosuppression. She is disease free on day+475. The review of literature showed a total of 28 patients with GATA2 mutation have undergone HSCT mostly nonmyeloablative and overall survival is 75%. Nonmyeloablatove HSCT is feasible and safe for the patients with GATA2 mutation.
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http://dx.doi.org/10.1097/MPH.0000000000000995DOI Listing
August 2018

Drug Rash, Eosinophilia, Systemic Symptoms (DRESS) in a Child With Acute Lymphoblastic Leukemia.

J Pediatr Hematol Oncol 2018 05;40(4):e266-e267

Departments of Pediatric Hematology Oncology and Bone Marrow Transplantation.

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http://dx.doi.org/10.1097/MPH.0000000000001031DOI Listing
May 2018

Reduced-toxicity alternate-donor stem cell transplantation with posttransplant cyclophosphamide for primary immunodeficiency disorders.

Pediatr Blood Cancer 2018 Jan 13;65(1). Epub 2017 Sep 13.

Pediatric Hematology Oncology Unit, Department of Pediatrics, Fortis Memorial Research Institute, Gurgaon, Haryana, India.

We describe here the outcomes of reduced-toxicity alternate-donor stem cell transplant (SCT) with posttransplant cyclophosphamide (PTCy) for primary immunodeficiency disorders (PIDs) in eight children (haploidentical-seven and matched unrelated donor-one). The conditioning was with serotherapy (alemtuzumab-3/rabbit-anti-thymoglobulin-5); fludarabine, cyclophosphamide, and total body irradiation-5 (additional thiotepa-3); fludarabine and treosulfan-2; and fludarabine and busulfan-1. All received PTCy 50 mg/kg on days 3 and 4 as graft versus host disease prophylaxis along with tacrolimus and mycophenolate. Mean CD34 dose was 13.8 × 10 /kg. Two children died because of PIDs. Acute graft versus host disease up to grades I and II was seen in three children. All six survivors are fully donor and disease free at median follow-up of 753 days. Alternate donor SCT with PTCy is feasible in PID and has good outcomes.
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http://dx.doi.org/10.1002/pbc.26783DOI Listing
January 2018

Successful Reduced Intensity Conditioning Alternate Donor Stem Cell Transplant for Wiskott-Aldrich Syndrome.

J Pediatr Hematol Oncol 2017 11;39(8):e493-e496

Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Department of Pediatrics, Fortis Memorial Research Institute, Gurgaon, Haryana, India.

There are very few reports of reduced intensity conditioning (RIC) hematopoietic stem cell transplant (HSCT) with alternate donor for Wiskott-Aldrich syndrome (WAS) and there is no report of RIC with posttransplant cyclophosphamide (PTCy) in WAS. There is only 1 report of T cell receptor αβ and CD19-depleted haploidentical HSCT for WAS. Here we report successful outcome in 3 children with WAS who underwent successful RIC alternate donor HSCT of whom 2 (matched unrelated donor and T-cell replete haploidentical) received PTCy and 1 underwent T cell receptor αβ and CD19-depleted haploidentical HSCT. We modified conditioning used by Luznik for haploidentical HSCT by adding thiotepa 8 mg/kg and Campath or rabbit antithymoglobulin for 2 cases who received PTCy. In third case we gave fludarabine, thiotepa, and treosulfan-based conditioning. The mean duration of follow-up for these patients was 23.6 months posttransplant (range, 21 to 26 mo). All 3 patients are transfusion independent. Acute graft versus host disease (GVHD) grade I occurred in 1 and none had chronic GVHD. Chimerism of all 3 was fully donor (>95% donor) at D+30 and D+100 posttransplant. All are alive, healthy, and doing well. Our 3 cases highlight that with newer conditioning and GVHD prophylaxis approach alternate donor HSCT in WAS can become a safe and effective treatment option.
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http://dx.doi.org/10.1097/MPH.0000000000000959DOI Listing
November 2017

Meningitis and intracranial bleed in a child with steroid-resistant nephrotic syndrome.

Saudi J Kidney Dis Transpl 2015 Nov;26(6):1270-3

Division of Pediatric Nephrology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Meningitis and associated intracranial bleeding have been rarely reported in patients with steroid-resistant nephrotic syndrome. We present such a case with raised intracranial tension in a 13-year-old child and discuss the management issues. Prompt recognition and appropriate treatment of these complications can be life saving in a child with nephrotic syndrome.
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http://dx.doi.org/10.4103/1319-2442.168668DOI Listing
November 2015

Kawasaki disease with autoimmune hemolytic anemia.

Indian Pediatr 2015 Mar;52(3):245-6

Pediatric Hematology Oncology and BMT Unit; and *Institute of Child Health; Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India. Correspondence to: Dr Anupam Sachdeva, Head of Department, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110 060, India.

Background: Association of autoimmune haemolytic anaemia has been seldom reported with Kawasaki disease.

Case Characteristics: A 7-month-old boy, presented with prolonged fever, erythematous rash, severe pallor and hepatosplenomegaly.

Observations: Positive Direct Coombs test and coronary artery aneurysm on echocardiography. He was managed with steroids along with intravenous immunoglobulins and aspirin.

Outcome: Early identification of the condition helped in the management.

Message: Patients of autoimmune hemolytic anemia with unusual features such as prolonged fever, skin rash, and mixed antibody response in Coombs test should be evaluated for underlying Kawasaki disease as a possible etiology.
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http://dx.doi.org/10.1007/s13312-015-0617-yDOI Listing
March 2015
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