Publications by authors named "Nabin Raj Karki"

6 Publications

  • Page 1 of 1

Indolent T-Lymphoblastic Proliferation in Idiopathic Multicentric Castleman Disease.

Acta Haematol 2021 Nov 24:1-7. Epub 2021 Nov 24.

Division of Hematology/Oncology, Augusta University, Augusta, Georgia, USA.

Benign and polyclonal proliferation of immature T cells in a lymph node with preserved morphological architecture is called indolent T-lymphoblastic proliferation (iT-LBP). Although overall rare, they have been described in association with both benign and malignant disorders including Castleman disease. We report the first case of idiopathic multicentric Castleman disease associated with iT-LBP, all previous reports of iT-LBP in Castleman disease were unicentric. A 37-year-old-male presented with 3 months of fevers and B-symptoms and was found to have enlargement of multiple bilateral lymph node sites on both sides of diaphragm along with splenomegaly. Anemia, elevated C-reactive protein, hypoalbuminemia, and elevated interleukin-6 levels were present. Biopsy of a lymph node showed features suggestive of idiopathic multicentric Castleman disease and iT-LBP. Bone marrow biopsy was unremarkable. Siltuximab and steroids were used to treat the condition.
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http://dx.doi.org/10.1159/000520240DOI Listing
November 2021

Diagnosis and management of cold agglutinin disease associated with low-grade B-cell lymphoma in a patient receiving pembrolizumab for lung cancer.

BMJ Case Rep 2021 Aug 16;14(8). Epub 2021 Aug 16.

Hematology Oncology, Augusta University, Augusta, Georgia, USA.

A 65-year-old with non-small cell lung cancer developed autoimmune haemolytic anaemia while receiving pembrolizumab containing chemoimmunotherapy. Initially thought to be due to pembrolizumab induced haemolysis, he was treated with steroids, and pembrolizumab was held. Haemolysis was refractory to steroids and blood was observed to agglutinate in cold room temperatures. Cold agglutinins in high titre and monoclonal serum IgM kappa protein were detected. Bone marrow biopsy showed marginal zone lymphoma confirming low grade B-cell lymphoma causing cold agglutinin disease. B-cell depletion by rituximab stopped haemolysis, and pembrolizumab was safely continued for lung cancer.
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http://dx.doi.org/10.1136/bcr-2021-243751DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370555PMC
August 2021

The Care of the Leukemic Patients in Times of SARS-CoV-2.

Curr Oncol Rep 2021 08 3;23(10):114. Epub 2021 Aug 3.

Division of Hematology/Oncology, Augusta University, Augusta, GA, USA.

Purpose Of Review: The spread of the novel coronavirus SARS-CoV-2 and its associated disease, coronavirus disease of 2019 (COVID-19), has significantly derailed cancer care. Patients with leukemia are more likely to have severe infection and increased rates of mortality. There is paucity of information on how to modify care of leukemia patients in view of the COVID-19 risks and imposed restrictions. We review the available literature on the impact of COVID-19 on different types of leukemia patients and suggest general as well as disease-specific recommendations on care based on available evidence.

Recent Findings: The COVID-19 infection impacts leukemia subtypes in variable ways and the standard treatments for leukemia have similarly, varying effects on the course of COVID-19 infection. Useful treatment strategies include deferring treatment when possible, use of less intensive regimens, outpatient targeted oral agents requiring minimal monitoring, and prioritization of curative or life-prolonging strategies. Reducing health care encounters, rational transfusion standards, just resource allocation, and pre-emptive advance care planning will serve the interests of leukemia patients. Ad hoc modifications based on expert opinions and extrapolations of previous well-designed studies are the way forward to navigate the crisis. This should be supplanted with more rigorous prospective evidence.
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http://dx.doi.org/10.1007/s11912-021-01111-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330191PMC
August 2021

P-Selectin Blockade in the Treatment of Painful Vaso-Occlusive Crises in Sickle Cell Disease: A Spotlight on Crizanlizumab.

J Pain Res 2021 30;14:849-856. Epub 2021 Mar 30.

Division of Hematology/Oncology, Augusta University, Augusta, GA, USA.

Microvascular vaso-occlusion driven pain crisis is the hallmark of sickle cell disease with profound morbidity and increased mortality. Selectins, most notably P-selectins have an integral role in this phenomenon. P-selection was first identified in 1989. In 2019, after 3 decades of basic, translational, and clinical work with this pathway, the US Food and Drug Administration approved a P-selectin antibody, crizanlizumab to reduce frequency of pain crisis in patients more than 16 years with sickle cell disease. We review the fundamentals of P-selectin pathobiology, P-selectin blocking agents, clinical data with the use of crizanlizumab and prospects of this novel class of drugs in the context of other treatments for painful vaso-occlusive episodes.
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http://dx.doi.org/10.2147/JPR.S278285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019662PMC
March 2021

Leukaemic relapse of anaplastic large cell lymphoma, ALK negative.

BMJ Case Rep 2021 Feb 22;14(2). Epub 2021 Feb 22.

Hematology Oncology, Augusta University, Augusta, Georgia, USA.

Anaplastic large cell lymphoma (ALCL), ALK negative (ALK-) is an aggressive lymphoproliferative disorder of mature T lymphocytes characterised by hallmark cells, CD30 positivity and lacking ALK protein expression. ALCL, ALK- has to be differentiated from peripheral T-cell lymphoma-not otherwise specified and classical Hodgkin's lymphoma. ALK- anaplastic large cell leukaemia should be considered in a patient with a history of ALCL, ALK- presenting with new leukaemia. We report a rare presentation of relapsed ALCL, ALK- with leukaemia after autologous stem cell transplantation in a 57-year-old male. Leukaemia, either as primary presentation or secondary transformation confers worse prognosis in ALCL, ALK- with very few cases reported so far. Emergency resuscitation with leukapheresis and treatment of tumour lysis syndrome along with supportive care should be followed by combination chemotherapy. Brentuximab vedotin and stem cell transplantation are the backbone of treatment for relapsed/refractory disease.
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http://dx.doi.org/10.1136/bcr-2020-239213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903072PMC
February 2021

DIAPH1 Mutation as a Novel Cause of Autosomal Dominant Macrothrombocytopenia and Hearing Loss.

Acta Haematol 2021 26;144(1):91-94. Epub 2020 Jun 26.

Division of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, Georgia, USA.

Macrothrombocytopenia (MTP) is a group of rare disorders characterized by giant platelets, thrombocytopenia, and variable association with abnormal bleeding. Inherited MTP are frequently misdiagnosed as immune thrombocytopenia. Associated second-organ manifestation can help narrow down syndromic MTPs. We describe a case of autosomal dominant sensorineural hearing loss and MTP caused by a gain of function mutation in DIAPH1. This mutation causes altered megarkaryopoiesis and platelet cytoskeletal deregulation. Although hearing loss and MTP were likely progressive, clinically significant bleeding was not observed. DIAPH1-related MTP can be distinguished clinically from MYH9 mutation by the absence of cataracts and glomerular disease.
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http://dx.doi.org/10.1159/000506727DOI Listing
March 2021
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