Dr. Akash Khandelwal (Hemato-Oncologist)

❤#Hematology Oncology ❤#BMT #CART
#INDIANCART /STEM CELL TRANSPLANT AND CELLULAR THERAPY EXPERT/
KGMC & AIIMS DELHI Alumni/Finance Buff

[Nikhil M Kumar @nikhil91sjmc]

Hematologists treat acute leukemias at most centers across the country . Excluding hematologists from clinical trials of “HEMATOLOGICAL MALIGNANCIES “ makes absolutely no sense and is an irony in itself . Really unfortunate that instead of widening access to patients , policy decisions ignore ground realities and come up with such absurd ideas @jayastuMD @royjpalatty @VergheseRenjith @chepsyphilip @TK2K6 @ishbtish @hematologydr @TribikramHemat @TikareNakul @Rohanhematdoc @shanuaswam @RahulDoc2 @dranupjdevasia

[Vincent Rajkumar @VincentRK]

Just in: Good news for the myeloma field.

FDA approves teclistamab plus daratumumab (Tec-Dara) combination for myeloma for patients who have had at least one prior line of therapy.
Note: Always use Tec-Dara with monthly IVIG. It’s not optional.

That was fast! And this is unprecedented curve is why.

[Stonehill Football #DIG @StonehillFB]

Our OC Dan Hebert stepped up and donated his bone marrow to help save the life of his match. Thank you to Dan and @nmdp_org for all you do!

#GoHill #DIG

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

@JasmineNephro Refer to a Hematologist

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

#Lymphoma
#lymphomaawareness
#hemeonc
#hematologist
#cart
https://t.co/iQj3459O0T

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

Agreed 💯
#indianCART data for #cd19CART
equally effective #immunoact

[Mazyar Shadman, MD MPH @mshadman]

Every patient with relapsed lymphoma deserves an official consultation with a CAR-T expert.

CAR-T cell therapy has been associated with improved overall survival in DLBCL, and longer follow-up now suggests the potential for cure in both aggressive and indolent lymphomas. 1/3

[Dr. Chokri Ben Lamine @abouabdrahman0]

🧠 CNS Lymphoma — Matrix

🎯 Classification
🏠 Primary CNS Lymphoma (PCNSL) — lymphoma confined to brain, leptomeninges, spinal cord, or eyes.
🌍 Secondary CNS Lymphoma (SCNSL) — systemic lymphoma (esp. DLBCL) with CNS involvement at dx or relapse.

🔬 Pathophysiology & Markers
💥 Nearly all PCNSL are DLBCL, non-GCB type.
🧩 MYD88 L265P and CD79B mutations → NF-κB activation.
🧫 IHC: CD20⁺, MUM1⁺, BCL6⁺, high Ki-67.

🧠 Clinical Picture
⚡ Focal deficits, seizures, cognitive decline, headache, ↑ICP.
👁️ Ocular involvement (vitreous haze) → diagnostic clue.
⚠️ Avoid steroids pre-biopsy (lympholysis → false negative).

📸 Diagnosis
🔎 MRI with contrast (deep periventricular enhancing lesions).
🧬 Stereotactic biopsy = gold standard.
💧 CSF: cytology, flow cytometry, IL-10, MYD88 mutation.
🧠 PET-CT to rule out systemic disease.

💊 Treatment Strategy
💧 Backbone: High-dose Methotrexate (≥3 g/m²) ± Cytarabine ± Rituximab ± Temozolomide.
🧴 Support: Hydration + Alkalinization + Leucovorin rescue + monitor MTX levels.
🌱 Consolidation:
 - Fit → Thiotepa-based ASCT 🚀
 - Others → Reduced-dose WBRT or chemo-consolidation.
♻️ Relapse: Ibrutinib, lenalidomide, CAR-T, or re-challenge with MTX-based chemo.

⚖️ Prognosis Factors
📊 Age > 60, ECOG ≥ 2, deep location, elevated LDH, multifocality, CSF/ocular disease.
⏳ Median OS ~4–5 yrs (younger + ASCT).

💡 Hema Pearls
💧 MTX BBB penetration > CHOP ➜ CHOP ineffective.
⚠️ Always check renal function before MTX.
🧠 Neurotoxicity risk ↑ after WBRT; use reduced dose in elderly.
🧬 Molecular confirmation (MYD88) boosts diagnostic yield.
🧪 CNS-IPI score guides prophylaxis in systemic DLBCL.

📘 MCQs

1️⃣ A 65-yo with deep periventricular lesion, CD20⁺, MYD88⁺. Best induction?
A. R-CHOP B. HD-MTX + Rituximab C. WBRT D. IT-MTX
✅ Answer: B. HD-MTX crosses BBB; CHOP doesn’t.

2️⃣ What reduces diagnostic yield?
A. Steroid use pre-biopsy B. Stereotactic biopsy C. Flow cytometry D. MYD88 testing
✅ Answer: A. Steroids lyse lymphoma cells.

3️⃣ High CNS-IPI systemic DLBCL → best prophylaxis?
A. IT-MTX B. IT-AraC C. None D. HD-MTX systemic
✅ Answer: A (± D in selected protocols).

🩺 OSCE Tips

👂 History: Duration of neuro symptoms, focal deficits, B-symptoms, immune status.
🧠 Exam: Cognitive assessment + cranial nerves + papilledema + motor/sensory.
🧾 Investigations: MRI + CSF + Biopsy + PET-CT.
💉 Management Plan: Hold steroids → Biopsy → HD-MTX regimen → Evaluate for ASCT.
🧍 Counseling: Discuss risk of neurotoxicity, relapse, need for MTX monitoring.
🧩 Follow-up: Cognitive testing + MRI q3-6 months + MTX toxicity watch.

📚 Key Sources:
•Ferreri AJ et al., Haematologica 2022;107(9):2149–2161.
•Houillier C et al., J Hematol Oncol 2022;15:94.
•Abrey LE et al., J Clin Oncol 2023;41(7):1185–1203.
•NCCN Guidelines: CNS Cancers v.2025.

#HemaPearls #CNSLymphoma #MTX #ASCT #Hematology #OSCE

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

A novel approach unlocking
#cart

[Muzaffar Qazilbash @Transplant_Doc]

CD19 CAR T-Cell Therapy in Multidrug-Resistant Ulcerative Colitis #CARTcell @nejm https://t.co/5K0ffGBeNX

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

#Lymphoma
#lymphomaawareness
#hemeonc
#hematologist
#cart
https://t.co/iQj3459O0T

[anand mahindra @anandmahindra]

This clip which was shared with me is about Shri Inder Jit Singh Sidhu of Chandigarh.

Apparently, every morning at 6 AM, in the quiet streets of Chandigarh’s sector 49, this 88-year-old retired police officer begins his day in service.

Armed with nothing but a cycle cart and an unwavering sense of duty, he moves slowly and purposefully, picking up rubbish from the roadside.

He says he wasn’t happy with the ‘low rank’ Chandigarh got in the Swachh Surekshan listing. But instead of complaining, he chooses action.

Each piece of trash he clears is more than just litter removed. It’s a statement. A quiet, persistent belief in a better world. A belief in living with meaning, regardless of age or recognition.

In a world often obsessed with youth and speed, his slow but steady footsteps tell us that Purpose doesn’t retire. Service doesn’t age.

A Salute to this quiet warrior of the streets. 👏🏽👏🏽👏🏽

[DrSanjeev @drsanjeev1980]

"Not all heroes wear capes — some wear white coats and carry stethoscopes. Happy Doctor’s Day!"

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

Great achievement #indianhealthcare

[AIIMS, New Delhi 🇮🇳 @aiims_newdelhi]

Proud moment for Bharat 🇮🇳!
@WHO has declared India as Trachoma-Free, eliminating a disease that once caused widespread blindness. With sustained efforts in hygiene, accessibility, and eye care services, this neglected tropical disease is now ELIMINATED.

@MoHFW_INDIA

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

Happy to announce the start of my new venture with my wife Dr Meetali #MDMEDICINE
A centre of excellence for complete #healthcare needs #daycare
At #lajpatnagar #southdelhi #NewDelhi #DelhiNCR
#haematology #oncology
#bonemarrowtransplant #chemotherapy #leukaemia #lymphoma

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

#bloodcancer #oncologycares
#chemotherapyinfusion
#BMT #CART therapy
#PalliativeCare
#solidcancer
#cancercure #cancersurvivor #cancerimmunotherapy #cancerdiagnostics #CancerResearch
#metabolichealth #weightloss
#vaccines #sugarcontrol #DiabetesCare #infectiousdisease
#ckd

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

https://t.co/yBCur5eS5L

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

#bloodcancer #oncologycares
#chemotherapyinfusion
#BMT #CART therapy
#PalliativeCare
#solidcancer
#cancercure #cancersurvivor #cancerimmunotherapy #cancerdiagnostics #CancerResearch
#metabolichealth #weightloss
#vaccines #sugarcontrol #DiabetesCare #infectiousdisease
#ckd

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

Happy to announce the start of my new venture with my wife Dr Meetali #MDMEDICINE
A centre of excellence for complete #healthcare needs #daycare
At #lajpatnagar #southdelhi #NewDelhi #DelhiNCR
#haematology #oncology
#bonemarrowtransplant #chemotherapy #leukaemia #lymphoma

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

https://t.co/yBCur5eS5L

#AUTOLOGOUSBMT
a potential game Changer for treatment of Relapsed Remitting #Multiplesclerosis #rrms
Offers benefit even after failure of immunosuppresants

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

https://t.co/yBCur5eS5L

[Dr. Akash Khandelwal (Hemato-Oncologist) @DocAkash22]

Not All Blood Cancers Are the Same! From leukemia to myeloma, each type affects the blood differently and has to be treated accordingly. Early diagnosis is your strongest defense. #BloodCancerAwareness #HematologyMatters
#Hemeonc
#hematologist #thebloodexpert