The AHL-DMG multidisciplinary group caters to the management of a variety of hematological malignancies in a comprehensive manner.

Unique aspects and strength of the DMG

This is the largest group dedicated to treating hemato-lymphoid malignancies in the country. 

It is involved in structured management of hematological malignancies which is evidence based and protocol based with emphasis given to personalized therapy based on the cytogenetic and molecular profiling of hematolymphoid malignancies. 

Emphasis in given to rapid diagnosis and early institution of therapy to immediately alleviate symptoms and life threatening problems at presentation.and identifying curable hematological malignancies and ensuring that their treatment is completed by providing assistance through various assistance programs within and outside the institute. 

Comprehensive diagnosis made feasible through a dedicated hematopathological and molecular hematology laboratory facility. This includes rare entities too.  

All patients registered with our unit are screened through the Joint clinics (JC) before treatment is instituted. The purpose of these JCs is not only to advice the best treatment options available to the patient but also to scrutinize, approve or modify planned therapies. The joint clinic also looks at the feasibility of patient to take treatment as per plan and also advice the patients as to where they could explore treatment if they are not able to or willing to do the same at our institute.

Apart from the treatment planning the Joint clinics also make the patient familiar with our Medical Social Workers and volunteers. The Medical Social Worker and the volunteers further counsel the patients in depth regarding the required financial support and logistic to start or sustain therapy. They also assist the treating consultants in taking decision for adopting (fully / partially) those patients with curable malignancy who are unable to start or sustain therapy due to financial / psychosocial challenges.

Patients in whom intensive therapy is warranted and where it will make a difference in their outcomes are identified and helped through our Medical Social Workers and individual volunteers for financial and logistic support including stay in Mumbai.

A financial support group meeting consisting of consultants, social workers and volunteers is held on every Friday between 3.00 pm to 5.00 pm to discuss and evaluate the financial support feasible for our patients on case to case bases for those patients who are identified in the Joint Clinics.

To consolidate the efforts that the hospital has been making towards catering to lymphoma/leukemia patients and their families, we have established a Lymphoma Leukemia Foundation wherein donors have a platform to contribute in the form of financial assistance. The corpus generated is used mostly in assisting in the initial treatment of the patient and at times sustaining therapy until such time that other aid start flowing in.

The DMG maintains ongoing quality improvement measures with continuous audits of our protocols, chemotherapy regimens, their morbidity and mortality, treatment compliance in long-term therapy and implementation of modifications derived from such audits.

OPD Timings

General OPD - All days Except Saturday
Timing - 09:15-17:30 Hours
Location - Golden Jubilee Building ,Room no 128.

Priviate OPD - Mon / Thurs
Timing - 09:15-17:30 Hours
Location - Main Building Ground Floor ,Room no.88

The patient care after registration is as below:

OUT PATIENT CARE

Patients suspected or diagnosed to have hemato- lymphoid malignancies are seen in the OPD from Monday morning to Saturday afternoon.

Patients undergo complete clinical evaluation and are recommended investigations to confirm the diagnosis and complete staging.

Sick patients and those with oncological emergencies (such as tumor lysis syndrome, superior venacaval syndrome, and impending paralysis) are admitted in the ward for emergency management.

Stable patients are followed up in the OPD till the diagnosis and staging workup is complete.

Treatment decisions are taken in the Joint Clinics for various malignancies.

DAY CARE

Treatment for all stable lymphoma, myeloma and certain leukemia patients is started in the Day Care. Patients needing admission for supportive care such as those with uncontrolled co-morbid conditions or complications of the disease are admitted for initiation of therapy

Patients with acute leukemia are seen in the Leukemia Clinic. They are evaluated for financial feasibility of completing treatment planned and then are admitted to the ward for treatment.

The remaining patients are given an opinion and encouraged to take treatment at or close to their native place with a referral letter to a trained hemato-oncologist

Patients with advanced disease not amenable to treatment and those multiply treated outside are considered for palliative care and referred for the same.  

IN- PATIENT CARE

Acute leukemia patients needing admission are admitted for tumor lysis prophylaxis, central line access, and starting treatment.

Patients with fever are admitted for management of febrile neutropenia. Once their condition is stable they are discharged and followed up in the OPD. 

FOLLOW UP CARE

Post completion of chemotherapy (and radiation if indicated) patients are followed up in afternoon clinics with specific days allocated to follow up for lymphomas, myeloma, and leukemia’s.

They are evaluated for recurrence of disease, long term side effects and other psycho-social problems they may face from day to day. 

TRANSPLANTATION

Patients requiring high dose chemotherapy and rescue with autologous hematopoietic stem cell transplantation (HSCT) or allogenic HSCT are referred to ACTREC for these procedures.

TABLE- I Number of New Registration and follow ups in 2017 at TMH

TABLE: II - Disease Wise Distribution

TABLE: III - Number of patients treated at Tata Memorial Centre

TABLE: IV – Dropout of Patients before diagnosis (n = 712)

TABLE- V Number of New Registration and follow ups in 2017 at ACTREC BMT unit

Cytogenetic Department workload:

Total Adult hemato-lymphoid requisitions were 8017. Requisitions for Conventional Cytogenetics was 1814 and for Fluorescent in situ hybridization (FISH) was 6203 (Fig 1)

Trainee programs

• Structured training of the DM students who are rotated in the AHL- DMG for 11 months during their curriculum.
• Visiting DM and non-DM trainees from other institutions and international fellows/ trainees for observer-ship in the unit (clinical and laboratory).
• Lectures for oncology nursing staff/ trainees.
• BMT Fellowship of 1year post DM

RESEARCH:

PUBLICATIONS:

The DMG members have constantly been involved at the national and international level as faculty for various conferences, delivering lectures presenting data and teaching postgraduates and junior colleagues who are in the field of oncology. We have been invited as examiners for academic degree courses and PhD in the university examinations. We also function as members of the review board for various journal. We have launched the lymphoma and myeloma foundation and have started the lymphoma registry and myeloma registry in the city of Mumbai. Overall we do enjoy a certain degree of credibility that has been built around a great deal of hard work which could have only happened with a team of dedicated members who have the immense potential for things bigger.

Dr. Dhanlaxmi Shetty successfully completed the NABL assessor’s training course   and is now a technical assessor for Genetics. She is elected as executive committee member of Indian Society for prenatal diagnosis and therapy (ISPAT) for the year 2017-2019.

Ms. Hemani Jain won the First prize for Oral presentation in ' Science behind the Cure' Awards - 1st THG Annual Conference 2017 for “Significance of Cytogenetic Aberrations In Bone Marrow of Patients With B-cell Non-Hodgkin’s Lymphoma”

MOU signed by Tata Memorial Centre and Government of Myanamar for training of students and junior faculty from Myanmar in hematolymphoid malignancies.

Next Generation Sequencing for various myeloid malignancies established by hematopathology laboratory..

Patient Education

• Monthly patient support group meetings for patient undertaking treatment in our department are conducted to educate the patients in terms of how when where and to whom they can approach in the situation of financial crisis or even to discuss their psychosocial issues.
• Lymphoma Awareness Program was conducted on occasion of World Lymphoma Awareness day for educating the patients on treatment compliance and its importance.

CME / Workshop / Conference conducted 

• The AHL-DMG conducted the 1^stAnnual Update in Lymphoma – Indian perspective “
• The laboratory staff provided orientation in cytogenetics to 50 consultants/ registrars and for students of diploma in oncology nursing on cytogenetics and general laboratory culture.
• The staff conducted a training workshop for total 23 doctors/ teaching faculty in collaboration with the Moving Academy of Medicine, Pune on Cancer Cytogenetics.
• Monthly art workshops are conducted for on treatment patients