Person: Dey, Bimalangshu
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Dey
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Bimalangshu
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Dey, Bimalangshu
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Publication Hematopoietic Stem-Cell Transplantation in the Resource-Limited Setting: Establishing the First Bone Marrow Transplantation Unit in Bangladesh(American Society of Clinical Oncology (ASCO), 2018) Yeh, Albert; Khan, Mohiuddin; Harlow, Jason; Biswas, Akhil; Akter, Mafruha; Ferdous, Jannatul; Ara, Tasneem; Islam, Manirul; Caron, Martin; Barron, Anne-Marie; Moran, Jenna; Brezina, Mark; Nazneen, Humayra; Kamruzzaman, Md; Saha, Anup; Marshall, Ariela; Afrose, Salma; Stowell, Christopher; Preffer, Frederic; Bangsberg, David; Goodman, Annekathryn; Attar, Eyal; McAfee, Steven; Spitzer, Thomas; Dey, BimalangshuPurpose: Treatment of malignant and nonmalignant hematologic diseases with hematopoietic stem-cell transplantation (HSCT) was first described almost 60 years ago, and its use has expanded significantly over the last 20 years. Whereas HSCT has become the standard of care for many patients in developed countries, the significant economic investment, infrastructure, and health care provider training that are required to provide such a service have prohibited it from being widely adopted, particularly in developing countries. Methods: Over the past two decades, however, efforts to bring HSCT to the developing world have increased, and several institutions have described their efforts to establish such a program. We aim to provide an overview of the current challenges and applications of HSCT in developing countries as well as to describe our experience in developing an HSCT program at Dhaka Medical College and Hospital in Bangladesh via a partnership with health care providers at Massachusetts General Hospital. Results and Conclusion: We discuss key steps of the program, including the formation of a collaborative partnership, infrastructure development, human resource capacity building, and financial considerations.Publication HLA-Mismatched Renal Transplantation without Maintenance Immunosuppression(New England Journal of Medicine (NEJM/MMS), 2008) Kawai, Tatsuo; Cosimi, A.; Spitzer, Thomas; Tolkoff-Rubin, Nina; Suthanthiran, Manikkam; Saidman, Susan; Shaffer, Juanita; Preffer, Frederic; Ding, Ruchuang; Sharma, Vijay; Fishman, Jay; Dey, Bimalangshu; Ko, Dicken; Hertl, Martin; Goes, Nelson B.; Wong, Waichi; Williams, Winfred; Colvin, Robert; Sykes, Megan; Sachs, DavidFive patients with end-stage renal disease received combined bone marrow and kidney transplants from HLA single-haplotype mismatched living related donors, with the use of a nonmyeloablative preparative regimen. Transient chimerism and reversible capillary leak syndrome developed in all recipients. Irreversible humoral rejection occurred in one patient. In the other four recipients, it was possible to discontinue all immunosuppressive therapy 9 to 14 months after the transplantation, and renal function has remained stable for 2.0 to 5.3 years since transplantation. The T cells from these four recipients, tested in vitro, showed donor-specific unresponsiveness and in specimens from allograft biopsies, obtained after withdrawal of immunosuppressive therapy, there were high levels of P3 (FOXP3) messenger RNA (mRNA) but not granzyme B mRNA.Publication Development of a Cervical Cancer Screening Program in a Slum Setting Using Visual Inspection With Acetic Acid: Analysis of Feasibility and Cost(Scientific Research Publishing, Inc,, 2012-06) Bradford, Leslie; Dey, Bimalangshu; Md Akram Hussain, Syed; Razia Begum, Sultana; Hussain, Farhat; Hoque, Sharmina; Goodman, AnnekathrynObjective: In Bangladesh, cervical cancer is the second most common cause of cancer deaths in women. Annually, over 50 million women are at risk for cervical cancer, with 17,686 cases diagnosed and 10,362 deaths each year. Visual inspection with acetic acid (VIA) is a well validated tool in low resource areas for identifying cervical lesions. In this pilot study, AK Khan Health Care Trust (AKKHCT), in collaboration with oncologists at Massachusetts General Hospital (LB, BD, AG), launched a VIA cervical cancer-screening program. Methods: A clinic was established in the Korail Slum of Dhaka, a 90-acre slum with over 70,000 inhabitants, in the summer of 2011. From September 17, 2011 to November 1, 2011, ten women living in the Korail Slum were recruited and completed the three-month training program to learn how to do a pelvic examination and to evaluate the cervix using VIA. Three of the ten women performed VIA screening during the study period. Results: 44 patients were recruited and 8 women were identified to have VIA-positive results for a screen-positive rate of 18.2%. Two of the eight women underwent treatment. One woman underwent an excisional procedure for pre-invasive disease in the slum clinic. The other woman had an early invasive cervical cancer and was successfully treated in a local hospital. Conclusion: Our pilot project demonstrates some important factors in developing and implementing a successful screening program. Involving laywomen as healthcare workers provides a strong tie to community, as well as education, economic independence, and empowerment for women who would otherwise occupy a lower social standing in their community. VIA is feasible in the complicated environment of an inner city slum. It was feasible to perform minor excisional procedures to treat pre-invasive cervical disease in the slum clinic.Publication Hospital Acquired Infections in Low and Middle Income Countries: Root Cause Analysis and the Development of Infection Control Practices in Bangladesh(Scientific Research Publishing, Inc,, 2016-01) Shahida, S. M.; Islam, Anisul; Dey, Bimalangshu; Islam, Ferdousi; Venkatesh, Kartik; Goodman, AnnekathrynNosocomial or hospital acquired infections are a major challenge for low and middle income countries (LMICs) which have limited healthcare resources. Risk factors include the lack of appropriate hospital facilities such as isolation units, bed space, and sinks; inadequate waste management, contaminated equipment, inappropriate use of antibiotics and transmission of infection from the hands of healthcare workers and family caretakers due to inadequate hand washing. Nosocomial infections increase the costs of healthcare due to added antimicrobial treatment and prolonged hospitalization. Since the prevalence of nosocomial infections is generally higher in developing countries with limited resources, the socio-economic burden is even more severe in these countries. This review summarizes the current knowledge on the risks of hospital acquired infections and summarizes current recommendations for the development of hospital infrastructure and the institution of protocols to reduce these infections in LMICs such as Bangladesh.Publication Challenges to Cervical Cancer Treatment in Bangladesh: The Development of a Women's Cancer Ward at Dhaka Medical College Hospital(Elsevier BV, 2017-08) Haque, Niloufar; Uddin, A.F.M.K; Dey, Bimalangshu; Islam, Ferdousi; Goodman, AnnekathrynCervical cancer is the second most common cause of female cancer mortality worldwide. Concurrent chemoradiotherapy represents the standard of care for patients with stages IB2 to IVa cervical cancer. Unfortunately radiation therapy capacity is severely limited to non-existent in many Low and Middle-Income Countries. One solution has been to use chemotherapy to reduce tumor size to allow for radical surgery or in the case of inoperable cancers, as a placeholder until radiation is available. In Bangladesh, there has been the progressive development of resources for the treatment of women with gynecologic cancers. However, radiation therapy resources are limited with a six-month waiting period to receive radiation. Neoadjuvant chemotherapy (NACT) remains the main primary treatment intervention for women with advanced cervical cancer in Bangladesh. This implementation study summarizes of the experience and challenges to caring for women in a new gynae-oncology ward at Dhaka Medical College Hospital, a 2600 bed government hospital in Dhaka, Bangladesh.Publication Global Health: Role of HPV Testing in Resource Poor Environment(OMICS Publishing Group, 2015) Goodman, Annekathryn; Joseph, Naima; Bradford, Leslie; Dey, BimalangshuEighty-five percent of cervical cancer deaths occur in the developing world. While cervical cancer is only the tenth most common cancer in women in developed countries, it is the leading cause of cancer related deaths in women in low and middleincome countries (LMICs). Despite this, there is a disproportionate allocation of cervical-cancer related resources in countries with the highest burden. Cervical cancer is preventable and amenable to early detection and treatment. Over the past two decades, largescale data investigating low cost screening interventions have demonstrated efficacy of cervical cancer prevention in many continents.Publication Bortezomib-based immunosuppression after reduced-intensity conditioning hematopoietic stem cell transplantation: randomized phase II results(Ferrata Storti Foundation, 2018) Koreth, John; Kim, Haesook; Lange, Paulina B.; Poryanda, Samuel J.; Reynolds, Carol G.; Rai, Sharmila Chamling; Armand, Philippe; Cutler, Corey; Ho, Vincent; Glotzbecker, Brett; Yusuf, Rushdia; NIkiforow, Sarah; Chen, Yi-Bin; Dey, Bimalangshu; McMasters, Malgorzata; Ritz, Jerome; Blazar, Bruce R.; Soiffer, Robert; Antin, Joseph; Alyea, Edwin P.Aprior phase I/II trial of bortezomib/tacrolimus/methotrexate prophylaxis after human leukocyte antigen (HLA)-mismatched reduced intensity conditioning allogeneic hematopoietic stem cell transplantation documented low acute graft-versus-host disease incidence, with promising overall and progression-free survival. We performed an open-label three-arm 1:1:1 phase II randomized controlled trial comparing grade II–IV acute graft-versus-host disease between conventional tacrolimus/methotrexate (A) versus bortezomib/tacrolimus/methotrexate (B), and versus bortezomib/sirolimus/tacrolimus (C), in reduced intensity conditioning allogeneic transplantation recipients lacking HLA-matched related donors. The primary endpoint was grade II–IV acute graft-versus-host disease incidence rate by day +180. One hundred and thirty-eight patients (A 46, B 45, C 47) with a median age of 64 years (range: 24–75), varying malignant diagnoses and disease risk (low 14, intermediate 96, high/very high 28) received 7–8/8 HLA-mismatched (40) or matched unrelated donor (98) grafts. Median follow up in survivors was 30 months (range: 14–46). Despite early immune reconstitution differences, day +180 grade II-IV acute graft-versus-host disease rates were similar (A 32.6%, B 31.1%, C 21%; P=0.53 for A vs. B, P=0.16 for A vs. C). The 2-year non-relapse mortality incidence was similar (A 14%, B 16%, C 6.4%; P=0.62), as were relapse (A 32%, B 32%, C 38%; P=0.74), chronic graft-versus-host disease (A 59%, B 60% C 55%; P=0.66), progression-free survival (A 54%, B 52%, C 55%; P=0.95), and overall survival (A 61%, B 62%, C 62%; P=0.98). Overall, the bortezomib-based regimens evaluated did not improve outcomes compared with tacrolimus/methotrexate therapy. clinicaltrials.gov Identifier: 01754389