Hematopathology

We offer a comprehensive range of diagnostic and monitoring services for leukemias. Our morphology workload includes bone marrow aspiration smears, cytochemistry, and analysis of body fluids for cell counts and morphology. In the flowcytometry laboratory, we specialize in diagnosing and characterizing conditions such as acute leukemia, B/T cell Non- Hodgkin Lymphoma (NHL), multiple myeloma (MM), myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), juvenile myelomonocytic leukemia (JMML), chronic myeloid leukemia in accelerated or blast phase (CML-AP/BC). In addition, immunophenotypic assays for some of the non-hematological neoplasms such as pediatric round cell tumors and epithelial malignancies, especially in body fluids and bone marrow samples are also performed.

We monitor the patients using high-sensitivity measurable residual disease (MRD) assays which include MRD for BALL, T-ALL, AML, MM, CLL, and Hairy Cell Leukemia. For patients who have received targeted therapy against CD19, we also have a separate panel to detect B-ALL MRD in such scenarios.

We also provide CD34+ stem cell enumeration, detailed immune profiling with over 80 immune cell subsets, T & NK cell function assays, inflammatory cytokine level assessments, VEGF levels, CD19-CAR-T assays, and Paroxysmal Nocturnal Hemoglobinuria testing.

Our molecular hematopathology laboratory provides advanced diagnostic tests such as next generation sequencing for various hematological malignancies, including acute myeloid leukemia, acute lymphoblastic leukemia, myelodysplastic neoplasm, myeloproliferative neoplasms, MDS/MPN overlap, and lymphoma/myeloma, along with kinase domain mutation testing. In addition, we also perform PCR for BCR::ABL1 transcript identification, PML::RARA fusion detection, BRAFV600E mutation testing, MYD8 L265P mutation testing, T- cell clonality assays, and testing for SARS-CoV-2. We also perform MRD monitoring using various molecular techniques such as qPCR and error-corrected sequencing. Our molecular diagnostics provide comprehensive reports that aid in diagnosis, prognostication, and theragnostic, ensuring a holistic approach to patient care.

For referral samples: please complete registration and payment online at webapps.actrec.gov.in/ReferralInvestigationPortal/Home/Registration prior to sending your samples to us.

The "Inter Laboratory Comparison Program (ILCP)" is an IRB-approved initiative focused on immunophenotyping for leukemia/lymphoma using flow cytometry. This not-for-profit program currently includes 55 participating laboratories from across India. Results from each participant are evaluated, and detailed assessments are provided for each survey.

Program Modules:

• Module D: Diagnostic leukemia/lymphoma immunophenotyping
• Module M: B-ALL Minimal Residual Disease (MRD)
• Module S: Stem cell enumeration

Combined Modules:

• Module D+M
• Module D+S
• Module D+M+S

Participating laboratories benefit from rigorous quality assessments, enhancing diagnostic accuracy and consistency nationwide. For more information, please contact us at ilcptmc@gmail.com.

Our department is part of the Homi Bhabha National Institute and offers a range of comprehensive educational programs, including:

• Fellowship Programs: Two-year fellowships in Hematopathology and Molecular Hemato-Oncology, designed to provide candidates with advanced diagnostic and research skills. The fellowship program is advertised in the website www.tmc.gov.in.
• MD Pathology: A three-year postgraduate in Pathology program featuring five months of dedicated training in hematopathology laboratory.
• Ph.D. Program: We currently host eight Ph.D. students who are engaged in groundbreaking research projects, making significant contributions to the field of health sciences. The PhD programs are advertised in either www.tmc.gov.in or www.actrec.gov.in
• Technologist Training: Advanced courses in flow cytometry and molecular hematology for technologists. The advertisement for the same is posted in www.actrec.gov.in
• Observers: We welcome numerous observers for short-term visits in our flow cytometry and molecular hemato-oncology laboratories. Interested applicants who are medically qualified can apply here.

India has more than 780 medical colleges and approximately 500 provide post graduate course in pathology (~2863 students per year). There are a few major concerns which need urgent help. A group of experienced pathologists/technologists can efficiently help in troubleshooting and standardizing the bare minimum initial tests to make a diagnosis in many pathology labs across India. At an operational level, the three most important stains in any Pathology department are H&E, Romanowsky and Papanicolaou stain. Similarly, team can help standardise basic immunohistochemistry, FISH and flow cytometric immunophenotyping etc, should such a facility exist in a medical college. Conducting slide seminars, CPCs, grand rounds/tumor boards is essential especially for the management in oncology and helps in improving the overall efficiency of pathologists. It is lacking in most colleges and is in this project.

Hypothesis of this project

Aim

Outlines of design/methods

Structure of the visit by the TTSOP team

Novelty and deliverables of the project

Work that has led up to this project

The overarching goal of this proposal is to improve the quality of oncopathology practice and education in India by learning together. There will be follow up meetings and continuous evaluation and quality checks to ensure that the changes are sustainable across these colleges.

A summary of the project requirements of the participating colleges

• Each hub should have a microscope attached to a screen where 100-150 pathologists can view and discuss the slides projected through the microscope.
• The hub should try and hold at least 2-3 regional meetings or catalyse such meetings in the region where pathology slides and technical problems will be shared using a similar format using locally available expertise.
• The Lab shall join an TQAP program provided by TTSOP Mumbai, for technical evaluation of common stains.
• Wherever possible, a representative from the participating institution or region should attend other activities of the central team of TTTSOP.
• The Department would be required to hold a follow up visit by the TTSOP team 15 months after the first visit.

Proposed hubs in this project (participating centres)

1. SKIMS Srinagar
2. MLNMC Prayagraj
3. GMC Musheerabad
4. GMC Nagpur
5. NSCB MC Jabalpur
6. SCB Cuttack
7. AMC Dibrugarh
8. BJMC Ahmedabad
9. SPMC Bikaner
10. JSS Mysore
11. MMC Chennai
12. SNMC Agra
13. CMC Ludhiana
14. IGIMS Patna
15. IPGMER Kolkata

Note: TMC will be happy to work with any of the colleges across India and outside. If your college wishes to join us in this program, you may e-mail us at following address.

Dr. Sumeet Gujral,
Prof Pathology & Honorary Consultant,
ACTREC, TMC, Mumbai.
Phone: +919820523962,
Email: flowtmh[at]gmail[dot]com

Our department hosts a variety of annual conferences and workshops to enhance knowledge and skills in hematopathology and related fields. These include:

• A Basic Hematopathology Course tailored for MD pathology students, providing foundational knowledge in the field.
• A Continuing Medical Education (CME) Program designed specifically for Medical Laboratory Technologists, focusing on the latest advancements and best practices.
• An Advanced Flow Cytometry workshop for clinicians, aimed at enhancing their expertise in utilizing flow cytometry for diagnostic and research purposes.
• A separate Advanced Flow Cytometry workshop for technicians, ensuring they are proficient in the technical aspects of flow cytometry.
• A Basic Workshop on Molecular Hematopathology, offering introductory training in molecular techniques and their applications in hematopathology.
• A Genomic Workshop for molecular pathologists, providing in-depth training on genomic technologies and their implications in molecular pathology.

These events are part of our commitment to continuous education and professional development in the field of hematopathology.

The Hematopathology department is committed to high-quality research, with many ongoing intramural and extramural projects in both subdivisions of the hematopathology laboratory. We primarily perform translational research in the field of Hemato-oncology in close collaboration with adult and pediatric hematolymphoid disease management groups and the bone marrow transplantation team. The major themes of research in the lab can be summarised as:

1. Developing methods to track cancer after initiation of therapy including high- sensitivity flow cytometry, error-corrected sequencing, immunoglobulin/TCR gene rearrangement, and circulating tumor DNA (ctDNA) assays.
2. Developing next-generation sequencing-based methods to characterize blood cancers.
3. Developing sensitive flow cytometry-based methods to predict underlying genetic abnormalities.
4. Developing high-dimensional flow cytometry-based methods to characterize cancer immunology
5. Developing methods to characterize cellular and clonal heterogeneity in blood cancers.
6. Metagenomics and applications to blood cancers