Ravi Krishnadasan

Interests

No activities entered.

Courses

Scholarly Contributions

Chapters

• Kumar, A., Krishnadasan, R., & Sundararajan, S. (2016). T-cell Prolymphocytic Lymphoma. In Handbook of Hematologic Malignancies 1st Edition.

Journals/Publications

• Krishnadasan, R., Nematollahi, S., & Acharya, U. (2015). "ATRA-Induced bone Marrow Necrosis in a Patient with Acute Promyelocytic Leukemia. A Case Presentation and Review of the Literature.". American Journal of Hematology/Oncology, 11(5).
• Zeidan, A. M., Borate, U., Pollyea, D. A., Brunner, A. M., Roncolato, F., Garcia, J. S., Filshie, R., Odenike, O., Watson, A. M., Krishnadasan, R., Bajel, A., Naqvi, K., Zha, J., Cheng, W. H., Zhou, Y., Hoffman, D., Harb, J. G., Potluri, J., & Garcia-Manero, G. (2023). A phase 1b study of venetoclax and azacitidine combination in patients with relapsed or refractory myelodysplastic syndromes. American journal of hematology, 98(2), 272-281.
  More info

  Patients with relapsed/refractory (R/R) higher-risk myelodysplastic syndromes (MDS) have a dismal median overall survival (OS) after failing hypomethylating agent (HMA) treatment. There is no standard of care for patients after HMA therapy failure; hence, there is a critical need for effective therapeutic strategies. Herein, we present the safety and efficacy of venetoclax + azacitidine in patients with R/R MDS. This phase 1b, open-label, multicenter study enrolled patients ≥18 years. Patients were treated with escalating doses of oral venetoclax: 100, 200, or 400 mg daily for 14 days every 28-day cycle. Azacitidine was administered on Days 1-7 every cycle at 75 mg/m /day intravenously/subcutaneously. Responses were assessed per modified 2006 International Working Group (IWG) criteria. Forty-four patients (male 86%, median age 74 years) received venetoclax + azacitidine treatment. Median follow-up was 21.2 months. Hematological adverse events of Grade ≥ 3 included febrile neutropenia (34%), thrombocytopenia (32%), neutropenia (27%), and anemia (18%). Pneumonia (23%) was the most common Grade ≥ 3 infection. Marrow responses were seen including complete remission (CR, n = 3, 7%) and marrow CR (mCR, n = 14, 32%); 36% (16/44) achieved transfusion independence (TI) for RBCs and/or platelets, and 43% (6/14) with mCR achieved hematological improvement (HI). The median time to CR/mCR was 1.2 months, and the median duration of response for CR + mCR was 8.6 months. Median OS was 12.6 months. Venetoclax + azacitidine shows activity in patients with R/R MDS following prior HMA therapy failure and provides clinically meaningful benefits, including HI and TI, and encouraging OS.
• Krishnadasan, R., Zeidan, A. M., Borate, U., Pollyea, D. A., Brunner, A. M., Roncolato, F., Garcia, J. S., Filshie, R., Odenike, O., Watson, A. M., Bajel, A., Naqvi, K., Zha, J., Cheng, W., Zhou, Y., Hoffman, D., Harb, J. G., Potluri, J., & Garcia‐Manero, G. (2022). A phase 1b study of venetoclax and azacitidine combination in patients with relapsed or refractory myelodysplastic syndromes. American Journal of Hematology, 98(2), 272-281. doi:10.1002/ajh.26771
• Krishnadasan, R. (2021). Hemolytic Anemias: Autoimmune and Beyond. Journal of the advanced practitioner in oncology, 12(3), 337-340.
  More info

  During JADPRO Live Virtual 2020, Ravi Krishnadasan, MD, FACP, provided an overview of the terminology of hemolysis, laboratory tests used in the diagnosis of hemolytic anemias, and appropriate indications for treatment of the various hemolytic anemias.
• McBride, A., Campen, C. J., Camamo, J., Maloney, M., Persky, D., Kurtin, S. E., Barket, N. L., Krishnadasan, R., Elquza, E., Anwer, F., & Weibel, K. (2018). Implementation of a pharmacy-managed program for the transition of chemotherapy to the outpatient setting. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 75(9), e246-e258.
  More info

  Implementation of a pharmacy-managed program for the transition of chemotherapy to the outpatient setting is described.
• Chan, O., Chen, H., Krishnadasan, R., & Anwer, F. (2016). Case of relentless chronic phase of chronic myeloid leukaemia. BMJ case reports, 2016.
  More info

  Initial treatment of chronic phase chronic myeloid leukaemia is straightforward in today's era of tyrosine kinase inhibitors. However, managing refractory cases remain a major challenge due to the multiple factors that can influence decision-making, including medication tolerance, disease burden, mutation status, comorbidities, availability of donor, and fitness for an ablative conditioning. We report a male patient presenting with chronic phase chronic myeloid leukaemia who was treated with 5 different tyrosine kinase inhibitors either due to intolerance and/or failed response. He subsequently received 2 haploidentical haematopoietic stem cells transplants before achieving complete remission. This case highlights various treatment options, need for vigilant disease monitoring, and the possibility of complete positive response even after many lines of therapy failure.
• Diri, R., Anwer, F., Yeager, A., Krishnadasan, R., & McBride, A. (2016). Retrospective review of intravenous pentamidine for Pneumocystis pneumonia prophylaxis in allogeneic hematopoietic stem cell transplantation. Transplant infectious disease : an official journal of the Transplantation Society, 18(1), 63-9.
  More info

  Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at risk of numerous opportunistic infections. Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that can develop in immunocompromised individuals. Current prophylaxis for PJP includes trimethoprim-sulfamethoxazole (TMP-SMX), dapsone, atovaquone, or inhaled pentamidine (PEN), often with varying breakthrough rates. The use of intravenous (IV) PEN for PJP prophylaxis has been evaluated in pediatric patients.
• Krishnadasan, R. (2016). Diagnosis and Treatment of Benign Bleeding Disorders. Journal of the advanced practitioner in oncology, 7(3), 327.
• Diri, R., Anwer, F., Yeager, A., Krishnadasan, R., & McBride, A. (2015). Retrospective review of intravenous pentamidine for Pneumocystis pneumonia prophylaxis in allogeneic hematopoietic stem cell transplantation. Transplant Infectious Disease.
• Diri, R., McBride, A., Yeager, A. M., Anwer, F., & Krishnadasan, R. (2015). Retrospective Review of Intravenous Pentamidine for Pneumocystis Pneumonia Prophylaxis in Patients Undergoing Hematopoietic Stem Cell Transplantation. Biology of Blood and Marrow Transplant, 21, S367.
• Nematollahi, S., Acharya, U. H., & Krishnadasan, R. (2015). ATRA-Associated Marrow Necrosis in a Patient With Acute Promyelocytic Leukemia: A Case Presentation and Review of the Literature. American Journal of Hematology/Oncology{\textregistered}, 11.
• Brown, G. E., Babiker, H. M., Cantu, C. L., Yeager, A. M., & Krishnadasan, R. (2014). "Almost bleeding to death": the conundrum of acquired amegakaryocytic thrombocytopenia. Case reports in hematology, 2014, 806541.
  More info

  Acquired amegakaryocytic thrombocytopenia (AAT) is a rare hematological disorder causing severe thrombocytopenia and bleeding. Previous in vitro studies postulated both cell-mediated suppression of megakaryocytopoiesis in early megakaryocytic progenitor cells and humoral-mediated suppression by anti-thrombopoietin antibodies as possible etiologies of AAT. Patients with AAT usually present with severe bleeding and thrombocytopenia that is unresponsive to steroids and intravenous immunoglobulin (IVIG). Although standard guidelines have not been established for management of AAT, a few case reports have indicated a response to immunosuppressive treatment. The prompt recognition of this disease entity is essential in view of the substantial risk of morbidity and mortality from excessive bleeding. We report a case of AAT successfully treated with equine antithymocyte globulin (ATG) and cyclosporine (CSP).
• Rogowitz, E., Babiker, H. M., Krishnadasan, R., Jokerst, C., Miller, T. P., & Bookman, M. (2013). Heart of lymphoma: primary mediastinal large B-cell lymphoma with endomyocardial involvement. Case reports in oncological medicine, 2013, 814291.
  More info

  Primary mediastinal B-cell lymphoma (PMBCL) is an uncommon aggressive subset of diffuse large B-cell lymphomas. Although PMBCL frequently spreads locally from the thymus into the pleura or pericardium, it rarely invades directly through the heart. Herein, we report a case of a young Mexican female diagnosed with PMBCL with clear infiltration of lymphoma through the cardiac wall and into the right atrium and tricuspid valve leading to tricuspid regurgitation. This was demonstrated by cardiac MRI and transthoracic echocardiogram. In addition, cardiac MRI and CT scan of the chest revealed the large mediastinal mass completely surrounding and eroding into the superior vena cava (SVC) wall causing a collar of stokes. The cardiac and SVC infiltration created a significant therapeutic challenge as lymphomas are very responsive to chemotherapy, and treatment could potentially lead to vascular wall rupture and hemorrhage. Despite the lack of conclusive data on chemotherapy-induced hemodynamic compromise in such scenarios, her progressive severe SVC syndrome and respiratory distress necessitated urgent intervention. In addition to the unique presentation of this rare lymphoma, our case report highlights the safety of R-CHOP treatment.
• Krishnadasan, R., Bifulco, C., Kim, J., Rodov, S., Zieske, A. W., & Vanasse, G. J. (2006). Overexpression of SOCS3 is associated with decreased survival in a cohort of patients with de novo follicular lymphoma. British journal of haematology, 135(1), 72-5.
  More info

  The prognostic significance of SOCS3 protein expression was determined in de novo follicular lymphomas (FL) with t(14;18) and bcl-2 overexpression. Presentation lymph nodes from 82 FL patients for whom clinical information was available were immunohistochemically segregated into SOCS3-positive (n = 42) or -negative (n = 40) cohorts, and overall survival (OS) was analysed. SOCS3-positive FL patients had a median OS of 10 years compared with 22 years in SOCS3-negative patients (P = 0.001, log rank test). After adjusting for Follicular Lymphoma International Prognostic Index subgroups, SOCS3 overexpression remained an independent predictor of decreased OS (P < 0.001). These findings suggest that overexpression of SOCS3 may be an independent poor prognostic variable in patients with de novo FL.

Case Studies

• Krishnadasan, R., Anwer, F., Yun, S., Nair, A., Ahmad, Y., & Deeg, H. (2015. Severe refractory immune thrombocytopenia successfully treated with high-dose pulse cyclophosphamide and eltrombopag(p. 4).
• Peel, C., Peel, C., Crawford, C., Crawford, C., Sisti, G., Sisti, G., Amaraneni, A., Amaraneni, A., Krishnadasan, R., Krishnadasan, R., Coppola, L., Coppola, L., Jain, J., & Jain, J. (2024. Glanzmann's Thrombasthenia During Pregnancy(pp Pending).