Pengobatan Limfoma Hodgkin di India

Hodgkin lymphoma, often referred to simply as Hodgkin's disease, is a type of cancer that affects the lymphatic system, a vital component of the immune system. It is named after Dr. Thomas Hodgkin, who first described the disease in 1832. Hodgkin lymphoma is a relatively rare form of cancer, but it is significant due to its distinct characteristics and the importance of early diagnosis and appropriate treatment.

Why Discussing Treatment Options in India Matters:

Discussing treatment options for Hodgkin lymphoma in India is of great significance for several reasons:

1. Global Prevalence: While Hodgkin lymphoma is relatively rare worldwide, India's large population means that a significant number of individuals are affected by the disease. Therefore, understanding the available treatment options in India is crucial for those diagnosed and their families.
2. Medical Expertise: India has a well-established healthcare system with numerous specialized cancer treatment centers and experienced oncologists. Patients from India and around the world seek treatment here, making it essential to explore the available expertise and resources.
3. Cost Considerations: The cost of cancer treatment can be a significant burden for patients and their families. India is known for providing high-quality medical care at a fraction of the cost compared to many Western countries, making it an attractive option for international patients.

Now, let's delve into a more detailed understanding of Hodgkin lymphoma:

Hodgkin Lymphoma:

Hodgkin lymphoma is a type of blood cancer that originates in the lymphatic system, particularly in the lymph nodes. The lymphatic system plays a crucial role in maintaining the body's immune function by filtering out harmful substances and producing lymphocytes, a type of white blood cell.

Types and Stages of Hodgkin Lymphoma:

There are two main types of Hodgkin lymphoma:

1. Classical Hodgkin Lymphoma (cHL): This is the most common type, comprising about 95% of all Hodgkin lymphoma cases. It is further classified into subtypes such as nodular sclerosis, mixed cellularity, lymphocyte-rich, and lymphocyte-depleted.
2. Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL): This is a rare subtype, accounting for about 5% of cases. It has distinct characteristics and a generally more favorable prognosis.

Hodgkin lymphoma is also staged to determine the extent of the disease's spread. The staging system commonly used is the Ann Arbor staging system, which includes four stages:

• Stage I: The cancer is limited to a single lymph node region or one organ.
• Stage II: Two or more lymph node regions on the same side of the diaphragm are affected.
• Stage III: Lymph nodes are affected on both sides of the diaphragm.
• Stage IV: The cancer has spread to distant organs or tissues, such as the liver, lungs, or bone marrow.

Common Symptoms and Risk Factors:

The symptoms of Hodgkin lymphoma can vary, but some common ones include:

• Painless swelling of lymph nodes, usually in the neck, armpits, or groin.
• Persistent fatigue.
• Unexplained weight loss.
• Night sweats.
• Fever and chills.

While the exact cause of Hodgkin lymphoma is unknown, several risk factors may increase the likelihood of developing the disease, including:

• Age: It most commonly affects young adults and individuals in their early 20s and those over 55.
• Family history: Having a family member with Hodgkin lymphoma may slightly increase the risk.
• Weakened immune system: People with conditions that weaken the immune system, such as HIV/AIDS, are at higher risk.

Understanding these aspects of Hodgkin lymphoma is the first step in making informed decisions about treatment options. The next sections of your blog can explore the available treatments in India, the importance of early diagnosis, and the role of healthcare professionals in managing the disease.

Diagnosis and Staging of Hodgkin Lymphoma:

Diagnosing Hodgkin lymphoma is a meticulous process that involves various medical tests and procedures. Accurate diagnosis is essential to determine the type and stage of the disease, which in turn guides the selection of the most appropriate treatment plan.

1. Clinical Evaluation: The diagnostic journey typically begins with a thorough clinical evaluation by a healthcare professional. This involves discussing the patient's medical history, including any symptoms, risk factors, and family history of cancer. A physical examination may also be conducted to check for swollen lymph nodes and other potential signs of Hodgkin lymphoma.

2. Blood Tests: Blood tests are often the first step in diagnosing Hodgkin lymphoma. These tests can help identify abnormalities in the blood, such as an elevated white blood cell count or abnormal levels of certain proteins. One specific blood test used to aid in the diagnosis of Hodgkin lymphoma is called the erythrocyte sedimentation rate (ESR) or sed rate.

3. Imaging Tests: Imaging tests are crucial for assessing the extent and location of the disease. Common imaging techniques used in the diagnosis of Hodgkin lymphoma include:

• Computed Tomography (CT) Scan: A CT scan provides detailed cross-sectional images of the body, allowing doctors to examine the lymph nodes and other organs for abnormalities.
• Positron Emission Tomography (PET) Scan: A PET scan can help determine if lymph nodes are metabolically active, which is useful in distinguishing between benign and malignant lymph nodes.
• Magnetic Resonance Imaging (MRI): MRI scans use strong magnetic fields and radio waves to create detailed images of the body's soft tissues. They are often used to assess lymph nodes in the chest and abdomen.

4. Biopsy: A biopsy is the definitive diagnostic procedure for Hodgkin lymphoma. It involves the removal of a small sample of tissue from an enlarged lymph node or affected organ. There are different types of biopsies, including:

• Excisional Biopsy: In this procedure, the entire lymph node is removed for examination.
• Core Needle Biopsy: A larger needle is used to obtain a core of tissue from the lymph node.
• Fine Needle Aspiration (FNA): A thin needle is used to extract a small sample of cells from the lymph node.

The biopsy sample is sent to a pathology lab where it is examined under a microscope. A diagnosis of Hodgkin lymphoma is confirmed when characteristic abnormal cells called Reed-Sternberg cells are present in the tissue sample.

Staging Process and Its Significance:

Once Hodgkin lymphoma is confirmed, staging is performed to determine the extent of the disease's spread. The most commonly used staging system is the Ann Arbor staging system, which divides the disease into four stages, as mentioned earlier:

• Stage I: The cancer is limited to a single lymph node region or one organ.
• Stage II: Two or more lymph node regions on the same side of the diaphragm are affected.
• Stage III: Lymph nodes are affected on both sides of the diaphragm.
• Stage IV: The cancer has spread to distant organs or tissues, such as the liver, lungs, or bone marrow.

Staging is crucial because it helps oncologists determine the appropriate treatment plan and prognosis. The stage of the disease guides decisions regarding the intensity and duration of treatment, whether chemotherapy, radiation therapy, or a combination of both is required, and the potential for a cure or long-term remission.

The diagnosis of Hodgkin lymphoma involves a combination of clinical evaluation, blood tests, imaging tests, and biopsy. Once diagnosed, staging is essential for planning the most effective treatment strategy and providing patients with a clear understanding of their prognosis. Early and accurate diagnosis, followed by appropriate treatment, is key to improving the chances of recovery for individuals with Hodgkin lymphoma.

1. Chemotherapy:

Chemotherapy is a systemic treatment that uses powerful drugs to kill cancer cells or prevent their growth. Chemotherapy is often used as the initial treatment for Hodgkin lymphoma, both in early and advanced stages. It can also be used as part of combination therapy.

Why It's Done:

• To shrink tumors before radiation therapy or surgery.
• To kill cancer cells that have spread beyond the lymph nodes.
• To treat patients with advanced-stage Hodgkin lymphoma.

Process:

1. Drug Selection: The first step is to determine the most appropriate chemotherapy drugs and regimens for the individual patient based on factors such as the stage of the disease, subtype of Hodgkin lymphoma, and overall health. Different combinations of drugs may be used to maximize effectiveness.

2. Administration: Chemotherapy drugs can be administered in various ways, depending on the specific regimen and the patient's condition. They may be taken orally as pills or capsules or delivered intravenously (IV) through a vein. Some chemotherapy regimens involve a combination of both oral and IV drugs.

3. Treatment Cycles: Chemotherapy is typically given in cycles, with each cycle consisting of an active treatment period followed by a rest period. The rest period allows the patient's body to recover from the side effects of chemotherapy. The number of cycles and their duration are determined by the treatment plan.

4. Monitoring: Throughout the treatment, the patient is closely monitored by healthcare professionals to assess the response to chemotherapy and manage any side effects. Blood tests and imaging scans may be conducted to evaluate the effectiveness of treatment and make necessary adjustments.

5. Side Effect Management: Chemotherapy can have side effects, which vary depending on the drugs used and the individual patient. Common side effects include nausea, fatigue, hair loss, and a decreased ability to fight infections. Supportive medications and interventions are often prescribed to manage these side effects and improve the patient's comfort and well-being.

6. Adjustments: Treatment plans may be adjusted based on how well the cancer responds to chemotherapy. If needed, modifications may be made to the type or dose of chemotherapy drugs to optimize outcomes.

Chemotherapy aims to target and destroy cancer cells throughout the body, which is particularly important in advanced-stage Hodgkin lymphoma where cancer cells may have spread to distant sites.

2. Radiation Therapy:

Radiation therapy uses high-energy X-rays or other forms of radiation to target and destroy cancer cells. Radiation therapy is often used:

• As part of the initial treatment for early-stage Hodgkin lymphoma.
• After chemotherapy or surgery to treat residual disease.

Why It's Done:

• To kill cancer cells in a specific area or lymph node.
• To reduce the risk of disease recurrence.

Process:

Radiation therapy for Hodgkin lymphoma involves precise planning and execution to effectively target cancer cells while minimizing damage to surrounding healthy tissue. Here's how radiation therapy is typically administered:

1. Treatment Planning: Before radiation therapy begins, the patient undergoes imaging scans, such as CT scans or PET scans. These scans help create a detailed map of the treatment area, allowing radiation oncologists to identify the exact location of the tumor and the surrounding lymph nodes.
2. Positioning: During radiation therapy sessions, the patient lies on a treatment table in a carefully planned and reproducible position. Immobilization devices, such as molds or cushions, may be used to ensure consistent positioning.
3. Targeted Radiation Delivery: A machine, such as a linear accelerator, delivers high-energy X-ray beams or other forms of radiation to the precise treatment area identified during planning. The radiation beams are carefully shaped and directed to accurately target the tumor, while sparing nearby healthy tissues.
4. Fractionation: Radiation therapy is typically delivered in multiple sessions, known as fractions, to optimize the effectiveness of treatment and reduce the risk of side effects. The specific number of sessions and radiation doses are determined by the treatment plan.
5. Monitoring: Throughout the course of radiation therapy, the patient's progress is closely monitored by the radiation oncology team. Any necessary adjustments to the treatment plan are made to ensure optimal outcomes.
6. Side Effect Management: Radiation therapy can lead to side effects, including skin changes, fatigue, and localized discomfort. Healthcare providers offer guidance and interventions to manage these side effects and enhance the patient's overall comfort during treatment.

3. Targeted Therapy (Brentuximab Vedotin):

Brentuximab vedotin is a targeted therapy drug designed to deliver a toxic payload directly to cancer cells. Brentuximab vedotin is typically used in cases of relapsed or refractory Hodgkin lymphoma, where other treatments have not been effective.

Why It's Done:

• To specifically target and destroy cancer cells while sparing healthy cells, reducing collateral damage.
• As a salvage therapy when other treatment options have failed to achieve remission.

Process:

Brentuximab vedotin is a targeted therapy drug used in the treatment of Hodgkin lymphoma. The process of administering Brentuximab Vedotin involves the following steps:

1. Patient Evaluation: Before starting treatment, the patient undergoes a thorough evaluation, including blood tests and assessments to ensure they are a suitable candidate for targeted therapy.

2. Treatment Setting: Brentuximab vedotin is typically administered in a clinical setting, such as a hospital or specialized cancer center, where trained medical professionals can monitor the patient closely.

3. Intravenous Infusion: A healthcare provider places an intravenous (IV) line, usually in the patient's arm. The drug is administered as a slow IV infusion over a designated period, which can vary depending on the patient's specific treatment plan.

4. Monitoring: During the infusion, medical staff monitor the patient for any adverse reactions or side effects. Vital signs, including blood pressure, heart rate, and oxygen levels, may be regularly checked.

5. Frequency and Duration: The frequency and duration of Brentuximab vedotin infusions depend on the patient's individual treatment plan, which is determined by the healthcare team. Treatment cycles and the total number of infusions are tailored to the patient's condition and response to the drug.

6. Side Effect Management: Patients may experience side effects, which can vary from person to person. Common side effects include nausea, fatigue, and infusion-related reactions. Healthcare providers take steps to manage these side effects and ensure patient comfort.

4. Stem Cell Transplant (Autologous):

Autologous stem cell transplant is a procedure that uses a patient's own stem cells to replace damaged or destroyed bone marrow. Autologous stem cell transplant is considered in cases of relapsed or high-risk Hodgkin lymphoma, typically after initial treatment with chemotherapy or if the disease has not responded adequately to other treatments.

Why It's Done:

• To enable the delivery of high-dose chemotherapy, which can be more effective in killing cancer cells but also damages the bone marrow.
• To help the patient's body recover after intensive chemotherapy by restoring healthy blood cell production.

Process:

Autologous stem cell transplant is a procedure used in the treatment of Hodgkin lymphoma. It involves several key steps:

a. Stem Cell Collection (Apheresis): The process begins with stem cell collection, often referred to as apheresis. This involves the following steps:

• The patient receives medications called growth factors to stimulate the production of stem cells in the bone marrow.
• Once the stem cells are sufficiently mobilized into the bloodstream, a special machine (apheresis machine) is used to collect the cells through a catheter or IV line. The machine separates the stem cells from the blood, and the remaining blood components are returned to the patient.

c. High-Dose Chemotherapy: After the stem cell collection and processing, the patient undergoes a course of high-dose chemotherapy. This intensive chemotherapy is designed to eradicate cancer cells throughout the body but also destroys healthy bone marrow.

d. Stem Cell Infusion: Once the high-dose chemotherapy is completed, the patient's previously collected and processed stem cells are thawed and reinfused into the bloodstream through an IV line. The infused stem cells travel to the bone marrow and gradually begin to rebuild healthy blood cells.

e. Recovery and Monitoring: The patient's progress is closely monitored in the days and weeks following the stem cell transplant. Blood counts, immune function, and overall health are assessed regularly. Supportive care, including medications to prevent infections and manage side effects, is provided as needed.

f. Engraftment: Engraftment is the term used to describe the successful integration of the transplanted stem cells into the bone marrow. This process can take several weeks, during which time the patient remains at risk of infection and other complications.

5. Supportive Care:

Supportive care focuses on managing symptoms, side effects, and emotional well-being. Supportive care is provided throughout the treatment journey, especially for patients with advanced-stage disease.

Why It's Done:

• To improve the patient's quality of life.
• To alleviate symptoms and side effects of treatment

• Palliative care specialists provide symptom management and pain relief.
• Psychosocial support services, including counseling and support groups, help patients cope with emotional challenges.

6. CAR-T Cell Therapy:

CAR-T cell therapy (Chimeric Antigen Receptor T-cell therapy) is an innovative immunotherapy approach that involves modifying a patient's own T cells to target cancer cells more effectively. CAR-T cell therapy is typically considered in specific cases, especially when other standard treatments have failed or when the disease has relapsed.

Why It's Done:

• To explore a promising new treatment that harnesses the power of the patient's immune system.
• To target cancer cells more specifically and precisely, potentially reducing damage to healthy tissues.

Process:

CAR-T cell therapy is an innovative and highly personalized treatment approach that harnesses the patient's own immune system to target and destroy cancer cells. The process of CAR-T cell therapy involves several intricate steps:

a. Patient Evaluation and Eligibility: Before initiating CAR-T cell therapy, the patient undergoes a comprehensive evaluation to assess their eligibility for the treatment. Factors such as the patient's overall health, the type and stage of cancer, and previous treatment history are taken into account.

b. T Cell Collection (Leukapheresis): The process begins with the collection of the patient's own T cells, a type of immune cell. This is typically done through a procedure called leukapheresis:

• A catheter or IV line is inserted into the patient's vein.
• Blood is withdrawn from the patient.
• In a specialized machine, T cells are separated from the blood and collected.
• The remaining blood components are returned to the patient.

c. Genetic Modification: The collected T cells are sent to a laboratory, where they are genetically modified to express chimeric antigen receptors (CARs) on their surface. CARs are designed to target specific proteins present on the surface of cancer cells, making T cells more effective at recognizing and attacking cancer.

d. Cell Expansion: After genetic modification, the CAR-T cells are cultured and allowed to multiply to generate a sufficient quantity of these engineered immune cells. This expansion process can take several days to a few weeks, depending on the treatment plan.

e. Lymphodepletion: Before CAR-T cell infusion, the patient may undergo a process called lymphodepletion. This involves receiving chemotherapy or radiation therapy to temporarily suppress the patient's existing immune system. This step helps create space for the infused CAR-T cells to expand and become more effective.

f. CAR-T Cell Infusion: Once a sufficient number of CAR-T cells have been produced, they are reinfused into the patient's bloodstream through an IV line. This is a one-time infusion and is typically done in a clinical or hospital setting.

g. Monitoring and Observation: After CAR-T cell infusion, the patient is closely monitored for potential side effects and treatment response. Common side effects may include cytokine release syndrome (CRS) and neurological symptoms, which are managed by the healthcare team.

h. Response Assessment: Over the following weeks and months, the patient's response to CAR-T cell therapy is assessed through various means, including imaging scans, blood tests, and clinical evaluations. This helps determine the treatment's effectiveness and whether the patient achieves remission.

i. Long-Term Follow-Up: Patients who respond positively to CAR-T cell therapy are typically monitored for an extended period to assess the durability of the response and manage any potential long-term side effects or complications.

CAR-T cell therapy has shown promising results in clinical trials for some patients with Hodgkin lymphoma, particularly in cases where other treatments have failed.

Best Professionals and hospital in India for Hodgkin Lymphoma Treatment in India :

1. Max Healthcare Saket

• Location: New Delhi, Saket, India
• Max Super Speciality Hospital is a renowned multi-specialty hospital located in Delhi, offering over 500+ bedded facilities and comprehensive medical services.
• Expertise: Our expert medical team has successfully treated more than 34+ lakh patients across various specialties.
• Advanced Technology: Equipped with state-of-the-art medical technology, including a 1.5 Tesla MRI machine and a 64 Slice CT Angio.
• Neurosurgical Advancement: Featuring Asia's first Brain SUITE, enabling MRI imaging during neurosurgery.
• Awards: Recognized by the Association of Healthcare Providers of India (AHPI) and honored by FICCI for Operational Excellence in Healthcare Delivery on September 7, 2010.

Key Highlights:

Specialized Dialysis Unit: Compliant with international standards, offering hemodialysis for patients with end-stage kidney disease and those requiring renal replacement therapy.

Specialty Clinics:

• Women's Heart Clinic
• Multiple Sclerosis (M.S.) Clinic
• Headache Clinic
• Geriatric Neurology Clinic
• Movement Disorder Clinic
• Pacemaker Clinic
• Arrhythmia & Electrophysiology Clinic

Max Super Speciality Hospital, Saket, is committed to delivering top-quality healthcare services and is recognized for its excellence in healthcare delivery and advanced medical infrastructure.

2. Fortis Memorial Research Institute, Gurgaon:

• Location: Sector - 44, Opposite HUDA City Centre, Gurgaon, Haryana - 122002, India
• Fortis Memorial Research Institute (FMRI) is a multi-super specialty, quaternary care hospital.
• It boasts an international faculty, reputed clinicians, super-sub-specialists, and specialty nurses.
• The hospital is known for utilizing cutting-edge technology to provide advanced medical care.
• FMRI aims to be the 'Mecca of Healthcare' for Asia Pacific and beyond.
• The hospital is situated on a spacious 11-acre campus and offers 1000 beds.
• It is often referred to as the 'Next Generation Hospital' and is built on the pillars of Talent, Technology, Infrastructure, and Service.
• FMRI has undergone a thorough on-site review of the quality and safety of care provided, and it is committed to continuously meeting rigorous international standards.
• FMRI is unmatched in the fields of Neurosciences, Oncology, Renal Sciences, Orthopedics, Cardiac Sciences, Obstetrics, and Gynecology.
• It has solidified its position as one of the top hospitals in Gurgaon by leveraging advanced technology and top clinicians to deliver high-quality healthcare.
• Fortis Memorial Research Institute is a flagship hospital of Fortis Healthcare, one of the leading healthcare providers in the country.
• Fortis Memorial Research Institute in Gurgaon is known for its exceptional healthcare services, advanced technology, and a wide range of medical specialties. It is committed to providing top-notch medical care and adhering to international standards of quality and safety.

3. Indraprastha Apollo Hospital, Delhi:

Location: Sarita Vihar, Delhi-Mathura Road, New Delhi - 110076, India

• Indraprastha Apollo Hospitals, New Delhi, is a multi-specialty tertiary acute care hospital.
• It boasts 710 beds and is one of the most sought-after healthcare destinations in Asia.
• The hospital is a state-of-the-art modern facility situated in the heart of the capital.
• It spans across 15 acres and has a built-up area of over 600,000 square feet.
• Indraprastha Apollo Hospitals, New Delhi, is a flagship hospital of the Apollo Hospitals Group, known for its clinical excellence.
• The hospital aims to achieve the best clinical outcomes for patients with complex diseases.
• This is made possible through the best staff, the latest technology, and standardized processes.
• Highly qualified consultants undergo a rigorous credentialing and privileging process.
• Staff members receive regular training, attend conferences, and participate in continuing medical education programs to stay updated with the latest developments in their fields.
• The hospital is equipped with cutting-edge medical technologies, including PET-MR, PET-CT, Da Vinci Robotic Surgery System, BrainLab Navigation System, Portable CT Scanner, NovalisTx, Tilting MRI, Cobalt-based HDR Brachytherapy, DSA Lab, Hyperbaric Chamber, Fibroscan, Endosonography, 3 Tesla MRI, and a 128-Slice CT scanner.
• These technologies ensure world-class healthcare services.
• Indraprastha Apollo Hospitals was the first hospital in India to receive JCI accreditation in 2005, highlighting its commitment to standardized processes.
• It was also reaccredited in 2008 and 2011.
• The hospital has NABL accredited clinical laboratories and a state-of-the-art blood bank.

Indraprastha Apollo Hospitals, New Delhi, is renowned for its comprehensive medical services, commitment to clinical excellence, and access to advanced medical technologies, making it a top healthcare destination in Asia.

Best Professionals for Hodgkin Lymphoma Treatment in India :

1. Dr. Rahul Bhargava

• Blood Disorders and Bone Marrow Transplant
• Consults at: Fortis Memorial Research Institute, Gurgaon, and Fortis Hospital, Noida
• Achievements: Pioneered stem cell transplant in multiple sclerosis in India.
• Experience: Over 15 years of medical expertise.
• Transplants: Successfully completed 400+ transplants.
• Vision: Established an integrated center of excellence in Hematology and Stem Cell Transplantation at Fortis Memorial Research Institute.
• Recognition: Renowned hematologist in Delhi and Gurgaon.
• Specialties: Benign Hematology, Hemato-oncology, Pediatric Hemato-oncology, Transplants (including haploidentical), Hematopathology, Molecular Hematology.

2. Dr Raja Sundaram

• Director – Surgical Oncology
• Consults at: Gleneagles Global Health City, Chennai
• Experience: Over 15 years of expertise in Surgical Oncology
• Surgeries: Successfully performed 15,000+ cancer surgeries
• Founding the Sundaram Cancer Centre: Pioneered the establishment of Sundaram Cancer Centre in Chennai, providing comprehensive and affordable cancer treatment
• Academic Excellence: Awarded a university rank and gold medal
• Research and Speaker: Author of numerous research papers in peer-renowned journals, invited speaker at national and international conferences
• Professional Affiliations: Life member of ASI, ISO, IASO, AROI, ESMO, and OGSSI
• Advocating Early Detection: Strong advocate for early cancer detection, leading Sundaram Cancer Foundation's initiatives for mobile cancer screening programs
• Global Recognition: Renowned not only among peers but also among patients worldwide, attracting individuals seeking cancer care from various parts of India and across the globe

3. Dr Gaurav Kharya

• Designation: Clinical Lead - Centre for Bone Marrow Transplant and Cellular Therapy Senior Consultant Pediatric Hematology, Oncology, and Immunology
• Consults at: Indraprastha Apollo Hospital
• Experience: Over 15 years of medical expertise:
• Medical Pioneering: Dr. Kharya performed the first haploidentical bone marrow transplant for sickle cell disease in India.
• Innovative Procedures: He conducted the first invitro TCR alpha beta CD 19 depleted haploidentical BMT in a 5-month-old baby with severe combined immunodeficiency, one of the youngest recipients of bone marrow transplant in India.
• Transplant Expertise: Dr. Kharya and his team have completed close to 700 transplants for various diseases
• Dr. Kharya believes that no child requiring treatment for cancer, immunological disease, or bone marrow transplant should be deprived due to financial constraints.
• He has established partnerships with NGOs to provide financial and social support to children and their families in need.

Dr. Gaurav Kharya's pioneering work, extensive experience, and commitment to accessible healthcare make him a respected authority in Pediatric Hematology, Oncology, and Immunology in India.