Bishwaranjan Jana

Abstracts Pediatric Hematology Oncology Journal 7 (2022) S8eS69 Background: Residual tumor avidity on PET, is associated with poor prognosis in Hodgkin lymphoma (HL). Metabolic PET parameters give idea of the whole body tumor burden and is prognostic in predicting response to treatment, progression free survival and overall survival. We aim to study the baseline metabolic parameters and its association with other baseline parameters and response to treatment in children with HL, treated at our centre. Methods: Prospective observational study, done from July 2020-June 2022, including patients with HL, from 1-18 years of age. All patients underwent PET-CT at baseline and after 2 cycles of ABVD chemotherapy, which was reviewed by 2 nuclear medicine experts. Results: Out of 43 patients 35 (81.3%) were males with mean age of 7.5 years (+2.5). Median symptom duration was 12 months (7-24) with B symptoms in 32 patients (74.41%). Stage III was the commonest presentation (44.1%). Bulky disease was present in 18.6%. Thirty one (72%) patients achieved complete metabolic response at interim assessment. Median baseline Total Lesion Glycolysis (TLG) and Metabolic Tumor Volume (MTV) in early complete responders and partial responders were [406.8 ml (153.8;856.2) and 636.5 ml (421.5;945.3)] and [66.95 ml (33.99;91.86) and 85.0 ml (58.81;159.5)] respectively. The baseline parameters including metabolic, were correlated with response to chemotherapy. Hemoglobin < 9.4 gm/dl, TLC > 9.6x 103/ mm3 and number of nodal sites (4.45 +1.74 vs 6 +2.73) were significantly associated with incomplete response at interim assessment. In multivariate only Hb and TLC maintained its significance. The baseline MTV and TLG were significantly high in those with unfavourable risk, B-symptoms and bulky disease, but did not predict response. Conclusions: Our study could not establish the predictive value of baseline metabolic parameters for response to chemotherapy, though Hb and TLC emerged as important variable. This could be explained by the fact that 72% of our patients went into CMR at interim assessment. These needs to be studied in larger cohort and further standardization for use in clinical practice. were classified as low (LR), intermediate (IR) and high risk (HR) respectively . LR group was treated with 4 cycles of ABVD while advanced stages (IR/HR) were treated with 6 cycles of ABVD. Early response assessment (ERA) was defined as adequate if PET-CT or CT based response after 2 cycles showed CR/VGPR. Those with bulky disease or inadequate response received IFRT 19.8 Gy and 30.6 Gy respectively Results: Of the total patients analysed (n¼67), median age was 8.1 years with male preponderance (M:F; 8:1). Two- third (44/67) presented with advanced stage and 38/67 had B symptoms (57%). ERA was adequate in 94% patients. Three patients relapsed, all of whom were salvaged and went on to achieve second remission. One patient developed progressive disease. On univariate analysis, prognostic factors such as age, risk, B symptoms, ESR, Hb, LDH, Albumin did not statistically impact EFS whereas adequate ERA tended to affect EFS (p¼0.07). The 2-year EFS was 94.3 +/- 3.5% and OS was 100%. Conclusions: ABVD appears to be a robust protocol with good short term outcomes in a resource-limited setting. Longer follow up a with larger cohort will be needed to better define its role, especially in view of potential late effects ALLOPURINOL ADJUVANT IN ACUTE LYMPHOBLASTIC LEUKAEMIA MAINTENANCE TREATMENT Akshay Kamle, Niharendu Ghara, Debjani Ghosh, Manash Pratim Gogoi, Bishwaranjan Jana, Tushar Mungle. TATA Medical Center, Kolkata Background: 6-mercaptopurine, a mainstay of acute lymphoblastic leukaemia (ALL) maintenance treatment, has a narrow therapeutic window. Non-haematological toxicities arise from excess methylated metabolites. Allopurinol modifies 6MP metabolism to mitigate toxicity. We report experience with allopurinol as adjuvant in ALL maintenance. €n ~ 30kg; Methods: Allopurinol adjuvant (50mg daily if <10 years and/or Ge 100mg daily otherwise), was introduced to mitigate thiopurine toxicity, as prophylaxis or to potentiate 6MPs pharmacological activity (persistent high neutrophil count). Toxicity included symptomatic hypoglycaemia, hepatotoxicity (liver transaminases >10├ù upper-normal-limit, cholestatic jaundice), troublesome cutaneous rash and/or gastrointestinal intolerance (GII). In patients with asparaginase-associated pancreatitis (AAP), allopurinol was introduced with maintenance start, as pancreatitis prophylaxis. In patients with persistent elevated neutrophils, allopurinol was added to potentiate 6MP activity. With allopurinol, 6MP dose was decreased and dose-titration individualised. Results: Between Aug2021-Jul2022, 15 patients (median, 6┬ ╖5 years) were administered allopurinol in ALL maintenance at a median 75 treatment weeks 11 to mitigate 6MP toxicity (at a median 52 weeks), 3 as prophylaxis and 1 to potentiate 6MP activity. 6MP toxicities included hypoglycaemia (n¼4) and hepatotoxicity (n¼8), alone or in combination (n¼2); one had hepatotoxicity & GII. In 9 (82%) of 11 evaluable patients, allopurinol ameliorated thiopurine-related toxicity completely at a median 3 weeks; GII persisted in one. No differences were observed in pre-/postallopurinol neutrophil counts. Pre-prophylaxis (Aug2013-Jul2021), 9/23 (39%) with AAP experienced recurrent pancreatitis at a median 16 weeks into 6MP treatment. On allopurinol prophylaxis, none experienced breakthrough pancreatitis. Allopurinol potentiation (n¼1, 11 weeks) failed to lower neutrophil count. No patient required allopurinol discontinuation. Non-significant higher incidence of haematological toxicity was observed with allopurinol adjuvant (45/1000-person days versus 31/1000-person days, p 0.42). Conclusions: Adjuvant allopurinol shows clinical benefit in mitigating non-haematological 6MP toxicity. Pharmacological monitoring would further optimise adjuvant allopurinol treatment. Non-significant excess haematological toxicity highlights requirement for close monitoring with this intervention. TO STUDY THE INCIDENCE AND ROLE OF NEUTROPENIA AS A PROGNOSTIC MARKER IN PEDIATRIC ONCOLOGY PATIENTS WITH ACUTE APPENDICITIS Navneet Kaur, Shruti Kakkar. Dayanand Medical College and Hospital Ludhiana, Punjab Background: Appendicitis in pediatric oncology patients can present with atypical signs and symptoms. The diagnosis can be delayed or missed ,thus increasing the morbidity and mortality . AIMS: To study the outcome of acute appendicitis in pediatric oncology patients . Methods: Medical records of patients admitted with acute appendicitis in the pediatric oncology unit over last 5 years were reviewed. The data regarding patients age, gender , disease , phase of treatment , laboratory and radiological reports, surgical notes and outcome was recorded. Results: A total of 166 pediatric patients were treated for acute leukemia and 6 patients developed acute appendicitis (3.6 %). The incidence of acute appendicitis in ALL and AML was 3.5 % and 4.1% patients respectively. Median age at time of diagnosis was 7.5 years; all patients were male. The disease was in remission in all patients except one, who was diagnosed relapsed AML. Abdominal pain and fever were the presenting symptoms. Two patients had developed appendiceal perforation. Appendicectomy was performed in all patients and none of the appendices showed evidence of leukemic infiltration on immunohistochemical study. Patient with relapsed AML expired due to sepsis 10 days post laparotomy. The average duration between fever and surgery was 2.8 Day. The average duration of hospital admission was 13.5 days , nil per oral kept for 38 hours. Conclusions: Appendicitis in children with leukemia has a good prognosis if diagnosed early. Disease status is an important indication of outcome. UNDERSTANDING METABOLIC PARAMETRS IN HODGKIN LYMPHOMADO THEY PREDICT RESPONSE TO CHEMOTHERAPY? TIME TO ANTIBIOTIC ADMINISTRATION AND OUTCOME OF FEBRILE NEUTROPENIA IN PEDIATRIC ONCOLOGY PATIENTS Piali mandal, Rachna Seth, Jagdish Prasad Meena, Aditya Kumar Gupta, Bankim K. Chandra, Rakesh Kumar. AIIMS, New Delhi Mitali Sharma, Deepak Bhat, Shruti Kakkar. DMCH, Ludhiana S48