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e19536 Background: Nasal NK –T cell lymphoma accounts for 5% of all NHLs at our centre. Methods: We reviewed data of 38 patients treated between January 2002 and August 2013. Results: Patients’ med...

e21502 Background: Ewing’s sarcoma family of tumors (ESFT) is a rare aggressive bone tumor of childhood with poor outcome. In developing countries most of ESFT patients have delayed presentation. W...

Presented here is a report of 3 children, out of 66 total pediatric Hodgkin's lymphoma (HL) patients (4.5%) with bone involvement over a 3 and a half year period. Two patients presented with osseous lesions at the time of relapse and one had concurrent evidence of non-osseous disease. The clinical presentation, radiographic findings, histology, treatment and outcome of these patients are discussed. Boys and girls are nearly equally affected, local bone pain is the commonest symptom and B-symptoms are common. Vertebrae and pelvis are most frequently involved, commonly with an osteolytic picture. Nodular sclerosis is the predominant histological subtype. Most children received combined modality treatment and the overall response and survival are good.

Here is reported a 14-year-old boy with spinal tuberculosis. The imaging features were suggestive of non hodgkin's lymphoma with sparing of intervertebral disc. The atypical imaging features of spinal tuberculosis is discussed.

7082 Background: Data on B cell Acute Lymphoblastic leukemia (ALL) in the poor prognostic age group of > 9 years from India is minimal. Methods: This is an analysis of patients of above 9 years that were diagnosed and treated from January 2000 to December 2010 at a single institute . All patients who completed at least 4 weeks of induction therapy were analysed for various outcomes. Results: Of the 241 newly registered patients, the median age was 19 years (Range 10-78 years) with an M:F ratio of 1.9:1. Out of this 47%, 25% & 28% patients belonged to 10-18, 19-30 & > 31 years age group respectively. Twenty seven (11.6%) and 5(2%) had CSF and testicular involvement respectively. Thirty nine per cent had a total leucocyte count (TLC) of above 30x109/L. Philadelphia chromosome (Ph) positivity was seen in 27% and was equally distributed among the different age groups. Patients available for outcome analysis were 213(88.4%). Complete remission rate (CRR) was 66.6% and induction mortality was 26.3%.At a median follow up of 65.8 months 5 year leukemia free survival was 30.5%. Seventy eight (55%) patients relapsed (median relapse time of 13.5 months, range 1.7 to 53.4 months) , 55% during maintenance phase. The 5 year overall survival (OS) was 30.3% with a median OS of 15.8 months. The OS was similar in 10-18 and 19-30 age groups (5 year OS 35% vs. 27.5%, p=0.641) but it was significantly lower in >31 years (5year OS 21%, p=0.008). Apart from this, extramedullary disease, not attaining a CR in 1st induction, albumin at presentation below 3.5gm% and TLC of >100x109/L were significant poor prognostic markers for survival. Conclusions: This is a large study of B-ALL outcomes in patients above 9 years from a single center in India. Patients above 30 years had a worse prognosis while the prognosis of 10-18 and 19-30 years age group were similar. Induction mortality was higher mainly because of advanced disease and poor performance status at presentation.

e21522 Background: Data on metastatic primitive neuroectodermal tumor (PNET) with uniform protocol is minimal. Methods: This is single institutional patient review treated between June 2003-Nov 2011, and evaluated on intent-to-treat analysis. All patients received uniform chemotherapy (VAC/IE) as follows: neoadjuvant chemotherapy (NACT), surgery and/or radiotherapy as local treatment followed by ACT. Local treatment was offered if patient achieved CR and/or PR at both primary and metastatic site. Results: 150/374 (40%) PNET patients were metastatic with median age 15 years (range: 2–50); tumor diameter 10 cm (range: 1.8-26) and symptom duration 4 months (range: 0.1-30). Most common tumor region was pelvis 34 (23%), thorax 26 (17%) and femur in 26 (17%). Most common metastatic sites were lung only 53 (35%), bone only 35 (23%), combined bone/lung 25(17%), and bone marrow 37 (25%). Post-NACT, 9 (6%) achieved CR and 79 (53%) PR (53%) with ORR 59%. Twenty patients underwent surgery; 55 patients received radical radiotherapy following NACT. At median follow-up of 20.8 months (range: 1.6–95), 5-year EFS, OS and local control rate (LCR) were 7.6%, 15% and 37.6%, respectively. Multivariate analysis of prognostic factors in entire group and lung only metastases group is shown in the Table. Conclusions: This is the largest study of metastatic PNET from Asia and has identified unique prognostic factors. Hypoalbuminemia had inferior EFS; radical radiotherapy had inferior LCR. In group with only lung metastases, age ≤15 years and number of metastases >3 had lower EFS. In view of dismal prognosis with conventional chemotherapy in metastatic PNET, metronomic therapy may be a potential therapeutic alternative for subgroup of metastatic patients with hypoalbuminemia. [Table: see text]

e21506 Background: Soft tissue sarcomas (STS) are rare malignancies constituting 1% of all solid tumors. Synovial sarcoma (SS) constitutes 5-10% of all sarcomas. Histopathologically SS is classified as Monophasic, Biphasic and Poorly differentiated varieties and majority are high grade. There is paucity of literature pertaining to SS from developing countries. Methods: Study population was selected from a prospectively maintained STS database at the department of Surgical Oncology, Dr BRAIRCH, AIIMS. All patients with pathological diagnosis of SS were included for the analysis. Results: A total of 446 patients of STS were treated from 1995 to 2009 and 80 cases of pathologically proven SS were selected. Median age at diagnosis was 33 years. There were 53 males (66.3%) and 27 females (33.8%). Most common site was proximal lower limb, majority involving thigh. Sixty one patients presented with prior inadequate interventions including intralesional excision or marginal excision. Sixty seven cases had tumors more than 5 cm in size and 27 more than 10 cm. Lymph nodes were seen in 9 patients (11.3%) but only 4 showed pathological involvement. According to MSKCC staging 83% had stage III disease and stage I and II constituted 10.5%. Ten patients had metastasis at presentation and all of them had lung metastasis. Among the extremity sarcoma, 35 (43.8%) patients had limb salvage surgery and the rest required amputations due to advanced nature of disease. Overall 15% of cases required reconstruction and only 6 had positive margin. Postoperatively 35 patients received radiotherapy and 52 received chemotherapy (Adriamycin Ifosamide based). At a median follow up of 59 months,10 patients had local recurrence and 34 (42.5%) patients had systemic relapse mainly in the lungs (27 patients). At last follow up, 58 patients were alive of which 44 were disease free. The overall 5 year survival was 52%. Conclusions: SS is a rare tumor involving younger age group. Due to lack of awareness among patients and physician, majority present with suboptimal surgical intervention or advanced stage in developing countries resulting in a low limb salvage rate. Most common site of relapse is lung despite multimodality management resulting in a modest 5-year survival of 52%.

10527 Background: Data on localized PNET with uniform protocol is minimal. Methods: This is single institutional patient review treated between June 2003-Nov 2011, and evaluated on intent-to-treat analysis. All patients received uniform chemotherapy (VAC/IE) as follows: neo-adjuvant chemotherapy (NACT), surgery and/or radiotherapy as local treatment followed by ACT. Results: 224/374 (60%) PNET patients were localized with median age 15 years (range: 0.1–55), tumor diameter 8 cm (range: 1.6-25) and symptom duration 4 months (range: 0.5-30). Regions were extremities 40%, thorax 25% and head & neck 14%. Post-NACT, CR was 32(14%); PR 152(68%) with ORR 82%. Ninety-nine patients underwent surgery (50/99 received adjuvant radiotherapy); 80 received radical radiotherapy as local therapy. There were no adverse tumor characteristics or poor NACT response in radical radiotherapy group versus surgery group. At median follow-up of 31.1 months (range: 1.3–113.4), 5-year EFS, OS and local control rate (LCR) were 34±3.5%, 52.5±4.7% and 59.5±4.8%, respectively. Multivariate analysis of prognostic factors is shown in the Table. Conclusions: This is largest data of localized PNET from Asia which identified unique prognostic factors. Localized PNET constituted 60% of entire cohort with delayed presentation. High WBC may be a marker of micrometastatic disease or an adverse paraneoplastic response. Skeletal primary and tumor diameter >8 cm predicted inferior OS and LCR; additionally radical radiotherapy predicted inferior LCR. All efforts should be made to resect primary tumor post-NACT as radical radiotherapy alone despite good NACT response results in inferior LCR. [Table: see text]

7081 Background: It is known that T cell acute lymphoblastic leukemias (ALL) have poorer outcomes than their B cell counterparts. Data on T-ALL in the age group of >9 years from India is minimal. Methods: This is a single institutional analysis of patients of above 9 years who were treated from January 2000 to December 2010. All patients who completed at least 4 weeks of induction therapy were analysed for various outcomes. Results: T-ALL formed 30% of all ALL in this age group. Of the 110 newly registered patients of T-ALL, the median age was 17 years (Range 10-50 years) with an M:F ratio of 5.9:1. Of this 62%, 30% and 18% patients belonged to 10-18, 19-30 and > 31 years age group respectively. Eighteen (19%) and 2 (2%) and 33 (30%) had CSF, testicular and other extramedullary sites involvement respectively. Twenty eight per cent had a total leucocyte count (TLC) of above 100x109/L. Patients available for survival analysis were 104(94.5%). Complete remission (CR)rate was 68.2% and induction mortality was 14.4%. At a median follow up of 56.4 months 5 year leukemia free survival was 52.3% (median not attained). Twenty seven (38%) patients relapsed (median relapse time of 15.2 months, range 0.7 to 47.3 months), 55% during maintenance phase. The 5 year overall survival (OS) was 46.9% (median OS of 35.4 months). The 5 year OS of 10-18, 19-30 and > 31 years age groups were 42.8%, 71% and 16.6% respectively (p value not significant). Not attaining CR in 1st induction, spontaneous tumor lysis syndrome and peripheral blood blast count of > 80% were significant poor prognostic factors for survival. Conclusions: This is one of the largest study of T-ALL outcomes in patients above 9 years from a single center from India. Attainment of CR in 1st induction was the most important risk factor for survival. 5 year OS was 47%.

Abstract 4500 Background: More than 70% of patients receiving high dose chemotherapy and haematopoietic stem cell transplantation (HSCT) are likely to develop grade III or IV mucositis causing significant morbidity. Palifermin, which helps in reducing duration and severity, is expensive and not available in many countries. Probiotic Lactobacillus CD 2 has been shown to reduce incidence and severity of chemo-radiotherapy induced mucositis in squamous cell carcinoma of head and neck (Sharma A, et al. Eur J Cancer 2012: 875–81). The objective of this study was to determine the efficacy of this probiotic in preventing grade III/IV mucositis in patients undergoing HSCT. Methods: Lozenges containing not less than 2×109 viable cells of Lactobacillus CD2 as active ingredient were started 4–7 days prior to commencing conditioning regimen of HSCT and continued till resolution of mucositis or Day+24 post stem cell infusion, whichever was earlier. The lozenges were supposed to be kept in mouth for it to be dissolved by itself. Mucositis (NCI-CTCAE V 4.03) was assessed daily till recovery; number of lesions, localization in the oral cavity, bleeding, erythema and ulceration were recorded. Photographs of the mucosal lesions (oral cavity) were taken once a week and saliva samples of patients was collected weekly till complete recovery or day +24 of the treatment to analyze the levels of pro-inflammatory cytokines. Results: Twenty-one patients (17 autologous and 4 RIC-allogeneic) in the age group of 10–70 years undergoing high dose chemotherapy and HSCT were enrolled. Median age was 29 years (range11–64 yrs). Multiple myeloma constituted 9 (43%) of cases. Others included HL (5), NHL (3), AML (3), and RMS (1). Fourteen patients had received at least 2 lines of prior therapy. Conditioning regimens used were high dose melphalan, BEAM, CBV, or melphalan treosulfan. Four patients received RIC (fludarabine with melphalan). One patient could not continue study drug beyond one day because of nausea, however, rest tolerated lozenges well. Eighteen patients took at least 3 or 4 lozenges daily for an average duration of 8 days. Six patients (28.6%) had no mucositis, 4 (19%) had grade I, 7 (33.3%) had grade II, and 2 (9.5%) patients each had grade III or IV mucositis (one of these was post autologous HSCT and another one was on long term methotrexate for rheumatoid arthritis). Seventeen patients had < grade 2 dysphagia. Median duration of IV antibiotic use was 8 days (range 5–18). Median days to onset of mucositis and time to recovery were 6 (range 3–8) and 8 days (range 5–40), respectively. No adverse events except occasional grade I/II nausea due to study drug were noted. Conclusion: This study suggests that the use of Lactobacillus CD2 significantly reduced events of severe mucositis in patients undergoing HSCT as only 19% developed grade III or IV mucositis compared to the expectation of >60%. This needs confirmation in randomized studies. ClinicalTrials.gov Identifier: NCT01480011 Disclosures: No relevant conflicts of interest to declare.

Background The significance of the mutations in FLT3 and c-kit genes in AML has been well established but the role of their expression is not studied together. The aim of this study was to evaluate clinical significance of FLT3 (CD135) and c-kit (CD117) co-expression on myeloblasts in AML. Methods Five ml peripheral blood/bone marrow from consecutive AML patients at diagnosis from April 2008 to May 2010 was evaluated by flow-cytometry. CD135 and CD117 expression was evaluated on dim CD45 positive myeloblasts. Positive expression was considered as >20% surface antigen expression. Results During the study period, there were 115 AML patients with median age 16 years and male:female ratio 2.02:1. M2 was the most common subtype 57% (66/115) followed by M4 14% (16/115). Cytogenetically (n = 85) these patients were classified as good risk in 20 (23%), intermediate risk in 50 (59%) and poor risk in 15 (18%) patients. Flt3 internal tandem duplication was present in 20 (17%) patients. CD135 was positive in 95 (82%) patients; CD117 was positive in 104 (90%) patients; co-expression of CD135 and CD117 was observed in 74 (64%) patients. In those patients who co-expressed CD135 and CD117, the median expression was 34.1% of the gated myeloblasts and patients were classified as high co-expression (>/= 34.1% expression) and low ( Conclusion High co-expression of proliferative markers CD135 and CD117 is an independent prognostic factor for poor outcome in AML. Disclosure All authors have declared no conflicts of interest.

9549 Background: Data of Tregs in pediatric AML is lacking. The study objectives were determining Tregs in pediatric AML at diagnosis and follow up; and correlating with outcome. Methods: From Nov 2010-May 2011, 30 consecutive AML patients ≤ 18 years were prospectively enrolled with 6 healthy controls. All patients received daunorubicin / cytarabine induction and 3 courses of cytarabine. Tregs (CD4+CD25+FoxP3+) were assessed at diagnosis, post-induction, post-consolidation, 3 and 6 months follow up and relapse. Results: 30 cases with median age 9.5 years; male/female ratio 14:16 had significantly higher baseline Tregs than healthy controls (12.36±4.65% vs 3.16±1.49%; p=0.0001). Patients with high Tregs frequency were females (p=0.044), WBC>50,000/mm3 (p=0.023), hypoalbuminemia (p=0.002), absence of lymphadenopathy (p=0.04) and linear correlation with peripheral blood blast% (r=0.55, p=0.0014). CR rate was 83.3% (25/30); EFS 38% and OS 73% at 14 months follow up. When Tregs were categorized as high and low based on median value, CR rate (86.6% vs 80%, p=NS), EFS [17% vs 60%, HR 1.46 (0.51-4.14) p=0.46] and OS (66% vs 80%, HR 0.58 (0.13-2.44) p=0.45) were not different. Amongst those who achieved CR, there were 7/13 relapses in those with high Tregs versus 3/12 in those with low Tregs (p=0.226).Tregs reduced post-induction (12.1±4.6 vs 6.32±2.8, p

9580 Background: Tregs in bone marrow have been previously evaluated in PNET patients; however, data on peripheral blood ccirculating Tregs is lacking. The objective of our study was to determine baseline Treg frequency in PNET patients and correlate the same with patient characteristics and outcome. Methods: Samples of 5ml venous blood were obtained from 38 newly diagnosed PNET patients at diagnosis along with six healthy controls. Flow cytometric analysis was done for detecting Treg cells [CD4+CD25+FoxP3+]. Results: Thirty-eight patients with median age 17 years; male/female ratio of 5.5:1 had significantly higher baseline Tregs than healthy controls [9.17%±.3.08 vs 3.16±1.49%; p=

9551 Background: Humoral immunity has been evaluated in pediatric ALL; data in pediatric AML is lacking. The objectives of this study were to assess humoral immunity on follow-up in pediatric AML patients. Methods: From April 2010-May 2011, 45 consecutive AML patients 1-18 years old were prospectively enrolled with 7 healthy controls. Immunoglobulin (Ig) levels in 45 patients and B-lymphocytes (CD19+) in 29 patients were assessed at diagnosis, post-induction, post-consolidation, 3 and 6 months follow-up and relapse. Results: At diagnosis, Ig levels were higher in patients as compared to healthy controls (IgG, p=0.041; IgA, p=0.07; IgM, p=0.16) while B-cells were lower (p=0.001). Patients with gum hypertrophy had low Ig levels (IgG, p=0.007; IgA, p=0.003; IgM, p=0.06). CR rate was 84.4% (38/45); EFS 40% and OS 58% at 20 months follow-up. Post-induction, there was reduction in IgM (p

To the Editor, Giant cell tumor (GCT) of the bone or osteoclastoma is generally a benign and locally invasive tumor that occurs close to the joint of a mature bone.[1] GCT is an aggressive lesion that behaves in an unpredictable fashion.[2] The rate of recurrence is high and it metastasizes to the lungs, in approximately 2 – 3% of the patients.[3] Metastatic lung nodules can present at the time of initial surgery or develop many years after the appearance of the primary tumor.[4] The primary and metastatic lesions usually have the same histological features of a benign tumor; however, malignant tumors with giant cells have been noted in some cases, on a retrospective review.[5] Although several cases of GCT with pulmonary metastases diagnosed on biopsy have been described, only four cases diagnosed by fine needle aspiration biopsy have been documented in the cytological literature. All the cases previously described, have presented with multiple pulmonary nodules.[6] We herein report a case of osteoclastoma metastatic to the lung in an 18 year-old female, who presented with pleural effusion, and a diagnosis of metastatic GCT was established initially, based on the pleural effusion cytology smears. To the best of our knowledge, no similar case has been previously documented in the literature, with such a presentation of pleural effusion and diagnosis based on effusion cytology. A 16-year-old female with left leg pain was detected to have a left distal femur lesion, in February 2010. The radiograph showed an eccentric lytic lesion in the left distal femur with soft tissue extension. Magnetic Resonance Imaging (MRI) demonstrated a well-defined, smoothly marginated, heterogeneously enhancing mass lesion, involving the epimetaphyseal region of the lower femur, which was hypointense on T1-weighted and predominantly hyperintense on T2-weighted images. She was treated with curettage. A diagnosis of giant cell tumor was made on histopathological examination. One-and-a-half years later, she presented with a complaint of pain in the anterior chest. A Computed Tomography (CT) scan revealed multiple rounded lesions, with peripheral enhancement and central necrosis in both the lungs. One of the lesions in the left upper lobe and one in the right middle lobe were pleural-based [Figures ​[Figures1a1a–d]. All the radiological findings suggested multiple bilateral pulmonary metastases. Two months later, she developed dyspnea and the chest radiograph revealed right-sided pleural effusion, along with the lung lesions [Figure 2]. A pleural tap was performed and 150 ml of pleural fluid was sent for cytopathological evaluation. Figure 1 (a-d) CT scan demonstrating lesions in the right middle lobe and left upper lobe, both of which are pleural-based with chest wall invasion Figure 2 Chest radiograph revealing right-sided lung lesion along with pleural effusion Microscopic examination showed many osteoclast giant cells with few interspersed mononuclear cells, numerous foamy histiocytes, and few mesothelial cells [Figures ​[Figures3a3a–c]. The findings led us to suspect a diagnosis of GCT, metastatic to the lung, involving the pleura and producing pleural effusion. Figure 3 (a-b) Microphotograph of pleural fluid showing osteoclast-like giant cells, with interspersed foamy histiocytes [(a) (Pap, 200×), (b) (MGG, 200×); (c) Osteoclast giant cell sticking to the mononuclear cells (MGG, 400×)]; (d) Biopsy ... The differentials of rheumatoid arthritis, herpes viral infection, giant cell carcinoma, carcinosarcoma, mesothelioma, radiotherapy, granulomatous inflammation, and surgical intervention were considered as they have been rarely associated with the presence of giant cells in pleural effusions. Lack of elongated giant cells and macrophages along with granular necrotic debri ruled out rheumatoid arthritis. There were no nuclear inclusions suggestive of herpetic infection. Giant cell carcinoma, carcinosarcoma, and mesothelioma were excluded because of the absence of bizarre cells. Moreover, the clinical presentation and radiological investigations helped in ruling out all the differentials, including granulomatous inflammation. There was no history of radiotherapy or surgical intervention. This was followed by fine needle aspiration [Figures ​[Figures4a4a–d] and biopsy of the lung lesion [Figure 3d], which confirmed the diagnosis of metastatic GCT. Both the pleural fluid and fine needle aspiration cytology smears showed attachment of the osteoclastic giant cells to the cohesive groups of mononuclear stromal cells. This was an important feature that helped in reaching the diagnosis of giant cell tumor. There were no cellular and nuclear pleomorphism, bizarre cells, mitoses, necrosis, or osteoid in both the primary and metastatic tumors, thus the important and common differential of osteogenic sarcoma was excluded. No ancillary studies were performed. The patient was started on chemotherapy. Pulmonary metastases were monitored by a chest CT scan and they were stable for 12 months. Figure 4 (a) Microphotographs of FNA smears from lung lesion showing osteoclast giant cells along with a stromal fragment (Pap, 200×); (b) Stromal fragment composed of mononuclear cells, with sticking of osteoclast giant cells (Pap, 400×); (c-d) ... Giant-cell tumor of the bone is described as the most unpredictable neoplasm of the skeletal system, which can metastasize despite its benign appearance.[7,8] Although, it was initially regarded as a benign tumor, the potential for metastasis without undergoing sarcomatous transformation was described by Jaffe et al., in 1940.[5] The incidence of lung metastases varies between 1 and 9.1%. Most of the metastases are diagnosed within the first few years. Some of the authors believe that they might not be found after 10 years.[8–10] Solitary metastases to other sites like the regional lymph nodes, scalp, and pelvis have also been documented.[2] Pulmonary metastasis occurs most frequently in recurrent GCT cases and these tumors have the potential to develop malignant biological behavior.[3] The common primary sites with a predilection for metastasis include, the radius, femur, and sacrum.[5,7,8] Radiologically aggressive (Enneking stage III) GCTs are more prone to develop lung metastases.[4,10] Previously, only four cases of metastatic pulmonary GCT have been diagnosed on aspiration cytology. The details of the reported cases are summarized in Table 1.[11–14] Ours is the fifth case that was diagnosed on pleural effusion and aspiration cytology, and confirmed on biopsy. Table 1 Details of all the reported cases of metastatic pulmonary giant cell tumor on FNA cytology The proposed pathogenesis behind the formation of lung nodules in cases of benign GCT includes the proliferation of a subpopulation of neoplastic cells, which has metastatic potential, and origin from the tumor emboli derived from the primary tumor. Mostly, metastatic GCTs are detected a year or more after the initial surgery of the primary lesion. Hemorrhage and thrombus formation occur within the bone, during the operation. Any residual GCT not removed at the time of surgery could grow into this thrombus and then break off, leading to an embolic metastasis in the lungs.[4,8,10] On account of prevalence of the tumor, microemboli at the time of surgery must be greater than the prevalence of metastases, and other biological factors like immune surveillance and intrinsic biological characteristics of the tumor, seem to play a role.[2] Malignant GCT and giant cellrich osteosarcoma should be considered in the differential diagnosis of metastatic GCT on aspiration cytology. In addition, rheumatoid arthritis, herpes infection, granulomatous disease, carcinosarcoma, and mesothelioma with osteoclast-like giant cells, should be excluded by appropriate investigations. A history of GCT of the bone is essential for diagnosis due to the rarity for GCT to present with pulmonary metastasis. When such a history is not available, primary lung carcinoma with osteoclast-like giant cells should be considered as a differential.[6] The natural history of the metastasizing lesions is quite variable.[10] They typically progress, although some may ossify peripherally and remain dormant. Rarely, do metastatic lesions of the lung disappear after biopsy.[2] Both the mononuclear and giant cells express CD 68, parathyroid hormone-like protein (PTH-LP), and matrix metalloproteinases (MMP). Molecular and cytogenetic abnormalities have been shown to be of potentially prognostic value. The Ki-67 labeling index, p53, and MMP expression are higher in GCTs with pulmonary metastasis, particularly in the aggressive type.[3,6] Surgical excision of the lung metastases is now the widely accepted treatment of choice, with excellent long-term survival.[9] The role of chemotherapy and radiotherapy is debatable.[1] The mortality rates for patients with a GCT metastasizing to the lungs vary from 0 to 37%.[5,8] To conclude, in the aspirate of a lung mass or pleural fluid, the presence of mixed osteoclast-like giant cells and bland mononuclear cells should warrant an inclusion of metastatic GCT in the differential diagnosis, particularly in patients with a positive history. This case report highlights the importance of a plain X-ray of the chest and Computed Tomography scan at the time of the first presentation, even in benign giant cell tumors. Follow-up investigations may be performed, as in primary skeletal sarcomas.

6538 Background: IA is a major cause of mortality in AL and HSCT. The objectives of this study were to determine the yield of GM assay for the diagnosis of probable IA, its temporal relationship with high-resolution computed tomographic scan (HRCT) scans and correlation with mortality in patients of AL and recipients of HSCT. Methods: Consecutive neutropenic episodes among inpatients aged ≥ 15 years with a diagnosis of AL and recipients of HSCT were prospectively evaluated over 1½ years. All patients received oral itraconazole or thrice weekly IV amphotericin B (AmB) as prophylaxis. Weekly serum GM assay was performed for all subjects. Optical density index (ODI) > 0.5 for two or more samples was defined as positive. Patients with persistent fever for ≥ 96 hours on intravenous antibiotics were evaluated with HRCT chest and received empiric AmB. IA was diagnosed according to EORTC 2008 guidelines and treated with therapeutic doses of voriconazole or AmB. Results: Of the 150 episodes enrolled, AL induction ...

9579 Background: Sensitive and specific diagnostic tools for invasive fungal infections (IFI) in acute leukemia (AL) patients are lacking. Blood cultures are often negative and performing invasive ...

10540 Background:Histologic necrosis (HN), the current gold standard for response evaluation in osteosarcoma (OS), is accessible only after neoadjuvant chemotherapy (NACT) and may get affected by confounding factors. Thus, it would be useful to have surrogate markers of response evaluation and prognostication using magnetic resonance imaging (MRI) to individualize therapy. Method:Thirty-one treatment naïve OS patients received 3 cycles of NACT followed by surgery during 2006–2008. All patients underwent baseline and post-NACT conventional(C), diffusion-weighted (DW) and dynamic contrast enhanced (DCE) MRI. Taking ‘Huvos grading’ (good response >/= 90% HN) as reference standard, various parameters of MRI were compared with it. Tumor considered as ellipsoidal; volume (V), average tumor plane (ATP) and relative(r)-ATP (ATP/body surface area) were calculated using standard formula for ellipse. Receiver operating characteristic curves were generated to assess the best threshold and predictability. Sensitivity and specificity were calculated along with 95% confidence limits. After deriving thresholds for each parameter in univariable analysis, multivariable analysis was carried out. Results: Both pre-and post NACT, absolute and relative size parameters were well correlated with HN, though post NACT change in parameters did not. Apparent diffusion coefficient (ADC), either pre-and post NACT measurements or change following chemotherapy were not correlating well. However, on adjusting for volume, significant correlation was found. Thus, we could derive a new parameter diffusion per unit volume (DV= ADC /V). Change in shape of time intensity curve did not show significant correlation. Conclusions: In OS, NACT response can be assessed and predicted by conventional and DW- MRI early in the disease course which correlates well with HN. DV seems to be a sensitive substitute for response evaluation. For DCE-MRI, more sophisticated models in future studies might be useful. [Table: see text] No significant financial relationships to disclose.

e18000 Background: Febrile neutropenia poses a major challenge during treatment of acute myeloid leukaemia (AML). Methods: Episodes of febrile neutropenia in 104 consecutive patients of AML admitted to the medical oncology ward between May 2001 and December 2006 were studied. There were 62 males and 42 females, median age 28 years (2–61 years). Results: 402 febrile episodes including 363 episodes of febrile neutropenia (180 in induction, 183 in consolidation) and 39 non-neutropenic episodes (18 in induction, 21 in consolidation) occurred. Clinical, microbiological and radiological foci could be detected in 51.1%, 22.2 %, and 31.1% episodes of febrile neutropenia during induction and 31.1%, 19.1% and 12.7% episodes during consolidation. Rates of documented infections during induction and consolidation were 74% and 52%. Respiratory (39.2%) and ear, nose, and throat ( 23.9%) were the commonest clinical sites during induction. Respiratory (21%) and central line infections (19.2%) were commonest during consolidation. Gram negative infections predominated (Pseudomonas aeruginosa, Klebsiella pneumoniae: major isolates). 32.5% of microbiologically proven infections during induction and 14.2% during consolidation were polymicrobial. Bronchopneumonia was the commonest radiological focus. There were 60 episodes of fungal infections (47 in induction, 13 in consolidation). There were: 1 definite: mucormycosis, 3 probable (1 case each: Candida krusei, Candida tropicalis in blood, 1 chronic disseminated hepatosplenic candidiasis), and 56 possible infections. Halo sign was seen in 18, sinusitis with bone erosion in 7. Infections accounted for 85% of the 20 deaths (induction: 18). Fungal infections and bronchopneumonia were major causes of mortality (p = 0.001). 3/4 enterococcal bacteremias were associated with mortality (p = 0.001). 6 cases of tuberculosis (5 pneumonias with necrotic mediastinal nodes, 1 Pott's spine) and 3 cases of malaria (1 cerebral malaria) were also detected. Conclusions: Induction was associated with greater morbidity and mortality. Prompt and proper institution of antibiotics and antifungals besides considering alternative diagnosis peculiar to the region (e.g. tuberculosis, malaria) may aid in better management. No significant financial relationships to disclose.

8533 Background: Majority of HL patients can be cured with available protocols. Goal of treatment is to reduce acute and late toxicity without compromising outcome. Earlier we have shown that bleomycin and DTIC in ABVD may be replaced by etoposide and prednisone. Method: We conducted a prospective single center phase III trial to test non-inferiority of EVAP as compared to ABVD as first line therapy. From September 2004 to January 2007, 100 newly diagnosed cases of HL were randomized to ABVD standard doses (Arm A) or EVAP- etoposide 60 mg/m2 infusion day 1–3, vinblastine 6 mg/m2 and doxorubicin 25 mg/m2 both IV day 1 and 8, and prednisone 40 mg/m2 PO day 1- 14 every 4 week (Arm B). IFRT was given to initial bulky sites or residual disease. The endpoints were RR, OS, PFS, and toxicity in 2 groups. Local ethics committee approved the project. Results: One patient in Arm A (n= 51) and 4 patients in Arm B (n=49) didn’t receive treatment and were excluded from analysis. The results are: CR rates 86% (ORR-88%) ...