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Background: Treatment outcomes for children and adolescents with Hodgkin lymphoma (HL) have improved over the past few decades. Most patients achieve long-term remission with a five-year survival of approximately 90%, as reported by different treatment groups in developed countries. However, there are limited data on the outcome of patients treated in developing countries. Here we report the outcomes of children and adolescents treated at a comprehensive cancer center in Riyadh, Saudi Arabia. Procedure: A retrospective review of the medical records of all pediatric patients younger than 16 years who were diagnosed with HL from July 2006 through December 2017 was performed. Results: Of the 54 patients with HL, 70.37% were boys with a median age of 9 years (mean ± SD, 9.11 ± 3.30). A total of 51.85% had B symptoms and 33.33% had bulky disease. The nodular sclerosis type was the most common histological subtype (48.15%). In total, 74.07% of the patients presented with advanced stage III and IV disease. The three-years relapse-free survival rate was approximately 82%, and the three overall survival (OS) rate was more than 95%. Conclusions: Survival outcomes in children and adolescents with HL in Saudi Arabia have improved with a five‐year OS rate now exceeding 85%. However, further prospective larger collaborative studies are necessary.

Objective: The primary objective is overall response rate (CR/CRi). Design: This is a single-institution, single-arm, phase II study of pre-treatment with azacytidine followed by FLAG for the treatment of relapsed or refractory AML. Setting: Salvage therapy in relapsed/refractory AML. Patients or Other Participants: Patients with relapsed or refractory AML, ECOG performance status ≤2, and patients with preserved organ function. Exclusion criteria: Patients with a diagnosis of acute promyelocytic leukemia (AML-M3), pregnant women, patients previously treated with fludarabine, and patients with uncontrolled intercurrent illness. Twenty-one patients were enrolled, and all were evaluable for toxicity and response. The median number of prior treatments was 1 (range: 1–3). Nine patients (43%) were refractory to the most recent treatment, while most other patients relapsed less than 6 months from the last treatment before enrollment. Interventions: Azacytidine was given at 75 mg/m2 per day for 5 days prior to the standard FLAG therapy. Main Outcomes Measures: Primary study endpoints were safety and ORR [ORR = CR, CRi, PR, morphologic leukemia-free state (MLFS) according to the International Working Group criteria], overall survival, and relapse-free survival. Results: Bone marrow suppression was the most common adverse event and was observed in all patients. The 30-day mortality was noted in 2 patients (10%), related to infection/septic shock with multi-organ failure. The combination was tolerated, and toxicities were as expected for patients receiving salvage intensive chemotherapy. The CR/CR with incomplete blood count recovery (CRi) rate was 53%. Of the 9 primary refractory patients, 5 (56%) achieved CR/CRi. Eight of 11 patients who achieved CR/CRi also attained minimal residual disease-negative status (≤1.0% by flow cytometry), and 8 patients (73%) went for stem cell transplant. Of the 11 patients who achieved CR/CRi, 5 were still alive on the last follow-up. The overall survival for the entire cohort was 4.1 months, and relapse-free survival was 4.7 months. Conclusions: AZA FLAG combination is safe and does not seem to have an added benefit in response rate or survival.

e19562 Background: Central nervous system (CNS) relapse develops in 2-10% of patients with diffuse large B cell lymphoma (DLBCL) and has an adverse prognosis. Tools like IPI and CNS-IPI scores identify patients at high risk of systemic or CNS relapse based on the presence of established risk factors ( Schmitz et al. JCO 2016). International guidelines propose prophylactic intravenous high-dose methotrexate (HD-MTX) for patients at high risk of CNS relapse; however, limited data is backing this approach. Methods: We conducted a retrospective review of newly diagnosed DLBCL patients aged 18-75 years treated with curative intent at large academic medical centers in Riyadh, Saudi Arabia, between 2015-2018. Patients who were planned for CNS HD-MTX after cycles 2, 4, and 6 of R-CHOP and received at least one HD-MTX cycle were included. Results: We identified 35 DLBCL patients who received at least one R-CHOP cycle with one cycle of HD-MTX. The median IPI and CNS-IPI score were 3, (range = 0-4) and 3, (range = 0-5), respectively. The median number of R-CHOP cycles received was 6 (range 3-6) and HD-MTX 3 (range 1-6). The overall response rate was 91%, with 3 (9%) primary refractory patients per interim evaluation on cycle 3 of R-CHOP. Achieving complete remission after six cycles of RCHOP was noted in 80%, with four additional patients showed residual disease at the end of treatment evaluation. The entire cohort's overall survival was not reached, and five years estimated survival is 75%. With a median follow-up duration of 37.3 months, none of the patients relapsed after achieving CR at the end of treatment evaluation. The risk of systemic or CNS relapse in our cohort was 0%. In restricting the analysis to CNS-IPI of ≥ 4, a total of 13 patients with a median follow-up of 42 months were included; four patients did not achieve CR by the end of treatment, while nine patients continue to be in CR without any evidence of relapsed disease. Conclusions: High-dose methotrexate with high-intensity chemoimmunotherapy (R-CHOP) seems to be associated with an improvement in the expected rate of CNS relapse. Our data set is small, and a more extensive study evaluating HD-MTX's effectiveness in high-risk DLBCL is warranted.[Table: see text]