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Background: The Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores are validated for risk stratification in the febrile neutropenia patients. Both these scores have advantages and limitations. This study was conducted to compare the MASCC and CISNE scores with respect to their ability to assign accurate risk stratification and predict outcomes. Materials and Methods: This is a hospital-based prospective study included all-comers fulfilling the eligibility criteria from January 2018 till October 2019. In addition to demographic data, clinical data were obtained prospectively regarding clinical deterioration requiring up-gradation in treatment or death. Both MASCC and CISNE scores were calculated for all the patients and each patient was risk stratified as per the two different scores. Patients could be discharged once there were afebrile and after count recovery and were followed up to 30 days post discharge. Results: A total of 96 febrile neutropenia episodes were included in the study (Total of 92 patients, with 4 patients with a repeat episode of febrile neutropenia). Mean age of the study population was 35 years (range 4 to 75 years). Total 58 (60.42%) episodes were in solid tumors and 38 (39.58%) were in hematological malignancies. With MASCC febrile neutropenia risk index, 63 (65.63%) were low risk and 33 (34.38%) were high risk. With CISNE, 7 (7.29%) were low risk, 72 (75%) were intermediate risk and 17 (17.71%) were high risk. When calculated with MASCC, 15 out of 33 episodes (45.45%) in high risk episodes required upgradation in the level of care and 18 out of 63(28.57%) episodes in low risk episodes required upgradation in the level of care. Whereas with CISNE 8 out of 17(87.5%) episodes in high risk required upgradation in the level of care and 25 out of 72 (34.72%) in intermediate risk required upgradation in the level of care, while none of the low risk required upgradation in the level of care. None of the low risk in CISNE experienced death. In MASCC low risk subset 1 out of 63(1.68%) died. Both MASCC and CISNE predicted outcomes of the febrile neutropenia episode accurately. Conclusion: Both CISNE and MASCC has reasonable discriminatory value in predicting the outcome, however CISNE performed better compared to MASCC in both low and high-risk subsets. [ABSTRACT FROM AUTHOR]

Central venous catheters (CVCs) represent a significant source of infection in patients undergoing hematopoietic stem cell transplantation and can add to the cost of care, morbidity, and mortality. Organisms forming biofilms on the inner surface of catheters require a much higher local antibiotic concentration to clear the pathogen growth. Antibiotic lock therapy (ALT) represents one such strategy to achieve such high intraluminal concentrations of antibiotics and can facilitate catheter salvage. Patients with catheter colonization (CC) or hemodynamically stable catheter‐related bloodstream infection (CRBSI) received ALT per institutional policy. We analyzed the incidence of CC and CRBSI and salvage rate of tunneled CVCs (Hickman) with ALT in patients undergoing hematopoietic stem cell transplant in this retrospective study. Catheter colonization was noted in 9.8% and CRBSI in 10.7% patients. Gram‐negative bacilli (GNB) accounted for 45% and 83% of isolates in CC and CRBSI, respectively. In patients with CRBSI, the rate of catheter salvage with the use of ALT in addition to systemic antibiotics was 86% compared to 55% in patients with systemic antibiotics use only (P = 0.06). There was no CRBSI related mortality, and no increase in resistant strains was noted at subsequent CRBSI. In conclusion, ALT represents an important strategy for catheter salvage, especially for gram‐negative infections, in a carefully selected patient population. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Primary spinal glioblastoma multiforme is an extremely rare malignancy, with an incidence of 1.5% of all the spinal cord tumors. Amongst the pediatric CNS tumors, spinal cord tumors represent less than 1% and out of this 1-3% are high-grade tumors. It has got an extremely poor prognosis with survival of approximately 1 year after diagnosis. Here we present a rare case of primary spinal GBM in an adolescent with multiple congenital malformations. CASE PRESENTATION: A 14-year-old adolescent female presented with acute onset paraplegia. The patient had a one week history of acute onset backache followed by sudden weakness of both lower limbs. Neurological examination showed intact higher mental functions and no cranial nerve deficits. There was flaccid motor weakness of the lower limbs with power 0/5 and absent lower limb deep tendon reflexes. Sensory system examination was remarkable for dermatomal level of L1. Bilateral plantars were mute. There was bladder involvement. Upper limb neurological examination was normal. Blood investigation showed raised creatinine. Brain and spinal magnetic resonance imaging showed an intradural, extramedullary lesion, 15cm in length, 7mm in AP dimension extending from D5 to D11 level and causing spinal cord compression. An USG abdomen done to look for the cause of raised creatinine showed an ectopic right kidney. Routine chest X-ray revealed dextrocardia. She underwent D5-D10 laminectomy with laminoplasty and evacuation of extradural collection. The histopathology report showed diffuse midline glioma, GBM - WHO grade IV, H3K27M mutant GFAP positive. She received external radiotherapy along with concurrent temozolamide. CONCLUSION: There are no well-known associations between GBM and dextrocardia or kidney malformations. This case is one of the rare presentations of pediatric GBM and multiple congenital anomalies. [ABSTRACT FROM AUTHOR]

Introduction: Paediatric soft tissue sarcoma treatments and outcomes have improved significantly in the last few decades. However, a significant number of patients still succumb to the disease. In low-middle income countries there are dual problems of advanced disease at presentation and financial burden leading to poor compliance to therapy. Hence, we designed a low-cost oral metronomic chemotherapy protocol for these patients and studied the responses and toxicities to therapy in a tertiary referral hospital., Patients and Methods: This is retrospective, single institutional, observational study. We retrospectively reviewed data of patients with relapsed, refractory or metastatic soft tissue sarcoma (STS) [ Ewing Sarcoma (ES); Rhabdomyosarcoma (RMS) or other STS] who were treated with the metronomic protocol of oral Tamoxifen, Etoposide and Cyclophosphamide (TEC) during the period April 1998 to September 2013, at the Tata Memorial Hospital, Parel, Mumbai. Patients with ES and RMS were primarily treated on our Institutional protocols. The patients included in the analysis were those who had relapsed after the primary protocols and then treated with metronomic TEC protocol; or those with primary refractory or metastatic disease (RMS, ES) and received metronomic TEC therapy., Results: 49 patients were enrolled. Among the 49 patients, 32 were diagnosed ES, 13 RMS and 4 other STS. For the whole cohort response rates (RR) were 59% and clinical benefit rate (CBR) was 79%. Patients in the study were grouped into the following subgroups. Systemic recurrent/relapsed disease (N=24), metastatic disease at presentation (N=15) and local disease (refractory/recurrent) (N=10). None of the patients required blood or platelet support or admission for supportive care. The PFS for the above groups were 16.8 months, 12.5 months and 126.68 months respectively. This compares favorably with other historical cohorts in a similar setting., Conclusions: This study provides a preliminary evidence efficacy and tolerability of metronomic chemotherapy in poor risk ES and RMS. It also demonstrates that with this low-cost low risk treatment few patients could go into long term remissions despite high disease burden.