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Patients: From November 2002 to May 2010, 634 patients with CML in any stage of
the disease were treated with imatinib at our tertiary cancer research institute.
Among them 274 were female and 221 were of 17 to 50 years age group. We report
information of 8 accidental pregnancies and 10 planned pregnancies involving 18
patients (10 females and 8 males) who conceived while receiving imatinib for the
treatment of CML.
Observations: Among 10 pregnancies reported in female sufferers there were two
spontaneous and one elective abortion all in unplanned group and seven live births
including one twin. There was one case of hypospadius which could be surgically
corrected. Among the eight male patients whose wives conceived four pregnancies
were planned, there was one spontaneous abortion, two elective abortions. The
conceptions resulted in the birth of five healthy babies (two females). There was no
other identifiable congenital anomaly.
Discussion: In the patients, who do become pregnant while on treatment, balancing
the risk to the fetus of continuing imatinib versus the risk to the mother of
interrupting treatment remains difficult. From the fetal perspective, imatinib should
be discontinued due to the potential risk of serious developmental abnormalities;
from the maternal perspective also there is chance of drug interruption induced
cytogenetic relapse. In conclusion, exposure to imatinib during pregnancy might
result in an increased risk of serious fetal abnormalities or spontaneous abortion.
Women and men (pregnant wife of male patient) with childbearing potential should
use adequate contraception while taking imatinib.
Disclosure: All authors have declared no conflicts of interest.
1091P IMPACT OF NUTRITION ON TREATMENT OUTCOME IN
ACUTE LYMPHOBLASTIC LEUKAEMIA OF CHILDHOOD IN
DEVELOPING COUNTRY
S. Poddar 1 , A. Mukhopadhyay 1 , P. Hor 1 , A. Nandi 1 , P. Gupta 1 ,
S. Mukhopadhyay 2
1 Medical Oncology, Netaji Subhas Chandra Bose Cancer Research Institute,
Kolkata, INDIA, 2 Medical Oncology, Calcutta Hospital Calcutta, West Bengal,
Kolkata, INDIA
Background: All conventional modalities of anti-cancer therapy interfere with
normal nutrition. Therefore, malnutrition is a major problem in children with
cancer. In this study we retrospectively analyzed 500 children suffering from Acute
Lymphoblastic Leukemia (ALL), who were being intensively treated by National
Cancer Institute protocol (MCP 841) during period beginning from August, 1999 to
December, 2011, in a tertiary cancer institute. Our aim was to determine the
nutritional status at preliminary diagnosis of ALL children and to study the influence
of nutrition on complete remission, disease free survival (DFS) and
chemotherapeutic toxicity.
Procedure: The variables studied were height for age (HFA), weight for age (WFA),
mid-arm circumference (MAC), biceps skinfold thickness (BSFT) and serum
albumin levels. The HFA, WFA, MAC and BSFT were taken as normal if they were
between 3rd and 97th percentile curve of the growth chart as recommended by the
Indian Council of Medical Research (ICMR). The albumin level was considered
normal if the value was equal to or more than 3g%.
Results: It was observed that 16.8% children were low weight for age and 10.4% were
low height for age during diagnosis. Low WFA (p value 0.001), low HFA (p value
0.0001) and low albumin (p-value 0.0001) were significant in DFS.
Conclusion: We conclude that malnutrition has high impact on ALL prognoses in
developing countries. Major nutritional indicators are HFA, WFA, MAC, BSFT and
serum albumin. Patients with malnutrition have less DFS duration, more chances for
relapse and more therapeutic toxicity when compared to well-nourished children.
Disclosure: All authors have declared no conflicts of interest.
1092P COST OF TREATMENT OF ACUTE MYELOID LEUKEMIA –
EXPERIENCES FROM A DEVELOPING COUNTRY
D. Arya 1 , B. Parikh 2 , P.M. Shah 2 , K.M. Patel 2 , S.N. Shukla 2 , A.S. Anand 2 ,
S.S. Talati 2 , S.A. Shah 2 , A.A. Patel 2 , B.B. Parekh 2
1 Medical Oncology, Action Cancer Hospital, Delhi, INDIA, 2 Dept. of Medical and
Pediatric Hemato Oncology, Gujarat Cancer and Research Institute Civil Hospital
Campus, M.P. Shah Cancer Hospital, Ahmedabad, INDIA
Background: Acute Myeloid leukemia (AML) is a difficult disease to treat requiring
specialised induction facilities, doctors, supportive staff and laboratory services. We
try to analyse how the cost of diagnosis and treatment combined with socio-cultural
and logistical issues affect treatment delivery and outcomes in AML in developing
countries like India.
Materials and methods: We conducted a retrospective analysis of case records of
adult patients diagnosed with AML between 2009 and 2010 at the Gujarat Cancer
and Research Institute, Ahmedabad, India. Patients diagnosed with AML-M3 were
excluded. Data reviewed included epidemiological and demographic details, AML
subtype, cytogenetic anomalies, co morbidities, treatment offered, complications, and
Annals of Oncology
duration of hospital stay. Billing information and other relevant data were retrieved
from the hospital electronic records and analysed.
Results: A total of 76 case records of patients with AML were identified (excluding
AML- M3). Females comprised 51% of all patients. Majority of diagnosed patients
(65%) worked as daily wage labourers. AML-M1 was the predominant subtype
(35%). Three % patients expired during initial workup and 27% were offered
supportive care only in view of significant co morbidities, advanced age or poor
performance status. Thirty four % patients refused treatment because of financial,
social or logistical constraints. Only 37 % of all patients received standard 7 + 3
(cytosine arabinoside with daunorubicin) induction treatment. Complication rate
during induction therapy was 71% with induction mortality rate being 8%. Average
stay in hospital was 34 days and cost of remission induction was equivalent of 1000
dollars with nearly 85% of that amount spent for supportive care. Remission rate was
71%, however only 29% patients were disease free at one year. Survival rate at one
year was 61%.
Conclusions: Nearly one third of patients were not candidates for standard treatment
in view of significant co morbidities, advanced age or poor performance status. Only
50% of patients candidate for standard treatment received it with the rest refusing the
same due to financial constraints, expected prolonged hospital stay, lack of social
support and logistical issues.
Disclosure: All authors have declared no conflicts of interest.
1093P BCR ABL FUSION PROTEIN DETECTION BY A MODERN
APPROACH: FLUROSCENT IMMUNO BEAD ASSAY
S. Dasgupta 1 , U.K. Ray 1 , A. Mukhopadhyay 2 , J. Basak 1 , S. Mukhopadhyay 1
1 Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute,
Kolkata, INDIA, 2 Dept. Medical Oncology, Netaji Subhas Chandra Bose Cancer
Research Institute, Kolkata, INDIA
Introduction: Chronic Myeloid Leukemia (CML) is probably the most extensively
studied human malignancy. CML patients (90-95%) harbor the Philadelphia (Ph)
chromosome, a shortened chromosome 22, resulting from a reciprocal
translocation t (9; 22) (q34; q11) between the long arms of chromosome 9 and
22, fusion ABL proto-oncogene on chromosome 9 with the BCR gene on
chromosome 22. BCR-ABL fusion gene plays a key role in pathogenesis of the
disease. Approximately 15-30% of adult and 2-5% of childhood ALL and