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lymphadenopathy and multiple cutaneous lesions. CT scan revealed additional bilateral
cervical, axillary, mediastinal and abdominal lymphadenopathy and involvement of lung
and liver. LDH levels were exorbitant elevated (233 mmol/l). On an individual base, our
patient received the ALK inhibitor Crizotinib 250 mg per os twice daily. No
glucocorticoids or other drugs with antineoplastic activity were co-administered. Within
72 hours LDH levels were halved (89 mmol/l). On day 8 cervical palpable
lymphadenopathy disappeared. Initial erythematous papular cutaneous lesion decreased
from 4.0 x 2.5 cm to a residual hyperpigmented macule of 1.5 x 2.5 cm. On day 16 LDH
levels were almost within normal limits (6 mmol/l). However, remission was not
sustained and patient developed resistance to Crizotinib. By day 21 after beginning the
treatment with Crizotinib LDH levels increased again and patient presented with a
swollen left arm due to lymphatic obstruction, detected by CT scan, which showed a
general progressive disease, causing death one month later.
Conclusion: To our knowledge, this is the first case which reports sensitivity in
ALK-positive DLBCL to ALK inhibition with Crizotinib. Despite remission duration
was short our results indicate a potential role of ALK in the pathogenesis of
ALK-positive DLBCL and suggest ALK inhibition as a potential treatment modality
in the therapy of this fatal disease.
Disclosure: All authors have declared no conflicts of interest.
1100 LIVER INVOLVEMENT BY LYMPHOMA – INDICATOR OF POOR
RESPONSE AND MORTALITY
S. Kumar, I.A. Muazzam, N. Siddiqui, N. Muzaffar, K. Das, U.E.K. Awan
Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Reserch
Centre (SKM), Lahore, PAKISTAN
Total = 46 Hodgkin’ Lymphoma (n = 24)
Heptic
(n = 12) Non-hepatic = 12
NonHodgkin’s Lymphoma
(n = 22)
hepatic
(n = 5)
Non-hepatic
(n= 17)
B-symptoms 9 (75%) 9 (75%) 3 (60%) 17 (77%)
Bulky 1 (8%) 1 (8%) 1 (20%) 7 (41%)
CR 8 (67%) 12 (100%) 4 (80%) 11 (64%)
PR 2 (16.5%) 0 (0) 1 (20%) 6 (36%)
PD 2 (16.5%) 0 (0) 0 (0) 0 (0)
ORR = CR + PR 83.5% 100% 100% 100%
Died 4 (33%) 0 (0) 1 (20% ) 6 (36%)
Introduction: Hepatic involvement is more common in Non-Hodgkin’s as compared
to Hodgkin’s Lymphoma (HL) at presentation. It is a poor prognostic feature. We
determined prognosis of our stage IV lymphoma patients who had liver involvement
at baseline.
Material and method: In last 1 year, 70 patients presented in our lymphoma clinic
with stage IV disease. Out of these, 46 had completed their treatment at the time of
analysis. Diagnosis of lymphoma was confirmed on excision or core biopsy of a nodal
site at presentation. PET/CT was done for staging before starting chemotherapy and
response assessment was done after 2-4 cycles of planned chemotherapy. Histologic
evaluation of any residual FDG-avid disease was made in patients who responded to
chemotherapy at all the other sites. Response rate (RR) was calculated by adding
percentage of patients in complete (CR) and partial (PR) remission.
Results: Out of these 46 patients, 24 had HL and intermediate-to-high grade NHL was
diagnosed in 22 patients. Median age at diagnosis was 29.5 years (range 16 to 60).
Secondary liver involvement was found in 17 patients (HL = 12/24; NHL = 5/22). More
NHL patients presented with B-symptoms and bulky disease than HL. Presence of
liver involvement predicted a lower response to initial therapy in patients with HL (RR
83.5%) as compared to NHL (RR 100%). Despite this initial response to treatment,
one-third of advanced stage HL patients died before the completion of therapy. Such
relationship was not observed in advanced stage NHL patients (see table).
Conclusion: Despite initial response to treatment, secondary liver involvement at
presentation predicted higher mortality in stage IV HL patients. This effect should be
further validated in larger studies.
Disclosure: All authors have declared no conflicts of interest.
1101 AN OVERVIEW OF YOUNG CHRONIC LYMPHOCYTIC
LEUKEMIA PATIENTS: A SINGLE CENTRE EXPERIENCE OF
117 CASES FROM NORTHERN INDIA
A. Gogia 1 , A. Sharma 1 , V. Raina 2 , L. Kumar 1 , R. Gupta 3 , R. Kumar 3
1 Medical Oncology, All India Institute of Medical Sciences, New Delhi, INDIA,
2 Dept. of Medical Oncology, All India Institute of Medical Sciences (AIIMS)
Institute Rotary Cancer Hospital, New Delhi, INDIA, 3 Lab Oncology, All India
Institute of Medical Sciences, New Delhi, INDIA
Background: In this study, the clinical characteristics, survival, and prognostic factors
of 117 cases of young ( = < 55 years) chronic lymphocytic leukemia (CLL) patients
were analysed at IRCH, AIIMS, a large tertiary care centre of Northern India.
Annals of Oncology
Methods: Patients records collected from computer database using ICD code
(C-91.1) between period of 2000-2010 were retrospectively evaluated.
Results: Over a period of 11 years, 285 CLL patients (117 [41.05%] = < 55 years of
age and 168 [58.95%] > 55 years of age) were evaluated. There were similar
distribution of sex, lymphadenopathy, organomegaly, and absolute lymphocyte
count in both groups At diagnosis, younger patients were less incidentally detected
(p < .0001), more B- symptoms (p = 0.001) and advanced Rai stage ( p = 0.021),
than older patients. Response rate and toxicity profile were same in both groups
with chlorambucil and fludarabine based chemotherapy. Overall response rate
(ORR) seen with chlorambucil and fludarabine was 69% and 88% with complete
remission (CR) rate was 3% and 44 % respectively. Richter’s transformation was
significantly higher in younger patients (3.41% v 0.5%; p = 0.001). Median follow
up period was 36 months. Younger and older patients showed a similar overall
median survival but were characterized by a different distribution of causes of
deaths. CLL unrelated deaths predominated in the older age group, as one third
of patients have different co-morbities like diabetes, hypertension, coronary artery
disease e.t.c, whereas the disease related death were prevalent in the younger age
group. Multivariate analysis showed that for young CLL patients, advanced clinical
stage (Rai III and IV) was associated with poor overall survival [HR 2.08 (95% CI
1.19-4.11) p = 0.001].
Conclusion: Forty one percent our CLL population was young. Young CLL patients
presented with more B symptoms and advanced stage (Rai III and IV) than elderly
CLL patients.
Disclosure: All authors have declared no conflicts of interest.
1102 CHRONIC MYELOID LEUKEMIA IN CHILDREN- EXPERIENCE
WITH IMATINIB MESYLATE AT A REGIONAL CANCER
INSTITUTE, BANGALORE, INDIA
K.V. Belathur, L. Appaji, K.C. Lakshmaiah, A.K. B S,, S. Purohith, D.
S. Madhumathi
Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, INDIA
Background: Childhood Philadelphia chromosome-positive (Ph+) CML constitutes
about 3- 5% of the total leukemias. Allogeneic stem cell transplantation (SCT) offers
best survival but in view of unaffordability and non availability of suitable donor,
Imatinib Mesylate becomes the next best treatment option. The present study was
thus undertaken to evaluate the clinical profile, response, survival and adverse effects
of the drug.
Methods: This is a retrospective study of Ph + CML in the age group of 4-18 yrs, at
Medical & Paediatric Oncology department of our institute.50 patients of CML,
enrolled under the Glivec International Patient Assistance Program (GIPAP) between
Jan 2004 to Dec 2011 and started on Imatinib at 340 mg /m2/day were analyzed.
Complete hemogram, liver function tests, bone marrow aspiration studies and
BCR-ABL by RT-PCR were done at intervals as per institution protocol.
Results: Mean age of patients enrolled in the study was 12.8 yrs. Mass and pain
abdomen were the predominant presentations in 21(42%) and 18(36%) respectively.
One patient each was in accelerated phase and blast crisis. Complete Hematological
Response (CHR) was achieved in 100% with 43 (86%) within 3 months. Complete
cytogenetic response was achieved in 20(40%) with median duration of 14 months
(8-18).13(26%) patients showed Major molecular response with a median of 16
months (6-29) & complete molecular response in 4 (8%) with a median of 21
months(16-22). One out of 4 patients with progressive disease is in blast crisis
waiting for transplantation, 3 are on escalated dose of Imatinib and either Cytarabine
or Interferons to maintain CHR. All 4 were negative for Imatinib Mutations. Most
common adverse events were grade 1/2 skin toxicities and weight gain in about 40%
of patients. About 8 (16%) patients had grade2/3 myelosupression which was
manageable. Event free survival and overall survival were 94.4% and 64% at a median
follow up of three years.Sokal score was evaluated with respect to the survival
outcome but was not found to be statistically significant.
Conclusions: In view of good response and tolerance, our results reaffirm previously
reported favorable results from various other centers. Imatinib can be considered as
an alternative to SCT in Pediatric CML population to improve the survival and
merits further evaluation.
Disclosure: All authors have declared no conflicts of interest.
1103 COMPLICATIONS OF “VERY HIGH” LEUKOCYTOSIS IN
PEDIATRIC ACUTE LEUKEMIA PATIENTS MANAGED
WITHOUT RASBURICASE AND LEUCOPHERESIS
R.B. Singh, K. Munot, S. Pathania, S. Bakhshi
Dept. of Medical Oncology, All India Institute of Medical Sciences (AIIMS)
Institute Rotary Cancer Hospital, New Delhi, INDIA
Background: Hyperleukocytosis in pediatric leukemias is associated with acute
complications of tumor lysis syndrome (TLS) and leucostasis. In developing
countries, rasburicase is not available and even if available, it may not be affordable
by all patients. Rasburicase became freely available in India in 2010. We evaluated
ix358 | Abstracts Volume 23 | Supplement 9 | September 2012