Diagnostic Accuracy of 18F-FDG PET - CT Imaging in determining the bone marrow involvement (BMI) in pediatric Hodgkin's Lymphoma (HL).

Objective: To determine diagnostic accuracy of 18F-FDG PET - CT imaging in determining Bone marrow involvement in pediatric HL by taking bone marrow biopsy as standard. Method: This descriptive cross-sectional study was conducted in the Department of Pediatric Hematology/Oncology, Indus Hospital and Health Network, Karachi from July 2021 to December 2022. Treatment naïve histologically proven pediatric HL patients of both gender and aged between two to 16 years with both 18F-FDG PET - CT and bone marrow biopsy imaging were included. Basic demographics such as age, gender, height, weight, as well as classification and staging of HL was obtained. Results were assessed by expert reviewers who were blinded to clinical outcome. Sensitivity, specificity, positive and negative predictive value, and diagnostic precision were assessed. The data was analyzed via SPSS 26.0. Results: Total 131 participants were included with a male predominance i.e. 104 (79.6%). The mean (±SD) age was 8.7 ± 3.4 years. The present study reported PET/CT to have a sensitivity, specificity diagnostic accuracy, PPV and NPV of 94.1%, 92%, 92%, 64% and 99% respectively. Conclusion: Our findings support the idea that BMB should not be routinely conducted in all patients but rather can be reserved exclusively for patients with dubious 18F-FDG bone marrow findings, as this test has strong diagnostic potential for evaluating BMI involvement in HL.

Impact of COVID-19 on the Children with Cancer in Six Pediatric Oncology Units (POUs) of Pakistan- A Multi-Center Study.

The study is to evaluate the impact of COVID-19 in the Pediatric Oncology Units (POUs) of Pakistan. Data from 1 April 2019 to 30 June 2019 and 1 April 2020 to 30 June 2020 for the first and second cohort, respectively, in order to compare the registration, abandonment rate, and delay in treatment. Six hundred and thirty-four were registered cases, 379 and 255 in the first and second cohort, respectively, which was significantly different <0.005. Seventy-seven were abandoned, 45 and 32 in the first and second cohort, respectively. Fifty-nine COVID-19 positive cases, 24, 4, 27, and 4 were admitted, referred, home isolated, and leave against medical advice (LAMA), respectively. Delayed treatment and reduction in new cases were observed.

Challenges in the Management of Wilms Tumor in a Developing Country: A Twenty Years' Experience From a Single Center in Pakistan.

BACKGROUND: Wilms Tumor (WT) is one of the most curable childhood cancers. High cure rates seen in the developed countries are not reproduced in developing countries. Lack of access to cancer treatment facilities, financial constraints, late presentation, and abandonment have previously been described. We reviewed our data over the last 20 years to highlight some of these challenges. METHODS: This is a retrospective chart review of children with WT at our center up to the age of 18 years between 1 November 1997 and 30 November 2017. Demographic details, presentation characteristics and treatment details were recorded. Factors associated with poor outcome were analyzed. RESULTS: Two hundred eleven children were registered; 117(55.5%) were males. Median age at presentation was 3 (range 0 to 18) years. Presentation data were available for 184/211 patients, staging details for 159/211 and metastatic status for 178/211. Of the available dataset, 60% presented without prior treatment, whereas 40% presented atleast after primary surgical excision. High-stage (stage III or above) disease was present in 79 (49.7%) patients; 61 (34.3%) was presented with metastases or recurrence; 63 (29.8%) abandoned or refused treatment; 99/172 (57.6%) patients finished treatment, 23 (13.4%) died during treatment, and 6 died before treatment. Of the 99 patients who finished treatment 83 (83.8%) are well off therapy; 15(15.2%) relapsed; 6 (40%) are alive after salvage therapy, while 9 (60%) died. CONCLUSIONS: Our data highlights the challenges of managing WT in resource poor environments. Prior surgery, incomplete staging work-up and abandonment are some of the most frequently encountered barriers. A multipronged approach is required to overcome these challenges.

8p11 associated myeloid/lymphoid neoplasms: An illustrative case report of this rare entity and review of literature.

This report describes a unique case of 8p11 myeloproliferative syndrome (EMS), also known as stem cell leukaemia-lymphoma syndrome. A 13 years old male was referred from a tertiary care hospital after cervical lymph node biopsy. The disease mechanism of this neoplasm is to either evolve into acute myeloid leukemia or mixed lineage leukaemia, and less frequently of T or B lymphoid lineage. However, here we show a case of a rare simultaneous presentation of T lymphoblastic lymphoma on cervical lymph node and B lymphoblastic leukaemia on bone marrow biopsy along with t (8; 13) on karyotype testing.

Predictors of treatment abandonment for patients with pediatric cancer at Indus Children Cancer Hospital, Karachi, Pakistan.

BACKGROUND: Abandonment of treatment is one of the toughest challenges to deal with in pediatric oncology. It leads to unnecessary mortality and morbidity in patients from low- and middle-income countries. PROCEDURE: The objective of our retrospective study was to determine the prevalence and predictors for abandonment among children with cancer at our hospital in Karachi, Pakistan. We analyzed data on patients younger than 18 years, diagnosed with any malignancy between November 2014 and May 2016. RESULTS: From a total of 821 patients, one hundred and eighty-two (22.2%) patients abandoned treatment at various stages, 92 (11.2%) patients did not initiate treatment at all, and the remaining 90 (11.0%) left during treatment. The gender ratio at registration was skewed toward males but not statistically significant for abandonment. Of 295 registered females, 74 (25.1%) abandoned treatment compared to 108 (20.5%) abandonments among 526 males. In multivariable regression analysis, the type of malignancy, guardian's profession, and travelling from outside the city of Karachi (odds ratio [OR]: 1.48; 95% confidence interval [CI] 1.02-2.15; P = 0.039) correlated with increased abandonment. Treatment abandonment was higher among patients with brain tumors (45.7%) and solid tumors (30.8%) and among those whose guardians were associated with a rural profession (24.7%). Monthly income, age, and number of siblings had no impact on the decision to abandon treatment. CONCLUSION: Despite the provision of free treatment, the prevalence of abandonment was high. More qualitative data need to be collected to identify and target groups of individuals who may be likely to abandon treatment, thus improving outcome of patients.

Tumour Lysis Syndrome in children with haematological cancers: Experience at a tertiary care hospital in Karachi.

OBJECTIVE: To determine the incidence of tumour lysis syndrome and to identify associated factors and mortality rate in paediatric haematological patients. METHODS: The prospective study was conducted from April to September 2016 at Indus Children Cancer Hospital, Karachi, and collected data for all new paediatric oncology patients registered with diagnosis of haematological malignancies. Each patient was monitored for a period of three days before and seven days after the start of the treatment. SPSS 21 was used for data analysis. RESULTS: of the 232 patients, 86(37.1%) developed laboratory tumour lysis syndrome and 35(40.7%) of these patients developed the spontaneous variety. Overall, 24 (10.3%) patients progressed to clinical syndrome with 12(50%) of them developing spontaneous clinical syndrome. Mortality occurred in 17 (7.3%) patients. CONCLUSIONS: Despite preventive measures, tumour lysis syndrome remains an oncological emergency in children with haematological malignancies.

Pediatric oncology in Pakistan.

Pediatric oncology in Pakistan has developed over last decade with substantial increase in the facility for treatment and number of expertise. Though large numbers of children still do not reach treatment center more children have now access to quality cancer treatment. There has been gradual improvement in Pediatric oncology nursing and allied services. Pediatric Palliative care in Pakistan is in initial phase of development. Pediatric Oncology services are largely supported by philanthropists. Children Cancer Hospital a project of Children Cancer Foundation Pakistan Trust is not only providing quality treatment to every child regardless of paying ability but also playing a pivotal role in capacity building and creating awareness about childhood cancer in Pakistan.

Development of palliative-care services in a developing country: Pakistan.

Palliative care services are poorly developed in most resource-poor countries. With the increase in the number of cancer cases being diagnosed in these countries, most of whom present in advanced stages, an urgent need for palliative care is emerging. Pakistan is an example of a resource-poor country where palliative care services are in the initial phase of development.

Clinical Profile and Short-Term Outcome of Pediatric Hyperleukocytic Acute Leukemia from a Developing Country.

This study was conducted to determine the frequency, clinical profile, and short-term outcome of children with hyperleukocytosis at two pediatric oncology centers in Karachi. Of a total 1,045 patients, 13.97% (n=146) patients had hyperleukocytosis. Majority (61.7%, n=90) were under 10 years of age and 76% (n=146) were male. The symptom duration before diagnosis was more than 30 days in 49.3% (n=72). The median WBC count was 181 x109/L(IQR=130.45298.3) and extreme hyperleukocytosis (>200 x109/L) was observed in 44.5% (n=65) patients. Majority (94.5%, n=138) of patients were diagnosed with acute lymphoblastic leukemia. One or more complications developed in 78% (n=114) of cases. Clinical and laboratory tumor lysis syndrome (TLS) was observed in 17.1% (n=25) and 39% (n=57) patients, respectively. Pulmonary and neurological complications related to leukostasis were noted in 9.5% (n=14) and 27.3% (n=40) of cases, respectively. Infectious complications occurred in 23.2% (n=34) patients. The case-specific mortality was 20.5% (n=30). No mortality was related to early complications of hyperleukocytosis.