Background Non-Hodgkin Lymphoma (NHL) accounts for 5% of childhood cancers in children. Pediatric NHL patients achieve complete remission in high-income countries; however, mortality is high in low and middle-income countries due to complicated febrile neutropenia. Data published from our centre showed acute mortality of 19.7% and sepsis as the most common cause of death. Use of Granulocyte Colony Stimulating Factor (G-CSF) has shown to reduce the duration and severity of neutropenia and decrease the incidence of febrile neutropenia (FN). Therefore, our study aims to assess a reduction in acute mortality with the use of GCSF as primary prophylaxis in B-cell NHL and a reduction in hospital admission days with febrile neutropenia and delays in subsequent chemotherapy cycle. Methods This is a retrospective cohort study, performed at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH) Lahore. All patients with diagnosis of B Cell NHL under 10 years of age from January 2018 to October 2021 were included. Data was collected on patient age, stage of disease, treatment regimen, day of start of GCSF, number of episodes of FN, duration of admission in hospital due to FN, day of count recovery and outcomes. Results Of the 106 patients, 45 (42.4%) were females and 61 (57.5%) were males and 60 patients (56.7%) were between 1-5 years of age. All patients were started on GCSF on 7 th day of COPADM regimen. Second cycle of induction chemotherapy was given on time at 21 st day in 57 (53.8%). 97 patients (91.5%) remained alive until end of induction and nine patients expired with mortality rate of (8.5%). Multi-drug resistant gram negative/positive bacteremia (32%) and invasive fungal infections (8.5%) remain the most frequent causes of prolonged febrile neutropenia in these patients. A total of 48 (45.4%) patients were discharged on 7 th day after 1 st cycle, 41 (38.6%) remained admitted for 8-15 days due to prolonged febrile neutropenia, and remaining 17 (16%) of patients remained admitted for more than 15 days due to prolonged FN. Conclusions Primary prophylactic use of GCSF in our patients helped reduce mortality to 8.5%, decreases number of FN episodes, decreases length of hospital stay, and improves count recovery. Therefore, the use needs to be promoted in pediatric cancer care centers especially in resource limited settings so that better outcomes can be achieved.

CLINICAL OUTCOME OF PEDIATRIC EWING SARCOMA AND SIGNIFICANCE OF PATHOLOGICAL NECROSIS AFTER NEOADHUVANT CHEMOTHERAPY: SINGLE INSTITUTIONAL STUDY Authors: Sindhu II, Mehreen A, Wali RM, Abubakar M Affiliation: Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore. Pakistan Abstract Purpose: Tumor necrosis and histopathological changes in Ewing sarcoma following neoadjuvant chemotherapy are important predictors of disease outcome. The aim of our study is to determine the clinical outcome and significance of pathological necrosis after neoadjuvant chemotherapy as it has not been reported in our country so far. Methods: Data was reviewed after IRB approval from January 2010 to December 2015 were retrospectively reviewed for patients with newly diagnosed Ewing sarcoma on histopathology and less than 20 years of age at the time of diagnosis. Results: A Total of 124 patients were included, in which 89 patients (72%) were non metastatic and 35 patients were metastatic (28%). Histopathology report after doing surgery showed Little or no (Grade 1 ) necrosis seen in 14 patients (11%) and 50-90% (Grade II) necrosis seen in 9 patients (7%), 90-99% (Grade III) necrosis seen in 8 patients (5.5%), and 100% (Grade IV) necrosis in 14 patients (11%). EFS of grade 4 necrosis was 93%, grade-3 71%, grade- 2 22% and grade-1 35%. OS of grade 4 necrosis was 93%, grade -3 75%, grade-2 25 % and grade-1 50%. EFS of Ewing sarcoma patients were 38% and OS was 38%. Conclusion: Tumor necrosis and histopathological changes after surgery has great impact on survival outcome in Ewing Sarcoma.