Background: Transplantation of primary isolates of human cord blood (CB) and fetal liver (FL) hematopoietic stem cells, and the use of ex vivo expanded progenitor cells from these sources hold promise for the treatment of a number of diseases. In order to fully realize the potential of this method and these cells, an understanding of the expression of hematopoietic growth factor receptors and the function of their ligands is crucial. Flt3 receptor is a member of the tyrosine kinase receptor familyand its ligand is a cytokine involved in hematopoiesis, and may have a significant potential for the expansion of hematopoietic stem cells ex vivo. Methods: We investigated the expression of flt3 receptor in CD34plus cells from CB and FL using RT-PCR andflow-cytometry. We also studied the colony forming potential of CB and FL CD34plus cells in methylcellulose culture using a combination of cytokines that included SCF, IL-3, IL-6, GM-CSF, G-CSF and erythropoietin with and without flt3 ligand. Results: Flt3 receptor mRNA and protein expression were observed in CD34plus cells from CB and FL. After 14 days in methylcellulose culture, there was a statistically significant increase in the number of CFU-GM but not BFU-E or CFU-GEMM colonies, when flt3 ligand was added to the cytokine cocktail. The increase in CFU-GM with flt3 ligand was reduced when anti-flt3 ligand antibody was added to the culture. Conclusions: These observations suggest that flt3 ligand may play a synergistic role with cytokines in augmenting CFU-GM formation from both CB and FL CD34plus cells.

Objective: To report the presenting clinical features and outcomes of the treatment of adult cancer patients presenting with spinal cord compression (SCC) at a single institution Setting: Tertiary referral and a specialist hematology / oncology center in Southern Pakistan. Methods: Retrospective, chart-based review of adult patients (more than 14 years) admitted to the hospital with a diagnosis of SCC over a period of 4 years was undertaken. Results: A total of 95 patients were diagnosed to have SCC during the study period. There were 56 males and 39 females. The mean age was 53 plus 14 years. Breast (29), lung (22) and prostate (9) cancers, multiple myeloma (7), and Ewing's sarcoma involving the vertebral body (7) were the common underlying malignancies. 40 percent of patients presented with leucocytosis, and 30 percent with acute renal failure. 6 percent presented with hypercalcemia. Symptoms included back pain (70 percent), lower limb motor weakness (63 percent), autonomic disturbances (43 percent), and decreased sensations (12 percent). The sites of involvement were lumbar spine (33.7 percent), thoracic spine (29.5 percent), multiple (26.3 percent), cervical spine (8.4 percent). Overall, 47.5 percent patients were able to walk with or without support after a week of diagnosis of SCC after treatment. 25.3 percent patients died within a month of the diagnosis of SCC. The median survival was 21 months. The median survival for prostate, breast and lung cancers were, unreached, 54, and 5 monthsrespectively. Conclusion: The majority of patients with SCC had an underlying breast, lung or prostate cancer or mutiple myeloma in this series. A significant proportion of these patients were salvageable despite the far advanced disease.

Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin's lymphoma with an overall poor prognosis. Recent reports have observed an increase in its incidence both among the patients with immunodeficient patients as well as immunocompetent individuals. This review highlights the epidemiology, pathogenesis, clinical profile, diagnosis, treatment modalities and prognosis of this extranodal lymphoma.

This multicentric randomized study was a phase III trial that aimed to assess and compare the efficacy and toxicity of COPP-ABVD with standard and increased dose BEACOPP regimen. From 1993 to 1998, 1201 eligible patients 15 to 65 years of age who had newly diagnosed Hodgkin's disease in unfavorable stage IIB or IIIA or stage 1MB or IV were randomly assigned to receive eight cycles of cyclophosphamide, vincristine, procarbazine, and prednisone alternating with doxorubicin, bleomycin, vinblastine, and dacarbazine, (COPP-ABVD); bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP), or increased-dose BEACOPP, along with growth factor support, each followed by local radiotherapy when indicated. Enrollment in the COPP-ABVD group was stopped in 1996 owing to inferior results. For the final analysis, 1195 of 1201 patients could be evaluated: 260 in the COPP-ABVD group, 469 in the BEACOPP group, and 466 in the increased-dose BEACOPP group; the median follow-up was 72, 54, and 51 months, respectively. The rate of freedom from treatment failure at five years was 69 percent in the COPP-ABVD group, 76 percent in the BEACOPP group, and 87 percent in the increased-dose BEACOPP group (P=0.04 for the comparisonof the COPP-ABVD group with the BEACOPP group and P less than 0.001 for the comparison of the increased-dose BEACOPP group with the COPP-ABVD group and with the BEACOPP group), and the five-year rates of overall survival were 83 percent, 88 percent and 91 percent, respectively (P=O.I6 for the comparison of the COPP-ABVD group with the BEACOPP group, P=0.06 for the comparison of the BEACOPP group with the increased-dose BEACOPP group, and P=0.002 for the comparison of the COPP-ABVD group with the increased-dose BRACOPP group). Rates of early progression were significantly lower with increased-dose BEACOPP than with COPP-ABVD or standard BEACOPP. The incidence of acute hematological effects was similar in the COPP-ABVD and standard BEACOPP groups but wassignificantly increased in the increased dose BEACOPP group. In this group grade 3 and 4 Icukopenia was common in all 8 cycles whereas the frequency of thrombocytopenia and anemia increased in the last 4 cycles. Grade 3 and 4 infections occurred in a higher proportion of patients in this group. The incidence of fatal acute treatment related effects were similar in all groups (less than 2 percent). The median duration of chemotherapy from the first to the last day of drug administration was weeks in the COPPABVD group (planned, 30 weeks), weeks in the BEACOPP group (planned, 23 weeks), and 27.7 weeks in the increased dose BEACOPP group (planned, 23 weeks) The percentage of patients who received radiotherapy was 64 percent in the COPP-ABVD group and 71 percent in the other two groups. Patients were divided into three subgroups based on the International prognostic index (IPI) within each prognostic subgroup standard and increased dose BEACOPP resulted in lower rates of early progression and five-year freedom from treatment failure. All age groups seemed to benefit from the standard and increased dose BEACOPP, with the possible exception of those who were 60 to 65 years of age. The actuarial rate of secondary acute leukemia five years after diagnosis of Hodgkin's disease was 0.4 percent in the COPP-ABVD group (n=l), 0.6 percent in the BEACOPP group (n=4) and 2.5 percent in the increased dose BEACOPP group (n=9). Solid tumors were recorded in three, eight and two patients, respectively and second non-Hodgkin's lymphoma in seven, four and five patients, respectively

Hodgkin's Lymphoma in childhood is a highly curable neoplasm. We describe how we manage cases of childhood Hodgkin's Lymphoma at the Cancer Institute (WIA), Adyar, Chennai and give our results with the use of Hybrid Chemotherapy and restricted use of Radiotherapy.

Ewing's sarcoma is the second most common malignant neoplasm of the bones. It occurs rarely in the foot and its occurrence in the metatarsal bones is extremely rare. Clinically and radiographically they may present with atypical features. Here we report an 8 year old boy with Ewing's sarcoma of the first metatarsal who was treated successfully with chemotherapy and limb saving surgery.

A 4-year-old female child presented with hematuria and flank pain. Nephrectomy was done. The tumor turned out to be renal cell carcinoma of clear cell type. Chemotherapy was given. After three years of follow-up the child is alive and disease free

Langerhans cell histiocytosis (LCH) is an uncommon disorder affecting primarily children, common sites being bones and skin. We here report a case of 12 year old boy who was treated for LCH. Thirteen months after diagnosis, he was detected to have acute lymphoblastic leukemia (ALL). Following chemotherapy for ALL (MCP-841), he achieved complete remission. This was followed by consolidation and maintenance therapy. Presently, the child is alive and continues to be in remission.