Background: CHOP (Cyclophosphamide, Vincristine, adriamycin and prednisolone) is the standard chemotherapy for intermediate and high grade none Hodgkin's lymphoma (NHL). We evaluated a new third generation combination chemotherapy protocol 'MCP 842' for the treatment of patients with advanced NHL. Patients and methods: 110 patients with aggressive diffuse NHL of intermediate and high grade (Working formulation) were treated with 'MCP 842' between December, 1985 and December, 1993. The protocol was designed in collaboration with the paediatric branch of National Cancer Institute, Bethesda, Maryland, USA. This protocol contains 7 drug comprising myelosuppressive and non or less myelosuppressive drugs administered alternately. Results: Patients median age was 35 years, male to female ratio being 2.79 :1 Ann Arbor staging revealed-stage I-10 percent, II-31 percent, III-39 percent and stage IV in 20 percent of patients. 36.4 percent of patients had B symptoms. 52 percent of patients had high grade and 48 percent had intermediate grade histology as per working formulation. Following chemotherapy 66.4 percent of patients achieved CR. Response rate was significantly higher in patients with early stage (stage I-II vs III-IV; 80 percent vs 57 percent, p.08), absence of `B' symptoms (78 percent vs 45 percent p.001) and in those with absence of bulky abdominal lymph nodes (p.001). Kaplan Meier probability of event-free and disease-free survival at 5 years was 48.3 percent and 69.5 percent, respectively. Marrow toxicity was the predominant toxicity and there were three infection related deaths. Concussions: In our hands, results of this new third generation protocol were not superior to those reported with standard CHOP.

High dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ASCT) is used for treatment of both haematological and solid cancers. Mononuclear cell Count (MNC), granulocyte macrophage-colony forming units (CFU-GM) or CD34 + cells are surrogate markers for haematopoietic capacity of infused (transplanted) stem cells. We studied correlation of these markers with post-engraftment kinetics. Methods: Twenty one patients [multiple myeloma, n=13, Hodgkin's disease -3, Non Hodgkin's lymphoma-2, metastatic breast cancer-2 and germ cell tumour of testis-1] undergoing ASCT were studied. Mononuclear cell counts were done manually, CFU-GM assays were performed using standard 14 day culture method. CD 34 + cell count were done using flow cytometry. Spearman correlation coefficient test was performed to determine factors that affect the kinetics of granulocyte and platelet recovery following infusion of peripheral blood stem cells i.e. MNc, CFU-GM and CD34 + cell assays. Results: Seventeen of 21 patients engrafted. Median CD34 + cell count was 4.91 *10 6 cells/ kg (range, 1.21 to 63.1), MNC count was 3.55*10 8/kg (range, 1.77-19.29) and CFU-GM was 35.05*10 4 colonies/kg (range, 10.75-110). Following analysis, CFU-GM colony count of the infused cells correlated with neutrophil recovery (p=0.03) but not with platelet recovery (p=0.09). MNC and CD34 + cell counts did not influence either neutrophil or platelet recovery. Four patients died, one prior to ASCT, due to progressive disease and three, due to transplant related toxicity. Conclusion: CFU-GM Colony assay is an important predictor of neutrophil recovery after ASCT regardless of disease or mobilization technique. Further experience is needed to predict the effect of CD34 + cell count on engraftment kinetics.

Ovarian cancer is one the most fatal gynaecological cancer because most cases are diagnosed at an advanced stage. 90 percent of malignant ovarian tumours arise by transformation of surface epithelium affected by ovulation. The development and progression of epithelial ovarian cancer (EOC) is correlated with various biological and molecular factors. These include over expression of various oncogenes, mutation of tumour suppressor genes, inappropriate expression of growth factors and/or their receptors, cytokines and genetic alterations that disrupt proliferation, apoptosis, senescence and DNA repair. These events, along with the inherent ability of epithelial cells to undergo proliferation, increase their chance of mutation, and their ability to produce cytokines and growth factors, could in turn promote oncogenesis. Subversion of host anti tumour immune response may also play a role in the pathogenesis. Approximately 10 percent of EOC arise in women who have inherited mutations in cancer susceptibility genes BRCA 1 or BRCA-2, but the vast majority of EOC are sporadic, resulting from the accumulation of genetic damage over a lifetime.

Fournier's Gangrene is a form of necrotising fascitis which affects perineum and scrotum and is a fulminating gangrene involving the fascia. Predisposing factors include diabetes mellitus, chronic renal failure, malignancy, poor nutrition with alcohol abuse. Fournier's gangrene is caused by penetration of the gastrointestinal or urethral mucosa by gram-negative bacteria, enterococci or anaerobes such as bacteroides species and peptostreptococci. Clinical features include severe pain, necrotising fascitis which may involve the anterior abdominal wall, gluteal muscle, scrotum and penis. This is the first case described in the setting of acute lymphoblastic leukemia, (ALL) though there are few case reports of Fournier's gangrene in acute non lymphoblastic leukemias (ANLL).

Granulocytic sarcoma (so called chloromas) are rare extra medullary tumour-like proliferates of myelogenous precursor cells that my be de novo precede acute leukaemia or coincide with the first manifestation or relapse of acute myeloid leukaemia. These tumours are rare and spinal epidural and vertebral involvement is however uncommon. We have report a case of spinal epidural Granulocytic sarcoma causing (G.S.) thoracic spinal cord compression at T4 -T5 level and vertebral body involvement in a 12 year old boy of an acute promyelocytic leukaemia. Moreover it high light the very rare association between granulocytic sarcoma (GS) and acute promyelocytic leukemia. Increased awareness of this entity will facilitate early diagnosis and minimize potentially preventable neurological morbidity.