King Hussein Cancer Center Research Articles

Stage I seminoma: treatment outcome at King Hussein Cancer Center in Jordan

BackgroundThe aim of this report is to address treatment outcomes of patients with early-stage seminoma in a single institution with special reference to patients with history of surgical violation of the scrotum.MethodsSeventy four patients with pure seminoma were treated at King Hussein Cancer Center (Amman, Jordan) between 2003 and 2010. All patients underwent orchiectomy. All but 3 patients received adjuvant radiotherapy. Patients who underwent surgical violation of the scrotum prior to referral were managed by further excision or irradiation of the scrotal scar. The follow-up ranged from 1 to 200 months (mean, 33 months).ResultsAt the time of follow-up; all but one patient remain alive. The 3-year relapse-free survival for the entire cohort was 95.9%. Three patients developed relapse, all of whom received adjuvant irradiation following inguinal orchiectomy and initially harbored tumors larger than 4 cm upon pathological examination. Median time to relapse was 14 months (range, 8–25 months). None were associated with elevated tumor markers prior to detection of relapse. All but one patient were successfully salvaged by chemotherapy.ConclusionsOur results confirm the excellent prognosis of patients with early-stage seminoma treated by orchiectomy and adjuvant radiotherapy in a developing country. Although all patients who developed relapse demonstrated adverse pathological findings upon initial assessment, no consistent predictor of relapse was found. Scrotal scar re-excision or irradiation in patients with prior history of surgical violation of the scrotum are effective measures in preventing local failure.

Radiotherapy with concurrent or sequential temozolomide in elderly patients with glioblastoma multiforme

The objective of this article was to evaluate therapeutic outcomes of elderly patients with glioblastoma multiforme (GBM) treated by surgery followed by combined modality therapy and compare achievable outcomes to those of a younger age population. Seventy-eight adult patients with histologically confirmed grade IV astrocytoma were treated at King Hussein Cancer Center (Amman, Jordan) between September 2004 and December 2008. Records were retrospectively reviewed and included 55 males and 23 females between 19 and 78 years of age (median age 50 years). This case series included 20 patients aged 60 years or older. All patients underwent craniotomy followed radiotherapy and concurrent or sequential temozolomide. The follow-up ranged from 1 to 56 months (median 9.4 months). The median survival for the whole cohort was 13.8 months. The median survival for patients less than 60 years was 14.3 months and for patients 60 years or older was 12.3 months (P = 0.19). Among elderly patients, radical surgical resection (P = 0.002), concurrent delivery of chemoradiation (0.041) and radiotherapy dose ≥ 5400 cGy (P = 0.0001) conferred statistically significant improvements in overall survival. Management of GBM in elderly patients should include maximal surgical resection followed by radiotherapy and temozolomide whenever medically feasible. Outcomes comparable to those obtained in younger age groups can be expected. Our results indicate that concurrent chemoradiation is superior to sequential chemoradiation in these patients.

Pediatric Oncology Situation Analysis (Jordan)

This article highlights the current situation of pediatric oncology in Jordan by reviewing the available population based data from the surveillance. Cancer among children aged less than 15 years make up 4 to 6% of all registered new cancer cases in all ages each year. The major types of cancer in females for the year 2008 are leukemia 32.2%, central nervous system 18.8%, skeletal and soft tissue 8.8%, lymphomas 5.5%, and sympathetic 5.5%, whereas in males, they are leukemia 28.1%, central nervous system 18.8%, lymphomas 16.2%, skeletal and soft tissue 7% and sympathetic 6.3%. Children with cancer receive treatment through pediatric oncology wards in King Hussein Cancer Center (KHCC) and Royal Medical Services hospital or through pediatric departments in King Abdullah university Hospital and Princes Rahma hospital with full government coverage of the treatment expenses. Currently the pediatric palliative care program is limited to KHCC which provides inpatient care, and out-patients and drop-in care on a daily basis to provide symptom management, counseling, and other services as appropriate. The lack of palliative care in other hospital and pediatric home care coverage stress the need to develop special plan of action to initiate these services.

Predictors of the Development of Surgical Complications among Hematopoietic Stem Cell Transplantation Recipients

This study was designed to determine possible risk factors for the development of surgical complications after hematopoietic stem cell transplantation (HSCT). HSCT carries the possibility for the development of surgical morbidities and mortalities; certain populations of patients are at higher risk for developing complications. Defining those risk factors will help surgeons to anticipate and manage these complications. The records of 165 patients at King Hussein Cancer Center (KHCC) were reviewed from January 2007 to December 2008. Patients' characteristics, including age, source and type of transplant, behavior of disease, total body irradiation (TBI), immunity status, and intensity of conditioning were studied. According to our data, abdominal complications were more common among patients who received TBI versus patients who did not, and in patients who received peripheral blood versus bone marrow and cord blood as the source of stem cells. Ear, nose, and throat (ENT) complications were found more in patients who underwent nonmyeloablation conditioning. Catheter-related complications were found more significantly in immune-compromised patients during the post-engraftment period. We also found that ENT complications were more frequent in patients with cord blood as the source of stem cells, although the results are inconclusive due to the small sample size. Pretransplantation factors can be used as predictors for the development of surgical complications in HSCT recipients. Abdominal complications were significantly more common in patients who received total body irradiation as part of their conditioning regimen and when the peripheral blood was a source for stem cell transplantation.

A multicenter study of pandemic influenza A (H1N1) infection in patients with solid tumors in 3 countries

Pandemic influenza A (hereafter 2009/H1N1) caused significant morbidity and mortality during the 2009 pandemia. Patients with chronic medical conditions and immunosuppressive diseases had a greater risk of complications. However, data regarding the characteristics and outcome of 2009/H1N1 infection in patients with solid tumors are nonexistent. Herein, the authors describe a series of influenza 2009/H1N1 in patients with solid malignancies at 3 major cancer hospitals worldwide. The authors retrospectively reviewed the records of patients with solid organ malignancies and 2009/H1N1 from The University of Texas M. D. Anderson Cancer Center in Houston, Texas; the Mexican National Cancer Institute, Federal District of Mexico; and King Hussein Cancer Center in Amman, Jordan from the period of the 2009 H1N1 pandemia. Data on demographics, disease characteristics, and outcome were extracted. In total, 115 cases were identified during the pandemic influenza among the 3 institutions. High rates of hospitalization (50%), pneumonia (23%), and death (9.5%) were reported. Patients who developed pneumonia and those who died were moderately to severely immunocompromised (P = .001 and P = .006, respectively). A multivariate competing risk analysis demonstrated that a delay >48 hours in starting antiviral therapy was associated significantly with an increased risk of developing pneumonia (P = .013). The 2009/H1N1 pandemic caused severe illness in immunocompromised patients with cancer who had solid tumors, and heavily immunosuppressed patients were at greater risk of developing pneumonia and death. Early initiation of antiviral therapy is crucial in this patient population to decrease morbidity and probably mortality.

High-Dose Therapy and Autologous Hematopoietic Progenitor Cells Transplantation for Recurrent or Refractory Hodgkin's Lymphoma: Analysis of King Hussein Cancer Center Results and Prognostic Variables

Purpose. to evaluate the outcome of patients with Hodgkin's lymphoma who underwent autologous transplantation at KHCC bone marrow transplant program. Patients and Methods. Over 6 years, 63 patients with relapsed or refractory Hodgkin's lymphoma underwent high dose chemotherapy followed by autologous transplant. There were 25.4% patients in complete remission (CR), 71.4% with chemotherapy responsive disease at the time of transplant. Prior to conditioning regimen, 56% received two chemotherapy lines, and, 44% received more than two lines. Results. The main outcomes of the study are the rate of complete remission at day 100, overall survival (OS), relapse-free survival (RFS), The impact of the following variables on OS and RFS: (a) disease status at the time of transplant, (b) number of chemotherapy lines prior to conditioning, (c) age group, (d) time of relapse < or >12 months were investigated. The CR at day 100 was 57%. The median overall survival for the whole group was 40.6 months; the median RFS was 20 months. The only factor which significantly impacts the study outcomes was the number of chemotherapy lines prior to conditioning on OS in favor of patients received two lines. Conclusion. In our study only the number of chemotherapy lines received before conditioning had statistically significant impact on OS.

Hodgkin Lymphoma in Jordan; A Retrospective Analysis of 477 Cases in King Hussein Cancer Centre

Abstract 4862 BACKGROUNDJordan is a small country with an estimated mid year population in 2008 of 5 850 000, 3015000 of whom are males and 2 835 000 are females (male: female ratio 1.06: 1). (Department of Statistics Jordan, 2008).About 12.7 % of the population is under 5 years old, and 37.3 % under 15 years old. 11%if the population are 15–19 year old, with a M:F ratio 1.06:1 as well) Only 3.3 % of the total population is above the age of 65 years old (sex ratio of 1.01 male per 1 female in this age group).According to the Jordan Cancer Registry Report for 2008, Lymphoma is the fourth most common Cancer in the country. A total of (4606 ) new cases of cancer were recorded among Jordanians in the year 2008, 333 (7.2%) of whom had a diagnosis of lymphoma.111 (2.4%) were diagnosed as Hodgkin's lymphoma (HL), and 222 (4.8%) as Non Hodgkin Lymphoma(NHL). OBJECTIVEIn this study, we aim to characterize some of the clinico-pathological features of Hodgkin lymphoma in Jordan by analyzing the data available for patients referred to King Hussein Cancer Center over a seven year period. PATIENTS AND METHODSA retrospective analysis was conducted of adults (>18 years) lymphoma patients referred to KHCC, between 1/1/2003 and 31/12/2010. Clinical features and histological subtypes were prospectively established for all patients registered in the Lymphoma Service Database. Pathology review and original paraffin block were mandated for all patients. RESULTSOver the 8 year period of 2003–2010,1329 lymphoma patients were referred to KHCC and registered in the Lymphoma Service Database, of whom 477 (35.9%) were diagnosed with Hodgkin’s lymphoma. Among this group all 477 patients were adults 18 years or older (100%), as children are treated in a different department. The median age was 35 years, (with an age range of 18–77), and 5% of patients were above the age of 60. 290 (61 %) of the patients were males, 187 (39%) were females, with a male to female (M:F) ratio of 1.55:1.276 (57.8%) of the HL cases had a diagnosis of nodular sclerosis Hodgkin lymphoma (HDNS), making it the most common histological subtype. 120(25.2%) had mixed cellularity Hodgkin lymphoma (HDMC), 9 (1.9%) had lymphocyte-rich Hodgkin lymphoma (HDLR), and 6 (1.2%) had lymphocyte-depleted Hodgkin (HDLD). Nodular lymphocyte predominance Hodgkin lymphoma (NLPHD) cases were 33, and constituted 6.9% of the HL cohort. CONCLUSIONHodgkin lymphoma appears to constitute a bigger share of the lymphoma burden in Jordan, as opposed to Europe and the US. Clinico-pathological features, however, appear to be closer to those described in Western countries, with similar incidence of HDNS, and HDMC subtypes, but possibly with less incidence of HDLR and HDLD subtypes. Disclosures:No relevant conflicts of interest to declare.

The Challenges of Managing Glioblastoma Multiforme in Developing Countries: A Trade-off Between Cost and Quality of Care

Temozolomide concurrent with radiotherapy followed by adjuvant temozolomide is considered the standard of care in patients with glioblastoma multiforme in developed countries. In variance, management of GBM in developing countries is still hindered by the paucity of clear protocols due, in part, to growing economic constraints and the lack of availability of expensive chemotherapeutic agents. We evaluated the deliverable treatment protocols and achievable outcomes of patients with GBM in a low-income country prior and subsequent to the worldwide adoption of temozolomide. One hundred forty-six adult patients with histologically confirmed high-grade glioma were treated at King Hussein Cancer Center (Amman, Jordan) between January 2003 and December 2008. Records were retrospectively reviewed and included 105 males and 41 females between 19 and 81 years of age (median age, 51 years). All patients underwent craniotomy. Eighty-two patients were treated with the radiotherapy and temozolomide of whom 42 patients received temozolomide concurrent with radiation followed by adjuvant temozolomide and 40 patients received irradiation followed sequentially by 6 cycles of temozolomide. In 40 patients; irradiation was utilized as a single modality treatment adjuvant to surgery. The follow-up ranged from 1 to 56 months (median, 9.4 months). The median survival for the whole cohort was 10.2 months. The median survival for radiotherapy-alone group was 5.3 months and for combined radiotherapy/ temozolomide was 14.8 months. Survival was similar in both concurrent and sequential groups. Temozolomide conferred a statistically significant survival benefit of 9 months as compared to standard therapeutic modalities. These results compare favorably to those reported in developed nations. The addition of temozolomide confers a significant survival benefit in patients with GBM. Current management of GBM in developing countries should include maximal surgical resection followed by radiotherapy/ temozolomide whenever medically and/or financially feasible. Outcomes comparable to those obtained within the context of randomized trials can be expected in low-income settings if healthcare delivery is carefully planned. Our results indicate that concurrent and sequential regimens are equally effective in these patients.

Psychometric properties of the Functional Assessment of Chronic Illness Therapy—Spiritual Well‐being (FACIT‐Sp) in an Arabic‐speaking, predominantly Muslim population

This study determined the psychometric properties of the Arabic Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-Sp) Version 4 and explored associations between its three factors (Peace, Meaning, and Faith) and health-related quality of life (HrQoL) among Arab patients with cancer. A total of 205 Arabic-speaking, study-eligible cancer patients who were in treatment at the King Hussein Cancer Center, Amman, Jordan, completed the FACIT-Sp scale. Cronbach's alpha reliability coefficients suggest that the Arabic FACIT-Sp is reliable and that moderate to strong correlations among subscales suggest validity. Correlation analyses showed that the 12-item Spiritual Well-being scale was associated with Social (r = 0.45, p = 0.01) and Functional Well-being (r = 0.48, p = 0.01). Hierarchical multiple regressions revealed that the Peace factor added 7.5% and the Meaning factor 3.8% to the prediction of HrQoL (p < 0.001). Faith did not significantly contribute to the unique prediction of HrQoL. Correlation analyses revealed that Peace was most prominently associated with the HrQoL subscale of Functional Well-being (r = 0.53, p = 0.01). This first study of Arabic-speaking, predominantly Muslim Jordanian cancer patients using the FACIT-Sp indicates that it is a psychometrically sound instrument for detailed assessment of the spiritual well-being of Arabic-speaking cancer patients. The three-factor model appears to allow for discrimination among factors that are most highly associated with different aspects of HrQoL.

Development and implementation of a method for characterizing clinical pharmacy interventions and medication use in a cancer center

Develop and implement a method to characterize clinical pharmacy activities and the associated medication use in a comprehensive cancer center. A standard characterization of clinical pharmacy services facilitates benchmarking and informs continuous development. A set of quantifiable parameters to describe clinical pharmacy activities and the associated medication use was proposed and validated by peer review. For implementation, clinical pharmacy interventions for six clinical pharmacy services at the King Hussein Cancer Center in 2008 were prospectively documented and the numbers of patients and medications dispensed for the same period were obtained from the admission office and pharmacy database respectively. The method comprised four main aspects: (1) number of interventions, (2) type of interventions, (3) number of doses dispensed, and (4) the NNI which is the number of doses dispensed for one intervention to occur. A total of 8552 interventions were recorded for 37,784 patient days. Interventions were highest in the pediatric oncology and ICU with 2612 (31%) and 1867 (22%) respectively, followed by medical oncology 1563 (18%), BMT 998 (12%), palliative care 792 (9%), and surgery 720 (8%). Interventions per 1000 patient days were: ICU 555, pediatric oncology 326, BMT 319, palliative care 244, medical oncology 137, and surgery 83. Main intervention categories for all services: therapeutic 3055 (36%), safety 2195 (26%), quality assurance 2376 (28%), and education-information 925 (10%). The number of doses dispensed per 1000 patient days was: BMT 19,404, palliative care 17,272, ICU 12,290, medical oncology 13,182, pediatric oncology 12,093, and surgery 8976. Finally, NNI was as follows: ICU 22, pediatric oncology 39, BMT 60, palliative care 71, medical oncology 96, and surgery 109. A method for characterizing clinical pharmacy interventions and medication use was developed and used to compare different oncology clinical pharmacy services. Further work is warranted to refine and validate the parameters proposed.

Management of Cancer During Pregnancy

This study aimed to assess the management and the obstetric and neonatal outcomes of pregnancies complicated by cancer. A retrospective analysis of patients with cancer during pregnancy who were treated at King Hussein Cancer Center and King Abdullah University Hospital in Jordan between January 2002 and December 2009 was conducted. The medical records of patients with invasive cancer diagnosed during pregnancy and their newborns were reviewed to retrieve information on treatment and obstetric and neonatal outcomes. Numerical data were tested for normal distribution using Kolmogorov-Smirnov. Statistical analyses were conducted using SPSS 18.0. A total of 46 patients with a diagnosis of cancer in pregnancy were treated. The most common tumor types were breast cancer, hematologic malignancies, and gastrointestinal malignancies. In 17 patients, a miscarriage or a termination of pregnancy occurred in the first trimester. In 25 of 46 patients, a single or a combination of treatment modalities was commenced. The distribution of therapies was as follows: chemotherapy alone, n = 5; surgery alone, n = 7; surgery and chemotherapy, n = 6; surgery and radiation therapy, n = 1; surgery with chemotherapy and radiation therapy, n = 3; chemotherapy and radiation therapy, n = 1; interferon, n = 1; and hormonal therapy, n = 1. The mean (SD) gestational age at delivery was 35.7 (2.7) weeks. The mean birth weight was 2580 (870) g. Preterm delivery occurred in 17 patients. There were 4 neonatal deaths, 2 of them delivered at 33 weeks, 1 delivered at 34 weeks, and 1 delivered at 35 weeks gestation. There were no congenital malformations. The remarkable finding is a high rate of iatrogenic preterm delivery with a high rate of neonatal mortality. Delivery should be postponed preferably until after a gestational age of 35 weeks.

Retinoblastoma in Jordan: An epidemiological study (2006-2010)

The epidemiological characteristics of retinoblastoma have been extensively studied in developed countries, however epidemiological data is scarce in the Middle East. We present a de- tailed epidemiological analysis of retinoblastoma in Jordan in an attempt to aid national and regional strategies for improved cancer surveillance and control. Retrospective review of retinoblastoma cases presenting to the sole and exclusive ocular oncology referral center in Jordan. Forty children (59 eyes) presenting with clinically and/or histologically confirmed retinoblastomas were treated at King Hussein Cancer Center (Amman, Jordan) between January 2006 and December 2010. This case series included 28 boys and 12 girls. Data relating to age at diagnosis, laterality, gender, treatment modality and survival were recorded. The mean age-adjusted incidence of retinoblastoma in Jordan was 9.32 cases per million children per year for children aged 0-5 years. The male: female ratio was 2.3:1. Bilateral cases were encountered in 19 pa- tients (47.5%) while 21 patients (52.5%) harbored unilateral retinoblastoma. At the time of follow-up, 38 patients (95%) were alive. Overall, 40 eyes (67.8%) were successfully preserved without the need for enucleation. The national epidemiological data gathered in this study indicates that the incidence of retinoblastoma in Jordan is similar to that reported in various countries of the world. Jordanian boys, however, are at significantly higher risk for developing retinoblastoma than age-matched girls. Furthermore, Jordanian patients are more likely to harbor bilateral retinoblastoma.

Multiple Primary Malignancies: Analysis of 23 Patients with at Least Three Tumors

There is scarcity of reports addressing patients with three or more malignancies. The aim of this study is to present a detailed analysis of patients presenting with at least three primary malignant tumors. Records of cancer patients presenting to King Hussein Cancer Center (Amman, Jordan) between June 2006 and March 2011 were retrospectively reviewed. Patients harboring multiple primary tumors were included for detailed analysis. Data relating to epidemiological features, pathological characteristics, and disease outcomes were extracted. Out of 14,040 cases, 319 patients (2.3%) harbored two or more while 23 patients (0.16%) harbored three or more primary malignant tumors. This study included 17 males and six females between 4 and 78 years of age (median, 52 years) at the time of diagnosis of the first malignancy. The most prevalent tumor was colorectal adenocarcinoma found in nine, followed by lymphoma in seven, and prostate adenocarcinoma in six patients. The most common tumor combinations were colorectum-non-melanoma skin, colorectum-kidney, and non-melanoma skin-kidney all found in four patients, respectively. At a median follow-up of 96 months from the time of diagnosis of the first primary (range, 2-337 months) and 8 months from the time of diagnosis of the last primary (range, 1-48 months), 13 were alive with no evidence of disease, six were alive with residual disease, three were dead due to disease, and one patient was alive with unknown disease status. The possibility of multiple primary malignancies should always be considered during the treatment and follow-up of cancer patients. This case series could prove helpful to clinicians faced with similar, however, exceedingly rare scenarios. Due to the realistic potential for long-term survival, we recommend aggressive treatment of these patients.

Bladder preservation by concurrent chemoradiation for muscle-invasive bladder cancer: Applicability in low-income countries

Background Radical cystectomy is the standard treatment for patients with muscle-invasive urinary bladder cancer; however, is associated with major treatment – related morbidity. Furthermore, a significant proportion of patients are deemed unsuitable for surgery due to inoperability, advanced age, and/or comorbid conditions. As such, several groups have explored effectiveness of less radical therapeutic strategies that aim at bladder preservation. Nonetheless, there is scarcity of reports assessing the applicability of urinary bladder-sparing outside developed countries. Aim Determine the achievable outcomes for patients with muscle-invasive urinary bladder cancer treated via bladder-sparing techniques in a low income country. Materials and methods Fourteen consecutive patients with a diagnosis of muscle-invasive urinary bladder cancer (clinical stage; T2-3N0M0) were treated via a bladder-sparing approach at King Hussein Cancer Center (Amman, Jordan) between 2005 and 2009. Records were electronically retrieved and retrospectively analyzed and included 11 males and 3 females from 41 to 74 years of age (median age, 61). Initial therapy consisted of trans-urethral resection of bladder tumor (TURBT) followed by induction chemotherapy then irradiation (4500cGy) with concurrent platinum-based chemotherapy. Urological evaluation directed additional therapy in a proportion of patients with irradiation (up to 6400 cGy) in patients who achieved CR. Results Eleven patients were evaluable for pathological response at time of re-staging; of whom 8 (73%) achieved CR and 3 (27%) achieved partial response (PR). In all but one patient; combined-modality treatment was well tolerated. After a median follow-up of 18.5 months (range, 3–48 months); 5 of 8 (62.5%) patients with CR were alive. Conclusions Bladder-sparing strategies via concurrent chemoradiation for muscle-invasive bladder cancer results in an acceptable rate of complete pathological response with adequate short-term outcomes. This approach appears applicable in low-income countries.

Embryonal tumor with abundant neuropil and true rosettes: a report of three cases of a rare tumor, with an unusual case showing rhabdomyoblastic and melanocytic differentiation

Embryonal tumor with abundant neuropil and true rosettes (ETANTR) is an increasingly recognized entity that belongs to the family of embryonal tumors of the CNS. The authors present three cases of this rare tumor that were encountered at King Hussein Cancer Center, Amman, Jordan. Discussion of the clinicopathological findings is presented along with a recent literature review. Sixteen-, 57- and 30-month-old children presented with tumors located in the pineal gland, the right fronto- parieto-temporal region and the cerebellum, respectively. The findings of hypocellular neuropil as well as the characteristic ependymoblastic rosettes were seen. In addition the third case showed an abnormal combination of patterns including melanocytic and rhabdomyoblastic differentiation. The tumors stained positively for synaptophysin in the neuropil and small cell component, while the ependymoblastic rosettes stained for vimentin only. Epithelial membrane antigen and CD99 were negative in all components. One of the cases showed tetraploidy of chromosome 2. All cases exhibited an aggressive course. This is a rare and recently recognized tumor with dismal outcome, and reporting of additional new cases should help in gaining more knowledge about it.

Surgical complications related to hematopoietic stem cell transplantation

Background Surgical complications in recipients of hematopoietic stem cell transplantation (HSCT) are common. However, this issue is infrequently reported in the literature. Methods The records of 165 patients who underwent hematopoietic stem cell transplantation at King Hussein Cancer Center between January 2007 and December 2008 were retrospectively reviewed. All surgical complications were included and were classified into gastrointestinal (GI), catheter-related, ear, nose and throat (ENT), peri anal, musculoskeletal, neurological and urological complications. Results There were 279 surgical complications in the studied patients. Gastrointestinal ( n = 122) and catheter-related ( n = 78) complications were the most frequent. The frequency and the percentage of patients needing surgical intervention for the 5 most common complications were as follows: Gastrointestinal ( n = 122, 4.5% needed surgical intervention), catheter-related ( n = 78, 46.2%), ear, nose and throat ( n = 31, 9.7%), perianal disease ( n = 21, 19%) and urinary complications ( n = 17, 5.9%). Surgical consultation was sought for 116 surgical complications. Surgical interventions were necessary for 55 patients. All the patients who underwent surgery did not have an intervention-related mortality except for one patient who died from surgical intervention post-gastrointestinal complication. Conclusion The majority of surgical complications after HSCT do not require surgical intervention. However, these conditions may overlap with the more common reasons for surgical consultation and must be identifiable by the surgeon. Extra vigilance is necessary when dealing with both GI and catheter-related complications as they are the most frequent. The early involvement of surgeons and proper timing of surgical management may circumvent detrimental outcomes.

Outcome of childhood acute lymphoblastic leukemia in Jordan

Accurate data about childhood acute lymphoblastic leukemia (ALL) in low- and middle-income countries are lacking. Our study is designed to assess survival of childhood ALL at King Hussein Cancer Center (KHCC) using modified St. Jude Children's Research Hospital protocols. We reviewed the medical records of children 1-18 years of age who were diagnosed with ALL and treated at KHCC from January 2003 through December 2009. Disease characteristics and outcome were analyzed. Over a 7-year period, 300 children with ALL were treated. One hundred and seventy-three (57.7%) were males and 127 (42.3%) were females. The median age at diagnosis was 5 years. One hundred and fifty-seven (52.3%) children were classified as low-risk, 118 (39.3%) were standard-risk and 25 (8.3%) were high-risk. Two hundred and sixty-two (88.5%) children had pre-B cell phenotype and 34 (11.5%) had T-cell phenotype. Two hundred and seventy-three (91.3%) children were classified as having CNS I disease, 24 (8%) had CNS II, and 2 (0.67%) had CNS III. Cytogenetic abnormalities included: t(12;21) in 30 (12%) children and t(9;22) in 18 (7.4%). Four (1.3%) children died in induction, 6 (2%) died in first remission and 27 (9%) relapsed. After a median follow-up of 34.5 months (range 0.32-84.5), the estimated 5-year event free survival and overall survival were 80% and 89%, respectively. Treatment protocols developed by major cooperative groups and institutions to treat childhood ALL was successfully adapted and suggest that such an approach may be useful in other low- and middle-income countries.

Inferior vena cava filters in cancer patients: to filter or not to filter

Purpose:Cancer and its treatment are recognized risk factors for venous thromboembolism (VTE); active cancer accounts for almost 20% of all newly diagnosed VTE. Inferior vena cava (IVC) filters are utilized to provide mechanical thromboprophylaxis to prevent pulmonary embolism (PE) or to avoid bleeding from systemic anticoagulation in high-risk situations. In this report, and utilizing a case study, we will address the appropriate utilization of such filters in cancer patients.Methods:The case of a 43-year-old female patient with rectal cancer, who developed deep vein thrombosis following a complicated medical course, will be presented. The patient was anticoagulated with a low molecular weight heparin, but a few months later and following an episode of bleeding, an IVC filter was planned. Using the PubMed database, articles published in English language addressing issues related to IVC filters in cancer patients were accessed and will be presented.Results:Many recent studies questioned the need to insert IVC filters in advanced-stage cancer patients, particularly those whose anticipated survival is short and prevention of PE may be of little clinical benefit and could be a poor utilization of resources.Conclusion:Systemic anticoagulation can be safely offered for the majority of cancer patients. When the risk of bleeding or pulmonary embolism is high, IVC filters can be utilized. However, placement of such filters should take into consideration the stage of disease and life expectancy of such patients.

Myeloid Sarcoma: Clinicopathologic, Cytogenetic, and Outcome Analysis of 21 Adult Patients

Myeloid sarcoma (MS) is a neoplasm of immature granulocytes, monocytes, or both involving any extramedullary site. Twenty one patients with MS at diagnosis who were treated at King Hussein Cancer Center in Jordan were included in this retrospective study with a male to female ratio of 2 : 1. The most common site was the reticuloendothelial system. The most common morphology subtype was M2 (38%) and the most frequent chromosomal abnormality was trisomy 8. Twenty patients received induction chemotherapy; only 14 (70%) achieved complete remission. Median survival time was 24.7 months for the whole group and 58.6 months for patients who underwent allogenic bone marrow transplant. This paper showed that MS has frequent M2 morphology, carries chromosomal aberrations other than t(8;21), and requires aggressive therapy as a front line approach.

Retrospective analysis of pediatric cancer patients diagnosed with the pandemic H1N1 influenza infection

Limited data are available on disease characteristics and outcome of children with cancer who contracted the H1N1 influenza infection during the 2009 pandemic. All 76 pediatric patients with cancer and documented H1N1 infection who presented to the Pediatric Department at King Hussein Cancer Center (KHCC) between October 1 and December 1, 2009 were reviewed for clinical characteristics and course of the disease. Two-thirds of the patients had hematological malignancies and half were receiving non-intensive chemotherapy at the time of infection. With the exception of two patients who needed pediatric intensive care unit admission, the course of the remaining patients was uneventful whether they were hospitalized or not. No deaths related to H1N1 influenza infection were reported. Sixty-three percent of patients became afebrile within 48 hr of receiving oseltamivir. One-third of hospitalized patients were discharged in < 3 days. The course of H1N1 influenza infection in children with cancer appears to be mild in most cases.