Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S258 Background: Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Aims: This study aims to provide comprehensive insights into the demographic characteristics, clinicopathological features and survival rates of pediatric ALL patients in Armenia. Methods: A retrospective analysis was conducted on pediatric patients diagnosed with ALL between January 2020 and December 2022 at the Pediatric Cancer and Blood Disorders of Armenia. This institution is the sole provider of diagnostics and treatment for pediatric ALL in Armenia, making it the primary source for data collection. Data were gathered from the medical records. The analysis focused on clinicopathological characteristics and outcomes of pediatric patients diagnosed with ALL. Statistical analysis was performed using IBM SPSS version 23 software. Results: The study in Armenia identified 83 cases of ALL, with an incidence rate of 4.03 per 100,000 children. The median age at diagnosis was 5.4 years, including 2.4% of infant leukemias (1.2% congenital). The male-to-female ratio was 1.3:1. Treatment was provided to 79 patients based on the ALLIC-BFM 2009 protocol, with a 2.4% abandonment rate. B-cell-precursor ALL accounted for 86.6% of cases, while T-cell-precursor ALL accounted for 13.4%. CNS involvement was observed in 3.6% of cases. Risk classification showed 39.2% as high-risk, 57% as intermediate-risk, and 3.8% as standard-risk. Common cytogenetic abnormalities were detected, including P16 gene deletion in 21%, IGH gene rearrangement in 18.5%, t(12;21)(q34;q22)TEL/AML1 in 14.8%, MLL gene rearrangement in 6.2%, cMYC gene rearrangement in 2.4%, and P53 gene deletion in 1.2% of cases. Philadelphia chromosome positivity was observed in 1.2% of cases. The poor response rate to prednisolone was 12.3%. On day 15, 31.0% of cases had the minimal residual disease (MRD) >10% in the bone marrow, and 23.4% experienced induction failure. Bone marrow transplant (BMT) eligibility was determined in 6.1% of the primary cases. The disease-specific mortality rate was 10%, with an induction mortality rate of 2.4%. Conclusions: This retrospective analysis contributes to the understanding of pediatric ALL in Armenia, providing valuable data for future research, treatment optimization, and the development of targeted interventions to improve the prognosis and quality of life for pediatric ALL patients. Keywords: pediatric acute lymphoblastic leukemia, clinicopathological characteristics, treatment outcomes, ALL-IC BFM 2009 protocol, Pediatric Cancer and Blood Disorders Center of Armenia ALL-625 Methotrexate Neurotoxicity in Adult Acute Lymphoblastic Leukemia Hannah Levavi MD1, Andre Khazak MD1, Yosef Joseph Rene Amel Riazat-kesh MD1, Orrin Pail MD1, Marina Kremyanskaya MD, PhD1,2, John Mascarenhas MD1,2, Michal Bar-Natan MD3 1Icahn School of Medicine at Mount Sinai, New York, USA. 2Tisch Cancer Institute, New York, USA. 3Weill Cornell Medical College, The New York Presbyterian Hospital, New York, USA Background: Methotrexate (MTX) neurotoxicity (NT) presents as severe acute/subacute stroke-like symptoms with potential long-term sequelae. Little data exists regarding the incidence and presentation in adults with ALL. We aimed to describe MTX NT in adult ALL. Methods: We retrospectively reviewed patients with ALL, age ≥18 years at diagnosis and treated with regimens containing IV and/or IT MTX at Mount Sinai Hospital from 1/1/2000 - 12/31/2022. Fisher’s exact test was used to assess relationships between patient-factors and MTX toxicity. Results: Of 203 patients included, 7.3% (15/203) developed signs and symptoms of MTX NT. One patient had NT on MTX re-challenge, for a total of 16 instances of MTX NT. Both sexes were equally affected (8 female, 7 male) at median age of 40.5 years (19-62). Compared to patients without MTX NT, there was no difference in ALL phenotype (82.4% vs 73.3% B-ALL, P=0.4834) or leukemic CNS involvement (20.2% vs 30.8%, P=0.4768). More patients were Hispanic/Latino in the NT group (73.3% vs 26.0%, P=0.0003). Symptoms developed after receiving both IT and IV MTX in 4 patients (26.7%), after only IT MTX in 9 (60%), and only IV MTX in 2 (13.3%). NT emerged a median of 8 days (range, 0-14) from IT MTX and 15 days (range 0 - 21) from IV MTX. Symptoms included weakness (n=6), movement disorder (n=1), aphasia (n=5), dysarthria (n=2), encephalopathy (n=4), visual disturbances (n=2), behavioral disturbance (n=1), paresthesias (n=3) and facial droop (n=2). Complete (n=12) or partial (n=4) symptom resolution occurred in all patients, with median time to resolution of 2 days (range, 0-13). Nine patients were rechallenged with IV and/or IT MTX, with only one NT recurrence. Conclusions: This is the largest retrospective review of MTX neurotoxicity in adult ALL patients. The incidence of MTX NT in adults is similar to that in the pediatric population (3-18%) and may be more prevalent in Hispanic patients. It resolves quickly, though some patients experience long-term sequelae. Recurrent symptoms on rechallenge can occur. Larger studies are needed to elucidate risk factors and effects of MTX NT on disease outcomes in adult ALL patients. Keywords: ALL, acute lymphoblastic leukemia, neurotoxicity, methotrexate ALL-648 The Effectiveness of Ambition Development Program Among Children With Acute Lymphoblastic Leukemia Fatma Ebeid PhD, MD, MRCPCH1, Laila Karm El-Din MD2, Hanan El-Gamal MD2, Nadia Sabra PhD2, Amany AboZayed MD3, Sara Makkeyah MD, MRCPCH1 1Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt. 2Faculty of Post Graduate Childhood Studies, Ain Shams University, Cairo, Egypt. 3Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt Background: Ambition, the strong desire to achieve our goals, develop as children grow and interact. Objectives: To assess the effectiveness of institutionally created “Ambition Level Development Program” (ALDP) in a sample of children with acute lymphoblastic leukemia (ALL). Methodology: Ten children with ALL were enrolled and divided into an experimental group who received the ALDP training and a control group. Demographic and
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