Background:Hematopoietic stem cell transplant using human leukocyte antigen (HLA)-matched sibling or unrelated bone marrow, or related or unrelated cord blood has been performed successfully to treat patients with different types of hematological malignancies, genetic disorders and hereditary immune deficiencies. Since 1983, stem cell transplantation has been carried out in different institutes of India. But, till then, no transplantation was performed in eastern India.Materials and Methods:Our present study is reporting for the first time stem cell transplantation in eastern India. From August 2000 to June 2011 (with a 3-year gap for up-gradation), we have performed a total of 22 transplants. Thirteen patients (M:F:9:4) with indications of aplastic anemia, thalassaemia, acute myeloid leukemia and chronic myeloid leukemia underwent allogenic transplant, whereas autologous transplant was performed for nine patients (M:F:2:1) of multiple myeloma, Hodgkin's and non-Hodgkin's lymphoma and neuroblastoma. The median age of the patients was 19.6 years, with a range of 5 years 8 months to 52 years. Fourteen patients received myeloablative conditioning regime whereas eight patients received immunosuppressive and less myeloablative protocol. Sources of stem cells in case of allogenic transplant are bone marrow and related or unrelated umbilical cord blood and in case of autologous transplant, these are peripheral blood stem cells or self-bone marrow. Standard prophylactic medication was followed prior to transplants.Results:A disease-free survival of 68.18% and overall survival of 86.3% were seen at the median follow-up period of 4.6 years. Common post-transplant complications were mucositis, infection, venoocclusive disease, graft versus host disease, hemorrhagic cystitis, etc.Conclusion:The use of cord blood as a source of stem cells has been proved inferior as compared with the bone marrow stem cell source in cases of thalassaemia in our institute and thus is not recommended for thalassaemia. But, it has been proved to be a very useful and effective stem cell source (both related and unrelated cord blood) in cases of aplastic anemia and other immunological disorders.

Background: Previously it was thought that the chlorophyll of wheat grass (Triticum astevum) may be the substitute of haemoglobin of RBC having resemblance of similar structure. A group of Austrelian scientists tried to prove that wheat grass juice increases the foetal haemoglobin level 3–5 folds in intermediate thalassaemia patients. A pilot study with wheat grass juice in major thalassaemia patients were done by Dr. Marwa et al in IPGMR, Chandigarh, India. But there is no satisfactory explanation behind the reduced blood transfusion requirements after consumption of wheat grass juice for a long period. The aim of our study was to see the effect of wheat grass juice in blood transfusion requirement in intermediate thalassaemia patients and also do the biochemical analysis of the wheat grass juice. Material & Methods: During period from January 2003 to December 2006 we selected 200 intermediate thalassaemia patients (E-thalassaemia, E-Beta & Sickle thal) in the paediatric oncology department of Netaji Subhash Chandra Bose Cancer Research Institute. The age range of the patients was 1 year to 35 years (median age 18 years). The different types of thalasssaemia were E-Beta Thalassaemia 80% (160 patients), E-Thalassaemia 15% (30 patients) and Sickle Thalassaemia 5% (10 patients). When the wheat grasses were 5–7 days old, the fresh leaves including steams were made fresh juice and had given 30ml of juice daily to all our 200 patients for continuous 6 months. Wheat grass juice was analysed by column chromatography and found to be rich in oxalic acid and malic acid which might have some role in dietary absorption of iron from intestine. Beside that the wheat grass juice was found to contain a unique iron chelating property which was performed by deoxyribose degradation assay. We compared aqueous soluble extract of 5–7th day plant and our dose dependant study showed a significant iron chelating activity of crude extract in comparison to known standard iron chelator desferroxamine (DFO). The active compounds of crude extract of wheat grass may chelate catalytic iron in iron overload disorders when taking systematic dose. Result: The mean levels of haemoglobin before starting wheat grass juice were 6.2gm%. After 6months of wheat grass therapy the mean value for haemoglobin was 7.8gm% (pvalue <. 005). Twenty four patients (12%) require blood transfusion (haemoglobin < 6gm%). The performance status was improved from 60% to 80% (Karnofsky) after wheat grass treatment. The ferritin level of all patients before the study was found to be decreased significantly after wheat grass juice consumption. The mean interval between transfusion were found increased. Being a natural potent iron chelator and H2O2 quencher, it prevents the hydroxyl radical production by Fenton reaction in the RBC. Thus it may prevent the breakdown of plasma membrane of RBC and haemoglobin level becomes stable for a prolonged period. Conclusion: We may conclude that wheat grass juice is an effective alternative of blood transfusion. It’s use in intermediate thalassaemia patients should be encouraged.

8634 Background: The solid content of juice made from wheat grass is 70% chlorophyll. Chlorophyll is often referred to as “The blood of plant life” and has almost the same chemical structure as haemoglobin. Chlorophyll cleanses the blood by improving the supply of oxygen to the circulatory system. Wheat grass is also a complete protein with about 30 enzymes, vitamins & minerals. Wheat grass juice has been proven over many years to benefit people in numerous ways, building the blood, restoring balance in the body, removing toxic metals from the cells, nourishing the liver & kidneys and restoring vitality. The aim of our study was to see the effect of wheat grass juice in terminally ill cancer patients to improve the quality of life. Methods: During period from January 2003 to December 2005 we selected 400 solid organ cancer patients in our palliative care unit of Netaji Subhash Chandra Bose Cancer Research Institute to see the effect of wheat grass on improvement of haemoglobin level, serum protein & performance status on terminally ill cancer patients. The age range of the patients was 22 year to 87 year (median age 42 years). The different types of cancers were Lung (25%), Breast (20%), Oesophagaus (11%), Colon (9%), Ovary (8%), Hepatocellular carcinoma (6%), Stomach (6%) and others (15%) respectively. We cultivated wheat grass in our campus. When the grasses were 5 days old we took the fresh leaves including roots and made fresh juice out of that and had given 30ml of juice to all our 400 cancer patients for continuous 6 months. Result: The mean levels of haemoglobin, Serum total protein, albumin and performance status were 8gm%, 5.4gm%, 2.2gm% and 50%. Fifty patients required transfusion support & those patients were excluded from the study. Other 348 patients are evaluated 6 months after giving wheat grass juice. The mean values for haemoglobin, total protein & albumin were improved significantly (pvalue < .005) and were observed mean of 9.6gm%, 7.4gm% and 3.1gm%. White blood cell & platelet count were same in both the cases. The performance status was improved from 50% to 70% (Karnofsky) after wheat grass treatment. Conclusion: We concluded that wheat grass juice is an effective alternative of blood transfusion. Its use in terminally ill cancer patients should be encouraged. No significant financial relationships to disclose.

No abstract

20015 Background: Acute Lymphatic Leukemia in children is a curable disease in the range of 80–90 % in developed Countries by aggressive protocol like BFM, St. Judes’. In developing Countries like ours, patients can’t tolerate those aggressive protocol because of Socio- economic and nutritional factors. The less aggressive Protocol like INCTR (International Network for Cancer Treatment & Research) are suitable in developing Countries like ours. The aim of our study was to see outcome of childhood ALL patient with INCTR protocol and tolerability of the protocol in Indian-asian population. Methods: We treated 480 Children (age range 1–25 years, median age of 11 yrs) with INCTR Protocol at Netaji Subhash Chandra Bose Cancer Research Institute, Kolkata, India, a tertiary cancer centre from Eastern India during period from April ’99 to Dec ’06. There was female preponderance in the study. Fever 283 (58.9%), lymphadenopathy 211 (43.9%) and haepatosplenomegaly 153 (31.8%) were the major clinical presentation. Forty-three (8.9%) patients were present with hyper Leukocytosis. C-ALL phenotype were the largest group though the incidence of the T-ALL were quite high (27.9%). Results: Remission induction were seen in 446 (92.9%) of the patient. In a follow-up period of 88 months (with an average of 54 months) the disease-free survival ( DFS) was 66.8% (321 patients) with an overall survival of 73.9% (355 patients). The isolated bone marrow relapse was seen in majority of the cases 40 (8.33%) and the major relapse was in maintenance and first 6 months of completion of therapy. The major cause of morbidity was infection 316 (65.8%) followed metabolic complications 81 (16.8%), hemorrhage 52 (10.8%), neurologic 10 (2.08%), hepatitis 6 (1.25%) and pancreatitis 5 (1.04%). The major cause of the mortality was infection 75%(360 patients) followed progressive disease 7.91% (38 patients) and Hemorrhage 5.83%( 28 patients). Conclusions: The data of acute lymphatic leukemia from a developing country is encouraging. The protocol was well tolerated by India- asian population. No significant financial relationships to disclose.

B139 Background The solid content of juice made from wheat grass is 70% chlorophyll. Chlorophyll is often referred to as “The blood of plant life” and has almost the same chemical structure as hemoglobin. Chlorophyll cleanses the blood by improving the supply of oxygen to the circulatory system. Wheat grass is also a complete protein with about 30 enzymes, vitamins and minerals. Wheat grass juice has been proven over many years to benefit people in numerous ways, building the blood, restoring balance in the body, removing toxic metals from the cells, nourishing the liver and kidneys and restoring vitality. The aim of our study was to see the effect of wheat grass juice in terminally ill cancer patients to improve the quality of life. Methods During period from January 2003 to December 2007 we selected 600 solid organ cancer patients in our palliative care unit of Netaji Subhash Chandra Bose Cancer Research Institute to see the effect of wheat grass on improvement of hemoglobin level, serum protein and performance status on terminally ill cancer patients. The age range of the patients was 22 year to 87 year (median age 42 years). The different types of cancers were lung (25%), breast (20%), esophagus (11%), colon (9%), ovary (8%), hepatocellular carcinoma (6%), stomach (6%) and others (15%) respectively. We cultivated wheat grass on our campus. When the grasses were 5 days old we took the fresh leaves including roots and made fresh juice out of that and gave 30 ml of juice to all our 400 cancer patients for 6 continuous months. Result The mean levels of hemoglobin, serum total protein, albumin and performance status were 8 gm%, 5.4 gm%, 2.2 gm% and 50%. Fifty patients required transfusion support and those patients were excluded from the study. Other 348 patients are evaluated 6 months after receiving wheat grass juice. The mean values for hemoglobin, total protein and albumin were improved significantly (p value &lt; .005) and means of 9.6 gm%, 7.4 gm% and 3.1 gm% were observed. White blood cell and platelet count were the same in both the cases. The performance status was improved from 50% to 70% (Karnofsky) after wheat grass treatment. Conclusion We concluded that wheat grass juice is an effective alternative of blood transfusion. It’s use in terminally ill cancer patients should be encouraged. Citation Information: Cancer Prev Res 2008;1(7 Suppl):B139.

4744 Malnutrition is a major problem in children with cancer. All conventional modalities of anti cancer therapy interfere with normal nutrition. In this study we retrospectively analyzed 331 children of Acute Lymphoblastic Leukaemia (ALL) being intensively treated by National cancer Institute protocol (MCP 841) during period from August, 2000 to December, 2010 in a tertiary cancer institute of the country. Our aim was to determine the nutritional status of children with ALL at diagnosis and to study the influence of nutrition on complete remission, disease free survival (DFS) and toxicity of chemotherapy. The variables studied were height for age, weight for age and serum albumin levels. The height for age and the weight for age were taken as normal if they were between 3rd and 97th percentile curve of the growth chart as recommended by the Indian Council of Medical Research (ICMR). The albumin level was considered normal if the value was equal to or more than 3 gm%. It was seen that 16.9% children were low weight for age and 10.3% were of low height for age at diagnosis. Low weight for age (p value <0.01) and low albumin (p-value <0.005) were significant in DFS. We conclude that malnutrition is having much impact on prognosis of ALL in developing countries like ours. The major nutrition indicators are height for age, weight for age and serum albumin. The patients with malnutrition have less DFS duration, more chances of relapse and more toxicity during therapy as compared to well nourished children.Table 1:Nutritional status of 331 childrenVariablesNormalLowWeight for age275 (83.08%)56 (16.91%)Height for Age297 (89.73%)34 (10.3%)Total Protein274 (82.78%)57 (17.22%)Serum Albumin301 (90.94%)30 (9.06%)Table 2:Effect of Nutritional variables on remission of ALLVariableTotalRemissionNon ResponderInduction DeathTotal failure of Inductionp-valueNormal Weight for age275260 (94.54%)4 (1.45%)11 (4%)15 (5.45%)Low Weight for Age5651 (91.1%)05 (8.9%)5 (8.9%)0.236Normal Height for Age297283 (95.23%)4 (1.35%)10 (3.37%)14 (4.7%)Low Height for Age3428 (82.35%)1 (2.94%)5 (14.7%)6 (17.6%)Normal Albumin301287 (95.35%)2 (0.66%)12 (4%)14 (4.6%)Low Albumin3024 (80%)2 (6.7%)4 (13.3%)6 (20%)Table 3:Effect of Nutritional variables on Disease Free SurvivalVariableTotalDFS (%)Relapse Death (%)Death due to Other Causes (%)Total Deathp-valueNormal Weight for age275198 (72%)59 (21.45%)18 (6.54%)77 (28%)Low Weight for Age5619 (33.9%)25 (44.6%)12 (21.4%)37 (66%).001Normal Height for Age297213 (71.7%)68 (22.9%)16 (5.4%)84 (28.3%)Low Height for Age344 (11.8%)20 (58.8%)10 (29.4%)30 (88.2%)0.0001Normal Albumin301212 (70.4%)62 (20.6%)27 (8.97%)89 (29.6%)Low Albumin305 (16.7%)13 (43.33%)12 (40%)25 (83.3%)0.0001Table 4:Effect of Nutritional variables on Toxicity ProfileVariableMyeloLiverGINeuroMetabolicPancreatitisTotalNormal Weight for age (275)45 (16.36%)15 (5.45%)1 (0.36%)13 (4.72%)2 (0.72%)2 (0.72%)55 (20%)Low Weight for Age (56)21 (37.5%)9 (16.07%)3 (5.36%)5 (8.93%)2 (5.36%)24 (42.8%)Normal Height for Age (297)50 (16.8%)17 (5.72%)2 (0.67%)14 (4.71%)2 (0.67%)2 (0.67%)61 (20.8%)Low Height for Age (34)16 (47%)7 (20.5%)2 (5.8%)4 (11.6%)2 (5.8%)18 (52.9%)Normal Albumin (301)12 (3.98%)3 (0.99%)02 (0.66%)1 (0.33%)64 (21.3%)Low Albumin (30)24 (66.67%)21 (58.33%)4 (11.1%)16 (44.4%)2 (5.55%)3 (8.3%)15 (50%)Table 5:Comparison of the effect of Nutritional variables in Remission vs Relapse Group with Other StudiesVariablesYu LC et al (1994)Present Study (2011)Remission GroupRelapseRemission GroupRelapseWeight %106.4 ± 29.9109.1 ± 19.323.96 ± 13.4421.1 ± 10.1Height %99.3 ± 4.9104.9 ± 16.1121.17 ± 27.02117.85 ± 22.8Protein Mean6.65 ± 0.886.38 ± 1.12Albumin Mean4.23 ± 0.33.59 ± 0.584.01 ± 0.733.63 ± 0.93 Disclosures: No relevant conflicts of interest to declare.

13156 Background: Myelodysplastic Syndrome (MDS) is a heterogeneous group of clonal diseases of the haematopoietic stem cells. The hallmark of the disease is ineffective haematopoiesis characterized by dysplasia with incomplete maturation and progressive increase in the percentage of myeloblast. No standard treatment is currently available for MDS. The early clinical experience has confirmed the activity of arsenic trioxide in MDS. The drug is able to induce differentiation and apoptosis and to inhibit cell proliferation or angiogenesis. It has the potential to be active in tumour models in MDS. The preliminary result of ongoing studies conducted in patients with MDS suggests that arsenic trioxide produces haematological improvement including durable transfusion independence in 30% of patients. The aim of our study was to see the response of MDS with arsenic trioxide and to see the toxicity profile of arsenic trioxide in Asian Indian population. Methods: During period from July 2005 to December 2005 we selected consecutive 10 patients of MDS in Refractory Anaemia, Refractory anaemia with ringed sideroblasts, Refractory anaemia with blast excess, Refractory anaemia with blast excess in transformations and chronic myelo monocytic leukemia phases. All patients had performance status more than 60%, some karyotypic abnormalities & in cytopenic phase. Median age of the patients 65 years (range 42 to 70 years). All patients were treated with arsenic trioxide 10mg (Alkem/India) daily for 2 hours infusion 28 days. In 15 days interval 3 courses were repeated. Response assessments were done by haematological, cytogenetic & quality of life assessment. All patients were evaluated after 3 courses of arsenic trioxide. Result: Sixty percent (6 patients) patients had shown major haematological response, forty percent minor & twenty percent has major cytogenetic response. Twenty percent of the patients has disease progression where as 20% has stable disease. The only mild adverse effects were seen in forms of nausea, vomiting, diarrhea, abdominal pain & dermatitis in 30% of patients. Only one patient (10%) had QT prolongation in ECG. Conclusion: We concluded that arsenic trioxide is very useful drug in myelodysplastic syndrome. It is also well tolerated in Asian Indian Population. No significant financial relationships to disclose.