Background: Acute myeloid leukemia [AML] represents 15–20% of pediatric acute leukemia. Although AML is a serious disease, it is treatable and usually curable with chemotherapy with or without a bone marrow /stem cell transplant. Several clinical features can predict complete remission and survival rate in patients with AML. There is a paucity of studies reporting treatment outcome of AML in developing countries. Here we are shedding light on treatment results and factors affecting survival of AML patients in South Egypt Cancer Institute, a tertiary care center in developing country. Patients and Methods: Medical records of 64 newly diagnosed AML children who admitted in Pediatric Oncology Department, South Egypt Cancer Institute [SECI], Assiut University from January 2009 to December 2018 were retrospectively reviewed for demographic characteristics, clinical features and laboratory studies at presentation, treatment and outcome. Results: Sixty Four patients were eligible for the study. Forty two patients [65.6%] were males and 22 [34.4%] were females. Mean age was 10.85 ± 4.30 years [range 2-18 years]. The most common subtypes were M4 [18.8%], M1 [14.1%] and M3 [12.5%]. Thirty one patients [48.4%] achieved continuous complete remission [CCR] and on regular follow up. Twelve patients [23.5%] had relapse. Death reported in 33 patients [51.5%]. Three-year overall survival [OS] was [47.8±3.5%] and three-year disease free survival [DFS] was [42.8±5.5%]. Conclusion: Nearly half of patients with AML at our center died from the disease and treatment related toxicity so Improving supportive cares facilities and Intensification of treatment should be done to reduce mortality rates and improving outcome.

Background: Acute myeloid leukemia [AML] represents 15–20% of pediatric acute leukemia. Although AML is a serious disease, it is treatable and usually curable with chemotherapy with or without a bone marrow /stem cell transplant. Several clinical features can predict complete remission and survival rate in patients with AML. There is a paucity of studies reporting treatment outcome of AML in developing countries. Here we are shedding light on treatment results and factors affecting survival of AML patients in South Egypt Cancer Institute, a tertiary care center in developing country. Patients and Methods: Medical records of 64 newly diagnosed AML children who admitted in Pediatric Oncology Department, South Egypt Cancer Institute [SECI], Assiut University from January 2009 to December 2018 were retrospectively reviewed for demographic characteristics, clinical features and laboratory studies at presentation, treatment and outcome. Results: Sixty Four patients were eligible for the study. Forty two patients [65.6%] were males and 22 [34.4%] were females. Mean age was 10.85 ± 4.30 years [range 2-18 years]. The most common subtypes were M4 [18.8%], M1 [14.1%] and M3 [12.5%]. Thirty one patients [48.4%] achieved continuous complete remission [CCR] and on regular follow up. Twelve patients [23.5%] had relapse. Death reported in 33 patients [51.5%]. Three-year overall survival [OS] was [47.8±3.5%] and three-year disease free survival [DFS] was [42.8±5.5%]. Conclusion: Nearly half of patients with AML at our center died from the disease and treatment related toxicity so Improving supportive cares facilities and Intensification of treatment should be done to reduce mortality rates and improving outcome.

Background: Acute myeloid leukemia [AML] represents 15–20% of pediatric acute leukemia. Although AML is a serious disease, it is treatable and usually curable with chemotherapy with or without a bone marrow /stem cell transplant. Several clinical features can predict complete remission and survival rate in patients with AML. There is a paucity of studies reporting treatment outcome of AML in developing countries. Here we are shedding light on treatment results and factors affecting survival of AML patients in South Egypt Cancer Institute, a tertiary care center in developing country. Patients and Methods: Medical records of 64 newly diagnosed AML children who admitted in Pediatric Oncology Department, South Egypt Cancer Institute [SECI], Assiut University from January 2009 to December 2018 were retrospectively reviewed for demographic characteristics, clinical features and laboratory studies at presentation, treatment and outcome. Results: Sixty Four patients were eligible for the study. Forty two patients [65.6%] were males and 22 [34.4%] were females. Mean age was 10.85 ± 4.30 years [range 2-18 years]. The most common subtypes were M4 [18.8%], M1 [14.1%] and M3 [12.5%]. Thirty one patients [48.4%] achieved continuous complete remission [CCR] and on regular follow up. Twelve patients [23.5%] had relapse. Death reported in 33 patients [51.5%]. Three-year overall survival [OS] was [47.8±3.5%] and three-year disease free survival [DFS] was [42.8±5.5%]. Conclusion: Nearly half of patients with AML at our center died from the disease and treatment related toxicity so Improving supportive cares facilities and Intensification of treatment should be done to reduce mortality rates and improving outcome.

Background: Acute myeloid leukemia [AML] represents 15–20% of pediatric acute leukemia. Although AML is a serious disease, it is treatable and usually curable with chemotherapy with or without a bone marrow /stem cell transplant. Several clinical features can predict complete remission and survival rate in patients with AML. There is a paucity of studies reporting treatment outcome of AML in developing countries. Here we are shedding light on treatment results and factors affecting survival of AML patients in South Egypt Cancer Institute, a tertiary care center in developing country. Patients and Methods: Medical records of 64 newly diagnosed AML children who admitted in Pediatric Oncology Department, South Egypt Cancer Institute [SECI], Assiut University from January 2009 to December 2018 were retrospectively reviewed for demographic characteristics, clinical features and laboratory studies at presentation, treatment and outcome. Results: Sixty Four patients were eligible for the study. Forty two patients [65.6%] were males and 22 [34.4%] were females. Mean age was 10.85 ± 4.30 years [range 2-18 years]. The most common subtypes were M4 [18.8%], M1 [14.1%] and M3 [12.5%]. Thirty one patients [48.4%] achieved continuous complete remission [CCR] and on regular follow up. Twelve patients [23.5%] had relapse. Death reported in 33 patients [51.5%]. Three-year overall survival [OS] was [47.8±3.5%] and three-year disease free survival [DFS] was [42.8±5.5%]. Conclusion: Nearly half of patients with AML at our center died from the disease and treatment related toxicity so Improving supportive cares facilities and Intensification of treatment should be done to reduce mortality rates and improving outcome.

Background: Phase II study was conducted to evaluate bladder preservation protocol in Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine and conformal radiotherapy (RT). Methods: 30 TCC patients with good performance status and renal function subjected to maximum trans-urethral resection of bladder tumor (TURBT). Patients received 66 Gy/33 fractions/6.5 weeks with weekly gemcitabine 125 mg/m2. Evaluation was done after one month with cystoscopy and CT/MRI pelvis. Patients who had complete remission (CR) subjected for follow up and patients who had invasive bladder tumor subjected to radical cystectomy. Results: 24 patients had CR after one month evaluation. Stage 2 tumor, low grade, non Bilharzial and maximum TUR were the only prognostic factors. The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of RT. Cystectomy free survival was 88% at a median follow up for 2 years. Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance. Organ preservation in Bilharzial bladder is still possible.

Background: Phase II study was conducted to evaluate bladder preservation protocol in Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine and conformal radiotherapy (RT). Methods: 30 TCC patients with good performance status and renal function subjected to maximum trans-urethral resection of bladder tumor (TURBT). Patients received 66 Gy/33 fractions/6.5 weeks with weekly gemcitabine 125 mg/m2. Evaluation was done after one month with cystoscopy and CT/MRI pelvis. Patients who had complete remission (CR) subjected for follow up and patients who had invasive bladder tumor subjected to radical cystectomy. Results: 24 patients had CR after one month evaluation. Stage 2 tumor, low grade, non Bilharzial and maximum TUR were the only prognostic factors. The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of RT. Cystectomy free survival was 88% at a median follow up for 2 years. Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance. Organ preservation in Bilharzial bladder is still possible.

Background: Phase II study was conducted to evaluate bladder preservation protocol in Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine and conformal radiotherapy (RT). Methods: 30 TCC patients with good performance status and renal function subjected to maximum trans-urethral resection of bladder tumor (TURBT). Patients received 66 Gy/33 fractions/6.5 weeks with weekly gemcitabine 125 mg/m2. Evaluation was done after one month with cystoscopy and CT/MRI pelvis. Patients who had complete remission (CR) subjected for follow up and patients who had invasive bladder tumor subjected to radical cystectomy. Results: 24 patients had CR after one month evaluation. Stage 2 tumor, low grade, non Bilharzial and maximum TUR were the only prognostic factors. The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of RT. Cystectomy free survival was 88% at a median follow up for 2 years. Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance. Organ preservation in Bilharzial bladder is still possible.

Background: Phase II study was conducted to evaluate bladder preservation protocol in Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine and conformal radiotherapy (RT). Methods: 30 TCC patients with good performance status and renal function subjected to maximum trans-urethral resection of bladder tumor (TURBT). Patients received 66 Gy/33 fractions/6.5 weeks with weekly gemcitabine 125 mg/m2. Evaluation was done after one month with cystoscopy and CT/MRI pelvis. Patients who had complete remission (CR) subjected for follow up and patients who had invasive bladder tumor subjected to radical cystectomy. Results: 24 patients had CR after one month evaluation. Stage 2 tumor, low grade, non Bilharzial and maximum TUR were the only prognostic factors. The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of RT. Cystectomy free survival was 88% at a median follow up for 2 years. Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance. Organ preservation in Bilharzial bladder is still possible.

Background: Phase II study was conducted to evaluate bladder preservation protocol in Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine and conformal radiotherapy (RT). Methods: 30 TCC patients with good performance status and renal function subjected to maximum trans-urethral resection of bladder tumor (TURBT). Patients received 66 Gy/33 fractions/6.5 weeks with weekly gemcitabine 125 mg/m2. Evaluation was done after one month with cystoscopy and CT/MRI pelvis. Patients who had complete remission (CR) subjected for follow up and patients who had invasive bladder tumor subjected to radical cystectomy. Results: 24 patients had CR after one month evaluation. Stage 2 tumor, low grade, non Bilharzial and maximum TUR were the only prognostic factors. The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of RT. Cystectomy free survival was 88% at a median follow up for 2 years. Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance. Organ preservation in Bilharzial bladder is still possible.

The high frequency of cancer bladder among Egyptian patients is related to Bilharzial infestation. Organ confined muscle invasive bladder cancer should be theoretically cured by cystectomy but unfortunately many patients have progressive disease even after apparent radical ablation. Therefore, identification of independent prognostic factors has potential clinical importance, as it can be used to define an individual's risk for tumor progression and to customize appropriate management strategies. Bcl-XL is one of the most important anti-apoptotic members of Bcl-2 family. As few studies have reported a connection between the Bcl-XL expression and bladder cancer, this work is done to verify the relation between Bcl-XL and Bilharzial related bladder cancer, determine its prognostic value and find any correlation between Bcl-XL expression and the pathological prognostic parameters. Also, to show its value as a radio-sensitivity marker. The present study included 100 cystectomy specimens obtained from patients with muscle invasive Bilharzial related bladder cancer who underwent radical cystectomy in the South Egypt Cancer Institute and the Department of Urology at Assiut University Hospital. Those patients were followed either for 2 years after cystectomy or until local recurrence or distant metastasis had occurred. Bcl-XL expression in the tissue specimens detected by immunohistochemical staining was correlated with; the 2 year recurrence-free survival rate, clinicopathological parameters (tumor type, stage, grade, gross picture & regional lymph node infiltration) and response to adjuvant radiotherapy. There was a statistically highly significant negative strong correlation between Bcl-XL expression and the recurrence-free survival (p0.0001 & r = - 0.731) and the response to adjuvant radiotherapy (p0.0001 & r = -0.741). These correlations were stronger in transitional cell carcinoma than in squamous cell carcinoma. A statistically highly significant positive correlation between Bcl-XL expression and tumor grade & iliac lymph nodes infiltration was detected (p = 0.006 & r = 0.271 and p = 0.003 & r = 0.354 respectively). Rabab M. H. El Ghorori et al,. ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ There was a statistically significant correlation between the histopathological tumor type and the Bcl-XL expression which was more in transitional cell carcinoma (p = 0.027 & r = 0.226). There was no statistically significant correlation between Bcl-XL and either tumor stage, tumor size or shape. In conclusion, Bcl-XL expression is a highly significant negative prognostic factor in patients with bilharzial-related bladder cancer and it is a highly significant indicator of radio-resistance. Bcl-XL is significantly correlated to regional lymph nodes infiltration, tumor grade and type.