Association of cytogenetics and immunophenotype in prognosis of children with acute lymphoblastic leukemia: literature review

Acute lymphoblastic leukemia [ALL] is the most common type of neoplastic disorder diagnosed in childhood. It is the cause of one third of all pediatric malignancies. ALL is characterized by the abnormal production and proliferation of immature lymphoblasts in bone marrow [BM]. It seems that ALL occurs due to a genetic mutation in DNA structure producing white blood cell [WBC] stem cells. Because ALL is a systemic disease, its primary management is based on chemotherapy. There are important risk factors responsible for the poor prognosis of ALL in children less than 1 year old and greater than 10 years old, such as: high WBC, mature T cell ,mature B cell, central nervous system [CNS] involvement, DNA index < 1 [hypodiploid], triploidy, tetraploidy, Mixed-Lineage Leukemia [MLL] gene re-arrangement on 11q23, the Philadelphia chromosome t[9;22], reduction in platelet count, hemoglobin>10 at diagnosis, no remission at the end of induction therapy and Minimal residual disease at the end of consolidation therapy. Complications might appear during the treatment including tumor lysis syndrome, bleeding, renal failure, sepsis, seizure, thrombosis, etc. Some consequences might identify after a long-term follow-up such as learning impairment, growth retardation, and secondary malignancies. It is estimated that up to 90% of pediatric ALL cases are curable

Comparison of dexamethasone and Anti-D Immune globulin for immune thrombocytopenia purpura in children

Different therapeutic options in children with immune thrombocytopenic purpura include observation alone, periodic treatment with corticosteroids, intravenous immunoglobulin [IVIG] or anti-D, chronic administration of immunosuppressive agents, and splenectomy. Preference of the type of therapy depends on the degree of thrombocytopenia and clinical bleeding manifestations. Dexamethasone is safe but its side effects are the main disadvantages for its usage. Anti-D is more expensive than dexamethason but the side effect is rare and not dangerous and response to treatment is assessed in approximately 3 days after infusion

[Post treatment thyroid dysfunction and obesity in children with acute lymphoblastic leukemia and non-hodgkin's lymphoma: a brief report]

In most children with Acute Lymphoblastic Leukemia [ALL] and Non Hodgkin's Lymphoma [NHL] who have received chemotherapy with and without radiotherapy, some late effects due to treatment may occur such as endocrinopathies. We evaluated growth criteria [including short stature, obesity] and thyroid test function in 50 children with ALL [n=25] and NHL [n=25] 3-17 year-old in remission period who randomly received chemotherapy with [n=25] or without [n=25] radiation such as our treatment groups. The values for height, weight and BMI in less than 5[th] or more than 95[th] percentile considers abnormal. Six [12%] patients were in less than 5[th] percentile height [short stature]. Two patients [4.0%] had over-weight and 48 [96%] were in normal range of BMI. Six [12%] patients were in less than 5[th] and 3 [6%] were in more than 95[th] weight percentile. There was no significant difference between two different treatment groups for TSH [P=0.662] but there was a significant difference between these groups in case of T4 [P=0.049]. Mean and SD for T4 in patients with chemotherapy alone was less than in whom received chemotherapy plus radiotherapy. There was no significant difference between ALL and NHL groups for TSH, T4 [P=0.567, 0.528 respectively]. Two boys with ALL without history of radiation had hypothyroidism that had based on their laboratory data. Regarding to effects of thyroid dysfunction on short stature and obesity in adolescent with ALL and NHL, we suggest to have more attention about growth, thyroid test to avoid late side effect of malignancy treatment

[Leukocyte adhesion deficiency]

Leukocyte adhesion deficiency [LAD] is a rare functional leukocyte disorder, which is divided into two separate types: LAD-1 and LAD-2. LAD-1 results from lack of beta2 integrin molecules [CD 11 and CD 18] on the leukocyte cell surface. These molecules are essential for leukocyte adhesion to endothelial cells and chemotaxis. The present case report is about a 42-month-old girl with recurrent otitis, pneumonia and gingivitis. On physical examination, patient was pale and malnourished. Multiple desquamated erythematous plagues were found on her body and extremities. Blood investigations revealed persistent leukocytosis with normal serum Immunoglobulin profile and complement. The diagnosis of LAD1 was made based on Flow cytometry finding; showing decreased in GD11 and CD 18 markers of PMN-a. When a patient has persistent leukocytosis and recurrent infections, investigation for the primary immune deficiency, specially leukocyte adhesion deficiency must be considered

Cryptosporidium infection in pediatric patients with lymphohematopoietic malignancies

Cryptosporidium parvum is a common protozoan pathogen with worldwide distribution. It localizes on the intestinal cells and prolonged diarrhea in immunocompromised patients. The aim of this study was to estimate the prevalence and the clinical features of enteric cryptosporidiosis in pediatric patients with lymphohematopoietic malignancies. in this cross-sectional study stool samples were collected from 100 children [67 boys, 33girls] with lymphohematopoietic malignancies who underwent chemotherapy between the ages of 6 months and 17 years [mean age 7.5 years]. All of the specimens were examined for the oocysts of C. parvum by modified Ziehl Neelsen [MZN] staining technique and coproantigens of C. parvum by EL IS A. Cryptosporidium infection was detected in 22 patients. 16 [72.7%] of the infected patients were male and 6 [27.3] female. 7 [31.8%] patients were <5 years, 8 [36.4%] 5-10 years and 7 [31.8] >10 years old. Parasites were detected in 19/85 [86.4%] patients with ALL, 2 of 5 [9.1%] with AML, and 1 of 10 [4.5%] with NHL. Clinical symptoms were found in 11 [50%] of the patients. We found longer duration of chemotherapy in patients who were positive for Cryptosporidium infection [Mean=2067 days] in comparison to negative group [Mean=258.5 days] [ANOVA, f=2.82, P=0.04]. The incidence of Cryptosporidium infection was 22% among pediatric patients with lymphohematopoietic malignancies. We recommend evaluation of these patients with at least two different diagnostic methods in order to prevent possible life threatening outcomes