Monthly variation in diagnosis of acute lymphoblastic leukemia and survival outcome in children and adults: 15-year trends at a single center

ABSTRACT Background: The date of acute lymphoblastic leukemia (ALL) diagnosis has been studied regarding potential etiologic roles with contrasting results and the issue remains controversial. The principal aim of this study was to analyze monthly variation of ALL diagnosis in a large homogenous Hispanic Latin American cohort over 15 years; its association with survival rates was also assessed. Methods: Clinical files and electronic records of 501 consecutive patients of all ages with ALL in northeastern Mexico over the years of 2004-2018 were scrutinized. Patients were divided into children <18 and adults >18 years. The Chi-square heterogeneity analysis was used to test for non-uniform variation. The Poisson regression analysis was used to fit sinusoidal (harmonic) models to the data, using the month of diagnosis as a covariate in a separate model. Results: During the study period 363 children (72.5%) and 138 adults (27.5%) (p < 0.001) were diagnosed with ALL. Heterogeneity across the months of diagnosis was confirmed (p = 0.019) and the Poisson regression analysis confirmed a significant monthly variation (p < 0.001) (95% CI, 3.024-3.745), a higher annual peak being observed in the month of March (p = 0.002), followed by a second peak in October (p = 0.026). The five-year OS for children was 68.2% (95% CI, 67.64-68.74) and for adults, 43.7% (95% CI, 42.67-44.71) (p < 0.001). No significant association between the month of diagnosis and OS was found (p = 0.789). Conclusion: The monthly variation of ALL diagnosis was documented; these results confirm the heterogeneous behavior of the disease and appear to be consistent with an interplay of environmental and biologic factors. Further studies are needed to examine putative candidate agents.

Revisiting the complete blood count and clinical findings at diagnosis of childhood acute lymphoblastic leukemia: 10-year experience at a single center

Abstract Background Heterogeneity regarding clinical and laboratory findings at diagnosis of acute lymphoblastic leukemia exists. The frequency of complete blood count abnormalities and its combinations, symptoms and physical findings were investigated in Hispanic children from an open population at the diagnosis of acute lymphoblastic leukemia. Methods The patient charts and electronic records of under 16-year-old children diagnosed with acute lymphoblastic leukemia over 10 years at a regional hematology center of a university hospital were analyzed to retrieve data concerning the complete blood count at first evaluation. Type and distribution of abnormal data, frequency of symptoms and physical findings at presentation were documented. Results The records of 203 children aged 0-15 years diagnosed with acute lymphoblastic leukemia from 2006 to 2016 were revisited. The results of the blood workup showed a median white blood cell count of 7120 × 109/L (range: 450-600,000 × 109/L), and a median hemoglobin concentration of 7.5 g/dL (range: 2.4-15.3 g/dL), whereas the median platelet count was 47,400 × 109/L (range: 4000-544,000 × 109/L). Leukocytosis and leukopenia were present in 36.6% and 36.1% of cases, respectively; anemia was diagnosed in 82.9% children. The order of frequency for major clinical symptoms was fatigue 62%, fever 60%, bone and joint pain 39%, hyporexia 33% and weight loss 21%, while main physical findings were hepatomegaly 78%, splenomegaly 63%, lymphadenopathy 57%, pallor 48%, and purpura 30%. Conclusion Data differing from those classically expected at diagnosis of acute lymphoblastic leukemia in children were documented in a cohort of Hispanic children over one decade with a wide spectrum of complete blood count abnormalities, forms of presentation and frequency of physical findings.

Use of complementary and alternative medicine by patients with hematological diseases: experience at a university hospital in northeast Mexico

BACKGROUND: Complementary and alternative medicine includes a diverse group of medical and healthcare systems, practices and products not considered part of conventional medicine. Although there is information on unconventional practices in oncological diseases, specific data regarding the use of complementary and alternative medicine by hematology patients is scarce. OBJECTIVE: The aim of this study is to document the prevalence of this modality of unconventional therapy in patients with malignant and benign hematological diseases, particularly children with acute lymphoblastic leukemia. METHODS: An observational study of adult patients and guardians of children with malignant or benign hematological diseases was carried out by applying a structured questionnaire detailing the use and results of the most prevalent complementary and alternative medicine practices. RESULTS: One hundred and twenty patients were included; 104 had malignant and 16 had benign hematological diseases. The use of complementary and alternative medicine was greater in benign diseases but the difference was not statistically significant (64.7% versus 41.7%; p-value = 0.08). Patients and guardians with high school or college educations used these alternative practices more than patients with less schooling (60.7% versus 54.7%; p-value = 0.032). The use of folk remedies was most prevalent followed by herbal preparations and spiritual healing. Sixty-four percent of patients that used these unconventional practices reported improvement in their symptoms and increased capacity to perform daily activities. CONCLUSION: No significant difference was documented between patients with malignant or benign hematological diseases using these alternative practices. The majority of complementary and alternative medicine users reported improvement of the disease or chemotherapy-related symptoms.

Anticuerpos monoclonales en el diagnóstico de la tromboastenia de Glanzmann / Monoclonal antibodies in the diagnosis of Glanzmann's thrombasthenia

La tromboastenia de Glanzmann (TG) es una trombocitopatía causada pro el déficit en la cantidad de glucoproteínas IIb y IIIa (GP IIb/IIIa) de la membrana plaquetaria. Son descritos tres pacientes con TG; todos presentaban un tiempo de sangrado prolongado con recuento plaquetario normal y porcentajes mínimos de agregación plaquetaria cuando se usaron adenosin difosfato, colágena y epinefrina como inductores. Dos de los pacientes eran hermanos y tenían el antecedente de consanguinidad. Dos de los pacientes tenían historia de hemorragia principalmente de mucosas y el otro era asintomático. En los tres se realizaron estudios de inmunocitoquímica con la técnica de la imunoperoxidasa tipo indirecto usando un anticuerpo monoclonal (HPI-1D cortesía del Dr. W.L. Nichols Clínica Mayo, Rochester, Minnesota EUA) específico contra las GP IIb/IIIa. En los pacietnes sintomáticos la captación del anticuerpo fue totalmente negativa y en el que no presentó síntomas el anticuerpo fue parcialmente captado. Esta técnica en nuestra experiencia es más rápida y económica que la agregometría plaquetaria permitiendo realizar el diagnóstico con seguridad. La TG es una entidad aparentemente muy rara en nuestro país; sin embargo, es probable que su diagnóstico no establezca en muchos casos por carecer de la tecnología adecuada

Tombosis venosa profunda en un paciente con brucelosis y un probable inhibidor lupico: informe de un caso / Deep venous thrombosis in a patient with brucellosis and a probable lufoid inhibitor: report of a case

Se presenta el caso de una paciente de 18 años de edad que ingresó al hospital por un padecimiento de 15 días de evolución caracterizada por dolor y edema de los miembros inferiores. En su estudio intra-hospitalario se demostró brucelosis aguda por un título sérico de 1:800 y cultivos positivos para brucella sp.; trombosis venosa profunda iliofemoral en asociación con un tiempo de protrombina normal y de tromboplastina parcial prolongado. Haciendo una mezcla del plasma de la enferma con un volumen igual d eun plasma normal, se demostró un anticoagulante ciruclante y mediante el tiempo de coagulación con caolina, se identificó un inhibidor tipo lúpico. La paciente recibió tratamiento con tetraciclinas orales y anticoagulación sistémica y cuatro meses después de su egreso del hospital se encontraba asintomática y no recibía tratamiento alguno. Sus estudios de control, tanto para la brucellosis como de coagulación estaban normales. Se hacen algunas consideraciones acerca de una posible asociación entre la brucelosis y el anticoagulante circulante