Outcome of childhood acute promyelocytic leukemia treated using a modified AIDA protocol / 대한혈액학회지

BACKGROUND: Combination treatment with all-trans-retinoic acid (ATRA) and anthracycline-based chemotherapy has led to major advances in the treatment of acute promyelocytic leukemia (APL). METHODS: In this study, we reviewed the outcome of pediatric APL patients treated using a modified AIDA protocol at our institution. RESULTS: Between May 1999 and December 2007, 23 patients were diagnosed with APL at the Department of Pediatrics, Saint Mary's Hospital, The Catholic University of Korea. Eleven patients were male (48%) (median age at diagnosis, 11 (range, 2-14) years). The treatment protocol consisted of remission induction (achieved by coadministration of ATRA and idarubicin), 3 courses of consolidation treatment, and 2 years of maintenance treatment during which ATRA was also administered. Three patients died early during remission induction due to CNS hemorrhage. The remaining 20 patients achieved complete remission (CR), with an overall CR rate of 87%. Two patients relapsed and died, and another patient died of pneumonia unrelated to APL. Four patients (17%) were diagnosed with ATRA syndrome, and all patients showed resolution of symptoms. The event-free survival (EFS) and overall survival (OS) of the cohort were 78.3+/-8.6% and 76.3+/-9.5%, respectively. Initial WBC count at diagnosis was the only significant prognostic factor for the rate of CR (P=0.039) and OS (P=0.039). CONCLUSION: A modified AIDA protocol for the treatment of childhood APL leads to improved EFS and OS, with limited ATRA syndrome-associated toxicity. Active monitoring and treatment of patients with high initial WBC counts may help in reducing mortality.

The characteristics of neurocardiogenic syncope in children / 소아과

Purpose: Syncope is relatively common in children and adolescents. Among the etiologies of syncope, neurocardiogenical syncope is the most common, but it is often confounded with seizure. We investigated the clinical features of patients under the age of 15 with neurocardiogenical syncope, compared to patients with neurologic disorders including epilepsy. Methods: Among the children who visited the Department of Pediatrics at Cheongju St. Mary's Hospital and Chungbuk National University Hospital from March 2005 to February 2007, we retrospectively analyzed 69 patients whose chief complaint was syncope. We classified the patients by syncope etiology and made comparisons between the neurocardiogenical syncope (NCS) group and the neurological disorders (ND) group regarding to age; location; time and season in which syncope occurred; associated symptoms, including seizures, provocation factors; prodromes; duration of syncope; frequency of previous syncope; birth history; associated disease; past medical history; family history; neurological exam; physical exam; laboratory findings; electrocardiography; electroencephalography (EEG); head-up tilt test; brain CT; and MRI. Results: Among 69 syncope patients, 53 (76.8%) were in the NCS group and 11 (15.9%) were in the ND group. There were no statistically significant differences between the two study groups except for the presence of prodromes and EEG abnormalities. The presence of prodromes in the NCS group was more common than in the ND group [46.9% (23/49) vs. 9.1% (1/11), (P=0.038)]. The EEG abnormality in the ND group was more common than in the NCS group [90% (9/10) vs. 5.8% (3/52), (P<0.01)]. Conclusion: Our study suggests that detailed history-taking, including that concerning prodromes, is important for the accurate diagnosis of neurocardiogenical syncope, and EEG should be obtained if neurological disorders are suggested.

Iron Status in Adolescents and University Students in Incheon / 대한혈액학회지

BACKGROUND: Iron deficiency anemia (IDA) frequently occurs in adolescents because of accelerated physical growth in boys and girls. This was aimed at assessing the prevalence of iron deficiency and IDA in apparently healthy Korean adolescents according to the gender and age. METHODS: Apparently healthy students(M: F=1: 1.2) aged 11 to 24 years were included in this study and blood samples were obtained from April to May, 2000. Hemoglobin, hematocrit, red blood cell indices, serum ferritin, iron and total iron-binding capacity were measured. RESULTS: In males, the prevalence of iron deficiency was 15.7% in the 11~12 years group, 16.1% in the 13~14 years group, 9.9% in the 15~16 years group, and 6.4% in the 17~18 years group. In females, the prevalence of iron deficiency was 26.8% in 11~12 years group, 27.9% in the 13~14 years group, 38.8% in the 15~16 years group, 36.0% in the 17~18 years group, 30.9% in the 19~24 years group. The prevalence of IDA in males was 3.6% in 11~12 years, 2.1% in 13~14 years group, 1.9% in 15~16 years group, and 0.6% in 17~18 years group. The prevalence of IDA in females was 4.2% in 11~12 years, 9.7% 13~14 years, 20.4% in 15~16 years, 16.2% in 17~18 years group, and 12.4% in 19~24 years group. CONCLUSION: As the prevalence of iron deficiency and IDA were substantially greater than expected, studies of iron state in adolescent girls, especially middle to high school age, should be undertaken to assess iron deficiency.