ABSTRACT
ObjectiveCentral nervous system （CNS） infiltration commonly occurs in children with acute lymphoblastic leukemia （ALL）. Early subclinical CNS infiltration in pediatric ALL is hard to detect with conventional methods. This study aimed to investigate the changes of brain structure volume parameters based on Synthetic MRI （SyMRI） in pediatric ALL without clinically diagnosed CNS infiltration. MethodsThirty-six ALL and twenty-nine typically developing （TD） children were prospectively collected and all underwent SyMRI. The Synthetic MR software was used to obtain brain volumetric parameters including total white matter volume （WMV）， gray matter volume （GMV）， cerebrospinal fluid （CSF） volume， etc. and their within-group differences were assessed by analysis of covariance. The Spearman correlation analysis was used to examine the correlation between biological characteristics and statistically significant brain volume parameters. ResultsALL children showed increased CSF volume （PFDR-corrected = 0.009） and decreased GMV （PFDR-corrected = 0.027） when compared to TD children. We also found a moderately negative association between GMV/intracranial volume and risk classification in pediatric ALL （rs = -0.380， P = 0.022）. ConclusionsPediatric ALL without clinically diagnosed CNS infiltration presented with accumulation of CSF and reduction of gray matter. The brain volumetric changes in subclinical CNS infiltration of pediatric ALL provides a new attempt for exploring the underlying mechanism and early detection of CNS infiltration in pediatric ALL.
ABSTRACT
The chromosomal abnormality of Philadelphia chromosome is mostly seen in Chronic Myeloid Leukemia (CML). But it is observed that the Philadelphia chromosome (Ph), t(9,22), is the most common cytogenetic abnormality in adult patients with acute lymphoblastic leukemia (ALL), occurring in about 20% to 30 % of all cases. Patients with Ph-positive ALL have breaks in the minor breakpoint region, m?BCR (exons 1?2) lead to a short fusion proteins (p190) and is most frequently associated with Ph chromosome- positive ALL. They have an increased risk for central nervous system (CNS) involvement, an aggressive clinical course and poor prognosis. Historically, they had an inferior outcome when compared with their Ph-negative counterparts. Adult Ph+ patients achieve Complete Remission rates comparable to Ph? ALL patients with standard chemotherapy, but the remissions are short and survival poor. The addition of tyrosine kinase inhibitors (TKIs) including imatinib has dramatically improved outcomes. We are presenting this case report of t(9;22), p190 BCR-ABL1 positive ALL in an elderly female patient of south Gujarat.
ABSTRACT
@#Introduction: Sex shapes immune response with possible consequence on tumor immune escape. Acute lymphoblastic leukemia (ALL) predominates in males while ovarian cancer (OC) occurs in females. NK cells essential for tumor killing may have male preponderance. Association of sex, NK cell activity and malignancies is unclear. We hypothesize that sex differentially affects KIR expressions in sex-biased cancers. Method: Expression of inhibitory (KIR2DL1-5 and KIR3DL1-3) and activating (KIR2DS1-2 and 4-5 and KIR3DS1) genes in B-, T-cell ALL, OC and normal controls were determined by reverse-transcription polymerase-chain-reaction. Result: All normal males (but not females) expressed the framework genes and generally maintained haplotype A, except KIR3DL1. Normal females expressed more activating KIRs. Frequencies of KIR2DL1, 2DL4 and 2DS2 were significantly reduced among ovarian cancer patients. Sex difference in frequencies of KIR expression was not detected in ALL as majority were undetectable except framework gene KIR3DL2, was more frequent among T-ALL. Conclusion: Cancers may be associated with reduced KIR expression and influence of sex requires investigation.
ABSTRACT
Objective: To analyze the clinical characteristics of children with acute lymphoblastic leukemia (ALL) diagnosed with secondary acute pancreatitis(AP). Methods: We collected data from a total of 11 patients with ALL and secondary acute pancreatitis who were treated in Tianjin Children's Hospital from February 2013 to February 2020. All patients followed the China Children's Leukemia Collaborative Group-Acute Lymphocytic Leukemia-2008 (CCLG- ALL 2008) combined regimen. We summarized the patient's risk stratification, primary clinical manifestations, treatment stage, cause of pancreatitis, and cumulative dosage of polyethylene glycol conjugated asparaginase (PEG-ASP). The results from examinations such as pancreatic enzyme index, imaging, blood routine, liver and kidney function, blood lipid and blood glucose, and coagulation function were also compared. Finally, the therapeutic effects and outcomes of the patients were compared; and subsequently their clinical characteristics were analyzed. Results: Among the 11 patients 7 were male, and 4 were female; aged between 1-14 years old, with a median age of 6 years. Ten patients had type B acute lymphoblastic leukemia (B-ALL) and 1 had type T acute lymphoblastic leukemia (T-ALL). Pancreatitis was observed in 8 cases within 45 days after start of therapy, in one high-risk case after the second cycle of HR3' chemotherapy and in 2 cases after intensive chemotherapy. It was observed in 10 cases after PEG-ASP treatment, and in one T-ALL case concomitant with tumor lysis syndrome following cyclophosphamide-dexamethasone cytoduction treatment. It manifested primarily as abdominal pain, nausea and vomiting in 11 patients; 8 patients had hypocalcemia; 9 patients had low albumin levels; and 8 patients had abnormal coagulation function. No hypersensitivity was observed. Conclusions: Secondary AP occurs in children with ALL during the early stages of combined chemotherapy. Most of the complications are related to the asparaginase treatment. The severity of the disease is not significantly correlated with the risk stratification of the disease and the cumulative dose of asparaginase. Serum pancreatic enzyme (PE) testing and imaging tests can help assess the clinical status and guide the later prognosis and medication.
ABSTRACT
@#Introduction: Acute Lymphoblastic Leukemia (ALL) is the most common childhood cancer. The leukemia affects not only the quality of life (QOL) of children but also their caregivers. This study aimed to identify the Quality of Life of parents of children with ALL and to find out the association between QOL of parents of children with ALL and the selected demographic variables. Methods: A descriptive study was conducted to assess the QOL among parents of children with ALL. Non-probability purposive sampling technique was followed to select 70 parents of children with ALL attending oncology Outpatient Department in selected hospitals of Kolkata, West Bengal. Semi-structured interview was conducted and the ‘Adult Carer Quality of Life (ACQOL)', the standardized questionnaire was used to assess the quality of life. Results: The study findings revealed that majority (71.43%) of the parents were mother, maximum (77.14%) parents were belonged to the 30-40 years of age group, majority (42.86%) of the parents spent more than 60 hours per week for caring. It was found that majority of the clients 48 (68.57%) had perceived their quality of life as ‘Mid-range'. There was a significant association between QOL and monthly family income and time (in hours) spent for caring per week. Conclusion: The study was believed to be a helpful guide for future study on assessment of Quality of Life of any other caregivers in a large sample for better generalization.
ABSTRACT
Relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a main question on treatment failure.Current strategies for management that usually include salvage chemotherapy,donor lymphocytic infusion and second transplantation.Our study assessed the efficacy of decitabine (DAC) for treating patients with acute lymphoblastic leukemia (ALL) who relapsed after allogeneic hematopoietic stem cell transplantation (allo-HSCT).We retrospectively analyzed the outcomes of 12 patients with relapsed ALL after allo-HSCT who received DAC therapy.Nine patients received DAC combined with chemotherapy and donor stem cell infusion,and 3 patients received single-agent DAC.Ten of the 12 patients achieved complete remission (CR),1 achieved a partial remission (PR),and 1 had no response (NR) after treatment at the latest follow-up (LFU),the median survival was 11.2 months (range,3.8-34,7 months).The 1-and 2-year overall survival (OS) rates were 50％ (6/12) and 25％ (3/12),respectively.Five patients were still alive;4 had maintained CR and 1 was alive with disease.Patients with Philadelphia chromosome-positive ALL had higher survival rate than patients with Philadelphia chromosome-negative ALL (57.1％ vs.20％).No aggravated flares of graft-versus-host disease (GVHD) were observed during DAC treatment.Therefore,DAC may be a promising therapeutic agent for ALL recurrence after allo-HSCT.
ABSTRACT
Over the recent years glutaminase free L-asparaginase has gained more importance due to better therapeutic properties for treatment of acute lymphoblastic leukemia. Actinomycetes are known for L-asparaginase activity. In the current study, 80 actinomycetes were isolated from various soil habitats by serial dilution technique. Presence of L-asparaginase was investigated in a total of 240 actinomycetes by tubed agar method using modified M-9 medium. A total of 165 actinomycetes were found positive for L-asparaginase activity. Among these, 57 actinomycetes producing larger zones of L-asparagine hydrolysis were further screened for their capacity to produce glutaminase-free L-asparaginase. Four L-glutaminase-free actinomycetes were found to be potential L-asparaginase producers. These actinomycetes were identified as Streptomyces cyaneus (SAP 1287, CFS 1560), S. exfoliates (CFS 1557) and S. phaeochromogenes (GS 1573) on the basis of morphological and biochemical identification studies. Maximum L-asparaginase activity (19.2 Uml-1) was observed in culture filtrate of S. phaeochromogenes under submerged fermentation. Results indicate that S. phaeochromogenes could be a potential source of glutaminase free L-asparaginase for commercial purpose. To the best of our knowledge, this is the first report on production of glutaminase free L-asparaginase from S. cyaneus, S. exfoliatus and S. phaeochromogenes.
ABSTRACT
Four children with vincristine (VCR)-induced neuropathy are being reported. All cases were followed with the diagnosis of acute lymphoblastic leukemia. Two were boys aged between 2 and 13 year. Electromyographic examination consisted of sensoriomotor polyneuropathy with axonal involvement in three patients. In another patient, it consisted of motor axonal polyneuropathy. In all patients, pyridoxine and pyridostigmine were successfully used in the treatment of VCR-induced neuropathy. They recovered completely with this drug combination. Recovering period of symptoms was between 1-2 week.
Subject(s)
Adolescent , Antineoplastic Agents, Phytogenic/administration & dosage , Antineoplastic Agents, Phytogenic/adverse effects , Child , Child, Preschool , Cholinesterase Inhibitors/therapeutic use , Drug Therapy, Combination , Female , Humans , Male , Polyneuropathies/chemically induced , Polyneuropathies/diagnosis , Polyneuropathies/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Pyridostigmine Bromide/therapeutic use , Pyridoxine/therapeutic use , Treatment Outcome , Vincristine/administration & dosage , Vincristine/adverse effects , Vitamin B Complex/therapeutic useABSTRACT
BACKGROUND: We evaluated the pattern as well as the predictive factors of obesity in children with acute lymphoblastic leukemia (ALL) according to body mass index (BMI) changes that occur during anticancer chemotherapy. METHODS: We reviewed the medical records of 58 patients who were diagnosed with ALL between 1995 and 2006 at the Department of Pediatrics at Hanyang University Hospital and Dong-A University Hospital. Five relapsed cases were excluded. The heights and weights of 55 children were measured at diagnosis, after induction, after consolidation, before maintenance and at the end of therapy. We analyzed the body mass index (BMI, kg/m(2)) for each treatment phase and evaluated the BMI differences for patients who received or did not receive cranial radiotherapy. RESULTS: The BMI increased in five children (10.4%) among the 48 children who were not obese at diagnosis. According to the treatment phase, the BMI of study patients significantly increased during induction and during chemotherapy. Even though the BMI also significantly increased according to the treatment phases in the children who underwent cranial radiotherapy, the BMI differences between patients that received or did not receive cranial radiotherapy were not statistically significant. CONCLUSION: We suggest that the risk for obesity in children with ALL should be considered even during chemotherapy. Physical activities, including physiotherapy, should be encouraged to prevent obesity, particularly during the long-term use of corticosteroids and during hospital admission.
Subject(s)
Child , Humans , Adrenal Cortex Hormones , Body Mass Index , Medical Records , Motor Activity , Obesity , Pediatrics , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Weights and MeasuresABSTRACT
Adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) constitute a distinct population from children and older adults. However, AYA represent a minority of patients enrolled onto either adult or pediatric clinical trials. As a result, little information is available regarding complete remission (CR), event-free survival (EFS) and overall survival (OS) rates for this age group, and the appropriate treatment regimen for this group of patients remains elusive. A systematic review of all published clinical trials, which provide data on treatment and outcome of AYA with ALL, has been summarized in an effort to determine whether they should be treated on pediatric or adult protocols. AYA with ALL have far superior outcomes when treated on more intensive pediatric regimens and are required specific collaborative trials in order to optimize and improved outcomes.