Presentación clínica de patologías no malignas que simulan leucemia cutis: a propósito de dos casos / Clinical presentation of non-malignant diseases mimicking leukemia cutis: A report of two cases

La infiltración cutánea por células leucémicas conocida como leucemia cutis es una presentación infrecuente de esta patología y constituye un desafío diagnóstico. Los diagnósticos como infecciones, otras patologías neoplásicas con afectación cutánea y los trastornos histiocíticos, entre otros, constituyen los principales diagnósticos diferenciales, ya que configuran un escenario pronóstico y terapéutico diferente. Se presentan dos pacientes que fueron diagnosticados inicialmente como leucemia cutis, cuyo diagnóstico final fue de patologías no malignas.

The infiltration of leukemia cells into the skin, known as leukemia cutis, is a rare presentation of this disease and accounts for a diagnostic challenge. The main differential diagnoses include infections, other neoplastic diseases with skin involvement and histiocytic disorders, among others, as they entail different prognostic and therapeutic approaches. Here we describe two patients who were initially diagnosed with leukemia cutis, whose final diagnosis was of non-malignant diseases.

Real-world practice of acute leukemia intrathecal chemotherapy administration: A Mexican nationwide survey

ABSTRACT Introduction: Intrathecal chemotherapy is a mainstay component of acute lymphoblastic leukemia treatment. In Mexico, there is a considerable practice variability in aspects, such as the manner of preparation and the administration technique. Objective: Our objective was to describe the different techniques used for the application of ITC and review the existing recommendations in the literature. Method: A cross-sectional, nationwide survey study was conducted by an electronic questionnaire sent to hematologists and oncologists in Mexico. We collected demographic data, personal experience, intrathecal chemotherapy techniques, drug preparation and postprocedural conduct. Results: We received 173 responses. Twenty percent had an anesthesiologist administering sedation and pain management. The platelet count considered safe was 50 × 109/L in 48% of the participants. In 77% (n = 133) of the cases, the conventional needle with stylet used was, 49% did not receive any added diluent in the intrathecal chemotherapy and only 42% were recommended to rest in a horizontal position for more than 30 min. Conclusion: We identified a considerable variation in the administration of intrathecal chemotherapy across the hematologists in Mexico. We discuss the implications and opportunities in reducing the variation in our setting, highlighting the unmet need to establish guidelines that should be evaluated by the Mexican professional society to produce a position paper regarding practice standardization.

Applicability of the acute leukemia (AL) - EBMT score as a prognostic model for allogeneic hematopoietic stem cell transplantation: a single-center, prospective, cohort study at a reference transplant center in Brazil

Abstract Introduction The Acute Leukemia-European Society for Blood and Marrow Transplantation (AL-EBMT) risk score was recently developed and validated by Shouval et al. Objective To assess the ability of this score in predicting the 2-year overall survival (OS-2), leukemia-free survival (LFS-2) and transplant-related mortality (TRM) in acute leukemia (AL) adult patients undergoing a first allogeneic hematopoietic stem cell transplant (HSCT) at a transplant center in Brazil. Methods In this prospective, cohort study, we used the formula published by Shouval et al. to calculate the AL-EBMT score and stratify patients into three risk categories. Results A total of 79 patients transplanted between 2008 and 2018 were analyzed. The median age was 38 years. Acute myeloid leukemia was the most common diagnosis (68%). Almost a quarter of the cases were at an advanced stage. All hematopoietic stem cell transplantations (HSCTs) were human leukocyte antigen-matched (HLA-matched) and the majority used familial donors (77%). Myeloablative conditioning was used in 92% of the cases. Stratification according to the AL-EBMT score into low-, intermediate- and high-risk groups yielded the following results: 40%, 12% and 47% of the cases, respectively. The high scoring group was associated with a hazard ratio of 2.1 (p= 0.007), 2.1 (p= 0.009) and 2.47 (p= 0.01) for the 2-year OS, LFS and TRM, respectively. Conclusion This study supports the ability of the AL-EBMT score to reasonably predict the 2-year post-transplant OS, LFS and TRM and to discriminate between risk categories in adult patients with AL, thus confirming its usefulness in clinical decision-making in this setting. Larger, multicenter studies may further help confirm these findings.

Sobrevida en población pediátrica con leucemia linfoblástica aguda tratada con protocolo ALLIC-BFM de quimioterapia. Revisión sistemática / Survival of pediatric population with acute lymphoblastic leukemia treated with ALLIC-BFM chemotherapy protocol. Systematic review

La leucemia linfoblástica aguda constituye la neoplasia infantil más frecuente. Los tratamientos actuales posibilitan más del 80% de supervivencia libre de enfermedad por cinco años. En el 2000, se probó un protocolo de quimioterapia llamado leucemia linfoblástica intercontinental Berlín-Frankfurt-Münster (ALLIC BFM). El proceso investigativo se realizó mediante la metodología PRISMA, con el propósito de sistematizar la información acerca de la supervivencia de los pacientes pediátricos con leucemia linfoblástica aguda tratados con el uso del protocolo de quimioterapia ALLIC BFM en sus versiones de 2002 o 2009. La supervivencia global en pacientes donde se utilizó el protocolo de 2002 fue del 52% al 91,7% y la libre de enfermedad fue del 45% a 83,3%; mientras que, con el uso del protocolo 2009 se reportó una supervivencia global del 71,1% al 90% y la libre de enfermedad fue del 69,4% al 90,3%. Los principales factores que afectaron la supervivencia fueron las complicaciones relacionadas con el tratamiento, los pacientes de alto riesgo y la medicación insuficiente.

Acute lymphoblastic leukemia is the most common childhood neoplasia. Current treatments allow more than 80% disease-free survival for five years. In 2000, a chemotherapy protocol called Berlin-Frankfurt-Münster intercontinental lymphoblastic leukemia (ALLIC BFM) was tested. The investigative process was carried out using the PRISMA methodology. This study aimed to systematize the information about the survival of pediatric patients with acute lympho-blastic leukemia treated with the ALLIC BFM chemotherapy protocol in its 2002 or 2009 versions. 52% to 91.7% of patients showed an overall survival in patients where the 2002 proto-col was used, and disease-free was from 45% to 83.3%; while, with the use of the 2009 protocol, an overall survival of 71.1% to 90% was reported, and disease-free survival was 69.4% to 90.3%. The main factors affecting survival were treatment-related complications, high-risk patients, and insufficient medication.

Establishment of leukemia cell model with inducible AML1-ETO expression and its effect on fatty acid metabolism in leukemia cells / 中华血液学杂志

Objective: To investigate the effect of the AML1-ETO (AE) fusion gene on the biological function of U937 leukemia cells by establishing a leukemia cell model that induces AE fusion gene expression. Methods: The doxycycline (Dox) -dependent expression of the AE fusion gene in the U937 cell line (U937-AE) were established using a lentivirus vector system. The Cell Counting Kit 8 methods, including the PI and sidanilide induction, were used to detect cell proliferation, cell cycle-induced differentiation assays, respectively. The effect of the AE fusion gene on the biological function of U937-AE cells was preliminarily explored using transcriptome sequencing and metabonomic sequencing. Results: ①The Dox-dependent Tet-on regulatory system was successfully constructed to regulate the stable AE fusion gene expression in U937-AE cells. ②Cell proliferation slowed down and the cell proliferation rate with AE expression (3.47±0.07) was lower than AE non-expression (3.86 ± 0.05) after inducing the AE fusion gene expression for 24 h (P<0.05). The proportion of cells in the G(0)/G(1) phase in the cell cycle increased, with AE expression [ (63.45±3.10) %) ] was higher than AE non-expression [ (41.36± 9.56) %] (P<0.05). The proportion of cells expressing CD13 and CD14 decreased with the expression of AE. The AE negative group is significantly higher than the AE positive group (P<0.05). ③The enrichment analysis of the transcriptome sequencing gene set revealed significantly enriched quiescence, nuclear factor kappa-light-chain-enhancer of activated B cells, interferon-α/γ, and other inflammatory response and immune regulation signals after AE expression. ④Disorder of fatty acid metabolism of U937-AE cells occurred under the influence of AE. The concentration of the medium and short-chain fatty acid acylcarnitine metabolites decreased in cells with AE expressing, propionyl L-carnitine, wherein those with AE expression (0.46±0.13) were lower than those with AE non-expression (1.00±0.27) (P<0.05). The metabolite concentration of some long-chain fatty acid acylcarnitine increased in cells with AE expressing tetradecanoyl carnitine, wherein those with AE expression (1.26±0.01) were higher than those with AE non-expression (1.00±0.05) (P<0.05) . Conclusion: This study successfully established a leukemia cell model that can induce AE expression. The AE expression blocked the cell cycle and inhibited cell differentiation. The gene sets related to the inflammatory reactions was significantly enriched in U937-AE cells that express AE, and fatty acid metabolism was disordered.

Acute Kidney Injury after Bone Marrow Transplantation in Patients with Lymphomas and Leukemias / Lesão Renal Aguda após Transplante de Medula Óssea em Pacientes com Linfomas e Leucemias Insuficiencia Renal Aguda tras / Trasplante de Médula Ósea en Pacientes con Linfomas y Leucemias

Introduction: Hematologic malignancies, including lymphomas and leukemias, may be treated with autologous or allogeneic bone marrow transplantation. However, these approaches can increase the risk of infection, sepsis, graft-versus-host disease, and nephrotoxicity, possibly resulting in acute kidney injury (AKI). Objective: To evaluate AKI in patients with lymphomas or leukemia submitted to bone marrow transplantation (BMT). Method: Retrospective, observational cohort study of cases from a database of 256 patients (53.9% males) hospitalized for BMT between 2012 and 2014 at a cancer hospital in São Paulo, Brazil. Of these, 79 were selected randomly for analysis. Demographic data, length of hospitalization, and associated morbidities were recorded. AKI was identified according to Kidney Diseases Improving Global Outcomes (KDIGO) criteria. Results: The most frequent diagnoses for the 79 cases were non-Hodgkin's lymphoma (30.4%), acute myeloid leukemia (26.6%), and Hodgkin's lymphoma (24.1%). The probability of 100 days-survival after BMT was 81%, and three years after BMT was 61%. In-hospital mortality was significantly higher among patients who presented AKI during hospitalization (p<0.001). However, there was no difference in overall life expectancy (p=0.770). Conclusion: A significant prevalence of AKI was found in patients with leukemia or lymphoma while they were hospitalized for BMT, resulting in significantly increased rates of in-hospital mortality. The presence of AKI during hospitalization was not associated with a subsequent reduction in life expectancy.

Introdução: As neoplasias hematológicas, incluindo linfomas e leucemias, podem ser tratadas com transplante autólogo ou halogênico de medula óssea. No entanto, essas abordagens podem aumentar o risco de infecção, sepse, doença do enxerto contra o hospedeiro e nefrotoxicidade, possivelmente resultando em lesão renal aguda (LRA). Objetivo: Avaliar LRA em pacientes com linfomas ou leucemia submetidos a transplante de medula óssea (TMO). Método: Estudo de coorte observacional retrospectivo de casos de um banco de dados de 256 pacientes (53,9% do sexo masculino) internados por TMO entre 2012 e 2014 em um hospital oncológico de São Paulo, Brasil. Destes, 79 prontuários foram selecionados aleatoriamente para análise. Dados demográficos, tempo de internação e morbidades associadas foram registrados. A LRA foi identificada de acordo com os critérios de Kidney Diseases Improving Global Outcomes (KDIGO). Resultados: Os diagnósticos mais frequentes da amostra de 79 casos foram linfoma não Hodgkin (30,4%), leucemia mieloide aguda (26,6%) e linfoma de Hodgkin (24,1%). A probabilidade de sobrevivência em 100 dias após o TMO foi de 81% e, em três anos após o TMO, foi de 61%. A mortalidade intra-hospitalar foi significativamente maior entre os pacientes que apresentaram LRA durante a internação (p<0,001). No entanto, não houve diferença na expectativa de vida geral (p=0,770). Conclusão: Neste estudo, observou-se prevalência significativa de LRA em pacientes com leucemia ou linfoma durante a internação por TMO, resultando em aumento significativo das taxas de mortalidade intra-hospitalar. A presença de LRA durante a hospitalização não se associou a uma subsequente redução da expectativa de vida

Introducción: Las neoplasias malignas hematológicas, incluidos los linfomas y las leucemias, pueden tratarse con trasplante autólogo o alogénico de médula ósea. Sin embargo, estos enfoques pueden aumentar el riesgo de infección, sepsis, enfermedad de injerto contra huésped y nefrotoxicidad, lo que posiblemente provoque lesión renal aguda (IRA). Objetivo: Evaluar el FRA en pacientes con linfomas o leucemias sometidos a trasplante de médula ósea (TMO). Método: Se realizó un estudio de cohorte observacional retrospectivo de casos de una base de datos de 256 pacientes (53,9% hombres) hospitalizados por TMO entre 2012 y 2014 en un hospital de cáncer en São Paulo, Brasil. De estos, 79 registros fueron seleccionados aleatoriamente para su análisis. Se registraron los datos demográficos, la duración de la hospitalización y las morbilidades asociadas. La IRA se identificó según los criterios de Kidney Diseases Improving Global Outcomes (KDIGO). Resultados: Los diagnósticos más frecuentes en la muestra de 79 casos fueron linfoma no Hodgkin (30,4%), leucemia mieloide aguda (26,6%) y linfoma de Hodgkin (24,1%). La probabilidad de supervivencia 100 días después del BMT fue del 81% y tres años después del BMT fue del 61%. La mortalidad hospitalaria fue significativamente mayor entre los pacientes que presentaron FRA durante la hospitalización (p<0,001). Sin embargo, no hubo diferencia en la esperanza de vida global (p=0,770). Conclusión: En este estudio, se observó una prevalencia significativa de LRA en pacientes con leucemia o linfoma mientras estaban hospitalizados por TMO, lo que resultó en un aumento significativo de las tasas de mortalidad hospitalaria. La presencia de FRA durante la hospitalización no se asoció con una reducción posterior de la esperanza de vida.

Como Deve Ser um Material Educativo? Percepção dos Familiares de Crianças com Leucemia / How an Educational Material Would Be Like? Perceptions of Relatives of Children with Leukemia

Introdução: A criança com leucemia, quando no domicílio, requer cuidados especiais. Nesse contexto, os familiares deparam-se com demandas de cuidados que precisam ser aprendidas em função da condição clínica de sua criança. Este artigo é um recorte da pesquisa "As demandas de aprendizagem dos familiares de crianças com leucemia para o cuidado domiciliar". Objetivo: Conhecer as percepções de familiares de crianças com leucemia sobre a proposta de construção de materiais educativos para o cuidado domiciliar e descrever os temas que os familiares julgarem significativos na composição desses materiais. Método: Estudo participativo desenvolvido em uma enfermaria de hematologia infantil no Rio de Janeiro. A teoria utilizada para fundamentar o estudo foi a educação problematizadora de Paulo Freire. Os dados foram coletados por meio de três círculos de discussão e, posteriormente, examinados a partir da análise de conteúdo de Bardin. Resultados: Oito familiares de crianças com leucemia participaram do estudo. Duas categorias emergiram: "a proposta de construção de materiais educativos para o cuidado domiciliar" e "temas relevantes para compor os materiais educativos". Conclusão: Considerar a percepção dos familiares na construção de material educativo pode contribuir de maneira assertiva na escolha de conteúdos e na forma de abordá-los, e ser uma estratégia mais eficaz nesse processo contínuo da educação em saúde dos familiares das crianças com leucemias.

Introduction: The child with leukemia, when at home, requires special care. In this context, family members are faced with care-related demands that need to be learned due to their child´s clinical condition. This article is part of the research "The learning demands of family members of children with leukemia for home care". Objective: To know the perceptions of family members of children with leukemia about the proposal to build education materials for home care and describe the themes that family members considered significant in the composition of these materials. Method: Participatory study developed in a children's hematology ward in Rio de Janeiro. Paulo Freire´s problematizing education was the theory utilized to support the study. Data were collected through three discussion circles, and subsequently examined using Bardin´s content analysis. Results: Eight family members of children with leukemia participated in the study. Two categories emerged: The proposal for the construction of education materials for home care and relevant themes to compose the educational materials. Conclusion: Considering the perception of family members in the construction of educational material can make an assertive contribution in choosing content, and how to approach them, and be a more effective strategy in this continuous process of health education for relatives of children with leukemias.

Introducción: El niño con leucemia, cuando está en casa, requiere cuidados especiales. En este contexto, los familiares se enfrentan a demandas de cuidado que necesitan ser aprendidas debido a la condición clínica de su hijo. Este artículo forma parte de la investigación "Las demandas de aprendizaje de los familiares de niños con leucemia para el cuidado domiciliario". Objetivo: Conocer las percepciones de los familiares de niños con leucemia sobre la propuesta de elaboración de materiales educativos para el cuidado domiciliario y describir los temas que los familiares consideraron significativos en la composición de materiales educativos. Método: Estudio participativo desarrollado en una sala de hematología infantil de Río de Janeiro, teniendo como base la teoría de la educación problematizadora de Paulo Freire. Los datos fueron recolectados a través de tres círculos de discusión y, posteriormente, analizados mediante el análisis de contenido de Bardin. Resultados: Participaron del estudio ocho familiares de niños con leucemia. Emergieron dos categorías: La propuesta de construcción de materiales educativos para la atencíon domiciliaria y temas relevantes para componer los materiales educativos. Conclusión: Considerar la percepción de los familiares en la construcción del material educativo puede contribuir asertivamente en la elección de los contenidos, en la forma de abordarlos, y ser una estrategia más efectiva en este proceso continuo de educación en salud para los familiares de niños con leucemia.

Clinical and microbiological profile and factors affecting outcome among pediatric febrile neutropenic patients with hematologic malignancies

Objective@#To evaluate the clinical and microbiological profile and factors affecting outcome among pediatric febrile neutropenic (FN) patients with hematologic malignancies (HM)@*Methodology@#This was a cross-sectional study which looked into medical records of Filipino children 0-18years old diagnosed with FN and HM and admitted from June 2016 up to June 2022 at the St. Luke’s Medical Center, Quezon City (SLMC-QC). Data on age, sex, underlying malignancy, stage of treatment, site of infection, presence of central line, initial antibiotic therapy, culture positivity and isolates were retrospectively evaluated. Incomplete records were excluded. The relationship between clinical & microbiologic profile and outcomes were analyzed using T-test and Chi-square test. Significance was set at p<0.05.@*Results@#This study included 267 episodes of FN. Patients had a mean age of 8.3 years with male preponderance (59%). The most frequent underlying malignancy was acute lymphoblastic leukemia (61%). Episodes occurred primarily during the induction (40%) and consolidation phases (28%) of chemotherapy. Most (65%) had an absolute neutrophil count (ANC) of <100/mm3 . Central line catheter was present in 59% of episodes and 52% had an implanted port. There was no identifiable focus of infection in 52% of cases. Gram-negative bacteria, specifically Klebsiella pneumoniae (13%) and Escherichia coli (11%) were the most common isolates. Most patients (88%) recovered. Age >10years, male sex, diagnosis of acute myelogenous leukemia, relapse disease, ANC <100/mm3 , presence of a central line, and central line associated bloodstream infection were significantly associated with duration of hospital stay. Presence of central venous line was the most significant factor associated with mortality. Conclusions: Several clinical and microbiological factors, specifically age >10years, male sex, diagnosis of acute myelogenous leukemia, relapse disease, ANC <100/mm3 , presence of a central line, and central line associated bloodstream infection, were documented to significantly affect outcome in Filipino pediatric FN patients with HM.

Intrathoracic masses in children and adolescents: a single tertiary pediatric institution experience

OBJECTIVES@#The Cancer and Hematology Division of the PCMC receives an average of 24 cases of pediatric intrathoracic masses annually. Comprehensive data on the demographic status, clinical profile, management, and outcome are still not available. This study aims to determine the clinical features, diagnosis, management and outcome of children and adolescents with intrathoracic masses from 2017 to 2019.@*MATERIALS AND METHODS@#Descriptive study design was utilized. Data were collected by doing a chart review. Possible associations between the clinical features and outcome were described.@*RESULTS@#Sixty-eight (68) cases were referred from January 2017 to December 2019. Mean age at diagnosis is 8.8 years with a 2.4:1 male to female ratio. Severe wasting was seen in 21%. All subjects were symptomatic at presentation, 50% with respiratory compromise. Anterior mediastinal lesions are observed at 82% of cases. Elevated LDH was seen in 50% of the patients. Malignant hematologic lesions are the most common etiology. Steroid pretreatment was given in 40% of patients. Only a small percentage (<20%) underwent definitive treatment. Patients were symptomatic for 18 days on average before consult. It took an average of 18 days for a case to be diagnosed definitively, and 10 days from the diagnosis to start of directed treatment. Mortality rate was high at 57.4%@*CONCLUSION@#Patients with intrathoracic mass and malnutrition are 1.4x more likely to die. Diagnosis is the most significant factor associated with death. Observed data can be used as basis to formulate protocols which can streamline the diagnostic and therapeutic approach in these patients.

Clinical Analysis of Patients with Blastic Plasmacytoid Dendritic Cell Neoplasm / 中国实验血液学杂志

OBJECTIVE@#To explore the clinical characteristics, treatment, and prognosis of patients with blastic plasmacytoid dendritic cell neoplasm(BPDCN).@*METHODS@#Clinical data of 5 patients diagnosed with BPDCN in Wuhan First Hospital and Wuhan Tongji Hospital from June 2016 to November 2021 were retrospectively analyzed.@*RESULTS@#Among the 5 patients, 3 were male and 2 were female, with a median age of 28(10-52) years old. Four patients showed obvious skin damage at the initial diagnosis; the other one showed clinical manifestations of acute leukemia rather than obvious skin damage at the initial diagnosis, but infiltrated skin when the disease relapsed after treatment. Other infiltration sites of lesions included bone marrow (2/5), peripheral blood (2/5), lymph nodes (3/5), liver and spleen (2/5). All patients had no clinical manifestation of central nervous system infiltration. Tumor cell specific immune markers CD4, CD56, CD123 were all positive, and the median Ki-67 index was 70%. TET2, ASXL1 and NRAS gene mutations were found respectively in 3 patients by next-generation sequencing technique (NGS). ALL-like, AML-like and invasive NK/T cell lymphoma-like first-line induction chemotherapy regimens were used for the patients. One patient died of severe complications during the early stage of chemotherapy, 3 patients were evaluated as CR, and 1 patient was evaluated as PR. 2 patients were recurred and progressed after induction of chemotherapy, and one of them was evaluated as CR after re-treatment. One patient received autologous hematopoietic stem cell transplantation (auto-HSCT) and got long-term survival (OS 87 months). 3 patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT), of which one died of transplantation related complications, and 2 cases survived. The median follow-up time of 4 patients with evaluable efficacy was 28.5(9-84) months, the median OS time was 31.5(10-87) months.@*CONCLUSION@#BPDCN is a highly heterogeneous malignant tumor with a poor prognosis. HSCT, especially allo-HSCT can significantly improve the prognosis of BPDCN patients.

Analysis of Clinical Features and Risk Factors for Oral Ulcers and Bloodstream Infection in Patients with Hematopoietic Stem Cell Transplantation / 中国实验血液学杂志

OBJECTIVE@#To investigate the risk factors of oral ulcers and bloodstream infection in patients with hematopoietic stem cell transplantation.@*METHODS@#The clinical data of 401 hematopoietic stem cell transplant patients in the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2021 were retrospective analyzed, and the risk factors of oral ulcers and bloodstream infection statistical and analyzed.@*RESULTS@#Among the 401 patients, the incidence of oral ulcers was 61.3% (246/401), and the incidence of bloodstream infection was 9.0% (36/401). A total of 40 strains of pathogenic bacteria were isolated from 36 patients, including 26 strains of Gram negative strains (65%), 13 strains of Gram positive strains (32.5%), and 1 strain of fungi (2.5%). Single-factor analysis showed that oral hygiene was associated with the occurrence of bloodstream infection, and the Multi-factor analysis showed that age ≥14 years old, disease diagnosis of leukemia, and allogeneic hematopoietic stem cell transplantation were risk factors for oral ulcers.@*CONCLUSION@#The incidence of oral ulcers in patients with hematopoietic stem cell transplantation is high. The age ≥14 years, disease diagnosis of leukemia, and allogeneic hematopoietic stem cell transplantation were risk factors for oral ulcers in patients, and oral hygiene was associated with the occurrence of bloodstream infection.

The Role and Mechanism of MiR-451 in Multidrug Resistance of Leukemia Cell Line K562/A02 / 中国实验血液学杂志

OBJECTIVE@#To detect the differential expressions of miR-451, ABCB1 and ABCC2 in drug-sensitive leukemia cell line K562 and drug-resistant cell line K562/A02, and explore the regulatory relationship between miR-451 and the expressions of ABCB1 and ABCC2 , and the mechanism of miR-451 involved in drug resistance in leukemia.@*METHODS@#CCK-8 assay was used to detect the drug resistance of K562/A02 and K562 cells. Quantitative Real-time PCR (qRT-PCR) was used to verify the differential expressions of miR-451 in K562 and K562/A02 cells. MiR-451 mimic and negative control (miR-NC), miR-451 inhibitor and negative control (miR-inNC) were transfected into K562 and K562/A02 cells respectively, then qRT-PCR and Western blot were used to detect the expression levels of mRNA and protein of ABCB1 and ABCC2 in K562 and K562/A02 cells and the transfected groups.@*RESULTS@#The drug resistance of K562/A02 cells to adriamycin was 177 times higher than that of its parent cell line K562. Compared with K562 cells, the expression of miR-451 in K562/A02 cells was significantly higher (P <0.001), and the mRNA and protein expression levels of ABCB1 and ABCC2 in K562/A02 cells were significantly higher than those in K562 cells (P <0.001). After transfected with miR-451 inhibitor, the expression of miR-451 was significantly down-regulated in K562/A02 cells (P <0.001), the sensitivity to chemotherapy drugs was significantly enhanced (P <0.05), and the mRNA and protein expressions of ABCB1 and ABCC2 were significantly decreased (P <0.01). After transfected with miR-451 mimic, the expression of miR-451 was significantly upregulated in K562 cells (P <0.001), and the mRNA and protein expressions of ABCB1 and ABCC2 were significantly increased (P <0.01).@*CONCLUSION@#There are significant differences in the expressions of miR-451, ABCB1 and ABCC2 between the drug-sensitive leukemia cell line K562 and drug-resistant cell line K562/A02, which suggests that miR-451 may affect the drug resistance of leukemia cells by regulating the expression of ABCB1 and ABCC2.

The Effect of Ena/VASP Family on the Expression of GPIb-IX Complex in Human Megakaryoblastic Leukemia Dami Cells / 中国实验血液学杂志

OBJECTIVE@#To explore the effects of Ena/VASP gene family on the expression of glycoprotein (GP) Ib-IX complex in human megakaryoblastic leukemia Dami cells.@*METHODS@#SiRNAs targeting Ena/VASP gene family were designed and synthesized to interfere Enah, EVL and VASP gene expression. When the siRNAs were transfected into Dami cells by using LipofectamineTM 2000 for 48 h, the expression of GPIb-IX complex was detected by quantitative real-time PCR, Western blot and flow cytometry.@*RESULTS@#We successfully established siVASP , siEVL and si Enah Dami cell lines. And it was found that the expression of GPIb-IX complex had no evident reduction in siEVL or siVASP Dami cells at both mRNA and protein level, while the total protein and membrane protein of GPIb-IX complex were obviously reduced when Enah was knocked down.@*CONCLUSION@#Enah could affect the expression of GPIb-IX complex in human megakaryoblastic leukemia Dami cells, but the underlying mechanism still needs to be further explored.

Influência da religiosidade/espiritualidade em cuidadores informais de crianças com leucemia / Influence of religiosity/spirituality on informal caregivers of children with leukemia / Influencia de la religiosidad/espiritualidad en cuidadores informales de niños con leucemia

Resumo Perante diagnóstico e tratamento de doença grave em crianças, incluindo a oncológica, os pais, em especial as mães, tendem a assumir integralmente as demandas de cuidados, necessitando desenvolver estratégias de enfrentamento situacional. Nesse sentido, este estudo descritivo e transversal objetivou identificar o uso do coping religioso/espiritual em cuidadores informais de crianças com leucemia linfoide aguda mediante aplicação da escala de coping religioso/espiritual breve. Participaram 30 cuidadores informais, que apresentaram coping religioso/espiritual alto (média=3,90; Dp=0,34) na modalidade positiva (média=3,67; Dp=0,48). Por fim, identificou-se que as mães utilizam coping religioso/espiritual para lidar com a demanda de cuidados a elas imposta, vinculada à condição de saúde da criança. Com isso, reforça-se a possibilidade de utilizar a espiritualidade e/ou a religiosidade como indicadores de bem-estar físico e mental, visto que a qualidade dos cuidados prestados está intimamente relacionada à saúde de quem cuida.

Abstract Faced with diagnosis and treatment of serious illness in children, including oncology, parents, especially mothers, tend to fully assume the demands of care and, consequently, must develop situational coping strategies. In this regard, this descriptive and cross-sectional study sought to identify the use of religious/spiritual coping by informal caregivers of children with acute lymphoid leukemia via the Brief Religious/Spiritual Coping (SRCOPE) scale. A total of 30 informal caregivers participated in the study, presenting high religious/spiritual coping (mean=3.90; SD=0.34) regarding positive methods (mean=3.67; SD=0.48). Finally, results show that mothers use religious/spiritual coping deal with the imposed demands for care, linked to the child's health condition. This reinforces the possibility of using spirituality and or religiosity as indicators of physical and mental well-being, since the quality of care is closely related to the caregivers' health.

Resumen Ante el diagnóstico y tratamiento de una enfermedad grave en niños como el cáncer, los padres, sobre todo las madres, tienden a asumir plenamente las demandas de cuidado, por lo que necesitan desarrollar estrategias de afrontamiento de la situación. Este estudio descriptivo y transversal tuvo por objetivo identificar el uso de coping religioso/espiritual en los cuidadores informales de niños con leucemia linfocítica aguda mediante la aplicación de la escala de coping religioso/espiritual breve. Participaron 30 cuidadores informales, quienes presentaron un alto coping religioso/espiritual (media=3,90; DE=0,34) en la modalidad positiva (media=3,67; DE=0,48). Se identificó que las madres utilizan coping religioso/espiritual para hacer frente a la demanda de cuidados que realizan, relacionada al estado de salud del niño. Esto refuerza la posibilidad de utilizar la espiritualidad y/o la religiosidad como indicadores de bienestar físico y mental, ya que la calidad de la asistencia prestada está relacionada directamente con la salud del cuidador.

Aspectos clínicos do câncer durante o período gestacional: desafios diagnósticos e terapêuticos / Clinical aspects of cancer during the gestational period: diagnostic and therapeutic challenges

O câncer é uma das maiores causas de morte em mulheres na idade reprodutiva e ocorre em aproximadamente 0,05% a 0,1% das gestações. Os cânceres ginecológicos, de mama, tireoide e hematológicos são os mais comuns na gravidez. O obstetra é o principal médico para investigar sintomas que podem estar relacionados à malignidade. O diagnóstico pode ser dificultado devido à sobreposição de sintomas da gravidez, como náusea, vômitos, aumento do útero e das mamas, dor abdominal, além da limitação para uso de exames de imagem e alterações comuns em exames laboratoriais. O risco e o benefício do diagnóstico e o tratamento para o bem-estar materno e fetal devem ser avaliados com cuidado pelos profissionais envolvidos. Este artigo tem como objetivo realizar uma revisão sobre quando suspeitar e como investigar os principais cânceres na gestação.(AU)

Cancer is the major cause of death in women on reproductive age and occurs in approximately 0.05% to 0.1% of pregnancies. Gynecological, breast, thyroid and hema- tological cancers are the most common in pregnancy. The obstetrician is the primary physician to investigate symptoms that may be related to malignancy. The diagnosis can be difficult due to the overlap of pregnancy symptoms, such as nausea, vomiting, enlargement of the uterus and breasts, abdominal pain, in addition to the limitation for the use of imaging tests and common changes in laboratory tests. The risk and be- nefit of diagnosis and treatment for maternal and fetal well-being should be carefully assessed by the professionals involved. This article aims to conduct a review on when to suspect and how to investigate the main cancers in pregnancy.(AU)

Oral manifestations of leukemia as part of early diagnosis

ABSTRACT Introduction: The oral cavity can present the first clinical manifestations of leukemia, therefore; it is important to recognize their principal characteristics. Objective: To identify oral manifestations as the first clinical signs of leukemia. Methods: This is an integrative review, that gathered data from articles with oral manifestations of leukemia as part of its first clinical features. The were included case reports, case series, clinical research, or reviews with case reports. The variables that were considered relevant: age, sex, sites of the oral lesions, characteristics of the oral lesions, medical history and physical examination, time of evolution, radiographic examination, blood test results, initial diagnosis, differential diagnosis and final diagnosis. Results: A total of 31 studies were included, with a total of 33 individuals identified. There were 19 (57.57%) males and 14 (42.42%) females. The age range was from 1.6 to 74 years. Acute myeloid leukemia (72.72%) and acute lymphoid leukemia (18.18%) presented more oral manifestations as the first clinical signs of the disease. All individuals with leukemia presented lesions, such as ulcer, erosion, bleeding, ecchymosis, color change of the bluish or pale mucous membranes and areas of tissue necrosis. Hard tissue lesions were less frequent, being 6 (18.18%). Conclusion: The first clinical manifestations of leukemia can be present in the oral cavity, mainly in acute myeloid leukemia. The principal oral tissues affected were gingival tissue, buccal mucosa and hard and/or soft palate. When hard tissues, such as the maxilla bone or mandible bone were affected, dental mobility was the principal clinical sign.

Virus de la leucemia e inmunodeficiencia felina: un estudio retrospectivo en clínicas veterinarias particulares en Bogotá y Chía (Colombia), 2015-2019 / Leukemia viruses and feline immunodeficiency: a retrospective study in private veterinary clinics in Bogotá and Chía (Colombia), 2015-2019

Resumen Los virus de inmunodeficiencia y leucemia felina representan un problema de gran envergadura para los felinos domésticos debido a la multiplicidad de sintomatologías que manifiestan. El objetivo del presente estudio fue establecer, retrospectivamente, la prevalencia en la presentación de ViLeF y VIF en pacientes de seis clínicas de pequeños animales en Bogotá y Chía, en relación con factores como su edad, raza y género. Se realizó un estudio transversal y retrospectivo, mediante la recopilación de datos de 1.014 historias clínicas de pacientes felinos que ingresaron a seis clínicas de la ciudad de Bogotá y Chía, para determinar la prevalencia de VIF y ViLeF y la asociación de estas con factores como edad, género y raza, entre 2015 y 2019, a través de la prueba OR. La detección de los virus se realizó mediante una prueba rápida basada en inmunocromatografía. La mayor prevalencia para cada enfermedad por año fue: 12,3% para VIF en 2012 y 18% para ViLeF en 2019. Los machos presentaron mayores seroprevalencias para ambas enfermedades durante la mayoría los años evaluados. Factores como raza (criolla: VIF: 1,85; ViLeF: 2,01), género (macho: VIF: 1,53 OR; ViLeF: 1,64) y edad (> 7 años: VIF: 3,82; ViLeF: 3,21) se relacionaron positivamente con la presentación de ambas enfermedades en la población felina evaluada.

Abstract Immunodeficiency virus and feline leukemia virus represent major problems for domestic felines due to the multiplicity of symptoms they manifest. The objective of the present study was to establish, retrospectively, the prevalence in the presentation of FeLV and FIV in patients from six small animal clinics in Bogota and Chia, related to factors such as age, race, and gender. A cross-sectional and retrospective study was carried out, collecting data from 1.014 clinical records of feline patients who were admitted to six clinics in the city of Bogota and Chia, to determine the prevalence of FIV and FeLV and their association with factors such as age, gender, and race, between 2015 and 2019 through the OR test. The detection of the viruses was carried out through a rapid test based on immunochromatography. The highest prevalence for each disease per year was 12,3% for FIV in 2012 and 18% for FeLV in 2019. Males presented higher seroprevalences for both diseases during most of the years evaluated. Factors such as race (Creole: FIV: 1,85; FeLV: 2,01), gender (male: FIV: 1.53 OR, FeLV: 1,64), and age (> 7 years: FIV: 3.82; FeLV: 3.21) were positively related to the presentation of both diseases in the feline population evaluated.

Calidad de vida en pacientes pediátricos tratados con quimioterapia por diagnóstico de leucemia linfoblástica aguda / Quality of life in pediatric patients treated with chemotherapy for the diagnosis of acute lymphoblastic leukemia

La leucemia es una patología neoplásica maligna que constituye un problema de salud que afecta fundamentalmente a la población infantil. Así, se realizó un proceso investigativo con el objetivo de describir la calidad de vida en pacientes pediátricos de LLA con edades entre 2 y 18 años, atendidos en 2019, en el Hospital Pediátrico Baca Ortiz y en el Hospital de Solca - Núcleo Quito, Ecuador; para lo cual se hizo un estudio observacional, transversal, descriptivo, con enfoque cuantitativo. Los datos fueron recopilados mediante la revisión de las historias clínicas de los 60 pacientes en el contexto de investigación. El 66,7% correspondió al sexo masculino, el 43,3% tenía edades entre 2 y 4 años, el 38,3% tuvo fiebre como síntoma inicial. El síndrome de Down resultó la comorbilidad más frecuente (6,7%). En 54 pacientes se diagnosticó LLA tipo B. El 66,7% recibía terapia psicológica, 22 de los enfermos estaban en la fase de inducción y mantenimiento. El 65% abandonó la escuela mientras se le administraba quimioterapia. Predomina-ron los que consideraron su calidad de vida como buena, seguido de los que tuvieron severa afectación. Las mayores afectaciones en los participantes fueron: dificultades con la alimentación, presencia de dolor, falta de comunicación, existencia de ansiedad y presencia de estrés por la preocupación debido a la posible infectividad del tratamiento.

Leukemia is a malignant neoplastic disease that constitutes a health problem that mainly affects children. Thus, this research aimed to describe the quality of life in pediatric ALL patients between 2 and 18 years of age, treated in 2019, at the Baca Ortiz Pediatric Hospital and at the Solca Hospital - Núcleo Quito, Ecuador. A cross-sectional, descriptive, and observational study with a quantitative approach. Data were collected by reviewing the medical records of the 60 patients in the research context. 66.7% were male, 43.3% were between 2 and 4 years old, 38.3% had fever as the initial symptom. Down syndrome was the most frequent comorbidity (6.7%). Type B ALL was diagnosed in 54 patients. 66.7% received psychological therapy. 22 of the patients were in the induction and maintenance phase. 65% dropped out of school while recei-ving chemotherapy. Those ones who considered their quality of life as good predominated, followed by those ones who were severely affected. The greatest effects on the participants were: difficulties with feeding, presence of pain, lack of communication, existence of anxiety and presence of stress due to worry due to the possible infectivity of the treatment.

Can SARS-CoV-2 induce hematologic malignancies in predisposed individuals? A case series and review of the literature

Abstract Introduction Coronavirus disease 2019 (COVID-19) may present with extrapulmonary manifestations, including hematologic changes. Previous studies suggest that severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) can interact with the renin-angiotensin system, ultimately causing increased production of angiotensin II. By reporting the cases of previously healthy young adults diagnosed with a hematologic malignancy after experiencing COVID-19, we raise the hypothesis that the SARS-Cov-2 infection could act as a trigger for leukemogenesis in predisposed individuals. Methods This was a case series performed through extraction of relevant clinical information from the medical records of three patients admitted to our Hematology unit between August 2020 and September 2020. Main Results Considering the relatively rapid development of cytopenias following recovery from COVID-19, it cannot be ruled out that SARS-Cov-2 played a role in leukemogenesis in those patients. Based on previous in vitro studies, the renin-angiotensin system imbalance induced by SARS-CoV-2 could potentially promote in vivo leukemogenesis through several mechanisms. Conclusion Despite the advances in pathophysiological and clinical characterization of COVID-19, the consequences of the pandemic to the incidence of hematologic diseases are still to be elucidated. In this context, future dissection of the status of the local bone marrow renin-angiotensin system in leukemogenesis is a clinically relevant basic research area.