ABSTRACT
OBJECTIVE: Understanding the clinical and genetic characteristics of pediatric acute lymphoblastic leukemia (ALL)
patients may help assigning the appropriate treatment. This study aims to understand patients' characteristics, "real-world"
treatment practice and outcomes of pediatric ALL. METHODS: A cohort of 213 pediatric ALL patients, treated at (King
Faisal Specialist Hospital and Research Center -Jeddah branch) KFSH and RC-J during the period of January 2002 to
December 2015 were analyzed retrospectively. Statistical analyses were performed on patients' demographic, clinical
and genetics characteristics and outcomes of different treatment protocols. Survival was evaluated using Kaplan-Meier
method, and differences in survival were tested using Log-Rank. Significance was set at 0.05 level. RESULTS: Median
age of the study cohort was 5 years (range 0.5-15 years) with 55.4% of male population. Majority of the patients had
pre-B-cell ALL (88.7%), WBC count <50, 000/µL at diagnosis (76.1%, median = 13.5/µL with a range of 0.51-553.0/
µL) with involvement of central nervous system (CNS) disease in 8.5%patients.Different common chromosomal
anomalies or abnormalities, including t(12, 21) translocation, MLL genre arrangements, trisomy (4, 10, 17)and others,
were detected. Early response to the risk-directed treatment received by the patients (91.1% achieving <5% blast in
the bone marrow) as well as the end of induction outcome (96.2%) was encouraging. CONCLUSION: We found that the
patients' clinical characteristics and distribution of genetic abnormalities were similar to those of the western countries.
Our findings show that the earlier gap between the western countries and KSA in terms of survival has been closed and
that competitive outcomes can be achieved with local infrastructure.
Subject(s)
Antineoplastic Agents/therapeutic use , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Adolescent , Bone Marrow/drug effects , Child , Child, Preschool , Chromosome Aberrations/drug effects , Female , Humans , Infant , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics , Retrospective Studies , Saudi Arabia , Translocation, Genetic/drug effects , Translocation, Genetic/geneticsABSTRACT
Atypical teratoid rhabdoid tumors (ATRTs) are rare and aggressive central nervous system tumors that infrequently arise in spinal locations in young children. Provided clinical and diagnostic suspicion is high, the histopathological diagnosis is relatively straightforward to secure by testing for the characteristic loss of the tumor suppressor protein SMARCB1/INI1. Here, we describe a case of thoracic spinal ATRT in a three-year-old boy that showed characteristic aggressive progression until managed with intensive multimodal therapy to achieve durable long-term remission. In doing so, we review the histopathological features, management, and current advances in molecular biology that hold promise for personalized ATRT therapy.
ABSTRACT
Langerhans cell histiocytosis (LCH) can involve multiple organs. "Primary" or isolated pulmonary LCH is a well-described entity in young adults but is exceedingly rare in children younger than 15 years of age. The authors report a new case in a 2-year-old girl and review other reported cases in the pediatric population. The patient had had respiratory symptoms since early infancy suggestive of hyperactive airway disease. At 2 years of age, she had severe pulmonary insufficiency with remarkable cystic changes noted on chest imaging studies. Biopsy of a pulmonary lesion confirmed the diagnosis of LCH. She had no other organ involvement. Pulmonary histiocytosis, though rare, should be considered in any child with chronic respiratory disease such as bronchial asthma, especially when the response to anti-asthma treatment is poor and/or there are cystic changes on the chest x-ray.
Subject(s)
Bronchial Hyperreactivity/diagnosis , Diagnostic Errors , Histiocytosis, Langerhans-Cell/diagnosis , Lung Diseases/diagnosis , Respiratory Insufficiency/etiology , Aorta, Thoracic/abnormalities , Child, Preschool , Dyspnea/etiology , Fatal Outcome , Female , Histiocytosis, Langerhans-Cell/complications , Histiocytosis, Langerhans-Cell/diagnostic imaging , Histiocytosis, Langerhans-Cell/pathology , Humans , Laryngeal Diseases/diagnosis , Lung Diseases/complications , Lung Diseases/diagnostic imaging , Lung Diseases/pathology , Radiography , Respiratory Distress Syndrome/etiology , Respiratory SoundsABSTRACT
Marble brain disease, also known as Guibaud-Vainsel syndrome, is a syndrome consisting primarily of renal tubular acidosis, cerebral calcification and osteopetrosis. The majority of reports originate from the Middle East. It is an autosomal recessive condition owing to carbonic anhydrase type II deficiency in renal and brain cells with a variant form of osteopetrosis. We report two siblings with this condition from Saudi Arabia. Both cases improved in both somatic growth and mental development after commencing treatment for renal tubular acidosis in the form of alkaline therapy and potassium supplementation.
