Clinical characteristics of SARS-CoV-2 Omicron variant infection in children with acute leukemia.

Hematologic diseases and various therapeutic stages can impact the presentation of SARS-CoV-2 Omicron variant infection. This study retrospectively analyzed data on Omicron infection in children with acute leukemia treated at our hospital between January 16, 2023, and February 25, 2023, using questionnaires. The prevalence of Omicron infection in children undergoing consolidation chemotherapy, maintenance chemotherapy, drug withdrawal, and healthy children was 81.8%, 75.2%, 55.2%, and 61.9%, respectively. The observed differences were statistically significant (P < 0.05). During the course of infection, children with leukemia undergoing chemotherapy, including both the consolidation and maintenance chemotherapy groups, exhibited a prolonged time to achieve SARS-CoV-2 negativity compared to the drug withdrawal and healthy groups. However, there was no significant increase in the incidence of symptoms across all body systems, and no children experienced serious sequelae or death. Furthermore, our observations indicated that all manifestations of Omicron infection in children with leukemia after drug withdrawal were not significantly different from those in healthy children. This suggested, to a certain extent, that the immune function of children with leukemia recovers effectively after the cessation of drug treatment. These findings are crucial for guiding clinical management and alleviating concerns about infection for both children with leukemia and their parents.

Homoharringtonine-Based Induction Regimen Improved the Remission Rate and Survival Rate in Chinese Childhood AML: A Report From the CCLG-AML 2015 Protocol Study.

PURPOSE: Homoharringtonine (HHT) is commonly used for the treatment of Chinese adult AML, and all-trans retinoic acid (ATRA) has been verified in acute promyelocytic leukemia (APL). However, the efficacy and safety of HHT-based induction therapy have not been confirmed for childhood AML, and ATRA-based treatment has not been evaluated among patients with non-APL AML. PATIENTS AND METHODS: This open-label, multicenter, randomized Chinese Children's Leukemia Group-AML 2015 study was performed across 35 centers in China. Patients with newly diagnosed childhood AML were first randomly assigned to receive an HHT-based (H arm) or etoposide-based (E arm) induction regimen and then randomly allocated to receive cytarabine-based (AC arm) or ATRA-based (AT arm) maintenance therapy. The primary end points were the complete remission (CR) rate after induction therapy, and the secondary end points were the overall survival (OS) and event-free survival (EFS) at 3 years. RESULTS: We enrolled 1,258 patients, of whom 1,253 were included in the intent-to-treat analysis. The overall CR rate was significantly higher in the H arm than in the E arm (79.9% v 73.9%, P = .014). According to the intention-to-treat analysis, the 3-year OS was 69.2% (95% CI, 65.1 to 72.9) in the H arm and 62.8% (95% CI, 58.7 to 66.6) in the E arm (P = .025); the 3-year EFS was 61.1% (95% CI, 56.8 to 65.0) in the H arm and 53.4% (95% CI, 49.2 to 57.3) in the E arm (P = .022). Among the per-protocol population, who received maintenance therapy, the 3-year EFS did not differ significantly across the four arms (H + AT arm: 70.7%, 95% CI, 61.1 to 78.3; H + AC arm: 74.8%, 95% CI, 67.0 to 81.0, P = .933; E + AC arm: 72.9%, 95% CI, 65.1 to 79.2, P = .789; E + AT arm: 66.2%, 95% CI, 56.8 to 74.0, P = .336). CONCLUSION: HHT is an alternative combination regimen for childhood AML. The effects of ATRA-based maintenance are comparable with those of cytarabine-based maintenance therapy.

Study on predictive factors of blood culture results in leukemia patients with fever during chemotherapy.

Infection is a common complication of leukemia patients undergoing chemotherapy. Blood culture results are often needed to guide clinical use, but repeated sampling is often necessary to improve the positive rate and eliminate contamination. The purpose of this paper is to find predictive factors of blood culture results among clinical and laboratory indicators and try to establish a prediction model, so as to better choose the time of blood culture examination, predict the results, and better guide clinical treatment. We retrospectively collected clinical and laboratory data of febrile acute leukemia patients undergoing chemotherapy. The samples were randomly assigned to the training set and the validation set, and the prediction model was constructed from the training set. The calibration curve was made in the validation set and the Hosmer-Lemeshow test was performed to evaluate the prediction performance of the prediction model. A total of 229 patients were included. Univariate and multivariate analyses suggested that temperature at fever and procalcitonin were variables of significant difference between positive and negative blood culture patients. The sensitivity of the 2 variables for predicting blood culture results was high, but the specificity was low. In the process of external validation, the predictive ability of the constructed prediction model to the blood culture results was low. This study identified clinical and laboratory parameters associated with blood culture outcomes, but the predictive model established has low predictive accuracy in external validation.

Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia during remission induction chemotherapy: a single-center retrospective study.

BACKGROUND: This study investigated the clinical characteristics, cranial magnetic resonance imaging (MRI) features, MRI follow-up, and prognosis of children with acute lymphoblastic leukemia (ALL) who developed posterior reversible encephalopathy syndrome (PRES) during remission induction chemotherapy. METHODS: We analyzed the age, gender, PRES symptoms and signs, cranial MRI findings, therapeutic effect, and prognosis of children with ALL who developed PRES during chemotherapy from January 2010 to December 2013 at the Hematology Oncology Center of Beijing Children's Hospital. Changes in cranial MRI findings were analyzed, and intelligence (IQ) and cognitive function were evaluated using the Wechsler Scale and the Wisconsin Card Score Test after the children completed chemotherapy. RESULTS: There were 850 children with newly diagnosed ALL in this period; 13 (1.5%), 6 boys and 7 girls, developed PRES. All were diagnosed as B-cell ALL. The median age at PRES onset was 7 years (2-11 years). The median day of PRES onset was day 28 (day 17-34) of remission induction chemotherapy. Of the 13 children with PRES onset and seizures, 4 had visual disturbances and 2 had consciousness disturbances. Cranial MRI showed hyperintensity in the subcortical white matter on T2-weighted axial and fluid-attenuated inversion recovery (FLAIR) images. The lesion locations were as follows: occipital lobe, 12 (92.3%) patients; frontal lobe, 7 (53.8%) patients; temporal lobe, 5 (38.4%) patients; parietal lobe, 3 (23.1%) patients; and cerebellum, 1 (7.7%) patient. There were 8 (61.5%) patients with vasogenic edema and 5 (38.5%) with cytotoxic edema. After treatment, all children recovered within one month, when their PRES symptoms were relieved, they continued to receive chemotherapy. However, 1 child (1.07%) died of severe central nervous system infection one year after PRES treatment, and 3 (25%) had recurrent seizures and were diagnosed with epilepsy after three months of PRES treatment. Their cranial MRIs showed cytotoxic edema, which was acute stage on day 15, with aggravated lesions on cranial MRI. The cranial MRI lesions returned to normal at one month in 3 (23.1%) patients, at three months in 6 (46.1%) patients, at one year in 8 (61.5%) patients, and at two years in 12 (92.3%) patients. The 12 surviving children all returned to school, and their full-scale, verbal, and performance IQs were normal, with no significant differences in intelligence or cognitive function compared with children with ALL without PRES during the same period. CONCLUSIONS: PRES can occur during remission induction chemotherapy treatment of children with ALL, but the incidence is low. Cranial MRI can be used for diagnosis and to characterize lesions. The children recover about a month after treatment, and cranial MRI lesions return to normal within two years. The time for complete resolution of MRI lesions differs, and children with cytotoxic edema have worse prognosis with sequelae, such as epilepsy, which requires close monitoring. PRES does not affect intelligence or cognitive development.

Corrigendum: Blinatumomab for treating pediatric B-lineage acute lymphoblastic leukemia: A retrospective real-world study.

[This corrects the article DOI: 10.3389/fped.2022.1034373.].

Blinatumomab for treating pediatric B-lineage acute lymphoblastic leukemia: A retrospective real-world study.

Objectives: Blinatumomab was shown to be safe and effective for consolidation therapy in B-cell acute lymphoblastic leukemia (B-ALL). This study aimed to investigate the effectiveness and safety of blinatumomab in pediatric B-ALL patients in a real-world setting. Methods: This was a retrospective, observational study that included patients who initiated blinatumomab treatment between October 1, 2020 and June 20, 2022. Patients with B-ALL diagnosis, age below 18 years, and at least one blinatumomab treatment cycle were included. Treatment-related toxicities were assessed. Result: Totally 23 pediatric patients were included in this study, with a median age of 6 years (range, 2 to 11 years). Blinatumomab therapy was applied for MRD-positive (disease ≥0.01%, n = 3) or chemotherapy-ineligible (n = 20) B-ALL cases. The median follow-up time was 9 months, and all evaluable patients achieved complete molecular remission with undetectable MRD. Four relapsed B-ALL cases proceeded to hematopoietic stem cell transplantation (HSCT) without further bridging therapy, while the others underwent maintenance chemotherapy after blinatumomab treatment. Grade ≥3 febrile neutropenia, white blood cell decrease and seizure were observed in 57%, 48% and 4.3% of patients, respectively. One case discontinued therapy due to neurologic toxicities. Elevated cytokine levels were observed in 4 patients. In all 23 patients, increased T-cell and low B-cell counts (<10/µl) were detected during blinatumomab therapy. Conclusion: These encouraging results suggest blinatumomab in pediatric B-ALL patients with MRD+ or chemotherapy-related toxicities is effective and safe in the short run, although long-term follow-up is still needed.

Enteral nutrition for children with acute leukemia-related pancreatitis.

OBJECTIVE: Pancreatitis in children with acute lymphoblastic leukemia and acute myeloid leukemia may cause discontinuation of chemotherapy, thus adversely affecting treatment outcomes. Enteral nutrition (EN) is recommended for acute pancreatitis. The optimal use of EN for leukemia-related pancreatitis is under debate. The aim of this study was to determine the clinical efficacy of EN for children with leukemia-related pancreatitis. METHODS: Medical records of 53 children with characteristics of leukemia-related pancreatitis were abstracted retrospectively. Considering specific outcome variables, the EN-associated factors improving treatment were analyzed. Enzyme and albumin changes during the 14-day follow-up period were also analyzed, to test for the safety of EN. RESULTS: Early EN was found to be a protective factor from secondary infection and significant weight loss. Jejunal EN was related to higher risk for enzyme elevation relapse compared with oral EN. Patients with severe pancreatitis had lower risk for significant weight loss but higher risk for abnormal glucose levels than their counterparts. EN type had a significant effect on lipase change, and early EN had interactive effects by time on amylase and lipase changes. CONCLUSIONS: Early EN within 7.5 days could reduce the risk for secondary infection and significant weight loss for pediatric leukemia-related pancreatitis, with decreased serum amylase and lipase levels, in a safe and effective manner. Beneficial effects of EN within 72 h were not observed.

Long-term follow-up of children with acute promyelocytic leukemia treated with Beijing Children's Hospital APL 2005 protocol (BCH-APL 2005).

We studied the outcomes of children with APL treated by the Beijing Children's Hospital's (BCH) acute promyelocytic leukemia (APL) 2005 protocol (BCH-APL2005). The clinical data of 77 patients enrolled from January 2005 to June 2015 were analyzed retrospectively. The hematologic complete remission (CR) rate and overall survival (OS) rate were evaluated between standard-risk (SR) and high-risk (HR) groups. Prognostic factors and complications were investigated in these two groups. CR in the SR and HR groups was 96.4% (54/56) and 85.7% (18/21), respectively, while the 10-year OS was 94.6% (53/56) and 76.2% (16/21), respectively. The cumulative incidence of early death was 6.5% (5/77), and the SR and HR groups were 1.8% (1/56) and 19.0% (4/21), respectively. Only two patients relapsed, and the relapse rate was 2.6% (2/77). According to Kaplan-Meier analysis, the SR group had a significantly better long-term survival than HR counterparts (p= .016). Initial leukocyte count was the only prognostic factor (p= .016) by univariate analysis, while other factors, such as FLT3-ITD and platelet count, had no correlation with prognosis. In addition, early deaths were mainly due to intracranial hemorrhage. Although the combination of all-trans retinoic acid (ATRA) and chemotherapy can improve the outcome of APL patients, the early deaths and anthracycline-related cardiac toxicity were relatively higher in our study. Current efforts focus on reducing or even avoiding chemotherapy in APL children and rest on the frontline regimen of intravenous arsenic trioxide or oral realgar-indigo naturalis formula plus ATRA, which is the direction for APL treatment.

Comparison among immunologically different subtypes of 595 untreated multiple myeloma patients in northern China.

BACKGROUND: Generally, characteristics of heterogeneous multiple myeloma (MM) have been described as a whole. Actually, isolated immunologic subtypes of MM may be associated with prognostic significance. PATIENTS AND METHODS: The aim of this retrospective single-center study was to determine the characteristics of immunologically different subtypes among 595 evaluable cases with previously untreated MM in northern China. RESULTS: The major distribution of MM subtypes were immunoglobulin (Ig)G, 47.9%; IgA, 23.3%; and light-chain, 21.0%. Nonsecretory, IgD, and biclonal subtypes were rarely seen, comprising only 7.7%. The male-to-female ratio was 1:7, and the median age was 59 years. In the IgG subtype, more patients presented with elevated M protein, fulfilling the major diagnostic criteria determined by Durie, and infection occurred more frequently; however, the prognosis was favorable. In the IgA subtype, in which survival was significantly poorer, the extent of anemia was more severe, and nonhyperdiploid abnormality may be its adverse indicator. In the light-chain subtype, the mean level of serum IL-6 was the highest, and more patients presented with advanced renal dysfunction, bone destruction, and thrombocytopenia. However, more light-chain patients were staged at International Staging System I, partially resulting in the favorable median survival of 51 months (almost equivalent to 50 months with the IgG subtype). Another rare subtype with unfavorable outcome was IgD myeloma, in which the median age was 50 years, and the serum calcium level was significantly decreased. Intriguingly, we also noted that more patients presented hypocalcemia than hypercalcemia (37.7% vs. 15.7%) in the current series. Multivariate analysis revealed that independent adverse indicators included age > 50 years, Durie-Salmon stage III, and increased values of C-reactive protein and beta2-microglobulin. CONCLUSION: The median duration of survival in MM reached 36.0 months. Distinctions among immunologically different subtypes can predict prognostic significance, namely, favorable in IgG and light-chain subtypes but significantly poorer in IgA and IgD subtypes.

[Effect of human umbilical cord mesenchymal stem cells on the CD34+ cells transplantation in NOD/SCID mice].

OBJECTIVE: To study the effect of human umbilical blood (UB) mesenchymal stem cells (MSC) on the CD34(+) cells transplantation in NOD/SCID Mice. METHODS: Umbilical blood CD34(+) cells (3.5 x 10(5) cells) alone or combined with umbilical cord MSC cells were transplanted into NOD/SCID mice that had been irradiated with (137)Cs (3.0 Gy) before transplantation. Changes in peripheral blood cells within 6 post-transplantation weeks were detected. The mice were sacrificed 6 weeks after transplantation. The human hematopoietic cells (hCD45(+)) and multi-lineage engraftment cells (CD3/CD19, CD33, CD14, CD61, and CD235a) in NOD/SCID recipients bone marrow, spleen, and peripheral blood were analyzed by flow cytometry. RESULTS: In the 3rd post-transplantation week, white blood cells (WBC), platelets (PLT), and red blood cells (RBC) began to increase in both two groups. In the 6th post-transplantation week, WBC and PLT counts in CD34(+) + MSC group reached peak levels and were significantly higher than CD34(+) alone group (P < 0.05), while RBC level was not significantly different between these two groups P > 0.05). hCD45(+) cell levels in bone marrow and peripheral blood were (42.66 +/- 2.57) % and (4.74 +/- 1.02) % in CD34(+) + MSC group, which were significantly higher than those in CD34(+) alone group [(25.27 +/- 1.67) % and (1.19 +/- 0.54) %, respectively, P = 0.006]. Also in the 6th post-transplantation week, the proportions of CD19(+), CD33(+), CD14(+), CD61(+), and CD235a(+) in CD34(+) + MSC group were significantly higher than those in CD34(+) alone group (P < 0.05), while the proportion of CD3(+) T lymphocyte in CD34(+) + MSC group was significantly lower than that in CD34(+) alone group (P = 0.003). The amplification of CD19(+) B lymphocyte was significantly higher than other blood cell lineages (P < 0.05). CONCLUSION: The co-transplantation of MSC cells and CD34(+) cells can promote hematopoietic stem cell transplantation and hematopoietic recovery in vivo.

[Study of influence of umbilical cord mesenchymal stem cells on CD34+ cells in vivo homing in NOD/SCID].

OBJECTIVE: To investigate the effect and the potential mechanism of umbilical cord (UC) derived mesenchymal stem cells (MSCs) on umbilical cord blood (UCB) derived CD34+ cells in vivo homing in xenotransplanted NOD/SCID mice model. METHODS: CD34+ cells and MSCs were derived from fresh UCB and UC, respectively. CD34+ cells (5 x 10(5) per mice) and MSC cells (5 x 10(6) per mice) were co-transplanted into irradiated NOD/SCID mice intravenously. CD34+ cells (5 x 10(5) per mice) alone were transplanted into the mice as control group. CD34+ cells home in bone marrow and spleen of recipient mice were detected 20 hours after transplant by FACS and RT-PCR, and the homing efficiencies were calculated. The effect of MSCs on CD34+ cells chemotactic function was investigated after co-cultured UCB CD34+ cells with UC MSCs in vitro. After 4 and 7 days coculture, the homing related adhesion molecules (the CD49e, CD31, CD62L, CD11a) expressed on CD34+ cells were detected by FACS. RESULTS: 1) The homing efficiencies in bone marrow in experimental and control group were (7.2 +/- 1.1)% and (5.4 +/- 0.9)%, respectively (P < 0.05). 2) Human GAPDH gene was detected in bone marrow in experimental group and in spleen in both groups. 3) The migration efficiency of CD34+ cells was significantly higher in experimental group (35.7 +/- 5.8)% than in control group (3.5 +/- 0.6)% (P < 0.05). 4) The expression of CD49e, CD31, CD62L on CD34+ cells kept higher level in MSCs cocultured group than in CD34+ cells alone group. CONCLUSIONS: MSCs can efficiently increase homing of CD34+ cells to bone marrow and spleen in vivo by keeping a high level of homing adhesion molecules expression and improving migration efficiency of UCB CD34+ cells.

[The efficacy of thalidomide for multiple myeloma: a clinical analysis of 102 Chinese patients].

OBJECTIVE: To analyse the efficacy and safety of thalidomide (Thal) for patients with multiple myeloma (MM). METHODS: Effectiveness and adverse events of 102 MM patients treated with thalidomide at a median dosage of 200 mg/d. Thirteen cases were treated with Thal alone (group A), and 105 case with Thal in combination with other therapeutic agents (group B) were retrospectively analyzed. RESULT: 1) The response rate (RR) (CR + PR) was 65.4% for induction therapy in 52 cases and 45.5% for salvage therapy in 66 cases. RR in group B was higher than that in group A (58.1% versus 23.1/%, P= 0.017), and the non-response/progress (NR) rate was lower (15.2% versus 46.2%, P= 0.015). In group B, the NR rate was lower in 50 cases of newly diagnosed MM than in 55 cases of refractory or relapsed MM (6.0% versus 23.6%, P=0.012). In group B, RR between Thal+VAD or M, regimen (72 cases) and Thal + MP regimen (33 cases) was not statistically significant (62.5% versus 48.5%, P >0.05). 2) The median duration of response maintenance was 15.5 (1.0-58.0) months in 21 cases. 3) Among 97 patients with follow-up data, the estimated median duration of OS was 44 months in a median follow-up duration of 20 months and the accumulative time for use of Thal was 8 months. In univariate analysis,the accumulative duration for use of Thal 6 months, hemoglobin > or = 100 g/L and bone marrow megakaryocytes > 20 per smear were associated with longer OS (P = 0.0014, 0.0101, 0.019, respectively). 4) Multivariate analysis suggested that the accumulative time for use of Thal and bone marrow megakaryocytes > 20 were independent good prognostic factors for OS (P = 0.006, 0.036, respectively). 5) The adverse events of Thal were mostly endurable, the rate of thrombus events was lower than that reported in literature. CONCLUSION: Thalidomide alone or combined with chemotherapy is an useful therapy for MM. The accumulative time for use longer than 6 months may improve survival.

[The analysis of prognostic variables in 123 patients with multiple myeloma].

OBJECTIVE: To assess the prognostic value of biological features and therapy-related factors in multiple myeloma (MM). METHODS: 123 patients with newly diagnosed MM between January 1998 and May 2005 were enrolled in this retrospective study. Biological features at presentation and therapy-related factors were analysed. The overall survival (OS) and time to progression (TTP) were estimated by Kaplan-Meier analysis and the distribution of OS and TTP were compared using log-rank test. Cox regression was used to identify the independent prognostic factors. RESULTS: (1) The univariate analysis indicated that more immature plasma cells in bone marrow biopsy, C-reactive protein >8. Omg/L, CD117 expression, serum beta2-microglobulin (beta2-MG) (3.5 approximately 5.5 mg/L), abnormal cytogenetics aberration of chromosome 13 (Delta13), hypodiploid, poor response to chemotherapy, interferon(IFN) therapy less than 6 months were associated with shorter OS(P <0.05). Lytic bone lesions at presentation, more immature plasma cells in bone marrow biopsy, serum beta2-MG (3.5 approximately 5.5 mg/L), poor response to chemotherapy, and IFN therapy less than 6 months as well as abnormal cytogenetics, hypodiploid and Delta13 were associated with shorter TTP (P <0.05). (2) Multivariable COX analysis indicated IFN therapy more than 6 months was a protective factor for OS and TTP, and more immature plasma cells in bone marrow biopsy was an independent poor prognostic factor for TTP. CONCLUSION: The morphology of myeloma cells is useful for assessing the prognosis. And IFN therapy more than 6 months could lengthen OS and TTP.