Prognostic effect of blood transfusion in children with acute lymphoblastic leukemia.

BACKGROUND: Most children with acute lymphoblastic leukemia (ALL) receive blood transfusions. Transfusions may affect ALL outcomes through transfusion-related immunomodulation (TRIM). METHODS: We analyzed overall survival (OS) and event-free survival (EFS) in relation to leukocyte reduced and irradiated (LR/IRR) blood products transfused during the induction phase in 136 children with ALL. Hazard ratios (HRs) for death and relapse were estimated through Cox regression analysis. RESULTS: One hundred and twenty patients (89%) were transfused with packed red blood cells (PRBCs) and 79 (58%) with single donor platelets (SDPs). The median number of transfusions was 2 (interquartile range [IQR]=1-3 events) and 1 (IQR=0-3 events) for PRBCs and SDPs, respectively. Patients who had white blood cell (WBC) count >50,000×10(9)/L, were classified as high risk according to the high National Cancer Institute criteria, displayed a T cell phenotype, or were minimal residual disease-positive at end of induction were more likely to receive >3 transfusions during induction (P=0.001, 0.002, 0.03, and 0.01, respectively). In univariate analysis, PRBC, SDP, and fresh frozen plasma transfusions did not have any significant association with relapse or death. For PRBC transfusions, the HRs for EFS and OS were 1.02 (95% CI, 0.85-1.24; P=0. 76) and 1.03 (95% CI, 0.83-1.27; P=0.76), respectively. For SDP transfusions, HRs were 1.03 (95% CI, 0.90-1.18; P=0.64) and 0.98 (95% CI, 0.80-1.20; P=0.87) for EFS and OS, respectively. CONCLUSION: LR/IRR blood products may not confer a TRIM effect in childhood ALL and are unlikely to affect outcome.

A prospective study of febrile neutropenia in pediatric cancer patients in Jordan.

OBJECTIVE: To describe the characteristics and clinical course of febrile neutropenia (FN) in pediatric patients admitted to a comprehensive cancer center in Jordan. METHODS: This is a 6-month prospective observational study. Patients admitted with FN were identified. Patient demographics, duration since last chemotherapy, use of granulocyte colony-stimulating factor, presence of central lines, transfer to the intensive care unit, length of hospital stay, mortality, and the results of all cultures were recorded. RESULTS: One hundred and nine episodes for 88 patients were included, with a median age of 6 years (range, 1 to 19 y) and 55% were females. Median duration since last chemotherapy was 7 days (range, 1 to 33 d); median duration of hospital stay was 7 days (range, 1 to 81 d). Transfer to the intensive care unit was required for 11% of episodes, and there were no deaths. Positive cultures were reported in 18.4% episodes. Pathogens isolated were gram-positive organisms (50%), gram-negative organisms (20%), viral (25%), and fungal (5%). Positive blood cultures were significantly more in episodes with central lines compared with those with no central lines (P=0.04). CONCLUSIONS: FN episodes had favorable outcomes and were mostly associated with negative cultures. There were differences between the microbiologic profiles reported in this study, compared with what has been previously described.

Chylopericardium and chylothorax: unusual mechanical complications of central venous catheters.

Obstruction and thrombosis of major systemic veins can occur due to indwelling central venous catheters. If obstruction of the innominate vein or superior vena cava occurs, lymphatic drainage can be impaired due to an increase in pressure in the thoracic duct and lymphatics. We describe a case where superior vena cava syndrome, chylopericardium and chylothorax occurred in a 16-year-old girl due to an indwelling central venous catheter. This was successfully treated with removal of the line, anticoagulation and angioplasty of the innominate vein and superior vena cava.

Hematopoietic stem cell transplant versus chemotherapy plus tyrosine kinase inhibitor in the treatment of pediatric Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL).

BACKGROUND: Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) remained until recently the molecular genetic abnormality associated with the worst outcome. Hematopoietic stem cell transplant (HSCT) was considered the treatment of choice, however, recent data have indicated that chemotherapy plus tyrosine kinase inhibitor (TKI) maybe an alternative effective therapy. METHODS: We conducted a retrospective analysis of children (<18 years) with Ph+ ALL who were treated at King Hussein Cancer Center (KHCC) from January 2003 till December 2011. RESULTS: Over a 9 year period, 411 children were diagnosed and treated for ALL at KHCC. Twenty three (6.6%) had Ph+ ALL; 16 males and 7 females. Median age at diagnosis was 9.5 years (range 1.67-17). The median white blood cell count was 58.6×10(3)/µL (range 1.6-459). Twelve patients underwent HSCT from a full matched related donor; and 10 were treated with intensive chemotherapy plus TKI (imatinib). Those who underwent HSCT were significantly older (P=0.004) and had a higher leukocyte count at diagnosis (P=0.53). After a median follow up of 42.2 months (range 12.7-107), the estimated 5 year event free survival (EFS) and overall survival (OS) were 75% and 91.6%, respectively, for those who underwent HSCT as primary therapy and 49.3% and 83.3%, respectively, for those treated with chemotherapy plus imatinib. There was no significant difference in EFS (P=0.98) or OS (P=1) between the two treatment modalities. CONCLUSIONS: Our results indicate that chemotherapy plus TKI may be a reasonable treatment option for some children with Ph+ ALL.

Publication bias in pediatric hematology and oncology: analysis of abstracts presented at the annual meeting of the American Society of Pediatric Hematology and Oncology.

Publication bias (PB) is a threat to the validity of medical literature, and has not been studied in the field of pediatric hematology/oncology. We analyzed the abstracts presented at the 2005 American Society of Pediatric Hematology/Oncology annual meeting to assess for PB. Abstracts were categorized by type of research, number of centers, funding status, presentation format, sample size, statistical significance, and the direction of results. Publication status was determined by searching PubMed. Thirty nine abstracts (51%) were categorized as clinical studies, 67 (36%) as basic research, and 24 (13%) as others. One hundred and twenty three abstracts (67%) were considered to have positive results, 14 (8%) negative results, and 47 (25%) with neutral or not stated results. About 62% of the abstracts were published in peer-reviewed journals at a median time to publication of 19 months (IQR = 11-29 months). Abstracts with positive results were more likely to get published than others (combined negative and neutral results) (P = .002). Factors like sample size, number of centers, or statistical significance reporting did not affect the publication rate. Our data suggests the existence of PB in the field of pediatric hematology/oncology. Still, further analysis of other international meetings is needed to validate our findings.

6-Mercaptopurine-induced recurrent acute pancreatitis in children with acute lymphoblastic leukemia/lymphoma.

Two children with acute lymphoblastic leukemia/lymphoma developed recurrent acute pancreatitis during treatment; the etiology was presumed to be secondary to 6-mercaptopurine (6MP). Both had no further attacks after discontinuation of 6MP. Acute pancreatitis secondary to 6MP is extremely rare in acute leukemia/lymphoma although it has been reported in patients with other conditions like inflammatory bowel disease; the reason for this difference is not clearly understood.

Indeterminate lupus anticoagulant results: Prevalence and clinical significance.

BACKGROUND: Reports of indeterminate lupus anticoagulant (LAC) results are common; however, no published data on their prevalence or clinical significance are available. We investigated the prevalence and clinical characteristics of patients with indeterminate LAC. METHODS: We retrospectively reviewed the clinical and serologic characteristics of 256 unselected patients with LAC results. RESULTS: Indeterminate results were observed in 32.7% of LAC profiles that were least frequent (25.4%) when activated partial thromboplastin time (aPTT) was normal, most frequent (39.8%) when aPTT was elevated, and were observed in 35% of patients taking warfarin. The final indeterminate LAC cohort included 65 patients with a mean follow-up of 18 months. Malignancy and autoimmune disease were present in 29% and 25% of patients, respectively. The most common thrombotic events were deep vein thrombosis (DVT) (28%), cerebral ischemic stroke (14%) and pulmonary embolism (14%). Patients with indeterminate results were more likely to be men, older, and with a history of DVT, superficial thrombosis, or myocardial infarction than patients with negative tests (N=106). Concurrent warfarin therapy was more prevalent in the indeterminate group, but was not statistically significant. In the multivariate analysis, none of the variables showed statistical significance. During follow-up, 10 of 16 patients with indeterminate results showed change in classification upon retesting. CONCLUSION: Patients with indeterminate LAC results were common, and their clinical characteristics differed from those with negative results. There is a need for a prospective study of the clinical history of patients with indeterminate LAC results.