Clinical Features and Long-term Outcomes of Infant Leukemias: A Review of Ten-Years' Experiences / 대한소아혈액종양학회지

PURPOSE: Infant leukemia is rare and accounts for 5% of leukemia in children. It differs from childhood leukemia in biologic and clinical features and has a poor prognosis. Research on infant leukemia is difficult due to the scarcity of cases. We studied the clinical progress and prognosis of infant leukemia diagnosed in our hospital, in order to contribute to the treatment and prognosis of infant leukemia. METHODS: The patients who were diagnosed with leukemia in the first 12 months of life were analysed between January 1991 and December 2000 in Yonsei Medical Center. We analysed the sex, age, clinical features, treatment outcome, prognostic factor, and survival rate. RESULTS: Among a total of 41 cases, 19 cases were diagnosed with acute lymphoblastic leukemia (ALL), 15 cases with acute myelogenous leukemia (AML), 2 cases with chronic myelogenous leukemia (CML), and 5 cases were unclassifed. Twenty-two were males and 19 females; age at diagnosis was 4 months in ALL, 8 months in AML, and 4 months in CML. Common clinical features at diagnosis were pale appearance and fever, others were poor oral intake, abdominal distension, and irritability. Hyperleukocytosis with average over 20,000/mm3, anemia, and thrombocytopenia were seen. By immunologic surface marker analysis, 8 of 15 B-lineage ALL were CALLA negative, early pre-B ALL. The remission induction rate was 79% in ALL and 60% in AML. The 5 year-survival rate of 41 patients was 29.2%. Sex, age at diagnosis, white blood cell count > 50 109/L, hepatomegaly, and CNS involvement were not prognostic factors. CONCLUSION: Infant leukemia differs from childhood leukemia in biological and clinical features and has a poor prognosis. Therefore, further clinical research is needed to improve the outcome of infant leukemia.

Chromosomal Analysis in Childhood Leukemia / 대한소아혈액종양학회지

PURPOSE: Chromosomal analysis has been helpful not only in pathophysiology of leukemia, but diagnosis, classification, management and predicting prognosis. However, little has been studied on chromosomal abnormality of pediatric leukemia in Korea. We have performed chromosomal analysis on childhood leukemia that we experienced, and tried to correlate chromosomal abnormalities with various types of leukemia. METHODS: Subjects were 28 of 84 patients diagnosed with leukemia and have been discovered to have chromosomal abnormalities on chromosomal analysis employing G-banding technique in Yonsei medical center from July 1996 to February 1999. RESULTS: Of the total 84 patients, Acute lymphocytic leukemia (ALL) accounted for 51 cases (61%), Acute myelocytic leukemia (AML), 30 cases (35%), Chronic myeloid leukemia (CML), 3 cases (4%). Chromosomal analysis in ALL: Of 51 cases, 9 cases (18%) showed chromosomal abnormality. Their mean age at diagnosis was 5.6+/-5.1 years. One case (12%) exhibited hyperploid (> 50 chromosomes), 4 cases (44%) pseudodiploid, and marginally-hyperdiploid was seen in 4 cases (44%). Structural abnormality involving translocation was seen in 6 cases, where t(3;9), t(4;11), t(12;?) 1 case respectively, del (13) 2 cases, and I (q9) 1 case. Chromosomal abnormality in AML: Of total 29 cases, 17 cases (55%) were found to have chromosomal abnormalities, with their mean age ranging 7.6+/-6.4 years. t(8;21) was found to be the largest, accounting for 5 cases, and t(15;17), t(1;22), t(1;11), t(10;11), del(5), inv(9) 1 case respectively, 21 trisomy in 1 case, 11 trisomy in 1 case. Other complex chromosomal abnormality was seen in 2 cases. Upon analysis of relationship between the chromosomal abnormality and FAB subtypes, 4 cases of M2- subtype were found amongst 5 cases of t(8;21), but the other chromosomal abnormalities and subtypes failed to show any correlation. Chromosomal abnormality in CML: Two cases (67%) of chromosomal abnormalities were found in 3 with CML. Their mean age at diagnosis was 152.7 years, and all cases showed t(9;22). CONCLUSION: Our study found that in pediatric AML, t(8;21) showed high incidence and was found to be related with M2-subtype. In CML, t(9;22) was found to be frequent, but the data lacks in accuracy as our sample was too small. For more precise information on incidences of chromosomal abnormalities and the prognostic implications that the cytogenetic properties of leukemia, further studies seem to be essential.

Acute gastroenteritis caused by calicivirus in childhood / 감염

BACKGROUND: Rotavirus is the most common agent of acute gastroenteritis in childhood worldwide. Besides rotavirus, calicivirus is well known another important cause of acute gastroenteritis in childhood. However, caliciviral acute gastroenteritis has not been studied well in Korea. Here we report clinical manifestations of caliciviral acute gastroenteritis confirmed by RT-PCR. METHODS: Eleven patients who were admitted to Severance Hospital, Yonsei University College of Medicine from April 1998 to April 1999, were involved in this study. RNA was isolated from the stool of the patients. RT-PCR was done. Electrophoresis with the PCR products was done. Viruses were identified by electron microscope. Medical records were reviewed retrospectively. RESULTS: Infections occurred below 7 years of age in almost all patients. No sex predominance was found. The clinical manifestations were those of acute gastroenteritis, such as diarrhea, vomiting, poor oral intake, fever, nausea, or abdominal pain. Symptoms were less severe compared to rotaviral infection. CONCLUSION: In case of viral gastroenteritis caused not by rotavirus, we should keep in mind that calicivirus is a possible cause.