Spontaneous remission of childhood acute marrow fibrosis and megakaryoblastic leukemia.

Spontaneous remission in 2 children with myelofibrosis, one with megakaryocytic acute myeloblastic leukemia and t(1;22) (with recurrence later) and one with Down syndrome and GATA1 mutation (permanent), are described. One had sepsis and was treated with antibiotics and blood products, whereas the other received only blood products. Remission was spontaneous, without chemotherapy treatment. Possible explanations for these outcomes include immunologic response to sepsis by a leukemia-specific T-cell response or the release of various cytokines, such as tumor necrosis factor and interleukin-2, during infections. Natural killer and cytotoxic T cells transfused with blood products might have also triggered an immune response.

Conjunctival lymphoma in a child.

PURPOSE: To report a rare case of large conjunctival B-cell lymphoma in a child. METHODS: A 13-year-old girl was initially diagnosed with a right lower eyelid chalazion. After 3 weeks during which the mass was growing, she was referred for treatment to our department. Because of the unusual appearance of the mass, an excisional biopsy was performed. RESULTS: Pathological findings were consistent with those of a large B-cell lymphoma. CD20 and Ki67 staining were positive, and polymerase chain reaction analysis showed monoclonality of B cells. CONCLUSIONS: Although conjunctival lymphoma is a very rare entity in children, it should be included in the differential diagnosis of an eyelid or conjunctival mass.

Upfront use of gemtuzumab ozogamicin in young children with CD33-positive AML.

Gemtuzumab ozogamicin (GO) is a humanized anti-CD33 antibody used for treating patients with CD33+ acute myeloid leukemia (AML). We report three young children (two infants and one toddler) with AML treated with GO 9 mg/m(2). Two received two doses at diagnosis alone with conventional chemotherapy and one received one dose after relapse. GO was well tolerated and all three achieved remission. All were transplanted: one relapsed after 5 months and died of disease, one died a toxic death in remission due to pulmonary fibrosis, and one survived (41 months from diagnosis). In conclusion, GO was well tolerated in these young patients with evidence for efficacy.

[Toxocariasis as a cause of hypereosinophilia].

Toxocariasis is one of the causes of eosinophilia in peripheral blood and provokes eosinophilic infiltration in internal organs. In Israel, the number of cases of toxocariasis is very low, 3 cases annually, according to the records at the Ministry of Health. Many cases of eosinophilia might be misdiagnosed as hypereosinophilia syndrome (HES), if serological testing for Toxocara is not conducted, leading to inappropriate treatment. The test is for specific serum IgG antibody of Toxocara canis antigen measured by enzyme-linked immunosorbent assay (ELISA). The authors present a 4 year old girl with hypereosinophilia of 40,000 cell/microl, without involvement of target organs. The authors found that toxocara was the cause of hypereosinophilia. After appropriate treatment the number of eosinophils decreases, presenting a measurement of the parasite activity.

Role of 18F-FDG PET/CT in staging and follow-up of lymphoma in pediatric and young adult patients.

OBJECTIVE: To assess the role of 18F-Fluorodeoxyglucose (18F-FDG) PET/CT in pediatric patients with Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL). MATERIALS AND METHODS: 31 patients, mean age 12.9 +/- 5.1, HD (n = 24), and NHL (n = 7) underwent 18F-FDG PET/CT at diagnosis (n = 31 studies) and later in the course of the disease (n = 75 studies). The findings of PET/CT were correlated with diagnostic CT and clinical follow-up. RESULTS: PET/CT findings resulted in a change of disease staging in 10 patients (32.3%), upstaging in 7 (22.6%) and downstaging in 3 (9.6%). On a lesion analysis, 164 disease sites were detected by PET/CT of which 38 were overlooked by DCT. At mid-treatment, PET was negative in 28 out of 31 patients (90%) with negative predictive value of 96% as all latter patients except for 1, were disease free (mean 15.4 +/- 8.8 months). The positive predictive value of persistent increased 18F-FDG uptake was 100% as 3 patients with latter findings had active disease. On the CT part, 76 residual masses were identified in 22 patients. Increased 18F-FDG uptake was detected in 11 masses in 4 patients who had active disease. Remaining 65 PET negative masses were false positive findings. The positive predictive value of residual CT mass was 14%. CONCLUSIONS: PET/CT is associated with change in staging in approximately 1 out of 3 pediatric patients with HD and NHL. When used for monitoring response to treatment, a negative study is associated with disease-free period, even when residual mass is detected. A positive PET study indicates residual malignant disease.