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Chisholm KM, Bohling SD. Childhood Myelodysplastic Syndrome. Clin Lab Med 2023; 43:639-655. [PMID: 37865508 DOI: 10.1016/j.cll.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Myelodysplastic syndrome (MDS) in children is rare, accounting for < 5% of all childhood hematologic malignancies. With the advent of next-generation sequencing, the etiology of many childhood MDS (cMDS) cases has been elucidated with the finding of predisposing germline mutations in one-quarter to one-third of cases; somatic mutations have also been identified, indicating that cMDS is different than adult MDS. Herein, cMDS classification schema, clinical presentation, laboratory values, bone marrow histology, differential diagnostic considerations, and the recent molecular findings of cMDS are described.
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Affiliation(s)
- Karen M Chisholm
- Hematopathology, Department of Laboratories, Seattle Children's Hospital, 4800 Sand Point Way Northeast, FB.4.510, Seattle, WA 98105, USA; Department of Laboratory Medicine and Pathology, University of Washington Medical Center, 4800 Sand Point Way Northeast, FB.4.510, Seattle, WA 98105, USA.
| | - Sandra D Bohling
- Hematopathology, Department of Laboratories, Seattle Children's Hospital, 4800 Sand Point Way Northeast, FB.4.510, Seattle, WA 98105, USA; Department of Laboratory Medicine and Pathology, University of Washington Medical Center, 4800 Sand Point Way Northeast, FB.4.510, Seattle, WA 98105, USA
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2
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Owens TJ, Patel SA, Greiner TC, Cannatella JJ, Grant WJ, Langnas AN, Vo HD. High-grade myelodysplastic syndrome in a pediatric multi-organ transplant recipient: A case report and literature review. Pediatr Transplant 2022; 26:e14287. [PMID: 35403329 DOI: 10.1111/petr.14287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/27/2021] [Accepted: 03/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric myelodysplastic syndrome is a rare but life-threatening condition requiring prompt recognition and management. METHODS We herein present the only reported case of a pediatric multi-organ transplant recipient developing myelodysplastic syndrome. RESULTS The patient was a 14-year-old girl on chronic calcineurin inhibitor therapy who presented with peri-rectal pain approximately 13 years after liver, small bowel, and pancreas transplant. The initial workup revealed pancytopenia and parvovirus B19 viremia. Her definitive diagnosis was complicated by a lack of adequate bone marrow biopsy specimens and expert consultation that resulted in treatment for hemophagocytic lymphohistiocytosis. She was later diagnosed with high-grade myelodysplastic syndrome. Although curative treatment with chemotherapy and hematopoietic stem cell transplantation was strongly considered, it was not performed due to the child's rapid clinical progression, ventilator status, and active infections. The patient died approximately 6 months following symptom onset. CONCLUSIONS This case emphasizes the importance of early recognition of myelodysplastic syndrome in multi-organ transplant recipients on chronic immunosuppression. Pancytopenia is a common presentation in the post-transplant period that requires thorough investigation. Multiple confounding considerations such as infection, immunosuppression, and systemic inflammation can delay the diagnosis of underlying hematological malignancies. Transplant care providers should be aware of myelodysplastic syndrome and advocate for a comprehensive evaluation, given early recognition and intervention can significantly improve outcomes.
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Affiliation(s)
- Trudie J Owens
- Department of Surgery, Transplantation Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sachit A Patel
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Timothy C Greiner
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jeffrey J Cannatella
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Wendy J Grant
- Department of Surgery, Transplantation Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Alan N Langnas
- Department of Surgery, Transplantation Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Hanh D Vo
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Sawada A, Shimizu M, Koyama-Sato M, Higuchi K, Okada Y, Goto K, Inoue S, Yasui M, Inoue M. Radiation-sparing reduced-intensity unrelated umbilical cord blood transplantation for rare hematological disorders in children. Int J Hematol 2021; 115:269-277. [PMID: 34739700 DOI: 10.1007/s12185-021-03254-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
Graft failure is a major pitfall of unrelated umbilical cord blood transplantation (CBT) in children with rare hematological disorders other than acute leukemia, such as acquired and inherited bone marrow failure, myelodysplastic syndrome, juvenile myelomonocytic leukemia, and chronic myeloid leukemia. We developed a less-toxic conditioning regimen for CBT that achieves a higher rate of complete donor chimerism, and retrospectively compared it against two other conditioning regimens for CBT performed at our single institution. The engraftment rate with complete donor chimerism was 100% and 5-year event-free survival (5y-EFS) was 90.9% in patients using our latest regimen (n = 11) of reduced-intensity conditioning (RIC) containing fludarabine (Flu) 180 mg/m2, melphalan (MEL) 210 mg/m2, and low-dose rabbit anti-thymocyte globulin (LD-rATG) 2.5 mg/kg without irradiation (regimen C). Outcomes were better than in patients (n = 10) treated with previous regimens involving irradiation (5y-EFS 30.0%, p = 0.004): regimen A, consisting of myeloablative conditioning containing cyclophosphamide (CY) and total body irradiation (TBI) with 8-12 Gy, or regimen B, consisting of RIC with Flu, CY, horse ATG, and thoracoabdominal irradiation (TAI) with 6 Gy. In conclusion, Flu/MEL/LD-rATG (regimen C) without TBI/TAI may be preferable as RIC for unrelated CBT in children with rare hematological disorders.
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Affiliation(s)
- Akihisa Sawada
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, 840 Murodo, Izumi city, Osaka, 594-1101, Japan.
| | - Mariko Shimizu
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, 840 Murodo, Izumi city, Osaka, 594-1101, Japan
| | - Maho Koyama-Sato
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, 840 Murodo, Izumi city, Osaka, 594-1101, Japan
| | - Kohei Higuchi
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, 840 Murodo, Izumi city, Osaka, 594-1101, Japan
| | - Yosuke Okada
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, 840 Murodo, Izumi city, Osaka, 594-1101, Japan
| | - Kimitoshi Goto
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, 840 Murodo, Izumi city, Osaka, 594-1101, Japan
| | - Shota Inoue
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, 840 Murodo, Izumi city, Osaka, 594-1101, Japan
| | - Masahiro Yasui
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, 840 Murodo, Izumi city, Osaka, 594-1101, Japan
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, 840 Murodo, Izumi city, Osaka, 594-1101, Japan
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CPX-351 Induces Remission in Newly Diagnosed Pediatric Secondary Myeloid Malignancies. Blood Adv 2021; 6:521-527. [PMID: 34710216 PMCID: PMC8791570 DOI: 10.1182/bloodadvances.2021006139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022] Open
Abstract
CPX-351 treatment is well tolerated and results in morphologic remission in newly diagnosed pediatric secondary myeloid malignancies. Favorable outcomes are achieved despite the presence of high-risk genetic lesions and previous therapies.
Secondary myelodysplastic syndromes and acute myeloid leukemia (sMDS/AML) are rare in children and adolescents and have a dismal prognosis. The mainstay therapy is hematopoietic cell transplantation (HCT), but there has been no innovation in cytoreductive regimens. CP X-351, a fixed 5:1 molar ratio of liposomal cytarabine to daunorubicin, has shown favorable safety and efficacy in elderly individuals with secondary AML and children with relapsed de novo AML. We report the outcomes of 7 young patients (6 with newly diagnosed sMDS/AML and 1 with primary MDS/AML) uniformly treated with CP X-351. Five patients had previously received chemotherapy for osteosarcoma, Ewing sarcoma, neuroblastoma, or T-cell acute lymphoblastic leukemia; 1 had predisposing genomic instability disorder (Cornelia de Lange syndrome) and 1 had MDS-related AML and multiorgan failure. The median age at diagnosis of myeloid malignancy was 17 years (range, 13-23 years). Patients received 1 to 3 cycles of CP X-351 (cytarabine 100 mg/m2 plus daunorubicin 44 mg/m2) on days 1, 3, and 5, resulting in complete morphologic remission without overt toxicity or treatment-related mortality. This approach allowed for adding an FLT3 inhibitor as individualized therapy in 1 patient. Six patients were alive and leukemia-free at 0.5 to 3.3 years after HCT. One patient died as a result of disease progression before HCT. To summarize, CP X-351 is an effective and well-tolerated regimen for cytoreduction in pediatric sMDS/AML that warrants prospective studies.
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Yoo JW, Im HJ, Kim H, Koh KN, Kang SH, Min SY, Choi ES, Jang S, Park CJ, Seo JJ. Improved outcomes of allogeneic hematopoietic stem cell transplantation including haploidentical transplantation for childhood myelodysplastic syndrome. Bone Marrow Transplant 2020; 55:1595-1603. [PMID: 32054998 DOI: 10.1038/s41409-020-0814-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 01/15/2020] [Accepted: 01/27/2020] [Indexed: 11/09/2022]
Abstract
This retrospective study aimed to investigate the outcomes of allogeneic hematopoietic stem cell transplantation (HSCT) for childhood myelodysplastic syndrome (MDS). Thirty-six patients (low-grade MDS, 24; advanced MDS, 12) received HSCT at the Asan Medical Center over two decades (early period, 1997-2007; recent period, 2008-2017). The transplantation outcomes were analyzed according to disease status, conditioning regimen, various donor types, and period of HSCT. During a median follow-up of 5.6 (range, 1.4-21.1) years, the probability of overall survival (OS) and failure-free survival was 77% and 69%, respectively. The cumulative incidence of transplantation-related mortality (TRM) was 12%. Significantly reduced TRM and improved OS were observed in patients who received HSCT during the recent period vs. the early period (TRM, 4% vs. 30%, P = 0.021; OS, 87% vs. 50%, P = 0.006). Comparable outcomes were observed for HSCT from haploidentical family donors vs. HLA-identical donors (TRM, 10% vs. 14%, P= 0.837; OS, 86% vs. 79%, P = 0.625). This study identified the improved outcomes of allogeneic HSCT for childhood MDS over time, in addition, the feasible outcomes of haploidentical HSCT suggested its use as an attractive alternative in the future procedures.
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Affiliation(s)
- Jae Won Yoo
- Department of Pediatrics, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Ho Joon Im
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea.
| | - Hyery Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Kyung-Nam Koh
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Sung Han Kang
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - So Yoon Min
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Eun Seok Choi
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Seongsoo Jang
- Department of Laboratory medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chan-Jeoung Park
- Department of Laboratory medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Jin Seo
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
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Acute Megakaryoblastic Leukemia With Diffuse Periosteal Reaction of Bilateral Lower Extremities. J Pediatr Hematol Oncol 2019; 41:e90-e93. [PMID: 30303870 DOI: 10.1097/mph.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We report the case of a 3-year-old girl diagnosed with acute megakaryoblastic leukemia, who presented after >1 year of bilateral leg pain. At times the pain was severe enough to prevent ambulation, prompting visits to her primary care provider. However, it was not until acute respiratory failure occurred with subsequent hospitalization in the pediatric intensive care unit that severe anemia and thrombocytopenia were discovered and the diagnosis of acute myeloid leukemia was made. Bilateral lower extremity swelling was noted on admission and radiographs showed diffusely abnormal appearance of the long bones of her lower extremities with periosteal reaction and echogenic debris in the subperiosteal space, thought to represent leukemic cells. This case highlights the importance of recognizing atypical signs and symptoms of myelodysplastic syndrome progressing to acute leukemia in the context of abnormal bone pain and radiographic changes.
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Chisholm KM, Xu M, Davis B, Ogi A, Pacheco MC, Geddis AE, Tsuchiya KD, Rutledge JC. Evaluation of the Utility of Bone Marrow Morphology and Ancillary Studies in Pediatric Patients Under Surveillance for Myelodysplastic Syndrome. Am J Clin Pathol 2018; 149:499-513. [PMID: 29659673 DOI: 10.1093/ajcp/aqy007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate the utility of flow cytometry, karyotype, and a fluorescence in situ hybridization (FISH) panel in screening children for myelodysplastic syndrome (MDS). METHODS Bone marrow morphology, flow cytometry, karyotype, and FISH reports from 595 bone marrow specimens (246 patients) were analyzed. RESULTS By morphology, 8.7% of cases demonstrated at least unilineage dysplasia and/or increased blasts. Flow cytometry identified definitive abnormalities in 2.8% of cases, all of which had abnormal morphology. Of the 42 cases (7.2%) with acquired karyotypic abnormalities, 26 had no morphologic dysplasia. With a 98.2% concordance between karyotype and MDS FISH, FISH only identified two additional cases, both with low-level (<4%) abnormalities. Peripheral blood count evaluation only identified the absence of thrombocytopenia to correlate with an absence of abnormal ancillary tests. CONCLUSIONS The combination of morphologic evaluation and karyotype with judicious use of flow cytometry and MDS FISH is sufficient to detect abnormalities for these indications.
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Affiliation(s)
- Karen M Chisholm
- Department of Laboratories, Seattle, WA
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Min Xu
- Department of Laboratories, Seattle, WA
- Department of Laboratory Medicine, University of Washington, Seattle
| | | | - Amy Ogi
- Department of Laboratories, Seattle, WA
| | - M Cristina Pacheco
- Department of Laboratories, Seattle, WA
- Department of Pathology, University of Washington, Seattle
| | - Amy E Geddis
- Laboratories Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, WA
- Division of Hematology and Oncology, Department of Pediatrics, University of Washington, Seattle
| | - Karen D Tsuchiya
- Department of Laboratories, Seattle, WA
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Joe C Rutledge
- Department of Laboratories, Seattle, WA
- Department of Laboratory Medicine, University of Washington, Seattle
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8
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How I treat myelodysplastic syndromes of childhood. Blood 2018; 131:1406-1414. [PMID: 29438960 DOI: 10.1182/blood-2017-09-765214] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/27/2018] [Indexed: 02/06/2023] Open
Abstract
Pediatric myelodysplastic syndromes (MDSs) are a heterogeneous group of clonal disorders with an annual incidence of 1 to 4 cases per million, accounting for less than 5% of childhood hematologic malignancies. MDSs in children often occur in the context of inherited bone marrow failure syndromes, which represent a peculiarity of myelodysplasia diagnosed in pediatric patients. Moreover, germ line syndromes predisposing individuals to develop MDS or acute myeloid leukemia have recently been identified, such as those caused by mutations in GATA2, ETV6, SRP72, and SAMD9/SAMD9-L Refractory cytopenia of childhood (RCC) is the most frequent pediatric MDS variant, and it has specific histopathologic features. Allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment of choice for many children with MDSs and is routinely offered to all patients with MDS with excess of blasts, to those with MDS secondary to previously administered chemoradiotherapy, and to those with RCC associated with monosomy 7, complex karyotype, severe neutropenia, or transfusion dependence. Immune-suppressive therapy may be a treatment option for RCC patients with hypocellular bone marrow and the absence of monosomy 7 or a complex karyotype, although the response rate is lower than that observed in severe aplastic anemia, and a relevant proportion of these patients will subsequently need HSCT for either nonresponse or relapse.
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9
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Smith FO, Dvorak CC, Braun BS. Myelodysplastic Syndromes and Myeloproliferative Neoplasms in Children. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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The genomic landscape of pediatric myelodysplastic syndromes. Nat Commun 2017; 8:1557. [PMID: 29146900 PMCID: PMC5691144 DOI: 10.1038/s41467-017-01590-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/29/2017] [Indexed: 01/19/2023] Open
Abstract
Myelodysplastic syndromes (MDS) are uncommon in children and have a poor prognosis. In contrast to adult MDS, little is known about the genomic landscape of pediatric MDS. Here, we describe the somatic and germline changes of pediatric MDS using whole exome sequencing, targeted amplicon sequencing, and/or RNA-sequencing of 46 pediatric primary MDS patients. Our data show that, in contrast to adult MDS, Ras/MAPK pathway mutations are common in pediatric MDS (45% of primary cohort), while mutations in RNA splicing genes are rare (2% of primary cohort). Surprisingly, germline variants in SAMD9 or SAMD9L were present in 17% of primary MDS patients, and these variants were routinely lost in the tumor cells by chromosomal deletions (e.g., monosomy 7) or copy number neutral loss of heterozygosity (CN-LOH). Our data confirm that adult and pediatric MDS are separate diseases with disparate mechanisms, and that SAMD9/SAMD9L mutations represent a new class of MDS predisposition. Myelodysplastic syndromes (MDS) are uncommon in children and have poor prognosis. Here, the authors interrogate the genomic landscape of MDS, confirming adult and paediatric MDS are separate diseases with disparate mechanisms, and highlighting that SAMD9/SAMD9L mutations represent a new class of MDS predisposition.
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Duchmann M, Fenaux P, Cluzeau T. [Management of myelodysplastic syndromes]. Bull Cancer 2015; 102:946-57. [PMID: 26410692 DOI: 10.1016/j.bulcan.2015.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/25/2015] [Accepted: 07/10/2015] [Indexed: 12/16/2022]
Abstract
Myelodysplastic syndromes are heterogeneous diseases whose molecular characteristics have only been identified in recent years. Better identification of prognostic factors, larger access to allogeneic stem cell transplantation and the advent of new drugs notably hypomethylating agents (azacitidine, decitabine) and lenalidomide have improved patient outcome.
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Affiliation(s)
| | - Pierre Fenaux
- Université Paris 7, Assistance publique des Hôpitaux de Paris, hôpital Saint-Louis, service d'hématologie séniors, 75010 Paris, France
| | - Thomas Cluzeau
- Assistance publique des Hôpitaux de Paris, hôpital Saint-Louis, service d'hématologie, 75010 Paris, France; Centre méditerranéen de médecine moléculaire, Inserm U1065, 06204 Nice, France.
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Lingegowda A, Kuntegowdenahalli L. An analysis of the demographic profile, clinical manifestations, investigations and outcome of paediatric myelodysplastic syndrome: A single centre, cross-sectional study. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2015. [DOI: 10.14319/ijcto.33.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tüfekçi Ö, Ören H, Demir Yenigürbüz F, Gözmen S, Karapınar TH, İrken G. Management of Two Juvenile Myelomonocytic Leukemia Patients According to Clinical and Genetic Features. Turk J Haematol 2015; 32:175-9. [PMID: 26316488 PMCID: PMC4451488 DOI: 10.4274/tjh.2014.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Juvenile myelomonocytic leukemia (JMML) is a rare clonal myeloproliferative disorder of childhood. Major progress has been achieved in diagnosis and the understanding of the pathogenesis of JMML by identifying the genetic pathologies that occur in patients. Mutations of RAS, NF1, PTPN11, and CBL are found in approximately 80% of JMML patients. Distinct clinical features have been reported to be associated with specific gene mutations. The advent of genomic studies and recent identification of novel genetic mutations in JMML are important not only in diagnosis but also in the management and prognosis of the disease. Herein, we present 2 patients with JMML harboring different mutations, NRAS and c-CBL, respectively, with distinct clinical features and different therapeutic approaches.
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Affiliation(s)
| | - Hale Ören
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey Phone: +90 232 412 61 41 E-mail:
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15
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Cada M, Segbefia CI, Klaassen R, Fernandez CV, Yanofsky RA, Wu J, Pastore Y, Silva M, Lipton JH, Brossard J, Michon B, Abish S, Steele M, Sinha R, Belletrutti M, Breakey V, Jardine L, Goodyear L, Sung L, Shago M, Beyene J, Sharma P, Zlateska B, Dror Y. The impact of category, cytopathology and cytogenetics on development and progression of clonal and malignant myeloid transformation in inherited bone marrow failure syndromes. Haematologica 2015; 100:633-42. [PMID: 25682607 DOI: 10.3324/haematol.2014.117457] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/10/2015] [Indexed: 01/13/2023] Open
Abstract
Inherited bone marrow failure syndromes are a group of rare, heterogeneous genetic disorders with a risk of clonal and malignant myeloid transformation including clonal marrow cytogenetic abnormalities, myelodysplastic syndrome and acute myeloid leukemia. The clinical characteristics, risk classification, prognostic factors and outcome of clonal and malignant myeloid transformation associated with inherited bone marrow failure syndromes are largely unknown. The aims of this study were to determine the impact of category, cytopathology and cytogenetics, the three components of the "Category Cytology Cytogenetics" classification of pediatric myelodysplastic syndrome, on the outcome of clonal and malignant myeloid transformation associated with inherited bone marrow failure. We used data from the Canadian Inherited Marrow Failure Registry. Among 327 patients with inherited bone marrow failure syndrome enrolled in the registry, the estimated risk of clonal and malignant myeloid transformation by the age of 18 years was 37%. The risk of clonal and malignant myeloid transformation varied according to the type of inherited bone marrow failure syndrome but was highest in Fanconi anemia. The development of clonal and malignant myeloid transformation significantly affected overall survival. Mortality varied based on cytopathological group. The largest group of patients had refractory cytopenia. Clonal marrow cytogenetic abnormalities were identified in 87% of patients with clonal and malignant myeloid transformation, and different cytogenetic groups had different impacts on disease progression. We conclude that category, cytopathology and cytogenetics in cases of clonal and malignant myeloid transformation associated with inherited bone marrow failure syndromes have an important impact on outcome and that the classification of such cases should incorporate these factors.
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Affiliation(s)
- Michaela Cada
- Marrow Failure and Myelodysplasia Program, Division of Haematology/Oncology, Department of Paediatrics and the Genetics and Genome Biology Program, Research Institute, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Catherin I Segbefia
- Marrow Failure and Myelodysplasia Program, Division of Haematology/Oncology, Department of Paediatrics and the Genetics and Genome Biology Program, Research Institute, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Robert Klaassen
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | - John Wu
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | | | | | - Josee Brossard
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Bruno Michon
- Centre Hospital University Quebec-Pav CHUL, Sainte-Foy, Quebec, Canada
| | - Sharon Abish
- Montreal Children's Hospital, Montreal, Québec, Canada
| | | | - Roona Sinha
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mark Belletrutti
- University of Alberta/Health Sciences Centre, Edmonton, Alberta, Canada
| | - Vicky Breakey
- McMaster Children's Hospital/McMaster University Health Sciences Centre, Hamilton, Ontario, Canada
| | | | - Lisa Goodyear
- Janeway Child Health Centre, St. John's, Newfoundland, Canada
| | - Lillian Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Shago
- Division of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joseph Beyene
- Program in Population Genomics, Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Preeti Sharma
- Marrow Failure and Myelodysplasia Program, Division of Haematology/Oncology, Department of Paediatrics and the Genetics and Genome Biology Program, Research Institute, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Bozana Zlateska
- Marrow Failure and Myelodysplasia Program, Division of Haematology/Oncology, Department of Paediatrics and the Genetics and Genome Biology Program, Research Institute, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Yigal Dror
- Marrow Failure and Myelodysplasia Program, Division of Haematology/Oncology, Department of Paediatrics and the Genetics and Genome Biology Program, Research Institute, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
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Udayakumar AM, Pathare AV, Mevada ST, Wali YA. Cytogenetic, clinical, and hematological features of pediatric myelodysplastic syndrome in Oman. Pediatr Blood Cancer 2015; 62:367-368. [PMID: 25382798 DOI: 10.1002/pbc.25290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/08/2014] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Surekha Tony Mevada
- Pediatric Hematology Unit, Department of Child Health, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Yasser Ahmed Wali
- Pediatric Hematology Unit, Department of Child Health, College of Medicine, Sultan Qaboos University, Muscat, Sultanate of Oman
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Calkoen FGJ, Vervat C, van Pel M, de Haas V, Vijfhuizen LS, Eising E, Kroes WGM, 't Hoen PAC, van den Heuvel-Eibrink MM, Egeler RM, van Tol MJD, Ball LM. Despite differential gene expression profiles pediatric MDS derived mesenchymal stromal cells display functionality in vitro. Stem Cell Res 2015; 14:198-210. [PMID: 25679997 DOI: 10.1016/j.scr.2015.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 12/03/2014] [Accepted: 01/19/2015] [Indexed: 12/21/2022] Open
Abstract
Pediatric myelodysplastic syndrome (MDS) is a heterogeneous disease covering a spectrum ranging from aplasia (RCC) to myeloproliferation (RAEB(t)). In adult-type MDS there is increasing evidence for abnormal function of the bone-marrow microenvironment. Here, we extensively studied the mesenchymal stromal cells (MSCs) derived from children with MDS. MSCs were expanded from the bone-marrow of 17 MDS patients (RCC: n=10 and advanced MDS: n=7) and pediatric controls (n=10). No differences were observed with respect to phenotype, differentiation capacity, immunomodulatory capacity or hematopoietic support. mRNA expression analysis by Deep-SAGE revealed increased IL-6 expression in RCC- and RAEB(t)-MDS. RCC-MDS MSC expressed increased levels of DKK3, a protein associated with decreased apoptosis. RAEB(t)-MDS revealed increased CRLF1 and decreased DAPK1 expressions. This pattern has been associated with transformation in hematopoietic malignancies. Genes reported to be differentially expressed in adult MDS-MSC did not differ between MSC of pediatric MDS and controls. An altered mRNA expression profile, associated with cell survival and malignant transformation, of MSC derived from children with MDS strengthens the hypothesis that the micro-environment is of importance in this disease. Our data support the understanding that pediatric and adult MDS are two different diseases. Further evaluation of the pathways involved might reveal additional therapy targets.
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Affiliation(s)
- F G J Calkoen
- Department of Pediatrics, Section Immunology, Hematology/Oncology and Hematopoietic Stem Cell Transplantation, Leiden University Medical Center, Leiden, The Netherlands.
| | - C Vervat
- Department of Pediatrics, Section Immunology, Hematology/Oncology and Hematopoietic Stem Cell Transplantation, Leiden University Medical Center, Leiden, The Netherlands
| | - M van Pel
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - V de Haas
- Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | - L S Vijfhuizen
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - E Eising
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - W G M Kroes
- Laboratory for Diagnostic Genome Analysis, Leiden University Medical Center, Leiden, The Netherlands
| | - P A C 't Hoen
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - M M van den Heuvel-Eibrink
- Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands; Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - R M Egeler
- Department of Pediatrics, Section Immunology, Hematology/Oncology and Hematopoietic Stem Cell Transplantation, Leiden University Medical Center, Leiden, The Netherlands; Department of Hematology/Oncology and Hematopoietic Stem Cell Transplantation, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - M J D van Tol
- Department of Pediatrics, Section Immunology, Hematology/Oncology and Hematopoietic Stem Cell Transplantation, Leiden University Medical Center, Leiden, The Netherlands
| | - L M Ball
- Department of Pediatrics, Section Immunology, Hematology/Oncology and Hematopoietic Stem Cell Transplantation, Leiden University Medical Center, Leiden, The Netherlands
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Moriwaki K, Manabe A, Taketani T, Kikuchi A, Nakahata T, Hayashi Y. Cytogenetics and clinical features of pediatric myelodysplastic syndrome in Japan. Int J Hematol 2014; 100:478-84. [PMID: 25261124 DOI: 10.1007/s12185-014-1674-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 09/08/2014] [Accepted: 09/08/2014] [Indexed: 11/26/2022]
Abstract
We analyzed the cytogenetics and clinical features of pediatric myelodysplastic syndrome (MDS) in Japan. Data on patients (<16 years) diagnosed with MDS from 1990 to 2000 were retrospectively collected from pediatric hematologists in 234 institutions. Chromosome analysis was successfully performed in 255 of 277 MDS patients. The numbers of patients with refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess of blasts (RAEB), refractory anemia with excess of blasts in transformation (RAEBt), chronic myelomonocytic leukemia, and juvenile myelomonocytic leukemia were 67 (24%), 51 (18%), 51 (18%), 20 (7%), and 65 (23%), respectively. The other 23 patients (8%) could not be classified specifically. The distribution of childhood MDS in Japan according to the French-American-British subclassification was similar to that in other countries. However, we identified a higher incidence of therapy-related cases. As for relationship between cytogenetics and prognoses, abnormal karyotypes were related to poorer prognoses than normal karyotype (P < 0.01). However, patients with trisomy 8 had prognoses comparable to those with normal karyotypes. Complex karyotypes were associated with poorer prognoses among RAEB and RAEBt patients. In conclusion, prognosis of pediatric MDS is related to cytogenetics. A more precise diagnosis and classification system is needed for childhood MDS.
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Affiliation(s)
- Koichi Moriwaki
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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19
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Hasegawa D, Chen X, Hirabayashi S, Ishida Y, Watanabe S, Zaike Y, Tsuchida M, Masunaga A, Yoshimi A, Hama A, Kojima S, Ito M, Nakahata T, Manabe A. Clinical characteristics and treatment outcome in 65 cases with refractory cytopenia of childhood defined according to the WHO 2008 classification. Br J Haematol 2014; 166:758-66. [DOI: 10.1111/bjh.12955] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Daisuke Hasegawa
- Department of Paediatrics; St. Luke's International Hospital; Tokyo Japan
| | - Xiaojuan Chen
- Department of Paediatrics; St. Luke's International Hospital; Tokyo Japan
- Department of Paediatrics; Institute of Haematology and Blood Disease Hospital; Chinese Academy of Medical Sciences; Tianjin China
| | - Shinsuke Hirabayashi
- Department of Paediatrics; St. Luke's International Hospital; Tokyo Japan
- Division of Paediatric Haematology and Oncology; Department of Paediatrics and Adolescent Medicine; University of Freiburg; Freiburg Germany
| | - Yasushi Ishida
- Department of Paediatrics; St. Luke's International Hospital; Tokyo Japan
| | - Shizuka Watanabe
- Department of Paediatrics; St. Luke's International Hospital; Tokyo Japan
| | - Yuji Zaike
- Clinical Laboratory; Research Hospital; The Institution of Medical Science; The University of Tokyo; Tokyo Japan
| | - Masahiro Tsuchida
- Paediatric Haematology/Oncology; Ibaraki Children's Hospital; Mito Japan
| | - Atsuko Masunaga
- Department of Surgical Pathology; Showa University Fujigaoka Hospital; Yokohama Japan
| | - Ayami Yoshimi
- Division of Paediatric Haematology and Oncology; Department of Paediatrics and Adolescent Medicine; University of Freiburg; Freiburg Germany
| | - Asahito Hama
- Department of Paediatrics; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Seiji Kojima
- Department of Paediatrics; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Masafumi Ito
- Department of Pathology; Japanese Red Cross Nagoya First Hospital; Nagoya Japan
| | | | - Atsushi Manabe
- Department of Paediatrics; St. Luke's International Hospital; Tokyo Japan
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20
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Honda Y, Tsuchida M, Zaike Y, Masunaga A, Yoshimi A, Kojima S, Ito M, Kikuchi A, Nakahata T, Manabe A. Clinical characteristics of 15 children with juvenile myelomonocytic leukaemia who developed blast crisis: MDS Committee of Japanese Society of Paediatric Haematology/Oncology. Br J Haematol 2014; 165:682-7. [DOI: 10.1111/bjh.12796] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 01/08/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Yuko Honda
- Department of Paediatrics; University of Occupational and Environmental Health; Kitakyusyu Japan
| | | | - Yuji Zaike
- Clinical Laboratory; Research Hospital; The Institution of Medical Science; The University of Tokyo; Tokyo Japan
| | - Atsuko Masunaga
- Department of Diagnostic Pathology; Showa University Fujigaoka Hospital; Yokohama Japan
| | - Ayami Yoshimi
- Department of Paediatrics and Adolescent Medicine; University of Freiburg; Freiburg Germany
| | - Seiji Kojima
- Department of Paediatrics; Graduate School of Medicine; Nagoya University; Nagoya Japan
| | - Masafumi Ito
- Department of Pathology; Nagoya Daiichi Red Cross Hospital; Nagoya Japan
| | - Akira Kikuchi
- Department of Paediatrics; School of Medicine; Teikyo University; Tokyo Japan
| | - Tatsutoshi Nakahata
- Department of Clinical Application; Center for iPS Cell Research and Application; Kyoto University; Kyoto Japan
| | - Atsushi Manabe
- Department of Paediatrics; St. Luke's International Hospital; Tokyo Japan
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21
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Smith AR, Christiansen EC, Wagner JE, Cao Q, MacMillan ML, Stefanski HE, Trotz BA, Burke MJ, Verneris MR. Early hematopoietic stem cell transplant is associated with favorable outcomes in children with MDS. Pediatr Blood Cancer 2013; 60:705-10. [PMID: 23152304 PMCID: PMC3668778 DOI: 10.1002/pbc.24390] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 10/09/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although hematopoietic stem cell transplantation (HSCT) is the treatment of choice for childhood myelodysplastic syndrome (MDS), there is no consensus regarding patient or disease characteristics that predict outcomes. PROCEDURE We reviewed 37 consecutive pediatric MDS patients who received myeloablative HSCT between 1990 and 2010 at a single center. RESULTS Twenty had primary MDS and 17 had secondary MDS. Diagnostic cytogenetics included monosomy 7 (n = 21), trisomy 8 (n = 7) or normal/other (n = 8). According to the modified WHO MDS classification, thirty had refractory cytopenia and seven had refractory anemia with excess blasts. IPSS scores were: low risk (n = 1), intermediate-1 (n = 15), and intermediate-2 (n = 21). OS and DFS at 10 years in the entire cohort was 53% and 45%. Relapse at 10 years was 26% and 1 year TRM was 25%. In multivariate analysis, factors associated with improved 3 years DFS were not receiving pre-HSCT chemotherapy (RR = 0.30, 95% CI 0.10-0.88; P = 0.03) and a shorter interval (<140 days) from time of diagnosis to transplant (RR = 0.27, 95% CI 0.09-0.80; P = 0.02). Three years DFS in patients who did not receive pre-HSCT chemotherapy and those who had a shorter interval to transplant (n = 16) was 80%. CONCLUSION These results suggest that children with MDS should be referred for allogeneic HSCT soon after diagnosis and that pre-HSCT chemotherapy does not appear to improve outcomes.
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Affiliation(s)
- Angela R. Smith
- Division of Pediatric Blood and Marrow Transplantation, University of Minnesota
| | | | - John E. Wagner
- Division of Pediatric Blood and Marrow Transplantation, University of Minnesota
| | - Qing Cao
- Masonic Cancer Center Biostatistics Core, University of Minnesota
| | | | | | - Barbara A. Trotz
- Division of Pediatric Hematology/Oncology, University of Minnesota
| | - Michael J. Burke
- Division of Pediatric Hematology/Oncology, University of Minnesota
| | - Michael R. Verneris
- Division of Pediatric Blood and Marrow Transplantation, University of Minnesota
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22
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Kikuchi A, Hasegawa D, Ohtsuka Y, Hamamoto K, Kojima S, Okamura J, Nakahata T, Manabe A. Outcome of children with refractory anaemia with excess of blast (RAEB) and RAEB in Transformation (RAEB-T) in the Japanese MDS99 study. Br J Haematol 2012; 158:657-61. [DOI: 10.1111/j.1365-2141.2012.09210.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/17/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Akira Kikuchi
- Department of Paediatrics; Teikyo University School of Medicine; Tokyo; Japan
| | - Daisuke Hasegawa
- Department of Paediatrics; St Luke's International Hospital; Tokyo; Japan
| | | | - Kazuko Hamamoto
- Department of Paediatrics; Hiroshima Red Cross Hospital; Hiroshima; Japan
| | - Seiji Kojima
- Department of Paediatrics; Nagoya University Graduate School of Medicine; Nagoya; Japan
| | - Jun Okamura
- Section of Paediatrics; Kyushu Cancer Centre Hospital; Fukuoka; Japan
| | | | - Atsushi Manabe
- Department of Paediatrics; St Luke's International Hospital; Tokyo; Japan
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Affiliation(s)
- Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark.
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24
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Strahm B, Nöllke P, Zecca M, Korthof ET, Bierings M, Furlan I, Sedlacek P, Chybicka A, Schmugge M, Bordon V, Peters C, O'Marcaigh A, de Heredia CD, Bergstraesser E, Moerloose BD, van den Heuvel-Eibrink MM, Starý J, Trebo M, Wojcik D, Niemeyer CM, Locatelli F. Hematopoietic stem cell transplantation for advanced myelodysplastic syndrome in children: results of the EWOG-MDS 98 study. Leukemia 2011; 25:455-62. [PMID: 21212791 DOI: 10.1038/leu.2010.297] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report on the outcome of children with advanced primary myelodysplastic syndrome (MDS) transplanted from an HLA-matched sibling (MSD) or an unrelated donor (UD) following a preparative regimen with busulfan, cyclophosphamide and melphalan. Ninety-seven patients with refractory anemia with excess blasts (RAEB, n=53), RAEB in transformation (RAEB-T, n=29) and myelodysplasia-related acute myeloid leukemia (MDR-AML, n=15) enrolled in the European Working Group of MDS in Childhood (EWOG-MDS) 98 study and given hematopoietic stem cell transplantation (HSCT) were analyzed. Median age at HSCT was 11.1 years (range 1.4-19.0). Thirty-nine children were transplanted from an MSD, whereas 58 were given the allograft from a UD (n=57) or alternative family donor (n=1). Stem cell source was bone marrow (n=69) or peripheral blood (n=28). With a median follow-up of 3.9 years (range 0.1-10.9), the 5-year probability of overall survival is 63%, while the 5-year cumulative incidence of transplantation-related mortality (TRM) and relapse is 21% each. Age at HSCT greater than 12 years, interval between diagnosis and HSCT longer than 4 months, and occurrence of acute or extensive chronic graft-versus-host disease were associated with increased TRM. The risk of relapse increased with more advanced disease. This study indicates that HSCT following a myeloablative preparative regimen offers a high probability of survival for children with advanced MDS.
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Affiliation(s)
- B Strahm
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University of Freiburg, Freiburg, Germany.
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25
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Santini V, Alessandrino PE, Angelucci E, Barosi G, Billio A, Di Maio M, Finelli C, Locatelli F, Marchetti M, Morra E, Musto P, Visani G, Tura S. Clinical management of myelodysplastic syndromes: update of SIE, SIES, GITMO practice guidelines. Leuk Res 2010; 34:1576-88. [PMID: 20149927 DOI: 10.1016/j.leukres.2010.01.018] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 01/11/2010] [Accepted: 01/17/2010] [Indexed: 12/13/2022]
Affiliation(s)
- V Santini
- Functional Unit of Haematology, AOU Careggi, University of Florence, Firenze, Italy.
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26
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Yang W, Stotler B, Sevilla DW, Emmons FN, Murty VV, Alobeid B, Bhagat G. FISH analysis in addition to G-band karyotyping: Utility in evaluation of myelodysplastic syndromes? Leuk Res 2010; 34:420-5. [PMID: 19800120 DOI: 10.1016/j.leukres.2009.09.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 09/02/2009] [Accepted: 09/10/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Wendy Yang
- Department of Pathology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
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27
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Lee CC, Yang CP, Tsai MH, Lee WI, Fang EC, Jaing TH. Successful cord blood transplantation in a girl with monosomy 7 myelodysplastic syndrome and reduced numbers of B cells. Int J Hematol 2010; 91:705-7. [PMID: 20232178 DOI: 10.1007/s12185-010-0548-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 02/09/2010] [Accepted: 02/24/2010] [Indexed: 11/26/2022]
Abstract
This report described unrelated umbilical cord blood transplantation for a 3-year-old girl with myelodysplastic syndrome and monosomy 7. The patient had a prolonged course characterized by recurrent infection and slowly progressive pancytopenia. She had reduced numbers of circulating B cells but no decline in immunoglobulin levels. Chemotherapy was not initially recommended because it was contraindicated due to intercurrent lower respiratory tract infection. After 10 months, the girl achieved hematologic remission after induction chemotherapy. The patient then underwent 2-loci HLA-mismatched unrelated donor cord blood transplantation. The time to neutrophil and platelet engraftment was 12 and 23 days post-transplantation, respectively. Acute graft-versus-host disease following transplantation was minimal. She was in continuing hematological remission with full donor chimerism 3 years after transplantation.
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Affiliation(s)
- Chien-Chung Lee
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
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28
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Yoshimi A, Kojima S, Hirano N. Juvenile myelomonocytic leukemia: epidemiology, etiopathogenesis, diagnosis, and management considerations. Paediatr Drugs 2010; 12:11-21. [PMID: 20034338 DOI: 10.2165/11316200-000000000-00000] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Juvenile myelomonocytic leukemia (JMML) is a rare hematopoietic malignancy of early childhood with features characteristic of both myelodysplastic and myeloproliferative disorders. Recent studies clearly show that the deregulated activation of the RAS signaling pathway plays a central role in the pathogenesis of JMML. Somatic defects in either RAS, PTPN11 or NF1 genes involved in this pathway are detected in 70-80% of JMML patients, allowing a molecular diagnosis to be made in the majority of cases. Patients with JMML respond poorly to chemotherapy, and the probability of survival without allogeneic hematopoietic stem cell transplantation (HSCT) is less than 10%. Recent studies show that the event-free survival after HSCT is between 24 and 54%, with no difference between transplants using matched family donors and those using unrelated donors. The use of therapies such as intensive chemotherapy and splenectomy prior to HSCT does not improve the outcome. The relapse rate following HSCT is over 30%, which is unacceptably high. Cumulative evidence suggests that a graft-versus-leukemia effect occurs in JMML. Donor leukocyte infusion is not usually successful in JMML, but the outcome of second HSCT is generally favorable. Based on recent advances in the understanding of the pathogenesis of JMML, the development of novel targeted therapies, which might improve the outcome of patients, is keenly awaited.
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Affiliation(s)
- Ayami Yoshimi
- Department of HSCT Data Management, Nagoya University, Japan.
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29
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Hasegawa D, Manabe A, Yagasaki H, Ohtsuka Y, Inoue M, Kikuchi A, Ohara A, Tsuchida M, Kojima S, Nakahata T. Treatment of children with refractory anemia: the Japanese Childhood MDS Study Group trial (MDS99). Pediatr Blood Cancer 2009; 53:1011-5. [PMID: 19499580 DOI: 10.1002/pbc.22121] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although hematopoietic stem cell transplantation (HSCT) is offered as a curative therapy for pediatric myelodysplastic syndrome (MDS), it may cause severe complications and mortality. Several reports have shown the efficacy of immunosuppressive therapy (IST) in adult patients with refractory anemia (RA), but its safety and efficacy remains to be fully elucidated in childhood RA. PROCEDURE Eleven children diagnosed with RA and enrolled on a prospective multicenter trial conducted by the Japanese Childhood MDS Study Group were eligible for analysis. If patients showed transfusion dependent or suffered from infection due to neutropenia, they received IST consisting of antithymocyte globulin (ATG), cyclosporine (CyA), and methylprednisolone (mPSL). RESULTS Eight children received IST, 2 received only supportive therapy, and one underwent HSCT without IST. Five (63%) of eight children who received IST showed hematological response. Of note, one patient showed the disappearance of monosomy 7 after IST. Responders were significantly younger than non-responders (29 months vs. 140 months; P = 0.03). No severe adverse events related to IST were reported in this study. Of 6 children with chromosomal abnormalities who received IST, four showed hematological response. The probability of failure-free and overall survival at 5 years was 63 +/- 17% and 90 +/- 9% respectively. CONCLUSION IST is likely to be a safe and effective modality for childhood RA.
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Affiliation(s)
- Daisuke Hasegawa
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan.
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30
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Muñoz A, Díaz-Heredia C, Badell I, Bureo E, Gómez P, Martínez A, Verdeguer A, Pérez-Hurtado JM, Fernández-Delgado R, González-Vicent M, Maldonado MS. Allogeneic stem cell transplantation for myelodysplastic syndromes in children: a report from the Spanish Working Party for Blood and Marrow Transplantation in Children (GETMON). Pediatr Hematol Oncol 2009; 26:345-55. [PMID: 19579081 DOI: 10.1080/08880010902976742] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Experience with the use of allogeneic hemopoietic stem transplantation (AHSCT) in pediatric myelodisplastic syndrome (MDS) in Spain is reviewed. METHODS AND PATIENTS Twenty-four children with MDS were analyzed retrospectively. Median age of the patients was 10 years. Twenty patients received a bone marrow graft and 4 an unrelated cord blood (UCB) transplant; 12 bone marrow grafts were from a matched related donor (MRD) and 8 from a matched unrelated donor (MUD). Conditioning regimen consisted of chemotherapy alone in 17 patients (busulfan and cyclophosphamide +/- melfalan) Seven patients received TBI and cyclophosphamide. RESULTS Ten patients died from transplant-related toxicity and 4 had relapse or disease progression post-AHSCT. Nine patients are alive and event-free with a median follow-up of 120 months. EFS rate in the MRD group was 0.48 (SE 0.13) versus 0.25 (SE 0.12) in the MUD/UCB group (p = .07). Lansky score in survivors is >or=90%. CONCLUSIONS In this historical series of children with MDS, in spite of severe transplant-related toxicity, encouraging EFS outcomes have been achieved after AHSCT with good quality of life.
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Affiliation(s)
- Arturo Muñoz
- Department of Pediatrics, Hospital Ramon y Cajal-University of Alcalá, Madrid, Spain.
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31
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Clinicopathological characteristics of erythroblast-rich RAEB and AML M6a in children. Int J Hematol 2008; 88:524-529. [PMID: 18951200 DOI: 10.1007/s12185-008-0183-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Revised: 09/15/2008] [Accepted: 09/24/2008] [Indexed: 11/27/2022]
Abstract
The distinction between RAEB, RAEB-T and AML M6a is difficult when erythroblasts in the bone marrow (BM) exceed 50%. We analyzed 19 children (2 RAEB, 13 RAEB-T and 4 AML M6a) enrolled in a prospective pathological central review in Japan and divided them into two groups according to the myeloblasts percentage among non-erythroid cells in BM: group A (n = 8), 5-19% myeloblasts; group B (n = 11), 20% or more myeloblasts. Their characteristics were very similar except for the number of myeloblasts. The median WBC was in the range of 1.0-5.0 x 10(9) L(-1), the median Hb was around 7.5 g/dL, the median MCV was greater than 90 fL and both group had Auer rods at 60-65%. Severe multilineage dysplasia was observed in most of the patients in two groups. Six with group A and seven with group B treated with AML type chemotherapy achieved complete remission. Five with group A and seven with group B undergoing SCT are alive at a median of 3 years after diagnosis. Erythroblast-rich RAEB and AML M6a in children have similar characteristics and may belong to a single disease entity.
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32
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Tilak V, Sookmane DD, Gupta V, Shukla J. Myelodysplastic syndrome. Indian J Pediatr 2008; 75:729-32. [PMID: 18716744 DOI: 10.1007/s12098-008-0138-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 05/27/2008] [Indexed: 11/28/2022]
Abstract
Pediatric myelodysplastic syndrome (MDS), though rare, constitutes a distinct entity quite different from adult MDS. They have unique clinical features, aggressive clinical course with an overall mean survival of only 9.9 months. A pediatric approach to the WHO classification has become necessary since the WHO classification of MDS has failed to address the uniqueness of pediatric MDS. A new prognostic system also needs to be evolved since the international prognostic system has limited prognostic impact in children. Intensive chemotherapy such as the one used in de novo-acute myeloid leukemia (AML) leads to complete remission in some children and this may be the treatment of choice in pediatric MDS.
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Affiliation(s)
- V Tilak
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Quantification of granulocyte-macrophage colony-stimulating factor hypersensitivity in juvenile myelomonocytic leukemia by 3H-thymidine assay. Leuk Res 2008; 32:1036-42. [DOI: 10.1016/j.leukres.2007.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 11/04/2007] [Accepted: 11/06/2007] [Indexed: 11/21/2022]
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Abstract
Myelodysplastic syndromes (MDS) are clonal disorders characterized by ineffective hematopoiesis and subsequent frequent development of acute myeloid leukemia (AML). In children and adolescents, MDS are uncommon disorders, accounting for less than 5% of hematopoietic malignancy, with great heterogeneity in presentation and clinical course. The genetic changes predisposing children to MDS are largely obscure. Monosomy 7 is the most common chromosomal abnormality, often occurring as a sole abnormality. The recent pediatric modification of the World Health Organization (WHO) classification has greatly facilitated the diagnostic process. Refractory cytopenia (RC) is the most common MDS subtype in children, occurring in about half of all MDS cases. There is consensus that the relationship between MDS with increased blast count and de novo AML is better defined by biological and clinical features than by blast count. Because monosomy 7 is the only chromosomal abnormality strongly suggestive of MDS, children presenting with a low blast count and other chromosomal aberrations or normal karyotype must be closely observed before a diagnosis of MDS can be established. With an increasing number of children surviving primary cancer with chemotherapy or radiation therapy, the incidence of secondary therapy-related MDS is rising. The MDS risk is also increased in patients with inherited bone marrow failure disorders; this relationship provides valuable insights into MDS biology. Allogeneic hematopoietic stem cell transplantation (HSCT) from a matched related or suitable unrelated donor is the choice for most children with MDS and can rescue a large proportion of patients.
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Affiliation(s)
- Charlotte M Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Freiburg, Freiburg, Germany.
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Niemeyer CM, Kratz CP. Paediatric myelodysplastic syndromes and juvenile myelomonocytic leukaemia: molecular classification and treatment options. Br J Haematol 2008; 140:610-24. [DOI: 10.1111/j.1365-2141.2007.06958.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Adachi S, Manabe A, Imaizumi M, Taga T, Tawa A, Tsurusawa M, Kikuchi A, Masunaga A, Tsuchida M, Nakahata T. Acute Myeloid Leukemia with Multilineage Dysplasia in Children. Int J Hematol 2007; 86:358-63. [DOI: 10.1532/ijh97.07025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Elghetany MT. Myelodysplastic syndromes in children: a critical review of issues in the diagnosis and classification of 887 cases from 13 published series. Arch Pathol Lab Med 2007; 131:1110-6. [PMID: 17617000 DOI: 10.5858/2007-131-1110-msicac] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT Pediatric myelodysplastic syndromes (MDSs) are uncommon disorders, which may be difficult to diagnose, particularly in the absence of increased blasts. Pediatric MDSs have several unique features including their association with inherited/constitutional disorders in approximately one third of patients. The classification of pediatric MDSs has undergone significant evolution in the past 20 years. OBJECTIVE To critically review existing classifications of pediatric MDSs and to evaluate their applicability on previously published large series. DATA SOURCES Previously published pediatric MDS series containing more than 10 patients from the English literature between 1982 and 2005. CONCLUSIONS Data were available on 887 patients from 13 published series. Most cases (68.7%) were idiopathic/de novo, 23.9% were associated with constitutional/inherited disorder, and 7.4% were therapy related. Approximately 10% of cases could not be classified by the French-American-British classification. Eighty-seven percent of unclassified cases were appropriately classified using the World Health Organization classification (2001), whereas 96% of them were classified with the modified World Health Organization classification for pediatric MDSs (2003). The impact of cytogenetics and constitutional/inherited disorders on the biology and outcome of the disease needs to be studied further.
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Affiliation(s)
- M Tarek Elghetany
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0743, USA.
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Barnard DR, Alonzo TA, Gerbing RB, Lange B, Woods WG. Comparison of childhood myelodysplastic syndrome, AML FAB M6 or M7, CCG 2891: report from the Children's Oncology Group. Pediatr Blood Cancer 2007; 49:17-22. [PMID: 16856158 DOI: 10.1002/pbc.20951] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS), acute erythroleukemia (FAB M6), and acute megakaryocytic leukemia (FAB M7) have overlapping features. PROCEDURE Children without Down syndrome or acute promyelocytic leukemia who were newly diagnosed with primary myelodysplastic syndrome or acute myeloid leukemia (AML) M6 or M7 were compared to children with de novo AML M0-M5. All children were entered on the Children's Cancer Group therapeutic research study CCG 2891. RESULTS The presentation and outcomes of the 132 children diagnosed with MDS (60 children), AML FAB M6 (19 children), or AML FAB M7 (53 children) were similar. Children with AML FAB M7 were diagnosed at a significantly younger age (P = 0.001). Children with MDS, M6, or M7 had significantly lower white blood cell (WBC) counts (P = 0.001), lower peripheral blast counts (P < 0.001), and an increased frequency of -7/7q- (P = 0.003) at presentation. All three groups had significantly inferior overall survival (OS) (P < 0.001) and event free survival (P < 0.001) compared with the 748 children diagnosed with AML FAB M0-M5 when assessed from entry on study. This poor survival was largely attributable to induction death and failure. However, when assessed from successful completion of induction therapy, the 5-year OS (P = 0.090)(49.1 vs. 56.9%) and disease-free survival (DFS) (P = 0.113)(38.0 vs. 46.3%) therapy were not significantly different from other children with AML. CONCLUSIONS Childhood AML FAB M6 and AML M7 resemble MDS in presentation, poor induction success rates, and outcomes.
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MESH Headings
- Acute Disease
- Child
- Child, Preschool
- Diagnosis, Differential
- Disease-Free Survival
- Female
- Humans
- Leukemia, Erythroblastic, Acute/diagnosis
- Leukemia, Erythroblastic, Acute/mortality
- Leukemia, Megakaryoblastic, Acute/diagnosis
- Leukemia, Megakaryoblastic, Acute/mortality
- Male
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/mortality
- Prognosis
- Remission Induction
- Survival Rate
- Treatment Outcome
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Brichard B, Poirel HA, Chantrain C, Dupont S, Libouton JM, Scheiff JM, Vermylen C. Unusual association of MLL rearrangement and secondary myelomonocytic leukemia in a 15-year-old patient treated for osteosarcoma. Leuk Res 2007; 31:1597-9. [PMID: 17280715 DOI: 10.1016/j.leukres.2006.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2006] [Revised: 12/06/2006] [Accepted: 12/07/2006] [Indexed: 11/16/2022]
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Abstract
PURPOSE OF REVIEW Myelodysplastic and myeloproliferative disorders are clonal myeloid malignancies characterized by the triad of a growth advantage of clonal cells, disturbed differentiation and increased apoptosis. The rarity of these disorders in children and the lack of a widely accepted classification have contributed to the paucity of reports on these malignancies in the pediatric literature. A number of significant advances have been achieved in recent years. The present review will focus on diagnostics and therapy. RECENT FINDINGS International consensus has been achieved on classifying these disorders into three main groups; myelodysplastic syndrome (MDS), myeloid leukemia of Down syndrome (ML-DS) and juvenile myelomonocytic leukemia (JMML). In the last few years we have witnessed important advances, especially regarding the therapy of these disorders, and we have gained insights into the molecular pathogenesis of ML-DS and JMML. SUMMARY Classification of myelodysplastic and myeloproliferative disorders has been facilitated. Chemotherapy regimens for ML-DS have been reduced, resulting in fewer toxic deaths and improved survival. The results of stem-cell transplantation for MDS and JMML have improved. Insight into the molecular mechanisms involved may open new therapeutic avenues.
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MESH Headings
- Child
- Diagnosis, Differential
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/classification
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myelomonocytic, Chronic/classification
- Leukemia, Myelomonocytic, Chronic/diagnosis
- Leukemia, Myelomonocytic, Chronic/therapy
- Myelodysplastic Syndromes/classification
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/therapy
- Myeloproliferative Disorders/classification
- Myeloproliferative Disorders/diagnosis
- Myeloproliferative Disorders/therapy
- Prognosis
- Transplantation Conditioning
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Affiliation(s)
- Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark.
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Abstract
A new classification of myelodysplastic and myeloproliferative diseases in childhood has greatly facilitated the diagnosis of these uncommon disorders. Because hematopoietic stem cell transplantation (HSCT) can cure more than half of the affected children, palliative treatment strategies often applied in adult myelodysplastic syndrome (MDS) are of little importance in pediatric MDS. Unraveling some of the underlying genetic factors predisposing to MDS at a young age may give important insights into leukemogenesis in the elderly.
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Affiliation(s)
- Charlotte Marie Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University of Freiburg, Mathildenstrasse 1, 79106 Freiburg, Germany.
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Affiliation(s)
- Atsushi Manabe
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan.
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Tsurusawa M, Manabe A, Hayashi Y, Akiyama Y, Kigasawa H, Inada H, Noguchi Y, Sawai N, Kobayashi R, Nagatoshi Y, Kawakami K, Kojima S, Nakahata T. Therapy-related myelodysplastic syndrome in childhood: A retrospective study of 36 patients in Japan. Leuk Res 2005; 29:625-32. [PMID: 15863201 DOI: 10.1016/j.leukres.2004.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Accepted: 11/29/2004] [Indexed: 01/08/2023]
Abstract
We report here a retrospective analysis of 36 children with therapy-related myelodysplastic syndrome (t-MDS) diagnosed between 1990 and 1999 in Japan. Their median age was 7.7 years and the median latency period for the development of t-MDS was 38.5 months. The primary tumors were hematologic in 15 of the cases and nonhematologic in 21. Chromosomal abnormalities were detected in 32/34(94%) patients: abnormalities of chromosomes 5and/or 7 in 41% and notably, 11q23 abnormalities in 31%. The prognosis of children with t-MDS was very poor as compared to children with primary MDS (5 year survival: 16% versus 54%, p<0.0001).
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Affiliation(s)
- M Tsurusawa
- Department of Pediatrics, Faculty of Medicine, Aichi Medical University, Aichi 4801195, Japan.
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Trobaugh-Lotrario AD, Kletzel M, Quinones RR, McGavran L, Proytcheva MA, Hunger SP, Malcolm J, Schissel D, Hild E, Giller RH. Monosomy 7 associated with pediatric acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS): successful management by allogeneic hematopoietic stem cell transplant (HSCT). Bone Marrow Transplant 2005; 35:143-9. [PMID: 15558042 DOI: 10.1038/sj.bmt.1704753] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pediatric acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) with monosomy 7 is associated with poor disease-free survival when treated by conventional chemotherapy, immunosuppression or supportive measures. Hematopoietic stem cell transplant (HSCT) may improve outcomes; however, data to support this are limited. To better understand the curative potential of HSCT in these patients, all cases of AML and MDS with monosomy 7 treated by two transplant programs (1992 to present) were reviewed. A total of 16 patients were treated, all by allogeneic HSCT. Primary diagnoses were MDS (N = 5), therapy-related MDS (N = 3), AML (N = 5) and therapy-related AML (N = 3). In all, 11 patients (69%) survive event-free at 2 years with median follow-up of 986 days (range 330-2011 days). Toxicity caused deaths of the five nonsurviving patients, four of whom were transplanted with active leukemia. Allogeneic HSCT is effective therapy for childhood AML and MDS associated with monosomy 7, particularly for patients with AML in complete remission and MDS.
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Affiliation(s)
- A D Trobaugh-Lotrario
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplantation, University of Colorado School of Medicine, Denver, CO 80218, USA
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Hasegawa D, Manabe A, Kubota T, Kawasaki H, Hirose I, Ohtsuka Y, Tsuruta T, Ebihara Y, Goto YI, Zhao XY, Sakashita K, Koike K, Isomura M, Kojima S, Hoshika A, Tsuji K, Nakahata T. Methylation status of the p15 and p16 genes in paediatric myelodysplastic syndrome and juvenile myelomonocytic leukaemia. Br J Haematol 2005; 128:805-12. [PMID: 15755284 DOI: 10.1111/j.1365-2141.2005.05392.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aberrant DNA methylation is frequently observed in adults with myelodysplastic syndrome (MDS), and is recognized as a critical event in the disease's pathogenesis and progression. This is the first report to investigate the methylation status of p15 and p16, cell cycle regulatory genes, in children with MDS (n = 9) and juvenile myelomonocytic leukaemia (JMML; n = 18) by using a methylation-specific polymerase chain reaction. The frequency of p15 hypermethylation in paediatric MDS was 78% (7/9), which was comparable to that in adult MDS. In contrast, p15 hypermethylation in JMML was a rare event (17%; 3/18). In JMML, clinical and laboratory characteristics including PTPN11 mutations and aberrant colony formation were not different between the three patients with hypermethylated p15 and the others. Aberrant methylation of p16 was not detected in children with either MDS or JMML. Since p15 and p16 genes were unmethylated in two children with JMML, in whom the disease had progressed with an increased number of blasts, a condition referred to as blastic crisis, we infer that the aberrant methylation of these genes is not responsible for the progression of JMML. The results suggest that demethylating agents may be effective in most children with MDS and a few patients with JMML.
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Affiliation(s)
- Daisuke Hasegawa
- Department of Paediatric Haematology-Oncology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
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Occhipinti E, Correa H, Yu L, Craver R. Comparison of two new classifications for pediatric myelodysplastic and myeloproliferative disorders. Pediatr Blood Cancer 2005; 44:240-4. [PMID: 15368549 DOI: 10.1002/pbc.20174] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The category, cytology, cytogenetics (CCC) system for myelodysplastic syndrome (MDS) and the pediatric WHO system for MDS/myeloproliferative disorder (MPD) have recently been proposed to characterize these diseases in pediatrics. OBJECTIVE We compare the CCC and pediatric WHO systems against each other and against the French, American, British (FAB) and adult WHO classifications in order to determine which more accurately classifies these diseases and predicts outcome. METHODS An 18-year retrospective review identified patients less than 18 years of age meeting CCC and/or pediatric WHO criteria for the diagnosis of MDS or MPD. Resolution, stability, progression, and death in the subcategories of each system were compared. RESULTS Twenty-eight patients were included in the study. Pediatric WHO: 17 patients met criteria, 10 died. Eight developed acute myelogenous leukemia (AML) (seven died), one juvenile myelomonocytic leukemia (JMML) (died), one chronic myelomonocytic leukemia (CMML) (currently in relapse), two died of complications, two responded to BMT, three have stable disease, one resolved. Eleven patients were not classifiable by the pediatric WHO system, one of which progressed to AML and died. CCC: 26 patients met criteria, 9 died. Nine developed AML (8 died), 1 died of complications, 10 responded to treatment (BMT and/or chemotherapy). Four are stable without treatment, two resolved. Two patients with MPD were not classifiable by the CCC system. CONCLUSIONS Both the pediatric WHO and CCC systems are better able to classify MDS in children than the adult WHO and FAB classifications. The pediatric WHO system is more exclusive. Children meeting these criteria are more likely to progress to AML or death. The restrictive nature of the pediatric WHO system was unable to classify one case of fatal MDS. The CCC system is more inclusive and can stratify patients into a neutral or poor prognosis based upon outcome. However, the CCC system ignores those diseases with a myeloprolifferative component. This resulted in two cases of MPD that were unclassifiable by the CCC system. One of these patients died, the other is currently in relapse.
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Affiliation(s)
- Elise Occhipinti
- Department of Pathology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
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Hasle H, Baumann I, Bergsträsser E, Fenu S, Fischer A, Kardos G, Kerndrup G, Locatelli F, Rogge T, Schultz KR, Starý J, Trebo M, van den Heuvel-Eibrink MM, Harbott J, Nöllke P, Niemeyer CM. The International Prognostic Scoring System (IPSS) for childhood myelodysplastic syndrome (MDS) and juvenile myelomonocytic leukemia (JMML). Leukemia 2004; 18:2008-14. [PMID: 15496981 DOI: 10.1038/sj.leu.2403489] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The International Prognostic Scoring System (IPSS) for myelodysplastic syndrome (MDS) is based upon weighted data on bone marrow (BM) blast percentage, cytopenia, and cytogenetics, separating patients into four prognostic groups. We analyzed the value of the IPSS in 142 children with de novo MDS and 166 children with juvenile myelomonocytic leukemia (JMML) enrolled in retro- and prospective studies of the European Working Group on childhood MDS (EWOG-MDS). Survivals in MDS and JMML were analyzed separately. Among the criteria considered by the IPSS score, only BM blasts <5% and platelets >100 x 10(9)/l were significantly associated with a superior survival in MDS. In JMML, better survival was associated with platelets >40 x 10(9)/l, but not with any other IPSS factors including cytogenetics. In conclusion, the IPSS is of limited value in both pediatric MDS and JMML. The results reflect the differences between myelodysplastic and myeloproliferative diseases in children and adults.
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Affiliation(s)
- H Hasle
- Department of Pediatrics, Skejby Hospital, Aarhus University, Denmark.
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Manabe A, Yoshimasu T, Ebihara Y, Yagasaki H, Wada M, Ishikawa K, Hara J, Koike K, Moritake H, Park YD, Tsuji K, Nakahata T. Viral Infections in Juvenile Myelomonocytic Leukemia: Prevalence and Clinical Implications. J Pediatr Hematol Oncol 2004; 26:636-641. [PMID: 27811604 DOI: 10.1097/01.mph.0000140653.50344.5c] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Viral infections may complicate the diagnosis of juvenile myelomonocytic leukemia (JMML) in a substantial proportion of patients, but this possibility has not been tested in a prospective study. The authors therefore measured the cellular expression of the MxA protein, a reliable marker of viral infection, at diagnosis in children with JMML to estimate the prevalence of such infections. METHODS Eighteen children, aged 1 to 69 months, who met the diagnostic criteria of the International JMML Working Group were prospectively studied. MxA expression was assessed by flow cytometric analysis of peripheral blood mononuclear cells stained with an antihuman MxA antibody. All data were obtained through the MDS Committee of the Japanese Society of Pediatric Hematology. RESULTS Twelve patients (67%) had elevated levels of the MxA protein, with rotavirus, RS virus, or CMV infection documented in three of these patients. Although none of the patients had primary Epstein-Barr virus (EBV) infection, reactivation of the virus was strongly suspected in four children, including two with monosomy 7, each having increased levels of MxA. Southern blot analysis revealed monoclonal integration of the EBV genome into bone marrow mononuclear cells from one of these patients. There was no discernible correlation between increases in the marker protein and the presenting features or course of the disease. CONCLUSIONS Viral infection may be present in two thirds of children with newly diagnosed JMML, but it does not constitute a basis for revising clinical management. The possibility that EBV or other viruses contribute to JMML pathogenesis by stimulating pre-exiting malignant clones warrants further investigation.
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Affiliation(s)
- Atsushi Manabe
- From the *Department of Pediatric Hematology-Oncology, Institute of Medical Science, University of Tokyo, Tokyo; †Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan; ‡Department of Pediatrics, Osaka University, Osaka, Japan; §Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan; ¶Department of Pediatrics, Miyazaki Medical College, Miyazaki, Japan; ∥Department of Pediatrics, Nara Medical University, Nara, Japan; and **Department of Pediatrics, Kyoto University, Kyoto, Japan
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Borojevic R, Roela RA, Rodarte RS, Thiago LS, Pasini FS, Conti FM, Rossi MID, Reis LFL, Lopes LF, Brentani MM. Bone marrow stroma in childhood myelodysplastic syndrome: composition, ability to sustain hematopoiesis in vitro, and altered gene expression. Leuk Res 2004; 28:831-44. [PMID: 15203281 DOI: 10.1016/j.leukres.2003.11.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2003] [Accepted: 11/24/2003] [Indexed: 10/26/2022]
Abstract
We studied bone marrow stromal cell cultures from patients with childhood myelodysplastic syndromes (MDS, refractory anemia with excess of blasts, RAEB) and from matched normal donors. Stromal cell monolayers were characterized as myofibroblasts by the expression of smooth muscle alpha-actin, collagen IV, laminin and fibronectin. When normal cord blood cells were plated onto myelodysplastic stromas, a pathologic cell differentiation was observed, indicating altered myelosupportive properties. cDNA array analysis showed that patient stromas expressed increased levels of thrombospondin-1, collagen-I alpha2-chain, osteoblast-specific factor-2 and osteonectin, indicating the presence of increased osteoblast content, as confirmed by enhanced alkaline phosphatase synthesis. Alterations in the myelodysplastic stroma environment might contribute to abnormal hematopoiesis in this pathology.
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Affiliation(s)
- Radovan Borojevic
- Hospital Universitário Clementino Fraga Filho and Departamento de Histologia e Embriologia, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
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50
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Polychronopoulou S, Panagiotou JP, Kossiva L, Mavrou A, Anagnostou D, Haidas S. Clinical and morphological features of paediatric myelodysplastic syndromes: a review of 34 cases. Acta Paediatr 2004; 93:1015-23. [PMID: 15456186 DOI: 10.1111/j.1651-2227.2004.tb02708.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The clinical and morphological spectrum of myelodysplastic syndromes (MDS) during childhood has not yet been completely documented. We herein present the clinical features and morphological data from peripheral blood (PB), bone marrow aspirates (BMA) and bone marrow biopsies (BMB) of a series of paediatric MDS patients, with particular emphasis on their specific morphological characteristics and their diverse underlying genetic background. PATIENTS AND METHODS Thirty-four patients with MDS (median age 8.45 y) were consecutively diagnosed and treated during a period of 15 y (1988-2002). Diagnosis was based on clinical manifestations, morphology of PB, BMA and BMB, and cytogenetic analysis of BM cells. Clonogenic methylcellulose cell cultures were performed in 23/34 patients. Patients were categorized into group A [26 primary/de novo MDS, i.e. refractory anaemia (RA) 18, RA with excess of blasts (RAEB) 2, RAEB in transformation (RAEB-t) 6] and group B (8 secondary MDS, i.e. RA 4, RAEB 1, RAEB-t 3). Treatment options varied according to protocols active during the period of the study and the availability of a suitable BM donor. Survival probabilities were estimated using the Kaplan-Meier method. RESULTS Dysplastic features of the erythroid, myeloid and megakaryocytic lineage were detected at BMA in 85%, 50% and 90% of the patients, respectively, while decreased cellularity was found at BMB in 21/34 patients (60%). RA patients of group A presented at BMB significant hypocellularity (14/18) as a prominent finding due to decrease of the myeloid (13/18 patients) and/or the megakaryocytic (14/18 patients) lineage. Hypocellularity in RA was accompanied by dysplasia of the erythroid (17/18 patients) and megakaryocytic (16/18 patients) lineage, the presence of abnormal localization of immature precursors (ALIP, 8/18 patients), fibrosis (5/18) and stromal changes (11/18). Chromosomal aberrations were revealed in 17/34 patients, of which monosomy 7 was present in seven. Cell cultures demonstrated abnormal myeloid and/or erythroid in vitro clonal growth pattern in all the examined patients. An associated disorder or inherited disease, was identified in 14/26 patients (54%) with primary MDS. Cumulative survival of group A patients was 44.2% (RA 66.6%, RAEB/RAEBt 14.6%; p = 0.001), and of the whole group 42.4%, at 14 y. CONCLUSIONS Hypocellularity of significant degree is a constant and prominent feature among paediatric MDS, especially those with RA. A large variety of associated disorders underlies the clinical appearance of paediatric MDS, reflecting their marked heterogeneity. RA represents the prominent subtype during childhood (69% in this study), and it appears to have the best prognosis, while prognosis of RAEB/RAEBt remains extremely poor.
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Affiliation(s)
- S Polychronopoulou
- Department of Paediatric Haematology/Oncology, Aghia Sophia Children's Hospital, Athens, Greece.
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