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Tüfekçi Ö, Evim MS, Güneş AM, Celkan T, Karapinar DY, Kaya Z, Baysal B, Baytan B, Koçak Ü, Yilmaz Ş, Çinar S, Ören H. Assessment of Minimal Residual Disease in Childhood Acute Lymphoblastic Leukemia: A Multicenter Study From Turkey. J Pediatr Hematol Oncol 2022; 44:e396-e402. [PMID: 35129146 DOI: 10.1097/mph.0000000000002419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
Assestment of minimal residual disease (MRD) in childhood acute lymphoblastic leukemia (ALL) is of utmost importance both for risk classification and tailoring of the therapy. The data of pediatric ALL patients that received treatment with Berlin-Frankfurt-Münster (BFM) protocols were retrospectively collected from 5 university hospitals in Turkey. Of the 1388 patients enrolled in the study 390 were treated according to MRD-based protocols. MRD assestment was with real time quantitative polymerase chain reaction (qPCR) in 283 patients and with multiparametric flow cytometry (MFC)-MRD in 107 patients. MRD monitoring had upstaged a total of 8 patients (2%) from intermediate risk group to high-risk group. Univariate analysis revealed age 10 years or above, prednisone poor response, PCR-MRD ≥10-3 on day 33 and on day 78 as poor prognostic factors affecting event-free survival (EFS). Detection of >10% blasts on day 15 with MFC (MFC-high-risk group) was not shown to affect EFS and/or overall survival (log-rank P=0.339). Multiple logistic regression analysis revealed PCR-MRD ≥10-3 on day 78 as the only poor prognostic factor affecting EFS (odds ratio: 8.03; 95% confidence interval: 2.5-25; P=0.000). It is very important to establish the infrastructure and ensure necessary standardization for both MRD methods for optimal management of children with ALL.
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Affiliation(s)
- Özlem Tüfekçi
- Department of Pediatric Hematology, Dokuz Eylül University Medical Faculty, İzmir
| | - Melike Sezgin Evim
- Department of Pediatric Hematology, Uludağ University Medical Faculty, Bursa
| | - Adalet Meral Güneş
- Department of Pediatric Hematology, Uludağ University Medical Faculty, Bursa
| | - Tiraje Celkan
- Department of Pediatric Hematology-Oncology, İstanbul University Cerrahpaşa Medical Faculty
| | | | - Zühre Kaya
- Department of Pediatric Hematology, Gazi University Medical Faculty, Ankara, Turkey
| | - Birsen Baysal
- Department of Pediatric Hematology, Dokuz Eylül University Medical Faculty, İzmir
| | - Birol Baytan
- Department of Pediatric Hematology, Uludağ University Medical Faculty, Bursa
| | - Ülker Koçak
- Department of Pediatric Hematology, Gazi University Medical Faculty, Ankara, Turkey
| | - Şebnem Yilmaz
- Department of Pediatric Hematology, Dokuz Eylül University Medical Faculty, İzmir
| | - Suzan Çinar
- İstanbul University Institute of Experimental Medicine, İstanbul
| | - Hale Ören
- Department of Pediatric Hematology, Dokuz Eylül University Medical Faculty, İzmir
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Oral manifestations of leukemia as part of early diagnosis. Hematol Transfus Cell Ther 2021; 44:392-401. [PMID: 34862157 PMCID: PMC9477758 DOI: 10.1016/j.htct.2021.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/25/2021] [Accepted: 08/06/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction The oral cavity can present the first clinical manifestations of leukemia, therefore; it is important to recognize their principal characteristics. Objective To identify oral manifestations as the first clinical signs of leukemia. Methods This is an integrative review, that gathered data from articles with oral manifestations of leukemia as part of its first clinical features. The were included case reports, case series, clinical research, or reviews with case reports. The variables that were considered relevant: age, sex, sites of the oral lesions, characteristics of the oral lesions, medical history and physical examination, time of evolution, radiographic examination, blood test results, initial diagnosis, differential diagnosis and final diagnosis. Results A total of 31 studies were included, with a total of 33 individuals identified. There were 19 (57.57%) males and 14 (42.42%) females. The age range was from 1.6 to 74 years. Acute myeloid leukemia (72.72%) and acute lymphoid leukemia (18.18%) presented more oral manifestations as the first clinical signs of the disease. All individuals with leukemia presented lesions, such as ulcer, erosion, bleeding, ecchymosis, color change of the bluish or pale mucous membranes and areas of tissue necrosis. Hard tissue lesions were less frequent, being 6 (18.18%). Conclusion The first clinical manifestations of leukemia can be present in the oral cavity, mainly in acute myeloid leukemia. The principal oral tissues affected were gingival tissue, buccal mucosa and hard and/or soft palate. When hard tissues, such as the maxilla bone or mandible bone were affected, dental mobility was the principal clinical sign.
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Zawitkowska J, Lejman M, Szmydki-Baran A, Zaucha-Prażmo A, Czyżewski K, Dziedzic M, Zalas-Więcek P, Gryniewicz-Kwiatkowska O, Czajńska-Deptuła A, Gietka A, Semczuk K, Hutnik Ł, Chełmecka-Wiktorczyk L, Żak I, Frączkiewicz J, Salamonowicz M, Tomaszewska R, Zając-Spychała O, Irga-Jaworska N, Bień E, Płonowski M, Bartnik M, Ociepa T, Pierlejewski F, Machnik K, Gamrot-Pyka Z, Badowska W, Brzeski T, Urbanek-Dądela A, Stolpa W, Mizia-Malarz A, Skowron-Kandzia K, Musiał J, Styczyński J. Varicella-zoster virus infection in the pediatric population with acute lymphoblastic leukemia in Poland. J Med Virol 2020; 92:3645-3649. [PMID: 32406935 DOI: 10.1002/jmv.26008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/20/2020] [Accepted: 05/11/2020] [Indexed: 11/10/2022]
Abstract
Varicella-zoster virus (VZV) infection in pediatric hemato-oncology patients can be a therapeutic problem when children are exposed to immunosuppression. The aim of this study is to evaluate the incidence of VZV infection, antiviral therapy and outcome in children with ALL treated in polish hemato-oncological centers between 2012 and 2019 years. This study included medical records of 1874 patients, aged 1 to 18 years, with newly diagnosed acute lymphoblastic leukemia. During chemotherapy, 406 children out of 1874 (21.6%) experienced viral infections. The incidence of VZV infection in the whole group children with ALL was 1.8%. Among them, 34 (8.4%) patients were diagnosed with VZV infection. Thirty-five episodes of viral infections were identified. The median time of VCV therapy was 12 days. Herpes zoster infection occurred in 24 (70.6%) children, and varicella in 10 (29.4%) ones. The average time from the start of chemotherapy to the appearance of herpes zoster was 7.26 ± 4.05 months. VZV infection occurred mainly during the maintenance therapy, the reinduction and induction phases. There was no correlation between steroid dosage or type and subsequent zoster. The total lymphocyte count of these patients on the first day of zoster was reduced. No serious complications were observed due to this infection. All patients survived. In conclusion, a low incidence of VZV infection was observed among pediatric patients with ALL in Poland. This analysis indicates that currently used therapeutic methods are effective in children with cancer and VZV infection. The main focus should be on the prevention of delayed chemotherapy.
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Affiliation(s)
- Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, Lublin, Poland
| | - Monika Lejman
- Genetic Diagnostic Laboratory, Department of Pediatric Hematology, Oncology, and Transplantation, University Children's Hospital, Lublin, Poland
| | - Anna Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, Lublin, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | - Patrycja Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | | | | | - Agnieszka Gietka
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | - Katarzyna Semczuk
- Department of Microbiology, Children's Memorial Health Institute, Warszawa, Poland
| | - Łukasz Hutnik
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Liliana Chełmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Iwona Żak
- Department of Microbiology, University Children's Hospital, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wrocław, Poland
| | - Małgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wrocław, Poland
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology, and Transplantology, University of Medical Sciences, Poznań, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdańsk, Poland
| | - Ewa Bień
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdańsk, Poland
| | - Marcin Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, Białystok, Poland
| | - Magdalena Bartnik
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Ociepa
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Filip Pierlejewski
- Department of Pediatric Oncology, Hematology, and Diabetology, Medical University, Łódź, Poland
| | - Katarzyna Machnik
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzów, Poland
| | - Zuzanna Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzów, Poland
| | - Wanda Badowska
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - Tomasz Brzeski
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | | | - Weronika Stolpa
- Division of Pediatric Oncology, Hematology, and Chemotherapy, Silesian Medical University, Katowice, Poland
| | - Agnieszka Mizia-Malarz
- Division of Pediatric Oncology, Hematology, and Chemotherapy, Silesian Medical University, Katowice, Poland
| | - Katarzyna Skowron-Kandzia
- Division of Pediatric Oncology, Hematology, and Chemotherapy, Silesian Medical University, Katowice, Poland
| | - Jakub Musiał
- Division of Pediatric Onoco-hematology, St. Queen Jadwiga's Regional Clinical Hospital No. 2, Rzeszów, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
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Zawitkowska J, Lejman M, Drabko K, Zaucha-Prażmo A. Diagnostic difficulties of AH1N1 influenza infection in children with acute lymphoblastic leukemia: Two case reports. Medicine (Baltimore) 2020; 99:e22790. [PMID: 33120795 PMCID: PMC7581103 DOI: 10.1097/md.0000000000022790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Children with acute lymphoblastic leukemia (ALL) are at a risk of developing influenza-related complications. Approximately 10% of influenza-infected children with ALL or other types of cancer need intensive care, and 5% of them eventually die. PATIENTS' CONCERNS We report 2 children with ALL and the swine-origin influenza A virus infection. Diagnosing influenza in them was a challenge. Medical records of these children were reviewed for demographic, clinical, and laboratory data. Patients were hospitalized in the Department of Pediatric Hematology, Oncology, and Transplantology of the Medical University of Lublin, Poland. Case 1 involved a 2-year-old girl who, according to acute lymphoblastic leukemia intercontinental Berlin-Frankfürt-Münster protocol 2009, started chemotherapy in July 2015. She was categorized in the intermediate risk group and received the induction and consolidation phase of the therapy without severe complications. The reinduction therapy was administered in the outpatient department till the 15 day. On the 20 day of this phase, she was admitted to our department with fever, mucositis, tachypnea, abdominal pain, and diarrhea. In September 2009, a 14-year-old boy (case 2) who, according to acute lymphoblastic leukemia intercontinental Berlin-Frankfürt-Münster protocol 2002, was categorized in the high-risk (HR) group, received the induction (Protocol I) phase of therapy without severe complications. On the 7 day of the HR-1 course, he manifested fever and strong, tiring cough, followed by strong mucositis. Chemotherapy had to be interrupted in both children. DIAGNOSIS Respiratory viral infections, causing pneumonia, occurred in both patients during anticancer treatment. Initially, the real-time polymerase chain reaction test for the swine-origin influenza A was negative in both patients, which delayed the diagnosis. Additionally, bacterial, and fungal complications were also observed. INTERVENTIONS Both patients received oseltamivir twice a day, a broad-spectrum antibiotic, antifungal drug, and granulocyte colony growth factor. OUTCOMES The disease progressed quickly, and our patients subsequently died. CONCLUSION We speculated that early antiviral treatment can help in the better management of patients in the HR group. It is also important to minimize influenza morbidity and mortality by vaccinating family members, using empiric therapy, providing immediate antiviral therapy, and educating parents about hygiene measures.
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Affiliation(s)
- Joanna Zawitkowska
- Department of Paediatric Haematology, Oncology, and Transplantology, Medical University
| | - Monika Lejman
- Department of Paediatric Haematology, Oncology, and Transplantology, Medical University
- Laboratory of Genetic Diagnostics, Medical University of Lublin, Poland
| | - Katarzyna Drabko
- Department of Paediatric Haematology, Oncology, and Transplantology, Medical University
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Liu K, Chu J, Dai Y, Jiang A, Yang L, Xie Z, Zhang K, Tu S, Cai H, Wu Z, Wang N. Long-term follow-up of acute lymphoblastic leukemia in young children treated by the SCMC-ALL-2009 protocol. Leuk Lymphoma 2020; 61:2850-2858. [PMID: 32643496 DOI: 10.1080/10428194.2020.1786557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study evaluated the long-term therapeutic effect and prognostic factors of acute lymphoblastic leukemia (ALL) in 100 young Chinese children (<2 years old) who were enrolled in the Shanghai Children's Medical Center (SCMC)-ALL-2009 study in five pediatric hematological disease centers based on collaboration. The 5-year and 10-year event-free survivals (EFS) were 74.7 ± 3.2% and 73.3 ± 3.4%. The 10-year EFS rates for low risk, intermediate-risk, and high-risk patients were 81.9 ± 5.0%, 71.3 ± 4.3%, and 22.2 ± 13.9%, respectively. Relapse occurred in 19 patients. MRD results on day 55, good or poor response to prednisolone, and age at diagnosis were shown to have important prognostic and therapeutic implications. Compared with the SCMC-ALL-2005 protocol, showed that the 10-year-EFS and 10-year-overall survival of the SCMC-ALL-2009 protocol were better than that of the -2005 protocol. Notably, the intermediate-risk group was improved after the chemotherapy intensity was strengthened.
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Affiliation(s)
- Kangkang Liu
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Jinhua Chu
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Yu Dai
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China.,Department of Pediatrics, The Fourth Hospital of Anhui Medical University, Hefei, China
| | - Aoshuang Jiang
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China.,Hematology Department, Anhui Provincial Children's Hospital, Hefei, China
| | - Linhai Yang
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Zhiwei Xie
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Kunlong Zhang
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Songji Tu
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Huaju Cai
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Zhengyu Wu
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Ningling Wang
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
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Zawitkowska J, Lejman M, Zaucha-Prażmo A, Sekuła N, Greczkowska-Chmiel T, Drabko K. Severe drug-induced hypertriglyceridemia treated with plasmapheresis in children with acute lymphoblastic leukemia. Transfus Apher Sci 2019; 58:634-637. [PMID: 31515171 DOI: 10.1016/j.transci.2019.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/05/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Abstract
Asparaginase (ASP) and steroids are a main part of treatment for ALL, in both front-line and relapse setting. It is known, that ASP can cause several toxicities such as hypersensitivity, pancreatitis, as well as severe lipid and coagulation disturbances. Administered steroids can result in diabetes, obesity, hyponatremia and also mild hyperlipemia, which can intensify side effects of asparaginase. When triglyceride elevation is greater than 1000 mg/dl, the risk of pancreatitis is significantly increased. We report two patients who were hospitalized in Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin in Poland and developed severe hypertriglyceridemia after receiving asparaginase and steroid therapy for acute lymphoblastic leukemia. These patients were treated using plasmapheresis. This procedure was performed with a venous catheter in the femoral vein and 5% albumin or fresh frozen plasma as the replacement fluid. We analysed the laboratory and clinical data of these children. Plasmapheresis was well tolerated in both cases and a decrease of hypertriglyceridemia was quickly observed. However, the girl developed pancreatitis. In our opinion, plasmapheresis appears to be safe and effective in reducing hypertriglyceridemia. We could recommend that this procedure should be performed early, as soon as the triglyceride level is above 1000 mg/dl, in order to prevent severe complications. Patients should continue chemotherapy without ASP. It is important to regularly monitor of the lipid profile, pancreatic enzymes and coagulation during ASP and steroids therapy.
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Affiliation(s)
- Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, Lublin, Poland.
| | - Monika Lejman
- Department of Pediatric Hematology, Oncology and Transplantation, University Children's Hospital, Genetic Diagnostic Laboratory, Lublin, Poland
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, Lublin, Poland
| | - Natasza Sekuła
- Department of Pediatric Hematology, Oncology and Transplantation, University Children's Hospital, Lublin, Poland
| | - Teresa Greczkowska-Chmiel
- Department of Pediatric Hematology, Oncology and Transplantation, University Children's Hospital, Lublin, Poland; Department of Blood Treatment, University Children's Hospital, Lublin, Poland
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, Lublin, Poland
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Zawitkowska J, Drabko K, Szmydki-Baran A, Zaucha-Prażmo A, Lejman M, Czyżewski K, Zalas-Więcek P, Gryniewicz-Kwiatkowska O, Czajńska-Deptuła A, Kulicka E, Semczuk K, Hutnik Ł, Chełmecka-Wiktorczyk L, Klepacka J, Frączkiewicz J, Salamonowicz M, Tomaszewska R, Zając-Spychała O, Irga-Jaworska N, Bień E, Płonowski M, Bartnik M, Ociepa T, Pierlejewski F, Woszczyk M, Gamrot-Pyka Z, Małas Z, Urbanek-Dądela A, Stolpa W, Musiał J, Styczyński J. Infectious profile in children with ALL during chemotherapy: A report of study group for infections. J Infect Chemother 2019; 25:774-779. [PMID: 31101529 DOI: 10.1016/j.jiac.2019.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/20/2019] [Accepted: 04/06/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The treatment-related mortality in currently published studies of acute lymphoblastic leukemia (ALL) in children is 2-4%, mainly due to infections. The aim of the study was to analyse the incidence, epidemiology, profile of infection and the death rate in children with ALL. PATIENTS AND METHODS The retrospective analysis included 1363 patients, aged 1-18 years, with newly diagnosed ALL, who were treated in 17 pediatric hematology centers between 2012 and 2017 in Poland. The patients received therapy according to the ALL IC-BFM 2002 and 2009 (International Berlin-Frankfurt-Munster Study Group) protocols. RESULTS In our study, 726 out of 1363 (53.2%) children were reported to have a microbiologically documented bacterial infection during chemotherapy. 1511 episodes of these infection were diagnosed. A total number of 251/1363 (18.4%) children experienced a viral infection. 304 episodes were documented by PCR test (polymerase chain reaction). A fungal infection was reported in 278 (20.4%) children, including 10.1% of probable, 6.0% of proven, 83% of possible diagnosis. A higher frequency of fungal infection was noted in the recent years. In our material, the rate of death was 2.4%, mainly due to fungal infection. CONCLUSIONS Our results present the epidemiology of infectious disease in the Polish ALL patient population. The most frequent were bacterial infections, followed by fungal and viral ones. Similar to the previously published data, the mortality rate in our material was 2.4%.
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Affiliation(s)
- Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, Lublin, Poland.
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, Lublin, Poland
| | - Anna Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, Lublin, Poland
| | - Monika Lejman
- Department of Pediatric Hematology, Oncology and Transplantation, University Children's Hospital, Genetic Diagnostic Laboratory, Lublin, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | - Patrycja Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | | | | | - Elwira Kulicka
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | - Katarzyna Semczuk
- Department of Microbiology, Children's Memorial Health Institute, Warszawa, Poland
| | - Łukasz Hutnik
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Liliana Chełmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Joanna Klepacka
- Department of Microbiology, University Children's Hospital, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wrocław, Poland
| | - Małgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wrocław, Poland
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznań, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdańsk, Poland
| | - Ewa Bień
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdańsk, Poland
| | - Marcin Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, Białystok, Poland
| | - Magdalena Bartnik
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Ociepa
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Filip Pierlejewski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Łódź, Poland
| | - Mariola Woszczyk
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzów, Poland
| | - Zuzanna Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzów, Poland
| | - Zofia Małas
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | | | - Weronika Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - Jakub Musiał
- Division of Pediatric Onoco-hematology, St. Queen Jadwiga's Regional Clinical Hospital No. 2, Rzeszów, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
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Shin J, Lee NY, Kim S, Lee JW, Jang PS, Chung NG, Cho B. Outcome and prognostic factors of children with Philadelphia chromosome-positive acute lymphoblastic leukemia treated with imatinib followed by allogeneic hematopoietic cell transplantation in first remission. Blood Res 2019; 54:45-51. [PMID: 30956963 PMCID: PMC6439289 DOI: 10.5045/br.2019.54.1.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/06/2018] [Accepted: 10/10/2018] [Indexed: 11/17/2022] Open
Abstract
Background Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) is a subset of ALL with poor prognosis. Here, we analyzed the outcomes and prognostic factors of children with Ph+ ALL who received imatinib and chemotherapy followed by allogeneic hematopoietic cell transplantation (HCT) in first complete remission (CR). Methods Thirty-one Ph+ ALL patients (female 10) diagnosed from January 2005 to December 2016 were included in the study. All patients were treated with imatinib and chemotherapy before HCT. Bone marrow (BM) evaluations included real-time quantitative polymerase chain reaction (RQ-PCR) study of the BCR-ABL1 fusion transcript. All patients received HCT with total body irradiation (TBI)-based conditioning at a median of 6.4 (range, 4.2-47.1) months from diagnosis. Results Compared to values at diagnosis, the median decrement of RQ-PCR value post-consolidation, and prior to HCT was -3.7 Log and -4.8 Log, respectively. The 5-year event-free survival (EFS) and overall survival of the patients were 64.5±9.4% (20/31) and 75.0±8.3% (23/31) respectively. Events included relapse (N=5) and death in CR post-HCT (N=6). The 5-year incidence of molecular relapse was 30.9±9.1% (9/31). An RQ-PCR decrement of at least -4 Log post-consolidation significantly predicted lower incidence of molecular relapse: 7.7±7.7% for ≥-4 Log decrement, 50.0±13.8% for <-4 Log decrement (P=0.027). Conclusion Decrement in RQ-PCR for the BCR-ABL1 transcript that was determined after consolidation was the only significant prognostic factor for incidence of molecular relapse. In the post-induction TKI initiation setting, steadfast imatinib treatment during consolidation may allow for optimum post-HCT outcomes.
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Affiliation(s)
- Juae Shin
- Department of Pediatrics, The Catholic University of Korea, Seoul, Korea
| | - Na Yeong Lee
- Department of Pediatrics, The Catholic University of Korea, Seoul, Korea
| | - Seongkoo Kim
- Department of Pediatrics, The Catholic University of Korea, Seoul, Korea
| | - Jae Wook Lee
- Department of Pediatrics, The Catholic University of Korea, Seoul, Korea
| | - Pil-Sang Jang
- Department of Pediatrics, The Catholic University of Korea, Seoul, Korea
| | - Nack-Gyun Chung
- Department of Pediatrics, The Catholic University of Korea, Seoul, Korea
| | - Bin Cho
- Department of Pediatrics, The Catholic University of Korea, Seoul, Korea
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