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Renaud J, Goemans BF, Locatelli F, Pigazzi M, Redmond S, Kuehni CE, Destaillats A, Alonzo TA, Gerbing RB, Gamis A, Aplenc R, Renella R, Cooper T, Ceppi F. Characteristics and treatment of acute myeloid neoplasms with cutaneous involvement in infants up to 6 months of age: A retrospective study. Pediatr Blood Cancer 2024; 71:e31006. [PMID: 38616361 DOI: 10.1002/pbc.31006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Myeloid neoplasms account for 50% of cases of pediatric leukemias in infants. Approximately 25%-50% of patients with newborn leukemia have cutaneous extramedullary disease (EMD). In less than 10% of patients, aleukemic leukemia cutis or isolated extramedullary disease with cutaneous involvement (cEMD) occurs when skin lesions appear prior to bone marrow involvement and systemic symptoms. Interestingly, in acute myeloid leukemia with cutaneous EMD (AML-cEMD) and cEMD, spontaneous remissions have been reported. METHOD This is a multicentric retrospective cohort study aiming to describe characteristics, treatment, and outcome of infants with either cEMD or presence of cutaneous disease with involvement of the bone marrow (AML-cEMD). This study included patients born between 1990 and 2018 from Italy, the Netherlands, Switzerland, and the United States, diagnosed between 0 and 6 months of life with cEMD or AML-cEMD. Descriptive statistics, Fisher's exact test, Kaplan-Meier method, and log rank test were applied. RESULTS The cohort consisted of n = 50 patients, including 42 AML-cEMD and eight cEMD patients. The most common genetic mutation found was a KMT2A rearrangement (n = 26, 52%). Overall 5-year event-free survival (EFS) and overall survival (OS) were 66% [confidence interval (CI): 51-78] and 75% [CI: 60-85], respectively. In two patients, complete spontaneous remission occurred without any therapy. Central nervous system (CNS) involvement was found in 25% of cEMD patients. No difference in outcomes was observed between the AML-cEMD and cEMD groups, but none of the latter patients included in the study died. KMT2A rearrangements were not associated with poorer prognosis. CONCLUSION In the largest cohort to date, our study describes the characteristics of infants with cutaneous involvement of myeloid neoplasms including cytomolecular findings and survival rates. Further prospective biologic and clinical studies of these infants with myeloid neoplasms will be required to individualize therapy for this rare patient population.
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Affiliation(s)
- Juliette Renaud
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Bianca F Goemans
- Princess Máxima Center for pediatric oncology, Utrecht, Netherlands
| | - Franco Locatelli
- Department of Haematology/Oncology and Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Martina Pigazzi
- Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Shelagh Redmond
- Institute of Social and Preventive Medicine (ISPM), University of Bern and Childhood Cancer Registry (ChCR), Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern and Childhood Cancer Registry (ChCR), Bern, Switzerland
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Alice Destaillats
- Sponsor Research Office, Direction of Innovation and Clinical Research (DIRC), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Todd A Alonzo
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Children's Oncology Group, Monrovia, California, USA
| | | | - Alan Gamis
- Department of Hematology-Oncology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Richard Aplenc
- Division of Pediatric Oncology/Stem Cell Transplant, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Raffaele Renella
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Todd Cooper
- Pediatric Hematology-Oncology Unit, Seattle Children Hospital, Seattle, Washington, USA
| | - Francesco Ceppi
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
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2
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Ducassou S, Abou Chahla W, Duployez N, Halfon-Domenech C, Brethon B, Poirée M, Adam de Beaumais T, Lemaître L, Sirvent N, Petit A. [SFCE harmonization workshops: Neonatal acute myeloid leukemia]. Bull Cancer 2024; 111:513-524. [PMID: 38503585 DOI: 10.1016/j.bulcan.2023.12.010] [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] [Received: 08/18/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 03/21/2024]
Abstract
Neonatal acute myeloid leukemias (AML) occurred within the first 28 days of life and constitute only a small proportion of all AL. They are distinguished from leukemias of older children by their clinical presentation, which frequently includes cutaneous localizations ("blueberry muffin rash syndrome") and a leukocytosis above 50 ×109/L. This proliferation may be transient, causing a transient leukemoid reaction in a background of constitutional trisomy 21 ("Transient Abnormal Myelopoieseis" or TAM) or Infantile Myeloproliferative Disease in the absence of constitutional trisomy 21 ("Infantile Myeloproliferative Disease" or IMD). In cases of true neonatal AML, the prognosis of patients is poor. Overall survival is around 35 % in the largest historical series. This poor prognosis is mainly due to the period of onset of this pathology making the use of chemotherapy more limited and involving many considerations, both ethical and therapeutic. The objective of this work is to review this rare pathology by addressing the clinical, biological, therapeutic and ethical particularities of patients with true neonatal AML or transient leukemoid reactions occurring in a constitutional trisomy 21 (true TAM) or somatic background (IMD).
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Affiliation(s)
- Stéphane Ducassou
- Service d'hématologie et d'oncologie pédiatrique, CHU de Bordeaux, Bordeaux, France
| | | | | | - Carine Halfon-Domenech
- Service d'hématologie pédiatrique, institut d'hématologie et d'oncologie pédiatrique, hospices civils de Lyon, université Lyon 1, Lyon, France
| | - Benoît Brethon
- Service d'hématologie pédiatrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - Marilyne Poirée
- Service d'hématologie et d'oncologie pédiatrique, CHU de Nice, Nice, France
| | | | - Laurent Lemaître
- Service d'hématologie et oncologie pédiatrique, CHU de Montpellier, Montpellier, France
| | - Nicolas Sirvent
- Service d'hématologie et oncologie pédiatrique, CHU de Montpellier, Montpellier, France
| | - Arnaud Petit
- Service d'hématologie et oncologie pédiatrique, hôpital Armand-Trousseau, AP-HP, Sorbonne université, Paris, France
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3
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Kalmode H, Podsiadly I, Kabra A, Boulton A, Reddy P, Gao Y, Li C, Bushweller JH. Small-Molecule Inhibitors of the MLL1 CXXC Domain, an Epigenetic Reader of DNA Methylation. ACS Med Chem Lett 2022; 13:1363-1369. [PMID: 35978680 PMCID: PMC9377001 DOI: 10.1021/acsmedchemlett.2c00198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The CXXC domain is a reader of DNA methylation which preferentially binds to unmethylated CpG DNA motifs. Chromosomal translocations involving the MLL1 gene produce in-frame fusion proteins in which the N-terminal portion of the MLL1 protein harboring its CXXC domain is fused to the C-terminal portion of multiple partners. For the MLL-AF9 fusion, mutations which disrupt CXXC domain-DNA binding abrogate the ability to cause leukemia in mice. Based on this, we initiated an effort to develop small-molecule inhibitors of the MLL1 CXXC domain as a novel approach to therapy. We developed a fluorescence polarization-based assay for MLL CXXC domain-DNA binding and screened a library of Cys-reactive molecules. For the most potent hit from this screen, we have synthesized a library of analogs to explore the structure-activity relationship, defined the binding site using chemical shift perturbations in NMR spectra, and explored the selectivity of compounds across the CXXC domain family.
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Affiliation(s)
- Hanuman
P. Kalmode
- Department
of Molecular Physiology and Biological Physics, University of Virginia, Charlottesville, Virginia 22903, United States
| | - Izabella Podsiadly
- Department
of Molecular Physiology and Biological Physics, University of Virginia, Charlottesville, Virginia 22903, United States
| | - Ashish Kabra
- Department
of Molecular Physiology and Biological Physics, University of Virginia, Charlottesville, Virginia 22903, United States
| | - Adam Boulton
- Department
of Molecular Physiology and Biological Physics, University of Virginia, Charlottesville, Virginia 22903, United States
| | - Prabhakar Reddy
- Department
of Molecular Physiology and Biological Physics, University of Virginia, Charlottesville, Virginia 22903, United States
| | - Yan Gao
- Department
of Molecular Physiology and Biological Physics, University of Virginia, Charlottesville, Virginia 22903, United States
| | - Christopher Li
- Department
of Molecular Physiology and Biological Physics, University of Virginia, Charlottesville, Virginia 22903, United States
| | - John H. Bushweller
- Department
of Molecular Physiology and Biological Physics, University of Virginia, Charlottesville, Virginia 22903, United States
- Department
of Chemistry, University of Virginia, Charlottesville, Virginia 22904, United States
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4
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A Simple-to-Use Nomogram for Predicting Survival in Children with Acute Myeloid Leukemia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7264623. [PMID: 33778082 PMCID: PMC7972835 DOI: 10.1155/2021/7264623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 02/07/2021] [Accepted: 02/20/2021] [Indexed: 01/22/2023]
Abstract
Background The research analyzed a group of patients to develop a statistical nomogram and a web-based survival rate predictor for the comprehensive estimate of the overall survival (OS) of children with acute myeloid leukemia. Methods Between 1999 to 2015, we used the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database to evaluate and randomly divide 440 children diagnosed with AML into the population of training (n = 309) and validation (n = 131). The analysis of Lasso Cox was used to identify separate predictive variables. We have used essential forecasting considerations to construct a nomogram and a web-based calculator focused on Cox regression analysis. Nomogram validation was tested through discrimination and calibration. Results Compared to the multivariate training cohort models, a nomogram integrating gender, age of diagnose, WBC at diagnosis, bone marrow leukemic blast percentage, and chromosomal abnormalities [t(8; 21), inv(16)] were designed for the prediction of OS. We also developed a predictive survival nomogram and a web-based calculator. C-indexes validated internally and checked externally were 0.747 and 0.716. The calibration curves have shown that the nomogram might accurately forecast 3-year and 5-year OS. Conclusions A nomogram effectively predicts survival in children with AML. This prognostic model can be used in clinical practice.
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5
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Green K, Tandon S, Ahmed M, Toscano W, O'Connor D, Ancliff P, Vora A, Bartram J, Samarasinghe S, Ghorashian S, Pavasovic V, Rao A. Congenital acute myeloid leukemia: challenges and lessons. A 15-year experience from the UK. Leuk Lymphoma 2021; 62:688-695. [PMID: 33225799 DOI: 10.1080/10428194.2020.1845335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/24/2020] [Indexed: 10/22/2022]
Abstract
Congenital Acute Myeloid leukemia (CAML) is a rare leukemia diagnosed within the first 28 days of life. Dismal survival rates of approximately 25% at two years from diagnosis have not improved despite multiple treatment protocols, and there lacks international consensus for optimal management of these vulnerable patients. We report a retrospective analysis of our fifteen-year experience from a large UK tertiary pediatric center, focusing on treatment modalities and outcomes, including late therapeutic toxicities. To our knowledge, this is the first UK series of congenital leukemia patients reported. Twelve patients with a median age of 16.4 days (1-60) were diagnosed with CAML in fifteen years. All patients presented unwell; 92% demonstrating skin involvement. 10 (83%) received chemotherapy; with 1 death at presentation and 1 spontaneous remission. 5 (42%) received subsequent stem cell transplant. Only 4 (33%) remain alive, with 5 (42%) dying in disease remission with treatment-related mortality. Documented cardiotoxicity was observed in 3 (25%) patients, with a further 2 (17%) suspected but not receiving postmortem. Treatment of congenital AML raises challenging diagnostic, therapeutic and ethical questions and requires multi-center, international collaboration to see improvements.
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Affiliation(s)
- Katherine Green
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sneha Tandon
- Division of Pediatric Oncology, Department of Pediatrics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mansur Ahmed
- Department of Pharmacy, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Wanda Toscano
- Department of Pharmacy, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - David O'Connor
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Philip Ancliff
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Ajay Vora
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Jack Bartram
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sujith Samarasinghe
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sara Ghorashian
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Vesna Pavasovic
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Anupama Rao
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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6
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Skin infiltration as a presenting sign of congenital leukaemia: presentation of two cases. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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7
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Abstract
Acute lymphoblastic leukemia (ALL) in a neonate can have a similar clinical appearance to other serious pathology and should be considered in the ill-appearing infant. We present the case of a 24-hour-old male infant born to a mother with limited prenatal care who was brought to the pediatric emergency department with a rash and decreased movement. His initial white blood cell count was 822 × 10 cells/L. Cytogenetics showed a complex t (9;19;11) translocation, indicating a diagnosis of neonatal ALL. Given the morbidity and mortality rate among infants with neonatal ALL, his parents elected not to pursue cancer-directed therapy in favor of symptomatic care.
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8
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Zhang Q, Ren Z, Yang J, Yin A. Analysis of 59 cases of congenital leukemia reported between 2001 and 2016. J Int Med Res 2019; 47:4625-4635. [PMID: 31558073 PMCID: PMC6833372 DOI: 10.1177/0300060519872899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Congenital leukemia (CL), defined as manifestations of leukemia within the first 4 weeks of life, is a rare condition with an estimated incidence of only 1 to 5 per million live births. Despite extensive research and the clinical application of new therapies, the prognosis of CL remains poor. Few large-scale studies have investigated the factors affecting the outcomes of infants with CL. Here, we conducted a retrospective study and analysis of CL cases published in the English language from 1 January 2001 to 1 May 2016. Our goal was to provide updated information about this rare disease and to investigate factors that may affect the outcomes of patients with CL.
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Affiliation(s)
- Qi Zhang
- Clinical Genetic Center, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhuxiao Ren
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jie Yang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Aihua Yin
- Clinical Genetic Center, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
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9
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Zhang N, Chen Y, Lou S, Shen Y, Deng J. A six-gene-based prognostic model predicts complete remission and overall survival in childhood acute myeloid leukemia. Onco Targets Ther 2019; 12:6591-6604. [PMID: 31496748 PMCID: PMC6701647 DOI: 10.2147/ott.s218928] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/26/2019] [Indexed: 01/07/2023] Open
Abstract
Objective Acute myeloid leukemia (AML) is a malignant clonal disorder. Despite enormous progress in its diagnosis and treatment, the mortality rate of AML remains high. The aim of this study was to identify prognostic biomarkers by using the gene expression profile dataset from public database, and to improve the risk-stratification criteria of survival for patients with AML. Materials and methods The gene expression data and clinical parameter were acquired from the Therapeutically Applicable Research to Generate Effective Treatment (TARGET) database. A total of 856 differentially expressed genes (DEGs) were obtained from the childhood AML patients classified into first complete remission (CR1) group (n=791) and not CR group (n=249). We performed a series of bioinformatics analysis to screen key genes and pathways, further comprehending these DEGs through Gene Ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. Results Six genes (SLC17A7, MSX2, CDC26, MSLN, CTSZ and DEFA3) identified by univariate, Kaplan-Meier survival and multivariate Cox regression analyses were used to develop the prognostic model. Further analysis showed that the survival estimations in the high-risk group had an increased risk of death compared with the low-risk group based on the model. The area under the curve of the receiver operator characteristic curve in the prognostic model for predicting the overall survival was 0.729, confirming good prognostic model. We also performed a nomogram to provide an individual patient with the overall probability, and internal validation in the TARGET cohort. Conclusion We identified a six-gene prognostic signature for risk-stratifying in patients with childhood AML. The risk classification model can be used to predict CR markers and may assist clinicians in providing realize the individualized treatment in this patient population.
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Affiliation(s)
- Nan Zhang
- Department of Hematology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, People's Republic of China
| | - Ying Chen
- Department of Hematology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, People's Republic of China
| | - Shifeng Lou
- Department of Hematology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, People's Republic of China
| | - Yan Shen
- Department of Hematology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, People's Republic of China
| | - Jianchuan Deng
- Department of Hematology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, People's Republic of China
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10
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Cabrero Hernández M, Andión Catalán M, Molina Angulo B, Castillo Robleda A, Madero López L. [Skin infiltration as a presenting sign of congenital leukaemia: Presentation of two cases]. An Pediatr (Barc) 2019; 92:106-108. [PMID: 31104895 DOI: 10.1016/j.anpedi.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/06/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Maitane Andión Catalán
- Servicio Hemato-Oncología y Trasplante hematopoyético, Hospital Infantil Universitario Niño Jesús, Madrid, España.
| | - Blanca Molina Angulo
- Servicio Hemato-Oncología y Trasplante hematopoyético, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Ana Castillo Robleda
- Servicio de Análisis Clínicos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Luis Madero López
- Servicio Hemato-Oncología y Trasplante hematopoyético, Hospital Infantil Universitario Niño Jesús, Madrid, España
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Knez V, Liu X, Schowinsky J, Pan Z, Wang D, Lorsbach R, Lu C, Luedke C, Haag M, Carstens B, Swisshelm K, Yang LH, Jug R, Wang E, Liang X. Clinicopathologic and genetic spectrum of infantile B-lymphoblastic leukemia: a multi-institutional study. Leuk Lymphoma 2018; 60:1006-1013. [DOI: 10.1080/10428194.2018.1508667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Virginia Knez
- Department of Pathology, University of Colorado School of Medicine, Aurora,CO, USA
| | - Xin Liu
- Department of Pathology, Duke University, Durham, NC, USA
| | - Jeffrey Schowinsky
- Department of Pathology, University of Colorado School of Medicine, Aurora,CO, USA
| | - Zenggang Pan
- Department of Pathology, University of Colorado School of Medicine, Aurora,CO, USA
| | - Dehua Wang
- Division of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Robert Lorsbach
- Division of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Chuanyi Lu
- Department of Laboratory Medicine, University of California and Veterans Affairs Medical Center, San Francisco, CA, USA
| | | | - Mary Haag
- Colorado Genetics Laboratory, University of Colorado School of Medicine, Aurora,CO, USA
| | - Billie Carstens
- Colorado Genetics Laboratory, University of Colorado School of Medicine, Aurora,CO, USA
| | - Karen Swisshelm
- Colorado Genetics Laboratory, University of Colorado School of Medicine, Aurora,CO, USA
| | - Lian-He Yang
- Department of Pathology, Duke University, Durham, NC, USA
| | - Rachel Jug
- Department of Pathology, Duke University, Durham, NC, USA
| | - Endi Wang
- Department of Pathology, Duke University, Durham, NC, USA
| | - Xiayuan Liang
- Department of Pathology, University of Colorado School of Medicine, Aurora,CO, USA
- Department of Pathology, Children’s Hospital Colorado, Aurora,CO, USA
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12
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Affiliation(s)
- Irene Roberts
- MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine; University of Oxford, Centre for Haematology; Oxford UK
- Oxford BRC Blood Theme, NIHR Oxford Biomedical Centre; Oxford UK
- Department of Paediatrics; University of Oxford; John Radcliffe Hospital; Oxford UK
| | - Nicholas J. Fordham
- MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine; University of Oxford, Centre for Haematology; Oxford UK
| | - Anupama Rao
- Great Ormond Street Hospital for Children; London UK
| | - Barbara J. Bain
- St Mary's Hospital campus of Imperial College London; St Mary's Hospital; London UK
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13
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Alfaar AS, Hassan WM, Bakry MS, Qaddoumi I. Neonates with cancer and causes of death; lessons from 615 cases in the SEER databases. Cancer Med 2017; 6:1817-1826. [PMID: 28639735 PMCID: PMC5504346 DOI: 10.1002/cam4.1122] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/03/2017] [Accepted: 05/11/2017] [Indexed: 01/15/2023] Open
Abstract
Neonatal tumors are rare with no standard treatment approaches to these diseases, and the patients experience poor outcomes. Our aim was to determine the distribution of cancers affecting neonates and compare survival between these cancers and older children. We analyzed SEER data (1973-2007) from patients who were younger than 2 years at diagnosis of malignancy. Special permission was granted to access the detailed (i.e., age in months) data of those patients. The Chi-square Log-rank test was used to compare survival between neonates (aged <1 month) and older children (>1 month to <2 years). We identified 615 neonatal cancers (454 solid tumors, 93 leukemia/lymphoma, and 68 CNS neoplasms). Neuroblastoma was the most common neonatal tumor followed by Germ cell tumors. The 5-year overall survival (OS) for all neonates was 60.3% (95% CI, 56.2-64.4). Neonates with solid tumors had the highest 5-year OS (71.2%; 95% CI, 66.9-75.5), followed by those with leukemia (39.1%; 95% CI, 28.3-49.9) or CNS tumors (15%; 95% CI, 5.4-24.6). Except for neuroblastoma, all neonatal tumors showed inferior outcomes compared to that in the older group. The proportion of neonates who died from causes other than cancer was significantly higher than that of the older children (37.9% vs. 16.4%; P < 0.0005). In general, the outcome of neonatal cancers has not improved over the last 34 years. The distribution of neonatal cancer is different than other pediatric age groups. Although the progress in neonatal and cancer care over the last 30 years, only death from noncancer causes showed improvement. Studying neonatal tumors as part of national studies is essential to understand their etiology, determine the best treatment approaches, and improve survival and quality of life for those patients.
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Affiliation(s)
- Ahmad S. Alfaar
- Ophthalmology DepartmentCharité ‐ Universitätsmedizin Berlin (Charité ‐ Berlin Medical University)BerlinGermany
| | - Waleed M. Hassan
- Research DepartmentChildren's Cancer Hospital EgyptCairo57357Egypt
| | | | - Ibrahim Qaddoumi
- Departments of OncologySt. Jude Children's Research HospitalMemphisTennessee
- International Outreach ProgramSt. Jude Children's Research HospitalMemphisTennessee
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14
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Ren ZX, Jiang HQ, Zhang LX, Deng QD, Zhang JY, Mu XP, Yang J. Disseminated cobblestone-like skin lumps in a newborn. J Eur Acad Dermatol Venereol 2016; 31:e291-e292. [PMID: 27896875 DOI: 10.1111/jdv.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Z X Ren
- Department of Neonatology, Women and Children Hospital of Guang Dong Province, Guang Zhou Medical University, Guangzhou, Guangdong, China
| | - H Q Jiang
- Department of Neonatology, Women and Children Hospital of Jiang Men City, Guangdong, China
| | - L X Zhang
- Department of Neonatology, Women and Children Hospital of Jiang Men City, Guangdong, China
| | - Q D Deng
- Department of Neonatology, Women and Children Hospital of Guang Dong Province, Guang Zhou Medical University, Guangzhou, Guangdong, China
| | - J Y Zhang
- Department of Pathology, Women and Children Hospital of Guang Dong Province, Guang Zhou Medical University, Guangzhou, Guangdong, China
| | - X P Mu
- Department of Clinical Laboratory, Women and Children Hospital of Guang Dong Province, Guang Zhou Medical University, Guangzhou, Guangdong, China
| | - J Yang
- Department of Neonatology, Women and Children Hospital of Guang Dong Province, Guang Zhou Medical University, Guangzhou, Guangdong, China
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Gyárfás T, Wintgens J, Biskup W, Oschlies I, Klapper W, Siebert R, Bens S, Haferlach C, Meisel R, Kuhlen M, Borkhardt A. Transient spontaneous remission in congenital MLL-AF10 rearranged acute myeloid leukemia presenting with cardiorespiratory failure and meconium ileus. Mol Cell Pediatr 2016; 3:30. [PMID: 27510896 PMCID: PMC5002396 DOI: 10.1186/s40348-016-0061-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 08/03/2016] [Indexed: 11/10/2022] Open
Abstract
Background Neonatal leukemia is a rare disease with an estimated prevalence of about one to five in a million neonates. The majority being acute myeloid leukemia (AML), neonatal leukemia can present with a variety of symptoms including hyperleucocytosis, cytopenia, hepatosplenomegaly, and skin infiltrates. Chromosomal rearrangements including mixed lineage leukemia (MLL) translocations are common in neonatal AML. Case presentation A female neonate born at 34 weeks gestation presented with cardiorespiratory failure, hepatosplenomegaly, pancytopenia, and coagulopathy. She required intensive care treatment including mechanical ventilation, high-dose catecholamine therapy, and multiple transfusions. Small intestinal biopsy obtained during laparotomy for meconium ileus revealed an infiltrate by an undifferentiated monoblastic, MLL-rearranged leukemia. No other manifestations of leukemia could be detected. After spontaneous clinical remission, lasting 5 months without any specific treatment, the patient presented with leukemia cutis and full-blown monoblastic leukemia. MLL-AF10-rearranged AML could be re-diagnosed and successfully treated with chemotherapy and hematopoietic stem cell transplantation. Conclusions Our patient exhibited a unique manifestation of neonatal MLL-AF10 rearranged AML with cardiorespiratory failure and intestinal infiltration. It highlights the importance of leukemia in the differential diagnosis of neonatal distress, congenital hematological abnormalities, and skin lesions.
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Affiliation(s)
- Tobias Gyárfás
- Medical Faculty, Department of General Pediatrics, Neonatology and Pediatric Cardiology, Centre for Child and Adolescent Health, University of Duesseldorf, Duesseldorf, Germany
| | - Juergen Wintgens
- Department of Neonatology, Staedtische Kliniken Moenchengladbach, Elisabeth Krankenhaus Rheydt, Rheydt, Germany
| | - Wolfgang Biskup
- Department of Neonatology, Staedtische Kliniken Moenchengladbach, Elisabeth Krankenhaus Rheydt, Rheydt, Germany
| | - Ilske Oschlies
- Department of Pathology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Wolfram Klapper
- Department of Pathology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Reiner Siebert
- Institute of Human Genetics, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Susanne Bens
- Institute of Human Genetics, Christian-Albrechts-University Kiel, Kiel, Germany
| | | | - Roland Meisel
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Michaela Kuhlen
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Duesseldorf, Germany.
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Duesseldorf, Germany
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16
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Helin H, van der Walt J, Holder M, George S. Case Report: Congenital Erythroleukemia in a Premature Infant with Dysmorphic Features. Pediatr Dev Pathol 2016; 19:334-7. [PMID: 26529397 DOI: 10.2350/15-04-1625-cr.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present a case of pure erythroleukemia, diagnosed at autopsy, in a dysmorphic premature infant who died of multiorgan failure within 24 hours of birth. Dysmorphic features included facial and limb abnormalities with long philtrum, microagnathia, downturned mouth, short neck as well as abnormal and missing nails, missing distal phalanx from the second toe, and overlapping toes. Internal findings included gross hepatomegaly and patchy hemorrhages in the liver, splenomegaly, and cardiomegaly; and subdural, intracerebral, and intraventricular hemorrhages. Histology revealed infiltration of bone marrow, kidney, heart, liver, adrenal, lung, spleen, pancreas, thyroid, testis, thymus, and placenta by pure erythroleukemia. Only 6 cases of congenital erythroleukemia have been previously reported with autopsy findings similar to those of this case. The dysmorphic features, although not fitting any specific syndrome, make this case unique. Congenital erythroleukemia and possible syndromes suggested by the dysmorphic features are discussed.
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Affiliation(s)
- Heidi Helin
- 1 Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Jon van der Walt
- 1 Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Muriel Holder
- 2 Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond SE1 9RT, UK
| | - Simi George
- 1 Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
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17
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Mosayebi Z, Omidian A, Movahedian AH, Kompani F, Hosseininodeh SS. Fournier's Gangrene in a Neonate With Acute Myeloid Leukemia: A Case Report. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e4537. [PMID: 27617071 PMCID: PMC4988100 DOI: 10.5812/ijp.4537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 12/21/2015] [Accepted: 01/23/2016] [Indexed: 11/28/2022]
Abstract
Introduction: Fournier’s gangrene is an infective necrotizing fasciitis of external genital and perineal region. Hematologic malignancies and immunocompromised status are predisposing factors. Simultaneous occurrence of Fournier’s gangrene and congenital leukemia in neonates is extremely rare. Case Presentation: We present a case of Fournier’s gangrene in a 4-day-old female infant with a necrotic lesion in perineum and no history of trauma or other predisposing condition. Focusing on high blast percentage in blood cell count she was affected by acute myeloid leukemia (M4 type). Pseudomonas aeruginosa was isolated from the blood and wound culture. She was treated with broad spectrum antibiotics and supportive care. The parents refused chemotherapy and the patient was discharged from hospital. Bleeding and DIC was the cause of death in a local hospital few days later. Conclusions: High index of suspicion is essential for diagnosis and appropriate treatment. Congenital leukemia should be considered in the differential diagnosis of a newborn with clinical features of sepsis and necrotizing fasciitis.
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Affiliation(s)
- Ziba Mosayebi
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, IR Iran
| | - Ali Omidian
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, IR Iran
| | - Amir Hossein Movahedian
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran
- Bahrami Children’s Hospital, Tehran, IR Iran
| | - Farzad Kompani
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, IR Iran
| | - Seyyed Saeed Hosseininodeh
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, IR Iran
- Corresponding author: Seyyed Saeed Hosseininodeh, Children's Medical Center, Pediatrics Center of Excellence, Tehran, IR Iran. E-mail:
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18
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Mondì V, Piersigilli F, Salvatori G, Auriti C. The Skin as an Early Expression of Malignancies in the Neonatal Age: A Review of the Literature and a Case Series. BIOMED RESEARCH INTERNATIONAL 2015; 2015:809406. [PMID: 26798643 PMCID: PMC4698537 DOI: 10.1155/2015/809406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/15/2015] [Accepted: 11/29/2015] [Indexed: 12/13/2022]
Abstract
Skin lesions are a frequent finding in childhood, from infancy throughout adolescence. They can arise from many conditions, including infections and inflammation. Most neonatal rashes are benign and self-limiting and require no treatment. Other conditions may be an expression of malignancy or may be a marker for other abnormalities, such as neural tube defects. Therefore, skin lesions require an extensive evaluation and close follow-up to ensure the best possible outcome. This paper briefly reviews the main tumor types presenting with cutaneous involvement in neonates, followed by the description of some patients admitted to our Neonatal Intensive Care Unit with an early skin expression of malignancies.
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Affiliation(s)
- Vito Mondì
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Fiammetta Piersigilli
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Guglielmo Salvatori
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Cinzia Auriti
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy
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19
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Minard-Colin V. Généralités médicales et spécificités thérapeutiques des cancers du nouveau-né et du nourrisson. PSYCHO-ONCOLOGIE 2015. [DOI: 10.1007/s11839-015-0535-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Neonatal Acute Megakaryoblastic Leukemia Presenting with Leukemia Cutis and Multiple Intracranial Lesions Successfully Treated with Unrelated Cord Blood Transplantation. Case Rep Hematol 2015; 2015:610581. [PMID: 26229698 PMCID: PMC4502332 DOI: 10.1155/2015/610581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 11/17/2022] Open
Abstract
Neonatal acute megakaryoblastic leukemia (AMKL) without Down syndrome (DS) is an extremely rare disorder. We report of a one-day-old male infant without DS who developed AMKL with leukemia cutis and right facial nerve palsy. Magnetic resonance imaging of the patient's brain revealed multiple intracranial tumors. A biopsy specimen of the skin lesion was suggestive of AMKL, but the bone marrow leukemic cells were less than 5% of the marrow nucleated cells. The skin and intracranial lesions had spontaneously regressed within one and a half months, but the patient's anemia and thrombocytopenia gradually worsened and the leukemic cells in the bone marrow gradually increased to more than 20% of the nucleated cells. In addition, multiple intracranial lesions reappeared at 72 days of life. We diagnosed the patient with AMKL, and chemotherapy followed by unrelated cord blood transplantation after a reduced-intensity conditioning regimen resulted in sustained complete remission. At present, the patient is well, and he has demonstrated normal development for five years.
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21
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Palman J, Karam M, Chee Y, Kandala V. Neonatal acute lymphocytic leukaemia: an unusual presentation of a rare disease. BMJ Case Rep 2015; 2015:bcr-2015-210606. [PMID: 26178003 DOI: 10.1136/bcr-2015-210606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Infantile acute lymphocytic leukaemia (ALL) seldom presents within the first month of life. Most are diagnosed before birth. Postnatal diagnoses are easily recognisable when characteristic features are present, namely hepatosplenomegaly, leukaemia cutis or infiltrative disease of the extramedullar and central nervous system. However, some children present with vague and non-specific symptoms masquerading as other diseases. We report an unusual presentation of infantile ALL in a 19-day-old infant, who struggled with feeding after a diagnosis of gastro-oesophageal reflux disease since birth. To the best of our knowledge, this is the youngest case report of neonatal ALL, presenting with vomiting, lethargy and dehydration. The neonate presented to our paediatric assessment unit acutely due to progression of her symptoms. General physical examination was unremarkable apart from signs of lethargy and dehydration. Blood investigation revealed an incidental finding of high white cells, including 90% blast cells. Early diagnosis in this case meant early treatment and a good prognosis.
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Affiliation(s)
- Jason Palman
- Department of Paediatrics, East & North Hertfordshire, Stevenage, UK
| | - Maria Karam
- Department of Paediatrics, East & North Hertfordshire, Stevenage, UK
| | - Ying Chee
- Department of Paediatrics, East & North Hertfordshire, Stevenage, UK
| | - Vijay Kandala
- Department of Paediatrics, East & North Hertfordshire, Stevenage, UK
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22
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Beard B, Turner J. Congenital Leukemia Presenting as Fever in a Neonate. J Emerg Med 2015; 48:e131-3. [DOI: 10.1016/j.jemermed.2015.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 01/05/2015] [Accepted: 01/11/2015] [Indexed: 10/23/2022]
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23
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Handler MZ, Schwartz RA. Neonatal leukaemia cutis. J Eur Acad Dermatol Venereol 2015; 29:1884-9. [PMID: 25851143 DOI: 10.1111/jdv.13049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
Neonatal leukaemia cutis is a significant neoplasm that may represent a cutaneous manifestation of systemic leukaemia, usually of myeloblastic type. Rarely, it may be or appear to be limited to skin, in which case it is called neonatal aleukaemic leukaemia cutis. By definition, it presents within the first 4 weeks of life and often has a 'blueberry muffin baby' appearance of magenta coloured nodules affecting almost any area of the skin, usually sparing mucous membranes, palms and soles. This clinical pattern is more commonly associated with neonatal infections such rubella and toxoplasmosis, and may be evident with other neonatal neoplasms such as neuroblastoma. Due to the morbidity associated with chemotherapy and reported cases of spontaneous remission without systemic progression in those with neonatal aleukaemic leukaemia cutis without 11q23 translocation, the authors not treating the child with chemotherapy, but to simply monitor for fading of the violaceous nodules, and watch for possible signs of systemic leukaemia.
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Affiliation(s)
- M Z Handler
- Dermatology, Pediatrics, Preventive Medicine, Community Health, and School of Public Affairs and Administration, Rutgers University New Jersey Medical School, Newark, NJ, USA
| | - R A Schwartz
- Dermatology, Pediatrics, Preventive Medicine, Community Health, and School of Public Affairs and Administration, Rutgers University New Jersey Medical School, Newark, NJ, USA
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24
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Moura SV, Andrade F, Magalhães IQ, Costa I, Silva DB, D'Andrea ML, Pinheiro VP, Lee MLM, Werneck F, Emerenciano M, Pombo-de-Oliveira MS. Clinical and molecular epidemiology of neonatal leukemia in Brazil. Leuk Lymphoma 2015; 56:903-9. [PMID: 24991719 DOI: 10.3109/10428194.2014.938327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The clinical and molecular findings of 77 cases of neonatal leukemia (NL) and 380 of infant leukemia (IL) were selected to distinguish features between NL and IL. Somatic gene mutations associated with acute leukemia including FLT3, RAS and PTPN11 were revisited. There were 42 cases of congenital leukemia associated with Down syndrome (DS) and 39 of these cases presented features of acute myeloid leukemia (AML)-M7. Twenty-seven of the DS cases underwent spontaneous remission and were reclassified as a transient myeloproliferative disorder. GATA1 mutations were found in 70% of these cases. In non-DS, frequent abnormalities were MLL rearrangements, mainly MLL-AFF1 in acute lymphoblastic leukemia and MLL-MLLT3 in AML. The FLT3 mutation was not found, while RAS (n = 4) and PTPN11 (n = 2) mutations were identified and reported for the first time in NL. There was substantial evidence to support that somatic abnormalities occur in utero. Thus, congenital leukemia is a good model for understanding leukemogenesis.
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Affiliation(s)
- Suellen Valadares Moura
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro , Brazil
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25
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Götze T, Blessing H, Grillhösl C, Gerner P, Hoerning A. Neonatal Cholestasis - Differential Diagnoses, Current Diagnostic Procedures, and Treatment. Front Pediatr 2015; 3:43. [PMID: 26137452 PMCID: PMC4470262 DOI: 10.3389/fped.2015.00043] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 04/29/2015] [Indexed: 12/18/2022] Open
Abstract
Cholestatic jaundice in early infancy is a complex diagnostic problem. Misdiagnosis of cholestasis as physiologic jaundice delays the identification of severe liver diseases. In the majority of infants, prolonged physiologic jaundice represent benign cases of breast milk jaundice, but few among them are masked and caused by neonatal cholestasis (NC) that requires a prompt diagnosis and treatment. Therefore, a prolonged neonatal jaundice, longer than 2 weeks after birth, must always be investigated because an early diagnosis is essential for appropriate management. To rapidly identify the cases with cholestatic jaundice, the conjugated bilirubin needs to be determined in any infant presenting with prolonged jaundice at 14 days of age with or without depigmented stool. Once NC is confirmed, a systematic approach is the key to reliably achieve the diagnosis in order to promptly initiate the specific, and in many cases, life-saving therapy. This strategy is most important to promptly identify and treat infants with biliary atresia, the most common cause of NC, as this requires a hepatoportoenterostomy as soon as possible. Here, we provide a detailed work-up approach including initial treatment recommendations and a clinically oriented overview of possible differential diagnoses in order to facilitate the early recognition and a timely diagnosis of cholestasis. This approach warrants a broad spectrum of diagnostic procedures and investigations including new methods that are described in this review.
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Affiliation(s)
- Thomas Götze
- Department for Pediatric and Adolescent Medicine, Friedrich-Alexander University of Erlangen-Nuremberg , Erlangen , Germany
| | - Holger Blessing
- Department for Pediatric and Adolescent Medicine, Friedrich-Alexander University of Erlangen-Nuremberg , Erlangen , Germany
| | - Christian Grillhösl
- Department for Pediatric and Adolescent Medicine, Friedrich-Alexander University of Erlangen-Nuremberg , Erlangen , Germany
| | - Patrick Gerner
- Department for Pediatric and Adolescent Medicine, Albert-Ludwigs-University Freiburg , Freiburg , Germany
| | - André Hoerning
- Department for Pediatric and Adolescent Medicine, Friedrich-Alexander University of Erlangen-Nuremberg , Erlangen , Germany
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26
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Congenital leukemia of fetus with acquired AML1 gene duplication. Obstet Gynecol Sci 2014; 57:325-9. [PMID: 25105108 PMCID: PMC4124096 DOI: 10.5468/ogs.2014.57.4.325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/13/2014] [Accepted: 04/01/2014] [Indexed: 11/08/2022] Open
Abstract
Congenital leukemia is very rare, and its prevalence according to recently published papers is from 1 to 5 per million live births. This can be often diagnosed in postpartum throughout bone marrow biopsy, showing abnormal proliferation of immature blasts and granulocytic precursors. Hepatosplenomegaly is the most common feature which is found during perinatal examinations, that diagnosing is difficult during perinatal period. Hepatosplenomegaly can occur not only in congenital leukemia but in many other cases such as infection which is the most common cause. In other words, congenital leukemia is the one of the rare causes of hepatosplenomegaly. However, this case shows the fetus with the features of hepatosplenomegaly during perinatal period and being diagnosed as congenital leukemia associated with acquired AML1 gene duplication in postpartum through bone marrow biopsy. Due to its rare instance, we are to describe the case with a review of literatures.
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27
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The clinical utility of genetic testing for t(8;16)(p11;p13) in congenital acute myeloid leukemia. J Pediatr Hematol Oncol 2014; 36:e325-7. [PMID: 24390445 DOI: 10.1097/mph.0000000000000099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute myeloid leukemia (AML) with t(8;16)(p11;p13) is known to have very poor prognosis in adults. In contrast, the prognosis is not clear in pediatric patients and chemotherapy is generally started immediately in cases of congenital leukemia because of its association with hyperleukocytosis and poor prognosis. This study reports a case of congenital AML where chemotherapy was discontinued after detection of a MOZ-CBP fusion, which remains in remission without additional treatment. This article stresses the importance of examination for the presence of the MOZ-CBP fusion at diagnosis to inform treatment decisions in congenital AML.
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28
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Whittington A, Kenner-Bell B. A 7-week-old boy with violaceous patches and skin nodules. Leukemia cutis. Pediatr Ann 2014; 43:e25-7. [PMID: 24549085 DOI: 10.3928/00904481-20131223-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 7-week-old boy presented to the pediatric dermatology clinic for evaluation of diffuse blue lesions on the skin. The mother first noticed a bluish lesion on the left thigh at 6 to 7 weeks of age. The child quickly developed several similar lesions and deeper nodules on the head, arms, and trunk. He had a history of ankyloglossia and subsequent uncomplicated repair, as well as a sister with neonatal anemia. He was otherwise well and thriving. Review of systems was unremarkable. His birth involved an uncomplicated delivery, with negative maternal serology. There was no history of maternal infection or recent exposure to infection. Physical exam revealed a well-appearing, non-dysmorphic, vigorous infant. Skin exam was notable for numerous dusky erythematous and violaceous-blue patches and nodules on the anterior scalp, bilateral arms, legs, face, and trunk - including the diaper area. Lesions ranged in size from 1 to 3 cm. The nodules were firm and non-tender. The remainder of his physical examination was normal without abnormal lymphadenopathy or hepatosplenomegaly noted. No mucosal lesions were noted. A biopsy was performed on a thigh lesion.
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29
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Zapata-Tarrés M, Ibarra-Ríos D, Cruz-Rodríguez IV, Juárez-Villegas LE, Peña-Del Castillo H. [Malignant neoplasms in the neonate]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2014; 71:261-270. [PMID: 29421614 DOI: 10.1016/j.bmhimx.2014.05.004] [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: 05/23/2013] [Accepted: 05/30/2014] [Indexed: 11/16/2022] Open
Abstract
Cancer in children has characteristics that differentiate it from other types reported in later ages. Overall survival at 3 years is up to 70% depending on the tumor studied. Major organs and systems affected are the hematopoietic system, central nervous system and sympathetic and mesenchymal tissues. The increased incidence of neonatal tumors observed in this and other studies is based on the increasing number of solid tumors (teratomas and neuroblastomas) because cases of central nervous system tumors and leukemias have remained constant. Ultrasonography is the first line of approach and can detect up to 70% of fetal anomalies. The physiology of the newborn causes the necessary multidisciplinary treatment in neoplastic disease to be modified substantially in this age group to avoid toxicity and sequelae. The most common treatment is surgery. Achieving timely diagnostic treatment options are effective in improving the survival of these patients.
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Affiliation(s)
- Marta Zapata-Tarrés
- Servicio de Oncología, Instituto Nacional de Pediatría, México D.F., México.
| | - Daniel Ibarra-Ríos
- Departamento de Neonatología, Hospital Infantil de México Federico Gómez, México D.F., México
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30
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Abstract
Physiological leucocytosis is common in neonates. Leukemoid reaction is defined as a variable degree of leucocytosis with immature precursors, similar to that occurring in leukaemia but because of other causes. Leukemoid reactions are well-recognised in the neonatal intensive care unit population and are associated with antenatal corticosteroids, Down's syndrome, chorioamnionitis, funisitis and perinatal infections. However, extreme hyperleucocytosis, exceeding a white blood cell count of 100×10(9)/l is rare. In the 7-year period from 2005 to 2012 three premature infants in our hospital presented with extreme hyperleucocytosis. Since there were no signs of neonatal leukaemia, transient myeloid disorder or leucocyte adhesion defect, a leukemoid reaction owing to antenatal corticosteroids, chorioamnionitis and funisitis was diagnosed. No obvious complications of hyperleucocytosis were observed. Therapy was not necessary and the leucocytes normalised spontaneously. In our small case series, extreme hyperleucocytosis in prematures occurred in the absence of leukaemia and had a mild course.
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Affiliation(s)
- Esther Jansen
- Maxima Medisch Centrum Veldhoven, Veldhoven, The Netherlands.
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