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Thrombotic Microangiopathy Due to Progressive Disseminated Histoplasmosis in a Child With Down Syndrome and Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2023; 45:38-40. [PMID: 36162003 DOI: 10.1097/mph.0000000000002556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
Histoplasmosis, a common mycosis in the south-central United States, may be life threatening in immunocompromised patients. We describe a 4-year-old female with Down syndrome and acute lymphoblastic leukemia who developed hemolytic anemia, thrombocytopenia, and renal failure, consistent with thrombotic microangiopathy. Bone marrow biopsy revealed non-necrotizing granulomas with GMS staining demonstrating budding yeast. Serum Histoplasma antigen testing was positive, providing further evidence for the diagnosis of progressive disseminated histoplasmosis. Treatment with amphotericin B, plasma exchange, and ventilator, vasopressor, and renal replacement support led to a full recovery. Providers should have a low threshold for histoplasmosis testing in ill immunocompromised patients, who are at greater risk for infection-related morbidity.
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Standing S, Tran S, Murguia-Favela L, Kovalchuk O, Bose P, Narendran A. Identification of Altered Primary Immunodeficiency-Associated Genes and Their Implications in Pediatric Cancers. Cancers (Basel) 2022; 14:cancers14235942. [PMID: 36497424 PMCID: PMC9741011 DOI: 10.3390/cancers14235942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Cancer is the leading cause of disease-related mortality in children and malignancies are more frequently observed in individuals with primary immunodeficiencies (PIDs). This study aimed to identify and highlight the molecular mechanisms, such as oncogenesis and immune evasion, by which PID-related genes may lead to the development of pediatric cancers. METHOD We implemented a novel bioinformatics framework using patient data from the TARGET database and performed a comparative transcriptome analysis of PID-related genes in pediatric cancers between normal and cancer tissues, gene ontology enrichment, and protein-protein interaction analyses, and determined the prognostic impacts of commonly mutated and differentially expressed PID-related genes. RESULTS From the Fulgent Genetics Comprehensive Primary Immunodeficiency panel of 472 PID-related genes, 89 genes were significantly differentially expressed between normal and cancer tissues, and 20 genes were mutated in two or more patients. Enrichment analysis highlighted many immune system processes as well as additional pathways in the mutated PID-related genes related to oncogenesis. Survival outcomes for patients with altered PID-related genes were significantly different for 75 of the 89 DEGs, often resulting in a poorer prognosis. CONCLUSIONS Overall, multiple PID-related genes demonstrated the connection between PIDs and cancer development and should be studied further, with hopes of identifying new therapeutic targets.
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Affiliation(s)
- Shaelene Standing
- Section of Pediatric Oncology and Blood and Marrow Transplantation, Division of Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Son Tran
- Section of Pediatric Oncology and Blood and Marrow Transplantation, Division of Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Luis Murguia-Favela
- Section of Pediatric Hematology and Immunology, Division of Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Olga Kovalchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Pinaki Bose
- Departments of Oncology, Biochemistry and Molecular Biology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Correspondence: (P.B.); (A.N.)
| | - Aru Narendran
- Section of Pediatric Oncology and Blood and Marrow Transplantation, Division of Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary, AB T3B 6A8, Canada
- Correspondence: (P.B.); (A.N.)
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Lee FSW, Lee CY, Hung GY, Tseng MH, Wang HH, Yen HJ. Recurrent microangiopathic hemolysis after recovery from complement-mediated hemolytic uremia syndrome during chemotherapy for a CFH-mutated patient with T-lymphoblastic lymphoma. Int J Hematol 2022; 116:812-818. [PMID: 35790695 DOI: 10.1007/s12185-022-03409-6] [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: 01/15/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
Complement-mediated hemolytic uremic syndrome (CM-HUS) following chemotherapy for pediatric acute lymphoid neoplasms has rarely been reported. We report the case of an 8-year-old boy with T-lymphoblastic lymphoma (T-LBL) who developed CM-HUS with complement factor H (CFH) mutations (S1191L, V1197A) during induction therapy. Safe administration of chemotherapy after CM-HUS recovery was challenging. By closely monitoring hemolytic and renal parameters during the 2-year treatment period, we observed four episodes of microangiopathic hemolytic anemia (MAHA) with hypocomplementemia and low haptoglobin but no renal dysfunction or thrombocytopenia. Here, we describe the MAHA and CM-HUS episodes in the hopes of elucidating the complex pathophysiology of disorders associated with CFH mutation.
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Affiliation(s)
- Fu-Shiuan Whitney Lee
- Department of Pediatrics, Taipei Veterans General Hospital, and National Yang Ming Chiao Tung University School of Medicine, Peitou District, NO. 201, Shih-Pai Rd Sec 2, Taipei, 112, Taiwan, ROC
| | - Chih-Ying Lee
- Department of Pediatrics, Taipei Veterans General Hospital, and National Yang Ming Chiao Tung University School of Medicine, Peitou District, NO. 201, Shih-Pai Rd Sec 2, Taipei, 112, Taiwan, ROC
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan, ROC
| | - Giun-Yi Hung
- Department of Pediatrics, Taipei Veterans General Hospital, and National Yang Ming Chiao Tung University School of Medicine, Peitou District, NO. 201, Shih-Pai Rd Sec 2, Taipei, 112, Taiwan, ROC
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan, ROC
| | - Min-Hua Tseng
- Division of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Hsin-Hui Wang
- Department of Pediatrics, Taipei Veterans General Hospital, and National Yang Ming Chiao Tung University School of Medicine, Peitou District, NO. 201, Shih-Pai Rd Sec 2, Taipei, 112, Taiwan, ROC
| | - Hsiu-Ju Yen
- Department of Pediatrics, Taipei Veterans General Hospital, and National Yang Ming Chiao Tung University School of Medicine, Peitou District, NO. 201, Shih-Pai Rd Sec 2, Taipei, 112, Taiwan, ROC.
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan, ROC.
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Turudic D, Milosevic D, Bilic K, Prohászka Z, Bilic E. A Limited Course of Eculizumab in a Child with the Atypical Hemolytic Uremic Syndrome and Pre-B Acute Lymphoblastic Leukemia on Maintenance Therapy: Case Report and Literature Review. J Clin Med 2022; 11:jcm11102779. [PMID: 35628906 PMCID: PMC9142928 DOI: 10.3390/jcm11102779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/25/2022] [Accepted: 05/10/2022] [Indexed: 02/06/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) is considered a possible risk for the occurrence of thrombotic microangiopathies. We present a girl with pre-B ALL successfully treated according to the BFM ALL IC-2009 protocol on maintenance therapy followed by aHUS occurrence. This is the seventh case of HUS/aHUS on ALL maintenance therapy and the first with clearly documented eculizumab use in the early stage of aHUS/secondary TMA. Standard and additional parameters were used in aHUS monitoring alongside the reticulocyte production index adjusted for age (RPI/A) and the aspartate aminotransferase-to-platelet ratio index (APRI) as markers of hemolysis and rapid response following treatment. RPI/A and APRI are markers of bone marrow response to anemia serving as red blood cell vs. platelet recovery markers. Together they mark the exact recovery point of thrombotic microangiopathy and serve as a prognostic marker of eculizumab treatment success. During the 8-month treatment and 6-month follow-up, no recurrence of hemolysis, ALL relapse, or renal damage were observed. A systematic review of the literature revealed 14/312 articles; five children had aHUS before the onset of ALL, and two children had both diseases concurrently. At least 3/7 patients are attributed to aHUS, of whom 2/7 have renal damage. Potential undiagnosed/unpublished cases may be assumed.
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Affiliation(s)
- Daniel Turudic
- Department of Pediatric Hematology and Oncology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (D.T.); (E.B.)
| | - Danko Milosevic
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia;
- Department of Pediatrics, General Hospital Zabok and Hospital of Croatian Veterans, Bracak 8, 49210 Bracak, Croatia
- Correspondence:
| | - Katarina Bilic
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia;
| | - Zoltán Prohászka
- Department of Internal Medicine and Haematology, Semmelweis University, 1085 Budapest, Hungary;
- Research Group for Immunology and Haematology, Semmelweis University, 1085 Budapest, Hungary
| | - Ernest Bilic
- Department of Pediatric Hematology and Oncology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (D.T.); (E.B.)
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia;
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Chatzikonstantinou T, Gavriilaki M, Anagnostopoulos A, Gavriilaki E. An Update in Drug-Induced Thrombotic Microangiopathy. Front Med (Lausanne) 2020; 7:212. [PMID: 32528969 PMCID: PMC7256484 DOI: 10.3389/fmed.2020.00212] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/29/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Maria Gavriilaki
- Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Eleni Gavriilaki
- BMT Unit, Hematology Department, G Papanicolaou Hospital, Thessaloniki, Greece
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Mantri S, Kendre G, Patil V, S C, Hilalpure S, Goyanka S, Toshniwal A, Jijina F. A case of atypical HUS during maintenance phase of acute lymphoblastic leukemia: A stitch in time saves nine. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2019. [DOI: 10.1016/j.phoj.2019.08.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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