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Yasudome Y, Nakagawa S, Nagahama J, Nakamura T, Abematsu T, Kodama Y, Nishikawa T, Okamoto Y. Spontaneous remission in a case of neonatal leukemia with KMT2A gene rearrangement. Pediatr Blood Cancer 2024; 71:e31235. [PMID: 39054692 DOI: 10.1002/pbc.31235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Yuki Yasudome
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Shunsuke Nakagawa
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Jun Nagahama
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Tatsuro Nakamura
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takanari Abematsu
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yuichi Kodama
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takuro Nishikawa
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yasuhiro Okamoto
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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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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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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Gonzales DN, Punia JN, Patil MS. Neonate With a Diffuse Maculopapular and Nodular Rash. Neoreviews 2024; 25:e232-e236. [PMID: 38556494 DOI: 10.1542/neo.25-3-e232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Danielle N Gonzales
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Texas Children's Hospital, Houston, TX
| | - Jyotinder Nain Punia
- Department of Pathology and Immunology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Monika S Patil
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Texas Children's Hospital, Houston, TX
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Gonzales DN, Punia JN, Patil MS. Neonate With a Diffuse Maculopapular and Nodular Rash. Neoreviews 2024; 25:e232-e236. [PMID: 38556503 DOI: 10.1542/neo.25-4-e232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Danielle N Gonzales
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Texas Children's Hospital, Houston, TX
| | - Jyotinder Nain Punia
- Department of Pathology and Immunology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Monika S Patil
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Texas Children's Hospital, Houston, TX
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Park J, Ondusko DS, Chang BH, Edwards EA, Doan S, Gatter K, Hajjali I, Kim A. Fetal Hepatomegaly. Neoreviews 2022; 23:e861-e868. [PMID: 36450648 DOI: 10.1542/neo.23-12-e861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Jina Park
- Division of Neonatology, Oregon Health & Science University, Portland, OR
| | | | - Bill H Chang
- Division of Hematology and Oncology, Oregon Health & Science University, Portland, OR
| | - Emily A Edwards
- Division of Diagnostic Radiology, Oregon Health & Science University, Portland, OR
| | - Sylvia Doan
- Division of Pediatric Gastroenterology, Oregon Health & Science University, Portland, OR
| | - Ken Gatter
- Division of Pathology, Oregon Health & Science University, Portland, OR
| | - Ibrahim Hajjali
- Division of Pathology, Oregon Health & Science University, Portland, OR
| | - Amanda Kim
- Division of Neonatology, Oregon Health & Science University, Portland, OR
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Enlarged Abdominal Lymph Node as a Cause of Polyhydramnios in the Course of Congenital Neonatal Leukaemia: A Case Report and Review of the Literature on Foetal Abdominal Tumours with Coexisting Polyhydramnios. J Clin Med 2022; 11:jcm11216598. [PMID: 36362825 PMCID: PMC9656261 DOI: 10.3390/jcm11216598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
Polyhydramnios represents a complication found in 0.2–2% of pregnancies, and it is usually diagnosed between 31 and 36 weeks of pregnancy. Although most cases of polyhydramnios are idiopathic, maternal diabetes or foetal malformations constitute frequent causes of the excessive accumulation of the amniotic fluid. Considering the latter, polyhydramnios may rarely be caused by foetal abdominal tumours, with the incidence rate of 2–14 cases per 100,000 live births. Congenital neonatal leukaemia (CNL) is a rare disease with a reported incidence rate of 5–8.6 cases per million live births. In the prenatal period, the ultrasound abnormalities associated with CNL include hepatomegaly and splenomegaly. In this paper, we presented a case of polyhydramnios caused by mechanical pressure on the foetal gastrointestinal tract by an enlarged lymph node in the course of CNL, as well as reviewing the available literature on foetal abdominal tumours with concurrent polyhydramnios.
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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: 5] [Impact Index Per Article: 1.7] [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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Schlegel S, Hamm H, Reichel A, Kneitz H, Ernestus K, Andres O, Wiegering VG, Eyrich M, Wölfl M, Schlegel PG. Neonatal Acute Lymphoblastic Leukemia with t(9;11) Translocation Presenting as Blueberry Muffin Baby: Successful Treatment by ALL-BFM Induction Therapy, Allogeneic Stem Cell Transplantation from an Unrelated Donor, and PCR-MRD-Guided Post-Transplant Follow-Up. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e927153. [PMID: 33106467 PMCID: PMC7603802 DOI: 10.12659/ajcr.927153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 3-day-old Final Diagnosis: Neonatal leukemia Symptoms: Skin lesions Medication: — Clinical Procedure: Biopsy • stem cell transplant Specialty: Hematology • Pediatrics and Neonatology
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Affiliation(s)
- Simon Schlegel
- Semmelweis School of Medicine, Semmelweis University Budapest, Budapest, Hungary.,Department of Pediatrics, Section of Pediatric Hematology and Oncology, Stem Cell Transplantation (SCT), University Hospital Würzburg, Würzburg, Hungary
| | - Henning Hamm
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Alexandra Reichel
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Hermann Kneitz
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Karen Ernestus
- Department of Pathology, University of Würzburg, Würzburg, Germany
| | - Oliver Andres
- Department of Pediatrics, Section of Neonatology, University Hospital Würzburg, Würzburg, Germany
| | - Verena G Wiegering
- Department of Pediatrics, Section of Pediatric Hematology and Oncology, Stem Cell Transplantation (SCT), University Hospital Würzburg, Würzburg, Germany
| | - Matthias Eyrich
- Department of Pediatrics, Section of Pediatric Hematology and Oncology, Stem Cell Transplantation (SCT), University Hospital Würzburg, Würzburg, Germany
| | - Matthias Wölfl
- Department of Pediatrics, Section of Pediatric Hematology and Oncology, Stem Cell Transplantation (SCT), University Hospital Würzburg, Würzburg, Germany
| | - Paul-Gerhardt Schlegel
- Department of Pediatrics, Section of Pediatric Hematology and Oncology, Stem Cell Transplantation (SCT), University Hospital Würzburg, Würzburg, Germany.,Comprehensive Cancer Center, CCCMF, University Hospital Würzburg, Würzburg, Germany
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