1
|
Hu M, Liu R, Li J, Zhang L, Cao J, Yue M, Zhong D, Tang R. Clinical features and prognosis of pediatric acute lymphocytic leukemia with JAK-STAT pathway genetic abnormalities: a case series. Ann Hematol 2023; 102:2445-2457. [PMID: 37209119 PMCID: PMC10199427 DOI: 10.1007/s00277-023-05245-y] [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: 01/28/2023] [Accepted: 04/20/2023] [Indexed: 05/22/2023]
Abstract
The objective of this study is to explore the clinical features and outcomes of pediatric patients with acute lymphoblastic leukemia (ALL) harboring JAK-STAT signaling pathway genetic abnormalities. This retrospective case series examined the clinical data of pediatric patients diagnosed with ALL harboring JAK-STAT pathway genetic abnormality at the Children's Hospital of the Capital Institute of Pediatrics between January 2016 and January 2022. Bone marrow next-generation sequencing was used to reveal the JAK pathway abnormalities. Descriptive statistics were used. From 432 children with ALL during the study period, eight had JAK-STAT pathway genetic abnormalities. Regarding immunotyping, there were four patients with common-B cell types and one with pre-B cell type. The three patients with T-ALL had early T-cell precursor(ETP) type, pre-T cell type, and T cell type. Gene mutations were more common than fusion genes. There was no central nervous system involvement in eight patients. All patients were considered at least at intermediate risk before treatments. Four patients underwent hematopoietic stem cell transplantation (HSCT). One child had a comprehensive relapse and died. The child had a severe infection and could not tolerate high-intensity chemotherapy. Another child relapsed 2 years after HSCT and died. Disease-free survival was achieved in six children. JAK-STAT pathway genetic abnormalities in pediatric Ph-like ALL are rare. Special attention should be paid to treatment-related complications, such as infection and combination therapy (chemotherapy, small molecule targeted drugs, immunotherapy, etc.) to reduce treatment-related death and improve long-term quality of life.
Collapse
Affiliation(s)
- Mengze Hu
- Department of Hematology, Children's Hospital, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Rong Liu
- Department of Hematology, Children's Hospital, Capital Institute of Pediatrics, Beijing, 100020, China.
| | - Juanjuan Li
- Department of Hematology, Children's Hospital, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Lei Zhang
- Department of Hematology, Children's Hospital, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Jing Cao
- Department of Hematology, Children's Hospital, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Mei Yue
- Department of Hematology, Children's Hospital, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Dixiao Zhong
- Department of Hematology, Children's Hospital, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Ruihong Tang
- Department of Hematology, Children's Hospital, Capital Institute of Pediatrics, Beijing, 100020, China
| |
Collapse
|
2
|
Kaya Z, Alıcı N, Kırkız S, Koçak Ü. Identifying Risk Factors and Improving Preventive Strategies for Febrile Neutropenia in Children with Leukemia Receiving Ciprofloxacin Prophylaxis. Turk J Haematol 2023; 40:183-186. [PMID: 37314294 PMCID: PMC10476261 DOI: 10.4274/tjh.galenos.2023.2023.0116] [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: 03/22/2023] [Accepted: 06/03/2023] [Indexed: 09/01/2023] Open
Abstract
The purpose of this study was to identify risk factors and improve preventive strategies for febrile neutropenia (FEN) in children with leukemia who were receiving ciprofloxacin prophylaxis. The study included 100 children with leukemia [n=80 with acute lymphoblastic leukemia and n=20 with acute myeloblastic leukemia (AML)]. Patients were divided into two groups based on whether they had three or fewer FEN episodes (Group 1) or more than three FEN episodes (Group 2). Group 1 contained 63 (63%) of the 100 patients, while Group 2 contained 37 (37%). Older age (≥7 years), leukemia type, prolonged neutropenia (>10 days), and the presence of neutropenia and hypogammaglobulinemia at diagnosis were all risk factors for having more than three FEN episodes. Our findings suggest that, in addition to ciprofloxacin prophylaxis, identifying risk factors and improving preventive strategies could help reduce FEN episodes in children with leukemia.
Collapse
Affiliation(s)
- Zühre Kaya
- Gazi University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Türkiye
| | - Nurettin Alıcı
- Gazi University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Türkiye
| | - Serap Kırkız
- Gazi University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Türkiye
| | - Ülker Koçak
- Gazi University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Türkiye
| |
Collapse
|
3
|
Prognostic role of serum cytokines and soluble HLA-G levels in children with leukemia who undergo allogeneic stem cell transplantation. Cytokine 2022; 153:155869. [DOI: 10.1016/j.cyto.2022.155869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 11/19/2022]
|
4
|
Tüfekçi Ö, Evim MS, Güneş AM, Celkan T, Karapinar DY, Kaya Z, Baysal B, Baytan B, Koçak Ü, Yilmaz Ş, Çinar S, Ören H. Assessment of Minimal Residual Disease in Childhood Acute Lymphoblastic Leukemia: A Multicenter Study From Turkey. J Pediatr Hematol Oncol 2022; 44:e396-e402. [PMID: 35129146 DOI: 10.1097/mph.0000000000002419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
Assestment of minimal residual disease (MRD) in childhood acute lymphoblastic leukemia (ALL) is of utmost importance both for risk classification and tailoring of the therapy. The data of pediatric ALL patients that received treatment with Berlin-Frankfurt-Münster (BFM) protocols were retrospectively collected from 5 university hospitals in Turkey. Of the 1388 patients enrolled in the study 390 were treated according to MRD-based protocols. MRD assestment was with real time quantitative polymerase chain reaction (qPCR) in 283 patients and with multiparametric flow cytometry (MFC)-MRD in 107 patients. MRD monitoring had upstaged a total of 8 patients (2%) from intermediate risk group to high-risk group. Univariate analysis revealed age 10 years or above, prednisone poor response, PCR-MRD ≥10-3 on day 33 and on day 78 as poor prognostic factors affecting event-free survival (EFS). Detection of >10% blasts on day 15 with MFC (MFC-high-risk group) was not shown to affect EFS and/or overall survival (log-rank P=0.339). Multiple logistic regression analysis revealed PCR-MRD ≥10-3 on day 78 as the only poor prognostic factor affecting EFS (odds ratio: 8.03; 95% confidence interval: 2.5-25; P=0.000). It is very important to establish the infrastructure and ensure necessary standardization for both MRD methods for optimal management of children with ALL.
Collapse
Affiliation(s)
- Özlem Tüfekçi
- Department of Pediatric Hematology, Dokuz Eylül University Medical Faculty, İzmir
| | - Melike Sezgin Evim
- Department of Pediatric Hematology, Uludağ University Medical Faculty, Bursa
| | - Adalet Meral Güneş
- Department of Pediatric Hematology, Uludağ University Medical Faculty, Bursa
| | - Tiraje Celkan
- Department of Pediatric Hematology-Oncology, İstanbul University Cerrahpaşa Medical Faculty
| | | | - Zühre Kaya
- Department of Pediatric Hematology, Gazi University Medical Faculty, Ankara, Turkey
| | - Birsen Baysal
- Department of Pediatric Hematology, Dokuz Eylül University Medical Faculty, İzmir
| | - Birol Baytan
- Department of Pediatric Hematology, Uludağ University Medical Faculty, Bursa
| | - Ülker Koçak
- Department of Pediatric Hematology, Gazi University Medical Faculty, Ankara, Turkey
| | - Şebnem Yilmaz
- Department of Pediatric Hematology, Dokuz Eylül University Medical Faculty, İzmir
| | - Suzan Çinar
- İstanbul University Institute of Experimental Medicine, İstanbul
| | - Hale Ören
- Department of Pediatric Hematology, Dokuz Eylül University Medical Faculty, İzmir
| |
Collapse
|
5
|
Oğuz IS, Kaya Z, Kirkiz S, Koçak Ü. Pulmonary Embolism Secondary to Intravenous Immunoglobulin in a Child with Leukemia. Turk J Haematol 2021; 38:335-336. [PMID: 34617434 PMCID: PMC8656116 DOI: 10.4274/tjh.galenos.2021.2021.0400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Işıl Seren Oğuz
- Gazi University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Zühre Kaya
- Gazi University Faculty of Medicine, Unit of Pediatric Hematology-Oncology, Ankara, Turkey
| | - Serap Kirkiz
- Gazi University Faculty of Medicine, Unit of Pediatric Hematology-Oncology, Ankara, Turkey
| | - Ülker Koçak
- Gazi University Faculty of Medicine, Unit of Pediatric Hematology-Oncology, Ankara, Turkey
| |
Collapse
|
6
|
Sunamak EÇ, Özdemir N, Koka A, Yantiri L, Apak H, Celkan T. Comparison of outcomes of children with acute lymphoblastic leukemia treated with BMF protocol across 2 decades. Pediatr Hematol Oncol 2021; 38:134-146. [PMID: 33170046 DOI: 10.1080/08880018.2020.1825573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Acute lymphoblastic leukemia is the most common malignancy of childhood. The aim of this study is to compare the outcome of children with acute lymphoblastic leukemia treated with BFM protocol over two decades at our center. We retrospectively examined the files of 421 patients by dividing them into two groups by decade of treatment, 1995-2005 and 2006-2015. After excluding 117 patients, overall, 304 patients were included in the analysis. From the first to the second decade, the proportion of patients over 12 years of age increased from 7.1% to 16.8% (p < 0.04), the high-risk group increased from 15.5% to 19.5% and patients with central nervous system leukemia increased from 5.2% to 11.4%. The relapse rate remained relatively unchanged during this period (from 12.9% to 12.7%), while the mortality rate decreased from 18.7% to 15.4% (p > 0.05) and the death rate during remission induction treatment decreased from 3.9% to 0.7%. The mortality rate of high-risk and standard-risk patients decreased from 62.5% to 34.5% (p < 0.05) and 11.1% to 3.0% (p > 0.05), respectively. The 5-year overall survival and event-free survival rates for standard-, medium- and high-risk patients were 92.7% ± 6.0%, 87.9% ± 4.7%, and 54.7% ± 13.3% and 92.5% ± 6.3%, 83.2% ± 5.5%, and 48.7% ± 14.7%, respectively. For the cohort, the 5-year overall survival rate was 83.2% ± 4.1% and the event-free survival rate was 79.9% ± 4.7%. These results demonstrate the impact of a standard protocol, experience of staff, achieving better risk stratification on treatment success.
Collapse
Affiliation(s)
- Evrim Çifçi Sunamak
- Department of Pediatric Hematology and Oncology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Nihal Özdemir
- Department of Pediatric Hematology and Oncology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Aida Koka
- Department of Pediatric Hematology and Oncology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Leman Yantiri
- Department of Pediatric Hematology and Oncology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Hilmi Apak
- Department of Pediatric Hematology and Oncology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Tiraje Celkan
- Department of Pediatric Hematology and Oncology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| |
Collapse
|
7
|
Öztürk AP, Koç B, Zülfikar B. Acute Complications and Survival Analysis of Childhood Acute Lymphoblastic Leukemia: A 15-year Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e39-e47. [PMID: 33046422 DOI: 10.1016/j.clml.2020.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/22/2020] [Accepted: 08/27/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND We evaluated the acute complications that occurred during the treatment of childhood acute lymphoblastic leukemia (ALL) and documented the survival rates of children with ALL. MATERIALS AND METHODS We retrospectively evaluated 110 children with a diagnosis of ALL treated with the Children's Oncology Group protocol from 1999 to 2014. The demographic, clinical, and laboratory data of 110 patients and acute complications of eligible and evaluable 105 patients were recorded. RESULTS Of the 110 patients, 65 were male and 45 were female. The mean age at admission was 8.3 ± 5.2 years. Ninety-seven patients (88.2%) had been diagnosed with pre-B-cell ALL, 11 (10%) with T-cell ALL, 1 (0.9%) with mixed phenotype acute leukemia, and 1 (0.9%) with mature B-cell acute leukemia. Of the 110 patients, 40 (36.3%) were in the standard-risk group and 70 (63.7%) were in high-risk group. Of the 110 patients, 105 had been followed up regularly and evaluated for acute complications. Infection was the most common complication (n = 93; 88.5%), followed by gastrointestinal (n = 29; 27.6%), neurologic (n = 28; 26.6%), metabolic/endocrine (n = 16; 15.2%), drug-related hypersensitivity (n = 16; 15.2%), avascular necrosis (n = 13; 12.3%), thrombotic (n = 11; 10.4%), severe psychiatric (n = 2; 1.9%), and various other (n = 12; 11.4%) complications. Of the 110 patients, 98 were assessed in terms of survival analysis. The 5- and 10-year overall survival rates were both 85.9% (standard error [SE], 3.6%). The relapse-free survival rates at 1, 3, and 5 years were 97.9% (SE, 1.5%), 91.3% (SE, 3%), and 86.3% (SE, 3.7%), respectively. CONCLUSION Childhood ALL, although categorized as curable malignancy owing to the improvements in treatment strategies in recent years, can cause acute complications affecting various systems. Thus, patients should be treated and followed up by multidisciplinary medical teams with high expertise.
Collapse
Affiliation(s)
- Ayşe Pınar Öztürk
- Department of Pediatrics, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
| | - Başak Koç
- Department of Pediatric Hematology-Oncology, Istanbul University Oncology Institute, Istanbul, Turkey
| | - Bülent Zülfikar
- Department of Pediatric Hematology-Oncology, Istanbul University Oncology Institute, Istanbul, Turkey
| |
Collapse
|
8
|
Gheorghe A, Chalkidou K, Shamieh O, Kutluk T, Fouad F, Sultan I, Sullivan R. Economics of Pediatric Cancer in Four Eastern Mediterranean Countries: A Comparative Assessment. JCO Glob Oncol 2020; 6:1155-1170. [PMID: 32697668 PMCID: PMC7392699 DOI: 10.1200/go.20.00041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2020] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Cancer is a leading cause of death among children in the Eastern Mediterranean region, where conflict and economic downturn place additional burden on the health sector. In this context, using economic evidence to inform policy decisions is crucial for maximizing health outcomes from available resources. We summarized the available evidence on the economics of pediatric cancer in Jordan, Lebanon, the occupied Palestinian territory, and Turkey. METHODS A scoping review was performed of seven academic databases and gray literature pertaining to pediatric cancer in the four jurisdictions, published between January 1, 2010, and July 17, 2019. Information was extracted and organized using an analytical framework that synthesizes economic information on four dimensions: the context of the health system, the economics of health care inputs, the economics of service provision, and the economic consequences of disease. RESULTS Most of the economic evidence available across the four jurisdictions pertains to the availability of health care inputs (ie, drugs, human resources, cancer registration data, and treatment protocols) and individual-level outcomes (either clinical or health-related quality of life). We identified little evidence on the efficiency or quality of health care inputs and of pediatric cancer services. Moreover, we identified no studies examining the cost-effectiveness of any intervention, program, or treatment protocol. Evidence on the economic consequences of pediatric cancer on families and the society at large was predominantly qualitative. CONCLUSION The available economic evidence on pediatric cancer care in the four countries is limited to resource availability and, to an extent, patient outcomes, with a substantial gap in information on drug quality, service provision efficiency, and cost-effectiveness. Links between researchers and policymakers must be strengthened if pediatric cancer spending decisions, and, ultimately, treatment outcomes, are to improve.
Collapse
Affiliation(s)
- Adrian Gheorghe
- Global Health and Development, Imperial College London, London, United Kingdom
| | - Kalipso Chalkidou
- Global Health and Development, Imperial College London, London, United Kingdom
- Center for Global Development Europe, London, United Kingdom
| | - Omar Shamieh
- Center for Palliative and Cancer Care in Conflict, Department of Palliative Care, King Hussein Cancer Center, Amman, Jordan
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University, Ankara, Turkey
| | - Fouad Fouad
- Faculty of Health Sciences, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Richard Sullivan
- Institute for Cancer Policy and Conflict & Health Research Group, King's College London, London, United Kingdom
| |
Collapse
|
9
|
Kaya Z, Akdemir OU, Atay OL, Akyürek N, Pınarlı FG, Yenicesu İ, Koçak Ü. Utility of 18-fluorodeoxyglucose positron emission tomography in children with relapsed/refractory leukemia. Pediatr Hematol Oncol 2018; 35:393-406. [PMID: 30657003 DOI: 10.1080/08880018.2018.1557306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Few data are available on the clinical significance of 18-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) results in patients with leukemia. We investigated the utility of FDG-PET/CT at the time of relapsed/refractory disease in pediatric patients with leukemia. METHODS Medical records of 28 children with suspected leukemia progression or recurrence during/after chemotherapy or allogeneic stem cell transplantation (allo-SCT) were retrospectively reviewed to determine the utility of FDG-PET/CT. RESULTS Twenty-two of the 28 patients have documented abnormal imaging findings during clinical follow-up, while six had were interpreted as not demonstrating signal consistent with active leukemia. Of the 22 patients with abnormal FDG-PET/CT studies 14 were found to have FDG-PET/CT reported as consistent with active leukemia and increased leukemia blasts on bone marrow biopsy. Regarding the eight patients without positive FDG-PET/CT and proven leukemia relapse, four had discordant findings on FDG-PET/CT and biopsy, and four had FDG-PET/CT reported as infection. Mean maximum standardized uptake values (SUVmax) were significantly higher among patients whose FDG-PET/CT findings were positive for leukemia as opposed to infectious disease (p < .05). Mean SUVmax was also significantly higher among patients with multifocal lesions on FDG-PET/CT than among those with diffuse lesions (p < .05). CONCLUSIONS The findings suggest that FDG-PET/CT may be a complementary imaging modality that could be combined with bone marrow examination to improve detection of subtle leukemic infiltration in children with suspected leukemia progression or recurrence after chemotherapy or allo-SCT.
Collapse
Affiliation(s)
- Zühre Kaya
- a Department of Pediatrics, Pediatric Hematology Unit , Gazi University, Faculty of Medicine , Ankara , Turkey
| | - Ozgür Umit Akdemir
- b Departments of Nuclear Medicine , Gazi University, Faculty of Medicine , Ankara , Turkey
| | - Ozlem Lütfiye Atay
- b Departments of Nuclear Medicine , Gazi University, Faculty of Medicine , Ankara , Turkey
| | - Nalan Akyürek
- c Department of Pathology , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Faruk Güçlü Pınarlı
- d Department of Pediatric Oncology , Gazi University Faculty of Medicine , Ankara , Turkey
| | - İdil Yenicesu
- a Department of Pediatrics, Pediatric Hematology Unit , Gazi University, Faculty of Medicine , Ankara , Turkey
| | - Ülker Koçak
- a Department of Pediatrics, Pediatric Hematology Unit , Gazi University, Faculty of Medicine , Ankara , Turkey
| |
Collapse
|
10
|
Association of CYP3A5 Expression and Vincristine Neurotoxicity in Pediatric Malignancies in Turkish Population. J Pediatr Hematol Oncol 2017; 39:458-462. [PMID: 28697165 DOI: 10.1097/mph.0000000000000910] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vincristine is a widely used chemotherapeutic agent in the treatment of childhood malignancies. Neuropathy is the most common adverse effect. CYP3A4 and CYP3A5 enzymes of cytochrome p450 enzyme system are responsible in vincristine metabolism. Genetic polymorphism may alter the vincristine metabolism and the neurotoxicity rate. In this study, distribution of CYP3A5 alleles among Turkish children with malignancies, relation between CYP3A5 genotype and neurotoxicity rates, as well as severity and duration of neuropathy and total vincristine doses were investigated. Patient group consisted of 115 patients (age, 1 to 17 y) with acute lymphoblastic leukemia and solid tumors, who were treated with vincristine consisting chemotherapy protocols. Control group consisted of 50 children without any neurological symptom or disorders. All patient files were reviewed for presence and severeness of neurotoxicity symptoms. Blood samples were obtained and CYP3A5 genotypes were analyzed. Neurotoxicity occurred in 20.8% of patients. Although it was found to occur more frequently after 4 doses of vincristine, and rates were higher in the low-dose vincristine group suggesting other contributing factors. Although neurotoxicity rate in the CYP3A5*1/*3 genotype was 17.6%, it was 21.6% in the CYP3A5*3/*3 genotype and the difference was not statistically significant (P<0.05). This study suggested that vincristine-related neurotoxicity is dose-independent and genotype is not the only causative factor in the occurrence of neurotoxicity in these patients.
Collapse
|
11
|
Yazıcıoğlu B, Kaya Z, Güntekin Ergun S, Perçin F, Koçak Ü, Yenicesu İ, Gürsel T. Influence of Folate-Related Gene Polymorphisms on High-Dose Methotrexate-Related Toxicity and Prognosis in Turkish Children with Acute Lymphoblastic Leukemia. Turk J Haematol 2017; 34:143-150. [PMID: 27094381 PMCID: PMC5440866 DOI: 10.4274/tjh.2016.0007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/25/2016] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE High-dose methotrexate (HD-MTX) is widely used in the consolidation phase of childhood acute lymphoblastic leukemia (ALL), but the roles that polymorphisms in folate-related genes (FRGs) play in HD-MTX toxicity and prognosis in children with ALL are not understood. The aims of this study were to investigate the frequencies of polymorphisms in the genes for thymidylate synthase (TS), methionine synthase reductase (MTRR), and methylene tetrahydrofolate reductase (MTHFR) in Turkish children with ALL and to assess associations between these polymorphisms and HD-MTX-related toxicity and leukemia prognosis in this patient group. MATERIALS AND METHODS FRG polymorphisms were assessed by real-time polymerase chain reaction. Survival status, MTX levels, and toxicity data were retrieved from 106 patients' charts. RESULTS The allele frequencies for the FRG polymorphisms were as follows: TS 2R 41.0%, 3R 57.0%, and 4R 2.0%; MTRR 66A 42.4% and 66G 57.6%; MTHFR 677C 59.3% and 677T 40.7%; and MTHFR 1298A 58.1% and 1298C 41.9%. At the 48th hour of HD-MTX infusion, serum MTX was significantly higher in patients who had TS 2R/3R/4R variants as compared to those with wild-type TS (p<0.05). No significant differences were detected with respect to event-free survival or toxicity between wild-type and other FRG variants. CONCLUSION The frequencies of FRG polymorphisms in Turkish children with ALL are similar to those reported in other Caucasian populations. This is the first published finding of the TS 3R/4R variant in the Turkish population. The results indicate that HD-MTX can be tolerated by leukemic children with some polymorphic variants of FRG; thus, it may prevent future risk of leukemic relapse.
Collapse
Affiliation(s)
| | - Zühre Kaya
- Gazi University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey E-mail:
| | | | | | | | | | | |
Collapse
|
12
|
Li SD, Chen YB, Li ZG, Wu RH, Qin MQ, Zhou X, Jiang J, Zhang RD, Xie J, Ma XL, Zhang R, Wang B, Wu Y, Zheng HY, Wu MY. Infections during induction therapy of protocol CCLG-2008 in childhood acute lymphoblastic leukemia: a single-center experience with 256 cases in China. Chin Med J (Engl) 2015; 128:472-6. [PMID: 25673448 PMCID: PMC4836249 DOI: 10.4103/0366-6999.151085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Infections remain a major cause of therapy-associated morbidity and mortality in children with acute lymphoblastic leukemia (ALL). Methods: We retrospectively analyzed the medical charts of 256 children treated for ALL under the CCLG-2008 protocol in Beijing Children's Hospital. Results: There were 65 infectious complications in 50 patients during vincristine, daunorubicin, L-asparaginase and dexamethasone induction therapy, including microbiologically documented infections (n = 12; 18.5%), clinically documented infections (n = 23; 35.3%) and fever of unknown origin (n = 30; 46.2%). Neutropenia was present in 83.1% of the infectious episodes. In all, most infections occurred around the 15th day of induction treatment (n = 28), and no patients died of infection-associated complications. Conclusions: The infections in this study was independent of treatment response, minimal residual diseases at the end of induction therapy, gender, immunophenotype, infection at first visit, risk stratification at diagnosis, unfavorable karyotypes at diagnosis and morphologic type. The infection rate of CCLG-2008 induction therapy is low, and the outcome of patients is favorable.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Min-Yuan Wu
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics, Ministry of Education; Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| |
Collapse
|
13
|
Küpeli S. Thiopurine S-Methyltransferase and Methylenetetrahydrofolate Reductase Polymorphisms in Leukemia. Turk J Haematol 2015; 32:184-5. [PMID: 26316490 PMCID: PMC4451490 DOI: 10.4274/tjh.2015.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Serhan Küpeli
- Çukurova University Faculty of Medicine, Department of Pediatric Oncology and Pediatric Bone Marrow Transplantation Unit, Adana, Turkey Phone: +90 322 338 74 44 E-mail:
| |
Collapse
|
14
|
Koka A, Saygin C, Uzunaslan D, Ozdemir N, Apak H, Celkan T. A 17-year experience with ALL-BFM protocol in acute lymphoblastic leukemia: Prognostic predictors and interruptions during protocol. Leuk Res 2014; 38:699-705. [DOI: 10.1016/j.leukres.2014.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 02/26/2014] [Accepted: 03/18/2014] [Indexed: 12/31/2022]
|
15
|
Güneş AM, Ören H, Baytan B, Bengoa ŞY, Evim MS, Gözmen S, Tüfekçi Ö, Karapınar TH, İrken G. The long-term results of childhood acute lymphoblastic leukemia at two centers from Turkey: 15 years of experience with the ALL-BFM 95 protocol. Ann Hematol 2014; 93:1677-84. [DOI: 10.1007/s00277-014-2106-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
|
16
|
Sakamoto LHT, Andrade RVD, Felipe MSS, Motoyama AB, Pittella Silva F. SMYD2 is highly expressed in pediatric acute lymphoblastic leukemia and constitutes a bad prognostic factor. Leuk Res 2014; 38:496-502. [PMID: 24631370 DOI: 10.1016/j.leukres.2014.01.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/19/2014] [Accepted: 01/28/2014] [Indexed: 12/13/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Although several clinical characteristics can be associated with worse prognosis, more robust biological markers still remains uncovered. SMYD2, a member of SMYD protein family, regulates the activity of several proteins through methylation. In this study, we performed quantitative real time PCR to compare the expression of SMYD2 in 83 pediatric ALL patients and non-neoplastic bone marrow samples (BMS). The study revealed that SMYD2 expression is altered in ALL BMS and its high expression was correlated with a bad prognosis. Moreover, we also revealed that SMYD2 expression level significantly decreases in patients that respond to chemotherapy treatment.
Collapse
Affiliation(s)
- Luis Henrique Toshihiro Sakamoto
- Laboratory of Molecular Pathology of Cancer, Faculty of Health Sciences, University of Brasilia, Brasilia, DF, Brazil; Cell Biology Department, University of Brasilia, Brasilia, DF, Brazil; Jose Alencar Children's Hospital of Brasilia, Brasilia, DF, Brazil
| | - Rosangela Vieira de Andrade
- Laboratory of Genomic Sciences and Molecular Biotechnology, Catholic University of Brasilia, Brasilia, DF, Brazil
| | - Maria Sueli Soares Felipe
- Laboratory of Genomic Sciences and Molecular Biotechnology, Catholic University of Brasilia, Brasilia, DF, Brazil; Cell Biology Department, University of Brasilia, Brasilia, DF, Brazil
| | - Andrea Barretto Motoyama
- Laboratory of Molecular Pathology of Cancer, Faculty of Health Sciences, University of Brasilia, Brasilia, DF, Brazil
| | - Fabio Pittella Silva
- Laboratory of Molecular Pathology of Cancer, Faculty of Health Sciences, University of Brasilia, Brasilia, DF, Brazil.
| |
Collapse
|