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Abdelaal AHK, Sedky M, Gohar S, Zaki I, Salama A, Hassanain O, El Ghoneimy AM. Skeletal involvement in children with Langerhans cell histiocytosis: healing, complications, and functional outcome. SICOT J 2020; 6:28. [PMID: 32672151 PMCID: PMC7364762 DOI: 10.1051/sicotj/2020024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/22/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: Skeletal involvement in children with Langerhans cell histiocytosis (LCH) is a common feature of the disease. Several options for the treatment of these skeletal lesions have been reported. We describe our experience in the treatment of skeletal involvement of LCH in this retrospective case series study, entailing anatomic distribution, pattern of healing, skeletal deformities, and functional outcome of skeletal LCH. Methods: A retrospective analysis was conducted for patients diagnosed with LCH and having skeletal lesions in the period between 2007 and 2015. Out of a total of 229 cases, 191 (83.4%) had skeletal involvement. Bone healing was divided into partial and complete based on the size of lesion and cortical changes in plain radiograph. Skeletal deformities were serially measured. Time to pain control, resumption of weight bearing, and the final functional status of the patient were reviewed. Results: The mean age at presentation was 4.4 years (3 m–14.8 y) and the mean follow-up period was 53.3 months (0.2–120.7). After screening of skeletal and extra-skeletal lesions, 59 patients (31%) had M-S (Multisystem) LCH and 132 (69%) had S-S (Single system) LCH. Unifocal bone lesions were found in 81 (42.5%) patients, and multifocal bone lesions in 110 patients (57.5%). Single or multiple bone lesions were found in the craniofacial bones in 152 patients (79.5%), femur in 19 patients, (10%), ribs in 18 patients (9.4%), spine in 15 patients (8.1%), pelvis in 14 patients (7.3%), scapula in 8 patients (4.1%), humerus in 6 (3.1%), clavicle in 6 patients (3.1%), tibia in 3 patients (1.5%), radius in 3 patients (1.5%), and the ulna in 2 patients (1%) patients. No lesions were found in the fibula, hand, or foot. Out of all skeletal lesions, 179 (93.7%) patients were treated either medically or conservatively and 12 patients (6.2%) were treated surgically. The mean time to complete healing was 5.2 months (2–12). Skeletal complications included: pathologic fractures (9 vertebra plana, 5 long bone, 1 iliac bone), deformities (9 thoracolumbar kyphosis, 2 cervical spine subluxations, 2 coxa vara deformity of the proximal femur and one flattening of iliac bone). Conclusion: Non-operative treatment can lead to adequate bone healing in few months period. Partial or complete remodeling of bone deformities can be observed without surgical correction. However, surgical intervention might be indicated when cervical spine affection may lead to instability and subsequent neurological affection. Functional impairment is rarely caused by skeletal lesions in LCH.
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Affiliation(s)
- Ahmed H K Abdelaal
- Consultant of Musculoskeletal Tumor Surgery, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt - Lecturer, Department of Orthopedic Surgery, Faculty of Medicine, Sohag University, 82524 Sohag, Egypt
| | - Mohamed Sedky
- Professor of Pediatrics, Pediatric Department National Research Centre, Consultant of Pediatric Oncology Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Seham Gohar
- Consultant of Pediatric Oncology, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Iman Zaki
- Professor of Radiodiagnosis National Cancer Institute NCI, Cairo University Head of Medical Imaging Department, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Asmaa Salama
- Professor of Pathology National Cancer Institute NCI, Cairo University Consultant of Pathology, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Omayma Hassanain
- Clinical Research Senior Supervisor, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt
| | - Ahmed M El Ghoneimy
- Head of Musculoskeletal Tumor Surgery Unit, Children Cancer Hospital-Egypt (57357), 11617 Cairo, Egypt - Lecturer, Department of Orthopedic Surgery, Faculty of Medicine, Cairo University, 12613 Giza, Egypt
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Hafez HA, Abdallah A, Hammad M, Hamdy N, Yassin D, Salem S, Hassanain O, Elhalaby L, Elhaddad A. Outcomes of allogenic hematopoietic cell transplantation for childhood chronic myeloid leukemia: Single-center experience. Pediatr Transplant 2020; 24:e13664. [PMID: 32043758 DOI: 10.1111/petr.13664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Despite the apparent efficacy and favorable toxicity profile of TKIs, allogeneic SCT remains the only curative treatment for CML especially in younger patients, but TRM should be considered. We evaluated the clinical outcomes of pediatric CML patients who had SCT in our center. METHODS This retrospective study included children with CML, who received an allogeneic SCT at Children Cancer Hospital Egypt, 57357, from 2007 to 2017. All patients received myeloablative conditioning chemotherapy containing busulfan/cyclophosphamide followed by stem cell infusion from MRD. RESULTS From 121 patients diagnosed with CML, 43 had available MRD and subjected to HSCT while 78 patients continued TKI therapy. The median time to transplant from diagnosis was 13 months. At initial diagnosis, there were 39 patients in CP and 4 had blastic crises. Bone marrow harvest was the stem cell source in 32 patients, while 11 cases received mobilized peripheral blood stem cells with average stem cell dose of 4.45 × 106 /kg. The probabilities of overall survival and event-free survival at 5 years were 97.4% and 79.8%, respectively. TRM at 100 days and TRM at 1-year post-transplant were 0%. The incidence of chronic GVHD was significantly higher in peripheral blood than bone marrow stem cell source (P = .004). CONCLUSION Considering the excellent survival rates and very low TRM, HSCT is still a valid option for pediatric patients with newly diagnosed CML with best using marrow stem cell source to avoid a significant risk of cGVHD and its related complications.
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Affiliation(s)
- Hanafy A Hafez
- Pediatric Hematology/Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.,Pediatric Hematology/Oncology, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Amr Abdallah
- Pediatric Hematology/Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.,Pediatric Hematology/Oncology, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Mahmoud Hammad
- Pediatric Hematology/Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.,Pediatric Hematology/Oncology, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Nayera Hamdy
- Clinical Pathology, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Dina Yassin
- Clinical Pathology, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Sherine Salem
- Clinical Pathology, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Omayma Hassanain
- Research Department, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Lama Elhalaby
- Research Department, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Alaa Elhaddad
- Pediatric Hematology/Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.,Pediatric Hematology/Oncology, Children Cancer Hospital Egypt, Cairo, Egypt
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Madney Y, Khedr R, Ahmed N, El-Mahallawy H, Youssef A, Taha H, Hassanain O, Ahmed G, Hafez H. Overview and outcome of mucormycosis among children with cancer: Report from the Children's Cancer Hospital Egypt. Mycoses 2019; 62:984-989. [PMID: 30983046 DOI: 10.1111/myc.12915] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/13/2019] [Accepted: 03/31/2019] [Indexed: 12/16/2022]
Abstract
Mucormycosis represents a real challenge in immunocompromised patients. This study aimed to describe the clinical characteristics, treatment outcome and infection-related mortality in our patients at the Children's Cancer Hospital 57357, Cairo, Egypt. This is a retrospective study during the period 2007-2017. Data analysis included demographic data, risk factors, diagnostic workup, treatment and outcome. During the study period, 45 patients developed proven mucormycosis according to EORTC/MSG criteria (2008). Ninety percentof cases were of haematological malignancies. Liposomal amphotericin B was the mainstay of treatment. Posaconazole was used as secondary prophylaxis in 35% of cases. Combination antifungal was used in three cases with progressive mucormycosis. Surgical intervention was achievable in 50% of cases. Therapy was successful in 35 patients (66%). Complications related to mucormycosis were seen in five cases with disfigurement and perforated hard palate. Chemotherapy delay with subsequent relapse of primary malignancy was reported in one case. Mucormycosis-related mortality was 33% (15 cases). Mucormycosis is a major cause of mortality among patients with haematological malignancies. Early diagnosis of Mucormycosis infection, with rapid initiation of appropriate antifungal therapy and surgical intervention, whenever feasible, is the backbone of mucormycosis treatment.
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Affiliation(s)
- Youssef Madney
- Pediatric Oncology Department, National Cancer Institute-Cairo University, Children Cancer Hospital, Cairo, Egypt
| | - Reham Khedr
- Pediatric Oncology Department, National Cancer Institute-Cairo University, Children Cancer Hospital, Cairo, Egypt
| | - Naglaa Ahmed
- Clinical Pharmacy, Children Cancer Hospital, Cairo, Egypt
| | - Hadir El-Mahallawy
- Clinical Pathology Department, National Cancer Institute-Cairo University, Cairo, Egypt
| | - Ayda Youssef
- Radio-Diagnosis Department, National Cancer Institute-Cairo University, Children Cancer Hospital, Cairo, Egypt
| | - Hala Taha
- Surgical Pathology Department, National Cancer Institute-Cairo University, Children Cancer Hospital, Cairo, Egypt
| | - Omayma Hassanain
- Clinical Research Department, Children Cancer Hospital, Cairo, Egypt
| | - Gehad Ahmed
- Surgery Department, Faculty of Medicine, Helwan University, Children Cancer Hospital, Cairo, Egypt
| | - Hanafy Hafez
- Pediatric Oncology Department, National Cancer Institute-Cairo University, Children Cancer Hospital, Cairo, Egypt
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Abdalla A, Hammad M, Hafez H, Salem S, Soliman S, Ghazal S, Hassanain O, El-Haddad A. Outcome and factors affecting survival of childhood myelodysplastic syndrome; single centre experience. Pediatric Hematology Oncology Journal 2019. [DOI: 10.1016/j.phoj.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Kamal M, El-Khateeb N, Awad M, Zaghloul MS, Ahmed S, El-Beltagy M, Taha H, Refaat A, Abouelnaga S, Refaat A, Aggag M, Youssef A, Kamal M, Gharieb A, El-Beltagy M, Taha H, Ezzat S, Kamal M, Hassanain O, Abouelnaga S, Hussein H, Hosny H, Sabry M, Samir A, El-Beltagy M, Kamal M, Zaghloul MS, Abouelnaga S, Taha H, El Beltagy M, Atteya M, Moiyadi A, Shetty P, El-Shazly M, El Masry A, Quaddoumi I, El-Fiki M, Fadel S, Xiong H, Shao J, Li J, Xu Z, Ezziane-Guechi K, Atif ML, Bouzid K, Bezzaoucha A, Faranoush M, Mehrvar A, Asl AAH, Tashvighi M, Parsa RR, Fazeli MA, Sobuti B, Mehrvar N, Ali J, Zangooei R, Alebouyeh M, Vossough P, Perek D, Baginska BD, Drogosiewicz M, Polnik MP, Grajkowska W, Roszkowski M, Sobol G, Musiol K, Wachowiak J, Kazmierczak B, Pogorzelski JP, Mlynarski W, Szewczyk BZ, Wysocki M, Niedzielska E, Kowalczyk J, Slusarz HW, Balwierz W, Czepko EZ, Szolkiewicz A, Haddad P, Zali A, Tabatabaeefar M, Nikoofar A, Kharazi HH, Ghadyani M, Fadavi P, Mukhomorova L, Faranoush M, Nami MT, Botelho I, Pedrosa F, Qaddoumi I, Ribeiro R, Pedrosa A, Hazim A, Furtado G, Serra S, Procopio S, Pillai A, Mr B, Panikar D, Jarrar M, Alharbi M, Alharbi T, Alsudairy R, Alomari A, Aljamaan K, Alsultan A, Hnin TM, Khaing A, Tin HH, Ebeid E, El Haddad M, Mansour A, El Haddad A, Maza I, Vasquez L, Ordonez K, Paredes G, Yabar A, Ugarte E, Geronimo J. NEURO-ONCOLOGY IN DEVELOPING COUNTRIES. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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