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Echecopar C, Del Val Rey I, Galán-Gómez V, González-Pérez C, Mozo Del Castillo Y, González Martínez B, Pérez-Martínez A. The paradigm of total body irradiation in acute lymphoblastic leukaemia: Therapeutic effectiveness versus the challenges of toxicity. An Pediatr (Barc) 2024; 100:259-267. [PMID: 38548564 DOI: 10.1016/j.anpede.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/18/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Total body irradiation (TBI) is part of the myeloablative conditioning for hematopoietic stem cell transplantation (HSCT) in malignant hematologic disorders. This therapy has recently shown improved survival in acute lymphoblastic leukemia (ALL) compared to chemotherapy-based regimens. However, side effects are a significant limitation, especially in the pediatric population. PATIENTS AND METHODS We retrospectively analyzed the survival of patients with ALL who underwent an HSCT at a tertiary hospital between 1996 and 2009 (N = 69 HSCT in 57 patients). We differentiated a cohort that received TBI (N = 44) from another that did not (N = 25). Subsequently, we interviewed the survivors from the TBI group with a minimum of 10 years of follow-up (N = 18), asking about the presence of side effects. RESULTS The overall survival (OS) at 2 and 5 years was 79.1% and 65.2% respectively for the TBI group and 66.2% and 55.8% for the non-TBI group, although this difference was not significant (P=.31). The event-free survival (EFS) at 2 and 5 years was 77.3% and 63.6% respectively for the TBI group and 56% and 32% for the non-TBI group (P=.02). The probability of relapse (PR) at 2 years for those who received TBI was 10% compared to 28.6% for those who did not receive TBI (P=.005). Survivors who received TBI developed secondary neoplasms (39%), dyslipidemia (67%), cognitive impairments affecting memory (44%), recurrent respiratory infections (39%), thyroid abnormalities (45%), premature ovarian failure (89%), cataracts (22%), and psychological problems (44%). However, the quality of life, as self-assessed by the patients, was considered good for 83% of the participants.. CONCLUSIONS Patients who received TBI had significantly higher EFS and lower PR. However, adverse effects are frequent and significant, although they do not subjectively affect quality of life.
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Affiliation(s)
- Carlos Echecopar
- Servicio de Hematología y Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Víctor Galán-Gómez
- Servicio de Hematología y Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | - Carlos González-Pérez
- Servicio de Hematología y Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Berta González Martínez
- Servicio de Hematología y Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Pérez-Martínez
- Servicio de Hematología y Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
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Araujo-Cárdenas JE, Rodríguez-Ruiz MA, López-Valdez JA, Rodríguez-Téllez RI, Garfias-Gómez Y, Parra-Ortega I, Patiño-López G. Myosin 1g as a high-risk biomarker in a pediatric patient with lineage switch from acute lymphoblastic leukemia to myeloid phenotype. Bol Med Hosp Infant Mex 2023; 80:135-143. [PMID: 37155721 DOI: 10.24875/bmhim.22000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Myosin 1g (Myo1g) has recently been identified as a potential diagnostic biomarker in childhood acute lymphocytic leukemia (ALL). CASE REPORT We describe the case of a 1-year-old Mexican female patient. Although initially studied for hepatomegaly, an infectious or genetic etiology was excluded. Liver biopsy showed infiltration by neoplastic B-cell precursors (BCPs), and bone marrow (BM) aspirate showed 14.5% of BCPs. In a joint session of the oncology, hematology, and pathology departments, low-risk (LR) BCP-ALL of hepatic origin with aberrant myeloid markers was diagnosed. Although treatment was initiated, the patient presented early with BM relapse. Modest overexpression of Myo1g was observed from the onset. However, at the end of the steroid window, expression increased significantly and remained elevated during this first relapse to BM. The parents refused hematopoietic stem cell transplantation, but she continued chemotherapy. After a second BM relapse at 5 years of age, the phenotype switched to myeloid. Her parents then opted for palliative care, and the patient died two months later at home. CONCLUSIONS This case shows the potential use of Myo1g in clinical practice as a high-risk indicator. Myo1g monitoring may reveal a high risk and relapse trend, even when typical parameter values are not altered: Myo1g could be used to classify patients from low to high risk from diagnosis, allowing patients to promptly receive the best treatment and potentially modifying prognosis and survival.
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Affiliation(s)
- Janeth E Araujo-Cárdenas
- Laboratorio de Investigación Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City
| | | | | | - Rosa I Rodríguez-Téllez
- Laboratorio de Investigación Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City
| | - Yanelly Garfias-Gómez
- Laboratorio de Investigación Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City
| | - Israel Parra-Ortega
- Laboratorio Clínico, Hospital Infantil de México Federico Gómez, Mexico City. Mexico
| | - Genaro Patiño-López
- Laboratorio de Investigación Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City
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Galán Gómez V, de la Fuente Regaño L, Rodríguez Villa A, Díaz de Heredia Rubio C, González Vicent M, Badell Serra I, María Fernández J, Isabel Pascual Martínez A, María Pérez Hurtado J, López Duarte M, Soledad Maldonado Regalado M, Pérez-Martínez A. Experience of the Spanish Group for Hematopoietic Transplantation (GETMON-GETH) in allogenic Hematopoietic stem cell Transplantation in Philadelphia acute lymphoblastic leukemia. An Pediatr (Barc) 2022; 96:309-318. [PMID: 35523687 DOI: 10.1016/j.anpede.2021.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/05/2020] [Accepted: 02/23/2021] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Outcomes in patients diagnosed of acute lymphoblastic leukemia with Philadelphia chromosome (Ph-ALL) remains unfavourable compared to other subtypes of acute lymphoblastic leukemia despite improvements in drug treatments as well as advances in hematopoietic stem cell transplantation (HSCT). PATIENTS AND METHODS The role of allogeneic HSCT in Ph-ALL patients has been analysed through a multicentric study where data belonging to 70 patients diagnosed of this entity in different centers that received HSCT between years 1998 and 2014, were reported by the Grupo Español de Trasplante Hematopoyético (GETH). RESULTS The performance of HSCT from year 2004, in first complete remission (CR) status with thymoglobulin (ATG) based conditioning had a favorable impact on overall survival (OS). HSTC performance from year 2004, in first CR with ATG-based conditioning in addition to acute graft versus host disease (aGvHD) development, increased event free survival (EFS). Treatment with imatinib as well as undetectable minimal residual disease (MRD) prior to HSCT, combined with aGvHD, reduced risk of relapse (RR). Patient age less than 10 years when HSCT, first CR and ATG-based conditioning were associated to a lower transplant related mortality (TRM). CONCLUSIONS Patients that could achieve first CR that also received ATG-based conditioning had a better OS and EFS, so HSCT should be considered for this group of patients.
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Affiliation(s)
- Víctor Galán Gómez
- Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain.
| | | | | | | | | | | | - José María Fernández
- Hemato-Oncología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | | | | | - Mónica López Duarte
- Hemato-Oncología Pediátrica, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain.
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Galán Gómez V, de la Fuente Regaño L, Rodríguez Villa A, Díaz de Heredia Rubio C, González Vicent M, Badell Serra I, Fernández JM, Pascual Martínez AI, Pérez Hurtado JM, López Duarte M, Maldonado Regalado MS, Pérez-Martínez A. [Experience of the Spanish Group for Hematopoietic Transplantation (GETMON-GETH) in allogenic hematopoietic stem cell transplantation in Philadelphia acute lymphoblastic leukemia]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00148-X. [PMID: 33781716 DOI: 10.1016/j.anpedi.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/05/2020] [Revised: 02/07/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Outcomes in patients diagnosed of acute lymphoblastic leukemia with Philadelphia chromosome (Ph-ALL) remains unfavourable compared to other subtypes of acute lymphoblastic leukemia despite improvements in drug treatments as well as advances in hematopoietic stem cell transplantation (HSCT). PATIENTS AND METHODS The role of allogeneic HSCT in Ph-ALL patients has been analysed through a multicentric study where data belonging to 70 patients diagnosed of this entity in different center that received HSCT between years 1998 and 2014, were reported by the Grupo Español de Trasplante Hematopoyético (GETH). RESULTS The performance of HSCT from year 2004, in first complete remission (CR) status with thymoglobulin (ATG) based conditioning had a favorable impact on overall survival (OS). HSTC performance from year 2004, in first CR with ATG-based conditioning in addition to acute graft versus host disease (aGvHD) development, increased event free survival (EFS). Treatment with imatinib as well as undetectable minimal residual disease (MRD) prior to HSCT, combined with aGvHD, reduced risk of relapse (RR). Patient age less than 10 years when HSCT, first CR and ATG-based conditioning were associated to a lower transplant related mortality (TRM). CONCLUSIONS Patients that could achieve first CR that also received ATG-based conditioning had a better OS and EFS, so HSCT should be considered for this group of patients.
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Affiliation(s)
- Víctor Galán Gómez
- Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, España
| | | | | | | | | | | | - José María Fernández
- Hemato-Oncología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | | | - Mónica López Duarte
- Hemato-Oncología Pediátrica, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
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Chávez-Aguilar LA, Peña-Vélez R. [Acute pancreatitis in children with hemato-oncological diseases: clinical aspects and treatment]. Bol Med Hosp Infant Mex 2021; 78:95-101Pancreatitis aguda. [PMID: 33434914 DOI: 10.24875/bmhim.20000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
La pancreatitis aguda es una enfermedad inflamatoria del páncreas. Se observa con mayor frecuencia en niños bajo tratamiento por alguna enfermedad hematooncológica y se asocia principalmente con la administración de L-asparaginasa. Identificar esta complicación de forma temprana y establecer un plan terapéutico adecuado puede mejorar el pronóstico y reducir el riesgo de otras complicaciones. En este trabajo se realizó una revisión crítica de la literatura actual, con especial énfasis en los aspectos clínicos, el diagnóstico y el tratamiento de la pancreatitis aguda en niños con cáncer.
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Affiliation(s)
- Lénica A Chávez-Aguilar
- Servicio de Hematología Pediátrica, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Rubén Peña-Vélez
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría; Facultad de Medicina, Universidad Nacional Autónoma de México. Ciudad de México, México
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Narro-Donate JM, Velasco-Albendea FJ, García-Pérez F, Gomar-Alba M, Castelló-Ruiz MJ, Masegosa-González J. Different radioinducid tumors synchrony in an acute lymphoblastic leukemia survivor. Neurocirugia (Astur) 2020; 32:S1130-1473(20)30101-9. [PMID: 33012645 DOI: 10.1016/j.neucir.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/21/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 11/21/2022]
Abstract
The cranial radiation-induced tumors appearance in pediatric patients treated for hematological diseases such as leukemia/T-lymphoblastic lymphoma (T-ALL/LBL) is a known phenomenon that may include lesions of different malignant degrees and require neurosurgical treatment. We present the case of a 38-year-old man referred to our department for a sudden diplopia with 6-month progressive left hemiparesis and frequent falls. After imaging tests, different intra and extraxial lesions with different radiological behavior were observed, performing a single surgical approach for their resection. The pathological anatomy confirms four histological variants: meningioma (grade 1 and 2 [atypical]), subependymoma, and cavernoma. We discuss the teratogenic role of ionizing radiation.
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Affiliation(s)
| | | | | | - Mario Gomar-Alba
- Departamento de Neurocirugía, Complejo Hospitalario Torrecárdenas, Almería, España
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Abdelmabood S, Fouda AE, Boujettif F, Mansour A. Treatment outcomes of children with acute lymphoblastic leukemia in a middle-income developing country: high mortalities, early relapses, and poor survival. J Pediatr (Rio J) 2020; 96:108-116. [PMID: 30240631 PMCID: PMC9432263 DOI: 10.1016/j.jped.2018.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 05/16/2018] [Revised: 07/07/2018] [Accepted: 07/24/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Acute lymphoblastic leukemia is the most common childhood cancer, yet surprisingly, very few studies have reported the treatment outcomes and the relapse rate of patients from low/middle-income countries. METHOD This study was a 5-year retrospective cohort study. It was conducted at Oncology Center of Mansoura University in Egypt and aimed to estimate the treatment outcomes and the relapse rates of newly diagnosed acute lymphoblastic leukemia in children. RESULTS Two hundred children suffering from acute lymphoblastic leukemia were studied; forty-six patients (23%) died during induction and most of those deaths were related to infection. Forty-one patients (27%) relapsed out of the 152 patients who achieved complete remission. The most common site of relapse was the bone marrow, followed by the isolated central nervous system, 53.7% and 31.7%, respectively. Seventy-eight percent of relapses occurred very early/early rather than later. The majority of relapse patients' deaths were related to infection and disease progression. The 5-year overall survival rate for patients was 63.1% (82.1% for non-relapsed compared to 36.6% for relapsed patients). CONCLUSION There was a high incidence of induction deaths related to infection and high percentages of very early/early relapses, with high mortalities and low 5-year overall survival rates. These findings suggest the urgent need for modification of chemotherapy regimens to be suitable for the local conditions, including implementation of supportive care and infection control policies. There is also a requirement for antimicrobial prophylaxis during induction period combined with the necessary increase in government healthcare spending to improve the survival of acute lymphoblastic leukemia in Egyptian children.
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Affiliation(s)
- Suzy Abdelmabood
- Mansoura University, Faculty of Medicine, Pediatric Department, Hematology/Oncology Unit, Al-Mansoura, Egypt
| | - Ashraf Elsayed Fouda
- Mansoura University, Faculty of Medicine, Pediatric Department, Hematology/Oncology Unit, Al-Mansoura, Egypt.
| | | | - Ahmed Mansour
- Mansoura University, Mansoura Faculty of Medicine, Mansoura Oncology Center - Pediatric Oncology Unit, Al-Mansoura, Egypt
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Barba P, Elorza I. Allogeneic stem cell transplantation in the era of novel therapies for acute lymphoblastic leukaemia. Med Clin (Barc) 2019; 153:28-34. [PMID: 30857792 DOI: 10.1016/j.medcli.2019.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 11/23/2022]
Abstract
Immunotherapy is changing the treatment of acute lymphoblastic leukaemia (ALL) in adults and children. However, regardless of these new therapies, allogeneic hematopoietic cell transplantation (allo-HCT) still play a key role in the treatment of ALL, although it is uncertain how these new therapies will impact on the transplant procedure and indications. This article reviews the indications of allo-HCT for children and adults diagnosed with ALL, the different sources and conditioning regimens for transplantation as well as the role of measurable residual diseases pre- and post-HCT in the era of the new therapies for ALL.
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Aguirre-Guillén WA, Angeles-Floriano T, López-Martínez B, Reyes-Morales H, Zlotnik A, Valle-Rios R. Omics techniques and biobanks to find new biomarkers for the early detection of acute lymphoblastic leukemia in middle-income countries: a perspective from Mexico. Bol Med Hosp Infant Mex 2018; 74:227-232. [PMID: 29382491 DOI: 10.1016/j.bmhimx.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/01/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) affects the quality of life of many children in the world and particularly in Mexico, where a high incidence has been reported. With a proper financial investment and with well-organized institutions caring for those patients, together with solid platforms to perform high-throughput analyses, we propose the creation of a Mexican repository system of serum and cells from bone marrow and blood samples derived from tissues of pediatric patients with ALL diagnosis. This resource, in combination with omics technologies, particularly proteomics and metabolomics, would allow longitudinal studies, offering an opportunity to design and apply personalized ALL treatments. Importantly, it would accelerate the development of translational science and will lead us to further discoveries, including the identification of new biomarkers for the early detection of leukemia.
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Affiliation(s)
- William Alejandro Aguirre-Guillén
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City, Mexico; Unidad Biológica y de Ciencias de la Salud, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Tania Angeles-Floriano
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City, Mexico; Departamento de Laboratorio Clínico, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Briceida López-Martínez
- Sub-Dirección de Diagnóstico Clínico, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Hortensia Reyes-Morales
- Departamento de Investigación, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Albert Zlotnik
- Department of Physiology and Biophysics and Institute for Immunology, University of California Irvine, Irvine, CA, USA
| | - Ricardo Valle-Rios
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City, Mexico; Unidad de investigación Escuela de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.
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Salazar Méndez R, Fonollá Gil M. Unilateral optic disk edema with central retinal artery and vein occlusions as the presenting signs of relapse in acute lymphoblastic leukemia. Arch Soc Esp Oftalmol 2014; 89:454-458. [PMID: 24332689 DOI: 10.1016/j.oftal.2013.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/29/2013] [Indexed: 06/03/2023]
Abstract
CLINICAL CASE A 39-year-old man with Philadelphia chromosome-positive acute lymphoblastic leukemia (LAL Ph+) developed progressive vision loss to no light perception in his right eye. He had optic disk edema and later developed central artery and vein occlusions. Pan-photocoagulation, as well as radiotherapy of the whole brain were performed in several fractions. Unfortunately the patient died of hematological relapse 4 months later. DISCUSSION Optic nerve infiltration may appear as an isolated sign of a leukemia relapse, even before a hematological relapse occurs. Leukemic optic neuropathy is a critical sign, not only for vision, but also for life, and radiotherapy should be immediately performed before irreversible optic nerve damage occurs.
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Affiliation(s)
- R Salazar Méndez
- Servicio de Oftalmología, Hospital Comarcal Jarrio, Coaña, Asturias, España.
| | - M Fonollá Gil
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Estrada-Padilla SA, Corona-Rivera JR, Sánchez-Zubieta F, Bobadilla-Morales L, Corona-Rivera A. [Minor phenotypic variants in patients with acute lymphoblastic leukemia from west Mexico]. An Pediatr (Barc) 2014; 82:75-82. [PMID: 24565987 DOI: 10.1016/j.anpedi.2013.11.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 05/18/2013] [Revised: 11/18/2013] [Accepted: 11/26/2013] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Acute lymphoblastic leukemia (ALL) has been associated with an excess of minor phenotypic variants (MPV), including common variants and minor anomalies, indicative of an altered phenogenesis. The objective of the study was to determine the association between MPV and ALL. PATIENTS AND METHODS In a hospital based case-control study, we studied 120 children with ALL (including standard and high risk) and 120 healthy children as a control group, matched for age and sex, seen in the Hospital Civil de Guadalajara Dr. Juan I. Menchaca (Guadalajara, Mexico). In both groups, 28 anthropometric measurements were made, as well as a systematic search for 405 MPV, through a physical examination. Adjusted odds ratio was estimated (aOR) with its intervening variables by logistic regression. The confidence interval was 95% (95%CI). RESULTS Anthropometric signs associated with ALL were: long upper segment (aOR= 2.19, 95%CI: 1.01-4.76), broad jaw (aOR= 2.62, 95%CI: 1.29-5.30), narrow ears (aOR= 6.22, 95%CI: 2.60-14.85), and increase in internipple distance (aOR= 2.53, 95%CI: 1.07-5.98). The hypoplasia mesofacial, broad forehead, small nose, short columella, narrow ears, telethelia, Sydney crease (SC), Greek type feet and café-au-lait spots (CALS), had a 3 to 17 times higher frequency in children with ALL. By number, an association was found from ≥4 MPV (aOR= 2.14, 95%CI: 1.25-3.66, P=.004). CONCLUSIONS From ≥4 MPV, an association was found with ALL, suggesting prenatal factors in phenogenesis and leukemogenesis. CALS and SC were confirmed as MPV in children with ALL.
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Affiliation(s)
- S A Estrada-Padilla
- Instituto de Genética Humana «Dr. Enrique Corona Rivera», Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - J R Corona-Rivera
- Instituto de Genética Humana «Dr. Enrique Corona Rivera», Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México; Servicio de Genética, División de Pediatría, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México.
| | - F Sánchez-Zubieta
- Unidad de Citogenética, Servicio de Hemato-Oncología, División de Pediatría, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Instituto de Investigación en Cáncer Infantil y de la Adolescencia, Departamento de Reproducción Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - L Bobadilla-Morales
- Unidad de Citogenética, Servicio de Hemato-Oncología, División de Pediatría, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Instituto de Investigación en Cáncer Infantil y de la Adolescencia, Departamento de Reproducción Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - A Corona-Rivera
- Unidad de Citogenética, Servicio de Hemato-Oncología, División de Pediatría, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Instituto de Investigación en Cáncer Infantil y de la Adolescencia, Departamento de Reproducción Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
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Odero V, Galán-Sánchez F, García-Agudo L, García-Tapia AM, Guerrero-Lozano I, Rodríguez-Iglesias MA. [Fungemia due to Trichosporon asahii in a patient with hematological malignancy]. Rev Iberoam Micol 2013; 32:59-61. [PMID: 24071639 DOI: 10.1016/j.riam.2013.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 04/08/2013] [Revised: 05/28/2013] [Accepted: 09/02/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Trichosporonosis is an opportunistic infection caused by the genus Trichosporon. The majority of cases of invasive trichosporonosis occurs in immunocompromised individuals. CASE REPORT We describe a case of disseminated infection by Trichosporon asahii in a hematology patient. A 52-year-old man diagnosed with acute lymphoblastic leukemia developed a febrile episode during the third cycle of the induction chemotherapy. The blood cultures were positive after 24h incubation, showing elongated structures compatible with fungal elements in the Gram stain. The identification of the fungus as Trichosporon asahii was carried out by the assimilation of compounds of carbon and the amplification and sequencing of the D1/D2 domain and the internal transcribed spacer of the ribosomal DNA. The fungus was also isolated from the pustular lesions that the patient had in the chest. After treatment with amphotericin B, the patient progressed satisfactorily. CONCLUSIONS Trichosporon asahii is an emergent pathogen in immunosupressed patients and its presence should not be considered as colonization, as there is risk of invasive infection.
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Affiliation(s)
- Valle Odero
- Unidad de Gestión Clínica de Microbiología, Medicina Preventiva y Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - Fátima Galán-Sánchez
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Puerta del Mar, Cádiz, España.
| | - Lidia García-Agudo
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Ana M García-Tapia
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Puerta del Mar, Cádiz, España
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Moscardó Guilleme C, Fernández Delgado R, Sevilla Navarro J, Astigarraga Aguirre I, Rives Solà S, Sánchez de Toledo Codina J, Fuster Soler JL, Parra Ramirez L, Molina Garicaño J, González Martínez B, Madero López L. [Update on L-asparaginase treatment in paediatrics]. An Pediatr (Barc) 2013; 79:329.e1-329.e11. [PMID: 23727426 DOI: 10.1016/j.anpedi.2013.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 03/19/2013] [Accepted: 03/20/2013] [Indexed: 11/22/2022] Open
Abstract
L-asparaginase (L-ASP) is one of the cornerstones of the treatment of acute lymphoblastic leukemia and non-Hodgkin lymphoma. It is an enzyme of bacterial origin capable of transforming L-asparagine to aspartic acid. The extracellular depletion of L-asparagine inhibits protein synthesis in lymphoblasts, inducing their apoptosis. Numerous studies have demonstrated that treatment with L-ASP improves survival of patients, but there are clear differences in the characteristics of the three currently available formulations. This article reviews the dosage, activity and side effects of the two L-ASP derived from Escherichia coli (native and pegylated), and the one derived from Erwinia chrysanthemi (Erwinia ASP). Despite its indisputable indication over the past50 years, there are still many points of contention, and its use is still marked by the side effects of the inhibition of protein synthesis. The short half-life of native forms, and the most frequently used parenteral administration by intramuscular injections, affects the quality of life of the patients. Therefore, recent studies claim to evaluate alternatives, such as the formulation of longer half-life pegylated L-ASP, and the use of intravenous formulations. There are encouraging results to date with both preparations. Still, further studies are needed to establish which should be the formulation and frontline indicated route of administration, optimal dosing, and management of adverse effects.
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