Experience with Generic Pegylated L-asparaginase in Children with Acute Lymphoblastic Leukemia from a Tertiary Care Oncology Center in South India

Dhaarani JayaramanBackground  Acute lymphoblastic leukemia (ALL) is a common type of leukemia in children. The innovator pegylated L-asparaginase has several advantages over native L-asparaginase; however, its use in India is limited due to availability and cost. Therefore, a generic pegylated L-asparaginase can be considered as an alternative to the innovator molecule. Methods  A retrospective study was conducted to assess the outcome (minimal residual disease [MRD]) and toxicity of a generic pegylated L-asparaginase (Hamsyl) at the end of induction therapy. Results  Eighty-eight (80.7%) and 21 (19.3%) patients had received generic pegylated L-asparaginase and conventional asparaginase, respectively, as a part of their treatment protocol. Nearly 82% of patients had B-type ALL. Eight-one percent of children had a white blood cell count of fewer than 50,000/mm 3 . At the end of induction, 80.7% (88) of children were minimal residual disease (MRD)-negative, and at the end of augmented consolidation therapy, 20.2% were MRD-negative. Ten percent of patients exhibited allergic reactions. Two children had pancreatitis, and one child had central venous thrombosis. Conclusion  The generic pegylated L-asparaginase (Hamsyl) was effective and safe for use in pediatric ALL.

Telangiectatic Osteosarcoma in a Young Child – A Case Report and Review of the Literature

Introduction:

Osteosarcoma (OS) is one of the most common primary malignant bone tumors in children and adolescents. OS incidence varies significantly with age and peak incidence is in adolescent age group. Telangiectatic osteosarcoma (TOS) is an unusual variant of OS, forming 3–10% of all OSs. Only few case reports of this rare variant of OS are described in the literature.

Case Report:

We report a 6-year-girl who presented with fracture of the left proximal humerus after a trivial trauma. X-ray left shoulder showed osteolytic lesions in the left proximal humerus with fracture of proximal humerus. Open biopsy from the left proximal humerus osteolytic lesion suggested clusters of highly atypical cells like osteoid material and focal areas of hemorrhage and necrosis suggestive of TOS. The child was started on chemotherapy followed by limb-salvage surgery with wide resection of the tumor in the left proximal humerus. She completed her adjuvant chemotherapy and is currently doing well for the past 4 years.

Conclusion:

OS occurs more frequently in adolescents around the knee in the metaphyses. The most common histologic type is osteoblastic/fibroblastic or chondroblastic type. Very few cases have been reported in <5 years age group and it’s relatively rare in 5–10-year-old children. Rare histologic variants, especially telangiectatic variant, are more common in younger children and occur more in upper limbs. Imaging reveals mainly osteolytic lesions, unlike in conventional OS. This case highlights the utmost role of histopathology in the diagnosis of the bone tumors which would guide the management appropriately.