scholarly journals Ocular manifestations of childhood acute leukemia in a tertiiary level eye centre of Kathmandu, Nepal

2014 ◽  
Vol 6 (2) ◽  
pp. 197-204 ◽  
Author(s):  
Deepak Khadka ◽  
Ananda Sharma ◽  
Jeevan K Shrestha ◽  
Gauri S Shrestha ◽  
Pun N Shrestha ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Childhood Leukemia ◽  
Lymphoblastic Leukemia ◽  
University Teaching ◽  
Ocular Involvement ◽  
Cross Sectional ◽  
Ocular Manifestations ◽  
Blast Cells ◽  
Childhood Acute Leukemia

Introduction: In some instances, the understanding of the ocular manifestations in childhood leukemia is not only important to establish the diagnosis but also reflects the disease state and prognosis. Objective: To study the ocular manifestations of childhood acute leukemia among the children attending a tertiary-level hospital in Nepal. Materials and methods: A cross-sectional, descriptive study was undertaken at the B.P. Koirala Lions Centre for Ophthalmic Studies (BPKLCOS) and Kanti Children Hospital (KCH), Kathmandu, over a period of one-and-a-half years. Children diagnosed with acute childhood leukemia referred to the BPKLCOS from the Oncology Unit of the KCH and the Emergency Department of the Tribhuvan University Teaching Hospital (TUTH) were included in the study, using a non-probability sampling method. Results:Of the 71 cases with childhood acute leukemia, 55 (77.5%; 95% CI = 66% - 85%) had acute lymphoblastic leukemia(ALL)whereas the other 16 (23%) had acute myeloblastic leukemia (AML). Ocular involvement were seen in 33 cases (46%) and were more frequent in cases of AML as compared to those with ALL (p=0.001, OR 5.0, 95% CI= 1.4 – 17.5). Direct ocular involvement and secondary ocular involvement were observed in 12 (16.9%) and 29 (40.8%) subjects, respectively. Ocular symptoms were present in only 11 cases (15.49%). Cerebro-spinal fluid (CSF) and bone marrow examination in cases with direct ocular involvement showed 10 cases (83.3%) positive for blast cells in the CSF and 6 cases (50%) positive for blast cells in bone marrow. The most common secondary manifestation was retinal haemorrhage, seen in 23 cases (32.4%). Conclusion: In view of the high asymptomatic ocular involvement and the significant visual morbidity, a routine ophthalmic examination is recommended as an integral part of the medical examination in all cases of childhood acute leukemia.DOI: http://dx.doi.org/10.3126/nepjoph.v6i2.11678Nepal J Ophthalmol 2014; 6(12):  pp. 197-204

scholarly journals Polymorphism of Biotransformation Genes and Risk of Relapse in Childhood Acute Leukemia

2009 ◽  
Vol 12 (1) ◽  
pp. 21-35 ◽  
Author(s):  
O Gra ◽  
Zh Kozhekbaeva ◽  
O Makarova ◽  
E Samochatova ◽  
T Nasedkina
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Childhood Leukemia ◽  
Hematological Malignancy ◽  
Lymphoblastic Leukemia ◽  
Leukemia Relapse ◽  
Polymorphic Variants ◽  
Childhood Acute Leukemia ◽  
Primary Leukemia ◽  
Risk Of Relapse

Polymorphism of Biotransformation Genes and Risk of Relapse in Childhood Acute LeukemiaLeukemia is a hematological malignancy that involves bone marrow. Polymorphism of biotransformation genes plays an important role in primary childhood leukemia and affects the incidence and character of acute leukemia relapse. A biochip designed to assess some polymorphisms of biotransformation genes was used to determine the frequency of the polymorphic variants ofCYP1A1, CYP2D6, GSTT1, GSTM1, MTHFR, MTRR, NQO1, CYP2C9, CYP2C19andNAT2in 332 children with acute lymphoblastic leukemia (ALL) and 71 children with acute myeloblastic leukemia (AML). TheCYP1A1 *1/*2A, GSTT1non null andGSTM1non null genotypes were more frequent in patients with primary leukemia than in relapse. Analysis of theNAT2genotype frequency revealed a characteristic genotype for each type of leukemia, which prevailed in patients with relapse: the genotype341C/-, 481T/-, 590G/G, 857G/Gprevailed in ALL patients with relapse, and the genotype341T/T, 481C/C, 590A/- in AML patients with relapse when compared with patients having primary ALL or AML, respectively. Thus, the polymorphisms ofCYP1A1, GSTT1, GSTM1andNAT2genes can be considered as markers for risk of relapse in childhood acute leukemia and can be used for the prognosis and individualization of standard therapy.

scholarly journals Acute leukemia of childhood: A single institution's experience

2005 ◽  
Vol 57 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Bojana Slavkovic ◽  
Marija Guc-Scekic ◽  
Gordana Bunjevacki ◽  
S. Djuricic ◽  
Aleksandra Krstic ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Childhood Leukemia ◽  
Lymphoblastic Leukemia ◽  
Chromosomal Rearrangements ◽  
Age Distribution ◽  
Normal Karyotype ◽  
Mediterranean Countries ◽  
B Lineage ◽  
Childhood Acute Leukemia

The aim of this study was to investigate distribution of immunophenotypic and cytogenetic features of childhood acute leukemia (AL) in the cohort of 239 newly diagnosed patients registered at the leading pediatric oncohematology center in the country during a six-year period (1996-2002). With approximately 60-70% of all childhood AL cases in Serbia and Montenegro being diagnosed and treated in this institution the used data represent a valid research sample to draw conclusions for entire country. On the basis of five phenotypic markers, the distribution of immunological subtypes was as follows: 169 (70.7%) expressed B-cell marker CD19 (137 were CD10 positive and 32 CD10 negative), 37 (15.5%) belonged to T-lineage acute lymphoblastic leukemia (T-ALL) (cyCD3 positive), and 33 (13.8%) were acute myeloblastic leukemia (AML) (CD13 positive and/or CD33 positive in the absence of lymphoid-associated antigens). The ratio of males and females was 1.5:1. Most of the cases were between the ages of 2 and 4, and were predominantly B-lineage acute lymphoblastic leukemia (B-ALL) cases. Another peak of age distribution was observed at the age of 7. The frequency of T-ALL (18% of ALL) was similar to that reported for Mediterranean countries: France (19.4%), Greece (28.1%), Southern Italy (28.3%), and Bulgaria (28.0%). Cytogenetic analyses were performed in 193 patients: 164 ALL and 29 AML. Normal karyotype was found in 57% of ALL and in 55% of AML patients, while cytogenetic abnormalities including structural, numerical, and complex chromosomal rearrangements were found in 43% of ALL and in 45% of AML patients. Our results represent a contribution to epidemiological aspects of childhood leukemia studies.

scholarly journals Lineage switch in acute leukemia

Blood ◽  
1984 ◽  
Vol 64 (3) ◽  
pp. 701-706 ◽  
Author(s):  
S Stass ◽  
J Mirro ◽  
S Melvin ◽  
CH Pui ◽  
SB Murphy ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Childhood Leukemia ◽  
Clonal Selection ◽  
Lymphoblastic Leukemia ◽  
Cell Lineage ◽  
Leukemic Cell ◽  
High Dose ◽  
Drug Induced ◽  
Lineage Switch

Abstract Conversions of leukemic cell lineage (lymphoid or myeloid) have been reported only rarely. Our review of the cytochemical and immunophenotypic features of 89 cases of childhood leukemia in marrow relapse indicated lineage switch (lymphoid to myeloid or the reverse) in six patients (6.7%). Five patients with acute lymphoblastic leukemia (ALL) at diagnosis had converted to acute nonlymphoblastic leukemia (ANLL), and one had converted from ANLL to ALL. Each child received lineage-specific multiagent chemotherapy when initially diagnosed, and all achieved a complete remission. After conversion, four patients readily achieved second remissions with treatment for the phenotype evident at lineage switch. Two patients with ANLL at conversion failed ALL-directed reinduction, while one of the two responded to high-dose cytarabine but died during bone marrow hypoplasia, emphasizing the importance of prompt recognition of lineage switch and selection of an appropriate plan of retreatment. Cytogenetic studies disclosed evidence of clonal selection in one patient and clonal stability in two. These findings indicate an unexpectedly high frequency of lineage switch in patients who relapse in the bone marrow after intensive chemotherapy. Although specific causative factors could not be identified, our observations suggest at least two general mechanisms for lineage switch in acute leukemia. In one, chemotherapy appears to eradicate the dominant clone present at diagnosis, permitting expansion of a secondary clone with a different phenotype. In the second, drug-induced changes in the original clone may either amplify or suppress differentiation programs so that phenotypic shift is possible.

Molecular Genetic Characterization of 3'-Deletion of MLL Gene in Infant Acute Leukemia.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2498-2498
Author(s):  
Grigory Tsaur ◽  
Olga Plekhanova ◽  
Alexander Popov ◽  
Tatyana Gindina ◽  
Yulia Olshanskaya ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Lymphoblastic Leukemia ◽  
Molecular Genetic ◽  
Fish Analysis ◽  
Long Distance ◽  
Mll Gene ◽  
Partner Gene ◽  
Genetic Features ◽  
Blast Cells

Abstract Abstract 2498 Background. MLL gene rearrangements are associated with unfavorable outcome in infant acute lymphoblastic leukemia (ALL) and have intermediate prognosis in infant acute myeloid leukemia (AML). Application of fluorescence in-situ hybridization (FISH) allows detecting not only conventional MLL rearrangements, but also concurrent 3'-deletion of MLL gene. However, detailed characteristics of infant leukemia carrying 3' MLL deletion remain unclear. Aim. To investigate molecular genetic features of MLL-rearranged infant acute leukemia with concurrent 3' MLL deletion. Methods. 64 patients (27 boys and 37 girls) aged from 1 day to 11 months (median 6.6 months) including 44 ALL patients, 18 AML patients, 1 patient with acute bilineage leukemia and 1 patient with acute undifferentiated leukemia were enrolled in the current study. Chromosome banding analysis was done according to standard procedure. FISH analysis using LSI MLL Dual Color, Break Apart Rearrangement Probe (Abbott Molecular, USA) was performed on at least 200 interphase nuclei and on all available metaphases. Presence of MLL rearrangements was detected by FISH, reverse-transcriptase PCR. In 29 cases long-distance inverse PCR was additionally performed. In case of MLL rearrangement presence standard FISH pattern was defined as simultaneous detection of 3 different fluorescent signals: 1 fused (orange) signal, 1 green signal derived from 3' part of MLL gene, 1 red signal from 5' end of MLL (1F1G1R). MLL rearrangements with concurrent 3' MLL deletion led to 1F1R FISH pattern formation due to lack of green signal. Results. FISH revealed MLL rearrangements in 73% of ALL cases that was higher than frequency of 11q23 translocations detected by conventional cytogenetics — 55%. In MLL-positive cases we found 38 patients (81%) with standard FISH pattern, 7 ones (15%) with concurrent 3'-deletion of MLL gene and 2 (4%) with complex MLL rearrangements. Among patients with 3' MLL deletions there were 1 case with 5' MLL duplication (1F2R) and 1 case with 5' MLL triplication (1F3R). Frequency of 3'-deletions were similar in ALL and AML patients (13% and 15%, respectively). We did not find more than one FISH pattern in bone marrow blast cells of each patient with 3' MLL deletion. In this cohort of patients all blast cells carried concurrent 3'-deletion of MLL gene. Moreover, percentage of blast cells carrying MLL rearrangements did not differ significantly between patients with standard FISH pattern (median 97%, range 22–100%) and 3'-deletion (median 83%, range 13–99%) (p=0.206). 3'-deletion of MLL was not associated with breakpoint position in MLL gene and type of translocation partner gene. MLL translocation partner genes detected in patients with 3' deletions were as follows AF4(n=2), MLLT3(n= 3), MLLT10(n=2). None of the patients with 3'-deletions had reciprocal fusion gene. Initial patients' characteristics (age, sex, WBC count, immunophenotype, CNS-status, type of MLL partner gene) and treatment response parameters (day 8 peripheral blood blast cell count, day 15 bone marrow status, day 36 remission achievement, minimal residual disease status at time point 4) did not differ significantly between 2 groups. Although cumulative incidence of relapse was lower in patients with 3'-deletion as compared to patients with standard FISH pattern (0.31±0.04 and 0.55±0.01, respectively), difference between these two groups was not statistically significant (p=0.359). Conclusion. In our work we characterized rare subgroup of infant MLL-rearranged acute leukemia carrying concurrent 3' MLL deletion. Our data provide additional information of molecular genetic features of acute leukemia in children younger than one year. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Maternal Residential Proximity to Major Roadways and the Risk of Childhood Acute Leukemia: A Population-Based Case-Control Study in Texas, 1995–2011

2019 ◽  
Vol 16 (11) ◽  
pp. 2029 ◽  
Author(s):  
Erin C. Peckham-Gregory ◽  
Minh Ton ◽  
Karen R. Rabin ◽  
Heather E. Danysh ◽  
Michael E. Scheurer ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Early Life ◽  
Childhood Leukemia ◽  
Lymphoblastic Leukemia ◽  
Birth Certificate ◽  
Population Based ◽  
Residential Proximity ◽  
Early Life Exposure ◽  
Proximity Measures ◽  
Childhood Acute Leukemia

Acute leukemia is the most common pediatric malignancy. Some studies suggest early-life exposures to air pollution increase risk of childhood leukemia. Therefore, we explored the association between maternal residential proximity to major roadways and risk of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Information on cases with acute leukemia (n = 2030) was obtained for the period 1995–2011 from the Texas Cancer Registry. Birth certificate controls were frequency matched (10:1) on birth year (n = 20,300). Three residential proximity measures were assessed: (1) distance to nearest major roadway, (2) residence within 500 meters of a major roadway, and (3) roadway density. Multivariate logistic regression was used to generate adjusted odds ratios (aOR) and 95% confidence intervals (CI). Mothers who lived ≤500 meters to a major roadway were not more likely to have a child who developed ALL (OR = 1.03; 95% CI: 0.91–1.16) or AML (OR = 0.84; 95% CI: 0.64–1.11). Mothers who lived in areas characterized by high roadway density were not more likely to have children who developed ALL (OR = 1.06, 95% CI: 0.93–1.20) or AML (OR = 0.83, 95% CI: 0.61–1.13). Our results do not support the hypothesis that maternal proximity to major roadways is strongly associated with childhood acute leukemia. Future assessments evaluating the role of early-life exposure to environmental factors on acute leukemia risk should explore novel methods for directly measuring exposures during relevant periods of development.

scholarly journals Pattern of childhood acute leukemia presentation at a tertiary hospital in Nigeria: a five-year review

2018 ◽  
Vol 5 (6) ◽  
pp. 2123
Author(s):  
Adewumi B. Oyesakin ◽  
Vincent E. Nwatah ◽  
Nwankwo U. Ukpai ◽  
Ekaette I. David ◽  
Tamunomieibi T. Wakama ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Clinical Features ◽  
Childhood Leukemia ◽  
Lymphoblastic Leukemia ◽  
Tertiary Hospital ◽  
Cross Sectional ◽  
Acute Leukemias ◽  
Lost To Follow Up

Background: Acute leukemia is the most common childhood malignancy but its occurrence in low- and middle-income countries are under-reported. Its pattern of presentation varies depending on several factors. The objective of this report is to determine the pattern of presentation of acute leukemias in children at a tertiary hospital in Nigeria.Methods: A retrospective cross-sectional study of children managed for acute leukemia at the Paediatric Department in a 5-year period. Of 31 patients, 27 had adequate records, which were reviewed. Data collected include patient’s demographics, clinical features and treatment outcome.Results: There were 16 males and 11 females, aged 8 months to 16 years (mean 7.45 years ±4.75 SD). The pattern of clinical features were fever (85.2%), pallor (92.6%) and splenomegaly (51.9%). The specific leukemia type ratio for Acute Myeloid leukemia (AML) and Acute lymphoblastic leukemia (ALL) was 1: 2.9. The parents of three patients took their children away before commencement of treatment, one patient completed treatment and 6 (22.2%) died before completing treatment. Nearly half of the patients were lost to follow up to seek alternative care while 9 (33.3%) of the patients were in remission at last follow up. Lost to follow-up was found not to be significantly associated with socioeconomic status, age and sex respectively.Conclusions: Acute lymphoblastic leukemia remains the predominant type of childhood leukemia in our setting. Majority of the patients presented with fever and pallor moreover the default to follow-up plagues treatment completion.

scholarly journals Immunophenotyping Pattern in Childhood Acute Leukemia in the Adam Malik Hospital Medan

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Putri Chadijah Tampubolon ◽  
Bidasari Lubis ◽  
Adi Koesoema Aman ◽  
Malayana R Nasution
Keyword(s):  
Acute Leukemia ◽  
General Hospital ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Improve Accuracy ◽  
Blast Cells ◽  
Childhood Acute Leukemia ◽  
Data Reproducibility ◽  
Pediatric Center ◽  
Common Malignancy

 Leukemia is the most common malignancy at the age of under 15 years, with a ratio of 1 to 3 cancer cases in children.Immunophenotyping will improve accuracy and easily provide data reproducibility. To determine the immunophenotypingpattern in patients with acute leukemia in the Pediatric Center at the Adam Malik General Hospital, Medan. This research wasa cross-sectional study in children suffering from acute leukemia in the Pediatric Unit Adam Malik General Hospital, Medanbased on CBC, peripheral smear, bone marrow morphology, and flow cytometry immunophenotyping. Samples wereevaluated for blast morphologic and immunophenotyping was carried out. Results of morphologic observation andimmunophenotyping were compared. From 20 samples using the monoclonal antibody with flow cytometryimmunophenotyping, concordance with morphology is good (κ = 0.886). After classification, the percentage of acuteleukemia was 45% B-ALL, 35% AML, and 20% T-ALL. One of 10 samples morphologically classified as ALL but reported asAML. Immunophenotyping has been shown to increase diagnostic accuracy and assist in establishing lines in blast cells,which was initially merely based on morphological features.

Nd: Yag laser treatment for sub-hyaloid hemorrhage in childhood acute leukemia

1970 ◽  
Vol 4 (1) ◽  
pp. 102-107 ◽  
Author(s):  
D Khadka ◽  
AK Sharma ◽  
JK Shrestha ◽  
B Pant ◽  
S Pant ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Myeloid Leukemia ◽  
Childhood Leukemia ◽  
Randomized Clinical Trials ◽  
Lymphoblastic Leukemia ◽  
Visual Disability ◽  
Tractional Retinal Detachment ◽  
Yag Laser ◽  
Retinal Breaks ◽  
Childhood Acute Leukemia

Introduction: Sub-hyaloid haemorrhage is common in acute leukemia. Objective: To investigate the effects of Nd: YAG Laser hyaloidotomy in 11 eyes of 8 patients with pre-macular haemorrhage in acute childhood leukemia. Materials and methods: Premacular sub-hyaloid haemorrhage is one of the leading causes of visual disability in children with acute leukemia. Eleven eyes of 8 patients attending Kanti Children Hospital and BP Koirala Lions Centre for Ophthalmic Studies from January 2006 to July 2007 with premacular subhyaloid haemorrhage were included in the study and treated with Nd: YAG Laser. The haemorrhage originated from acute myeloid leukemia (AML) in 4 cases (6 eyes) and acute lymphoblastic leukemia (ALL) in 4 cases (5 eyes). Results: Drainage of premacular sub-hyaloid haemorrhage into the vitreous cavity within 3 months succeeded in 9 eyes out of 11 eyes treated. One eye had a dense clotted haemorrhage and the other had a re-bleed. Overall visual improvement was equal in both AML and ALL cases. No obvious epiretinal membrane, retinal breaks and tractional retinal detachment occurred in any eye. Conclusion: Nd: Yag laser hyaloidotomy is a relatively safe, simple and alternative treatment for eyes with a dense premacular sub-hyaloid haemorrhage in acute childhood leukemia. The risks and benefits have to be weighed in randomized clinical trials to establish Nd: YAG hyaloidotomy treatment as a routine procedure in leukemic children. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5860 NEPJOPH 2012; 4(1): 102-107

scholarly journals Lineage switch in acute leukemia

Blood ◽  
1984 ◽  
Vol 64 (3) ◽  
pp. 701-706 ◽  
Author(s):  
S Stass ◽  
J Mirro ◽  
S Melvin ◽  
CH Pui ◽  
SB Murphy ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Childhood Leukemia ◽  
Clonal Selection ◽  
Lymphoblastic Leukemia ◽  
Cell Lineage ◽  
Leukemic Cell ◽  
High Dose ◽  
Drug Induced ◽  
Lineage Switch

Conversions of leukemic cell lineage (lymphoid or myeloid) have been reported only rarely. Our review of the cytochemical and immunophenotypic features of 89 cases of childhood leukemia in marrow relapse indicated lineage switch (lymphoid to myeloid or the reverse) in six patients (6.7%). Five patients with acute lymphoblastic leukemia (ALL) at diagnosis had converted to acute nonlymphoblastic leukemia (ANLL), and one had converted from ANLL to ALL. Each child received lineage-specific multiagent chemotherapy when initially diagnosed, and all achieved a complete remission. After conversion, four patients readily achieved second remissions with treatment for the phenotype evident at lineage switch. Two patients with ANLL at conversion failed ALL-directed reinduction, while one of the two responded to high-dose cytarabine but died during bone marrow hypoplasia, emphasizing the importance of prompt recognition of lineage switch and selection of an appropriate plan of retreatment. Cytogenetic studies disclosed evidence of clonal selection in one patient and clonal stability in two. These findings indicate an unexpectedly high frequency of lineage switch in patients who relapse in the bone marrow after intensive chemotherapy. Although specific causative factors could not be identified, our observations suggest at least two general mechanisms for lineage switch in acute leukemia. In one, chemotherapy appears to eradicate the dominant clone present at diagnosis, permitting expansion of a secondary clone with a different phenotype. In the second, drug-induced changes in the original clone may either amplify or suppress differentiation programs so that phenotypic shift is possible.

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