Acute myeloid leukaemia presenting as proptosis in an infant

Paediatric patients with acute myeloid leukaemia (AML) often present with symptoms associated with the disruption of normal haematopoiesis and subsequent cellular deficiencies. Periosteal reactions are common in paediatric leukaemia, but typically manifest as a thin, laminated pattern along long bones. Aggressive periosteal reactions are much less frequently seen. Here, we report a case of paediatric AML initially presenting with proptosis and periorbital swelling caused by aggressive, sunburst periosteal reactions surrounding the sphenoid and zygomatic bones. This unique presentation emphasises the importance of considering leukaemic infiltration in the differential for sunburst periosteal reaction in paediatric patients.

Folate metabolism: a re-emerging therapeutic target in haematological cancers

Folate-mediated one carbon (1C) metabolism supports a series of processes that are essential for the cell. Through a number of interlinked reactions happening in the cytosol and mitochondria of the cell, folate metabolism contributes to de novo purine and thymidylate synthesis, to the methionine cycle and redox defence. Targeting the folate metabolism gave rise to modern chemotherapy, through the introduction of antifolates to treat paediatric leukaemia. Since then, antifolates, such as methotrexate and pralatrexate have been used to treat a series of blood cancers in clinic. However, traditional antifolates have many deleterious side effects in normal proliferating tissue, highlighting the urgent need for novel strategies to more selectively target 1C metabolism. Notably, mitochondrial 1C enzymes have been shown to be significantly upregulated in various cancers, making them attractive targets for the development of new chemotherapeutic agents. In this article, we present a detailed overview of folate-mediated 1C metabolism, its importance on cellular level and discuss how targeting folate metabolism has been exploited in blood cancers. Additionally, we explore possible therapeutic strategies that could overcome the limitations of traditional antifolates.

Relationship with a physician in the narratives of children and adolescents hospitalized due to cancer

The key value of the physician-patient relationship has been strongly emphasized in scientific literature for a long time. This relationship impacts significantly the patient’s therapeutic process. In case of children and adolescents suffering from cancer, the relationship with physician is of a specific value due to both the age of such patients and the type of disease. Children and adolescents meet various specialists (physicians) during their treatment; however, they establish a long-term and quite intensive relationship with their treating physician. This relationship is, by definition, most important during intensive and maintenance therapy. The physician’s involvement is indisputable and it is directly related to the therapeutic process and its success. However, what is also extremely important is the physician’s interest in a particular patient and a personalized nature of this relationship: treating physician (subject) – child (subject). The manner in which the physician communicates with and treats his or her patient has a significant impact on the patient’s wellbeing during treatment and afterwards. The relationship with a physician also determines the patient’s subjectivity and self-esteem in later everyday life. The paper presents the results of research focused on the opinions of children and adolescents concerning relationships with their treating physicians. The study was conducted in three institutions which belong to the Polish Paediatric Leukaemia and Lymphoma Study Group. It involved 62 children aged 7–17 years old at different stages of their cancer treatment.