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Objective: Acute leukemia is the most common type of malignancy in childhood. Fever, malaise, hepatosplenomegaly and lymphadenopathy are among the most common presentations of leukemia. It is of vital importance for the physician, who is the first to evaluate the patient, to comprehend/ understand about the presenting findings of acute leukemia for early diagnosis and treatment. We aimed to emphasize the significant clues which point to acute leukemia in childhood for non-hematologist physicians. Materials and Methods: All children aged 0-18 years who were diagnosed with acute leukemia in our clinic between May 2017 and February 2021 were included. The complaints, physical examination findings and blood test results of all patients diagnosed with acute leukemia at their admission were retrospectively analyzed. Results: The files of 62 children with acute leukemia were analyzed. The male/female ratio was 1.58, and the mean age was 6±4.93 years (min-max 1-17 years). The median time of onset of complaints was 15 days. The most common complaints were fatigue (85.5%), fever (51.1%) and leg pain (33.8%). The most common findings on physical examination were pallor (74.2%), hepatosplenomegaly(43.1%) and lymphadenopathy (37.1%). At admission, all of the patients had abnormalities of complete blood counts in at least one series. 79% of the patients had anemia (hb<10g/dl), 69.4% had thrombocytopenia (<100000/mm3) and 67.7% of the patients had neutropenia (<1500/mm3). The most common abnormality in the biochemical tests was elevated LDH values (median LDH: 576IU/L). Conclusion: Recognizing the most common presentation findings of childhood leukemia by the first physician is an important step for early diagnosis and treatment in childhood leukemia. [ABSTRACT FROM AUTHOR]

Purpose: In this study, the outcomes and flow cytometry results of childhood acute leukemia patients and their relationship with the prognosis and other clinical conditions was investigated. Materials and Methods: A total of 93 patients, including 69 acute lymphoblastic leukemia (ALL) and 24 acute myeloid leukemia (AML) patients diagnosed at our hospital between January 2008 and November 2013, were included. Results: 5-year overall survival (OS) was 66% in ALL patients and 80% in AML patients. When leukemia patients were classified flow cytometrically according to their cell surface antigens (CD); 5-year OS was 77% in CD2(+) patients and 58% in CD2(-) patients. Five-year OS was 82% in patients with CD10(+) and 61% in patients with CD10(-). However, the results were not statistically significant (p>0.05). ALL patients were divided into two groups as ALL with positive T cell markers and ALL with positive B cell markers in the foreground and evaluated accordingly, and the OS of ALL patients with positive T cell markers in the foreground was lower than ALL patients with positive B cell markers in the 5 year (59% and 75%, respectively) (p =0.518). On the other hand, AML patients were divided into two groups as AML with positive lymphoid markers and AML with negative lymphoid markers, and the 5 year OS of AML patients with positive lymphoid markers was higher than AML patients with negative lymphoid markers (83% and 70%, respectively) (p = 0.638). These results were not statistically significant. Conclusion: In the flow cytometric evaluation of our patients with leukemia, it was found that patients with CD10(+) had a better 5-year OS and patients with CD2(+) had a lower 5-year OS. The results of patients with positive B cell markers were better in ALL patients, and the results of patients with positive lymphoid markers were better in AML patients.

Chronic lymphocytic leukemia (CLL); neoplasm of mature B cells characterized by progressive accumulation of monoclonal B lymphocytes in blood, bone marrow, lymph gland, liver and spleen. Leukemia may cause nonspecific skin lesions or leukemic skin infiltration. Leukemia cutis is the infiltration of the skin with malignant leukemic cells. It is most commonly seen in acute myelomonocytic leukemia in adults and it is rare in CLL. Skin lesions are seen in 25% of patients with CLL and leukemia cutis is less than 5%. Leukemic skin infiltrations can be seen as macules, papules, plaques, nodules, ulcers or blisters. Skin lesions indicate the recurrence of a malignant disease in remission and are important for treatment planning. It may also appear as the first sign of malignancy. Here; leukemic skin infiltration in a male patient with CLL in remission is presented because it suggests relapse and is rare. [ABSTRACT FROM AUTHOR]

Introduction:Leukemia is a multifactorial disease. Some genetic syndromes is well known related to leukemia. We evaluated non-syndromic malformation and leukemia relation. Materials and Methods: 288 patients diagnosed with acute leukemia are included the study. 201 patients with non-malign hematologic disease are accepted as a control. Syndromic children were excluded both group. All children were examined according to ICD-10th, Chapter XVII for congenital malformation. The type and number of malformations were compared both group. Results: There were no differences between leukemia and control group in terms of age at diagnosis, gender, consanguinity between parents, parents age at birth, family history of cancer and pregnancies of mother. Congenital malformations were more observed in leukemic population (p<0.001). The most common malformation in the control group was on the skin. Whereas the most common malformation in leukemic children was seen in the circulatory system, second region was skin. Having circulatory system malformation explained 12.53 high of the leukemia risk. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between immunophenotyping and clinical characteristics of children diagnosed with acute lymphoblastic leukemia (ALL). Method: The relationship between immunophenotyping results examined by flowcytometry and clinical features of 192 patients under 18 years who were diagnosed with ALL between 1989 and 2007 in our center were evaluated. Results: Of the patients, 79 (41,1%) were girls and 113 (58,9%) were boys. The cases were divided into two groups as those with precursor-B cell ALL, and precursor T cell ALL groups. Cases of precursor B, and T-ALL were seen in 27,6% of male, and 14,2% of female patients (p=0,038) Age groups were also evaluated according to age groups. All patients under 1 year of age were in the precursor-B cell ALL group, while 82,9% of the cases between 1 and 10 years were in precursor-B cell ALL group, and 17,1% of them in T cell ALL group. Still 58% of the cases above .10 years of age were in the precursor-B cell ALL group, and 41,4% were in the T cell ALL group. Hyperleukocytosis, extramedullary involvement, lymphadenopathy and mediastinal mass were significantly more frequent in the T cell ALL group. The frequency of T cell ALL was found to decrease over time. Conclusion: Acute lymphoblastic leukemia is more frequently seen in males when compared with females. The incidence of T cell ALL increases in male children, and those aged over 10 years of age. The frequency of lymphadenomegaly, mediastinel mass, extramedullary involvement and hyperleukocytosis is significantly increases in the T cell ALL group compared to the precursor B-cell ALL group. It is thought that the decrease in the frequency of T cell ALL over the years may be related to the improvement in socio-economic level. [ABSTRACT FROM AUTHOR]

Aim: Perianal infection is one of the most important causes of infection in acute leukemia which puts the life of patients at risk, increases their morbidity and impairs quality of life. Material and Method: At the Ankara Atatürk Training and Research Hospital Hematology Clinic, 125 patients who received standard chemotherapy for acute leukemia between 2009 and 2017 werestudied, retrospectively. Results: Of these 125 acute leukemia patients, 25 (20%) developed perianal disease and 13 (10,4%) developed perianal infection. Perianal disease and infection developed in 34% and 21% of patients with ALL; in 16% and 7% of patients with AML (p=0.03 and p=0.04), respectively. Perianal disease was present in 29% of the patients with a leukocyte count greater than 10,000 at diagnosis, but remained at 12% in those with a leukocyte count below 10,000 (p=0.02). Perianal disease and perianal infection developed in 64% and 69% of the patients during induction and at a median of 13 days (range: 1-40) and 17 days (range: 3-34), respectively. It was observed that 60% of the patients with perianal disease had fever, 28% had positive blood culture, 16% had sepsis and 20% required surgical treatment. Among 7 patients with perianal disease and positive blood cultures, all had Gram (-) bacilli (5 Klebsiella pneumonia and 2 E. coli). Of the 6 patients who had masses in physical examination under went pelvic magnetic resonance imaging (MRI). All patients diagnosed with abscesses on MRI. Five patients who under went surgery; 3 abscess drainage, 1 colostomy and 1 polypectomy was performed. Conclusion: It was observed that perianal disease and infection developed more frequently in ALL patients compared with AML patients; perianal disease could be controlled mainly with conservative treatment and MRI could be an important guide in the management of these patients. [ABSTRACT FROM AUTHOR]

Objective: The major problem in the long term follow up of children who survive acute leukemia is chemotherapy related organ toxicity. Anthracycline related cardiotoxicity is one of the most important cause of morbidity and mortality for those patients. Therefore, we investigate echocardiographic (echo) data for the detection of acute, early and late anthracycline toxicity in patients with acute leukemia, who were diagnosed and treated in our clinic over the last decade. Method: Echocardiographic data and risk factors of 21 acute myeloid leukemia (AML) patients treated with MRC-12 protocol and 80 acute lymphoid leukemia (ALL) patients treated with BFM-95 protocol were recorded before chemotherapy (T0) and within 3-6 months (T1), 6-12 months (T2), 12-24 months (T3) of treatment and after 24 months (T4) of treatment in our study. Results: We did not observe acute cardiac toxicity in any cases. The values of mitral E/A-velocity (vel) and tricuspid E/A vel were significantly lower in patients with leukemia in T2 than in control (p<0.05). The values of mitral E/A-vel, tricuspid E/A vel, ejection fraction and fractional shortening were significantly lower in patients with leukemia in T3 than in control and in T0 (p<0.05). It has been found that 10-15% of all patients who developed cardiac toxicity on long term follow-up were anthracycline exposure at a dose of more than 550 mg/m2 and relapsed AML cases. Conclusion: Our study suggests that the standard echocardiographic examination used in the toxicity grading is still cheap and noninvasive test which may be preferred in the first place in the long term follow-up of acute leukemia patients. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to retrospectively analyze the epidemiological, clinical and laboratory features of patients who were diagnosed as acute leukemia and received chemotherapy in our hospital in a five-year period. All the systemic complications of these patients were also reviewed in order to contribute to the therapeutic approaches to such patients. Material and Methods: A total of 97 patients who were followed by the pediatric hematology department between January 2004 and December 2008 were included in our study. The patients' demographic, clinical, laboratory, radiological and echocardiographic characteristics at the time of diagnosis were documented. Finally, 94 of these patients were evaluated in terms of their systemic complications. results: The mean age was 6.0±4.1 (2 months -17 years) (min - max). Males made up 64.9% and females 35.1% of all cases. The diagnoses were acute lymphoblastic leukemia in 84.5% and acute myeloid leukemia in 15.5% of the patients. While the most common complaints were fever (63.9%) and fatigue (57.7%), the most common findings on physical examination were hepatomegaly (77.3%) and pallor (68%) at the time of diagnosis. The complications observed during chemotherapy in the patients were at least one episode of febrile neutropenic attack in 90%, five-fold increase in hepatic enzymes in 82.9%, mucositis in 43.6%, allergy to L-asparaginase in 28.7%, and compliance problems in 9.5%. conclusion: Childhood leukemia has a potential to cause complications in many organ systems due to both the disease itself and the chemotherapeutics used for the treatment. Multidisciplinary management and follow-up are required in the follow-up of children with acute leukemia. [ABSTRACT FROM AUTHOR]

Biphenotypic acute leukemia (BAL) is defined as the existence of multiple antigen coexpression in leukemic blasts or two different types of blast population. In this study, a patient who was first diagnosed with BAL and later with acute myeloid leukemia M1 (AML-M1) is presented. The patient was four-year-old male and had complaints about high fever, fatigue, lack of appetite, and weight loss for two months. % 96 L2 type blasts were identified in bone marrow aspiration, and positive values for CD79a, CD56, CD5, CD13, CD33, and MPO were observed in flow-cytometry. These findings, evaluated on the basis of "European Group for the Immunological Characterization of Leukemias (EGIL)" criteria, suggested BAL. As the steroid treatment returned no response, the flow-cytometry findings were reevaluated based on "World Health Organization (WHO)" criteria. BAL was excluded and AML M1 was considered as a diagnosis. The positive values for CD79a, CD56 , and CD5 were evaluated as coexpression. Chemotherapy was given as AML treatment, and the dramatic response was reported. This case is presented to show that, using EGIL criteria to evaluate BAL may be misleading , and thus using WHO criteria to evaluate BAL may be more appropriate. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to determine the possible side effects of central nervous system (CNS) prophylactic treatment in childhood leukemia by using cranial imaging techniques. Material and Method: Data collected from records of 90 patients diagnosed as acute lymphoblastic leukemia (ALL) and treated according to BFM-90 or TR-ALL 2000 protocols which used lowered dose of methotrexate , between January 1991 and December 2004. Gender, age at diagnosis, immunophenotype, cranial radiation doses, risk groups, intrathecal treatment modalities, neurological and electroencephalography (EEG) findings, imaging interval and techniques were recorded. These variables were analyzed for their role in cranial lesions. Patiens with CNS leukemia and mature B-cell phenotype were excluded. Results: Ninety patients were enrolled in the study. Sixty three patients had up to 18 Gy cranial radiation, whereas in 27 patients radiation was not utilized. Eleven doses of Intrathecal methotrexate were administered to 77 patients and 13 patients had more intensive regimen. No patients demonstrated cortical atrophy or calcifications. Mild white matter changes (WMC) were observed in eight patients. Only one patient had moderate changes. Eight of the nine patients with WMC had radiotherapy but no significant correlation was found (p>0.05). There were also no significant relation of WMA with gender, age at diagnosis, treatment protocol, risk groups, intrathecal therapy, neurologic symptoms, EEG finding and imaging techniques (p>0.05). Conclusions: Intrathecal treatment does not cause cortical atrophy. White matter changes are not influenced by systemic methotrexate dose but radiotherapy may have an additive effect. Short interval between CNS prophylaxis and imaging can be responsible for the limitation of our study at detecting the late effects of radiotherapy. A new study aiming at investigating the late effects of radiotherapy by performing late imaging studies may be more informative. [ABSTRACT FROM AUTHOR]

We present a case report of a 25-year-old female who developed acute myelogenous leukemia (AML) associated with subaortic mass. The patient was admitted to emergency service with generalized weakness, headache, echhymosis on the upper extremities. Examination of bone marrow and flow cytometric analysis indicated AML-M2. The patient was complete remission antileukemic chemotherapy. Multiple cerebral fungal abscesses developed in patient. magnetic resonance imaging showed cerebral abscesses. A stereotaxic biopsy showed hypha. Aspergillus spp was isolated abscesses culture. Transthoracic echocardiography (TTE) revealed that 2,5x1,4x1,2 cm smooth-shaped, mobile, subaortic mass. Her condition deteriorated rapidly and the patient died. [ABSTRACT FROM AUTHOR]

Febrile neutropenia is a commonly encountered complication during the treatment of hematological malignancies. Respiratory system, skin, gastrointestinal system and genitourinary system infections are the common causes of febrile neutropenia. The infection of thyroid gland is rarely seen even in neutropenic patients. Here, we describe a patient with acute lymphoblastic leukemia who was treated with intensive chemotherapy and developed suppurative thyroiditis during neutropenic period. It is proposed that prior neutropenia and preceding cellulitis around the thyroid gland, which might be subsequent to oral mucosal damage induced by anticancer drugs, may play a role in the development of gland infection. Thyroid gland infection should be considered a potential complication of aggressive chemotherapy for leukemia. [ABSTRACT FROM AUTHOR]

Limping is defined as an abnormal pattern of ambulation in which the swing and the stance phases of gait are markedly asymmetric according to the age and gender of the child. Limping should be considered as a serious complaint, which accounts for an important portion of the applications to the pediatric emergency services. In such a condition, the important thing is to differentiate the life-threatening causes. Acute trauma and many musculoskeletal diseases caused by neurologic rheumatologic and infectious conditions can give rise to limping. Limping can also be the first symptom of hematologic and oncologic malignancies such as leukemia, Ewing sarcoma and osteosarcoma, which may result in serious mortality and morbidity if there is a delay in diagnosis. In this article, a child with limping who was diagnosed as acute lymphoblastic leukemia is reported. [ABSTRACT FROM AUTHOR]