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Introduction: Total body irradiation (TBI) with megavolt photon energy is a treatment that can be applied before bone marrow transplantation (BMT) in many hematologic diseases. Two-dimensional TBI (2D-TBI) is one of the oldest RT techniques. We performed a retrospective study to evaluate the radiotherapy (RT)-related acute adverse events in pediatric patients with TBI. Methods: Patients who received TBI between January 1, 2021, and December 30, 2021, in the Radiation Oncology Clinic of Ankara City Hospital were evaluated retrospectively. The primary endpoint of the study was the assessment of RT-related acute adverse events (RT-AE). The Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 was used for RT-AE. Results: Twenty-one pediatric patients treated with 2D-TBI between February 20, 2021, and October 10, 2021, have been retrospectively analyzed. The median follow-up period is 7 (range 1-14) months. The median age of the patients is 11 (range 2-17) years. The median time to BMT following TBI is 4 (range 3-13) days. A total of 12 Gy was applied to 15 (71.4%) patients diagnosed with acute lymphoblastic leukemia and acute myeloid leukemia. A total of 3 Gy was applied to 5 (23.8%) patients due to aplastic anemia and thalassemia major. A total of 4 Gy was applied to 1 (4.8%) patient who had anaplastic large cell lymphoma. In the first week after TBI, all 21 (100%) patients were neutropenic in grade 3 or higher. One day after TBI, there was a 23.4% increase in grade 3 or higher leukopenia [p=0.042; OR (95% CI) 0.278 (0.132-0.585)]. Discussion and Conclusion: The 2D-TBI is applied with acceptable toxicity. TBI-related pneumonia was not observed in any of the patients in our treatment technique with a dose/rate of 0.053 Gy/min. [ABSTRACT FROM AUTHOR]

Objective: Anthracyclines are widely used in the treatment of acute lymphoblastic leukemia (ALL). However, cardiotoxicity is the most critical side effect that requires dose limitation. It is thought to occur at first exposure, but the clinical presentation may occur years later. In this study, we aimed to determine the time of initial damage and cardiotoxicity that develops in children with ALL. Methods: In this prospective study, 13 patients with newly diagnosed intermediate-risk precursor B cell ALL treated with the ALL-IC BFM 2009 protocol were included. Conventional echocardiography, tissue Doppler imaging (TDI), and speckle-tracking echocardiography (STE) were performed in all the patients before chemotherapy, after completing the induction phase, and at the end of the reinduction phase. Results: The mean age of the patients was 7.8±4.6 (3.1–16.3) years. Myocardial velocity during systole (Sm) determined by TDI at the interventricular septum significantly decreased during the induction phase. Despite a decrease in STE parameters, a statistically significant reduction was determined in the global longitudinal strain rate at both left and right ventricles at the end of the induction. Nevertheless, a statistically significant increase was observed among the conventional echocardiographic findings in the left ventricular end-diastolic diameter at the end of the reinduction. Conclusion: During the treatment of ALL, subclinical anthracycline-associated cardiotoxicity develops in the early stages of treatment. The findings detected by TDI and STE could be missed by conventional echocardiography. We recommend evaluating patients with these newly developed techniques to detect subclinical cardiotoxicity at an early stage and starting appropriate therapy on time. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to evaluate the impact of pretreatment folate and vitamin B12 deficiencies on the frequency of complications and peripheral blood recovery, in children with acute lymphoblastic leukemia (ALL). Methods: Pre-induction serum folate and vitamin B12 levels of 88 newly diagnosed ALL patients were evaluated retrospectively. Folate < 3 ng/mL and vitamin B12 < 200 pg/mL were accepted as deficiency. Median hemoglobin, absolute neutrophil count (ANC), and platelet counts, transfusion needs, and complications such as mucositis, febrile neutropenia (FN), bleeding at diagnosis, at 15th and 33rd day of induction, were assessed. Recovery of peripheral blood count, which was defined as an ANC > 1.0 × 109/L and platelet count > 100 × 109/L at 33rd day of chemotherapy were also evaluated. Results: Folate or vitamin B12 deficiencies were observed in 21 (23%) and 40 (45%) children, respectively. Peripheral blood counts, complications rates, and transfusion needs were not statistically different between deficient and normal level groups during induction. The number of febrile days, though not statistically significant, was higher in the both deficient groups. Seventeen of 40 (42.5%) patients with vitamin B12-deficient and 12 of 21 (57.1%) folate-deficient patients experienced at least one episode of FN during induction. FN was more common in folate-deficient group, but that was not statistically significant. Complete peripheral blood recovery at 33rd day of induction was seen in 40% in the vitamin B12-deficient group and 28.6% in folate-deficient group. Peripheral blood recovery rate at day 33 was also similar in both deficient and normal level groups. Conclusion: Although pre-induction low serum levels of vitamin B12 and folate did not have statistically significant impact on disease-/treatment-related complications and peripheral blood recovery at induction, the frequency of FN and number of febrile day were higher in both deficiencies and folate-deficient patients, respectively. [ABSTRACT FROM AUTHOR]