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Copyright of Journal of Uludag University Medical Faculty / Uludağ Üniversitesi Tıp Fakültesi Dergisi is the property of Journal of Uludag University Medical Faculty and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.

Objective: Based on the immunophenotype, acute lymphoblastic leukemia (ALL) can be categorized into B-cell or T-cell lineages. B-cell precursor ALL (BCP-ALL) cases show various genetic/molecular abnormalities, and varying frequencies of chimeric fusion transcripts in BCP-ALL cases are reported from different parts of the world. We studied the immunophenotypic aberrancy profiles of a large number of BCP-ALL cases with respect to various common chimeric fusion transcripts. Materials and Methods: Flow cytometric immunophenotyping and multiplex reverse-transcription polymerase chain reaction assays were performed for 986 BCP-ALL cases. Results: Among 986 BCP-ALL cases, the incidence of various fusion transcripts was 38.36% in adult cases and 20.68% in pediatric cases. Adult BCP-ALL patients with t(9;22)(BCR-ABL1) fusion transcripts and expression of aberrant myeloid markers were significantly older at presentation (p=0.0218) with male preponderance (p=0.0246) compared to those without aberrant myeloid expression. In pediatric patients with the t(12;21)(ETV6-RUNX1) chimeric fusion transcript, aberrant expression of CD13 was observed in 39.13%, CD33 in 36.95%, and CD117 in 8.69% of patients, respectively. Pediatric BCP-ALL patients with the ETV6-RUNX1 fusion transcript and expression of aberrant myeloid markers were not significantly different compared to those without with respect to demographic and clinical/hematological characteristics (p=0.5955). Aberrant myeloid markers were rarely or never expressed in pediatric and adult BCP-ALL patients with the t(4;11)(KTM2A-AF4) and t(1;19)(TCF3-PBX1) fusion transcripts. Conclusion: Aberrant myeloid markers were frequently expressed among BCP-ALL patients with the t(9;22)(BCR-ABL1) and t(12;21) (ETV6-RUNX1) fusion transcripts. However, BCP-ALL patients with the t(4;11)(KTM2A-AF4) and t(1;19)(TCF3-PBX1) fusion transcripts rarely or never expressed aberrant myeloid markers. Aberrant myeloid CD markers can be used in predicting chimeric fusion transcripts at baseline so as to plan appropriate tyrosine kinase inhibitor therapy in cases of BCP-ALL with specific chimeric fusion transcripts. This study has delineated the relationship of chimeric fusion transcripts with the aberrant expression of myeloid markers in a large cohort of BCP-ALL cases. [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: Allogeneic hematopoietic stem cell transplantation (AHSCT) is a potentially curative treatment of choice for many hematological diseases. However, there are some transplantation-related risks. Predicting the risk-benefit ratio prior to AHSCT facilitates the choice of conditioning regimens and posttransplant follow-up. Hence, many risk models have been developed. The aim of the present study was to compare 6 different risk models that are clinically used. Materials and Methods: A total of 259 patients were enrolled in this study. The European Society for Blood and Marrow Transplantation (EBMT), Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), Age-Adjusted Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI-Age), revised Pretransplant Assessment of Mortality (rPAM), Acute Leukemia-EBMT (AL-EBMT), and Disease Risk Index (DRI) risk models were applied retrospectively. Results: The AL-EBMT, HCT-CI, and HCT-CI-Age scoring systems were found to be predictive for 2-year overall survival (OS) and 2-year non-relapse mortality (NRM) (2-year OS: AL-EBMT, reference vs. score 8.5-10, HR: 1.3, p=0.035; AL-EBMT, reference vs. score >10, HR: 3.8, p=0.001; HCT-CI: reference vs. score 1-2, HR: 1.4, p=0.018; HCT-CI: reference vs. score ≥3, HR: 2.5, p<0.001; HCT-CI-Age: reference vs. score 1-2, HR: 1.3, p<0.001; HCT-CI-Age: reference vs. score ≥3, HR: 3.2, p<0.001) (2-year NRM: AL-EBMT: reference vs. score 8.5-10, HR: 1.61, p<0.001; AL-EBMT: reference vs. score >10, HR: 3.3, p<0.001; HCT-CI: reference vs. score 1-2, HR: 1.3, p=0.028; HCT-CI: reference vs. score ≥3, HR: 2.3, p=0.011; HCT-CI-Age: reference vs. score 1-2, HR: 1.3, p=0.01; HCT-CI-Age: reference vs. score ≥3, HR: 2.4, p=0.003). In terms of the Kaplan-Meier estimates of 2-year OS and 2-year NRM, the risk scoring system with the highest predictive power was found to be AL-EBMT (2-year AUC: 0.59 and 0.60, respectively). The other scores were not found to be predictive for 2-year OS and NRM. Conclusion: In the present study at our bone marrow and stem cell transplant center, it has been demonstrated that the HCT-CI, HCT-CI-Age, and AL-EBMT are good predictors of 2-year NRM and OS. [ABSTRACT FROM AUTHOR]

Purpose: In this study, the outcomes and flow cytometry results of our pediatric acute leukemia patients and their relationship with the prognosis and other clinical conditions were investigated. Materials and Methods: A total of 93 patients, 69 acute lymphoblastic leukemia (ALL) and 24 acute myeloid leukemia (AML) diagnosed at our clinic 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 58% in CD2(+) patients and 77% in CD2(-) patients. Five-year OS was 82% in patients with CD10(+) and 61% in patients with CD10(-). 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). Conclusion: In the flow cytometric evaluation of our patients with leukemia, 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. [ABSTRACT FROM AUTHOR]

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare malignancy with skin tropism. The entity was recently defined and the diagnosis is generally made by skin biopsies. It is necessary to apply appropriate immunohistochemistry to recognize this rare entity. There is no consensus on therapy and the survival rates are low. The aim of this study is to describe the clinical and histopathological features of BPDCN. We retrospectively reviewed 8 BPDCN cases of the Cerrahpaşa Medical Faculty diagnosed between 2005 and 2019. We documented the clinical findings, histopathologic diagnoses, and outcomes. The mean age of the patients was 58.7 years (range=11-86 years), and 7 patients were male. The patients presented with erythematous or purple papules, plaques, and papulonodular or nodular cutaneous lesions. Two had lymphadenomegaly at presentation. In microscopic evaluations, tumor cells infiltrated the entire dermis with a clear-cut subepidermal Grenz zone in all cases. CD4, CD56, and CD123 were the most frequently expressed immunohistochemical markers. The median follow-up of 7 cases was 14 months, ranging from 6 to 48 months. Three patients died of the disease, while 4 patients were still alive. Out of 7 patients, 5 received chemotherapy. We found that the outcomes of some patients were different from others but we did not link any distinct clinical or histopathological characteristics to these different outcomes. [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]

The impacts of serum iron parameters and/or radiological evidence of systemic iron overload on the prognosis of hematopoietic stem cell transplantation (HSCT) in acute leukemia are controversial. Unfortunately, some of the studies evaluating iron overload in transplant setting did not precisely show the patients with iron overload, mainly due to ignoring consideration of transferrin saturation along with hyperferritinemia for elimination of non-iron overload etiologies of hyperferritinemia. The aim of this study is to assess the effect of iron overload on transplantation related complications and prognosis in acute leukemia. Patients who undergone allogeneic HSCT for acute leukemia in Hacettepe University Medical School Department of Hematology were screened retrospectively in order to find cases with serum iron tests within 9 months before transplant. The endpoints investigated were overall and disease-free survivals, acute and chronic graft-versus-host disease and veno-oclussive disease (VOD). There were 84 patients suitable for inclusion. When various ferritin plus transferrin saturation (TS) cut-off values were investigated for a possible relationship with major transplant-related complications/results only ferritin> 2000 plus TS> 45% was found to have an association with VOD at borderline significance (p= 0.067). In conclusion, we observed a non-significant borderline relationship between iron overload and post-transplant VOD. We did not confirm other post-transplant complications reported in the literature. It must be noticed that although many studies intended to investigate the relationship between iron status and transplant outcomes, only a few of them have really looked for the effect of iron overload. [ABSTRACT FROM AUTHOR]

Objective: Nuclear factor kappa B (NF-κB) is an important transcription factor in cancer and NF-κB activation has been seen in angiogenesis, tumor progression, and metastasis. Relationships between specific NF-κB gene networks, leukemogenesis, and radiation exposure are still unknown. Our aim was to study the expression levels of the NF-κB1, NF-κB2, and Rel genes in hematological malignancies in the post-Chernobyl period. Materials and Methods: We analyzed gene expression levels of NFκB1, NF-κB2, and Rel in 49 B-cell chronic lymphocytic leukemia, 8 B-cell non-Hodgkin's lymphoma, 3 acute myeloid leukemia, 3 chronic myeloid leukemia, 2 hairy cell leukemia, 2 myelodysplastic syndrome, and 2 T-cell large granular lymphocytic leukemia patients using realtime polymerase chain reaction. Results: Expression levels of NF-κB1, NF-κB2, and Rel genes were found to be deregulated. Conclusion: These results could be accepted as specific gene traces to radiation-induced leukemia or as potential candidates for new diagnostic biomarker studies. Larger experiments and non-exposed control malignant cell populations are needed to clarify these suggestions. [ABSTRACT FROM AUTHOR]

Objective: Rapid and effective treatment of invasive fungal infection (IFI) in patients with leukemia is important for survival. In this study, we aimed to describe variations regarding clinical features, treatment modalities, time of restarting chemotherapy, and outcome in children with IFI and acute leukemia (AL). Materials and Methods: The charts of all pediatric AL patients in our clinic between the years of 2001 and 2013 were retrospectively reviewed. All patients received prophylactic fluconazole during the chemotherapy period. Results: IFI was identified in 25 (14%) of 174 AL patients. Most of them were in the consolidation phase of chemotherapy and the patients had severe neutropenia. The median time between leukemia diagnosis and definition of IFI was 122 days. Twenty-four patients had pulmonary IFI. The most frequent finding on computed tomography was typical parenchymal nodules. The episodes were defined as proven in 4 (16%) patients, probable in 7 (28%) patients, and possible in 14 (56%) patients. The median time for discontinuation of chemotherapy was 27 days. IFI was treated successfully in all patients with voriconazole, amphotericin B, caspofungin, or posaconazole alone or in combination. Chemotherapy was restarted in 50% of the patients safely within 4 weeks and none of those patients experienced reactivation of IFI. All of them were given secondary prophylaxis. The median time for antifungal treatment and for secondary prophylaxis was 26 and 90 days, respectively. None of the patients died due to IFI. Conclusion: Our data show that rapid and effective antifungal therapy with rational treatment modalities may decrease the incidence of death and that restarting chemotherapy within several weeks may be safe in children with AL and IFI. [ABSTRACT FROM AUTHOR]

Invasive fungal infections have turned out to be a significant cause of morbidity and mortality in pediatric patients with malignant disorders. Massive hemoptysis, a rare complication of invasive pulmonary aspergillosis, may threaten the lives of patients, usually during the resolution of neutropenia. In this report, we describe a patient with massive hemoptysis due to invasive pulmonary aspergillosis whose bleeding was controlled successfully with off-label use of recombinant factor VIIa and subsequent coil embolization of the right pulmonary artery. [ABSTRACT FROM AUTHOR]

Myelosuppression is a serious complication during treatment of acute lymphoblastic leukemia and the duration of myelosuppression is affected by underlying bone marrow failure syndromes and drug pharmacogenetics caused by genetic polymorphisms. Mutations in the thiopurine S-methyltransferase (TPMT) gene causing excessive myelosuppression during 6-mercaptopurine (MP) therapy may cause excessive bone marrow toxicity. We report the case of a 15-year-old girl with T-ALL who developed severe pancytopenia during consolidation and maintenance therapy despite reduction of the dose of MP to 5% of the standard dose. Prednisolone therapy produced a remarkable but transient bone marrow recovery. Analysis of common TPMT polymorphisms revealed TPMT *3A/*3C. [ABSTRACT FROM AUTHOR]

Giriş: Hematolojik maligniteli hastalarda sebat eden enfektif klinikte ayırıcı tanıda enfektif endokarditin değerlendirilmesidir. Olgu 1: Altmış altı yaş erkek hasta acil servise öksürük ve sol yan ağrısı şikayeti nedeniyle başvurdu. Hemogramında beyaz küre: 72.000 saptanması üzerine gönderilen periferik yaymada %85 blast görülmesi üzerine akut lösemi ön tanısıyla hematoloji servisine interne edildi. Kemik iliği biyopsisi B-hücreli ALL olarak değerlendirildi. Sebat eden ateş nedeniyle alınan kan kültürlerinde E. faecium üremesi bildirildi. Transtorasik EKO ile yapılan değerlendirmede endokardit lehine bulgu izlenmedi. TEE ile yapılan incelemede aort kapakta 6 mm endokardit lehine vejetasyon izlendi. Olgu 2: Altmış beş yaş erkek hasta unutkanlık, baş dönmesi, konuşurken kelimeleri karıştırma şikayeti nedeniyle başvurdu. Çekilen kraniyal BT’de kitle ile uyumlu görünüm izlendi. Kemik iliği biyopsisi marjinal zon lenfoma olarak değerlendirildi. Kemoterapi sırasında gelişen dizüri şikayeti ve akut faz reaktanlarında artış nedeniyle alınan kan ve idrar kültüründe S. aureus üremesi bildirildi. Mevcut üremeleri nedeniyle yapılan transtorasik EKO’da özellik saptanmazken, TEE ile yapılan incelemede aort kapakta 8x4 mm endokardit ile uyumlu vejetasyon izlendi. Sonuç: Hematolojik malignitelerin tedavisi sırasında sebat eden enfektif klinikte enfektif endokardit ayırıcı tanıda düşünülmelidir. Transtorasik EKO başlangıçta önerilen görüntüleme yöntemidir. Transtorasik EKO ile yapılan değerlendirmede endokardit lehine bulgu saptanmadığında klinik şüphenin devamı halinde görüntülemenin tekrarlanması gerekmektedir. Trombositopeni, yoğun antibiyoterapi kullanımı hematolojik malignitesi olan hastalarda tipik EKO bulgularının görülme sıklığını azaltmaktadır. Endokardit ayırıcı tanıda düşünüldüğünde ısrarlı değerlendirme gerekmektedir. [ABSTRACT FROM AUTHOR]

Objective: The expression of the tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) protein and its regulation by chemotherapeutics were analyzed in primary acute leukemic cells. Materials and Methods: Peripheral blood was collected from 16 patients with acute leukemia on days 0, 1, 3, and 5 of chemotherapy. The mononuclear cells were separated from the peripheral blood, and TRAIL expression was assessed by flow cytometry. The bone marrow mononuclear cells of patients with acute leukemia were separated before chemotherapy and cultured in vitro with VP-16 and/or interferon (IFN). The TRAIL expression level was detected after the cell culture. Results: TRAIL expression in the mononuclear cells of peripheral blood was significantly upregulated on day 1 (p<0.05) and then significantly decreased on day 5 after chemotherapy (p<0.05). Results from the in vitro culture revealed that VP-16 upregulated TRAIL expression in the bone marrow mononuclear cells of patients with acute leukemia, but the binding of VP-16 to IFN did not enhance TRAIL expression as compared with VP-16 alone (p>0.05). Conclusion: OA single chemotherapy mechanism for leukemia may suffice to induce TRAIL expression and promote the apoptosis of leukemic cells. [ABSTRACT FROM AUTHOR]

Granulocytic sarcoma is a rare tumor composed of immature granulocytic cells that is usually associated with acute myelogenous leukemia. Intraparenchymal cranial localization without skull, meningeal, or hone marrow invasion is extremely rare. The mechanisms of intraparenchymal cranial localization of GS remains unknown, as only 10 cases with cerebellar granulocytic sarcoma have been previously reported. Herein, we report a four year old boy with cerebellar localization of granulocytic sarcoma. [ABSTRACT FROM AUTHOR]

Objective: Posterior reversible leukoencephalopathy syndrome (PRES) is characterized by headache, altered mental status, cortical blindness, and seizures associated with neuroradiological findings. It involves predominantly white matter of the parieto-occipital lobes. Several medications and disorders play a role in the etiology of PRES. In this study, we aimed to show how the prognosis of PRES in hematological diseases of childhood might be according to the etiological factors. Materials and Methods: Here, we report PRES in six patients, aged 4 to 14 years, with diagnoses of leukemia and aplastic anemia. Results: Suggested causes in our patients were chemotherapeutics, hypertension, infection and antimicrobial drug administration, tumor lysis syndrome, acute renal failure and hemodialysis, immunosuppressive drug administration, and hypomagnesemia. One of the patients died of sepsis, renal failure and pulmonary hemorrhage and another died of relapse after total recovery from PRES. The other four patients are under follow-up without problems. Conclusion: We suggest that PRES can recover fully with early diagnosis and treatment whereas it can show poor prognosis depending on the etiology. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the antibody response to combined passive-active immunization versus active immunization against hepatitis B in 71 patients with acute leukemia with negative hepatitis B virus serology at presentation. Materials and Methods: The first group (n=28) received a double dose of hepatitis B vaccine at 0, 1, 2 and 6 months and immunoglobin (HBIG) at 0 and 1 month concurrently with vaccine but at a different intramuscular site. The second group (n=43) received double dose of hepatitis B vaccine at 0, 1, 2, and 6 months. HBsAg and anti-HBs titers were determined one month after the 1st, 2nd, 3rd and 4th doses of vaccine. Results: In the vaccine-only group, 2.56%, 8.33%, 14.28% and 34.29% of patients developed anti-HBs titer ≥10 IU/L after the 1st, 2nd, 3rd and 4th doses of vaccine, respectively. In the HBIG group, 91.30%, 91.30%, 69.56% and 73.91% of patients developed anti-HBs titer ≥10 IU/L after the 1st, 2nd, 3rd and 4th doses of vaccine, respectively. Those in the vaccine-HBIG group maintained their anti-HBs titer ≥10 IU/L from the 1st to the 4th doses. In the vaccine-only group, 34.29% of patients gained protective antibody titer after receiving the 4th dose of vaccine. Subgroup analysis of age (pediatric vs adult) and disease (acute lymphoblastic leukemia vs acute myeloid leukemia) groups showed no effect of either on the development of protective antibody titer. The incidence of HBsAg positivity one month after the 4th dose of vaccine was 8.62%. No patient became positive for anti-HCV or HIV antibody before or after chemo therapy. Conclusion: Combined HBIG and vaccine may protect acute leukemia patients during the intensive chemotherapy period. [ABSTRACT FROM AUTHOR]

Objective: In anemic patients, the correlation between serum erythropoietin (sEpo) level and the severity of anemia has been reported previously. However, in different anemia groups, different sEpo levels are measured in patients with similar hemoglobin levels and the etiology of this situation could not be explained. Methods: We evaluated hemoglobin and sEpo levels in 31 iron deficiency anemia, 26 Fanconi anemia (FA), 21 thallasemia intermedia (TI), 15 acute lymphoblastic leukemia (ALL) patients at presentation and 12 healthy controls. Results: In all disease groups, an inverse linear correlation was shown between hemoglobin and logarhytmic sEpo level. The covariance analyses according to corrected hemoglobin levels exhibited the highest sEpo level in FA, followed by ALL, TI and iron deficiency anemia, sequentialy. Conclusion: There was no statisticaly significant difference of sEpo levels in FA patients in terms of androgen treatment and this finding supports that androgen affects erythropoisis directly, and has no effect on erythropoietin. The results indicate that there is no erythropoietin deficiency in the anemia of these patients and the admnistration of exogenous erythropoietin offers no clinical benefit. [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]

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]

The article presents a case study of a 53-year-old woman who was admitted to the endocrinology clinic with a lump in the throat. Topics discussed diagnosis of acute lymphoblastic leukemia in the central nervous system; thyroid ultrasonography revealed moderate enlargement of bilateral thyroid lobes; and treatment of woman with drug methylprednisolone.

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]

A case study is presented of a five-year-old girl with acute lymphoblastic leukemia (ALL), occurred in the induction phase of chemotherapy. It informs that the patient developed tachypnea, bilateral rales and disseminated intravascular coagulation (DIC). It mentions that sepsis is the most common cause of mortality and the overall risk of symptomatic thrombosis.

The article presents a case study of a 47-year-old male with swelling and pain in the right thigh from one month and admitted to the orthopaedics clinic. Physical examination shows the lesion in the anterior and the lateral part of the thigh. He was treated with the acute myeloid leukemia chemotherapy with idarubicin for three days and cytosine arabinoside for seven days. The article discusses the extramedullary myeloid tumor (EMMT) which arises at bone, lymph nodes and soft tissues.