Diagnosis Of Acute Lymphoblastic Leukemia Research Articles

Classification of bone marrow cells in the diagnosis of acute lymphoblastic leukemia

The paper presents approaches to automated classification of bone marrow cells in the diagnosis of acute lymphoblastic leukemia and minimal residual disease using image recognition procedures. The classification methods that show the best accuracy in the recognition of eight types of bone marrow cells were experimentally determined. Recommendations for their use are given.

Clinical and Radiological Findings in Children with Cerebral Sinovenous Thrombosis

Objective: Cerebral sinovenous thrombosis (CSVT) is increasingly recognized in children with advanced use of neuroimaging techniques. In this study, we aimed to present clinical and radiologic features of CSVT in children. Material and Methods: Children aged 1 month to 18 years old diagnosed with CSVT were retrospectively analyzed. Demographic and clinical data of patients including age at diagnosis, sex, presenting symptoms and signs, risk factors for thrombosis, treatment and prognosis were collected. Results: Twelve children were included in the study, 8 of them were male. Headache (n=7), seizures (n=5) and visual impairment (n=4) were the most common presenting symptoms. The superficial venous system was involved in all patients, in five patients deep venous system was also involved. Parenchymal involvement was present in three patients. Two children had isolated cortical vein thrombosis. All patients had underlying risk factors. Five children had recent infections, six children were diagnosed with Behçet’s disease, three with mastoiditis. High lipoprotein (a) level was found in two patients. One patient had a diagnosis of acute lymphoblastic leukemia and received l-asparaginase treatment. All patients were treated with anticoagulants. One patient received tissue plasminogen activator, complicated with intracranial bleeding. Three patients with parenchymal involvement had moderate to severe motor impairment. All patients presenting with seizure had parenchymal involvement and followed up with epilepsy. Conclusion: CSVT causes significant morbidity. Especially in older children presenting with CSVT, symptoms and signs of Behçet’s disease should be questioned. Mastoiditis is still an important reason for CSVT in children.

ALL-052: New Therapeutics in Cancer Treatment: Analysis of Socioeconomic and Demographic Characteristics of Use Among Acute Lymphoblastic Leukemia (ALL) Patients in the United States

Objective: Evaluate the socioeconomic dynamics associated with new therapeutics use among acute lymphocytic leukemia (ALL) patients in the United States. Design: This retrospective study included the primary and secondary diagnosis of acute lymphocytic leukemia (ALL) in the National Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP) between 2016 and 2018. ALL and new treatment therapeutics, diagnoses, and procedure codes were identified using their corresponding International Classification of Disease (ICD-10) codes. ALL ICD-10 codes were acute lymphoblastic leukemia not having achieved remission (C91.00), acute lymphoblastic leukemia in remission (C91.01), acute lymphoblastic leukemia in relapse (C91.02), and new technologies codes for anatomical regions (XW0, XW1, XW2). Patient characteristics and demographics data were analyzed among the population with both indicators. Chi-squared analysis was also conducted to identify relationships between variables. Results: A weighted sample of 158,090 primary and secondary ALL diagnoses were identified. A total of 2,320 (1%) records with ALL diagnoses were treated with new therapeutics. The most common new therapies included administration of blinatumomab antineoplastic immunotherapy (1.9%), cytarabine and daunorubicin liposome (0.3%), and engineered autologous chimeric antigen receptor T-cell immunotherapy (0.2%). The utilization rate of engineered chimeric antigen varied by sex, with 6,250 males and 3,750 females per 10,000 hospitalizations. Use of new therapeutics varied significantly (p Conclusions: Access to new therapeutics varied by race, income, and region. Therefore, providers and researchers must ensure comprehensive inclusion of all patient populations to better understand new drug effectiveness among these populations.

Why do subcutaneous ports get stuck? A case-control study

PurposeWe sought to identify clinical features associated with difficult subcutaneous port removals in children. MethodsPorts placed between April 2014 and September 2017 at our institution were prospectively tracked for difficult removals. A case-control analysis was performed. Patients with ports that were difficult to remove (stuck; cases) were compared to biological sex and age-matched controls in a ratio of 1:3. Logistic regression determined the association between case/control status and clinical features adjusting for biological sex and age as covariates. A multivariable analysis was performed to identify independent associations. Results57 stuck ports (28 extreme [10 endovascular intervention] and 29 moderate) and 171 controls were analyzed. Stuck ports were associated with a diagnosis of acute lymphoblastic leukemia (86% cases versus 22.2% controls; p < 0.001) and a longer placement duration (median 2.6 years [interquartile range (IQR) 2.5–2.6] versus 0.8 years [IQR 0.5–1.4]; p < 0.001). On univariate analysis, procedural and device features associated with stuck ports included subclavian access (71.9% cases versus 48.5% controls; p = 0.0126), a polyurethane versus silicone catheter (96.5% cases versus 79.9% controls; p = 0.001), and a rough catheter appearance at removal (92.6% cases versus 9.4% controls; p < 0.0001). A diagnosis of ALL and duration of line placement were associated with having a stuck port on multivariate analysis. ConclusionPolyurethane central venous catheters placed for the two-year treatment of acute lymphoblastic leukemia may become difficult to remove. This constellation of factors warrants more extensive preoperative discussion of risk, endovascular backup availability, and scheduling for longer operating room time.

Cost-Effectiveness of Limited Screening Panel for Acute Lymphoblastic Leukemia Diagnosis in a Resource-Limited Setting

Background: Flow cytometry is an invaluable tool in the diagnostic evaluation of acute leukemia and post therapy monitoring; however, majority of Filipino population cannot afford the cost. The use of a minimal screening panel which is both cost-effective and provides an accurate diagnosis of acute lymphoblastic leukemia is seen as an alternative. Objectives: We aim to determine the cost-effectiveness and accuracy of using a minimal screening panel for the diagnosis of acute lymphoblastic leukemia (ALL). Methodology: We selected a limited panel of 9 antibodies comprising of CD45/CD19/CD20/CD10/HLA-DR/CD34/cCD3/cCD79a/cTdt and retrospectively reviewed newly diagnosed cases of B-cell and T-cell ALL from September 2016 to December 2019 using this panel. Results: Out of 719 bone marrow aspirates submitted for basic leukemia flow cytometric analysis we identified 268 ALL cases (239 B-ALL and 29 T-ALL). In all cases, a diagnosis was established using the limited panel. Compared to the current cost of our comprehensive panel (₱ 9,903.60). This limited panel cost ₱ 3,062.29, that offers a 69.08% savings per test, which translated to a ₱1.2 million savings a year (for an average of 180 annual cases). Conclusion: We underscore the utility of a limited panel for the diagnosis of ALL. Although this panel remains to be assessed with a larger validation cohort, its application in resource-limited developing countries is diagnostically useful and cost-effective. Recommendation: The use of a limited panel of 9 antibodies is recommended as a screening panel for patients who are highly suspected of having ALL both clinically and initial bone marrow smear assessment.

CORRELATION BETWEEN ANAEMIA AND THROMBOCYTOPENIA IN YOUNGER PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKAEMIA

Background: Thrombocytopenia needs careful attention of the physician for immediate management to avoid complications. Limited local data is available on low platelet count among patients of all age group on diagnosis of acute lymphoblastic leukaemia (ALL). The aim of this study was to assess the frequency and correlation of anaemia and liver function tests with thrombocytopenia among patients diagnosed with ALL. Methods: A prospective study was conducted on patients diagnosed with ALL at Hayatabad Medical Complex, Peshawar. Age, gender, presence of anaemia and deranged liver function tests were correlated with low platelet count in patients with ALL. Results A total of 90 patients diagnosed with ALL at the department during the study period were included in the study. Mean age of the patients was 15.43±4.756 years. Among these, 64 (71.1%) were male and 26 (28.9%) patients were female. Low platelet count was observed in 41 (45.5%) of the patients while 49 (54.5%) had platelet count within the range. Low haemoglobin levels were strongly related to presence of low platelet count in our target population (p&lt;0.001). Deranged liver functions were not significantly correlated to thrombocytopenia in patients with ALL. Conclusion: Low platelet count was a common finding at the time of diagnosis among patients diagnosed with acute lymphoblastic leukaemia. Presence of anaemia was statistically significantly correlated with presence of low platelet count among the patients at the time of diagnosis of ALL. Pak J Physil 2021;17(2):7–9

Outcomes in Acute Lymphoblastic Leukemia at the University of Wisconsin: An Institutional Review

Background: Adult acute lymphoblastic leukemia (ALL) treatment has undergone a significant shift in initial management over the previous decade. While pediatric patients have historically responded well to chemotherapy with cure rates around 90%, adult ALL patients have significantly worse outcomes with long-term cure rates in the mid 40% range. Several studies in the last decade have shown improved overall survival (OS) rates in adolescents and young adults (AYA) being treated with pediatric-type regimens. In 2011, our institution adopted guidelines recommending that all patients under the age of 40 at time of diagnosis undergo treatment with Berlin-Frankfurt-Münster (BFM) based regimen typically containing asparaginase. Patients over the age of 40 typically receive hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) based therapy with option to proceed either to maintenance chemotherapy vs transplantation following complete remission (CR). Prior to 2011, our group's approach to ALL patients was clinician-dependent, with some using BFM-based regimens and some using hyper-CVAD but without a standardized group approach.Methods: We conducted a single center retrospective review of patients with new diagnosis of acute lymphoblastic leukemia treated at the University of Wisconsin Hospital and Clinics between 2008-2016. Data collected included age at diagnosis (<40 vs >/= 40), WBC at presentation, B vs T cell subtype, Hyper-CVAD vs BFM based regimen, BCR/ABL status, transplant status, enrollment in clinical trial, overall survival (OS), relapse free survival (RFS), minimal residual disease status.Results: Overall there were 40 patients identified with new diagnosis of acute lymphoblastic leukemia. Estimated median OS for all new diagnoses was 3.93 years. There were a total of 23 patients over the age of 40 and 18 patients under the age of 40 at the time of diagnosis. There was no significant difference between the subgroup of under 40 vs over 40 in estimated median OS (p=0.103). There were 18 patients initiated on therapy with a hyper-CVAD based regimen vs 23 treated with non Hyper-CVAD regimen. Estimated median overall survival of patients treated with hyper-CVAD based regimen was 3.93 years vs 4.17 years for those treated with non Hyper-CVAD based regimen which was not significantly different (p=0.89). There were 10 patients who underwent allogeneic transplant in first remission. There was no significant difference in OS for those undergoing transplant vs not (p=0.42). There were 9 patients enrolled in clinical trial at time of diagnosis, all but one of whom were under the age of 30 and treated on Children's Oncology Group (COG) studies. Patients who enrolled in a clinical trial had a significantly higher estimated median overall survival 8.48 years vs 2.88 years (p=0.02). Minimal residual disease (MRD) status was evaluated after induction in 27 patients. Patients who achieved a negative MRD status had a significantly increased median OS vs those who had positive MRD testing (median not reached vs 2.15 years, p=0.001). Presenting WBC, B- vs T-cell disease, and BCR/ABL status were not significant predictors of OS.Conclusion: In 2011, the leukemia group at the University of Wisconsin adopted general guidelines for choosing initial treatment regimens for patients under vs over 40 years of age (BFM-based vs hyper-CVAD). Our single institution analysis showed that achieving MRD negative status was associated with improved estimated overall survival. This observation is consistent with published data that achieving MRD negative status is the single greatest prognostic indicator after the initiation of therapy. In addition, enrollment on a clinical trial was also associated with improved outcomes, though the number of patients on trial was significantly higher in the under-40 patient population. There was no significant difference in OS or RFS with treatment of Hyper-CVAD vs non Hyper-CVAD based regimen. Limitations of this study include a relatively small sample size and short follow up duration. These data indicate that achieving disease control as measured by MRD analysis with whichever initial regimen an institution is most familiar with may be the greatest single predictor of successful treatment. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Prognostic Significance of Cytogenetic Abnormalities in Patients with Philadelphia-Negative ALL Undergoing Allogeneic Hematopoietic Stem Cell Transplantation in Complete Remission: A CIBMTR Analysis

▪Background: Several cytogenetic risk stratifications have been developed and used as prognostic tools at diagnosis of acute lymphoblastic leukemia (ALL). However, most prior studies on the prognostic significance of ALL karyotyping were influenced by inclusion of Philadelphia-positive (Ph+) patients and those treated predominantly with conventional chemotherapies. The application of existing cytogenetic risk schemas to recipients of allogeneic hematopoietic cell transplantation (alloHCT) with Ph-negative (Ph-) ALL remains elusive because of the relatively low frequencies of individual Ph- abnormalities and modest population samples of prior studies.Patients and Methods: In this large international cohort (N=1731; 256 transplant centers from 38 countries) of adult Ph- ALL recipients of alloHCT (1995-2011), we examined the prognostic impact of individual cytogenetic abnormalities together with major established cytogenetic risk classifications (MRC-ECOG, modified MRC, SWOG, NILG-ALL, North UK, and GIMEMA 0496) on clinical outcomes after alloHCT. Abnormal cytogenetic profiles were validated via review of original reports (54%) from participating centers or from the CIBMTR database (46%); normal cytogenetics were reviewed and confirmed for 27% of reports (>95% accuracy). Leukemia-free survival (LFS) was the primary study endpoint. We included allograft recipients of both myeloablative (92.3%; 78% TBI-based) and reduced intensity/non-myeloablative (7.7%) conditioning using matched related (50%) and unrelated donor (27% 8/8 MUD; 21% mismatched UD), peripheral blood (46%) or bone marrow (54%) grafts.Results: A total of 632 patients (36.5%) had abnormal and 1099 (63.5%) had normal cytogenetics (Table). Young adults (<45 years) accounted for 82% of the entire cohort (63% males; 69% with B-cell ALL; 23% with high-risk hyperleukocytosis at diagnosis). Fifty-seven percent of patients underwent alloHCT in CR1 and 43% in CR2. Patients with abnormal cytogenetics had 40% LFS and 42% OS at 5-years post-transplant; which was similar to those with normal karyotype (both p>0.6). As opposed to all other cytogenetic schemas, only the modified MRC-ECOG stratification of patients into standard (n=24 with better outcomes) vs. intermediate (n=1447), high (n=160), and very high (n=78) groups was prognostic for LFS (overall p=0.03) in the multivariable analysis adjusted for recipient age, pre-HCT remission status, conditioning regimen, KPS, donor type, and GVHD prophylaxis (all co-variates were prognostic for LFS, p<0.01). Individual cytogenetic abnormalities that were consistent in their prognostic significance with modified MRC-ECOG but also associated independently with LFS in our cohort included unfavorable t(8;14) (HR=2.9; 95%CI, 1.4-6.0), del7q/-7 (HR=1.4; 95%CI, 1.0-2.1), and favorable high hyperdiploidy (HR=0.6; 95%CI, 0.4-1.0). Complex cytogenetics, monosomal karyotype, t(4;11), -17/i17q/del17p, +8, or t(1;19) were not associated with post-transplant LFS or OS in individual adjusted models.Conclusions: In this large analysis of adult Ph- ALL recipients of alloHCT with screened and validated cytogenetic profiles, we show that previously established high-risk ALL cytogenetics can be overcome by alloHCT. Although modified MRC-ECOG risk stratification appeared to be most prognostic for post-transplant LFS, its effect was largely driven by only few and relatively infrequent cytogenetic abnormalities. Our data argue that factors other than cytogenetic risk have greater impact on post-transplant survival of Ph- ALL. [Display omitted] DisclosuresBachanova:Zymogen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding; Seattle-Genetics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Oxis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Juno: Membership on an entity's Board of Directors or advisory committees. De Lima:Celgene Corporation: Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees.

Flow Cytometry Immunophemotyping Evaluation in the Diagnosis of Acute Lymphoblastic Leukemia in Patients from Rio Grande Do Norte State, Brazil

The authors conducted a flow cytometry immunophenotyping study in patients with acute lymphoblastic leukemia (ALL) from Natal, Rio Grande do Norte state, Brazil. The patients (n=126) were newly diagnosed using a panel of monoclonal antibodies: CD1a, CD2, CD3, CD4, CD7, CD8, CD10, CD13, CD33, CD14, CD19, CD22, CD79a, CD117, CD34, anti-IgM, anti-TdT, anti-HLA-Dr, anti-human kappa and lambda light chains. Additional data, such as patient age and gender, clinical and laboratory findings such as the presence of tumor masses, lymphadenopathy, hepatomegaly, splenomegaly, leukemic infiltration into the central nervous system (CNS) were also investigated. Results showed that 56.7% of the cases were B-lineage ALL and 55% T-cell ALL. Moreover, we found that males were more affected by the disease, regardless of immunological classification. The correlation between age and immunological subtypes showed that the B-lineage ALL occurred more frequently in patients younger than 15 years of age, while the T-cell ALL subtype was more frequent in adults. Immunophenotypic profiles and morphological subtypes demonstrated a direct correlation between L3 subtype and B-lineage ALL, while L1 and L2 subtypes correlated more often with B-cell lineage and T-cell ALL, respectively. Correlation analysis between immunophenotypic and clinical profiles revealed that T-cell ALL was more associated with a higher incidence of lymphadenopathy, hepatomegaly, splenomegaly and CNS leukemic infiltration, in addition to showing a greater blast cell count in peripheral blood than the other subgroups. The data suggest that immunophenotyping is an important method in diagnosis, monitoring and prognosis when determining the pathological mechanisms of evolution in acute lymphoblastic leukemia. DisclosuresNo relevant conflicts of interest to declare.

An efficient deep Convolutional Neural Network based detection and classification of Acute Lymphoblastic Leukemia

Automated and accurate diagnosis of Acute Lymphoblastic Leukemia (ALL), blood cancer, is a challenging task. Nowadays, Convolutional Neural Networks (CNNs) have become a preferred approach for medical image analysis. However, for achieving excellent performance, classical CNNs usually require huge databases for proper training. This paper proposes an efficient deep CNNs framework to mitigate this issue and yield more accurate ALL detection. The salient features: depthwise separable convolutions, linear bottleneck architecture, inverted residual, and skip connections make it a faster and preferred approach. In this proposed method, a novel probability-based weight factor is suggested, which has a significant role in efficiently hybridizing MobilenetV2 and ResNet18 with preserving the benefits of both approaches. Its performance is validated using public benchmark datasets: ALLIDB1 and ALLIDB2. The experimental results display that the proposed approach yields the best accuracy (with 70% training and 30% testing) 99.39% and 97.18% in ALLIDB1 and ALLIDB2 datasets, respectively. Similarly, it also achieves the best accuracy (with 50% training and 50% testing) 97.92% and 96.00% in ALLIDB1 and ALLIDB2 datasets, respectively. Moreover, it also achieves the best performance compared to the recent transfer learning-based techniques in both the datasets, in terms of sensitivity, specificity, accuracy, precision, F1 score, and receiver operating characteristic (ROC) in most of the cases.

Automated blast cell detection for Acute Lymphoblastic Leukemia diagnosis

Acute Lymphoblastic Leukemia (ALL) is a cancer of the blood cells which is characterized by a large number of immature lymphocytes, known as blast cells (myeloblasts). To aid the ALL diagnosis, we propose to automate the blast cell detection using Artificial Intelligence (AI). Our automation system incorporates an object detection method that predicts leukemic cells from microscopic blood smear images. We have implemented version 4 of the You Only Look Once (YOLOv4) algorithm for both cell detection and cell classification. As such, the classification was set up as a binary problem, where each cell was labeled as either blast cells (ALL) or healthy cells (HEM). The Object Detection algorithm was trained and tested with images from the ALL_IDB1 and C_NMC_2019 dataset. The mAP (Mean Average Precision) was 96.06 % for the ALL-IDB1 dataset and 98.7 % for the C_NMC_2019 dataset. Both models were trained with Google Colaboratory using a Nvidia Tesla P-100 GPU. This proposed blast cell detection algorithm might be used as an adjunct tool during pre-screening where it can help to detect Leukemia based on microscopic blood smear images.

Bacteremia in Febrile, Non-neutropenic, and Well-appearing Children With Cancer.

Fever in a neutropenic pediatric oncology patient requires prompt assessment due to the risk of infectious complications. The appropriate management of fever in non-neutropenic patients, however, is not well-established. We describe the rate of bacteremia in a cohort of non-neutropenic pediatric oncology patients with fever at a large institution. Patients were included if they presented to the emergency department or outpatient clinic between 2009 and 2014 with fever, had a central venous catheter (CVC), and were not neutropenic. Three hundred eighty-six episodes of fever occurring in 159 patients were included in the data analysis. Fifty-nine percent of patients were male, 41% had a diagnosis of acute lymphoblastic leukemia, and 90% had a port-a-cath as CVC. The rate of bacteremia was 3.4%; presence of a port-a-cath was protective against bacteremia whereas a white blood cell count >20,000/mm3 was associated with a higher likelihood of bacteremia. Gram-positive microorganisms were most commonly isolated (64.3%) and frequently resistant to cephalosporins. In summary, in our study, the rate of bacteremia was low among non-neutropenic, well-appearing pediatric cancer patients with a CVC and was not associated with any serious medical complications. Prospective research is needed to determine the most appropriate management of these patients.

Listening to the experts: Parents' perspectives around infection risk and returning to education and social activities following their child's diagnosis of acute lymphoblastic leukemia.

BackgroundDuring a child's prolonged treatment for acute lymphoblastic leukemia (ALL), there is a need to balance their increased risk of developing infection‐related complications with meeting their educational and social needs.AimsTo determine the safe timing of return to social activities for children undergoing treatment for ALL and to determine how parents perceive and act on advice related to infection risk while navigating their child's “return to normal.”Methods and resultsMedical and educational attendance records were reviewed for 47 children who were diagnosed with ALL and 24 semi‐structured qualitative interviews were conducted with a representative sample of their parents. The majority of children (69%) did not return to education prior to the start of maintenance therapy regardless of the advice that the families received from their healthcare team. Those who returned earlier were at no greater risk of major infection complications (mean = 0.5) than those who did not return until after commencing maintenance (mean = 0.4, P = .74). Parents spoke of the difficulty in obtaining practical, consistent, and timely advice and of balancing infection risk with a desire to return to normalcy. Inconsistent advice and constant vigilance placed a burden on parents which often profoundly affected their mental wellbeing. Overall, parents wanted to make their own decisions about how and when their child returned to education and social activities. They made these decisions based on many factors, of which infection risk was just one.ConclusionFollowing the study conclusion, a national working group was established—including parent representatives—to implement the study recommendations. This includes the development of a range of practical resources to better support families. Health professional guidelines provide quantitative data pertaining to infection risk, while emphasizing that the returning decisions ultimately rest with the families. This research demonstrates that listening to parents—who are the experts through their lived experiences—is a critical element in creating policies that are responsive, meaningful, and widely accepted.

Ruptured infectious ICA pseudoaneurysm into the sphenoid sinus after maxillofacial infection, successfully treated by selective embolization

Background: Intracranial infectious aneurysms are cerebral aneurysms caused by pathogen-induced inflammation undermining the arterial wall. We present a rare case of inflammatory pseudoaneurysm of cavernous internal carotid artery (ICA).Case Description: A 51-year-old female with a recent diagnosis of acute lymphoblastic leukemia developed maxillofacial infection with Pseudomonas and Acinetobacter after chemotherapy onset. Initial plain computed tomography (CT) revealed bony dehiscence of the left ICA canal, as well as bilateral protrusion of the vessel within the sphenoid sinus. Following infection spread into the left sphenoid sinus, she presented with episodes of intermittent epistaxis, without any profound vascular abnormalities on postcontrast CT. CT angiography that was performed 15 days later, due to refractory epistaxis, illustrated a large narrow necked irregular shape pseudoaneurysm of the left paraophthalmic ICA, extending into the ipsilateral sphenoid sinus. The aneurysm was completely occluded by selective embolization without parent or adjacent vessel sacrifice, documented on both intraoperative and follow-up angiogram, with no recurrence of epistaxis.Conclusion: Conclusively, ruptured internal carotid infectious aneurysms are rare but potentially fatal causes of epistaxis when extended into the sphenoid sinus. Selective coiling is feasible and can provide definitive treatment of these lesions.

Dental late effects of antineoplastic treatment on childhood cancer survivors: Radiographic findings.

Dental anomalies are common late side effects of childhood cancer therapy and may lead to anatomical, functional, and aesthetic sequelae. The study aimed to record dental late effects of antineoplastic treatment and associate them with disease and treatment characteristics in order to identify possible risk factors. Orthopantomograms of 70 survivors aged 4-21years, who were treated at ages 0-10years for any type of malignancy and completed antineoplastic treatment at least one year before, were examined. Incidence of developmental disturbances was recorded. Their severity was calculated, and odds ratios for the development of severe defects were estimated. Root defects presented in 62% of the participants, with impaired root growth being the most common (58%). Increased incidence was associated with combination treatment protocols, irradiation to the head and neck region, and administration of antimetabolites, steroids, and vincristine. Mean DeI value was 17.46 with risk factors for the development of severe root defects being diagnosis of acute lymphoblastic leukemia, combination treatment protocols, administration of cyclophosphamide and steroids, and hemopoietic stem cell transplantation. Root defects are common among childhood cancer survivors, with their incidence and severity being affected by multiple disease and treatment characteristics.

Chloroma: an uncommon presentation of the acute lymphopblastic leukaemia (ALL) in a child

Leukemia is the most common malignancy of childhood. Chloromas are a rare presentation of an underlying leukemia. Here, we discuss a rare case of acute lymphoblastic leukemia (ALL) presenting with swelling over right eye. The patient was evaluated radiologically for the extension of disease and treatment planning. ALL was diagnosed with complete blood count and bone marrow examination. The orbital swelling was the initial presentation which led to further diagnosis of acute lymphoblastic leukemia (ALL) in our case. Chloroma is usually a common clinical presentation of acute myeloid leukemia (AML), however, it may rarely be found in a case of acute lymphoblastic leukemia (ALL) such as ours.

Comparison of the Prognostic Ability of the HCT-CI, the Modified EBMT, and the EBMT-ADT Pre-transplant Risk Scores for Acute Leukemia

BackgroundAllogeneic hematopoietic cell transplantation (HCT) outcomes may be predicted by published risk scores; however, the ideal system has not been identified for acute leukemias. Patients and MethodsWe retrospectively examined the Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI), modified European Group for Blood and Marrow Transplantation (mEBMT), EBMT-Alternating Decision Tree (ADT), and others on 231 patients with acute leukemia. ResultsAcute myeloid leukemia was diagnosed in 200 patients, and acute lymphocytic leukemia was diagnosed in 31 patients. For HCT-CI, patients were grouped as 0 to 1, 2 to 3, and > 3. For mEBMT, patients were grouped as 0 to 2, 3, and > 3. For EBMT-ADT, the 100-day mortality was calculated and grouped as ≤ 4.1%, 4.1% to 11.5%, and > 11.5%. Higher HCI-CI demonstrated inferior overall survival (P = .04; c-statistic, 0.57), whereas mEBMT and EBMT-ADT did not stratify well. A new weighted score was developed that assigned 1 point for age ≥ 60 years, acute lymphocytic leukemia diagnosis, mismatch unrelated or haploidentical donor, cardiovascular comorbidity, and pre-transplant diabetes, whereas arrhythmia received 2 points. The new weighted score assigned 0 points to 88 (38%), 1 to 2 points to 121 (52%) and ≥ 3 points to 22 (10%) patients, and demonstrated improved prognostic capability compared with the other scores (P = .0001; c-statistic, 0.61). ConclusionsThe HCT-CI stratifies patients with leukemia for overall survival but is inferior to our single-center score, which is influenced by cardiac comorbidity and arrhythmia. Differences in pre-transplant risk scores may be related to different transplant practices.

Risk Factors for Ocular Involvement in Pediatric Graft-Versus-Host Disease.

To identify risk factors for ocular graft-versus-host disease (oGVHD) in children with graft-versus-host disease (GVHD). This retrospective cohort study identified 38 children diagnosed with GVHD who underwent an ophthalmological examination. Survival to onset of oGVHD after transplant was analyzed using Kaplan-Meier analyses with log-rank tests. A multivariable Cox proportional hazards model was run for time to oGVHD using univariate risk factors. The average age was 10.0 ± 5.4 years at the time of transplant. Underlying illness was acute lymphoblastic leukemia in 19 (50%) and acute myeloid leukemia in 8 (21%). Nonocular GVHD organ involvement included skin (84%), lungs (16%), intestines (50%), liver (24%), and bone marrow (3%). Fifteen children (39%) had oGVHD, of which 47% were asymptomatic. oGVHD was diagnosed 601 ± 878 days after GVHD. A significant association between risk of oGVHD and diagnosis of acute lymphoblastic leukemia (P = 0.10) or acute myeloid leukemia (P = 0.08) was not found. Organ involvement associated with oGVHD included skin (P = 0.03) and lungs (P = 0.02). Survival curves were significantly influenced by GVHD organ involvement (P = 0.02), but not underlying disease (P = 0.51). The adjusted Cox regression model yielded an independent hazard ratio of 8.82 (95% CI: 1.51-51.49; P = 0.016) for the presence of concomitant GVHD involvement of skin, lungs, and another organ. Children with multiorgan GVHD involvement including skin and lung disease are at increased risk for oGVHD. Given the proportion of asymptomatic cases found in this series, regular eye examinations are warranted in this population.

Monthly variation in diagnosis of acute lymphoblastic leukemia and survival outcome in children and adults: 15-year trends at a single center

BackgroundThe date of acute lymphoblastic leukemia (ALL) diagnosis has been studied regarding potential etiologic roles with contrasting results and the issue remains controversial. The principal aim of this study was to analyze monthly variation of ALL diagnosis in a large homogenous Hispanic Latin American cohort over 15 years; its association with survival rates was also assessed. MethodsClinical files and electronic records of 501 consecutive patients of all ages with ALL in northeastern Mexico over the years of 2004–2018 were scrutinized. Patients were divided into children ≤18 and adults >18 years. The Chi–square heterogeneity analysis was used to test for non-uniform variation. The Poisson regression analysis was used to fit sinusoidal (harmonic) models to the data, using the month of diagnosis as a covariate in a separate model. ResultsDuring the study period 363 children (72.5%) and 138 adults (27.5%) (p < 0.001) were diagnosed with ALL. Heterogeneity across the months of diagnosis was confirmed (p = 0.019) and the Poisson regression analysis confirmed a significant monthly variation (p < 0.001) (95% CI, 3.024–3.745), a higher annual peak being observed in the month of March (p = 0.002), followed by a second peak in October (p = 0.026). The five-year OS for children was 68.2% (95% CI, 67.64–68.74) and for adults, 43.7% (95% CI, 42.67–44.71) (p < 0.001). No significant association between the month of diagnosis and OS was found (p = 0.789). ConclusionThe monthly variation of ALL diagnosis was documented; these results confirm the heterogeneous behavior of the disease and appear to be consistent with an interplay of environmental and biologic factors. Further studies are needed to examine putative candidate agents.

Method for Diagnosis of Acute Lymphoblastic Leukemia Based on ViT-CNN Ensemble Model.

Acute lymphocytic leukemia (ALL) is a deadly cancer that not only affects adults but also accounts for about 25% of childhood cancers. Timely and accurate diagnosis of the cancer is an important premise for effective treatment to improve survival rate. Since the image of leukemic B-lymphoblast cells (cancer cells) under the microscope is very similar in morphology to that of normal B-lymphoid precursors (normal cells), it is difficult to distinguish between cancer cells and normal cells. Therefore, we propose the ViT-CNN ensemble model to classify cancer cells images and normal cells images to assist in the diagnosis of acute lymphoblastic leukemia. The ViT-CNN ensemble model is an ensemble model that combines the vision transformer model and convolutional neural network (CNN) model. The vision transformer model is an image classification model based entirely on the transformer structure, which has completely different feature extraction method from the CNN model. The ViT-CNN ensemble model can extract the features of cells images in two completely different ways to achieve better classification results. In addition, the data set used in this article is an unbalanced data set and has a certain amount of noise, and we propose a difference enhancement-random sampling (DERS) data enhancement method, create a new balanced data set, and use the symmetric cross-entropy loss function to reduce the impact of noise in the data set. The classification accuracy of the ViT-CNN ensemble model on the test set has reached 99.03%, and it is proved through experimental comparison that the effect is better than other models. The proposed method can accurately distinguish between cancer cells and normal cells and can be used as an effective method for computer-aided diagnosis of acute lymphoblastic leukemia.