Background: Acute lymphoblastic leukemia (ALL) is the most common cancer in children. Nowadays there have been achievements in treatment for ALL but side effects and toxicities of chemotherapy are still the major causes of death. Objectives: (1) To find out the rate and grades of side effects and toxicities of chemotherapy on blood forming organ of children with ALL ; (2) to study characteristics of toxicity on blood forming organ in phase of chemotherapy. Subjects and methods: 67 patients with ALL were admitted to Hematology and Oncology Departments of National Hospital of Pediatrics and were treated with chemotherapy of CCG (children cancer group) protocol. Grades of myelosuppression were followed by CCG criteria. Results (l) side effects and toxicities on blood forming organ were common and severe: Leucopenia accounted for 95,5% (grades 3 - 4: 83,6%); neutropenia was 100% (grades 3 - 4: 98,5%); thrombocytopenia was 92,5% (grades 3 - 4: 80,6%); anemia accounted for 98,5% (grades 3 - 4: 58,2%); lymphocytopenia was 89,6% (grades 3 - 4: 64,1%); and marked hypocellularity of marrow was 78,8% in the 14th day (grades 3 - 4: 57,4%) but (2) most of them occurred in the first 2 weeks. Conclusion: Side effects and toxicities of chemotherapy on blood forming organ was common and at quite severe levels but mainly occured in the first two weeks\r\n', u'\r\n', u'\r\n', u'
Precursor Cell Lymphoblastic Leukemia-Lymphoma/ blood

PURPOSE: We aimed to identify the impact of NUDT15 variants on thiopurine intolerance and 6-thioguanine nucleotide (6-TGN) levels in Korean children with acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS: Genotyping of NUDT15 was tested in 258 patients with ALL registered at Samsung Medical Center. Patients were classified into normal-activity (wild-type), intermediate-activity (heterozygous variant), and low-activity groups (homozygous or compound heterozygous variant). Clinical and laboratory features during the first year of maintenance therapy were investigated. RESULTS: A total of 182 patients were included in the final analysis. There were five (2.7%), 46 (25.3%), and 131 (72.0%) patients in low-, intermediate-, and normal-activity groups, respectively. The lowest 6-mercaptopurine (6-MP) dose (mg/m2/day) was administered to the low-activity group (low-activity group 7.5 vs. intermediate-activity group 24.4 vs. normalactivity group 31.1, p < 0.01) from three months to a year after beginning maintenance therapy. The low-activity group experienced the longest duration of therapy interruption during the first year (low-activity group 169 days vs. intermediate-activity group 30 days vs. normal-activity group 16 days, p < 0.01). They also showed the lowest blood cell counts and had a longer duration of leukopenia (low-activity group 131 days vs. intermediate-activity group 92 days vs. normal-activity group 59 days, p < 0.01). 6-TGN level and its ratio to 6-MP dose were lowest in the low-activity group. CONCLUSION: NUDT15 variants cause hematopoietic toxicity with low 6-TGN levels. NUDT15 genotyping should be conducted before administering thiopurine, and dose adjustments require caution regardless of 6-TGN levels.
6-Mercaptopurine ; Blood Cell Count ; Child* ; Humans ; Leukemia ; Leukopenia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Thioguanine

No abstract available.
Blood Cell Count* ; Blood Cells* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prognosis* ; Remission Induction*

Graft-versus-host disease can develop in immunosuppressed individuals who receive blood product transfusions that contain imrnunocompetent lymphocytes. We report a case of transfusion-associated graft-versus-host disease(TA-GVHD) that developed in a patient with acute lymphocytic leukemia who were undergoing therapy. The groups at risk for development of TA-GVHD, the clinical presentation and course, and methods of diagnosis are summarized. Prevention of TA-CVHD is possible by irradiation of blood products given to patients at risk, but problems remain in determining the groups that warrant such measures. We should be aware of the risk of developing TA-GVHD after routine blood transfusion, especially in areas where the population's HLA types are rather homogeneous.
Blood Transfusion ; Diagnosis ; Graft vs Host Disease ; Humans ; Leukemia* ; Lymphocytes ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Transplants*

Fetal Blood ; Humans ; Infant, Newborn ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; blood ; congenital ; diagnosis

Adult ; Humans ; Male ; Peripheral Blood Stem Cell Transplantation ; methods ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; therapy

PURPOSE: The hematologic change during the treatment of acute lymphoblastic leukemia(ALL) is critical as a prognostic determinant and a variable to determine the dose of chemotherapeutic agents. It is known that the dose of vincristine used in the maintenance phase of ALL is small enough to increase the count of platelet. To investigate the change of platelet count according to the vincristine administration in maintenance phase of ALL chemotherapy, we performed this study. METHODS: Eleven patients eligible under the criteria of Children's Cancer Study Group(CCG)-1882 and who had completed chemotherapy were enrolled in this study. The count of platelets before vincristine administration was compared with those of vincristine administration 1, 2 and 3 weeks after the early and last periods of maintenance phases. The platelet count before vincristine administration was defined as 100 percent and that after vincristine were compared. In addition, we tentatively defined an enhancing effect of vincristine as positive when the relative count was more than 120 percent. RESULTS: Platelet count did not differ according to the early and last periods of maintenance phase. Platelet count at first week after vincristine administration increased more significantly than that before vincristine in early and last periods. There was an enhancing effect in 10(90.9 percent) of 11 patients after 1 week vincristine administration both in the early and last periods of the maintenance phase. CONCLUSION: Vincristine, used in ALL maintenance phases as a low dose, increased platelet count 1 week after administration. The increased platelet count resumed to the previous level 2-3 weeks later. However, the thrombocytosis observed in the maintenance phase by vincristine was not high enough to induce thrombosis. In addition, vincristine is known to reduce the activity of platelets. Therefore, the risk of thrombosis in the maintenance phase of ALL chemotherapy would be low.
Blood Platelets* ; Drug Therapy* ; Humans ; Platelet Count* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Thrombocytosis ; Thrombosis ; Vincristine*

Recent advances in the treatment of leukemia are closely related to the development of intensive chemotherapy, which needs multiple blood transfusions during bone marrow suppression. Patients of the Jehovah's Witness refuse blood transfusions and therefore hematologists are faced with major dilemma in the treatment of these patients with leukemia. We report an 11-year-old girl of Jehovah's Witness with acute lymphoblastic leukemia, who refused blood transfusions during chemotherapy. She was treated by intensive chemotherapy and her remission and induction was successful with the support of G-CSF and erythropoietin. She has been in remission state for over 6 years since the completion of chemotherapy. We also made a brief review of related literatures.
Blood Transfusion ; Bone Marrow ; Child ; Drug Therapy ; Erythropoietin ; Female* ; Granulocyte Colony-Stimulating Factor ; Humans ; Leukemia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma*

OBJECTIVE: To investigate the expression change of ROCK1 gene in patients with acute lymphoblastic leukemia (ALL) and its prognostic significance. METHODS: Sixty patients with ALL were selected in our hospital from April 2017 to April 2018, and 60 healthy persons subjected to physical examination were selected as control. The venous blood was taken from the subjects, and then the mononuclear cells were separated. The ROCK1 gene expression level in the samples was detected by RT-PCR, and the expression level of ROCK1 protein was detected by Western blot. The correlation between ROCK1 gene expression and clinical characteristics of ALL patients was analyzed by using statistical methots. RESULTS: The RT-PCR showed that the relative expression level of ROCK1 gene in ALL patients was 1.37 (1.28-1.46), which was significantly higher than that in the control group (P<0.05). Western blot showed that the protein expression level of ROCK1 in ALL patients was higher than that in the control group (P<0.05). The expression level of ROCK1 gene correlated with age, WBC count, lactate dehydrogenase (LDH) level, peripheral blood immature cell count, and risk stratification of ALL patients (P<0.05). The expression level of ROCK1 gene did not correlate with sex, hemoglobin (Hb) level, platelet count and immunophenotype in ALL patients (P>0.05). The standard risk ratio of B-ALL and T-ALL patients with low ROCK1 expression was significantly higher than that in patients with high ROCK1 expression (P<0.05). The high risk ratio of B-ALL and T-ALL patients with low ROCK1 expression was significantly lower than those with high ROCK1 expression (P<0.05). The ratio of CR in the group with low ROCK1 expression patients was significantly higher than that in patients with high ROCK1 expression (P<0.05). The Relapse rate of the group with low ROCK1 expression was significantly lower than that of the group with high ROCK1 expression (P<0.05). Kaplan-Meier survival analysis showed that OS and DFS in ALL patients with low ROCK1 expression were superior to those in ALL patients with high ROCK1 expression (P<0.05). Multiple factor Cox regression analysis showed that age and ROCK1 gene were independent influencing factors for OS (P<0.05); leukocyte count and ROCK1 gene were independent influencing factors for DFS (P<0.05). CONCLUSION The expression level of ROCK1 gene in ALL patients is high, which may stimulate the genesis of ALL, and the down-regulation of ROCK1 gene expression may help improve the therapeutic effect for ALL patients.
Acute Disease ; Blood Cell Count ; Humans ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prognosis ; Recurrence ; rho-Associated Kinases ; metabolism

BACKGROUND: Although the overall survival of childhood acute lymphoblastic leukemia (ALL) approaches 85-90%, the prognosis of relapsed or refractory (R/R) ALL is grave. This study aimed to identify the treatment pattern, treatment response, and overall survival of these patients.METHODS: We reviewed data of 64 patients with R/R ALL whose initial diagnosis of ALL had been made between 1 and 21 years of age. Patients who received clofarabine as part of an induction regimen were excluded. Relapsed patients were limited to those who relapsed after ≥2 prior induction regimens. Treatment patterns, response rates, and overall survival were analyzed.RESULTS: Patients' median age was 15.0 years (range, 6.0-25.0) at the diagnosis of R/R ALL. The most frequently used agents other than steroid were vincristine (54.0%), cytarabine (44.6%), and idarubicin (36.5%), while L-asparaginase was used in only one patient. The complete remission (CR) and overall response (OR) rates were 38.1 and 42.9%, respectively. Sixteen patients (25.4%) underwent allogeneic hematopoietic stem cell transplantation (HSCT). The 5-year overall survival was 6.7%. The survival of patients with HSCT was significantly higher compared with those without HSCT (35.2% vs 0%, P=0.0097). Among 14 patients who achieved CR or CR without platelet recovery (CRp) before HSCT, the 3-year survival was 46.9%.CONCLUSION: The survival of Korean patients with R/R childhood ALL was dismal despite a reasonable CR rate, whereas that of those who received HSCT after CR or CRp was excellent. More treatment options are needed to improve the overall outcome of R/R childhood ALL.
Blood Platelets ; Cytarabine ; Diagnosis ; Hematopoietic Stem Cell Transplantation ; Humans ; Idarubicin ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prognosis ; Retrospective Studies ; Vincristine