B-Lymphocytes ; Child ; Humans ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; immunology ; Precursor Cells, B-Lymphoid ; pathology

OBJECTIVESince the outbreak of a highly contagious new pneumonia, atypical pneumonia or severe acute respiratory syndrome (SARS) occurred in Guangzhou area, 33 children with this syndrome were treated in the authors' hospital. The present study aimed to understand clinical characteristics and prognosis of pediatric SARS patients in Guangzhou area.

METHODSClinical manifestations, laboratory and radiologic findings, therapeutic approaches and prognosis of the 33 children with SARS in Guangzhou area were analyzed.

RESULTSOf the 33 cases, 17 were males and 16 were females. The age was between 3 months to 13 years, and 3 - 12 years old patients accounted for 82%. Five (15%) cases had an evident history of contacting SARS patient before the symptoms occurred. Another 5 (15%) cases had a history that contacts of these patients (family members or friends) developed fever and/or cough later. The most common symptoms in this cohort were fever (100%) and cough (91%). Most of the cases had high fever, higher than 39 degrees C. Near half of the cases had nonproductive cough. The initial blood cells count showed that total white blood cell (WBC) count was (2.5 - 9.7) x 10(9)/L. In 22 (67%) cases the WBC count was < 5.0 x 10(9)/L, and in 10 (30%) WBC was (5.0 - 7.0) x 10(9)/L, in 18 cases most of the WBC were lymphocyte count. Chest radiograph showed patchy infiltrates, in 15 cases the changes were unilateral, and in 18 were bilateral. The radiologic changes developed fast, in some cases the changes progressed from one side to both sides. The opacity was absorbed slowly, significant absorption took in average two weeks. Elevated ALT was found in 3 cases and elevated CK-MB in 2 cases. Treatment included isolation, good ventilation of the ward, bed rest, supportive regimens, low volume oxygen inhalation, use of Chinese traditional medicine, antibiotics to prevent bacterial infection, and anti-inflammation therapy. All the patients recovered and discharged from hospital after a mean period of 10.0 +/- 3.8 days.

CONCLUSIONSARS in children may have its own characteristics. The main clinical manifestations were high fever and cough while no severe toxic symptoms, nor respiratory failure was seen; few symptoms or signs suggesting involvement of systems other than respiratory system were seen. Chest radiograph showed uni- or bilateral asymmetric air-space infiltrates which could worsen quickly and were absorbed slowly. Though there were severe changes in the lung, the patients might not have corresponding symptoms or signs. The total white blood cell count in peripheral blood did not increase. All the patients studied had a favorable outcome after the combined treatment.

Adolescent ; Anti-Bacterial Agents ; therapeutic use ; Bed Rest ; Child ; Child, Preschool ; China ; Cohort Studies ; Cough ; complications ; Female ; Fever ; complications ; Humans ; Infant ; Length of Stay ; Lung ; drug effects ; microbiology ; pathology ; Male ; Prognosis ; Severe Acute Respiratory Syndrome ; complications ; diagnosis ; therapy ; Treatment Outcome

OBJECTIVETo analyze outcomes and prognostic factors of children with B-cell non-Hodgkin lymphoma (B-NHL).

METHODSOne hundred and four newly diagnosed B-NHL children were enrolled in protocol of B-NHL 2001. The statistics were performed by SPSS 13.0.

RESULTSOf 104 children (79 males, the median age of 7.1 years), 60, 32 and 4 patients were diagnosed with Burkitt lymphoma, diffuse large B-cell lymphoma and unclassifiable B-cell lymphoma, respectively. Four patients were in stage Ⅰ, 27 stage Ⅱ, 55 stage Ⅲ and 18 stage Ⅳ; 1, 26 and 77 patients were allocated into R1, R2 and R3 risk groups, respectively. Three patients never got complete remission (CR), 9 patients relapsed after CR with the duration of relapse from 1 to 7 months after chemotherapy. The estimated 5-year EFS of 104 patients was (86.7 ± 3.5)%. Univariable analyses identified that risk factors for recurrence were of higher staging, elevated LDH, serum ferritin and poor early response. Age, sex, pathologic diagnosis, original tumor, bone or marrow involvement, C-MYC and risk group were not found to be associated with the risk of failure to treatment. Multivariable COX regression models confirmed serum ferritin as a significant independent prognostic marker.

CONCLUSIONB-NHL 2001 protocol was reasonable for B-NHL children. Higher staging, elevated LDH, serum ferritin and poor early response increased risk for recurrence.

Adolescent ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Lymphoma, B-Cell ; diagnosis ; drug therapy ; Lymphoma, Non-Hodgkin ; diagnosis ; drug therapy ; Male ; Prognosis ; Prospective Studies ; Treatment Outcome

OBJECTIVETo reduce the risk of infection during the induction therapy while to ensure remission rates, and to evaluate the protocol ALL-2005.

METHODSThe minimal residual disease (MRD) was detected by flow cytometry on day 35 and 55 of induction therapy. The efficacy of induction and the clinic grouping were evaluated by MRD level. From May 1, 2005 to April 30, 2007, 158 children with newly diagnosed ALL were enrolled in this study. According to clinic grouping criteria of ALL-2005, patients were stratified into 3 groups: low-risk( LR), intermediate-risk (MR) and high-risk (HR). The remission rates, therapy related complication during induction, and the relationship between MRD level on day 35 and 55 of induction and prognosis were analyzed. The endpoints are disease-free survival (DFS), relapse and death of any cause. Patients lost to follow-up were censored at the time of their withdrawal.

RESULTSOf the 158 patients, 59 were LR, 93 MR and 6 HR. The CR rate on day 35 was 98.1%. There were detectable MRD in 139 (88.0%) patients. In 94 patients (68.6%) MRDs were < or = 0.01% on day 35 being 73.1% (49/67) for LR and 63.4% (45/71) for MR (P = 0.219). During induction therapy, 43 patients (27.2%) developed infection and among them 1.3% (2/158) suffered serious infection and 0.6% (1/158) died of complication. Four patients (2.5%) in CR were lost follow-up, 17 patients (10.8%) relapsed, including 4 patients (4.3%) with MRD < or = 0.01% and 10 (23.3%) >0.01% on day 35 (P = 0.003). One died of severe malnutrition and infection in CR. With a median follow-up of 20 (12-35) months, the estimated 30 month DFS for whole group was (81.6 +/- 4.5)% including (94.1 +/- 3.3)% for LR, (82.8 +/- 4.4)% for MR, and (91.0 +/- 5.4)% for MRD < or = 0.01%, (67.1 +/- 9.5)% for MRD >0.01% on day 35 and (89.1 +/- 5.3)% for MRD < or = 0.01% and (46.9 +/- 15.6)% for MRD >0.01% on day 55.

CONCLUSIONThe risk of infection and therapy related death during induction with protocol ALL-2005 are lower, while the remission rate and quality of the induction are better. Longer follow-up is needed to estimate the long-term result.

Adolescent ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Neoplasm, Residual ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; Prognosis ; Remission Induction ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo analyze the incidence, clinical characteristics and prognosis of childhood T-cell acute lymphoblastic leukemia (T-ALL).

METHODSFrom January 1999 to April 2005, 305 patients with newly diagnosed ALL were enrolled in protocol ALL-XH-99. The clinical characteristics of these children were analysed.

RESULTSOf 305 childhood ALL patients, 43 were T-ALL. There were 34 males among the 43 T-ALLs. The mean age at diagnosis was 7.8 (2.2 to 16.4) years, 29 (67.4%) cases of them were older than 10 years, and 27 (62.8%) cases had initial WBC count more than 50 x 10(9)/L. In comparison with that of B cell ALL (B-ALL), the percentages of age older than 10 years, initial WBC count more than 50 x 10(9)/ L, prednisone poor response (PPR), and failed to achieve remission at day 19 of induction chemotherapy in the T-ALLs were all higher. No statistic difference was found in sex between them. The eight-year event-free survival (EFS), relapse-free survival (RFS) and overall survival (OS) were (40.2 +/- 10.1)%, (51.4 +/- 11.6)% and (49.8 +/- 9.9)% for T-ALL, and (72.1-3.0)%, (83.2 +/- 2.7)%, and (76.6 +/- 2.9)% for B-ALL, respectively, being differed significantly between the two types of ALL (P < 0.01).

CONCLUSIONThere were statistic differences between T-cell and B-cell childhood ALLs in age, initial WBC count, early response to therapy, and eight-year EFS and RFS. Childhood T-ALL was associated with a worse prognosis than other sub-types of childhood ALL.

Adolescent ; Child ; Child, Preschool ; Disease-Free Survival ; Female ; Humans ; Immunophenotyping ; Infant ; Karyotyping ; Male ; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma ; genetics ; immunology ; pathology ; therapy ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma ; genetics ; immunology ; pathology ; therapy ; Prognosis

AIMTo investigate the dynamic changes of Egr-1 expression in the lungs of acute pulmonary embolism of rats by infusion of autoblood thrombs.

METHODSThe model of pulmonary embolism by infusion of autoblood thrombs in the pulmonary artery of rats was established and the mean pulmonary arterial pressure was continuously monitored by computer, and the results were evaluated by lung perfusion scan and pathological changes. Expression of Egr-1 proteinum and mRNA were measured by immunohistochemistry and reverse transcription polymerase chain reaction.

RESULTSThe mPAP of rats was increased significantly after infusion of autoblood thrombs at the half hour, and reached high level at the second hour, then remained the high level to four hours compared with group control at the same time point (P < 0.01). ECT image was showed significantly filling defect after infusion of autoblood thrombs at the first hour. The infused thromb was witnessed by hematoxylin and eosin stain. In the tracheal epithelium cells, alveolar epithelium cells and vascular smooth muscle cells of embolism rats, Egr-1 protein expression was increased significantly after embolization at the second hour compared with group control at the same time point (P<0.01), and was decreased slowly at the fourth hour. Egr-1 mRNA expression was showed the similar changes.

CONCLUSIONExpression of Egr-1 was low level in group control, but increased significantly after infusion of autoblood thromb at the second hour in the specificity of cells, suggesting that Egr-1 expression might be an important link of pathological changes in the acute pulmonary embolism.

Animals ; Early Growth Response Protein 1 ; genetics ; metabolism ; Gene Expression ; Lung ; metabolism ; Male ; Pulmonary Embolism ; genetics ; metabolism ; pathology ; RNA, Messenger ; genetics ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo evaluate the efficacy and safety of the ICE regimen (iphosphamide + carboplatin + etoposide) used in treating children with hepatoblastoma in the Shanghai Children's Medical Center.

METHODSFrom June 2000 to June 2008, 14 children with newly diagnosed hepatoblastoma (7 males and 7 females) were enrolled. Their median age on diagnosis was 1.33 years (range: 0.25-8.25 years). Six patients had stage I disease, 1 had stage II, 5 had stage III, and 2 had stage IV diseases. Thirteen children had markedly increased serum AFP level, and 1 had normal serum AFP level. Multidisciplinary co-operation treatment was performed. Eight patients had primary surgery while 3 patients had pre-operation chemotherapy before surgery. ICE chemotherapy regimen was used. Totally, 73 courses of chemotherapy were administered for the 14 children and 25 out of the 73 courses were performed before operation.

RESULTSTwelve patients responded to the treatment (85.7%) and 2 failed. Ten patients (71.4%) achieved complete remission after treatment, and two had partial remission. By July 31st, 2008, 9 patients survived without any event, with a median follow-up duration of 35 months (range: 16-96 months). The 5-year overall survival rate was 70.71+/-12.37%, and the 5-year event-free survival rate was 64.29+/-12.81%. One patient had disease relapse and two patients were lost to follow-up after they achieved partial remission.

CONCLUSIONSThe ICE regimen combined with operation is effective and safe in treating children with hepatoblastoma.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carboplatin ; administration & dosage ; Child ; Child, Preschool ; Etoposide ; administration & dosage ; Female ; Hepatoblastoma ; drug therapy ; Humans ; Ifosfamide ; administration & dosage ; Infant ; Liver Neoplasms ; drug therapy ; Male

OBJECTIVETo recognize and improve the outcome of childhood Ewing's sarcoma family tumors, and to identify the efficacy and safety of the chemotherapy using RS-2002 Protocol.

METHODSFrom September 1997 to September 2006, 14 newly diagnosed patients with the tumors were admitted, 9 were boys, and 5 were girls, the median age was 7.04 years, ranging from 1.58 years to 11.67 years. Among them, 9 patients were younger than 10 years. By the time of diagnosis, 9 patients had local diseases, and the other 5 patients had metastatic diseases. All the patients' diagnoses were confirmed by pathological studies. Nine patients had Ewing's sarcoma by histology, and the other 5 patients had peripheral primitive neuroectodermal tumors (PPNET). All of the patients were treated with multidisciplinary therapy, and RS-2002 Protocol for chemotherapy was used to treat patients with rhabdomyosarcoma in our hospital. Surgery and irradiation were performed for local control. Imaging studies were used for evaluation, reevaluation and follow-up.

RESULTSTill April 30th 2007, 13/14 patients survived. The median follow-up time was 41 months (range: 7 months-115 months). The 10-year overall survival (OS) was 88.9%+/-10.5%, and the 10-year disease-free-survival (DFS) was 72.2%+/-13.8%; 3/14 patients had disease relapse, the median time to relapse from initial diagnosis was 23 months (range: 16-30 months). One patient developed second malignancy. No therapy related death was documented.

CONCLUSIONSChildhood Ewing's sarcoma family tumors were not very rare, and the prognosis was acceptable with optimal treatment. RS-2002 Protocol was effective and safe in treating such patients.

Child ; Child, Preschool ; Combined Modality Therapy ; Female ; Humans ; Infant ; Male ; Sarcoma, Ewing ; therapy ; Treatment Outcome

OBJECTIVETo improve the long-term prognosis of childhood Hodgkin's lymphoma (HL) by standard treatment protocol HL-98.

METHODSPatients were divided into low (R(1)), middle (R(2)) and high-risk (R(3)) groups based on staging, tumor size and with or without B symptoms. Patients of R(1), R(2) and R(3) groups were given 4, 6, and 9 courses of chemotherapy, respectively. Low dose radiotherapy to involved area was given to patients with residual disease at the end of chemotherapy. All patients diagnosed between 1998 and Dec. 2008 were enrolled. The software of SPSS 11.0 was used and the event free survival (EFS) was generated by Kaplan-Meier.

RESULTSThere was a total of 26 patients with male 20 and female 6. The average age was 97 (30 to 179) months and median age 94.5 months. Three patients were in stage I, 4 in stage II, 9 in stage III and 10 in stage IV. Of 26 patients, 24 were found with neck tumor, 12 with mediastinum tumor, 11 with spleen infiltration and 5 with B symptom. Four patients were allocated into R(1) group, 12 R(2) group and 10 R(3) group. Eight of 26 with residual disease received radiotherapy, 7 received 20-26 Gy and 1 received 36 Gy. To Jun 2009, 21 (80.76%) of them kept in complete remission (CR) at 10 to 120 months follow-up (average 36 months, and median 31 months). Five cases relapsed (1 of stage III and 4 of stage IV) within 5 to 12 months. Three out of 4 in stage IV with B symptom relapsed. The estimated 5-year overall survival (OS) was 85.9% and EFS was 73.7%.

CONCLUSIONThe estimated 5-year EFS indicated that protocol HL-98 is reasonable good. Patients of stage I and II can obtain a good prognosis without radiotherapy.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Child ; Disease-Free Survival ; Follow-Up Studies ; Hodgkin Disease ; drug therapy ; Humans ; Neoplasm Staging ; Survival Rate

OBJECTIVETo investigate the main causes of deaths and the influencing factors in children with malignant tumors in the hospital, explore the possible way to improve the treatment.

METHODSClinical data of 84 patients with malignant tumors who died during hospitalization in the Department of Hematology/Oncology from June 1999 to December 2008 were collected and retrospectively analyzed. Major causes of deaths and their influencing factors were analyzed.

RESULTS(1) Treatment related complications which occurred in 73 cases (86.9%) were the leading cause of death, including infection-related death which was the most common cause of 51 cases (60.7%), hemorrhage-related death occurred in up to 28 cases (33.3%), and acute tumor lysis syndrome (ATLS) related death occurred in 2 cases (2.4%), graft versus host disease (GVHD) related death after allogeneic hematopoietic stem cell transplantation occurred in 4 cases (4.8%). Moreover, primary diseases related death occurred in 30 cases (35.7%). (2) In this group, there were no significant differences in treatment phases when the death occurred among patients with leukemia (56 cases), lymphoma (9 cases) and other non-hematopoietic and lymphoid tissue tumors (7 cases, chi(2) = 4.784, P = 0.310). (3) The infection related death increased significantly when WBC count was lower than 1.0 x 10(9)/L, which is totally different from those whose WBC was higher than or equal to 1.0 x 10(9)/L (chi(2) = 25.486, P < 0.001). (4) Twenty-six cases were detected to be infected with definite pathogens; different pathogens were identified 36 times in the 26 patients. Gram-negative bacteria (15/36, 41.7%) were the most common pathogens, followed by fungal organisms (14/36, 38.9%) and gram-positive bacteria (7/36, 19.4%).

CONCLUSIONMore attention should be paid to the prevention and treatment of cancer therapy related complications in children with malignant tumors. Infection was the leading cause of death, gram-negative bacteria and fungi were predominating pathogens. Application of effective antibiotics and combined antifungal drugs timely, especially in the remission induction or first chemotherapy period as well as in the period of neutropenia, may reduce mortality of children with malignant tumors significantly.

Adolescent ; Cause of Death ; Child ; Child, Preschool ; Female ; Hospital Mortality ; Hospitalization ; Humans ; Infant ; Male ; Neoplasms ; complications ; mortality ; Neoplasms, Second Primary ; mortality