OBJECTIVE: To evaluate the prognosis value of average daily platelet amount increase in children with B-cell acute lymphoblastic leukemia(B-ALL) treated by CCCG-ALL-2015 regimen. METHODS: 106 children with primary B-ALL were retrospective analyzed, standardized MRD test protocol was used to detect the MRD level (19 d and 46 d) after chemotherapy. The platelet count was measured by Sysmex XE-2100. Kaplan-Meier survival curve statistics was used to analyze the event free survival(EFS) rate of the children. RESULTS: The trend of negative correlation existed between PPC and TPR (r_s=-0.519, P=0.021). The 3-year EFS rate of the patients in Ap>5.4×10⁹/L group was 95.7%, which was significantly higher than those in Ap≤5.4×10⁹/L group(79.5%) (χ²=5.236, P=0.035); multivariate analysis showed that Ap≤5.4×10⁹/L was the independent prognostic factor affecting survival of the patients (RR=3.978; 95%CI: 1.336-11.523, P=0.041). With both MRD and Ap≤5.4×10⁹/L as candidate variables, Ap≤5.4×10⁹/L lost its independent prognostic value (RR=1.225; 95%CI: 0.892-13.696, P=0.089), the correlation between d 19/d 46 MRD levels and Ap>5.4×10⁹/L (χ²=4.318, P=0.038) could explain the phenomenon. CONCLUSION Ap can reflect the effect of B-ALL chemotherapy and can be used to monitor the curative effect and prognosis of B-ALL children.
Blood Platelets ; Burkitt Lymphoma ; Child ; Disease-Free Survival ; Humans ; Neoplasm, Residual/diagnosis* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy* ; Prognosis ; Retrospective Studies

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

OBJECTIVETo investigate the effect of leukodepleted blood transfusions on peripheral blood Th1/Th2 cell balance in patients with acute lymphoblastic leukemia (ALL).

METHODSFifty-seven ALL patients in our hospital from March 2016 to August 2017 were selected, 31 of them received routine blood transfusion were enrolled in group A, and 26 patients received depleted-blood leukotransfusion were enrolled in group B, 36 cases in normal physical examination at the same period were enrolled in control group. And the basic clinical characteristics of patients were recorded; the ratio of Th1/Th2 cells in peripheral blood of patients was analyzed by flow cytometry;the serum levels of IL-2, IFN-γ, IL-4, IL-10 were detected by ELISA method; the mRNA levels of T-bet and GATA-3 in lymphocytes were detected by RT-PCR;the protein levels of T-bet and GATA-3 in lymphocyte were detected by Western blot.

RESULTSThe Th1/Th2 ratio in peripheral blood of ALL patients significantly related with patient age and risk grade (P<0.05).After treatment,the change of Th1/Th2 ratio in group A showed no statistical difference from Th1/Th2 ratio before treatment (P>0.05), while the Th1/Th2 ratio in group B increased (P<0.05);the levels of IL-2, IFN-γ, IL-4 and IL-10 secreted from Th1 and Th2 cells of ALL patients in A group were not changed significantly(P>0.05), while the levels of IL-2 and IFN-γ secreted from Th1 cells of ALL patients in group B increased, the levels of IL-4 and IL-10 secreted from Th2 cells in group B decreased with statistical difference (P<0.05); the RT-PCR and Western blot showed that the expression levels of T-bet mRNA and T-bet protein in group A were lower than those in control group, while the expression levels of T-bet mRNA and T-bet protein in group B were higher than those in group A (P<0.05); the expression levels of mRNA and GATA-3 protein in group A were higher than those in control group, the expression levels of mRNA and GATA-3 protein in group B were lower than those in group A (P<0.05).

CONCLUSIONThe leukoreduced blood transfusion helps to improve the balance of Th1/Th2 cells in peripheral blood and improve the immune function of patients, which may closely relate with the expression levels of T-bet and GATA-3.

A patient with Down syndrome has hematologic and oncologic disorders of medical complication. Down syndrome shows that characteristic hematologic and oncologic abnormalities and developments of disorders are different at ages. Many hematologic disorders were related to Down syndrome. There are diseases of red blood cells, white blood cell disorders, platelet and bleeding disorders, aplastic anemia, and transient myeloproliferative disease. Acute myeloid leukemia, acute lymphoblastic leukemia, and rarely solid tumors (Neuroblastoma, Wilm's tumor, Hodgkin's lymphoma) are also associated with Down syndrome. We checked clinical manifestations of each disorder and we should make standard hematologic index of different age groups. In addition, the relations between chromosome 21 and hemato-oncologic disorders should be found. We need to investigate potential therapeutic interventions that can improve quality of life and life expectancy in patients with Down syndrome.
Anemia, Aplastic ; Blood Platelets ; Chromosomes, Human, Pair 21 ; Down Syndrome* ; Erythrocytes ; Hemorrhage ; Humans ; Leukemia, Myeloid, Acute ; Leukocytes ; Life Expectancy ; Myeloproliferative Disorders ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Quality of Life ; Wilms Tumor

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

Hematopoietic stem cell transplantation (HSCT) causes many complications such as anorexia, nausea, vomiting, diarrhea, and mucositis. Most patients undergoing HSCT have risk for malnutrition in the process of transplantation so artificial nutrition support is required. The purpose of this case report is to share our experience of applying nutrition intervention during the transplantation period. According to HSCT process, the change of the patient's gastrointestinal symptoms, oral intake and nutritional status was recorded. By encouraging oral intake and providing parenteral nutrition, the patient had only 0.3%, losing weight during the transplantation period. In conclusion, it emphasized that the nutritional status changes during the HSCT period should be closely monitored and nutritional management through appropriate nutritional support and interventions in hospital and after discharge.
Anorexia ; Diarrhea ; Hematopoietic Stem Cell Transplantation ; Humans ; Malnutrition ; Mucositis ; Nausea ; Nutritional Status ; Nutritional Support ; Parenteral Nutrition ; Peripheral Blood Stem Cell Transplantation* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Vomiting

Various endocrine dysfunctions occur during chemotherapy, including hypoglycemia. However, reports of hypoglycemia associated with 6-mercaptopurine (6-MP) are rare. Herein, we report an 8-year-old boy with severe symptomatic hypoglycemia likely due to 6-MP during chemotherapy. He had been diagnosed with acute lymphoblastic leukemia 3 years previously and was in the maintenance chemotherapy period. Treatment included oral dexamethasone, methotrexate, and 6-MP, of which only 6-MP was administered daily. Hypoglycemic symptoms appeared mainly at dawn, and his serum glucose dropped to a minimum of 37 mg/dL. Laboratory findings showed nothing specific other than increased serum cortisol, free fatty acids, ketone, alanine aminotransferase, and aspartate aminotransferase. Under the hypothesis of hypoglycemia due to chemotherapy drugs, we changed the time of 6-MP from evening to morning and recommended him to ingest carbohydrate-rich foods before bedtime. Hypoglycemia improved dramatically, and there was no further episode during the remaining maintenance chemotherapy period. To the best of our knowledge, this is the first report of this type of hypoglycemia occurring in an Asian child including Korean.
6-Mercaptopurine* ; Alanine Transaminase ; Asian Continental Ancestry Group ; Aspartate Aminotransferases ; Blood Glucose ; Child* ; Dexamethasone ; Drug Therapy* ; Fatty Acids, Nonesterified ; Humans ; Hydrocortisone ; Hypoglycemia* ; Maintenance Chemotherapy ; Male ; Methotrexate ; Precursor Cell Lymphoblastic Leukemia-Lymphoma*

Herpes zoster is caused by the reactivation of the varicella-zoster virus, and it typically presents as single dermatomal rash and vesicles. It can cause postherpetic neuralgia as a common complication. In immunocompromised patients, the lesions can be cutaneous, disseminated into two non-contiguous dermatomes, and this entity is referred to as herpes zoster duplex unilateralis or bilateralis. We present a case of postherpetic neuralgia after herpes zoster duplex bilateralis in a 60-year-old immunocompromised man. He had a past history of acute lymphocytic leukemia and was treated with allogeneic peripheral blood stem cell transplantation 1 year before herpes zoster reactivation. His postherpetic neuralgia pain was difficult to treat and it was refractory to conservative medication and neuraxial block.
Exanthema ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Immunocompromised Host* ; Middle Aged ; Neuralgia, Postherpetic* ; Peripheral Blood Stem Cell Transplantation ; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Acute lymphocytic leukemia (ALL) is uncommon lymphoid malignancy in dogs, and its diagnosis is challenging. A 14-year-old spayed female mixed breed dog was transferred to a veterinary medical teaching hospital for an immediate blood transfusion. The dog showed lethargy, pale mucous membranes, and a weak femoral pulse. Complete blood count revealed non-regenerative anemia and severe leukopenia with thrombocytopenia. ALL was tentatively diagnosed based on the predominance of immature lymphoblasts on blood film examination. For confirmation of lymphoid malignancy, PCR for antigen receptor rearrangement (PARR) on a peripheral blood sample and flow cytometry analysis were performed after blood transfusion. Flow cytometry analysis revealed that lymphocyte subsets were of normal composition, but PARR detected a T-cell malignancy. The dog was diagnosed with ALL and survived 1 wk after diagnosis. In conclusion, after blood transfusion, flow cytometry was not a reliable diagnostic method for an ALL dog, whereas PARR could detect lymphoid malignancy. Our results suggest that PARR should be the first-line diagnostic tool to detect canine lymphoid malignancy after a blood transfusion.
Adolescent ; Anemia ; Animals ; Blood Cell Count ; Blood Transfusion* ; Diagnosis* ; Dogs* ; Female ; Flow Cytometry ; Hospitals, Teaching ; Humans ; Lethargy ; Leukopenia ; Lymphocyte Subsets ; Methods ; Mucous Membrane ; Polymerase Chain Reaction* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Receptors, Antigen* ; T-Lymphocytes ; Thrombocytopenia

We describe our experience regarding metronidazole-induced encephalopathy in a patient with acute lymphoblastic leukemia during chemotherapy. A 17-year-old girl was admitted to our institution with complaints of abdominal pain and mucoid stools. She was diagnosed with acute lymphoblastic leukemia and had been undergoing intensified chemotherapy protocol. During the fifth week of interim maintenance-1 therapy, she developed a fever and complained of chills. On stool examination, stool occult blood was positive and Clostridium difficile toxin A/B test was positive. She was started on metronidazole treatment for possible Clostridium difficile infection and other inflammatory gastrointestinal diseases. Ten days later, the patient complained of dizziness and nausea. A brain MRI was performed to make a differential diagnosis of any chemotherapy- induced CNS complication such as necrotizing leukoencephalopathy. The brain MRI showed features of metronidazole-induced encephalopathy. Metronidazole was discontinued and symptoms started to subside four days after. A follow-up brain MRI performed at four weeks showed that lesions of the dentate nucleus had disappeared.
Abdominal Pain ; Adolescent ; Brain ; Brain Diseases ; Cerebellar Nuclei ; Chills ; Clostridium difficile ; Diagnosis, Differential ; Dizziness ; Drug Therapy ; Female ; Fever ; Follow-Up Studies ; Gastrointestinal Diseases ; Humans ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Metronidazole ; Nausea ; Occult Blood ; Precursor Cell Lymphoblastic Leukemia-Lymphoma