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Diagnosis and Laboratory Features of the Childhood Acute Leukemias

Year 2020, Volume: 42 Issue: 3, 296 - 300, 27.05.2020
https://doi.org/10.20515/otd.540255

Abstract

The leukemias may be defined as a
group of malignant diseases in which genetic abnormalities in a hematopoietic
cell give rise to an unregulated clonal proliferation of cells.  Leukemias account for 30% of childhood
cancers, and acute lymphoblastic leukemia (ALL) in 75% of leukemias. Ionizing
radiation, chemical agents, drugs and some genetic diseases are some risk risk
factors that cause leukemia. The most common complaints are fever, mucosal
hemorrhage, pallor,  pain in the long
bones . Leukemias are suspected  to the
history, phyical examination, blood count and biochemistry and supported by
atypical cell monitoring in peripheral blood smear. Bone marrow samples are taken
from the patients, morphological, 
immunological and genetically examine for  a definitive diagnosis. The aim of this study
was to evaluate the findings and laboratory features of the patients with
leukemia who diagnosed in our clinic.One hundred and two patients were included
in the study  who were diagnosed with
acute leukemia in a tertiary health care university hospital, Complaints,
physical examination and laboratory findings of patients were retrospectively
recorded. The data were evaluated using SPSS 17.0 software. The most common
primary presentation complaints  of
patients with a median age of 6.5 years (0.7-17 years)  were fever, fatigue and bone pain. Sixty
three per cent  hepatomegaly, 61% lymphadenopathy
and 50% splenomegaly were found in physical examination. Pancytopenia was found
in 55/102 (54%) and bisitopenia 37/102 (36%) isolated anemia in 10/102 (10%)
patients. While no isolated thrombocytopenia or neutropenia was detected,
neutropenia + thrombocytopenia was observed in three patients with normal
hemoglobin age. In blood biochemistry, LDH 
and uirc acide were found higher than normal levels in patients , 91%  and 33%, respectively. Most of the patients
with ALL who made up 85% of the patients complied with preB  immunophenotype and standard (low) risk group.
Survival rates of survival have been achieved over the years, while treatment
according to risk class, treatment with minimal residual disease and advanced
care services are the main factors. Patients with fever, hemorrhage and/or bone
pain and who have organomegaly and lymphadenopathy are detected in physical
examination, normositer anemia and LDH elevation were the leading causes of
leukemia in pediatric patients. Family physicians and pediatricians do not
comply with the characteristics we have summarized, children with suspicion of
leukemia should be provided by the  Pediatric Hematolo-Oncologists.

References

  • 1. Kliegman RM, et al editors. Nelson Textbook of Pedaitrics. 20th ed. vol 1, 2016.
  • 2. Kutluk T. Çocukluk çağı kanserlerinin epidemiyolojisi. Klinik Gelişim, 2007; 20: 5–12.
  • 3. Schüz J, Erdmann F. Environmental Exposure and Risk of Childhood Leukemia: An Overview. Arch Med Res. 2016 Nov;47(8):607-614.
  • 4. Porter CC, Druley TE, Erez A, Kuiper RP, Onel K, Schiffman JD, Wolfe Schneider K, Scollon SR, Scott HS, Strong LC, Walsh MF, Nichols KE. Recommendations for Surveillance for Children with Leukemia-Predisposing Conditions. Clin Cancer Res. 2017 Jun 1;23(11): 14-22.
  • 5. Lanzkowsky P, et al editors. Lankowsky Manual of Pediatric Hematology & Oncology, 6th ed. 2016.
  • 6. Hunger SP, Mullighan CG. Acute Lymphoblastic Leukemia in Children. N Engl J Med. 2015 Oct 15;373(16):1541-52.
  • 7. Pui CH, Yang JJ, Hunger SP, Pieters R, Schrappe M, Biondi A, Vora A, Baruchel A, Silverman LB, Schmiegelow K, Escherich G, Horibe K, Benoit YC, Izraeli S, Yeoh AE, Liang DC, Downing JR, Evans WE, Relling MV, Mullighan CG. Childhood Acute Lymphoblastic Leukemia: Progress Through Collaboration. J Clin Oncol. 2015 Sep 20;33(27):2938-48.
  • 8. Carroll WL, Hunger SP. Therapies on the horizon for childhood acute lymphoblastic leukemia. Curr Opin Pediatr. 2016 Feb;28(1):12-8.
  • 9. Inaba H, Greaves M, Mullighan CG. Acute lymphoblastic leukaemia. Lancet. 2013 Jun 1;381(9881):1943-55.
  • 10. Kline MW, et al editors. Rudolph’s Pediatrics, 23rd ed. 2018.
  • 11. Lustosa de Sousa DW, de Almeida Ferreira FV, Cavalcante Félix FH, de Oliveira Lopes MV. Acute lymphoblastic leukemia in children and adolescents: prognostic factors and analysis of survival. Rev Bras Hematol Hemoter. 2015 Jul-Aug;37(4):223-9.
  • 12. Fantin VR, St-Pierre J, Leder P. Attenuation of LDH-A expression uncovers a link between glycolysis, mitochondrial physiology, and tumor maintenance. Cancer Cell. 2006 Jun;9(6):425-34.
  • 13. Miao P, Sheng S, Sun X, Liu J, Huang G. Lactate dehydrogenase A in cancer: a promising target for diagnosis and therapy. IUBMB Life. 2013 Nov;65(11):904-10.
  • 14. Hazar V, Karasu GT, Uygun V, Akcan M, Küpesiz A, Yesilipek A. Childhood acute lymphoblastic leukemia in Turkey: factors influencing treatment and outcome: a single center experience. J Pediatr Hematol Oncol. 2010 Nov;32(8):e317-22.

Çocukluk Çağı Akut Lösemilerinin Tanı ve Laboratuvar Özellikleri

Year 2020, Volume: 42 Issue: 3, 296 - 300, 27.05.2020
https://doi.org/10.20515/otd.540255

Abstract

Genetik anomallik içeren
hematopoietik hücrelerin kontrolsüz çoğalmaları lösemi olarak adlandırılır. Çocukluk çağı kanserlerinin %30’unu
lösemiler, lösemilerin %75’ini akut lenfoblastik lösemi (ALL) oluşturur.
İyonize radyasyon, kimyasal ajanlar, ilaçlar ve bazı genetik hastalıklar lösemi
oluşturan bazı risk faktörleriyken; ateş, mukozal kanamalar, solukluk, kemik
ve  eklemlerde ağrı en sık başvuru  yakınmalarıdır. Öykü, fizik inceleme, kan
sayımı ve biyokimyası ile şüphe doyulan lösemi hastalığının tanısı, periferik
kan yaymasında atipik hücre izlenmesi ile desteklenir. Hastaların kemik
iliğinden alınan örneklerin  morfolojik,
immünolojik  ve genetik  incelemelerinin sonucunda kesin tanı konulur.
Araştırmada kliniğimizde tanı alan lösemili hastaların başvuru bulgularını ve
laboratuvar  özelliklerini irdelemeyi
amaçladık. Bu araştırmada üçüncü basamak sağlık hizmeti veren bir üniversite
hastanesi Çocuk Hematoloji-Onkoloji Bilim Dalında akut lösemi tanısı alan 102
hastanın; yakınma, fizik inceleme ve laboratuvar bulguları retrospektif kayıt
altına alındı. Verilerin
değerlendirmesi SPSS 17.0 programı kullanılarak
yapıldı.
Ortanca yaşları 6,5 yıl (0,7-17 yıl)
olan hastaların en sık birincil başvuru yakınmaları sırasıyla ateş, halsizlik
ve kemik ağrısı olurken fizik incelemelerde %63 hepatomegali, %61 lenfadenopati
ve %50 splenomegali saptandı. Pansitopeni 55/102 (%54), bisitopeni 37/102 (%36)
izole anemi 10/102 (%10) hastada saptandı. İzole trombositopeni veya nötropeni
saptanmazken, başvuruda yaşına göre normal düzeyde hemoglobine sahip 3 hastada
nötropeni + trombositopeni olduğu görüldü. Kan biyokimyasında LDH düzeyi %91,
ürik asid %33 hastada çalışılan testin üst sınırından yüksek saptandı.
Hastaların
%85’ini oluşturan ALL’li olguların çoğu ‘preB’ immünfenotipe ve standart
(düşük) risk grubuna uymaktaydı.
Sağ kalım oranlarında yıllar içerisinde
büyük başarı yakalanırken, bu sonuçlarda 
risk sınıfına göre tedavi, minimal kalıntı hastalıkla tedavi yönetimi ve
gelişmiş bakım hizmetleri ana etmendir.
Ateş, kanama ve kemik ağrısı
yakınmalarının eşlik ettiği organomegali ve lenfadenopatinin fizik incelemede
saptandığı olgularda normositer anemi ve LDH yüksekliği çocuk hastalarda ilk
karşılaşmada lösemi öntanısını ilk sıraya çıkarmaktadır. Aile hekimleri ve
pediatristlerin özetlediğimiz özelliklere uymasa da lösemi şüphesi olan
çocukların  Çocuk Hematolo-Onkologları
tarafından değerlendirmesini sağlanmaları şarttır.

References

  • 1. Kliegman RM, et al editors. Nelson Textbook of Pedaitrics. 20th ed. vol 1, 2016.
  • 2. Kutluk T. Çocukluk çağı kanserlerinin epidemiyolojisi. Klinik Gelişim, 2007; 20: 5–12.
  • 3. Schüz J, Erdmann F. Environmental Exposure and Risk of Childhood Leukemia: An Overview. Arch Med Res. 2016 Nov;47(8):607-614.
  • 4. Porter CC, Druley TE, Erez A, Kuiper RP, Onel K, Schiffman JD, Wolfe Schneider K, Scollon SR, Scott HS, Strong LC, Walsh MF, Nichols KE. Recommendations for Surveillance for Children with Leukemia-Predisposing Conditions. Clin Cancer Res. 2017 Jun 1;23(11): 14-22.
  • 5. Lanzkowsky P, et al editors. Lankowsky Manual of Pediatric Hematology & Oncology, 6th ed. 2016.
  • 6. Hunger SP, Mullighan CG. Acute Lymphoblastic Leukemia in Children. N Engl J Med. 2015 Oct 15;373(16):1541-52.
  • 7. Pui CH, Yang JJ, Hunger SP, Pieters R, Schrappe M, Biondi A, Vora A, Baruchel A, Silverman LB, Schmiegelow K, Escherich G, Horibe K, Benoit YC, Izraeli S, Yeoh AE, Liang DC, Downing JR, Evans WE, Relling MV, Mullighan CG. Childhood Acute Lymphoblastic Leukemia: Progress Through Collaboration. J Clin Oncol. 2015 Sep 20;33(27):2938-48.
  • 8. Carroll WL, Hunger SP. Therapies on the horizon for childhood acute lymphoblastic leukemia. Curr Opin Pediatr. 2016 Feb;28(1):12-8.
  • 9. Inaba H, Greaves M, Mullighan CG. Acute lymphoblastic leukaemia. Lancet. 2013 Jun 1;381(9881):1943-55.
  • 10. Kline MW, et al editors. Rudolph’s Pediatrics, 23rd ed. 2018.
  • 11. Lustosa de Sousa DW, de Almeida Ferreira FV, Cavalcante Félix FH, de Oliveira Lopes MV. Acute lymphoblastic leukemia in children and adolescents: prognostic factors and analysis of survival. Rev Bras Hematol Hemoter. 2015 Jul-Aug;37(4):223-9.
  • 12. Fantin VR, St-Pierre J, Leder P. Attenuation of LDH-A expression uncovers a link between glycolysis, mitochondrial physiology, and tumor maintenance. Cancer Cell. 2006 Jun;9(6):425-34.
  • 13. Miao P, Sheng S, Sun X, Liu J, Huang G. Lactate dehydrogenase A in cancer: a promising target for diagnosis and therapy. IUBMB Life. 2013 Nov;65(11):904-10.
  • 14. Hazar V, Karasu GT, Uygun V, Akcan M, Küpesiz A, Yesilipek A. Childhood acute lymphoblastic leukemia in Turkey: factors influencing treatment and outcome: a single center experience. J Pediatr Hematol Oncol. 2010 Nov;32(8):e317-22.
There are 14 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section ORİJİNAL MAKALE
Authors

Ersin Toret 0000-0002-6379-8326

Yeter Düzenli Kar 0000-0003-2917-7750

Ayşe Bozkurt Turhan This is me 0000-0002-6671-0596

Zeynep Canan Özdemir 0000-0002-9172-9627

Özcan Bör 0000-0002-1662-3259

Publication Date May 27, 2020
Published in Issue Year 2020 Volume: 42 Issue: 3

Cite

Vancouver Toret E, Düzenli Kar Y, Bozkurt Turhan A, Özdemir ZC, Bör Ö. Çocukluk Çağı Akut Lösemilerinin Tanı ve Laboratuvar Özellikleri. Osmangazi Tıp Dergisi. 2020;42(3):296-300.


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