Iranian Journal of Pediatric Hematology and Oncology
Volume:14 Issue: 2, Spring 2024

DNA methylation is catalyzed by DNA methyltransferases (DNMTs) which are encoded by DNMT1, DNMT3A, and DNMT3B. DNMTs play a major role in the abnormal methylation of tumor suppressors and cancer-related genes. Herein, this study explored the expression profile of DNMTs in pediatric patients with B-cell acute lymphoblastic leukemia (ALL), before and after methotrexate (MTX)/mercaptopurine (6-MP) treatment.

This before-after prospective study included 30 matched children in sex and age (20 children with B-cell ALL and 10 healthy children used as a control or calibrator group). The expression profile of DNMTs was assessed at two-time points; at the diagnosis time and after MTX/6-MP treatment in the consolidation-maintenance phase of therapy. Notable, all pediatric patients included in this study continued the therapy without adverse events, except two children who were excluded from the study.

The average age of the patient group was 7.1 ± 1.3 years (in the range of 4-9 years), and the average age of the control group was 8.3 ± 1.7 years (6-10 years). The expression profile of DNMTs in B-cell ALL children was obtained completely different from that in the healthy group. After MTX/6-MP treatment of B-cell ALL children, the expression levels of DNMT1 and 3A were increased (p <0.01 & 0.04, respectively), and the expression level of DNMT3B was decreased (p <0.01), significantly.

In ALL, the expression profile of DNMTs would be changed whereby contribute to abnormal growth and maturation capacity of leukemic stem cells and MTX/6-MP treatment could reverse this profile from a cancerous phenotype to the normal one.DNA Methyltransferases (DNMTs), Methotrexate (MTX), Mercaptopurine (6-MP)

Due to the toxicity of chemotherapy drugs in cancer patients, thrombocytopenia can lead to bleeding. Trifolium pratense L. is traditionally used as an anti-inflammatory compound for the treatment of various diseases. The aim of the present study was to evaluate the effect of T. pratense (red clover) extract (TPE) on thrombocytopenia and the related factors in a rat model of chemotherapy.

In this experimental in vivo study, 28 rats were randomly divided into four groups of seven members (four males and three females) including Group1 as the control subjects, Group2 as thrombocytopenia cases, and Groups 3 and 4 with thrombocytopenic animals receiving TPE (100 and 200 mg/kg). Thrombocytopenia was induced by intraperitoneal injection of cyclophosphamide (CP) on three consecutive days. Then, the TPE was fed to rats for 14 days. At the end of the study, the rats' weight was measured. Blood samples were collected, complete blood count (CBC) was performed, and PF4 and clotting time were measured. After the dissection of the animals, the bone marrow and spleen were separated, and hisopathological changes were determined. The data were analyzed by one-way ANOVA and a post-hoc Tukey test.

Cyclophosphamide decreased the platelets and the white blood cells (WBCs) and increased PF4 and the clotting time significantly (P < 0.05). Also, TPE significantly increased the platelets and the WBC counts but decreased the time of clotting and the PF4 factor (P < 0.05). TPE increased megakaryocyte (P < 0.001) and enhanced the bone marrow and spleen cellularity.

T. pratense can increase the number of platelets and WBCs and improve thrombocytopenia and bone marrow cellularity induced by chemotherapy.

Microarray technology enables the examination of gene expression in thousands of genes and can be highly effective in identifying various types of cancers, including leukemia. However, many genes in microarray data are redundant and lack useful information for cancer diagnosis. The main objective of this study is to identify relevant and effective genes in classification of leukemia microarray data using a spline regression-based method, taking into account the correlation between genes.

In this analytical study, leukemia microarray data are used to identify relevant genes in classification of leukemia into Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL) using a spline regression-based gene selection method, called SRS3FS based on ℓ2,p-norm (0 < p ≤ 1). Subsequently, the support vector machine (SVM) algorithm is employed to classify leukemia data into AML and ALL.

In this study, the classification results of SVM algorithm for 5, 10, 15, and 20 genes reveal that the SRS3FS method, employing ℓ2,1/4-norm, ℓ2,1/2-norm and ℓ2,3/4-norm, exhibited the highest accuracy of 97.06% when identifying 10 genes for distinguishing between AML and ALL. Moreover, the leukemia data was classified into AML and ALL with an accuracy of 100%, using a gene identified by the SRS3FS method based on ℓ2,3/4-norm and ℓ2,1-norm. The gene labeled as number 3252, annotated as GLUTATHIONE S-TRANSFERASE, MICROSOMAL, is recognized as the most important gene.

The experimental results on leukemia microarray data demonstrate that the spline regression-based gene selection method can effectively identify relevant genes in classification and prediction of leukemia.

It is of paramount significance to address the needs of parents who have children with cancer. This research aims to analyze the health information needs of families with children suffering from cancer in Yazd city.

This descriptive-analytical study was conducted on a total of 248 individuals from families whose children underwent cancer treatment at Shahid Sadoughi Hospital in Yazd. The participants were selected through a non-random, purposeful, and voluntary sampling method. The data were collected using a comprehensive questionnaire consisting of 48 items. The data analysis was performed with the SPSS software version 25 and through t-tests, chi-square, ANOVA, and correlation analyses.

Through a meticulous comparison of the scores obtained with a predetermined threshold of 3, all levels of information needs were satisfactorily met. However, it became evident that the parents needed more information to be given by the treatment staff regarding cancer and called for social, economic and spiritual support (p≤0.5). Moreover, the study identified and prioritized the information needs based on the average scores across the four examined factors. The highest-priority need was identified as “the information about cancer provided by the treatment staff"(2.99±0.7). The second most important need was found to be "social, economic and spiritual support"(2.98±0.7). The third priority was assigned to “the accessibility and exchange of relevant health information"(2.77±0.62). Lastly, the fourth priority pertained to"health facilities, services and counseling"(2.61±0.63). Furthermore, the independent t-test revealed that the average score on the total health information needs of the families with cancer-affected children was significantly higher for the women (140.5±20.4) than for the men (117.7± 11.55).

When handling children with cancer, it is crucial for the treatment staff to provide information about cancer and give social, economic and spiritual support in order to fully meet the information requirements of the families involved.

This study aimed to assess the epidemiological, clinical, and therapeutic aspects and prognosis of juvenile nasopharyngeal carcinoma in Tunis country.

This study included 68 patients, younger than 18 years of age. All the patients had a clinical and para-clinical tumoral assessment. The study of survival and prognostic factors was done after a descriptive analysis. These prognostic factors were studied through uni and multivariate analysis.

The median age was 14.7 years and the sex ratio was 2 male to 1 female. The average time to first consultation was 4 months. Rhinological signs were the most frequent symptom for consultation (n= 41). The T3-T4 tumors accounted for 78% of patients and there was a lymph node invasion stage N2-N3 in 63% of cases. Non-metastatic patients had radiotherapy associated with chemotherapy in 97% of cases. Metastatic patients received hypofractionated radiotherapy on bone metastasis, and first-line chemotherapy followed by radiotherapy on the primitive tumor and lymph node areas in case of good response to chemotherapy ( n= 2). The mean follow-up was 94 months; 78% of these patients were alive and in complete remission, 19% were in therapeutic failure, and 16% of them had metachronous metastases. The five-year-overall survival was 95%. Hyposialia and skin dystrophy were the most frequent late complications.
In univariate analyses, significant prognostic factors were cranial nerve invasion, intracranial invasion, and infra-temporal fossa invasion. In multivariate analysis, the most parsimonious model associated extension to the infratemporal fossa, endo-cranial extension, and initial therapeutic modality (treatment failures were less frequent with neoadjuvant chemotherapy (p= 0.22)). 

Treatment of nasopharyngeal carcinoma in children consists of chemotherapy and radiotherapy. Synchronous or metachronous metastases are common in this patient population. Modern radiotherapy techniques, including conformal radiotherapy with intensity modulation, are promising and could overcome toxicities in long-term survivors.

One of the complications of sickle cell disease (SCD) is hearing loss. The purpose of the present study is to determine the prevalence of hearing loss in SCD.

This is a descriptive-analytical cross-sectional study conducted on 100 patients with SCD in 2019-2020. All the patients underwent otololaryngological examination and audiometric tests to assess their hearing status. The type and severity of hearing loss were determined, the demographic information of the patients was recorded, and the data were analyzed using the SPSS software version 21, a Chi-square test, and the Kruskal-Wallis test. The P-values of < 0.05 were considered statistically significant.

The mean age of the patients was 17.6 ± 10.8 years. Of them, 60% were male. Hearing loss was diagnosed in 26 patients (26%), 16 of whom had sensorineural hearing loss (SNHL) and 10 had conductive hearing loss (CHL). In terms of the disease severity, 12, 10, 3 and 1 patients had mild, moderate, severe and profound hearing loss, respectively. The mean age of the patients with SNHL was significantly higher than the median age of the subjects with CHL (p-value = 0.043). Also, the patients with hearing loss had no statistically significant difference in terms of the variables of age, gender, unilateral or bilateral ear involvement and type of SCD (p-value = 0.069).

This study revealed a hearing loss frequency of 26% among patients with SCD. Regular hearing assessment and timely treatment and rehabilitation measures are recommended for these patients.

Hematopoietic stem cell transplantation commonly known as bone marrow transplantation (BMT) or allogeneic BMT (using healthy blood stem cells from a donor) is the preferred therapeutic option for numerous blood-related conditions, both malignant and non-malignant. It is often the sole therapy strategy and essential for relapsed and refractory hematologic malignancies. There have studies regarding BMT on regimen containing total body irradiation (TBI) and a regimen without TBI. It is expected that TBI-based conditioning regimens provide better antitumor effects than chemotherapy regimens. The primary objective of TBI is to eradicate the recipient's bone marrow, facilitating the successful engraftment of donor bone marrow. Acute lymphoid leukemia (ALL) is the principal indication for TBI in bone marrow transplantation.  Other diseases including Hodgkin’s lymphoma, chronic myeloid leukemia (CML), acute myeloid leukemia (AML), multiple myeloma (MM), etc., may benefit from TBI-based regimens; however, TBI use is associated with many side effects.The main complications of patients who underwent TBI-containing conditioning regimens in bone marrow transplantation are vomiting and nausea, with frequencies of approximately 66% and 35%, respectively. However, these events are easily managed. Acute complications include stomatitis, diarrhea, loss of appetite, temporary loss of taste, rash and asthenia. Moreover, veno-occlusive disease, interstitial pneumonitis, lung side effects, growth hormone deficiency, neurological side effects, cataracts, renal toxicity, endocrine impairments, and infertility are other complications in patients who underwent TBI-containing conditioning regimens in bone marrow transplantation. In review article, a complication of total-body irradiation in allogeneic bone marrow transplantation was assessed.

Wilms tumor (WT) is the most common malignant tumor (neoplasm) of the urinary tract in early childhood. The median age at WT diagnosis is 3-4 years, and 90% of cases are diagnosed before the age of 7 years. In this report, three adolescent patients with WT, aged 12, 17 and 16, are investigated. Left kidney involvement was observed in these three cases. The clinical presentation in case one was the complaint of abdominal pain with a palpable abdominal mass. The second case was presented with hematuria and an abdominal mass. The clinical symptoms in case three included left flank pain and weight loss. Although WT is usually observed in children under 7 years of age, its diagnosis should also be expected in older children with abdominal pain, palpable mass and gross hematuria.