Iranian Journal of Pediatric Hematology and Oncology
Volume:13 Issue: 4, Autumn 2023

The scattered radiation from the treatment volume might be more significant for children than for adults because of life expectancy. The present study used biological effects of ionizing radiation (BEIR) VII models to estimate radiation-induced secondary cancer risks in irradiated organs following three-dimensional conformal radiation therapy (3D-CRT) of Acute Lymphocytic Leukemia (ALL) in children. Both excess absolute risk (EAR) and excess relative risk (ERR) models were used to estimate the secondary cancer risks of eye lenses, thyroid, parotid, breast, and region overlying ovaries.

In this expository cross-sectional study, from 45 patients who were examined, 16 patients age under 18 years (mean age of 9.6) met the criteria for entering the study in Shahid Ramezanzadeh Hospital in Yazd underwent whole brain radiotherapy (WBRT) using COMPACT accelerator. Measurement was performed using thermoluminescent dosimeters (TLD). After radiation therapy, the secondary cancer risk in these organs was calculated.

The organ dose mean values in female patients were 1.8±0.1, 1.65±0.61, 1.47±0.04, 0.1±0.03, and 1.58±0.52 cGy in the eye lenses, parotid, thyroid, breast, and region overlying ovaries, respectively and 2.7±0.6, 0.76±0.17, 0.6±0.05, and 0.005±0.002 cGy for eye lens, parotid, thyroid, breast, and testis of male patient, respectively. The ERR and EAR were estimated after 3, 5, 10, 15 and 20 years for eye lens, parotid breast, and ovary/testis for female/male.

Higher risk values were found for eye lenses and thyroid. The scattered rays decreased by increasing the organ distance from the treatment radiation field.

Despite breakthroughs in the development of chemotherapy drugs to treat pediatric B-acute lymphoblastic leukemia (B-ALL), the relapse rate remains a major therapeutic challenge, requiring more detailed characterization of molecular elements underlying disease development and resistance to treatment. Checkpoint kinase 1 (CHK1) and checkpoint kinase 2 (CHK2) are two critical mediators of the DNA damage response (DDR) mechanism that activate the downstream components responsible for DNA repair, cell cycle regulation, and apoptosis. It has been shown that altered expression of CHK1 and CHK2 in various tumor entities promotes tumorigenesis and disease progression.

In this case-control study, we evaluated the relative expression status of CHK1 and CHK2 genes in pediatric B-ALL patients at diagnosis (n=20), during complete remission (n=23) and relapse phase (n=10), as well as 20 peripheral blood samples from healthy children as a normal control group. The mRNA expression levels of CHK1 and CHK2 were determined by the Real-time PCR method. Data were compared using the Mann–Whitney U test for the relative expression level of target mRNA in different phases of B-ALL. Data were presented as median and statistical significance was described as a P-value less than 0.05.

Our results revealed that CHK1 expression increased in newly diagnosed patients than in healthy individuals (p ≤ 0.001). Relapsed patients had higher CHK1 expression than the newly diagnosed (p ≤ 0.05) and complete remission (p ≤ 0.001) counterparts. CHK2 was overexpressed in all phases of the diseases (p ≤ 0.001) without any significant alteration among the studied groups.

Given the CHK1 ability to endow cancer cells with a survival advantage upon chemotherapy, the present study suggests it as a potentially promising target in the fight against B-ALL.

Human bone marrow mesenchymal stem cells (hBM -MSCs), as supporters for hematopoiesis, differentiate into osteoblasts and adipocytes. Studies showed that infection of hBM -MSCs by Parvovirus B19 (B19V) can affect the differentiation capability of hBM -MSCs. This study aims to evaluate B19V effects on the differentiation of hBM -MSCs.

In this experimental study hBM -MSCs were cultured up to passage 3. Nucleofection was subsequently employed to deliver a plasmid containing the B19V genome into the cells. The transfected cells were then differentiated into osteoblast and adipocyte lineages. qRT -PCR was then performed to analyze the differentiation 14 days after transfection.

On the 14th day after induction the findings demonstrated a significant increase in adipocyte -specific (PPARγ and LPL) gene expression compared to the control group (p<0.05) and a slight but not statistically significant decrease in the expression of the osteocyte -specific genes (RUNX2 and osteocalcin) (p>0.05).

The results suggest that B19V infection can promote the differentiation of hBM -MSCs towards adipocytes and affect the bone marrow microenvironment as well as hematopoiesis.

Iron chelating agents (ICAs) may induce changes in the blood and the liver indices. This study aimed to compare the effects of deferasirox (oral) and deferoxamine (parenteral) on the hematological and liver indices.

A cross -sectional study was conducted on patients at the Thalassemia Center in Sulaymaniyah, Iraq. The study included 76 β -thalassemia major children (37 females and 39 males, with a median age of 6 years). The patients were divided into Group I (n = 51, treated with deferasirox) and Group II (n = 25, treated with deferoxamine). Complete blood count and liver enzymes (alanine [ALT] and aspartate [AST] aminotransferase) were determined; the hemoglobin densities were calculated to differentiate absolute from restrictive iron deficiency; and the fibrosis-4 score (FIB-4, aspartate-to-platelet ratio index (APRI), and (AST/ALT ratio) were calculated.

Hemoglobin density indices showed restricted iron deficiency in both treated groups . However, serum ferritin level was higher in Group II than in Group I (1.9 times higher, p=0.037). Also, the median value of MCV in Group II was significantly higher than in Group I (79.8 fL vs. 77.0 fL, respectively). In contrast, liver fibrosis indices defined with the mean values of AST -to -ALT ratio and FIB -4 score were higher in Group I compared to Group II. A positive and significant correlation was observed between APRI level and serum ferritin in Group I (r = 0.518, df = 49, p<0.001).

Based on the data, it can be concluded that both deferasirox and deferoxamine affect red blood cells parameters , which may be related to their function as ICAs, leaing to temporary iron deficiency in treated patients. Both drugs may induce inconsistent changes in the liver which are highly associated with circulating ferritin level. However, the destructive effect of deferasirox on the liver is more evident, leading to the induction of fibrosis.

The mainstay of managing severe β -thalassemia remains lifelong blood transfusion. Mismatched red blood cell phenotypes between donors and recipients in multiple blood transfusions can result in the development of alloimmunization in recipients. The aim of this study was to determine the frequency of major and subgroup antigens and their phenotypes in thalassemia major patients.

This cross -sectional descriptive study was performed on 105 patients with thalassemia major who referred to Baghaei Hospital in Ahvaz in 2021. Their alloimmunization to erythrocyte antigens was determined with standard tubular antibody search kits.

Among the thalassemia major patients participating in the study, 51 were female (48.45%). The mean age of the participants was 21.10 ± 5.8 years. Out of the 105 patients studied, 26 had detectable alloantibodies in the serum (24.7%). The two groups of patients with positive and negative alloantibodies were significantly different in terms of Rh and C blood groups (P -values of 0.03 and 0.05, respectively). There was no significant association between the existence alloantibody and age, gender, spleen condition and the time of first transfusion (P > 0.05).

It was concluded that red blood cell matching, at least for Rh and C groups, is necessary to prevent alloimmunization in thalassemia major patients.

Β-thalassemia is the severe form of genetic illnesses which decreases the hemoglobin synthesis. One of the major complications in thalassemic syndromes, including β -thalassemia major and intermedia is thromboembolic events. In addition, thromboembolic events are more common in non -transfusion -dependent thalassemia than those in well -transfusion -dependent β -thalassemia. A combination of hypercoagulable states including, abnormalities in red blood cells, and platelet, antithrombin III, protein C, and protein S, and splenectomy are involved in thrombotic events, but thromboembolic events can be prevented and treated in these patients via blood transfusion, hydroxyurea, anticoagulants, and aspirin. Moreover, recent studies have demonstrated the involvement of the brain lesion in β -thalassemia patients. The involvement of vascular events of brain in patients with β -thalassemia intermedia is 29 -83%, but the rate of asymptomatic brain lesions in the healthy people is 0 -11%. In addition, neurological complications which have been attributed to various factors are chronic hypoxia, iron overload, bone marrow expansion, and desferrioxamine neurotoxicity. This review evaluated thromboembolic events and neurological lesions in patients with β -thalassemia and its probable curative therapy.

Abstract Hepatitis A Virus (HAV) infection is a benign, self-limited gastrointestinal infection of children. Autoimmune hematological manifestation is very rare in children. Here, we report an 11 -year -old male child having HAV infection with acute liver failure, complicated with persistent thrombocytopenia and haematuria during the course of illness and eventually diagnosed as a case of HAV infection associated with immune thrombocytopenic purpura. The child was treated successfully with a short course of steroid therapy.