Oral manifestations in pediatric patients receiving chemotherapy for acute lymphoblastic leukemia.

The purpose of this study was to determine the prevalence of oral manifestations in pediatric patients with acute lymphoblastic leukemia (ALL) receiving chemotherapy, and to evaluate the significance of independent risk factors (oral health, gender, age, time and type of treatment, and phase of chemotherapy). A cross-sectional study was made in 49 children with ALL between 2 and 14 years of age. To describe oral manifestations, a clinical diagnosis was made and the following criteria were applied: the OHI-S index to describe oral health and the IMPA index to describe periodontal conditions and to differentiate gingivitis from periodontitis. The prevalence of oral manifestations was: gingivitis, 91.84%; caries, 81.63%; mucositis, 38.77%; periodontitis, 16.32%; cheilitis, 18.36%; recurrent herpes, 12.24%; and primary herpetic gingivostomatitis, 2.04%. Other oral manifestations were: dry lips, mucosal pallor, mucosal petechiae, ecchymoses, and induced ulcers. The prevalence of oral candidiasis was 6.12%. It was observed that high risk ALL and poor oral hygiene were important risk factors for the development of candidiasis and gingivitis. The type of leukemia, gender and phase of chemotherapy were apparently associated with the presence of candidiasis, gingivitis, and periodontitis, and they could be considered risk factors for the development of oral manifestations.

Pediatric mature B-cell NHL, early referral and supportive care problems in a developing country.

OBJECTIVE: Mature B-cell non-Hodgkin lymphoma (B-NHL) comprises more than 50% of all non-Hodgkin lymphoma (NHL) in children and adolescents. An official report published by the Mexican National Center for the Control and Prevention of Cancer in the Pediatric and Adolescent Populations, reported a lymphoma OS of 71% (including all Hodgkin and NHL). The Mexican Association of Pediatric Oncology and Hematology conducted a retrospective study to analyze the clinical characteristics and outcomes of children with diagnosis of B-NHL in Mexico, in order to perceive the main areas of improvement in the health care. METHODS: From 1 January 2000 to 31 December 2016, 166 pediatric patients were diagnosed with B-cell NHL at the participant institutions. RESULTS: According to histology the outcomes were 5-year EFS 63%, for BL/BLL, and 80% DLBCL, (P = .051), 5-year PFS 81%, for BL/BLL, and 91% for DLBCL, (P = .126), and 5-year OS 71%, for BL/BLL, and 83% for DLBCL, (P = .095). DISCUSSION: Overall, 18 patients died due to acute treatment toxicity, resulting in a cumulative incidence of toxic death of 10.84% and an early death rate of 7.23%, defined as <30 days after initial treatment. In conclusion, there is an urgent need to establish an academic collaboration to create strategies to improve pediatric cancer care according to our resources, especially in diseases with expected excellent prognosis as B-NHL. These strategies must include comprehensive supportive care, early referral, and the creation of easy communication between pediatric and adults centers as well as late-effects clinics.

Langerhans cell histiocytosis: Current concepts in dentistry and case report.

UNLABELLED: Langerhans cell histiocytosis (LCH), which is a rare granulomatous pediatric disease of unknown etiology, is characterized by the idiopathic proliferation and accumulation of abnormal and clonal Langerhans cells or their marrow precursors, resulting in localized, solitary or multiple destructive lesions. These lesions are most commonly eosinophilic granuloma, which are found in craniofacial bone structures such as the skull and mandible, skin and other organs. In children, the disease has a variable initial presentation, and the clinical course, prognosis and survival are unpredictable. The aims of this report were to present an LCH case in a girl aged 2 years, 8 months and her clinicopathological features, to describe the bucodental management provided, and to discuss special dental considerations of this disease. KEY WORDS: Children, dental management, histiocytosis, Langerhans cells.

[Prognostic value of pre-B immunophenotype in early treatment response among acute pediatric lymphoblast leukemia patients]. / Valor pronóstico del inmunofenotipo en la respuesta temprana de la leucemia aguda linfoblástica pre-B en niños.

OBJECTIVE: To determine the prognostic value of preB immunophenotype and its variants on early treatment response among of acute pediatric lymphoblast leukemia. PATIENTS AND METHODS: A case-control study nested in a cohort was carried out with male and female patients 15 years and younger with recently diagnosed pre-B lymphoblast leukemia. A panel of B, T, monoclonal antibodies of the myelo-monocytic and megakaryocytic cell type was used. Response was assessed by bone marrow aspiration 14 days post treatment. RESULTS: 54 patients were included. The median age was 7 years (2 months - 14 years) median leukocyte count was 13,450/mm3 (1200-986,000/mm3). We identified 29 cases with late pre-B immune phenotype, 19 cases with common pre B and 6 cases with early preB immunophenotype. Eleven, patients also displayed myeloid antigens. A significant association (p=0.034) was found between early treatment response and the presence of myeloid antigens. No association was found between the pre-B immunophenotype, age and leukocyte count with early treatment response (p=0.264). CONCLUSIONS: We need to pay special emphasis on early treatment response in children with lymphoblast leukemia as our study did not corroborate the common finding that clinical factors and immune phenotype can be predictive factors.

Valor pronóstico del inmunofenotipo en la respuesta temprana de la leucemia aguda linfoblástica pre-B en niños / Prognostic value of pre-B immunophenotype in early treatment response among acute pediatric lymphoblast leukemia patients

Objetivo: Determinar el valor pronóstico del inmunofenotipo pre B con sus variantes en la respuesta temprana al tratamiento de la leucemia aguda linfoblástica pediátrica, ajustando edad y cifra de leucocitos inicial. Pacientes y método: Se realizó un estudio de casos y controles anidado en una cohorte con pacientes menores de 15 años de edad, de los dos géneros, con leucemia aguda linfoblástica pre B de diagnóstico reciente. Se utilizó un panel de anticuerpos monoclonales específicos de la estirpe B, T, monocito mielocito y megacariocítica. Se evaluó la respuesta después de 14 días de tratamiento mediante aspirado de médula ósea. Resultados: Se incluyeron 54 pacientes. La mediana de edad fue de 7 años (2 m 14 años), la mediana de cifra de leucocitos fue 13,450/mm³ (1200-986,000/mm³). Se identificaron 29 casos con inmunofenotipo Pre B tardío, 19 casos pre B común y 6 casos de pre B precoz. Once pacientes presentaron antígenos mieloides asociados. Se encontró asociación significativa (p=0.034) entre respuesta temprana y la presencia de antígenos mieloides. No se demostró asociación entre las variantes del inmunofenotipo pre B, edad y cifra de leucocitos con la respuesta temprana (p=0.264). Conclusiones: Es necesario estudiar directamente la respuesta tem prana al tratamiento en los niños con leucemia linfoblástica ya que en nuestra muestra de pacientes los factores clínicos y el inmunofenotipo no fueron predictivos de ésta.

Objective: To determine the prognostic value of pre B immunophenotype and its variants on early treatment response among of acute pediatric lymphoblast leukemia. Patients and methods: A case control study nested in a cohort was carried out with male and female patients 15 years and younger with recently diagnosed pre B lymphoblast leukemia. A panel of B, T, monoclonal antibodies of the myelo monocytic and megakaryocytic cell type was used. Response was assessed by bone marrow aspiration 14 days post treatment. Results: 54 patients were included. The median age was 7 years (2 months - 14 years) median leukocyte count was 13,450/mm3 (1200-986,000/mm3). We identified 29 cases with late pre B immune phenotype, 19 cases with common pre B and 6 cases with early pre B immunophenotype. Eleven patients also displayed myeloid antigens. A significant association (p=0.034) was found between early treatment response and the presence of myeloid antigens. No association was found between the pre B immunophenotype, age and leukocyte count with early treatment response (p=0.264). Conclusions: We need to pay special emphasis on early treatment response in children with lymphoblast leukemia as our study did not corroborate the common finding that clinical factors and immune phenotype can be predictive factors.