Incidence of myelosuppression in AML is higher compared with that in ALL.

Acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL) are two subtypes of acute leukemia. However, studies investigating the ability of complete blood count (CBC) parameters to distinguish between patients with AML and ALL remain scarce in the literature. The objective of the present study was to compare the parameters of CBC analysis between Chinese patients with AML and ALL and between patients with M3 AML and non-M3 AML. Prognostic factors for overall survival were also estimated, including sex, age, white blood cell count and hemoglobin. The present study included 147 patients, including children and adults, with newly diagnosed acute leukemia. Information on the age, sex, leukemia subtype, initial CBC results and clinical follow-up findings was recorded and compared between the indicated groups using statistical tests of Mann-Whitney U test and χ2 test. Leukopenia (white blood cell count <3.5x109/l), both leukopenia and anemia, both leukopenia and thrombocytopenia and pancytopenia were found to be significantly more frequent among patients with AML compared with that in patients with ALL (P=0.015, 0.016, 0.015 and 0.019, respectively). For patients with ALL, anemia was recognized as a predictor of a favorable outcome (Hazard ratio, 0.185; 95% CI, 0.046-0.747; P=0.018). These findings suggest that normal hematopoiesis is more frequently inhibited in patients with AML compared with that in patients with ALL. Patients with AL with peripheral blood findings indicative of leukopenia, pancytopenia, or both leukopenia and anemia or both leukopenia and thrombocytopenia are more likely to have AML.

Hematopoietic Neoplasms of the Sinonasal Tract.

Hematologic malignancies are one of the more common neoplasms to occur in the sinonasal tract and include a wide range of entities, including mature and immature B cell and T cell neoplasms as well as plasma cell dyscrasias and histiocytic disorders. CD45 expression can be helpful in identifying many, but not all, hematopoietic neoplasms in the sinonasal tract, and more extensive immunophenotyping, including EBV in situ hybridization, as well as correlation with genetic results and clinical features may be required for diagnosis.

Auer rod-positive acute leukemia with predominantly lymphoid immunophenotype: Report on 11 cases and review of literature.

BACKGROUND: Auer rods (AuRs) are prominent intracellular structures found almost exclusively in myeloid cell malignancies, such as acute myeloid leukemia (AML), chronic and juvenile myelomonocytic leukemia and myelodysplastic syndrome. Extremely rare AuRs have been reported in patients with acute lymphoblastic leukemia (ALL) or among ambiguous lineage leukemia patients with a dominantly lymphoblastic immunophenotype. PROCEDURE: We report diagnostic and follow-up data of an international cohort of 11 children suffering from leukemias with AuRs and with significant presence of T and myeloid markers, majority of whom categorized as early T-cell precursor (ETP, n = 7); or T-ALL (ETP status unknown, n = 2), ALAL (acute leukemia of ambiguous lineage, n = 1), and AML reclassified from ALAL (n = 1). We described other diagnostic details and treatment types and responses. Moreover, we summarize previously published data. RESULTS: Among the four patients who started and remained on ALL-type therapy, all were in the first complete remission, whereas both patients who started and remained on AML-type therapy relapsed and died. Of the patients who followed either a combined ALL/AML protocol (Interfant 06) or who switched from one of the two types of therapy to the other, one patient died, and the remaining four were in first complete remission at the most recent follow-up. We also searched for similar cases in the literature and found only three additional children with nonmyeloid leukemia and AuRs and 10 adults with this type of leukemia. CONCLUSIONS: Briefly, ALL- or combined ALL/AML-type therapy may be effective for treating AuR-positive leukemia patients with a lymphoid immunophenotype.

Mutant NPM1 marginally impacts ribosome footprint in acute myeloid leukemia cells.

Background: NPM1-mutated acute myeloid leukemia (AML) is the most frequent AML subtype. As wild-type NPM1 is known to orchestrate ribosome biogenesis, it has been hypothesized that altered translation may contribute to leukemogenesis and leukemia maintenance in NPM1-mutated AML. However, this hypothesis has never been investigated. We reasoned that if mutant NPM1 (NPM1c) directly impacts translation in leukemic cells, loss of NPM1c would result in acute changes in the ribosome footprint. Methods: Here, we performed ribosome footprint profiling (Ribo-seq) and bulk messenger RNA (mRNA) sequencing in two NPM1-mutated cell lines engineered to express endogenous NPM1c fused to the FKBP (F36V) degron tag (degron cells). Results and discussion: Incubation of degron cells with the small compound dTAG-13 enables highly specific degradation of NPM1c within 4 hours. As expected, RNA-sequencing data showed early loss of homeobox gene expression following NPM1c degradation, confirming the reliability of our model. In contrast, Ribo-seq data showed negligible changes in the ribosome footprint in both cell lines, implying that the presence of NPM1c does not influence ribosome abundance and positioning on mRNA. While it is predictable that NPM1c exerts its leukemogenic activity at multiple levels, ribosome footprint does not seem influenced by the presence of mutant NPM1.

Histone deacetylase inhibitors: targeting epigenetic regulation in the treatment of acute leukemia.

Acute leukemia (AL) is a rare yet perilous malignancy. Currently, the primary treatment for AL involves combination chemotherapy as the cornerstone of comprehensive measures, alongside hematopoietic stem cell transplantation as a radical approach. However, despite these interventions, mortality rates remain high, particularly among refractory/recurrent patients or elderly individuals with a poor prognosis. Acetylation, a form of epigenetic regulation, has emerged as a promising therapeutic avenue for treating AL. Recent studies have highlighted the potential of acetylation regulation as a novel treatment pathway. Histone deacetylase inhibitors (HDACis) play a pivotal role in modulating the differentiation and development of tumor cells through diverse pathways, simultaneously impacting the maturation and function of lymphocytes. HDACis demonstrate promise in enhancing survival rates and achieving a complete response in both acute myeloid leukemia and acute T-lymphoblastic leukemia patients. This article provides a comprehensive review of the advancements in HDACi therapy for AL, shedding light on its potential implications for clinical practice.

Histone deacetylase inhibitors represent a method of treating acute leukemia by targeting DNA acetylation to regulate genetic information without altering the DNA sequence Acute leukemia (AL) is a rare yet perilous malignancy. Presently, the primary treatments for AL encompass combination chemotherapy as the cornerstone of a comprehensive approach, and hematopoietic stem cell transplantation (HSCT) as a radical treatment. However, despite these interventions, mortality rates remain elevated, particularly among refractory/relapsing patients or older adults with a grim prognosis. Epigenetic regulation entails altering the expression of genes through pertinent genetic information without modifying the DNA sequence. Acetylation modification, as a form of epigenetic regulation, has emerged as a promising avenue for AL treatment. Recent studies have underscored the potential of acetylation regulation as a novel therapeutic approach. Histone deacetylase inhibitors (HDACis) modulate the differentiation and development of tumor cells through various mechanisms and impact the maturation and function of lymphocytes. HDACis exhibits promise in enhancing survival rates for acute leukemia, among other benefits. This article offers a comprehensive review of the advancements in HDACis therapy for AL, shedding light on its potential implications for clinical practice.

Recent Developments and Evolving Therapeutic Strategies in KMT2A-Rearranged Acute Leukemia.

BACKGROUND: Rearrangements of the histone-lysine-N-methyltransferase (KMT2A), previously referred to as mixed-lineage leukemia (MLL), are among the most common chromosomal abnormalities in patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), involving numerous different fusion partners. KMT2A-rearranged (KMT2A-r) leukemia is characterized by a rapid onset, aggressive progression, and significantly worse prognosis compared to non-KMT2A-r leukemias. Even with contemporary chemotherapeutic treatments and hematopoietic stem cell transplantations (HSCT), patients with KMT2A-r leukemia typically experience poor outcomes and limited responses to these therapies. OBJECTIVES: This review aims to consolidate recent studies on the general gene characteristics and associated mechanisms of KMT2A-r acute leukemia, as well as the cytogenetics, immunophenotype, clinical presentation, and risk stratification of both KMT2A-r-AML and KMT2A-r-ALL. Particularly, the treatment targets in KMT2A-r acute leukemia are examined. METHODS: A comprehensive review was carried out by systematically synthesizing existing literature on PubMed, using the combination of the keywords 'KMT2A-rearranged acute leukemia', 'lymphoblastic leukemia', 'myeloid leukemia', and 'therapy'. The available studies were screened for selection based on quality and relevance. CONCLUSIONS: Studies indicate that KMT2A rearrangements are present in over 70% of infant leukemia cases, approximately 10% of adult AML cases, and numerous instances of secondary acute leukemias, making it a disease of critical concern to clinicians and researchers alike. The future of KMT2A-r acute leukemia research is characterized by an expanding knowledge of the disease's biology, with an emphasis on personalized therapies, immunotherapies, genomic advancements, and innovative therapeutic combinations. The overarching aim is to enhance patient outcomes, lessen the disease burden, and elevate the quality of life for those affected. Ongoing research and clinical trials in this area continue to offer promising opportunities for refining treatment strategies and improving patient prognosis.

The efficacy and safety of third-party umbilical blood/umbilical cord mesenchymal stem cell assisted related haploid hematopoietic stem cell transplantation in pediatric patients with acute leukemia: an observational study.

Background: There is limited data on third-party umbilical cord blood (UCB) or mesenchymal stem cell (MSC) transplantation-assisted haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in pediatric patients. Objective: To evaluate the efficacy and safety of UCB and MSC transplantation-assisted haplo-HSCT in pediatric patients with acute leukemia (AL). Design: Observational study. Methods: Clinical data of 152 children with AL undergoing haplo-HSCT at the Children's Hospital of Soochow University between January 2020 and June 2022 were collected. The patients were divided into the haplo-HSCT + UCB group (n = 76), haplo-HSCT + MSC group (n = 31), and haplo-HSCT group (n = 45). Hematopoietic reconstruction time, complications within 30 days after transplantation, and survival and recurrence at 3 years after transplantation were compared among the groups. Results: Multivariate analysis revealed that haplo-HSCT with MSC and human leukocyte antigen (HLA) matching ⩾6/10 were independent factors reducing engraftment syndrome (ES) incidence. There were no significant differences among the groups in the hematopoietic reconstruction time or incidence of complications within 30 days after transplantation (p > 0.05). Overall survival, relapse-free survival, cumulative incidence of relapse, cumulative incidence of hematological relapse, and 3-year transplant-related mortality were not significantly different (p > 0.05). The incidence of adverse reactions in the haplo-HSCT + UCB group was 97.3% within 4 h after UCB infusion, with a particularly high occurrence rate of 94.7% for hypertension. No transfusion-related adverse reactions occurred after the transfusion of umbilical cord MSC in the haplo-HSCT + MSC group. Conclusion: MSC-assisted haplo-HSCT can reduce ES incidence after transplantation in pediatric patients with AL. UCB infusion is associated with a high incidence of reversible hypertension. However, no adverse reactions were observed in umbilical cord MSC transfusion.

Resilience Development Among Adult Patients With De Novo Acute Leukemia: A Qualitative Study.

OBJECTIVE: This study aimed to explore the development process of psychological resilience among adult patients with de novo acute leukemia. METHODS: This study utilized a descriptive qualitative approach, employing a purposeful sampling method to select a sample of 15 newly diagnosed patients with acute leukemia (AL) who underwent their initial induction chemotherapy treatment at the Hematology Department of the First Affiliated Hospital of Zhejiang University School of Medicine, China. Semi-structured interviews were conducted with the selected patients. Content analysis methodology was used to analyze, summarize, and extract themes from the collected data. RESULTS: Three categories emerged-namely, (1) negative period, (2) adaptive response phase, and (3) growth transformation period. The negative period occurs during the initial diagnosis and throughout the treatment cycle. However, influenced by both internal and external protective factors, including personal characteristics and social support, individuals enhance their psychological resilience through emotional regulation, mental adjustment, and adaptive strategies vis-à-vis healthcare decision-making and disease management. Overall, psychological resilience development follows an upward spiral trajectory. CONCLUSIONS: This study identified that negative emotions and symptom clusters impede the development of patients' psychological resilience. Moreover, it revealed a substantial need for disease-related information among patients. Therefore, healthcare professionals should prioritize addressing the negative emotions of patients, early identification of protective factors, dynamic monitoring of symptom clusters, effective management, and provision of psychological counseling and interventions. Simultaneously, providing personalized, professional, and systematic disease-related information is vital for promoting psychological resilience development.

[Application of high-throughput drug sensitivity testing in children with relapsed and refractory acute leukemia]. / é«˜é€šé‡è¯æ•æ£€æµ‹æŠ€æœ¯åœ¨å„¿ç«¥å¤å‘éš¾æ²»æ€§æ€¥æ€§ç™½è¡€ç— ä¸­çš„åº”ç”¨.

OBJECTIVES: To explore the current application of high-throughput drug sensitivity (HDS) testing in children with relapsed and refractory acute leukemia (RR-AL) and analyze the feasibility of salvage treatment plans. METHODS: A retrospective collection of clinical data from children with RR-AL who underwent HDS testing at the Department of Children's Hematology and Oncology of the First Affiliated Hospital of Zhengzhou University from November 2021 to October 2023 was conducted, followed by an analysis of drug sensitivity results and treatment outcomes. RESULTS: A total of 17 children with RR-AL underwent HDS testing, including 7 cases of relapsed refractory acute myeloid leukemia and 10 cases of relapsed refractory acute lymphoblastic leukemia. The detection rate of highly sensitive chemotherapy drugs/regimens was 53% (9/17), while the detection rate of moderately sensitive chemotherapy drugs/regimens was 100% (17/17). Among the 17 RR-AL patients with highly and moderately sensitive chemotherapy drugs and regimens, the MOACD regimen (mitoxantrone + vincristine + cytarabine + cyclophosphamide + dexamethasone) accounted for 100%, with the highest inhibition rate for single-agent mitoxantrone (94%, 16/17), and the highest inhibition rate for targeted therapy being bortezomib (94%, 16/17). Nine patients adjusted their chemotherapy based on HDS testing results, with 4 undergoing hematopoietic stem cell transplantation. Four patients achieved disease-free survival, while 5 died. Eight patients received empirical chemotherapy, with 2 undergoing hematopoietic stem cell transplantation; 4 achieved disease-free survival, while 4 died. CONCLUSIONS: HDS testing can identify highly sensitive drugs/regimens for children with RR-AL, improving the rate of re-remission and creating conditions for subsequent hematopoietic stem cell transplantation.

[Clinical features and prognosis of children with fungal bloodstream infection following chemotherapy for acute leukemia]. / å„¿ç«¥æ€¥æ€§ç™½è¡€ç— åŒ–ç–—åŽåˆå¹¶çœŸèŒè¡€æµæ„ŸæŸ“çš„ä¸´åºŠç‰¹å¾åŠé¢„åŽåˆ†æž.

OBJECTIVES: To investigate the clinical features and prognosis of children with fungal bloodstream infection (BSI) following chemotherapy for acute leukemia (AL). METHODS: A retrospective analysis was performed on 23 children with fungal BSI following chemotherapy for AL in three hospitals in Fujian Province, China, from January 2015 to December 2023. Their clinical features and prognosis were analyzed. RESULTS: Among all children following chemotherapy for AL, the incidence rate of fungal BSI was 1.38% (23/1 668). At the time of fungal BSI, 87% (20/23) of the children had neutrophil deficiency for more than one week, and all the children presented with fever, while 22% (5/23) of them experienced septic shock. All 23 children exhibited significant increases in C-reactive protein and procalcitonin levels. A total of 23 fungal isolates were detected in peripheral blood cultures, with Candida tropicalis being the most common isolate (52%, 12/23). Caspofungin or micafungin combined with liposomal amphotericin B had a relatively high response rate (75%, 12/16), and the median duration of antifungal therapy was 3.0 months. The overall mortality rate in the patients with fungal BSI was 35% (8/23), and the attributable death rate was 22% (5/23). CONCLUSIONS: Fungal BSI following chemotherapy in children with AL often occurs in children with persistent neutrophil deficiency and lacks specific clinical manifestations. The children with fungal BSI following chemotherapy for AL experience a prolonged course of antifungal therapy and have a high mortality rate, with Candida tropicalis being the most common pathogen.

Menin-MLL protein-protein interaction inhibitors: a patent review (2021-present).

INTRODUCTION: Acute leukemia harboring rearrangement of the Mixed lineage leukemia (MLL) and/or mutation of the nucleophosmin is a type of poorly prognostic and highly malignant leukemia which is extremely difficult to treat. Blocking the protein-protein interaction between Menin and MLL is a strategic approach for treating leukemias, as a new direction for drug discovery. Many biotech and pharmaceutical companies made great efforts to this drug development field, and a large number of small molecular Menin-MLL PPI inhibitors were reported during the recent three years. AREAS COVERED: This review is to mainly summarize the Menin-MLL PPI inhibitors reported in the recent three years' patents. EXPERT OPINION: Although the past 12 years have witnessed the progress of the Menin-MLL PPI inhibitors in the treatment of acute leukemia, especially for leukemia harboring rearranged KMT2A and/or mutated NPM1, recent studies showed Menin-MLL PPI inhibitors suffered from new issues such as toxicity, acquired resistance, and homogenization. Therefore, new drug discovery strategies should be considered in advance. The expert opinion was proposed from several aspects, such as developing diverse chemical structures, discovering covalent inhibitors, designing small molecular PROTACs, and targeting the amino acids mutations for next-generation inhibitors.

Acute promyelocytic leukemia: A rare presentation without systemic disease.

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia characterized by an abnormal proliferation of promyelocytes. It is often associated with an aggressive clinical presentation involving complex coagulopathies including disseminated intravascular coagulation, with a significant risk of bleeding and/or thrombosis if treatment with all-trans-retinoic acid (ATRA) is not rapidly initiated. Here we present a unique case of APL which was isolated to femoral bone lesions, without definitive evidence of peripheral blood or bone marrow involvement, and without systemic sequelae.

[Molecular profiling of myeloid/natural killer (NK) cell precursor acute leukemia].

Myeloid/natural killer (NK) cell precursor acute leukemia (MNKPL) has been described based on its clinical phenotype and immunophenotype, and proposed as a unique leukemia entity. However, due to its rarity and lack of defined distinctive molecular characteristics, there is currently no international consensus on this disease concept. We performed multi-omics analysis and revealed that MNKPL is distinct from acute myeloid leukemia, T-cell acute lymphoblastic leukemia, and mixed-phenotype acute leukemia. NOTCH1 and RUNX3 activation and BCL11B downregulation are hallmarks of MNKPL. Although NK cells have been classically considered to be lymphoid lineage-derived, our single-cell analysis using MNKPL cells suggested that NK cells and myeloid cells share common progenitor cells. Our retrospective case study uncovered that outcomes of MNKPL are unsatisfactory, even with hematopoietic cell transplantation. Multi-omics analysis and in vitro drug sensitivity assays revealed increased sensitivity to L-asparaginase and reduced levels of asparagine synthetase, supporting the clinically observed effectiveness of L-asparaginase.

Clinical data and MRI features-based nomogram for differentiation of central nervous system infection and central nervous system involvement in hematological malignancy.

Central nervous system leukemia (CNSL) and central nervous system infection (CNSI) are the most important complications in patients with acute leukemia (AL). However, the differential diagnosis could represent a major challenge since the two disorders are all heterogeneous entities with overlapping clinical characteristics and radiological appearances. In this paper, we conduct a retrospective study to develop a model based on clinical data and magnetic resonance imaging (MRI) to distinguish CNSL from CNSI. A total of 108 patients with AL who underwent cranial MRI between January 2020 and December 2023 in our hospital were included. Univariate and multivariate logistic regression analyses were used to determine the independent predictors. A nomogram was developed based on the predictors, and the performance of the nomogram was evaluated by the area under the receiver operating characteristic (ROC) curve. The validation cohort was used to test the predictive model. Hyperleukocytosis at initial diagnosis, marrow state, fever, conscious disturbance, coinfection in other sites and MRI (parenchyma type) were identified as independent factors. A nomogram was constructed and the discrimination was presented as AUC = 0.947 (95% CI 0.9105-0.984). Calibration of the nomogram showed that the predicted probability matched the actual probability well.

Exhaled Breath Condensate Surveillance for Aspergillus in Acute Leukemia-a Pilot Trial.

Invasive fungal infections in patients with leukemia carry a high mortality rate, but early diagnosis has the potential to modify this natural history. A novel screening method using Aspergillus droplet-digital polymerase chain reaction in exhaled breath condensate may have a similar performance to serum galactomannan screening. Larger studies, including other molds, are necessary.

Invasive pulmonary aspergillosis in patients with acute leukemia.

INTRODUCTION: Invasive pulmonary aspergillosis is a serious complication in hematology. AIM: Describe the prevalence, diagnostic aspects, therapeutic modalities, and evolution of the IPA cases occurring in patients with acute leukemia. METHODS: Our study was retrospective including patients with acute leukemia who developed invasive pulmonary aspergillosis during the period January 2009 and December 2020 at the hematology department in south Tunisia. The IPA was defined in three levels of probability according to the criteria of the EORTC / MSG 2019. RESULTS: We collected 127 patients who presented with Invasive pulmonary aspergillosis. Sixty-three percent of our patients had acute myeloid leukemia. The diagnosis of invasive pulmonary aspergillosis was during the induction course in 76% of cases. Twenty-seven of our patients had chest pain. The chest Computed tomography (CT) scan showed the Halo sign in 89% of cases. The Aspergillus galactomannan antigen was positive in 38% of cases. Extrapulmonary aspergillosis involvement was noted in 18% of cases: IPA was possible and probable respectively in 59% and 41% of cases. All patients treated with Voriconazole with a favorable response in 54% of cases. The mortality rate was 46%. The overall survival at week 12 was 56%. CONCLUSION: The morbidity and mortality of patients who developed invasive pulmonary aspergillosis with acute leukemia in our series were high. We need to improve our strategy for early diagnosis and management.

Outcomes of intracranial hemorrhage in critically ill patients with acute leukemia: Results of a retrospective cohort study.

Background: Admission to the intensive care unit (ICU) is frequently required for patients with acute leukemia (AL) because of life-threatening complications such as intracranial hemorrhage (IH). In this study, we evaluated the impact of IH on survival and neurological outcomes in this population. Methods: This was a single-center retrospective cohort study including adult patients with AL requiring ICU admission and experiencing IH between 2002 and 2019 at Saint Louis Hospital. Leukemia type was determined according to the French-American-British classification. Brain imaging (either computed tomography or magnetic resonance imaging) was available for all the patients. The primary endpoint of the study was to describe the clinical and biological characteristics and evaluate the mortality and neurological outcome of patients hospitalized in the ICU with newly diagnosed AL and IH. The secondary endpoint was to identify predictive factors of IH in these patients. Results: Thirty-five patients with AL were included, median age of the patients was 59.00 (interquartile range [IQR]: 36.00-66.00) years. Twenty-nine patients (82.9%) had acute myeloid leukemia, including 12 patients with acute promyelocytic leukemia. Thrombocytopenia was constant, and 48.5% of patients had disseminated intravascular coagulation (DIC). At ICU admission, the median Sequential Organ Failure Assessment score was 5 (IQR: 3-9). The median time between AL onset and IH was 2.0 (IQR: 0.0-9.5) days. The ICU and hospital mortality rates were 60.0% (n =21) and 65.7% (n=23), respectively. In univariate analysis, mechanical ventilation and stupor were associated with mortality, but DIC and acute promyelocytic leukemia were not. Upon multivariate analysis, stupor or coma was the only factor significantly associated with a poor outcome (odds ratio = 8.56, 95 % confidence interval: 2.40 to 30.46). Conclusion: IH is associated with a high mortality rate in AL patients, with stupor or coma at the onset of intracranial bleeding being independently associated with poor outcomes.

Clinical value of 18F-FDG PET/CT in patients with newly diagnosed acute leukemia.

PURPOSE: To explore the correlation between semi-quantitative parameters of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) scans findings and the clinical features of patients with acute leukemia (AL), as well as to evaluate the clinical utility of 18F-FDG PET/CT in the management of AL. METHODS: A retrospective study was conducted with 44 patients newly diagnosed with acute leukemia (AL) at Zhongnan Hospital of Wuhan University between January 2019 and August 2024. RESULTS: Multivariate analysis revealed that age at diagnosis of AL (odds ratio [OR]: 0.888, P < 0.01) and percentage of blasts in the peripheral blood (PB) (OR: 1.061, P < 0.05) were independent predictors of the appearance of active extramedullary disease (EMD). Kaplan-Meier survival analysis for patients with EMD(+) indicated that those with organ infiltration beyond the lymph nodes experienced markedly reduced overall survival (OS) compared to those without such infiltration (157 days and 806 days, respectively). Furthermore, in the AL subgroup with EMD, the ratio of the maximum standardized uptake value (SUVmax) in the bone marrow (BM) to SUVmax of the liver emerged as an independent prognostic factor for OS (Hazard ratio [HR]: 2.372; 95% confidence interval [CI]: 1.079-5.214, P < 0.05). CONCLUSION: 18F-FDG PET/CT offers the benefits of being non-invasive and highly sensitive for the thorough evaluation of disease status in patients newly diagnosed with AL. Furthermore, the SUVmax BM/liver ratio is of significant clinical importance for prognosticating outcomes in patients with AL presenting EMD.

Anorectal Pathologies in the Course of Acute Leukaemias; Predictive Parameters.

Introduction: Patients with leukaemia are exposed to infections as long as they are neutropenic. During this period, anorectal pathologies are among the common foci of infection with high mortality. In this study, we aim to investigate the factors that may have a predictive effect on early diagnosis and rapid intervention in perianal complications occurring in neutropenic patients diagnosed with leukaemia. Materials and Methods: A total of 90 patients with acute leukaemia, including 45 patients with anorectal pathology and 45 patients without anorectal pathology, were analysed. Demographics, blood group, BMI, haemogram and biochemical parameters at the time of diagnosis, and types of perianal pathology were recorded. Results: In the group of patients with anorectal pathology, WBC, lymphocytes, monocytes, and LDH were significantly (p<0.05) higher, and platelets, MPV, and PCT were significantly (p<0.05) lower. The multivariate model showed significant-independent (p<0.05) efficacy of WBC and MPV values in differentiating patients with and without anorectal pathology. A significant efficacy was observed at the WBC cut-off of 17000 [area under the curve 0.656 (0.542-0.770)] and the MPV cut-off of 10 [area under the curve 0.667 (0.554-0.780)] in differentiating patients with and without anorectal pathology. Discussion: Anorectal pathologies are common foci of infection in patients with acute leukaemia. Having predictive parameters that may help for early intervention will help the clinician. This is the first study in the literature to compare a control group with a group with anorectal pathologies in leukaemia patients providing a cut-off for WBC.