Autologous peripheral blood stem cell mobilization and apheresis in pediatric patients with cancer: A single-center report of 64 procedures.

BACKGROUND: The published experience concerning autologous peripheral blood stem cell collection in children is very limited. METHODS: The data of pediatric patients who underwent autologous stem cell mobilization and apheresis between January 2011 and April 2020 were analyzed retrospectively. RESULTS: We studied retrospectively 64 mobilization and apheresis procedures in 48 pediatric patients (34 males, 14 females), mean age of 7.31 ± 5.38 (range, 1.5-19.7) years, the underlying disease was mostly neuroblastoma (NBL). The body weight of 21 patients (43.75%) was 15 kg or less. The targeted autologous peripheral stem cell apheresis (APSCA) was successfully achieved in 98% of patients. Neuroblastoma patients were younger than the rest of the patients and underwent apheresis after receiving fewer chemotherapy cycles than others and all of them mobilized within the first session successfully. Plerixafor was added to mobilization in nine heavily pretreated patients (18.7%), median two doses (range, 1-4 doses). 11 patients (22.9%) underwent radiotherapy (RT) before mobilization with doses of median 24 Gy (range, 10.8-54.0 Gy). Patients with RT were older at the time of apheresis and had received more chemotherapy courses than patients without RT. As a result, patients with a history of RT had significantly lower peripheral CD34+ cells and CD34+ yields than those without RT. In 17 patients (35.4%), 22 different complications were noted. The most common complications were catheter-related infections (n:10, 20.8%), followed by catheter-related thrombosis in eight patients (16.7%). CONCLUSIONS: Patients who had far less therapy before apheresis were more likely to mobilize successfully. Our study provides a detailed practice approach including complications during APSCA aiming to increase the success rates of apheresis in transplantation centers.

Evaluating Postoperative Outcomes and Investigating the Usefulness of EU-TIRADS Scoring in Managing Pediatric Thyroid Nodules Bethesda 3 and 4

Objective: The aim was to assess postoperative outcomes in pediatric thyroid nodules with atypia of undetermined significance (AUS/FLUS) or suspicious for a follicular neoplasm (SFN) and their respective the European-Thyroid Imaging Reporting and Data System (EU-TIRADS) scores. Methods: Forty-four pediatric patients at a single center with thyroid nodules classified as AUS/FLUS or SFN from August 2019 to December 2022 were retrospectively reviewed. Data on demographics, thyroid function, nodule size, and ultrasonographic features were collected. Postoperative pathologies were categorized into benign, low-risk, and malignant neoplasms according to the World Health Organization 2022 criteria, and EU-TIRADS was used for retrospective radiological scoring. Results: Among 21 (47.7%) of patients who had surgical intervention, 72% had Bethesda 3 and 28% had Bethesda 4 thyroid nodules. Post-surgical histopathological classifications were 43% benign, 19% low-risk, and 38% malignant. Of note, EU-TIRADS 3 and 5 scores were present in 44% and 56% of the benign cases, respectively. Malignant cases tended to produce higher EU-TIRADS scores, with 64% rated as EU-TIRADS 5. Bethesda category 4 nodules had a 66% malignancy rate, significantly higher than the 27% in category 3. Conclusion: A substantial proportion of histologically benign cases were classified as EU-TIRADS 5, suggesting that EU-TIRADS may lead to unnecessary biopsies in benign cases. Malignant cases were more likely to have a higher EU-TIRADS score, indicating a positive correlation with malignancy risk, particularly in Bethesda 4 cases. However, the EU-TIRADS system's predictive value for malignancy in Bethesda 3 cases was poorer.

The relation between staging fluorine-18 fluorodeoxyglucose positron emission tomog- raphy/computed tomography metabolic parameters and tumor necrosis rate in pediatric osteosarcoma patients

Background/aim: The aim of this study was to investigate the contribution of fluorine-18 (F-18) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging in staging of pediatric osteosarcoma patients and also to evaluate the ability of metabolic parameters from the primary tumor to predict tumor necrosis rate (TNR). Material and methods: F-18 FDG-PET/CT imaging was performed in staging 37 pediatric osteosarcoma patients. The metabolic pa- rameters SUVmax (maximum standardised uptake value), MTV (metabolic tumour volume), and TLG (total lesion glycolysis) were measured from the primary tumor. TNR level of the primary tumor was histopathologically measured after standard neoadjuvant chemotherapy treatment. The contribution of F-18 FDG-PET/CT to staging of pediatric osteosarcoma patients and the accuracy of metabolic parameters of the primary tumor to predict TNR were analized by regression analysis. Results: MTV and TLG of the primary tumor were found to efficiently predict histopathologic TNR, whereas SUVmax was not (P = 0.012, P = 0.027, P = 0.25, respectively). Also 5 of 12 patients (41.6%) who were initially defined as localised osteosarcoma were upstaged in consequence of staging F-18 FDG-PET/CT findings. Conclusion: F-18 FDG-PET/CT staging in pediatric osteosarcoma patients can effectively distinguish metastatic-localised disease. MTV and TLG values are important parameters, which can efficiently be used to predict TNR.

Can Burkitt's Lymphoma and Hodgkin's Lymphoma occur in siblings simultaneously?

Familial clustering of Hodgkin lymphoma (HL) and increased risk of developing disease among the siblings has been reported earlier. Usually familial lymphoma in sibling pairs occurs in the pairs of either non-Hodgkin lymphoma or HL. In the familial HL, same type of human leukocyte antigens (HLA) is responsible in the affected family members. There are also some studies stating "Killer cell immunoglobulin like receptor (KIR)" genotypes can be important in the etiology of familial HL. Here we report two siblings; one with Non-Hodgkin and the other with Hodgkin lymphoma which showed Epstein-Barr virus encoded small RNAs positivity in the tumor tissues. We have also found that their HLA genotypes are same with each other. In addition, we have discussed familial lymphoma pathogenesis and HLA haplotypes.

Level of oxidative stress and damage in erythrocytes in apprentices indirectly exposed to lead.

BACKGROUND: Oxidative stress (OS) may result in damage to critical macromolecules, and an association between lead (Pb) toxicity and OS is a matter of research. Therefore, the aim of the present study was to investigate the effect of Pb on the oxidative system in indirectly Pb-exposed male apprentices. METHODS: Established parameters of Pb toxicity (aminolevulinic acid dehydratase index [ALAD index], zinc-protoporphyrin [ZPP]) as well as Pb-level in blood were determined in Pb-exposed apprentices (n > 25) and controls (n > 24). Enzymatic (glutathione peroxides [GPx], superoxide dismutase [SOD], catalase [CAT]) and non-enzymatic (alpha-tocopherol, beta-carotene) indices of OS, and malondialdehyde (MDA) level were also determined. RESULTS: There was a statistically significant increase in Pb level, ALAD index, ZPP concentration, GPx activity and MDA concentration in Pb-exposed apprentices when compared to controls. Although a statistically significant decrease in alpha-tocopherol and beta-carotene levels was seen, SOD and CAT activities were unaltered in Pb-exposed apprentices. Pb level and duration of Pb exposure were correlated with each other, as well as various indices of OS and MDA concentration. CONCLUSIONS: Chronic indirect Pb exposure results in lipid peroxidation in erythrocytes of apprentices via OS, and duration of Pb exposure is a reliable marker of Pb toxicity.

Renal effects and erythrocyte oxidative stress in long-term low-level lead-exposed adolescent workers in auto repair workshops.

Lead poisoning is an old but persistent public health problem in developing countries. The present study investigated blood lead levels and its effects on markers of renal function and parameters of erythrocyte oxidative stress in adolescent male auto repair workers in Turkey. Blood Pb level and the ALAD index (logarithm of activated delta-aminolaevulinic acid dehydratase/nonactivated delta-aminolaevulinic acid dehydratase) were measured as indicators of exposure to Pb. Markers of tubular damage urine N-acetyl-beta-D-glucosaminidase (NAG), beta2-microglobulin (beta-2 MG), creatinine (Cr), uric acid (UA), and calcium, markers of glomerular filtration blood urea nitrogen (BUN), serum Cr, UA, and parameters of oxidative damage in erythrocyte were studied in 79 Pb-exposed adolescent and 71 healthy control subjects. Blood lead levels and ALAD index were found significantly higher in the study group than that of normal control group. BUN, UA level, and glomerular filtration rates were detected in normal range in the lead-exposed group. Urinary NAG excretion and calciuria were higher in the study group than in controls. Urinary excretion of NAG was positively correlated with the blood lead levels (r=0.427). There was no relationship between blood lead levels and UA or beta-2 MG in urine. Malondialdehyde and glutathione peroxidase levels were significantly elevated in lead-exposed adolescents than controls, but changes in the catalase and superoxide dismutase activities in lead-exposed adolescents did not reach statistical significance. In conclusion, chronic low-dose lead exposure seems as a cause of subtle renal impacts in adolescent workers of auto repair workshops. Lead-induced oxidative stress in erythrocytes probably contributes to these subclinical renal effects.