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    Central nervous system thrombosis in pediatric acute lymphoblastic leukemia in Turkey: A multicenter study
    (Wiley, 2023) Guzelkucuk, Zeliha; Karapinar, Deniz Yilmaz; Gelen, Sema Aylan; Tokgoz, Huseyin; Ozcan, Alper; Ay, Yilmaz; Bahadir, Aysenur
    BackgroundIn patients with acute lymphoblastic leukemia (ALL), the risk of thromboembolism increases due to hemostatic changes secondary to the primary disease and due to treatment-related factors. In this multicenter study, we aimed to research the frequency of central nervous system (CNS) thrombosis occurring during treatment, hereditary and acquired risk factors, clinical and laboratory features of patients with thrombosis, treatment approaches, and thrombosis-related mortality and morbidity rates in pediatric ALL patients. ProcedurePediatric patients who developed CNS thrombosis during ALL treatment from 2010 to 2021 were analyzed retrospectively in 25 different Pediatric Hematology Oncology centers in Turkiye. The demographic characteristics of the patients, symptoms associated with thrombosis, the stage of the leukemia treatment during thrombosis, the anticoagulant therapy applied for thrombosis, and the final status of the patients recorded through electronic medical records were determined. ResultsData from 70 patients with CNS thrombosis during treatment, out of 3968 pediatric patients with ALL, were reviewed. The incidence of CNS thrombosis was 1.8% (venous: 1.5 %; arterial: 0.03%). Among patients with CNS thrombosis, 47 had the event in the first 2 months. Low molecular weight heparin (LMWH) was the most commonly used treatment with a median of 6 months (min-max: 3-28 months). No treatment-related complications occurred. Chronic thrombosis findings occurred in four patients (6%). In five (7%) patients who developed cerebral vein thrombosis, neurological sequelae (epilepsy and neurological deficit) remained. One patient died related to thrombosis, and the mortality rate was 1.4%. ConclusionCerebral venous thrombosis and, less frequently, cerebral arterial thrombosis may develop in patients with ALL. The incidence of CNS thrombosis is higher during induction therapy than during other courses of treatment. Therefore, patients receiving induction therapy should be monitored carefully for clinical findings suggestive of CNS thrombosis.
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    Single center 10 years’ experience of acute lymphoblastic leukemia in childhood: Retrospective cohort study
    (2019) Erol Aytekin, Selma; Tokgoz, Huseyin; Caliskan, Umran; Aytekin, Gokhan
    Aim: We reviewed the files of 188 patients diagnosed with acute lymphoblastic leukemia at Pediatric Hematology Department, Necmettin Erbakan University Faculty of Medicine, Konya, between April 2006 and April 2016 retrospectively. 167 patients, who had sufficient records and accepting to participate in the study, were included. Patients were classified 3 groups according to their treatment protocols. These protocols were Saint Jude Total Therapy (St. Jude) protocol, Berlin-Frankfurt-Munster 2000 (BFM 2000) protocol and BFM 2009 protocol. Acute lymphoblastic leukemia (ALL) is a malignant disorder characterized with clonal enlargement of lymphoid progenitor cells. It is most common malignancy in childhood. Recent developments in immunologic and genetic methods have significantly altered the diagnostic and classification approaches. Nowadays advanced studies such as immunologic and cytogenetic studies have become more important in prognosis and treatment response. In this study, we aimed to present the clinical and laboratory features of patient with ALL who were followed in our Pediatric Hematology Clinic (Necmettin Erbakan University Faculty of Medicine, Konya) and determine the factors affecting the mortality and morbidity in patients with ALL.Results: When the results of the study were evaluated, we found that uric acid levels, blast ratio on the 15th day bone marrow evaluation, presence of relapse and relapse type were effective on overall survival. Also, we found that blast ratio on 15th day bone marrow evaluation, high levels of uric acid, and lactate dehydrogenase (LDH) were effective for event-free survival. Conclusion: In conclusion, our overall survival and disease-free survival rates are similar to those performed by St. Jude Total therapy XIIIB, BFM 2000 and BFM 2009 protocol.