Background: As a new point, some very rare features can be revealed as initial diagnosis of acute lymphoblastic leukemia (ALL) without any evidence of lymphoma-like behavior which after initial recovery, presents with new evidence of lymphoma. Herein, a case of the immunophenotypes of blast cells in B-cell Precursor acute lymphoblastic leukemia originated from MYC gene-related that was evidenced later by burkitt lymphoma feature. Case Presentation: Our case was initially diagnosed as a typical B-cell ALL cells with L1 morphology in peripheral blood smear and bone marrow aspiration that was not recovered and referred again that was finally featured as burkitt’, s lymphoma with L3 morphological feature. Conclusion: Thus, in the primary diagnosis of B-cell ALL and especially in cases with treatment failure, the final feature of burkitt’, s lymphoma should be potentially in mind.

Background: Transcription factors (TFs) play a key role in the development, therapy, and relapse of B-cell malignancies, such as B-cell Precursor acute lymphoblastic leukemia (BCP-ALL). Given the essential function of Forkhead box protein P1 (FOXP1) transcription factor in the early development of B-cells, this study was designed to evaluate FOXP1 gene expression levels in pediatric BCP-ALL patients and NALM6 cell-line. Materials and Methods: This case-control study was done on the NALM6 cell-line and bone marrow specimens of 23 pediatric BCP-ALL patients (median age: 7. 5 years; range: 2. 0 – 15. 0 years) at different clinical stages including new diagnosis, 15th day after the treatment, and relapse. Also, 10 healthy children were included as the control group. FOXP1 gene expression was analyzed by quantitative real-time polymerase chain reaction (qRTPCR). The correlation analysis was performed between the FOXP1 gene expression and patients’ demographic and laboratory characteristics. Results: The results showed that FOXP1 gene expression was significantly downregulated in the NALM-6 cellline (median=0. 05, P<0. 001) and patients at new diagnosis (median=0. 06, p<0. 0001), and relapse (median=0. 001, p<0. 0001) phases, compared to the control group (median=0. 08). FOXP1 gene expression on the 15th day of the treatment was significantly higher than its level at the new diagnosis stage (p<0. 001). Moreover, FOXP1 gene was significantly downregulated in the relapse phase compared to the new diagnosis. Patients whose number of bone marrow blasts on the 15th day of the treatment was below 5% had higher FOXP1 gene expression at the diagnosis phase (Spearman’ s correlation, P<0. 05, r=-0. 485) and higher ratio of diagnosis/day 15 (p<0. 001, Mann-Whitney U test). Conclusions: FOXP1 levels could be a potential biomarker of therapy response in remission induction therapy for pediatric BCP-ALL patients.

Background: Acute lymphoblastic leukemia (ALL) is the most common neoplasm in pediatric and adolescent populations. Overall survival has improved in recent decades. This study aimed to assess the overall survival of patients with pediatric ALL in a Latin American hospital. Materials and Methods: A longitudinal and retrospective analytical study was conducted on 31 patients less than 16 years of age diagnosed with ALL at the hematology department of a Peruvian hospital during the period 2015-2016. Overall survival at 5 years was determined using the Kaplan-Meier curve with parametric log-rank tests, and the Cox regression model was employed to ascertain the hazard ratios of significant variables. Results: The average age was 6 years, and 21 (67. 7%) were female. The 5-year overall survival rate was 35%, with a median survival of 33 months (95% CI = 34. 078-66. 861). Being 10 years or older was associated with lower survival (p = 0. 002). No significant association with B-cell acute lymphoblastic leukemia was found (p = 0. 057). Conclusion: The overall survival rate obtained was similar to that reported in other local studies, however, several international studies have reported better survival rates compared to our findings. Age was identified as a significant factor affecting survival.

Background: Acute lymphoblastic leukemia (ALL) is the most common cancer among children. The prognostic significance of the cluster of differentiation 34 (CD34) markers in children with B-cell acute lymphoblastic leukemia (B-ALL) is not yet fully understood. Materials and Methods: This study is a case-control trial based on the clinical data of 40 children with B-ALL who referred to a pediatric oncology center in the city of Sari, Iran. The data were derived from the demographic findings, laboratory test results at diagnosis, immunophenotyping, transfusion of blood products including packed red blood cells and platelet concentrates, and the frequency and duration of hospitalization due to febrile infection. Results: Of the participants, 42.5% were CD34-negative and 57.5% were CD34-positive. The mean age of the patients at diagnosis was 3.1 ± 3.3 years (Range:0.1-13.3 years). Also, 60.9% of the CD34-positive children and 47.1% of the CD34-negative ones were boys (P = 0.38). According to the calculated Cohen's d, the relationship of CD34 positivity with transfused packed red blood cell and platelet concentrates was mild -0.15 (95% CI -0.78 to 0.47) (P = 0.55) and moderate 0.49 (95% CI -0.15 to 1.12) (P = 0.29), respectively, which was significant in neither case. Moreover, the relationship of CD34 positivity with the hospitalization frequency of -0.51 (95% CI -1.14 to 0.13) (P = 0.22) and the hospitalization duration of -0.52 (95% CI -1.16 to 0.12) (P = 0.27) due to febrile infection was moderate to strong. Conclusion: The CD34-positive children with B-ALL experienced less blood products transfusion (except packed red blood cells) and febrile infection in terms of both the frequency and duration of hospitalization during chemotherapy. Therefore, CD34 expression in the B-ALL children was associated with better prognosis.

Introduction: Acute lymphoblastic leukemia (ALL) has various clinical manifestations due to bone marrow or extra medullary involvement. Osteomyelitismayoccur as the first presentation or relapsing sign of ALL. Multifocal osteomyelitis in non-neutropenic children with ALL is rare. Case Presentation: This study reported on an 8-year-old male with ALL during the maintenance phase of his treatment, who presented fever and generalized body pain. Bone scan showed multiple bones involvement and biopsy was in favor of osteomyelitis. Conclusions: Multifocal osteomyelitis should be kept in mind as a possible diagnosis in patients with leukemia, who are presented with prolonged fever.

Background: Acute lymphoblastic leukemia (ALL) is a malignancy of the white blood cells characterized by its rapid and aggressive progress that needs immediate treatment. ALL could affect both adults and children. Various patient-and disease-related factors may be involved in ALL patients’,prognosis. Therefore, it is critical to identify important risk factors related to the competing outcomes of patients with ALL. Objectives: This study aimed to stratify the risk of outcomes of children with Precursor B-cell ALL using demographic characteristics, laboratory characteristics, and extramedullary diseases. To achieve this goal, we used the best competing risks model to make an appropriate decision for children’, s treatment according to this classification. Methods: In this retrospective cohort study, 393 patients with ALL were included. ALL with B cell origins (CD20, CD19, CD10, and CD22 positive markers) was differentiated using flow cytometry. Complete remission was defined by a lymphoblast count of less than 5% in the bone marrow, presence of no blasts in cerebrospinal fluid (CSF), as well as complete disappearance of clinical symptoms. Patients with ALL were treated based on Berlin-Frankfurt-Mü, nster (BFM). Competing outcomes were first-relapse and non-relapse mortality, respectively. Risk factors affecting competing outcomes were assessed based on a fully specified sub-distribution model. Results: Five-year estimates for overall survival and event free survival were 75% (95% CI: 69-79%) and 71% (95% CI: 66-75%), respectively. Five-year incidence rates for first-relapse and non-relapse mortality in children were 11. 4% (95% CI: 8. 32-15. 16%) and 17. 6% (95% CI: 13. 98-21. 67%), respectively. Moreover, according to the results, children with WBC ,50000, hemoglobin < 8, and tumor lysis syndrome for the first-relapse outcome, and children with central nervous system (CNS) involvement and tumor lysis syndrome for the non-relapse mortality (NRM) outcome were considered as high-risk groups. Conclusions: We found that extramedullary diseases could have a crucial role in the risk stratification of children with Precursor Bcell ALL. Therefore, for a targeted and effective treatment of high-risk children, in addition to chemotherapy, using appropriate PI3K pathway inhibitors, JAK2 pathway inhibitors, and antibody-based immunotherapy is recommended to reduce minimal residual disease and, consequently, mortality rate.