Turkish Journal of Hematology Volume: 33 - Issue: 4

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Turk J Hematol 2016;33:339-345 Patıroğlu T and Akar HH; HLA (A, B, and DRB1) Alleles and Acute Lymphoblastic Leukemia (OR=0.50), the A*02/B*35/DRB1*13 haplotype (OR=0.09), and A*02/A*02 homozygosity (OR=0.11). The lower OR values can most likely be explained by the small importance of these data among the genetic factors predisposing to ALL. In conclusion, although A*03, DRB1*03, and DRB1*04 were observed to be susceptible alleles, A*23, B*13, B*40, and DRB1*13 were found to be protective alleles in patients with ALL. Although some results of our study support earlier findings, others are inconsistent. The increasing frequency of DRB1*04 and the decreasing frequency of A*23 and DRB1*13 alleles support results of earlier Turkish studies [11,12]. As new data, the frequencies of the A*02/B*35/DRB1*13 haplotype and A*02 homozygosity were observed to be higher as predisposing factors in patients with ALL. The frequency of DRB1*07 and DRB1*04 was observed to higher in the SRG and HRG, respectively, as additional predisposing factors. Ethics Ethics Committee Approval: Retrospective study; Informed Consent: It was not required. Authorship Contributions Concept: Türkan Patıroğlu, H. Haluk Akar; Design: Türkan Patıroğlu, H. Haluk Akar; Data Collection or Processing: H. Haluk Akar; Analysis or Interpretation: Türkan Patıroğlu; Literature Search: H. Haluk Akar; Writing: Türkan Patıroğlu, H. Haluk Akar. Conflict of Interest: The authors of this paper have no conflicts of interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included. References 1. Wintrobe MM. Clinical Hematology. 20th ed. Philadelphia, Wolters Kluwer- Lippincott Williams & Wilkins, 2009. 2. Greaves M. Infection, immune responses and the aetiology of childhood leukaemia. Nat Rev Cancer 2006;6:193-203. 3. Hunger SP, Mullighan CG. Acute lymphoblastic leukemia in children. N Engl J Med 2015;373:1541-1552. 4. Bradshaw G, Hinds PS, Lensing S, Gattuso JS, Razzouk BI. Cancer-related deaths in children and adolescents. J Palliat Med 2005;8:86-95. 5. Schrappe M, Reiter A, Ludwig WD, Harbott J, Zimmermann M, Hiddemann W, Niemeyer C, Henze G, Feldges A, Zintl F, Kornhuber B, Ritter J, Welte K, Gadner H, Riehm H. Improved outcome in childhood acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy: results of trial ALL-BFM 90. German-Austrian-Swiss ALL-BFM Study Group. Blood 2000;95:3310-3322. 6. Hosking FJ, Leslie S, Dilthey A, Moutsianas L, Wang Y, Dobbins SE, Papaemmanuil E, Sheridan E, Kinsey SE, Lightfoot T, Roman E, Irving JA, Allan JM, Taylor M, Greaves M, McVean G, Houlston RS. MHC variation and risk of childhood B-cell precursor acute lymphoblastic leukemia. Blood 2011;117:1633-1640. 7. Clayton J, Lonjou C. Allele and haplotype frequencies for HLA loci in various ethnic groups. In: Charron D, (ed). Genetic Diversity of HLA. Functional and Medical Implications. Paris, Medical and Scientific International, 1997. 8. Khosravi F, Amirzargar A, Sarafnejad A, Nicknam MH, Alimoghadam K, Dianat S, Solgi G, Nikbin B. HLA class II allele and haplotype frequencies in Iranian patients with leukemia. Iran J Allergy Asthma Immunol 2007;6:137- 142. 9. Taylor M, Hussain A, Urayama K, Chokkalingam A, Thompson P, Trachtenberg E, Buffler P. The human major histocompatibility complex and childhood leukemia: an etiological hypothesis based on molecular mimicry. Blood Cells Mol Dis 2009;42:129-135. 10. Yari F, Sobhani M, Sabaghi F, Zaman-Vaziri M, Bagheri N, Talebian A. Frequencies of HLA-DRB1 in Iranian normal population and in patients with acute lymphoblastic leukemia. Arch Med Res 2008;39:205-208. 11. Ozdilli K, Oguz FS, Anak S, Kekik C, Carin M, Gedikoglu G. The frequency of HLA class I and II alleles in Turkish childhood acute leukaemia patients. J Int Med Res 2010;38:1835-1844. 12. Uçar F, Sönmez M, Erkut N, Balcı M, Yücel B, Yılmaz M, Erduran E, Ovalı E. Relation of HLA-A, -B, -DRB1 alleles and haplotypes in patients with acute leukemia: a case control study. Arch Med Res 2011;42:305-310. 13. Taylor GM, Hussain A, Lightfoot TJ, Birch JM, Eden TO, Greaves MF. HLAassociated susceptibility to childhood B-cell precursor ALL: definition and role of HLA-DPB1 supertypes. Br J Cancer 2008;98:1125-1131. 14. Urayama KY, Thompson PD, Taylor M, Trachtenberg EA, Chokkalingam AP. Genetic variation in the extended major histocompatibility complex and susceptibility to childhood acute lymphoblastic leukemia: a review of the evidence. Front Oncol 2013;3:300. 15. Walsh KM, de Smith AJ, Welch TC, Smirnov I, Cunningham MJ, Ma X, Chokkalingam AP, Dahl GV, Roberts W, Barcellos LF, Buffler PA, Metayer C, Wiemels JL. Genomic ancestry and somatic alterations correlate with age at diagnosis in Hispanic children with B-cell acute lymphoblastic leukemia. Am J Hematol 2014;89:721-725. 16. Greaves MF, Maia AT, Wiemels JL, Ford AM. Leukemia in twins: lessons in natural history. Blood 2003;102:2321-2333. 17. Schumacher HR, Alvares CJ, Blough RI, Mazzella F. Acute leukemia. Clin Lab Med 2002;22:153-192. 18. Curtoni ES, Mattiuz PL, Tosi RM, (eds). Histocompatibility Testing. Copenhagen, Munksgaard, 1967. 19. Fernandes TA, Fukai R, Souza CA, Lorand-Metze I, Magna LA, Kraemer MH. Molecular identification of the HLA-DRB1-DQB1 for diagnosis and followup of acute leukemias. Blood Cells Mol Dis 2010;44:69-73. 20. Dorak MT, Lawson T, Machulla HK, Darke C, Mills KI, Burnett AK. Unraveling an HLA-DR association in childhood acute lymphoblastic leukemia. Blood 1999;94:694-700. 345
BRIEF REPORT DOI: 10.4274/tjh.2016.0046 Turk J Hematol 2016;33:346-348 Varicella-Zoster Virus Infections in Pediatric Malignancy Patients: A Seven-Year Analysis Pediatrik Malignite Hastalarında Varicella Zoster Virüs Enfeksiyonları: Yedi Yıllık Analiz Mine Düzgöl 1 , Gülcihan Özek 2 , Nuri Bayram 1 , Yeşim Oymak 2 , Ahu Kara 1 , Bengü Demirağ 2 , Tuba Hilkay Karapınar 2 , Yılmaz Ay 2 , Canan Vergin 2 , İlker Devrim 1 1Dr. Behçet Uz Children Training and Research Hospital, Clinic of Pediatric Infectious Diseases, İzmir, Turkey 2Dr. Behçet Uz Children Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İzmir, Turkey Abstract Primary varicella-zoster virus (VZV) infection is a benign self-limited disease. In this study, we review our experience in focusing on the outcome and treatment of VZV infection in pediatric malignancy patients. During the study period, a total of 41 patients with pediatric malignancy had been hospitalized with the diagnosis of VZV infection. All the patients were treated with intravenous acyclovir for a median of 7 days (ranging from 5 to 21 days). The calculated attributable delay of chemotherapy due to VZV infections was 8 days (ranging from 2 to 60 days). VZV-related complications were observed in 3 of 41 patients (7%) who suffered from acute respiratory distress syndrome, and one of them with hemophagocytic lymphohistiocytosis died due to respiratory failure despite acyclovir and broad-spectrum antimicrobial treatment plus supportive treatment. VZV infections are still important contagious diseases in pediatric cancer patients, because they cause not only significant mortality but also a delay in chemotherapy. Keywords: Varicella, Malignancy, Pediatric patient Öz Primer varisella zoster virüs (VZV) enfeksiyonu benign, kendi kendini sınırlayan bir hastalıktır. Bu çalışmada pediatrik malignitesi olan hastalarda VZV enfeksiyonu ve tedavisine odaklı tecrübelerimizi gözden geçirmeyi amaçladık. Çalışma süresi boyunca; VZV enfeksiyonu tanısı alan pediatrik maligniteli toplam 41 hasta hastaneye yatırıldı. Tüm hastalar ortalama 7 gün (5 ila 21 gün arasında değişen) intravenöz asiklovir ile tedavi edildi. VZV enfeksiyonlarına bağlı olarak hesaplanan atfedilebilir kemoterapi gecikmesi ortalama 8 gündü (2 ile 60 gün arasında değişen). VZV enfeksiyonuna bağlı komplikasyonlar 41 hastadan 3’ünde (%7) akut solunum distres sendromu olarak görüldü ve bu hastalardan hemofagositik lenfohistiyositozu olan bir tanesi asiklovir, geniş spektrumlu antibiyotik ve destekleyici tedaviye rağmen solunum yetmezliği nedeniyle kaybedildi. VZV enfeksiyonları, pediatrik malignite hastalarında hala önemli bulaşıcı hastalıklardan biridir, çünkü sadece ciddi mortaliteye sebep olmakla kalmayıp kemoterapi başlangıcını da geciktirmektedir. Anahtar Sözcükler: Varisella, Malignite, Çocuk hasta Introduction Immunocompromised children are at greater risk of suffering from severe, prolonged, and complicated varicella-zoster virus (VZV) infection [1]. Before introduction of antiviral therapy, the mortality rate of VZV infections in children with cancer was reported to be 7%, with numbers reaching up to 55% in cases with visceral involvement [2,3,4,5]. In this study, we aimed to review our experience in focusing on the outcome and treatment of VZV infections in pediatric malignancy patients. Materials and Methods A retrospective cohort study design was used to evaluate pediatric cancer patients with VZV infections who were hospitalized in the Pediatric Hematology-Oncology and Infectious Diseases Units of the Dr. Behçet Uz Children’s Hospital from December 2008 to March 2015. In this study, the attending physician’s clinical diagnosis of VZV infection was based on case definitions set by the United States Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists guidelines reported in 2009 [6,7]. Therapy with intravenous acyclovir (1500 Address for Correspondence/Yazışma Adresi: Mine DÜZGÖL, M.D., Dr. Behçet Uz Children Training and Research Hospital, Clinic of Pediatric Infectious Diseases, İzmir, Turkey Phone : +90 232 489 56 56 E-mail : mineduzgol@gmail.com Received/Geliş tarihi: January 27, 2016 Accepted/Kabul tarihi: March 28, 2016 346
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