Taha M. Khattab

A pilot study of prophylactic ciprofloxacin during delayed intensification in children with acute lymphoblastic leukemia

We hypothesized that prophylactic administration of an appropriate antibiotic following each delayed intensification (DI) in children with acute lymphoblastic leukemia (ALL) would reduce the episodes of fever and bacteremia associated with neutropenia, and hence reduce both the rate and duration of hospitalization.

Improved outcome in pediatric AML due to augmented supportive care

We conducted a retrospective review of patients treated following the MRC acute myeloid leukemia (AML) 10 protocol to determine if supportive care measures sequentially introduced by our institution led to a significant improvement in treatment‐related mortality (TRM) in newly diagnosed pediatric patients with AML. Patients were partitioned based on supportive care measures into era1, from 1996 to 2002 (n = 20), and era2, from 2003 to 2011 (n = 40). The introduced supportive care measures reduced the TRM from 23.4% in era1 to 2.5% in era2 (P = 0.034). The results demonstrate that supportive care is a significant factor in determining the outcome of childhood AML. Pediatr Blood Cancer 2012; 59: 919–921.

Identifying causes of variability in outcomes in children with acute lymphoblastic leukemia treated in a resource-rich developing country.

The outcome of children with acute lymphoblastic leukemia (ALL) in developing countries is less favorable than in developed countries, primarily due to resource constraints. However, it is unknown whether the therapeutic results differ. Thus, we hypothesized that outcomes in resource‐rich developing countries would be similar to those in industrialized regions.

Does the early intensification of intrathecal therapy improve outcomes in pediatric acute lymphoblastic leukemia patients with CNS2/TLP+ status at diagnosis?

Abstract Objectives We aimed to determine whether the addition of two extra intrathecal methotrexate (ITM) doses during induction in acute lymphoblastic leukemia (ALL) patients eliminate the prognostic significance of CNS2/TLP+ status. Methods We retrospectively analyzed 224 patients according to the central nervous system (CNS) involvement at diagnosis: CNS1, CNS2, or CNS3. Patients with CNS2/TLP+ received two additional ITM doses during induction. Patients were treated according to the Childrens Cancer Group (CCG)-1991/1961 protocols between January 2001 and December 2007. Results The 5-year relapse-free survival (RFS) rates for the ALL patients in the CNS1, CNS2, and CNS3 groups were 80.4 ± 3.0, 100, and 73.5 ± 11.3%, respectively; a non-significant difference was observed between the groups (P = 0.063). However, the patients with CNS2 had significantly better survival compared with the CNS3 patients (P = 0.03). The 5-year cumulative incidence of relapse (CIR) rates for the three groups were 17 (95% confidence interval (CI): 11.9–22.9), 0, and 18.8% (95% CI: 4.3–41.1), respectively; (P = 0.214) and those of isolated or combined CNS relapse were 9.6 (95% CI: 5.8–14.5), 0 and 6.3% (95% CI: 0.3–25.8), respectively (P = 0.424). Conclusions This study shows that the intensification of ITM therapy during induction improves outcomes in patients with CNS2/TLP+ status and eliminates its prognostic significance. This suggests that early intensification using CNS-directed therapy is beneficial in controlling minimal CNS disease.

Unusual complication of sickle cell crisis

A 6-year-old Saudi boy with sickle cell anemia had cough, fever, chest pain, and anemia. A chest x-ray showed a slight opacity in the left lower lobe. A diagnosis of pneumonia with sickle cell crisis was made. Despite broad-spectrum antibiotics, he had increased respiratory distress requiring ventilatory support. A repeat chest x-ray revealed a left pleural effusion and mediastinal shift (Fig. 1). Insertion of a chest tube produced only a small volume of serosanguinous fluid that was sent out for smear and culture. Two exchange transfusions were undertaken to reduce pulmonary sickling. Computerized axial tomography of the chest showed extensive consolidation (Fig. 2). Examinations of the pleural fluid and specimens from bronchoalveolar lavage and cerebrospinal fluid showed no organisms and all cultures were negative. However, the