Cytogenetics and molecular biology in Acute Lymphoblastic Leukemia ( ALL )

Acute lymphoblastic leukemia is a group of heterogeneous diseases. Actually, 20% of acute leukemia cases are reported for adults against 80% for children. Several clinical, biological and therapeutic factors are essential for defining optimal treatment modalities. In children, acute lymphoblastic leukemia is known by the presence of recurrent genetic abnormalities. These abnomalities are described as specific markers which represent an important clinical aspect in the identification of significant risks. Cytogenetic analysis (karyotype along with, if necessary, adequate FISH analyzes) is an essential examination when diagnosing acute lymphoblastic leukemia (ALL) Aims Our focus in this study is to define the cytogenetic abnormalities considering some Moroccan patients and their frequency. A comparison of the cytogenetic profiles of cancer cells with other prognostic factors is also demonstrated with the evolution of ALL Patient and methods We established a descriptive study covering a period from 2014 to 2018 with an established diagnosis of ALL children and patients less than 20 years in the pediatric hematology and oncology department at the August 20th hospital. The data concerning cytogenetic profile were collected from patients' charts and we classified cytogenetic abnormalities according to French cytogenetic guidelines. The three identified groups are favorable, intermediate and unfavorable. In the Caryotype the sample containing the blasts is cultured and treated to obtain a sufficient number of mitotic cells which will be analyzed in conventional cytogenetics. The material used in this study is the bone marrow or the peripheral blood, when it contains blast cells. The Fish technique is used as a complementary test to confirm the prognosis of the ALL patient. Results 141 Patients were collected for this study. The karyotype was performed on 105 patients. We analyzed 75 patients with B ALL. It was normal in 33 cases (37%). A hyperdiploidy between 51 and 65 chromosomes was found in 17 cases (17%). 10 cases showed karyotype failure. 25% of karyotypes were complex. The use of molecular biology allowed the detection of MLL + gene in 4 patients, and BCR/ABL gene in 5 patients during this study. Conclusion The management of pediatric ALL has progressed enormously in these recent years, resulting in improved patient survival. In our study we identified several cytogenetic abnormalities where the prognosis is unknown, as well as intermediate prognostic abnormalities, which encouraged us to set up a collaboration between hemato-biologists, geneticists and hematologists

Characterization of Acute Lymphoblastic Leukemia Subtypes in Moroccan Children

We present the incidence and the immunologic characteristics of acute lymphoblastic leukemia (ALL) subsets in Moroccan children. We studied 279 unselected patients below the age of 18 years with newly diagnosed ALL. Cases were classified according to immunophenotype: 216 (77.42%) precursor B-cell phenotype (pB-cell), mature B-cell in 4 (1.43%), and T-cell in 59 (21.15%) cases. The subclassification using the CD10 antibody revealed 197 cases pB-ALL CD10+ (91.2%) and 9 cases T-ALL CD10+ (19.2%). The age distribution showed a peak in incidence between 3 and 5 years among the pB-cell ALLs subtype. There was a significantly higher frequency of males in the T-ALL subset (M/F ratio: 2.93 : 1) and more females in the T-ALL CD10+ subset when compared with the T-ALL CD10– subset. All tested pB-cell-lineage ALLs expressed CD19, CD79a, and surface CD22, terminal deoxynucleotidyl transferase (TdT) was detectable in 89.9% of cases, and cells in 74.1% of cases express CD34. All tested T-lineage ALL cells have surface CD7 and cytoplasmic CD3 (cCD3) antigens, CD5 was found in 98.2% cases, and 70.5% express TdT. CD1a, surface CD3 (sCD3), and CD4 are detected in more than 80% of cases; this frequency is higher than the 45% generally observed. Myeloid antigens occur more frequently and were expressed in 124 (57.4%) of pB-cell-ALL cases and 20 (33.9%) of T-cell ALL cases. Our results show that the distribution of ALLs in Moroccan children is similar with the general distribution pattern in developed countries except for the high frequency of T-ALL phenotype. The phenotypic profiles of our patients are close to those reported in literature for B-lineage ALLs; for the T-cell ALL subgroup, the blast cells express more CD1a, surface CD3, and CD4 while expressing less TdT. The high frequency of CD1a expression resulted in an excess of the common thymocyte subtype

Current Cytogenetic Abnormalities in Acute Myeloid Leukemia

Cytogenetic abnormalities are frequently reported in the literature describing the presence of chromosomal rearrangements in important cases of acute myeloid leukemia (AML); the rate can reach 50–60% of cases of AML. Cytogenetic abnormalities represent an important prognosis factor, their analysis is crucial for AML; cytogenetic study permits to classify prognostic groups and indicate the treatment strategy and helps to improve the outcome of these patients and to increase their chances of cure. Hundreds of uncommon chromosomal aberrations from AML exist. This chapter summarizes chromosomal abnormalities that are common and classifies AML according to the World Health Organization (WHO) classifications from 2008 to 2016; we will discuss briefly gene mutations detected in normal karyotype (NK) AML by cutting-edge next-generation sequencing technology, like FLT3-ITD, nucleophosmin (NPM1), CCAAT/enhancer-binding protein alpha (CEBPA), and other additional mutations

Secondary Thymoma among Adult Treated For Acute Lymphoblastic Lymphoma/Leukemia: Report of a Case and Review of the Literature

BACKGROUND: Concomitant thymoma and T- lymphoblastic/leukaemia lymphoma is possible. Secondary thymoma after treatment for T-lymphoblastic/leukaemia lymphoma was also occasionally reported, although this is quite rare. CASE REPORT: We report a case of 44-year-old women with secondary thymoma after chemotherapy treatment for T Acute Lymphoblastic leukaemia/lymphoma. Diagnosis of lymphoblastic/leukaemia lymphoma was made in 2015 by morphological and histological study. The patient underwent Moroccan protocol for acute lymphoblastic leukaemia (MARALL) from 2015 to 2017 and achieved complete remission. One year later, the patient developed an anterior mediastinal mass, relapse was suspected, but the surgical biopsy was performed and histological, the mass showed thymoma. CONCLUSION: At the time of diagnosis of thymoma for a patient treated for T-lymphoblastic/leukaemia lymphoma it is necessary to eliminate a relapse because the distinction between thymoma and T-lymphoblastic/leukaemia lymphoma is sometimes difficult, and the association is possible

Pain Management in Children with Cancer: National Surveys of Practices and Perceptions in Morocco

AIM: The aim of the study was to improve the quality of pain management in Moroccan pediatric oncology units, the Moroccan Society of Paediatric Haematology/Oncology initiated a national quality improvement project in 2014 with the support of the Lalla Salma Foundation for Prevention and Treatment of Cancer. METHODS: To assess the current situation of pain management in Moroccan pediatric oncology patients, two cross-sectional surveys were conducted, involving patient/parental proxies and health-care providers’. RESULTS: The first survey concerned 108 care providers from five institutions. The second survey covered 155 children with cancer from the five Moroccan pediatric oncology units. Among them, 145 reported suffering from pain, which patients/families attributed to the underlying cancer (n = 85), to procedures and treatment (n = 46), or to both the cancer and procedures/treatment (n = 19). Procedural pain was mainly related to lumbar puncture and bone marrow aspirate. The majority of patients/parents reported that pain negatively impacted their emotional, physical, and social functioning. The majority of parents requested further information and communication about pain management. CONCLUSION: Both health-care providers and families of children with cancer in Morocco report need for pain management improvement, including in institutional and educational practices. This current baseline data have informed the development of our ongoing project including continuing education, training, and practice policies development

Pain assessment and management in the Moroccan haemophilia population: a prospective descriptive study

For people with haemophilia (PwH) who live in developing countries, haemophilia continues to be a condition with serious medical and social consequences. In Morocco, the efforts of patient associations and medical teams have led to the creation of a national programme for haemophilia care since the end of 2012, and the country is no longer solely reliant on World Federation of Hemophilia (WFH) donations for access to factor products. There is growing recognition of the impact of the pain experienced by PwH. To continue to improve treatment for PwH in Morocco, it is important to ensure that they are also able to manage haemophilia-related pain

AMYLOSE CONJONCTIVALE: PREMIERE MANIFESTATION D’UNE AMYLOSE SYSTEMIQUE ASSOCIEE AU MYELOME MULTIPLE

IntroductionL’amylose systémique de type AL a été décrite dans presque tous les organes. Cependant l’atteinte conjonctivale est relativement rare et décrite le plus souvent sous forme de cas isolés et petites séries de cas. Elle est le plus souvent une manifestation de l’amylose oculaire localisée; toutefois, une atteinte palpébrale peut survenir dans le cadre d’une forme systémique. Nous rapportons l’observation d’une amylose AL, qui apparait originale par l’atteinte conjonctivale révélatrice en soulignant le retard diagnostic et thérapeutique du à la méconnaissance de cette localisation et les tentatives de traitement symptomatique.ObservationUn patient de 58 ans présentait un purpura palpébral, périorbitaire bilatéral en lunette et des masses conjonctivales avec notion d’hémorragies conjonctivales intermittentes. Cette symptomatologie évoluait depuis plus de 12 mois, ayant suscitée plusieurs consultations ophtalmologiques et dermatologiques, ainsi que divers traitements symptomatiques jusqu’à réalisation d’un bilan biologique objectivant un pic des gammaglobulines à l’électrophorèse des protéines sériques suivi de la réalisation d’une biopsie conjonctivale posant le diagnostic d’amylose et imposant une recherche extensive ayant retrouver d’autres localisations d’amylose associées au myélome multiple.Discussion/ Conclusion  L’amylose  conjonctivale est une affection rare, dont le diagnostic est suspecté cliniquement et confirmé par examen histopathologique. Elle peut être le seul signe révélateur d’une atteinte systémique et son diagnostic impose une recherche systémique d’autres localisations