Recombinant alpha-2a interferon treatment in a child with T-cell leukemia and chronic hepatitis B

We present the case of a 12-year-old boy with T-cell acute lymphoblastic leukemia (ALL) who developed a chronic hepatitis-B virus (HBV) infection during the consolidation phase of chemotherapy and was unable to receive further therapy because of hepatotoxicity. Recombinant alpha-2a interferon (a-IFN) treatment (5 million units/m(2) per dose, three times a week) was started for chronic HBV infection at the end of the sixth month, and vincristine (1.5 mg/m(2)) was administered once a month as the only well-tolerated chemotherapeutic agent. During follow-up, the dose of cr-IFN was increased to 10 million units/m2 three times a week, depending on the patient's laboratory data. Three months later, elimination of HBe Ag and HBV DNA and seroconversion from HBe Ag to HBe Ab occurred. The duration of a-IFN therapy was prolonged to 18 months, since other chemotherapeutic agents caused hepatotoxicity whenever they were tried and alpha-IFN treatment can be used in children with refractory T-cell leukemia in view of its antitumor effect. Our patient has now been in complete remission for 4 years. alpha-IFN therapy should be considered as an alternative treatment for patients with T-cell ALL who cannot receive chemotherapy because of HBV infection or for any other reasons

Lack of association between plasma leptin levels and appetite in children with iron deficiency

PubMedID: 11448591A negative correlation between leptin and appetite or food intake has been shown in healthy individuals. However, the role of leptin in clinical conditions characterized by anorexia has not been established. One of the well-known clinical features of iron-deficiency anemia is poor appetite. We examined the changes in plasma leptin levels in relation to expected improvement in appetite with iron treatment in children with iron deficiency. In 24 infants and small children (mean age ± standard deviation = 19.6 ± 7.7 months) with iron deficiency, we studied plasma leptin levels before and after iron therapy. After 15.0 ± 2.4 wk of iron treatment, serum ferritin levels improved significantly, with accompanying increases in their subjective appetite scores and food intakes. However, as their mean age and plasma leptin levels adjusted their body mass indexes were unchanged. Serum ferritin correlated significantly with appetite score (r = 0.680, P < 0.001) and food intake (r = 0.480, P < 0.01). Leptin correlated only with body mass index (r = 0.405, P < 0.01). Lack of association between plasma leptin levels and degree of appetite in iron-deficient children treated with iron suggests a leptin-independent mechanism for the observed increase in appetite. Copyright © 2001 Elsevier Science Inc

Development of acute promyelocytic leukemia with isochromosome 17q after BCR/ABL positive chronic myeloid leukemia

We describe a pediatric case of acute promyelocytic leukemia with an i(17q) after treatment of BCR/ABL positive chronic myeloid leukemia (CML) for 3.5 years. The patient was treated with Busulphan, alpha-2a interferon, hydroxyurea, and cytosine arabinoside at various times in the course of the chronic phase of CML, because he had no HLA-identical donor for bone marrow transplantation. Hematologic remission was achieved for a short time, but cytogenetic remission was never possible, When promyelocytic blast crisis was diagnosed according to the French-American-British classification, cytogenetic studies revealed an i(17q) as a new feature in our patient. The promyelocytic transformation was associated with the appearance of an i(17q) preceding CML are discussed in the light of recent literature. (C) Elsevier Science Inc., 1999. All rights reserved

Combined central retinal artery and vein occlusion in a child with systemic non-Hodgkin's lymphoma.

Purpose: To report on a case of systemic non-Hodgkin's lymphoma and unilateral combined central retinal artery and vein occlusion. Method: We examined a 14-year-old boy who experienced a sudden unilateral visual loss five months after the initial diagnosis of systemic non-Hodgkin's lymphoma. Result: Visual loss was due to combined central retinal artery and vein occlusion in association with tumoral optic nerve involvement. Conclusion: Alhough very rare systemic non-Hodgkin's lymphoma may present with central retinal artery and vein occlusion prior to overt central nervous system involvement

Combination of steroid with azathioprine in treatment of giant cell autoimmune hepatitis

Giant cell hepatitis is a rare disorder after the newborn period. Drugs, autoimmunity, and viruses (lately, paramyxovirus infection) have been implicated in its etiology. Without treatment, liver dysfunction is progressive and fatal. Immunosuppression with steroids and azathioprine has been demonstrated to sustain improvement in the disease. In this report, a one-year-old boy who has giant cell hepatitis with Coombs' positive hemolytic anemia and anti-smooth muscle antibodies is presented, and the course of the disease and the patient's response to treatment with steroid and azathioprine is reviewed