Background: The immunomodulator mifamurtide plus a chemotherapy regimen has been shown to significantly improve the outcome in non-metastatic osteosarcoma patients. We report the results of the addition of mifamurtide to chemotherapy in newly diagnosed patients with osteosarcoma. Methods: A total of 36 children with osteosarcoma without detectable metastasis were treated between November 2010 and April 2018 at the Ankara University Department of Pediatric Oncology. Mifamurtide was added to the chemotherapy regimen in 17 patients while the remaining 19 did not receive mifamurtide. The probabilities of metastasis and overall survival were compared between the groups. Results: The 43-month survival rate was 87.5% and 89.9% in the patients who received and did not receive mifamurtide, respectively (p=0.65). Common side effects of mifamurtide were chills and fever. The addition of mifamurtide in the high-risk group with ≤95% necrosis tended to decrease the probability of distant metastasis (36.4% vs. 58.3%) (p=0.39). The time to metastasis in the group with positive surgical margins (4 months in one patient in the non-mifamurtide group, 7 and 20 months in the mifamurtide group) was also longer in the mifamurtide group. During the 43-month follow up period, median time to metastasis was longer in the mifamurtide group (20 vs. 5 months). In addition, mifamurtide plus chemotherapy decreased the risk of metastasis in the cases with primary site relapse. Conclusions: The addition of mifamurtide to chemotherapy might improve event-free survival by decreasing the probability of distant metastasis in bad histologic responders, and also by increasing the time to distant metastasis in the surgical margin positive group. Additional clinical studies are necessary to determine the long-term effects of mifamurtide on metastatic disease.
Aim:The aim of this study was to determine the frequency of iron deficiency anemia in patients with severe anemia, and to investigate and compare the difference in the hematological parameters between patients with and without iron deficiency anemia. Material and Methods: A total of 119 patients diagnosed with severe anemia between January 2012 and July 2014 were retrospectively analyzed in this study. Demographic and clinical characteristics of severe anemia patients were evaluated. Patients were evaluated in terms of iron deficiency anemia, and clinical characteristic and laboratory findings of the patients with and without iron deficiency anemia were compared. Results: Of the 119 cases 49 (41.2%) were male and 70 (58.8%) were female, mean age was 6.7±6.2 years. Various comorbidities were present in the patients. In all patients, the group with a hemoglobin value below 6 g/dL had a significantly lower platelet count than those equal to or above 6 g/dL (p=0.037). It was found that 52 (43.7%) of all cases had iron deficiency anemia and 27 (51.9%) of them were aged 5 to 18 years. Patients with iron deficiency anemia had lower ferritin level (p<0.001) than patients without iron deficiency anemia, while platelet count was higher in patients with iron deficiency anemia (p=0.001). Conclusion:In patients with severe anemia, a significant decrease in platelet count was found with hemoglobin value below 6 g/dL. In order to reduce the need for red blood cells transfusion, early diagnosis of iron deficiency anemia is important and iron supplementation should be given earlier.
Background/Objectives: Propranolol is the mainstay treatment of infantile hemangioma, and the optimal dose is unclear. Few studies are comparing the efficacy of propranolol dose of 2 vs.3 mg/kg/day. We compared the efficacy between these two doses and propranolol groups with no treatment group. Methods: One hundred eight patients with infantile hemangioma (15 days-27 months of age) were examined. The patients with high-risk features and/or a score of >6 points are given propranolol with a final dose of 2 or 3 mg/kg/day according to tolerance for 6-12 months. The resolutions rates for propranolol vs. placebo and propranolol 2 mg/kg/day vs. 3 mg/kg/day are compared. Results: The demographic and clinical features of the groups ( the non-treatment, propranolol 2 mg/kg/day group, propranolol 3 mg/kg/day group) are similar. Propranolol is significantly efficent in infantil hemangioma treatment (p<0.001). The resolution rates are not statistically different between 2 mg/kg/day propranolol group vs 3 mg/kg/day propranolol group at the sixth (68,59 ± 28,95 vs 73,44 ± 32,54)(p=0,673) and twelfth month (p=0,673) (89,08 ± 46,58 vs 91,13 ± 37,46 respectively )of follow up. A milld (n=3)(4%) adverse event was reported with no need for cessation.Conclusions: Propranolol is a safe drug for treating infantile hemangioma with an ideal dose of 2 mg/kg/day rather than 3 mg/kg/day.
In local high-risk Ewing Sarcoma, treatment approaches differ between COG (Children's Oncology Group) and Euro Ewing 2012 protocols. In Euro-Ewing protocol, high-dose chemotherapy and autologous stem cell transplantation is performed after local therapy. COG protocol includes fourteen chemotherapy regimens and local therapy after the fourth chemotherapy regimen. Targeted agents added to standard chemotherapy and novel agents for maintenance are warranted (11)(12)(13)(14). Here, we discuss the time of local therapy in stem cell rescue, high-dose chemotherapy, and autologous stem cell transplantation in this aggressive tumor. Our fifteen-year-old patient had right pelvic Ewing sarcoma with a volume higher than 400 ml. After three chemotherapy regimens, the tumor was inoperable and radiotherapy was applied. Stem cell rescue is performed after the fourth chemotherapy regimen. High-dose chemotherapy and autologous stem cell transplantation are planned for relapse consolidation (17). There is no consensus about the indication of high-dose chemotherapy and autologous stem cell transplantation in high risc Ewing sarcoma with an initial tumor volume > 400 ml.
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