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Purpose: Patients who receive frequent blood transfusions are at an elevated risk of developing hepatic fibrosis due to iron overload in the liver. In this study, we evaluated the effectiveness of transient elastography (TE) (FibroScan®) for assessing liver fibrosis in patients with pediatric cancer. Methods: We enrolled 106 consecutive cases of acute leukemia in individuals under 21 years of age. The participants were followed for 2 years. Based on their serum ferritin (SF) levels, the patients were divided into two groups: group 1 (SF≥300 ng/mL) and group 2 (SF<300 ng/mL). A liver FibroScan® was performed, and a p-value of less than 0.05 was considered statistically significant. Results: Among the various parameters in the liver function test (LFT), alkaline phosphatase was significantly higher in a subgroup of patients aged 5--8 years in group 2 compared to those in group 1. The indices of liver fibrosis determined by TE, including the FibroScan score, controlled attenuation parameter score, steatosis percentage, and meta-analysis of histological data in viral hepatitis score, as well as indirect serum markers of liver fibrosis such as the aminotransferase (AST)/alanine aminotransferase (ALT) ratio, Fibrosis 4 score, and AST to platelet ratio index, did not differ significantly between the two groups. The association between the TE results and LFT parameters was only significant for ALT. Conclusion: Transfusion-associated iron overload does not have a significant correlation with severe liver fibrosis. FibroScan® is not a sensitive tool for detecting early stages of fibrosis in survivors of pediatric leukemia. [ABSTRACT FROM AUTHOR]

This meta-analysis evaluated the impact of prophylactic post-chemotherapy granulocyte colony-stimulating factor (G-CSF) in patients with acute myeloid leukemia (AML). Overall, the relapse rate, overall survival, event-free survival, and mortality rate were similar in G-CSF (+) compared to G-CSF (−) patients. However, the relative risk (RR) of relapse was higher in children and in secondary AML patients who were treated with G-CSF compared to the G-CSF (−) group [RR, 95% confidence interval: 1.26, 1.04–1.52, and 1.12 (1.02–1.24)]. Treatment with post-chemotherapy G-CSF should be prescribed with caution in pediatric patients with AML and secondary AML as possibly increasing the relapse risk. [ABSTRACT FROM AUTHOR]

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Previous studies have shown that patients with sickle cell disease (SCD) are at high risk for obstructive sleep apnea (OSA). In the current study, we aimed to systematically review the literature to address the prevalence of OSA and associated symptoms among patients with SCD. Electronic databases, including Web of Science, Scopus, PubMed, Google Scholar, and Embase were systematically searched to identify the relevant original articles on patients with SCD. Newcastle Ottawa scale was used for quality assessment. Data were pooled by using random effects models. Subgroup analyses were performed by age groups. Thirty-nine studies containing details of 299,358 patients with SCD were included. The pooled results showed that more than half of these patients had OSA with different severities. The prevalence rates of OSA among children with apnea hypopnea index (AHI) cutoffs of above 1, 1.5, and 5 were 51% (95% confidence interval (CI) 36–67%), 29% (95% CI 19–40%), and 18% (95% CI 14–23%), respectively. The prevalence of OSA among adults with AHI cutoff of 5 was 43% (95% CI 21–64%). The pooled rates of snoring, nocturnal enuresis, nocturnal desaturation, and daytime sleepiness were 55% (95% CI 42–69%), 37% (95% CI 33–41%), 49% (95% CI 26–72%), and 21% (95% CI 12–30%), respectively. Given the high prevalence of OSA in patients with SCD, probable greater burden of SCD complications, and irreversible consequences of OSA, screening for OSA symptoms and signs seems useful in these patients. By screening and identifying this heterogeneous disorder earlier, available treatment modalities can be individualized for each patient. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac complications are the leading cause of mortality amongst transfusion-dependent thalassemia (TDT) patients. The multifactorial etiology of cardiac disorders makes their management challenging. Therefore, in addition to evaluating the incidence of heart failure (HF) and pulmonary hypertension (PHT), we assessed the associated factors among 737 TDT patients, aiming to achieve a plenary perspective of their cardiac disorders and relative factors. Material and methods: In this cross-sectional study, we evaluated the incidence of HF and PHT in 737 TDT patients while considering imperative factors such as endocrinopathies, iron status, and serum vitamin D level. Results: The incidence of total heart failure and pulmonary hypertension were estimated at 12.3% among participants, although the rate of cardiac iron overload was c.40%. Splenectomy, serum vitamin D, low bone mass, age, gender, hypoparathyroidism, hypogonadism, and diabetes significantly impaired the cardiac function of our patients. In univariate analysis, only the frequency of blood transfusion proved to have a risk effect on left ventricle ejection fraction. Conclusions: Cardiac iron overload has the highest impact on the incidence of cardiac disorders among TDT patients. We observed significant statistical associations between both HF and PHT with iron chelation regimen, endocrinopathies, splenectomy, serum vitamin D, and total body iron status in univariate analysis. Such results were not statistically significant in multiple logistic regression. However, in clinical practice, their effect could not be ignored. Further studies are required to achieve efficient management of thalassemia patients with cardiac disorders. [ABSTRACT FROM AUTHOR]