Abstracts from Proceedings of the Society of Hematologic Oncology 2023 Annual Meeting Acute Lymphoblastic Leukemia ALL-019 Iron Status and Overload in Children With Acute Lymphoblastic Leukemia (ALL) during Different Phases of Therapy in a Pediatric Oncology Center in Egypt Mohsen S. Elalfy MD, PhD1, Samah Ramadan MD1, Sameh N. Kamel MD2, Khadiga Eltonbary MD1 1Department of Pediatrics, Ain Shams University, Cairo, Egypt. 2Department of Diagnostic and Interventional Radiology, Ain Shams University, Cairo, Egypt Context: Children with ALL may develop iron overload, primarily due to repeated transfusions. Excess iron exerts toxic effects through oxygen free radicals, which may increase the risk of infectious complications and proliferation of malignant cells. Objective: To assess iron status and iron overload in pediatric ALL patients at different phases of treatment. Design and Setting: A cross-sectional study was performed in children with ALL (aged >1–16 years) being followed in the Pediatric Oncology Unit, Children’s Hospital, Ain Shams University, from March 2022 to September 2022. Patients: Almost one-third of the patients were receiving induction or consolidation, one-third continuation therapy, and one-third were survivors. The patients’ transfusion histories, clinical data and risk stratification were recorded. Iron profiles (serum iron, serum ferritin [SF] and total iron binding capacity) were assessed. R2* magnetic resonance imaging (R2*-MRI) was performed to measure liver iron content (LIC) in a limited group (≥8 years, with either SF >1000 ng/ mL, >6 packed red blood cell [PRBC] transfusions or total transfusion volume ≥100 mL/kg). Main Outcome Measures: The relationship of iron status in ALL to transfusion and/or disease process and to the possible need for intervention was assessed. Results: The study included 70 ALL patients (Pre-B, 78.8% and T cell, 21.2%). Almost 33% received ≥6 PRBC transfusions. SF was elevated in 60% of patients but there were no significant differences in SF in relation to different age groups or sex. SF was significantly elevated in patients with T-cell ALL and it was significantly higher in patients during induction and consolidation phases, whereas serum iron and transferrin saturation were significantly higher in patients during the maintenance phase, but no correlation was found with the number of PRBC transfusions. Almost 60% (10 out of 16 ALL) of those who had the R2*-MRI assessment had mild-moderate iron load (LIC range 1.36-8.96 mg/g, median 2.31 (IQ 1.85-5.0). Conclusion: Children with ALL, mainly the T-cell subset, developed significant iron overload and SF was also significantly elevated during induction and consolidation phases. PRBC transfusion is an important risk factor for iron overload, being correlated with mild-moderate hepatic iron overload. The significance of altered iron homeostasis during leukemia management needs to be further elucidated. Keywords: ALL, ferritin, iron overload, liver iron content, transfusion ALL-020 Localized and Generalized Lymphadenopathy Referred to 3 Tertiary Pediatric Centers Over 6 Years: The Alarming Signs Omar Elalfy MD1,2, Mohsen Elalfy MD3, Amira Adly MD3, Islam el Ghamry MD3 1Ain Shams Oncology Unit, Cairo, Egypt. 2National Research Centre, Cairo, Egypt. 3Ain Shams University, Cairo, Egypt Context: Lymphadenopathy (LN) is a common problem in children. Most cases are benign and patients recover quickly. Alarming signs of more serious illness are rapid progression and firm-to-hard and nontender LN, with or without splenomegaly. Unnecessary diagnostic lymph node biopsy is a common practice. Patients and Interventions: All cases of LN in children 2-16 years old referred to 3 centers—Ain Shams Children’s Hospital (80%), National Research Centre (10%), and Sultan Qaboos University Hospital (10%)—over 6 years were fully evaluated. Acute bacterial- and granulomatous-related LNs were excluded. Complete history, examination, and investigations were carried out, including hemogram, viral screening, imaging, and bone marrow examination, if necessary. Results: 646 children were enrolled: 63% male, median age 6.6 (IQ 4.2–9.1 y). Among patients referred to the general pediatrics clinic (n=229), only 1.9% of LNs were malignant. Among those referred to the pediatric oncology clinic (n=417), 51 (12%) had either leukemia (n=26), lymphoma (n=5 Hodgkin and n=11 NHL), or immune-mediated lymphadenopathy (n=9). Viral infection was the most common: two-thirds had Epstein-Barr virus (EBV) and one-third had cytomegalovirus (CMV) infection. Affected children with leukemia or NHL were commonly younger than 5 years. The frequency of lymphadenopathy and hepatosplenomegaly were similar among patients with CMV and EBV. Alarming signs of leukemia were fever >2 weeks, purpura, and bone aches. Generalized nonregressive, firm, nontender LN and splenomegaly were more common in noninfectious etiology. Delay in diagnosis was 9–56 days (mean 17±3.1 days) and comparable for Abstracts Clinical Lymphoma, Myeloma & Leukemia, Vol 23, No S1, S236-S538, 2023 Clinical Lymphoma, Myeloma & Leukemia September 2023 S236 2152-2650/$ - see front matter © 2023 Published by Elsevier Inc.
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