Iranian Journal of Pediatric Hematology & Oncology

The Effectiveness of N-acetylcysteine in Preventing Oral Mucositis Induced by Chemotherapy among Children with Cancer: A Double-Blind Randomized Controlled Trial

Tue, 16 Jun 2026 03:49:42 +0000

Background: Oral mucositis (OM) is a common chemotherapy complication in children, linked to oxidative stress. The aim of the study was to evaluate the efficacy of oral N-acetylcysteine (NAC) compared to placebo in children with malignancy at risk of mucositis induced by chemotherapy.

Materials and Methods: The double-blind randomized controlled trial was performed on 80 children hospitalized in the oncology departments of Shahid Baghaei and Abuzar hospitals in Ahvaz, Iran. The patients were randomly assigned to NAC and placebo groups using a four-block randomization method. The NAC group received oral NAC (20–25 mg/kg on day 1, then 10–15 mg/kg daily for 14 days), while the control group received placebo. The outcomes included OM severity, fever duration, hospital stay, serum malondialdehyde (MDA), and adverse effects.

Results: The rate of no mucositis (grade 0) was higher in the NAC group (72.5% vs. 47.5%, P = 0.030), while severe mucositis (grade 3) occurred only in the control group (10% vs. 0%, P = 0.030). The duration of fever in the NAC and the control groups was 1.63 ± 2.04 and 3.68 ± 4.77 days, respectively (P = 0.016). The hospital stays in the NAC and control groups were significantly different (4.55 ± 1.01 vs. 5.8 ± 1.22, P = 0.001). The level of MDA on the seventh day was significantly different between the two groups (4.73 ± 0.36 µmol/L in the NAC group vs. 8.89 ± 0.26 µmol/L in the control group, P < 0.001). The level of MDA on the fifteenth day in the NAC and control groups was 2.76 ± 0.31 and 6.06 ± 0.23 µmol/L, respectively (P < 0.001).

Conclusion: Given its role in reducing the severity of chemotherapy-induced mucositis, NAC may serve as an effective adjunct in pediatric oncology care alongside standard oral and dental hygiene measures.

Survival Outcomes and Prognostic Indicators in Pediatric Acute Lymphoblastic Leukemia: A Study in a Tertiary Care Setting from Bangladesh

Abu Jafar Mohammed , Quazi Smita Haq, Tahir Rahman, Masba Uddin Chawdhury — Tue, 16 Jun 2026 03:53:53 +0000

Background: Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Survival outcomes are significantly higher in high-thiess to diagnostics and standardized therapy contributes to poor prognosis. This study evaluated survival patterns and prognostic indicators in pediatric ALL patients treated at a tertiary care center in Bangladesh.

Materials and Methods: A retrospective cohort of 36 pediatric ALL patients treated between March 2016 and March 2024 was analyzed. Overall survival (OS) and event-free survival (EFS) were estimated using the Kaplan–Meier method. Prognostic indicators included age, white blood cell count, minimal residual disease (MRD) status, CD20 expression, risk classification, and Day 8 steroid response. Associations with MRD clearance were tested using Fisher’s exact and Mann–Whitney U tests. Risk differences with 95% confidence intervals were calculated for subgroup comparisons.

Results: MRD clearance (<0.01%) at the predefined analytic endpoint was achieved in 66.7% of patients. Clearance was more frequent in standard-risk than high-risk patients (85.71% vs. 40.00%; risk difference: 45.71%, 95% CI: 7.60–83.80; p = 0.032) and in CD20-negative compared to CD20-positive patients (86.67% vs. 52.38%; risk difference: 34.33%, 95% CI: 8.60–60.00; p = 0.040). No significant associations were found with initial blast count or steroid response. The 3- and 5-year Kaplan–Meier–adjusted OS and EFS were both 96.55% (95% CI: 77.95–99.51%). One non-relapse death due to infection was recorded.

Conclusion: This study demonstrates favorable survival outcomes among ALL patients at Evercare Hospital pediatric in Bangladesh who completed standardized therapy. MRD clearance was significantly associated with risk classification and CD20 expression, underscoring its utility in risk stratification. Larger, prospective multicenter studies are required to validate these findings and guide treatment strategies in resource-limited settings.

Clinicopathological Features, Prognostic Factors, and Survival Outcomes of Retroperitoneal Lesions

Mahmood Reza Roknaldini , Maryam Vajihinejad — Tue, 16 Jun 2026 03:57:08 +0000

Background: Retroperitoneal tumors (RPTs) are rare and heterogeneous neoplasms that show distinct biological and clinical features across age groups. This study aimed to assess the clinicopathological characteristics of RPTs in pediatric and adult patients.

Materials and Methods: This retrospective cohort study included patients diagnosed with RPTs from 2016 to 2021. The clinical data, histopathological findings, and outcomes were reviewed and compared between the children (< 18 years) and adults (≥ 18 years). Statistical analyses were performed using chi-square and Fisher’s exact tests, independent t-tests, Kaplan–Meier survival analysis, and Firth’s penalized logistic regression.

Results: Among 109 patients, 14 (12.8%) were children and 95 (87.2%) were adults. Metastatic tumors were the most common lesion type (72.5%), followed by primary malignant (21.1%) and benign tumors (6.4%). Metastatic tumors were the predominant histopathological category (72.5%), followed by primary malignant mesenchymal tumors (16.5%). Histopathological distributions were similar between children and adults, with no significant differences observed across categories (all p>0.05). Overall survival was similar between children and adults (p=0.35). Abdominal pain was the most common symptom (51.4%), while nausea occurred more frequently in children (p=0.01). Firth’s penalized logistic regression identified no significant associations between clinicopathological factors and recurrence or necrosis (all p>0.05).

Conclusion: Metastatic tumors predominated in both age groups, followed by primary malignant mesenchymal tumors. No significant age-related differences were observed in histopathological categories, tumor origin, or survival.

Adaptive Structure Learning for Leukemia Biomarker Discovery from Gene Expression Data

Razieh Sheikhpour , Morteza Zangeneh Soroush, Azam Sadat Hashemi — Tue, 16 Jun 2026 04:01:27 +0000

Background: Leukemia classification based on gene expression data is a challenging problem due to the high dimensionality of microarray datasets and the limited number of patient samples. Identifying a small subset of informative genes (biomarkers) that can accurately distinguish between acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) is essential for improving diagnostic accuracy and supporting precision medicine approaches.

Materials and Methods: In this methodological study, an adaptive structure learning framework is proposed for biomarker discovery using the Golub Leukemia Dataset. The proposed method jointly integrates adaptive similarity structure learning, sparse feature selection, and sample reweighting into a unified optimization model. This framework learns both the intrinsic geometric structure of the data and the most discriminative gene subset simultaneously. The selected genes were evaluated using two classifiers, including k-nearest neighbor (KNN) and support vector machine (SVM).

Results: Experimental results show that the proposed method achieves 97.06% classification accuracy using KNN with 8 selected genes and 100% accuracy using SVM with only 7 genes. Comparative analysis with existing feature selection methods demonstrates that the proposed approach achieves superior or competitive performance while using a significantly smaller number of genes.s

Conclusion: The proposed framework effectively identifies compact and highly discriminative biomarker sets for leukemia classification. By jointly modeling sample relationships and gene relevance, the method improves classification performance while reducing feature dimensionality. The results suggest that the proposed framework has potential applications in clinical decision-support systems and other high-dimensional biomedical classification problems.

Spleen-Saving or Spleen-Sacrificing? Rethinking Splenectomy Strategies in Thalassemia

Tue, 16 Jun 2026 04:06:53 +0000

Background: Splenomegaly and hypersplenism are common complications in thalassemia that may require splenectomy. Although total splenectomy (TS) effectively improves hematologic parameters, it is associated with increased risks of infection and thrombosis. Partial splenectomy (PS) has been proposed as a spleen-preserving alternative to reduce these complications. This study compares the clinical outcomes of PS and TS in patients with thalassemia.

Materials and Methods: In this retrospective study, 74 thalassemia patients who underwent splenectomy from 2011 to 2018 were analyzed (median follow-up: 4 years). Twenty-five patients (33.8%) underwent PS, and 49 (66.2%) underwent TS. The outcomes, including hematologic improvement, transfusion intervals, incidence of diabetes mellitus, thrombotic events, and infection-related complications, were compared between the groups. The results were analyzed using an independent t-test, Fisher’s exact test, and logistic regression.

Results: In this study, both PS and TS groups showed significant post-operative improvements in hemoglobin levels (P < 0.0001). However, complications varied notably between the two groups. Diabetes mellitus developed in 12 patients (16.2% overall); only one case (4%) occurred in the PS group, while 11 cases (22.4%) were observed in the TS group. This corresponded to a significantly higher odds of diabetes after total splenectomy (OR = 6.9; 95% CI: 0.22–32.22; P = 0.04). The wide confidence interval reflects the small number of events, particularly in the PS group. Moreover, 13 cases of infection were observed exclusively in the TS group.

Conclusion: Partial splenectomy may serve as a safer alternative to total splenectomy in thalassemia patients, providing hematologic benefits while reducing the risk of infectious and metabolic complications. Further prospective studies are warranted to validate this finding.

Mean Platelet Volume and Neutrophil-to-Lymphocyte Ratio in Pediatric Gastritis: Relation to Helicobacter pylori Infection

Tue, 16 Jun 2026 04:12:41 +0000

Background: Helicobacter pylori (H. pylori) is a primary contributor to chronic gastritis in children, leading to both local and systemic inflammatory responses. Although endoscopic and histopathologic evaluations are the diagnostic standards, they are invasive and costly. Recently, hematologic indices such as the neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) have been proposed as simple, accessible markers of systemic inflammation. However, previous studies assessing their association with H. pylori infection in pediatric gastritis have reported inconsistent findings. Therefore, the aim of this study was the assessment of MPV and NLR in pediatric gastritis and relation to helicobacter pylori Infection.

Materials and Methods: This cross-sectional study was conducted on children aged 1–17 years with gastrointestinal symptoms were candidates for endoscopy at the Gastroenterology Clinic of Amirkola Children’s Hospital. Gastric tissue samples were collected via biopsy and examined histopathologically, and H. pylori infection was confirmed using Giemsa staining. In addition, complete blood count (CBC) tests were performed for NLR and MPV measurements.

Results: The study included 126 children (mean age 10.03 ± 2.51 years). H. pylori infection was significantly associated with both endoscopic (p = 0.001) and histopathologic gastritis (p = 0.011). No significant differences were observed in NLR or MPV between H. pylori–positive and H. pylori–negative groups (p = 0.990 and p = 0.459, respectively). Similarly, NLR and MPV did not differ significantly according to the presence of histopathologic (p = 0.874 and p = 0.891, respectively) or endoscopic gastritis (p = 0.667 and p = 0.103).

Conclusion: H. pylori infection was significantly associated with endoscopic and histopathologic gastritis in children, highlighting its central role in pediatric gastritis. However, NLR and MPV showed no significant differences according to H. pylori infection or gastritis status, indicating limited diagnostic utility of these hematologic markers.

Small Nucleolar RNAs as Novel Biomarkers and Therapeutic Targets in Hematologic Malignancies: A Systematic Review

Fateme Tabrizi, Mehri Khatami, Mohammad Mehdi Heidari — Tue, 16 Jun 2026 04:23:09 +0000

Background: Carcinogenesis is associated with the dysregulated expression of small nucleolar RNAs (snoRNAs). However, their specific expression profiles and clinical implications in hematologic malignancies remain limited. This systematic review aims to evaluate the role of snoRNAs as potential diagnostic and prognostic biomarkers and to assess their utility in monitoring treatment responses in hematologic cancers.

Materials and Methods: A systematic review was conducted following PRISMA guidelines. The protocol was registered in PROSPERO (CRD42024574222). Relevant data regarding study characteristics, cancer subtypes, specimen types, sample sizes, methodologies, and clinical outcomes were extracted. The quality of the studies and risk of bias were independently assessed using the Newcastle-Ottawa Scale (NOS), with discrepancies resolved through consensus.

Results: From an initial pool of 783 records, 12 studies met the inclusion criteria, highlighting the novelty of this research field. Despite the limited number of studies, the analysis identified 133 distinct snoRNAs with complex roles in the pathogenesis of hematologic malignancies. Dysregulated snoRNA expression was found to significantly influence critical cellular functions, including proliferation, invasion, and apoptosis. Furthermore, aberrant snoRNA levels showed a strong association with prognostic outcomes, particularly overall survival in multiple myeloma (MM) and chronic lymphocytic leukemia (CLL).

Conclusion: This review emphasizes the emerging significance of snoRNAs as promising biomarkers for diagnosis, prognosis, and therapeutic monitoring. The limited available data, compared with miRNAs and lncRNAs, highlight a significant knowledge gap. Nonetheless, current evidence suggests that snoRNAs offer distinct advantages, including greater molecular stability and higher specificity. While challenges such as incomplete functional characterization and limited clinical validation persist, this first systematic examination emphasizes the potential of snoRNAs to complement existing RNA-based biomarkers. Current findings highlight the need for more extensive research to fully utilize their diagnostic and therapeutic value in precision oncology.

Pilocytic Astrocytoma with Massive Microcalcification in a Child: A Tumor with Excellent Prognosis

Mazaher Ramezani , Masoud Sadeghi — Tue, 16 Jun 2026 04:25:14 +0000

Background: Pilocytic astrocytoma (PA) is the most common primary astroglial neoplasm in children and adolescents. Massive calcification is a rare feature of PA and may complicate radiologic and pathologic diagnosis. Herein, we report a case of PA with extensive microcalcification in western Iran.

Case Presentation: A 12-year-old boy presented with a two-year history of headache and vomiting that had worsened during the previous 15 days. Physical examination revealed a conscious and hemodynamically stable patient with no focal neurologic deficits. Histopathologic examination demonstrated a fascicular and microcystic tumor composed of cells with oval to spindle-shaped nuclei and bipolar cytoplasmic processes within a fibrillary matrix. Hyalinized arborizing ectatic vessels, Rosenthal fibers, and extensive areas of microcalcification were also identified.

Conclusion: Calcification is an uncommon feature of PAs and may create diagnostic challenges for radiologists and pathologists. Calcified PAs may occur at any age, with an approximately equal male-to-female ratio. Headache, vomiting, seizures, and visual disturbances are among the most common presenting symptoms in patients with calcified PA.

Top Ten Cancers in Iran: Incidence, Mortality, and Shared Risk Factors

Adel Eftekhari, Farzan Madadizadeh — Tue, 16 Jun 2026 04:27:33 +0000

The Article Abstract is not available.