Background When developed countries are considered; in the treatment of childhood acute lymphoblastic leukemia (ALL), the survival rate has reached 90% in recent years. We aimed to examine the survival rate and the factors that may affect this rate, especially in our patients treated with the ST Jude Total Therapy XV protocol. Procedures Pediatric patients aged 1-18 years, who were treated at our hospital and completed their treatment between January 2011 and December 2018, and only pre-B and T-cell leukemias treated with the St Jude Total Therapy XV protocol were included in the study. Results The 5-year event-free survival (EFS) and overall survival (OS) were 78.3% and 80%. We observed that some factors that affect survival, such as gender, blastic type, risk group, and number of WBCs, did not affect survival in our study. Even though it is known that the female gender has better EFS, in our study, the survival of girls was found to be lower than boys. Tragically, we observed that the most common cause of death (20/23, 87%) was infection and infection-related causes. Conclusions The primary purpose of the St Jude Total XV treatment protocol is to monitor minimal residual disease (MRD) and to guide treatment according to MRD results. It is also the removal of radiotherapy from treatment protocols by adding additional intra-thecal treatments (ITT). However, unfortunately, if we cannot protect our patients from infection and other related factors, the factors that make a difference in treatment become meaningless.

Autologous hematopoietic stem cell transplantation(AHSCT) is an increasingly used curative treatment for some solid tumors in children. Instead of allogeneic transplantation, the risk of developing graft versus host disease (GvHD) is much lower after AHSCT. Although the clinical findings of auto-GVHD are mild and self-limited in most cases, rare cases may be severe and need intensive immunosuppressive treatment. Here, we present a case who underwent autologous HSCT due to relapsed neuroblastoma, developed steroid-refractory GvHD after AHSCT, and achieved remission using ruxolitinib. A 12 years old female patient was diagnosed with relapsed neuroblastoma. After metaiodobenzylguanidine treatment, AHSCT was performed, and the status of the disease was a very good partial response at the time of transplantation. Our patient was diagnosed with severe and steroid-refractory GvHD with skin involvement after AHSCT. We used ruxolitinib with extracorporeal photopheresis because of the essential side effects of the other drugs and got a very good response. Over the following five months, there was no recurrence of GvHD. She was in complete remission of neuroblastoma after two years of AHSCT. It is crucial to keep in mind that GvHD may develop after AHSCT. Ruxolitinib is an effective treatment for GvHD also after AHSCT.

Background: Data on the outcome and risk factors of pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. Objectives: We aimed to describe risk factors for a severe course and mortality. Method: In this nationwide study, data were collected retrospectively from 28 transplant centers. Results: One hundred ninety-six children [(63.8% male; median age 8.75 (IQR, 4.86-14.30)] who received allogeneic (n: 184, 93.9%) or autologous (n: 12, 6.1%) HSCT were included. The median time from HSCT to SARS-CoV-2 infection was 207.5 days (IQR, 110.2-207.5). The most common clinical manifestation was fever (58.2%), followed by cough (33.7%); 43 cases (21.9%) were asymptomatic. Lower respiratory tract disease (LRTD) and multisystem inflammatory syndrome in children (MIS-C) developed in 58 (29.6%) and 8 (4.1%) patients, respectively. Twenty-six patients (13.3%) required ICU admission. Nine patients died at a median of 17 days (min-max 1-33) after COVID-19 diagnosis, 6 of whom died due to the disease, with a COVID-19 lethality rate of 3.1%. The 6-week overall survival was 95.4% (95% CI 92.5-98.3). Multivariate analysis found that HSCT with a mismatched donor (OR, 8.98, p: 0.039) and LRTD (OR, 61.55, p: 0.001) were independent risk factors for ICU admission; MIS-C (OR, 9.55, p: 0.044) and lymphopenia (OR, 4.01, p: 0.030) at diagnosis were risk factors for mortality. Conclusion: Overall mortality was lower in children than in adult counterparts, and HSCT with a mismatched donor, lymphopenia, LRTD, MIS-C and ICU admission were important risk factors for adverse outcomes.

Abstract: Immune thrombocytopenic purpura (ITP) is an autoimmune disease presents with isolated thrombocytopenia (thrombocyte count < 100.000/mm3) and develops due to increased thrombocyte destruction by autoantibodies. ITP is the most common cause of pediatric thrombocytopenia. Usually a self-limiting disease with an acute course of 70% - 80%. However, 20% - 25% cases are chronical. These cases are follow-up and management difficult and expensive. It is important to distinguish events that may become chronic at the time of initial diagnosis. In this study, we sought clues to be able to choose, which the patient will be chronicle?