Papers by Walentyna Balwierz
Pathogens
Viral infections can be a serious complication of therapy in children with acute lymphoblastic le... more Viral infections can be a serious complication of therapy in children with acute lymphoblastic leukemia (ALL). In this study, we focused on the incidence and the profile of viral infection in children with ALL treated in 17 pediatric oncology centers in Poland in the two-year periods of 2018–2019 and 2020–2021. We also compared the frequency of viral infections in 2018–2019 to that in 2020–2021. In 2020–2021, a total of 192 children with ALL had a viral infection during intensive chemotherapy. A total number of 312 episodes of viral infections were diagnosed. The most common infections detected in the samples were: COVID-19 (23%), rhinovirus (18%), and respiratory syncytial virus (14%). COVID-19 and BK virus infections were the reason for the death 1% of all patients. In 2018–2019, a total of 53 ALL patients who had a viral infection were reported and 72 viral events were observed, mainly adenovirus (48.6%), rotavirus (31.9%), and herpes zoster (8.3%). No deaths were reported during...
Wstęp. Gronkowce są jednym z najczęstszych patogenów wpływających na powikłania u pacjentów podda... more Wstęp. Gronkowce są jednym z najczęstszych patogenów wpływających na powikłania u pacjentów poddawanych chemioterapii. Cel pracy. Ocena występowania zakażeń gronkowcowych u pacjentów onkologicznych leczonych w oddziałach hematoonkologii (PHO) lub poddawanych przeszczepieniu komórek krwiotwórczych (HSCT) w krajowych ośrodkach hematoonkologii dziecięcej
Wstęp. Pacjenci z guzami kości są poddawani intensywnej chemioterapii, której konsekwencjami są n... more Wstęp. Pacjenci z guzami kości są poddawani intensywnej chemioterapii, której konsekwencjami są neutropenia i stan immunosupresji, prowadzące do powikłań infekcyjnych. Cel pracy. Analiza zakażeń bakteryjnych, grzybiczych i wirusowych u dzieci z guzami kości. Materiał i metody. W latach 2014-2015 w Polsce w 9 ośrodkach onkologii dziecięcej leczeniu poddano 52 dzieci z nowo rozpoznanymi guzami kości, w tym 25 dzieci z mięsakiem Ewinga (ES) oraz 27 dzieci z mięsakiem kościopochodnym (OS). Wyniki. Zakażenia wystąpiły u 21 dzieci, w tym u 15 z ES i 6 z OS. Zakażenia bakteryjne: stwierdzono łącznie 30 epizodów, w tym 23 w ES i 7 w OS. Mediana czasu do rozpoznania zakażenia od rozpoczęcia terapii p/nowotworowej: 8,1 miesiąca (zakres: 0,9-17,8). Czas terapii: mediana 10 dni (zakres: 7-20). W 27 (90%) przypadkach leczenie zakończyło się sukcesem. W 3 przypadkach zakażenia były związane ze zgonem pacjenta. Częstość kumulacyjna zakażeń bakteryjnych u pacjentów z ES wyniosła 60%, a w OS 22,2% (p = 0,005).
Acta Haematologica Polonica, 2020
IntroductionEpidemiological analysis of severe acute respiratory syndrome coronavirus-2 (SARS-CoV... more IntroductionEpidemiological analysis of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections in pediatric hematology and oncology (PHO) and hematopoietic cell transplant (HCT) centers in a Polish nationwide study, as well as analysis of the preventive strategies in these centers.MethodsAll of the 18 PHO/HCT centers participated in eight surveys and questionnaires conducted over the first 5 months of the SARS-CoV-2/coronavirus disease 2019 (COVID-19) pandemic in Poland. Epidemiological data were collected at eight regular time points, and the strategy of preventive management was done once after 4 months of the pandemic.ResultsDuring this analyzed period, eight patients were positive for SARS-CoV-2. The estimated incidence of SARS-CoV-2 positivity in Polish PHO/HCT centers was 0.5%. After exclusion of HCT patients (with one patient being infected), the estimated incidence of SARSCoV-2 positivity was between 0.5 and 0.6%. In all but one case, the course of COVID-19 ...
Results of Immunosuppressive Therapy in Children with Severe Aplastic Anaemia (SAA). Report Polish Pediatric Hematology Group (Warszawa, Lublin, Krakow, Wroclaw, Zabrze, Bydgoszcz, Poznan, Lodz, Bialystok, Szczecin, Gdansk) Blood, 2007
Introduction: Bone marrow transplantation (BMT) from HLA identical family donors is the treatment... more Introduction: Bone marrow transplantation (BMT) from HLA identical family donors is the treatment chosen, according indication of Polish Pediatric Hematology Group, for children with severe aplastic anemia (SAA). When no donor is available, combined immunosuppressive therapy (IST) is given. Material and method: SAA was recognized in 105 children (42 girls, 73 boys) aged 2–18 years in eleven pediatric hematological center in Poland between 1993–2006 years. All patients received IST according Polish Pediatric Hematology and Working Party SAA of the EBMT protocol: antithymocyte globulin horse or rabbit, cyclosporine A (CSA), prenisolon and in 79 patients G-CSF or GM-CSF was additionally administered. Hematological response was evaluated on day 84 and 180 of therapy. Results and conclusion: On day 180 remission was obtained in 80 from 105 patients (76.1%), complete remission (CR) in 53 patients (51.5%), partial remission (PR) in 27 (24.7%), There was no response to treatment (NR) in 25 ...
Postepy Nauk Medycznych, Aug 26, 2013
S t r e s z c z e n i e Wstęp. Ostra białaczka limfoblastyczna (ALL) rozpoznana w pierwszym roku ... more S t r e s z c z e n i e Wstęp. Ostra białaczka limfoblastyczna (ALL) rozpoznana w pierwszym roku życia jest rzadką chorobą, stanowiącą 2-5% ALL u dzieci. Dotychczas opublikowane dane na temat niemowlęcej ALL w Polsce opierają się na niewielkich grupach pacjentów lub dotyczą opisu pojedynczych przypadków. Brakuje również wielu informacji, zwłaszcza danych genetycznych i immunofenotypowych. Cel pracy. Celem pracy była charakterystyka kliniczna, immunofenotypowa i genetyczna niemowlęcej ALL w Polsce. Materiał i metody. Grupę badaną stanowiło 36 niemowląt z ALL leczonych w ośrodkach hematoonkologicznych Polskiej Pediatrycznej Grupy ds. Leczenia Białaczek i Chłoniaków (PPGLBC) według protokołów INTERFANT. W skład grupy kontrolnej weszło 53 dzieci z ALL leczonych w tym samym okresie w Katedrze i Klinice Pediatrii, Hematologii i Onkologii SUM według międzynarodowego Programu ALL-IC BFM 2002. Wnioski. Niemowlęca ALL charakteryzuje się znacznie większym zaawansowaniem choroby przy rozpoznaniu w porównaniu do ALL u starszych dzieci. Znamiennie wyższa jest wstępna leukocytoza, częściej stwierdza się hepatosplenomegalię Jest odwołanie do ryciny drugiej, nie ma do ryciny pierwszej. Żadna rycina nie została dołączona do tekstu. i wstępne zajęcie ośrodkowego układu nerwowego. W niemowlęcej ALL bardzo często występują aberracje genu MLL, co odzwierciedla immunofenotyp pro-BALL. ALL u niemowląt charakteryzuje się w porównaniu do ALL u starszych dzieci znamiennie większą opornością na stosowane leczenie (częstsza sterydooporność, większy odsetek wznów). Wyniki. Osiągnięte wyniki leczenia ALL u niemowląt w Polsce są w pełni porównywalne do innych krajów Europy i świata. Słowa kluczowe: ostra białaczka limfoblastyczna, niemowlęta, gen MLL S u m m a r y Introduction. Acute lymphoblastic leukemia (ALL) diagnosed in the first year of life is a rare disease, comprising 2-5% of all childhood ALL cases. The data on infant ALL in Poland published until now are based on small patient groups or concern case reports. Important information, particularly concerning genetic and immunophenotypic data is still not available. Aim. The study aimed at comprehensive clinical, immunophenotypic and genetic characteristic of infant ALL in Poland. Material and methods. The study group consisted of 36 infants treated for ALL at the hemato-oncologic centers of Polish Pediatric Leukemia and Lymphoma Study Group according to INTERFANT protocols. The control group comprised 53 childhood ALL patients treated in the same time period at the Department of Pediatric Hematology and Oncology of the Medical University of Silesia in Zabrze according to the ALL-IC BFM 2002 treatment protocol. Results. Infant ALL is characterized by more severe presentation as compared to ALL in older children. This is reflected by significantly higher initial leukocytosis, more frequent hepatosplenomegaly and central nervous system involvement. MLL gene aberrations are hallmark of infant ALL and are associated with pro-BALL immunophenotype. Infant ALL is characterized by significantly worse response to treatment (more frequent steroid-resistance, higher relapse rate) as compared to ALL in older children. Conclusions. Clinical, immunophenotypic and genetic characteristics as well as treatment course and therapy results of infant ALL in Poland are fully comparable to other European and world countries.
Postepy Nauk Medycznych, Mar 20, 2014
Wstęp. Ostra białaczka szpikowa (AML) jest niejednorodną i rzadko występującą chorobą nowotworową... more Wstęp. Ostra białaczka szpikowa (AML) jest niejednorodną i rzadko występującą chorobą nowotworową układu krwiotwórczego u dzieci. Pomimo stosowania intensywnych metod leczenia, uzyskiwane wyniki terapii są ciągle niezadowalające. W celu lepszego poznania biologii AML, w ośrodkach Polskiej Pediatrycznej Grupy ds. Leczenia Białaczek i Chłoniaków (PPGLBC) w 2006 roku rozszerzono diagnostykę zaburzeń genetycznych o badania w kierunku występowania genów fuzyjnych RUNX1(AML1)-RUNX1T1(ETO), PML-RARα, CBFβ-MYH11 i nadekspresji genu WT1. Cel pracy. Celem pracy jest ocena częstości występowania wybranych zaburzeń genetycznych u dzieci z AML w Polsce oraz określenie ich znaczenia prognostycznego. Słowa kluczowe ostra białaczka szpikowa, dzieci, mutacja FLT3/ITD, geny fuzyjne, nadekspresja WT1
Reports of Practical Oncology & Radiotherapy, 2003
Journal of Cancer Research Updates, 2013
According to the AML-BFM 2004 Interim, a treatment protocol used in Poland since 2005, presence o... more According to the AML-BFM 2004 Interim, a treatment protocol used in Poland since 2005, presence of FLT3 internal tandem duplication (FLT3/ITD) qualifies a patient with acute myeloid leukemia (AML) to a high-risk group (HRG). The present study was aimed to identify the prevalence of FLT3/ITD in children with AML in Poland and to evaluate its prognostic significance in the HRG patients. Out of 291 children with de novo AML treated in 14 Polish centers between January 2006 and December 2012, samples from 174 patients were available for FLT3/ITD analysis. Among study patients 108 children (61.7%) were qualified to HRG. Genomic DNA samples from bone marrow were tested for identification of FLT3/ITD mutation by PCR amplification of exon 14 and 15 of FLT3 gene. Clinical features and treatment outcome in patients with and without FLT3/ITD were analyzed in the study. The FLT3/ITD was found in 14 (12.9%) of 108 HRG children. There were no significant differences between children with and without FLT3/ITD in age and FAB distribution. The white blood cells count in peripheral blood at diagnosis was significantly higher (p <0.01) in the children with FLT3/ITD. Over 5-year overall survival rate for FLT3/ITD positive children was worse (42.4%) comparing to FLT3/ITD negative children (58.9%), but the statistical difference was not significant. However, over 5-year survivals free from treatment failures were similar. The FLT3/ITD rate (12.9%) observed in the study corresponded to the published data. There was no significant impact of FLT3/ITD mutation on survival rates, although further studies are needed on this subject.
Neuro-Oncology, 2011
INTRODUCTION: Primitive neuroectodermal tumor (PNET) is the most common primary malignant childho... more INTRODUCTION: Primitive neuroectodermal tumor (PNET) is the most common primary malignant childhood brain tumor and is usually seen as an intraparenchymal lesion, typically arising in the cerebellum (as a medulloblastoma). Peripheral PNET (PPNET), a member of the Ewing's sarcoma (ES) family of tumors, is a tumor of putative parasympathetic neural histogenesis, typically developing in the soft tissue and skeletal structures of the trunk and extremities. We report here four cases of atypical primary ES/PPNET in very young children involving pericranial structures, two with significant intracranial involvement. METHODS: Following IRB approval, we compiled the clinical, imaging, and pathology records from four children with aggressive pericranial ES/PPNET. RESULTS: Ages at diagnosis were 1 day (female), 5 days (male), 12 months (male), and 13 months (female). Two patients had orbitofacial tumors with significant bony erosion but no intracranial extension, one patient had a temporal bone lesion with significant middle cranial fossa extension, and one patient had an intracranial temporal lobe-based tumor without extracranial extension. Immunohistochemical evidence of the EWS/FLI-1 chimeric protooncogene, typical of PPNET, was identified in one patient; genetic analysis in two patients revealed EWSR1 gene rearrangement in one patient and a novel t(20;22)(q11.2;q12) translocation in the other. All tumors were relatively large (for body size), measuring 3-8 cm in maximal dimension. Treatment included tumor resection and sarcoma-style combination chemotherapy. Two patients are alive and continue therapy, whereas two have died of sepsis and progressive disease at 3 and 6 months after diagnosis, respectively. CONCLUSIONS: Pericranial primary ES/PPNET is a rare tumor, heretofore typically described only in preschool and school-aged children. Our study suggests this entity can occur in very young children, in whom it has a poor prognosis. It appears to be more infiltrative and to violate the usual tissue compartments. Further awareness and reporting of this rare tumor will aid understanding of histogenesis, prognosis, and optimal therapy.
BMC Neurology, 2009
Although chemotherapy with procarbazine, lomustine and vincristine (PCV) is considered to be well... more Although chemotherapy with procarbazine, lomustine and vincristine (PCV) is considered to be well tolerated, side effects frequently lead to dose reduction or even discontinuation of treatment of oligodendroglial brain tumors. The primary objective of the analysis was to retrospectively compare progression-free survival (PFS) after PCV vs. PC chemotherapy (without vincristine to avoid side effects). Patients were retrospectively identified from a database containing our patients between 1990 and 2003. For the selected cases, all histopathology reports were re-evaluated by a local neuropathologist. Based on the updated histology data, patients were included in the study if they had at least one histological diagnosis of an oligodendroglial tumor. PFS after start of PCV (n = 61) and PC (n = 84) chemotherapy identical (median 30 months). Multivariate analysis adjusting for prognostic imbalances favouring the PC group showed a minor, statistically non-significant benefit for PCV (hazard ratio 0.81, 95% confidence interval 0.53-1.25; p = 0.346). Younger age (< 50 y) was a statistically significant predictor of longer PFS. Significant advantages in terms of overall survival after first diagnosis of oligodendroglial tumor (OS, n = 315) were found for patients < 50 y (p < 0.001), oligodendrogliomas versus oligoastrocytomas (p = 0.002), and WHO°II vs. °III (p < 0.001). Three risk groups regarding OS were identified. Findings support the hypothesis that PC may be as effective as PCV chemotherapy, while avoiding the additonal risks of vincristine. Younger age, lower tumor grade and histology of an oligodendroglioma were identified to be favorable prognostic factors.
Cancers, 2021
Background: From 1983, standardized therapeutic protocols for pediatric acute myeloid leukemia (A... more Background: From 1983, standardized therapeutic protocols for pediatric acute myeloid leukemia (AML) based on the BFM group experience were introduced in Poland. We retrospectively analyzed the results of pediatric AML treatment in Poland from 1983 to 2019 (excluding promyelocytic, therapy-related, biphenotypic, and Down syndrome AML). Methods: The study included 899 children suffering from AML treated with the following: AML-PPPLBC 83 (1983–1993, n = 187), AML-PPGLBC 94 (1994–1997, n = 74), AML-PPGLBC 98 (1998–2004, n = 151), AML-BFM 2004 Interim (2004–2015, n = 356), and AML-BFM 2012 (2015–2019, n = 131). Results: The probability of three-year overall survival was 0.34 ± 0.03, 0.37 ± 0.05, 0.54 ± 0.04, 0.67 ± 0.03, and 0.75 ± 0.05; event-free survival was 0.31 ± 0.03, 0.34 ± 0.05, 0.44 ± 0.04, 0.53 ± 0.03, and 0.67 ± 0.05; and relapse-free survival was 0.52 ± 0.03, 0.65 ± 0.05, 0.58 ± 0.04, 0.66 ± 0.03, and 0.78 ± 0.05, respectively, in the subsequent periods. A systematic reducti...
memo - Magazine of European Medical Oncology, 2012
Background Since 1983 four consecutive unified regimens: acute myeloid leukemia-Polish pediatric ... more Background Since 1983 four consecutive unified regimens: acute myeloid leukemia-Polish pediatric leukemia/lymphoma study group (AML-PPLLSG) 83, AML-PPLLSG 94, AML-PPLLSG 98 and AML-BFM 2004 Interim, for AML have been conducted by the Polish Pediatric Leukemia/Lymphoma Study Group (PPLLSG). In this paper, we review four successive studies on the basis of acute myeloid leukemia-Berlin-Frankfurt-Munster (AML-BFM) protocol, in which a stepwise improvement of treatment outcome was observed. Treatment results of the last protocol AML-BFM 2004 Interim are presented in detail.
Acta Haematologica Polonica, 2014
Anticancer research
The role of cellular drug resistance in childhood acute myeloid leukemia (AML) has not yet been e... more The role of cellular drug resistance in childhood acute myeloid leukemia (AML) has not yet been established. The aim of the study was the analysis of the clinical value of ex vivo drug resistance in pediatric AML. A cohort of 90 children with de novo AML were assayed for drug resistance profile by the 3-4,5-dimethylthiazol-2-yl-2,5-difenyl tetrazolium bromide (MTT) assay and prognostic model of in vitro drug sensitivity was analyzed. Children who relapsed during follow-up showed higher in vitro resistance of leukemic blasts to most of the drugs tested, except for cytarabine, cladribine, vincristine, mercaptopurine and thioguanine. A combined in vitro drug resistance profile to fludarabine, treosulfan and mitoxantrone (FTM score) was defined and it had an independent prognostic significance for disease free survival in pediatric AML. The combined fludarabine, treosulfan and mitoxantrone resistance profile to possibly may be used for better stratification of children with AML or indic...
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Papers by Walentyna Balwierz