Thirachit Chotsampancharoen

Background: Hematopoietic stem cell transplantation (HSCT) is a curative treatment for patients with transfusion-dependent thalassemia (TDT), and the outcomes are influenced by multiple factors.Purpose: We retrospectively evaluated the clinical characteristics, risk factors, complications, and treatment outcomes in Thai patients aged 2,500 ng/mL, low CD34+ doses, and the use of oral busulfan conditioning as factors associated with unfavorable survival. Long-term complications, primarily endocrine disorders, affected 22.7% of survivors.Conclusion: Our results broaden the donor pool by demonstrating comparable outcomes between MRD and MUD transplantation. Optimizing pretransplant care, such as regular pre-HSCT transfusion, adjusting conditioning intensity, and improving posttransplant supportive care, may mitigate age-related risks in older recipients.

Sarcopenia and sarcopenic obesity are increasingly recognized sequelae of anticancer therapy in children, yet a consensus definition remains elusive. Diminished skeletal muscle area (SMA) and increased adiposity have been associated with poor outcomes in several pediatric malignancies, but data for childhood lymphoma, particularly in Thailand, are lacking. We retrospectively analyzed 73 children with lymphoma treated with chemotherapy (CMT) between 2004 and 2024 at a single institution. SMA and adiposity parameters were measured using computed tomography (CT) at the L4/L5 intervertebral disc level using in-house software developed in MATLAB and freeware Python 3.6.13. Sarcopenia and sarcopenic obesity were determined, and survival analysis was performed. The cohort’s mean age was 8.9 ± 3.7 years. The prevalence of sarcopenia was 60.3% based on the SMA change rate (< 9.12% per 6 months) and 67.1% based on the skeletal muscle index (SMI) change rate (< 8.46% per 6 months); 65.8% met the criteria for sarcopenic obesity. Patients with Hodgkin lymphoma (HL) were more likely than those with non-Hodgkin lymphoma (NHL) to exhibit sarcopenia (SMA: odds ratio [OR] = 6.32, 95% confidence interval [CI] 2.16–21.58; SMI: OR = 5.65, 95% CI 1.82–21.64) and sarcopenic obesity (OR = 4.35, 95% CI 1.48–14.80). However, sarcopenia and sarcopenic obesity were not significantly associated with survival outcomes. Post-CMT sarcopenia and sarcopenic obesity are more prevalent in HL than in NHL. Nevertheless, the change in sarcopenia and sarcopenic obesity parameters after treatment may not significantly influence long-term survival outcomes in children with lymphoma, potentially due to ongoing muscle growth during development.

Background/Objectives: Acute pancreatitis (AP) is an uncommon but serious complication in children undergoing treatment for acute leukemia. We aimed to determine the prevalence of AP in pediatric patients with acute leukemia, identify its risk factors, and evaluate their impact on treatment outcomes and overall survival. Materials and Methods: We retrospectively reviewed the medical records of children with acute leukemia who developed acute abdominal pain suggestive of AP at Songklanagarind Hospital between 2004 and 2024. Demographic data, including leukemia subtypes, treatment protocols, and clinical outcomes, were compared between the patients with and without AP. Results: Of the 618 patients with leukemia, 70 children with abdominal pain were identified, and 17 were diagnosed with AP. The prevalence of AP was 2.8%. Most children with acute leukemia and AP had T-cell subtypes (50.0%) and received high- to very-high-risk treatment protocols (76.5%). Patients with AP experienced a shorter duration of abdominal pain before diagnosis and required imaging more frequently than the non-AP patients did (100% vs. 56.6%). They required a prolonged fasting period and greater intravenous fluid volume within 48 h. The overall mortality rate (all-cause during follow-up) was significantly higher in the AP group. Using high- to very-high-risk chemotherapy protocols was a risk factor for AP, and the accumulative L-asparaginase dose of ≥55,200 IU/m² could increase AP risk. Conclusions: AP is significantly associated with increased overall mortality in children with acute leukemia. Careful monitoring of L-asparaginase dosing may be required. Larger studies are needed to better identify the risk factors and preventive strategies.

The survival of Langerhans cell histiocytosis (LCH) in high-income countries is favorable, with rates of over 95%. However, there are few studies from resource-limited countries. Thus, this study aimed to examine survival risk factors and outcomes of LCH patients in Thailand. A retrospective review was conducted on LCH patients aged < 15 years at Songklanagarind Hospital over 40-year period. Cox regression analysis was utilized to identify risk factors. The overall (OS) and event-free survival (EFS) rates were calculated using the Kaplan-Meier method. A total of 68 patients were included with a median age of 2.1 years. Of these, 27 (39.7%) had single-system (SS)-LCH, 17 (25.0%) had no risk organ (RO-) multisystem (MS)-LCH, and 24 (35.3%) had risk organ (RO+) MS-LCH. The 5-year EFS of patients with SS-, RO-, and RO + MS-LCH were 95.2%, 58.4%, and 44.1%, respectively (p < 0.01). MS-LCH patients had a higher reactivation rate compared to those with SS-LCH (50.0% vs. 4.3%, p = 0.02, respectively). Age < 1 year was an independent risk factor for inferior survival (HR 13.79, 95% CI: 1.5-123.4, p = 0.02). The OS and reactivation rates of LCH patients treated with our national protocol are comparable to those of high-income countries. The infant was associated with inferior survival.

Background: The survival outcomes among children with acute myeloid leukemia (AML) in low‐ and middle‐income countries are still poor despite adopting modern treatment regimens from developed countries. The study aimed to identify additional potential determinant factors for relapse and death among children with AML in Thailand. Methods: In all, data from 282 children newly diagnosed with AML between 2015 and 2019 across Thailand were retrospectively reviewed. Data, including initial white blood cell numbers, genetic analysis, post‐induction minimal residual disease (MRD), hematopoietic stem cell transplantation, and supportive care, were analyzed. Results: The probability of 5‐year, event‐free survival, overall survival, and cumulative incidence of relapse were 40.5%, 42.3%, and 47.4%, respectively. The risk of death was significantly increased among patients stratified as high‐risk AML with an adjusted hazard ratio (HR) of 1.8 (95% confidence interval [CI]: 1.1–2.9, p = 0.01). The accessibility to MRD was significantly associated with the risk of death with an adjusted HR of 1.7 (95% CI: 1.1–2.5, p = 0.01). Patients with low‐risk AML did carry a significant risk for both death, with an adjusted HR of 1.8 (95% CI: 1.1–3.0, p = 0.02), and relapse, with an adjusted HR of 2.6 (95% CI: 1.5–4.7, p < 0.001) for initial WBC greater than 100,000/mm ³ . Conclusion: Elevated initial WBC numbers and accessibility to MRD could be considered additional risk factors for unfavorable outcomes in childhood AML.

Background: Vitamin C deficiency remains an under-recognized condition in children, especially in Southeast Asia. This study aimed to study the clinical characteristics, dietary risk factors, and outcomes of pediatric vitamin C deficiency in a tertiary hospital in Southern Thailand. Methods: This retrospective study reviewed the medical records of children aged 1 to 15 years diagnosed with vitamin C deficiency from 2004 to 2024. Diagnosis was based on serum ascorbic acid levels below 0.4 mg/dL, or clinical-radiographic findings. Data collected included demographics, developmental status, dietary history, clinical presentations, radiological and laboratory results, treatment, and outcomes. Results: Forty-six children were diagnosed; the median age was 4.8 years, and 60% were male; developmental delay was present in 54.4%. The majority had poor dietary intake, with 73% not consuming adequate fruits and vegetables; no significant differences were observed when classified by developmental status. Common clinical signs included: limb pain (76.1%), refusal to walk (52.2%), and bleeding gums (39.1%). Radiographs showed osteopenia in 73.8% and white line of Frankel in 47.6%. Serum ascorbic acid deficiency was significantly associated with low fruit and vegetable intake and excessive milk consumption over the recommendations (p < 0.05). Treatment with oral vitamin C resulted in clinical improvement; although, residual symptoms persisted in some cases. Conclusions: As pediatric vitamin C deficiency is still of concern, this study highlights the importance of early detection in at-risk children and the critical role of detailed dietary history to identify inadequate nutrition. Prompt recognition and intervention can prevent misdiagnosis and improve clinical outcomes. Hence, strengthening parental education on nutritional intake is essential to reduce future incidences.

Objective: This study aimed to examine the prognostic factors and treatment outcomes of patients with acute leukemia aged under 2 years. Material and methods: The medical records of acute leukemia patients aged under 2 between January 1979 and December 2021 were retrospectively reviewed. The Kaplan-Meier method was used to calculate the event-free survival (EFS) and overall survival (OS) rates. A univariate Cox proportional hazards regression model was used to identify clinical factors associated with poor EFS and OS. A p-value<0.05 was considered statistically significant.Results: Over the 43-year study period, 137 children with acute leukemia aged under 2 years of age were identified. Of these, 70 (51.1%) had acute lymphoblastic leukemia (ALL) and 67 (48.9%) had acute myeloid leukemia (AML). After induction, 89.1% of ALL patients achieved complete remission, with an induction death rate of 3.2%. The 5-year OS and EFS rates were 46.0% and 41.0%, respectively. After induction, 44.8% of the AML patients achieved complete remission, with an induction death rate of 29.3%. The 5-year OS and EFS rates in this group were 10.0% and 9.0%, respectively. No significant prognostic factors were identified to predict survival outcomes in children with AML under 2 years. Conclusion: Both ALL and AML childhood leukemia patients aged under 2 years had poor survival outcomes.

Tumor lysis syndrome (TLS) in childhood leukemia was assessed retrospectively in 252 patients in a single tertiary center in Thailand during 2009-2019. Fifty-one (20.2%) developed TLS during their induction chemotherapy; 60.7% (31/51) were spontaneous TLS and 47% (24/51) developed clinical TLS. The predictive score model consisted of white blood cell (WBC) count more than 50,000 cells/mm3, glomerular filtration rate less than 90, and aspartate transaminase more than 44 units/L. The TLS development rates were 11.1%, 46.2%, and 78.5% in the low, intermediate, and high-risk groups, respectively. Death during the first induction phase in patients with TLS was significantly higher than in the patients without TLS. However, the 5-year overall survival rates for the children with and without TLS were not significantly different.

Although there have been advances in treating pediatric patients with acute myeloid leukemia (AML) in developed countries, outcomes in low- to middle-income countries remain poor. The goal of this study was to investigate the outcomes in children with AML who were treated at a tertiary care center in Thailand. We divided the study into 4 research periods based on the chemotherapy protocols employed. The 5-year probabilities of event-free survival (pEFS) rates for periods 1-4 were 19.0%, 20.6%, 17.4%, and 37.3% (p value = 0.32), while the 5-year probabilities of overall survival (pOS) rates were 19.0%, 24.7%, 18.7%, and 42.5% (p value = 0.18), respectively. The multivariable model indicated an improvement in 5-year pOS between periods 1 and 4 (p value = 0.04). Age, white blood cell count, and study period were significant predictors of survival outcomes. The pOS of AML patients improved over time, increasing from 19.0% to 42.5%.

Increased liver stiffness (LS) can be result of increased liver iron concentration (LIC) which may not yet be reflected in the liver fibrotic status. The objective of our study was to examine relationship between hemochromatosis, LS, and serum ferritin level in transfusion-dependent patients. We recruited all 70 transfusion-dependent patients, whose median age was 15, referred for evaluating LIC status by magnetic resonance imaging (MRI) followed by two-dimensional ultrasonography shear wave elastography (2D-SWE). Thalassemia beta affected the majority of the patients. The optimal cut point for prediction of severe hemochromatosis using median SWE (kPa) and SWV (m/s) was >= 7.0 kPa and >= 1.54 m/s, respectively, with sensitivity of 0.76 (95% confidence interval [CI] 0.55, 0.91) and, specificity of 0.69 (95%CI 0.53, 0.82). When combing the optimal cut point of SWE (kPa) at >= 7.0 and serum ferritin >= 4123 ng/mL, the sensitivity increased to 0.84 (95%CI 0.64, 0.95) with specificity of 0.67 (95%CI 0.50, 0.80), positive predictive value (PPV) of 0.60 (95%CI 0.42, 0.76), and negative predictive value (NPV) of 0.88 (95%CI 0.71, 0.96). Simultaneous tests of 2D-SWE and serum ferritin for prediction of severe hemochromatosis showed the highest sensitivity of 84% (95%CI 0.64-0.95), as compared to 2D-SWE alone at 76% (95%CI 0.55, 0.91) or serum ferritin alone at 44% (95%CI 0.24-0.65). We recommend measuring both 2D-SWE and serum ferritin in short interval follow up patients. Adding 2D-SWE to management guideline will help in deciding for aggressive adjustment of iron chelating medication and increased awareness of patients having severe hemochromatosis.