Gökalp Rüstem Aksoy

Background: The SIOP-RTSG and NWTSG/COG approaches differ primarily in the timing of nephrectomy and the clinical information used for risk stratification. Direct comparisons are complicated because protocol selection is closely linked to treatment center, institutional practice, and healthcare-system context. We compared real-world survival outcomes between two protocol–care ecosystems after adjustment for harmonizable baseline risk factors. Methods: This retrospective, two-country, multicenter cohort study included 183 consecutive children treated for Wilms tumor between 1997 and 2025 at centers in Azerbaijan and Türkiye. Of these, 78 received SIOP-RTSG-based treatment and 105 received NWTSG/COG-based treatment. Overall survival (OS) and event-free survival (EFS) were estimated using the Kaplan–Meier method and compared using the log-rank test. Cox proportional hazards models were used to evaluate the association of protocol–care ecosystem with OS and EFS after adjustment for age category and harmonized disease stage. Preoperative response and histological risk were evaluated exploratively within the SIOP-RTSG cohort. Results: Five-year OS was 84.8% in the SIOP-RTSG group and 87.0% in the NWTSG/COG group, with no difference between the survival curves (log-rank p=0.978). Five-year EFS was 76.3% and 80.7%, respectively (log-rank p=0.661). In the multivariable OS model, the protocol–care ecosystem was not independently associated with mortality (adjusted hazard ratio [aHR] 1.046, 95% confidence interval [CI] 0.453–2.413; p=0.916). Older age category (aHR 2.858, 95% CI 1.513–5.400; p=0.0012) and stage III–V disease (aHR 3.364, 95% CI 1.117–10.132; p=0.031) were independently associated with poorer OS. Similarly, the protocol–care ecosystem was not associated with EFS (aHR 0.963, 95% CI 0.501–1.853; p=0.911), whereas older age category (aHR 1.869, 95% CI 1.173–2.978; p=0.0085) and stage III–V disease (aHR 2.556, 95% CI 1.186–5.510; p=0.0166) were associated with a higher event risk. Within the SIOP-RTSG cohort, poor preoperative response was associated with inferior OS (HR 5.957, 95% CI 1.542–23.016; p=0.0097) and EFS (HR 3.640, 95% CI 1.341–9.883; p=0.0112). High-risk histology was associated with inferior EFS (HR 3.748, 95% CI 1.010–13.903; p=0.0482), but not significantly with OS.Conclusions: After adjustment for age and stage, the protocol–care ecosystem was not independently associated with OS or EFS. Older age and advanced-stage disease were the principal unfavorable prognostic factors, while poor preoperative response and high-risk histology provided additional prognostic information within the SIOP-RTSG cohort. These findings do not establish equivalence between the SIOP-RTSG and NWTSG/COG strategies but indicate that both may achieve satisfactory survival outcomes when implemented within structured multidisciplinary care systems. Due to the retrospective, observational nature of the study and the use of anonymized patient data, the requirement for written informed consent was waived by the institutional review boards.

Background: In the pediatric population, gastrointestinal (GIS) cancers are rare, and paraneoplastic syndromes associated with these malignancies are even more uncommon. Observations: A 15-year-old patient with a clinical presentation of microangiopathic hemolytic anemia (MAHA) resistant to plasma exchange was found to have metastatic adenocarcinoma in a biopsy of a supraclavicular lymphadenopathy. Subsequent endoscopy revealed gastric signet ring cell carcinoma. Conclusions: This case highlights that malignancy should be suspected in pediatric patients with MAHA who are unresponsive to plasma exchange and have normal ADAMTS-13 activity.

Background: Adolescent anemia is a global public health concern, disproportionately affecting low- and middle-income countries. Despite this burden, Türkiye lacks a national screening or supplementation program targeting this age group. Aim of the study: The aim of the study is investigating the etiological spectrum and clinical characteristics of anemia in adolescents aged 10–18 years referred to a tertiary pediatric hematology clinic in Türkiye.Material and methods: This retrospective study evaluated 356 adolescents diagnosed with anemia at Bursa City Hospital between August 2020 and September 2023. Demographic, clinical, and laboratory data—including serum iron, ferritin, vitamin B12, and folate levels—were analyzed. Anemia was defined per WHO thresholds.Results: The mean age was 14.07 1.96 years, with 81.5% being female. Iron deficiency anemia (IDA) was the most prevalent etiology (74.4%). Borderline or overt vitamin B12 deficiency was detected in 27.8%, and folate deficiency in 8.7%. Combined nutritional deficiencies were present in 24% of patients. Genetic anemias, particularly beta-thalassemia trait (14.9%), were also observed. Approximately 23.6% were asymptomatic at diagnosis, and excessive menstrual bleeding was a common contributor among girls. IDA was significantly associated with older age and female gender (p<0.001).Conclusions: Nutritional deficiencies—especially iron, vitamin B12, and folate—remain the leading causes of adolescent anemia in Türkiye. The high rate of asymptomatic cases and coexisting micronutrient deficits underscore the need for national, age- and gender-sensitive screening and supplementation strategies. These findings may support the development of targeted, age- and sex-sensitive screening and nutritional assessment strategies for adolescents, particularly in high-risk clinical populations.Background: Adolescent anemia is a global public health concern, disproportionately affecting low- and middle-income countries. Despite this burden, Türkiye lacks a national screening or supplementation program targeting this age group. Aim of the study: The aim of the study is investigating the etiological spectrum and clinical characteristics of anemia in adolescents aged 10–18 years referred to a tertiary pediatric hematology clinic in Türkiye.Material and methods: This retrospective study evaluated 356 adolescents diagnosed with anemia at Bursa City Hospital between August 2020 and September 2023. Demographic, clinical, and laboratory data—including serum iron, ferritin, vitamin B12, and folate levels—were analyzed. Anemia was defined per WHO thresholds.Results: The mean age was 14.07 1.96 years, with 81.5% being female. Iron deficiency anemia (IDA) was the most prevalent etiology (74.4%). Borderline or overt vitamin B12 deficiency was detected in 27.8%, and folate deficiency in 8.7%. Combined nutritional deficiencies were present in 24% of patients. Genetic anemias, particularly beta-thalassemia trait (14.9%), were also observed. Approximately 23.6% were asymptomatic at diagnosis, and excessive menstrual bleeding was a common contributor among girls. IDA was significantly associated with older age and female gender (p<0.001).Conclusions: Nutritional deficiencies—especially iron, vitamin B12, and folate—remain the leading causes of adolescent anemia in Türkiye. The high rate of asymptomatic cases and coexisting micronutrient deficits underscore the need for national, age- and gender-sensitive screening and supplementation strategies. These findings may support the development of targeted, age- and sex-sensitive screening and nutritional assessment strategies for adolescents, particularly in high-risk clinical populations.

Background: Manual morphological analysis of peripheral blood smears (PBS) with light microscopy is an essential diagnostic and monitoring tool. Recently, automated morphology analyzers have been developed that can preclassify cells using artificial intelligence algorithms. This study aims to evaluate the preliminary leukocyte classification capabilities of the MC-80 digital morphology analyzer, a novel system, in pediatric patients and compare its performance with that of manual microscopy, the current gold standard. Methods: This retrospective study was conducted at SBU Bursa Yüksek İhtisas Training and Research Hospital between September 5 and 29, 2022. Blood samples from 153 consecutive pediatric patients (age range: 0–18 years; median age: 3 years) undergoing simultaneous hemograms and PBS analyses were assessed using both the MC-80 digital morphology analyzer and manual microscopy. Results: Spearman rank correlation coefficients indicated a high correlation for neutrophils (rho = 0.742; 95% CI: 0.661–0.807) and lymphocytes (rho = 0.745; 95% CI: 0.666–0.810) while the correlation for blast cells was significantly lower (rho = 0.079; 95% CI: −0.099–0.238). Concordance between the MC-80 and manual microscopy was minimal for monocytes (κ = 0.21; 95% CI: 0.11–0.29) and negligible for blast cells (κ = 0.08; 95% CI: 0.00–0.17). Conclusions: The MC-80 digital morphology analyzer shows acceptable preliminary classification for neutrophils and lymphocytes; further development is required before it can be routinely implemented in laboratory workflows.

Beta-thalassemia is a genetic multisystem disease characterized by either absent or decreased beta globin chain production. The most clinically severe form of beta thalassemia is called thalassemia major. The generation of beta-globin is significantly reduced or absent in thalassemia major. Large increases in alpha globin chain synthesis lead to ineffective erythropoiesis. We provide a case of a patient with thalassemia major who developed comorbidities as a result of treatment noncompliance, although they were receiving regular oral iron chelation therapy. The patient in this case study underwent interdisciplinary monitoring and assessment.

Background/Aim: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. Patients usually present with fatigue, pallor, weight loss, and joint and/or bone findings. However, the effects of bone-associated symptoms on prognosis remains controversial. We aimed to demonstrate whether bone-associated symptoms affect prognosis in children with ALL. Methods: This retrospective cohort study included the data from 268 patients with ALL who were diagnosed and treated between January 2011 and December 2020. The patients were divided into two groups as those with and without bone-associated symptoms. We compared the groups in terms of age, gender, immunophenotyping, day 8 prednisolone response, and risk groups, in addition to minimal residual disease (MRD), relapse, and survival rates. Results: Eighty-five out of 268 (32%) children had bone-associated symptoms at the time of diagnosis, whereas others (n=183) had none of these symptoms. The relapse rate in children with bone-associated symptoms was found to be higher than the others (17.6% versus 12%), but the difference was not significant (P=0.24). However, children with bone findings developed earlier relapse when compared with the others (18.6 versus 28.6 months; PConclusion: Therefore, we suggest that bone-associated symptoms at the time of diagnosis could be considered a warning sign for earlier relapse, and these children should be carefully followed. '+st+' Stanulla M, Schrappe M. Treatment of childhood acute lymphoblastic leukemia. In: Seminars in hematology. Elsevier; 2009. p. 52–63. DOI: https://doi.org/10.1053/j.seminhematol.2008.09.007 Pui CH. Childhood leukemias. 3rd. 2012. DOI: https://doi.org/10.1017/CBO9780511977633 Zombori L, Kovacs G, Csoka M, Derfalvi B. Rheumatic symptoms in childhood leukaemia and lymphoma-a ten-year retrospective study. Pediatric Rheumatology. 2013;11:1–5. 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Bone involvement at diagnosis as a predictive factor in children with acute lymphoblastic leukemia. Hippokratia. 2016;20:227. BK AR, Singh KA, Shah H. Orthopedic manifestation as the presenting symptom of acute lymphoblastic leukemia. Journal of Orthopaedics. 2020;22:326–30. DOI: https://doi.org/10.1016/j.jor.2020.05.022 Radu L-E, Colita A, Pasca S, Tomuleasa C, Popa C, Serban C, et al. Day 15 and day 33 minimal residual disease assessment for acute lymphoblastic leukemia patients treated according to the BFM ALL IC 2009 protocol: Single-center experience of 133 cases. Frontiers in oncology. 2020;10:923. DOI: https://doi.org/10.3389/fonc.2020.00923 Copyright (c) 2023 Aytül Temuroğlu, Salih Güler, Gökalp Rüstem Aksoy, Melike Sezgin Evim, Adalet Meral Güneş This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.