Iranian Pediatric Hematology and Oncology Society Iranian Journal of Blood and Cancer 2008-4595 17 4 2025 2 1 Alteration of LncRNAs Expression Level in Blood of New Case and Medicated Behcet Patients as a Prognostic Biomarker 1 9 EN Faezeh Mehdizadeh Department of Microbiology, Ta.C., Islamic Azad University, Tabriz, Iran. Kamran Javidi-Aghdam Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Abolfazl Jafari-Sales Department of Microbiology, Ta.C., Islamic Azad University, Tabriz, Iran & Department of Microbiology, Kaz.C., Islamic Azad University, Kazerun, Iran. Attabak Toofani Milani Department of Laboratory Sciences and Microbiology, TaMS.C., Islamic Azad University, Tabriz, Iran. Mehrdad Pashazadeh Infectious Diseases Research Center, TaMS.C., Islamic Azad University, Tabriz, Iran. Background: Behcet’s disease is a complex systemic inflammatory vasculitis marked by recurrent oral and genital ulcers, and uveitis. This study aims to evaluate the expression levels of long non-coding RNAs (LncRNAs) such as IFNG-AS1 and AC007278.2, along with the IL18 and IL18R1 genes, in the blood of active Behcet’s disease patients compared to HCs. Given the elevated levels of inflammatory cytokines in these patients, exploring the role of LncRNAs could provide insights into their involvement in the disease's pathogenesis and inflammatory response. Methods: This case-control study involved 40 Behcet’s disease patients (20 medicated, 20 new cases) and 40 HCs. 2.5 ml venous blood of all subject were collected, and RNA extracted by using cDNA synthesis kit. Evaluation of genes expression level through qRT-PCR to analyze the expression levels of specific genes associated with inflammation, providing insights into Behçet's disease pathology Results: Elevated expression of IL-18, IL-18R1, Lnc-AC007278.2, and Lnc-IFNG-AS1 showed in new case patients compare to medicated patients and HCs. ROC curve analysis demonstrated high diagnostic efficacy for these biomarkers, particularly IL18R1, indicating their potential for accurate patient identification. Conclusion: This study highlights the potential of LncRNAs IFNG-AS1 and IL18 as non-invasive biomarkers for Behcet’s disease, offering insights into disease pathology and enhancing diagnostic accuracy, especially in new cases.

Iranian Pediatric Hematology and Oncology Society Iranian Journal of Blood and Cancer 2008-4595 17 4 2025 2 1 Extensive Splenic Infarction in a Pediatric Patient with Acute Promyelocytic Leukemia: A Case Report Highlighting Dual Hemostatic Dysregulation 10 13 EN pourya mashategan Department of Pediatrics, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran. hassan Abolghasemi Department of Pediatrics, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran. Background: Acute promyelocytic leukemia (APL) is characterized by a life-threatening coagulopathy, traditionally associated with hemorrhagic complications. However, thrombotic events, including arterial infarction, are increasingly recognized as significant contributors to morbidity during induction therapy. Case Presentation: We report a 16-year-old male diagnosed with APL who developed extensive splenic infarction two weeks after initiation of all-trans retinoic acid (ATRA). He presented with persistent fever and left upper quadrant pain. Abdominal imaging revealed a large subcapsular splenic infarct without evidence of macrovascular thrombosis. Despite improving blood counts and resolution of initial cytopenias, systemic inflammation and coagulopathy persisted. ATRA was temporarily discontinued due to suspicion of differentiation syndrome, which may have delayed disease control. With resumption of ATRA and addition of arsenic trioxide (ATO), along with supportive care, the patient achieved complete hematologic remission with undetectable minimal residual disease (MRD) at day 50. Conclusion: Thrombotic complications such as splenic infarction can occur in APL even during early treatment, emphasizing the dynamic and dual nature of hemostatic dysregulation. Clinicians should maintain a high index of suspicion for non-infectious causes of fever and abdominal pain in APL patients. Early recognition and uninterrupted targeted therapy are critical to resolving the underlying prothrombotic state and improving outcomes.

Iranian Pediatric Hematology and Oncology Society Iranian Journal of Blood and Cancer 2008-4595 17 4 2025 2 1 A Novel Chromosomal Translocation t(X;10) in a Pediatric Acute Myeloid Leukemia Patient Complicated by Subarachnoid Intraventricular Hemorrhage 14 19 EN Suresh Kumar Prajapati Parul Institute of Applied Sciences, Parul University, Post Limda, Waghodia Road, Vadodara, Gujarat, India. Charmi Jyotishi Parul Institute of Applied Sciences, Parul University, Post Limda, Waghodia Road, Vadodara, Gujarat, India. Dharmesh Vaghasiya Blood Cancer Institute, Surat, Gujarat, India. Reeshu Gupta Parul Institute of Applied Sciences, Parul University, Post Limda, Waghodia Road, Vadodara, Gujarat, India. Background: Acute myeloid leukemia (AML) is a malignancy of hematopoietic stem cells, seen rarely in children. Intraventricular hemorrhage (IVH) is an uncommon but often fatal complication of AML, and its management is difficult because it requires balancing intensive chemotherapy with supportive care for bleeding. Case Presentation: We report the case of an 11-year-old child with newly diagnosed AML who presented with fever, neurological deterioration, and respiratory distress, and was found to have subarachnoid intraventricular hemorrhage. Cytogenetic Findings: Bone marrow karyotyping demonstrated a novel translocation involving chromosomes X and 10 with breakpoints at Xq13 and 10p11.2 or 46,XY,t(X;10)(q13;p11.2). This was confirmed by fluorescence in situ hybridization (FISH). Other recurrent AML-associated abnormalities were not detected. Clinical Course: The patient received antifibrinolytics, platelet support, anticonvulsants, and external ventricular drainage. Flow cytometry of bone marrow aspirate showed 85% blasts expressing CD34, CD117, HLA-DR, CD13, and CD33, consistent with AML. The patient developed refractory shock and cardiac arrest, and death occurred before leukemia-directed treatment could be initiated. Conclusions: This case describes a rare cytogenetic abnormality in AML associated with IVH. A direct causal relationship cannot be inferred from a single report; however, documenting such rare findings adds to the body of knowledge and may help in future studies exploring genetic factors and clinical outcomes in AML.

Iranian Pediatric Hematology and Oncology Society Iranian Journal of Blood and Cancer 2008-4595 17 4 2025 2 1 Clinical efficacy of Empirical (Piperacillin/tazobactam plus Amikacin) Combined Therapy of Febrile Neutropenia Among Pediatric Patients with Cancer: A Cohort Observational Study 20 26 EN Sarah Alfaqaih Department of Pediatrics, Faculty of Medicine, Misurata University, Misurata, Libya. Nowara Ghlio Department of Pediatric Oncology, National Cancer Institute, Misurata, Libya. Abdulaleem Assadi Department of Pediatrics, Faculty of Medicine, Misurata University, Misurata, Libya. Background: Febrile neutropenia (FN) is a life-threatening complication in pediatric oncology patients that requires prompt and effective empirical antibiotic treatment. Local data on the success of these regimens are essential for guiding clinical practice. This study assesses the effectiveness and safety of the local empirical combined therapy of Piperacillin/tazobactam plus Amikacin for FN in pediatric cancer patients. Methods: A prospective observational cohort study was conducted on 68 FN episodes in 34 pediatric cancer patients between August 2022 and December 2023. The first-line regimen included intravenous Piperacillin/tazobactam and Amikacin, with Amikacin de-escalated after 72 hours of fever resolution. The primary outcome was the success rate of the first-line regimen, defined as fever resolution and clinical clearance without modification or switch. Safety was evaluated by monitoring creatinine levels. Results: The overall success rate of the empirical regimen without modification was 63.2%, with a failure rate of 22%. The success rate increased to 77.9% when Vancomycin was added (14.7% of cases). Microbiologically documented infections (MDI) were mostly Gram-positive (62.5%), including MRSA isolates resistant to Piperacillin/tazobactam. No treatment-related mortality or significant nephrotoxicity was observed (mean creatinine difference: -0.0107, p=0.338). Additionally, the duration of neutropenia was strongly correlated with the length of hospital stay (r=0.7, p<0.00001). Conclusion: The combined Piperacillin/tazobactam and Amikacin regimen shows a reasonable success rate and a good safety profile in the local setting, supporting its continued use as a first-line option. However, the high prevalence of Gram-positive MDI and the frequent need for Vancomycin addition highlight the importance of ongoing local resistance monitoring and maintaining a low threshold for early Vancomycin use in high-risk patients.

Iranian Pediatric Hematology and Oncology Society Iranian Journal of Blood and Cancer 2008-4595 17 4 2025 2 1 Mechanisms of Resistance in CML and the Emerging Role of Asciminib and Other Next-Generation Inhibitors 27 35 EN Sanchita Srivastava Department of Biotechnology, Era’s Lucknow Medical College and Hospital Lucknow, India. Riya Nag Department of Biotechnology, Era’s Lucknow Medical College and Hospital Lucknow, India. Ale Eba Department of Biotechnology, Era’s Lucknow Medical College and Hospital Lucknow, India. Syed Tasleem Raza Department of Biotechnology, Era’s Lucknow Medical College and Hospital Lucknow, India. Chronic myeloid leukemia (CML) is a myeloproliferative disorder driven by the BCR-ABL1 fusion gene that confers constitutive tyrosine kinase activity. Although tyrosine kinase inhibitors (TKIs) have revolutionized CML therapy, resistance remains a major clinical challenge, primarily due to kinase domain mutations, leukemic stem cell persistence, and compensatory signalling pathways. Asciminib, a novel allosteric STAMP inhibitor targeting the ABL myristoyl pocket, introduces a distinct mechanism to overcome resistance associated with ATP-site mutations such as T315I. This review highlights the molecular basis of TKI resistance, mechanisms of BCR-ABL1–dependent and –independent resistance, and emerging strategies including combination therapy, degraders, and immunotherapeutic approaches. Real-world data and clinical trials demonstrate asciminib’s efficacy and favorable safety in multi-resistant CML. The future of CML management lies in precision-driven multimodal therapy aimed at eradicating leukemic stem cells and achieving treatment-free remission.

Iranian Pediatric Hematology and Oncology Society Iranian Journal of Blood and Cancer 2008-4595 17 4 2025 2 1 Gene Expression Profiling in Patients with CML Experiencing Loss of Treatment Response 36 46 EN Butool Zahra Rizvi Department of Biotechnology Khwaja Moinuddin Chishti Language University Lucknow, India. Riya Nag Department of Biochemistry, Eras Lucknow Medical College and Hospital, Era University, Lucknow 226003, Uttar Pradesh, India. Syed Tasleem Raza Department of Biochemistry, Eras Lucknow Medical College and Hospital, Era University, Lucknow 226003, Uttar Pradesh, India. Sanchita Srivastava Department of Biotechnology, Era’s Lucknow Medical College and Hospital Lucknow, India. Ale Eba Department of Biotechnology, Era’s Lucknow Medical College and Hospital Lucknow, India. Saliha Rizvi Department of Biotechnology, Era’s Lucknow Medical College and Hospital Lucknow, India. Naseem Fatima Department of Biotechnology, Era’s Lucknow Medical College and Hospital Lucknow, India. Farheen Khan Department of Biotechnology, Era’s Lucknow Medical College and Hospital Lucknow, India. Chronic Myeloid Leukemia (CML) is a hematological malignancy characterized by the presence of the BCR-ABL1 fusion gene, which leads to uncontrolled proliferation of leukemic cells. Despite the effectiveness of Tyrosine Kinase Inhibitors (TKIs) such as imatinib, dasatinib, and nilotinib in controlling CML, treatment resistance remains a major clinical challenge. The mechanisms contributing to resistance include BCR-ABL1 mutations, epigenetic modifications, and dysregulated microRNA (miRNA) expression. Gene expression profiling serves as a crucial tool for understanding disease progression, identifying novel therapeutic targets, and predicting treatment responses. This study explores the molecular basis of TKI resistance in CML through differential gene expression analysis, highlighting key biomarkers such as STAT5, BCL2L1 (Bcl-XL), MCL1, miR-150, and MYC. Additionally, we discuss emerging treatment strategies, including next-generation TKIs (asciminib, olverembatinib), non-BCR-ABL targeted therapies (mTOR inhibitors, JAK2 inhibitors, and HDAC inhibitors), and innovative approaches such as oncolytic viruses, exosome-based therapies, and CRISPR gene editing. Understanding the genetic and molecular landscape of CML can help optimize treatment strategies, improve early resistance detection, and advance personalized medicine for CML patients.

Iranian Pediatric Hematology and Oncology Society Iranian Journal of Blood and Cancer 2008-4595 17 4 2025 2 1 Clinical Guidelines for the Prevention and Management of Oral and Dental Complications in Pediatric Oncology Patients: A Narrative Review 47 52 EN Babak Abdolkarimi Department of pediatric, Hakim children hospital, Tehran university of medical science, Tehran, Iran. Ali Amanati Clinical Research Development Center, Amir Oncology Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Nahid Derikvand Department of Periodontics, Bo.c., Islamic Azad University, Borujerd, Iran. Niki Panahi Azad Islamic university, science and research branch, Tehran, Iran. Sepideh Mirzaie Azad Islamic university, science and research branch, Tehran, Iran. Background: Oral complications are among the most frequent and debilitating adverse effects of cancer therapy in pediatric patients. Chemotherapy, radiotherapy, and hematopoietic stem cell transplantation can result in acute manifestations such as mucositis, infections, bleeding, and pain, as well as long-term sequelae including dental developmental abnormalities, craniofacial growth disturbances, and xerostomia. Comprehensive oral care is therefore a critical component of supportive oncology management. Objectives: This narrative review aims to summarize current evidence regarding oral and dental care strategies for pediatric oncology patients, focusing on preventive assessment, hygiene maintenance, management of treatment-related complications, and long-term follow-up. Methods: Relevant literature was reviewed to consolidate clinical recommendations and evidence-based strategies for oral care in children undergoing oncology treatment. The review highlights practical approaches for pre-treatment dental evaluation, in-treatment oral hygiene and infection control, and post-treatment follow-up, with integration of levels of evidence where available. Results: Pre-treatment dental assessment and elimination of infectious foci significantly reduce oral and systemic complications. During active therapy, gentle oral hygiene practices, fluoride use, antiseptic rinses, and careful management of pain and infection are essential. Oral mucositis remains the most common dose-limiting complication, and preventive strategies such as cryotherapy, keratinocyte growth factors, and low-level laser therapy demonstrate strong supporting evidence. Post-treatment follow-up should include regular dental visits, ongoing preventive care, and monitoring for late sequelae such as dental developmental anomalies and xerostomia. Conclusions: Structured oral care, encompassing pre-treatment assessment, active therapy management, and long-term follow-up, is essential to minimize morbidity and improve quality of life in pediatric oncology patients. Evidence-based interventions, particularly for mucositis prevention and caries management, provide a foundation for standardized clinical practice and highlight areas for future research.

Iranian Pediatric Hematology and Oncology Society Iranian Journal of Blood and Cancer 2008-4595 17 4 2025 2 1 Rasayana-Based Adjuvant Strategies in Cancer Care: An Ayurvedic–Oncologic Perspective 53 68 EN Himani Sharma Department of Shalakya Tantra, Sanjeevani Ayurvedic Medical College, Gajraula, Uttar Pradesh, India. Raja Ram Mahto Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India. Sudhanshu Kumar Jha Centre for Integrative Oncology, All India Institute of Ayurveda, New Delhi, India. Sonam Chauhan Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India. Prachi Khandelwal Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India. Sanjay Kumar Tiwari Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India. Background: Cancer is a serious global health issue, and as multimodal therapies have advanced, treatment-related toxicities have a significant influence on function, compliance, and quality of life. Integrative oncology looks for supportive treatment and resilience-promoting supplementary techniques that are supported by research. Rasayana is the rejuvenating branch of Ayurveda that emphasizes on ojas (vitality), immunological balance, and metabolic homeostasis. It is probably useful for cancer care. Objective: To integrate the safety considerations, emerging clinical cues, conceptual rationale, and implementation pathways of Rasayana-concordant botanicals and regimens as cancer care-modifying adjuncts. Methods: Using iterative PubMed, Cochrane, EMBASE, AYUSH Portal, ctri.nic.in, ClinicalTrials.gov and WHO ICTRP searches until August 2025, a review was conducted in accordance with SANRA principles. Human clinical and translational data on Rasayana-compatible therapies given in addition to conventional oncologic treatments were, with focus on symptom clusters, safety, mechanistic plausibility, and herb–drug interactions. Classical Ayurvedic terms (e.g., Medhya, Balya, Ojovardhaka, and Raktaprasadana) were linked to their biological correlates and patient-reported outcomes using thematic data synthesis. Results: Major Rasayana herbs with immunomodulatory, antioxidant, neuroendocrine, and mucosal-protective properties include Withania somnifera, Curcuma longa, Phyllanthus emblica, Tinospora cordifolia, and Ocimum tenuiflorum. Preliminary clinical data indicate improvements in symptoms. Safety themes highlight the importance of product authentication, pharmacovigilance, and monitoring potential herb-drug interactions, particularly those involving CYP3A4 and P-gp regulation. Conclusion: In integrative oncology, Rasayana-based therapies show early supportive care and physiologically believable potential. Under multidisciplinary supervision, their usage should continue to be customized, safety-monitored, quality-assured, and adjunctive. Well-planned, oncology-focused clinical trials are required.

Iranian Pediatric Hematology and Oncology Society Iranian Journal of Blood and Cancer 2008-4595 17 4 2025 2 1 A Meta-Analysis on the Prognostic and Predictive Role of Stem-like CD8+ T Cells in Cancer Immunotherapy: Correlating Clinical Outcomes 69 81 EN Sonika Sharma Department of Anatomy, Teerthanker Mahaveer Medical College & Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India. Prithpal Singh Matreja Department of Pharmacology, Teerthanker Mahaveer Medical College & Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India. Sudhir Singh Department of Microbiology, Teerthanker Mahaveer Medical College & Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India. Pothu Usha Kiran Department of Biochemistry, Teerthanker Mahaveer Medical College & Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India. Background: Stem-like CD8+ T cells, marked by TCF1 and PD-1, possess self-renewal and effector differentiation abilities, crucial for cancer immunotherapy. Despite tumor microenvironment constraints, their abundance often correlates with favourable outcomes. Aim: To assess the prognostic and predictive relevance of stem-like CD8+ T cells in patients receiving immunotherapy for cancer. Methodology: 721 publications from PubMed, Embase, Scopus, and Web of Science (2015–2025) were evaluated in accordance with PRISMA 2020 guidelines. 8 studies were included in the meta-analysis. Two independent reviewers conducted data extraction. Pooled hazard ratios (HRs) and confidence intervals (CIs) were calculated using RevMan software, and the I2 statistic was employed to measure heterogeneity. The ROBINS-I instruments and the Newcastle-Ottawa Scale were used to assess the quality of the study. Results: 8 of the 13 included papers qualified for meta-analysis. Follow-up periods varied from six months to five years, and sample sizes ranged from 12 to 94 patients. Multiplex immunofluorescence, scRNA-seq, or flow cytometry were used to quantify stem-like CD8+ T cells. Hazard ratios (HRs) in the woodland plot ranged from 1.18 to 28.50. High HRs of 4.31 (95% CI: 2.68–6.92) and 28.50 (95% CI: 3.30–246.15) were observed in two investigations, suggesting a significant adverse prognostic effect. With considerable heterogeneity (I2 = 89%, Chi2 = 61.38, P < 0.00001), the pooled HR was 1.34 (95% CI: 1.22–1.47). Conclusion: In cancer immunotherapy, stem-like CD8+ T cells serve as both therapeutic targets and significant prognostic indicators. Standardized methods for evaluation and strategies to lessen immunosuppressive effects in the tumor microenvironment are necessary for clinical use.

Iranian Pediatric Hematology and Oncology Society Iranian Journal of Blood and Cancer 2008-4595 17 4 2025 2 1 Unravelling the Role of IL-6, TNF-alpha and CRP in Pathogenesis of Coronary Artery Disease: A Systematic Review 82 103 EN Priya Anjali Department of Biochemistry, Teerthanker Mahaveer Medical College and Research Centre, Teerthanker Mahaveer University, Moradabad, UP, India. Pothu Ushakiran Department of Biochemistry, Teerthanker Mahaveer Medical College and Research Centre, Teerthanker Mahaveer University Moradabad, UP, India. Jigar Haria Department of Medicine, Teerthanker Mahaveer Medical College and Research Centre, Teerthanker Mahaveer University Moradabad, UP, India. Background: India has high incidence of cardiovascular disease and coronary artery disease (CAD). Coronary artery disease is attaining epidemic proportions in India. Higher levels of C-reactive protein were connected to an augmented risk of coronary heart disease (CHD).  TNF-alpha & IL-6 contribute in the pathogenesis of CHD and their levels are closely linked with the extent of coronary heart disease. Aim and objectives: This objective of this review is to analyze the status of inflammatory markers and to establish their relation with the extent of CAD. Methodology: The literature search for this review was done through databases incorporated are PubMed, Web of sciences, Scopus, Medline, Research Gate and Google scholar. The keywords used were “coronary artery disease”, “inflammatory markers,” and “cytokines in inflammation”. The Preferred Reporting Items for Systematic Research and Meta-Analysis (PRISMA) were used to build this review article. Results: There were 1860 articles found which were relevant to the aim of our review, out of which only 57 fulfilled the inclusion criteria. A substantial variability across the studies was found. To figure out its correlation with inflammatory processes, these studies employed a variety of inflammatory markers. Most studies found a high level of inflammatory markers such as IL-6, TNF-alpha, and CRP in patients with coronary artery disease and cardiovascular disease. Conclusion: Data from the literature searched highlighted a significant association between inflammatory markers and CAD.