Acute lymphoblastic leukemia (ALL) is the most common disease in pediatric oncology. The history of developmental therapeutics for ALL began in the 1960s with the repetition of “unreliable” medical interventions against this lethal disease. By the 1990s, the development of multi-agent chemotherapy and various types of supportive care rendered ALL treatable. Highly sophisticated, molecular, diagnostic techniques have enabled highly accurate prediction of the relapse risk, and the application of risk-adapted treatments has increased the survival rate in the standard-risk group to nearly 100% in most European nations and North America. Incorporation of state-of-the-art, molecularly targeted agents and novel treatments, including cell and immunotherapy, is further improving outcomes even in the high-risk group. On the other hand, the financial burden of treating children with ALL has increased, imperiling the availability of these diagnostic and treatment strategies to patients in low- and middle-income countries (LMICs). The fundamental treatment strategy, consisting of corticosteroid and classical cytotoxic therapy, has achieved fairly good outcomes and should be feasible in LMICs as well. The present review will discuss the history of developmental therapeutics for childhood ALL in various countries through an extensive literature review with the aim of proposing a model for a treatment backbone for pediatric ALL. The discussion will hopefully benefit LMICs and be useful as a base for future clinical trials of novel treatments.

In order to understand the signal transduction system that regulates apoptosis of human umbilical vein endothelial cells (HUVEC), we investigated the effects of inhibitors of the activity of phospholipases. All three tested inhibitors of phospholipase A₂ (PLA₂), namely, manoalide, 3-(4-octadecyl)benzoylacrylic acid (OBAA), and oleyoxyethylphosphorylcholine (OOPC), induced apoptotic cell death of HUVEC. After 16 h of treatment, almost all of the cells had disintegrated into apoptotic bodies, and DNA ladders characteristic of apoptotic cell death were clearly observed upon analysis of DNA on agarose gels. The release of arachidonic acid from the cells that had been treated with manoalide, OBAA or OOPC (at the same concentrations as those at which these compounds induced apoptosis) was inhibited. We also studied the effects of two inhibitors of phosphatidylinositol-specific phospholipase C (PLC), U73122, and compound 48/80. Both compounds promoted the apoptosis of HUVEC. After 16 h of treatment, few cells remained intact, and DNA fragmentation was clearly detectable after only 12 h. Quantitation of inositol released from cells treated with U73122 and compound 48/80 showed that the release of inositol was blocked. By contrast, U73343, a similar aminosteroid that does not inactivate PLC, had no such effects. Our results suggest that PLA₂ and phosphatidylinositol-specific PLC might be involved in the signaling pathway of apoptosis in HUVEC, and that the metabolism of arachidonic acid and of inositol might play important roles in the present apoptotic signal-transduction system.

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food allergy characterized by repetitive vomiting within 1-4 h and/or diarrhea within 24 h after ingesting the causative food. We herein report a rare Japanese case of rice-induced FPIES. A six-month-old, female, Japanese patient presented to the emergency room (ER) with the complaint of vomiting after feeding. Postprandial vomiting had occurred occasionally since she started ingesting solid food at the age of 5 months. Rice-induced FPIES was suspected only after the fourth ER visit based on the characteristic history of recurrent vomiting occurring 1-2 h after ingesting food containing rice. Allergen-specific IgE testing and a skin prick test with an allergen scratch extract were both negative for rice. During an oral food challenge test (OFC), vomiting was observed after the patient ingested 2 g of rice porridge. Based on the OFC results and the entire clinical course, FPIES due to rice was diagnosed. A lymphocyte stimulation test with rice revealed a significantly elevated stimulation index. Rice-induced FPIES is rarely reported among Japanese infants despite rice being a staple in the Japanese diet. The prevalence of rice-induced FPIES differs greatly among populations, suggesting a multifactorial cause associated with its development. Delays in diagnosis are common in FPIES, and our case demonstrates the importance of obtaining a dietary history of food ingested prior to symptom onset in cases of infantile repetitive vomiting.

Background: Yersinia infection is known to present with Kawasaki disease (KD)-like symptoms although differentiating the 2 has been a challenge. The present study aimed to describe the clinical characteristics and prevalence of Yersinia infection presenting with KD-like symptoms. Methods: The present, prospective, multicenter study enrolled patients who received a diagnosis of KD between January 2021 and January 2022 at 2 hospitals in Tokyo. Stool samples were collected within 3 days of the start of KD treatment, and cultures were performed for Yersinia. Clinical history and symptoms suggestive of Yersinia infection were also evaluated. Results: During the study period, 141 KD patients were screened and 117 patients with evaluable stool samples were registered. Only 1 patient was positive for Yersinia pseudotuberculosis, which was detected from both stool and blood cultures. The patient was refractory to KD treatment but improved after initiation of appropriate antibiotic therapy. Conclusions: Routine screening for Yersinia is not appropriate for patients with KD and should be limited to certain patients in high-risk areas and those who are refractory to the standard KD treatment.