The preventability of acute lymphocytic leukemia during childhood is currently receiving great attention, as it is one of the most common cancers in children. Among the known risk factors so far are those affecting the development of gut microbiota, such as a short duration or absence of breastfeeding, cesarean section, a diet lacking in short-chain fatty acids (SCFAs), the use of antibiotics, absence of infection during infancy, and lack of pets, among other factors. Namely, it has been shown that iron deficiency anemia (IDA) and lack of vitamin D may cause intestinal dysbiosis, while at the same time, both increase the risk of hematological malignancies. The presence of IDA and vitamin D deficiency have been shown to lead to a decreased proportion of Firmicutes in stool, which could, as a consequence, lead to a deficit of butyrate. Moreover, children with IDA have increased blood concentrations of cadmium, which induces systemic inflammation and is linked to the onset of an inflammatory microenvironment in the bone marrow. Finally, IDA and Cd exposure increase fibroblast growth factor 23 (FGF23) blood levels, which in turn suppresses vitamin D synthesis. A lack of vitamin D has been associated with a higher risk of ALL onset. In brief, as presented in this review, there are three independent ways in which IDA increases the risk of acute lymphocytic leukemia (ALL) appearance. These are: intestinal dysbiosis, disruption of vitamin D synthesis, and an increased Cd load, which has been linked to systemic inflammation. All of the aforementioned factors could generate the appearance of a second mutation, such as ETV6/RUNX1 (TEL-AML), leading to mutation homozygosity and the onset of disease. ALL has been observed in both IDA and thalassemia. However, as IDA is the most common type of anemia and the majority of published data pertains to it, we will focus on IDA in this review.

Objective: To evaluate Tc-99m-PSMA SPECT/CT detection of biochemical recurrence (BCR) of prostate cancer across serum PSA levels in patients treated with radical prostatectomy or radiation therapy, to explore clinical/pathologic predictors of scan positivity and metastatic disease, and to assess its potential role as a pragmatic alternative when PSMA PET/CT is unavailable in resource-limited settings. Materials and Methods: In this prospective single-center study, we included 132 men with biochemical recurrence who underwent Tc-99m-PSMA SPECT/CT between January 2024 and December 2025 after predefined inclusion and exclusion criteria were applied, and they were further stratified by primary treatment (radical prostatectomy or radiation therapy). Patients were followed up for up to 6 months after imaging to verify observed findings (histopathology, confirmatory imaging and PSA response) and a logistic regression was applied to identify predictors of scan positivity and metastatic disease. Results: In men initially treated with radical prostatectomy, detection increased from 38.9% at PSA 0.2 to <2 ng/mL to 63.2% at 2 to <4 ng/mL, 71.4% at 4 to <7 ng/mL, and 90% at PSA ≥ 7 ng/mL (overall 69.1%). In the radiation therapy cohort, detection was 58.3% at PSA 2 to <4 ng/mL, rising to 85.7% at 4 to <7 ng/mL and 96% at PSA ≥ 7 ng/mL (overall 84.3%). In the multivariable analysis, PSA doubling (log2[PSA]) independently predicted scan positivity and metastatic disease in both cohorts, while seminal vesicle invasion independently predicted metastatic spread in the post-prostatectomy group. Conclusions: Tc-99m-PSMA SPECT/CT is a useful tool for detecting prostate cancer BCR, with performance strongly dependent on PSA and higher detection in patients with higher PSA levels. Increasing PSA independently predicted scan positivity and metastatic disease, while seminal vesicle invasion was independently associated with metastatic spread. In settings where PSMA PET/CT is unavailable, Tc-99m-PSMA SPECT/CT may represent a practical alternative, particularly for patients with elevated PSA.