Cytomegalovirus (CMV) disease in pediatric acute lymphoblastic leukemia in the nontransplant setting is very rare. We report our experience with 4 such cases, and review the literature (n=12). The median age at diagnosis was 10 years and 50% of patients were males. Among the 11 cases with available information at the time of diagnosis, CMV disease occurred during maintenance therapy in 10 patients. Fever was present in 9 cases. CMV disease manifested as retinitis in 6, hepatosplenic disease in 3, pneumonitis in 1, and hemophagocytic lymphohistiocytosis in 1 patient. One patient had both CMV retinitis and CMV-related hemophagocytic lymphohistiocytosis. Four of the 7 patients with retinitis complained of visual disturbance at diagnosis. CMV viremia was present in 10 patients. Three patients had at least 1 relapse and developed permanent visual defects, and 1 patient developed recurrent retinal detachment. In conclusion, prolonged immunosuppression is the major etiology and retinitis is the most common manifestation of CMV disease. As a significant number of patients with retinitis are asymptomatic, early diagnosis and treatment is important to prevent permanent visual loss.

Background: Health systems have adopted financing to enhance access to care for patients with cancer. The cost of acute lymphoblastic leukemia (ALL) treatment is a blurred image for hospitals and third party payers. The cost of each component of the care should be analyzed to differentiate justifiable cost and to act on wasteful practices. Objectives: Therefore, this is a study on the direct and indirect costs of ALL based on the United Kingdom protocol (UKALL), in pediatric ALL management in Iran. Methods: A retrospective study design was used to study children with ALL managed with UKALL protocol in specialized pediatric hospitals from 2010-2015. The data was collected from patients' medical records. Results: Total direct medical cost per patient was 8282 USD. Most of costs were from inpatient beds (3338 ± 1110 USD) and drug expenditures (2157 ± 1035 USD). The direct non-medical cost incurred by study participants was 1286.4 USD, the total indirect cost of productivity loss was 769.9. Conclusions: The cost of ALL management imposed huge treat on financial capability of peoples caring for children. The treats will affect the whole society and the health system of the country unless strategies are designed to contain the costs. The policy makers from the top level of the country to the service providers should be hand and glove to devise a suitable national ALL management protocol which will avert the observed alarms.

Acute lymphoblastic leukemia (ALL) has a high prevalence at early age and in children and regard to life expectancy index this disease cause to losing many years of life in these patients. Two well-known European protocols called United Kingdom (UK-ALL) and Berlin-Frankfurt-Munster (BFM-ALL) protocols are used to treat the disease in Iran, so the objective of this study is modelling of the treatment process using the protocols of BFM-ALL and UK-‎ALL to estimate more ‎cost-effectiveness method. A decision tree model was applied to depict the real treatment process to calculate costs per quality-adjusted life-year (QALY). Total costs were included to the model. The cost effectiveness ratio of UK-ALL is lower than BFM-ALL (1145.52 USD /3.87 QALY for UK-ALL and 1942.35 USD /3.02 QALY for BFM-ALL). Therefore, the UK-ALL is dominant and BFM-ALL is dominated.‎ The modeling results showed a double difference between the two studied options so policymakers and oncologist ‎should advocate the economic evaluation methods and modeling to select a real option in the treatment of patients to save resources like UK-ALL.