Elucidation of the molecular mechanisms of leukemogenesis is important for a better understanding of the prognosis of acute lymphoblastic leukemia (ALL). Studies have shown that the expression of upregulated gene 4 (URG4), which promotes cell growth and survival, is increased in different types of carcinomas including hepatocellular carcinoma, gastric cancer and osteosarcoma. Similarly, higher expression of URG4 and cyclin D1 gene might promote proliferation of the blast cells by causing escape from the G1 checkpoint and entry into the S phase. This study reports the high expression level of URG4 in 2 high-risk ALL patients for the first time in the literature. In conclusion, the higher expression of URG4 in our 2 patients suggests that URG4 might be involved in leukemogenesis. Future studies with a large number of high-risk ALL patients and cell culture studies are needed to demonstrate the exact role of URG4 in leukemogenesis.

Objective: There are limited data focusing on incidence and manifestations of cytomegalovirus (CMV) in children with acute lymphoblastic leukemia (ALL) apart from bone marrow transplant recipients. In this study, we aimed to review our experience regarding the manifestations, treatment, and outcome of cytomegalovirus infection in pediatric ALL patients. Methods: We retrospectively reviewed the clinical characteristics of patients with ALL that were diagnosed with CMV disease while they were on standard chemotherapy. Results: Fourteen patients were included in the std. Fever was the most common symptom (64%). Eyes, lungs and liver were the most commonly involved organs in CMV disease. Lymphopenia was found in most of the patients. At the time of diagnosis, 50% of the patients were on maintenance phase of chemotherapy. All patients were treated with intravenous ganciclovir. Two patients died because of concomitant infections, and two children with retinitis had permanent visual sequelae while others had a complete recovery. Conclusion: In children with ALL, CMV is an important pathogen with serious consequences including retinitis which may be asymptomatic and result in complete visual loss. Not only during intense chemotherapy but also in maintenance phase CMV disease may occur. Especially when prolonged (>7 days) febrile neutropenia and lymphopenia is present, CMV must be kept in mind in the differential diagnosis.