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Introduction. The prognosis of pediatric solid tumors has improved in recent years through the use of multimodal treatment – chemotherapy, local control (surgery and radiotherapy) and hematopoietic stem cell transplantation (HSCT) for high-risk forms. A limiting factor of these transplant procedures is short-term toxicity, oral mucositis (OM) being associated with potential severe evolution. The introduction of tandem stem cell transplant procedures, which increase the intensity of chemotherapy treatment and thus increase the response rate, is associated with increased toxicity. In this study we evaluated the impact of multiple transplant procedures on the severity and evolution of OM. Materials and methods. This retrospective study included 57 pediatric patients diagnosed with solid tumors (neuroblastoma, germ cell tumor, Ewing sarcoma, nephroblastoma) who underwent HSCT in the Pediatric Bone Marrow Transplantation Unit of Fundeni Clinical Institute, between January 2002 and December 2020. Patients were divided into 2 study groups: the first group included patients who had one HSCT procedure (43 patients) and the second group included patients who benefited from multiple HSCT procedures (14 patients). We evaluated the degree and average extent of OM, associated risk factors, duration of analgesic treatment and parenteral nutrition, as well as infectious risk. Conditioning regimens were based on administration of busulfan, thiotepa or ifosfamide. All patients received prophylactic antimicrobial therapy and followed a daily oral care protocol. Results. The 57 patients underwent 73 HSCT procedures for the following diagnoses: 36 neuroblastoma, 6 germinal cell tumor, 12 Ewing sarcoma and 3 Wilms tumor. Patients were diagnosed, staged and treated according to international protocols. The study highlights the influence on the degree of OM: delayed platelet engraftment and increased parenteral nutrition requirements correlated with the number of HSCT procedures per patient. Infectious risk was higher for patients from the second study group. Conclusions. OM treatment remains prevention-centered and identifying effective measures, encouraging modern treatment strategies and developing practical evidence-based guidelines are imperative.

Introduction. Down syndrome (DS) is an important medical problem because it is one of the most frequent genetic diseases in children despite thorough neonatal screening, with an incidence of approximately 1:10 to 1.000 live births worldwide (1,3,4). An essential aspect is that patients with DS have a 10-15 higher risk than the general paediatric population to develop malignant hemopathy, 20-30% develop acute leukaemia (AL) (5). Recent studies reveal a good response of AL to chemotherapy in patients with DS, mortality is due to multiple complications associated with associated morbidity, which makes the management of these pathologies a real challenge especially in adapting chemotherapy, which has determined the interest for the clinic's caseload analysis. We conducted an 8-year study at the Paediatric Department of Fundeni Clinical Institute of Bucharest, Romania. Objectives. Analysis of the particular diagnostic and therapeutic aspects of patients with DS and acute leukaemia (AL), ALL and AML, on the records of the Paediatric department of Fundeni Clinical Institute during 2010-2018. Material and method. The retrospective, observational, analytical study monitored the cohort from the following points of view: incidence, epidemiology, age at diagnosis, AL type, clinical symptoms at onset, survival rate, overall mortality, treatment related mortality (TRM), identification of relapse and the complex therapeutic attitude of both the underlying pathology and of leukaemia with the assessment of the response rate to chemotherapy. Conclusions. The complex approach of DS-associated hematologic pathology led to an increased percentage of complete remission, 91.6%, without identifying any relapse during the study. Low values of overall survival rate over 8 years and EFS at 3 years = 50% demonstrates an increased mortality rate during the chemotherapy due to the complications generated by this one (TRM 41.6%), which demonstrates the difficulty of managing such a child with two serious diseases, DS and AL. The DS-specific genetic profile produces increased sensitivity to chemotherapy toxicity and multiple organic impairment, which increases the morbidity and mortality rate in these patients, regardless the mortality due to malign hemopathy.

Introducere. Leucemia acută limfoblastică (LAL) este cea mai frecventă formă de cancer în populaţia pediatrică (1). Datorită ajustării continue a protocoalelor terapeutice, rata de supravieţuire a crescut în ultimii ani (2). În ciuda tuturor eforturilor depuse, rata mortalităţii date de complicaţii (TRM = treatment related mortality) se situează în jur de 2-4% în ţările vest-europene (3,4). Materiale şi metode. Studiul este unul analitic, observaţional, retrospectiv, de tip cohortă, primul de acest tip în Romania, efectuat într-un singur centru hematologic pediatric, Clinica IC Fundeni, în perioada 2014-2017. Acesta evaluează incidenţa mortalităţii globale, incidenţa mortalităţii date de orice cauză, alta decât progresia bolii (NRM = Non Relapse Mortality) şi principala cauză a decesului la copii diagnosticaţi cu LAL. Rezultate. Am inclus 142 pacienţi diagnosticaţi în perioada ianuarie 2014-iunie 2017, cu monitorizare pe parcursul a 48 de luni post diagnostic. Mortalitatea globală a cohortei este 10,5% (15/142). Rata mortalităţii data de NRM este 7,04% (10/15). Aceşti 10 pacienţi aflaţi în remisiune moleculară au drept principală cauză a decesului infecţia precipitată de complicaţiile apărute pe parcursul tratamentului (TRM = treatment related mortality cu/fără IRM = infection related mortality). Studiul a evidenţiat procente crescute de IRM, 6,3%, peste valoarea decelată de alte studii, ceea ce explică şi creşterea valorii de NRM şi cea a mortalităţii globale, în contrast cu valorile TRM 2,1%, aceasta fiind în intervalul de referinţă (12,17,19,20). Cea mai frecventă cauză de NRM a fost infecţia cu Clostridium difficile (4/10). Concluzie. Sunt importante de reţinut procentul mare de obţinere a remisiunii complete (98%) şi supravieţuirea globală impresionantă la 4 ani (89,4%).

Introduction. Acute lymphoblastic leukemia (ALL) is the most common form of cancer in the pediatric population (1). The survival rate has increased in recent years due to the continuous adjustment of therapeutic protocols (2). Despite all the efforts made alongside the evolution of new therapeutic protocols, the treatment related mortality (TRM) is around 2-4% in the Western European countries (3,4). Materials and methods. This retrospective is an analytical, observational and cohort-type study, the first of this kind in Romania, performed in a single pediatric hematology center, Clinical Institute Fundeni, between 2014 and 2017. It assesses the incidence of global mortality, the incidence of mortality due to any cause other than progression of disease (NRM = Non Relapse Mortality) and the main cause of death in children diagnosed with ALL. Results. We included 142 patients diagnosed between January 2014 and June 2017, with follow-up of 48 months post-diagnosis. The overall mortality of the cohort is 10.5% (15/142). The mortality rate for any other cause except disease progression (NRM) is 7.04% (10/15). These ten patients, in molecular remission, have as main cause of death complications that occurred during treatment (TRM= treatment related mortality with / without IRM = infection related mortality). The study showed increased percentages of IRM 6.3%, over value of other studies, explaining and increasing also the value of NRM and also the value of global mortality; In contrast to TRM 2.1%, this being in the reference range (12,17,19,20). The most common cause of NRM was Clostridium difficile infection (4/10). Conclusion. There are important to note the high percentage of achievement of complete remission (98%) and impressive global survival at 4 years (89.4%).

Introducere. Leucemia acută limfoblastică (LAL) este cea mai frecventă formă de cancer în populaţia pediatrică (1). Datorită ajustării continue a protocoalelor terapeutice, rata de supravieţuire a crescut în ultimii ani (2). În ciuda tuturor eforturilor depuse, rata mortalităţii date de complicaţii (TRM = treatment related mortality) se situează în jur de 2-4% în ţările vest-europene (3,4). Materiale şi metode. Studiul este unul analitic, observaţional, retrospectiv, de tip cohortă, primul de acest tip în Romania, efectuat într-un singur centru hematologic pediatric, Clinica IC Fundeni, în perioada 2014-2017. Acesta evaluează incidenţa mortalităţii globale, incidenţa mortalităţii date de orice cauză, alta decât progresia bolii (NRM = Non Relapse Mortality) şi principala cauză a decesului la copii diagnosticaţi cu LAL. Rezultate. Am inclus 142 pacienţi diagnosticaţi în perioada ianuarie 2014-iunie 2017, cu monitorizare pe parcursul a 48 de luni post diagnostic. Mortalitatea globală a cohortei este 10,5% (15/142). Rata mortalităţii data de NRM este 7,04% (10/15). Aceşti 10 pacienţi aflaţi în remisiune moleculară au drept principală cauză a decesului infecţia precipitată de complicaţiile apărute pe parcursul tratamentului (TRM = treatment related mortality cu/fără IRM = infection related mortality). Studiul a evidenţiat procente crescute de IRM, 6,3%, peste valoarea decelată de alte studii, ceea ce explică şi creşterea valorii de NRM şi cea a mortalităţii globale, în contrast cu valorile TRM 2,1%, aceasta fiind în intervalul de referinţă (12,17,19,20). Cea mai frecventă cauză de NRM a fost infecţia cu Clostridium difficile (4/10). Concluzie. Sunt importante de reţinut procentul mare de obţinere a remisiunii complete (98%) şi supravieţuirea globală impresionantă la 4 ani (89,4%). [ABSTRACT FROM AUTHOR]

Introduction. Acute lymphoblastic leukemia (ALL) is the most common form of cancer in the pediatric population (1). The survival rate has increased in recent years due to the continuous adjustment of therapeutic protocols (2). Despite all the efforts made alongside the evolution of new therapeutic protocols, the treatment related mortality (TRM) is around 2-4% in the Western European countries (3,4). Materials and methods. This retrospective is an analytical, observational and cohort-type study, the first of this kind in Romania, performed in a single pediatric hematology center, Clinical Institute Fundeni, between 2014 and 2017. It assesses the incidence of global mortality, the incidence of mortality due to any cause other than progression of disease (NRM = Non Relapse Mortality) and the main cause of death in children diagnosed with ALL. Results. We included 142 patients diagnosed between January 2014 and June 2017, with follow-up of 48 months post-diagnosis. The overall mortality of the cohort is 10.5% (15/142). The mortality rate for any other cause except disease progression (NRM) is 7.04% (10/15). These ten patients, in molecular remission, have as main cause of death complications that occurred during treatment (TRM= treatment related mortality with / without IRM = infection related mortality). The study showed increased percentages of IRM 6.3%, over value of other studies, explaining and increasing also the value of NRM and also the value of global mortality; In contrast to TRM 2.1%, this being in the reference range (12,17,19,20). The most common cause of NRM was Clostridium difficile infection (4/10). Conclusion. There are important to note the high percentage of achievement of complete remission (98%) and impressive global survival at 4 years (89.4%). [ABSTRACT FROM AUTHOR]

Introduction. The prognosis of pediatric solid tumors has improved in recent years through the use of multimodal treatment – chemotherapy, local control (surgery and radiotherapy) and hematopoietic stem cell transplantation (HSCT) for high-risk forms. A limiting factor of these transplant procedures is short-term toxicity, oral mucositis (OM) being associated with potential severe evolution. The introduction of tandem stem cell transplant procedures, which increase the intensity of chemotherapy treatment and thus increase the response rate, is associated with increased toxicity. In this study we evaluated the impact of multiple transplant procedures on the severity and evolution of OM. Materials and methods. This retrospective study included 57 pediatric patients diagnosed with solid tumors (neuroblastoma, germ cell tumor, Ewing sarcoma, nephroblastoma) who underwent HSCT in the Pediatric Bone Marrow Transplantation Unit of Fundeni Clinical Institute, between January 2002 and December 2020. Patients were divided into 2 study groups: the first group included patients who had one HSCT procedure (43 patients) and the second group included patients who benefited from multiple HSCT procedures (14 patients). We evaluated the degree and average extent of OM, associated risk factors, duration of analgesic treatment and parenteral nutrition, as well as infectious risk. Conditioning regimens were based on administration of busulfan, thiotepa or ifosfamide. All patients received prophylactic antimicrobial therapy and followed a daily oral care protocol. Results. The 57 patients underwent 73 HSCT procedures for the following diagnoses: 36 neuroblastoma, 6 germinal cell tumor, 12 Ewing sarcoma and 3 Wilms tumor. Patients were diagnosed, staged and treated according to international protocols. The study highlights the influence on the degree of OM: delayed platelet engraftment and increased parenteral nutrition requirements correlated with the number of HSCT procedures per patient. Infectious risk was higher for patients from the second study group. Conclusions. OM treatment remains prevention-centered and identifying effective measures, encouraging modern treatment strategies and developing practical evidence-based guidelines are imperative. [ABSTRACT FROM AUTHOR]