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ABSTRACT Background Methods Results Conclusion Children who have received chemotherapy and/or radiotherapy treatment resulting in neutropenia can suffer painful mucositis. We explored the relationship between pain score and white cell count in children with mucositis due to immunosuppression and assessed the influence of opioid and ketamine analgesia.Children with mucositis nursed in the pediatric oncology and hematology ward were invited to partake in this observational study following referral to the pediatric pain service for intravenous analgesia. Pain scores, white cell count, neutrophil count, and analgesia requirements were recorded daily until intravenous analgesia was either stopped or transitioned to oral analgesia. Data were analyzed using nonlinear mixed effects models that sought a relationship between white cell count and pain score using a sigmoid maximal effect (EMAX) model. The impact of analgesic use on pain score was determined. The temporal relationship between white cell count and pain score was characterized by using a delayed effect model with an equilibration half‐time.Fifty children were enrolled in the study from January 2022 to December 2023. The equilibration half‐time relating the rise in white cell count and pain response was 0.29 days. The initial pain score (estimated in those children already started on treatment with paracetamol and tramadol) was 6.3 (maximum pain 10). The maximum pain reduction was 59% of that initial pain score. Morphine and ketamine further reduced pain; the maximum response for opioids was 38% reduction and that for ketamine was 11%.Pain relief from mucositis is related to an increase in white cell count after a period of severe neutropenia, where white cell count is a surrogate for neutrophil count. There is a delay in analgesic response of approximately 1 day. This analgesic response to increasing white cell count had greater dominance than analgesia achieved using either opioids or ketamine. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy and procedure safety of ultrasound-guided core needle biopsy of extra cranial solid masses in the pediatric population. Method: A cross-sectional survey was conducted by the Department of Pediatric Hematology/Oncology and Radiology at Indus Hospital and Health Network Karachi from August 2022 to April 2023. A total of 118 pediatric patients, from age one month to 18 years, with extra cranial solid masses were studied. Data was analyzed using SPSS version 24. Results: The median age of study participants was six years with IQR = 7.2 years. Among all study participants 62.7% (n=74) were male while 37.3% (44) were female. Out of all biopsies 94.07% (n=111) were conclusive and provided an accurate diagnosis of the tumor while only 5.63% (n=07) biopsies remained inconclusive. No serious post-procedure complication was reported. Pain on the site of biopsy was the most post-procedure complain reported by 34.7% (n=41) of all the study participants. Forty-two percent of the study participants never reported any post-procedure complaints after ultrasound-guided biopsy. The diagnostic accuracy was significantly higher for malignant lesions as compared to non-malignant lesions. Conclusion: Ultrasound-guided percutaneous core needle biopsy had high diagnostic accuracy and a good safety profile among children with extra cranial solid masses in private tertiary care hospital in Karachi Pakistan. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ankara University Faculty of Medicine / Ankara Üniversitesi Tip Fakültesi Mecmuasi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The document discusses the impact of CDKN2A/B deletion as a negative prognostic factor for allogeneic hematopoietic stem cell transplantation in childhood B cell precursor acute lymphoblastic leukemia. The study examined 164 children with B-ALL who underwent transplantation, finding that CDKN2A/B deletion was significantly associated with lower leukemia-free survival and higher relapse rates. The study suggests that CDKN2A/B deletion may affect chemosensitivity and immune response, highlighting the need for further research and potential incorporation of cellular therapy or targeted agents in treatment strategies. [Extracted from the article]

Since the 1970s, Italian pediatric oncologists have collaborated through the Italian Association for Pediatric Hematology Oncology (AIEOP) network using a common centralized system for the registration of childhood cancer, known as Model 1.01 (Mod. 1.01). In this study, we report on recruitment trends, extra‐regional migration and changes in outcome over time in the Italian population of children (0–14 years) and adolescents (15–19 years) registered and treated within the national AIEOP network in the period between 1989 and 2017. In almost 30 years, a cohort of 43,564 patients with a neoplasia diagnosis was registered in Mod. 1.01. The analysis of national extra‐regional migration showed that patients tend to migrate from the South to the North and, to a lesser extent, to the Center of the country. During the study period, migration apparently decreased, especially for lymphohematopoietic diseases, whereas it remained substantial for solid tumors. Our data showed a progressive and significant increase in the cumulative survival 5 years after diagnosis since the 1990s, reaching almost 84% for all patients diagnosed in the last decade. Survival rates of Mod. 1.01 patients are similar to those provided by the main national and international reports showing childhood cancer surveillance estimates. The AIEOP Mod 1.01 has proved to be an invaluable tool from both an epidemiological and a health policy point of view, allowing us, in this study, to examine the survival experience of the largest cohort of Italian pediatric cancer patients with a very long follow‐up. [ABSTRACT FROM AUTHOR]

Background: As frontline healthcare workers, pediatric oncology nurses are at high risk for burnout, compassion fatigue, and decreased compassion satisfaction. Research indicates that up to 60% of oncology staff experience some form of burnout. This can lead to difficulties in personal and professional relationships, decreased staff retention, and negative effects on patient safety. This evidence-based practice project evaluated the impact of a staff well-being program on pediatric oncology nurses in a 28-bed hematology–oncology unit at a children's hospital. Method: After reviewing the literature related to compassion satisfaction, compassion fatigue, burnout, and well-being, an interdisciplinary team identified best practices for implementing a staff well-being program. This program integrated the components of Code Lavender, which is an alert designed to reduce stress and provide psychological first aid, including social support and a purposeful break from the unit, with staff debriefings, or dedicated time to reflect and focus on the team's emotional response and coping strategies. Results: Nurses reported that Code Lavender met their expectations; 69% agreed or strongly agreed that it had an immediate positive impact on their well-being. The team experienced challenges in coordinating debriefings with consistency, so the process was modified to develop a format that would address the needs of those who access the well-being program. There was a marginally significant improvement in compassion satisfaction from baseline to 12 months (p =.05). Discussion: Promoting healthcare worker well-being continues to be a priority to reduce burnout and to improve compassion satisfaction. Implementation of Code Lavender and debriefings is an important step toward improving the well-being of pediatric oncology nurses. [ABSTRACT FROM AUTHOR]

Objective: Invasive candidiasis is defined as an important infection that increases the duration of patients' hospital stay, costs, mortality and morbidity. In this study, we aimed to investigate the frequency of candidiasis in blood cultures of pediatric hematology patients, Candida species, antifungal susceptibilities, and their effects on mortality. Materials and Methods: Patients with Candida growth in their blood cultures at follow-up in the pediatric hematology clinic of our hospital between 2020 and 2024 were included in the study. Age, gender, primary diseases and risk levels, subtypes and antifungal susceptibilities of Candida grown in blood cultures, the presence of neutropenia in patients, the antifungals used for prophylaxis and treatment, the duration of infection, other bacteria grown additionally during the fungal infection period, the local infection source and the patients' discharge status were obtained from medical records. These constituted the study data. Results: Blood cultures were requested for 594 patients from the Pediatric hematology Clinic, and Candida was grown in only 37 (6.7%) of them. A total of 43.2% of them were the Candida parapsilosis complex, 29.7% were Candida albicans and 8.1% were the Candida haemulonii complex. Antifungal susceptibilities were over 90% for anidulafungin, micafungin, caspofungin, posaconazole, itraconazole and amphotericin B, followed by 86.7% for fluconazole and 84.4% for voriconazole. The mean age of the patient group was 6.8 years, 50.5% of whom were female and 40.5% of whom were male. The Candida infections developed on the 12.1th day of the neutropenia process on average. The mean invasive Candida infection period was 7 days. A total of 18.9% had a second bacterial infection and 13.5% had a local infection. A total of 51.4% had a single antifungal, 18.9% had two antifungals and 2.1% had more than two antifungals. A total of 35.1% of the patients with invasive candidiasis died. The primary diagnosis of the disease, Patient risk level, and the female gender were important factors affetting mortality. Conclusions: In a pediatric hematology clinic, the non-albicans group in invasive candidiasis infections was notable, with the C. parapsilosis complex occurring most frequently. There was still a high sensitivity to echinocandin antifungals and a decreased sensitivity to triazoles. It was found that the factor of the clinical diagnosis, being in the high-risk group and being female had significant effects on the survival rate of patients with candidiasis infections. [ABSTRACT FROM AUTHOR]

Objective: Direct referral of patients to pediatric hematology and oncology outpatient clinics without questioning their complaints, investigating the etiology, and following up causes concern in patients and families and increases the burden on oncology outpatient clinics. However, very few of these children have conditions that cannot be diagnosed and managed by pediatricians, and even fewer are diagnosed with life-threatening conditions. In this study, we examined the diagnoses of patients admitted to the pediatric hematology and oncology outpatient clinic, the rate of life-threatening diseases, and the need for referral. Materials and Methods: We retrospectively reviewed the records of patients referred or consulted by pediatricians to the Pediatric Hematology and Oncology Outpatient Clinic over a one year period. Results: Among the 4210 patients included in the study, the most common diagnosis was anemia, followed by lymphadenopathy, bleeding disorders, and infantile hemangioma. Of these patients, 0.95% (n=40) were diagnosed with life-threatening diseases. Only 0.07% of the patients died during the follow-up period. Conclusion: This very low life-threatening diseases and mortality for a reference center suggests that patients are referred to pediatric hematology and oncology outpatient clinics without comprehensive evaluation in primary and secondary health care centers. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate the real-world results of childhood acute lymphoblastic leukemia (cALL) cases in Fujian, China. The clinical data of 1414 patients with newly diagnosed cALL in Fujian were retrospectively analyzed. Patients were treated according to the Chinese Children Leukemia Group 2008 protocol (CCLG-ALL 2008 group) or Chinese Children's Cancer Group 2015 protocol (CCCG-ALL 2015 group). Cumulative incidence of treatment abandonment (TA) at 5 years was 4.2% ± 0.6% and significantly associated with treatment period and risk stratification. The 5-OS and EFS were significantly higher in the CCCG-ALL 2015 group than in the CCLG-ALL 2008 group. Patients treated with CCCG-ALL 2015 from Fujian Medical Union Hospital had a significantly higher 4-year OS and EFS than did those from the other four hospitals. Real-world TA of cALL greatly decreased, and its long-term survival significantly increased in Fujian, which may be related to optimizing programs, multi-center collaboration, and improving treatment compliance. [ABSTRACT FROM AUTHOR]

The literature widely supports the benefits of early integration of palliative care into pediatric oncological care; however, many barriers to its successful integration remain. Integrating palliative care as early as possible in the oncology pathway is critical, but other criteria are relevant to positive results. This paper aims to contribute to the early/late referral dualism in pediatric palliative care (PPC) and highlight the importance of a collaborative approach between oncologists and palliative care teams. This study investigates the impact of early versus late referral to PPC, intersecting it with the synergy work between services and the related outcomes. The four pediatric cancer cases were selected based on clinical (e.g., disease duration, multiple treatments, and pain management), management (e.g., involvement of multiple services and multiple home-hospital transitions), and relevance of multidisciplinary team (e.g., difficult clinical decisions and ethical discussions) criteria. A mixed-methods approach was employed, combining qualitative case analysis using clinical diaries, literature review, and practice guidelines development. Critical clinical information, time course, clinician-family communication, and patient involvement were analyzed. The outcomes show how simultaneous care creates continuous discussion and dialogue between professionals. The results indicate the importance of better communication and care coordination to improve patient and family satisfaction, highlighting the uniqueness of the pediatric field and the relationship with children and families. Through the discussion of clinical cases and a literature review, we provide practical guidance for clinicians working in oncology and PPC. These findings underscore the crucial need for amultidisciplinary approach in pediatric oncology, advocating policy changes to support early PPC integration and translate it into complementarity best operating practices. In conclusion, besides assessing the timeliness of referral to the PPC service, the synergy, harmony, and choralwork of the professionals involved are equally valuable for a quality-of-life-oriented care plan. [ABSTRACT FROM AUTHOR]

In Italy, 1400 children and 800 adolescents are diagnosed with cancer every year. About 80% of them can be cured but are at high risk of experiencing severe side effects, many of which respond to rehabilitation treatment. Due to the paucity of literature on this topic, the Italian Association of Pediatric Hematology and Oncology organized a Consensus Conference on the role of rehabilitation of motor impairments in children/adolescents affected by leukemia, central nervous system tumors, and bone cancer to state recommendations to improve clinical practice. This paper includes the consensus on the rehabilitation of children and adolescents with these cancers. [ABSTRACT FROM AUTHOR]

IntroductionSickle cell disease (SCD) is a genetic blood disorder caused by a mutation in the HBB gene, which encodes the beta-globin subunit of hemoglobin. This mutation leads to the production of abnormal hemoglobin S (HbS), causing red blood cells to deform into a sickle shape. These deformed cells can block blood flow, leading to complications like chronic hemolysis, anemia, severe pain episodes, and organ damage. SCD genotypes include HbSS, HbSC (HbC is an abnormal variant of hemoglobin), and HbS/β-thalassemia. Sickle cell trait (SCT), HbAS, represents the carrier state, while other hemoglobin variants include HbCC, HbAC, and the normal HbAA. Over 7.5 million people worldwide live with SCD, with a high mortality rate in sub-Saharan Africa, including Ghana. Despite its prevalence, SCD is underdiagnosed and poorly managed, especially in children. Characterized by intravascular hemolysis, SCD leads to oxidative stress, endothelial activation, and systemic inflammation. Identifying circulating blood biomarkers indicative of organ damage and systemic processes is vital for understanding SCD and improving patient management. However, research on biomarkers in pediatric SCD is limited and few have been identified and validated. This study explores specific circulating biomarkers in pediatric SCD in Ghana (West Africa), hypothesizing that inflammatory and neuronal injury markers in children with SCD could predict disease outcomes.MethodsClinical data were collected from 377 children aged 3–8 years with various Hb genotypes, including SCD and SCT, at Korle-Bu Teaching Hospital in Accra, Ghana (2021–2022). A total of 80 age- and sex-matched subjects were identified. A cross-sectional study utilized a multiplexed immunoassay procedure to evaluate serum biomarkers, including cytokines, chemokines, vascular injury markers, systemic inflammation markers, cell-free heme scavengers, brain-derived neurotrophic factor (BDNF), and angiogenic factors.ResultsElevated levels of BDNF, Ang-2, CXCL10, CCL11, TNF-α, IL-6, IL-10, IL12p40, ICAM-1, VCAM-1, Tie-2, and VEGFA were observed in HbSS subjects, correlating with hemoglobin level, leukocyte, and erythrocyte counts. Heme scavengers like HO-1, hemopexin, and haptoglobin also correlated with these parameters. ROC and AUC analyses demonstrated the potential of these biomarkers in predicting SCD outcomes.ConclusionThese findings suggest that there are significant differences between biomarker expression among the different genotypes examined. We conclude that a predictive algorithm based on these biomarkers could be developed and validated through longitudinal assessment of within-genotype differences and correlation of the data with disease severity or outcomes. With such a tool one can enhance SCD management and improve patient outcomes. This approach may pave the way for personalized interventions and better clinical care for pediatric SCD patients.

Supportive care is employed in pediatric hematology to improve children’s quality of life (QoL). This study explores the impact of supportive care modalities on the QoL in pediatric hematologic disorders. Studies were searched from online databases and selected against predetermined eligibility criteria. A random-effects subgroup meta-analysis was conducted to calculate the standardized mean difference (SMD) at 95% confidence interval. Subgroups were based on physical, emotional, familial/social, and scholarly functionalities. Six studies met the requirements for inclusion. The meta-analysis reported a significant change in QoL when comparing initial QoL scores to final QoL scores (SMD −1.11 [−1.54, −0.68], P < 0.00001). When compared to a control standard treatment, the impact of these interventions lacks significance (SMD −0.01 [−0.67, 0.65] [P = 0.97]). Included studies explored interventions such as group creative art therapy, social support, adapted physical activity, and nurse-led interventions (custom). Standard hospital care and supportive care interventions have a relatively similar impact on the QoL of children hematologic patients.

Many healthcare systems overlook the importance of enrolling a child life specialist (CLS) on board, possibly due to the lack of knowledge and awareness on the impact they might yield. This study highlights the essential contributions of CLS in improving pediatric oncology healthcare experiences. A thorough search of numerous databases was performed to identify English-language publications between 2005 and 2024, using a variety of study methods to establish a diverse evidence base. CLSs offer emotional support, educate patients and their families, implement distraction techniques, and collaborate with healthcare personnel to assist patients throughout their treatment journey. They also aid in providing adequate knowledge to patients and their families regarding medical procedures and treatment outcomes. Hence, CLSs play a vital role to play in the care of pediatric hematology oncology patients. A comprehensive interdisciplinary approach is needed to extend the role of CLS and ensure that every child receives the support and care they deserve.

Allogeneic hematopoietic stem cell transplantation has become a treatment option for otherwise non-curative conditions, both malignant and benign, affecting children and adults. Nevertheless, the latest research has been focusing extensively on transplantation from related and unrelated haploidentical donors, suitable for patients requiring emergent hematopoietic stem cell transplantation (HSCT) in the absence of an HLA-matched donor. Haploidentical HSCT (haplo-HSCT) can be an effective treatment for non-malignant pediatric disorders, such as primary immunodeficiencies or hemoglobinopathies, by enabling a much quicker selection of the appropriate donor for virtually all patients, low incidence of graft-versus-host disease (GVHD), and transplant-related mortality (TRM). Moreover, the outcomes of haplo-HSCT among children with hematological malignancies have improved radically. The most demanding tasks for clinicians are minimizing T-cell-mediated alloreactivity as well as early GVHD prevention. As a result, several T-cell depletion approaches, such as ex vivo T-cell depletion (TCD), and T-cell replete approaches, such as a combination of anti-thymocyte globulin (ATG), post-transplantation cyclophosphamide (PTCy), cyclosporine/tacrolimus, mycophenolate mofetil, or methotrexate, have been taken up. As more research is needed to establish the most beneficial form of therapy, haplo-HSCT is currently considered an alternative donor strategy for pediatric and adult patients with complications like viral and bacterial infections, invasive fungal disease, and GVHD. [ABSTRACT FROM AUTHOR]

Introduction: Autoimmune cytopenias (AICs) are a group of disorders characterized by immune-mediated destruction of blood cells. In children, they are often secondary to immune dysregulation that may require long-lasting immunosuppression. Mycophenolate mofetil and sirolimus represent two welltolerated options to treat these disorders, often as a steroid-sparing option. However, no data are available on the infection risk for patients undergoing longlasting treatments. Patients and methods: The rate of severe infective events was calculated in episodes per 100 persons/months at risk (p/m/r) documented by the analysis of hospitalization charts between January 2015 and July 2023 of patients treated with mycophenolate mofetil or sirolimus given for isolated AIC or AICs associated with autoimmune lymphoproliferative syndrome (ALPS)/ALPS-like syndromes in two large Italian pediatric hematology units. Results: From January 2015 to July 2023, 13 out of 96 patients treated with mycophenolate mofetil or sirolimus developed 16 severe infectious events requiring hospitalization. No patients died. Overall infection rate was 0.24 person/*100 months/risk (95% CI 0.09-0.3). Serious infectious events incidence was higher in patients with ALPS-like compared to others (0.42 versus 0.09; p = 0.006) and lower in patients who underwent mycophenolate treatment alone compared to those who started sirolimus after mycophenolate failure (0.04 versus 0.29, p = 0.03). Considering only patients who started treatment at the beginning of study period, overall cumulative hazard was 18.6% at 60 months (95% CI 3.4-31.4) with higher risk of infectious events after 5 years in ALPS-like patients (26.1%; 95% CI 3.2-43.5) compared to other AICs (4%; 95% CI 0-11.4; p = 0.041). Discussion: To the best of our knowledge, this is the first study to describe the infectious risk related to mycophenolate and sirolimus chronic treatment in patients with AICs and immune dysregulation. Our data highlight that infection rate is very low and mainly related to the underlying hematological condition. Conclusions: Mycophenolate and sirolimus represent a safe immunosuppressive therapy in AICs and immune dysregulation syndromes. [ABSTRACT FROM AUTHOR]

Background: Beta-thalassemia major (β-TM) is a genetic hemoglobinopathy that necessitates frequent blood transfusions and is brought on by defective β-globin chain synthesis. The matrix metalloproteinases (MMPs) family of zinc-dependent endopeptidases is in responsible of both physiological and pathological tissue restructuring. This study aims at assessing plasma levels of matrix metalloproteinase 9 in patients with beta thalassemia. Methods: This case-control study was done in the pediatric hematology out-patient clinic of Zagazig University Hospitals from March 2019 till October 2019. We included 50 patients more than 10 years of both sexes and with beta thalassemia during their regular follow up visits. 50 age- and sex-matched healthy children were also included as a control group. All participants were subjected to full medical history and precise clinical examination. Routine laboratory investigations for beta thalassemia were done. Biochemical study of plasma matrix metalloproteinase 9 was also conducted by ELISA. Results: MMP-9 was significantly higher in patients than controls (112.5 versus 18.5 pg/ml), respectively. Regarding the relation between serum level of MMP-9 and demographic characteristics of patients, though patients >15 years and females had higher levels of MMP-9 yet, the difference didn't reach a statistically significant level. MMP-9 levels were significantly higher in patients with complications than those without complications. Conclusion: Thalassemia major patients had considerably increased plasma MMP-9 levels. MMP-9 seems to be a valuable marker in those patients. [ABSTRACT FROM AUTHOR]

Many healthcare systems overlook the importance of enrolling a child life specialist (CLS) on board, possibly due to the lack of knowledge and awareness on the impact they might yield. This study highlights the essential contributions of CLS in improving pediatric oncology healthcare experiences. A thorough search of numerous databases was performed to identify English-language publications between 2005 and 2024, using a variety of study methods to establish a diverse evidence base. CLSs offer emotional support, educate patients and their families, implement distraction techniques, and collaborate with healthcare personnel to assist patients throughout their treatment journey. They also aid in providing adequate knowledge to patients and their families regarding medical procedures and treatment outcomes. Hence, CLSs play a vital role to play in the care of pediatric hematology oncology patients. A comprehensive interdisciplinary approach is needed to extend the role of CLS and ensure that every child receives the support and care they deserve. [ABSTRACT FROM AUTHOR]

Background: Total body irradiation (TBI) for hematopoietic stem cell transplant (HSCT) has certain distinct advantages, such as uniform dose distribution and lack of drug resistance, but it is not widely available in resource-constrained settings. To overcome the limitations of in-house radiotherapy services in hematology centers, we evaluated the feasibility of conducting HSCT programs in coordination with two physically distant centers using a reduced-intensity TBI protocol. Methods: Thirty-two patients with a median age of 20.5 years were included in the study. Fifteen patients were diagnosed with aplastic anemia, 10 patients with acute myeloid leukemia (AML), 3 patients with acute lymphocytic leukemia (ALL), and 4 patients with other hematological conditions. Conditioning regimens used were fludarabine plus cyclophosphamide in 29 cases, fludarabine-cytarabine ATG in 2 cases, and busulfan plus fludarabine in 1 case. The TBI dose was 3 Gy in 28 cases and 2 Gy in 4 cases. Patients were followed monthly after TBI, and the major toxicities were recorded. Results: The median follow-up was 22 months. The most common acute complication was acute graft-versus-host disease (GVHD), which occurred in 15.6% of patients. The major late complications were chronic GVHD (9.3%), Cytomegalovirus (CMV) infection (34.3%), and CMV-induced secondary graft failure (6.2%). Seventy-five percent of patients were alive, 21.9% were dead, and 1 patient was lost to follow-up. Conclusions: HSCT based on TBI is feasible even if the center lacks a radiotherapy facility by coordinating with a remote radiotherapy facility. without compromising the patient's outcome. [ABSTRACT FROM AUTHOR]

Background: Children with hemato-oncological diseases or following stem cell transplantation (SCT) are at high risk for life-threatening infections; sepsis in this population constitutes a substantial proportion of pediatric intensive care unit (PICU) admissions. The current pediatric prognostic scoring tools to evaluate illness severity and mortality risk are designed for the general pediatric population and may not be adequate for this vulnerable subpopulation. Methods: Retrospective analysis was performed on all PICU admissions for sepsis in children with hemato-oncological diseases or post-SCT, in a single tertiary pediatric hospital between 2008 and 2021 (n = 233). We collected and analyzed demographic, clinical, and laboratory data and outcomes for all patients, and evaluated the accuracy of two major prognostic scoring tools, the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) and the Pediatric Risk of Mortality III (PRISM III). Furthermore, we created a new risk-assessment model that contains additional parameters uniquely relevant to this population. Results: The survival rate for the cohort was 83%. The predictive accuracies of PELOD-2 and PRISM III, as determined by the area under the curve (AUC), were 83% and 78%, respectively. Nine new parameters were identified as clinically significant: age, SCT, viral infection, fungal infection, central venous line removal, vasoactive inotropic score, bilirubin level, C-reactive protein level, and prolonged neutropenia. Unique scoring systems were established by the integration of these new parameters into the algorithm; the new systems significantly improved their predictive accuracy to 91% (p = 0.01) and 89% (p < 0.001), respectively. Conclusions: The predictive accuracies (AUC) of the PELOD-2 and PRISM III scores are limited in children with hemato-oncological diseases admitted to PICU with sepsis. These results highlight the need to develop a risk-assessment tool adjusted to this special population. Such new scoring should represent their unique characteristics including their degree of immunosuppression and be validated in a large multi-center prospective study. [ABSTRACT FROM AUTHOR]

Background: Patients with hematological malignancies often require multidrug therapy using a variety of antineoplastic agents and supportive care medications. This increases the risk of drug-related problems (DRPs). Determining DRPs in patients hospitalized in hematology services is important for patients to achieve their drug treatment goals and prevent adverse effects. This study aims to identify DRPs by the clinical pharmacist in the multidisciplinary team in patients hospitalized in the hematology service of a university hospital in Turkey. Methods: This study was conducted prospectively between December 2022 and May 2023 in the hematology service of Suleyman Demirel University Research and Application Hospital in Isparta, Turkey. DRPs were determined using the Pharmaceutical Care Network Europe (PCNE) 9.1 Turkish version. Results: This study included 140 patients. Older age, longer hospital stay, presence of acute lymphoblastic leukemia, presence of comorbidities, higher number of medications used, and polypharmacy rate were statistically significantly higher in the DRP group than in the non-DRP group (p < 0.05). According to multivariate logistic regression analysis, the probability of DRP in patients with polypharmacy was statistically significant 7.921 times (95% CI: 3.033–20.689) higher than in patients without polypharmacy (p < 0.001).Every 5-day increase in the length of hospital stay increased the likelihood of DRP at a statistically significant level (OR = 1.476, 95% CI: 1.125–1.938 p = 0.005). In this study, at least one DRP was detected in 69 (49.3%) patients and the total number of DRPs was 152. Possible or actual adverse drug events (96.7%) were the most common DRPs. The most important cause of DRPs was drug choice (94.7%), and the highest frequency within its subcategories was the combination of inappropriate drugs (93.4%). Conclusions: This study shows the importance of including a clinical pharmacist in a multidisciplinary team in identifying and preventing DRPs in the hematology service. [ABSTRACT FROM AUTHOR]

Non-Hodgkin lymphoma (NHL) is among the five most common pediatric cancer diagnoses in children and adolescents and consists of a heterogeneous group of lymphoid tissue malignancies –with B-cell-derived NHL accounting for nearly 80% of cases. Novel and high-throughput diagnostic tools have significantly increased our understanding of B-NHL biology and molecular pathogenesis, leading to new NHL classifications and treatment options. This retrospective cohort study investigated 17 cases of both mature B-cell NHL (Burkitt lymphoma or BL; Diffuse large B-cell lymphoma or DLBCL; Primary mediastinal large B-cell lymphoma or PMBCL; Follicular lymphoma or FL) and immature B-cell progenitor NHL (B-lymphoblastic lymphoma or BLL) that were treated in a tertiary Pediatric Hematology-Oncology Department during the last 20 years. Modern NHL protocols for children, adolescents, and young adults, along with the addition of rituximab, are safe and efficient (100% overall survival; one relapse). Elevated ESR was more prevalent than elevated LDH. Analyses have focused on immune reconstitution (grade ≥3 infections, lymphocyte and immunoglobulin levels recovery) and body-mass-index changes post-treatment, late effects (in 53% of patients), and the presence of histology markers BCL2, BCL6, CD30, cMYC, and Ki-67%. One patient was diagnosed with a second malignant neoplasm (papillary thyroid cancer). [ABSTRACT FROM AUTHOR]

It is important to predict adverse outcomes in febrile children with hematology/oncology diseases. Procalcitonin (PCT) is a promising biomarker for the prediction of infection severity, but further studies have revealed its performance in excluding adverse outcomes of infection. IL-6 and IL-10 were reported to have a close association with those infection outcomes. The aim of the study was to investigate the performance of IL-6 and IL-10 in febrile pediatric hematology/oncology patients with normal PCT. This was a retrospective study conducted in a tertiary children's hospital in China over the past ten years. Inflammatory biomarkers, including IL-6, IL-10, PCT and C-reactive protein (CRP), were detected at the onset of infection. Separate analyses were conducted in patients with neutropenia and without neutropenia. In total, 5987 febrile cases were enrolled. For patients with neutropenia, IL-6, IL-10 and PCT were significantly increased in patients with bloodstream infection (BSI), gram-negative bacteremia (GNB) and severe sepsis (SS), but only IL-6 and IL-10 were predictive of GNB and SS. For patients without neutropenia, IL-6, IL-10 and PCT were significantly increased in patients with BSI, GNB and SS, but no biomarkers were predictive of adverse outcomes. All biomarkers failed to exclude patients with fever of unknown origin or upper respiratory infection/bronchitis in patients with neutropenia. IL-6 and IL-10 could be predictors for GNB and SS in febrile patients with neutropenia and had some association with unfavorable outcomes in febrile patients without neutropenia. All biomarkers failed to exclude patients with fever of unknown origin or upper respiratory infection/bronchitis. [ABSTRACT FROM AUTHOR]

Introduction: The increase in the number of patients with hemoglobinopathies in Europe in recent decades highlights the need for more detailed epidemiological information in Spain. To fulfil this need, the Spanish Society of Pediatric Hematology and Oncology (SEHOP) sponsored the creation of a national registry of hemoglobinopathies known as REHem-AR (Spanish Registry of Hemoglobinopathies and Rare Anemias). Data from the transfusion-dependent (TDT) and non–transfusion-dependent (NTDT) β-thalassemia cohorts are described and analyzed. Methods: We performed an observational, multicenter, and ambispective study, which included patients of any age with TDT and NTDT, registered up to December 31, 2021. Results: Among the 1741 patients included, 168 cases of thalassemia were identified (103 TDT and 65 NTDT-patients). Survival at 18 years was 93% for TDT and 100% for NTDT. Regarding management, 80 patients with TDT (77.7%) and 23 patients with NTDT (35.4%) started chelation treatment during follow-up, with deferasirox being the most widely used. A total of 76 patients within the TDT cohort presented at least 1 complication (73.8%), the most frequent being hemosiderosis and osteopenia-osteoporosis. Comparison of both cohorts revealed significant differences in the diagnosis of hepatic hemosiderosis (p = 0.00024), although these were not observed in the case of cardiac iron overload (p = 0.27). Discussion: Our registry enabled us to describe the management of β thalassemia in Spain and to analyze the morbidity and mortality of the cohorts of patients with TDT and NTDT. Complications related to iron overload in TDT and NTDT account for most of the morbidity and mortality of the disease, which is associated with a considerable social, psychological, and economic impact, although cardiac, osteopathy and endocrinological complications requiring more attention. The convenience and simplicity of online registries make it possible to homogenize variables and periodically update data, thus providing valuable information on these diseases. [ABSTRACT FROM AUTHOR]

The clinical features of Multisystem Inflammatory Syndrome in Children (MIS-C) have been well documented, but there is limited data regarding the short term and longitudinal outcomes of children living in rural areas. We report the demographic and clinical features, as well as the multi-specialty follow-up of patients with MIS-C served by a large tertiary care rural health system. Patients that met the Centers for Disease Control (CDC) case definition of MIS-C admitted between March 1, 2020, and March 31, 2021, were included in this case series. Manual chart review was used to report demographic characteristics, clinical, laboratory and radiologic features during acute hospitalization and multispecialty follow-up, and adherence to follow-up 6–10 weeks after hospital discharge. Twenty-one patients with MIS-C were admitted at our center during the review period. Ninety percent of the cohort required intensive care during hospitalization. Of 19 patients with measured ejection fractions, 52 % had some degree of left ventricular dysfunction on admission; nine patients had electrocardiogram changes on admission. The majority of patients had elevated inflammatory markers during hospitalization. Most patients had resolution of symptoms, improvement in inflammatory markers, and normal cardiac function at the time of discharge. Follow-up with pediatric cardiology, hematology-oncology and infectious disease was indicated for most patients at discharge. Of these, 100 % of patients kept initial follow-up appointments with pediatric cardiology and infectious disease, while 94 % kept initial follow-up appointments with pediatric hematology-oncology. Though most patients were critically ill during hospitalization, the majority had resolution of cardiac abnormalities and inflammatory markers at discharge and timely follow-up with multiple subspecialists after admission with MIS-C. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of chronic neutropenia (CN) and the clinical profile of patients with CN aged up to 18 years, followed in the pediatric hematology, rheumatology, or immunology outpatient clinic of a tertiary medical center from May 1, 2018, to 30 April 2019. Methods: Retrospective observational study carried out by collecting data from the patient's medical charts. CN was defined as absolute neutrophil count (ANC) below 1.5 £ 109/L lasting over three months. Autoimmune neutropenia (AIN) was defined by clinical criteria and an over twofold increase in ANC after glucocorticoid stimulation. AIN was considered secondary when associated with autoimmune or immunoregulatory disorders. Wilcoxon and Fisher's exact tests were used to compare variables; the significance level was 5 %. Results: A total of 1,039 patients were evaluated; 217 (20 %) presented CN. Twenty-one (2 %) had AIN, classified as primary in 57 % of the cases. The average age at the onset of symptoms was 38.6 months. During follow-up, patients had 4.2 infections on average; frequency was higher among patients with secondary AIN (p = 003). Isolated neutropenia occurred in 43 % of the patients with AIN. Neutropenia resolved in eight (38 %) of the 21 patients with AIN within 19.6 months on average. Eight patients with secondary AIN met the criteria for Inborn Errors of Immunity. Conclusion: AIN prevalence was 2 %. Most cases were first evaluated by a pediatric immunologist or rheumatologist rather than a pediatric hematologist. This study highlights the need for a multidisciplinary approach involving a pediatric immunologist, rheumatologist, and hematologist. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "ROR1 and ROR2 - novel targets for neuroblastoma" published in the journal Pediatric Hematology & Oncology. The correction addresses errors in Figure 1C of the original manuscript, which showed duplicated bands in the western blot analysis. However, the authors assert that the protein expression of ROR1 in neuroblastoma was independently confirmed through immunohistochemistry using tissue samples from cell lines and tumors. The correction also includes corrected images of ROR1 and ROR2 expression in neuroblastoma cell line SH-SY5Y, as well as a typographical error in Figure 3D. Supplementary Figure 1 is provided to further support the study's conclusions. [Extracted from the article]

Objective The objective of this study was to assess the clinical impact and outcome of the SARS-CoV-2 infection on children with cancer or those who received a hematopoietic stem cell transplantation. Methods AIEOP (Italian Association of Pediatric Hematology and Oncology) performed a nationwide multicenter observational cohort study, including consecutive patients between April 2020 and November 2022. Results Twenty-five Italian centers participated and 455 patients were enrolled. We reported a significant increasing trend of symptomatic cases over the years, while the number of nonmild infections remained stable. Early infection after oncologic diagnosis (<60 days) and severe neutropenia were identified as independent risk factors for developing moderate, severe, or critical infections. The percentage of patients who were asymptomatic and mildly symptomatic and who stopped chemotherapy reduced over the years of the pandemic. Nine patients died, but no death was attributed to SARS-CoV-2 infection. Conclusions SARS-CoV-2 infection presented a self-limiting benign course in the Italian pediatric oncohematology population during the pandemic, and its main consequence has been the discontinuation of cancer-directed therapies. The rate of patients who were asymptomatic and stopped chemotherapy reduced over the years, suggesting that the continuation of chemotherapy is a feasible option. [ABSTRACT FROM AUTHOR]

Supportive care is employed in pediatric hematology to improve children’s quality of life (QoL). This study explores the impact of supportive care modalities on the QoL in pediatric hematologic disorders. Studies were searched from online databases and selected against predetermined eligibility criteria. A random‑effects subgroup meta‑analysis was conducted to calculate the standardized mean difference (SMD) at 95% confidence interval. Subgroups were based on physical, emotional, familial/social, and scholarly functionalities. Six studies met the requirements for inclusion. The meta‑analysis reported a significant change in QoL when comparing initial QoL scores to final QoL scores (SMD −1.11 [−1.54, −0.68], P < 0.00001). When compared to a control standard treatment, the impact of these interventions lacks significance (SMD −0.01 [−0.67, 0.65] [P = 0.97]). Included studies explored interventions such as group creative art therapy, social support, adapted physical activity, and nurse‑led interventions (custom). Standard hospital care and supportive care interventions have a relatively similar impact on the QoL of children hematologic patients. [ABSTRACT FROM AUTHOR]

Our aim was to identify national consensus criteria for the management of children with chemotherapy-induced febrile neutropenia (FN), for evidence-based step-down treatment approaches for patients classified at low risk of severe infection. In 2018, a five-section, 38-item survey was e-mailed to all pediatric hematology and oncology units in France (n = 30). The five sections contained statements on possible consensus criteria for the (i) definition of FN, (ii) initial management of children with FN, (iii) conditions required for initiating step-down therapy in low-risk patients, (iv) management strategy for low-risk patients, and (v) antibiotic treatment on discharge. Consensus was defined by respondents' combined answers (somewhat agree and strongly agree) at 75% or more. Sixty-five physicians (participation rate: 58%), all specialists in pediatric onco-hematology, from 18 centers completed the questionnaire. A consensus was reached on 22 of the 38 statements, including the definition of FN, the criteria for step-down therapy in low-risk children, and the initial care of these patients. There was no consensus on the type and duration of antibiotic therapy on discharge. In conclusion, a consensus has been reached on the criteria for initiating evidence-based step-down treatment of children with FN and a low risk of severe infection but not for the step-down antimicrobial regimen. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency anaemia (IDA) is a significant public health issue, especially in infants and toddlers. Early detection is crucial for prompt intervention. This study focuses on identifying reliable biomarkers for the early diagnosis of IDA in this vulnerable age group. Objectives: The primary objective was to identify and validate effective biomarkers for iron deficiency anaemia in infants and toddlers. Additionally, the study aimed to assess the prevalence of IDA among the participants. Methods: A prospective, observational study was conducted involving 200 infants and toddlers, aged between 6 months and 3 years, from pediatric outpatient clinics. Blood samples were analyzed for iron status biomarkers including serum ferritin, hemoglobin, mean corpuscular volume (MCV), and transferrin saturation. Data were analyzed using descriptive statistics, correlation, and regression analyses. Results: The study found a noticeable prevalence of IDA in the sample population. Serum ferritin and hemoglobin levels were the most effective biomarkers in detecting IDA, showing a strong correlation with the condition. MCV and transferrin saturation also provided valuable insights but to a lesser extent. Conclusion: This study highlights the importance of serum ferritin and hemoglobin levels in the early detection of iron deficiency anaemia in infants and toddlers. These findings can assist in improving clinical practices for early diagnosis and treatment of IDA. The study also underscores the need for regular screening in this age group and suggests directions for future research. [ABSTRACT FROM AUTHOR]

Introduction:Caregivers of children with chronic illness, such as hematology-oncology conditions, face numerous stressors, and a subset experience persistent distress and poor psychological outcomes. Many logistical and ethical barriers complicate the provision of mental health care to caregivers in children's hospital settings. Telemental health (TMH) is one method to increase access and reduce barriers. Methods:A partnership was established with an outside TMH agency to provide mental health care to caregivers of children with hematology-oncology conditions. Development and implementation strategies are described, and feasibility was measured on four dimensions. Results:One hundred twenty-seven (n = 127) caregivers were referred for TMH services in the first 28 months of program implementation. Of the total, 63/127 (49%) received TMH services for at least one session. Most caregivers had a child in active medical treatment (89%). A small portion (11%) of caregivers were bereaved or had a child in hospice care. Program feasibility was enhanced by hospital leadership support and availability of staffing, financial, and technology resources. Available resources also contributed to the practicality of program development and swift implementation and integration within the defined hospital system. Discussion:Partnership with an outside TMH agency increased access to care and reduced barriers to treating caregivers in a children's hospital setting. Offering mental health interventions to caregivers aligns with evidence-based standards of care. Future research will elucidate caregiver satisfaction with this modality of treatment and whether use of TMH reduces disparities in caregiver receipt of mental health care in children's hospital settings. [ABSTRACT FROM AUTHOR]

Central nervous system (CNS) tumors are one of the main causes of cancer-related deaths in childhood. Although approximately 60% of all patients are alive 5 years after diagnosis, a sequela due to the disease and treatments are common. In this study, we aimed to evaluate the demographic, clinical characteristics, and outcomes of the childhood CNS tumors in our center. A total of 141 patients between 0-18 years who were followed up and completed their treatment in our pediatric oncology center were included. The files were reviewed retrospectively. The median age of patients was 7 years (range 1 month-17.6 years). The male/female ratio was 1.1: 1. The most common presenting symptom was headache. The median time from the first symptom to diagnosis was 1.4 months. Medulloblastoma was the most common diagnosis (n= 28, 19.9%), followed by pilocytic astrocytoma (18.4%, n= 26) respectively. Out of 141 patients, a sequela was seen in 55 (39%) patients. The relationship between high-dose radiotherapy and the development of short stature was statistically significant (p= 0.009). The patients with metastatic disease were likely to have lower survival rates than nonmetastatic disease (p= 0.001). The presence of metastasis increased the death status 6.482 times (OR: 6,482, p= 0.001). The overall 5-year survival rate of all patients was found 80%. There was an association between the histopathological subtypes and overall survival rates (p= 0.001). In the multivariate analysis, metastasis was the most important factor in survival. According to Cox regression analysis, the two most important factors affecting overall survival were the histopathological subtype and the presence of metastasis. [ABSTRACT FROM AUTHOR]

To explore the feasibility of implementing the joint guideline on integrative medicine for pain management in oncology, published by the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO), for integrative oncology (IO) services in supportive and palliative care. A qualitative research methodology was co-designed by the SIO-ASCO guideline committee, with the Society for Complementary Medicine, Israel Medical Association (IMA). A questionnaire with five open-ended questions exploring barriers and enablers to implementing the guideline was distributed to chairs and board members of nine IMA-affiliated medical societies; four deans of Israeli medical schools; and nurses from the Israeli Society for Oncology Nursing. Respondent narratives were qualitatively analyzed using ATLAS.Ti software for systematic coding. Questionnaires were completed by 52 physicians and nurses from medical oncology, hematology, gynecological oncology, pediatric oncology, palliative medicine, pain, family medicine, internal medicine, and integrative medicine. The SIO-ASCO guidelines were endorsed by nine IMA-affiliated societies. The domains identified included the importance of guideline implementation in clinical practice; barriers and facilitators to implementation; practical aspects required for this implementation (e.g., IO training); clinical indications for referral; budget-related issues; and clinical and administrative models enabling practical implementation of the guideline. We found across-the-board consensus among the nine IMA-affiliated societies supporting the current guideline. This, while identifying potential facilitators and barriers in order to address the implementation of the SIO-ASCO guideline recommendations. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to evaluate the approaches of pediatric rheumatologists and pediatric hematologists to patients with similar musculoskeletal (MSK) complaints and to highlight the differences that general pediatricians should consider when referring patients to these specialties. Methods: This is a cross-sectional study involving the patients who applied to pediatric rheumatology centers with MSK complaints and were diagnosed with malignancy, as well as patients who were followed up in pediatric hematology centers with a malignancy diagnosis, and had MSK complaints at the time of admission. Results: A total of 142 patients were enrolled in the study. Of these patients, 83 (58.4%) applied to pediatric rheumatology centers, and 59 (41.6%) applied to pediatric hematology centers. Acute lymphoblastic leukemia (ALL) was the most common diagnosis among the patients who applied to both centers, with 80 cases (56.3%). The median age of diagnosis was 87 (interquartile range, IQR: 48-140) months. The most common preliminary diagnosis in pediatric rheumatology centers was juvenile idiopathic arthritis (JIA), with 37 cases (44.5%). MSK involvement was mainly seen as arthralgia, and bone pain. While arthralgia (92.7%) was the most common complaint in rheumatology centers, bone pain (88.1%) was more common in hematology centers. The most frequently involved joints were the knee (62.9%), ankle (25.9%), hip (25%), and wrist (14%). The most common laboratory abnormalities were high lactate dehydrogenase (LDH), high C-reactive protein (CRP), anemia, and high erythrocyte sedimentation rate (ESR). Thrombocytopenia, neutropenia, and high LDH were statistically significantly more frequent in patients admitted to hematology centers than in patients admitted to rheumatology centers (p<0.001, p=0.014, p=0.028, respectively). Patients who applied to rheumatology clinics were found to have statistically significantly higher CRP levels (p=0.032). Conclusions. Malignancies may present with only MSK system complaints in childhood. Therefore, malignancies should be included in the differential diagnosis of patients presenting with MSK complaints. [ABSTRACT FROM AUTHOR]

Purpose: Peripheral neuroblastic tumors are the most common extracranial cancers found in children, and they are characterized by a diverse spectrum of clinical manifestations and heterogeneous behaviors. This study aimed to investigate the epidemiological and clinical characteristics of children with peripheral neuroblastic tumors admitted to the Department of Pediatric Hematology and Oncology of the Hospital August 20 in Casablanca. Methods: The medical files of 48 children with peripheral neuroblastic tumors addressed to our department between February 2018 and February 2023 were reviewed. The clinical and demographic characteristics of patients were analyzed by the Statistical Package for the Social Sciences (SPSS), survival curves were obtained by Kaplan–Meier technique, and we assigned the tumor stage to patients based on the International Neuroblastoma Risk Group Staging System (INRGSS). Results: The median age of diagnosis was 30 months (1–174), with a ratio F/M of 1.28. 93.75% of patients had neuroblastoma, and the rest had ganglioneuroma. About 64.6% of patients had at their initial presentations stage M of peripheral neuroblastic tumors. The adrenal region made up 71% of the primary tumor site. The bone was one of the most prevalent metastatic sites (54.2%). The five-year overall survival rate was 35.4%. Conclusion: Overall, this study revealed a high stage of peripheral neuroblastic tumors in the majority of the diagnosed patients in our Department of Pediatric Hematology and Oncology. Moreover, the heterogeneity of peripheral neuroblastic tumors makes clinical recognition difficult and, in general, too late. [ABSTRACT FROM AUTHOR]

Background: Infections significantly predominate during induction chemotherapy for acute lymphoblastic leukaemia (ALL) in children. Antibacterial prophylaxis is one strategy that lowers the risk of these infections. This study evaluates the role of levofloxacin prophylaxis on the frequency of infections, febrile neutropenia (FN) and outcomes associated with it along with the development of drug-resistance. Subject and methods: This was a single-centre cohort study in which the data were collected from electronic health records between two cohorts of high-risk ALL patients in the induction phase: the first one before the initiation of levofloxacin prophylaxis and the second was after the implementation of levofloxacin prophylaxis. The variables were compared between both the groups and odds ratios were calculated for clinical outcomes. Results: Out of 227 patients, 115 were given levofloxacin prophylaxis and 112 were in the no prophylaxis group. Both cohorts were similar in demographic factors, treatment regimen and supportive care services. There was a significant difference in total inpatient admissions along with FN admissions (p = 0.026). Microbiologically documented infections and infection-related critical interventions were significantly higher in the no prophylaxis group (p < 0.05). Odds ratios with a 95% confidence interval were applied to both groups for clinical outcomes in patients with and without FN which also illustrated similar results. Overall mortality and drug resistance patterns were similar among both groups. Conclusion: This study emphasised that levofloxacin is effective in reducing inpatient admissions with FN and its complications but did not affect the drug-resistance pattern. Long-term monitoring for antibiotic resistance is mandatory. [ABSTRACT FROM AUTHOR]

Venetoclax is a strongly effective B-cell lymphoma-2 inhibitor (BCL-2) with an ability to selectively restore the apoptotic potential of cancerous cells. It has been proven that in combination with immunotherapy, targeted therapies, and lower-intensity therapies such as hypomethylating agents (HMAs) or low-dose cytarabine (LDAC), the drug can improve overall outcomes for adult patients with acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), and multiple myeloma (MM), amongst other hematological malignancies, but its benefit in pediatric hematology remains unclear. With a number of preclinical and clinical trials emerging, the newest findings suggest that in many cases of younger patients, venetoclax combination treatment can be well-tolerated, with a safety profile similar to that in adults, despite often leading to severe infections. Studies aim to determine the activity of BCL-2 inhibitor in the treatment of both primary and refractory acute leukemias in combination with standard and high-dose chemotherapy. Although more research is required to identify the optimal venetoclax-based regimen for the pediatric population and its long-term effects on patients' outcomes, it can become a potential therapeutic agent for pediatric oncology. [ABSTRACT FROM AUTHOR]

Background: Intrauterine transfusion (IUT) is an invasive but critical and potentially life‐saving intervention for severe fetal anemia with demonstrated improvement in outcomes. The fetus is vulnerable to hemodynamic alterations and transfusion‐related adverse events; therefore, special consideration must be given to blood component selection and modification. There is widespread IUT practice variability, and existing guidance primarily relies on expert opinion and single center experiences. Study Design and Methods: Experts in Maternal Fetal Medicine, Pediatric Hematology, and Transfusion Medicine from centers across the United States, collectively performing about 120 IUT annually, offer a multidisciplinary perspective on the performance of IUT and preparation of blood components. This perspective includes strategies for identifying an at‐risk fetus, communicating between disciplines, determining the necessary blood volume, selecting and processing blood components, documenting the procedure in medical record, and managing the neonate. Results: Identifying an at‐risk fetus relies on review of the clinical history, non‐invasive monitoring, and laboratory evaluation. We recommend the use of relatively fresh, group O, cytomegalovirus‐safe, freshly irradiated, red blood cells (RBC) that are Hemoglobin S negative and antigen‐negative for any maternal antibody, if indicated. These RBC units should be concentrated to remove additives and increase the hematocrit thus minimizing fluctuations in fetal volume status. The units intended for IUT should be labeled clearly and the documentation of transfusion differentiated in the maternal medical record. Discussion: An awareness of the technical, logistical, and regulatory considerations for IUT performance will facilitate improved communication and patient care, especially when rare units of RBC are required. [ABSTRACT FROM AUTHOR]

Purpose: In the absence of a standardized tool to assess the quality of pediatric hematology/oncology training programs, the Education Program Assessment Tool (EPAT) was conceptualized as a user‐friendly and adaptable tool to evaluate and identify areas of opportunity, pinpoint needed modifications, and monitor progress for training programs around the world. Methods: The development of EPAT consisted of three main phases: operationalization, consensus, and piloting. After each phase, the tool was iteratively modified based on feedback to improve its relevance, usability, and clarity. Results: The operationalization process led to the development of 10 domains with associated assessment questions. The two‐step consensus phase included an internal consensus phase to validate the domains and a subsequent external consensus phase to refine the domains and overall function of the tool. EPAT domains for programmatic evaluation are hospital infrastructure, patient care, education infrastructure, program basics, clinical exposure, theory, research, evaluation, educational culture, and graduate impact. EPAT was piloted in five training programs in five countries, representing diverse medical training and patient care contexts for proper validation of the tool. Face validity was confirmed by a correlation between the perceived and calculated scores for each domain (r = 0.78, p <.0001). Conclusions: EPAT was developed following a systematic approach, ultimately leading to a relevant tool to evaluate the different core elements of pediatric hematology/oncology training programs across the world. With EPAT, programs will have a tool to quantitatively evaluate their training, allowing for benchmarking with centers at the local, regional, and international level. The Education Program Assessment Tool (EPAT) is an adaptable tool to evaluate and identify areas of opportunity, pinpoint needed modifications, and monitor progress for pediatric hematology/oncology fellowship programs around the world. This tool was developed following a systematic approach, ultimately leading to a relevant tool to quantitatively evaluate programs and their training, allowing for benchmarking with centers at the local, regional, and international levels. [ABSTRACT FROM AUTHOR]

This article discusses the need for coordinated specialty care for patients who have or have had the potential to menstruate or become pregnant, and who also have disorders of haemostasis and thrombosis. The article focuses on the benefits, challenges, and opportunities associated with offering focused hematologic and gynecologic/obstetric care for patients across the lifespan. The authors describe their own program, which includes adult hematology-only clinics for female individuals, combined hematology/gynecology clinics for adolescents and adults, and combined hematology/perinatology clinics. The article also discusses the impact of the COVID-19 pandemic on clinic processes and the lessons learned from their experience. The authors emphasize the importance of improving clinic efficiency and expanding outreach to diverse populations. [Extracted from the article]

Parents of pediatric oncology patients have an increased prevalence of psychiatric symptoms. The feasibility of two short-term interventions (CBT with Biofeedback; Supportive Therapy and audio-visual relaxation, 9 sessions over 6 weeks in both arms) on reducing psychiatric morbidity was tested in 16 parents of pediatric oncology patients. Parents' and children's questionnaires and parents' endocrinological and immunological parameters (blood count, cortisol levels, lymphocyte cells subpopulations) were evaluated before and after interventions. Parents had fewer post-traumatic stress disorder (PTSD) symptoms (d = 0.74) and lower dysfunction scores (r = -0.51) after interventions, lower cortisol levels and platelet count (d = 0.41 and d = 0.46), and higher CD16 cell numbers (d = -0.46). This pilot study demonstrates the benefit of short-term psychological interventions for parents of pediatric oncology patients, as they may reduce PTSD symptomatology in this population. [ABSTRACT FROM AUTHOR]

Paediatric early warning systems (PEWS) aid in the early identification of clinical deterioration events in children admitted to hospital. We aimed to investigate the effect of PEWS implementation on mortality due to clinical deterioration in children with cancer in 32 resource-limited hospitals across Latin America. Proyecto Escala de Valoración de Alerta Temprana (Proyecto EVAT) is a quality improvement collaborative to implement PEWS in hospitals providing childhood cancer care. In this prospective, multicentre cohort study, centres joining Proyecto EVAT and completing PEWS implementation between April 1, 2017, and May 31, 2021, prospectively tracked clinical deterioration events and monthly inpatient-days in children admitted to hospital with cancer. De-identified registry data reported between April 17, 2017, and Nov 30, 2021, from all hospitals were included in analyses; children with limitations on escalation of care were excluded. The primary outcome was clinical deterioration event mortality. Incidence rate ratios (IRRs) were used to compare clinical deterioration event mortality before and after PEWS implementation; multivariable analyses assessed the correlation between clinical deterioration event mortality and centre characteristics. Between April 1, 2017, and May 31, 2021, 32 paediatric oncology centres from 11 countries in Latin America successfully implemented PEWS through Proyecto EVAT; these centres documented 2020 clinical deterioration events in 1651 patients over 556 400 inpatient-days. Overall clinical deterioration event mortality was 32·9% (664 of 2020 events). The median age of patients with clinical deterioration events was 8·5 years (IQR 3·9–13·2), and 1095 (54·2%) of 2020 clinical deterioration events were reported in male patients; data on race or ethnicity were not collected. Data were reported per centre for a median of 12 months (IQR 10–13) before PEWS implementation and 18 months (16–18) after PEWS implementation. The mortality rate due to a clinical deterioration event was 1·33 events per 1000 patient-days before PEWS implementation and 1·09 events per 1000 patient-days after PEWS implementation (IRR 0·82 [95% CI 0·69–0·97]; p=0·021). In the multivariable analysis of centre characteristics, higher clinical deterioration event mortality rates before PEWS implementation (IRR 1·32 [95% CI 1·22–1·43]; p<0·0001), being a teaching hospital (1·18 [1·09–1·27]; p<0·0001), not having a separate paediatric haematology-oncology unit (1·38 [1·21–1·57]; p<0·0001), and having fewer PEWS omissions (0·95 [0·92–0·99]; p=0·0091) were associated with a greater reduction in clinical deterioration event mortality after PEWS implementation; no association was found with country income level (IRR 0·86 [95% CI 0·68–1·09]; p=0·22) or clinical deterioration event rates before PEWS implementation (1·04 [0·97–1·12]; p=0·29). PEWS implementation was associated with reduced clinical deterioration event mortality in paediatric patients with cancer across 32 resource-limited hospitals in Latin America. These data support the use of PEWS as an effective evidence-based intervention to reduce disparities in global survival for children with cancer. American Lebanese Syrian Associated Charities, US National Institutes of Health, and Conquer Cancer Foundation. For the Spanish and Portuguese translations of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

Objective: Nurses in Hematology provide nursing care and management for patients with hematological illnesses and prepare patients for therapeutic apheresis procedures. The purpose of this study is to assess nurses' knowledge about apheresis procedure and to identify the relationship between the nurses' knowledge about apheresis and their characteristics. It is expected to help reduce deaths, survive patients' life and prevent complication during and after apheresis by providing good knowledge about apheresis to nurses who working at hematology center. Methodology: Descriptive design study, using one group test-retest approach, is carried throughout at Hematological Center in Medical City Directorate for the period of November 25th 2022 through April 29th 2023. A non-probability purposive sample of (30) nurse who are providing nursing care for patients in hematological center in Baghdad Medical Directorate, the knowledge question was constructed according to apheresis procedure, which was contained of (30) item as they were classified into four domains of priority care, indication, replacement fluid in apheresis, complications and nursing care, descriptive and inferential data were analyzed by using: frequency, percentage, mean of score, standard deviation and paired t test. Results: The present study indicates that correct response of nurses' knowledge about apheresis was (19.90%), The results revealed that there is no a significant relationship between the nurse's knowledge and their level of education, year of experiences in nursing, and year of experiences in hematological at P= 0.05. Conclusions: Based on the study findings, the study concludes that Nurses' knowledge about apheresis was poor. [ABSTRACT FROM AUTHOR]

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