Pediatric Oncology Department Research Articles

Multidisciplinary PAIN management features of pediatric oncology patients in a pediatric cancer center in Turkiye: A developing country experience.

e22002 Background: Pain is one of the most important problems that affects more than half of cancer patients at any stage of the disease and disrupts the quality of life of patients. The aim should be to relieve pain as soon as possible and prevent its recurrence. In this study, we aimed to evaluate the clinical characteristics of our patients who were followed up with a diagnosis of cancer in our clinic and whose pain management was planned in a multidisciplinary manner with the department of Algology. The clinic where the study was conducted is the reference center of a middle income developing country. Therefore, the data obtained will represent the characteristics of developing countries. Methods: In this retrospective descriptive study, patients followed up with diagnosis of cancer at Ankara University Faculty of Medicine, Department of Pediatric Oncology between 2018 and 2023 and consulted to Department of Algology for pain management were included. Patients whose file information could not be accessed from the hospital information system were excluded from the study. Demographic and clinical parameters of the patients were recorded. The data were evaluated with descriptive statistical methods appropriate to distribution. Results: A total of 33 patients, 19 girls and 14 boys, aged between 2.2 and 23.5 (median 14.4) were evaluated in the study. For each case, a median of 2 (1-16) consultations were made. The most frequent cancer diagnosis was bone tumors with 42% (n:14). Nociceptive pain was present in 25 of the patients, nociceptive and neuropathic pain were present together in 8 patients. It was determined that the most commonly used treatment for pain management was paracetamol, which was used in all patients. Other agents used, in order of frequency: Fentanyl in 19 (57.6%) of the patients, NSAID in 13 (39.4%), gabapentin in 9 (27.3%), oxycodone in 12 (36.4%), 7 (3%) 21.2) were tramadol, 4 (12.5%) were morphine, and 1 (3%) was codeine-paracetamol. Intravenous patient-controlled analgesia (PCA) was used in one patient. Side effects were observed in 3 patients. Fentanyl-related constipation was observed in 1 patient, fentanyl-related globe vesicale was observed in 1 patient, and thrombocytopenia was observed in 1 patient due to gabapentin. Conclusions: Pain is an important factor affecting the quality of life and treatment compliance of children with cancer. Therefore, it is important to ensure effective treatment and to raise the awareness of physicians and care providers by keeping it constantly on the agenda especially in developing countries. Prospective studies will be most useful guide for clinicians.

Outcome and Prognostic Factors of Hemophagocytic Lymphohistiocytosis in Children: Experience From a Low- and Middle-Income Country.

Objective Hemophagocyticlymphohistiocytosis (HLH) is a life-threatening condition especially in low- and middle-income countries (LMICs). This study was done to evaluate the outcome and prognostic factors of HLH in patients presenting to our center. Methods The study was carried out at the Paediatric Oncology Department of Combined Military Hospital (CMH) in Rawalpindi, Pakistan. All cases of HLH, from one month to 15 years of age enrolled between January 1, 2013 to June 30, 2023, were included. IBM SPSS Statistics for Windows, version 25.0 (released 2017, IBM Corp., Armonk, NY) was used for statistical analysis, and t-test and chi-square tests were used for comparison between continuous and categorical variables. Frequencies and percentages were calculated for categorical variables. Results Out of 115 patients, seven (6%) abandoned the treatment. The data of 108 cases, including 58 males (53.7%), were analyzed. The mean age at diagnosis was 31.5 ± 39.03 months. The mean time to reach a pediatric oncologist was 30.20 ± 22.15 days. Fever and pallor were common symptoms occurring in 107 (99.1%) and 98 (90.7%) cases, respectively. Jaundice was present in 44 (40.7%), visceromegaly in 64 (59.3%), and bruising/bleeding in 16 cases (14.8%). Twenty-six (24.1%) patients underwent hematopoietic stem cell transplant (HSCT), out of which 17 (65.4%) children were cured. Overall survival at two years, five years, and 10 years was 38%, 37%, and 36.1%, respectively. Disease-free survival at two years, five years, and 10 years was 33.3%, 32.4%, and 31.5%, respectively. Conclusion HLH leads to high mortality due to delayed or misdiagnosis in LMICs. Early diagnosis and early referral to a pediatric oncologist is the detrimental factor in survival for HLH. HSCT is the treatment of choice for primary, refractory, or relapse cases.

Hepatoblastoma: Experience of the paediatric haematology and oncology department, Hassan II university hospital of Fez.

Introduction: Hepatoblastoma is the most common malignant hepatic tumour in children. However, it is a rare disease, representing approximately 2% of childhood tumours. The treatment combines chemotherapy with surgical excision. The objective of this study was to describe the epidemiological, clinical, therapeutic and progressive aspects of hepatoblastoma treated in the paediatric haematology and oncology department at the University Hospital Hassan II of Fès. Patients and Methods: This was a descriptive and retrospective study conducted over a 11-year period. All patients aged 0 to 15 years who were admitted and treated for hepatoblastoma were included. Results: 24 patients met the study criteria, including 9 boys and 15 girls. The average age at diagnosis was 11.52 months ± 4.9. The most common reason for consultation was abdominal distension. Hepatomegaly was observed in 50% of cases. The average tumour size was 116 mm. At the time of diagnosis, one-third of patients had pulmonary metastases, and all patients were classified as high risk. Therapeutically, 19 patients (79.17%) received chemotherapy and 16 (66.67%) underwent surgery. On the evolutionary level, we observed a recovery without events in 10 (41.67%) patients. Conclusion: hepatoblastoma is a rare tumour, but remains the most common hepatic tumour in children. Despite progress in diagnostic and therapeutic means, the mortality rate is significant.

Older age, CNS leukaemic involvement and induction tumour lysis increases the risk of methotrexate (MTX)-induced neurotoxicity in childhood acute lymphoblastic leukaemia/lymphoma: Experience from a tertiary care centre in South India.

Methotrexate (MTX), although an indispensable part of contemporary treatment protocols for childhood acute lymphoblastic leukaemia (ALL)/lymphomas (LBL) in improving outcomes, can lead to serious neurotoxicity with long-term consequences. The aetiopathogenesis, predisposing factors and treatment for MTX-induced neurotoxicity are not yet well defined. The aim of our study was to detect the incidence, risk factors and to assess the overall outcomes of MTX-induced neurotoxicity among large cohort of paediatric ALL/LBL patients treated on a uniform protocol. We conducted retrospective audit of medical records of 622 consecutive children (≤14 years) diagnosed with ALL and LBL between January 2018 and December 2022 and treated on modified BFM-95 protocol at the Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram. Risk factors predisposing to MTX-induced neurotoxicity were identified using binary logistic regression analysis. Forty-three children were diagnosed with MTX-induced neurotoxicity with an incidence rate of 6.9%. More than two-thirds of them had high-grade MTX-induced neurotoxicity CTCAE v5.0 with a median age of 9 years (range: 9 months to 14 years). Almost half of them developed MTX neurotoxicity during Protocol M followed by Phase-Ib consolidation (15%). Majority of these patients (84%, 36/43) were challenged again with MTX, with 11% (4/36) developing recurrence. Fifteen per cent had persistent neurological deficits at last follow-up. Univariate analysis found older age (age > 5 years) (p < 0.001), T-cell phenotype (p = 0.040), tumour lysis syndrome during induction (p < 0.001), baseline renal problems prior to MTX exposure (p < 0.001) and CNS leukaemic involvement (p < 0.003) to be significantly associated with MTX neurotoxicity. On multivariate analysis, older age (>5 years), tumour lysis during induction and CNS leukaemia retained statistical significance (p < 0.05). Methotrexate-induced neurotoxicity during paediatric acute lymphoblastic leukaemia/lymphoma therapy is a transient phenomenon in majority and re-challenge with MTX is generally safe. Older age children who develop tumour lysis during induction and CNS leukaemic involvement are at increased risk for MTX-induced neurotoxicity during ALL/LBL treatment.

Investigating the Relationship between Religiosity and Post-Traumatic Stress Disorder in Mothers of Children with Cancer Admitted to t Pediatric Oncology Department of Shahid Sadoughi Hospital , Yazd , 2019

Introduction: Religiosity can help in adapting to difficult situations and provide better care. Therefore, this study was conducted to determine the relationship between religiosity and post-traumatic stress disorder in mothers of children with cancer. Methods: This was a cross-sectional and descriptive-correlational study conducted on 115 mothers of children with cancer who were admitted to Shahid Sadoughi Hospital, in Yazd, in 2019. Sampling was done through convenience sampling method. Data collection tools were the demographic information questionnaire, and Mississippi PTSD and Glock and Stark questionnaires. . Descriptive (mean and standard deviation) and analytical (Pearson's correlation, chi-square) statistical tests and indicators were used; data were investigated and statistically analyzed using SPSS 21 software with a confidence level of 95%. Results: The findings showed that in the post-traumatic stress disorder questionnaire, the average score was 97/61±36/78 and the average score of the religiosity questionnaire was 26/77±61/85. Pearson's correlation coefficient showed a negative relationship between religiosity and PTSD (p= 0/160, r= -0/132). The average score of PTSD and religiosity among mothers was not significantly different according to various variables such as mother's occupation, child's gender, and education level. The difference in the average score of PTSD in mothers was different according to the characteristics such as education level and occupation. The average score of religiosity was more different when comparing working mothers with housewives. The average stress score after the accident showed a greater difference in mothers according to the type of child's illness. The average PTSD score was 83/87±25/79 for neuroblastoma and 92/33±24/98 for solid tumor disease. Conclusion: PTSD among mothers was close to the cut-off point for the disorder. Although there was no significant relationship between PTSD and mothers' religiosity, it can be said that the severity of mental situation of mothers with severe cancer was effective in the study.

Reproducibility of Naked Eye Single Tube Red cell Osmotic Fragility Test (NESTROFT) as a screening test for the detection of b thalassemia and Hemoglobin E traits with the variation of reading time

Background: Though 0.36% NaCl buffered solution has been used as an effective reagent for carrying out Naked Eye Single Tube Red cell Osmotic Fragility Test (NESTROFT) as a screening test for the detection of b thalassemia and Hemoglobin E traits, reading time for its interpretation is yet to be settled. Methods: This cross -sectional analytic study was done at Department of Pediatric Hematology and Oncology, BSMMU from January 2006-June 2007. NESTROFT was performed in 3 separate tubes for each of the 100 subjects (with â thalassemia trait and HbE trait and normal hemoglobin) with 0.36% NaCl buffered solution and reading was taken at different time at 5-minute, 15-minuteand 30-minute. Results were recorded as positive and negative. Hb electrophoresis, Hemogram with RBC indices for each sample and iron profile of selected subjects were done. Results: Among the 100 study subjects, 48 were carriers (18 were â thalassemia traits, 30 were Hb E traits). Age range was 1 to 52 yrs. Mean Hemoglobin concentration, MCV, MCH of both b thalassemia and Hb E carrier were significantly lower than normal subjects (p values &lt;. 001). At 5-minute observation, NESTROFT was positive in 17 out of 18 â thalassemia traits with a sensitivity of 94.4%, 24 out of 30 HbE traits gave positive result with a sensitivity of 80%. Among the 52 normal subjects 35 gave negative result with a specificity of 67%. Positive predictive value and negative predictive value for detection of b thalassemia traits and HbE traits were 50% &amp; 97% and 58% and 85%respectively. Result of NESTROFT interpreted at 15-minute and 30-minute did not show any change. Conclusion: From this study it may be concluded that for interpretation of NESTROFT reading at 5-minute would be optimum. BANGLADESH J CHILD HEALTH 2022; VOL 46 (3) : 130-137

Exploring the perspective of adolescent childhood cancer survivors on follow-up care and their concerns regarding the transition process-A qualitative content analysis.

In Germany, children diagnosed with cancer survive their initial disease in more than 80%, and the majority will become long-term survivors. Around the age of 18, survivors are transferred to adult healthcare. The transition can be a critical period in the process of care at which many childhood cancer survivors discontinue to participate in regular follow-up care. Hence, the objective of the paper was to explore (a) survivors' attitudes towards pediatric follow-up care and (b) their concerns regarding the transition process to draw conclusions for optimizing pediatric care and transition processes. We conducted semi-structured interviews with 21 adolescent childhood cancer survivors between the ages of 14 and 20. The survivors were recruited via a pediatric oncology department of a university hospital in Germany. Based on the principles of qualitative content analysis, a deductive-inductive method according to Kuckartz was applied. Based on the interview guide and derived from the exploratory research questions, two key categories were generated: (a) Survivors' attitudes towards pediatric follow-up care, which encompasses all formal and emotional aspects of survivors regarding follow-up care, and (b) their concerns regarding transition from pediatric to adult healthcare, where hindering and facilitating factors for a successful transition occur. Our results show high satisfaction among survivors with follow-up care. Nevertheless, they wish to be more integrated into processes and the organization of their follow-up care. Most adolescent survivors do not feel ready for transition. The integration of survivors into the organization processes and routines, and the promotion of emotional detachment from pediatric health care professionals (HCPs) are important to reduce concerns and uncertainties of adolescent survivors regarding the transition process and to promote subjective readiness for transition. To gain confidence in the adult healthcare, it is crucial to provide tailored education depending on individual requirements and needs and to build trusting relationships between survivors and adult HCPs.

Pyruvate kinase deficiency: A case series of congenital non-spherocytic hemolytic anemia

BackgroundPyruvate kinase deficiency (PKD) is a common cause of congenital non-spherocytic hemolytic anemia (CNSHA). The heterogeneity of clinical presentation complicates the diagnosis and management of this disease. The objective was to describe the clinical, laboratory, and genetic profile of pediatric patients with PKD. Material and methodsIt was a retrospective, observational study. Children and their family members presenting to the Department of Pediatric Hematology and Oncology, St John's Medical College Hospital Bangalore, India, and diagnosed with PKD during 2011–2023 were enrolled. ResultsEight patients were identified through retrospective chart reviews. Four cases were clustered in one family and affected twins in the second family. All patients had a history of neonatal jaundice; however, they varied in their severity and the requirement for transfusion support. Some patients underwent splenectomy and one had hematopoietic stem cell transplant. ConclusionPKD is a known cause of congenital non-spherocytic hemolytic anemia with heterogeneous presentation. A high index of suspicion, enzyme assay, and genetic studies are required for diagnosis.

Evaluation of less treatment interruption of 6-Mercaptopurine by co-administration of ursodeoxycholic acid with chemotherapy in pediatric acute lymphoblastic leukemia

Background: Ursodeoxycholic acid, a bile acid, protects the liver through various mechanisms, including bile composition modulation and enhanced secretion. In ALL chemotherapy, 6MP is hepatotoxic, requiring dose reduction. UDCA is used to alleviate liver toxicity in ALL and other chronic cholestatic conditions. The study aims to evaluate the effectiveness of UDCA with chemotherapy in reducing 6MP treatment interruptions and its impact on treatment continuity in pediatric ALL. Methods: This randomized controlled trial study conducted at the Department of Pediatric Hematology and Oncology, BSMMU in pediatric ALL patients during chemotherapy from September 2018 to August 2019. Fifty children aged 1 to 18 years with ALL were enrolled, half receiving UDCA alongside chemotherapy and the rest forming the control group. Serum hepatic transaminases, total bilirubin, and CBC were monitored every 14 days. Statistical analysis was performed using SPSS, with significance set at p&lt;0.05. Results: In this study of 50 pediatric ALL patients, there were no statistically significant age or gender differences between the "Case" (UDCA-treated) and "Control" groups. However, the UDCA group showed a significant decrease in abnormal liver function tests (32.0%) compared to controls (60.0%). Moreover, 6MP dose reduction was significantly lower in cases (4.0%) than controls (40.0%), indicating UDCA's potential hepatoprotective effects. Multivariate logistic regression revealed male gender and mean AST levels as significant factors associated with hepatotoxicity in pediatric ALL patients. Conclusions: Co-administration of UDCA with chemotherapy reduces hepatotoxicity in pediatric ALL patients on 6 MP, but more research is needed for dosage optimization and to assess impact on survival.

Resilience among Caregivers of the Pediatric Cancer Patients

Abstract Backgound: Studies portray that one in every nine Indians develops cancer during their lifetime. Admissions to the Pediatric Oncology departments are increasing like any other department. Cancer affects not only the patients but also their caregivers both physically and psychologically. Aims and Objectives: In this scenario, the study aims to understand the caregivers’ level of resilience and the associated risk and protective factors. Materials and Methods: This descriptive study was conducted in Kerala. Sixty caregivers of the children in the age group between 1-17 years, diagnosed with cancer were selected for the study. Mexican Resilience Scale and self-prepared interview schedule were used to collect the quantitative data. Qualitative data were collected using an in-depth interview guide. Results: The study found that the majority of the respondents are moderately resilient, with men exhibiting higher resilience than women. The prime factors contributing to resilience were identified as strength and self-confidence, social competence, family support, social support, and structure. The study further identified individual factors (flexibility, emotional stability, etc.), familial factors (positive family environment), and community factors (support from NGOs and support groups, etc.) as protective factors contributing to resilience. Additionally, the study revealed how individual (lack of emotional stability, introverted nature, etc.), familial (relationship issues), and community (social perceptions about the disease) levels of risk factors impact resilience. Conclusion: The importance of strengthening the support systems around the caregivers and importance of oncology social worker to deal with the psychosocial issues of patients and caregivers are also discussed in this paper.

Experience of pediatric palliative care among children with cancer in a tertiary care hospital in Bangladesh

Background: Palliative care is a holistic approach which can improve patients and their family’s quality of life through the prevention and relief of physical symptoms as well as support for emotional, social and spiritual suffering. Despite the substantial need for palliative care there is very limited access in Bangladesh, with only a few palliative care services focused on children including several hospital-based services as well as home and hospice-based services, within the capital city of Dhaka. The aim of the study was to evaluate the effect of pediatric palliative care on quality of life in children with cancer. Methods: This was an institutional based descriptive study conducted in the department of pediatric hematology and oncology and pediatric palliative care unit, Dhaka medical college hospital, Dhaka, from May to August 2023. A total of thirty child and parent pairs were taken as the study population according to inclusion and exclusion criteria. Outcome was evaluated by the CPOS-2 questionnaires for symptom and Lanskys performance status scale for assessment of activity level. Results: The median age of the children were 5.7 years where 70.0% were male. The duration of disease of the patients was up to 6 months in 63.3% cases. One third of the patients had ALL, 13.3% had NHL, and 10.0% had Ewing sarcoma while another 10.0% having neuroblastoma. Conclusions: There is significant improvement in the quality of life of pediatric cancer patients and their parents, as well as the enhanced performance status of patients with cancer after receiving pediatric palliative care.

Determination of l-Asparaginase Activity and Its Therapeutic Monitoring in Children with Hematological Malignancies in a Single Croatian Center.

Among malignant diseases which develop during childhood, hematological cancers, such as leukemias and lymphomas, are the most common. Outcomes have greatly improved due to the refinement of multiagent chemotherapy regimens that include enhanced asparaginase therapy. In this study, we aimed to evaluate our experiences related to the analytical and clinical significance of determining l-Asparaginase activity. Since 2016, the Laboratory of the Children's Hospital Zagreb has routinely measured l-Asparaginase activity and to date, has measured more than 280 examples of activity in a total of 57 children with hematological malignancy treated at the Pediatric Oncology Department of the Children's Hospital Zagreb. Three asparaginase products were available: native E. colil-Asparaginase; a pegylated form of this enzyme; and a native product from Erwinia chrysanthemi. A retrospective data analysis was performed. Out of the fifty-seven children, seven had an allergic reaction (12.3%), five (8.8%) had silent inactivation, and seven (12.3%) developed acute pancreatitis. Allergic reactions and silent inactivation were more common in children treated with native E. colil-Asparaginase, while pancreatitis was more common in children treated with the pegylated form. The monitoring of l-Asparaginase activity may help to optimize therapy by identifying patients with 'silent inactivation', and/or by dose correction when l-Asparaginase activity is too high (slow elimination).

Determining the cost and cost-effectiveness of childhood cancer treatment in Haiti.

Haiti is a low-income country with one of the lowest human development index rankings in the world. Its childhood cancer services are provided by a single hospital with the only dedicated paediatric oncology department in the country. Our objective was to assess the cost and cost-effectiveness of all types of childhood cancer in Haiti to help prioritise investments and to support national cancer control planning. All costing data were collected from the year 2017 or 2018 hospital records. Costs were classified into 11 cost categories, and the proportion of the overall budget represented by each was calculated and converted from Haitian Gourde to United States dollars. The 5-year survival rate was retrieved from hospital records and used to calculate the cost-effectiveness of disability-adjusted life year (DALY) averted, using a healthcare costing perspective. Additional sensitivity analyses were conducted accounting for late-effect morbidity and early mortality and discounting rates of 0%, 3% and 6%. The annual cost of operating a paediatric oncology unit in Haiti treating 74 patients with newly diagnosed cancer was $803,184 overall or $10,854 per patient. The largest cost category was pharmacy, constituting 25% of the overall budget, followed by medical personnel (20%) and administration (12%). The cost per DALY averted in the base-case scenario was $1,128, which is 76% of the gross domestic product per capita, demonstrating that treating children with cancer in Haiti is very cost-effective according to the World Health Organisation Choosing Interventions that are Cost-Effective (WHO-CHOICE) threshold. In the most conservative scenario, the cost per DALY averted was cost-effective by WHO-CHOICE criteria. Our data will add to the growing body of literature illustrating a positive return on investment associated with diagnosing and treating children with cancer in even the most resource-limited environments. We anticipate that these data will aid local stakeholders and policymakers when identifying cancer control priorities and making budgetary decisions.

(305) Contemporary Therapies in Oncofertility: Identifying the Common Consults

Abstract Introduction Fertility inquiries among chemotherapy, immunotherapy, and targeted therapy regimens are increasing in volume and heterogeneity of referrals. There is limited research highlighting the prevalence of contemporary oncologic therapies seen by urologists and patient-specific fertility concerns. Objective This study seeks to identify the most common contemporary chemotherapy, immunotherapy, and targeted therapy regimens referred to urology for oncofertility inquiries and concerns. Methods We performed a retrospective single institutional review of all oncologic agents referred to the department of pediatric hematology oncology for fertility evaluation over the past five years (April, 2018- April, 2023). These included both frontline and salvage treatments. Agents were defined as contemporary if drug approval was received by the Food and Drug Administration 2006 or later. Results We identified 75 patients who underwent 28 unique contemporary agents ranging across 16 different drug classes referred for fertility evaluation (Figure 1). The majority of agents referred were used by 1-2 patients. The most common agents for oncofertility consultation included the monoclonal antibody Brentruximab (9), immune checkpoint inhibitor pembrolizumab (8), and T-cell engager Bilinotumomab (8). The most common agents included immune checkpoint inhibitors (16), monoclonal antibodies (16), and tyrosine kinase inhibitors (15). Conclusions There is significant variability and diversity among modern oncologic agents among patients referred for oncofertility evaluation, demonstrating the need for provider familiarity and future research in the oncofertility space. Disclosure No.

Prevalence of Latent Tuberculosis Infection Among Nurses Working in Critical Areas at a Tertiary Care Hospital in Riyadh, Saudi Arabia.

Introduction Tuberculosis is a critical health issue worldwide.Most infected persons are asymptomatic and categorized as having a latent tuberculosis infection (LTBI). Healthcare workers (HCWs) are more prone to being infected with tuberculosis and should be enrolled in a screening program for early detection. Objectives The study aims to estimate the prevalence of LTBI among nurses working in critical areas which include adult intensive care units, pediatric intensive care units, emergency departments, oncology departments, dialysis departments, tuberculosis labs, isolation rooms, and cardiac center intensive care units. Methods A record-based cross-sectional survey measured the prevalence of LTBI among nurses working in critical areas at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. We reviewed the occupational health records of all nurses working in critical areas from June 1, 2021, to June 1, 2022. We recorded the data reviewed throughout the year in the Occupational Health Department at PSMMC. We excluded all participants with previously documented positive tuberculin skin test (TST) from the study. We analyzed the sociodemographic data, working years, working location, job title, and TST results. Results We included a total of 771 out of 2025 nurses in this study. Participants were mostly women (88%) and in the 26-35-year age group (67.7%). Most of the participants were originally from the Philippines (66.3%). The overall LTBI prevalence among nurses was 34.5%. The highest prevalence of LTBI was among nurses working in the cardiac intensive care unit (53.5%), and the lowest prevalence was among nurses working in the isolation department (8.9%; p-value <0.0001). Those who worked more in the hospital were significantly more infected with LTBI (p-value <0.04). Conclusion LTBI remains a significant health risk worldwide andin the Middle East as well as among HCWs. This underscores the necessity of comprehensive pre-hiring screening, annual screening, infection control protocols, and active management of HCWs with LTBI.

Pulmonary metastatectomy in pediatric cancer patients at National Cancer Institute, Egypt: prognostic factors and outcome

BackgroundMetastatic tumors account for 80% of all lung tumors in children. Wilms tumour and osteosarcoma are the most tumors of childhood that produce lung metastases. The aim of the current study is to assess the prognostic factors of pulmonary metastatectomy in pediatric solid tumours as age, number, size, site,laterality, resectability of pulmonary nodules, and number of Thoracotomies. Calculate overall survival among patients who underwent pulmonary metastatectomy.MethodsIt is a retrospective study including all pediatric patients with metastatic solid tumors to lungs treated at pediatric oncology department, National Cancer Institute, Cairo University from 2008 to 2014. Fifty-five patients were included, 43 (78.2℅) patients of them had Osteosarcoma.ResultsThirty (54.5℅)patients were male. The mean age was 15 years ranging from (4.5- 23) years. The site of primary disease was at lower limbs in 43 (78.2%) patients. All patients underwent complete surgical resection of the primary disease with negative margin, 22(51.1%) of the osteosarcoma patients did amputation with tumor necrosis less than 90%. All patients received chemotherapy and only 9 received radiation therapy. The patients were classified into four groups according to time of diagnosis of pulmonary metastasis: at time of diagnosis in 13 (21.8%) patients, within treatment in 16 (30.9%) patients, within first year follow up in 18 (32.7%) patients and detected late in 8 (14.5%) patients. Bilateral lung metastasis diagnosed by CT chest were detected in 42 (76.4%) patients. Size of metastatic nodules was ranging from (0.5 to 10 cm) with mean 3.4 cm. Number of metastatic nodules was ranging from (1 to 28) median 4.Metastatic complications were detected in 19 patients. 5-year OS was 74.8% in the study group, and 68% in osteosarcoma patients. Effect of prognostic factors as sex, time of respectability, laterality, tumor necrosis of the 1ry disease, Timing of lung metastasis, size and site of the primary, Surgical approach of metastatectomy, postoperative complications on overall survival of the studied patients was done with significant P-value of tumor necrosis of the 1ry disease and Timing of lung metastasis 0.017, 0.001 respectively.ConclusionResection of pulmonary metastases of pediatric solid tumours is a safe and effective treatment that offers better survival.

Treatment outcome of pediatric rhabdomyosarcoma at national cancer institute, Egypt

Background Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in infants and children. It is the third most common solid tumor in children after neuroblastoma and Wilms tumor, making up 10–15% of all solid pediatric tumors. At National Cancer Institute (NCI), Egypt, soft tissue sarcomas represent 3.75% of total malignancies and 27.6% of these occur in the pediatric group. RMS is the most common type. Aim and objectives This work aims to study the treatment outcome, overall survival (OS), and event free survival (EFS) of pediatric RMS patients diagnosed and treated at NCI. Patients and methods This is a retrospective study that included 54 pediatric patients, newly diagnosed with RMS who were treated at the pediatric oncology department, NCI, Cairo University, Egypt during the period from January 2012 to December 2016. Results Totally 54 pediatric patients with RMS with ages ranging from 7 months to 17 years (median age 5 years) were studied. The median follow-up period ranged with a minimum 1 year for the last patient. In this study, we classify our patients into low, intermediate, and high-risk groups according to IRS and we found that 11 (20.4%) patients were eligible for the low-risk group, 27 (50%) patients were eligible for the intermediate risk group and 16 (29.6%) patients were eligible for the high-risk group. The 2-year OS for low-risk group was 90.9%, it was 52.1% for intermediate-risk group, while it was 43.8% for high-risk group (P=0.02). The 2-year EFS for low-risk group was 63.6%, it was 41.2% for intermediate-risk group, while it was 31.3% for high-risk group (P=0.203). Conclusion RMS requires combined-modality therapy. Late presentation and advanced local disease compromise treatment options and decrease OS and EFS.

Metastatic Neuroblastoma with Initial Orbital Presentation

Neuroblastoma, also called sympathoblastoma, is a malignant embryonal tumor developed at the expense of neural crest cells, the most frequent solid tumor in children under 5 years of age. The objective is to recall the clinical variability and the importance of evoking neuroblastoma in a child presenting with an ophthalmological symptom. We report the case of a 5-year-old child who presented with a right orbital metastatic neuroblastoma, whose ophthalmologic complaint led to the diagnosis. An ophthalmologist in the emergency room for a VAD and eye pain first saw the child. On examination, true exophthalmos with palpebral edema was found on the right. Cerebral and orbital CT revealed a right latero-orbital osteolytic mass of secondary appearance with endocranial extension. The workup showed lymph node involvement, unilateral right adrenal, osteomedullary, hepatic, and pancreatic involvement. The child was admitted to a specialized pediatric oncology department and received chemotherapy. The patient was then declared under palliative treatment.

Influence of Nutritional Status of Children with Acute Lymphoblastic Leukemia (ALL) on Treatment Outcome after Completion of Induction

Background: Malnutrition and cancer both influences tolerance and response to treatment especially ALL. Malnutrition increases morbidity, mortality, reduces the effectiveness of treatment and impairs the quality of life significantly. Objective: Assessment of the nutritional status and its influence on treatment outcome children with Acute Lymphoblastic Leukemia (ALL) before and after induction chemotherapy. Materials &amp; Methods: This prospective observational study included 72 children with ALL, aged 1-15 years, was conducted from January to December 2014 in the Department of Pediatric Hematology and Oncology, BSMMU. The anthropometric measurements (weight-for-age, height-for-age, weight-for-height, MUAC, BMI) hematological and biochemical parameter (serum albumin, total protein) were measured. The children got induction chemotherapy according to the UK ALL 2003 (modified) protocol. Results: Among the study population, 18(39.1%) were underweight, 8(17.4%) were stunted, 16(34.8%) were wasted, MUAC for age 14(56.0%) and BMI for age 12(57.1%) were malnourished, 10.9% had low total proteins (&lt;5.7g/dl), 37.0% low serum albumin (&lt;3.2g/dL). Mean anthropometric measurements and biochemical parameters were higher among the survivors compared to non-survivors. Significant difference was found between the well-nourished and the malnourished group according to WAZ. Complications like febrile neutropenia, treatment delay, number of transfusion (PRBC) requirement were more in malnourished group. Conclusion: Malnutrition is widely prevalent in children with ALL and a major determining factor in treatment planning, complications and final outcome. BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 3-8

Rate of Cardiotoxicity in Childhood Acute Lymphoblastic Leukemia Treated with Daunorubicin Using Echocardiography and Troponin I

Background and Aim: Acute lymphoblastic leukemia (ALL) is the commonest malignancy in childhood. Childhood ALL Survivors have a lifelong increased risk for cardiovascular morbidity and mortality compared to the general population, mainly caused by chemotherapy with daunorubicin. The aim of the study is to detect the rate of daunorubicin induced cardiotoxicity in children with acute lymphoblastic leukemia during induction phase chemotherapy. Meterials &amp; Methods : This prospective observational study was conducted in the department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU) on 40 newly diagnosed patients of ALL aged between 1 to17.9 years who got daunorubicin during induction. Complete blood count and echocardiography were done and troponin I was measured in all patients before and after completion of induction period. Result: Of the 40 patients, 8 patients (20%) had developed cardiotoxicity evidenced by reduction of left ventricular ejection fraction (LVEF) in echocardiography. Baseline LVEF was 68.80±5.98% which was then reduced to 65.32±7.07% after induction phase of chemotherapy (p=0.023). No significant alteration of troponin I was seen (P= 0.581) between baseline and after completion of induction. Total WBC count and hemoglobin had a significant difference (P&lt;0.05) between baseline and after induction period. Male patients had a greater risk of developing cardiotoxicity than females but statistically was not significant (P=0.643). There was no significant association between age of the patients and cardiotoxicity (P=0.112).Cardiotoxicity was seen higher in patient with initial high WBC count (p=0.039). Echocardiography also reveled increased tendency of mitral regurgitation and left ventricular hypertrophy after induction phase chemotherapy. Conclusion: This study showed the rate of cardiotoxicity was 20% in ALL patients treated with daunorubicin. It also found that LVEF was decreased during therapy.Echocardiography can be used to detect early cardiotoxicity induced by daunorubicin. University Heart Journal 2023; 19(1): 20-25