Department Of Hematology-Oncology Research Articles

A Pilot Study in a Recently Established Childhood Cancer Center for Evaluating the Priority of National Pediatric Cancer Registry

Background: Pediatric cancers account for nearly 2% of all cancers worldwide. In 2018, there were approximately 200,000 newly diagnosed cases of childhood cancer. Objectives: The aim of this study was to assess the need for a national pediatric cancer registry based on case incidence. Methods: This pilot study was conducted on 100 children with cancer who were treated in a recently established pediatric hematology oncology department of Golestan Hospital. Demographic and epidemiological data were collected and analyzed using SPSS software version 25. Results: Sixty-four percent of children with cancer were girls, and the average age of the patients was 7.6 ± 0.42 years. The most common types of cancer diagnosed were leukemia, brain tumor, lymphoma, and retinoblastoma respectively. Metastasis was confirmed in 11 cases. The most prevalent clinical manifestations of cancer included fever, weakness, loss of appetite, paleness, and weight loss. Conclusions: The results of this study align with global rates and data. Based on the findings, the authors emphasize the necessity and priority of establishing a pediatric cancer registry in Iran's health ministry. Therefore, all healthcare workers and specialists in pediatric hematology and oncology should make concerted efforts to establish this registry.

Central Nervous System Fungal Diseases in Children with Malignancies: A 16-Year Study from the Infection Working Group of the Hellenic Society of Pediatric Hematology Oncology.

We analyzed data on pediatric invasive fungal diseases of the central nervous system (CNS-IFDs) reported by five of a total of eight Pediatric Hematology-Oncology Departments in Greece for 16 years (2007-2022). A total of twelve patients (11 boys, median age: 9.5 years, range: 2-16) were reported suffering from CNS-IFDs. The underlying malignancy was acute lymphoblastic leukemia in 9/12 and acute myeloid leukemia, Ewing sarcoma, and rhabdomyosarcoma in one each. Eleven patients presented with CNS-related symptoms (i.e., seizures, headache, cerebral palsy, ataxia, hallucination, seizures, blurred vision, amaurosis). All patients had pathological MRI findings. Multifocal fungal disease was observed in 6/12 patients. Nine proven and three probable CNS-IFD cases were diagnosed. Causative pathogens in proven cases were Aspergillus spp. and Candida albicans (n = 2 each), Mucor spp., Rhizopus arrhizus, Absidia spp., Fusarium oxysporum and Cryptococcus neoformans (n = 1 each). Causative pathogens in probable cases were Aspergillus spp. (n = 2) and Candida spp. (n = 1). All patients received appropriate antifungal therapy (median duration: 69.5 days, range 19-364). Two patients underwent additional surgical treatment. Six patients were admitted to the Intensive Care Unit due to complications. Three patients (25%) died, two due to IFD and one due to an underlying disease. Early recognition and prompt intervention of CNS-IFDs may rescue the patients and improve overall survival.

An Integrative Pediatric Oncology Program Addressing Parents’ Quality of Life-Related Concerns

BackgroundParents of children with cancer face bio-psycho-social-spiritual concerns which can significantly reduce quality of life (QoL). We examined the impact of an integrative oncology (IO) intervention on QoL-related concerns among parents of children in a pediatric hematology-oncology department. MeasuresThe study was prospective, controlled, nonrandomized and patient-preferenced. Parents of children recently (≤6 weeks) diagnosed with cancer were assessed using the measure yourself concerns and wellbeing (MYCaW), Edmonton Symptom Assessment Scale (ESAS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Parents in both groups were reassessed after three weeks. InterventionAn IO consultation was provided, with training in daily relaxation-breathing and manual treatments, and guidance on herbal medicine. OutcomesOf 68 parents consenting to participate, 37 (54%) underwent the intervention with 31 serving as controls. Multivariate analysis found the IO intervention group to contain more Hebrew-speakers (OR=5.96, 95% CI=1.3-27.3, P=0.022); females (OR=5.23, 95% CI=1.1-24.8, P=0.038); and report pain (OR=1.2, 95% CI=1.0-1.4, P=0.045) and impaired appetite on ESAS (OR=1.23, 95% CI=1.01-1.48, P=0.034) when compared to controls. Only the intervention group showed improved baseline-to-3-week scores for physical functioning (P<0.001), cognitive functioning (0=0.018) and fatigue on EORTC (P<0.001); and for ESAS appetite (P<0.001) and anxiety (P=0.02). ESAS sleep increased only in controls (P=0.029). Conclusions/Lessons LearnedIO interventions in pediatric hematology-oncology addressing QoL-related concerns among parents are feasible, potentially increasing predominantly physical symptoms and functioning. Further research is needed to confirm these “real-world” clinical outcomes, and the role of IO in ”Caring for the Caregiver”.

Prediction of Distress Tolerance in Patients with Breast Cancer based on Anger Rumination and Physical Health: Using an Artificial Neural Network

Background: Breast cancer is a common cancer in women, causing significant psychological consequences. Traditionally, researchers have relied on statistical methods to predict factors influencing distress in cancer patients. However, this study explores the potential of artificial neural networks (ANNs) as a novel approach for predicting distress tolerance in women with breast cancer. This study aims to explore the use of ANNs in predicting distress tolerance in women with breast cancer, based on anger rumination and physical health. Methods: The research method was descriptive and correlational. The statistical population of this study consisted of 207 women with breast cancer admitted to the hematology oncology department of Shafa Hospital in Ahvaz in 2023, selected using convenience sampling. Data were collected using Distress Tolerance Scale (DTS), Anger Rumination Scale (ARS), and Physical Health Questionnaire (PHQ). Data analysis involved Pearson correlation coefficient and ANN. SPSS-27 was used for initial analyses and MATLAB-2019 was used for ANN modeling. Results: The results showed a negative relationship between anger rumination and distress tolerance, and a positive one between physical health and distress tolerance in women with breast cancer (P &lt; 0.001). Furthermore, a significant correlation was found among anger rumination, physical health, and distress tolerance in these women (P &lt; 0.001). The ANN analysis also highlighted that anger rumination had the most significant connection with distress tolerance in the patients, with physical health following in the next stage. Conclusion: This study identified significant associations between anger rumination, physical health, and distress tolerance in women with breast cancer. These findings add to understanding distress tolerance in women with breast cancer, emphasizing the need to address psychological and physical health in interventions to improve well-being.

Epidemiology of Invasive Fungal Diseases: A 10-Year Experience in a Tertiary Pediatric Hematology-Oncology Department in Greece.

Although advances in the management of pediatric neoplasms have profoundly improved infectious disease outcomes, invasive fungal diseases (IFDs) remain a major cause of morbidity and mortality in children and adolescents with high-risk hematological malignancies. A retrospective study was conducted in the Pediatric Hematology-Oncology Department of the University General Hospital of Heraklion for 2013-2022 to estimate the prevalence and describe the clinical and epidemiological characteristics of IFDs for pediatric and adolescent patients with neoplasia. Demographic, clinical, and laboratory parameters were analyzed to identify risk factors for the development of IFD. The overall prevalence of IFDs was estimated to be 7.8% (12/154 patients) throughout the study. The mean age at IFD diagnosis was 9.8 years (SD 6.4 years). The most common IFD was possible/probable invasive pulmonary aspergillosis (IPA; in ≈50%), followed by candidemia/invasive candidiasis (in 44%). Candida parapsilosis was the most prevalent Candida species (4/6 events). Of interest, the majority (75%) of IFDs were breakthrough infections. Patients with increased risk for IFDs were those who were colonized by fungi in sites other than the oral cavity, hospitalized in the intensive care unit for >7 days, received >7 different antimicrobials in the last 3 months, or had severe neutropenia for >44 days. Two children out of a total of 12 with IFD died due to refractory disease or relapse (16.7%). More detailed and prospective epidemiological studies on fungal infections in pediatric patients with hematological or solid neoplasms can contribute to the optimization of prevention and treatment.

B-NHL Cases in a Tertiary Pediatric Hematology-Oncology Department: A 20-Year Retrospective Cohort Study.

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).

Clinical Profile of Pediatric Oncology Patients Treated by Radiotherapy: A Retrospective Audit from a Tertiary Cancer Care Center in South India

Introduction With the increase in the number of pediatric cancers in India, there is a need for a multimodal approach involving various disciplines of therapy in which radiotherapy is one of the important areas of treatment. As there is a paucity of studies in South India about the profile of pediatric cancer patients who have undergone radiotherapy the present study was undertaken. Methods A record-based retrospective study was conducted at the department of pediatric hematology-oncology and radiotherapy at a tertiary care hospital in South India using a data abstraction form which consisted of sociodemographic details of study participants, primary diagnosis, confirmed diagnosis, site of radiotherapy, current status of the patient, etc. Chi-square test or Fisher's exact test was used to find out significant association between current status of study participants and various determinants influencing it. Results Highest proportion, n = 35 (30.4%), of cases were in the age group of 10 to 14 years. Among them, 48 children were primarily diagnosed to have hematolymphoid malignancy while 67(%) had solid tumor. Majority of the patients, n = 110 (95.6%), were treated on curative intent. Conclusion Radiotherapy remains an important modality of cancer-directed therapy in children with cancer. Radiotherapy still forms an integral part of cancer-directed treatment in children with cancer as demonstrated in our population.

Healthcare-associated Infections in the Department of Pediatric Hematology-oncology; A Single Center Evaluation

Healthcare-associated Infections in the Department of Pediatric Hematology-oncology; A Single Center Evaluation

Evaluation of Staphylococcus Aureus and Pseudomonas Aeruginosa in Saliva of Patients with Acute Myeloid Leukemia.

Patients with leukemia are prone to infectious and often life-threatening complications. Evidence suggests that a specific oral microbiota may contribute to septicemia, which can delay antineoplastic treatment, compromise treatment efficacy, or even endanger patients' lives. This study investigated the prevalence of Staphylococcus aureus and Pseudomonas aeruginosa in the saliva of patients with acute myeloid leukemia who were candidates for bone marrow transplantation. This cross-sectional study was conducted in 2019 in the Hematology-Oncology Department of Namazi Hospital, Shiraz University of Medical Sciences. The study included 28 patients with acute myeloid leukemia eligible for bone marrow transplantation as the case group and age- and sex-matched healthy individuals as the control group. Unstimulated saliva samples were collected to determine the frequency of Staphylococcus aureus and Pseudomonas aeruginosa. Data were analyzed using SPSS version 18, the chi-square test, and the independent t-test. In the patients with acute myeloid leukemia, 26 (86%) were positive for Staph-ylococcus aureus and 18 (60%) were positive for Pseudomonas aeruginosa. In the healthy group, 11 (22.9%) were positive for Staphylococcus aureus and 3 (6.2%) were positive for Pseudomonas aeruginosa. The frequency of Pseudomonas aeruginosa and Staphylococcus aureus in the saliva samples of patients with acute myeloid leukemia was significantly higher than in the healthy control subjects (p value < 0.05). Chi-square test showed no significant association between age and the frequency of bacteria (p value= 0.27). In the current study, the frequency of Staphylococcus aureus and Pseudomonas aeruginosa in the saliva of patients with acute myeloid leukemia was higher than in the healthy control group.

Comparison of the efficacy Talc solution injection through Chest Tube and Talcum Powder through Pleuroscopy for the Treatment of Malignant Pleural Effusion: a randomized clinical trial

Background: The aim of the present study was to compare the different outcomes and response rates of talc powder injection via chest tube and talc spray through thoracoscopy in the treatment of malignant pleural effusion in patients.&#x0D; Methods: In this randomized controlled trial, patients with malignant pleural effusion, who were hospitalized in the surgery and hematology-oncology departments of Shariati and Imam Khomeini Hospitals, were enrolled. The patients were randomly divided into two groups: chest tube and pleuroscopy, using simple randomization. The mean and standard deviation, frequency and percentage, independent sample t-tests, chi-square, and Fisher’s exact tests were used for data analysis. A p-value of less than 0.05 was considered statistically significant.&#x0D; Results: No significant difference was observed between the two groups in the incidences of chest pain, fever, and both symptoms (p &gt; 0.05). The treatment success rates among the chest tube and pleuroscopy cases were 83.3% and 100%, respectively, and there was no significant difference between the two groups (p = 0.05). Among the five patients who had a recurrence, four (80%) had lung cancer, and one (20%) had liver cancer, and this difference was significant (P = 0.003). Regarding the rate of response to the treatment according to the side with effusion, among the people who had a relapse, two people (40%) had right-sided effusion, and three others (60%) had left-sided effusion (P = 0.623).&#x0D; Conclusions: Both techniques were safe, had minor side effects, were transient, and easy to manage. However, the recurrence of the disease in the thoracoscopic pleurodesis method was significantly less than in the chest tube.&#x0D;

Predictive Factors of Renal Damage during Sickle Cell Disease at the Hematology-Oncology Department of Donka University Hospital

Predictive Factors of Renal Damage during Sickle Cell Disease at the Hematology-Oncology Department of Donka University Hospital

Identification of the core competencies of pediatric hematology-oncology nurses: A Delphi study

PurposeTo identify the core competencies of the pediatric hematology-oncology nurse. MethodsA Delphi study was conducted. After identifying the competencies of the pediatric hematology-oncology nurse through a literature review, a questionnaire was created to be administered to a panel of experts to obtain consensus. The panel of experts consisted of 19 nurses. For each competence identified, it was necessary to evaluate the competence in terms of “understanding” and “relevance”, assigning a score from 0 (not at all) to 4 (completely), according to a Likert scale. Then, the experts identified what could be the necessary “level of work experience” within which a nurse should become autonomous in every competency choosing among the levels: beginner, intermediate, expert. Consensus among the experts was reached in two rounds. ResultsAfter submitting the document to two rounds, a final document was obtained with a total of 126 competencies, divided into nine areas. Fifty-eight competencies fall into the “beginner” level, 46 competencies into the “intermediate” level and 22 competencies into the “expert” level. ConclusionsThe document produced by this study could be a starting point for organizing specific training courses for nurses in the pediatric hematology-oncology department. A clear description of specific competencies for pediatric hematology-oncology nurses would help ensure the best care for the child.

Standardized Clinical Pathways Improve Management of Vaso-Occlusive Episodes in the Pediatric Emergency Department

Introduction: Pain secondary to vaso-occlusive episodes (VOE) is one of the most common and debilitating complications of sickle cell disease (SCD). Although there are guidelines for pain management, these are often not well-followed. Pain management is entrenched in subjectivity and susceptible to implicit bias. Research has shown that clinical pathways improve care for patients which is especially important in vulnerable populations such as pediatric patients with SCD. Following a quality improvement project at our institution that resulted in significantly improved inpatient care for pediatric patients with SCD, the goal of this project was to create an accessible clinical pathway with multidisciplinary input to streamline management of VOE in the emergency department (ED) and assure equitable care for all. We aimed to improve time to analgesics, increase the percent of patients receiving pain medications within 30 minutes, and increase intranasal fentanyl and patient-controlled anesthesia (PCA) utilization in the pediatric ED. Methods: The care signature clinical pathway was created using a multidisciplinary approach with individuals representing the department of pediatric hematology-oncology, pediatric emergency, anesthesiology, pharmacy, and nurse management. The pathway was developed based on updated American Society of Hematology guidelines for pain management in pediatric VOE. The pathway became available for use via electronic medical record on July 12 th, 2022. Outcome measures regarding pain management were evaluated for one year prior to pathway publication and compared to outcomes one year after publication. Patients with a primary or secondary diagnosis of SCD presenting to the Yale pediatric ED with vaso-occlusive pain were included. Results: A total of 214 ED visits were evaluated. The pre-pathway cohort included 108 encounters from July 1 st, 2021 to June 30 th, 2022 and the post-pathway cohort included 106 ED encounters from August 1 st, 2022 to July 21 st, 2023. During the first year post implementation, a provider utilized the clinical pathway a total of 534 times (121 individuals) with an average of 1 time per day. An analgesic was ordered for 63 (58.3%) patients and administered for 31 (28.7%) patients within 30 minutes of arrival in the pre-pathway cohort. An analgesic was ordered for 73 (68.9%) and administered for 32 (30.2%) patients within 30 minutes of arrival in the post-pathway cohort. Comparing pre- and post-pathway cohorts, the median time to pain medication order was 22 vs 17 minutes and pain medication administration was 42 vs 40 minutes respectively. Intranasal fentanyl was used for 2 (1.9%) patients in the pre-pathway cohort and 12 (11.3%) patients in the post-pathway cohort. A total of 0 (0%) hydromorphone PCAs were administered in the ED in the pre-pathway cohort compared to 4 (3.8%) hydromorphone PCA administered in the ED in the post-pathway cohort. Conclusion: Standardizing pain management using a clinical pathway has shown improvement in ED management of VOE in the first year post implementation with increased utilization of intranasal fentanyl and PCAs. Our goal of increased percentage of patients receiving pain medication within 30 minutes and decreased time to first analgesic was not achieved, however this is an ongoing project and with education in implementation of the clinical pathway we hope to continue to see long term progress. Additionally, in the future, we plan to expand use of this pathway to additional sites within our health care system.

The Arabic Hospital Anxiety and Depression Scale: validation in a sample of Lebanese patients with cancer

BackgroundDepression and anxiety are common comorbid psychological disorders among patients with cancer. Despite the wide use of the Arabic Hospital and Anxiety Scale (HADS) in oncological settings, it has not been yet validated among Lebanese patients with cancer. We aimed to assess the reliability and validity of the HADS in a sample of Lebanese patients with cancer. One-hundred one Lebanese patients diagnosed with cancer presenting to the Ambulatory Care Center in the Hematology Oncology Department at the American University of Beirut Medial Center filled the Arabic version of the HADS. The Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Patient Health Questionnaire 9-Item Scale (PHQ-9) were used to assess its concurrent validity in capturing anxiety and depression, respectively.ResultsReliability analysis using Cronbach’s alpha (α) coefficient revealed good internal consistency for the Arabic HADS (α = 0.89) and both subscales (α = 0.86 for depression and α = 0.78 for anxiety). Correlations between HADS with both GAD-7 and PHQ-9 were statistically significant and strong for both depression (r = 0.795; p < 0.0001) and anxiety (r = 0.727; p < 0.0001). Confirmatory factor analysis revealed that the observed data fits the two-factor model of depression and anxiety (Kaiser–Meyer–Olkin = 0.86; Tucker Lewis Index = 0.879; root-mean-square error of approximation = 0.08). Depression and anxiety rates were approximately 52% and 25%, respectively.ConclusionWe conclude that the Arabic version of the HADS is a credible and valid tool for clinical assessment of psychological distress (anxious and depressive states) among Lebanese patients with cancer.

Changes in Health-Related Quality of Life During Multiple Myeloma Treatment: A Qualitative Interview Study.

To explore whether patients with multiple myeloma changed their construct of health-related quality of life during treatment. 14 participants were selected from 10 hematology-oncology departments in Denmark. This interview study used a prospective, longitudinal, exploratory design. Semistructured interviews were conducted while participants were undergoing active treatment for multiple myeloma and six months after the baseline interview. Interviews were analyzed using systematic text condensation. The overall theme at baseline was insecurity, and the overall theme at six months was coping. The following subthemes were also identified based on participants' description of their health-related quality of life: concerns about having a meaningful life, dealing with everyday limitations, and maintaining social networks; adjusting expectations to abilities; expanding social networks; and exploring a meaningful life. Patients' ability to use coping strategies should be considered when screening for rehabilitation needs. During systematic in-depth symptom screening, unmet rehabilitation needs (e.g., physical functioning, fatigue, pain) may become apparent.

BI18 The role of an acute on-call dermatology service in a haemato-oncology unit using pioneering treatments: a retrospective analysis of 134 dermatology consultations in a tertiary hospital

Abstract Our dermatology department receives the largest number of internal on-call referrals from the haematology–oncology department. Patients with haematological malignancies are particularly vulnerable to an array of dermatological conditions due to immunosuppression and multiagent exposure, which can impact cancer treatment and result in significant morbidity and even mortality. Our primary objective was to quantify and analyse the dermatological conditions encountered. Our secondary objective was to identify potential associations of dermatological conditions with haematological malignancy subtype and anticancer therapies. We conducted a retrospective single-centre review of acute haematology–oncology referrals to an on-call dermatology service made between August 2020 and November 2022. Consultations were retrospectively identified from the dermatology on-call referral log. In total, 134 patients were identified. Underlying haematological malignancies were categorized into lymphoid neoplasms (45%), myeloid neoplasms (29%), plasma cell dyscrasias (13%), Hodgkin lymphoma (6%) and other (7%), with acute myeloid leukaemia (AML; 20%) being the most frequently seen distinct haematological malignancy. Cutaneous adverse drug eruptions (23%), infections (13%), folliculitis/acneiform eruptions (10%) and eczematous dermatoses (7%) accounted for the most common diagnoses, followed by benign skin lesions (6%), cutaneous lymphoma (6%), leukaemia cutis (5%) and cutaneous vasculitis (4%). Notably, cutaneous drug reactions frequently occurred in patients with myeloid neoplasms (32%) and, out of all malignancies, most frequently in multiple myeloma (26%). Folliculitis and acneiform eruptions occurred predominantly in patients with myeloid lineage malignancy (i.e. AML and myelodysplastic syndrome; 73%), although it is unclear whether they were triggered by the underlying malignancy or treatment received. Fifteen patients (11.2%) undergoing novel chimeric antigen receptor (CAR) T-cell therapy were referred to our on-call dermatology service. In conclusion, dermatology plays an integral consultative service to patients from haematology–oncology. Skin biopsy is diagnostically useful and has been crucial in the early detection of lymphoma and leukaemia recurrence. However, with the recent development of new CAR T-cell therapies and other novel agents, new adverse dermatological complications are surfacing, and this is likely to increase the demand for dermatology input.

Differential analysis of immune reconstitution after allogeneic hematopoietic stem cell transplantation in children with Wiskott-Aldrich syndrome and chronic granulomatous disease.

To investigate similarities and differences in immune reconstitution after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with Wiskott-Aldrich syndrome (WAS) and chronic granulomatous disease (CGD). We retrospectively analyzed the lymphocyte subpopulations and the serum level of various immune-related protein or peptide on Days 15, 30, 100, 180 and 360 post-transplantation in 70 children with WAS and 48 children with CGD who underwent allo-HSCT at the Transplantation Center of the Department of Hematology-Oncology, Children's Hospital of Chongqing Medical University from January 2007 to December 2020, and we analyzed the differences in the immune reconstitution process between the two groups. ① The WAS group had higher lymphocyte subpopulation counts than the CGD group. ② Among children aged 1-3 years who underwent transplantation, the WAS group had higher lymphocyte subpopulation counts than the CGD group. ③ Further comparisons were performed between children with non-umbilical cord blood transplantation (non-UCBT) and children with umbilical cord blood transplantation (UCBT) in the WAS group. On Day 15 and 30 post-transplantation, the non-UCBT group had higher B-cell counts than the UCBT group. On the remaining time points post-transplantation, the UCBT group had higher lymphocyte subpopulation counts than the non-UCBT group. ④ Comparisons were performed between children with non-UCBT in the WAS group and in the CGD group, the lymphocyte subpopulation counts were higher in the WAS group compared to the CGD group. ⑤ On Day 100 post-transplantation, the CGD group had higher C3 levels than the WAS group. On Day 360 post-transplantation, the CGD group had higher IgA and C4 levels than the WAS group. ① The rate of immunity recovery was faster in children within the WAS group compared to those children within the CGD group, which may be attributed to the difference of percentage undergoing UCBT and primary diseases. ② In the WAS group, the non-UCBT group had higher B-cell counts than the UCBT group at Day 15 and 30 post-transplantation, however, the UCBT group had higher B-cell counts than the non-UCBT group at Day 100 and 180 post-transplantation, suggesting that cord blood has strong B-cell reconstitution potentiality after transplantation.

MDB-10. EPIDEMIOLOGICAL PROFILE OF MEDULLOBLASTOMA IN MOROCCO: A 2-YEAR RETROSPECTIVE STUDY

Abstract Medulloblastoma is a malignant, invasive embryonal tumor of the central nervous system. This pathology is the leading malignancy in children, accounting for 30% of central nervous system pediatric tumors. This study aimed to present the epidemiological profile of medulloblastoma in Morocco. It was a retrospective study including all children aged 0 to 16 years and diagnosed with medulloblastoma at the pediatric hematology-oncology department of the children’s hospital in Rabat (Morocco) over two years, from January 1, 2021, to December 31, 2022. A total of 12 patients were included in the study, 7 boys and 5 girls (M/F ratio 1.4). The mean age was 9 ± 3 years. The majority (91.7%) of children were over 5 years of age. Only one child was aged 18 months. over half of the patients were from a rural areas. Most cases were living over 30 Km from the center. Among them, 40% were more than 150 km. A low socio-economic level was reported by 75% of the families. Two children were born to consanguineous parents. A familial cancer history was noted in 41.7% of patients. Clinical symptoms were dominated by headache (83.3%) and vomiting (66.7%). Regarding treatment, two patients were treated with surgery and seven with a combination of surgery, radiotherapy, and chemotherapy. During the period of study, there were no cases of death. A good outcome was noted in 91.7% of patients. Only one child received palliative care. Childhood cancer in general, and medulloblastoma in particular, is on the rise in Morocco. Given the scarcity of publications on this type of cancer in our country, a national registry is necessary for the monitoring and appropriate management of this disease.

Antifungal Stewardship Programs in Children: Challenges and Opportunities.

Antifungal Stewardship Programs in Children: Challenges and Opportunities.

Clinical Characteristics and Outcomes of Cancer Cases Among Syrian Refugees From Southern Turkey

Cancer was a common noncommunicable disease in Syria before the present conflict and is now a major disease burden among 3.6 million Syrian refugees in Turkey. Data to inform health care practice are needed. To explore sociodemographic characteristics, clinical characteristics, and treatment outcomes of Syrian patients with cancer residing in the southern border provinces of Turkey hosting more than 50% of refugees. This was a retrospective hospital-based cross-sectional study. The study sample consisted of all adult and children Syrian refugees diagnosed and/or treated for cancer between January 1, 2011, and December 31, 2020, in hematology-oncology departments of 8 university hospitals in the Southern province of Turkey. Data were analyzed from May 1, 2022, to September 30, 2022. Demographic characteristics (date of birth, sex, and residence), date of first cancer-related symptom, date and place of diagnosis, disease status at first presentation, treatment modalities, date and status at last hospital visit, and date of death. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision and International Classification of Childhood Cancers, Third Edition, were used for the classification of cancer. The Surveillance, Epidemiology, and End Results system was applied for staging. The diagnostic interval was defined as the number of days from first symptoms until the diagnosis. Treatment abandonment was documented if the patient did not attend the clinic within 4 weeks of a prescribed appointment throughout the treatment. A total of 1114 Syrian adult and 421 Syrian children with cancer were included. The median age at diagnosis was 48.2 (IQR, 34.2-59.4) years for adults and 5.7 (IQR, 3.1-10.7) years for children. The median diagnostic interval was 66 (IQR, 26.5-114.3) days for adults and 28 (IQR, 14.0-69.0) days for children. Breast cancer (154 [13.8%]), leukemia and multiple myeloma (147 [13.2%]), and lymphoma (141 [12.7%]) were common among adults, and leukemias (180 [42.8%]), lymphomas (66 [15.7%]), and central nervous system neoplasms (40 [9.5%]) were common among children. The median follow-up time was 37.5 (IQR, 32.6-42.3) months for adults and 25.4 (IQR, 20.9-29.9) months for children. The 5-year survival rate was 17.5% in adults and 29.7% in children. Despite universal health coverage and investment in the health care system, low survival rates were reported in this study for both adults and children with cancer. These findings suggest that cancer care in refugees requires novel planning within national cancer control programs with global cooperation.