Pediatric Oncology Unit Research Articles

Totally Excited about Moving Mobility and Exercise (TEAM Me): A Successful Multidisciplinary Exercise Quality Improvement Initiative for Pediatric and Young Adult Oncology and Stem Cell Transplant Inpatients.

Background: Pediatric, adolescent and young adult (PAYA) patients are less active than their healthy counterparts, particularly during inpatient stays. Methods: We conducted a quality improvement initiative to increase activity levels in patients admitted to our pediatric oncology and cellular therapy unit using a Plan-Do-Study-Act (PDSA) model. An interdisciplinary team was assembled to develop an incentive-based inpatient exercise and activity program titled Totally Excited About Moving Mobility and Exercise (TEAM Me). As part of the program, patients were encouraged by their care team to remain active during their inpatient stay. As an additional incentive, patients earned stickers to display on TEAM Me door boards along with tickets that could be exchanged for prizes. Activity was assessed by documentation of physical therapy participation, tests of physical function, and surveys of staff perceptions of patient activity levels, motivations, and barriers. Results: Compared to baseline, patient refusals to participate in physical therapy decreased significantly (24% vs. 2%) (p < 0.02), and staff perceptions of patient motivation to stay active increased from 40% to 70% in the post implementation period. There were no changes in physical function tests. Conclusions: An incentive-based exercise program for young oncology inpatients greatly improved patient activity levels, participation in physical therapy and influenced professional caregivers’ beliefs.

Spectrum and Outcome of Intra-abdominal Tumors in children Under-five in a Pediatric Critical Care Unit of a Tertiary Care Center of Pakistan

Objective: To determine the spectrum and outcome of intra-abdominal tumors in children less than five years admitted in the critical care unit of a tertiary care center of Pakistan. Methodology: This retrospective study included children less than five years with malignant abdominal mass admitted in the pediatric critical care unit of the tertiary care center of Pakistan from July 2015 to June 2019.&#x0D; Undiagnosed patients or with relapsed or benign abdominal tumors managed in an outpatient or admitted in the critical care for post-operative care only were excluded from the study. Data was entered and analyzed by using SPSS version 21.0. Result: Total 55 patients were included with 69% boys and median age three years (IQR – 2 years). Abdominal distention was the commonest complain (100%). Only 42% children survived (n=23/55). High grade mature Bcell Non Hodgkin Lymphoma was the most common (45%) diagnosis. Advance Stage III/IV was seen in 94%. Combined multiple site metastasis was most common (45.4%). Sepsis (OR-5.30, 95% CI-1.24-22.65, p-0.024), inotropic use (OR-9.00, 95% CI-1.33-60.92, p-0.024) and malnutrition (OR-4.85, 95% CI-1.08-21.63, p-0.039) were identified as the most significant prognostic factors related to high mortality. Conclusion: B-cell Non-Hodgkin Lymphoma was the most common histopathological diagnosis, while sepsis was the commonest reason for admission in critical care unit. Majority presented with advanced stages (stage III/IV) with poor outcome(58% mortality). Sepsis, malnutrition and need of inotropes were found to be the independent risk factors contributing to this high mortality. We recommend for early recognition of abdominal distention as an important sign of cancer with prompt referral to pediatric oncology unit which would definitely decrease the upfront critical care requirement and improve survival.

Improvement of survival in Wilms Tumor patients at the paediatric oncology unit, KATH

BackgroundWilms Tumor (WT) is one of the common and curable cancer types targeted by the World Health Organization (WHO) Global initiative for childhood cancer (GICC). Although, survival in high income countries is good, the same cannot be said of survival in low- and middle-income countries (LMIC) like Ghana. The main aim of this study was to determine the clinical presentation and survival of patients with WT presenting at the Komfo Anokye Teaching Hospital MethodsThis research is a 5-year (2016 - 2020) prospective hospital based cross sectional study. Patient characteristics, tumor characteristics and outcome were described, and survival analysis was done. The survival was compared to a historical cohort (2011- 2013) which was evaluated in 2015 where 18.5% of patients survived. ResultsA total of 51 patients were seen over the 5-year period with a male to female ratio of 1.2:1. The median age of presentation was 3years. Majority of patients (56.5%) presented with a left sided renal mass. A significant proportion presented with Stage III (37.1%) and Stage IV (20.98%) disease. The commonest site of metastasis was the liver with 19.4% of patients presenting with it. Thirty three percent (33%) of the patients died with 8(47%) occurring before initiation of treatment. Mortality was highest amongst patients with advanced disease with a p-value of 0.19. The 3-year event free survival with abandonment as an event in patients seen from 2016 - 2019 was 55.6% (p-0.026). ConclusionPatients with high stage tumors (Stage III and IV) were at a higher risk of death as compared to the patients with lower stage tumors. Early detection and treatment of patients with WT can lead to a favorable outcome.

Profile Of Childhood Cancer Cases Seen At The Paediatric Oncology Unit Of A Tertiary Hospital In Ghana - A 10 Year Review

Introduction&#x0D; Childhood cancers though curable have inequalities in outcomes between low- and middle-income countries and high-income countries. The World Health Organisation (WHO) Global initiative on Childhood cancer (GICC) has a goal of increasing survival rate at least by 60% by 2030 while reducing suffering and improving quality of life for children with cancer globally.&#x0D; The main aim for this study was to assess the trends in yearly proportions and numbers of cases seen and to evaluate the survival patterns and also to serve as a baseline as interventions are implemented in tandem with the WHO GICC.&#x0D; MethodsA retrospective study was conducted to review secondary data from the paediatric cancer registry of all patients diagnosed with cancer from 2011-2020. Demographic and clinical data stored in excel was exported to Stata and analyzed. Outcome data included death or alive.&#x0D; ResultsTotal number of patients diagnosed were 1,094 with the lowest number of new patients (n=84) seen in 2012 and the highest (n=132) seen in 2014. There was a Male: Female ratio of 1.4:1. The commonest cancers seen was lymphomas forming about 38.1% of the new diagnosis made. The incidence of lymphomas reduced from 62.8% in 2011 to 23.0% in 2020. Proportions for Acute leukaemia’s also increased from 11.3% in 2011 to 23.8% in 2020. Number of patients alive in reference to the year of diagnosis was lowest in 2016 with 29% of patients being alive. Subsequent years have higher survival with 53% of patients in 2019 still alive. Leukaemia treatment is expensive and unaffordable and translated to poor outcomes as patients tend to abandon treatment.&#x0D; ConclusionThis baselines preliminary data showed a reducing trend in the incidence of lymphomas with an increase in the number of leukaemia patients seen but poor outcomes in patients with leukaemia. This calls for concerted effort with interventions to improve on the outcome and be able to reach the 60% survival goal for the WHO GICC.

A national study of antibiotic use in Greek pediatric hematology oncology and bone marrow transplant units.

We surveyed antimicrobials used in Greek pediatric hematology-oncology (PHO) and bone marrow transplant (BMT) units before and after an intervention involving education regarding the 2017 clinical practice guidelines (CPG) for the management of febrile neutropenia in children with cancer and hematopoietic stem-cell transplant recipients. Antibiotic prescribing practices were prospectively recorded between June 2016 and November 2017. In December 2017, baseline data feedback was provided, and CPG education was provided. Prescribing practices were followed for one more year. For antibiotic stewardship, days of therapy, and length of therapy were calculated. Five of the 6 PHO units in Greece and the single pediatric BMT unit participated. Admitted children in each unit who received the first 15 new antibiotic courses each month. Administration of ≥4 antibiotics simultaneously and administration of antibiotics with overlapping activity for ≥2 days were significantly more common in PHO units in general hospitals compared to children's hospitals. Use of at least 1 antifungal was recorded in ∼47% of the patients before and after the intervention. De-escalation and/or discontinuation of antibiotics on day 6 of initial treatment increased significantly from 43% to 53.5% (P = .032). Although the number of patients requiring intensive care support for sepsis did not change, a significant drop was noted in all-cause mortality (P = .008). We recorded the antibiotic prescribing practices in Greek PHO and BMT units, we achieved improved prescribing with a simple intervention, and we identified areas in need of improvement.

Atypical presentation of langerhans cell histiocytosis of temporal bone in a toddler

Ever since Langerhans cell histiocytosis (LCH) was first described in 1865, mystery revolving around its cause and pathogenesis remains, although most agree that LCH is either a reactive or neoplastic process. We aim to highlight the importance of careful investigations of common presentation, which may lead to the diagnosis and treatment in a toddler. We report a case of LCH of the temporal bone with an atypical presentation in a toddler, which led to delayed diagnosis. The patient presented with a vague preauricular swelling and aural polyp. Imaging and histopathological examination of the biopsy revealed temporal bone LCH, and the child was referred to the pediatric oncology unit and successfully treated. This case clearly demonstrates the highly diversified clinical manifestation of LCH and the high level of suspicion required to diagnose it. We describe the challenge faced in managing this rare entity.

Malignant extracranial germ cell tumours: A first national report by the South African Children's Cancer Study Group.

To determine the overall survival (OS) and prognostic factors influencing outcomes in children and adolescents with malignant extracranial germ cell tumours (MEGCTs) in preparation for the development of a harmonised national treatment protocol. A retrospective folder review was undertaken at nine South African paediatric oncology units to document patient profiles, tumour and treatment-related data and outcomes for all children with biopsy-proven MEGCTs from birth up to and including 16years of age. Between 1 January 2000 and 31 December 2015, 218 patients were diagnosed with MEGCTs. Female sex (hazard ratio [HR] 0.284, p=.037) and higher socio-economic status (SES) (HR 0.071, p=.039) were associated with a significantly lower risk of death. Advanced clinical stage at diagnosis significantly affected 5-year OS: stage I: 96%; stage II: 94.3%; stage III: 75.5% (p=.017) and stage IV (60.1%; p<.001). There was a significant association between earlier stage at presentation and higher SES (p=.03). Patients with a serum alpha-fetoprotein (AFP) level of more than 33,000ng/ml at diagnosis had significantly poorer outcomes (p=.002). The use of chemotherapy significantly improved survival, irrespective of the regimen used (p<.001). The cohort demonstrated a 5-year OS of 80.3% with an event-free survival (EFS) of 75.3%. Stage, the use of chemotherapy and an elevated serum AFP level of more than 33,000ng/ml were independently predictive of outcome. The relationship between SES and outcome is important as the implementation of the new national protocol hopes to standardise care across the socio-economic divide.

Considerations in Methods and Timing for Delivery of Genetic Counseling Information to Pediatric Oncology Patients and Families.

Many pediatric oncology patients and their families may benefit from genetic counseling and testing; however, identifying the best timing and delivery method for these referrals is sometimes a challenge. The goal of this study was to understand how and when caregivers prefer to receive information about genetic counseling and testing. A total of 56 surveys completed by caregivers at The Johns Hopkins Hospital Pediatric Oncology unit in Baltimore, Maryland were analyzed. A sizeable subset of respondents was interested in receiving information about the availability of genetic counseling from an oncology doctor or nurse, but not a genetic counselor (n=13/55, 24%). Most respondents preferred to be informed about genetic services at diagnosis (n=28/54, 52%) or within 1 to 2 months of diagnosis (n=14/54, 26%). In conclusion, patients and their families may benefit from prompt and early recognition of the risk of cancer predisposition syndromes, preferably within the first 2 months following diagnosis. Oncology professionals are an important source of information, and can introduce the availability of genetic counseling services and motivate families to undergo genetic testing, though alternative communication methods such as brochures may also be useful.

A case of Acute myeloid leukemia complicated by post COVID-19 multi-system inflammatory syndrome-children

Corona Virus disease 2019 (COVID-19) pandemic has presented a huge challenge to the health care system in terms of magnitude of cases and to pediatric oncology units with varied clinical presentations. Acute myeloid leukemia(AML) is a rare heterogenous cancer of childhood with an induction mortality around 15% in our country due to neutropenic sepsis. Multisystem inflammatory syndrome in children(MIS-C) is an hyperinflammatory syndrome seen 4–6 weeks after COVID-19 infection. COVID infection in some of these children would have gone unnoticed. Here we report a two year eight months old boy diagnosed with AML on induction chemotherapy developed post COVID MIS-C.

The development of an international childhood cancer hospital register database in 13 African countries. A project of the French African Pediatric Oncology Group (GFAOP).

The establishment of an international hospital-based register (HBR) for the French African Pediatric Oncology Group (GFAOP) was a necessary step in the group's clinical research program. With help from the Sanofi Espoir Foundation's "My Child Matters" program, the GFAOP resolved to develop an international HBR network to collect quality data on children attending the Pediatric Oncology Units (POUs). All children entering POUs from January 2016 to December 2018 were registered using an online questionnaire. Data collection included information on diagnosis, disease stage, demographics, socioeconomic status, and outcome. An intensive training program was developed to improve both data quality and quantity. Among the 3348 children registered, 3230 had a suspected cancer, 681 were not confirmed. A diagnosis was confirmed on radiological, clinical, or histological examination for 2549 children including Burkitt lymphoma (516: 20%)-the most frequent diagnosis, Wilms' tumor (459: 18%), retinoblastoma (357: 14%), and acute lymphoblastic leukemia (345: 13%). Of these, 2187 children were treated. Early deaths, abandonment, economic difficulties, and lack of equipment were some of the reasons offered to explain the numbers of undiagnosed and untreated children. Vital status is known for 1994 children: 1187 died and 807 were alive, 551 of these with a follow-up>12 months. This work has provided reliable data on children attending the POUs, especially clarifying reasons and occasions for care rupture. The data will help to identify material, human resources, and staff training needs, to evaluate progress, and to encourage consideration of pediatric cancer in national cancer plans.

Preserved Long-Term Lung Function in Young Adult Survivors of Common Childhood and Adolescence Malignancies.

Purpose: We aimed to evaluate long-term lung function and respiratory outcomes in young adults who survived common pediatric malignancies, treated in a single center. Methods: We enrolled young adults who had been treated during their childhood or adolescence for hematological or solid cancer at our Pediatric Oncology Unit, and performed pulmonary function tests (PFT) and clinical evaluation. PFT included spirometry and Diffusing Capacity of Lung for Carbon Monoxide (DLCO). Results: We included 121 survivors, mean age 23 years at follow-up, median 15 years from diagnosis. The most common diagnoses were hematological malignancies, mainly acute lymphoblastic leukemia, whereas 31% of the patients were treated for nonhematological cancer, mainly neuroblastoma. Treatments consisted of chemotherapy alone or in combination with radiotherapy and/or hematopoietic stem cell transplantation. Most of the patients denied respiratory symptoms throughout the years. In the whole group only eight patients (6%) had abnormal PFT, consisting mainly in a restrictive pattern and reduced DLCO. PFT abnormalities were of mild degree in most of the cases. Overall, the mean values of forced vital capacity, forced expiratory volume in 1 second, and DLCO were normal, but lower in females, in those who received radiotherapy and in those treated for lymphoma. Conclusion: In a group of young adults, surviving the most common childhood malignancies, we found a preserved lung function after a median follow-up of 15 years. The constantly increasing survival in childhood cancer is now associated with a trend toward an improvement in long-term respiratory outcomes.

768. Gaining Compliance-Getting Results

BackgroundCompliance with the chlorhexidine gluconate (CHG) daily application component of the CLABSI prevention bundle potentially could negatively affect infection rates. In an attempt to increase CHG compliance, a 3-month trial for soap based CHG bathing was undertaken on two pediatric oncology units with long term central line patients. MethodsThe current bathing process involved 2 steps, a soap and water bath followed one hour later by a CHG wipe. It was time consuming and received complaints from staff and parents resulting in lower documented compliance rates. A one step process was implemented combining skin cleansing and CHG application with one product.Staff, parents and patients were educated on proper bathing technique. Instruction brochures printed in multiple languages were employed and discussed for education. An electronic survey was developed to collect parent feedback.ResultsThe trial was from October - December 2020 and included 25 select patients in the cancer center. Patients and parents provided positive feedback with the new process.Audits measured both line maintenance and bathing. If one step was missed-than non- compliance with the bundle was noted . Bundle adherence increased with auditors noting that this was due entirely to an increase in bathing compliance. From April to September 2020 prior to implementation of the soap based CHG bathing, CHG compliance on the Stem Cell Transplant Unit (SCTU) averaged 48%. During the three month period after the trial, CHG compliance has averaged 64%. CHG monthly compliance reached 85% by April 2021. In addition, patients compliant with CHG bathing demonstrated a significant reduction in coagulase negative staphylococcus (CoNS ) blood stream infections due to the reduction of CoNS skin colonization. Cost analysis for the one week in the 15 bed BMT unit and 10 HemONC patients showed that the one step soap based CHG was &161.50 and the CHG wipe cost &960,75; a difference of &799.25per week or &41,561.00 annually.ConclusionAny infection prevention strategy needs to involve staff and parents for compliance and outcome success.Disclosures All Authors: No reported disclosures

The scope of childhood cancer in South Africa: A response to 'Childhood cancers in a section of the South African private health sector - Analysis of medicines claims data'.

Childhood cancer is an under resourced medical field that is emerging as a great healthcare concern in low- and middle-income countries such as South Africa. Therefore, reporting data in this field that may inform policymakers should be representative of the subject matter. This article aims to discuss why medicines claims as an indicator for incidence, as per an article published in 2020, is not representative of childhood malignancies in the South African setting. Literature to support the commentary were sourced using Pubmed, Google scholar, and data presented by members of the South African Children’s Cancer Study Group (SACCSG). Private medical aid coverage in South Africa between 2002 and 2018 varied between 15.5% and 18.2%. Of these, 9.5% were children under 18 years and 3.5% were under the age of six. Only 13.5% of children were treated in private paediatric oncology units during 2015. The limitations in the study were the variable medical aid coverage, the disproportionate age representation, and lack of reliable indicators for measurement and calculation of incidence. Utilising one medicines claims data base to evaluate the incidence of childhood cancer in South Africa is not representative and cannot inform policy.ContributionThis article highlights the importance of accurate registration of childhood cancer diagnoses, especially when data and conclusions based on these results inform policy. The study highlights the limitations of extrapolating general conclusions based on data representing only a small sector of the childhood cancer landscape in South Africa.

Improving visitors’ hand hygiene compliance in a pediatric oncology unit

BackgroundHand hygiene (HH) is the single most important method to prevent infections. We aim at improving HH compliance by visitors to a pediatric oncology unit. MethodsA performance improvement project implemented several Plan-Do-Study-Act cycles in July-November 2018. At baseline, a wall-mounted alcohol-based hand sanitizer dispenser was available at the unit entrance. Cycle 1 (visual cue), cycle 2 (visual cue plus verbal symptom screen), and cycle 3 (visual cue, symptom screen, plus HH verbal instructions) were tested. Patient care associates (PCA) positioned at the entrance implemented the cycles and recorded data about visitor's estimated age, day and time of observations, and covert HH compliance monitoring. Participating PCAs were surveyed regarding process feasibility. ResultsOf 1230 (97%) analyzed observations; 204 (17%) were baseline, 293 (24%) in cycle 1, 374 (30%) in cycle 2, and 359 (29%) in cycle 3. The visitors’ HH compliance significantly increased to 16.0%, 22.5%, and 48.5% in cycles 1, 2, and 3, respectively, from a baseline of 4.9% (P < .001). Visitors were more likely to perform HH when directly instructed (cycle 3) compared to baseline (adjusted OR = 19.77, 95% CI, 10.30-42.09, P < .001). Although the surveyed PCAs agreed the process is easy and fast, they reported few barriers. ConclusionsDirect verbal instructions for HH were the most effective in improving visitors’ HH compliance.

Transcend the Death of Child with Cancer: Professional Health Experiences

Objective: To reveal the perception of grief support of professionals in pediatric oncology units, after the death of the patients. Method: Qualitative phenomenological study. 22 in-depth interviews were conducted with professionals from 5 pediatric oncology units of public hospitals in Santiago. Once the narratives were transcribed, the comprehensive analysis and subsequent triangulation of the data was performed, achieving saturation. Results: Professionals perceive themselves supported in their grief by being able to experience the losses in a protected environment and feeling supported by their surroundings. They recognized the existence of external and internal factors that facilitated the process of grief. However, this support is perceived as insufficient, as there is a lack of formal support from the institution, as well as a protected grief period, or support from mental health professionals to the teams. All death experiences allow professionals to transcend their pain based on lifelong learning and to give meaning to their work. Conclusion: Grief support felt by the professionals is generated from their own initiatives of re-encounter within the teams, which is insufficient. Therefore, training in coping with death is necessary from undergraduate level, which would allow greater cohesiveness in coping and greater self-care within the teams.

Beyond the Standard of Care: An Exploratory Qualitative Study of an Implemented Integrative Therapeutic Care Program in a Brazilian Pediatric Oncology Unit.

Introduction: This article examines the feedback of health care providers within the implementation of an integrative care project in a clinic for pediatric oncology in São Paulo, Brazil. Since 2017, the project has implemented external anthroposophic therapies in the activities of daily nursing. The objective is to evaluate how the project evolved and what impact it had on the daily operation of the hospital. A special focus emphasizes the perspective of study nurses. Materials and Methods: Twelve qualitative semistructured interviews were conducted. Audio files were transcribed, translated to German, and underwent a MAXQDA software-assisted analysis. Using a thematic approach, coherent cross-case topics were defined. Results: Three main topics emerged from analysis of the data. (1) The implementation and its effects on daily patient care demonstrated positive outcomes in patients and were well accepted with minimal changes in daily activities. (2) The perspective of study nurses showed a large motivation due to beneficial and stress-relieving effects of the application and a growing patient-health care provider relationship. (3) Problems and aspirations for improvement were the lack of time and the urge to make the project grow in the future. Conclusion: Not only patients but also health care providers seem to benefit from integrative methods. They have the potential to improve the working atmosphere and to strengthen relations between patients, caregivers, and family members. General feedback was positive and acceptance in the team arose over time when beneficial effects became visible.

The effect of physical and psychosocial symptoms on caregiver burden of parents of children with cancer.

The aim of this study was to investigate the effects of parent's characteristics, physical and psychosocial symptoms, and child-related factors on caregiver burden of parents of children with cancer. This is a descriptive and cross-sectional study that included 172 parents of children with cancer. This study was performed between February and July 2019 in three major paediatric haematology and oncology units located in the centre of Turkey. Data were collected by using the descriptive information form, Pittsburgh Sleep Quality Index, Piper Fatigue Scale, Beck Depression Inventory, Trait Scale of the State-Trait Anxiety Inventory, Multidimensional Scale of Perceived Social Support and Zarit Caregiver Burden Scale. For data analysis, average and percentage calculations and multiple linear regression analyses were used. It was found that most of parents had poor sleep quality, moderate depression, fatigue, anxiety, high social support and moderate to severe caregiver burden. It was found that low education level, poor sleep quality, depression, trait anxiety, social support among the factors related to the parents, and the type of treatment and duration of the treatment from the factors related to the child had an effect on the caregiver burden. It was determined that the effective predictive factors explained 73.5% of the parents' caregiver burden. Caregiver burden is influenced by the parent- and child-related factors. Paediatric oncology nurses should plan interventions that support parents to cope with the caregiver burden during their children's cancer experience.

Translation and psychometric evaluation of the Chinese version of the resilience scale for children with cancer

BackgroundTo test the psychometric properties of a traditional Chinese version of the Resilience Scale for Children (RS-10) and examine its factorial structure via a confirmatory factor analysis (CFA).MethodsOne hundred and eighty-six Hong Kong Chinese children with cancer were recruited in the paediatric oncology units of two public acute-care hospitals in Hong Kong to participate in this cross-sectional study. The psychometric properties of the traditional Chinese version of the RS-10 were assessed, namely its content equivalence, convergent and discriminant validity, construct validity, internal consistency and test–retest reliability.ResultsThe newly translated traditional Chinese version of the RS-10 demonstrated adequate internal consistency (Cronbach’s α = .83, McDonald’s Ω = .80), excellent test–retest reliability (.89), good content equivalence (CVI = 96%) and appropriate convergent (r = − .52, P = .01) and discriminant validity (r = .61, P = .01). The CFA results demonstrated that there was a good fit between the factor structure of the Chinese version of the RS-10 and the observed data (χ2/df = 2.34, TLI = .951, RMSEA = .053, CFI = .962, GFI = .948, SRMR = .052), thereby confirming the construct validity of this instrument.ConclusionsThe traditional Chinese version of the RS-10 was found to be a reliable and valid tool for assessing the resilience of Hong Kong Chinese children with cancer. The newly developed traditional Chinese version of the RS-10 is an appropriate clinical research tool for evaluating the effectiveness of nursing interventions in enhancing the resilience of and promoting mental well-being in children with cancer.Trial registration NCT03544190.

Children and adolescent solid tumours and high-intensity end-of-life care: what can be done to reduce acute care admissions?

Despite improvements in survival, cancer remains the leading cause of non-accidental death in children and adolescents, who risk receiving high-intensity end-of-life (HI-EOL) care.ObjectiveTo analyse treatments for relapses (particularly in the...

SIGNIFICANCE OF ABERRANT CD 82 EXPRESSION IN PEDIATRIC ACUTE LYMPHOBLASTIC LEUKEMIA

Background: Acute lymphoblastic leukemia (ALL) is the most common type of childhood malignancy. It is characterized by uncontrolled clonal proliferation of lymphoid blasts with reduced capacity to differentiate into mature cells. The CD82, an adhesion molecule, performs an important role in the interaction between Leukemic stem cells (LSCs) and their niche. It is aberrantly expressed in CD34+CD38- acute myelogenous leukemia cells. However, little is known regarding its expression and roles in pediatric ALL patients and its clinical characteristics.Aim of the work: To assess CD82 expression in patients with pediatric acute lymphoblastic leukemia (ALL), and to evaluate the association with the clinical data.Patients and Methods: This study included a total of 35 pediatric ALL patients and 35 age-matched normal children. Using flow cytometric assessment CD82 expression levels were measured in peripheral blood samples and bone marrow. Patients were recruited from Pediatric Oncology Unit, Ain-Shams University Hospitals, blood samples and bone marrow were collected from all patients. Diagnostic workup of ALL was done for all patients including: 1-Complete blood picture 2-Leishamn stained peripheral blood and bone marrow smears 3- flowcytometric immunophenotyping.Results: Flow cytometry expression showed a statistically significant difference between ALL patients and controls. The intensity of CD82 expression by flow cytometry in dim and bright expression showed a statistically significant difference between ALL patients and controlsConclusion: A significantly higher expression of CD82 was detected in pediatric ALL patients compared to matching controls indicating that CD82 may play an important role in the diagnosis of pediatric ALL