Pediatric Hematology-oncology Research Articles

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).

Profile and Outcomes of Pediatric Hematology and Oncology Patients Diagnosed with COVID-19 in the Philippine General Hospital

Introduction. The coronavirus pandemic has affected millions worldwide. Better understanding of COVID-19 inpediatric hematology-oncology patients in a resource-limited setting is crucial to improve care as the pandemicensues. Objectives. This study describes the clinical profile and outcomes of pediatric hematology oncology patients with COVID-19 seen at the Philippine General Hospital (PGH). Methods. A retrospective, descriptive review of pediatric hematology oncology patients with COVID-19 seenbetween March 2020 to March 2021 in PGH was done. Results. Forty patients were identified. Seventeen percent had non-malignant hematologic conditions, 40% hadleukemias, and 42.5% had solid tumors. Fever and cough were the most common manifestations. Seventy-sixpercent were on treatment, 9% were newly diagnosed, and 7% were in relapse or disease progression. Fifty-fivepercent had mild COVID-19; 5% and 2.5% had severe and critical COVID-19, respectively. Thirty-seven percentwere asymptomatic. Cancer-related therapy was placed on hold for most patients. There were two mortalities, none was due to COVID-19. Conclusion. Results suggest that patients with hematologic and oncologic conditions have a mild course, withmajority showing recovery from COVID-19. Delays in cancer-related therapy however, may contribute to diseaseprogression and mortality.

Immunophenotype of lymphocytes and real-world outcome of COVID-19 infection in children with hematology and oncology

BackgroundPatients with immunocompromise were suspected to encounter a high risk for severe coronavirus disease 2019 (COVID-19) infection on early period; however, data is lacking nowadays and immune response remain unclear.MethodsIn this retrospective study, internet questionnaire survey and medical records were acquired in pediatric hematology oncology patients. Clinical severity, immunological characteristics, and outcomes were analyzed from December 1, 2022 to January 31, 2023 at the 3rd year of pandemic in China.ResultsA total of 306 patients were included, with 21 patients (6.9%) asymptomatic, 262 (85.6%) mild severity, 17 (5.6%) moderate severity, 5 (1.6%) severe severity, and 1 (0.3%) critical severity. Seventy-eight (25.5%) patients were on intensive chemotherapy, and 32.0% children were on maintenance chemotherapy. Delays in cancer therapy occurred in 86.7% patients. Univariable analysis revealed active chemotherapy (P < 0.0001), long duration of symptom (P < 0.0001), low lymphocytes count (P = 0.095), low CD3 + and CD8 + T cell count (P = 0.013, P = 0.022), high percentage of CD4 + TCM (P = 0.016), and low percentage of transitional B cells (P = 0.045) were high risk factors for severe COVID-19 infection. Cox regression model showed that the absolute lymphocytes count (P = 0.027) and long duration of symptom (P = 0.002) were the independent factors for severity. Patients with CD8 + dominant and B cell depletion subtype wasn’t related with severity, but had higher percentage of CD8 + effector memory T cells (TEM) and terminally differentiated effector memory T cells (TEMRA) (P < 0.001, P < 0.001), and a longer COVID-19 duration (P = 0.045).ConclusionThe severity was relatively mild in children with immunodeficiencies in the third year of COVID-19 pandemic. Low lymphocyte count and long duration of symptom were the independent risk factors with COVID-19 severity. Delays in cancer care remain a major concern and the long outcome is pending.

Outcomes of Referrals in Pediatric Patients With Peripheral Lymphadenopathy.

Lymphadenopathy is a common reason for referral to a subspecialist, which may result in significant anxiety for parents. Understanding which patients require a subspecialty referral for lymphadenopathy is key to streamlining health care utilization for this common clinical entity. This is an IRB-approved retrospective study examining pediatric patients consecutively referred to pediatric hematology oncology, otolaryngology, or surgery for lymphadenopathy from 2012 to 2021 at a free-standing tertiary-care children's hospital. Logistic regression was fitted to examine the association between the maximum size of the lymph nodes (LN) and a diagnosis of malignancy. The odds ratio, area under the receiver operator curve, sensitivity, and specificity were estimated. We found a significant association between LN size and cancer diagnosis. For every centimeter increase in the maximal dimension of LN, there was an estimated 2.3 times increase in the odds of malignancy (OR=2.3, 95% CI: 1.65-3.11; P<0.0001). The estimated area under the curve (0.84, 95% CI: 0.78-0.90) indicated that LN size correlated well with cancer diagnosis. A LN cut-off size of 2cm resulted in an estimated sensitivity of 1.0 (95% CI: 0.87-1.00) and specificity of 0.54 (95% CI: 0.46-0.61). Maximum LN size may be a predictor of malignancy among pediatric patients with lymphadenopathy.

Results of a long-term, prospective study on complications of central venous catheter in pediatric patients with hematologic-oncologic diseases.

Central venous catheter (CVC)-related complications remain a significant cause of morbidity in pediatric hematology-oncology. We prospectively surveyed the incidence of CVC-related complications in children with hematologic-oncologic diseases. Five-hundred-eighty-one CVCs were inserted in 421 patients from January 2010 to June 2022 (153,731 CVC days observation; follow-up data up to December 31, 2022). Overall, 671 complications were recorded (4.365/1000 CVC days): 49.7% malfunctions (1.88/1000 CVC days, 4.8% of CVC early removals), 23.9% bacteremia (0.90/1000, 15.1%), 19.6% mechanical complications (0.74/1000, 70.2%), 20.1% localized infections (0.76/1000, 17.1%), 0.5% thrombosis (0.02/1000, 33.3%). At multivariate analysis, risk factors for malfunction were Broviac-Hickman type of CVC (hazard ratio [HR] 2.5) or Port-a-cath (HR 3.4) or Proline (HR 4.3), p<.0001; for bacteremia double-lumen CVC (HR 3.2, p<.0001); for mechanical complications age at CVC insertion under median (HR 4.5, p<.0001) and Broviac-Hickman (HR 1.6) or Proline (HR 2.7), p=.01; finally for localized infections Broviac-Hickman (HR 2.9) or Proline (HR 4.4), p=.0001. The 2-year cumulative incidence of premature removal was 23.5%, and risk factors were age at CVC insertion under median (HR 2.4, p<.0001), Broviac-Hickman (HR 2.3) or Proline (HR 4.2), p<.0001. Premature removal occurs in approximately 20%-25% of long-term CVCs. A surveillance program has a fundamental role in identifying the risk factors for CVC complications and the areas of intervention to improve CVC management.

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

Effect of mHealth-based relaxation program on stress coping and anxiety levels in mothers of children with cancer: A randomized controlled study

ObjectiveThis study aimed to explore the effects of a mHealth-based relaxation program on anxiety and stress coping levels in mothers of children with cancer. MethodsThis randomized controlled, single-blind, parallel-group trial was conducted in the pediatric hematology-oncology unit of a university hospital. The study was completed by 50 mothers (intervention group: n = 25; control group: n = 25). The mothers in the intervention group participated in a mHealth-based relaxation program for eight weeks (including progressive muscle relaxation, guided imagery, and the four-leaf clover of mindfulness). Videos of the relaxation program were sent to mothers’ WhatsApp accounts. The mothers in the control group received routine care. The State-Trait Anxiety and Stress Coping Scales were administered during the first and eighth weeks. The registration number of this study on ClinicalTrials.gov is NCT05807295. ResultsMothers who participated in the relaxation program had lower anxiety levels and higher stress-coping scores than those in the control group (p < 0.05). ConclusionProgressive muscle relaxation exercises, guided imagery, and cognitive-based therapeutic approaches were effective in reducing mothers’ anxiety and stress coping. Practice implicationsPediatric oncology nurses can apply mHealth-based relaxation programs to support caregivers, particularly mothers. In this way, ensuring the continuity and integrity of care is easy.

Psychometric properties of the Turkish Version General Self-Efficacy Scale in children and adolescents with cancer

ObjectivesThe study aimed to evaluate the validity and reliability of the Turkish version of the General Self-Efficacy Scale in children and adolescents aged 8–18 undergoing cancer treatment. MethodsThe sample of this methodological and descriptive study consisted of 128 children and adolescents between the ages of 8 and 18 in the pediatric hematology-oncology wards and outpatient units of a university hospital. The study was implemented in a university hospital in Turkey between March 2023 and November 2023. Data were collected through face-to-face interviews with children and adolescents attending the clinic or outpatient clinic. Data were collected using the information form and General Self-Efficacy Scale psychometric tests, Cronbach's alpha, Test-retest, validity and reliability analysis). Item-total score correlation was used. ResultsIn the exploratory factor analysis, Kaiser Meyer Olkin was p 0.77, for which Bartlett's test of sphericity was significant (p < 0.001). Exploratory factor analysis revealed a ten-item unidimensional structure with satisfactory representation. Item-total score correlations of the scale ranged between 0.32 and 0.52. In the confirmatory factor analysis, the model fit indices of this scale were obtained as follows: χ2/sd = 1.36, Goodness-of-Fit Index = 0.94, Comparative Fit Index = 0.92, Adjusted Goodness-of-Fit Index = 0.90, and Cronbach alpha value, indicating the internal consistency of the entire scale, was 0.76. ConclusionsThe scale is a valid and reliable tool for assessing self-efficacy in children and adolescents between the ages of eight and eighteen undergoing cancer treatment. Practice implicationsThe study will provide precious information for experimental interventions and follow-up studies to assess the self-efficacy of children and adolescents with cancer.

Healthcare migration in Italian paediatric haematology-oncology centres belonging to AIEOP

BackgroundIn Italy, there is a network of centres headed by the Italian Association of Pediatric Hematology and Oncology (AIEOP) for the diagnosis and treatment of paediatric cancers on almost the entire national territory.Nevertheless, migration of patients in a hospital located in a region different from that of residence is a widespread habit, sometimes motivated by several reasons.The aim of this paper is to assess the impact of migration of children with cancer to AIEOP centres in order to verify their optimal distribution throughout the national territory.MethodsTo this purpose, we used information on 41,205 registered cancer cases in the database of Mod.1.01 Registry from AIEOP centres, with age of less than 20 years old at diagnosis, diagnosed from 1988 to 2017.Patients’ characteristics were analysed and compared using the X2 or Fisher’s exact test or Mann–Whitney test, when appropriate.Survival distributions were estimated using the method of Kaplan and Meier, and the log-rank test was used to examine differences among subgroups.ResultsExtra-regional migration involved overall 19.5% of cases, ranging from 23.3% (1988–1997) to 16.4% (2008–2017) (p < 0.001).In leukaemias and lymphomas we observed a mean migration of 8.8% overall, lower in the North (1.2%) and Centre (7.8%) compared to the South & Isles (32.3%).In the case of solid tumours, overall migration was 25.7%, with 4.2% in the North, 17.2% in the Centre and 59.6% in the South & Isles.For regions with overall levels of migration higher than the national average, most migration cases opted for AIEOP centres of close or even neighbouring regions.Overall survival at 10 years from diagnosis results 69.9% in migrants vs 78.3% in no migrants (p < 0.001).ConclusionsThere is still a certain amount of domestic migration, the causes of which can be easily identified: migration motivated by a search for high specialization, migration due to lack of local facilities, or regions in which no AIEOP centres are present, which makes migration obligatory.Better coordination between AIEOP centres could help to reduce so-called avoidable migration, but technical and political choices will have to be considered, with the active participation of sector technicians.

Çocukluk çağı Kronik ve Persistan Lenfadenopatilerin Ultrason ve Laboratuvar Veriler eşliğinde Öngörülebilirliği; Bir Çocuk Hematoloji-Onkoloji Polikliniği Deneyimi

Aim:&#x0D; Lymphadenopathies occupy an important part of pediatric hematology-oncology practice. More than 95 per cent of cases are known to be reactive, and infection-related. Lymphadenopathies are followed up at 1-3-6 month intervals, and the process requires ultrasound follow-up. Our study aimed to compare the persistent and non-persistent cases.&#x0D; Results: In our study, lymphadenopathy cases (n=93) admitted to our pediatric haematology-oncology outpatient clinic between 2022-2023 were examined and diagnosed; reactive lymph nodes (n=76)(81. 7%), infectious mononucleosis (n=9)(9. 7%), tuberculosis (n=1)(1%), lymphoma (n=2)(2%), benign cytology (n=2)(2%). Mean age ± standard deviation (SD); 8. 2±4. 4, number of girls; 42 (45. 2%). The median time to resolution of acute (n=8)(8. 6%), subacute (n=26)(28%), chronic (n=59)(63. 4%) lymphadenopathy was 1 [5-155] week. Cases with and without ultrasonographic disappearance of lymphadenopathy were compared; the mean hemoglobin value (g/dL) (12. 7±1. 4 vs. 12. 3±1. 2, respectively) (p=0. 047) and platelet value (x10³/mm³) (334. 2±108. 012 vs. 288. 4±89. 5, respectively) (p=0. 047) were higher and the presence of hilar vascularity on ultrasonography (76% vs. 98. 1%) (p=0. 001) was LOWER in those who disappeared compared to those who did not disappear. There was no correlation between hypoechoic lymph node, indistinct border, necrosis, fatty hilus, perinodal cortical vascularity, cortical thickening, presence of lymph node in more than one region and non-loss of lymph node.&#x0D; Conclusion: In conclusion, it has been shown that in the presence of lymphadenopathy, elevated hemoglobin and platelets, together with the presence of hilar vascularity, may be predictive findings in the failure of the lymph node to disappear.&#x0D; Key words: lymphadenopathy, ultrasonography, haemoglobin, platelets, childhood

Application of the Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to guide the empiric antibiotic treatment of febrile neutropenia in oncological paediatric patients: experience from two paediatric hospitals in Northern Italy

BackgroundGuidelines about febrile neutropenia in paediatric patients are not homogeneous; the best empiric treatment of this condition should be driven by local epidemiology. The Weighted-Incidence Syndromic Combination Antibiogram (WISCA) addresses the need for disease-specific local susceptibility evidence that could guide empiric antibiotic prescriptions based on outcome estimates of treatment regimens obtained as a weighted average of pathogen susceptibilities. This study developed a WISCA model to inform empirical antibiotic regimen selection for febrile neutropenia (FN) episodes in onco-haematological paediatric patients treated at two Italian paediatric tertiary centres.MethodsWe included blood cultures from patients with a bloodstream infection and neutropenia admitted to the Paediatric Haematology-Oncology wards in Padua and Genoa Hospitals from 2016 to 2021. WISCAs were developed by estimating the coverage of 20 antibiotics as monotherapy and of 21 combined regimens with a Bayesian probability distribution.ResultsWe collected 350 blood cultures, including 196 g-negative and 154 g-positive bacteria. Considering the most used antibiotic combinations, such as piperacillin–tazobactam plus amikacin, the median coverage for the pool of bacteria collected in the study was 78%. When adding a glycopeptide, the median coverage increased to 89%, while the replacement of piperacillin–tazobactam with meropenem did not provide benefits. The developed WISCAs showed that no monotherapy offered an adequate coverage rate for the identified pathogens.ConclusionsThe application of WISCA offers the possibility of maximizing the clinical utility of microbiological surveillance data derived from large hospitals to inform the choice of the best empiric treatment while contributing to spare broad-spectrum antibiotics.

Evaluation of non-research and research industry payments to pediatric hematologist/oncologists in the United States between 2013 and 2021

Financial interactions between healthcare industry and pediatric hematologist/oncologists (PHOs) could be conflicts of interest. Nevertheless, little is known about financial relationships between healthcare industry and PHOs. This cross-sectional analysis of the Open Payments Database examined general and research payments to PHOs from healthcare industry in the United States between 2013 and 2021. Payments to the PHOs were analyzed descriptively. Trends in payments were assessed using generalized estimating equation models. Of 2784 PHOs, 2142 (76.9%) PHOs received payments totaling $187.3 million from the healthcare industry between 2013 and 2021. Approximately, $46.3 million (24.8%) were general payments and $137.7 million (73.5%) were funding for research where PHOs served as principal investigators (associated research funding). Both general payments and associated research funding considerably increased between 2014 and 2019. The number of PHOs receiving general payments and associated research funding annually increased by 2.2% (95% CI: 1.2–3.3%, p < .001) and 5.0% (95% CI: 3.3–6.8%, p < .001) between 2014 and 2019, respectively.

Posterior reversible encephalopathy syndrome in immunocompromised children - A single-center study from South India.

This study describes the profile of children diagnosed with posterior reversible encephalopathy syndrome (PRES) in the pediatric hematology oncology unit and highlights the clinical features of PRES in immunosuppressed children. This retrospective study included 10 children diagnosed with PRES with a mean age of 6.8 years. Acute lymphoblastic leukemia was the most common primary diagnosis followed by post-hematopoietic stem cell transplant patients. Most cases of PRES occurred within one month of treatment initiation. Hypertension was noted in all at the time of diagnosis. Neuroimaging revealed bilateral lesions with parietal and occipital lobe involvement being the most common. All patients received corticosteroids as part of treatment for primary diagnosis. Controlling blood pressure was critical in managing PRES. Consideration of PRES as a clinical possibility in pediatric hematology oncology unit in children presenting with symptoms such as headache, seizures, and visual disturbances will aid in early diagnosis after ruling out other causes of these symptoms.

(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.

Child Health and the Pediatric Hematology-Oncology Workforce: 2020-2040.

Pediatric hematology-oncology (PHO) is 1 of the oldest recognized pediatric subspecialities. PHO physicians care for infants, children, adolescents, and young adults with all types of cancer and nonmalignant blood conditions, in many cases temporarily assuming the role of a primary care physician because of the complexity and intensity of treatment. However, the number of clinically active PHO subspecialists needed to care for children in the United States remains unknown. Recent papers suggest a potential oversaturation of PHO physicians in some geographic areas. This article is part of a Pediatrics supplement focused on projecting the future supply of the pediatric subspecialty workforce. It draws on information available in the literature, data from the American Board of Pediatrics, and findings from a new microsimulation model estimating the future supply of pediatric subspecialists through 2040. The model predicts a workforce growth in PHO subspecialists of 66% by 2040. Alternative scenarios, including changes in clinical time and fellowship size, resulted in a difference in growth of ±18% from baseline. The model also forecasts significant geographic maldistribution. For example, the current workforce is concentrated in the Northeast Census region and the model predicts the New England Census division will have a 2.9-fold higher clinical workforce equivalent per 100 000 children aged 0 to 18 years than the Mountain Census division by 2040. These findings suggest potential opportunities to improve the PHO subspecialty workforce and the outcomes and experiences of its patient population through educational changes, practice initiatives, policy interventions, and dedicated research.

Forecasting the Future Supply of Pediatric Subspecialists in the United States: 2020-2040.

Concerns persist about whether the United States has an adequate supply of pediatric subspecialists and whether they are appropriately distributed across the nation to meet children's health needs. This article describes the data and methods used to develop a workforce projection model that estimates the future supply of 14 pediatric subspecialities certified by the American Board of Pediatrics at the national and US census region and division levels from 2020 to 2040. The 14 subspecialties include adolescent medicine, pediatric cardiology, child abuse pediatrics, pediatric critical care medicine, developmental-behavioral pediatrics, pediatric emergency medicine, pediatric endocrinology, pediatric gastroenterology, pediatric hematology-oncology, pediatric infectious diseases, neonatal-perinatal medicine, pediatric nephrology, pediatric pulmonology, and pediatric rheumatology. Hospital medicine was excluded because of the lack of historical data needed for the model. This study addresses the limitations of prior models that grouped adult and pediatric physician subspecialty workforces together and aggregated pediatric subspecialties. The model projects supply at national and subnational levels while accounting for geographic moves that pediatric subspecialists make after training and during their career. Ten "what if" scenarios included in the model simulate the effect of changes in the number of fellows entering training, the rate at which subspecialists leave the workforce, and changes in hours worked in direct and indirect clinical care. All model projections and scenarios are available on a public, interactive Web site. The model's projections can also be examined with other data to provide insight into the possible future of the pediatric subspecialty workforce and offer data to inform decision-making.

The Prediction of Health Literacy of Parents Who Have Children with Cancer on Their Healthcare Satisfaction

Purpose: This study was a descriptive and cross-sectional study to examined the prediction of health literacy of parents having children with cancer on the healthcare satisfaction.&#x0D; Methods: The descriptive and cross-sectional study was conducted between January and May 2019 and included 207 parents who had children treated at the pediatric hematology-oncology unit of a university hospital. A parental information form, the Health Literacy Index, and the Pediatric Quality of Life (PedsQL) Inventory Healthcare Satisfaction Hematology/Oncology Module parental report was used to collect the data. Percentage calculations, mean values, Pearson’s correlation analysis, linear regression analysis, and multiple correlation analysis were used to analyze the data. &#x0D; Results: According to the relationship between variables in regression analysis, five models were created. Each subscale in the Health Literacy Index was identified as a separate model. In the last model, the effect of the total score of the Health Literacy Index on PedsQL Healthcare Satisfaction Hematology/Oncology Module was determined. According to these models, healthcare satisfaction increased as the health literacy subdimension scores and total scores increased. Increased scores of the Health Literacy Index were found to promote healthcare satisfaction. &#x0D; Conclusion: The ability of parents to manage their children’s disease process and daily life activities becomes better as their health literacy levels increase.

Letermovir for Cytomegalovirus infection in pediatric patients undergoing allogenic hematopoietic stem cell transplantation: a real-life study by the Infectious Diseases Working Group of Italian Association of Pediatric Hematology-Oncology (AIEOP).

Letermovir prophylaxis revolutionized the approach to Cytomegalovirus infection in adult hematopoietic stem cell transplant (HCT), while data in pediatric setting are still lacking. We retrospectively analyzed 87 HCT children transplanted in 11 AIEOP centers receiving letermovir as off-label indication between January 2020 and November 2022. Letermovir was used as primary, secondary prophylaxis or CMV treatment in 39, 26 and 22 cases, respectively; no discontinuation due to toxicity was reported. Median duration was 100 days (14-256) for primary and 96 days (8-271) for secondary prophylaxis, respectively. None of the patients experienced CMV-clinically significant reactivation during Letermovir primary prophylaxis; one patient developed breakthrough infection during secondary prophylaxis, and 10 and 1 patient experienced asymptomatic CMV-reactivation and CMV-primary infection after drug discontinuation, respectively. Median duration of letermovir in CMV treatment was 40 days (7-134), with 4/22 patients suffering CMV-pneumonia, with an overall response rate of 86.4%. With a median follow-up of 10.7 months (8.2-11.8), estimated 1-year overall survival was 86%; no CMV-related deaths were reported in prophylaxis groups. This is the largest report on Letermovir use in pediatric HCT; real-life data confirm an excellent toxicity profile, with high efficacy as CMV prophylaxis; results in CMV-infection treatment should be investigated in larger, prospective trials.

The use of routinely collected electronic prescribing data to benchmark intravenous antibiotic use between two tertiary paediatric haematology-oncology inpatient units: a retrospective study.

High-quality systematic data on antimicrobial use in UK inpatient paediatric haematology-oncology services are lacking, despite this population being at high risk from antimicrobial exposure and resistance. We conducted a retrospective study to demonstrate how routinely collected electronic prescribing data can address this issue. This retrospective study describes and compares IV antibiotic consumption between two UK paediatric haematology-oncology inpatient units, between 2018 and 2022. Both sites provide similar services and receive proactive antimicrobial stewardship input. Data were extracted from each site's antimicrobial surveillance system, which report monthly days of therapy (DOT) per 100 patient-days (PD). Consumption was reported for specific and total antibiotics. Trends were modelled using linear regression and autoregressive moving average models. Total IV antibiotic consumption at each site was similar. Median monthly DOT per 100 PD were 25.9 (IQR: 22.1-34.0) and 29.4 (24.2-34.9). Total antibiotic use declined at both sites, with estimated annual yearly reductions of 3.52 DOT per 100 PD (95% CI: 0.46-6.59) and 2.57 (1.30-3.85). Absolute consumption was similar for carbapenems, piperacillin/tazobactam and aminoglycosides, whilst ceftriaxone and teicoplanin demonstrated approximately 3-fold relative differences in median monthly consumption. Meropenem, piperacillin/tazobactam, teicoplanin, vancomycin and gentamicin all demonstrated statistically significant reductions in use over time at either one or both sites, although this was most marked for piperacillin/tazobactam and vancomycin. Routinely collected electronic prescribing data can aid benchmarking of antibiotic use in paediatric haematology-oncology inpatients, highlighting areas to target stewardship strategies, and evaluating their impact. This approach should be rolled out nationally, and to other high-risk groups.

The effect of virtual reality on pain, fear and emotional appearance during blood draw in pediatric patients at the hematology-oncology outpatient clinic: A randomized controlled study

ObjectiveInvasive attempts can be very painful and stressful for pediatric patients. Virtual Reality (VR) can be used to distract patients undergoing such procedures in pediatric hematology oncology patients. MethodsA parallel trial design approach was adopted for this randomized controlled trial, guided by the CONSORT checklist. The study sample (n = 69) was divided into a VR group (n = 34) and a control group (n = 35) using stratified randomization. For the blood draw attempt, no distraction method was applied to the control group, while the children in the VR group were distracted from the procedure with the Epic Roller Coasters VR application. The primary variable assessed was pain, while secondary variables were fear and emotional appearance. The scores of emotional appearance, fear, and pain were compared with a Mann-Whitney U Test. ResultsThe pre-procedure emotional appearance score was 11.3 ± 4.3 in the VR group and 11.0 ± 5.0 in the control group, and the post-procedure score was 6.5 ± 3.3 in the VR group and 11.8 ± 5.3 in the control group, indicating a difference in emotional appearance after the procedure. VR group had lower negative emotional appearance, lower pain, and lower fear scores after procedure compared to the control group. ConclusionVR can be considered an effective approach to reducing the negative emotional appearance and for relieving pain and fear in children aged 4–12 years undergoing blood draw procedures in pediatric hematology and oncology outpatient unit (ClinicalTrials.gov: NCT05675358).