Pediatric 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.

Current approaches in development and implementation of medical education strategies among pediatric hematology/oncology fellowship programs

Application of evidenced-based practices is often lacking in medical education. Increased recognition that methods of knowledge delivery based in relevant learning theories are more effective has led to improved ability to meet the needs of adult learners. We designed a study to assess approaches to education for Pediatric Hematology/Oncology (PHO) trainees and identify opportunities for incorporation of evidence-based practices. A national survey was shared with program directors (PDs) of PHO programs to investigate current trends in education design. Respondents were contacted via email, the survey was distributed by REDCap, and data were collected from April-July 2023. Quantitative data were analyzed descriptively and free-text responses using directed content analysis. Of the 77 eligible participants, 46 completed the survey (59.74% response rate), representing various geographic regions and class sizes. Respondents reported a wide range of familiarity with adult learning theory (range 1–5, median 3) and self-regulated learning (range 1–5, median 2). While programs employed active learning strategies to varying degrees, the lecture format was the most used method of education delivery. PDs recognized the need for development in several domains, including incorporation of educational frameworks, support for structure and content of didactics, and implementation of feedback related to education sessions. Differences in approaches were described, revealing a wide range of familiarity with and application of specific educational theories, as well as inconsistent efforts to consider principles of adult learning theory and self-regulated learning. These data demonstrate opportunities for targeted education and curriculum development.

Blood component-associated acute transfusion reactions in pediatric patients: experience of a tertiary care hospital.

The transfusion of blood products is a life-saving clinical practice in patients with bleeding, hemoglobinopathy, and cancer. It was aimed herein to analyze the frequency and types of blood component-related acute transfusion reactions (ATRs) in pediatric patients. This retrospective study was conducted at a tertiary care academic pediatric hospital. During the study period, 30,811 transfusions were administered to 25,448 patients. There were 103 ATRs detected in 81 patients (0.33%; 3.34 reactions per 1000 transfusions, mean age 8.3 ± 5.98 years, 36 females and 45 males). All the reactions were observed within an average of 4 h after the transfusion began. The most common ATRs were allergic reactions (79; 76.6%) and febrile nonhemolytic transfusion reactions (12; 11.6%). All the allergic transfusion reactions occurred within the first hour after the start of the transfusion. Granulocyte concentrates were the blood component associated with the highest ATR rate (2.1%). Within our hospital, pediatric hematology-oncology wards and the stem cell transplantation unit had the most frequent ATR reports; therefore, when transfusions are carried out, increased attention should be given to these units. Educating health staff about the adverse effects of transfusion therapy should increase the awareness and reporting of ATRs in children.

Successful Development and Implementation of Communication Skills Simulation Training Within Pediatric Hematology-oncology Fellowship Education.

Difficult discussions with patients and families are a primary component of pediatric oncology care. We report our experience in the development and implementation of a longitudinal simulation-based Communication Skills Curriculum within a pediatric hematology-oncology fellowship training program. A 6-session simulation curriculum was created for fellows to practice difficult oncology related discussions with a standardized patient (SP). This program was implemented in 2017 and continues presently. Throughout fellowship training the scenarios progress in content and scope. Each simulation was observed and recorded, and written and verbal feedback was provided. The Gap-Kalamazoo Communication Skills Assessment Form was used to assess communication skills in each session. A total of 15 fellows (100% of possible participants) have participated in this curriculum to date. Across all domains of communication skills assessed, the ratings given by the physician evaluators and self-evaluations improved over the course of the scenarios completed throughout fellowship training. This type of simulation-based communication skills curriculum within a pediatric hematology-oncology fellowship training program is feasible to implement. This training is useful to fellows beyond training in improving communication skills, which has the potential to directly benefit the future patients they care for.

Clinico-Epidmological Study and Outcome of COVID 19 Infection in Children with Hemato-Oncological Disorders

Abstract Background Severe acute respiratory syndrome Coronavirus 2 (SARS-Cov2) outbreak has caused a pandemic rapidly impacting on the way of life of the entire world. Several studies reported the specific role of an immunocompromised status as a possible risk factor for CoV-related pneumonia. The detrimental impacts of COVID-19 pandemic on childhood cancer are multiple including a delay in diagnosis and starting treatment, the impact of infection, and the uncertainty about the decision for chemotherapy in polymerase chain reaction–positive asymptomatic patients. Aim of the Work The study aimed to Measure the frequency of COVID-19 infection among children with hemato-oncological disorder in a period from 27 February 2022 till 27 March 2023 and to develop a registry dataset which can be used as a template for national registry for children with hemato-oncological disorder with proven COVID19 infection. Patients and Methods This is a retrospective cohort non-interventional study in which we recruited 620 child and adolescents patients who attended the pediatric hematology oncology unit, Ain Shams University, Children’s hospital in a period from 27 February 2022 till 27 March 2023. Results This is a cohort study included 620 immunocompromised children including 319 patients with hematological malignancies, 30 patients with solid malignancy, 271 patients with benign hematology. Our findings showed that 620 patients, 87 of them were found to be COVID-19 positive. The median age of COVID-19 the patients was 5 years (range: 0.75–16 years). The median duration of COVID-19 positivity of the patients was 12 days (range: 3–38 days). There was significant increase in the percentage of patients with positive chest X-ray, abnormal echo, patients with organomegaly in abdominal US in COVID-19 group than non COVID-19 group. Conclusion The percentage of patients with COVID-19 were higher among patients with hematological malignancies and benign hematological diseases especially acute lymphoplastic leukemia and aplastic anemia respectively. COVID-19 was tolerable among immunocompromised patients. Mortality was associated with abnormal neurological examination in patients with COVID-19 disease.

Improving childhood cancer care in South Africa using the Paediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool

Aim Using the St. Jude Paediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool, the South African Association of Paediatric Haematology Oncology (SAAPHO) collaborated with St Jude Children’s Research Hospital to evaluate the delivery of health services and provide evidence-based assessments to inform and prioritise action plans to improve childhood cancer care. Methods PrOFILE was used to assess paediatric oncology care in thirteen public-sector hospitals comprehensively. Following that, representatives from each of the thirteen public-sector hospitals and from SAAPHO, the National Department of Health, the World Health Organization, St. Jude Global, and Childhood Cancer Foundation South Africa participated in a national stakeholder prioritisation workshop. Participants were assigned one of the PrOFILE components (Context, Workforce, Diagnostics, Multidisciplinary Team, Therapy, or Patients and Outcomes), forming six working groups to assess, map, and evaluate childhood cancer topics. Using a modified implementation mapping approach and through participation in structured co-designed activities, each group designed multi-level health interventions: prioritising initiatives identified by the SAAPHO, setting goals for each priority, co-designing project-specific logic models, reviewing potential barriers to implementation, and developing a post-workshop agenda. Results Individual hospital reports and a national aggregate report were compiled to discuss opportunities and priorities. The goal of the workshop was to utilise evidence-based assessments to achieve, a) objective assessment data to inform prioritisation exercises conducted by stakeholders, and b) priorities and action plans to inform childhood cancer control activities and demonstrate national organisation, human resources capabilities, and technical support to improve childhood cancer care. Through structured discussion and voting, six priority areas were identified and assigned to working groups: redrafting the organisation’s constitution, standardising multidisciplinary reporting, developing protocols and treatment guidelines, establishing fever-management guidelines, strengthening chemotherapy safety practices, and enhancing hospital-based cancer registries. Conclusions An implementation map enabled stakeholders to develop actionable plans, the success of which is demonstrated by the active implementation of the identified priorities by the focused working groups. This could serve as a model for countries with identified priorities but need more means to implement them. Based on mapping and outputs from the PrOFILE workshop, the NDoH will facilitate the creation of a childhood cancer committee to sustain progress on the key themes and priorities identified through the PrOFILE mapping process.

Palliative Care Services for Children with Cancer, Current Situation, and Areas of Improvement

Abstract Background Pediatric palliative care is a holistic approach that aims to enhance the quality of life of seriously ill children and their families. Despite the documented benefits, many barriers challenge early integration of such care. Objective The primary aim of the study is to evaluate the current situation of palliative care services for pediatric oncology patients from patient’s, parents’ and physician’s perspective and the secondary aim is to highlight the areas of improvement of palliative care services to provide better quality of life for pediatric oncology patients. Methodology A Cross-sectional questionnaire-based study was conducted on 80 parents/caregivers and young patients, in addition to all health care providers in the pediatric hematology/oncology unit at the Pediatric Hematology/Oncology Unit, Children's Hospital, Ain Shams University over six months. A validated Arabic version for PedsQL4 questionnaire was distributed to patients and/or their parents if feasible. The PedsQL is a 23-item instrument and consists of four domains: physical (eight items), emotional (five items), Social (five items), and School (five items) functioning. A 25 questions questionnaire was offered to physicians in the pediatric hematology oncology unit and other specialties treating hematology oncology patients. The questionnaire was based on review of literature, it was validated and offered to 3 physicians to check the applicability of the questionnaire. The physician perception section of the questionnaire covered confidence in and need for PPC, perceived appropriate referral timing of and barriers to PPC. Results The current study included the response of 19 parents of 2-4 years old children, 22 parents of 5-7 years old, 23 parents of 8-12 years old and 17 parents of 13-18 years old. Starting age of 5-12 yrs old children also reported their input. The mean score of physical domain was (69.1±21.1, 58.1±23.91, 66.47±26.48, 54.75±27.85, 60.87±27.05, 47.85±22.95, 52.2±24.40) respectively. The mean score of emotional domain (33.76±21.3, 33.86±26.0, 43.18±34.55, 48.92±29.30, 54.62±31.53, 35.3±24.58, 36.76±21.71) respectively. The mean score of social domain (78.92±19.8, 69.54±18.05, 77.28±24.91, 71.74±19.74, 79.14±19.28, 65.88±25.32, 67.94±24.56) respectively. Most school aged patients were home schooled. The worst reported score was the emotional domain especially among (13-18 years) as fear, anger and sadness were mostly reported by both parents and children. Among physicians involved with pediatric oncology patients, the response rate was 62%. All reported the lack of well- structured PPC service and the lack of specialty training in palliative care. The most common reported barrier was the lack of institutions offering PPC as well as the lack of trained manpower. Other common reported barrier was physicians` and parents` perception towards palliative care either physicians giving up or caregivers insisting on continuation of standard treatment. Almost half of physicians see that initiation of palliative care and home based palliation is necessary, 70% did not recommend referring to adult PC centers with the main concern being the lack of experience and knowledge of such centers with pediatric age group. Conclusion PPC is an essential element of care in patients with malignancy. The lowest score for quality of life were mainly for emotional domain as patients reported fear and worry from the disease prognosis. PPC is not a well established service in our center with most physicians considering PPC as equivalent to end of life care only. The main barrier was lack of manpower and PPC specialized institutions. To improve or initiate this service, specialty training in PPC is a with designation of team of health care professionals (nurse, pediatric oncologist, pain specialist).

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.

The Predictive Power of Religious Coping on Care Burden, Depression, Stress, and Anxiety of Parents of Pediatric Oncology Patients in Turkey.

This study aimed to determine the predictive power of religious coping of parents of children with canceron caregiver burden, depression, anxiety, and stress in Turkey. It was designed as a descriptive and cross-sectional study, utilizing correlational analysis and regression models to explore associations between variables. Data were collected from 164 parents in the pediatric hematology-oncology clinics of a university hospital between November 2023 and March 2024. There was a negative correlation between caregiver burden score and negative and positive religious coping scores. Caregiver burden scores werepositively correlated with depression, anxiety, and stress scores. Results indicated that caregiver burden, education level, employment status, family structure, family income, and age at diagnosis significantly predicted positive religious coping. For negative religious coping, caregiver burden, education level, family structure, and family income were significant predictors. This suggests that religious coping may help reduce caregiver burden, underscoring the importance of promoting constructive coping strategies to support caregivers' well-being.

The role of the mental health nurse in pediatric hematology-oncology - Part 1: Developing an innovative practice.

Pediatric hematological and oncological illnesses present many coping challenges. Mental health issues can arise during and after treatment, in both patients and their families. The current model of care does not always seem to meet the needs identified by some young patients. In Quebec, nurses are allowed to assess and care for patients experiencing physical and mental health difficulties (Ordre des infirmières et infirmiers du Québec, 2016). Therefore, a mental health nurse clinician (MHNC) with experience in pediatric hematology/oncology could provide care that is complementary to that offered by psychologists, social workers, and other psychosocial professionals in the pediatric hematology/oncology unit in order to meet any needs that remain unmet. The MHNC project has three stages: (1) role development, (2) role implementation, and (3) role assessment one year after implementation. In this first article, we explain how the MHNC role was developed. We used the participatory, evidence-based, patient-focused process for advanced practice nursing (APN) role development, implementation, and evaluation (PEPPA Framework; Bryant-Lukosius & Dicenso, 2004) to develop this model. The first five steps in the PEPPA Framework were applied in the creation of the MHNC role to (1) select the target population, (2) identify the stakeholders to be involved, (3) ascertain needs, (4) determine and prioritize problems and set goals, and (5) define a new model of care. After multiple meetings involving numerous health professionals and managers, the MHNC role was developed with a versatile, transdisciplinary perspective to address better the needs of young cancer patients (especially those in their teens) and their families. The role was developed around four main areas of practice: (1) interventions offered to patient-family, (2) interventions offered to health professionals, (3) psychiatric consultation-liaison, and (4) education and research. The next steps are to use a strategic plan to implement the role and then to evaluate the impact of the role one year after implementation.

Approach to Mycosis Fungoides in children: Consensus-based recommendations

Pediatric Mycosis fungoides (MF) management extrapolates from adult guidelines, despite differing clinical aspects. Recommendations are essential to address unique challenges in this distinct patient group. This project aims to derive consensus recommendations for pediatric MF management. Experts from pediatric dermatology, general dermatology, dermatopathology, and pediatric hematology-oncology (N=83) were invited to contribute to consensus recommendations. The process involved 3 electronic Delphi rounds, concluding with a final consensus meeting using a modified Nominal Group Technique for unresolved items. Consensus included more clinical severity measures than tumor-node-metastasis-blood staging: pruritus, functional or esthetic impairment (eg, palms, soles, genitalia), quality of life impact, and psychological aspects (eg,embarrassment, anxiety, depression), plus parental anxiety. Ten recommendations were made for managing early and advanced pediatric MF. Disagreement emerged in choosing therapies beyond stage I of the disease. This multinational initiative aimed to standardize optimal pediatric MF management and successfully generated consensus recommendations. Additional work is needed for structured, prospective protocols in advanced-stage pediatric MF. Lack of pediatric hematologists-oncologists and patients' representatives. Documentation of extended clinical severity and outcome measures is recommended. Addressing the need for structured protocols in advanced-stage pediatric MF and implementing systematic, prospective data collection is crucial.

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”.

Effectiveness of an Educational Program on Improving Nursing Care for Thalassemia Patients Undergoing Blood Transfusion

Background: Thalassemia is a genetic disorder that disrupts hemoglobin production, leading to severe anemia. Beta-thalassemia major patients often require lifelong blood transfusions. Nurses play a crucial role in managing these transfusions, but gaps in knowledge and practice can lead to complications. This study assessed the impact of an educational program on nurses' knowledge and skills regarding thalassemia and blood transfusion protocols. Methods: A quasi-experimental study was conducted at the Jin Pediatric Hematology-Oncology Center in Duhok City, Iraqi Kurdistan. The sample included 20 nurses. The program consisted of four sessions (two theoretical and two practical). Data collection instruments included a socio-demographic sheet, a knowledge questionnaire, and a skills checklist. Pre- and post-intervention knowledge and practice scores were analyzed using paired t-tests and chi-square tests. Results: The educational program significantly improved nurses' knowledge of thalassemia (P &lt; 0.00) and transfusion protocols, with the mean knowledge score increasing from 5.2 ± 2.09 to 8.05 ± 1.82. Practice scores also showed statistically significant improvements (P &lt; 0.002). Correlations between total knowledge and practice scores, as well as with nurses' experience and educational level, were statistically significant. Conclusion: The study demonstrated that an educational program can enhance nurses' knowledge and practices in managing thalassemia patients undergoing blood transfusions. Continued education and targeted interventions are essential to improving the quality of care for these patients.

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.

Survival rates and extra-regional migration patterns of children and adolescents with cancer in Italy: The 30-year experience of the Italian Association of Pediatric Hematology and Oncology (AIEOP) with the Italian hospital-based registry of pediatric cancer (Mod. 1.01).

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

Health Related Quality of Life and Psychosocial Profile of Patients with Sickle Cell Disease and Their Caregivers

Abstract Background Sickle cell disease (SCD) is a chronic, debilitating disorder can negatively affect health-related quality-of-life (HRQoL) outcomes in SCD. Aim of the Study Primary objective was to assess the prevalence of impaired psychosocial profile and poor HRQoL among SCD patients and their caregivers in comparison to age and sex matched controls, while secondary objective was to determine the association of such impairment if any with parameters of disease severity. Methods An observational, case control study recruited sixty-five children and adolescent with confirmed SCD, conducted at Paediatric Haematology Oncology clinic, Ain Shams University, Egyptfrom1st of August 2020 to 28th of February 2021. Demographic and clinical data were collected, and thorough clinical and psychiatric assessments were conducted. Quality-of-life (QoL) of both children and their caregivers were performed compared to 65 matched healthy control. Results sixty five children and adolescents with confirmed SCD were included; there were 34 (52.3%) boys and 31 (47.7%) girls and their mean age was 11.40 ± 3.55. Most patients 44(67.7%) had sickle HbSβ+-thalassemia, the most frequent manifestations were vasoooclusive crises in 24 (36.9%) patients, The most common causes for hospital admission were pain crisis in 14 (33.3%) patients and vasoocclusive crisis in 14 (33.3%). Results indicated that patients with SCD and their caregivers had depression and anxiety symptoms scores more than reported in control group.Sickle children had significantly less self-esteem and quality of life than control children, least scores in s ick le c hild re n Q O L wer e in co mmunica t io n do ma in. These were s ignific a nt ne ga t ive consequences, advanced age, duration of illness, number and duration of hospitalizations, disease severity score and occurrence of complications were associated with psychological disorders. Conclusion The QOoL of children suffered from SCD and their caregivers is adversely affected necessitate implementation of interventions which focus on reducing depressive symptoms, enhancing self-esteem and QoL.

An expert consensus on prevention, diagnosis, and management of hemorrhagic cystitis in pediatric hematopoietic cell transplantation, on behalf of the Infectious Disease and Hematopoietic Cell Transplant Working groups of Italian Pediatric Hematology Oncology Association (AIEOP).

The optimal management of hemorrhagic cystitis (HC) in hematopoietic stem cell transplantation (HCT) is debated, both for early onset HC (EOHC) secondary to chemotherapy toxicity and BK Polyomavirus (BKPyV)-related HC, due to the lack of controlled trials, particularly referred to pediatric setting. Actually, clinical practice is mainly based on guidelines of the European Conference on Infections in Leukemia, 6th edition, which considers both adult and pediatric populations but concludes that, despite much progress in understanding the pathogenesis, epidemiology, and risk factors, this complication still represents a disabling unmet clinical need with limited prophylactic and therapeutic options. Additionally, the Guidelines of the American Society of Clinical Oncology define the management of chemotherapeutic toxicity independently from the patients' population. A panel of experts belonging to the Hematopoietic Cell Transplant and Infectious Disease Working Group (WG) of Associazione Italiana di Emato-Oncologia Pediatrica (AIEOP) developed a consensus to define the best practices in prevention, diagnosis, and management of HC in pediatric HCT setting.

Predictors of Moderate-High Posttraumatic Growth in Parents of Children With Cancer: A Cross-sectional Study.

Parents of children with cancer may experience posttraumatic growth (PTG). In clinical practice, this parental enhancement is more likely to be seen with a moderate-high PTG. The aim of this study was to determine the moderate-high PTG prevalence of parents of children diagnosed with cancer at least 6 months and to investigate its relationship with hope, social support, and patient-parent characteristics. This cross-sectional study was conducted with the parents of children with cancer admitted to the pediatric hematology-oncology unit using the Parent-Child Characteristic Questionnaire, Posttraumatic Growth Inventory, Multidimensional Scale of Perceived Social Support and Dispositional Hope Scale. Univariate and multivariate logistic regression analyses were performed to investigate the variables associated with moderate-high PTG. One hundred one parents were enrolled in this study, and the prevalence of the moderate-high PTG was 79.2%. There was a statistically significant difference between moderate-high PTG and children's age (P = .037). Multivariate logistic regression analysis showed that social support from significant others (odds ratio = 1.138, 95% confidence interval = 1.030-1.257, P = .011) was a predictor of moderate-high PTG. Moderate-high PTG is common among parents of children diagnosed with cancer. Perceived social support from healthcare professionals and other patient parents is a predictive factor. Interventions that encourage the support of health professionals and interaction with the parents of other patients, such as peer counseling, group-based interventions, and expanding the social support network, seem to be clinically promising in helping parents to improve from the cancer experience.

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.