Journal of Pediatric Hematology/Oncology最新文献

Objectives: Although thromboembolic events are less common in children compared with adults, complications related to thromboembolism are becoming more frequent due to improved care for children with chronic illnesses. The aim of the study was to evaluate thromboembolic events in pediatric patients hospitalized in palliative care unit (PCU).

Materials and methods: The files of the patients who were hospitalized in PCU of our hospital between January 2020 and January 2023 were retrospectively analyzed. A total of 1002 hospitalizations of 449 patients were examined.

Results: The median age was 6.1 years, F/M: 214/235. We found that 83 (18.4%) patients had thrombosis. In most patients with thrombosis, the primary diseases were malignancy and trauma. During hospitalization, the median time for detecting thrombosis was 26 days (range: 1 to 180 d). We treated 67 out of 83 thrombosis patients with low-molecular-weight heparin (LMWH) for an average of 26 days, ranging from 1 to 188 days. Unfractionated heparin was used in 2 patients, while thrombolytic therapy was used in 2 patients with massive pulmonary embolism and middle cerebral artery thrombosis. None of the thromboembolic events resulted in fatality.

Conclusions: This study revealed that the frequency of thrombosis in pediatric patients hospitalized in PCU was ∼1/5, which is significantly higher than the rates observed in childhood. Catheter-related thrombosis was more frequently observed among patients with thrombosis in the PCU, with malignancy and trauma representing the most common indications for hospitalization. Our findings suggest that certain patient groups should be evaluated for prophylactic anticoagulation.

Levofloxacin is the first line antibiotic used to prevent infection in pediatric oncology patients with prolonged and profound neutropenia. These patients often receive vincristine, a critical component of therapy for leukemia and for many solid tumors. Both levofloxacin and vincristine are known to cause peripheral neuropathy (PN); however, the cumulative effect of both drugs on PN remains unknown. The objective of this study was to evaluate the incidence and extent of PN in pediatric oncology patients receiving vincristine and levofloxacin (VL) compared with vincristine alone (VA). In this retrospective cohort study, manual chart review was performed to extract demographic and clinical data for newly diagnosed patients treated at our institution between 2015 and 2020. Patients who received vincristine alone (VA) were compared with patients who received vincristine and levofloxacin (VL). There was no significant difference in the incidence of peripheral neuropathy between the 2 groups; however, the cohort exposed to vincristine and levofloxacin (VL) experienced significantly more peripheral neuropathy symptoms, had more affected categories of peripheral neuropathy, and received additional treatment for their neuropathy symptoms. Exposure to levofloxacin in addition to vincristine therapy was associated with an increased burden of peripheral neuropathy in this pediatric oncology cohort.

Background: Pediatric cancer survivors remain at risk for numerous late effects of therapy and have shown signs of advanced aging. The specific mechanisms at play are unclear but epigenetic modulation may play a role.

Methods: This cross-sectional study included 20 pediatric cancer survivors who received intensive chemotherapy with or without radiation and were a minimum of 5 years from treatment and 20 healthy biological siblings. DNA methylation patterns were analyzed from peripheral blood samples to determine epigenetic age (the difference between biological age and chronological age). Paired t test analysis or the Wilcoxon signed-rank test was used to compare results between survivors and siblings.

Results: The childhood cancer survivor cohort consisted of 12 males and 8 females; the comparative sibling cohort consisted of 8 males and 12 females. Mean chronological age was 15.2±6.28 years for survivors and 16.4±8.31 years for siblings (mean±SD). Survivors demonstrated increased epigenetic age compared with siblings (1.38±3.71 vs. -0.03±3.12 y (mean±SD), mean difference 1.41, [0.30 to 2.52], P=0.016, n=20 pairs). Patients who additionally received photon radiation demonstrated a more notable increase in epigenetic age compared with siblings (3.33±4.13 vs. 0.78±3.04 y (mean±SD), mean difference 2.55, [0.75 to 4.35], P=0.012, n=8 pairs).

Conclusions: Childhood cancer survivors demonstrate increased epigenetic age compared with their healthy siblings. Exposure to radiation was associated with further increased epigenetic age. Epigenetic modulation through DNA methylation may be a potential mechanism contributing to the aging process in childhood cancer survivors.

Background: L-asparaginase is an essential chemotherapeutic agent for treating pediatric acute lymphoblastic leukemia (ALL), but its use is commonly linked to severe complications, including pancreatitis. Pancreatic pseudocysts and panniculitis are a rare complication of L-asparaginase-induced pancreatitis.

Case presentation: We report the case of a 20-month-old girl diagnosed with pre-B ALL who developed pancreatitis, complicated by pseudocyst formation and panniculitis, following L-asparaginase therapy. The patient had clinical deterioration and the development of a mechanical ventilation requirement; septic shock was initially suspected. However, due to the appearance of cutaneous findings a few days later, radiologic investigations were performed, revealing the formation of intra-abdominal pseudocysts and subcutaneous fat necrosis. Consequently, a delayed diagnosis of pancreatitis was made, which was managed conservatively with a multidisciplinary approach. Eventually, the pseudocyst resolved with close clinical and radiologic monitoring.

Discussion: Pancreatic pseudocyst formation in pediatric oncology patients is uncommon but necessitates prompt recognition and an individualized treatment strategy. Panniculitis secondary to pancreatitis is even rarer and may serve as an early cutaneous clue to underlying pancreatic pathology. Conservative management of pseudocysts, supported by interventional radiology and close follow-up, can be effective in select cases, reducing the risk associated with surgical intervention.

Conclusion: This case underscores the importance of heightened clinical suspicion for pancreatic complications in pediatric patients receiving L-asparaginase. A multidisciplinary team approach is essential for effective diagnosis and treatment. Additional research is warranted to refine treatment guidelines for L-asparaginase-induced pancreatitis and its complications.

As of December 2022, calaspargase-pegol is the standard long-acting asparaginase formulation for patients younger than 22 years of age with acute leukemia. This 3-year retrospective evaluation compared real-world safety and efficacy of calaspargase-pegol versus pegaspargase in pediatric patients. Incidence and severity of hypersensitivity reactions, silent inactivation, and common asparaginase-associated adverse effects were collected. A total of 103 patients were included, of whom 50 received calaspargase-pegol and 58 received pegaspargase. Similar rates of symptomatic hypersensitivity reactions (20% vs. 10.3%; P=0.16) and silent inactivation (16% vs. 5.2%; P=0.18) were seen with calaspargase-pegol versus pegaspargase, respectively. However, 13 patients in the calaspargase-pegol group required conversion to short-acting asparaginase compared with 6 patients in the pegaspargase group (26% vs. 10.3%; P=0.03). Most adverse effects were comparable between the 2 groups, except for a lower rate of hyperbilirubinemia with calaspargase-pegol compared with pegaspargase (34% vs. 58.6%; P=0.01). Overall, no significant differences were found between the formulations in terms of rate of hypersensitivity reactions and silent inactivation. However, calaspargase-pegol did require more conversions to short-acting asparaginase therapy. Additional monitoring and preventative measures should be utilized to prevent calaspargase-pegol-associated adverse effects.

Iron deficiency and iron deficiency anemia (IDA) are prevalent during infancy. Timely iron prophylaxis can prevent associated irreversible complications. As part of the "Iron Like Turkey" program initiated in April 2004, iron prophylaxis is administered from the fourth month of life for at least 5 months. This study aims to evaluate the implementation of iron prophylaxis in our country and compare the effectiveness of different iron preparations used in prophylaxis. Between January 2021 and January 2024, the iron prophylaxis status of 248 healthy, full-term, breastfed infants 9 to 15 months old who were referred to the Pediatric Hematology outpatient clinic of Manisa City Hospital for various reasons was assessed. Iron prophylaxis was administered to 204 (82.3%) infants, of whom 92 (44.1%) had irregular usage. Among those receiving iron prophylaxis, 110 (53.9%) used Fe+3, while 94 (46.1%) used Sucrosomial Iron (SI). No infants received Fe+2 for prophylaxis. Iron deficiency anemia (IDA) was present in 142 (57.3%) cases. No significant difference was found between Fe+3and Sucrosomial Iron in terms of adherence and duration of prophylaxis (P>0.05). However, hemoglobin (Hb), mean corpuscular volume (MCV), ferritin, and transferrin saturation levels were significantly lower in the Sucrosomial Iron group compared with the Fe+3 group (P<0.05). Iron prophylaxis is an easy and effective method to prevent IDA. Both mothers during pregnancy and infants should receive prophylaxis on time and for an adequate duration. Further research is needed to evaluate the efficacy of different iron formulations used in prophylaxis.

Objective: Iron and vitamin B12 deficiencies remain widespread among school-age children, contributing to growth and developmental issues. This study aimed to investigate iron and vitamin B12 levels in school-age children.

Materials and methods: A cross-sectional study was conducted at a Family Medicine Unit in Istanbul. Hemogram, serum iron, total iron-binding capacity, ferritin, and vitamin B12 levels of 6 to 18-year-old children under regular follow-up were retrospectively evaluated.

Results: The study included 234 children (115 boys, 119 girls; mean age: 9.9±3.2 y). Anemia prevalence was 9.4%, significantly higher in girls (13.4%) than boys (5.2%). Iron deficiency anemia was detected in 3.4% without significant gender or age variation. Ferritin levels were below 12 ng/mL in 56.3% of cases, with a significant difference between genders. Mean vitamin B12 level was 261.5±162.9 pg/mL (boys: 217.3±173.9; girls: 275.2±151.1). Vitamin B12 deficiency affected 40.6% of children, particularly boys and those age 12 to 18 years of age (P<0.05). No correlation was found between vitamin B12 levels and other parameters except hemoglobin.

Conclusion: While anemia is more common in school-age girls, vitamin B12 deficiency has been found to be more common in adolescent boys. Regular monitoring of anemia, iron and vitamin B12 levels in school-age children is critical for a healthy future.

Background: Bloom syndrome is an autosomal recessive condition of genomic instability caused by increased sister-chromatid exchange, which results in a predisposition to a variety of cancers at a young age. The molecular alterations in Bloom Syndrome predisposing to chromosomal instability alter the expected response to and toxicities of chemotherapy in patients with this condition.

Observations: We report a 16-year-old patient with previously undiagnosed Bloom syndrome who presented with metastatic mucinous adenocarcinoma and tolerated palliative chemotherapy, initially with modified FOLFOX and subsequently with FOLFIRI, both at 50% dose reduction, without significant toxicity.

Conclusions: Dose modified multiagent chemotherapy was well tolerated in an adolescent patient with Bloom Syndrome and metastatic colorectal cancer.

Objective: In recent years, one of the most significant advancements in hemophilia treatment has been the introduction of extended half-life (EHL) factors. This study aims to identify the 50 most influential articles on EHL factor use in hemophilia treatment and analyze their key characteristics.

Methods: A comprehensive literature search was conducted without restrictions on publication date, country, or language using the Boolean operator "OR." A total of 665 documents published between 2005 and 2024 were identified from the Web of Science (WOS) Core Collection as of December 3, 2024. Articles were ranked in descending order of citation count.

Results: The 50 most-cited articles were published between 2008 and 2020, with the most productive years being 2016 and 2019, contributing 25 articles. These studies accumulated 4130 citations, averaging 82.6 citations per article. The most-cited paper, published in 2014, received 388 citations, and had the highest citation density (35.27 citations per year). The 50 articles encompassed 6 study types: reviews, phase II to III clinical trials, experimental/ex vivo studies, prospective and retrospective observational studies, and questionnaire-based studies. Review articles were the most prevalent (22 articles), while the most-cited study was a phase II to III clinical trial. No systematic reviews, meta-analyses, or randomized controlled trials were among the top-cited papers.

Conclusion: The literature on EHL factors in hemophilia has expanded over the past 2 decades, with notable growth between 2016 and 2019. Haemophilia was the most prominent journal in this field.

Nelarabine is an essential component in the treatment of pediatric T-cell lymphoblastic malignancies. Rare high-grade neurologic toxicities have been reported, but nelarabine discontinuation when early symptoms arise mitigates poor outcomes. Currently, no standard assessment of neurotoxicity exists. Our patient safety initiative implemented a novel 7-question neurologic assessment tool performed daily during nelarabine courses, which prompted early identification of neurotoxicity and allowed for appropriate interventions. Investigating 31 patients over 18 months demonstrated improved documentation from 65.9% to 97.2% (Δ+31.3%). Nine doses were omitted due to discovered neurotoxicity. Tool implementation advanced our ability to optimize patient care during nelarabine administration.