Pediatric Blood & Cancer最新文献

Introduction: Little is known about psychosocial outcomes in pediatric cancer based on the area of residency. Therefore, we longitudinally examined differences in the adjustment of children with cancer living in rural and Appalachian areas relative to urban and non-Appalachian children.

Methods: Data were from a larger study of coping and communication in families of children with cancer (n = 336; M_age = 10.69). Rural (n = 118) and Appalachian (n = 58) residency were based on federal codes. Mothers, fathers, and children reported on child internalizing problems, externalizing problems, and total competence near diagnosis and 1 year later.

Results: Children with cancer exhibited significant increases in behavioral and emotional difficulties by 1 year post-diagnosis, as reported by all three sources. There were no group differences in behavioral and emotional problems at diagnosis nor in change from diagnosis to 1 year based on rural or Appalachian residency. At 1 year post-diagnosis, children from rural areas had significantly lower social competence based on mother (b = -0.77, p = 0.02) and child reports (b = -1.27, p = 0.02). Additionally, at 1 year post-diagnosis, fathers reported children in Appalachian counties had significantly lower total competence (b = -2.35, p = 0.04) and social competence (b = -1.32, p = 0.03) than non-Appalachian peers.

Conclusions: Survivors in rural and Appalachian areas may experience greater social difficulties 1 year post-diagnosis than those in more urban areas. Clinicians should routinely assess survivors' access to mental health and follow-up care. Future research should examine cultural barriers and beliefs that may contribute to these disparities.

Ongoing evidence indicates increased risk of sarcopenic obesity among children and young people (CYP) with acute lymphoblastic leukemia (ALL), often beginning early in treatment, persisting into survivorship. This review evaluates current literature on body composition in CYP with ALL during and after treatment. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelinesand was registered at the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023480732). Three databases (PubMed, MEDLINE (OVID), and CINAHL) were searched until March 2024. Studies with individuals aged 0-21 years with ALL during or after treatment were included. The Joanna Briggs Institute checklist was used to assess the bias risk. Of the 126 studies, 13 were included (eight cross-sectional and five prospective). Eight studies used dual-energy X-ray absorptiometry, three used bioelectrical impedance analysis, two used air-displacement plethysmography, and one applied the four-compartment model. Fat mass (FM) increased early (T2-T3 ≈ +1standard deviation score [SDS]), and remained elevated at treatment end, and was above reference at follow-up (T5 ≈ +0.7 SDS). Fat-free mass (FFM) declined during therapy (lowest at T4 ≈ -0.7 SDS) with partial recovery by T5 (confidence interval crossing 0). Body mass index was elevated in the ALL groups versus controls. Heterogeneity was substantial, reflecting variation in age, assessment timing, and methodology. Despite methodological limitations, this review demonstrates persistent increases in FM and a reduction in FFM during and after treatment. Large, international studies using standardized body composition methodologies and clinically relevant cut-offs are needed to define long-term risks.

Radiotherapy (RT) is essential in pediatric cancer treatment and often requires complete immobility. In younger or noncompliant children, this is typically achieved through sedation or general anesthesia (GA), which raises concerns about acute complications and potential long-term neurodevelopmental effects. Despite widespread use, standardized anesthesia protocols for pediatric RT are lacking. To support the development of practice recommendations, the SIOPE Working Group on Pediatric Anesthesia in Radiation Therapy conducted a systematic literature review. Studies from Medline and Embase were reviewed (March-September 2024) according to PRISMA guidelines, focusing on sedation and GA in pediatric RT. Thirty-nine studies were included, mostly retrospective and of low to moderate quality. Considerable heterogeneity was observed in anesthetic techniques, staffing, and monitoring. Propofol-based sedation was most frequently reported, with favorable safety when delivered by experienced pediatric anesthetists. Complication rates varied widely and were often poorly defined. Additional concerns included long-term neurocognitive impact, vascular access, and procedural burden, especially in resource-limited settings. Evidence supports the safe use of sedation/GA in pediatric RT, but current literature is limited and inconsistent. Standardized protocols and prospective studies are urgently needed to better define safety, long-term outcomes, and staffing requirements.

Introduction: The TEDDI trial tested the feasibility and reproducibility of deep-inspiration breath-hold (DIBH) in pediatric patients referred for radiotherapy. This report presents final results, including patient-reported outcomes (PRO) and dosimetric comparison of DIBH and free-breathing (FB).

Patients and methods: Pediatric patients able to perform three sequential breath-holds and potentially requiring thoracic or upper abdominal radiotherapy were recruited. DIBH training was during staging or planning computed tomography (CT) scanning, using external gating with an external marker and visual coaching. Each patient underwent planning CT in both DIBH and FB, generating two radiotherapy plans. DIBH was selected if it resulted in a lower overall dose to organs at risk. At two centers, patients evaluated their DIBH experience during training. Those treated in DIBH also completed three daily questions and extended questionnaires at the start, midpoint, and end of treatment, using yes/no and five-point Likert scales.

Results: Twenty-five patients (12 females/13 males, median age 15 years, range: 9-17 years) were enrolled across three centers. Eight received photon radiotherapy, five in DIBH. Of 13 eligible patients, 11 rated DIBH training, with 10 selecting "Really good" or "Good." Patients treated in DIBH reported feeling safe and comfortable. Dosimetric analysis showed clear heart and lung dose reductions with DIBH. FB patients had similar doses across both plans.

Conclusion: The TEDDI trial demonstrated the feasibility and safety of DIBH in pediatric radiotherapy. High compliance with the procedure and favorable dosimetric outcomes support the use of DIBH to reduce long-term toxicity risks in this population.

Introduction: Neuroblastoma (NB) with central nervous system (CNS) metastases is rare at diagnosis, but occurs more often during relapse/progression. Patients with CNS metastases face a dismal prognosis, with no standardized curative treatment available. Novel therapeutic approaches, such as intraventricular radio-immunotherapy with ¹³¹I-omburtamab (Omb), have been developed. In this study, we report a retrospective, single-tertiary center analysis of a 23-year cohort of NB patients with CNS metastases, highlighting current treatment strategies.

Patients and methods: Retrospective data analysis of all NB patients with CNS metastases treated at Hospital Sant Joan de Déu, Barcelona, from January 2000 to January 2023. Patient characteristics at diagnosis, first-line treatment, relapse patterns, and CNS metastasis management were analyzed in search of risk variables and survival outcomes.

Results: CNS metastases at relapse were identified in 39/185 (21.1%) patients. Median age at diagnosis was 2.7 years, and 24/39 were male. Stage 4 NB with multisite compartment metastases accounted for most cases (92.2%). CNS events occurred predominantly at first relapse (29/39, 74.4%) and with neurological symptoms (23/38, 60.5%). MCYN amplification and concomitant extra-CNS metastases at CNS relapse were associated with poorer overall survival (OS) (p = 0.018 and p = 0.0059, respectively). Neurological symptoms upon relapse significantly increased the risk for subsequent CNS events (p = 0.028). Curative-intent treatment was attempted in 34/39 (87.2%) patients. After adjusting for immortal time bias, RT plus Omb significantly improved OS (p < 0.0001).

Conclusions: In our experience, MYCN amplification and concomitant extra-CNS metastases at CNS relapse significantly decrease OS. Multimodal treatment, including ¹³¹I-omburtamab radioimmunotherapy, significantly improves survival outcomes.

Background/objectives: Pain is a prevalent late effect of cancer that can disrupt critical developmental milestones during young adulthood. This study examined the relationship between pain and psychosocial outcomes in young adult (YA) survivors of cancer.

Methods: One hundred YA cancer survivors completed measures assessing pain, anxiety, depression, posttraumatic stress, and alcohol use at baseline and follow-up (2-4 weeks later).

Results: In multivariate regression analyses, higher pain predicted poorer outcomes across all domains at follow-up (p's <.05).

Conclusions: Pain predicts psychosocial outcomes in YA cancer survivors, underscoring the need for routine assessment of and early intervention for pain to support psychological well-being.

Children with cancer are at-risk for infertility, yet most desire biological parenthood. Fertility preservation is available for pre- and postpubertal patients, with tissues typically banked for autologous use. Some survivors require third-party reproduction (TPR) but do not complete the Food and Drug Administration (FDA)-required donor eligibility steps when banking their reproductive materials. This article reviews medical and nonmedical factors associated with TPR, FDA regulatory requirements, risks of non-compliance, and recommendations for facilitation in the pediatric oncology setting. Challenges, opportunities, and clinical decision trees for discussing TPR during pediatric fertility consultations are presented, emphasizing collaboration with adult reproductive clinics to support survivors' long-term reproductive goals.

The pediatric hematology-oncology fellowship training curriculum has not substantially changed since its inception. The first year of training is clinically focused, and the second and third years are devoted to scholarship. However, this current structure leaves many fellows less competitive in the current job market, resulting in approximately one-third of all pediatric hematology/oncology fellowship graduates pursuing subspecialty fellowship training in niche fields such as stem cell transplant, neuro-oncology, and hemostasis/thrombosis. In this article, we propose an individualized PHO fellowship curriculum to better prepare the future PHO physician for their future career, potentially abrogating the need for additional subspecialty training.