Pediatric Blood & Cancer最新文献

Central venous access is essential for delivering chemotherapy and supportive care in children with cancer. Yet the practical decisions surrounding device selection, placement, maintenance, and salvage vary widely among institutions. In our center, we use a systematic, multidisciplinary workflow to anticipate the treatment trajectory, prioritize venous preservation, prevent complications, and support structured salvage strategies when device dysfunction or infection occurs. This "How I Approach" article outlines a pragmatic, experience-based model drawn from daily practice in a high-volume pediatric oncology setting. The focus is on applying established concepts to real-world clinical decision-making to maintain continuity of therapy and minimize morbidity.

Background/objectives: Ovarian malignancies in children and young women exhibit distinct clinical characteristics and may be managed by either paediatric surgeons or gynaecologists, depending on patient age and institutional protocols. This multicentre retrospective study aims to evaluate similarities and differences in the management and outcomes of ovarian malignancies treated by different surgical teams.

Design/methods: A multicentre retrospective review was conducted, including patients who underwent surgery for ovarian malignancies from 2013 to the present. Data were collected from two paediatric surgical departments and one adult gynaecological department. Patients were categorized into two groups according to the surgical team: Group A (paediatric surgeons) and Group B (gynaecologists). Clinical, diagnostic, surgical and oncological data were analysed.

Results: A total of 52 patients were included: 29 in Group A (median age 10 years, range 3-15) and 23 in Group B (median age 31 years, range 23-39). The most common tumour types were immature teratomas in Group A (45%) and borderline tumours in Group B (43.5%). Group A commonly underwent transabdominal ultrasound (87%) and MRI (31%), whereas Group B received transvaginal ultrasound (100%) and CT scans (78.2%). In Group A, 62% of girls underwent laparotomy, whereas 83.4% of women (Group B) underwent laparoscopy (p < 0.01). Oophorectomy was performed in 90% of cases across both groups. Patients in Group A presented more frequently with early-stage disease (93% vs. 30%, p < 0.05). During follow-up, relapse occurred in three paediatric and four adult patients, and two patients (one from each group) died due to disease progression.

Conclusions: Despite variations in preoperative assessment and surgical approaches, postoperative oncological treatment and long-term outcomes, including disease-free and overall survival, were comparable between the groups. Integrating the strengths of both paediatric and gynaecological approaches may further optimize the management of ovarian malignancies in young patients.

Background: Complete pulmonary metastasectomy is central to curative-intent therapy for sarcoma, but lesion localization can be challenging. Indocyanine green (ICG) near-infrared fluorescence offers real-time intraoperative guidance, though data in pediatric and adolescent/young adult sarcoma patients are limited.

Methods: A retrospective review of patients with metastatic sarcoma who underwent pulmonary metastasectomy was performed. Patients were dosed preoperative ICG (dose: 4 mg/kg, 24 h before surgery) between April 2019 and November 2022. Demographics, tumor histology, operative details, lesion characteristics, and ICG status were analyzed. Sensitivity, positive predictive value (PPV), and the proportion of lesions identified solely by ICG were calculated.

Results: Thirty-one patients aged 6-42 years underwent 51 pulmonary metastasectomies. Overall sensitivity of ICG for detecting metastatic lesions was 81.0% with a PPV of 39.0%. ICG identified 17.0% of metastases not palpable or visible on inspection. Patients with prior lung radiation demonstrated lower sensitivity at 64.0% than the overall cohort. No adverse reactions to ICG were observed.

Conclusion: ICG fluorescence imaging is a safe adjunct to pulmonary metastasectomy in pediatric, adolescent, and young adult sarcoma patients. It facilitates more complete resection by identifying additional lesions not detected with standard techniques without significant adverse effects. These findings support use of ICG as a complement to meticulous surgical exploration. Further multicenter studies are needed to assess its impact on oncologic outcomes.

In response to the evolving complexity of inpatient care, pediatric hematology/oncology (PHO) hospitalist programs have become a vital component of care delivery. To advance this emerging field, we convened a multidisciplinary collaboration from programs across the United States to define the landscape, identify challenges, and outline a path forward. This Special Report highlights the critical role of PHO hospitalists in delivering specialized, high-acuity care, leading quality improvement and patient safety efforts, and discussing workforce challenges. It offers a collaborative framework to support sustainable growth and define the future of PHO hospitalist medicine.

We present two pediatric cases of pediatric low-grade gliomas (PLGG) with BRAF V600E mutations diagnosed and monitored using cerebrospinal fluid (CSF) liquid biopsy analyzed via digital droplet PCR (ddPCR), without tissue biopsy. Both patients were treated with dabrafenib and trametinib and monitored through clinical assessments, magnetic resonance imaging (MRI), and repeat CSF analyses. Both patients showed rapid and sustained clinical and radiological improvement following targeted therapy. In one case, follow-up CSF analysis 3 months post-treatment initiation was negative for BRAF V600E, indicating a potential role for liquid biopsy in monitoring treatment response. No significant toxicity was observed.