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Transcriptional regulation of genes by MYCN in PAX3::FOXO1-positive rhabdomyosarcomas and their roles in cell cycle progression
Pub Date : 2025-04-17 DOI: 10.1016/j.ejcped.2025.100230
Zoë S. Walters , Daniel Leongamornlert , Barbara Villarejo-Balcells , Carmen Tse , Reuben Pengelly , Ian Titley , Janet Shipley

Background

MYCN amplification and high expression is associated with pediatric malignancies including neuroblastoma and alveolar rhabdomyosarcoma. MYCN transcription in alveolar rhabdomyosarcomas is driven by a feedback loop with the PAX3::FOXO1 fusion protein. However, the role of MYCN is not well-defined.

Methods

Chromatin ImmunoPrecipitation (ChIP)-sequencing of alveolar rhabdomyosarcoma cell lines was used to identify genome-wide MYCN binding sites. Ontology analyses of genes adjacent to MYCN binding sites corresponding to expression changes after siRNA reduction was performed and confirmed by ChIP-qPCR. Cells from each phase of the cell cycle were isolated by Fluorescence Activated Cell Sorting for assessing protein expression by Western blotting.

Results

Genes encoding transcription factors adjacent to MYCN binding sites and genes with binding sites proximal to their promoters were strongly associated with RNA synthesis and cell cycle pathways, respectively. MYCN binding sites in regions that positively correlated with gene expression changes were linked to cell cycle regulation, consistent with phenotypic absence of cell cycle checkpoint control. Cell cycle regulated genes CDK4 and KDM4B were validated as MYCN-regulated and, in-keeping with unchecked cell cycle progression, expressed throughout the cell cycle, coincident with MYCN.

Conclusions

MYCN binding sites associated with gene expression changes defined the contribution of MYCN to the transcriptional control of key pathways/molecular processes in the development and progression of rhabdomyosarcomas. MYCN aberrantly regulated CDK4 and KDM4B expression throughout the cell cycle in PAX3::FOXO1 positive rhabdomyosarcoma. The regulatory network defined supports MYCN, CDK4 and KDM4B as therapeutic targets in the treatment of rhabdomyosarcoma patients.
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引用次数: 0
European standard clinical practice recommendations for children and adolescents with Rhabdomyosarcoma a joint EpSSG, CWS and ERN PaedCan project
Pub Date : 2025-04-11 DOI: 10.1016/j.ejcped.2025.100229
Johannes H.M. Merks , Eva Brack , Martin Ebinger , Véronique Minard-Colin , Anne-Sophie Defachelles , Raquel Hladun , Timothy Rogers , Jörg Fuchs , Jan Godzinski , Sheila Terwisscha van Scheltinga , Gabriela Guillén Burrieza , Henry Mandeville , Beate Timmermann , Raquel Davila Fajardo , Rick R. van Rijn , Jürgen Schäfer , Helen Rees , Andrea Ferrari , Rita Alaggio , Anna Kelsey , Gianni Bisogno
Rhabdomyosarcoma (RMS) is a heterogeneous group of malignancies with specific histopathological characteristics. Distinct molecular findings help to classify RMS into PAX::FOXO1 fusion gene positive and fusion gene negative subtypes. Further new molecular subtypes give insight into the heterogeneity of these rare tumours. Multiple international clinical trials have been conducted to improve the prognosis for paediatric, adolescent, and young adult patients with RMS. The overall cure rate is around 70 % but varies dramatically between the low risk localised and very high-risk metastatic patients. New treatment approaches are needed in the High-Risk and Very High-Risk RMS disease to improve patients’ outcome. State of the art diagnostics and staging is crucial and the multimodal treatment approach in specialized paediatric-oncology centres is highly recommended. Treatment includes chemotherapy with vincristine, actinomycin, and ifosfamide with or without anthracyclines. Local treatment with the aim of microscopically complete resection and/or radiotherapy is warranted depending on patient and tumour characteristics. Maintenance treatment is recommended to (Very) High Risk groups. This consensus summarizes the standard of care diagnostic work up, multimodal treatment and surveillance recommendations for paediatric, adolescent, and young adult patients with RMS. The guideline was developed as a joint project by the European paediatric Soft tissue sarcoma Study Group (EpSSG) and the Cooperative Weichteilsarkom Studiengruppe (CWS) summarized as the European RMS working group supported by European Reference Network on Paediatric Cancer (ERN PaedCan).
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引用次数: 0
European standard clinical practice recommendations for newly diagnosed ependymoma of childhood and adolescence
Pub Date : 2025-04-09 DOI: 10.1016/j.ejcped.2025.100227
Alba Rubio-San-Simón , Timothy A. Ritzmann , Denise Obrecht-Sturm , Martin Benesch , Beate Timmermann , Pierre Leblond , John-Paul Kilday , Geraldina Poggi , Nicola Thorp , Maura Massimino , Marie-Lise van Veelen , Martin Schuhmann , Ulrich-Wilhelm Thomale , Stephan Tippelt , Ulrich Schüller , Stefan Rutkowski , Richard G. Grundy , Stephanie Bolle , Ana Fernández-Teijeiro , Kristian W. Pajtler
Ependymomas are tumors of glial origin representing the second most common malignant brain tumors of childhood. Peak incidence in childhood is under 3 years of age. Most paediatric ependymomas arise intracranially and are molecularly divided into four groups, namely supratentorial ependymoma, ZFTA fusion-positive (ST-ZFTA), supratentorial ependymoma, YAP1 fusion-positive (ST-YAP1), posterior fossa group A (PF-A), and posterior fossa group B (PF-B) ependymoma. Spinal ependymomas in children are rare. An integrated diagnosis requires a combination of histological and molecular features as well as tumour localization. Staging with pre- and early post-surgery magnetic resonance imaging of the neuraxis, accompanied by cerebrospinal fluid (CSF) analysis 14 days post surgery must be performed. CSF at primary surgery is highly recommended to both detect and inform biomarkers. Patients should ideally be treated in specialized centers and, whenever possible, within a prospective clinical trial. Molecular classification has become increasingly important and will be applied to enable patient stratification in upcoming clinical trials. However, there are not yet specific treatment recommendations for distinct molecular groups. Apart from the molecular group, the extent of neurosurgical resection is the most consistent prognostic factor. Therefore, the feasibility of second-look surgery targeting complete resection should always be evaluated if residual disease. Adjuvant radiotherapy has been shown to be effective in consolidating local control and is therefore recommended following complete resection. Focal radiotherapy is the standard of care for patients with non-disseminated ependymoma, and craniospinal radiotherapy is recommended in older children with metastatic disease. For very young children with metastatic disease, radiotherapy avoidance strategies using systemic therapy is recommended to reduce the risk of neurocognitive effects. Highly conformal techniques such as proton beam therapy or intensity-modulated radiation therapy are preferred. Chemotherapy bridging therapy may be applied until patients reach 12–18 months of age, or to facilitate complete resections where further surgery is planned.
外胚窦瘤是神经胶质起源的肿瘤,是儿童期第二常见的恶性脑肿瘤。3岁以下儿童发病率最高。大多数小儿脑外胚瘤发生于颅内,在分子上可分为四类,即上脑膜外胚瘤性 ZFTA 融合阳性(ST-ZFTA)、上脑膜外胚瘤性 YAP1 融合阳性(ST-YAP1)、后窝 A 组(PF-A)和后窝 B 组(PF-B)脑外胚瘤。儿童脊髓上皮瘤非常罕见。综合诊断需要结合组织学和分子特征以及肿瘤定位。必须在手术前和手术后早期对神经轴进行磁共振成像分期,并在手术后 14 天进行脑脊液(CSF)分析。强烈建议在初次手术时进行脑脊液分析,以便检测生物标记物并为其提供信息。患者最好在专业中心接受治疗,并尽可能在前瞻性临床试验中接受治疗。分子分类已变得越来越重要,在即将进行的临床试验中,将应用分子分类对患者进行分层。然而,目前还没有针对不同分子组别的具体治疗建议。除分子组别外,神经外科切除范围是最一致的预后因素。因此,如果有残留疾病,应始终评估以完全切除为目标的二次手术的可行性。事实证明,辅助放疗能有效巩固局部控制,因此建议在完全切除后进行辅助放疗。局部放疗是非播散性上胚乳瘤患者的标准治疗方法,对于有转移性疾病的年长儿童,建议采用颅骨放疗。对于患有转移性疾病的年幼儿童,建议采用全身治疗的放射治疗避免策略,以降低神经认知影响的风险。首选高适形技术,如质子束疗法或调强放射疗法。化疗桥接疗法可应用到患者年满12-18个月时,或在计划进一步手术时用于促进完全切除。
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引用次数: 0
Immunotherapy for paediatric diffuse large B-cell lymphoma: A review of current clinical trials and future directions
Pub Date : 2025-03-28 DOI: 10.1016/j.ejcped.2025.100228
Anne van Kuijk , Pamela Kearns , G.A. Amos Burke
Paediatric diffuse large B-cell lymphoma (DLBCL) is a rare but aggressive form of non-Hodgkin lymphoma. Although rituximab has significantly improved outcomes in both adult and paediatric patients, challenges remain for those who relapse or are resistant to the initial treatment. This review examines recent clinical trials investigating various immunotherapies for relapsed or refractory (R/R) paediatric DLBCL, including immunomodulatory agents, monoclonal antibodies, antibody-drug conjugates, bispecific antibodies, checkpoint inhibitors, and chimeric antigen receptor (CAR) T-cell therapy. A comprehensive search identified forty-eight relevant trials with significant focus on CAR-T cell therapy. This review highlights the potential benefits of these novel therapies for improving the survival rate and quality of life of paediatric patients. However, it also underscores the need for increased international collaboration and paediatric-specific research to address the unique challenges in treating this vulnerable population. Future directions include the integration of personalised medicine and development of chemotherapy-free regimens.
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引用次数: 0
An overview of the European standard clinical practice recommendations for choroid plexus tumours
Pub Date : 2025-03-18 DOI: 10.1016/j.ejcped.2025.100226
David King , Brigitte Bison , Ofelia Cruz , Claudia C. Faria , Iwona Filipek , Jonathan L. Finlay , Miklós Garami , Uwe R. Kordes , Ulrike Löbel , Jilly Maclean , Torben Stamm Mikkelsen , Denise Obrecht-Sturm , Guirish Solanki , Christian Thomas , Beate Timmerman , Michal Zapotocky , Jenny Adamski
Choroid plexus tumours (CPT) are rare epithelial brain tumours that primarily affect very young children. They can be classified as benign choroid plexus papilloma (CPP, WHO grade 1), intermediate grade atypical choroid plexus papilloma (aCPP, WHO grade 2) or highly malignant choroid plexus carcinoma (CPC, WHO grade 3). Treatment is dependent on tumour grade, surgical resection, the age of the child and somatic and germline TP53 mutational status. CPP and aCPP have a good prognosis and are frequently curable with surgery alone. In contrast, the prognosis in CPC is often poor, despite intensive multimodal treatment with surgery, chemotherapy and radiotherapy. Management is complicated by the increased incidence of germline TP53 mutations and cancer predisposition (Li-Fraumeni syndrome), especially in CPC, whilst the rarity of the diagnosis means there are a lack of robust clinical data on which to base treatment decisions. Studies generally comprise of retrospective, single arm and centre trials or case series, and patient numbers are small leading to conflicting results that are difficult to interpret. Standardised treatment protocols have historically been lacking.
The aim of this document is to provide a reference standard for the treatment of CPT on behalf of the European Society for Paediatric Oncology (SIOPE). We review the previously published literature and provide consensus key recommendations for the management of CPP, aCPP and CPC including surgical approaches and when appropriate, the role of chemotherapy and radiotherapy. Suggested follow-up and possible relapse strategies are also suggested.
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引用次数: 0
Curing using the minimal – Strategies for treatment reduction in childhood acute lymphoblastic leukemia
Pub Date : 2025-03-04 DOI: 10.1016/j.ejcped.2025.100222
Bernice LZ Oh , Stephen P. Hunger , Allen EJ Yeoh , Shawn HR Lee
Childhood acute lymphoblastic leukemia (ALL) in the contemporary era of intensive chemotherapy is highly curable, but is associated with a plethora of toxicities, with persistent disparities in survival outcomes globally especially in low-middle income countries (LMIC). Because of limited supportive care in LMIC, treatment-related morbidity and mortality may be a more critical treatment factor than relapse. Therefore, the next frontier in childhood ALL is to cure low-risk ALL with as minimal therapy as possible. Here, we discuss how to identify the subset of low-risk patients for whom this is possible, along with the components of deintensification strategies across several regimens in recent clinical trials for low-risk ALL. In treating low-risk childhood ALL, the key is accurately identifying this curable subset. NCI standard-risk criteria at diagnosis (age 1–10 years, WBC < 50,000/uL) remains an effective cornerstone of stratification. Other favorable features such as identifying low risk genetics (ETV6::RUNX1, hyperdiploidy), early peripheral blood and bone marrow responses, and simplified flow MRD at the end of induction can be added depending on resources to enhance stratification. A reduced intensity induction particularly through anthracycline-free induction, allows early marrow recovery and reduces the need for intensive supportive care. Other key effective deintensification strategies in low-toxicity protocols include: replacing high-dose with low-dose escalating methotrexate; judicious or even omission of anthracyclines throughout therapy; non-augmentation of consolidation therapy; reducing or even omitting delayed intensification; decreasing thiopurine or methotrexate doses during maintenance; and lowering intensity of steroid pulses during maintenance. Future directions include potential implementation of immunotherapy upfront to low-risk ALL, which may allow for even further reducing toxic chemotherapy or treatment duration. Overall, the first effective step in achieving global ALL cure is to focus on curing low-risk ALL through as minimal therapy as possible.
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引用次数: 0
Therapeutic drug monitoring in the treatment of childhood acute lymphoblastic leukemia – A practical guideline
Pub Date : 2025-03-01 DOI: 10.1016/j.ejcped.2025.100225
Miguel Vieira Martins , Anna Sofie Buhl Rasmussen , Jesper Heldrup , Linea Natalie Toksvang , Marianne Ifversen , Stine Nygaard Nielsen , Kjeld Schmiegelow , Inge Margriet van der Sluis
Treatment regimens for childhood acute lymphoblastic leukemia have developed steadily over the last decades, significantly improving patient outcomes. This has been achieved mainly by intensifying therapy, which also increased the risk of associated toxicity. To address this issue, therapeutic drug monitoring (TDM) has been introduced in clinical research and, for certain chemotherapeutic agents, as standard of care in protocols like the ALLTogether1. The goal of TDM is to optimize delivery of a given cytotoxic drug, while minimizing the risk of toxicity. Notwithstanding, only a subset of drugs included in the backbone of ALL treatment will be eligible for TDM, since specific pharmacokinetic and pharmacodynamic properties need to apply. Despite the recent rise of innovative therapies like immunotherapy, cytotoxic drugs remain a core component of ALL treatment, making the application of TDM crucial for improving patient outcomes. Among these chemotherapeutic agents, we focus on the monitoring of asparaginase, high-dose methotrexate, 6-mercaptopurine and low dose methotrexate in maintenance therapy, tyrosine kinase inhibitors and busulfan, in order to enhance clinical effectiveness. This narrative review further explains how TDM for these drugs should be conducted and offers practical recommendations for managing them in childhood ALL treatment. Moreover, ongoing research in TDM will allow for more personalized therapy delivery in frontline strategies, while optimizing care with lesser toxicity burden for patients.
{"title":"Therapeutic drug monitoring in the treatment of childhood acute lymphoblastic leukemia – A practical guideline","authors":"Miguel Vieira Martins ,&nbsp;Anna Sofie Buhl Rasmussen ,&nbsp;Jesper Heldrup ,&nbsp;Linea Natalie Toksvang ,&nbsp;Marianne Ifversen ,&nbsp;Stine Nygaard Nielsen ,&nbsp;Kjeld Schmiegelow ,&nbsp;Inge Margriet van der Sluis","doi":"10.1016/j.ejcped.2025.100225","DOIUrl":"10.1016/j.ejcped.2025.100225","url":null,"abstract":"<div><div>Treatment regimens for childhood acute lymphoblastic leukemia have developed steadily over the last decades, significantly improving patient outcomes. This has been achieved mainly by intensifying therapy, which also increased the risk of associated toxicity. To address this issue, therapeutic drug monitoring (TDM) has been introduced in clinical research and, for certain chemotherapeutic agents, as standard of care in protocols like the <em>ALLTogether1</em>. The goal of TDM is to optimize delivery of a given cytotoxic drug, while minimizing the risk of toxicity. Notwithstanding, only a subset of drugs included in the backbone of ALL treatment will be eligible for TDM, since specific pharmacokinetic and pharmacodynamic properties need to apply. Despite the recent rise of innovative therapies like immunotherapy, cytotoxic drugs remain a core component of ALL treatment, making the application of TDM crucial for improving patient outcomes. Among these chemotherapeutic agents, we focus on the monitoring of asparaginase, high-dose methotrexate, 6-mercaptopurine and low dose methotrexate in maintenance therapy, tyrosine kinase inhibitors and busulfan, in order to enhance clinical effectiveness. This narrative review further explains how TDM for these drugs should be conducted and offers practical recommendations for managing them in childhood ALL treatment. Moreover, ongoing research in TDM will allow for more personalized therapy delivery in frontline strategies, while optimizing care with lesser toxicity burden for patients.</div></div>","PeriodicalId":94314,"journal":{"name":"EJC paediatric oncology","volume":"5 ","pages":"Article 100225"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Screening for childhood cancer: Several devils in the details
Pub Date : 2025-03-01 DOI: 10.1016/j.ejcped.2025.100224
Logan G. Spector, Erin L. Marcotte
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引用次数: 0
IGH rearrangements in Down syndrome acute lymphoblastic leukemia
Pub Date : 2025-02-25 DOI: 10.1016/j.ejcped.2025.100223
Naomi Michels , Jade Admiraal , Aurélie Boeree , Edwin Sonneveld , Anthony V. Moorman , Gabriele Escherich , Rosemary Sutton , H. Berna Beverloo , Rob Pieters , C. Michel Zwaan , Monique L. den Boer , Judith M. Boer

Background

The IGH locus is susceptible to translocations or insertions that contribute to B-cell precursor acute lymphoblastic leukemia (ALL) by ectopic or enhanced expression of a gene relocated to the IGH enhancer. The frequency of IGH rearrangements is relatively high in Down syndrome (DS) ALL. IGH rearrangements can be cryptic and might not be detected as a chimeric transcript, hence, their frequency, partner genes and prognostic value are largely unknown.

Methods

We performed RNA-sequencing and IGH break-apart fluorescent in-situ hybridization (FISH) to determine the genetic and clinical characteristics of IGH rearrangements in 50 DS ALL patients.

Results

We identified 10 patients with a chimeric IGH transcript and another 22 IGH-rearranged patients solely by FISH. The IGH rearrangement was clonal (≥ 50 % of leukemic cells) in 11 cases and subclonal (10–50 % of cells) in 21 cases. Almost one-third of the subclonal IGH rearrangements co-occurred with known oncogenic driver aberration. The partner gene was identified in 16 cases and the most frequent partners were CEBPD (n = 6) and CRLF2 (n = 4). A trend towards a worse event-free survival was seen for DS ALL patients with a clonal IGH rearrangement (clonal: HR 3.34, p = 0.053; subclonal: HR 1.80, p = 0.31) compared with DS ALL patients without an IGH rearrangement.

Conclusion

By combining RNA-sequencing and FISH, we identified IGH rearrangements in 64 % (n = 32) of DS ALL. A clonal IGH rearrangement (22 %) may point to an unfavorable outcome in DS ALL.
{"title":"IGH rearrangements in Down syndrome acute lymphoblastic leukemia","authors":"Naomi Michels ,&nbsp;Jade Admiraal ,&nbsp;Aurélie Boeree ,&nbsp;Edwin Sonneveld ,&nbsp;Anthony V. Moorman ,&nbsp;Gabriele Escherich ,&nbsp;Rosemary Sutton ,&nbsp;H. Berna Beverloo ,&nbsp;Rob Pieters ,&nbsp;C. Michel Zwaan ,&nbsp;Monique L. den Boer ,&nbsp;Judith M. Boer","doi":"10.1016/j.ejcped.2025.100223","DOIUrl":"10.1016/j.ejcped.2025.100223","url":null,"abstract":"<div><h3>Background</h3><div>The <em>IGH</em> locus is susceptible to translocations or insertions that contribute to B-cell precursor acute lymphoblastic leukemia (ALL) by ectopic or enhanced expression of a gene relocated to the <em>IGH</em> enhancer. The frequency of <em>IGH</em> rearrangements is relatively high in Down syndrome (DS) ALL. <em>IGH</em> rearrangements can be cryptic and might not be detected as a chimeric transcript, hence, their frequency, partner genes and prognostic value are largely unknown.</div></div><div><h3>Methods</h3><div>We performed RNA-sequencing and <em>IGH</em> break-apart fluorescent in-situ hybridization (FISH) to determine the genetic and clinical characteristics of <em>IGH</em> rearrangements in 50 DS ALL patients.</div></div><div><h3>Results</h3><div>We identified 10 patients with a chimeric <em>IGH</em> transcript and another 22 <em>IGH-</em>rearranged patients solely by FISH. The <em>IGH</em> rearrangement was clonal (≥ 50 % of leukemic cells) in 11 cases and subclonal (10–50 % of cells) in 21 cases. Almost one-third of the subclonal <em>IGH</em> rearrangements co-occurred with known oncogenic driver aberration. The partner gene was identified in 16 cases and the most frequent partners were <em>CEBPD</em> (n = 6) and <em>CRLF2</em> (n = 4). A trend towards a worse event-free survival was seen for DS ALL patients with a clonal <em>IGH</em> rearrangement (clonal: HR 3.34, p = 0.053; subclonal: HR 1.80, p = 0.31) compared with DS ALL patients without an <em>IGH</em> rearrangement.</div></div><div><h3>Conclusion</h3><div>By combining RNA-sequencing and FISH, we identified <em>IGH</em> rearrangements in 64 % (n = 32) of DS ALL. A clonal <em>IGH</em> rearrangement (22 %) may point to an unfavorable outcome in DS ALL.</div></div>","PeriodicalId":94314,"journal":{"name":"EJC paediatric oncology","volume":"5 ","pages":"Article 100223"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Non-invasive wearable devices in paediatric cancer care: Advancing personalized medicine, addressing challenges and shaping the future
Pub Date : 2025-02-19 DOI: 10.1016/j.ejcped.2025.100220
Christa Koenig , Roland A. Ammann , Eva Brack
Wearable devices (WDs) are capable of collecting large volumes of objective and clinically relevant patient data that is not yet routinely captured. This ability to collect continuous, real-time data offers a unique opportunity to gather health information in new and insightful ways. In paediatric oncology, advancement in treatment have led to significant improvements in survival rates. However, aggressive therapies often result in a range of distressing side effects, which can severely impact quality of life, and even can become life-threatening themselves. Supportive care plays a crucial role in mitigating these symptoms, aiming to prevent and manage side effects. Patient-reported outcomes should be used to guide initiation and choice of supportive care treatment whenever possible. In this context, continuous monitoring of vital signs, physical activity and other health parameters using WDs could add individual, patient specific information regarding a patient’s current condition. In this article we discuss the requirements of non-invasive WDs for their use in paediatric oncology, give an overview on possible areas of application in children with cancer and discusses challenges that must be addressed. Also we identify key research gaps and speculate on future perspectives.
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引用次数: 0
期刊
EJC paediatric oncology
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