151
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Reedijk AMJ, Zijtregtop EAM, Coebergh JWW, Meyer-Wentrup FAG, Hebeda KM, Zwaan CM, Janssens GOR, Pieters R, Plattel WJ, Dinmohamed AG, Zijlstra JM, Kremer LCM, Lugtenburg PJ, Beishuizen A, Karim-Kos HE. Improved survival for adolescents and young adults with Hodgkin lymphoma and continued high survival for children in the Netherlands: a population-based study during 1990-2015. Br J Haematol 2020; 189:1093-1106. [PMID: 32030738 PMCID: PMC7318561 DOI: 10.1111/bjh.16491] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/24/2019] [Indexed: 11/26/2022]
Abstract
Population‐based studies that assess long‐term patterns of incidence, major aspects of treatment and survival are virtually lacking for Hodgkin lymphoma (HL) at a younger age. This study assessed the progress made for young patients with HL (<25 years at diagnosis) in the Netherlands during 1990–2015. Patient and tumour characteristics were extracted from the population‐based Netherlands Cancer Registry. Time trends in incidence and mortality rates were evaluated with average annual percentage change (AAPC) analyses. Stage at diagnosis, initial treatments and site of treatment were studied in relation to observed overall survival (OS). A total of 2619 patients with HL were diagnosed between 1990 and 2015. Incidence rates increased for 18–24‐year‐old patients (AAPC + 1%, P = 0·01) only. Treatment regimens changed into less radiotherapy and more ‘chemotherapy only’, different for age group and stage. Patients aged 15–17 years were increasingly treated at a paediatric oncology centre. The 5‐year OS for children was already high in the early 1990s (93%). For patients aged 15–17 and 18–24 years the 5‐year OS improved from 84% and 90% in 1990–1994 to 96% and 97% in 2010–2015, respectively. Survival for patients aged 15–17 years was not affected by site of treatment. Our present data demonstrate that significant progress in HL treatment has been made in the Netherlands since 1990.
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Affiliation(s)
| | - Eline A M Zijtregtop
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Dutch Childhood Oncology Group, Utrecht, the Netherlands
| | - Jan Willem W Coebergh
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Friederike A G Meyer-Wentrup
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Dutch Childhood Oncology Group, Utrecht, the Netherlands
| | - Konnie M Hebeda
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Dutch Childhood Oncology Group, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Geert O R Janssens
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob Pieters
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Wouter J Plattel
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
| | - Avinash G Dinmohamed
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Josée M Zijlstra
- Department of Hematology location VU Medical Center, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Dutch Childhood Oncology Group, Utrecht, the Netherlands
| | - Henrike E Karim-Kos
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
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152
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Abstract
Febrile neutropenia (FN) is a common and dangerous consequence of myelosuppressive chemotherapy but can occur as part of the disease processes. Bacterial bloodstream infection is the most commonly diagnosed cause of febrile neutropenia, with Gram-positive organisms most frequently isolated. However, Gram-negative organisms are becoming more prevalent, with a worrying trend towards resistant organisms. When FN is prolonged, lasting for more than 5 days, there is an increased risk of invasive fungal infections. Prompt recognition, diagnosis and initiation of treatment with broad-spectrum antibiotics are essential to avoid complications and prevent rapid progression to sepsis and possible death. This short article summarises the definition, causes, pathogenesis, applied physiology and management of FN in children.
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Affiliation(s)
- Kimberly Davis
- , Clinical Lecturer/Honorary Paediatric Infectious Diseases Registrar, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Conflicts of interest: none declared.,, Paediatric Oncologist, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Conflicts of interest: none declared
| | - Shaun Wilson
- , Clinical Lecturer/Honorary Paediatric Infectious Diseases Registrar, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Conflicts of interest: none declared.,, Paediatric Oncologist, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Conflicts of interest: none declared
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153
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Abstract
Sporadic Burkitt's lymphoma affecting the nasopharyngeal region is an extremely rare disease, especially in infants. We describe the case of a 2-year-old boy who presented to the ear, nose and throat department with a history of snoring, blood-stained rhinorrhoea and symptoms consistent with upper respiratory tract infections. Physical examination revealed massive cervical lymphadenopathy. MRI of the head and neck showed a mass lesion in the nasopharynx with bilateral lymph node enlargement. Debulking of the mass was performed and biopsies were sent for histology, which confirmed Burkitt's lymphoma. The patient was treated with complex chemotherapy and had a good clinical response. The patient remains in remission after 6 years.
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Affiliation(s)
- Gerd Xuereb
- Foundation Programme Malta, Mater Dei Hospital, Msida, Malta .,Faculty of Medicine & Surgery, University of Malta, Msida, Malta
| | - Justine Borg
- Faculty of Medicine & Surgery, University of Malta, Msida, Malta
| | - Kurt Apap
- Faculty of Medicine & Surgery, University of Malta, Msida, Malta.,Emergency Department, Mater Dei Hospital, Msida, Malta
| | - Charles Borg
- Faculty of Medicine & Surgery, University of Malta, Msida, Malta.,Ear, Nose and Throat Department, Mater Dei Hospital, Msida, Malta
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154
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Muñoz Builes M, Vela Cuenca M, Fuster Soler JL, Astigarraga I, Pascual Martínez A, Vagace Valero JM, Tong HY, Valentín Quiroga J, Fernández Casanova L, Escudero López A, Sisinni L, Blanquer M, Mirones Aguilar I, González Martínez B, Borobia AM, Pérez-Martínez A. Study protocol for a phase II, multicentre, prospective, non-randomised clinical trial to assess the safety and efficacy of infusing allogeneic activated and expanded natural killer cells as consolidation therapy for paediatric acute myeloblastic leukaemia. BMJ Open 2020; 10:e029642. [PMID: 31919123 PMCID: PMC6955478 DOI: 10.1136/bmjopen-2019-029642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Acute myeloblastic leukaemia (AML) constitutes the second most common haematological malignancy in the paediatric population. Current treatment regimens are based on the administration of polychemotherapy, combining high doses of cytarabine with anthracyclines and topoisomerase inhibitors. Allogeneic haematopoietic stem cell transplantation (HSCT) is an option for high-risk patients with AML (and for intermediate-risk patients if a sibling donor is available). With this strategy, AML survival has increased substantially; however, it has remained stagnant at approximately 60%, with relapse being the principal culprit. The predominant role of the immune system and natural killer (NK) cells in controlling paediatric AML has gained importance within the context of HSCT. In this protocol, we propose incorporating this cell therapy as an adjuvant treatment through the infusion of activated and expanded haploidentical NK (NKAE) cells in paediatric patients with AML who are in cytological remission after completing consolidation therapy, and with no indication for HSCT. METHODS AND ANALYSIS Patients up to 30 years of age, diagnosed with AML, in their first cytological remission, who have completed both the induction and the consolidation phases of chemotherapy and do not meet the criteria for allogeneic HSCT are eligible. The patients will receive two doses of NKAE cells once a week, using a GMP K562-mbIL15-41BBL stimulus from a haploidentical donor and interleukin 2 subcutaneously. The patients will then be followed up for 36 months to assess the primary endpoint, which is the probability of relapse after NK cell infusion. ETHICS AND DISSEMINATION This clinical trial was approved by the Clinical Research Ethics Committee of La Paz University Hospital and The Spanish Agency of Medicines and Medical Devices. Findings will be disseminated through peer-reviewed publications, conference presentations and community reporting. TRIAL REGISTRATION NUMBER EudraCT code: 2015-001901-15, ClinicalTrials.gov Identifier: NCT02763475.
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Affiliation(s)
- Mario Muñoz Builes
- La Paz Central Research and Clinical Trials Unit, Hospital Universitario La Paz, Madrid, Spain
| | - María Vela Cuenca
- Translational Research Unit in Paediatric Haemato-Oncology, Hematopoietic Stem Cell Transplantation and Cell Therapy, Hospital Universitario La Paz, Madrid, Spain
| | - Jose L Fuster Soler
- Paediatric Haematology-Oncology Unit, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Spain
| | - Itziar Astigarraga
- Department of Paediatrics, Hospital Universitario Cruces, Barakaldo, Spain
| | - Antonia Pascual Martínez
- Paediatric Haematology Unit, Maternal and Children Hospital, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Jose M Vagace Valero
- Paediatric Haematology Department, Maternal and Children Hospital, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Hoi Y Tong
- La Paz Central Research and Clinical Trials Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Jaime Valentín Quiroga
- Translational Research Unit in Paediatric Haemato-Oncology, Hematopoietic Stem Cell Transplantation and Cell Therapy, Hospital Universitario La Paz, Madrid, Spain
| | - Lucía Fernández Casanova
- Haematological Malignancies Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Adela Escudero López
- Translational Research Unit in Paediatric Hemato-Oncology, Haematopoietic Stem Cell Transplantation and Cell Therapy, Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, Madrid, Spain
| | - Luisa Sisinni
- Paediatric Haemato-Oncology Deparment, Hospital Universitario La Paz, Madrid, Spain
| | - Miguel Blanquer
- Paediatric Haematology-Oncology Unit, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Spain
| | - Isabel Mirones Aguilar
- Translational Research Unit in Paediatric Haemato-Oncology, Hematopoietic Stem Cell Transplantation and Cell Therapy, Hospital Universitario La Paz, Madrid, Spain
| | - Berta González Martínez
- Translational Research Unit in Paediatric Haemato-Oncology, Hematopoietic Stem Cell Transplantation and Cell Therapy, Hospital Universitario La Paz, Madrid, Spain
- Paediatric Haemato-Oncology Deparment, Hospital Universitario La Paz, Madrid, Spain
| | - Alberto M Borobia
- Clinical Pharmacology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Pérez-Martínez
- Translational Research Unit in Paediatric Haemato-Oncology, Hematopoietic Stem Cell Transplantation and Cell Therapy, Hospital Universitario La Paz, Madrid, Spain
- Paediatric Haemato-Oncology Deparment, Hospital Universitario La Paz, Madrid, Spain
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155
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Billeau H, Olivier C, Lemelle L, Wascheul S. [Cross-cultural experience of knowledge sharing in relation to pain]. Rev Infirm 2020; 69:32-34. [PMID: 32146963 DOI: 10.1016/j.revinf.2019.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Health professionals working in paediatric oncology met in Bamako, Mali, as part of a healthcare partnership between the Gabriel-Touré Hospital in Bamako and the Curie Institute in Paris. Open to dialogue and intercultural encounters, the hospital medical and paramedical teams exchanged views on their practices with a particular focus on pain management.
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Affiliation(s)
- Hélène Billeau
- Service de pédiatrie, Centre oncologie Siredo (Soins, innovations, recherche, enseignement en oncologie des enfants, adolescents et jeunes adultes atteints de cancer), Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Céline Olivier
- Service de pédiatrie, Centre oncologie Siredo (Soins, innovations, recherche, enseignement en oncologie des enfants, adolescents et jeunes adultes atteints de cancer), Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Lauriane Lemelle
- Service de pédiatrie, Centre oncologie Siredo (Soins, innovations, recherche, enseignement en oncologie des enfants, adolescents et jeunes adultes atteints de cancer), Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Sylvie Wascheul
- Service de pédiatrie, Centre oncologie Siredo (Soins, innovations, recherche, enseignement en oncologie des enfants, adolescents et jeunes adultes atteints de cancer), Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
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156
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Huertas-Castaño C, Gómez-Muñoz MA, Pardal R, Vega FM. Hypoxia in the Initiation and Progression of Neuroblastoma Tumours. Int J Mol Sci 2019; 21:E39. [PMID: 31861671 DOI: 10.3390/ijms21010039] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022] Open
Abstract
Neuroblastoma is the most frequent extracranial solid tumour in children, causing 10% of all paediatric oncology deaths. It arises in the embryonic neural crest due to an uncontrolled behaviour of sympathetic nervous system progenitors, giving rise to heterogeneous tumours. Low local or systemic tissue oxygen concentration has emerged as a cellular stimulus with important consequences for tumour initiation, evolution and progression. In neuroblastoma, several evidences point towards a role of hypoxia in tumour initiation during development, tumour cell differentiation, survival and metastatic spreading. However, the heterogeneous nature of the disease, its developmental origin and the lack of suitable experimental models have complicated a clear understanding of the effect of hypoxia in neuroblastoma tumour progression and the molecular mechanisms implicated. In this review, we have compiled available evidences to try to shed light onto this important field. In particular, we explore the effect of hypoxia in neuroblastoma cell transformation and differentiation. We also discuss the experimental models available and the emerging alternatives to study this problem, and we present hypoxia-related therapeutic avenues being explored in the field.
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157
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Abstract
This case report describes the case of a 37-year-old man that noticed an intrascrotal right mass with 1 month of evolution. During physical exam presented with a large mass at the inferior portion of the right testicle, clearly separated from the testicle, with a tender consistency and mobile. An ultrasound was performed that showed a solid and subcutaneous nodular lesion, extra testicular, heterogeneous, measuring 7.2 cm. Pelvic magnetic resonance imageMRI showed a lesion compatible with a lipoma. The patient was subjected to surgical excision of the lesion by scrotal access, having histology revealed a lipoblastoma (LB) of the scrotum. Histological diagnosis was obtained by microscopic characteristics (well-circumscribed fatty neoplasm) and immunohistochemistry (stains for CD34, S100 protein and PLAG1 were positive; stains for MDM2 and CDK4 were negative). LB is extremely rare after adolescence in any location, being this first described case of intrascrotal LB described in adulthood.
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Affiliation(s)
- Mário José Pereira-Lourenço
- Urology and Kidney Transplantation, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal .,Urology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Duarte Vieira-Brito
- Urology and Kidney Transplantation, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal.,Urology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - João Pedro Peralta
- Urology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Noémia Castelo-Branco
- Pathology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
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158
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Udo C, Kreicbergs U, Axelsson B, Björk O, Lövgren M. Physicians working in oncology identified challenges and factors that facilitated communication with families when children could not be cured. Acta Paediatr 2019; 108:2285-2291. [PMID: 31206784 PMCID: PMC6899467 DOI: 10.1111/apa.14903] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/08/2019] [Accepted: 06/13/2019] [Indexed: 11/26/2022]
Abstract
Aim We explored physicians’ experiences of communicating with families when their child had cancer and a cure was no longer an option, by focusing on barriers and facilitating factors. Methods Physicians from the six cancer centres in Sweden took part in focus group discussions between December 2017 and May 2018, and the data were analysed using qualitative content analysis. Focus groups enabled us to gather individual and shared perspectives. Results The 35 physicians (20 male) had a mean age of 47 (range 31‐74) and a mean of 11 years’ experience in oncology, ranging from under one year to 43 years. They reported communication challenges when a cure was not possible, namely: emotional and mental drain, lack of mutual understanding and uncertainty about communication skills. They also reported facilitating factors: flexibility in complex conversations, the child’s position in the conversations, continuity and trusting relationships, support from colleagues and having discussed the potentially life‐threatening nature of cancer from the very start of treatment. Conclusion Training to overcome communication issues could support the early integration of palliative care.
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Affiliation(s)
- Camilla Udo
- School of Education, Health and Social Studies Dalarna University Falun Sweden
- CKF Center for Clinical Research Dalarna Falun Sweden
- Department of Health Care Sciences, Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Department of Women’s and Children’s Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit Karolinska Institutet Stockholm Sweden
| | - Bertil Axelsson
- Department of Radiation Sciences, Unit of Clinical Research Centre‐Östersund Umeå University Umeå Sweden
| | | | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Department of Women’s and Children’s Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit Karolinska Institutet Stockholm Sweden
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159
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Nap-van der Vlist MM, Dalmeijer GW, Grootenhuis MA, van der Ent CK, van den Heuvel-Eibrink MM, Wulffraat NM, Swart JF, van Litsenburg RRL, van de Putte EM, Nijhof SL. Fatigue in childhood chronic disease. Arch Dis Child 2019; 104:1090-1095. [PMID: 31175124 DOI: 10.1136/archdischild-2019-316782] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/30/2019] [Accepted: 05/18/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Recently, in adults, the incidence and severity of fatigue was found to exist rather independently from the somatic diagnosis. Since fatigue is distressing when growing up with a chronic disease, we aim to investigate: (1) the prevalence and extent of fatigue among various paediatric chronic diseases and (2) the effect of fatigue on health-related quality of life (HRQoL). DESIGN AND SETTING Cross-sectional study in two children's hospitals. PATIENTS Children and adolescents 2-18 years of age with cystic fibrosis, an autoimmune disease or postcancer treatment visiting the outpatient clinic. OUTCOME MEASURES Fatigue and HRQoL were assessed using the Pediatric Quality of Life Inventory (PedsQL) multidimensional fatigue scale (with lower scores indicating more fatigue) and PedsQL generic core scales, respectively. Linear regression analysis and analysis of covariance were used to compare fatigue scores across disease groups and against two control groups. The effect of fatigue on HRQoL was calculated. Data were adjusted for age, sex and reporting method. RESULTS 481 children and adolescents were assessed (60% participation rate, mean age 10.7±4.9, 42% men). Children and adolescents with chronic disease reported more fatigue than the general population (mean difference -6.6, 95% CI -8.9 to -4.3 (range 0-100)), with a prevalence of severe fatigue of 21.2%. Fatigue scores did not differ significantly between disease groups on any fatigue domain. Fatigue was associated with lower HRQoL on all domains. CONCLUSIONS Fatigue in childhood chronic disease is a common symptom that presents across disease, age and sex groups. Fatigue affects HRQoL. Our findings underscore the need to systematically assess fatigue. Future studies should determine possible biological and psychosocial treatment targets.
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Affiliation(s)
- Merel M Nap-van der Vlist
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geertje W Dalmeijer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Department of Psycho-oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Cornelis K van der Ent
- Cystic Fibrosis Center and Department of Pediatric Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Nico M Wulffraat
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost F Swart
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Raphaële R L van Litsenburg
- Department of Paediatric Oncology-Hematology, Emma Children's Hospital, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
| | - Elise M van de Putte
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne L Nijhof
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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160
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Cheron M, Jezequel T, Boscaro M, Consani D. [Support care in paediatric oncology]. Rev Infirm 2019; 68:29-30. [PMID: 31757326 DOI: 10.1016/j.revinf.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
From the diagnosis of leukaemia and throughout the complex care pathway in paediatric oncology, nurses support the child and the parents, notably as part of the cross-disciplinary support care provided. They play a pivotal role within the multidisciplinary team and favour a personalised treatment helping the child-parent dyad cope better with the disease.
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Affiliation(s)
- Maëva Cheron
- Service oncologie pédiatrique, PHU 5 femme, enfant, adolescent, 5(e) étage, centre hospitalier universitaire de Nantes, hôpital enfant-adolescent, quai Moncousu, 44093 Nantes cedex 1, France
| | - Thomas Jezequel
- Service oncologie pédiatrique, PHU 5 femme, enfant, adolescent, 5(e) étage, centre hospitalier universitaire de Nantes, hôpital enfant-adolescent, quai Moncousu, 44093 Nantes cedex 1, France
| | - Maria Boscaro
- Service oncologie pédiatrique, PHU 5 femme, enfant, adolescent, 5(e) étage, centre hospitalier universitaire de Nantes, hôpital enfant-adolescent, quai Moncousu, 44093 Nantes cedex 1, France.
| | - Delphine Consani
- Service oncologie pédiatrique, PHU 5 femme, enfant, adolescent, 5(e) étage, centre hospitalier universitaire de Nantes, hôpital enfant-adolescent, quai Moncousu, 44093 Nantes cedex 1, France
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161
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Abstract
A 1-day-old child was brought to the clinic for evaluation of enlarged right eye (OD). On examination, OD showed buphthalmos with diffuse scleral melanocytosis, fleshy blackish-brown extrascleral mass with corneal extension, and secondary glaucoma. Anterior segment evaluation revealed darkly pigmented iris and fundus evaluation OD revealed a darkly pigmented choroidal lesion. The left eye was within normal limits. A clinical diagnosis of choroidal melanocytoma with ocular melanocytosis was made. Enucleation OD followed by orbital implant was performed. Histopathology showed features of diffuse ocular melanocytosis involving limbus, iris, ciliary body, choroid, sclera, optic nerve head, optic nerve sheath, along with choroidal melanocytoma with extrascleral tumour extension. We presume that choroidal melanocytoma may have arisen from ocular melanocytosis.
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Affiliation(s)
- Arpita Maniar
- Ocular Oncology, LV Prasad Eye Institute, Hyderabad, India
| | - Saumya Jakati
- Ophthalmic Pathology, LV Prasad Eye Institute, Hyderabad, India
| | - Swathi Kaliki
- Ocular Oncology, LV Prasad Eye Institute, Hyderabad, India
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162
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Abu-Ain MS, Shatnawi R, Yousef YA, Watts P. Heterochromia irides and mistaken identity of retinoblastoma. BMJ Case Rep 2019; 12:12/10/e231091. [PMID: 31653630 DOI: 10.1136/bcr-2019-231091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Retinoblastoma is the most common intraocular malignancy of infancy which frequently manifests with a white pupillary reflex. We report a case of delayed presentation of a child with retinoblastoma in his left eye because parents thought the change in iris colour in this eye was due to the innocent heterochromia irides that was previously diagnosed in his elder sibling. This late presentation necessitated enucleation of the affected eye followed by chemotherapy.
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Affiliation(s)
- Moh'd Saleh Abu-Ain
- Ophthalmology, Hashemite University Faculty of Medicine, Zarqa, Jordan .,Ophthalmology Department, Prince Hamzah Hospital, Amman, Jordan
| | - Raed Shatnawi
- Ophthalmology, Hashemite University Faculty of Medicine, Zarqa, Jordan
| | | | - Patrick Watts
- Ophthalmology Department, University Hospital of Wales, Cardiff, UK
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163
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Ho KY, Lam KKW, Chung JOK, Xia W, Cheung AT, Ho LK, Chiu SY, Chan GCF, Li HCW. Systematic review of the effectiveness of complementary and alternative medicine on nausea and vomiting in children with cancer: a study protocol. BMJ Open 2019; 9:e031834. [PMID: 31628132 PMCID: PMC6803108 DOI: 10.1136/bmjopen-2019-031834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Nausea and vomiting are two most common symptoms reported by children with cancer when they undergo active treatment. However, pharmacological treatment is not sufficient to manage these two symptoms, with over 40% of children still experience nausea and vomiting after receiving antiemetics. There has been an exponential growth of studies to demonstrate the effectiveness of different complementary complementary medicine (CAM) to control nausea and vomiting during cancer treatment. Appropriate application of CAM enhances the effectiveness of antiemetics, thus reducing the symptom burden on children as well as improving their general condition and quality of life during cancer treatment. Nevertheless, it remains unclear which CAM is the best approach to help children to prevent or reduce nausea and vomiting during and after cancer treatment. This paper describes a protocol for identifying, analysing and synthesising research evidence on the effectiveness of CAM on nausea and vomiting in children with cancer. METHODS AND ANALYSIS A total of 10 databases will be searched to identify appropriate literature: MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, CINAHL, PsycINFO, LILACS, OpenSIGLE, the Chinese Biomedical Literature Database, the Chinese Medical Current Contents and the Chinese National Knowledge Infrastructure. All randomised controlled trials which meet the inclusion criteria will be included. The primary outcome is the changes in nausea and vomiting either assessed by self-reported and/or objective measures. Review Manager 5.3 will be used to synthesise the data, calculate the treatment effects, perform any subgroup analysis and assess the risk of bias. ETHICAL AND DISSEMINATION The results will be presented at international conferences and published in peer-reviewed journals. As no individual data will be involved in this review, ethical approval is not required. PROSPERO REGISTRATION NUMBER CRD42019135404.
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Affiliation(s)
- Ka Yan Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | | | | | - Wei Xia
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Ankie Tan Cheung
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Long Kwan Ho
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Sau Ying Chiu
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
| | - Godfrey Chi Fung Chan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
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164
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Hara Y, Shiba N, Yamato G, Ohki K, Tabuchi K, Sotomatsu M, Tomizawa D, Kinoshita A, Arakawa H, Saito AM, Kiyokawa N, Tawa A, Horibe K, Taga T, Adachi S, Taki T, Hayashi Y. Patients aged less than 3 years with acute myeloid leukaemia characterize a molecularly and clinically distinct subgroup. Br J Haematol 2019; 188:528-539. [PMID: 31612466 DOI: 10.1111/bjh.16203] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/22/2019] [Indexed: 12/18/2022]
Abstract
Although infants (age <1 year) with acute myeloid leukaemia (AML) have unique characteristics and are vulnerable to chemotherapy, children aged 1-2 years with AML may have characteristics similar to that of infants. Thus, we analysed 723 paediatric AML patients treated on the Japanese AML99 and AML-05 trials to identify characteristics of younger children. We identified patients aged <3 years (the younger group) as a distinct subgroup. KMT2A-rearrangement (KMT2A-R), CBFA2T3-GLIS2, CBFB-MYH11 and NUP98-KDM5A were frequently found in the younger group. Prognostic analyses revealed poor 5-year overall survival (OS), event-free survival (EFS) and cumulative incidence of relapse (CIR) in patients with CBFA2T3-GLIS2 (42%, 17% and 83%, respectively) and those with NUP98-KDM5A (33%, 17% and 83%, respectively). Additionally, we identified KMT2A-R and CBFB-MYH11 as age-specific prognostic markers. Regarding KMT2A-R, the younger group had significantly better OS, EFS and CIR than the older group (aged 3 to <18 years) (P = 0·023, 0·011 and <0·001, respectively). Conversely, concerning CBFB-MYH11, the younger group had significantly poor EFS and CIR than the older group (each P < 0·001), suggesting that certain molecular markers are linked to different prognoses according to age. Therefore, we characterized patients <3 years as a distinct subgroup of paediatric AML.
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Affiliation(s)
- Yusuke Hara
- Department of Paediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Haematology and Oncology, Gunma Children's Medical Centre, Shibukawa, Japan.,Clinical Research Centre, National Hospital Organization Nagoya Medical Centre, Nagoya, Japan
| | - Norio Shiba
- Department of Haematology and Oncology, Gunma Children's Medical Centre, Shibukawa, Japan.,Clinical Research Centre, National Hospital Organization Nagoya Medical Centre, Nagoya, Japan.,Department of Paediatrics, Yokohama City University Hospital, Kanagawa, Japan
| | - Genki Yamato
- Department of Paediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Haematology and Oncology, Gunma Children's Medical Centre, Shibukawa, Japan.,Clinical Research Centre, National Hospital Organization Nagoya Medical Centre, Nagoya, Japan
| | - Kentaro Ohki
- Department of Haematology and Oncology, Gunma Children's Medical Centre, Shibukawa, Japan.,Department of Paediatric Haematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Ken Tabuchi
- Department of Paediatrics, Tokyo Metropolitan Cancer and Infectious Diseases Centre Komagome Hospital, Tokyo, Japan
| | - Manabu Sotomatsu
- Department of Haematology and Oncology, Gunma Children's Medical Centre, Shibukawa, Japan
| | - Daisuke Tomizawa
- Division of Leukaemia and Lymphoma, Children's Cancer Centre, National Centre for Child Health and Development, Tokyo, Japan
| | - Akitoshi Kinoshita
- Department of Paediatrics, St Marianna University School of Medicine, Kawasaki, Japan
| | - Hirokazu Arakawa
- Department of Paediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akiko M Saito
- Clinical Research Centre, National Hospital Organization Nagoya Medical Centre, Nagoya, Japan
| | - Nobutaka Kiyokawa
- Department of Paediatric Haematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Akio Tawa
- Department of Paediatrics, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Keizo Horibe
- Clinical Research Centre, National Hospital Organization Nagoya Medical Centre, Nagoya, Japan
| | - Takashi Taga
- Department of Paediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Souichi Adachi
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomohiko Taki
- Department of Medical Technology, Kyorin University Faculty of Health Sciences, Mitaka, Japan
| | - Yasuhide Hayashi
- Department of Haematology and Oncology, Gunma Children's Medical Centre, Shibukawa, Japan.,Clinical Research Centre, National Hospital Organization Nagoya Medical Centre, Nagoya, Japan.,Institute of Physiology and Medicine, Jobu University, Takasaki, Japan
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165
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Abstract
The presentation of a fast-growing cervical mass necessitates prompt attention due to risk of the mass effect on vital structures and requires preferential screening for infections, bleeding and malignancies in an extensive list of differential diagnoses. This case report describes a 4.5-year-old boy with a fast-growing, unilateral lesion in the neck, with clinical features in keeping with malignant characteristics. Surgical excision with pathocytological examination revealed an exceptional diagnosis of haemorrhage in an ectopic cervical thymic cyst. Thymic cysts are a rare cause of unilateral masses in the neck, usually presenting as an asymptomatic, painless, slow-growing or stable mass anywhere along the thymopharyngeal duct. Spontaneous haemorrhages in thymic tissue can occur, often due to coagulation defects. Treatment of symptomatic thymic cysts is based on surgical excision. Partial resection of the thymus should be encouraged if possible, since clinical consequences of removing all thymic tissue in children are still unclear.
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Affiliation(s)
- Laura Claes
- Paediatrics, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Amélie Dendooven
- Department of Pathology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Jaques van Heerden
- Paediatrics, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.,Paediatric Haematology and Oncology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
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166
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Abstract
Osteosarcoma of the skull is a rare primary malignant bone tumour in children, representing 1-2% of all cranial tumours. We describe a case of a 17-year-old adolescent with chondroblastic osteosarcoma of the parietal-occipital bone and no distant metastases at presentation treated with neoadjuvant chemotherapy, surgery and, later, concurrent chemoradiotherapy. The patient suffered progressive disease and died 15 months after diagnosis. There are at least 15 paediatric cases of osteosarcoma of the skull described in the literature. Due to its rarity, there are no broad prospective studies on this entity, which has distinctive features when compared to other craniofacial tumours, carrying a worse prognosis. Complete surgical resection is needed for long-term survival, whereas chemotherapy and radiotherapy have still questionable indications.
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Affiliation(s)
- Liliana Vasquez
- Pediatric Oncology, Rebagliati Hospital, Lima, Peru.,Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres Facultad de Medicina Humana, La Molina, Lima, Peru
| | - Victor Tejada
- Department of Head and Neck Surgery, Rebagliati Hospital, Lima, Peru
| | - Ivan Maza
- Pediatric Oncology, Rebagliati Hospital, Lima, Peru
| | - Ronald Mendoza
- Department of Pathology, Rebagliati Hospital, Lima, Peru
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167
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Flores C, Lundberg J, Richardson RR, Prasad D. Utility of cardiac imaging in diagnosis of atypical presentation of cardiac fibroma. BMJ Case Rep 2019; 12:12/9/e230333. [PMID: 31492729 DOI: 10.1136/bcr-2019-230333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary cardiac tumours are relatively rare in the paediatric population, with benign tumours accounting for >90% of cases. Cardiac fibromas are rare primary tumours that typically reside in the ventricles. Symptoms are usually the result of blood outflow obstruction or disruption of the cardiac conduction system. They do not typically regress and usually require surgical intervention. In this case, we report a rare finding of a right atrial fibroma in an 18-month-old female who presented with lethargy and vomiting. Chest X-ray revealed an enlarged cardiac silhouette, and follow-up CT showed a 3.7×3.2×3.7 cm hypodense lesion in the right atrium. Cardiac MRI revealed the diagnosis, which was confirmed on pathology.
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Affiliation(s)
- Catalina Flores
- Phoenix Regional Campus, School of Medicine, Creighton University, Phoenix, AZ, USA
| | - Jaclyn Lundberg
- Phoenix Regional Campus, School of Medicine, Creighton University, Phoenix, AZ, USA
| | - Randy R Richardson
- Phoenix Regional Campus, School of Medicine, Creighton University, Phoenix, AZ, USA.,Department of Radiology, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Deepa Prasad
- Department of Child Health, Banner Desert Medical Center/Cardon Children's Medical Center, Mesa, AZ, USA
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168
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Abstract
OBJECTIVES Global incidence and attention to childhood cancer is increasing and treatment abandonment is a major cause of treatment failure in low- and middle-income countries. The purpose of this study was to gain an understanding of factors contributing to non-adherence to treatment. DESIGN A prospective cohort study with 2 year follow-up of incidence, family-reported motives and risk factors. SETTING The largest tertiary paediatric oncology centre in Northern Vietnam. PARTICIPANTS All children offered curative cancer treatment, from January 2008 to December 2009. PRIMARY AND SECONDARY OUTCOME MEASURES Family decision to start treatment was analysed with multivariable logistic regression, and family decision to continue treatment was analysed with a multivariable Cox model. This assessment of non-adherence is thereby methodologically consistent with the accepted definitions and recommended practices for evaluation of treatment abandonment. RESULTS Among 731 consecutively admitted patients, 677 were eligible for treatment and were followed for a maximum 2 years. Almost half the parents chose to decline curative care (45.5%), either before (35.2%) or during (10.3%) the course of treatment. Most parents reported perceived poor prognosis as the main reason for non-adherence, followed by financial constraints and traditional medicine preference. The odds of starting treatment increased throughout the study-period (OR 1.04 per month (1.01 to 1.07), p=0.002), and were independently associated with prognosis (OR 0.51 (0.41 to 0.64), p=<0.0001) and travel distance to hospital (OR 0.998 per km (0.996 to 0.999), p=0.004). The results also suggest that adherence to initiated treatment was significantly higher among boys than girls (HR 1.69 (1.05 to 2.73), p=0.03). CONCLUSIONS Non-adherence influenced the prognosis of childhood cancer, and was associated with cultural and local perceptions of cancer and the economic power of the affected families. Prevention of abandonment is a prerequisite for successful cancer care, and a crucial early step in quality improvements to care for all children with cancer.
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Affiliation(s)
- Bui Ngoc Lan
- Pediatric Oncology Hematology Center, Vietnam National Children’s Hospital (VNCH), Hanoi, Vietnam
| | - Anders Castor
- Pediatric Oncology, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Thomas Wiebe
- Pediatric Oncology, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Jacek Toporski
- Pediatric Oncology, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Christian Moëll
- Pediatric Oncology, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Lars Hagander
- Pediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
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169
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Liou NSY, Willmott F. Neurogenic bladder in an adolescent woman with an ovarian tumour: an unusual presentation of anti-NMDA-receptor encephalitis. BMJ Case Rep 2019; 12:12/8/e229626. [PMID: 31383677 DOI: 10.1136/bcr-2019-229626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is rarely seen in women with ovarian teratoma. It is characterised by neuropsychiatric symptoms and may also cause autonomic imbalance. We present the case of a 16-year-old nulliparous woman who presented with an acute history of seizures and neurogenic bladder. Antiviral and antiepileptic therapy conferred no therapeutic benefit. A cystic pelvic mass measuring 185×140×92 mm was identified separate from the bladder. Serum titres of NMDA receptor antibodies were significantly elevated. The mass was surgically removed and histology revealed benign ovarian teratoma with NMDA receptors. The patient made a rapid improvement and had full resolution of urinary and neuropsychiatric symptoms within 1 year. This case demonstrates that increased awareness in adolescents is crucial for avoiding symptom dismissal, misdiagnosis and inappropriate treatment of this condition. Surgical removal of the teratoma should be the first line therapy of anti-NMDA-receptor encephalitis as this often leads to symptom resolution soon after.
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Affiliation(s)
- Natasha Soong-Ying Liou
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Bart's Health Trust, London, UK
| | - Fredric Willmott
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Bart's Health Trust, London, UK
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170
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Abstract
BACKGROUND Up to 50% of children diagnosed with cancer in low- and middle-income countries are malnourished, which likely affects survival. SUBJECTS AND METHODS An online survey to paediatric oncology units (POUs) in Africa was done regarding nutritional assessment and care. RESULTS Sixty-six surveys were received from POUs in 31 countries. Only 44.4% had a dedicated dietician for nutritional assessment and support; 29.6% undertook routine nutritional assessment during treatment. None reported defined criteria for nutritional intervention. Total parenteral nutrition was not available for 42.6% of POUs, while 51.8% did not have access to commercial enteral nutrition for inpatients, and 25.9% of the hospitals could not supply any home-based nutritional supplements. CONCLUSION Nutritional assessment in POUs in Africa is neither routinely undertaken nor are there defined criteria to initiate nutritional interventions. Standardized guidelines for nutritional assessment and interventions are needed for African POUs to enable improved outcome.
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Affiliation(s)
- Judy Schoeman
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elena J Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, USA
| | - Paul C Rogers
- Division of Pediatric Oncology/Haematology/BMT, BC Children's Hospital and University of BC, Vancouver BC, Canada
| | - Suvekshya Aryal
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, USA
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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171
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Abstract
Multifocal bone Langerhans cell histiocytosis (LCH) is usually treated with prednisolone and vinblastine. We present a case conservatively treated with indomethacin with good clinical and radiological response. A 7-year-old achondroplastic boy presented with worsening thoracic back pain and leg weakness. An admission MRI spine showed a pathological T1 vertebrae fracture with posterior soft tissue extension compressing and distorting the spinal cord. A CT guided biopsy revealed an LCH. Steroids were avoided to reduce osteopenia risk and further vertebral fragility. Considering the risk of a thoracic surgical approach in a child with this background, he was managed conservatively with indomethacin and a Sternal Occipital Mandibular Immobilizer (SOMI) Brace. Pain resolved completely within 6 months and the brace was discontinued. Serial follow-up scans showed progressive resolution of the pathological T1 fracture and complete resolution of the spinal cord compression.
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Affiliation(s)
- Zoe Chan
- Neurosurgery, NHS Lothian, Edinburgh, UK
| | - Lesley Simpson
- Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Pasquale Gallo
- Paediatric Neurosurgery, Royal Hospital for Sick Children, Edinburgh, UK
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172
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Abstract
We report the case of an 8-year-old boy with diffuse large B cell lymphoma who developed a right-sided spontaneous pneumothorax with pleural effusion after recovery from septic shock. The pleural fluid was thought to be malignancy-associated chylothorax concomitant with complicated pleural effusion due to a milky-like appearance, a high level of triglycerides and Gram-negative bacteria staining in the fluid. He was put on total parental nutrition and octreotide for 2 weeks, but did not improve. The laboratory results also showed a persistent bacterial infection in the pleural fluid despite appropriate antibiotics. Eventually, a CT scan revealed a fistulous tract between the right pleural cavity and the stomach. Fistula repair was successful by right open thoracotomy with decortication. Even though the gastropleural fistula is a very rare condition in paediatric patients, the physician should consider this diagnosis in a patient who has an unusual presentation or refractory chylothorax-like pleural effusion.
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Affiliation(s)
- Pharsai Prasertsan
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Wanaporn Anuntaseree
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kanokpan Ruangnapa
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kantara Saelim
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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173
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Thorsteinsson T, Schmiegelow K, Thing LF, Andersen LB, Helms AS, Ingersgaard MV, Lindgren LH, Larsen HB. Classmates motivate childhood cancer patients to participate in physical activity during treatment: A qualitative study. Eur J Cancer Care (Engl) 2019; 28:e13121. [PMID: 31215079 DOI: 10.1111/ecc.13121] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 11/02/2018] [Accepted: 04/12/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Children with cancer experience reduced physical fitness and compromised social relationships during and following intensive treatment. This may negatively impact their quality of life. As part of the RESPECT study, we explored the motivations for participation in a physical activity programme during treatment. METHODS Thirteen semi-structured interviews were conducted with seven boys and six girls, diagnosed with paediatric cancer in 2013 and treated with chemotherapy (age 8-16 years; time from diagnosis to interview 6-16 months). Interviews were conducted in the children's homes. RESULTS The qualitative analysis showed that children's motivations for engaging in the physical activity programme during intensive medical treatment were primarily influenced by (a) opportunity for physical activity with a classmate; (b) participation in group physical activity sessions; (c) support from significant others; and (d) improvement of physical well-being. Main barriers included (a) poor physical well-being; (b) compliance with medical procedures and being treated in protective isolation; and (c) limited physical activity facilities. CONCLUSION Despite barriers, it is possible to motivate and engage children with cancer in physical activity during intensive treatment in a paediatric oncology ward. Physical exercise and activity should be recommended and promoted from diagnosis throughout the treatment period and should include psychosocial and professional support.
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Affiliation(s)
- Troels Thorsteinsson
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Ø, Denmark.,Division of Paediatric Haematology/Oncology, Perlmutter Cancer Centre, New York University Langone Medical Centre, New York, New York
| | - Lone Friis Thing
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen N, Denmark
| | - Lars Bo Andersen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Department of Teacher Education and Sport, Western Norway University of Applied Sciences, Haugesun, Norway
| | - Anne Sofie Helms
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark
| | - Marianne Vie Ingersgaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark
| | - Lea Hjortshøj Lindgren
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark
| | - Hanne Baekgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark
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174
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Abstract
A 14-year-old boy with familial Li-Fraumeni syndrome presented with diplopia. Brain MRI revealed a right temporoparietal rim-enhancing mass. Following surgical resection and diagnosis of a gigantocellular-type glioblastoma multiforme (GBM), his family wished to avoid cytotoxic chemotherapy given the amplified risk of secondary malignancy. As such, we performed whole exome and transcriptome sequencing, which revealed germline TP53 and somatic TSC2 mutations. On completion of adjuvant radiotherapy, he was started on maintenance therapy with everolimus per recommendations from our multi-institutional brain tumour precision medicine tumour board. He has achieved a complete remission with resolution of visual symptoms and remains on everolimus therapy with concurrent electromagnetic field therapy, now 33 months from diagnosis. Our data highlight the benefit of precision medicine in children with GBM and offer insight into a targetable pathway that may be involved in similar cases.
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Affiliation(s)
- Andrew H Zureick
- University of Michigan Medical School, Michigan Medicine, Ann Arbor, Michigan, USA.,Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan, USA
| | | | - Rajen Mody
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Carl Koschmann
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
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175
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Zhao CW, Singh V, Singh V. Childhood acute lymphoblastic leukaemia relapse with atypical localised presentation mimicking ankle trauma in a 28-year-old man. BMJ Case Rep 2019; 12:12/5/e228541. [PMID: 31118175 DOI: 10.1136/bcr-2018-228541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Acute lymphoblastic leukaemia (ALL) is a common paediatric cancer with a tendency to relapse, usually within 3 years of remission. Most patients present with hepatomegaly, splenomegaly, pallor, fever and bruising. Localised muskuloskeletal presentation is extremely rare. Here, we present a case of leukaemia relapse in the bone marrow of a 28-year-old man 9 years after achieving remission, presenting only with ankle pain and normal routine labs besides mild hypercalcemia, and no signs of disease in common bone marrow biopsy sites. This highly localised presentation is unusual and would hopefully inform clinicians to have a high index of suspicion for relapse in an adult patient who has had childhood ALL.
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Affiliation(s)
- Charlie Weige Zhao
- Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Vinit Singh
- Physiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Vasundhara Singh
- Hospital Medicine, Mount Sinai Hospital, New York, New York, USA
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176
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Robertson EG, Mitchell R, Wakefield CE, Lewis P, Cousens N, Marshall GM, Russell SJ, Ziegler DS, Anazodo AC, Trahair TN, Barbaric D, Cohn RJ, Alvaro F, O'Brien TA. Enrolment in paediatric oncology early-phase clinical trials: The health-care professionals' perspective. J Paediatr Child Health 2019; 55:561-566. [PMID: 30288839 DOI: 10.1111/jpc.14248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/07/2018] [Accepted: 09/07/2018] [Indexed: 11/27/2022]
Abstract
AIM Approximately 20-30% of children/adolescents with cancer will not respond to standard therapies. These children are usually offered experimental treatment in the form of an early-phase clinical trial. We examined the perspectives of health-care professionals (HCPs) regarding obtaining informed consent for early-phase trials in paediatric oncology. METHODS We collected survey data from 87 HCPs working in paediatric cancer centres across Australia and New Zealand. RESULTS HCPs were, on average, 44 years old (range = 25-74), with 15.8 years' experience in paediatric oncology (range = 1-40). Few HCPs (17.4%) received training for early-phase trial consent; however, most were willing to attend training (77.9%). HCPs (61.6%) reported that they informed families about early-phase trials without any attempt to influence their decision. However, 23.3% of HCPs reported that they informed families that their child would benefit. HCPs' main obstacle in obtaining consent was their perception of parents' eagerness to 'try anything' (52.3%). HCPs perceived that many parents misunderstood key clinical trials concepts, with 25.2% of HCPs believing that not being given clear information influenced parents' decisions. Physicians were more likely than social workers/nurses to inform families that other children will benefit from enrolment in the study. Social workers/nurses appeared to rate the chance of benefits for the patient higher than physicians. CONCLUSIONS HCPs may experience difficulty conducting early-phase trial consultations and obtaining valid informed consent. Our study highlights the need for formal training for HCPs and additional patient education tools.
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Affiliation(s)
- Eden G Robertson
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Richard Mitchell
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Peter Lewis
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Nicole Cousens
- Prince of Wales Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Glenn M Marshall
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Susan J Russell
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - David S Ziegler
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Antoinette C Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Cancer Centre, Sydney, New South Wales, Australia
| | - Toby N Trahair
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Draga Barbaric
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Frank Alvaro
- Oncology and Haematology Service, John Hunter Children's Hospital, Sydney, New South Wales, Australia
| | - Tracey A O'Brien
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
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177
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Abstract
Hypereosinophilic syndromes are rare in children. Sporadic, mild-severity FIP1L1-platelet-derived growth factor receptor α (PDGFRα) rearrangement cases have been reported, mainly in boys. We present the case of a 5-year-old girl referred from her African country of birth, due to severe constitutional symptoms, multifocal bone pain, headache, gastrointestinal complaints, cardiomyopathy and unexplained hypereosinophilia. She presented multiple end-organ diseases and striking bone involvement. Although she had a positive serology for Strongyloides stercoralis, extensive evaluation detected a FIP1L1-PDGFRA fusion gene. Systemic corticosteroids and low-dose imatinib were started and the child became asymptomatic. After 9 months of treatment, FIP1L1-PDGFRA was no longer detected.
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Affiliation(s)
- Sofia Bota
- Women, Child and Adolescents Department, Hospital Dona Estefania, Lisboa, Portugal
| | - Pedro Alves
- Radiology Department, Hospital Dona Estefania, Lisboa, Portugal
| | - Claudia Constantino
- Pediatric Oncology Department, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
| | - Raquel Maia
- Women, Child and Adolescents Department, Hospital Dona Estefania, Lisboa, Portugal.,Pediatric Hematology Unit, Hospital Dona Estefania, Lisboa, Portugal
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178
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Abstract
Therapies of complementary and alternative medicine (CAM) are used increasingly in paediatric oncology. We present and discuss the influence of supportive mistletoe therapy on factors, such as quality of life, physical ability and performance, and course of disease based on the case of a female patient diagnosed at age 18 with metastasised neuroblastoma, which responded insufficiently to chemotherapy.
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Affiliation(s)
- Jens Kaestner
- Klinik für Kinder- und Jugendmedizin, Friedrich-Schiller-Universität Jena, Jena, Germany
| | | | | | - Bernd Gruhn
- Klinik für Kinder- und Jugendmedizin, Friedrich-Schiller-Universität Jena, Jena, Germany
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179
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Abstract
A 43-year-old woman, whose pregnancy was complicated by the presence of a large single solid intra-abdominal fetal mass, was referred from the private sector into our fetal maternal unit at the Corniche Hospital, Abu Dhabi at 36 weeks postmenstrual age.Investigations subsequently confirmed that this mass was a congenital hepatoblastoma, one of the very rare embryonic tumours. The baby had chemotherapy and surgical excision of the tumour. Fifteen months later, the alpha feto-protein levels remain normal and follow-on MRI scans do not show recurrence or any residual disease.To our knowledge, this is the first case of congenital hepatoblastoma in the United Arab Emirates (UAE). In the UAE, the interphase between private health insurance schemes and medical (public and private) care within a growing health economy enhances access to unique services such as cancer treatments within specialised centres.
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Affiliation(s)
| | | | | | - Latifeh Ghosn
- Neonatal Unit, Al Corniche Hospital, Abu Dhabi, United Arab Emirates
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180
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Gerintes JM. [Music therapy in paediatric oncology]. Soins Pediatr Pueric 2019; 40:32-34. [PMID: 30910072 DOI: 10.1016/j.spp.2019.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
At Gustave Roussy Institute in Villejuif, musicians regularly work with hospitalised children. Music offers young patients and their family a moment of wellbeing. The caregivers also appreciate this tool which can help to facilitate difficult care procedures.
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Affiliation(s)
- Jean-Marie Gerintes
- Musique et santé, Hameaux du Château Vert, 27 placette Dronte, 83110 Sanary-sur-Mer, France.
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181
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Chau LQ, Levy ML, Crawford JR. Unusual KRAS missense mutation (p.E63K) in patient with juvenile pilocytic astrocytoma of the tectum. BMJ Case Rep 2019; 12:12/2/e228128. [PMID: 30798277 DOI: 10.1136/bcr-2018-228128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Lianne Q Chau
- Tumor Initiation and Maintenance Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California, USA
| | - Michael L Levy
- Neurosurgery, University of California San Diego, San Diego, California, USA
| | - John Ross Crawford
- Neurosciences and Pediatrics, University of California San Diego, San Diego, California, USA
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182
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Abstract
OBJECTIVES The primary objective was to assess the utility of the number needed to treat (NNT) to inform decision-making in the context of paediatric oncology and to calculate the NNT in all superiority, parallel, paediatric haematological cancer, randomised controlled trials (RCTs), with a comparison to the threshold NNT as a measure of clinical significance. DESIGN Systematic review DATA SOURCES: MEDLINE, EMBASE and the Cochrane Childhood Cancer Group Specialized Register through CENTRAL from inception to August 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Superiority, parallel RCTs of haematological malignancy treatments in paediatric patients that assessed an outcome related to survival, relapse or remission; reported a sample size calculation with a delta value to allow for calculation of the threshold NNT, and that included parameters required to calculate the NNT and associated CI. RESULTS A total of 43 RCTs were included, representing 45 randomised questions, of which none reported the NNT. Among acute lymphoblastic leukaemia (ALL) RCTs, 29.2% (7/24) of randomised questions were found to have a NNT corresponding to benefit, in comparison to acute myeloid leukaemia (ALM) RCTs with 50% (3/6), and none in lymphoma RCTs (0/13). Only 28.6% (2/7) and 33.3% (1/3) had a NNT that was less than the threshold NNT for ALL and AML, respectively. Of these, 100% (2/2 ALL and 1/1 AML) were determined to be possibly clinically significant. CONCLUSIONS We recommend that decision-makers in paediatric oncology use the NNT and associated confidence limits as a supportive tool to evaluate evidence from RCTs while placing careful attention to the inherent limitations of this measure.
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Affiliation(s)
- Haroon Hasan
- Epi Methods Consulting, Toronto, Ontario, Canada
| | - Karen Goddard
- Department of Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - A Fuchsia Howard
- School Of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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183
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Wang YM, Mo JQ, Kuo DJ, Wong V. MLL rearranged acute lymphoblastic leukaemia presenting as a maxillary sinus mass with a discordant immunophenotypic profile from the bone marrow. BMJ Case Rep 2019; 12:12/2/e227400. [PMID: 30772833 DOI: 10.1136/bcr-2018-227400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe an unusual case of pre-B lymphoblastic leukaemia presenting with a unilateral maxillary sinus mass in which biopsies of the primary mass and the bone marrow demonstrated conflicting immunophenotyping results. The extramedullary mass was consistent with a precursor B-cell malignancy, while the bone marrow was initially reported as a possible mature B-cell malignancy. The treatments for the two are fundamentally different, which necessitated a delay in the initiation of his chemotherapy until a clear diagnosis was made. Mixed lineage leukaemia gene rearrangement was confirmed by fluorescence in situ hybridisation in both the primary mass and bone marrow, which unified the diagnosis as pre-B acute lymphoblastic leukaemia given the common cytogenetic feature.
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Affiliation(s)
- Yunzu Michele Wang
- Department of Pediatric Hematology-Oncology, University of California San Diego, San Diego, California, USA
| | - Jun Qin Mo
- Department of Pathology, University of California San Diego, San Diego, California, USA
| | - Dennis John Kuo
- Department of Pediatric Hematology-Oncology, University of California San Diego, San Diego, California, USA
| | - Victor Wong
- Department of Pediatric Hematology-Oncology, University of California San Diego, San Diego, California, USA
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184
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Aghajan Y, Malicki DM, Levy ML, Crawford JR. Atypical anaplastic astrocytoma with unique molecular features and diffuse leptomeningeal spread in a child with long-term survival. BMJ Case Rep 2019; 12:12/2/e228153. [PMID: 30765449 DOI: 10.1136/bcr-2018-228153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paediatric high-grade gliomas, including glioblastoma and anaplastic astrocytoma, make up 8%-12% of paediatric central nervous system tumours 1 and have poor prognosis, with 2-year survival less than 30% 2 and overall survival less than 10%. The only known prognostic factors in this population include extent of resection and tumour histological grade. We present the case of a 9-year-old boy with disseminated anaplastic astrocytoma treated with subtotal resection, craniospinal radiation and temozolomide, with 8-year survival despite metastatic disease at presentation and subtotal resection. Next generation cancer gene panel sequencing revealed an usual pattern of 12 amplifications and four mutations not previously described.
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Affiliation(s)
- Yasmin Aghajan
- School of Medicine, UC San Diego, La Jolla, California, USA
| | - Denise M Malicki
- Pathology, Rady Children's Hospital University of California San Diego, San Diego, California, USA
| | - Michael L Levy
- Neurosurgery, University of California San Diego, San Diego, California, USA
| | - John Ross Crawford
- Neurosciences and Pediatrics, University of California San Diego, San Diego, California, USA
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185
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Ehrhardt MJ, Hochberg J, Bjornard KL, Brinkman TM. Long-term survivors of childhood, adolescent and young adult non-Hodgkin lymphoma. Br J Haematol 2019; 185:1099-1110. [PMID: 30714126 DOI: 10.1111/bjh.15775] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Progress in overall survival rates for childhood non-Hodgkin lymphoma (NHL) can be largely attributed to effective development and conduct of a number of international treatment studies. Knowledge gained from these studies has shifted the treatment paradigm from a "one-size fits all" strategy to a histologically dependent approach. More specifically, many now adhere to a risk-stratified approach, prescribing cumulative doses and intensities of chemotherapeutic exposures based upon the aggressiveness of disease. Moreover, recognition that high cure rates could be achieved without the use of radiation has eliminated the use of this modality in frontline settings for the majority of newly diagnosed children. These changes have contributed to the emergence of a heterogeneous group of NHL survivors. As the number of NHL survivors continues to increase, providers will encounter a wide spectrum of individuals whose risk for long-term complications are accordingly diverse. The following review summarizes the existing literature surrounding late effects, such as chronic health conditions, functional and neurocognitive performance outcomes, and health-related quality of life, that are unique to NHL survivors, as well as those extrapolated from the broader childhood cancer survivor population.
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Affiliation(s)
- Matthew J Ehrhardt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jessica Hochberg
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Kari L Bjornard
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
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186
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Affiliation(s)
- Andrew Ng
- Department of Child Neurology, Rady Children's Hospital University of California San Diego, San Diego, California, USA
| | - Michael L Levy
- Department of Neurosurgery, University of California San Diego, San Diego, California, USA
| | - Denise M Malicki
- Department of Pathology, Rady Children's Hospital University of California San Diego, San Diego, California, USA
| | - John Ross Crawford
- Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, California, USA
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187
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Leckey BD, Carney JM, Sun JM, Pavlisko EN. Novel intronic DICER1 variation associated with pleuropulmonary blastoma in two siblings. BMJ Case Rep 2019; 12:12/1/e227391. [PMID: 30665929 DOI: 10.1136/bcr-2018-227391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pleuropulmonary blastomas (PPB) are rare aggressive paediatric lung malignancies associated with DICER1 variants. We present two cases, a 2-year-old girl with upper respiratory tract symptoms as well as a 6-month-old girl sibling undergoing screening due to family history of malignancy. Imaging of the 2-year-old girl revealed a large mass filling the right hemithorax which was determined to be a type II PPB after pathological examination. Imaging of the 6-month-old sibling demonstrated a small cystic lesion in the posterior basal segment of the right lower lobe which was determined to be a type 1r PPB after pathological examination. The 2-year-old girl received adjuvant chemotherapy while the baby sister underwent resection alone and both are alive and well at 12 months and 7 months, respectively. Sequence analysis in both cases confirmed the same DICER1 variation, c.2437-2A>G (likely pathogenic), which has not been previously described in the literature.
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Affiliation(s)
- Bruce D Leckey
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - John M Carney
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jessica M Sun
- Department of Pediatric Hematology Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth N Pavlisko
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
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188
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Aghajan Y, Malicki DM, Levy ML, Crawford JR. Atypical central neurocytoma with novel EWSR1-ATF1 fusion and MUTYH mutation detected by next-generation sequencing. BMJ Case Rep 2019; 12:12/1/bcr-2018-226455. [PMID: 30642852 DOI: 10.1136/bcr-2018-226455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 13-year-old boy with a very unusual periventricular atypical central neurocytoma with unique molecular features treated with subtotal surgical resection and photon intensity-modulated radiotherapy. Histological features were most consistent with atypical central neurocytoma. However, next-generation sequencing analysis revealed a novel EWSR1-ATF1 gene fusion (EWSR1-ATF1) as well as a MUTYH mutation. The EWSR1-ATF1 raised the possibility of Ewing sarcoma or angiomatoid fibrous histiocytoma, however, FLI-1 immunohistochemistry was negative. MUTYH mutations have been reported in diffuse midline paediatric glioma. The role of EWSR1-ATF1 and MUTYH mutations in central nervous system tumours is not well established. We present the first case of EWSR1-ATF1 and MUTYH mutation in a rare paediatric atypical central neurocytoma. Further studies are indicated to elucidate the consequences of these gene alterations in the context of paediatric central nervous system tumours as well as to investigate the potential role for targeted therapies.
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Affiliation(s)
- Yasmin Aghajan
- School of Medicine, UC San Diego, La Jolla, California, USA
| | - Denise M Malicki
- Department of Pathology, Rady Children's Hospital University of California San Diego, San Diego, California, USA
| | - Michael L Levy
- Department of Neurosurgery, University of California San Diego, San Diego, California, USA
| | - John Ross Crawford
- Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, California, USA
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189
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Egan G, Goldman S, Alexander S. Mature B-NHL in children, adolescents and young adults: current therapeutic approach and emerging treatment strategies. Br J Haematol 2019; 185:1071-1085. [PMID: 30613948 DOI: 10.1111/bjh.15734] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Mature B cell lymphomas account for approximately 60% of all cases of non-Hodgkin lymphoma (NHL) in children and adolescents and includes Burkitt lymphoma (BL), diffuse large B cell lymphoma (DLBCL) and other less common histologies. The outcome for patients treated with modern regimens in resource-intensive settings is excellent. Improvements in care have been accomplished through enhanced supportive therapy, including tumour lysis management and incremental refinement of chemotherapy backbones via cooperative group clinical trials in which patients receive risk group-specific intensive chemotherapy. More recent trials have established the safety and efficacy of immunotherapy. Ongoing work is required to address the substantial burden of acute therapy-related toxicity, as well as the identification of effective therapies for those patients with relapsed and refractory disease, for whom outcomes remain very poor. In this review we will summarize the results from recent therapeutic clinical trials, describe the evidence to support the inclusion of rituximab and review the rationale for the investigation of several new categories of novel agents for mature B cell lymphomas in children and adolescents.
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Affiliation(s)
- Grace Egan
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Stan Goldman
- Department of Pediatrics, Medical City Children's Hospital and Texas Oncology, Dallas, TX, USA
| | - Sarah Alexander
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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190
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Bate J, Baker S, Breuer J, Chisholm JC, Gray J, Hambleton S, Houlton A, Jit M, Lowis S, Makin G, O'Sullivan C, Patel SR, Phillips R, Ransinghe N, Ramsay ME, Skinner R, Wheatley K, Heath PT. PEPtalk2: results of a pilot randomised controlled trial to compare VZIG and aciclovir as postexposure prophylaxis (PEP) against chickenpox in children with cancer. Arch Dis Child 2019; 104:25-29. [PMID: 29730641 DOI: 10.1136/archdischild-2017-314212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/16/2018] [Accepted: 04/17/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the likely rate of patient randomisation and to facilitate sample size calculation for a full-scale phase III trial of varicella zoster immunoglobulin (VZIG) and aciclovir as postexposure prophylaxis against chickenpox in children with cancer. DESIGN Multicentre pilot randomised controlled trial of VZIG and oral aciclovir. SETTING England, UK. PATIENTS Children under 16 years of age with a diagnosis of cancer: currently or within 6 months of receiving cancer treatment and with negative varicella zoster virus (VZV) serostatus at diagnosis or within the last 3 months. INTERVENTIONS Study participants who have a significant VZV exposure were randomised to receive PEP in the form of VZIG or aciclovir after the exposure. MAIN OUTCOME MEASURES Number of patients registered and randomised within 12 months of the trial opening to recruitment and incidence of breakthrough varicella. RESULTS The study opened in six sites over a 13-month period. 482 patients were screened for eligibility, 32 patients were registered and 3 patients were randomised following VZV exposure. All three were randomised to receive aciclovir and there were no cases of breakthrough varicella. CONCLUSIONS Given the limited recruitment to the PEPtalk2 pilot, it is unlikely that the necessary sample size would be achievable using this strategy in a full-scale trial. The study identified factors that could be used to modify the design of a definitive trial but other options for defining the best means to protect such children against VZV should be explored. TRIAL REGISTRATION NUMBER ISRCTN48257441, EudraCT number: 2013-001332-22, sponsor: University of Birmingham.
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Affiliation(s)
- Jessica Bate
- Department of Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stephen Baker
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, UK
| | - Julia C Chisholm
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Juliet Gray
- Department of Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Cancer Sciences Academic Unit, University of Southampton, Southampton, UK
| | - Sophie Hambleton
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aimee Houlton
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen Lowis
- School of Clinical Sciences, University of Bristol, London, UK
| | - Guy Makin
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Catherine O'Sullivan
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St. Georges, University of London, London, UK
| | - Soonie R Patel
- Department of Paediatrics, Croydon Health Services NHS Trust, London, UK
| | | | - Neil Ransinghe
- Parent representative, Paediatric Oncology Reference Team, UK
| | | | - Roderick Skinner
- Great North Children's Hospital, Department of Paediatric and Adolescent Haematology/Oncology, Newcastle upon Tyne, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St. Georges, University of London, London, UK
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191
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Ojha S, Gaskin J, Saunders M. Subglottic acute lymphoblastic leukaemia. BMJ Case Rep 2018; 11:11/1/e226364. [PMID: 30567102 DOI: 10.1136/bcr-2018-226364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute lymphoblastic leukaemia (ALL) is one of the the most common malignancies of childhood and can occasionally present as acute airway obstruction. We present the unusual case of a 1-year-old boy who was referred to our Paediatric Otolaryngology (ENT) clinic with a recurrent history of croup. This is the first reported case of localised ALL presenting as a subglottic mass in a paediatric patient. It highlights the need to have a broader differential diagnosis in children presenting with 'recurrent croup' including extramedullary presentation of leukaemia and to have a low threshold for performing endoscopy in such cases.
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Affiliation(s)
- Shilpa Ojha
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Julian Gaskin
- ENT, University Hospitals Bristol NHS Foundation Trust, Bristol, Bristol, UK
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192
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Suerink M, Ripperger T, Messiaen L, Menko FH, Bourdeaut F, Colas C, Jongmans M, Goldberg Y, Nielsen M, Muleris M, van Kouwen M, Slavc I, Kratz C, Vasen HF, Brugiѐres L, Legius E, Wimmer K. Constitutional mismatch repair deficiency as a differential diagnosis of neurofibromatosis type 1: consensus guidelines for testing a child without malignancy. J Med Genet 2018; 56:53-62. [PMID: 30415209 DOI: 10.1136/jmedgenet-2018-105664] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/05/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022]
Abstract
Constitutional mismatch repair deficiency (CMMRD) is a rare childhood cancer predisposition syndrome caused by biallelic germline mutations in one of four mismatch-repair genes. Besides very high tumour risks, CMMRD phenotypes are often characterised by the presence of signs reminiscent of neurofibromatosis type 1 (NF1). Because NF1 signs may be present prior to tumour onset, CMMRD is a legitimate differential diagnosis in an otherwise healthy child suspected to have NF1/Legius syndrome without a detectable underlying NF1/SPRED1 germline mutation. However, no guidelines indicate when to counsel and test for CMMRD in this setting. Assuming that CMMRD is rare in these patients and that expected benefits of identifying CMMRD prior to tumour onset should outweigh potential harms associated with CMMRD counselling and testing in this setting, we aimed at elaborating a strategy to preselect, among children suspected to have NF1/Legius syndrome without a causative NF1/SPRED1 mutation and no overt malignancy, those children who have a higher probability of having CMMRD. At an interdisciplinary workshop, we discussed estimations of the frequency of CMMRD as a differential diagnosis of NF1 and potential benefits and harms of CMMRD counselling and testing in a healthy child with no malignancy. Preselection criteria and strategies for counselling and testing were developed and reviewed in two rounds of critical revisions. Existing diagnostic CMMRD criteria were adapted to serve as a guideline as to when to consider CMMRD as differential diagnosis of NF1/Legius syndrome. In addition, counselling and testing strategies are suggested to minimise potential harms.
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Affiliation(s)
- Manon Suerink
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Tim Ripperger
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Ludwine Messiaen
- Department of Genetics, University of Alabama, Birmingham, Alabama, USA
| | - Fred H Menko
- Family Cancer Clinic, Antoni van Leeuwenhoek Hospital and The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Franck Bourdeaut
- Département d'Oncologie Pédiatrique et d'Adolescents Jeunes Adultes, Institut Curie, Paris, France
| | - Chrystelle Colas
- Department of Genetics, Institut Curie, Paris Sciences Lettres Research University, Paris, France.,Centre de Recherche Saint-Antoine, Sorbonne Universités, UPMC Univ Paris 06, INSERM, CNRS, Paris, France
| | - Marjolijn Jongmans
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yael Goldberg
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Maartje Nielsen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martine Muleris
- Centre de Recherche Saint-Antoine, Sorbonne Universités, UPMC Univ Paris 06, INSERM, CNRS, Paris, France
| | - Mariëtte van Kouwen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Irene Slavc
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Christian Kratz
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Hans F Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Laurence Brugiѐres
- Children and Adolescent Oncology Department, Gustave Roussy Cancer Institute, Villejuif, France
| | - Eric Legius
- Department of Human Genetics, University Hospital Leuven and KU Leuven, Leuven, Belgium
| | - Katharina Wimmer
- Division of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
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193
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Lim D, Barker R, Maltby K, George E. A snotty nose: more than just a cold. BMJ Case Rep 2018; 2018:bcr-2018-226686. [PMID: 30317210 PMCID: PMC6194411 DOI: 10.1136/bcr-2018-226686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- David Lim
- Paediatrics, Frimley Park Hospital, Camberley, UK
| | | | - Karyn Maltby
- Paediatrics, Frimley Park Hospital, Camberley, UK
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194
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Sylvester DE, Chen Y, Jamieson RV, Dalla-Pozza L, Byrne JA. Investigation of clinically relevant germline variants detected by next-generation sequencing in patients with childhood cancer: a review of the literature. J Med Genet 2018; 55:785-793. [PMID: 30287599 DOI: 10.1136/jmedgenet-2018-105488] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/06/2018] [Accepted: 09/09/2018] [Indexed: 11/04/2022]
Abstract
Genetic predisposition is an important underlying cause of childhood cancer, although the proportion of patients with childhood cancer carrying predisposing pathogenic germline variants is uncertain. This review considers the pathogenic or likely pathogenic germline variants reported by six studies that used next-generation sequencing to investigate genetic predisposition in selected cohorts of patients with childhood cancer and used incompletely overlapping gene sets for analysis and interpretation. These six studies reported that 8.5%-35.5% of patients with childhood cancer carried clinically relevant germline variants. Analysis of 52 autosomal dominant cancer predisposition genes assumed common to all six studies showed that 5.5%-25.8% of patients with childhood cancer carried pathogenic or likely pathogenic germline variants in at least one of these genes. When only non-central nervous system solid tumours (excluding adrenocortical carcinomas) were considered, 8.5%-10.3% of the patients carried pathogenic or likely pathogenic germline variants in at least one of 52 autosomal dominant cancer predisposition genes. There was a lack of concordance between the genotype and phenotype in 33.3%-57.1% of the patients reported with pathogenic or likely pathogenic germline variants, most of which represented variants in autosomal dominant cancer predisposition genes associated with adult onset cancers. In summary, germline genetic testing in patients with childhood cancer requires clear definition of phenotypes and genes considered for interpretation, with potential to inform and broaden childhood cancer predisposition syndromes.
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Affiliation(s)
- Dianne E Sylvester
- Children's Cancer Research Unit, Kids Research and Discipline of Child and Adolescent Health, University of Sydney, Westmead, New South Wales, Australia
| | - Yuyan Chen
- Children's Cancer Research Unit, Kids Research and Discipline of Child and Adolescent Health, University of Sydney, Westmead, New South Wales, Australia
| | - Robyn V Jamieson
- Eye & Developmental Genetics Research Group, The Children's Hospital at Westmead and Children's Medical Research Institute, Westmead, New South Wales, Australia
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jennifer A Byrne
- Children's Cancer Research Unit, Kids Research and Discipline of Child and Adolescent Health, University of Sydney, Westmead, New South Wales, Australia
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195
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Affiliation(s)
- Eilidh Bell
- Foundation Doctor, Aberdeen Royal Infirmary, Aberdeen, UK
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196
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Abstract
A 4-year-old boy presented with fatigue and was found to have severe kidney injury requiring haemodialysis. A renal ultrasound demonstrated bilateral nephromegaly with mild loss of corticomedullary differentiation but preserved echogenicity. He had a persistent isolated monocytosis. Renal biopsy revealed extensive infiltration by primary renal diffuse large B-cell lymphoma. He required haemodialysis for 18 days and received chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone, rituximab and intrathecal methotrexate. He achieved remission with an estimated glomerular filtration rate of 50 mL/min/1.73 m2, and his kidneys returned to normal size. Nephromegaly due to renal-limited haematolymphoid disease is extremely rare, especially in children.
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Affiliation(s)
- Andrew Michael South
- Department of Pediatrics, Section of Nephrology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
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197
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Affiliation(s)
- Linda Nguyen
- Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - John Ross Crawford
- Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, California, USA
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198
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Valind A, Öra I, Mertens F, Gisselsson D. Neuroblastoma with flat genomic profile: a question of representativity? BMJ Case Rep 2018; 2018:bcr-2018-225568. [PMID: 30196258 DOI: 10.1136/bcr-2018-225568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neuroblastoma is one of the most common paediatric malignancies. Detection of somatic genetic alterations in this tumour is instrumental for its risk stratification and treatment. On the other hand, an absence of detected chromosomal imbalances in neuroblastoma biopsies is difficult to interpret because it is unclear whether this situation truly reflects the tumour genome or if it is due to suboptimal sampling. We here present a neuroblastoma in the left adrenal of a newborn. The tumour was subjected to single-nucleotide polymorphism array analysis of five tumour regions with >80% tumour cells in histological mirror sections. This revealed no aberrations compared with a normal reference sample from the patient. Whole exome sequencing identified two single-nucleotide variants present in most tumour regions, corroborating that the tumour resulted from monoclonal expansion. Our data provide proof-of-principle that rare cases of neuroblastoma can have a normal whole genome copy number and allelic profile.
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Affiliation(s)
- Anders Valind
- Division of Clinical Genetics, Lunds Universitet, Lund, Sweden
| | - Ingrid Öra
- Division of Clinical Genetics, Lunds Universitet, Lund, Sweden
| | - Fredrik Mertens
- Division of Clinical Genetics, Lunds Universitet, Lund, Sweden
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199
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Friis Abrahamsen C, Ahrensberg JM, Vedsted P. Utilisation of primary care before a childhood cancer diagnosis: do socioeconomic factors matter?: A Danish nationwide population-based matched cohort study. BMJ Open 2018; 8:e023569. [PMID: 30121615 PMCID: PMC6104784 DOI: 10.1136/bmjopen-2018-023569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Early diagnosis of childhood cancer is critical. Nevertheless, little is known about the potential role of inequality. This study aims to describe the use of primary care 2 years before a childhood cancer diagnosis and to investigate whether socioeconomic factors influence the use of consultations and diagnostic tests in primary care. DESIGN A national population-based matched cohort study. SETTING AND PARTICIPANTS This study uses observational data from four Danish nationwide registers. All children aged 0-15 diagnosed with cancer during 2008-2015 were included (n=1386). Each case was matched based on gender and age with 10 references (n=13 860). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was additional rates for consultations and for invoiced diagnostic tests for children with cancer according to parental socioeconomic factors. Furthermore, we estimated the association between socioeconomic factors and frequent use of consultations, defined as at least four consultations, and the odds of receiving a diagnostic test within 3 months of diagnosis. RESULTS Children with cancer from families with high income had 1.46 (95% CI 1.23 to 1.69) additional consultations 3 months before diagnosis, whereas children from families with low income had 1.85 (95% CI 1.60 to 2.11) additional consultations. The highest odds of frequent use of consultations was observed among children from low-income families (OR: 1.94, 95% CI 1.24 to 3.03). A higher odds of receiving an invoiced diagnostic test was seen for children from families with mid-educational level (OR: 1.46, 95% CI 1.09 to 1.95). CONCLUSION We found a socioeconomic gradient in the use of general practice before a childhood cancer diagnosis. This suggests that social inequalities exist in the pattern of healthcare utilisation in general practice.
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Affiliation(s)
| | - Jette Møller Ahrensberg
- Department of Clinical Medicine, Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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200
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Abstract
Gallbladder (GB) empyema is an uncommon complication in acute myeloid leukaemia (AML). Non-specific signs and symptoms and rarity of disease in AML make it difficult to diagnose early. We report a case of 13-year-old boy who had AML and developed GB empyema in the neutropaenic period. The patient was managed with antibiotics, ultrasound-guided tapping and interval cholecystectomy and recovered well. GB empyema is a life-threatening complication which should be kept as a possibility while evaluating patients with neutropaenia with pain abdomen localised to right hypochondrium as early diagnosis and treatment can lead to better outcomes.
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Affiliation(s)
- Gitika Pant
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Archana Kumar
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nishant Verma
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anil Sharma
- Department of Pediatric hematoncology and BMT, Medanta The Medicity, Gurgaon, Haryana, India
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