BACKGROUND/OBJECTIVES:Pain is a prevalent late effect of cancer that can disrupt critical developmental milestones during young adulthood. This study examined the relationship between pain and psychosocial outcomes in young adult (YA) survivors of cancer. METHODS:One hundred YA cancer survivors completed measures assessing pain, anxiety, depression, posttraumatic stress, and alcohol use at baseline and follow-up (2-4 weeks later). RESULTS:In multivariate regression analyses, higher pain predicted poorer outcomes across all domains at follow-up (p's <.05). CONCLUSIONS:Pain predicts psychosocial outcomes in YA cancer survivors, underscoring the need for routine assessment of and early intervention for pain to support psychological well-being.
OBJECTIVE:This study aimed to explore the impact of different parenting styles on the physical activity of childhood cancer survivors based on the parent-based expansion of the theory of planned behavior. METHODS:This cross-sectional study investigated 271 childhood cancer survivors and their parents in China. RESULTS:The path model was well fitted with χ2/df = 1.740, RMSEA = 0.052, GFI = 0.964, NFI = 0.958, IFI = 0.982, TLI = 0.969, CFI = 0.981. Positive parenting styles (β = 0.181) directly affected the physical activity of childhood cancer survivors. Positive parenting styles indirectly influenced behavioral intention through both attitude (β = 0.022) and perceived behavioral control (β = 0.027), ultimately affecting physical activity in childhood cancer survivors. Parents who frequently encouraged or co-participated in physical activity with children had children with significantly higher physical activity levels. CONCLUSIONS:These findings highlight the critical role of positive parental style influence in fostering physical activity among childhood cancer survivors and suggest that interventions promoting positive parenting styles could enhance physical activity and overall well-being in this vulnerable population.
Macrocephaly capillary malformation syndrome (M-CM or MCAP) is a rare overgrowth disorder characterized by primary megalencephaly, overgrowth, and a range of additional anomalies. This report presents findings from a survey of 101 caregivers or individuals with M-CM, collected by the M-CM Network. Respondents shared medical and psychosocial concerns across the age spectrum, with common issues including motor delays, speech deficits, hydrocephalus, and vascular abnormalities. The survey highlighted significant developmental and behavioral challenges for individuals. The report advocates for continued research focused on the comprehensive needs of patients with M-CM.
The pediatric hematology-oncology fellowship training curriculum has not substantially changed since its inception. The first year of training is clinically focused, and the second and third years are devoted to scholarship. However, this current structure leaves many fellows less competitive in the current job market, resulting in approximately one-third of all pediatric hematology/oncology fellowship graduates pursuing subspecialty fellowship training in niche fields such as stem cell transplant, neuro-oncology, and hemostasis/thrombosis. In this article, we propose an individualized PHO fellowship curriculum to better prepare the future PHO physician for their future career, potentially abrogating the need for additional subspecialty training.
Children with cancer are at-risk for infertility, yet most desire biological parenthood. Fertility preservation is available for pre- and postpubertal patients, with tissues typically banked for autologous use. Some survivors require third-party reproduction (TPR) but do not complete the Food and Drug Administration (FDA)-required donor eligibility steps when banking their reproductive materials. This article reviews medical and nonmedical factors associated with TPR, FDA regulatory requirements, risks of non-compliance, and recommendations for facilitation in the pediatric oncology setting. Challenges, opportunities, and clinical decision trees for discussing TPR during pediatric fertility consultations are presented, emphasizing collaboration with adult reproductive clinics to support survivors’ long-term reproductive goals.
BACKGROUND:Avatrombopag, a second-generation thrombopoietin receptor agonist (TPO-RA), is approved for treatment of chronic immune thrombocytopenia (ITP) in adults and has been studied in a Phase 3 trial in pediatric ITP. The reported efficacy, oral administration, safety profile, and lack of dietary restrictions are appealing treatment characteristics for children. Data on real-world use in children are limited. METHODS:This multicenter cohort study included patients diagnosed with ITP at age < 21 years treated with avatrombopag. Clinical features were collected from electronic medical records. Overall platelet response was defined as platelet count ≥ 30 × 109/L and doubling from baseline. RESULTS:A total of 58 pediatric patients were treated with avatrombopag. Median time from diagnosis to treatment initiation was 4.6 years, with a median of 3 (range 0-11) prior treatments. Overall platelet response was 89.3% with similar response in primary and secondary ITP. Most patients achieved a response on the initial dose. Response rates did not differ by age at treatment initiation. Median time to platelet response was 13.5 days. High-grade bleeding scores were lower after initiation of treatment. Most patients (62%) switched from another TPO-RA to avatrombopag. Response to prior TPO-RA was associated with higher likelihood of response to avatrombopag (OR 15.00, 95% CI 1.824-187.7, p = 0.017). Of 12 patients with no response to prior TPO-RA, 8 responded to avatrombopag. Adverse effects were rare. CONCLUSIONS:In this real-world study, avatrombopag was highly effective at both improving platelet counts and reducing bleeding in children with ITP, even in patients with secondary ITP or who had failed other TPO-RAs.
INTRODUCTION:We aimed to describe T lymphocyte reconstitution during the first 100 days after allogeneic hematopoietic stem cell transplantation (HSCT) to identify differences associated with graft-versus-host disease (GvHD) manifestation. PROCEDURE:Eighty-three children who received transplants from unrelated donors were included in this single-institution study. Peripheral blood stem cells (PBSC) grafts and anti-T lymphocyte immunoglobulin (ATLG) were used. RESULTS:We observed greater proportions of CD8+ stem cell memory (SCMs) lymphocytes on day 28 in acute GvHD (aGvHD) patients and of CD4+ SCMs (CD3+TCRαβ+CD4+CD45RO-or CD45RA+CCR7+or CD62L+CD95+) on days 60 and 100 in chronic GvHD (cGvHD) patients. A greater proportion (≥5% CD4+ cells) of CD4+ SCMs on day 100 in patients with aGvHD was associated with a significantly greater cGvHD cumulative incidence (CI) (two-year value = 80.0% ± 0.9% vs. 27.1% ± 0.6%). Furthermore, a greater risk of non-relapse mortality (NRM) (two-year value = 16.1% ± 0.6% vs. 0%) and a lower risk of relapse (CI of relapse) (two-year value = 0% vs. 18.4% ± 0.3%) were observed in the group with a higher CD4+ SCM proportion on day 100, together with a lower probability of GvHD-free, immunosuppressive treatment-free, relapse-free two-year survival (GIRFS) (two-year value = 55.0% ± 11.1% vs.78.4% ± 7.3%). CONCLUSION:CD4+ SCM frequency is a potential biomarker of allogeneic immune response intensity and cGvHD risk in the early posttransplantation period.
Individuals with neutropenia or defective neutrophil disorders exhibit significantly increased susceptibility to oral infections and dental complications compared to the general population. Despite the elevated risk profile associated with these conditions, comprehensive and standardized dental care guidelines for affected individuals remain limited. Optimal management requires a multidisciplinary approach that incorporates pre-procedural risk stratification, individualized treatment planning, and appropriate post-procedural care strategies. There is a pressing need for well-controlled clinical studies to evaluate the efficacy of prophylactic antibiotic regimens and granulocyte colony-stimulating factor in mitigating infection risks in this vulnerable population. However, the rarity and heterogeneity of neutrophil disorders pose substantial challenges to the development of evidence-based protocols. Risk assessment must be individualized, tailored to individual patient profiles, considering factors such as the degree of neutropenia, prior history of infections, and the nature of planned dental procedures. Here, we review and summarize guidelines for dental management in patients with congenital neutrophil disorders and propose the need for targeted, evidence-based clinical studies to ensure safe and effective care.
While children with cancer are at risk of severe COVID-19, little is known about reinfection. Among infections (n = 2075) in children (≤ 21 years old, median age = 10 years old) receiving cancer-directed therapy and reported to the Pediatric Oncology COVID-19 case report, reinfection represented 6%. Children with subsequent infections did not have lower odds of hospitalization, intensive care unit admission, or changes to cancer-directed therapy. Odds of reinfection were higher among children with hematologic malignancies but did not vary with sociodemographics, disease status, comorbidities, or vaccination status. The disease course for reinfected children was not less severe than the first infection, emphasizing the importance of preventing reinfection.
