Pediatric blood & cancer
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Pediatric blood & cancer · Mar 2007
Outcome for children <4 years of age with malignant central nervous system tumors treated with high-dose chemotherapy and autologous stem cell rescue.
Children <4 years of age (yo) with malignant central nervous system (CNS) tumors have a dismal prognosis. In an attempt to delay or obviate radiation therapy (XRT) and improve outcome, our institution has treated children <4 yo with newly diagnosed malignant CNS tumors with high-dose chemotherapy (HDC) and autologous stem cell rescue (ASCR) followed by selective XRT. ⋯ We are encouraged by the outcome of 15 children <4 yo with malignant CNS tumors treated with tandem cycles of HDC and ASCR at our institution. The treatment regimen is relatively well tolerated.
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Pediatric blood & cancer · Mar 2007
Fiberoptic bronchoscopy and bronchoalveolar lavage for the evaluation of pulmonary disease in children with primary immunodeficiency and cancer.
Patients with childhood cancer or primary immunodeficiencies (PID) are at high risk for developing pulmonary infections and non-infectious complications. The broad differential diagnoses and the critical condition of these patients often drive physicians to start broad-spectrum antibiotic therapy before a definite diagnostic procedure is performed. A definite diagnosis may be achieved in these situations by fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL). ⋯ Rapid and accurate diagnoses were achieved in most procedures performed on immunocompromised patients. Although the rate of complications was higher in the immunocompromised group, they were usually very mild with no mortality. Based on these results, broncoalveolar lavage should be considered as an initial diagnostic tool in pediatric immunocompromised patients with pulmonary complications.
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Pediatric blood & cancer · Feb 2007
Case ReportsIntraspinal and intracranial hemorrhage after lumbar puncture.
Two cases of spinal epidural hematoma and two cases of intracranial subdural hematoma after lumbar puncture (LP) are reported in children receiving chemotherapy for acute lymphoblastic leukemia and non-Hodgkin lymphoma. The bleeding was asymptomatic but interfered with treatment in one case, and caused either severe backache or headache but no neurological deficit in the other three patients. ⋯ There is an inherent, albeit uncommon, risk of bleeding into the central nervous system associated with LP in children with cancer and should be distinguished from postdural puncture headache (PDPH). Thrombocytopenia is not always an accompanying factor.
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Pediatric blood & cancer · Feb 2007
Case ReportsVincristine sulfate as a possible cause of optic neuropathy.
A 6-year-old boy with skin lesions suggestive of neurofibromatosis developed a frontotemporal primitive neuroectodermal tumor and was subsequently treated with surgery, craniospinal irradiation, and chemotherapy. After the sixth cycle of treatment with vincristine sulfate, 9 months after diagnosis, the child developed a rapidly progressive bilateral deterioration in visual acuity. ⋯ Brain imaging at this time showed no tumor progression, and in the absence of other etiologies, we implicate vincristine as a probable cause. Discontinuation of this particular agent has allowed bilateral improvement in visual acuity.