Journal of pediatric hematology/oncology
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J. Pediatr. Hematol. Oncol. · Dec 2009
Comparative StudyA comparison of clinical trial enrollment between adolescent and young adult (AYA) oncology patients treated at affiliated adult and pediatric oncology centers.
Over the past 30 years, there has been a dramatic increase in the survival rates of younger pediatric cancer patients in contrast to adolescent and young adult (AYA) oncology patients. The reasons for this discrepancy are multifactorial, but it is clear that clinical trial enrollment correlates with better outcomes. ⋯ Our data demonstrate that clinical trial enrollment was superior when AYA patients were treated at a pediatric cancer center. As most AYA patients are not treated at pediatric centers, this may partly explain why their cure rates have not improved as significantly as younger pediatric oncology patients.
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J. Pediatr. Hematol. Oncol. · Nov 2009
Review Case ReportsIntrathecal vincristine: 3 fatal cases and a review of the literature.
We report 3 cases of accidental intrathecal vincristine administration. All 3 patients died between 8 and 18 days after the incident because of decerebration. In the literature, we found 41 cases of accidental intrathecal injection of vincristine. ⋯ The third case occurred during the implementation of rules by the Dutch Childhood Oncology Group on how to handle intrathecal triple therapy; and despite sequential safety measures, the accident still occurred. In the Netherlands no more accidents of this nature have occurred in children after the introduction of a quadruple syringe system 8 years ago. In our opinion the best fail-safe solution would be the development of a unique connection that is incompatible with a standard Luer syringe.
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J. Pediatr. Hematol. Oncol. · Oct 2009
Case ReportsChildhood Plasmodium vivax malaria with severe thrombocytopenia and bleeding manifestations.
Thrombocytopenia of varying magnitude, usually without hemorrhagic manifestations, is commonly observed in Plasmodium falciparum and Plasmodium vivax malaria. However, severe thrombocytopenia associated with bleeding manifestations in malarial infection is distinctly unusual. ⋯ He improved with antimalarial and intravenous immunoglobulin therapy. Clinicians caring for children should be aware of potential bleeding manifestations that may be the result of apparently innocuous infection like vivax malaria.
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J. Pediatr. Hematol. Oncol. · Oct 2009
Multicenter Study Comparative StudyEvaluation of the effects of different transfusion trigger levels during the treatment of childhood acute lymphoblastic leukemia.
Differences in the triggering levels for red blood cell (RBC) and platelet (PLT) transfusions were analyzed in association to the amount and total costs of transfusions and the number of febrile episodes during childhood acute lymphoblastic leukemia (ALL) treatment. Transfusions are given with hemoglobin (Hb) < or =90 to 100 g/L and PLT count < or =20 to 30 x 10(9)/L in Tampere, and with Hb < or =80 g/L and PLT count < or =10 x 10(9)/L in Turku. Median pretransfusion PLT count was 48 x 10(9)/L in Tampere, and 16 x 10(9)/L in Turku. ⋯ The number of febrile episodes was associated with the treatment protocol (P=0.03), and age at diagnosis (P=0.07). Lower trigger levels did not cause more delays or complications in treatment. Clinical trials are, however, necessary to determine optimal criteria for supportive blood transfusions in childhood cancer patients.