Population Pharmacokinetics and Pharmacodynamics of Ciprofloxacin Prophylaxis in Pediatric Acute Lymphoblastic Leukemia Patients

Background. Ciprofloxacin is used as antimicrobial prophylaxis in pediatric acute lymphoblastic leukemia (ALL) to decrease infections with gram-negative bacteria. However, there are no clear guideline

Outcomes of pediatric patients with therapy-related myeloid neoplasms

Long-term outcomes after allogeneic hematopoietic cell transplantation (HCT) for therapy-related myeloid neoplasms (tMNs) are dismal. There are few multicenter studies defining prognostic factors in pediatric patients with tMNs. We have accumulated the largest cohort of pediatric patients who have undergone HCT for a tMN to perform a multivariate analysis defining factors predictive of long-term survival. Sixty-eight percent of the 401 patients underwent HCT using a myeloablative conditioning (MAC) regimen, but there were no statistically significant differences in the overall survival (OS), event-free survival (EFS), or cumulative incidence of relapse and non-relapse mortality based on the conditioning intensity. Among the recipients of MAC regimens, 38.4% of deaths were from treatment-related causes, especially acute graft versus host disease (GVHD) and end-organ failure, as compared to only 20.9% of deaths in the reduced-intensity conditioning (RIC) cohort. Exposure to total body irradiation (TBI) during conditioning and experiencing grade III/IV acute GVHD was associated with worse OS. In addition, a diagnosis of therapy-related myelodysplastic syndrome and having a structurally complex karyotype at tMN diagnosis were associated with worse EFS. Reduced-toxicity (but not reduced-intensity) regimens might help to decrease relapse while limiting mortality associated with TBI-based HCT conditioning in pediatric patients with tMNs

KNO-manifestaties van Fanconi-anemie: het belang van screenen

Fanconi-anemie (FA) is een zeldzame erfelijke ziekte die vooral wordt gekenmerkt door congenitale afwijkingen, een verhoogd risico op beenmergfalen en een verhoogd risico op maligniteiten. Congenitale afwijkingen van het oor en gehoorverlies komen frequent voor bij FA-patiënten. Vroege diagnostiek is belangrijk om een goede taal- en spraakontwikkeling en schoolprestaties mogelijk te maken. Daarnaast hebben FA-patiënten een sterk verhoogd risico op het ontwikkelen van een hoofd-halsplaveiselcelcarcinoom, vooral in de mondholte. Deze hoofdhalslokalisatie is bij uitstek geschikt voor screening door een KNO-arts/hoofd-halschirurg

Discriminating Between Research and Care in Paediatric Oncology—Ethical Appraisal of the ALL-10 and 11 Protocols of the Dutch Childhood Oncology Group (DCOG)

Paediatric oncology is a classic example of a field in which research and care are closely intertwined. Moreover, bioethicists have argued that in environments such as paediatric oncology we should no longer draw sharp distinctions between research and care. Recently, two Dutch protocols for the treatment of children with Acute Lymphoblastic Leukaemia (ALL) have been categorised in two different ways, one as research (ALL-11) and the other as treatment (ALL-10). We analysed these protocols in order to explore whether the distinction between research and care in paediatric oncology is morally relevant. We applied several characteristics of research to the ALL-10 and 11 protocols: the goal of producing generalisable knowledge; systematic collection of data; potentially high and uncertain risks; burdens and risks unrelated to treatment; and provision of treatment according to detailed protocols. Both ALL-protocols exhibit general characteristics of research. At the same time, both protocols also clearly satisfy the objective of delivering the best available treatment. Therefore, it remains to be discussed how to review these kinds of protocols that integrate a research goal with the objective of providing individual patients with best current treatment. A change in both research ethics regulation and oversight of conventional care is needed. More case studies are essential to expand the moral evaluation of the intertwinement between research and care in paediatric oncology