Évaluation de la gastrostomie précoce dans la prise en charge des tumeurs osseuses primitives malignes de l’enfant. Expérience du groupe Grand Ouest Cancer de l’Enfant (GOCE) sur 10 ans [Assessment of early gastrostomy in the treatment of primary malignant bone tumors in children. A report from the French children's oncology study Group GOCE]

International audiencePurpose. - Patients in pediatric oncology are at high risk of undernourishment, especially during intensive treatment such as malignant primary bone tumors. Many consequences of malnutrition have been highlighted, yet the nutritional care is not standardized. We evaluated the nutritional benefits and the feasibility of enteral nutrition on early gastrostomy, by comparison to other methods of nutritional support during the treatment of malignant primary bone tumor in children. Methods. - The characteristics of patients with malignant primary bone tumors have been retrospectively analyzed in Western regions of France from 2003 to 2013. The census of complications of early gastrostomy and the nutritional parameters of patients (Z-scores weight for height and height for age and body mass index) allowed the evaluation of its feasibility and effectiveness. Complications data, nutritional status and oncology treatment were also analyzed in the groups of patients who received enteral nutrition through nasogastric tube and those who did not receive it. Results. - Early gastrostomy was inserted in 58 patients, a nasogastric tube in 20 and 60 did not receive any of these two nutritional supports. Early gastrostomy is a purveyor of complications (82 for 58 patients) but they are minor and not specific (92.7%). No difference between the three groups has been demonstrated about the frequency of complications, the number of hospitalization or their duration. Early gastrostomy avoided a deterioration of the nutritional status as soon as the preoperative stage unlike the two other groups. No significant difference in survival at 4 years was found between the three groups. Conclusion. - Early gastrostomy is an effective nutritional support which does not increase complications and which does not affect the oncologic prognosis. Its psychological evaluation and nutritional impact in the long term are to be assessed on a prospective group. (C) 2017 Elsevier Masson SAS. All rights reserved

Br J Haematol

Childhood chronic immune thrombocytopenic purpura (cITP) is a rare disease. In severe cases, there is no evidence for the optimal therapeutic strategy. Our aim was to describe the real‐life management of non‐selected children with cITP at diagnosis. Since 2004, patients less than 18 years old with cITP have been enrolled in the national prospective cohort, OBS’CEREVANCE. From 1990 to 2014, in 29 centres, 392 children were diagnosed with cITP. With a median follow‐up of six years (2·0–25), 45% did not need second‐line therapy, and 55% (n = 217) received one or more second lines, mainly splenectomy (n = 108), hydroxychloroquine (n = 61), rituximab (n = 61) or azathioprine (n = 40). The overall five‐year further second‐line treatment‐free survival was 56% [95% CI 49·5–64.1]. The use of splenectomy significantly decreased over time. Hydroxychloroquine was administered to children with positive antinuclear antibodies, more frequently older and girls, and reached 55% efficacy. None of the patients died. Ten years after the initial diagnosis, 55% of the 56 followed children had achieved complete remission. Children with cITP do not need second‐line treatments in 45% of cases. Basing the treatment decision on the pathophysiological pathways is challenging, as illustrated by ITP patients with positive antinuclear antibodies treated with hydroxychloroquine