Mode of administration of glucocorticoids and osteonecrosis in children treated for acute lymphoblastic leukemia: An update

peer reviewedEn tant que tumeur pédiatrique la plus fréquente, de surcroît grevée d’un excellent pronostic global, la leucémie lymphoblastique aiguë (LAL) représente la plus grande pourvoyeuse de survivants exposés à la toxicité des traitements chimiothérapeutiques. L’ostéonécrose est une complication bien décrite du traitement de la leucémie touchant jusqu’à un enfant sur dix, avec un tropisme particulier pour les adolescents atteints de leucémie à haut risque. Cette complication est liée à l’emploi des corticoïdes, dont la toxicité osseuse est potentialisée par l’emploi d’autres molécules, telles l’asparaginase et le méthotrexate. L’incidence de cette complication est plus élevée chez les patients recevant la dexaméthasone à titre de corticoïde principal. De récents protocoles thérapeutiques ont adopté, dans le but de réduire l’incidence de l’ostéonécrose, l’usage du schéma thérapeutique baptisé « split dexamethasone », une initiative du Children's Oncology Group (COG) consistant à marquer une pause de quelques jours dans l’administration de la dexaméthasone lors de la phase de réintensification. À ce jour, seuls un modèle animal et deux essais randomisés contrôlés du COG ont évalué l’intérêt de cette pratique. Ces derniers mettent en évidence un bénéfice de la méthode, avec une réduction de l’incidence d’ostéonécrose à 5 ans de l’ordre de 50 % pour le CCG 1961 et de 33 % chez les patients entre 10 et 12 ans pour le AALL0232, sans modification de la survie sans événement à 5 ans (EFS-5), qui reste de l’ordre de 75 % chez ces patients à haut risque. En conclusion, la prévention de l’apparition des lésions d’ostéonécrose via des amendements thérapeutiques, tel le « split dexamethasone » est non seulement réalisable et efficace, mais semble également sans danger sur le plan pronostic

Spontaneous fractures during 13-cis retinoic acid therapy for neuroblastoma.

peer reviewe

Upper and/or lower respiratory tract infection caused by human metapneumovirus after allogeneic hematopoietic stem cell transplantation.

peer reviewed[en] PATIENTS AND METHODS: This retrospective multicenter cohort study examined the epidemiology, clinical characteristics, and risk factors for poor outcomes associated with human metapneumovirus (hMPV) infections in recipients of allogeneic stem cell transplantation (allo-HCT). RESULTS: We included 428 allo-HCT recipients who developed 438 hMPV infection episodes between January 2012 and January 2019. Most recipients were adults (93%). hMPV infections were diagnosed at a median of 373 days after allo-HCT. The infections were categorized as upper respiratory tract disease (URTD) or lower respiratory tract disease (LRTD), with 60% and 40% of cases, respectively. Patients with hMPV LRTD experienced the infection earlier in the transplant course and had higher rates of lymphopenia, neutropenia, corticosteroid use, and ribavirin therapy. Multivariate analysis identified lymphopenia and corticosteroid use (>30 mg/d) as independent risk factors for LRTD occurrence. The overall mortality at day 30 after hMPV detection was 2% for URTD, 12% for possible LRTD, and 21% for proven LRTD. Lymphopenia was the only independent risk factor associated with day 30 mortality in LRTD cases. CONCLUSIONS: These findings highlight the significance of lymphopenia and corticosteroid use in the development and severity of hMPV infections after allo-HCT, with lymphopenia being a predictor of higher mortality in LRTD cases

Endocrine consequences of neuroblastoma treatment in children: 20 years’ experience of a single center

Background: Neuroblastoma (NBL) is a child neoplasia affecting extracranial tissue of neuroectodermal origin. It accounts for 10% of solid malignancies in children and is characterized by a survival rate approaching 70%, confronting physicians with the emergence of an adult survivor population who have been previously exposed to surgery, cytotoxic drugs, radiation therapy or metaio- dobenzylguanidine (MIBG) therapy. All these treatments potentially affect the endocrine system. Our study consists in a retrospective review of late endocrine effects arising in survivors treated for NBL during childhood. Methods: The medical files of 47 patients (M/F = 26/21) treated for NBL were reviewed. Collected data consisted of age, height, weight and biological hormonal values at diagnosis and at the last follow-up consultation. The inci- dence of late effects in our sample was compared to the data from the literature. Results: Patients were between 0 and 15.8 years of age at diagnosis (median: 1.16 years) and between 1 and 25 years of age at last follow-up (median: 16 years). Twenty-six patients were treated with chemotherapy (CT), 11 under- went CT and radiation therapy and five were treated with CT and MIBG therapy. Ten percent of the patients died before reaching the end of therapy. Late effects occurred in 54% of the patients. Thirty-six percent of patients had non-endocrine complications (musculoskeletal, neuro- logical, hematological or hepatic chronic conditions). Endocrine complications (28%) affected mainly patients treated with CT and consisted of gonadal dysfunction (up to 42% patients of over 12 years of age at follow-up) and hypothyroidism (21%). Our analysis revealed that CT had a significant impact on final height (p < 0.05). Conclusions: Treatment for childhood malignancies exposes children to late effects affecting the endocrine sys- tem. In children treated for NBL, hypothyroidism, gonadal failure and impaired growth appear to be the main endo- crine complications. Close follow-up of survivors is thus appropriate

Analyzing but Not Buying: The Mere Exposure Effect on Children’s Behavior in an Ecological Context

The mere exposure effect is usually considered a robust phenomenon whereby people’s attitudes can easily be influenced. However, recent studies suggest that some conditions must be met for this effect to emerge. In this experiment, the influence of the features of a specific material on the mere exposure effect was examined in an ecological context. Children were told that they would play a game during which they would have to buy several items in different shops. In these shops, half of the participants were incidentally exposed to two target stimuli. During a subsequent judgment phase, the target stimuli were presented to each child, either with perceptually similar items or with perceptually dissimilar items. Prior encounter with an item only influenced children’s preference choices when the test items were dissimilar. These findings are discussed in terms of the processing styles that are necessary for the mere exposure effect to appear

Concomitant nodal involvement by Langerhans Cell Histiocytosis and Hodgkin Lymphoma

Introduction : Langerhans cell histiocytosis is defined as a clonal neoplastic proliferation of myeloid dendritic cells that upon activation migrate from the mucosal to lymph nodes. Definitive diagnosis is made by anatomo-pathological and immunohistochemical analysis. Langerhans cell histiocytosis is rarely, yet not exceptionally, found coexisting with other malignant neoplasms, suggesting it might arise in reaction to the cytokinic secretion of malignant cells. Case : We report the case of a 10-year-old female presenting with an isolated laterocervical lymphadenopathy and a mild general condition alteration tracing back to two months earlier. Nodal biopsy was performed and revealed concomitant involvement by Langerhans cell histiocytosis and Hodgkin lymphoma. Treatment of lymphoma led to the disappearance of the whole symptomatology. Discussion : Literature beholds reports of 30 cases of the simultaneous occurence of Hodgkin lymphoma with Langerhans cell histiocytosis, which is more than fortuitous regarding the low incidence of both diseases. A common etiology could explain such an association, but it might also be possible that background inflammatory cells of Hodgkin lymphoma stimulate the proliferation of Langerhans cells, making it a reactive process when occurring simultaneously with other neoplasms. Clinicians should thus be aware of the possibility of this association and carefully exclude any other life-threatening malignant proliferation when confronted to apparently isolated Langerhans cell histiocytosis