Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Primary thoracic epidural lymphoma: A rare cause of spinal cord compression

Spinal epidural lymphoma is a rare entity that is not often considered in the differential diagnosis of an epidural mass in a previously healthy individual. Pfatients with Primary Spinal Epidural Lymphomas (PSELs) have negative diagnostic work up for systemic lymphoma and unlike disseminated lymphoma, they achieve good functional recovery and long survival following prompt intervention. We report a case of isolated primary lymphoma of the thoracic spine in a 75 year old woman who presented with spinal cord compression syndrome and had negative work up for systemic lymphoma. She was managed with decompressive surgery and chemotherapy with long term good functional outcome. The clinical presentation, treatment modalities and outcome of presentation, primary spinal epidural lymphoma are discussed. Keywords: Spinal, Epidural, Lymphoma, Spinal cor

The True Status of Family Replacement Blood Donors in a Tertiary Hospital Blood Service in Central Nigeria

Background: To make up for the low blood collection from voluntary non-remunerated blood donors (VNRBD), by the blood services in Nigeria, patients’ families are often requested to provide substitute blood donors for their family members’ usage. However, many so-called family replacement donors (FRDs) are thought not to be true relatives.Objective: The objective of this study was to establish the true family status of donors presenting as FRDs in a tertiary hospital blood service in central Nigeria.Methods: Consecutive blood donors were studied with a structured questionnaire immediately after blood donation. The questionnaire contained six pretested, variably discriminatory and revealing questions. Donors’ responses to questions about the recipients were verified by cross-checking with hospital records, and also by interviewing recipients. Personal telephone contacts given by the donors were verified by calls to the phone numbers. Donors’ responses were scored, and donors scoring below a cut-off point were classified as false relatives.Results: Seven hundred and sixty consecutive blood donors were recruited for the study. Sixty-seven (8.8%), 673 (88.8%), and 20 (2.6%) of them claimed to be VNRBD, FRD, and paid blood donors (PBDs) respectively. Of the 673 presumed FRDs, 323 (48%) scored below the cut-off mark of 5 points. Hence, 48% of the presumed FRDs were regarded as false family donors.Conclusion: Significant proportions (48%) of presumed FRDs were found likely to be false family donors. Unquestioning acceptance of such donors may compromise blood safety.Key Words: VNRBD, FRD, PBD, Blood safety, false family donor French Title: Le Véritable Statut des Donneurs de Sang Familiaux ou de Remplacement dans un Service de Sang d'un Hôpital Tertiaire au Nigeria CentralContexte: Pour compenser la faible collecte de sang des donneurs de sang volontaires non rémunérés (DVNR) par les services de transfusion sanguine au Nigeria, les familles des patients sont souvent invitées à fournir des donneurs de sang de substitution. Cependant, de nombreux soi-disant donneurs familiaux de remplacement (DFR) ne sont pas considérés comme de vrais parents.Objectif: L’objectif de cette étude était d’établir le véritable statut familial des donneurs se présentant sous la forme de DFR dans un service de transfusion dans un hôpital tertiaire du centre du Nigéria.Méthodes: Les donneurs de sang consécutifs ont été étudiés avecun questionnaire structuré immédiatement après le don de sang. Lequestionnaire comportait six questions prétestées, discriminatoireset révélatrices. Les réponses aux questions des donneurs concernantles bénéficiaires ont été vérifiées par recoupement avec lesdossiers de l’hôpital, ainsi que par des entretiens avec les bénéficiaires.Les contacts téléphoniques personnels donnés par les donneursont été vérifiés par des appels téléphoniques. Les réponses des donneurs ont été notées, et les donneurs dont le score était inférieur à un seuil ont été classés dans la catégorie de faux parents.Résultats: Sept cent soixante donneurs de sang consécutifs ont étérecrutés pour l'étude. Soixante-sept (8,8%), 673 (88,8%) et 20 (2,6%) d'entre eux se sont déclarés comme étant des DVNR, DFR et des donneurs rémunérés (DR), respectivement. Sur les 673 DFR présumés, 323 (48%) ont obtenu un score inférieur à la barre des 5 points. Ainsi, 48% des DFR présumées étaient considérées comme de faux donneurs de la famille.Conclusion: Des proportions significatives (48%) de DFR présumésétaient susceptibles d'être de faux donneurs de la famille. L'acceptationinconditionnelle de tels donneurs peut compromettre la sécurité du sang

Clinico-Pathologic Features and Outcome of Chronic Lymphocytic Leukemia In Ilorin, North Central Nigeria.

A retrospective analysis of all patients that were diagnosed and managed for Chronic lymphocytic Leukemia (CLL) in the Department of Haematology of University of Ilorin Teaching Hospital, Ilorin between 1st January 2005 and 31st December 2018 was carried out with the aim of characterizing the clinical, haematological and prognostic features as well as outcome in the patients. A total of 39 patients were reviewed consisting 25 (64.1%) males and 14 (35.9%) females giving a M:F ratio of 1.6:1. The median age of patients at diagnosis was 65.5 years and the highest prevalence was found in the 60 – 69 years age group. The commonest symptoms at presentation were night sweats (59.0%), Body weakness (51.3%), fever (41.0%), and weight loss (41.0%) while the commonest signs included lymphadenopathy in all patients (100%), splenomegaly (87.2%), pallor (53.9%) and hepatomegaly (46.2%). The mean values of haematological parameters were: Packed cell volume (28.6%), Haemoglobin concentration (9.4g/dL), Total white blood cell count (87.6 x 109/L), Absolute lymphocyte count (55.8 x 109/L) and platelet count (134.8 x 109/L). The majority of the patients (94.9%) were diagnosed with advanced disease (Rai stage III and IV) while only 2(5.1%) had Rai stage II and none in Rai stage 0 – I. Chlorambucil-based regimen was used in 71.8% of patients, and only 2 patients had Rituximab as part of their treatment regimen. The clinical presentation, haematological features and disease outcome observed in our study was similar to what had been reported in Nigeria and other parts of the world. Keywords: Clinical, Haematological, Features, Chronic lymphocytic leukemia, Ilori