Anne Marie Maloney

Features at presentation predict children with acute lymphoblastic leukemia at low risk for tumor lysis syndrome

Tumor lysis syndrome (TLS) is a well‐recognized complication of acute lymphoblastic leukemia (ALL). The ability to predict children at differing risk of TLS would be an early step toward risk‐based approaches. The objectives of the current study were 1) to describe the prevalence and predictors of TLS in childhood ALL and 2) to develop a sensitive prediction rule to identify patients at lower risk of TLS.

An approach to fertility preservation in prepubertal and postpubertal females: A critical review of current literature

Advancements in childhood cancer treatment have led to increasing survivorship, creating a greater emphasis on long‐term management of patients, including quality of life and side effects from therapy; foremost of which is preserving fertility. The American Society of Clinical Oncology (ASCO) recently revised their guidelines and recommend fertility preservation options be discussed at the earliest possible opportunity for newly diagnosed patients, including methods available for children that remain investigational. Herein, we discuss the current barriers to and the impact of these guidelines for pediatric oncologists caring for young female patients, and provide some suggestions on how to approach this complicated topic. Pediatr Blood Cancer 2015;62:935–939.

Non-relapse mortality in pediatric acute lymphoblastic leukemia: a systematic review and meta-analysis

Abstract The primary objective of the study was to describe non-relapse mortality (NRM) and the proportion of first events that are deaths in children with acute lymphoblastic leukemia (ALL). Secondary objectives were to identify groups at higher risk and to determine whether proportions have changed over time. We performed a systematic review of randomized pediatric ALL studies. From 1337 articles, 59 were included, comprising a total of 49 071 patients. The induction death rate was 1.38%, remission death rate was 1.94% and total NRM was 3.60%. Deaths were responsible for 53.84% of first events during induction and 13.03% in total. Standard risk patients had significantly lower NRM during remission. The year of study was not associated with NRM. The results of the study show that the rate of NRM in children with ALL is 3.60% and those with high risk ALL have significantly higher NRM during remission, but NRM has not changed over time. Future research should focus on the exploration of patient-related risk factors for NRM.

Efficacy and safety of caspofungin for the empiric management of fever in neutropenic children.

This retrospective review evaluates the response to caspofungin when given to children with febrile neutropenia and describes adverse effects attributable to caspofungin, including risk of hepatotoxicity during concomitant therapy with cyclosporine. Sixty-seven courses of caspofungin administered to 56 patients (1–17 years) were surveyed; 53 (79%) courses resulted in an overall favorable response. Ten children (15% of courses) experienced an adverse drug-related event that was probably or possibly attributable to caspofungin. Rash and hypokalemia were the most commonly identified adverse effects. One of 19 children receiving caspofungin and cyclosporine concurrently developed hepatotoxicity possibly related to caspofungin.

Testicular Biopsy for Fertility Preservation in Prepubertal Boys with Cancer: Identifying Preferences for Procedure and Reactions to Disclosure Practices

PURPOSE Fertility preservation options are limited in prepubertal boys with cancer. Worldwide there has been growing interest in testicular tissue cryopreservation as a promising experimental strategy to address future infertility. We measured and compared parent, male cancer survivor and provider willingness to accept the risk of testicular biopsy among prepubertal boys with cancer, and identified reactions to disclosure practices. MATERIALS AND METHODS We conducted a multicenter study that included 153 parents of prepubertal boys with cancer, 77 male survivors of childhood cancer and 30 oncology providers. The threshold technique was used to measure subject relative willingness to accept risk of testicular biopsy under 4 different aspects of care, ie chance of infertility, complications from biopsy, development of technology to use tissue and tissue storage cost. A total of 47 in-depth interviews were conducted to identify reactions to disclosure practices. RESULTS A total of 52 survivors (67%), 22 providers (73%) and 110 parents (72%) selected to have testicular biopsy (vs no biopsy). Median minimum infertility risk to make biopsy worthwhile varied from 25% to 30% among the 3 respondent groups. Interviews revealed that some providers would not offer biopsy in cases of greater perceived risk than benefit, that parents preferred having information regardless of risk of infertility and that nondisclosure elicited adverse feelings from some parents. CONCLUSIONS Parents, survivors and providers were willing to accept risk of prepubertal testicular biopsy. Parental/survivor desire for information and provider decision not to disclose suggest that barriers to information delivery need to be addressed.

Alternaria sinusitis in children with acute myeloid leukemia: case reports from the Childhood Acute Myeloid Leukemia Infection Research Group

Division of Haematology/Oncology, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada, Division of Haematology/Oncology, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada, Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA