Pediatric Blood & Cancer最新文献

{"title":"Prospective Evaluation of Single-Time-Point Methotrexate Monitoring During High-Dose Therapy in Pediatric Leukemias and Lymphomas.","authors":"Aamir Dogra, Prateek Bhatia, Deepak Bansal, Amita Trehan","doi":"10.1002/1545-5017.70672","DOIUrl":"10.1002/1545-5017.70672","url":null,"abstract":"<p><strong>Background: </strong>Conventional multi-time point monitoring during high-dose methotrexate (HD-MTX) therapy is often impractical in low- and middle-income countries (LMICs). A simplified single-time-point monitoring strategy may offer a feasible alternative.</p><p><strong>Objectives: </strong>To determine the proportion of patients achieving adequate MTX clearance (≤0.4 µmol/L) at 48 h following initiation of HD-MTX.</p><p><strong>Methodology: </strong>In this prospective observational study, children with high-risk B-lineage and T-cell acute lymphoblastic leukemia receiving HD-MTX were enrolled. Single time point MTX levels were measured 48 h from initiation of infusion. MTX level >0.4 µmol/L received intensified hydration and leucovorin rescue. Toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Patients with pre-existing renal insufficiency or prior Grades 3 and 4 MTX toxicity were excluded.</p><p><strong>Results: </strong>Thirty-two children (age 2-12 years) undergoing 106 cycles of HD-MTX were evaluated. MTX clearance at 48 h was achieved in 74.5% (79/106). Delayed clearance normalized at 72 h in 5/16 retested cycles. Age >7 years (p = 0.025) and higher baseline serum creatinine (p = 0.022) predicted delayed clearance. Elevated 48-h levels correlated with neutropenia (13%, p = 0.0096), transaminitis, mucositis, and acute kidney injury occurred in 10.4%, 7.5%, and 3.8% of cycles.</p><p><strong>Conclusions: </strong>A single 48-h MTX level can facilitate discharge decisions in approximately 75% of treatment cycles in a preselected cohort of patients. This approach may provide a pragmatic and cost-effective strategy in resource-limited settings, though its safety in unselected populations remains to be established. Validation in larger, unselected cohorts is needed before broad implementation can be recommended.</p>","PeriodicalId":19822,"journal":{"name":"Pediatric Blood & Cancer","volume":" ","pages":"e70672"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastrointestinal Bleeding During Proton Beam Therapy Following Multimodal High-Dose Chemotherapy and Anti-GD2 Immunotherapy in a Child With High-Risk Neuroblastoma.","authors":"Airu Okada, Hiroko Fukushima, Kumie Nagatomo, Masako Inaba, Sho Hosaka, Yuni Yamaki, Rintaro Ono, Daisuke Hasegawa, Takashi Saito, Masashi Mizumoto, Hideyuki Sakurai, Hidetoshi Takada","doi":"10.1002/1545-5017.70623","DOIUrl":"10.1002/1545-5017.70623","url":null,"abstract":"","PeriodicalId":19822,"journal":{"name":"Pediatric Blood & Cancer","volume":" ","pages":"e70623"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Provider and Parent Perspectives on Prioritizing the \"Asking and Monitoring\" Pediatric Cancer Psychosocial Standards of Care.","authors":"Julia B Tager, Natalie Koskela-Staples, Emily M Pariseau, Michele Scialla, Kimberly Buff, Lori Wiener, Victoria Sardi Brown, Anne E Kazak, Kimberly S Canter","doi":"10.1002/1545-5017.70634","DOIUrl":"10.1002/1545-5017.70634","url":null,"abstract":"<p><strong>Background: </strong>The Standards for Psychosocial Care for Children with Cancer and Their Families (\"Standards\") are evidence-based guidelines for psychosocial care in pediatric oncology. Care related to the three \"Asking and Monitoring\" Standards-Assessment of Psychosocial Needs, Assessment of Financial Needs, and Monitoring Neurocognitive Problems-is frequently provided, but community member input regarding the implementation of this care is notably absent in extant literature. The Implementing the Standards Together: Engaging Parents and Providers in Psychosocial Care (iSTEPPP) team conducted a mixed-methods, community-engaged study to understand parent and provider perceptions and prioritization of these three Standards.</p><p><strong>Methods: </strong>A two-round Delphi technique identified consensus on prioritization of the Standards by pediatric oncology providers (medical and psychosocial) and parents. The survey included optional free-text responses to explain their reasoning for their selections. Data were analyzed using an iterative qualitative process.</p><p><strong>Results: </strong>Responses were included from 129 parents and 62 providers. For Assessment of Psychosocial Needs and Assessment of Financial Needs, parent responses focused on immediate consequences when the Standards are not provided, while providers described their relevance to broader medical and psychosocial outcomes. For Monitoring Neurocognitive Problems, providers noted its importance because families prioritize it, while parents reflected on a lack of understanding and attention to neurocognitive deficits.</p><p><strong>Conclusion: </strong>While parents shared concerns about both immediate and long-term consequences if Standards-aligned care is not delivered, providers emphasized broader or longer term consequences. Findings reflect the critical importance of frequent, structured monitoring of psychosocial and financial needs and more comprehensive monitoring for neurocognitive deficits.</p>","PeriodicalId":19822,"journal":{"name":"Pediatric Blood & Cancer","volume":" ","pages":"e70634"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Situational Assessment of the Diagnostic Landscape and Organizational Readiness to Implement Next-Generation Sequencing at Two Childhood Cancer Treatment Centers in Ghana.","authors":"Melissa Carvalho, Emmanuella Amoako, Nihad Salifu, Lily Gloria Tagoe, Yaw Bediako, Michelle Hermiston, Catherine Segbefia","doi":"10.1002/1545-5017.70670","DOIUrl":"10.1002/1545-5017.70670","url":null,"abstract":"<p><strong>Purpose: </strong>Next-generation sequencing (NGS) has emerged as a promising approach to improve diagnostic accuracy, but its feasibility in low- and middle-income countries remains unknown. This study characterized the diagnostic landscape and assessed organizational readiness for NGS implementation at two childhood cancer treatment centers in Accra, Ghana.</p><p><strong>Methods: </strong>A situational assessment of pediatric cancer diagnostics at Korle Bu Teaching Hospital (KBTH) and the Greater Accra Regional Hospital (GARH) was conducted between October and December 2024. Data were collected through site assessments, interviews, and the Organizational Readiness for Implementing Change (ORIC) scale. Descriptive statistics and the Wilcoxon rank-sum tests were used for analysis.</p><p><strong>Results: </strong>In 2024, approximately 211 and 41 new pediatric cancer cases were diagnosed at KBTH and GARH, respectively. Morphology remained the primary diagnostic modality, with limited access to immunohistochemistry and outsourcing required for immunophenotyping, cytogenetic analyses, and molecular testing. Both centers reported access to essential laboratory resources for NGS testing through a public-private research partnership providing sequencing equipment and technical expertise. However, notable gaps in research infrastructure were identified. Pediatric oncology providers at KBTH and GARH demonstrated high organizational readiness for NGS implementation (median ORIC score: 50/60). Cited barriers to NGS implementation in Ghana included high equipment costs, limited training opportunities, and insufficient political prioritization.</p><p><strong>Conclusion: </strong>While morphology remains the cornerstone of pediatric cancer diagnosis at KBTH and GARH, both centers demonstrated readiness and emerging capacity to implement NGS. However, addressing financial, infrastructural, and workforce barriers will be critical for its sustainable integration into pediatric oncology care in Ghana.</p>","PeriodicalId":19822,"journal":{"name":"Pediatric Blood & Cancer","volume":" ","pages":"e70670"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parent-Clinician Communication and End-of-Life Preparation in Pediatric Oncology: An Explanatory Sequential Mixed-Methods Study.","authors":"Na Ouyang, M Tish Knobf, Prasanna J Ananth, Justin N Baker, Kimberly Hieftje, Sarah B McCarthy, Michael Backman, Shelli L Feder, Jennifer M Snaman","doi":"10.1002/1545-5017.70640","DOIUrl":"10.1002/1545-5017.70640","url":null,"abstract":"<p><strong>Purpose: </strong>Parental preparedness for their child's end of life (EOL) may lessen perceived suffering and prolonged grief. Although clear communication may support parental preparedness, the specific communication components that influence this process remain poorly understood. This study examined how communication influences parental EOL preparation.</p><p><strong>Methods: </strong>We employed an explanatory sequential mixed-methods design. We analyzed cross-sectional survey data from recently bereaved parents (6-24 months post-loss) using multiple logistic regression. Informed by quantitative findings, we conducted semi-structured interviews with bereaved parents and analyzed the data using thematic analysis. We then applied the Pillar Integration Process to link statistical associations with qualitative data.</p><p><strong>Results: </strong>The quantitative sample included 124 bereaved parents (mean age 46 years; 82% White; 64% mothers), and the qualitative sample comprised 15 parents (median age 43; 86% White; 93% mothers). Parents who felt adequately informed of a poor prognosis were more likely to feel prepared for their child's EOL than those wanting more prognostic information (69% vs. 44%, p = 0.023), and adjusted models confirmed this association. Communication quality and trust were not associated with EOL preparedness. Qualitative findings revealed that clear, direct EOL conversations helped parents recognize impending death, provided anticipatory guidance, and facilitated concrete planning. Integration showed that prognostic communication was necessary but insufficient; parents also needed help translating information into actionable plans. Trust and high-quality communication lay the foundation that allows difficult conversations to be heard and acted upon.</p><p><strong>Conclusion: </strong>Clinicians may best support parents by providing explicit, action-oriented guidance, compassionate and preference-concordant communication, trusted relationships, and supportive resources.</p>","PeriodicalId":19822,"journal":{"name":"Pediatric Blood & Cancer","volume":" ","pages":"e70640"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Radiotherapy Across a Multi-Geography Referral Network for Children With Ewing Sarcoma and Rhabdomyosarcoma: Treatment Delivery and Early Outcomes-A Single-Centre Experience.","authors":"Srinivas Chilukuri, Abhilasha Sinha, Sham Sundar, Vishnu Ramanujan, Ramya Uppuluri, Revathi Raj, Radhakrishnan Satheesan, Indumathi D, Anand Murugesan, Dhilipkumar Rajan, Godson Samuel, Prashant Jawahar, Rakesh Jalali","doi":"10.1002/1545-5017.70657","DOIUrl":"10.1002/1545-5017.70657","url":null,"abstract":"<p><strong>Background: </strong>Children with Ewing sarcoma (ES) and rhabdomyosarcoma (RMS) across Asia, the Middle East and Africa often require cross-border referral for advanced radiotherapy, risking a disruption of multimodality care. We evaluated whether a structured referral network could deliver advanced radiotherapy while preserving treatment continuity.</p><p><strong>Methods: </strong>This retrospective single-centre study included 54 consecutive children (27 ES, 27 RMS) treated in India between 2019 and 2025, referred from 13 countries and 11 Indian states. Primary endpoints were radiotherapy completion, treatment interruptions, chemotherapy continuity, treatment abandonment and follow-up retention. Survival outcomes were secondary endpoints.</p><p><strong>Results: </strong>Median age was 7 years (range, 1-18), and 87% received proton beam therapy. All patients completed planned radiotherapy; interruptions occurred in only three patients, all ≤4 days. There was no treatment abandonment, and loss to follow-up was 2%. Planned chemotherapy was completed in all patients, with shared delivery between referring and treating centres in 80%. Median time from chemotherapy initiation to radiotherapy was 23.3 weeks for ES and 17.7 weeks for RMS. Among patients receiving definitive radiotherapy, treatment began within 15 weeks of chemotherapy start in 72% of ES and 88% of RMS patients. After radiotherapy, 63% resumed chemotherapy within 14 days and 78% within 21 days. Three-year overall survival and progression-free survival were 89.7% and 55.0% for ES (100% and 66.4% in localised disease) and 82.5% and 69.7% for RMS (90.0% and 74.2% in localised disease).</p><p><strong>Conclusions: </strong>In a single-centre cohort of children referred across state and national borders, a structured referral network enabled the delivery of advanced radiotherapy while preserving multimodality treatment continuity. Although survival outcomes are descriptive and derived from a selected cohort, this model may inform access strategies in regions without local advanced radiotherapy capability.</p>","PeriodicalId":19822,"journal":{"name":"Pediatric Blood & Cancer","volume":" ","pages":"e70657"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Targeted Therapies and Response Heterogeneity in Two Children With T-Cell Acute Lymphoblastic Leukemia With BCL11B::TLX3 Fusion Genes.","authors":"Qiang Yao, Xiaoyong Chen, Meizhu Luo, Zhenhu Lin, Xiaoying Fu","doi":"10.1002/1545-5017.70649","DOIUrl":"10.1002/1545-5017.70649","url":null,"abstract":"","PeriodicalId":19822,"journal":{"name":"Pediatric Blood & Cancer","volume":" ","pages":"e70649"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Referral Practices and Utilisation of Paediatric Oncology Physiotherapy Services in Ghana: A Cross-Sectional Study.","authors":"Dorothy Ekua Adjabu, Philip Junior Nyarko, Precious Madzimbe, Kofi Adesi Kyei, Tawagidu Mohammed, Sandra Banini","doi":"10.1002/1545-5017.70671","DOIUrl":"10.1002/1545-5017.70671","url":null,"abstract":"<p><strong>Introduction: </strong>Physical rehabilitation is highly recognised in improving the quality of life of cancer survivors through prehabilitation, sequelae management and palliative care, yet its integration into routine care in Ghana has not been characterised, leading to potential gaps in service access.</p><p><strong>Aim: </strong>To determine referral practices and utilisation of physiotherapy services as self-reported by healthcare professionals (HCPs).</p><p><strong>Methods: </strong>A quantitative cross-sectional study involving proportionate sampling was conducted in three major tertiary healthcare facilities offering oncology services in Ghana. The study included 85 HCPs who work in these three facilities. Data were collected from the HCPs between May and September 2025 using a demographic information sheet and an adapted survey tool on cancer referral practices to physical rehabilitation. Data were entered into Microsoft Excel and further summarised using SPSS version 26 into frequencies and percentages.</p><p><strong>Results: </strong>Most medical practitioners (76.2%, n = 48), including paediatricians, radiotherapists, oncologists, medical officers and paediatric residents, reported referring children/adolescents for physiotherapy. The majority of physiotherapists (72.7%, n = 16) also made referrals to other physiotherapists. Over half (54.0%, n = 34) of the medical practitioners and physiotherapists (68.2%, n = 15) referred between one and 10 cases annually. Medical practitioners (39.7%, n = 25) referred 'sometimes', whilst physiotherapists (36.4%, n = 8) referred 'often'. Reasons prompting referrals included muscle weakness, limitations in activities of daily living and gait alterations. The majority of medical practitioners (61.9%, n = 39) and physiotherapists (63.6%, n = 14) revealed that children/adolescents utilised physiotherapy services. Major reasons for non-utilisation self-reported by the HCPs included caregivers' financial barriers and parental choice.</p><p><strong>Conclusion: </strong>The majority of HCPs reported referring children/adolescents for physiotherapy because of physical limitations. Most referred cases utilised physiotherapy services; however, reasons for non-utilisation included financial barriers and parental choice. Further investigations are suggested to unearth barriers to non-referrals to improve referral pathways and physiotherapy utilisation.</p>","PeriodicalId":19822,"journal":{"name":"Pediatric Blood & Cancer","volume":" ","pages":"e70671"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Case of Non-Islet Cell Tumor Hypoglycemia Driven by Hepatoblastoma: The Diagnostic Approach and Impact of Chemotherapy on Big IGF-II.","authors":"Kuniaki Tanaka, Mototsugu Nagao, Izumi Fukuda, Atsushi Iwai, Kenichiro Kobayashi, Tatsuya Okamoto, Shinya Okamoto, Shohei Azumi, Itaru Kato, Katsutsugu Umeda, Junko Takita, Ikuya Usami","doi":"10.1002/1545-5017.70655","DOIUrl":"10.1002/1545-5017.70655","url":null,"abstract":"","PeriodicalId":19822,"journal":{"name":"Pediatric Blood & Cancer","volume":" ","pages":"e70655"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"How I Approach Anxiety in Children and Teens with Cancer\".","authors":"Pei Xuan Tseng, Lien-Chung Wei","doi":"10.1002/1545-5017.70660","DOIUrl":"10.1002/1545-5017.70660","url":null,"abstract":"","PeriodicalId":19822,"journal":{"name":"Pediatric Blood & Cancer","volume":" ","pages":"e70660"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}