CC BY
18
May 2016, Moscow, Russia
OF PEDIATRIC HEMATOLOGY and ONCOLOGY
OTHER TREATMENT AND CARE
ABSTRACT NO.: 0P-092
Safety of cyclophosphamide infusion in the outpatient setting in pediatric patients with malignancies: a retrospective review
Amal Al Sabahi1, Diana Bushnak2, Viqaruddin Mohammed2, Ibrahim Al Fawaz2, Amani Al Kofide2,
Mouab Ayas2, Afshan Ashraf Ali2
1Royal University Hospital; 2King Faisal Specialist Hospital & Research Centre Key words: cyclophosphamide, safety, hydration, side effects, short infusion
Introduction. Some complications of cyclophosphamide (CTX) administration may be hemorrhagic cystitis or renal impairment. This is avoided by giving prolonged hydration and mesna for bladder protection concurrently. Pediatric patients at our institution receive outpatient cyclophosphamide with mesna and short hydration as a standard of care. We reviewed the incidence of complications using this method of administration.
Aim. 1) Identify the incidence and severity of complications associated with administration of outpatient cyclophosphamide; 2) Correlate the risk factors that may contribute to the incidence of complications.
Materials and methods. A review of the medical records of patients age 0-14 years diagnosed with Rhabdomyosarcoma or Ewing Sarcoma treated at King Faisal Specialist Hospital from January 2005 until December 31, 2012 was conducted. Patients who received outpatient cyclophosphamide, dose range from 1200 mg/m2/dose to 2200 mg/m2/dose every 2 to 3 week, 2 doses of mesna, and a 3-hour hydration (125 ml/m2/hour) were included. The incidence of complications such as Grade III/IV myelosuppression, impairment of renal function, electrolyte imbalance, hematuria, and hemorrhagic cystitis in this group were reviewed.
Results. A total of 87 patients received Cyclophosphamide infusion over the above time period. 36 (41 %) of the patients had Rhabdomyosarcoma and 51 (59 %) Ewing Sarcoma. There were 55 female (63 %) and 32 male (37 %). The age at diagnosis was categorized in to three sub-groups: Group-I (0 to 3 years), Group-II (3 to 7 years) and Group-III (7 to 14 years). There were 20 (23 %), 29 (33%), and 38 (44 %) patients in Groups I, II, and III respectively. Complications related to cyclophosphamide infusion were observed in 43 patients (48 %) of which 25 patients had Ewing Sarcoma and 18 had Rhabdomyosarcoma. 38 patients developed hematuria at some time during their therapy (88 %), febrile neutropenia was observed in 3 patients (7 %), and 2 patients had hemorrhagic cystitis (5 %). None of the patients required hospitalization for the management of the above mentioned complications. Renal impairment or grade III/IV myelosuppression was not seen in any of the patients. When analyzing the age subgroups, it was observed that 56 % of the patients who had complications belonged to Group-I and II. Correlation between the dose of cyclophosphamide and the incidence of side effects was not found in this review. Conclusion. In our setting, cyclophosphamide may be given safely in the outpatient setting with the use of a short 3-hour hydration even in small children. There was no incidence of increased complications requiring hospitalization or compromise in the treatment for this group of patients. This method is more convenient for the patient and the family and also potentially more cost effective.
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ABSTRACT NO.: P-118
Rehabilitation of children with onco-hematological diseases at Kirov Health Resort "Avitec"
O.M. Tselousova1, N.M. Pozdeev1, A.V. Rylov1, G.G. Anufrieva2
'Kirov Scientific Research Institute of Hematology and Blood Transfusion, Kirov, Russia; 2LLC Health Resort "Avitec", Kirov, Russia
Key words: rehabilitation, children, onco-hematological diseases
Introduction. The treatment of onco-hematological pathologies by means of cytoreductive therapy in 70-90 % of cases entails full recovery of patients 0 - 18 years of age. However, as a result of the disease and its treatment, some physiological, psychological and social functions are often disrupted and lost. Rehabilitation is a complex of therapeutic and preventive measures aimed at eliminating or compensating functional defects, boosting the organism's resistance against damaging factors of the environment and correcting immune deficiency, all of which enables the patient's adaptation, in particular, the patient's social adaptation, to new life conditions. The most famous children;s rehabilitation centre for onco-hematological patients in the Russian Federation is the health resort "Russkoe Pole" (the Moscow Region). Since 2015, rehabilitation programmes were put into practice at the health resort "Avitec" (Kirov).
Aim. To assess the efficacy of rehabilitation programmes for children with onco-hematological pathologies in the setting of Kirov health resort "Avitec". Materials and methods. In 2015, 29 patients aged 6 to 16 years old (21 patients - with acute lymphoblastic leukemia, 2 - with acute myeloblastic leukemia, 1 of which - in 1 year after allogenic unrelated bone marrow transplantation; 6 - with various lymphomas) underwent rehabilitation at the health resort"Avitec". All children had had complete clinical and hematological remission without any specific treatment for 2.5 years at average (1 to 8 years).
The rehabilitation programme included naturotherapy with phytotherapy, speleochamber, hydrotherapy (a pool with mineral water, baths), art therapy, psychotherapy, remedial excercises, Nordic walking, games in the open air. The duration of the course constituted 21 days.
Results. The indications for rehabilitation therapy were: a chronic pathology of ENT organs, functional disorders of gastrointestinal tract and toxic liver damage in the form of cholestasis in all patients. The efficacy of rehabilitation treatment was noted in all children manifesting itself in the normalization of emotional tonus and sleep, a decrease in the frequency of acute respiratory viral infections, the absence of aggravation of chronic infections of ENT organs over the observation period of 6 months, recovery of peer communication skills. These changes are persistent.
Conclusion. The opening of a new rehabilitation centre for children with oncohematological diseases located in the familiar climate and within walking distance creates the conditions for rehabilitation treatment of patients who for various reasons cannot undergo therapy outside the region. The advantage of Kirov health resort "Avitec" is that the physicians from the Pediatric Department of Hematology and Chemotherapy of Kirov Research Institute of Hematology and Blood Transfusion can perform regular health monitoring of patients.
ABSTRACT NO.: P-142
The efficacy of frozen-thawed irradiated washed erythrocytes in children with
hematological malignancies
N.N. Starostin, P.E. Trakhtman
Federal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Moscow, Russia
Key words: cryoconservation of RBC, hematological malignancies, RBC transfusion
Introduction. Modern programs of treatment of patients with hematological malignancies require a long-term transfusion support. The issue of the selection of erythrocyte suspension (ES) for patients with rare blood groups, sensitized patients is particularly acute in autoblood procurement.
Aim. To perform a comparative analysis of efficacy of frozen-thawed and washed erythrocytes (T&WE) transfusion and normal ES transfusion to children that received the therapy in hematological malignancies with anemia syndrome.
Materials and methods. A retrospective analysis of patients with hematological malignancies was performed that received hemotransfusional therapy of the normal ES - group A (30 patients) and T&WE - group B (28 patients). The main criteria for transfusion was a hemoglobin level decrease less than 80 g/l in the absence of an ongoing bleeding. The process of glycerolization and deglycerolization was carried out with automatic system of cell processing ACP 215 (Haemonetics, USA). Campared groups were similar by mean mass (group A - 23.7 ± 5 kg, group B - 25.4 ± 4.2 kg), diagnosis (group A: acute myeloblastic leukemia (AML) - 15 patients, juvenile myelomonocytic leukemia (JMML) - 11, acute lymphoblastic leukemia (ALL) - 4 patients; group B: AML - 14, JMML - 10 and ALL - 4 patients), indications to transfusion (mean hemoglobulin level in group A was 76.6 ± 4.2 gm/dl, in group B - 74.75 ± 7.05 gm/dl). Recipients of both groups received volume of ES at 10-12 ml per 1 kg of body weight.
Results. ES characteristics: hemoglobulin - 55.8 ± 3.34 g/dose, erythrocytes - 6.16 ± 0.6 x 1012/l, hematocrit - 56 ± 4.8%. T&WE characteristics: hemoglobulin - 46.6 ± 1.5 g/dose, erythrocytes - 5.43 ± 0.3 x 1012/l, hematocrit - 48.8 ± 1.3%. In the analysis of hemotranfusions efficacy the increase of erythrocytic indications was observed inside each group, however the increase of a hemoglobulin level, number of erythrocytes and hematocrit was significantly lower in the group of patients that received T&WE. The increase of indication in the group A: hemoglobulin - 23.5 ± 12.1 gm/dl, erythrocytes - 0.8 ± 0.4 x 1012/l, hematocrit - 6.52 ± 3.7%; in the group B: hemoglobulin - 12.9 ± 6.5 gm/dl, erythrocytes - 0.53 ± 0.27 x 1012/l, hematocrit - 3.2 ± 1.6%. Considering initially lower characteristics of T&WE compared to ES it is possible to assess the efficacy of transfusion of erythrocyte-containing environments as positive.
In the analysis of ES and T&WE transfusions tolerance in recipients, the general state of the patient, time pattern of systolic and diastolic blood pressure, pulse rate, breathing, the body temperature were considered. The follow-up results showed that during and after transfusion there was no development of post transfusional complications. Conclusion. Thus, the performed studies allow stating the sufficient efficacy of both erythrocyte-containing environments for correction of anemia in patients with hemoblastosis. Alongside this, the performed comparative analysis showed that more frozen-thawed erythrocytes or repeated transfusion in comparison with ES may be required to achieve target
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ABSTRACT NO.: P-171
Neurological outcomes in children with extracranial solid neoplasms
by the age of 24 months
L.L. Pankratieva, D.A. Praulova, L.V. Sidorenko, N.N. Volodin, A.G. Rumyantsev
Federal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Moscow, Russia
Key words: malignant neoplasms, infants, complications after polychemotherapy, neurological outcomes, Bayley scale
Introduction. In spite of significant achievements in the treatment of malignant neoplasms in children of the first year of life, neurological complications mainly caused by the intensification of polychemotherapy (PCT) can have a considerable impact on the outcomes.
Aim. To assess neurological outcomes in children with extracranial solid neoplasms, who underwent PCT within the first 6 months of life.
Materials and methods. We have examined 25 children with malignant neoplasms. Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III, 2006) were applied. The investigation was carried out at the age of 24 months, under standard conditions in the presence of one of the parents. According to the results of the tasks completed by a child (cognitive developmental scales, speech function scales - subtests of impressive and expressive speech, motor skill scales - subtests of fine and gross motor skills) and parents'survey (social-emotional development and adaptive behavior scales) a composite score on certain subtests and a total score on each scale with the use of centile tables were estimated. The comparison group included 10 children of equal age for correct assessment.
Results. Summary score values on five Bayley-III scales in a group of patients with malignant neoplasms turned out to be statistically much lower.
Conclusion. The children with malignant neoplasms who underwent antitumour treatment in the first 6 months of life belong to the risk group of unfavorable neurologic outcomes that requires early development of individual rehabilitation plan.
ABSTRACT NO.: 0P-206
Efficiency of photodynamic treatment for recurrent solid tumors in children
N.M. Rostovtsev1, V.G. Polyakov2, A.N. Kotlyarov3, S.G. Kovalenko1
Chelyabinsk Regional Children's Hospital, Russia; 2Pediatric Oncology and Hematology Research Institute of N.N. Blokhin Russian Cancer Research Centre, Moscow, Russia; 3South Ural State Medical University, Chelyabinsk, Russia
Key words: photodynamic therapy, solid tumors
Introduction. Recurrent solid tumors of childhood is a challenge for pediatric oncology. The search for new methods to improve the results of local therapy still extremely important. Aim. To assess direct clinical, radiological and multislice CT results of photodynamic treatment (PDT) with photosensitizers of chlorine family in children with solid tumors. Materials and methods. In paediatric surgical department of Chelyabinsk regional children's clinical hospital PDT was conducted to 9 patients with recurrent solid tumors (Wilms' tumor, neuroblastoma, germ cell tumors), stage III-IV.
Patients with neuroblastoma prevailed - 41.2 %. The mean age of the whole group was 1.8. PDT was intraoperative following after oncotomy. We used laser equipment "Lakhta Milon" (Russia). Output laser power was 2.5 W. During treatment the laser power density ranged from 0.1 to 0.8 W/sm2. We used different doses of photo energy - from 300 to 400 J/sm2, and for tumors deep infiltrating growth - up to 500 J/sm2. Administered photosensitizer amount was calculated per 1 kg of the patient's body weight - 0.6-0.8 mg/kg. Exposure duration depended on tumor size and was from 10 to 30 min. For tumor exposure we used the light guide with end-formed microlens. Case follow-up and dressing changes were outpatient. Number of appointments starting with primary inspection and up to results of assessment of the chosen treatment (3 years later) was from 10 to 15, in average. Results. Assessment of PDT efficiency involved the following criteria: full absence of local recurrence of the tumor; absence of visible (according to US findings) and palpable sings of the tumor growth; local recurrence in 6 months; no effect - continued tumor growth within near post-operational period, according to US findings. In this respect, it should be noted that the local recurrence was regarded as a positive treatment effect. Direct results of PDT were assessed during 1 year. For most cases, this period was long enough for recurrent tumor detection. Absence of recurrent tumor was observed in 7 (77.7 %) patients, recurrence was observed in 2 (22.3 %) patients. Recurrence was detected only in patients with Wilms' tumor of neuroblastoma. In these cases photodynamic re-treatment was not preformed due to tumor dissemination. Follow-up monitoring of 7 patients for 6 months to 3 years did not reveal any recurrence.
Conclusion. The study shows high efficiency of PDT for solid tumors in children at advanced stages. In this respect, 82.4 % children had no tumor recurrence within 3 years. PDT should be implemented more widely in treatment for residual and recurrent tumors, and also when radio- and/or chemotherapy are impossible.
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ABSTRACT NO.: OP-235
Metronomic chemotherapy with vinblastine, cyclophosphamide, methotrexate and celecoxib in progressive or relapsed childhood cancers
Burca Aydin, Canan Akyuz, Neslihan Kalkan, Nilgun Kurucu, Bilgehan Yalcin, Ali Varan, Tezer Kutluk
Hacettepe University Cancer Institute
Key words: metronomic chemotherapy, relapsed solid tumors
Introduction. Metronomic chemotherapy (MC) has been increasingly used for patients with relapsed or progressive cancer. It presents the opportunity of reducing side effects of chemotherapy in heavily pre-treated patients, prolonging survival with acceptable tumor control and improving the quality of life. Mostly small patient groups reported with some response to different MCs. A regimen with vinblastine, cyclophosphamide, methotrexate and celecoxib was reported with objective responses. Aim. This study was planned to assess the outcome of the four-drug MC regimen in relapsed or refractory tumors in children.
Materials and methods. From January 2014 to January 2016, 10 children whom have no other chemotherapy option due to cumulative drug doses were given MC and outcome was evaluated retrospectively. The MC regimen was reported by Andre et al before and consisted weekly vinblastine 3 mg/m2, daily oral cyclophosphamide 30 mg/m2 in first three weeks, methotrexate 10 mg/m2 twice weekly next three weeks, and celecoxib 100 mg to 400 mg twice daily for 7 weeks.
Results. The median age of patients was 8.5 years old ranged between 3.3 and 18. Tumors were neuroblastoma in four patients and osteosarcoma, Ewing's sarcoma, inflammatory myofibroblasts tumor, retinoblastoma and yolk sac tumor, each in one patient. Patients received MC until disease progressed or completely disappeared as in one patient median 3 months (1-12 moths). One patient with osteosarcoma at the 3rd relapse of the disease continued 12 months after tumor resection. Treatment discontinued and she is still complete remission 10 months off-therapy without disease. Four patients had stable diseases at median 2.2 months (1-12 months) and still on MC. Five patients had progressive disease at median 3.8 months (1-5.4 months). At last follow-up, 5 patients (50 %) are alive. One patient with chronic renal failure had hypomagnesemia, hypopotasemia and hypophosphatemia. Other than this no severe toxicity was observed.
Conclusion. The low-dose and continuous chemotherapy of MC strategy shows encouraging results with increased compliance, less side effects, prolonged survival and improved quality of life. The 4-drug metronomic regimen with vinblastine, cyclophosphamide, methotrexate and celecoxib was a well-tolerated schema. With the objective responses and one complete response, this regimen presents a reliable treatment option for patients who have limited treatment choice. Clinical trials with larger groups will help understanding the antitumor effect and impact on outcome or quality of life of MC in patients.
ABSTRACT NO.: PP-250
Clinical features, predictors and outcome of posterior reversible encephalopathy syndrome
in children with cancer
Subramaniam Ramanathan, Seema Medhi, Shripad Banavali, Gaurav Narula, Girish Chinnaswamy,
Tushar Vora, Maya Prasad, Brijesh Arora
Tata Memorial Hospital, Mumbai, India
Key words: childhood cancer, magnetic resonance imaging (MRI), posterior reversible encephalopathy syndrome (PRES), seizures
Introduction. Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological syndrome characterized by a neurotoxic state with vasogenic edema which can be life threatening if detected late. Being a rare occurence, it has limited published data in children afflicted with cancer.
Aim. The aim of this retrospective study was to elucidate the clinical profile, predisposing factors, imaging features and outcome of PRES in children receiving treatment for various malignancies.
Materials and methods. Retrospective audit of the clinical data and radiological features of patients with cancer and having PRES diagnosed between October 2004 to December 2015 was conducted and analyzed.
Results. Forty four patients (male:female - 3:1) were diagnosed with a median age of 8 years(range, 1-15). Primary diagnosis were acute lymphoblastic leukemia (n = 29), acute myeloid leukemia(n = 5), non-Hodgkin lymphoma(n = 5), chronic myeloid leukemia (n = 1) and solid tumors (n = 4). Most common presenting symptoms were seizures which was observed in all children followed by headache in 31 children (70 %), altered sensorium was in 29 children (66 %) and visual disturbances in 24 children (54 %). Most common sign was hypertension observed in 41 (93 %) patients. All the patients with ALL were in either in latter part of induction (87 %) or delayed reinduction (10 %) and had hypertension (steroid induced) or abdominal pain/constipation (55 %) when they developed PRES. CT scan was abnormal in 15 (51 %) patients but was diagnostic in only 31 %. MRI was performed in 41 patients; all showed abnormalities. Classic hyperintense lesions on FLAIR and Diffusion weighed images were noted in parieto-occipital region in 33 patients (75 %). Frontal lobe lesions in association with other regions were noted in 15 patients (34 %). Atypical findings (leptomeningeal enhancement & hemorrhage) were noted in 8 % patients. Follow-up MRI/CT was obtained in 16 patients which revealed residual abnormalities in 5 patients. No patient died of PRES but 5 patients died of other complications. Neurological sequelae were observed in only 2 of the surviving 39 patients; both had considerable delay in PRES diagnosis. There were no cases of recurrent PRES in our cohort.
Conclusion. PRES is an important clinico-radiological syndrome in patients undergoing chemotherapy for hematological malignancies. High index of suspicion, early DW images on MRI in children with classic tetrad of symptoms and hypertension confirms early diagnosis of PRES and ensures good long-term outcome. Aggressive management of abdominal pain and constipation that can cause acute hypertension and PRES may help reduce chances of PRES and its complications.
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ABSTRACT NO.: PP-271
Study of anticoagulant effect of LMWH in children with cancer and thrombosis using Thrombodynamics, aPTT and anti-Xa activity
M. Gracheva, P. Zharkov, E. Seregina, A. Poletaev, A. Pshonkin, F. Ataullakhanov
Federal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Moscow, Russia
Key words: cancer, thrombosis, low-weight heparin, haemostasis, thrombodynamics, anti-Xa activity
Introduction. The drugs of choice in treatment of venous thrombotic episodes (VTE) in children are low molecular weight heparins (LMWH). There is no information on the application of a new global method of haemostasis assessment Thrombodynamics (TD) in anticoagulation therapy monitoring in children with cancer at the moment. Aim. New laboratory method of hemostatic assessment TD is sensitive to the anticoagulant effect of LMWH according to in vitro studies. In this study TD, aPTT and anta-Xa activity were used to monitor anticoagulation therapy in children with cancer with detected DVT.
Materials and methods. 35 children aged from 5 months to 18 years who were at the stage of active treatment of cancer were enrolled in prospective study. In all patients DVT was confirmed / diagnosed by Doppler ultrasound. On the day of thrombosis detection anticoagulant LMWH therapy was administered to all children at initial dose of 100ME / kg every 12 hours. Anti-Xa activity, aPTT and TD were used to assess the coagulation status of patients. Haemostatic system was evaluated before and at the 4th day of anticoagulant therapy with LMWH. Hypercoagulability in TD was defined as the increase in clot growth rate (V) above the normal range, hypocoagulability - when V was reduced below the normal range. OriginPro 8.0 (Microcal Software, Nordhempton, USA) software was used for all calculations.
Results. On the day of VTE detection hypercoagulability in TD was detected in 24 children (69 %): mean V = 33.8 um/min (normal range in children is 22-29 um/min), APTT was shortened in 4 children (11 %). On the 4th day of LMWH therapy TD demonstrated a significant shift to the area of anticoagulation: V decreased in 2.7 times (*P=0.0001, paired t-test), aPTT elongated in 1,17 times (*P = 0.0001), but the main part of values were within the normal range (25.1-36.5 sec). On LMWH therapy there was a correlation between anti-Xa activity and the values of 1/V: Spearman corr. coeff. 0.67 (*P = 0.0001), there was no correlation between anti-Xa activity and aPTT.
Conclusion. TD allows to reveal changes in the clot growth rate on LMWH anticoagulant therapy in children with cancer with thrombosis. Changes of these parameters correlate with the degree of anticoagulation according to anti-Xa activity. APTT does not reveal the effect of LMWH on the haemostasis of children with cancer with VTE.
ABSTRACT NO.: P-294
The case of clinical emergency reinfusion of red blood cells in massive blood loss
A. Karelin, D. Litvinov, E. Spiridonova, P. Trakhtman, V. Shchukin
Federal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Moscow, Russia
Key words: emergency reinfusion, red blood cells, massive blood loss
Introduction. Massive blood is referred to as the loss of 25-49 % of total circulating blood volume. At the same time the decrease in the mass of circulating hemoglobin by 50 % is accompanied by a decrease in oxygen delivery by 27 %.
Aim. The transfusion therapy is provided by supplementation of intravascular fluid volume, filling the deficiency of coagulation factors and the level of circulatingred red blood cells (RBCs). In order to reduce the risk of transfusion reactions and complications of the intraoperative reinfusion autoerythrocytes collected from wound were used. The use of autoerythrocytes helps to restore the RBC, hemoglobin and hematocrit level 1-2 days after the operation.
Materials and methods. The example of successful use of apparatus RBC reinfusion is the following clinical case of the patient O. (age 13, weight 54 kg, height 153 cm) with a diagnosis of "Juvenile angiofibroma of the nasopharynx and skull base (the 2nd stage; Fisch), 3rd relapse". The laboratory and clinical indicators were within normal ranges. A surgery - transnasal endoscopic removal of juvenile angiofibroma of the nasopharynx and skull base under the control of CT - based navigation system - was performed. In order to reduce the risk of intraoperative bleeding, endovascular occlusion of the tumor from the pools of the maxillary right and left facial artery was performed with hydrogel cylinders (500 pm) a day before the surgery.
Results. The device for autoerythrocyte reinfusion CATs was used during the operation. Intraoperative blood loss reached 1350 ml (38 % of total circulating blood volume). Intraoperative infusion volume amounted to 3044 ml, which included 2000 ml of ringer solution, 350 ml of gelofuzin, 394 ml of autoerythrocytes with a hematocrit of 60 %, 300 ml of donor RBCs suspension.
Hemodynamic parameters remained stable within the operation.The laboratory data after the surgery showed no significant abnormalities (the hemoglobin level was 118 g/l, hematocrit was 34 %). The patient was observed in intensive care unit for 12 hours and was discharged home in satisfactory condition 9 days later.
Conclusion. The use of apparatus autoerythrocyte reinfusion allows to reduce the risk of transfusion reactions and complications, reduces the duration of the observation in intensive
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ABSTRACT NO.: P-297
The results of treatment of intraoperative blood loss in pediatric оncology
V. Shchukin, E. Spiridonova, Yu. Ovsyannikov
Federal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Moscow, Russia
Key words: intraoperative blood loss
Introduction. In Oncology practice, the initial condition of the patients may contribute to an increased risk of bleeding both during surgery and after it.
Aim. In order to perform the in-time therapy it is necessary to focus both on predicted and real blood loss, assessing the volume of blood loss during the surgery.
Materials and methods. The analysis of the effectiveness of intraoperative blood loss was performed in 1311 children with cancerous diseases. The volume of blood loss was
determined by visual assessment of the degree of wipes impregnation with blood, the measurement of blood volume collected by aspirator, the evaluation of hemoglobin
and hematocrit level. The decrease of hemoglobin level down to 80 g/l and hematocrit down to 25 % with prolonged bleeding was the indication for the beginning of blood transfusion.
The indication for fresh frozen plasma (FFP) transfusion included the deficiency of blood coagulation factors and the threatened coagulopathy bleeding. Thrombocytopenias required
medical correction in case of low platelet levels (less than 100 thousand/ml).
Taking into account the fact that hypothermia significantly reduces the functional activity of platelets, which contributes to the hemorrhagic syndrome in all the performed cases, intraoperative warming of the patient was performed.
Results. Intraoperative blood loss up to 20 %, 20-40 %, 40-100 %, over 100 % of total circulating blood volume was diagnosed in 84.2 % (1104 children), 13.2 % (173 children), 2.3 % (30 children), 0.3 % (4 children), respectively. The replenishment of blood loss was performed by step method according to the Protocol, which included crystalloids (for patients with blood loss up to 20 %), infusion therapy and the use of fresh frozen plasma (for patients with blood loss of 20-40 % and activated partial thromboplastin time or protrombin time increase by 1.5 times), crystalloid/colloids, fresh-frozen plasma and RBC mass in the ratio of 1:1:1 ( for patients with blood loss of 40-100 %). In case of blood loss over 100 % fresh frozen plasma, red blood cells, platelets in the ratio of 1:1:1 were used. Positive treatment outcomes were achieve in the vast majority of cases (1310 children, 99.9 %). Intraoperative blood loss was the cause of death of 1 baby due to disseminated intravascular coagulation syndrome.
Conclusion. The therapy of acute intraoperative blood loss in pediatric oncology should be primarily aimed at maintaining of the circulating fluid volume and cardiac output. The restoring of the deficiency of blood corpuscles is to be started at hemoglobin level below 80 g/l.
ABSTRACT NO.: 0-390
The remedial treatment of children with malignant solid tumours at an early postoperative stage
A.V. Petrichenko, E.A. Bukreeva, A.A. Katyzhenkov, K.F. Savlaev, N.M. Ivanova
Research and Practice Centre for Specialized Medical Care for Children named after V.F. Voyno-Yasenetsky, Moscow, Russia
Key words: rehabilitation, solid tumours
Introduction. The problem of the development of rehabilitation programmes for treatment of children after surgeries on malignant tumours is becoming ever more acute due to an increased amount and a quality growth of high-tech surgeries, the conduct of organ-preserving therapies including those using various implants; as well as due to the use of complex innovative equipment.
Aim. A reduction of time gaps between stages of local tumour control and adjuvant treatment, a recovery of a maximal quality of life in terms of residual capacity. Materials and methods. In 2013-2015, rehabilitation treatment at an early postoperative stage was received by 460 patients who had undergone 497 surgeries. The age of the postoperative patients ranged between 3 months and 18 years with the predominance of school-aged children (72.8 %) and the median age comprising 6.3 years. Surgeries with the use of waterjet and plasma technologies as well as thermal ablation of tumours had been conducted. Hip and knee endoprosthetic replacements as well as total endoprosthetic replacements had been carried out. Polychemotherapy was started on day 5-7 after the removal of a tumour in order to prevent local recurrences and distant metastases. On day 1-3 after a surgery, remedial treatment was conducted at intensive care unit, whereas on days 4-21 it was continued in hospital wards. The employed methodologies included kinesiotherapy, laser therapy, aero phytotherapy, orthopedic correction, orthotic therapy and corset therapy.
Results. Postoperative complications included: healing by second intention in 2 patients, diaphragmatic cupula paresis in 1 child. An improvement in the overall state of health and in the functions of vital organs was registered in all patients. Patients who had undergone endoprosthetic replacement demonstrated a recovery of motor skills without contractions. Adjuvant antitumour treatment was carried out for all patients on day 5-7 after a surgery.
Conclusion. Timely multimodal rehabilitation treatment at an early postoperative stage enables a correction of the consequences of special treatment at early stages, which significantly reduces children's incapacitation as well as improves their social adaptation and quality of life.
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ABSTRACT NO.: 0P-400
Assessment of patient awareness regarding chemotherapy and related supportive medications in pediatric cancer patients in pediatric oncology hospital
Sarah Mohamed Abdelsamie, Mohamed Abdelrahman, Karim Alfarsi, Nada Mohamed
Childrens Cancer Hospital 57357, Egypt
Key words: caregivers chemotherapy, adverse drug events
Introduction. Patient/ patient caregivers' awareness of chemotherapy basic information and compliance to preventive measures are important components of cancer care. Unfortunately, this aspect of care may be overlooked until problems arise. This leads to needless distress and discomfort and in some cases serious clinical consequences. Assessment of patient/ patient caregivers awareness regarding chemotherapy treatment and related adverse events was run using open and closed questions survey during waiting to receive chemotherapy cycles.
Aim. To screen pediatric cancer patients /parents awareness regarding chemotherapy medications, supportive medications and related procedures. Materials and methods. 66 patients/ parents were interviewed to answer 23 questions (total 1518 questions) regarding chemotherapy medications and supportive medications. Questions were categorized as: Chemotherapy basic knowledge (7 Questions), drug indication (5 Questions), drug monitoring (2 Questions), patient compliance (2 Questions), Local anesthesia cream usage (3 Questions) and hygiene behaviors (4 Questions).
Results. Regarding Chemotherapy basic knowledge (7 questions), a total of 462 answers by 66 patients were provided (n = 264) were correct while 43 % (n = 198) were incorrect. Regarding drug indication (5 Questions), a total of 330 answers by 66 patients were provided. 47 % (n = 154) were correct while 53 % (n = 176) were incorrect. Regarding drug monitoring (2 Questions), a total of 132 answers by 66 patients were provided. 46 % (n = 61) were correct while 54 % (n = 71) were incorrect. Regarding patient compliance (2 Questions), a total of 132 answers by 66 patients were provided. 73 % (n = 96) were correct while 27 % (n = 36) were incorrect. Regarding local anesthesia cream usage (3 Questions), a total of negative 198 answers by 66 patients were provided. where all patients were uneducated about the usage of local anesthesia cream usage before needle insertion. Regarding hygiene behaviors (4 Questions), a total of 264 answers by 66 patients were provided. 38 % (n = 100) were correct while 62 % (n = 164) were incorrect. From 66 patients 32 were receiving corticosteroids. 44 % (n = 14) were aware of corticosteroid role in chemotherapy regimen while 56 % (n = 18) were unaware of it. From 66 patients 53 were on Trimethoprim prophylaxis during chemotherapy while 13 were not on Trimethoprim prophylaxis due to medical reasons as advised by the physician. From the 53 patients on Prophylaxis, 47 % (n = 25) were aware of Trimethoprim role during chemotherapy while 53 % (n = 28) were unaware of it.
Conclusion. Improvement plans were needed to enhance Patient/ patient caregiver awareness regarding chemotherapy basic information and supportive medications.
ABSTRACT NO.: 0P-401
Assessment of patient awareness regarding chemotherapy side effects in pediatric cancer
patients at a pediatric cancer hospital
Sarah Mohamed Abdelsamie, Mohamed Abdelrahman, Karim Alfarsi, Nada Mohamed
Childrens Cancer Hospital 57357, Egypt
Key words: chemotherapy adverse, events, patient, awareness
Introduction. Chemotherapy side effects have a profound effect on the person with cancer, causing discomfort, longer hospital stays, and in some situations death. Patient/ caregivers awareness of common side effects is an important aspect of cancer care. The aim of the study was to assess patient knowledge and dealing with common chemotherapy side effects. Aim. To screen pediatric cancer patients /parents awareness regarding dealing with chemotherapy side effects.
Materials and methods. 66 patients/ parents were interviewed to answer 24 questions (total 1584 questions) regarding chemotherapy side effects. Questions were categorized as: Constipation (3 Questions), Diarrhea (3 Questions), Emesis (3 Questions), Hair Loss(3 Questions), Oral Mucositis (3 Questions), Nausea & vomiting (3 Questions), Fever (3 Questions), Tiredness (3 Questions. From total 1584 questions, 1152 questions were inapplicable on patients who did not experience some chemotherapy side effects while 432 questions were analyzed).
Results. 1152 questions were inapplicable on patients who did not experience some chemotherapy side effects, while 432 questions were applicable. From 432 answers, 58 % (n=250) were correct while 42 % (n = 182) were incorrect. Of 66 patients 30 % (n = 20) suffered from Fever while 70 % (n=46) did not experience Fever, with appropriate awareness of cause 80 % (n = 16), dealing with fever 100 % (n = 20), prevention 65 % (n = 13). Of 66 patients 27 % (n = 18) suffered from mucositis while 73 % (n = 48) did not experience mucositis with appropriate awareness of cause 83 % (n = 18), dealing with mucositis 39 % (n = 7), prevention 28 % (n = 5). Of 66 patients 38 % (n = 25) suffered from Emesis while 62 % (n = 41) did not experience emesis, with appropriate awareness of cause 80 % (n = 20), dealing with emesis 76 % (n = 19), prevention 32 % (n = 8). Of 66 patients 23 % (n = 15) suffered from nausea while 77 % (n = 51) did not experience nausea, with appropriate awareness of cause 87 % (n = 13), dealing with nausea 73 % (n = 11), prevention 27 % (n=4). Of 66 patients 18 % (n = 12) suffered from Constipation while 82 % (n = 54) did not experience Constipation, with appropriate awareness of cause 50 % (n = 6), dealing with Constipation 33 % (n=4), prevention 25 % (n=3). Of 66 patients 21 % (n = 14) suffered from Diarrhea while 79 % (n = 52) did not experience Diarrhea, with appropriate awareness of cause 79 % (n = 11), dealing with Diarrhea 50 % (n = 7), prevention 21 % (n = 3). Of 66 patients 33 % (n = 22) suffered from Hair Loss, while 67 % (n=44) did not experience Hair Loss, with appropriate awareness of cause 91 % (n = 20), dealing with hair loss 64 % (n = 14), prevention 45 % (n = 10). Of 66 patients 21 % (n = 18) suffered from Tiredness while 79 % (n = 52) did not experience Tiredness, with appropriate awareness of cause 67 % (n = 12), dealing with tiredness 61 % (n = 11), prevention 22 % (n = 4).
Conclusion. Patient/ patient caregivers awareness regarding chemotherapy side effects was unsatisfying, which required more efforts towards improvement. tr
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SIOP ASIA CONGRESS
ABSTRACT NO.: P-406
Modern methods of venous access in pediatric oncology
Yu.Yu. Kozel, N.A. Maksimova, E.Yu. Semiletkina, S.A. Kuznetsov, G.A. Mkrtchyan, M.V. Starzeckaya
Rostov Research Oncology Institute, Rostov-on-Don, Russia
Key words: central venous catheter, peripheral access, pediatric oncology
Introduction. Treatment of oncological diseases requires prolonged usage of chemotherapy drugs. Unstoppable treatment and laboratory control is available in case of presence of permanent venous access.
Aim. Choose of optimal way of venous access (VA) for treatment of children with oncological diseases. Modern methods of treatment and arsenal of drugs for pediatric oncology requires long-term, sustainable, safe and applicable VA.
Materials and methods. Retrospective analysis of different variants VA for 532 patients from 1 month to 17 y.o. treated in FSBI RROI was performed. Patients were divided on 3 groups. Four hundred seventy three patients included to the first group received catheter for subclavian and femur veins. Second group - 21 children with port catheter and third (38 patients) which were treated with central venous (CV) catheter implanted thru peripheral access (PICC). The analysis of frequency and types of complications after the usage of above mentioned catheters with different types of VA was done.
Results. Complications associated with implantation and usage of external central venous catheters (CVC) were registered in 32.9 % of cases. Complications in case of port-catheters - in 66.5 % of cases. The majority of problems were presented as infection problems required antibacterial treatment, second surgery and urgent removing of port-catheter. From 21 implanter port-catheters, 14 were urgently removed.
From 2013 we installed 38 peripheral implanting catheters PICC type. Rate of complications with this type of catheters were 18.2 %. One catheter was removed due to suspicion on infection. Catheter continuity violation was registered at 2 patients. Three patients removed catheters by themselves. Hematoma of lower third part of shoulder was revealed at 1 patient due to initial thrombocytopenia. Violation of catheter crossability due to it's thrombosis was not observed.
Thus, the data of the investigations shows that usage of subclavian venous access (SVA) for CVC implantation in comparison with CV and ports have the several advantages:
a. SVA implantation is safe and small-invasive;
b. Terms of SVA catheters usage from 6 days to 1 year;
c. Presence of Groshong vessel makes catheter safe for bleeding and air embolism;
d. Thrombocitopenia and hyperplasia of lymph nodes is not absolute contraindication for SVA catheter implantation
e. SVA catheter implantation do not provides any troubles for patients;
f. In cases of needed SVA catheter can be removed in any medical institution or at home;
g. SVA catheter usage is painless;
h. There is no damage of SVA catheters;
i. SVA catheters implantation can promote the decreasing of frequency of infection complications because the bacterial load on sq.m. in the area of shoulder is less than neck and chest. Conclusion. From all methods of VA, included in this work, the peripheral, used for PICC-catheters implantation is less invasive, safe, sustainable, long-term, easy in usage. This type of VA is the method of choice in pediatric oncology.
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