Oral mucositis in pediatric cancer patients undergoing allogenic hematopoietic stem cell transplantation preventively treated with professional dental care and photobiomodulation: Incidence and risk factors

2021 ◽  
Author(s):  
Wanessa Miranda‐Silva ◽  
Felipe Paiva Fonseca ◽  
Alessandra Araujo Gomes ◽  
Ana Beatriz Bechara Mafra ◽  
Vanderson Rocha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cancer Patients ◽  
Cell Transplantation ◽  
Dental Care ◽  
Pediatric Cancer ◽  
Hematopoietic Stem ◽  
Pediatric Cancer Patients

scholarly journals 1158. D-index as a Novel Index to Predict Invasive Fungal Disease in High-Risk Neutropenic Pediatric Cancer Patients and Hematopoietic Stem Cell Transplantation

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S605-S606
Author(s):  
Muayad Alali ◽  
Jennifer Pisano
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cancer Patients ◽  
Cell Transplantation ◽  
Pediatric Cancer ◽  
Invasive Fungal Disease ◽  
Hematopoietic Stem ◽  
Pediatric Cancer Patients

Abstract Background Prolonged and profound neutropenia are risk factors for invasive fungal disease (IFD) during febrile neutropenia (FN) episodes. The D-index combines both depth and duration of neutropenia in a single assessment and has been proposed as a useful tool to exclude or predict IFD in high-risk adult patients. We assessed the D-index as a predictor of IFD in pediatric cancer patients. Methods We conducted a retrospective study of pediatric oncology patients with FN at UCM Comer Children’s Hospitals. IFD was stratified as possible, probable, and proven according EORTC/MSG criteria. Patients considered high risk of IFD were receiving intensive chemotherapy with expected prolonged neutropenia >7 days, including, but not limited to, AML, high-risk acute ALL, and hematopoietic stem cell transplantation (HSCT). The D1-index was equal to 2t1 + 3t2, where t1, and t2 are the number of days from the first day of neutropenia < 500mm3 and < 100/ mm3 respectively, until the development of IFD. The D2-index approximates the area over the neutrophil curve during neutropenia. A cumulative D-index (c-D-index) was also calculated using the first day of neutropenia until the date of the first clinical manifestation of IFD. We compared duration of neutropenia vs D-index vs c-D-index as a predictor of IFD using receiver operating characteristic curve (ROC)/AUC analysis. Figure 1 Figure 2 Results We identified 455 FN episodes in 203 high-risk patients. 53/455 (11.6%) had IFD, 12 (2.6%) proven, 23 (5%) probable, and 18 (4%) possible. The median of D1, D2 indexes and c-D-index were significantly higher in patients developing IFD (38, 5225, 7352) compared to the non-IFD group (26, 3857, 5169) (P=.001, P=.001, and P=.01) respectively. The ROC curve of D-index and c-D-index (figure 1,2,3) showed better performance (AUC of 0.85,0.89, 0.81) respectively compared to the duration of neutropenia alone. The ROC was highest when D-index was combined with prolonged fever >5 days (AUC 0.94) Figure 3 Figure 4 Conclusion The D-index may be a useful tool to stratify high-risk pediatric patients according to risk of IFD. The c-D-index, particularly, may be a useful tool to guide for empiric antifungal therapy and diagnostic testing. Prospective multi-center studies using these tools are required to refine the clinical approach to IFD. Disclosures All Authors: No reported disclosures

scholarly journals 2857. A Statistical Model to Predict Invasive Fungal Disease in Pediatric Cancer and Hematopoietic Stem Cell Transplantation Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S76-S76
Author(s):  
Muayad Alali ◽  
Madan Kumar
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Pediatric Oncology ◽  
Pediatric Cancer ◽  
Oncology Patients ◽  
Hematopoietic Stem

Abstract Background Invasive fungal diseases (IFDs) are devastating opportunistic infections that result in significant morbidity and death in pediatric cancer and hematopoietic stem cell transplantation (SCT) patients. Identification of risk factors for IFD will help clinical decisions relevant to the diagnosis and management of IFD in a timely manner. Despite this, data evaluating prediction risk tools for IFD in pediatric cancer are limited. Methods We conducted a retrospective review of pediatric oncology patients with a diagnosis of febrile neutropenia (FN) at UChicago Comer Children’s Hospital from July 2009 to December 2016. We analyzed 13 clinical, laboratory, and treatment-related risk factors for IFD including (age, gender, underlying diagnosis, SCT status, graft vs. host disease, chemotherapy in the last 2 weeks, temperature, height, fever duration, presence of hypotension, absolute neutrophil count, duration of neutropenia, absolute monocyte count, and the absolute lymphocyte count (ALC)). IFD was stratified as possible, probable, and proven according to the latest EORTC/MSG criteria (2008). Multivariable logistic regression risk prediction models were developed with separate analyses for all suspected IFD cases and only proven and probable cases. Results A total of 667 FN episodes (FNEs) were identified in 265 patients. IFD was diagnosed in 62 episodes (9.2%) of which 13 (1.9%) were proven, 27 (4%) probable, and 22 (3.3%) possible. Five variables obtained were significantly more common in IFD. Patients presenting with hypotension and fever >5 days were highly associated with IFD (P < 0.001). SCT receipts (P < 0.01), neutropenia longer than 10 days (P = 0.02), and ALC <300 mm3 at time of presentation (P = 0.03) were additional risk factors. The final model performs very well compared with other published models with a receiver operating characteristic–area under the curve (ROC-AUC) of 86.5 for all IFD cases and ROC-AUC of 84.5 for proven, probable IFD cases. Conclusion Our findings showed important clinical markers for the development of IFD in pediatric oncology patients. A predictive regression model including identified significant factors has been created. Risk stratification with prospective external validation using this model can be used to refine the clinical approach. Disclosures All Authors: No reported Disclosures.

P1825ANALYSIS OF LATE RENAL COMPLICATIONS AND RISK FACTORS IN CHILDREN WITH HEMATOPOIETIC STEM CELL TRANSPLANTATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Anar Gurbanov ◽  
Bora Gülhan ◽  
Barış Kuşkonmaz ◽  
Fatma Visal Okur ◽  
Duygu Uçkan Çetinkaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem ◽  
Renal Complications

Abstract Background and Aims The aim of the study is to investigate the incidence and risk factors of hypertension (HT) and chronic kidney disease (CKD) in patients who had hematopoietic stem cell transplantation (HSCT) during their childhood. Method Patients who had HSCT between January 2010-2019 with a minimum follow-up period of 6 months were included in the study. Data regarding renal complications were collected from the medical records of the patients. Guidelines of European Society of Hypertension (ESH) and American Academy of Pediatrics (APA) were used for the evaluation of hypertension. 24-hr ambulatory blood pressure monitoring (ABPM) was performed in children older than 5 years of age (68 patients). Ambulatory hypertension is diagnosed when systolic and/or diastolic blood pressure (BP) load is higher than 25%. Ambulatory prehypertension is diagnosed when mean systolic and/or diastolic BP is less than 95th percentile with systolic and/or diastolic BP load higher than 25%. Results A total of 72 patients (41 males and 31 females) were included in the study. The mean age of the patients at last visit was 10.8±4 years. ABPM revealed ambulatory HT in 6 patients (8.8%) and ambulatory prehypertension in 12 patients (17.6%). Office BP revealed HT in 3 patients (4.2%) and increased BP in four patients (5.6%) according to APA guideline (2017). In cohort, 12 patients with normal office BP (according to APA guideline) had ambulatory prehypertension or hypertension with ABPM. Office BP revealed HT in 1 patient (1.4%) and high-normal BP in 3 patients (4.2%) according to ESH guideline. In cohort, 15 patients with normal office BP (according to ESH guideline) had ambulatory prehypertension or hypertension with ABPM (Table 1). After a mean follow-up period of 4.4±2.5 years, CKD developed in 8 patients (11.1%). Patients with chronic graft-versus-host disease, with HLA-mismatched HSCT and/or transplantation of peripheric or cord blood hematopoietic stem cells had increased risk of CKD (p=0.041, p=0.033 and p=0.002, respectively). Conclusion Patients with HSCT should be regularly followed for the development of HT and ABPM should be used on regular basis. Patients with risk factors should be closely monitored for the development of CKD.

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