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Introduction: The past few years, much attention has been paid to the weight gain observed in pediatric acute lymphoid leukemia (ALL) survivors. Literature already described a potential role for cranial radiotherapy (CRT) and glucocorticoids (GC). The aim of this review was to analyze overweight and obesity rates before and after treatment and investigate which treatment modalities and clinical factors primarily influence weight. Methods: A literature search was performed in Pubmed and Web of Science. We collected longitudinal and cross sectional weight data of ALL patients that were followed during and/or after treatment. We also gathered clinical characteristics and analyzed if these could be potential predictors for overweight and obesity. Results: The literature search resulted in the selection of 17 articles that qualified for analysis. Most authors observed an increase in overweight compared to diagnosis. They also described higher BMI values among CRT treated patients compared to non irradiated patients. BMI increase was more pronounced after dexamethasone than after prednisone. High BMI at diagnosis appeared to be the only significant clinical predictor for overweight and obesity at follow-up (FU). We could not find an important influence of chemotherapy. Conclusion: ALL survivors may be at risk of becoming overweight or obese and this is mainly attributed to CRT, GC (especially dexamethasone) and weight excess at diagnosis. However, current prevalence rates are based on BMI values, which is probably an underestimation of actual obesity rates among ALL survivors.

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Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in immunocompromised patients. Diagnosis can be challenging and there are no strong guidelines available for the treatment nor for the prevention of IFIs in pediatric patients. Moreover, epidemiology in a Belgian pediatric population is largely unknown. This retrospective study included all patients between 0 and 18 years of age treated at the pediatric hemato-oncology and stem cell transplantation unit of the University Hospitals Leuven, who had a positive result suggestive for an IFI between January 1st, 2009 and December 31st, 2018. Frequency and type of IFI, type of prophylaxis and outcome were analyzed. A total of 85 IFIs occurred in 70 patients: 64 aspergillus, 15 candida and 6 other infections. Twenty episodes were proven, 26 were probable, 13 possible, 10 undefined and 16 false positive. Thirty-two patients (41,6%) were not on any antifungal therapy at time of IFI, 36 patients (46,8%) received antifungal prophylaxis and 9 patients (11,7%) were on ongoing antifungal therapy, with no statistical difference between different types of prophylaxis (amphotericin B vs fluconazole). The mortality rate was 31.4% but only 5 patients (7.1%) died at least partially due to the IFI. Aspergillus was the most frequent cause of IFI in our patients. Even high risk patients on prophylaxis remain at risk for IFI but there was no significant difference between fluconazole or amphotericin B. Both regimens might be considered but alertness remains crucial in the fight against IFIs.

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Background: Vascular malformations are lesions, arising out of blood vessel formation disturbances, that can have an impact on quality of life and can lead to severe complications. To date, vascular malformations are managed by invasive techniques with mostly temporary results. Sirolimus, best known for its immunosuppressive effect, has been used off-label in patients refractory to other therapies. This drug acts as a downstream inhibitor on the PI3K/AKT cascade pathway in which disturbances give rise to malformations. Objectives: We want to combine all the published data to evaluate what the effect of sirolimus is on the size and symptoms of the different types of malformations. We also want to summarize the main safety issues. Methods: A systematic search was performed to find all articles concerning this topic published between the start of 2010 and May 1st, 2019 on Pubmed, Embase, Web of Science and SCOPUS. Relevant data were extracted and analyzed. Additionally, we reported 10 more cases who were treated and followed in UZ Leuven. Results: The literature review included 68 articles. The size and/or symptoms of almost all types of malformations responded well to sirolimus, yet full response was only seen sporadically. Few data were available for capillary and arteriovenous malformations. Side effects occurred regularly, though most were mild and manageable by dose reduction. Some more endangering side effects like bone marrow suppression were seen sporadically. Conclusion: Although our review shows promising results, further research including clinical trials is necessary to prove its effectivity and make it an option as a standard treatment modality.

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Background The etiology of arterial ischemic stroke (AIS) in children (28 days - 18 years old) is still incompletely understood. Multiple risk factors have been described, but the exact cause of the cerebrovascular accident (CVA) can often not be identified. Genetic factors are believed to play a greater role in AIS in children compared to adults. Aim This systematic review aims to provide an overview of genetic risk factors for childhood stroke. Methods We systematically searched databases (PubMed/MEDLINE, Embase) and reviewed genetic variants associated with pediatric stroke. Results Of 28,455 articles, 156 were included (5 prospective studies, 44 retrospective studies, 54 case- control studies, and 53 case reports). All genetic factors described in childhood stroke were reviewed, from prothrombotic factors, homocystinuria, hemoglobinopathies, and vasculopathies, to neurocutaneous, metabolic, and syndromic disorders. Regarding prothrombotic factors, Factor V Leiden and inherited protein C deficiency are probably associated with childhood stroke. Co-inheritance of multiple genetic variants in children with sickle cell disease (e.g., alpha-thalassemia and the G1238C variant in VCAM-1) also significantly affected stroke risk. In contrast, none of the variants in homocysteine metabolism (e.g., MTHFR C667T and A1298C) were significantly associated with pediatric stroke. No comparative studies were available on other topics, but multiple genetic variants in children suffering a stroke were described. Conclusion Different genetic variants have been associated with childhood stroke. However, prospective studies are lacking. Future available evidence will clarify the possible causal role in the stroke etiology or indicate other factors that explain the association. This knowledge will play a great role regarding risk assessment in children carrying these genetic variants.

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Achtergrond: Malnutritie bij de pediatrische kankerpatiënt kan zich presenteren op moment van diagnose, elk stadium van ziekteverloop/behandeling of jaren nadien en heeft implicaties op de overlevingskansen van de patiënt. Het risico op malnutritie bij kinderen is bovendien groter dan bij volwassenen, gezien zij een sneller metabolisme en hogere calorienood hebben voor groei en ontwikkeling. Doel: Deze systematische literatuurstudie beoogt een documentatie op te stellen van de huidige literatuur rond meten van nutritionele status, preventie van en behandeling van malnutritie. Alsook werd gezocht naar verschillen in en handvaten voor kankertherapie bij kinderen uit ontwikkelingslanden. Methoden: Er werd een literatuuronderzoek uitgevoerd naar artikels uit bibliografische zoekmachines (PUBMED, Medline, Web of Science en Embase) die voldeden aan vooropgestelde selectiecriteria en volgende drie hoofdonderwerpen bespraken: kanker bij kinderen, nutritionele ondersteuning/therapie en malnutritie. Resultaten: Deze literatuurstudie includeerde 48 artikels en toonde dat 75% van de geïncludeerde studies de nutritionele status bepaalt o.b.v. antropometrische waarden. 43,75% van geïncludeerde studies bespraken preventieve maatregelen om malnutritie te voorkomen. Preventief ingrijpen om malnutritie te voorkomen kan op 3 mogelijke niveaus: voeding en voeding inname, kankertherapie en/of levensstijl en sociale omgeving van de patiënt. Bij voorkeur gebeurt nutritionele ondersteuning via gastro-intestinale route, maar de meest effectieve nutritionele interventies en indicaties van opstart hiervan bleven discutabel. Het frequenter ondervoed zijn bij diagnose is een factor die meespeelt in de lagere overlevingscijfers bij kinderen uit ontwikkelingslanden. Conclusie: Nutritionele ondersteuning is een van de belangrijke factoren om tot succesvolle behandeling en algemeen welzijn van het kind met maligniteit te komen. Deze dient in acht genomen te worden zowel voor, tijdens als na kankerbehandeling. Meer onderzoek is echter nodig om de beste manier hiervoor te vinden.