One hundred and eighteen (118) episodes of bacteremia and fungemia in children with cancer were compared to 401 episodes of bacteremia and fungemia in adults with cancer to assess differences in etiology, risk factors and outcome. A retrospective univariate analysis was performed of all episodes of bacteremia in national pediatric and adult cancer institutions appearing in 1990-1996. A total of 519 episodes of bacteremia were assessed and compared. Both cancer centers differed in prophylactic antibiotic policies. About 50% of adults but less than 5% of children received quinolone prophylaxis during neutropenia, even though the empiric antibiotic therapeutic strategy was similar. There were differences in etiology between the groups: staphylococci and Stenotrophomonas maltophilia were more frequently observed in children (P<0.01), Pseudomonas aeruginosa and Acinetobacter spp. in adults (P<0.05). Gram-positive bacteremia was surprisingly more commonly observed in adults (65.7% vs 33.3%, P<0.01). Mixed polymicrobial bacteremia occurred more commonly in adults (31.8% vs 7.6%, P<0.001) than in children. Analysis of risk factors did not observe differences in risk factors except for underlying disease (acute leukemia was more frequently observed in children -48.3% vs adults 33.7%, P<0.05 and prophylaxis: (prior prophylaxis with quinolones was more common in adults (47.5%) than in children (2.5%) P<0.0001). Overall and attributable mortality in pediatric bacteremia was significantly lower than in adults (P<0.03).
Treatment of childhood acute lymphoblastic leukemia (ALL) according to the 1st Slovak protocol started in the Slovak Republic in 1971 in eight pediatric departments. Gradually, two other protocols were written, and 496 children were treated with these three protocols from 1971 to 1992. Since 1992, all children have been treated in three pediatric oncological departments. From 1992 to 1996, protocols for standard and high-risk ALL were developed that were used for 111 children in Bratislava, while the centres in Banska Bystrica and Košice had started to use BFM protocols. Since 1997, all patients with ALL have been treated according to ALL BFM 95, and since 2002, they have been included in the ALL IC BFM 2002 study. We evaluated treatment results in the standard arm of ALL BFM 95 and compared it with previous Slovak protocols. Rates of complete remission increased from 90.6% in the fi rst Slovak protocol to 97.1% in BFM 95; EFS and OS increased from 0.46 and 0.50 to 0.67 and 0.72, respectively. Relapse rates decreased from 42% to 20.5%. EFS was signifi cantly worse in children with leukocyte counts >100 × 10 9 /l and in the HR group in comparison to standard-and medium-risk groups. OS was also signifi cantly worse in T-cell ALL than in B-cell ALL. Death rates in the 1st complete remission decreased gradually in the Slovak protocols from 10.4% to 1.8%, but were high in BFM 95 (10.8%) due to more intensive therapy and initial unsatisfactory experiences with BFM protocols. All parameters improved in the ALL IC BFM 2002 study.
Long-term cardiac complications, occurring several years after completion of anticancer treatment, may develop from subclinical myocardial damage induced during cardiotoxic therapy. The aim of this study was to evaluate the usefulness of frequency-domain signal-averaged ECG analysis of the QRS complex for assessing the cardiotoxicity of anthracycline cytostatics. Altogether, 172 signal-averaged electrocardiography (SAECG) registrations were performed in 50 repeatedly evaluated oncologic patients. These registrations were performed 0.2-15 years after completion of anthracycline therapy for childhood cancer. The control group consisted of 120 healthy children and young volunteers; in 20 of these controls, SAECGs were performed repeatedly. Using gliding window fast Fourier transformation within the QRS complex, values area ratio (AR) 60-120 Hz/0-120 Hz were calculated in X, Y, and Z lead. Area ratio of patients after anthracycline therapy was significantly higher than those in control group in X lead. Differences in frequency content in the QRS complex between patients and controls might signal an initial stage of anthracycline-induced myocardial damage.
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