No abstract

Purpose In this report, the Pediatric Oncology Group (POG) experience with lymphocyte predominant Hodgkin Disease (LPHD) in children is reviewed. Materials and Methods From 1984–1993, the POG conducted 3 clinical trials for advanced stage HD and 2 for early stage HD. There were 26 cases of LPHD in 613 patients in these trials. Patients' ages ranged from 3.1–17.8 years (mean of 12.9 years). There was a marked male predominance. Results Histologic subtypes were 17 nodular, 8 diffuse pattern; 1 was indeterminant. The sites involved at diagnosis were primarily the peripheral lymph nodes. Fourteen patients had stage (S) I disease; 9 had SII; 3 had SIII; there was no SIV disease. Only 4 of 26 patients had B symptoms. All 26 patients achieved complete remission, 10 with radiotherapy, 6 with chemotherapy and 10 with combined modality therapy. Treatment was not uniform since patients were registered on different protocols. Event‐free survival after 5 years was 86.5 percent. Two patients developed and succumbed to large cell, T‐cell type, non‐Hodgkin lymphoma (NHL). Conclusions Optimal treatment for LPHD should focus on efforts to limit the risk of second malignancy. Med. Pediatr. Oncol. 29:519–525, 1997. © 1997 Wiley‐Liss, Inc.

The efficacy of antibiotic treatment of port-associated bloodstream infection without device removal has not been systematically studied. We analyzed the outcome of 43 consecutive portassociated bloodstream infections in pediatric hematology-oncology patients. Etiologies included Staphylococcus epidermidis (30) and Staphylococcus aureus (6). Antibiotics were given through the port for a median of 11 days. Four ports were removed within 72 hours. In 36 (92%) of the remaining 39 episodes, there was a response to antibiotic therapy (defervescence and negative blood culture). In 78% of episodes in which there was a response (excluding two in which the catheters were removed because of mechanical problems), the infections were cured without port removal. Two of the four relapses were cured with a second course of antibiotics. The cure rate was 92% for S. epidermidis infections and 67% for S. aureus infections. Thus, the majority of port-associated bloodstream infections in pediatric hematology-oncology patients can be cured without device removal.There are two types of surgically placed, subcutaneously tunneled Silastic (Dow Corning, Midland, MI) central venous catheters designed for long-term use. Broviac-or Hickmantype catheters exit through the skin after being passed through a subcutaneous tunnel, and totally implantable venous access ports ("ports") end in a subcutaneous reservoir after being passed through a subcutaneous tunnel (as, for example, with Mediport [Norfolk, Medina, NY] and Port-A-Cath [Pharmacia Deltec, St. Paul] ports). Ports are accessed by means of a special needle through intact skin. In pediatric oncology patients, ports are associated with a lower rate of catheterrelated bloodstream infection than are Broviac/Hickman catheters [1][2][3][4].Although cure of bloodstream infections related to nontunneled vascular catheters generally requires catheter removal, we and others have found that ϳ75% of Broviac/Hickman catheter-related bloodstream infections are cured without catheter removal [3][4][5][6]. In contrast, there are limited data concerning the efficacy of antibiotic treatment of port-associated bloodstream infection without port removal. To determine the advisability of initial antibiotic therapy without device removal, we studied the outcome of consecutive catheter-related bloodstream infections occurring in pediatric hematologyoncology patients with totally implantable venous access ports. MethodsPatient population. All pediatric hematology-oncology patients cared for at the Schneider Children's Hospital (New Hyde Park, NY) between 1 January 1991 and 31 December 1993 were identified through a log book of all patients seen by the division of pediatric hematology/oncology. Patients with a port were identified by review of the comprehensive flow sheets maintained for each patient by that division, on which data on all surgically placed vascular catheters, hospital admissions, infections, courses of antibiotic therapy, and vascular catheter removal are tabulated prospectively.To ensure that a...