Background Previous studies have shown that children and adolescents with COVID-19 generally have mild disease. Children and adolescents with cancer, however, can have severe disease when infected with respiratory viruses. In this study, we aimed to understand the clinical course and outcomes of SARS-CoV-2 infection in children and adolescents with cancer. Methods We did a cohort study with data from 131 institutions in 45 countries. We created the Global Registry of COVID-19 in Childhood Cancer to capture de-identified data pertaining to laboratory-confirmed SARS-CoV-2 infections in children and adolescents (<19 years) with cancer or having received a haematopoietic stem-cell transplantation. There were no centre-specific exclusion criteria. The registry was disseminated through professional networks through email and conferences and health-care providers were invited to submit all qualifying cases. Data for demographics, oncological diagnosis, clinical course, and cancer therapy details were collected. Primary outcomes were disease severity and modification to cancer-directed therapy. The registry remains open to data collection. Findings Of 1520 submitted episodes, 1500 patients were included in the study between April 15, 2020, and Feb 1, 2021. 1319 patients had complete 30-day follow-up. 259 (19•9%) of 1301 patients had a severe or critical infection, and 50 (3•8%) of 1319 died with the cause attributed to COVID-19 infection. Modifications to cancer-directed therapy occurred in 609 (55•8%) of 1092 patients receiving active oncological treatment. Multivariable analysis revealed several factors associated with severe or critical illness, including World Bank low-income or lower-middle-income (odds ratio [OR] 5•8 [95% CI 3•8-8•8]; p<0•0001) and upper-middle-income (1•6 [1•2-2•2]; p=0•0024) country status; age 15-18 years (1•6 [1•1-2•2]; p=0•013); absolute lymphocyte count of 300 or less cells per mm³ (2•5 [1•8-3•4]; p<0•0001), absolute neutrophil count of 500 or less cells per mm³ (1•8 [1•3-2•4]; p=0•0001), and intensive treatment (1•8 [1•3-2•3]; p=0•0005). Factors associated with treatment modification included upper-middle-income country status (OR 0•5 [95% CI 0•3-0•7]; p=0•0004), primary diagnosis of other haematological malignancies (0•5 [0•3-0•8]; p=0•0088), the presence of one of more COVID-19 symptoms at the time of presentation (1•8 [1•3-2•4]; p=0•0002), and the presence of one or more comorbidities (1•6 [1•1-2•3]; p=0•020).Interpretation In this global cohort of children and adolescents with cancer and COVID-19, severe and critical illness occurred in one fifth of patients and deaths occurred in a higher proportion than is reported in the literature in the general paediatric population. Additionally, we found that variables associated with treatment modification were not the same as those associated with greater disease severity. These data could inform clinical practice guidelines and raise awareness globally that children and adolescents with cancer are at high-risk of developing severe COVID-19 illn...

Background-Improved cure rates for childhood acute lymphoblastic leukemia over the past 2 decades have allowed greater attention to patients' quality of life. Neuropathic pain is an unpleasant side effect of chemotherapeutic agents for leukemia, especially vincristine.

The FDA's 2012 risk evaluation and mitigation strategy is a major step toward systematically reducing the inherent risks of chronic opioid therapy for pain, but does not distinguish between risks related to sources of pain. This article discusses the effect of risk mitigation in the treatment of cancer pain, with a focus on pretreatment screening and ongoing monitoring in this patient population that often requires pain management at some time during cancer treatment. Experience with screening, risk stratification, and interventions at one cancer center is shared, along with some recommendations for practice. A new screening checklist is proposed that summarizes known risk factors. Patients with cancer are not protected from the problems of opioid abuse/misuse, and the multidisciplinary cancer treatment team should coordinate an evaluation of risk and the monitoring of aberrant behaviors as part of the comprehensive care plan.

Background Addition of anti-GD2 antibody ch14.18 to the treatment of neuroblastoma has improved outcomes. The most common side effect of ch14.18 is neuropathic pain, which may in part be complement-mediated. Hu14.18K322A is a humanized anti-GD2 antibody designed to diminish complement activation and induce less pain. We compare the pain outcomes in patients treated with ch14.18 and those treated with hu14.18K322A, and explore dose-dependent relationships between pain scores, opioid requirements and complement levels in patients treated with hu14.18K322A. Patients and Methods Opioid (morphine equivalent mg/kg) and anxiolytic requirements during course 1 (4 days) in patients treated with hu14.18K322A and ch14.18 were reviewed. Correlations between antibody dose and pain scores, opioid requirements, and complement levels were examined for patients receiving hu14.18K322A. Results Patients treated with hu14.18K322A (n=19) had lower opioid requirements than those who received ch14.18 (n=9). The differences in median opioid requirements (mg/kg) were statistically significant for the overall course (1.57 vs. 2.41, p=0.019) as well as for days 3 (0.34 vs. 0.65, p=0.005), and 4 (0.32 vs. 0.64, p=0.010). No difference in anxiolytic use was observed between the two groups. In the group treated with hu14.18K322A, we found a positive correlation between antibody dose administered and pain scores, but no correlation between antibody dose and opioid requirements or changes in complement levels. Conclusions In this retrospective analysis, hu14.18K322A induced less pain than ch14.18 based on opioid requirements.

Background Clinicians may avoid continuous pain blocks in pediatric cancer patients at the end of life for fear of complications or of interfering with the desired location of death. Objectives To examine the impact of epidural or peripheral nerve catheters on pain control in children and young adults with cancer within the last three months of life. Methods We retrospectively reviewed the medical records to assess pain scores, systemic opioid requirements, and impact on death at the preferred location. Results Ten patients (4.4 to 21.3 years of age), 9 with solid tumors, 1 with lymphoma, had 14 devices (11 epidural, 3 peripheral nerve catheters) for a range of 3 to 81 days. Twelve of 13 catheters provided improvement by at least one of three criteria: improved mean pain scores at 24 hours (8 of 13) and decreased opioid requirement at 24 hours in 9 cases and at day 5 in 9 cases. Eight patients died in their preferred setting. Six patients had catheters (5 epidural, 1 peripheral) until death, including 2 who died at home. In some cases, typical contraindications for indwelling catheters (spinal metastasis, vertebral fracture, thrombocytopenia, fever) were superseded by palliative care needs. We found no bleeding, infectious, or neurological complications. Conclusions Our findings suggest that continuous catheter-delivered pain blockade at the end of life contributes to analgesia, moderates opioid requirements, and usually does not preclude death at the preferred location.