This clinical report represents the first English-language recommendations for the management of pediatric AP. Future aims should include prospective multicenter pediatric studies to further validate these recommendations and optimize care for children with AP.

BackgroundSeveral treatment strategies are available for children with severe immune thrombocytopenic purpura (ITP) and other immune cytopenias refractory to initial therapies. 6‐Mercaptopurine (6MP) is one option, however it has not been well studied in children, especially as a single agent, and no pediatric case series have been reported since 1970.Patients and MethodsWe reviewed the experience at our institution over 8 years, using 6MP as a steroid sparing treatment for children with ITP, auto‐immune hemolytic anemia (AIHA) or Evans syndrome. A total of 29 pediatric patients were treated with 6MP from 2000 to 2007.ResultsResponse was defined as a rise in hemoglobin by at least 1.5 g/dl and to a level of 10 g/dl or greater in patients treated for anemia, or a platelet count ≥50 × 109/L in patients treated for thrombocytopenia. We found an overall response rate of 83% among all patients. Fourteen percent of patients stopped drug because of side effects.ConclusionsThese results suggest that 6MP can be an effective single‐agent treatment for refractory immune cytopenias in children. Prospective studies are warranted to determine long‐term efficacy and toxicity and to more clearly define patient populations most likely to respond. Pediatr Blood Cancer 2009;52:80–84. © 2008 Wiley‐Liss, Inc.

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P ostoperative management of esophageal atresia (EA) frequently mandates serial dilations and application of local antifibrotic agents to control recalcitrant anastomotic strictures. Recently, temporary esophageal stenting has been described to maintain patency (1-4). Indwelling foreign material has an associated risk of erosion, and this must be considered when managing patients with anastomotic strictures after long-gap EA repair. We report 2 cases of arterioesophageal fistula formation and massive upper gastrointestinal bleeding (UGIB) related to stent placement after EA repair, each with unrecognized aberrancy of the right subclavian artery (ARSA). Based on these events, the authors advise that esophageal stents be placed only after detailed imaging studies rule out vascular aberrancy.