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Purpose High-dose chemotherapy with autologous stem-cell rescue (SCR) is a key component of high-risk neuroblastoma (HRNB) therapy. Carboplatin, etoposide, and melphalan (CEM) or busulfan and melphalan (Bu/Mel) are the most evaluated, effective high-dose chemotherapy for HRNB on the basis of results from major cooperative group studies. Toxicity profiles vary between these regimens, and practice variation exists regarding the preferred high-dose therapy (HDT). We sought to evaluate the safety of HDT and autologous SCR for HRNB in a resource-limited country (Egypt) compared with the resource-rich United States. Patients and Methods We performed a retrospective comparative review of single CEM-based HDT/SCR outcomes through day 100 for HRNB at the Fred Hutchinson Cancer Research Center (FH) in the United States (2005 to 2015) versus Bu/Mel-based HDT at El-Sheikh Zayed Specialized Hospital (SZ) in Egypt (2009 to 2015). Results Forty-four patients at FH and 77 patients at SZ were reviewed. Pretransplant hepatic comorbidities were significantly higher at SZ (29 of 77 v nine of 44; P = .05), with 19 of 77 patients at SZ having hepatitis infection. Engraftment was delayed after SZ-Bu/Mel therapy compared with FH-CEM therapy for neutrophils (median 12 days v 10 days, respectively; P .001) and platelets (median 20 days v 18 days, respectively; P .001). Sinusoidal obstruction syndrome occurred later, after SZ-Bu/Mel therapy (median 19 days v 7 days; P = .033), and four of eight cases were fatal (six of eight patients had underlying hepatitis infection), whereas three of three cases after FH-CEM therapy were moderately severe. Resource utilization associated with the number of days with fever, antibiotic use, and the number of transfusions administered was significantly higher after FH-CEM therapy than after SZ-Bu/Mel therapy. Conclusion Use of autologous stem-cell transplantation is feasible in the context of a resource-limited country.

Purpose High-dose chemotherapy with autologous stem-cell rescue (SCR) is a key component of high-risk neuroblastoma (HRNB) therapy. Carboplatin, etoposide, and melphalan (CEM) or busulfan and melphalan (Bu/Mel) are the most evaluated, effective high-dose chemotherapy for HRNB on the basis of results from major cooperative group studies. Toxicity profiles vary between these regimens, and practice variation exists regarding the preferred high-dose therapy (HDT). We sought to evaluate the safety of HDT and autologous SCR for HRNB in a resource-limited country (Egypt) compared with the resource-rich United States. Patients and Methods We performed a retrospective comparative review of single CEM-based HDT/SCR outcomes through day 100 for HRNB at the Fred Hutchinson Cancer Research Center (FH) in the United States (2005 to 2015) versus Bu/Mel-based HDT at El-Sheikh Zayed Specialized Hospital (SZ) in Egypt (2009 to 2015). Results Forty-four patients at FH and 77 patients at SZ were reviewed. Pretransplant hepatic comorbidities were significantly higher at SZ (29 of 77 v nine of 44; P = .05), with 19 of 77 patients at SZ having hepatitis infection. Engraftment was delayed after SZ-Bu/Mel therapy compared with FH-CEM therapy for neutrophils (median 12 days v 10 days, respectively; P .001) and platelets (median 20 days v 18 days, respectively; P .001). Sinusoidal obstruction syndrome occurred later, after SZ-Bu/Mel therapy (median 19 days v 7 days; P = .033), and four of eight cases were fatal (six of eight patients had underlying hepatitis infection), whereas three of three cases after FH-CEM therapy were moderately severe. Resource utilization associated with the number of days with fever, antibiotic use, and the number of transfusions administered was significantly higher after FH-CEM therapy than after SZ-Bu/Mel therapy. Conclusion Use of autologous stem-cell transplantation is feasible in the context of a resource-limited country.

Purpose High-dose chemotherapy with autologous stem-cell rescue (SCR) is a key component of high-risk neuroblastoma (HRNB) therapy. Carboplatin, etoposide, and melphalan (CEM) or busulfan and melphalan (Bu/Mel) are the most evaluated, effective high-dose chemotherapy for HRNB on the basis of results from major cooperative group studies. Toxicity profiles vary between these regimens, and practice variation exists regarding the preferred high-dose therapy (HDT). We sought to evaluate the safety of HDT and autologous SCR for HRNB in a resource-limited country (Egypt) compared with the resource-rich United States. Patients and Methods We performed a retrospective comparative review of single CEM-based HDT/SCR outcomes through day 100 for HRNB at the Fred Hutchinson Cancer Research Center (FH) in the United States (2005 to 2015) versus Bu/Mel-based HDT at El-Sheikh Zayed Specialized Hospital (SZ) in Egypt (2009 to 2015). Results Forty-four patients at FH and 77 patients at SZ were reviewed. Pretransplant hepatic comorbidities were significantly higher at SZ (29 of 77 v nine of 44; P = .05), with 19 of 77 patients at SZ having hepatitis infection. Engraftment was delayed after SZ-Bu/Mel therapy compared with FH-CEM therapy for neutrophils (median 12 days v 10 days, respectively; P .001) and platelets (median 20 days v 18 days, respectively; P .001). Sinusoidal obstruction syndrome occurred later, after SZ-Bu/Mel therapy (median 19 days v 7 days; P = .033), and four of eight cases were fatal (six of eight patients had underlying hepatitis infection), whereas three of three cases after FH-CEM therapy were moderately severe. Resource utilization associated with the number of days with fever, antibiotic use, and the number of transfusions administered was significantly higher after FH-CEM therapy than after SZ-Bu/Mel therapy. Conclusion Use of autologous stem-cell transplantation is feasible in the context of a resource-limited country.

Pediatric Risk of Mortality Score (PRISM III-12) is a physiology-based predictor for risk of mortality. We conducted prospective study from January 1, 2014 to 2015 in pediatric oncology intensive care unit (POICU) at South Egypt Cancer Institute, Egypt to explore the ability of 1st PRISM III-12 to predict the risk of mortality in critically ill cancer patients and the ability of serial PRISM III measured every 72 hours to follow-up the patients’ clinical condition during POICU stay. In total, 123 (78 males) children were included. Median age was 5 years (1 to 15 y). Death rate was 20%. 1st PRISM III-12 mean was 19 (0 to 61). The mean 1st PRISM III-12 for survivors was significantly higher compared with nonsurvivors (15 vs. 37 respectively; P0.001). 1st PRISM III-12 mean was significantly correlated to the reasons for admission and organ failures’ number (P0.001 and 0.001). 1st PRISM III-12 correlated weakly positive with the length of stay (r=0.2; P=0.024). Receiver operator curve for 1st PRISM III-12 was 0.913 (95% confidence interval, 0.85-0.98; P0.001). Decline in serial PRISM III was significantly correlated with favorable (survivor) outcome (P0.001). We concluded that PRISM III-12 can be used effectively in predicting the risk of mortality and following the clinical condition of patients during POICU stay.

Pediatric Risk of Mortality Score (PRISM III-12) is a physiology-based predictor for risk of mortality. We conducted prospective study from January 1, 2014 to 2015 in pediatric oncology intensive care unit (POICU) at South Egypt Cancer Institute, Egypt to explore the ability of 1st PRISM III-12 to predict the risk of mortality in critically ill cancer patients and the ability of serial PRISM III measured every 72 hours to follow-up the patients’ clinical condition during POICU stay. In total, 123 (78 males) children were included. Median age was 5 years (1 to 15 y). Death rate was 20%. 1st PRISM III-12 mean was 19 (0 to 61). The mean 1st PRISM III-12 for survivors was significantly higher compared with nonsurvivors (15 vs. 37 respectively; P0.001). 1st PRISM III-12 mean was significantly correlated to the reasons for admission and organ failures’ number (P0.001 and 0.001). 1st PRISM III-12 correlated weakly positive with the length of stay (r=0.2; P=0.024). Receiver operator curve for 1st PRISM III-12 was 0.913 (95% confidence interval, 0.85-0.98; P0.001). Decline in serial PRISM III was significantly correlated with favorable (survivor) outcome (P0.001). We concluded that PRISM III-12 can be used effectively in predicting the risk of mortality and following the clinical condition of patients during POICU stay.

Pediatric Risk of Mortality Score (PRISM III-12) is a physiology-based predictor for risk of mortality. We conducted prospective study from January 1, 2014 to 2015 in pediatric oncology intensive care unit (POICU) at South Egypt Cancer Institute, Egypt to explore the ability of 1st PRISM III-12 to predict the risk of mortality in critically ill cancer patients and the ability of serial PRISM III measured every 72 hours to follow-up the patients’ clinical condition during POICU stay. In total, 123 (78 males) children were included. Median age was 5 years (1 to 15 y). Death rate was 20%. 1st PRISM III-12 mean was 19 (0 to 61). The mean 1st PRISM III-12 for survivors was significantly higher compared with nonsurvivors (15 vs. 37 respectively; P0.001). 1st PRISM III-12 mean was significantly correlated to the reasons for admission and organ failures’ number (P0.001 and 0.001). 1st PRISM III-12 correlated weakly positive with the length of stay (r=0.2; P=0.024). Receiver operator curve for 1st PRISM III-12 was 0.913 (95% confidence interval, 0.85-0.98; P0.001). Decline in serial PRISM III was significantly correlated with favorable (survivor) outcome (P0.001). We concluded that PRISM III-12 can be used effectively in predicting the risk of mortality and following the clinical condition of patients during POICU stay.

Background/Objectives: Cancer in children is a potentially curable disease, How to deal with pain is an integral part of symptom management in pediatric cancer patients in general. Proper recognition of underlying pathophysiology and various causes of pain are so essential for pain management, and for ameliorating suffering in the realm of holistic care for children with cancer. The aim of this study is to address and meticulously analyze the spectrum of pain characteristics in children with cancer at an institutional university cancer center to unravel pain profile in these patients as an experience for a developing country Design/Methods: A hospital based, prospective study was conducted, involving pediatric cancer patients, who presented with pain due to cancer itself or its treatment in the period from 2013Jul to 2015 Jan. Evaluation of patients’ documented pain cycles for pain cause, type, and location & also for pain treatment characteristics was done. Results: A total of 286 pain cycles was documented comprising 2216 treatment days (range 3‐56 days). Disease‐related pain was the most frequent cause of pain in our study. Oral mucosa was the most frequent site for treatment‐related pain & strongly correlated with NHL diagnosis. Leukemia was strongly correlated with “the extremities” as a location of bone pain. Visceral pain was most often associated with lymphomas. Neuropathic pain was the least frequent type of pain, however, associated with higher initial pain intensity scores & longer pain cycle duration. Conclusions: Children with cancer in the developing countries still have more disease‐related pain than their counterparts in the developed countries. Pain experience may indirectly reflect presentations of childhood cancer, and could be a surrogate profile for tumor location, metastatic sites, the degree of treatment intensity, likewise the context of the disease state either at diagnosis, during treatment, or at progression.

Background/Objectives: Cancer in children is a potentially curable disease, How to deal with pain is an integral part of symptom management in pediatric cancer patients in general. Proper recognition of underlying pathophysiology and various causes of pain are so essential for pain management, and for ameliorating suffering in the realm of holistic care for children with cancer. The aim of this study is to address and meticulously analyze the spectrum of pain characteristics in children with cancer at an institutional university cancer center to unravel pain profile in these patients as an experience for a developing country Design/Methods: A hospital based, prospective study was conducted, involving pediatric cancer patients, who presented with pain due to cancer itself or its treatment in the period from 2013Jul to 2015 Jan. Evaluation of patients’ documented pain cycles for pain cause, type, and location & also for pain treatment characteristics was done. Results: A total of 286 pain cycles was documented comprising 2216 treatment days (range 3‐56 days). Disease‐related pain was the most frequent cause of pain in our study. Oral mucosa was the most frequent site for treatment‐related pain & strongly correlated with NHL diagnosis. Leukemia was strongly correlated with “the extremities” as a location of bone pain. Visceral pain was most often associated with lymphomas. Neuropathic pain was the least frequent type of pain, however, associated with higher initial pain intensity scores & longer pain cycle duration. Conclusions: Children with cancer in the developing countries still have more disease‐related pain than their counterparts in the developed countries. Pain experience may indirectly reflect presentations of childhood cancer, and could be a surrogate profile for tumor location, metastatic sites, the degree of treatment intensity, likewise the context of the disease state either at diagnosis, during treatment, or at progression.