Stage 4S neuroblastoma, a disseminated tumor with excellent outcome.

OBJECTIVE: To review the clinical features and outcome of all cases of stage 4S neuroblastoma treated at our center. METHODS: We retrospectively reviewed the files of all patients (n=75) with neuroblastoma treated at King Abdul-Aziz Medical City, Jeddah, Kingdom of Saudi Arabia between 1986 and 2005. We studied the clinical features and outcome of patients with stage 4S neuroblastoma. RESULTS: Six patients (8%) were confirmed to have stage 4S neuroblastoma. Three were boys with a median age at diagnosis of 4.5 months (range 28 days-11 months). Four patients required no intervention. The remaining 2 patients were treated with chemotherapy due to progressive hepatomegaly and respiratory distress. No patient required radiotherapy or surgical intervention. With a median follow up of 4 years (range 9 months-15.5 years), all patients are alive and well. Two patients continue to have a residual abdominal mass, while complete resolution occurred in the others. CONCLUSION: Stage 4S neuroblastoma is a special tumor that carries excellent prognosis. Spontaneous regression may occur and intervention is only required in symptomatic patients.

A pilot study of prophylactic ciprofloxacin during delayed intensification in children with acute lymphoblastic leukemia.

BACKGROUND: We hypothesized that prophylactic administration of an appropriate antibiotic following each delayed intensification (DI) in children with acute lymphoblastic leukemia (ALL) would reduce the episodes of fever and bacteremia associated with neutropenia, and hence reduce both the rate and duration of hospitalization. PROCEDURE: All patients in the study were treated according to a modified Medical Research Council United Kingdom ALL XI (MRC UKALL XI) protocol utilizing three DI courses. Between June and December 2000 patients received prophylactic ciprofloxacin following DI courses. The rates of hospitalization and bacteremias were compared to ALL patients who had received between one and three DI courses prior to June 2000. RESULTS: There were 69 patients who received a total of 194 DIs (controls 130; study group 64). The rate of hospitalization was 90% in the controls and 58% in the study group (P < 0.001). The median hospital stay was 10.1 days for controls and 6.0 for the study group (P < 0.001). Intensive care unit admissions were reduced from 12 to 1.5% (P = 0.02). The overall rate of proven bacteremia was reduced from 22 to 9% (P = 0.028). There were no Gram-negative bacteremias in the study group compared to 10 (7.7%) in the controls (P < 0.001). CONCLUSIONS: Compared to historical controls, patients in this study receiving prophylactic ciprofloxacin had a reduced rate and duration of hospitalization and incidence of Gram-negative bacteremia.

Factors influencing central line infections in children with acute lymphoblastic leukemia: results of a single institutional study.

BACKGROUND: We compared the rates of infection in external catheters (ECs) and totally implantable devices (TIDs) and the effect of timing of insertion in children with acute lymphoblastic leukemia (ALL). PROCEDURE: Central line data was collected on all children with ALL referred to the National Guard Hospital, Jeddah. Data was collected retrospectively from 1996 to September 1999 and prospectively thereafter. Only ECs were inserted prior to 1999 subsequently TIDs were preferred. RESULTS: One hundred forty eight children with ALL, mean age 5.1 years had 129 ECs and 70 TIDs inserted for a total of 41,382 catheter days. The overall rate of infective episodes (infections/1,000 catheter days) was 3.43. Of the initial 148 lines 100 developed complications of which 76 (51%) were secondary to an infective episode. Only young age and treatment protocol were risk factors for first line infections (P < 0.05). There was weak evidence that ECs had an earlier time to infection compared to TIDs (P = 0.056). CONCLUSIONS: In this study, population central lines were associated with a high rate of infection. Treatment protocol and age were the only significant risk factors when only first lines were considered. Delaying catheter insertion for more than 3 weeks from diagnosis did not reduce the risk of infection.