Combined therapy in children and adolescents with classical Hodgkin's lymphoma: A report from the SFCE on MDH-03 national guidelines.

Hodgkin's lymphoma (HL) in children and adolescents is highly curable, but children are at risk of long-term toxicity. The MDH-03 guidelines were established in order to decrease the burden of treatment in good-responder patients, and this report should be considered a step toward further optimization of treatment within large collaborative trials. We report the therapy and long-term outcomes of 417 children and adolescents treated according to the national guidelines, which were applied between 2003 and 2007 in France. The patients were stratified into three groups according to disease extension. Chemotherapy consisted of four cycles of VBVP (vinblastine, bleomycin, VP16, prednisone) in localized stages (G1/95 pts/23%), four cycles of COPP/ABV (cyclophosphamide, vincristine, procarbazine, prednisone, adriamycin, bleomycin, vinblastine) cycles in intermediate stages (G2/184 pts/44%) and three cycles of OPPA (vincristine, procarbazine, prednisone, adriamycin) plus three cycles of COPP in advanced stages (G3/138 pts/33%). Radiation therapy of the involved field was given to 97% of the patients, with the dose limited to 20 Gy in good responders (88%). With a median follow-up of 6.6 years, the 5-year event-free survival (EFS) and overall survival (OS) were 86.7% (83.1-89.7%) and 97% (94.5-98.1%), respectively. EFS and OS for G1, G2, and G3 were 98% and 100%, 81% and 97%, and 87% and 95%, respectively. Low-risk patients treated without alkylating agents and anthracycline had excellent outcomes and a low expected incidence of late effects. Intensification with a third OPPA cycle in high-risk group patients, including stage IV patients, allowed for very good outcomes, without increased toxicity.

[HHV-6 infection and acute lymphoblastic leukemia in a child]. / Infection à HHV-6 et leucémie aiguë lymphoblastique chez un enfant.

We report the case of a child who was infected by HHV-6 and who started an acute lymphoblastic leukemia two months later. This case reminds that an etiologic role have been suggested for many viral infections in some leukemias in childhood, particularly the human herpesvirus 6 (HHV-6).

[Evaluation of pre-travel prevention, except vaccination, in children returning from Africa with fever]. / Évaluation des conseils donnés avant un voyage, hors vaccinations, chez des enfants présentant une fièvre au retour d'Afrique.

OBJECTIVES: Evaluating the frequency and modalities of transmissible infection prevention counseling in children before a stay in tropical or subtropical areas. METHODS: Description of the frequency and modalities of transmissible infection prevention counseling (except specific vaccination) given prior to travel in children attending a tertiary care center in Paris, France, for fever occurring within 3 months following a return from Africa. Data were collected retrospectively from medical observations and telephone interviews with parents. RESULTS: A total of 173 children were included; 98 and 75 returned from sub-Saharan Africa and North Africa, respectively. Forty-one percent were less than 2 years old. Eighty-one percent of the children had consulted before leaving. Among children who returned from North Africa, the proportion of children who had a specific preventive consultation before travel was lower than among children who returned from sub-Saharan Africa (respectively, 72.1% versus 94.7%; p<0.001). In children having consulted before traveling, specific hygiene and diet advice had been given in 72% of cases but less frequently in children who traveled in North Africa compared to children who traveled to sub-Saharan Africa (respectively, 57.8% vs. 92.2%; p<0.001). Among children who returned from North Africa, those who had no preventive consultation before travel had febrile gastrointestinal infection more frequently than those who had a consultation before traveling (p=0.003). CONCLUSION: Although in this study the majority of children traveling to Africa receive transmissible infection prevention counseling before the travel, prevention could be improved, particularly before a stay in North Africa.

[Efficacy of systematic information and prescription of vaccine to implement the recommendations to prevent post-partum pertussis: A limited impact]. / Efficacité d'une stratégie d'application des recommandations vaccinales anticoqueluche en post-partum : un impact limité

OBJECTIVES: Despite official recommendations in 2004, antipertussis vaccine coverage in post-partum remains low. Measures used to date to improve the appliance of these recommendations were not implemented. The purpose of this study was to evaluate the effectiveness of a strategy of education and systematic prescription of antipertussis vaccine, on immunization coverage of mothers in the post-partum. PATIENTS AND METHODS: This was an analytical, interventional, monocentric study conducted on delivered patients, hospitalized between July 10th and 31st, 2009 in our establishment. Oral (twice: midwife and doctor) and written information about pertussis and order of vaccine were delivered in post-partum. RESULTS: No patient had reliable information on her vaccination status during hospitalization. According to the patients, information by midwife was provided in 70% of cases. At 6 weeks, the immunization coverage was 16% (10/61 patients), including 8% related to the intervention (vaccinated during postpartum) and 11% for fathers (7/61 fathers) with 7% newly vaccinated. Lack of time, omission in proliferation of information context in puerperium and low socio-economic backgrounds may have influenced the non-vaccination. However medical information is so far still perfectible as evidenced by the rate of patients actually sensitized and postponement vaccination after breastfeeding despite official recommendations. DISCUSSION AND CONCLUSION: Antipertussis vaccination care should also involve physicians before, during and after pregnancy, and pediatricians.

[Alcohol and pregnancy]. / Alcool et grossesse.

Alcohol consumption during pregnancy is a major cause of mental retardation in Western countries. Fetal alcohol syndrome (FAS) is mainly characterized by pre- and postnatal stunted growth, neurocognitive disorders, and facial dysmorphism. It compromises the intellectual and behavioral prognosis of the child. Prevention tools exist, through better information of health professionals, for optimal care of high-risk women before, during, and after pregnancy, which would decrease the incidence of SAF in the future.