Safety of Procalcitonin Guided Early Discontinuation of Antibiotic Therapy among Children Receiving Cancer Chemotherapy and Having Low-Risk Febrile Neutropenia: A Randomized Feasibility Trial (ProFenC Study).

In low-risk febrile neutropenia (LR-FN), the safety of early discontinuation of empiric antibiotics without marrow recovery is not well established. This study aimed to evaluate the safety of procalcitonin (PCT) guided early discontinuation of antibiotics in LR-FN. In this trial, children with LR-FN with an afebrile period of at least 24 h, sterile blood culture, and negative/normalized PCT were randomized at 72 h of starting antibiotics into two groups: intervention arm and standard arm. The antibiotics were stopped in the intervention arm regardless of absolute neutrophil count (ANC), while in the standard arm, antibiotics were continued for at least 7 days or until recovery of ANC (>500/mm3). The primary objective was to determine the treatment failure rates, and the secondary objective was to compare the duration of antibiotics and all-cause mortality between the two arms. A total of 46 children with LR-FN were randomized to either the intervention arm (n = 23) or the standard arm (n = 23). Treatment failure was observed in 2/23 (8.7%) of patients in the intervention arm compared to 1/23 (4.3%) in the standard arm [RR: 2 (95% CI: 0.19-20.6); p = 0.55]. The median duration of antibiotics in the intervention arm and standard arm were 3 days vs 7 days (P= <0.001). There was no mortality in this study. PCT-guided early discontinuation of empirical antibiotics in LR-FN is feasible. There was no significant difference observed in treatment failure between the early discontinuation of antibiotics vs standard therapy. The total duration of antibiotic exposure was significantly lesser in the discontinuation arm. Further, larger multicenter studies are needed to confirm the finding of this study.

Reducing chemotherapy dose intensity by 25% and adding rituximab improves survival in pediatric mature B-cell non-Hodgkin lymphoma in LMIC setting.

BACKGROUND AND OBJECTIVES: Pediatric B-cell non-Hodgkin lymphomas (NHL) in low- and middle-income countries (LMICs) have historically had inferior outcomes due to higher treatment-related mortality (TRM) and relapses. To address this issue, we evaluated the impact of reducing chemotherapy dose intensity by 25% and adding rituximab on outcomes in pediatric B-NHL. PATIENTS AND METHODS: Patients, less than 18 years of age with group B and C disease as per the Lymphome Malin de Burkitt (LMB) risk stratification were enrolled between September 2017 and October 2022. The LMB-89 protocol, with a 25% reduction in all chemotherapy doses and the addition of rituximab, was administered. The response was assessed using positron emission tomography with computed tomography (PET/CT) after four cycles of chemotherapy (interim) and at the end of treatment. RESULTS: The study included 25 patients with a median age of 6.9 years, among whom 20 (80%) were males. Twenty patients had group B and five had group C disease. Complete metabolic response (CMR) was achieved by 22/25 (88%) patients, and three (12%) achieved partial metabolic response (PMR) in the interim PET/CT. At the end of treatment, 22/24 (92%) patients achieved CMR, one had PMR, and one had progressive disease. The median follow-up was 45 months (range: 3-71 months). The 4-year event-free survival and overall survival were 88% and 92%, respectively. There were two deaths, one due to disease progression and the other due to sepsis. CONCLUSION: Our study demonstrates a significant improvement in outcomes in pediatric B-NHL compared to previous reports from LMICs, achieved through a 25% reduction in chemotherapy dose intensity and the addition of rituximab.

Eltrombopag post autologous hematopoietic stem cell transplant - an emerging indication in younger pediatric patients.

BACKGROUND: Engraftment of neutrophils and platelets after hematopoietic stem cell transplant (HSCT) is imperative for optimal outcomes. Eltrombopag has been used in adults after HSCT to boost platelet production. Its use in pediatric post HSCT patients has been limited. METHODS: The clinical and laboratory details of a post autologous HSCT patient were fetched by a retrospective review of the records. RESULTS: A 5-year old male child had primary thrombocytopenia post autologous HSCT for refractory Hodgkin lymphoma. Although the stem cell dose infused was adequate, the child had a delay in the engraftment of platelets. After ruling out the causes of post HSCT thrombocytopenia, eltrombopag was started for the child. With the use of eltrombopag, normal thrombopoiesis was restored in the child. CONCLUSION: Eltrombopag was effective and safe in overcoming post-HSCT primary thrombocytopenia in our patient.

Study of spectral characteristics of black carbon from biomass burning and source apportionment over Agartala in the northeastern India.

We have studied the black carbon (BC) mass concentrations, contributions from Fossil Fuels (FF), and Biomass burning (BB) to total BC mass concentrations using a 7-wavelength Aethalometer (Model, AE-31; Make, Magee Scientific, USA) at a rural continental location in the northeastern India. We have taken the continuous measurements of BC from January 2011 to December 2017 (excluding the year 2016 due to nonavailability of data). The annual mean BC concentration at 880 nm is observed maximum 12.56±5.06 µgm-3 in the year 2011 with a minimum of 7.26±2.76 µgm-3 during the year 2015." is the final sentence. BC, BCff, and BCbb mass concentrations show significant variation during morning, afternoon, evening, and night hours. The significant monthly, seasonal, and annual variabilities in the BC concentration, equivalent BC from FF and BB, are due to seasonal change in the emission sources, boundary layer dynamics, and dispersion and dilution conditions. The determination of Angstrom exponent (α) for the BC emitted during burning of different biofuels by performing a burning experiment is an important part of the present study. We have conducted a survey in and around the study location to know the different biofuels used by the people for daily household activities, and those biofuels are used in the burning experiment. As a result of biomass burning experiment to determine Angstrom exponent, we have found the α values to be ranging from 1.20 to 2.37 for flaming and a range from 1.59 to 2.33 for smoldering conditions for different biofuels. Annual mean contributions of BCff and BCbb to the total BC are found to be dominated by FF emissions during the whole study period. The percentage contribution of BCff and BCbb is found to be 56% and 44% during winter season due to increase in wood and biomass burning activities for various purposes. We have found the higher percentage contribution from BCff (85%) during monsoon season due to reduction in usage of biofuels.