Background: In adults, there is a link between socioeconomic status (SES) and cancer prognosis, notably due to increased time to diagnosis (TTD) in deprived population leading to the spread of the disease. In children, such an association has not been clearly reported. The objective of our study was to assess the impact of SES on TTD of childhood cancer and its potential consequences on cancer prognosis. Methods: We carried out a multicenter retrospective study based on the LOGAFTER multicentric database. We studied the SES at the individual and ecological levels. Results: Overall, 854 children were included. The median time to diagnosis was 28 days [12;64]. A usual care pathway did not seem to impact TTD, but the use of alternative medicine and an initial management by professionals not usually involved in the specific childhood cancer context increased TTD. None of the SES ecological variables were strictly associated with a significant impact on TTD. However, we noted strong trends for single-parent families and children whose fathers had died who presented with an increased TTD. Conclusions: In the current study, the impact of SES on TTD in children on both the individual and ecological levels was not clear. However, we noted some keys at the individual scale that require further investigation to explain a potential association between deprivation and TTD.

Introduction: Childhood immune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by isolated thrombocytopenia. Prolonged ITP (persistent and chronic) leads to a reduced quality of life for children in many domains. To provide optimal support for children, with ITP, it is important to be able to predict those who will develop prolonged ITP. This study aimed to develop a mathematical model based on platelet recovery that allows the early prediction of prolonged ITP. Methods: In this retrospective study, we used platelet counts from the six months following the diagnosis of ITP to model the kinetics of platelet evolution using a pharmacokinetic-pharmacodynamic model. Results: In a learning set (n=103), platelet counts were satisfactorily described by our kinetic model. The K heal parameter, which describes spontaneous platelet recovery, allowed a distinction between acute and prolonged ITP with an AUC of 0.74. In a validation set (n=58), spontaneous platelet recovery was robustly predicted using platelet counts from 15 (AUC=0.76) or 30 (AUC=0.82) days after ITP diagnosis. Discussion: In our model, platelet recovery quantified using the k heal parameter allowed prediction of the clinical course of ITP. Future prospective studies are needed to improve the predictivity of this model, in particular, by combining it with the predictive scores previously reported in the literature.

Background. Osteonecrosis (ON) is a long-known complication of acute leukemia (AL) management affecting 1 to 10% of young patients, leading to long-term morbidity. Widespread access to Magnetic Resonance Imagery (MRI) over the past ten years has allowed earlier detection and more accurate assessment. This study investigated clinical and radiological features of ON, among the large French cohort L.E.A (Leucémie Enfant Adolescent) Procedure. Patients with ON were retrospectively enrolled and risk factors for the onset, the multifocal involvement and severe damage were analyzed. Quality of life (QoL) was also evaluated. A sub-study described radiological features. Results. 129/4973 patients developed ON (2.5%) and were preferentially aged over 10 years at time of AL diagnosis (OR 22.46, p <10-6). Females were preferentially affected (OR 1.8, p=0.002) like patients treated for relapse (OR 1.81, p=0.041). Patients presenting ON suffered more frequently from other sequelae (p<10-6). Most of the necrosis were involving weight-bearing joints and multiple joints in 69% of cases. MRI of 39 patients with ON were double blinded reviewed. Overall, 14/39 suffered from severe impairment, preferentially on hips. QoL of adolescents and adults was poor and permanently affected once ON occurred. Conclusions. Age of over 10 years at diagnosis of AL, relapse and female sex were at risk of developing ON involving preferentially multiple joints. One third was severe and lasting poor QoL impacting several domains was found. Future studies should include prospective data on management and biological genetic features to build a targeted screening program to detect and manage ON earlier.

Background The posttreatment period is a key part of the management of pediatric cancer care. At this period, psychosocial effects (scholarly and psychological difficulties) have been described in pediatric cancer patients and can be prognostic for the success of social reintegration. Psychosocial effects and their impact may be related to the household’s socioeconomic background. The aim of this study was to estimate psychosocial difficulties during the posttreatment period based on a social deprivation score. Design This study is based on a prospective multicentric study database, and focused on the children who had received psychosocial evaluation during their follow-up after cancer treatment since 01/01/2013. We retrieved data on their learning and psychological difficulties. Socioeconomic status of the household was estimated by a social deprivation score. Results 1003 patients were analyzed. Learning difficulties at school were noted in 22% of patients. A greater social deprivation was significantly associated with learning difficulty (OR=1.09 per unit of the deprivation score). Tumor relapse, treatment with hematopoietic stem cell transplantation, and diagnosis of a CNS tumor remained significant risk factors. In the subgroup analysis of children with CNS tumors, learning difficulties were increased and associated with greater social deprivation. By contrast, psychological difficulties were not associated with the deprivation score. Conclusion There is a link between SE status and learning difficulties in survivors of childhood cancer. Further investigations should be carried out to confirm these results for children with CNS tumors, which is the population of the greatest concern.