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.

Therapeutic options in B-acute lymphoblastic leukemia (ALL) relapses after anti-CD19 CAR-T cells are still debated. Here, we analysed leukemic cells of a young patient who had several CD19+ relapses of B-ALL after hematopoietic stem cells transplant (HSCT) and after anti-CD19 CAR-T cells (tisagenlecleucel). Extensive membrane immunophenotype revealed the appearance of new targets. Lysis sensibility analysis performed by 51Cr release and long term killing assays revealed the in vitro persistence of sensitivity to cytolytic activity of CAR-T cells. An immunosuppressive monocytic population was identified in the last relapse sample. Mechanisms leading to ALL resistance are analysed and therapeutic options are discussed.

A three-year-old girl with a history of epilepsy seizures was diagnosed with acute lymphoblastic leukemia. A comprehensive genetic study of blast cells led to the discovery of a constitutional deletion of the PCDH19 gene. This description underlines how modern techniques of molecular investigations in hematological disorders may lead to unexpected findings.