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CANCEL
COVID-2019 Alert

The latest information about the 2019 Novel Coronavirus, including vaccine clinics for children ages 5 years old and older.

La información más reciente sobre el nuevo Coronavirus de 2019, incluidas las clínicas de vacunación para niños de 5 años en adelante.

/nutch_noindex

Catherine Aftandilian, MD

Specialties

Hematology-Oncology

Work and Education

Professional Education

Tufts University School of Medicine, Boston, MA, 06/01/2007

Internship

Mass General Hospital for Children Pediatric Residency, Boston, MA, 06/30/2008

Residency

Mass General Hospital for Children Pediatric Residency, Boston, MA, 06/30/2011

Fellowship

Stanford University Pediatric Hematology Oncology Fellowship, Palo Alto, CA, 06/30/2014

Board Certifications

Pediatric Hematology-Oncology, American Board of Pediatrics

Pediatrics, American Board of Pediatrics

Conditions Treated

Acute Lymphocytic Leukemia

Acute Myelogenous Leukemia

All Publications

Comparison of the Transcriptomic Signatures in Pediatric and Adult CML. Cancers Youn, M., Smith, S. M., Lee, A. G., Chae, H., Spiteri, E., Erdmann, J., Galperin, I., Jones, L. M., Donato, M., Abidi, P., Bittencourt, H., Lacayo, N., Dahl, G., Aftandilian, C., Davis, K. L., Matthews, J. A., Kornblau, S. M., Huang, M., Sumarsono, N., Redell, M. S., Fu, C. H., Chen, I., Alonzo, T. A., Eklund, E., Gotlib, J., Khatri, P., Sweet-Cordero, E. A., Hijiya, N., Sakamoto, K. M. 1800; 13 (24)

Abstract

Children with chronic myeloid leukemia (CML) tend to present with higher white blood counts and larger spleens than adults with CML, suggesting that the biology of pediatric and adult CML may differ. To investigate whether pediatric and adult CML have unique molecular characteristics, we studied the transcriptomic signature of pediatric and adult CML CD34+ cells and healthy pediatric and adult CD34+ control cells. Using high-throughput RNA sequencing, we found 567 genes (207 up- and 360 downregulated) differentially expressed in pediatric CML CD34+ cells compared to pediatric healthy CD34+ cells. Directly comparing pediatric and adult CML CD34+ cells, 398 genes (258 up- and 140 downregulated), including many in the Rho pathway, were differentially expressed in pediatric CML CD34+ cells. Using RT-qPCR to verify differentially expressed genes, VAV2 and ARHGAP27 were significantly upregulated in adult CML CD34+ cells compared to pediatric CML CD34+ cells. NCF1, CYBB, and S100A8 were upregulated in adult CML CD34+ cells but not in pediatric CML CD34+ cells, compared to healthy controls. In contrast, DLC1 was significantly upregulated in pediatric CML CD34+ cells but not in adult CML CD34+ cells, compared to healthy controls. These results demonstrate unique molecular characteristics of pediatric CML, such as dysregulation of the Rho pathway, which may contribute to clinical differences between pediatric and adult patients.

View details for DOI 10.3390/cancers13246263

View details for PubMedID 34944883

Medical Outcomes, Quality of Life, and Family Perceptions for Outpatient vs Inpatient Neutropenia Management After Chemotherapy for Pediatric Acute Myeloid Leukemia. JAMA network open Getz, K. D., Szymczak, J. E., Li, Y., Madding, R., Huang, Y. V., Aftandilian, C., Arnold, S. D., Bona, K. O., Caywood, E., Collier, A. B., Gramatges, M. M., Henry, M., Lotterman, C., Maloney, K., Mian, A., Mody, R., Morgan, E., Raetz, E. A., Rubnitz, J., Verma, A., Winick, N., Wilkes, J. J., Yu, J. C., Fisher, B. T., Aplenc, R. 2021; 4 (10): e2128385

Abstract

Importance: Pediatric acute myeloid leukemia (AML) requires multiple courses of intensive chemotherapy that result in neutropenia, with significant risk for infectious complications. Supportive care guidelines recommend hospitalization until neutrophil recovery. However, there are little data to support inpatient over outpatient management.Objective: To evaluate outpatient vs inpatient neutropenia management for pediatric AML.Design, Setting, and Participants: This cohort study used qualitative and quantitative methods to compare medical outcomes, patient health-related quality of life (HRQOL), and patient and family perceptions between outpatient and inpatient neutropenia management. The study included patients from 17 US pediatric hospitals with frontline chemotherapy start dates ranging from January 2011 to July 2019, although the specific date ranges differed for the individual analyses by design and relative timing. Data were analyzed from August 2019 to February 2020.Exposures: Discharge to outpatient vs inpatient neutropenia management.Main Outcomes and Measures: The primary outcomes of interest were course-specific bacteremia incidence, times to next course, and patient HRQOL. Course-specific mortality was a secondary medical outcome.Results: Primary quantitative analyses included 554 patients (272 [49.1%] girls and 282 [50.9%] boys; mean [SD] age, 8.2 [6.1] years). Bacteremia incidence was not significantly different during outpatient vs inpatient management (67 courses [23.8%] vs 265 courses [29.0%]; adjusted rate ratio, 0.73; 95% CI, 0.56 to 1.06; P=.08). Outpatient management was not associated with delays to the next course compared with inpatient management (mean [SD] 30.7 [12.2] days vs 32.8 [9.7] days; adjusted mean difference, -2.2; 95% CI, -4.1 to -0.2, P=.03). Mortality during intensification II was higher for patients who received outpatient management compared with those who received inpatient management (3 patients [5.4%] vs 1 patient [0.5%]; P=.03), but comparable with inpatient management at other courses (eg, 0 patients vs 5 patients [1.3%] during induction I; P=.59). Among 97 patients evaluated for HRQOL, outcomes did not differ between outpatient and inpatient management (mean [SD] Pediatric Quality of Life Inventory total score, 70.1 [18.9] vs 68.7 [19.4]; adjusted mean difference, -2.8; 95% CI, -11.2 to 5.6). A total of 86 respondents (20 [23.3%] in outpatient management, 66 [76.7%] in inpatient management) completed qualitative interviews. Independent of management strategy received, 74 respondents (86.0%) expressed satisfaction with their experience. Concerns for hospital-associated infections among caregivers (6 of 7 caregiver respondents [85.7%] who were dissatisfied with inpatient management) and family separation (2 of 2 patient respondents [100%] who were dissatisfied with inpatient management) drove dissatisfaction with inpatient management. Stress of caring for a neutropenic child at home (3 of 3 respondents [100%] who were dissatisfied with outpatient management) drove dissatisfaction with outpatient management.Conclusions and Relevance: This cohort study found that outpatient neutropenia management was not associated with higher bacteremia incidence, treatment delays, or worse HRQOL compared with inpatient neutropenia management among pediatric patients with AML. While outpatient management may be safe for many patients, course-specific mortality differences suggest that outpatient management in intensification II should be approached with caution. Patient and family experiences varied, suggesting that outpatient management may be preferred by some but may not be feasible for all families. Further studies to refine and standardize safe outpatient management practices are warranted.

View details for DOI 10.1001/jamanetworkopen.2021.28385

View details for PubMedID 34709389

Comparative Effectiveness of Echinocandins vs Triazoles or Amphotericin B Formulations as Initial Directed Therapy for Invasive Candidiasis in Children and Adolescents. Journal of the Pediatric Infectious Diseases Society Fisher, B. T., Zaoutis, T. E., Xiao, R., Wattier, R. L., Castagnola, E., Pana, Z. D., Fullenkamp, A., Boge, C. L., Ross, R. K., Yildirim, I., Palazzi, D. L., Danziger-Isakov, L., Vora, S. B., Arrieta, A., Yin, D. E., Aviles-Robles, M., Sharma, T., Tribble, A. C., Maron, G., Berman, D., Green, M., Sung, L., Romero, J., Hauger, S. B., Roilides, E., Belani, K., Nolt, D., Soler-Palacin, P., Lopez-Medina, E., Muller, W. J., Halasa, N., Dulek, D., Hussain, I. Z., Pong, A., Hoffman, J., Rajan, S., Gonzalez, B. E., Hanisch, B., Aftandilian, C., Carlesse, F., Abzug, M. J., Huppler, A. R., Salvatore, C. M., Ardura, M. I., Chakrabarti, A., Santolaya, M. E., Localio, A. R., Steinbach, W. J. 2021

Abstract

BACKGROUND: Invasive candidiasis is the most common invasive fungal disease in children and adolescents, but there are limited pediatric-specific antifungal effectiveness data. We compared the effectiveness of echinocandins to triazoles or amphotericin B formulations (triazole/amphotericin B) as initial directed therapy for invasive candidiasis.METHODS: This multinational observational cohort study enrolled patients aged >120 days and <18 years with proven invasive candidiasis from January 1, 2014, to November 28, 2017, at 43 International Pediatric Fungal Network sites. Primary exposure was initial directed therapy administered at the time qualifying culture became positive for yeast. Exposure groups were categorized by receipt of an echinocandin vs receipt of triazole/amphotericin B. Primary outcome was global response at 14 days following invasive candidiasis onset, adjudicated by a centralized data review committee. Stratified Mantel-Haenszel analyses estimated risk difference between exposure groups.RESULTS: Seven-hundred and fifty invasive candidiasis episodes were identified. After exclusions, 541 participants (235 in the echinocandin group and 306 in the triazole/amphotericin B group) remained. Crude failure rates at 14 days for echinocandin and triazole/amphotericin B groups were 9.8% (95% confidence intervals [CI]: 6.0% to 13.6%) and 13.1% (95% CI: 9.3% to 16.8%), respectively. The adjusted 14-day risk difference between echinocandin and triazole/amphotericin B groups was -7.1% points (95% CI: -13.1% to -2.4%), favoring echinocandins. The risk difference was -0.4% (95% CI: -7.5% to 6.7%) at 30 days.CONCLUSIONS: In children with invasive candidiasis, initial directed therapy with an echinocandin was associated with reduced failure rate at 14 days but not 30 days. These results may support echinocandins as initial directed therapy for invasive candidiasis in children and adolescents.CLINICAL TRIALS REGISTRATION: NCT01869829.

View details for DOI 10.1093/jpids/piab024

View details for PubMedID 34374424

Systematic Review of Approaches to Preserve Machine Learning Performance in the Presence of Temporal Dataset Shift in Clinical Medicine. Applied clinical informatics Guo, L. L., Pfohl, S. R., Fries, J., Posada, J., Fleming, S. L., Aftandilian, C., Shah, N., Sung, L. 2021; 12 (4): 808-815

Abstract

OBJECTIVE: The change in performance of machine learning models over time as a result of temporal dataset shift is a barrier to machine learning-derived models facilitating decision-making in clinical practice. Our aim was to describe technical procedures used to preserve the performance of machine learning models in the presence of temporal dataset shifts.METHODS: Studies were included if they were fully published articles that used machine learning and implemented a procedure to mitigate the effects of temporal dataset shift in a clinical setting. We described how dataset shift was measured, the procedures used to preserve model performance, and their effects.RESULTS: Of 4,457 potentially relevant publications identified, 15 were included. The impact of temporal dataset shift was primarily quantified using changes, usually deterioration, in calibration or discrimination. Calibration deterioration was more common (n=11) than discrimination deterioration (n=3). Mitigation strategies were categorized as model level or feature level. Model-level approaches (n=15) were more common than feature-level approaches (n=2), with the most common approaches being model refitting (n=12), probability calibration (n=7), model updating (n=6), and model selection (n=6). In general, all mitigation strategies were successful at preserving calibration but not uniformly successful in preserving discrimination.CONCLUSION: There was limited research in preserving the performance of machine learning models in the presence of temporal dataset shift in clinical medicine. Future research could focus on the impact of dataset shift on clinical decision making, benchmark the mitigation strategies on a wider range of datasets and tasks, and identify optimal strategies for specific settings.

View details for DOI 10.1055/s-0041-1735184

View details for PubMedID 34470057

Psychosocial impacts of the COVID-19 pandemic on young adult cancer survivors and parents of children with cancer. Smith, S. M., Kumar, D., Benedict, C., Heathcote, L. C., Aftandilian, C., Bondy, M., Schapira, L. LIPPINCOTT WILLIAMS & WILKINS. 2021
Molecular and phenotypic diversity of CBL-mutated juvenile myelomonocytic leukemia. Haematologica Hecht, A., Meyer, J. A., Behnert, A., Wong, E., Chehab, F., Olshen, A., Hechmer, A., Aftandilian, C., Bhat, R., Choi, S. W., Chonat, S., Farrar, J. E., Fluchel, M., Frangoul, H., Han, J. H., Kolb, E. A., Kuo, D. J., MacMillan, M. L., Maese, L., Maloney, K. W., Narendran, A., Oshrine, B., Schultz, K. R., Sulis, M. L., Van Mater, D., Tasian, S. K., Hofmann, W., Loh, M. L., Stieglitz, E. 2020; Online ahead of print

Abstract

Mutations in the gene CBL were first identified in adults with various myeloid malignancies. Some patients with juvenile myelomonocytic leukemia (JMML) were also noted to harbor mutations in CBL, but were found to have generally less aggressive disease courses compared to other forms of Ras pathway-mutant JMML. Importantly, and in contrast to most reports in adults, the majority of CBL mutations in JMML patients are germline with acquired uniparental disomy occurring in affected marrow cells. Here, we systematically studied a large cohort of 33 JMML patients with CBL mutations and found this disease to be highly diverse in presentation and overall outcome. Moreover, we discovered somatically-acquired CBL mutations in 15% of pediatric patients who presented with more aggressive disease. Neither clinical features nor methylation profiling were able to distinguish somatic CBL patients from germline CBL patients, highlighting the need for germline testing. Overall, we demonstrate that disease courses are quite heterogeneous even among germline CBL patients. Prospective clinical trials are warranted to find ideal treatment strategies for this diverse cohort of patients.

View details for DOI 10.3324/haematol.2020.270595

View details for PubMedID 33375775

Paraneoplastic Neurologic Symptoms in a Pediatric Patient with Hodgkin Lymphoma. Cancer investigation Baniel, C. C., Donaldson, S. S., Aftandilian, C., Hiniker, S. M. 2020: 17

Abstract

Neurological paraneoplastic syndromes are exceedingly rare, and often difficult to recognize clinically. Paraneoplastic achalasia is a condition characterized by new onset dysphagia that is unrelated to tumor burden, most often due to the development of auto-immune antibodies targeting esophageal tissue. Due to the rarity of this condition, diagnosis is often delayed, leading to increased time to treatment. Here we report a case of a rare paraneoplastic achalasia in a female child with EBV+Hodgkin lymphoma, review literature describing paraneoplastic achalasia, and discuss treatment strategies for improving clinical outcome in these patients.

View details for DOI 10.1080/07357907.2020.1852412

View details for PubMedID 33191790

Summary of COVID-19 clinical practice adjustments across select institutions PEDIATRIC BLOOD & CANCER Schultz, L., Link, M. P., Rheingold, S., Hawkins, D. S., Dome, J. S., Wickiser, J., Kung, A. L., Henderson, T. O., Aftandilian, C. 2020

View details for DOI 10.1002/pbc.28411

View details for Web of Science ID 000549825100001

Summary of COVID-19 clinical practice adjustments across select institutions. Pediatric blood & cancer Schultz, L. n., Link, M. P., Rheingold, S. n., Hawkins, D. S., Dome, J. S., Wickiser, J. n., Kung, A. L., Henderson, T. O., Aftandilian, C. n. 2020: e28411

View details for DOI 10.1002/pbc.28411

View details for PubMedID 32779834

CONTINUATION OF TYROSINE KINASE INHIBITORS AFTER CHEMOTHERAPY IN PH plus ACUTE LYMPHOBLASTIC LEUKEMIA Smith, S., Aftandilian, C. WILEY. 2019
Mucormycosis diagnosed during induction chemotherapy in five pediatric patients with acute lymphoblastic leukemia. Pediatric blood & cancer Aftandilian, C., Eguiguren, L., Mathew, R., Messner, A. 2019: e27834

Abstract

Mucormycosis in pediatric oncology patients is a rare invasive fungal infection associated with significant morbidity and mortality. We describe five patients diagnosed with mucormycosis during induction chemotherapy for acute lymphoblastic leukemia at our institution. All of the patients in our series survived, some in spite of having disseminated disease. Most of the patients' chemotherapy was modified with the aim of controlling their leukemia while minimizing immunosuppression until their fungal infection was under control. Although mucormycosis is frequently fatal, rapid diagnosis and a multidisciplinary approach can lead to excellent outcomes, even in patients undergoing intensive chemotherapy.

View details for DOI 10.1002/pbc.27834

View details for PubMedID 31131954

Comparison of the Transcriptomic Signature of Pediatric Vs. Adult CML and Normal Bone Marrow Stem Cells Chae, H., Murphy, L. C., Donato, M., Lee, A. G., Sweet-Cordero, E., Abidi, P., Bittencourt, H., Lacayo, N. J., Dahl, G., Aftandilian, C., Davis, K. L., Huang, M., Sumarsono, N., Redell, M., Fu, C. H., Chen, I. L., Alonzo, T. A., Eklund, E. A., Gotlib, J. R., Khatri, P., Hijiya, N., Sakamoto, K. M. AMER SOC HEMATOLOGY. 2018
Chromation Remodeling Therapy and Capizzi Methotrexate in Treatment-Related MDS/AML Aftandilian, C., Sakamoto, K. M., Davis, K. L., Dahl, G., Lacayo, N. J. AMER SOC HEMATOLOGY. 2018
Identifying patient- and family-centered outcomes relevant to inpatient versus at-home management of neutropenia in children with acute myeloid leukemia PEDIATRIC BLOOD & CANCER Szymczak, J. E., Getz, K. D., Madding, R., Fisher, B., Raetz, E., Hijiya, N., Gramatges, M. M., Henry, M., Mian, A., Arnold, S. D., Aftandilian, C., Collier, A. B., Aplenc, R. 2018; 65 (4)

View details for DOI 10.1002/pbc.26927

View details for Web of Science ID 000425642100028

Identifying patient- and family-centered outcomes relevant to inpatient versus at-home management of neutropenia in children with acute myeloid leukemia. Pediatric blood & cancer Szymczak, J. E., Getz, K. D., Madding, R. n., Fisher, B. n., Raetz, E. n., Hijiya, N. n., Gramatges, M. M., Henry, M. n., Mian, A. n., Arnold, S. D., Aftandilian, C. n., Collier, A. B., Aplenc, R. n. 2018; 65 (4)

Abstract

Efficacy of therapeutic strategies relative to patient- and family-centered outcomes in pediatric oncology must be assessed. We sought to identify outcomes important to children with acute myeloid leukemia and their families related to inpatient versus at-home management of neutropenia. We conducted qualitative interviews with 32 children 8years old and 54 parents. Analysis revealed the impact of neutropenia management strategy on siblings, parent anxiety, and child sleep quality as being outcomes of concern across respondents. These themes were used to inform the design of a questionnaire that is currently being used in a prospective, multiinstitutional comparative effectiveness trial.

View details for PubMedID 29286570

Multisite external validation of a risk prediction model for the diagnosis of blood stream infections in febrile pediatric oncology patients without severe neutropenia. Cancer Esbenshade, A. J., Zhao, Z., Aftandilian, C., Saab, R., Wattier, R. L., Beauchemin, M., Miller, T. P., Wilkes, J. J., Kelly, M. J., Fernbach, A., Jeng, M., Schwartz, C. L., Dvorak, C. C., Shyr, Y., Moons, K. G., Sulis, M., Friedman, D. L. 2017

Abstract

Pediatric oncology patients are at an increased risk of invasive bacterial infection due to immunosuppression. The risk of such infection in the absence of severe neutropenia (absolute neutrophil count500/L) is not well established and a validated prediction model for blood stream infection (BSI) risk offers clinical usefulness.A 6-site retrospective external validation was conducted using a previously published risk prediction model for BSI in febrile pediatric oncology patients without severe neutropenia: the Esbenshade/Vanderbilt (EsVan) model. A reduced model (EsVan2) excluding 2 less clinically reliable variables also was created using the initial EsVan model derivative cohort, and was validated using all 5 external validation cohorts. One data set was used only in sensitivity analyses due to missing some variables.From the 5 primary data sets, there were a total of 1197 febrile episodes and 76 episodes of bacteremia. The overall C statistic for predicting bacteremia was 0.695, with a calibration slope of 0.50 for the original model and a calibration slope of 1.0 when recalibration was applied to the model. The model performed better in predicting high-risk bacteremia (gram-negative or Staphylococcus aureus infection) versus BSI alone, with a C statistic of 0.801 and a calibration slope of 0.65. The EsVan2 model outperformed the EsVan model across data sets with a C statistic of 0.733 for predicting BSI and a C statistic of 0.841 for high-risk BSI.The results of this external validation demonstrated that the EsVan and EsVan2 models are able to predict BSI across multiple performance sites and, once validated and implemented prospectively, could assist in decision making in clinical practice. Cancer 2017. 2017 American Cancer Society.

View details for DOI 10.1002/cncr.30792

View details for PubMedID 28542918

Pediatric Oncology Discharges With Febrile Neutropenia: Variation in Location of Care JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY Alvarez, E., Chamberlain, L. J., Aftandilian, C., Saynina, O., Wise, P. 2017; 39 (1): E1-E7

Abstract

We examined the use of Pediatric Cancer Specialty Centers (PCSCs) over time and the length of stay (LOS) in pediatric oncology patients with a diagnosis of febrile neutropenia. PCSCs were defined as Children's Oncology Group and California Children's Services designated centers. We performed a retrospective analysis on all discharges of pediatric (0 to 18) oncology patients with febrile neutropenia in California (1983 to 2011) using the private Office of Statewide Health Planning and Development database. We examined influence of age, sex, race/ethnicity, payer, income, distance, tumor type, and complications on utilization of PCSCs and LOS (SAS 9.2). Analysis of 24,559 pediatric oncology febrile neutropenia discharges showed hospitalizations in PCSCs increasing from 48% in 1983 to 94% in 2011. The adjusted regression analysis showed decreased PCSC utilization for ages 15 to 18, Hispanic patients, and those living >40 miles away. The median PCSC LOS was 9 days compared with 7 days at a non-PCSC (P<0.0001). Discharge from a PCSC was associated with a LOS >8 days after controlling for complications. Inpatient PCSC care for febrile neutropenia in California has increased since 1983. Receiving care at a PCSC is influenced by age, tumor type, ethnicity, geography, and complications.

View details for DOI 10.1097/MPH.0000000000000716

View details for Web of Science ID 000391634100001

View details for PubMedID 27918351

Invasive Fungal Disease in Pediatric Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplant JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY Aftandilian, C., Weinberg, K., Willert, J., Kharbanda, S., Porteus, M., Maldonado, Y., Agarwal, R. 2016; 38 (7): 574-580
Invasive Fungal Disease in Pediatric Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplant. Journal of pediatric hematology/oncology Aftandilian, C. n., Weinberg, K. n., Willert, J. n., Kharbanda, S. n., Porteus, M. n., Maldonado, Y. n., Agarwal, R. n. 2016; 38 (7): 57480

Abstract

Invasive fungal disease (IFD) remains a major cause of morbidity and mortality in pediatric patients after allogeneic hematopoietic stem cell transplant (HSCT). We analyzed the outcome of 152 consecutive pediatric patients who underwent allogeneic HSCT from 2005 to 2012: 126 of these without a history of IFD and 26 with IFD before HSCT. Antifungal prophylaxis agent was determined by the primary transplant attending. The rate of IFD after HSCT among patients with or without prior IFD was similar (7.7% with and 7.1% without a history of fungal disease before transplant). Mortality in these 2 populations did not differ (35% vs. 28%, P=0.48, ). Patients deemed at higher risk for IFD were generally placed on voriconazole prophylaxis; however, this did not affect rates of posttransplant IFD. All-cause mortality in patients with posttransplant IFD was significantly higher than those without posttransplant IFD (67% vs. 21%, P<0.0001,). Identifying risk factors for posttransplant IFD remains a high priority to improve outcome of HSCT.

View details for PubMedID 27658021

Evaluation of Febrile, Nonneutropenic Pediatric Oncology Patients with Central Venous Catheters Who Are Not Given Empiric Antibiotics JOURNAL OF PEDIATRICS Bartholomew, F., Aftandilian, C., Andrews, J., Gutierrez, K., Luna-Fineman, S., Jeng, M. 2015; 166 (1): 157-162

Abstract

To evaluate the practice of empiric antibiotics for febrile, nonneutropenic pediatric oncology patients with a central venous catheter (CVC) in place.Episodes of fever without neutropenia (absolute neutrophil count [ANC] 500 cells/mm(3)) were reviewed retrospectively in pediatric oncology patients with a CVC undergoing chemotherapy. Characteristics and symptoms were compared between patients with bacteremia and patients without bacteremia.A total of 392 episodes of nonneutropenic fever in 138 subjects (52 females; 38%) were reviewed. In this cohort, the median age at an episode was 7 years, and the majority of patients had a diagnosis of acute leukemia (54%). Median ANC was 3100 cells/mm(3) (IQR, 1570-5980 cells/mm(3)). Median temperature was 38.7C (IQR, 38.3-39.2C). Twenty-four infectious episodes (6%) occurred in 18 subjects, and 5 CVCs required removal; all patients requiring removal admitted and received antibiotics owing to chills. There were no significant difference in age, sex, or ANC between patients with bacteremia and those without bacteremia; however, mean temperature was higher in the patients with bacteremia (39.4C vs 38.7C; P = .003). No deaths due to sepsis occurred, and no CVCs were removed because antibiotics were not administered empirically.Our practice of observing pediatric oncology patients undergoing chemotherapy with CVCs who are not neutropenic does not appear to lead to increased serious adverse outcomes and avoids antibiotic exposure for >90% of patients without a bacterial infection.

View details for DOI 10.1016/j.jpeds.2014.09.008

View details for PubMedID 25444524

The Neutropenic Diet ... Still Ageless? C. Aftandilian Article Reviewed ONCOLOGY-NEW YORK Aftandilian, C. C., Milotich, C., Sakamoto, K. M. 2012; 26 (6): 586-589
The neutropenic diet... still ageless? Oncology (Williston Park, N.Y.) Aftandilian, C. C., Milotich, C., Sakamoto, K. M. 2012; 26 (6): 586-?

View details for PubMedID 22870544

Burkitt Lymphoma With Pancreatic Involvement JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY Aftandilian, C. C., Friedmann, A. M. 2010; 32 (8): E338-E340

Abstract

A 10-year-old boy was referred to our clinic for tonsillectomy and was found to have a large mass within his oropharynx. Intraoperative biopsies confirmed Burkitt lymphoma. Further imaging and biopsy revealed pancreatic involvement. He was treated with multiagent chemotherapy. He remains disease-free 6 years later. Review of the literature demonstrates other cases of non-Hodgkin lymphoma with pancreatic involvement with good outcomes. Pancreatic involvement is a relatively rare occurrence in childhood lymphoma.

View details for DOI 10.1097/MPH.0b013e3181ed1178

View details for Web of Science ID 000283538300021

View details for PubMedID 20930650

Group therapy for substance use disorders: What do we know? HARVARD REVIEW OF PSYCHIATRY Weiss, R. D., Jaffee, W. B., de Menil, V. P., Cogley, C. B. 2004; 12 (6): 339-350

Abstract

Although group therapy is the most prevalent treatment modality for substance use disorders, an up-to-date review of treatment outcome literature does not exist. A search of the literature yielded 24 treatment outcome studies comparing group therapy to other treatment conditions. These studies fell into one of six research design categories: (1) group therapy versus no group therapy; (2) group therapy versus individual therapy; (3) group therapy plus individual therapy versus group therapy alone; (4) group therapy plus individual therapy versus individual therapy alone; (5) group therapy versus another group therapy with different content or theoretical orientation; and (6) more group therapy versus less group therapy. In general, treatment outcome studies did not demonstrate differences between group and individual modalities, and no single type of group therapy reliably demonstrated greater efficacy than others. Unique methodological and logistical hurdles encountered in research on group therapy for substance use disorders, as well as considerations for future research, are also discussed.

View details for DOI 10.1080/1067322049095723

View details for Web of Science ID 000226593100004

View details for PubMedID 15764469

Requiring remission of undue influence of weight and shape on self-evaluation in the definition of recovery for bulimia nervosa Annual Conference of the Academy-for-Eating-Disorders Cogley, C. B., Keel, P. K. JOHN WILEY & SONS INC. 2003: 200210

Abstract

The current study evaluated the concurrent validity of requiring remission of undue influence of weight and shape on self-evaluation (undue influence) in defining recovery from bulimia nervosa (BN).Three groups completed the Beck Depression Inventory, the Mood and Anxiety Symptom Questionnaire, the Body Shape Questionnaire, and the Social Adjustment Scale: 31 women were fully recovered from BN (FR), 28 women had no behavioral symptoms of BN (partially recovered [PR]), and 59 matched non-eating-disordered controls (MC).The PR group had more pathologic scores on depression, anxiety, body dissatisfaction, and social adjustment compared with both the FR and MC groups, which did not differ from each other.These findings suggest that including remission of cognitive symptoms in a standardized definition of recovery may prove to be clinically useful in establishing reliable prognostic indicators. Future research should evaluate the role played by cognitive symptoms in triggering relapse.

View details for DOI 10.1002/eat.10187

View details for Web of Science ID 000184510900003

View details for PubMedID 12898556