not-yet-known not-yet-known not-yet-known unknown Background: Timely diagnosis is critical in pediatric oncology to optimize treatment outcomes. Diagnostic delays may impact tumor extension and prognosis, necessitating analysis of diagnostic intervals across different neoplasms. Methods: We analyzed data from 749 pediatric patients diagnosed with rhabdomyosarcoma between 1996 and 2016. Diagnostic interval (DI) was defined as days from symptom onset to diagnosis, and treatment interval (TI) from symptom onset to treatment initiation. Factors influencing DI and TI were collected, including patient age, histology, tumor characteristics, and protocol of treatment. Survival outcomes were assessed using Kaplan-Meier analysis. Results: Median DI was 32 days, decreasing insignificantly from 1996-2004 to 2005-2016. Longer DI was associated with metastatic disease (p=0.0021). The proportion of patients diagnosed within one month increased over time, but remained lower for metastatic cases. Median TI was 48 days, unchanged over time. Longer TI correlated with larger tumors (p<0.0001). Adolescents had prolonged DI (>2 months) more frequently. The quantile regression models showed that on univariate analysis DI was associated with age at diagnosis, unfavourable histology and metastatic diaeses, but not confirmed in multivariate Five-year event-free survival (EFS) and overall survival (OS) were 59.7% and 69.3%, respectively. Conclusions: This study evaluated the role of timely diagnosis and treatment initiation in pediatric patients with rhabdomyosarcoma . Our data highlights that DI and TI are crucial in adolescents and often longer in metastatic patients. Future efforts should focus on streamlining access to diagnostic facilities and improving processes to ensure timely interventions, especially for patients presenting with more advanced disease.

Purpose. To describe ecthyma gangrenosum (EG) characteristics and complications in a large multicenter pediatric retrospective collection of children with malignancies or bone marrow failure syndromes. Methods. EG episodes diagnosed in the period 2009-2019 were identified by a retrospective review of clinical charts at centers belonging to the Italian Pediatric Hematology Oncology Association. Results. EG occurred in 38 children (male/female 16/22; median age 5.2 years) with hematological malignancy (33), allogeneic stem cell transplantation (2) or relapsed/refractory solid tumor (3). The involved sites were: perineal region (19), limbs (10), trunk (6), head and the iliac crest (3). Bacteremia was present in 22 patients. Overall, the germs isolated were Pseudomonas aeruginosa (34), Stenotrophomonas maltophilia (3) and Escherichia Coli (1); 31% of them were MDR. All patients received antibacterial treatment while surgery was performed in 24 patients (63.1%). Predisposing underlying conditions for EG were: severe neutropenia (97.3%), corticosteroid treatment (71%), iatrogenic diabetes (23.7%). All patients recovered, but EG recurred in 5 patients. Nine patients (24%) showed sequelae (deep scars, with muscle atrophy in 2). Four patients (10.5%) died, 1 due to relapse of EG with KPC co-infection, 3 due to the underlying disease. Conclusions. EG requires early recognition and a proper and timely treatment to obtain the recovery and to avoid larger necrotic evolution. The occurrence of scarring sequelae might affect the quality of life of patients.

Carbapenemase-producing Enterobacteriaceae (CPE) , multidrug resistant (MDR) threatens children undergoing chemotherapy. A previous survey reported increase of bloodstream infections and colonization in a 2 year-observation time. To test the efficacy of the measures put in place , a second survey was performed. Data were collected from 13 Italian pediatric cancer centers of AIEOP network. The colonization rate per 1000 hospitalizations days was 0.5 (0.37-0.65) not different from the 0.48 rate (0.36-0.63) observed previously .Yet the 0.12 rate of bacteriemia (0.07-0.21) compared favorably with the 0.42 (0.31-0.57) observed. The awareness of colonization status allowed reducing CPE related morbidity and mortality.

SARS-COV-2 infection can be asymptomatic or mildly symptomatic. The effect of chemotherapy on an asymptomatic infected patient is unknown. Three hundred-thirty-four and 56 NFS were performed as screening for SARS-CoV-2 infection in 247 and 34 pediatric patients undergoing chemotherapy and stem cell transplantation, respectively. NFS was positive in 10 patients. All positive patients withdrew from chemotherapy. Nine patients became negative. One patient is still positive after 38 days.The identification of asymptomatic SARS-COV-2 infection is important to reduce the hospital spread of infection. Further studies are needed to define the least risky management of chemotherapy in asymptomatic SARS-CoV-2 patients.