Background: Music therapy (MT) is a complementary therapy offered to children, young adults and their families in pediatric oncology and palliative care. We performed a survey to collect information about MT in pediatric oncology in Italy. The outbreak of COVID-19 unavoidably changed the scenario of MT, suggesting some considerations presented in this survey. Methods: 27/32 (84,4%) Centres belonging to the Italian Association of Pediatric Hematology and Oncology (AEIOP) completed in 2 different time points (T1 and T2) an online survey on MT, before and after Covid-19 pandemia. Results: Different kinds of music approach were used taking care of patients in 21/27 centers, while in 14/21 (66%) a specific project of MT conducted by a music therapist was present. In 6/14 Centres MT activities were delivered for <3 hours/week, in 3 Centres for >3 and <10 hours/week, in the remaining 5 for >3 hours/week. MT sessions were in different areas, day hospital or ward (patient rooms, operating rooms, waiting rooms), on an individual basis or by groups. Patients were invited to MT by psychologists, caring physician or nurse, or on equipé decision. MT was evaluated with tools self-made by Music therapist in 11/14 centres. After Covid-19. MT has been withdrawal in 3 centres, sessions in the waiting rooms were reduced, individual sessions were preferred and enrollment by multidisciplinary teams increased. Conclusion: This survey represents the starting platform to compare and discuss different experience of MT in AIEOP Centres, to implement MT in pediatric oncology for a more qualified assistance to patients and to improve quality of care.

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.

SUMMARY Neutropenia is a generic term that indicates a reduction of neutrophils below the threshold for age and race. This condition encompasses a number of diseases with a wide range of duration and severity. In the present paper, the approach to diagnosis and treatment of neutropenia has been reviewed and implemented with the knowledge acquired during the last decade, by a group of experts, 10 years after the first publication. The diagnostic itinerary highlights the most important tools available to define the type of neutropenia and updates the list of genes causative of the disease. In addition, the present paper underlines the progresses towards a better definition of “primary autoimmune neutropenia” without remission which often hides different diseases. Moreover, indications on how to speed up neutropenia diagnosis and the indications to perform the bone marrow examination in the genetic forms, are given. The management and treatment of the “well-known” diseases and “special situations” are also reviewed giving literature derived and expert opinion-based suggestions tailored on the single patient/diagnosis.