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Objective: to determine the expression of neurotrophins and their tyrosine-kinase receptors in patients with osteosarcoma (OS) and their correlation with clinical outcomes., Methods: we applied immunohistochemistry to biopsy specimens of patients consecutively treated for primary OS at a single institution between 2002 and 2015, analyzing them for expression receptors of tyrosine kinase A and B (TrKA and TrKB), neural growth factor (NGF) and brain derived neurotrophic factor (BDNF). Independently, two pathologists classified the immunohistochemical markers as negative (negative or weak focal) or positive (moderate focal/diffuse or strong focal/diffuse)., Results: we analyzed data from 19 patients (10 females and 9 males), with median age of 12 years (5 to 17.3). Tumors' location were 83.3% in the lower limbs, and 63.2% of patients had metastases at diagnosis. Five-year overall survival was 55.3%. BDNF was positive in 16 patients (84%) and NGF in 14 (73%). TrKA and TrKB presented positive staining in four (21,1%) and eight (42,1%) patients, respectively. Survival analysis showed no significant difference between TrK receptors and neurotrophins., Conclusion: primary OS samples express neurotrophins and TrK receptors by immunohistochemistry. Future studies should explore their role in OS pathogenesis and determine their prognostic significance in larger cohorts.

Objective: To compare the use of intravenous vs. oral antibiotic therapy., Methods: All febrile neutropenic patients younger than 18 years old with low risk of complications and receiving chemotherapy were selected. The study was conducted from 2002 to 2005 at the Pediatric Oncology Unit of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Patients were divided into group A and group B and were randomly assigned to receive oral or intravenous therapy. The empirical antimicrobial treatment used for group A consisted in oral ciprofloxacin plus amoxicillin-clavulanate and intravenous placebo, and group B received cefepime and oral placebo., Results: A total of 91 consecutive episodes of febrile neutropenia in 58 children were included in the study. For patients of group A, treatment failure rate was 51.2%; the mean length of hospital stay was 8 days (range 2-10 days). For patients treated with intravenous antibiotic therapy, treatment failure rate was 45.8%; the mean length of hospital stay was 7 days (range 3-10 days)., Conclusion: There was no difference in the outcome in oral vs. intravenous therapy. There is need of larger randomized trials before oral empirical therapy administered to this population should be considered the new standard of treatment.

Objective: To describe the demographics and the most important acute clinical complications in patients undergoing bone marrow transplantation in the Pediatric Oncology Unit at Hospital de Clínicas de Porto Alegre, Brazil., Material and Methods: A retrospective analysis was performed including 41 patients treated between August 1997 and June 2002. Twenty patients received allogeneic transplants (AG) and 21 received autologous transplants (AT)., Results: The mean age of AG patients was 8.9 +/- 5.4 years. Twelve patients were male. Stem cell sources were: bone marrow in 12 patients; peripheral blood in five; and unrelated cord blood in three. The diseases were acute lymphoid leukemia in seven patients; acute myeloid leukemia in four; chronic myeloid leukemia in two; myelodysplastic syndrome in two; Burkitt's lymphoma in one; severe combined immunodeficiency in one; Chediaki-Higashi syndrome in one; Fanconi anemia in one; and aplastic anemia in one. One patient developed grade II acute graft-versus-host-disease (GVHD), and three patients had grade IV GVHD. Three patients developed chronic GVHD. In all of them, the cell source was peripheral blood. Survival in this group was 70.0 +/- 10.3%. The main cause of death was GVHD in three patients and sepsis in another three. All deaths occurred before day 100. One of the patients who received unrelated cord blood is alive 3.5 years after the transplantation. In AG patients, mean age was 8.7 +/- 4.3 years. Eleven patients were male. The stem cell sources were: peripheral blood in 16; bone marrow in three; and peripheral blood + bone marrow in two. The diseases were: Wilms' tumor in five patients; Ewing's sarcoma family tumors in four; neuroblastoma in three; Hodgkin's disease in three; non-Hodgkin's lymphoma in one; rhabdomyosarcoma in two; neuroectodermic tumor of the central nervous system in two; acute myeloid leukemia in one. Survival in this group was 59.4 +/- 11.7%. Five patients died due to tumor relapse, two patients due to sepsis and one patient died in remission 20 months after bone marrow transplantation due to infection. In the whole group, the most common toxicities were vomiting, mucositis, diarrhea and abdominal pain. Infections were recorded in 58.5% of the patients. In 46.9%, at least one pathogen was isolated in the blood culture. The time required for neutrophil and platelet engraftment was correlated to the number of hematopoietic stem cell infused., Conclusion: The overall survival in our patients is similar to that reported in the literature. We did not find differences between AT and AG patients regarding acute toxicities and infections.

OBJECTIVE: To review the indications, main steps and complications of bone marrow transplantation in children. SOURCES: Medline-based literature review. SUMMARY OF THE FINDINGS: We comment about the indications of autologous, allogeneic and syngeneic bone marrow transplantation, donor selections, harvest and infusion of the hematopoietic progenitor cells that will reconstitute the hematopoietic and immune systems. We describe the different conditioning regimens and the new sources of cells, such as cord blood. We also describe the most common events after the procedure, including infections, graft versus host disease, and cardiovascular, pulmonary, hepatic, genitourinary, and gastrointestinal complications. The late effects and their impact on quality of life are also discussed. CONCLUSIONS: Bone marrow transplantation does not confer an absolutely normal life span to all the patients; however, it represents the only chance of cure for children with certain neoplastic or immunological diseases. By knowing the steps of the procedure, pediatricians can be a source of information on bone marrow transplantation to the patients and their families.