Randall Y. Chan

Accurate and timely interpretation of microcytic anemia can be diagnostically challenging in the primary care setting. We sought to develop a novel model for distinguishing iron-deficiency anemia from thalassemia trait in the modern pediatric population. Demographic history and red blood cell indices were retrospectively characterized for 76 children referred to our pediatric hematology clinic for evaluation of microcytic anemia. Statistically significant variables were sequentially added into a logistic regression model to develop the final model. The final discriminating model incorporates red cell distribution width, mean corpuscular hemoglobin concentration, and red blood cell values. Favorable predictive performance is seen in the initial (sensitivity 89.2%, specificity 92.3%) and external validation cohort (sensitivity 84.4%, specificity 88.9%). This novel tool may aid in determining the cause of hypochromic, microcytic anemia in the primary care setting. Finally, the study cohort reflects an underrepresented group in the development of screening tools, and thus offers generalizability.

Background Adriamycin, bleomycin, vinblastine, dacarbazine (ABVD), the de facto standard of care in adult‐onset Hodgkin lymphoma (HL), has not been directly compared to doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE‐PC), a pediatric‐aimed regimen designed to reduce late effects. We aimed to describe the single‐institution experience of using both regimens in patients with pediatric HL. Methods This retrospective cohort study evaluated a total of 224 patients diagnosed with HL between 1999 and 2018 at Children's Hospital Los Angeles (CHLA), of which 93 patients were eligible having received ABVD ( n = 46) or ABVE‐PC ( n = 47) chemotherapy as their initial treatment. Descriptive analyses were performed using the Student's t ‐test or Fisher's exact test. Survival analysis used the Kaplan–Meier method. Events included death, relapse, and secondary malignancy. We also describe the use of radiation therapy, pulmonary toxicity, and cardiomyopathy determined by shortening fraction <29%. Analyses followed an intention‐to‐treat principle. Results There was no difference in baseline characteristics between the patients receiving ABVE‐PC or ABVD in regard for stage, risk group, or prognostic variables, such as the presence or absence of “B” symptoms, bulky disease, and extra‐nodal involvement. A greater proportion of patients treated with ABVE‐PC received consolidating external beam radiation treatment (XRT) either by randomization or by response compared to ABVD (59.6% vs. 32.6%, respectively, p = .01). While not statistically significant, response to therapy, assessed by positron emission tomography/computerized tomography (PET/CT) where available, mirrored the use for radiation (rapid response 58.3% vs. 90.0%, n = 34, p = .11). The median dose of anthracycline (doxorubicin) was the same in patients receiving ABVE‐PC versus ABVD (200 vs. 200 mg/m 2 , interquartile range 200–250 vs. 200–300 mg/m 2 , p = .002). There was no difference in event‐free survival ( p = .63) or overall survival ( p = .37) with a median follow‐up length of 3.9 years. Conclusions ABVD and ABVE‐PC achieved similar survival outcomes in our single‐institution cohort.