Children with cancer require long-term hospitalization. Thus far, few studies have addressed issues related to the quality of life of childhood cancer patients during hospitalization from the children’s family perspective. In this study, we aimed to clarify the characteristics of childhood cancer patients’ lives in the hospital. Forty-three families of children with cancer who were hospitalized between April 2004 and October 2009 in our hospital participated in this cross-sectional questionnaire survey. Twenty-two families (51%) felt that the hospital regulations overly restrict TV viewing. This answer was not affected by children’s age and TV viewing time before hospitalization. The families who felt restricted by TV regulation answered that their children were under stress due to the deprivation of distraction. Hospitalized children were more likely to have a mobile phone than their age group peers who were not hospitalized. Over 50% of the families provided mobile phones to their children during hospitalization. Regarding hospital diet, 78% of families who experienced difficulty because they were prohibited from bringing their own meals from home and/or the store to their children felt that children did not eat hospital diet at all during hospitalization. Sixty-three percent of the families perceived a change in their children’s sense of taste. In particular, children tended to prefer salty and strong flavors during hospitalization. The results of our survey suggest that the utilization of electronic devices and bringing meals might lead to greater satisfaction during hospitalization rather than strictly adhering to hospital regulations. More flexibility in hospital regulations may improve the quality of life of hospitalized children with cancer.

Pancytopenia induced by a noncytotoxic drug is a rare adverse event, but it makes the evaluation of bone marrow test results difficult once it occurs in patients with hematological diseases or receiving chemotherapy. We report here a case of acute lymphoblastic leukemia (ALL) accompanied by propranolol-induced pancytopenia, which made it difficult for us to assess remission achievement. A two-year-old girl with Noonan syndrome was diagnosed as having B-cell precursor ALL. Hypertrophic cardiomyopathy was detected during the induction chemotherapy, and propranolol was started. Despite a temporal hematopoietic recovery at the end of the induction chemotherapy, pancytopenia reappeared and bone marrow aspiration showed hypocellularity without leukemic blasts. Rapid hematopoietic recovery was observed after the suspension of propranolol and complete remission was confirmed thereafter. It is important to suspect noncytotoxic drug-induced pancytopenia and stop the administration of the responsible agent when unexplainable bone marrow suppression continues.

In this report, we focus on a case of bacteremia caused by Gordonia sp. A 3-year-old boy with B-cell precursor lymphoblastic leukemia was admitted to our hospital owing to persistent fever during intermittent maintenance therapy. On the basis of cultures of blood samples from the central venous catheter, the patient was diagnosed as having bacteremia caused by catheter contamination. The microorganisms were first thought to be Corynebacterium-like spp., but were later identified as Gordonia sp. by 16S rRNA gene sequencing. The patient was successfully treated for the catheter-associated infection by replacing the contaminated catheter was removed and the administration of antibiotics for five weeks. Gordonia sp. infections are difficult to diagnose by bacterial culture alone, and the infections may be severe in immunosuppressed patients. Analysis by 16S rRNA sequencing is warranted to identify Gordonia sp. as needed.

We report the case of an 8-year-old boy with hemophagocytic lymphohistiocytosis (HLH) caused by chronic active EBV infection (CAEBV). He was transferred to our hospital because he was refractory to steroids and multidrug chemotherapy. Although we treated him with intensified multidrug chemotherapy, his condition deteriorated. The patient underwent emergent peripheral blood stem cell transplantation (PBSCT) from his mother. After the conditioning regimen, his high fever and laboratory findings resolved. He achieved complete donor engraftment on day 18 and complete remission with an EBV-DNA load that was lower than the detection limit. If a case of HLH caused by CAEBV is refractory to steroids or multidrug chemotherapy, we need to carry out hematopoietic stem cell transplantation immediately.

A 6-year-old girl with von Hippel–Lindau disease was diagnosed as having pheochromocytoma on the basis of histological examination of the totally resected right adrenal tumor. At the age of 13, interaortocaval tumor and multiple bone metastases were detected. Seven courses of cyclophosphamide–vincristine–dacarbazine therapy after resection of the interaortocaval tumor were not effective; therefore, the patient was administered two courses of high-dose ¹³¹I-MIBG therapy with autologous hematopoietic stem cell rescue. The blood catecholamine level normalized and the uptake of MIBG in bone metastases decreased on ¹²³I-MIBG scintigraphy following the high-dose ¹³¹I-MIBG therapy. The patient is alive and progression-free 3 years after the treatment. High-dose ¹³¹I-MIBG therapy is feasible as a safe and effective treatment for unresectable malignant pheochromocytoma.

Temozolomide (TMZ) has recently been used for relapsed medulloblastoma; however, its use is limited in Japan. A 6-year-old boy with high-risk medulloblastoma in the cerebellum was treated by surgery, radiotherapy, and chemotherapy consisting of ifosfamide, cisplatin, and etoposide, followed by high-dose chemotherapy consisting of busulfan and melphalan and rescued by autologous stem cell transplantation. Twenty-four months after surgery, the medulloblastoma relapsed in the right lateral ventricle, temporal lobe, and left cerebellar hemisphere. Oral temozolomide [150 mg/m² once daily for 5 days, repeated every 28 days (one cycle)] was started as a palliative therapy. To date, temozolomide has been repeated for 30 cycles for 28 months and the relapsed lesions have become smaller. The adverse effects of temozolomide on the patient were mild, and he was able to live with a good quality of life. Temozolomide is a good agent for medulloblastoma relapse.

We encountered a case of Wilms tumor in a patient who was found to have retractile testes on examination prior to whole abdominal irradiation, thereby avoiding gonodal radiation exposure by immediate orchiopexy. A 3-year-old boy diagnosed as having Wilms tumor stage III was treated at our institute using the standard protocol of the Japan Wilms Tumor Study Group, which consists of up-front surgery, postoperative chemotherapy and whole abdominal irradiation. Radiological and physical examinations before radiotherapy revealed bilateral retractile testes, which were not detected preoperatively. We performed immediate orchiopexy, thus removing both testes from the radiation field in advance. Unlike chryptorchidism, a retractile testis seldom has surgical indications. During whole abdominal irradiation, however, the presence of a retracted testis or cryptorchidism could lead to infertility. Therefore, attending pediatricians and radiation oncologists must rule out retractile testes in patients due to undergo whole abdominal irradiation, so as to avoid unnecessary gonodal radiation exposure.