Acute lymphoblastic leukemia (ALL) accounts for approximately 30 percent of all childhood cancer. Leukemic infiltration is generally present in the bone marrow, liver and spleen. It is uncommon to demonstrate infiltration to the kidneys as an initial presenting feature. We present the case of an 11-year-old boy who presented with back pain, without peripheral evidence of bone marrow involvement, who was found to have bilateral renal masses and 70 percent leukemic blasts upon bone marrow evaluation.

Black and Hispanic children with leukemia experience inferior survival compared to non-Hispanic White (NHW) children. Identifying modifiable social determinants of health can inform intervention targets to address inequities. We characterized the frequency of income poverty and household material hardship (HMH) by race/ethnicity in a clinical trial cohort with de novo acute lymphoblastic leukemia. Compared to NHW families, Black and Hispanic families reported more frequent HMH (19% vs. 47% vs. 68% respectively); low-income (27% vs. 52% vs. 74%), and combined low-income and HMH (12% vs. 37% vs. 52%) poverty exposures. Disparate poverty exposures are interventional targets to address racial/ethnic outcome inequities.

BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, with diagnosis preceded by symptoms that may include fever, weight loss, fatigue, bleeding and bruising. Timely diagnosis and treatment of ALL may lead to improved outcomes and reduced morbidity from associated complications including tumor lysis syndrome, hyperviscosity, and stroke. PROCEDURE: We performed a retrospective cohort analysis of 274 pediatric pre-B cell ALL and lymphoma patients within Montefiore Health System to determine whether there were factors associated with time from symptom onset to diagnosis. RESULTS: Median time to diagnosis for all patients was 11.5 days (IQR7.8, 14.3) and was similar between Hispanic, Non-Hispanic Black, and Non-Hispanic White racial/ethnic groups (10.5 vs 14.0 vs 8.0 days; p=0.70), and by male and female patients (14 vs 10 days; p=0.08). Those with Medicaid insurance (n=189) were diagnosed sooner than those with private or self-pay insurance (n=85) (median of 10 vs 16 days; p=0.05). Similar findings were demonstrated when evaluating by Medicaid, Private, and Self-Pay insurance types. English and Other language speakers experienced fewer median days from symptom onset to diagnosis date compared to Spanish speakers (11 vs 7 vs 14; p=0.05). Exploratory analyses suggest that insurance status may impact the time to diagnosis to a greater degree in Non-Hispanics, while English language and female sex may represent a greater advantage to Hispanics. CONCLUSIONS: This study demonstrates that insurance status and language preference may impact the time to diagnosis of pediatric ALL. There is further need to confirm our findings and to study possible causes driving these disparities.

Social determinants of health (SDoH) are associated with stark disparities in cancer outcomes, but systematic SDoH data collection is currently absent from oncology clinical trials. Trial-based SDoH data are essential to ensure representation of marginalized populations, contextualize outcomes, and identify health-equity intervention opportunities. We report the feasibility of the first pediatric oncology multicenter trial-embedded SDoH investigation. Among 448 trial participants, 392 (87.5%) opted-in to the embedded SDoH study; 375 (95.7%) completed baseline surveys, with high longitudinal response rates (87.2-92.8%) over 24-months of therapy. Trial-embedded SDoH data collection is feasible and acceptable, and must be consistently included within future oncology trials.

Posttransplant lymphoproliferative disorder is a rare but well-known complication in solid organ or hematopoietic transplant recipients secondary to immunosuppression. It can range from a cellular hyperplasia to a classic lymphoma. We describe a case of a nine-year-old male with Barth syndrome and a history of cardiac transplantation who developed plasmacytoid EBV-negative PTLD, an extremely rare entity in the pediatric population, and the evolvement of his PTLD to a more aggressive plasma cell neoplasm.