ObjectivesGlobal incidence and attention to childhood cancer is increasing and treatment abandonment is a major cause of treatment failure in low- and middle-income countries. The purpose of this study was to gain an understanding of factors contributing to non-adherence to treatment.DesignA prospective cohort study with 2 year follow-up of incidence, family-reported motives and risk factors.SettingThe largest tertiary paediatric oncology centre in Northern Vietnam.ParticipantsAll children offered curative cancer treatment, from January 2008 to December 2009.Primary and secondary outcome measuresFamily decision to start treatment was analysed with multivariable logistic regression, and family decision to continue treatment was analysed with a multivariable Cox model. This assessment of non-adherence is thereby methodologically consistent with the accepted definitions and recommended practices for evaluation of treatment abandonment.ResultsAmong 731 consecutively admitted patients, 677 were eligible for treatment and were followed for a maximum 2 years. Almost half the parents chose to decline curative care (45.5%), either before (35.2%) or during (10.3%) the course of treatment. Most parents reported perceived poor prognosis as the main reason for non-adherence, followed by financial constraints and traditional medicine preference. The odds of starting treatment increased throughout the study-period (OR 1.04 per month (1.01 to 1.07), p=0.002), and were independently associated with prognosis (OR 0.51 (0.41 to 0.64), p=<0.0001) and travel distance to hospital (OR 0.998 per km (0.996 to 0.999), p=0.004). The results also suggest that adherence to initiated treatment was significantly higher among boys than girls (HR 1.69 (1.05 to 2.73), p=0.03).ConclusionsNon-adherence influenced the prognosis of childhood cancer, and was associated with cultural and local perceptions of cancer and the economic power of the affected families. Prevention of abandonment is a prerequisite for successful cancer care, and a crucial early step in quality improvements to care for all children with cancer.

Severe combined immunodeficiency includes inherited diseases with impairment of T cells development, often associated with profound defects of B and/or NK cells differentiation. Rotavirus infection is responsible for severe acute gastroenteritis and over 400,000 deaths a year in children aged < 5 years, especially in low and middle-income countries. We report a nine-month-old girl presented with failure to thrive left axillary lymphadenitis post-BCG-vaccination, persistent, nonvaccine-associated rotavirus gastroenteritis. An immune evaluation revealed absent T lymphocytes, B lymphocytes, normal NK cells with genetic testing confirmed RAG2 severe combined immunodeficiency. Rotavirus gastroenteritis persisted despite the administration of oral immunoglobulin pre-transplantation. The patient was treated by a haploidentical transplant -from mother as a donor using CD3/CD45RA+ depletion kit, CliniMACs system (Miltenyi). The first transplant was performed without conditioning. One month post-transplant, rotavirus was cleared. The second transplant was performed three months later, with myeloablative conditioning (Bu-Flu-rATG). Neutrophils engrafted on day +10 post-transplant, platelet engrafted on day +45. Whole blood chimerism on day +28 post 2nd transplant was 100%. Serum IgG level has been normalized without IVIG infusion three months post 2nd transplant.

Neuroblastoma (NBL) is the most common extracranial solid cancer of childhood and is characterized by a remarkable biological heterogeneity, cause of mutiple genetic changes. The genetic profiles are the powerful tools for the clinical in risk stratification and choice of suitable treatment protocol in NBL patients. This will increase the chance of treatment's success and minimize the chemotherapy per patient. Sample: 6 NBL patients lower 18 months, non-amplified MYCN in National Children's Hospital. Method: The CGH technique is performed on the Agilent's system with the 400k chip. Results: 4 patients are found the numerical chromosomal aberations (NCA) (both stage L2), the others are the segmental chromosomal aberations (SCA) (1 stage L2 and 1 stage M). Based on this results, 4/5 patients will stop the chemotherapy, 1 patient continues the treatment. The stage M patient has the 50% chance of success in high-dose chemotherapy and stem cell transplantation. Conclusion: The genomic profile by CGH is established successfully in Vietnam, bring to NBL patients the higher chance of complete treatment with the minimal chemotherapy.

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Panel Theatre created from Japan is a method of expression in which pictures or letters made by paper attached or detached on a cloth board to develop drama, stories combined with games, singing and movement. Panel theatre has many advantages to develop communication for children with disabilities. In this study, panel theatre was used in intervention to develop communication skills for 1 child with developmental disorders through exposing him to materials, performing motor activities in combination with listening to stories and letting him participate in the drama activities which were adapted to his communication abilities. The results show that the child has improved attention, imitation, alternation, language understanding and using skills. These results show that it is possible to use panel theatre in intervention for children with developmental disorders and further studies should be considered in the future.