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As a call to action in the field, we highlight that the COVID-19 pandemic is an abrupt and chronic stressor to children and families of disadvantaged and marginalized backgrounds. Critically, this global crisis has a disproportionate impact on the physical, mental and behavioral health of these vulnerable members of society, due to pre-existing disadvantages such as economic hardship, educational inequities, risks of maltreatment and community violence. A lack of access to mental health support further deprives children and their caregivers of the resources needed to cope with magnified adversities during the pandemic. We believe these inequalities are not the mere result of the pandemic, but enduring issues in society that are detrimental to the wellbeing of the most vulnerable. We advocate for long-term strategies to change societal structures that oppress marginalized children and families, and believe the pandemic reflects a pressing need to invest in interventions.

Melphalan uptake in the intestine has recently been shown to be an energy-dependent process which is affected by metabolic inhibitors. It is therefore theoretically possible that amino acids in food could reduce melphalan absorption by competing for uptake at the sites of absorption in the intestine. Since L-leucine has been shown to be the most potent inhibitor of melphalan transport into cells in vitro, this amino acid was chosen for the present study in patients. Oral melphalan (4.5 +/- 0.5 mg/m2) was given to ten fasting patients with and without a 2-g oral dose of L-leucine on separate randomized occasions at least 1 week apart. Melphalan plasma levels were measured by high-performance liquid chromatography (HPLC) for 5-h after dosing. L-Leucine plasma levels were measured by HPLC before and at 1 h after dosing. The area under the curve for melphalan was lower in seven of the patients after L-leucine. Plasma L-leucine levels 1 h after melphalan administration were 15.4 +/- 3.7 micrograms/ml fasting and 35.4 +/- 5.2 micrograms/ml after L-leucine. The results indicate that L-leucine can reduce plasma melphalan levels in some patients, probably through a reduction in absorption of the drug from the gastrointestinal tract. However, the effect, like that of food, is highly variable.

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