The current survival rate of Lithuanian children treated for AML was comparable to the expected rate in other parts of Europe. What is Known: • In the last three decades, significant improvement has been achieved in treating childhood cancer, with an overall survival (OS) rate of > 80% in high-income countries. The difference in survival rates between Northern/Western and Eastern European countries as well as between high- and middle-/low-income countries is as much as 20%. Recently, the 5-year event-free survival rate of acute myeloid leukemia (AML) has reached > 60% in high-income countries. The survival rates for myeloproliferative diseases were the lowest in Eastern European countries. • The reported inferior survival rates were calculated based on outcome data of patients treated until 2007. The recent survival rates in Eastern European countries are unknown. What is New: • Being a small Eastern European country, Lithuania has experienced good economic growth during the last decade. We hypothesized that economic growth and gain of experience could result in better survival rates of children treated for cancer in our country in recent years. • A population-based analysis of treatment outcome of childhood AML treated in Lithuania in the recent years was performed for the first time. The survival rates of childhood AML in Lithuania are comparable to those of other high-income countries. Current survival rates of children treated for cancer in Eastern European countries could be comparable to the best current standards contributing to better European survival rates of childhood cancer in general.

RVs accounted for only a small proportion of visits to the ED. RVs were more prevalent among younger patients and patients with a GP referral as well as performed more often after discharging from the ED in the evening and at night.

Background: Parenteral nutrition is commonly used to ensure nutrition support and prevent the harmful effects of malnutrition, which frequently occurs after allogeneic hematopoietic stem cell transplantation (aHSCT). Nevertheless, enteral nutrition supports the restoration of the gut barrier and microbiome as well as protects against infectious complications and acute graft-vs-host disease. Percutaneous endoscopic gastrostomy (PEG) may also be beneficial for gastric decompression and drug administration. Methods: We performed a retrospective cohort study to evaluate the impact of PEG on treatment outcomes in 75 children who underwent aHSCT with (n = 34) or without (n = 41) PEG from 2005 to 2016.Results: In 34 patients, PEG was used to ensure enteral nutrition support (n = 30), oral drug intake (n = 28), and abdominal decompression (n = 2). During the study period, we observed a beneficial association between PEG placement and transplant-related mortality as well as 5-year overall survival compared with the non-PEG group (12.9% vs 59.0%, P = 0.000; 85.3% vs 35.1%, P = 0.000, respectively). The beneficial impact of PEG was most prominent on 5-year overall survival in older children (12-17 years) with grafts from matched unrelated donors.Conclusions: PEG placement had a positive association with transplant outcomes in pediatric patients undergoing aHSCT. To confirm these results, larger prospective studies are needed.

Chronic granulomatous disease (CGD) is an inherited X-linked or, less frequently, with somatic mutations linked disorder of phagocytic cells which presents in early childhood as recurrent granulomatous lesions and atypical bacterial or fungal infections of skin, lungs, gastrointestinal tract, liver, spleen or lymph nodes. Some patients remain undiagnosed until adulthood or rarely diagnosis is made post mortem. Haematopoietic stem cell transplantation (HSCT) can cure CGD, thus timely diagnosis is essential for saving life of such patients. We present two complicated clinical cases of children with CGD, diagnosed in Lithuania for the first time. After the history of recurrent epizodes of severe infections, reviewed family history, repeated spontaneous and stimulated nitroblue tetrazolium tests (NBT), CGD diagnosis was confirmed for both patients. Allogeneic HSCT is planned in both cases expecting curative effect. All children with recurrent atypical infections should be checked for immunodeficiency. Multidisciplinary approach is essential for making rapid and correct diagnosis based on life and family history, clinical manifestation, immunologic tests and genetic counseling. CGD is curable by HSCT, thus patients should be referred to a HSCT center without delay

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