Primary malignant lung tumors in children: A report from the Australian Childhood Cancer Registry, 1983‐2015

Lung cancers in children under the age of 15 are very uncommon, with a scarcity of literature describing patient characteristics and survival. This study assessed first primary malignant cancers occurring in the trachea, bronchus, or lung (International Classification of Diseases for Oncology, 3rd edition [ICD‐O‐3] codes C33‐C34) for the period 1983‐2015, using data from the population‐based Australian Childhood Cancer Registry. Variables of interest included morphology, sex, age group, and metastatic status at diagnosis. Mode of treatment was also assessed where possible. The Kaplan‐Meier method was used to calculate 5‐year observed survival. Of the 53 in‐scope patients, almost half (n = 23, 43%) were diagnosed with pleuropulmonary blastoma and a further 8 (15%) had a carcinoid tumor. Few of the patients with details available on stage at diagnosis (n = 7 of 43, 16%) presented with metastatic disease. Surgical excision was the most common treatment (30 of 37 children, 81%), with two‐thirds (n = 28 of 43, 65%) receiving chemotherapy. Five‐year observed survival was estimated to be 74% (95% CI = 61%‐85%). Our results represent one of the largest and most complete population‐based cohorts of children with primary malignant lung cancers available to date. Detection of childhood lung cancer can be difficult due to the rarity of this disease and symptoms that are typically nonspecific.     

C1 Inhibitor in Acute Antibody‐Mediated Rejection Nonresponsive to Conventional Therapy in Kidney Transplant Recipients: A Pilot Study

Complement inhibitors have not been thoroughly evaluated in the treatment of acute antibody‐mediated rejection (ABMR). We performed a prospective, single‐arm pilot study to investigate the potential effects and safety of C1 inhibitor (C1‐INH) Berinert added to high‐dose intravenous immunoglobulin (IVIG) for the treatment of acute ABMR that is nonresponsive to conventional therapy. Kidney recipients with nonresponsive active ABMR and acute allograft dysfunction were enrolled between April 2013 and July 2014 and received C1‐INH and IVIG for 6 months (six patients). The primary end point was the change in eGFR at 6 months after inclusion (M+6). Secondary end points included the changes in histology and DSA characteristics and adverse events as evaluated at M+6. All patients showed an improvement in eGFR between inclusion and M+6: from 38.7 ± 17.9 to 45.2 ± 21.3 mL/min/1.73 m² (p = 0.0277). There was no change in histological features, except a decrease in the C4d deposition rate from 5/6 to 1/6 (p = 0.0455). There was a change in DSA C1q status from 6/6 to 1/6 positive (p = 0.0253). One deep venous thrombosis was observed. In a secondary analysis, C1‐INH patients were compared with a similar historical control group (21 patients). C1‐INH added to IVIG is safe and may improve allograft function in kidney recipients with nonresponsive acute ABMR.