Objectives. Compared with the general population, childhood cancer survivors (CCS) could be at greater risk of psychological distress following the emergence of the COVID-19 pandemic. This cross-sectional study assessed the psychological consequences of COVID-19 on the mental health of CCS. Methods. In December 2020, we interviewed through an online self-report questionnaire 580 5-year CCS participating in the French Childhood Cancer Survivor Study (FCCSS) cohort. We first compared the mental health score of CCS with that observed in the French general population of the same age and gender. Subsequently, combining clinical and patient-reported outcomes, we studied predictors of the mental health score of CCS. Results. External comparisons revealed that the mental health score of CCS was similar to that observed in the general population. Among CCS, almost 42% stated that their psychological state had been worse during the lockdown. Predictors of poorer mental health included, among others, female gender, reporting a change of his/her occupational situation, having a relative who had been hospitalized or had died following COVID-19, and a greater perceived infection risk. Conclusion. Given the pre-existing vulnerability of some CCS to mental distress, the additional psychological consequences of COVID-19 in vulnerable survivors should receive attention from health care providers.

Background. Osteonecrosis (ON) is a long-known complication of acute leukemia (AL) management affecting 1 to 10% of young patients, leading to long-term morbidity. Widespread access to Magnetic Resonance Imagery (MRI) over the past ten years has allowed earlier detection and more accurate assessment. This study investigated clinical and radiological features of ON, among the large French cohort L.E.A (Leucémie Enfant Adolescent) Procedure. Patients with ON were retrospectively enrolled and risk factors for the onset, the multifocal involvement and severe damage were analyzed. Quality of life (QoL) was also evaluated. A sub-study described radiological features. Results. 129/4973 patients developed ON (2.5%) and were preferentially aged over 10 years at time of AL diagnosis (OR 22.46, p <10-6). Females were preferentially affected (OR 1.8, p=0.002) like patients treated for relapse (OR 1.81, p=0.041). Patients presenting ON suffered more frequently from other sequelae (p<10-6). Most of the necrosis were involving weight-bearing joints and multiple joints in 69% of cases. MRI of 39 patients with ON were double blinded reviewed. Overall, 14/39 suffered from severe impairment, preferentially on hips. QoL of adolescents and adults was poor and permanently affected once ON occurred. Conclusions. Age of over 10 years at diagnosis of AL, relapse and female sex were at risk of developing ON involving preferentially multiple joints. One third was severe and lasting poor QoL impacting several domains was found. Future studies should include prospective data on management and biological genetic features to build a targeted screening program to detect and manage ON earlier.

Emicizumab is a prophylaxis for patients with severe haemophilia A with inhibitor. Despite the daily prophylaxis, coagulation states stay below normal value and cannot be assessed by standard hemostasis techniques. In our two patients, we use thrombin generation assay (endogenous thrombin potential (ETP) and Peak) to monitor the patient’s clotting status. Under emicizumab, it is needed to add by-passing agent such as FVIIa (Novoseven®) to avoid bleeding before surgery. By-passing agent dose was chosen with the help of thrombin generation assay and after collegial concertation.