Search Results (582)

Background/Objectives: Socioeconomic indicators and geographic factors influence pediatric cancer outcomes, but evidence in Romania is limited. Methods: This retrospective cohort study included 6247 patients aged 0–19 years diagnosed with cancer and recorded in the Romanian National Pediatric Oncology and Hematology Registry between 1 January 2010, and 31 December 2024. Kaplan–Meier analysis was used to estimate the survival probabilities across four strata of regional and county socioeconomic categorization and two strata of community marginalization status. Unadjusted and multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for sex, age group, primary cancer type (ICCC-3), tumor behavior, and geographical residence. Subgroup analyses assessed the association between rurality and pediatric cancer survival, irrespective of community marginalization status. Results: Survival probabilities were consistently lower among patients residing in more socioeconomically disadvantaged regions, counties, and marginalized communities (log-rank p ≤ 0.0001). In the most deprived strata, 5-year survival for regions, counties, and communities was 69.86% (95% CI: 67.49–72.10), 67.47% (95% CI: 63.32–71.26), and 65.51% (95% CI: 61.33–69.35), respectively. In adjusted models, residence in the least deprived regions (HR = 0.783, 95% CI = 0.744–0.952) and counties (HR = 0.749, 95% CI = 0.620–0.905) was associated with improved survival, a 22% and 25% lower risk of death, respectively, compared with residence in the most deprived categories. Community marginalization was associated with lower survival outcomes in unadjusted analyses, but was not significant after adjustment. Rural residence was associated with a 44% higher risk of death (HR = 1.436, 95% CI = 1.304–1.582), with a 5-year survival of 66.76% (95% CI: 64.91–68.53) among rural patients, compared with 75.93% (95% CI: 74.28–77.48) in urban patients. Conclusions: This is Romania’s first pediatric cancer survival study to evaluate persistent social and geographical disparities. Survival outcomes were consistently lower in more socioeconomically disadvantaged regions and counties, while the findings suggest that rural residence may explain the observed differences in survival at the community level. Policymakers and health systems in Romania should focus on covering pediatric cancer patients with appropriate proximity services across the entire national territory, thus enabling all patients to get timely access to quality care. Full article

Background/Objectives: The aim of the present study was to assess the influence of physical activity on retinal microvascularization in patients with uveal melanoma (UM) and nevus. In addition, vascular differences between tumor and nevus patients as well as the interaction effect of physical activity (PA) and group on retinal microvascular density (MVD) were analyzed. Methods: This cross-sectional, observational clinical study was conducted at the outpatient ophthalmic oncology department at the Center for Integrated Oncology of the University Hospital Cologne (between April 2024 and July 2025). Patients with confirmed uveal melanoma or choroidal nevus were enrolled. Physical activity and retinal MVD via optical coherence tomography angiography were assessed. In addition, regression analyses were performed. Results: A total of 42 participants were enrolled with a mean age of 56.14 (±13.48) years (nevus) and 63.45 (±13.76) years (UM). UM eyes (N = 20) demonstrated significantly reduced MVD in both the superficial and deep layer compared to Nevus (N = 22, all p < 0.001, η² = 0.155–0.190), while UM eyes showed greater mean vessel length (B = 5.54, p = 0.009, η² = 0.104). Physical activity was positively associated with MVD in the superficial layer, including vessel area density (B = 1.07, p = 0.022, η² = 0.133) and vessel length density (B = 0.28, p = 0.028, η² = 0.119), independent of group. No significant associations were found in the deep layer and no interaction effects between group and PA were detected. Conclusions: Our findings suggest that habitual PA is positively associated with retinal MVD in the superficial layer, independent of diagnostic group, and may partially counteract tumor-induced as well as treatment-related microvascular disruption. As a low-risk and accessible intervention, PA holds promise as a supportive strategy in the oncological management of UM. Full article

Pediatric oncology nursing is among the highest-intensity care specialties, exposing nurses to repeated child death and sustained emotional investment in family relationships. This occupational burden is a recognized psychosocial risk factor and a driver of compassion fatigue, burnout, and reported intention to leave, yet the organizational and educational determinants of this risk remain poorly captured by existing assessment approaches. This study investigated the lived experiences of nurses caring for terminally ill children in a pediatric onco-hematology unit and hospice ward in central Italy (N = 15), using a qualitative descriptive design, informed by a phenomenological sensibility to lived experience, supported by computer-assisted textual analysis. Structured face-to-face interviews were analyzed through thematic content analysis with stepwise replication, while quantitative textual analysis was performed using T-Lab software to map co-occurrence patterns among key lemmas, providing a frequency-based, semantically grounded picture of nurses’ representations of occupational risk. Seven themes emerged, including quality of nursing care, parental relationships, coping with a child’s death, and impact on personal and professional life. Findings showed that reported intention to leave was associated, in participants’ accounts, with absent psychological debriefing, cumulative emotional burden, inadequate end-of-life training, and a near-total absence of organizational vocabulary for peer-level support—a gap directly visible in the co-occurrence structure of nurses’ language. As a secondary aim, by combining qualitative depth with complementary lexical analysis of thematic patterns, this study also offers a methodological example of how psychosocial risk in high-intensity care settings can be assessed and translated into actionable indicators for organizational climate and workforce well-being. The findings inform concrete prevention strategies and policy recommendations for nursing education and occupational health, consistent with this Special Issue’s focus on methodological innovation for psychosocial risk assessment and public health policy design. Full article

Background/Objectives: Early identification of high-grade lymphoma in children presenting with cervical lymphadenopathy is essential to ensure timely referral while avoiding unnecessary invasive procedures. We have previously developed a diagnostic model to support referral decisions. The aim of this study was to validate this model in an independent cohort and improve it based on clinical feedback and new data. Methods: We included 255 pediatric patients with cervical lymphadenopathy, of whom 62.4% were diagnosed with malignancy. External validity was assessed by applying the original scoring model to the new dataset and calculating the sensitivity, specificity, and area under the curve (AUC). Thereafter, the model was updated by addressing overlapping predictors, and evaluating additional variables that were identified through univariate analysis. Results: The original model demonstrated stable performance in the new cohort, with sensitivity and specificity remaining within the previously reported 95% confidence intervals. No new clinically relevant predictors emerged beyond those already included in the original model. Model refinement resulted in a simplified model with 9 variables (reduced from 12), which improved clinical usability by reducing redundancy among predictors and facilitating implementation in routine practice. The revised model showed stable diagnostic accuracy with a sensitivity of 94% and specificity of 91% in the new dataset. Conclusions: Our updated diagnostic nine-factor model maintains high diagnostic performance while having a reduced number of variables. These findings support its use as a practical tool for early identification of children at risk of high-grade lymphoma. Full article

Background/Objectives: Empathy is a fundamental component of pediatric oncology nursing. This study aims to examine in depth how nurses working in pediatric oncology define empathy, experience it in clinical practice, and manage emotional and professional boundaries in the empathetic care process. Methods: A qualitative research design was used. Semi-structured individual interviews were conducted with 17 nurses with at least 2 years of experience in pediatric hematology-oncology units. The interviews were conducted via Zoom. Data were analyzed using Braun and Clarke’s thematic analysis, and data collection continued until thematic saturation was achieved. Results: Three main themes were identified: Understanding Empathy, The Journey of Empathy, and The Cost of Empathy. Nurses defined empathy as an indispensable part of high-quality pediatric oncology care; however, they reported conceptual uncertainty in distinguishing empathy from sympathy and indecision regarding appropriate emotional boundaries. Empathy was perceived as a dynamic process shaped more by clinical experience than formal education. Early professional experiences were often characterized by emotional distress, while increasing experience enabled nurses to regulate their emotions and adopt more sustainable empathic practices. Despite this adaptation, prolonged exposure to children’s suffering and death was associated with compassion fatigue and emotional exhaustion. The absence of structured empathy training and formal emotional support systems further intensified these challenges. Conclusions: In pediatric oncology nursing, empathy is a complex, evolving professional competency that demands continuous emotional regulation and boundary management. Structured empathy training, reflective supervision, and strengthening institutional support mechanisms are essential to promote sustainable empathic care while protecting nurses’ emotional well-being. Full article

Objectives: The importance of sleep disturbance as a component of supportive care in pediatric oncology has recently been recognized, but the characteristics of sleep for this particular disease category have yet to be elucidated. Methods: This cross-sectional study included 54 pediatric patients diagnosed with leukemia or lymphoma and 56 age- and sex-matched clinically stable children attending routine pediatric hematology outpatient follow-up for benign hematological conditions. Sleep was assessed using the Children’s Sleep Habits Questionnaire (CSHQ). Global and domain-specific sleep scores were compared. Multivariable linear regression was used to identify correlates of global sleep disturbance, including parental educational attainment. Within the patient group, recent hospitalization and corticosteroid exposure were modeled separately because of strong collinearity. Results: Patients had higher global CSHQ scores than the comparison group (53.56 ± 8.28 vs. 49.07 ± 8.09, p = 0.005; Cohen’s d = 0.55). Differences were most evident in sleep anxiety and parasomnias (exploratory subscale findings), whereas sleep duration did not differ significantly. In the whole-sample model, patient status (B = 4.16, p = 0.006) and higher parental educational attainment (B = −2.13, p < 0.001) were independently associated with global sleep disturbance. Within the patient group, recent hospitalization was the strongest clinical correlate of sleep burden (B = 11.18, p < 0.001; R² = 0.433). Corticosteroid exposure was associated with higher sleep disturbance only in models excluding hospitalization. Conclusions: Children with leukemia and lymphoma showed a selective parent-reported sleep disturbance pattern characterized mainly by sleep anxiety and parasomnias rather than reduced sleep duration. Recent hospitalization and parental educational attainment appear to be important correlates of sleep burden in pediatric hematology-oncology care. Full article

Background/Objectives: Spectral flow cytometry enables the single-tube integration of all markers required for the assessment of measurable residual disease (MRD) in AML. The routine clinical use of spectral flow cytometry is challenged by the need for adequate single-stained unmixing controls. To pave the way for the clinical implementation of spectral flow cytometry, we opted to develop a multifunctional AML MRD panel, whose unmixing routine solely depends on ubiquitously available peripheral blood leukocytes (PBLs). Methods: We reconfigured our previously developed 19-color single-tube spectral MRD assay to incorporate viability, hemodilution, and leukemic stem cell (LSC) markers. In parallel, primitive markers were reassigned to non-tandem fluorochromes, resulting in a finalized 22-color panel. These fluorochromes were additionally leveraged as CD14 surrogate controls, whereas all other markers retained their dedicated fluorochromes for unmixing based on single-stained PBLs. Results: PBL-based controls enabled accurate spectral unmixing and reproducible assessment of CD16-based hemodilution and cell viability in spike-in experiments. Linear leukemia-associated immunophenotype (LAIP) detection, sensitivity, as well as intra- and inter-assay precision within predefined acceptance criteria were demonstrated in KG-1 dilution experiments using normal bone marrow (nBM). Furthermore, the 22-color assay resolved LAIPs and LSCs in patient samples with strong concordance to the 5-tube reference assay and revealed aberrant marker combinations that could not be assessed using the multi-tube design. Conclusions: This single-tube 22-color spectral flow cytometry assay may support a more clinically applicable and potentially standardizable approach to AML MRD diagnostics through a universal PBL-based unmixing strategy. Full article

Background/Objectives: Illness uncertainty is a pervasive psychosocial experience in chronic conditions that is particularly prominent in pediatric oncology. While existing research has explored its psychological impact, a gap remains in understanding how this uncertainty evolves throughout the disease trajectory and how families collectively negotiate and manage this experience over the long term. Methods: This qualitative study was conducted in the hematology ward at a pediatric hospital in Shanghai, China. Using purposive sampling, semi-structured interviews were performed with 32 participants from 12 families of children currently undergoing cancer treatment. Data were collected through in-depth interviews and analyzed using reflexive thematic analysis. The sample was dominated by leukemia cases, with a small number of lymphoma cases; therefore, the findings are most directly transferable to families of children with hematological malignancies. Results: Illness uncertainty is a dynamic and persistent experience permeating the entire pediatric cancer trajectory. Key sources of uncertainty include diagnostic ambiguity and delays, barriers in physician–patient communication, and profound disruptions to family daily life. In response, families proactively develop multidimensional coping strategies: reframing meaning to accept uncertainty, reorganizing family roles and responsibilities, strengthening internal communication, and mobilizing external support networks. These strategies demonstrate both family resilience and inherent vulnerability under sustained pressure. Conclusions: Illness uncertainty in pediatric cancer transcends medical boundaries and is deeply embedded in family life. Healthcare systems should recognize uncertainty as a core experience throughout the disease process and provide family-centered psychosocial and structural support. Strengthening hospital social work services and fostering synergy between peer networks and community resources are essential to enhancing families’ capacity to manage uncertainty and alleviating their long-term psychosocial burden. Full article

Background/Objectives: Chemotherapy-related fatigue (CRF) affects 50–80% of children receiving chemotherapy and significantly impairs quality of life. Despite the family-centered care framework guiding pediatric oncology practice, evidence on parent-delivered, home-based non-pharmacological interventions for CRF remains limited. This study aimed to evaluate the effect of a parent-delivered warm-water foot bath on CRF in children aged 7–12 years undergoing chemotherapy. Methods: A two-arm parallel randomized controlled trial (NCT06529484; October 2024–May 2025) was conducted at a university hospital pediatric hematology–oncology outpatient clinic. Sixty-one children with stage 3–4 Non-Hodgkin Lymphoma (intervention, n = 29; control, n = 32) were randomized using computer-generated allocation and sequentially numbered, opaque, sealed envelopes. Following structured family education, parents delivered nightly foot baths (38–40 °C, 20 min) at home for 7 consecutive days after chemotherapy administration. Adherence and fidelity were monitored via a daily WhatsApp communication protocol. Fatigue was assessed daily using the Oncology Nursing Society Visual Fatigue Scale (ONS-VFS; primary outcome) and pre/post analysis using the Pediatric Oncology Fatigue Assessment Scale (child and parent forms). Reporting followed CONSORT 2025. Results: Median ONS-VFS scores declined significantly over the 7 days in both groups (Friedman p < 0.001 for each), from 5 (Day 1) to 2 (Day 7); between-group comparisons showed no statistically significant differences on any day (all p > 0.05). On the Pediatric Oncology Fatigue Assessment Scale, no between-group differences favored the intervention; a single child-report subscale difference favored the control group and is most plausibly attributable to multiple comparisons. Adherence was complete (100%), no adverse events occurred, and all 61 participants completed the protocol. Conclusions: A parent-delivered foot bath is a safe, feasible, and well-accepted family-centered nursing intervention, with complete adherence and no adverse events. This trial was not powered to detect between-group differences and did not demonstrate superiority over standard care; adequately powered trials are needed to determine efficacy. Full article

Background/Objectives: This study describes body composition, bone mineral density (BMD), and dietary intake in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation compared to healthy children. Methods: In this prospective observational study, dual-energy X-ray absorptiometry was used to assess appendicular lean mass index (ALMI), fat mass index (FMI), fat mass percentage (FM%), and BMD, and a 4-day dietary record was used to assess dietary intake at 3 months and 1 year post-transplant. Healthy children were assessed once by the same methods. Results: We included 28 patients (mean 10.3 years, SD 4.0) and 50 healthy children (mean 10.0 years, SD 3.6). At 1 year, median Z-scores were lower for ALMI (−1.34 vs. 0.40, p < 0.001), higher for FMI (0.34 vs. −0.33, p < 0.012) and FM% (0.59 vs. −0.98, p < 0.001), lower for BMD total body less head (−1.0 vs. 0.3, p = 0.006), but similar for BMD spine compared to healthy children. At 1 year, 9/15 (60%) had ALMI Z-score ≤ −1, 6/15 (40%) had FMI Z-score ≥ 1, 5/15 (33%) had FM% Z-score ≥ 1, and 8/18 (53%) had BMD total body less head Z-score ≤ −1, and 3/15 (20%) had BMD spine Z-score ≤ −1. Dietary intake improved, and at 1 year, energy and protein intakes were comparable, fat, calcium, and vitamin D intakes were higher, but fiber intake remained lower in patients than in healthy children. Conclusions: Patients had a more unfavorable body composition and bone health. Dietary intake improved from 3 months to 1 year post-transplant. However, the results indicate a need for nutritional follow-up, particularly targeting protein, fat, fiber, calcium, and vitamin D. Full article

Objectives: Pediatric nasopharyngeal carcinoma (NPC) is rare and often presents at an advanced stage. Although multimodal treatment can achieve favorable survival, long-term survivors may experience substantial treatment-related morbidity. We aimed to evaluate survival outcomes according to stage and metastatic status and to characterize late toxicity in a 20-year single-center pediatric NPC series. Methods. We retrospectively reviewed 24 pediatric patients diagnosed with NPC between 2003 and 2023. Histology was classified according to WHO criteria, and tumors were staged using the AJCC TNM system. Overall survival (OS) and event-free survival (EFS) were estimated using the Kaplan–Meier method. Survival distributions were compared using the log-rank test. Late treatment-related toxicities documented during follow-up were recorded descriptively. Results: Twenty-four patients with WHO type III NPC were included. Fourteen patients had stage III disease and 10 had stage IV disease; three had distant metastasis at diagnosis. The median follow-up duration was 50.5 months. At last follow-up, 19 patients were alive and five had died. The estimated 5- and 10-year OS rates were both 72.7%, and the corresponding EFS rates were both 63.7%. Stage IV disease and metastatic presentation were associated with inferior OS. Dysphagia, malnutrition, xerostomia, fibrosis, hypothyroidism, and deafness were the most frequently recorded adverse health effects. Conclusions: This 20-year single-center experience shows that AJCC stage and metastatic status remain key determinants of survival in pediatric NPC. The high burden of late treatment-related complications highlights the importance of integrating long-term multidisciplinary survivorship surveillance into the care of pediatric NPC survivors. Full article

Background/Objectives: Glucose transporter type 1 deficiency syndrome (GLUT1DS) is a rare neurometabolic disorder with an expanding clinical spectrum, including mild and non-classical presentations. We report a boy with severe transient neonatal hyperkalemia, bilateral congenital cataracts, and later subtle neurological and neurocognitive symptoms, in whom genomic testing supported the diagnosis of mild GLUT1DS. Methods: This single-patient case report describes clinical follow-up from birth to nine years of age, including neurological, metabolic, neuropsychological, imaging, and genetic investigations. Whole-exome sequencing using next-generation sequencing technology was performed. Results: The patient required intensive care immediately after birth because of severe transient hyperkalemia of unclear etiology. Bilateral congenital cataracts were surgically corrected during infancy. Later, he developed two brief seizure episodes, reduced exercise tolerance, episodic fatigue, attentional difficulties, motor restlessness, and mild graphomotor impairment. Neuropsychological assessment showed overall average intellectual functioning, below-average verbal abilities, low-average non-verbal abilities, and attention-deficit/hyperactivity disorder. Repeated metabolic investigations, electroencephalography, and brain magnetic resonance imaging were unrevealing. Whole-exome sequencing identified an apparently de novo heterozygous SLC2A1 variant, NM_006516.4.1333_1335del, p.(Phe445del), supporting the diagnosis of mild GLUT1DS. Because of the mild phenotype and preserved everyday functioning, ketogenic diet therapy was not initiated. Conclusions: This case highlights the diagnostic challenges of mild GLUT1DS and the value of genomic testing in children with unexplained neurological or neurocognitive symptoms despite normal routine investigations. Although neonatal hyperkalemia and GLUT1DS coexisted in this patient, current evidence is insufficient to establish a causal relationship. Full article

Background/Objectives: Despite overall excellent outcomes for Wilms tumour, regional variations in stage at diagnosis and care pathways remain a concern across Europe. We evaluated stage distribution, three-year survival, and treatment patterns in Italy, considering hospital care as a proxy for healthcare capacity and migration. Methods: Data were obtained from 26 population-based cancer registries (PBCRs), covering 148 patients (ages 0–14) diagnosed between 2013 and 2017, representing about 80% of the Italian population. Stage was classified according to the Toronto guidelines. Information on treatment and diagnosed/treating hospitals was collected. Stage at diagnosis was further refined using probabilistic linkage with the clinical registry 1.01 Model. Overall survival, defined as all-cause mortality, was estimated using the Kaplan–Meier method. Results: Most patients presented with localized disease (77%), 32% Stage I, while 19% were Stage IV. Three-year survival analysis showed significant differences between stages, ranging from 98% in patients with Stage I to 78% in the ones with Stage IV. No significant disparity across the Italian regions was observed in stage distribution or survival. Diagnoses and treatments were mostly (>90%) centralized in the same region for patients residing in the Centre or North of Italy. However, the cross-regional health migration from the South was of about 30% for diagnosis and larger for treatments. Conclusions: This study shows that standardized staging improves data comparability and highlights challenges in managing metastatic cases and regional care pathways. The results support the use of clinical and PBCR information to interpret survival patterns and guide improvements in paediatric oncology care. Full article

Background: Neuroendocrine tumors—are relatively rare but increasingly diagnosed malignancies originating from diffuse neuroendocrine cells, most commonly affecting the gastroenteropancreatic system. Due to their long asymptomatic development and low incidence, pose a diagnostic and therapeutic challenge for physicians. Recently, the role of nuclear medicine has been growing not only in the diagnostic stage but also in treatment. Systemic radionuclide therapy using somatostatin analogs labelled with the radioisotope lutetium-177 is becoming increasingly common in patients with advanced-stage disease. Currently, most patients receive a standard activity of therapeutic radiopharmaceuticals. Recent clinical studies provide increasing evidence of a close relationship between the absorbed radiation dose in pathological lesions and the therapeutic effect of radioisotope therapy. Internal dosimetry is used to measure the doses of ionising radiation absorbed by the patient after administration of the radiopharmaceutical. The lack of individual internal dosimetry prior to therapy means that only a small fraction of patients receive optimal doses of radioactivity, which is markedly different from external beam radiotherapy planning. Methods: A narrative literature review was conducted using the PubMed/MEDLINE and Embase databases, focusing primarily on publications from the last years. The search strategy included combinations of keywords related to peptide receptor radionuclide therapy and dosimetry, such as “Lutetium-177”, “neuroendocrine tumors”, “dosimetry”, “PRRT”, “systemic radionuclide therapy” and “artificial intelligence”. Particular emphasis was placed on recent prospective clinical studies, multicenter investigations, systematic reviews and consensus documents published by major nuclear medicine societies, including the European Association of Nuclear Medicine (EANM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). Seminal earlier publications considered essential for understanding the development of dosimetry concepts and clinical implementation were also included. Results: This study confirms the existence of a clinically significant dose-response relationship in ¹⁷⁷Lu-PRRT. Higher absorbed doses to tumour lesions are associated with longer progression-free survival. The lack of individualized internal dosimetry prior to therapy means that only a small proportion of patients receive optimal radiation doses. Simplified dosimetric approaches with a reduced number of imaging time points, together with emerging artificial intelligence–based tools, appear promising for reducing the complexity of the dosimetry process. Conclusions: The aim of this study was to analyse the current literature on the role of internal dosimetry in the treatment of neuroendocrine tumors using the radioisotope lutetium-177. Available data support the clinical relevance of individualized dosimetry and highlight its potential to optimize both therapeutic efficacy and treatment safety. Full article

Background: Multiparameter flow cytometry is widely used in the diagnosis of acute leukemia, allowing for rapid identification of leukemic cells based on their immunophenotype. The EuroFlow Acute Leukemia Orientation Tube was designed as a standardized screening tool to support early diagnostic orientation and guide further, more targeted testing. In this study, we assessed the diagnostic performance of the ALOT panel in pediatric patients with suspected acute leukemia. Methods: A total of 254 pediatric patients (0–18 years) with suspected acute leukemia were analyzed. Bone marrow samples were assessed using multiparameter flow cytometry with the EuroFlow ALOT panel, comprising eight markers (MPO, cyCD79a, CD34, CD19, CD3, cyCD3, CD7, and CD45). Final diagnoses were established using extended immunophenotypic panels and additional diagnostic methods when required. Samples were processed according to EuroFlow standard operating procedures and acquired on FACSCanto II and FACSCanto 10-color flow cytometers (BD Biosciences). Diagnostic performance was assessed by calculating sensitivity, specificity, precision, accuracy, and negative predictive value. Results: Among 254 patients, 234 were diagnosed with hematologic disorders, while 20 had normal bone marrow findings. The ALOT panel correctly identified all pathological samples and did not misclassify any normal sample, resulting in 100% sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for discrimination between abnormal and normal samples. In terms of exact diagnostic orientation, ALOT correctly classified 244 of 254 cases (96.1%) using a single-tube approach. The remaining 10 cases (3.9%), including rare entities such as Burkitt leukemia, chronic myeloid leukemia, and transient myeloproliferative syndrome, required extended immunophenotypic evaluation. Importantly, these cases were not false negative results, as all were correctly identified as abnormal. Conclusions: The EuroFlow ALOT panel is a reliable screening tool for rapid diagnostic orientation in pediatric acute leukemia. Its implementation facilitates targeted selection of extended immunophenotypic panels, improving the efficiency and cost-effectiveness of diagnostic workflows. Full article