{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:45:52Z","timestamp":1792057552999,"version":"4.4.0"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Background<\/jats:bold>\n                    : Infant and young children medulloblastoma poses significant treatment challenges due to high recurrence rates and the severe neurodevelopmental risks associated with craniospinal irradiation (CSI). Outcome data from low\u2010middle\u2010income countries (LMICs) remain scarce.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods<\/jats:bold>\n                    : A retrospective chart review was conducted for children (age &lt;5 years) diagnosed with medulloblastoma at King Hussein Cancer Center, Jordan, between 2010 and 2023.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results<\/jats:bold>\n                    : Twenty\u2010seven patients were identified. The median age was 2 years (range, 0.5\u20134.3 years) with 78% males, and over half (52%) presented with metastatic disease. Twelve patients (44%) had \u2264 1.5\u00a0cm\n                    <jats:sup>2<\/jats:sup>\n                    residual tumor. Seventeen patients (63%) required ventriculoperitoneal shunt placement. Seven (26%) developed postoperative complications. Ten tumors were of classic histology, eight desmoplastic, six anaplastic, and three MBEN. Sixteen tumors (59%) were molecularly subgrouped: SHH (fourteen), Group\u20103 (two). Patients received various treatment protocols: HeadStart 1&amp;2\u2010like protocols (seventeen), SKK\u201092 (eight), and BBSFOP (two). Although 21 patients were planned for autologous stem cell transplantation (ASCT), only 13 received it (three received SKK\u201092 due to financial constraints, two prematurely stopped therapy, two developed early tumor progression, and one shifted to BBSFOP protocol due to chemotherapy toxicity). At a median follow\u2010up of 7.4 years (range, 2.5\u201316 years), 17 patients (63%) are alive. Twelve patients (44%) are alive in CR1 without radiotherapy (five of whom also avoided ASCT), three in CR2 after CSI\u201036\u00a0Gy, one in CR3 after ASCT then CSI\u201023.4\u00a0Gy, and one patient lost to follow\u2010up after salvage CSI\u201036\u00a0Gy. Two patients developed secondary tumors: one died from high\u2010grade glioma and one developed thyroid carcinoma. Two survivors needed cataract surgery, and four had hearing loss. Ten survivors need hormonal supplements.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions<\/jats:bold>\n                    : Some infants and young children with medulloblastoma can achieve durable cure without ACST or radiotherapy, even in LMICs. While these therapies remain critical salvage options, lifelong comprehensive support is imperative to optimize survival and quality of life.\n                  <\/jats:p>","DOI":"10.1002\/1545-5017.70771","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T08:57:01Z","timestamp":1792054621000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Conquering Infant and Young Children Medulloblastoma in Resource\u2010Limited Settings: Challenges, Opportunities, and Treatment Outcomes"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7972-5885","authenticated-orcid":false,"given":"Nisreen","family":"Amayiri","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Neuro\u2010Oncology King Hussein Cancer Center  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1143-4545","authenticated-orcid":false,"given":"Eman","family":"Khattab","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology Oncology and Bone Marrow Transplantation King Hussein Cancer Center  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3246-0760","authenticated-orcid":false,"given":"Mayada","family":"Abu Shanab","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology Oncology and Bone Marrow Transplantation King Hussein Cancer Center  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6392-150X","authenticated-orcid":false,"given":"Maysa","family":"Al\u2010Hussaini","sequence":"additional","affiliation":[{"name":"Department of Cell Therapy and Applied Genomics King Hussein Cancer Center  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2485-3845","authenticated-orcid":false,"given":"Mouness","family":"Obeidat","sequence":"additional","affiliation":[{"name":"Department of Surgery, Neurosurgery King Hussein Cancer Center  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9455-188X","authenticated-orcid":false,"given":"Bayan","family":"Maraqa","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine King Hussein Cancer Center  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4681-4726","authenticated-orcid":false,"given":"Hasan","family":"Hashem","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology Oncology and Bone Marrow Transplantation King Hussein Cancer Center  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6256-861X","authenticated-orcid":false,"given":"Ahmad Kh.","family":"Ibrahimi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology King Hussein Cancer Center  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4610-6272","authenticated-orcid":false,"given":"Rawad","family":"Rihani","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology Oncology and Bone Marrow Transplantation King Hussein Cancer Center  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasim","family":"Sarhan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology King Hussein Cancer Center  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6832-6539","authenticated-orcid":false,"given":"Eric","family":"Bouffet","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Neuro\u2010Oncology The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.02730"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2021.2224"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13311\u2010022\u201001273\u20100"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1093\/neuonc\/nor025","article-title":"Treatment of Young Children With Localized Medulloblastoma by Chemotherapy Alone: Results of the Prospective, Multicenter Trial HIT 2000 Confirming the Prognostic Impact of Histology","volume":"13","author":"Bueren A. 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