Screening and Data Abstraction
We utilized Covidence® web-based systematic review software for screening the studies. All screenings were performed in duplicate, and any disagreements were reconciled through group discussion. Four authors (BAS, EG, RMK, and CB) and one additional staff member collaboratively screened the studies in a two-stage format. First, RMK and EG screened titles and abstracts. In this stage, only studies that included patients with VAs treated with an mTOR inhibitor were accepted. Second, RMK, EG, CB, and another staff member completed a full text review to confirm that included studies reported on infections in this population. In this stage, we indicated reasons for exclusion based on the following: duplicates, wrong intervention, wrong study design or publication type, infection not reported, wrong patient population, or text unavailable in English. We only included studies that explicitly reported infections, because the absence of reporting infections does not necessarily mean that patients did not experience infections. It is possible that case reports or case series failed to report infections if this was not the focus of their report, or if the infection was minor. At the end of screening, all eligible studies were reviewed by BAS, a pediatric hematologist oncologist with expertise in treating VAs. Two authors (BAS and CB) abstracted data in duplicate from all included studies, reviewed the other’s abstraction, and resolved differences through discussion.