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Zatarah R, Faqeer N, Mahmoud A, Quraan T, Matalka L, Kamal A, Nazer L. Validation of the CSRFENCE score for prediction of febrile neutropenia during chemotherapy cycles 2-6. Discov Oncol 2022; 13:107. [PMID: 36251222 PMCID: PMC9576834 DOI: 10.1007/s12672-022-00575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/08/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Though febrile neutropenia (FN) risk prediction models are important in clinical practice, their external validation is limited. In this study, we validated the Cycle-Specific Risk of FEbrile Neutropenia after ChEmotherapy (CSRFENCE) score for predicting FN. METHODS We reviewed the medical records of patients with solid malignancies and diffuse large B-cell lymphoma during chemotherapy cycles 2-6 and recorded if patients developed FN, defined as absolute neutrophil counts less than 500 cells/microL with fever more than or equal to 38.2 ℃. The CSRFENCE score was determined by adding the risk factors' coefficients described by the original study; subsequently, the score was used to classify chemotherapy cycles into the following risk groups for developing FN: low, intermediate, high, and very high risk. The discriminatory ability of the score was assessed using area under the receiver operating characteristics curve (AUROCC) and incidence rate ratios (IRR) within each CSRFENCE risk group. RESULTS We analyzed 2870 chemotherapy cycles, of which 42 (1.5%) were associated with FN. Among those, 3 (7.1%), 14 (33.3%), 5 (12%), and 20 (47.6%) were classified as low, intermediate, high, and very high risk for developing FN, respectively. The AUROCC was 0.72 (95% CI 0.64-0.81). Compared with the low risk group (n = 666), the IRR of developing FN was 1.01 (95% CI 0.15-43.37), 0.69 (95% CI 0.08-32.46) and 1.17 (95% CI 0.17-49.49) in the intermediate (n = 1431), high (n = 498) and very high (n = 275) risk groups, respectively. CONCLUSION The CSRFENCE model can moderately stratify patients into four risk groups for predicting FN prior to chemotherapy cycles 2-6.
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Affiliation(s)
- Razan Zatarah
- Department of Pharmacy, King Hussein Cancer Center, Queen Rania Street, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan.
| | - Nour Faqeer
- Department of Pharmacy, King Hussein Cancer Center, Queen Rania Street, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan
| | - Aseel Mahmoud
- Department of Pharmacy, King Hussein Cancer Center, Queen Rania Street, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan
| | - Tasnim Quraan
- Department of Pharmacy, King Hussein Cancer Center, Queen Rania Street, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan
| | - Lujain Matalka
- Department of Pharmacy, King Hussein Cancer Center, Queen Rania Street, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan
| | - Aya Kamal
- Department of Pharmacy, King Hussein Cancer Center, Queen Rania Street, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan
| | - Lama Nazer
- Department of Pharmacy, King Hussein Cancer Center, Queen Rania Street, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan
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Agegnew Wondm S, Dagnew EM, Tadesse Abegaz S, Kiflu M, Kebede B. Burden, risk factors, and management of neutropenic fever among solid cancer patients in Ethiopia. SAGE Open Med 2022; 10:20503121221098236. [PMID: 35646361 PMCID: PMC9130822 DOI: 10.1177/20503121221098236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/14/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives: Although neutropenic fever is one of the most well-known oncologic
emergencies and the common causes of death, a few studies have been
conducted in resource-limited countries, particularly in Ethiopia. This
study aimed to assess the burden, risk factors, and management of
neutropenic fever among solid cancer patients in Ethiopia. Methods: A hospital-based retrospective follow-up study was conducted from January
2017 to February 2021. Data were collected from patient’s medical charts
using a structured data abstraction format and analyzed using STATA version
14.2. Logistic regression analyses were used to identify independent
predictors of neutropenic fever, and a p-value of < 0.05
was considered statistically significant. Results: A total of 416 patients were included, with a mean age of 51 ± 14 years. The
cumulative incidence of neutropenic fever was 13%. Advanced age, low
baseline white blood cell, prolonged duration of neutropenia, and presence
of two or more comorbidities were factors significantly associated with
neutropenic fever (p < 0.05). Among patients who need
primary prophylaxis, 68% of patients did not get appropriate primary
prophylaxis, and 30%, 71%, and 93% of prescribed anti-bacterial,
anti-fungal, and anti-viral agents were inappropriate according to
Infectious Disease Society of America Guideline, respectively. Conclusion: Neutropenic fever was common among solid cancer patients and it is
multifactorial. The rate of guideline adherence during prophylaxis and
treatment of neutropenic fever was poor. Health care professionals should be
aware of these risk factors, and greater effort is needed to reduce the risk
of neutropenic fever.
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Affiliation(s)
- Samuel Agegnew Wondm
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Ephrem Mebratu Dagnew
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Sumeya Tadesse Abegaz
- Clinical Pharmacy Department, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mekdes Kiflu
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bekalu Kebede
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Risk Factors for Infections, Antibiotic Therapy, and Its Impact on Cancer Therapy Outcomes for Patients with Solid Tumors. Life (Basel) 2021; 11:life11121387. [PMID: 34947918 PMCID: PMC8705721 DOI: 10.3390/life11121387] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022] Open
Abstract
Infections represent a significant cause of morbidity and mortality in cancer patients. Multiple factors related to the patient, tumor, and cancer therapy can affect the risk of infection in patients with solid tumors. A thorough understanding of such factors can aid in the identification of patients with substantial risk of infection, allowing medical practitioners to tailor therapy and apply prophylactic measures to avoid serious complications. The use of novel treatment modalities, including targeted therapy and immunotherapy, brings diagnostic and therapeutic challenges into the management of infections in cancer patients. A growing body of evidence suggests that antibiotic therapy can modulate both toxicity and antitumor response induced by chemotherapy, radiotherapy, and especially immunotherapy. This article provides a comprehensive review of potential risk factors for infections and therapeutic approaches for the most prevalent infections in patients with solid tumors, and discusses the potential effect of antibiotic therapy on toxicity and efficacy of cancer therapy.
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Brunello A, Galiano A, Finotto S, Monfardini S, Colloca G, Balducci L, Zagonel V. Older cancer patients and COVID-19 outbreak: Practical considerations and recommendations. Cancer Med 2020; 9:9193-9204. [PMID: 33219746 PMCID: PMC7774711 DOI: 10.1002/cam4.3517] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
Since the COVID-19 outbreak started, it has been affecting mainly older individuals. Among the most vulnerable older individuals are those with cancer. Many published guidelines and consensus papers deal with prioritizing cancer care. Given the lack of high-quality evidence for management of cancer in older patients also in normal times, it is even more stringent to provide some resources on how to avoid both undertreatment and overtreatment in this population, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated. We hereby discuss some general recommendations (implement triage procedures; perform geriatric assessment; carefully assess comorbidity; promote early integration of palliative care in oncology; acknowledge the role of caregivers; maintain active take in charge to avoid feeling of abandonment; mandate seasonal flu vaccination) and discuss practical suggestions for specific disease settings (early-stage and advanced-stage disease for solid tumors, and hematological malignancies). The manuscript provides resources on how to avoid both undertreatment and overtreatment in older patients with cancer, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated.
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Affiliation(s)
- Antonella Brunello
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
| | - Antonella Galiano
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
| | - Silvia Finotto
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
| | | | - Giuseppe Colloca
- Dipartimento di Diagnostica per ImmaginiRadioterapia Oncologica ed EmatologiaIstituto di RadiologiaFondazione Policlinico A. Gemelli IRCCS ‐ Università Cattolica Sacro CuoreRomaItaly
| | - Lodovico Balducci
- Moffitt Cancer CenterUniversity of South Florida College of MedicineTampaFloridaUSA
| | - Vittorina Zagonel
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
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Aagaard T, Reekie J, Jørgensen M, Roen A, Daugaard G, Specht L, Sengeløv H, Mocroft A, Lundgren J, Helleberg M. Mortality and admission to intensive care units after febrile neutropenia in patients with cancer. Cancer Med 2020; 9:3033-3042. [PMID: 32144897 PMCID: PMC7196064 DOI: 10.1002/cam4.2955] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 01/06/2020] [Accepted: 02/19/2020] [Indexed: 12/13/2022] Open
Abstract
Febrile neutropenia (FN) is a critical complication of chemotherapy associated with increased in‐hospital mortality. However, associations with increased mortality and intensive care unit (ICU) admissions during longer follow‐up are not established. Patients treated with standard first‐line chemotherapy for solid cancers at Rigshospitalet, Denmark in 2010‐2016 were included. Incidence rate ratios (IRR) of all‐cause, infectious and cardiovascular mortality, and ICU admissions after FN were analyzed by Poisson regression. Risk factors at the time of FN were analyzed in the subpopulation of patients with FN; all‐cause mortality was further stratified by the time periods 0‐30, 31‐365, and 366+ days after FN. We included 9018 patients with gastric (14.4%) and breast (13.1%) cancer being the most common, 51.2% had locally advanced or disseminated disease and the patients had a median Charlson Comorbidity Index score of 0 (interquartile range, 0‐0). During follow‐up, 845 (9.4%) experienced FN and 4483 (49.7%) died during 18 775 person‐years of follow‐up. After adjustment, FN was associated with increased risk of all‐cause mortality, infectious mortality, and ICU admissions with IRRs of 1.39 (95% CI, 1.24‐1.56), 1.94 (95% CI, 1.43‐2.62), and 2.28 (95% CI, 1.60‐3.24). Among those with FN, having a positive blood culture and low lymphocytes were associated with excess risk of death and ICU admissions (predominantly the first 30 days after FN), while elevated C‐reactive protein and low hemoglobin predicted mortality the first year after FN. The risk of death varied according to the time since FN; adjusted IRR per additional risk factor present for the time periods 0‐30, 31‐365, and 366+ days after FN were 2.00 (95% CI, 1.45‐2.75), 1.36 (95% CI, 1.17‐1.57), and 1.17 (95% CI, 0.98‐1.41). FN was associated with increased mortality and risk of ICU admissions. An objectively identifiable subgroup of patients among those with FN carried this excess risk.
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Affiliation(s)
- Theis Aagaard
- Centre of Excellence for Health, Immunity and Infections (CHIP)RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Joanne Reekie
- Centre of Excellence for Health, Immunity and Infections (CHIP)RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Mette Jørgensen
- Centre of Excellence for Health, Immunity and Infections (CHIP)RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Ashley Roen
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Gedske Daugaard
- Department of OncologyRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Lena Specht
- Department of OncologyRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Henrik Sengeløv
- Department of HaematologyRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP)RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Marie Helleberg
- Centre of Excellence for Health, Immunity and Infections (CHIP)RigshospitaletUniversity of CopenhagenCopenhagenDenmark
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A comparative effectiveness study of lipegfilgrastim in multiple myeloma patients after high dose melphalan and autologous stem cell transplant. Ann Hematol 2019; 99:331-341. [PMID: 31853703 DOI: 10.1007/s00277-019-03901-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/11/2019] [Indexed: 12/16/2022]
Abstract
G-CSF administration after high-dose chemotherapy and autologous stem cell transplantation (ASCT) has been shown to expedite neutrophil recovery. Several studies comparing filgrastim and pegfilgrastim in the post-ASCT setting concluded that the two are at least equally effective. Lipegfilgrastim (LIP) is a new long-acting, once-per-cycle G-CSF. This multicentric, prospective study aimed to describe the use of LIP in multiple myeloma patients receiving high-dose melphalan and autologous stem cell transplantation (ASCT) and compare LIP with historic controls of patients who received short-acting agent (filgrastim [FIL]). Overall, 125 patients with a median age of 60 years received G-CSF after ASCT (80 patients LIP on day 1 post-ASCT and 45 patients FIL on day 5 post-ASCT). The median duration of grade 4 neutropenia (absolute neutrophil count [ANC] < 0.5 × 10 [9]/L) was 5 days in both LIP and FIL groups, whereas the median number of days to reach ANC ≥ 0.5 × 10 [9]/L was 10% lower in the LIP than in the FIL group (10 vs 11 days), respectively. Male sex was significantly associated with a faster ANC ≥ 0.5 × 10 [9] L response (p = 0.015). The incidence of FN was significantly lower in the LIP than in the FIL group (29% vs 49%, respectively, p = 0.024). The days to discharge after ASCT infusion were greater in patients with FN (p < 0.001). The study indicates that LIP had a shorter time to ANC recovery and is more effective than FIL for the prevention of FN in the ASCT setting.
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Wareham NE, Li Q, Sengeløv H, Da Cunha-Bang C, Gustafsson F, Heilmann C, Perch M, Rasmussen A, Sørensen SS, Mocroft A, Lundgren JD. "Risk of de novo or secondary cancer after solid organ or allogeneic haematopoietic stem cell transplantation". J Cancer Res Clin Oncol 2019; 145:3125-3135. [PMID: 31587105 DOI: 10.1007/s00432-019-03039-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 09/25/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Solid organ (SOT) and allogeneic haematopoietic stem cell (HSCT) transplant recipients have elevated risks of de novo or secondary cancer. We explored risk factors hereof. METHODS Among SOT and HSCT between January 2004 and December 2014, standardised incidence ratio (SIR) of de novo/secondary cancer compared with the Danish population was determined and risk factors were identified using Poisson regression. RESULTS During a median of 3.4 (IQR 1.3-6.4) and 2.6 (0.8-5.4) person-years (PY) after SOT and HSCT, a total of 212/1656 (13%) and 75/992 (8%) persons developed cancer; SIR 3.61 (3.0-4.3) and 2.2 (1.6-3.0), resp.). SIR correlated with younger age and was highest for skin and haematological cancers for both types of transplantation. Within the cohort, cancer was associated with older age (adjusted incidence rate ratio > 50 vs ≤ 19 years, among SOT and HSCT: 9.4 (3.4-25.7) and 25.4 (5.1-126.0), resp.) and current elevated C-reactive protein (CRP) (≥ 10 vs < 10 mg/L: 2.5 (1.8-3.4) and 2.3 (1.4-3.9), resp.), but neither with prior cancer nor type of immunosuppressants. CONCLUSION Rates of de novo or secondary cancers are elevated in both SOT and HSCT compared with the general population and mainly for skin and haematological cancers. Among transplant recipients, older age and current elevated CRP are risk factors.
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Affiliation(s)
- Neval E Wareham
- CHIP, Department of Infectious Diseases, Centre for Cardiac, Pulmonary and Infectious Diseases Vascular, University of Copenhagen, Rigshospitalet, Section 2100, Blegdamsvej 9, 2100 Copenhagen, Copenhagen Ø, Denmark.
| | - Qiuju Li
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), University College London, London, UK
| | - Henrik Sengeløv
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | | | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Michael Perch
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
| | | | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), University College London, London, UK
| | - Jens D Lundgren
- CHIP, Department of Infectious Diseases, Centre for Cardiac, Pulmonary and Infectious Diseases Vascular, University of Copenhagen, Rigshospitalet, Section 2100, Blegdamsvej 9, 2100 Copenhagen, Copenhagen Ø, Denmark
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Nordvig J, Aagaard T, Daugaard G, Brown P, Sengeløv H, Lundgren J, Helleberg M. Febrile Neutropenia and Long-term Risk of Infection Among Patients Treated With Chemotherapy for Malignant Diseases. Open Forum Infect Dis 2018; 5:ofy255. [PMID: 30377628 PMCID: PMC6201153 DOI: 10.1093/ofid/ofy255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/12/2018] [Indexed: 11/14/2022] Open
Abstract
Background Febrile neutropenia (FN) is a common complication to chemotherapy, associated with increased short-term morbidity and mortality. However, the long-term outcomes after FN are poorly elucidated. We examined the long-term risk of infection and mortality rates in cancer patients with and without FN. Methods Patients aged >16 years treated with firstline chemotherapy were followed from 180 days after initiating chemotherapy until first infection, a new treatment with chemotherapy, death, or end of follow-up. Risk factors for infections were analyzed by competing risks regression, with death or another treatment with chemotherapy as competing events. Adjusted incidence rate ratios (aIRRs) of infection and death were analyzed using Poisson regression. In analyses of mortality, infection was included as a time-updated variable. Results We included 7190 patients with a median follow-up (interquartile range) of 0.58 (0.20–1.71) year. A total of 1370 patients had an infection during follow-up. The aIRRs of infection were 1.86 (95% confidence interval [CI], 1.56–2.22) and 2.19 (95% CI, 1.54–3.11) for patients with 1 or >1 episode of FN compared with those without FN. Mortality rate ratios were 7.52 (95% CI, 6.67–8.48) <1 month after, 4.24 (95% CI, 3.80–4.75) 1–3 months after, 2.33 (95% CI, 1.63–3.35) 3–6 months after, and 1.09 (95% CI, 0.93–1.29) >6 months after an infection, compared with the time before infection. Conclusions FN during chemotherapy is associated with a long-term increased risk of infection. Mortality rates are substantially increased for 6 months following an infection.
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Affiliation(s)
- Josefine Nordvig
- Centre for Health, Immunity and Infections (CHIP), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Theis Aagaard
- Centre for Health, Immunity and Infections (CHIP), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Peter Brown
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Henrik Sengeløv
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jens Lundgren
- Centre for Health, Immunity and Infections (CHIP), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Marie Helleberg
- Centre for Health, Immunity and Infections (CHIP), Copenhagen University Hospital, Rigshospitalet, Denmark
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