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Fioredda F, Onofrillo D, Farruggia P, Barone A, Veltroni M, Notarangelo LD, Menna G, Russo G, Martire B, Finocchi A, Verzegnassi F, Bonanomi S, Ramenghi U, Pillon M, Dufour C. Diagnosis and management of neutropenia in children: The approach of the Study Group on Neutropenia and Marrow Failure Syndromes of the Pediatric Italian Hemato-Oncology Association (Associazione Italiana Emato-Oncologia Pediatrica - AIEOP). Pediatr Blood Cancer 2022; 69:e29599. [PMID: 35253359 DOI: 10.1002/pbc.29599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/09/2022]
Abstract
Neutropenia refers to a group of diseases characterized by a reduction in neutrophil levels below the recommended age threshold. The present study aimed to review the diagnosis and management of neutropenia, including a diagnostic toolkit and candidate underlying genes. This study also aimed to review the progress toward the definition of autoimmune and idiopathic neutropenia rising in infancy or in late childhood but without remission, and provide suggestions for efficient diagnostics, including indications for the bone marrow and genetic testing. The management and treatment protocols for common and unique presentations are also reviewed, providing evidence tailored to a single patient.
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Affiliation(s)
| | - Daniela Onofrillo
- Pediatric Hematology and Oncology Unit, Department of Hematology, Spirito Santo Hospital, Pescara, Italy
| | - Piero Farruggia
- Department of Pediatric Onco-Hematology, University Hospital, Parma, Italy
| | - Angelica Barone
- Pediatric Hematology and Oncology Unit, ARNAS (Azienda di Rilievo Nazionale ad Alta Specializzazione) Ospedale Civico, Palermo, Italy
| | - Marinella Veltroni
- Department of Pediatric Onco-Hematology, Meyer Children's Hospital, Florence, Italy
| | - Lucia Dora Notarangelo
- Oncology-Haematology and Bone Marrow Transplantation Unit, Children's Hospital, Brescia, Italy
| | - Giuseppe Menna
- AORN (Azienda Ospedaliera Rilievo Nazionale), Santobono Pausillipon, Naples, Italy
| | - Giovanna Russo
- Pediatric Ematologi and Oncology Unit, Azienda Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Baldassarre Martire
- Unit of Pediatrics and Neonatology, "Monsignor Dimiccoli" Hospital, Barletta, Italy
| | - Andrea Finocchi
- Unit of Immune and Infectious Disease, University Department of Pediatrics DPUO, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Federico Verzegnassi
- Institute of Maternal and Child Health, IRCCS Burlo Garofalo, Trieste, Italy.,Department of Pediatric Hematology, San Gerardo Hospital, Monza, Italy
| | - Sonia Bonanomi
- MBBM (Monza e Brianza per Bambino e Mamma) Foundation, Department of Pediatrics, University of Milano - Bicocca, Monza, Italy
| | - Ugo Ramenghi
- Department of Pediatric and Public Health Sciences, University of Torino, Turin, Italy
| | - Marta Pillon
- Pediatric Onco-Hematology Unit, University Hospital of Padua, Padua, Italy
| | - Carlo Dufour
- Unit of Haematology, IRCCS - Istituto Giannina Gaslini, Genoa, Italy
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Yılmaz Karapınar D, Patıroğlu T, Metin A, Çalışkan Ü, Celkan T, Yılmaz B, Karakaş Z, Karapınar TH, Akıncı B, Özkınay F, Onay H, Yeşilipek MA, Akar HH, Tüysüz G, Tokgöz H, Özdemir GN, Aslan Kıykım A, Karaman S, Kılınç Y, Oymak Y, Küpesiz A, Olcay L, Keskin Yıldırım Z, Aydoğan G, Gökçe M, İleri T, Aral YZ, Bay A, Atabay B, Kaya Z, Söker M, Özdemir Karadaş N, Özbek U, Özsait Selçuk B, Özdemir HH, Uygun V, Tezcan Karasu G, Yılmaz Ş. Homozygous c.130-131 ins A (pW44X) mutation in the HAX1 gene as the most common cause of congenital neutropenia in Turkey: Report from the Turkish Severe Congenital Neutropenia Registry. Pediatr Blood Cancer 2019; 66:e27923. [PMID: 31321910 DOI: 10.1002/pbc.27923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Severe congenital neutropenia is a rare disease, and autosomal dominantly inherited ELANE mutation is the most frequently observed genetic defect in the registries from North America and Western Europe. However, in eastern countries where consanguineous marriages are common, autosomal recessive forms might be more frequent. METHOD Two hundred and sixteen patients with severe congenital neutropenia from 28 different pediatric centers in Turkey were registered. RESULTS The most frequently observed mutation was HAX1 mutation (n = 78, 36.1%). A heterozygous ELANE mutation was detected in 29 patients (13.4%) in our cohort. Biallelic mutations of G6PC3 (n = 9, 4.3%), CSF3R (n = 6, 2.9%), and JAGN1 (n = 2, 1%) were also observed. Granulocyte colony-stimulating factor treatment was given to 174 patients (80.6%). Two patients died with infectious complications, and five patients developed myelodysplastic syndrome/acute myeloblastic leukemia. The mean (± mean standard error) follow-up period was 129.7 ± 76.3 months, and overall survival was 96.8% (CI, 94.4-99.1%) at the age of 15 years. In Turkey, severe congenital neutropenia mostly resulted from the p W44X mutation in the HAX1 gene. CONCLUSION In Turkey, mutation analysis should be started with HAX1, and if this is negative, ELANE and G6PC3 should be checked. Because of the very high percentage of consanguineous marriage, rare mutations should be tested in patients with a negative mutation screen.
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Affiliation(s)
| | - Türkan Patıroğlu
- Department of Pediatric Immunology, Erciyes University Faculty of Medicine, İzmir, Turkey
| | - Ayşe Metin
- Department of Pediatric Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ümran Çalışkan
- Department of Pediatric Hematology-Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Tiraje Celkan
- Department of Pediatric Hematology, Cerrahpaşa Medical Faculty, İstanbul University, Istanbul, Turkey
| | - Barış Yılmaz
- Department of Pediatric Hematology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Zeynep Karakaş
- Department of Pediatric Hematology-Oncology, İstanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Tuba H Karapınar
- Department of Pediatric Hematology-Oncology, Dr. Behçet Uz Children Research and Training Hospital, İzmir, Turkey
| | - Burcu Akıncı
- Department of Pediatric Hematology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ferda Özkınay
- Department of Pediatric Genetic, Ege University Faculty of Medicine, İzmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetic, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mehmet Akif Yeşilipek
- Pediatric Bone Marrow Transplantation Unit, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Himmet Haluk Akar
- Department of Pediatric Immunology, Erciyes University Faculty of Medicine, İzmir, Turkey
| | - Gülen Tüysüz
- Department of Pediatric Hematology, Akdeniz University Medical School, Antalya, Turkey
| | - Hüseyin Tokgöz
- Department of Pediatric Hematology-Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gül Nihal Özdemir
- Department of Pediatric Hematology, Cerrahpaşa Medical Faculty, İstanbul University, Istanbul, Turkey
| | - Ayça Aslan Kıykım
- Department of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Serap Karaman
- Department of Pediatric Hematology-Oncology, İstanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yurdanur Kılınç
- Department of Pediatric Hematology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Yeşim Oymak
- Department of Pediatric Hematology-Oncology, Dr. Behçet Uz Children Research and Training Hospital, İzmir, Turkey
| | - Alphan Küpesiz
- Department of Pediatric Hematology, Akdeniz University Medical School, Antalya, Turkey
| | - Lale Olcay
- Department of Pediatric Hematology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Zuhal Keskin Yıldırım
- Department of Pediatric Hematology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Gönül Aydoğan
- Department of Pediatric Hematology, Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Müge Gökçe
- Department of Pediatric Bone marrow Transplantation Unit, Yeni Yüzyıl Üniversitesi, Gaziosmanpaşa Hastanesi, Istanbul, Turkey
| | - Talia İleri
- Department of Pediatric Hematology, Ankara University Medical Faculty, Ankara, Turkey
| | - Yusuf Ziya Aral
- Department of Pediatric Hematology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Ali Bay
- Department of Pediatric Hematology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Berna Atabay
- Department of Pediatric Hematology, Tepecik Teaching and Research Hospital, İzmir, Turkey
| | - Zuhre Kaya
- Department of Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Murat Söker
- Department of Pediatric Hematology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | | | - Uğur Özbek
- Department of Genetics, İstanbul University Faculty of Medicine, Istanbul, Turkey
| | - Bilge Özsait Selçuk
- Department of Genetics, İstanbul University Faculty of Medicine, Istanbul, Turkey
| | - Hamiyet Hekimci Özdemir
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Vedat Uygun
- Pediatric Bone Marrow Transplantation Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Gülsün Tezcan Karasu
- Pediatric Bone Marrow Transplantation Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Şebnem Yılmaz
- Department of Pediatric Hematology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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