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Chen Y, Fang C, Yang Z, Qiu G, Tang S. Hypercalcemia in children induced by denosumab: a case report and an analysis of the FDA adverse event reporting system database. Expert Opin Drug Saf 2024:1-12. [PMID: 39007894 DOI: 10.1080/14740338.2024.2379446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/22/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND The potential risks of denosumab on pediatric patients have raised concerns about its safety. This article aims to analyze the adverse effects of denosumab in minors, with a specific focus on hypercalcemia. RESEARCH DESIGN AND METHODS A case study involving a child was analyzed. The OpenVigil 2.1 was utilized to extract adverse event data from the FAERS database, focusing on denosumab as the primary suspect drug in pediatric patients. The study also reviewed published cases of children developing hypercalcemia after discontinuing denosumab. RESULTS The incidence of denosumab induced hypercalcemia in individuals under 18 years old is significantly higher than the overall incidence. The signal value for hypercalcemia was higher in the male group and was highest in the adolescent group. Hypercalcemia usually appeared approximately 4 months after denosumab discontinuation. Males had a higher peak blood calcium level. Patients aged 0-11 years had a higher average peak serum calcium compared to aged 12-17 years. CONCLUSIONS This study highlights the risk of hypercalcemia after discontinuation of denosumab in minors, with young age and male gender identified as potential high-risk factors. These findings offer valuable safety warnings and preventative measures for the secure administration of this drug in pediatric populations.
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Affiliation(s)
- Yiyu Chen
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chuxuan Fang
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhiyong Yang
- Department of PICU, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guosheng Qiu
- Department of PICU, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shuangyi Tang
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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2
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Liu X, Xie Y, Tang J, Zhong J, Lan D. Hypercalcemia in Children Following a Discontinuation of Denosumab Therapy: A Case Report and Literature Review. Clin Pediatr (Phila) 2024; 63:750-754. [PMID: 37594083 DOI: 10.1177/00099228231194427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- Xu Liu
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yanshu Xie
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jing Tang
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jingzi Zhong
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dan Lan
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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3
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Vanderniet JA, Szymczuk V, Högler W, Beck-Nielsen SS, Uday S, Merchant N, Crane JL, Ward LM, Boyce AM, Munns CF. Management of RANKL-mediated Disorders With Denosumab in Children and Adolescents: A Global Expert Guidance Document. J Clin Endocrinol Metab 2024; 109:1371-1382. [PMID: 38041865 PMCID: PMC11031248 DOI: 10.1210/clinem/dgad657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 12/04/2023]
Abstract
CONTEXT Denosumab is an effective treatment for many receptor activator of nuclear factor kappa-B ligand (RANKL)-mediated disorders but there are potential safety considerations and limited data to guide its use in children and adolescents. OBJECTIVE This document seeks to summarize the evidence and provide expert opinion on safe and appropriate use of denosumab in pediatric RANKL-mediated disorders. PARTICIPANTS Ten experts in pediatric bone and mineral medicine from 6 countries with experience in the use of denosumab participated in the creation of this document. EVIDENCE Data were sourced from the published literature, primarily consisting of case reports/series and review articles because of the lack of higher level evidence. Expert opinion of the authors was used substantially when no published data were available. CONCLUSION Denosumab is an effective treatment for RANKL-mediated disorders in children and adolescents but is often not curative and, in some cases, is best used in conjunction with surgical or other medical treatments. Careful multidisciplinary planning is required to define the goals of treatment and expert oversight needed to manage the risk of mineral abnormalities. Substantive, collaborative research efforts are needed to determine optimal treatment regimens and minimize risks.
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Affiliation(s)
- Joel A Vanderniet
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney and Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia
| | - Vivian Szymczuk
- Metabolic Bone Disorders Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20814, USA
| | - Wolfgang Högler
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz 4020, Austria
| | - Signe S Beck-Nielsen
- Centre for Rare Diseases, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus N DK-8200, Denmark
| | - Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital and Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TG, UK
| | - Nadia Merchant
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington, DC 20010, USA
| | - Janet L Crane
- Department of Pediatrics and Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Leanne M Ward
- Department of Pediatrics, University of Ottawa and Division of Endocrinology, Children's Hospital of Eastern Ontario, Ottawa, Ontario K1H 8L1, Canada
| | - Alison M Boyce
- Metabolic Bone Disorders Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20814, USA
| | - Craig F Munns
- Child Health Research Centre and Mayne Academy of Paediatrics, University of Queensland, Brisbane, QLD 4101, Australia
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4
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Amorós CM, Bascones AE, Leone RC, De la Sen Corcuera Ó, Barone S, De Pedro Marina M. Central giant cell granuloma: Off-label treatment with Denosumab in a patient with Noonan syndrome. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101640. [PMID: 37729965 DOI: 10.1016/j.jormas.2023.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/17/2023] [Indexed: 09/22/2023]
Abstract
This study aims to describe the utilization of Denosumabࣨ, a human monoclonal antibody against the RANK-L receptor, in a mandibular giant cell granuloma (GCG) with a significant local aggressiveness component that was unresponsive to surgical treatment. We present a case of a 19-year-old male patient diagnosed with Noonan syndrome, who presented a multifocal giant cell granuloma with aggressive behaviour resistant to surgical treatment. Due to the functional and aesthetic implications associated with a surgical procedure, a decision was made to initiate medical treatment using Denosumabࣨ. Throughout the treatment, the patient presented excellent clinical and analytical tolerance, with no reported adverse effects. Surgical intervention remains the preferred approach for GCG. Denosumabࣨ emerges as an alternative, either as neoadjuvant treatment or as definitive therapy for unresectable or resectable tumors associated with significant morbidity. It leads to size stabilization and regression of the tumour stage.
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Affiliation(s)
- Carlota Mazo Amorós
- Maxillofacial Surgery Department, Hospital Clínico Universitario San Carlos, Madrid 28040, Spain.
| | | | - Roy Camacho Leone
- Maxillofacial Surgery Department, Hospital Clínico Universitario San Carlos, Madrid 28040, Spain
| | - Óscar De la Sen Corcuera
- Maxillofacial Surgery Department, Hospital Clínico Universitario San Carlos, Madrid 28040, Spain
| | - Simona Barone
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Maxillofacial Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Manuel De Pedro Marina
- Maxillofacial Surgery Department, Hospital Clínico Universitario San Carlos, Madrid 28040, Spain
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5
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Tallent B, Padilla RJ, McKay C, Foreman AKM, Fan Z, Blatt J. Response of Central Giant Cell Granuloma of the Jaw to Imatinib. J Pediatr Hematol Oncol 2023; 45:278-280. [PMID: 36706268 DOI: 10.1097/mph.0000000000002608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/02/2022] [Indexed: 01/28/2023]
Abstract
Central giant cell granuloma of the jaw (CGCJ) can be locally aggressive and result in facial and dental deformity. A child with CGCJ was treated surgically and with denosumab with a response but life-threatening toxicity. Imatinib, a tyrosine kinase inhibitor, was prescribed based on clinical similarities between CGCJ and cherubism, for which Imatinib has been effective. Within 2 months, a computed tomographic scan showed significant ossification, which increased over the following 8 months. This case suggests that tyrosine kinase inhibitors may be an effective option, and one with limited toxicity, for CGCJ.
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Affiliation(s)
| | - Ricardo J Padilla
- Division of Oral and Maxillofacial Pathology Laboratory, The University of North Carolina Adams School of Dentistry
| | | | | | - Zheng Fan
- Department of Neurology, The University of North Carolina School of Medicine, Charlotte, NC
| | - Julie Blatt
- Division of Pediatric Hematology Oncology
- The Lineberger Comprehensive Cancer Center
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6
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Catalfamo L, De Rinaldis D, Cicchiello S, Scozzaro C, Nava C, De Ponte FS. Central Giant Cell Reparative Granuloma (CGCRG) of the Jaw in Children Treated with Neoadjuvant Bisposphonates: Review and a Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:1117-1122. [PMID: 37275050 PMCID: PMC10235363 DOI: 10.1007/s12070-022-03413-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/11/2022] [Indexed: 12/30/2022] Open
Abstract
Central giant cell reparative granuloma (CGCRG) of the jaw is a neoformation localized in the mandible or in the maxillary bone and characterized by fibrous tissue, osteoclast-like giant cells and reactive bone formation. The CGCRG is a less frequent benign tumor but sometimes it is characterized by an aggressive behavior with a very rapid growth. It affects the young adults mainly and the children occasionally. Nowadays no medication therapy is approved for CGCRG in pediatric cases. We present a case of an aggressive form of a mandibular CGCRG in a 5-year child with Arnold-Chiari syndrome. This case is unique for the use of bisphosphonates (BPs) as neoadjuvant therapy in pediatrics. The therapy were administrated with the purpose of arresting the rapid growth of the tumor in order to avoid a demolitive surgery to the young patient. The child was without symptoms and presented an unusual swelling in the left mandible developed in a few weeks. The lesion was diagnosed by a CT scan and it was confirmed by a biopsy performed for histopathological assessment a few days later. The drug therapy consisted of seven cycles iv of Zoledronate associated to Calcium Gluconate. The child was closely observed through clinical and serological evaluations during the following months. About five months after the last cycle of BPs the child underwent CT scan and a conservative surgical treatment, consisted in a deep curettage, was programmed. Seven months after surgery the aesthetic profile of the patient improved and CT scan reported a significant calcic neoapposition in the area of the previous bone lesion. After more than one year from surgery, no relapse was observed. This case report demonstrates that BPs can be used safely in pediatric patients with CGCRG. Especially BPs could have a role as neoadjuvant therapy: If administrated before surgical treatment BPs avoid the necessity of resective surgery and reduce the risk of recurrence in pediatric CGCRG after conservative curettage.
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Affiliation(s)
- Luciano Catalfamo
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy
| | - Danilo De Rinaldis
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy
| | - Samuele Cicchiello
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy
| | - Calogero Scozzaro
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy
| | - Carla Nava
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy
| | - Francesco Saverio De Ponte
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy
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7
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Vanderniet JA, Tsinas D, Wall CL, Girgis CM, London K, Keane C, Briody J, Hibbert S, Poon M, Padhye B, Biggin A, Dalla-Pozza L, Gray RJ, Munns CF. Surgical Management and Denosumab for Aneurysmal Bone Cysts of the Spine in an Australian Tertiary Paediatric Centre. Calcif Tissue Int 2023; 112:592-602. [PMID: 36810677 DOI: 10.1007/s00223-023-01068-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
Aneurysmal bone cysts (ABC) are rare osteolytic, benign but often locally aggressive tumours of the long bones or vertebrae. For spinal ABC, surgical management, embolisation or sclerotherapy alone often carry high morbidity and/or high recurrence rates. Interruption of receptor activator of nuclear factor-kappa B ligand (RANKL) signalling holds promise as an effective therapeutic strategy for these tumours. We aimed to review the approach to surgical management and evaluate the efficacy and safety of denosumab for ABC of the spine in children. Retrospective review of 7 patients treated with denosumab using a standardised protocol for ABC of the spine in a tertiary paediatric centre. Surgical intervention was only conducted if there was spinal instability or significant neurological impairment. Denosumab 70 mg/m2 was given 4-weekly for at least 6 months, followed by 2 doses of zoledronate 0.025 mg/kg, aiming to prevent rebound hypercalcaemia. All patients achieved stability of the spine and resolution of neurological impairment, if present. Six patients achieved metabolic remission and have ceased denosumab without recurrence to date; the other showed clinical and radiological improvement without complete metabolic remission. Three patients developed symptomatic hypercalcaemia 5-7 months after cessation of denosumab, requiring additional bisphosphonate treatment. We present our algorithm for the surgical and medical management of paediatric spinal ABC. Denosumab produced a radiological and metabolic response in all patients, with complete remission in most. Follow-up time was not long enough to evaluate the endurance of response after cessation in some patients. Incidence of rebound hypercalcaemia in this paediatric cohort was high, prompting a change to our protocol.
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Affiliation(s)
- Joel A Vanderniet
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Dionysios Tsinas
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Christie-Lee Wall
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia
| | - Christian M Girgis
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW, Australia
| | - Kevin London
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Corinne Keane
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Julie Briody
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sally Hibbert
- Department of Dentistry, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Department of Paediatric Dentistry, Westmead Centre for Oral Health, Sydney, NSW, Australia
| | - Myra Poon
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia
| | - Bhavna Padhye
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Andrew Biggin
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Luciano Dalla-Pozza
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Randolph J Gray
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Craig F Munns
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
- Mayne Academy of Paediatrics, The University of Queensland, Brisbane, QLD, Australia
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8
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Schreuder WH, Lipplaa A, Cleven AHG, van den Berg H, Bisschop PH, de Jongh RT, Witjes MJH, Kessler PAWH, Merkx MAW, Edelenbos E, Klop C, Schreurs R, Westermann AM, Tromp JM, Levenga H, Gelderblom H, de Lange J. RANKL inhibition for giant cell lesions of the jaw: A retrospective cohort analysis. Eur J Cancer 2022; 175:263-273. [PMID: 36174298 DOI: 10.1016/j.ejca.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In all giant-cell-rich lesions (GCRL) occurring in bone, a common underlying excessive RANKL expression is held responsible for the osteolytic activity. Apart from giant cell tumour of bone (GCTB), systematic outcome analysis of RANKL inhibition in other GCRL is unavailable. The aim of this study is to assess the efficacy and safety of a 1-year denosumab protocol in giant cell lesions of the jaw (GCLJ). METHODS A retrospective cohort study was conducted compromising patients treated with a 1-year protocol of monthly subcutaneously administered 120 mg denosumab. Objective tumour response based on histology and imaging was used to calculate objective tumour response rate, progression-free survival (PFS) and time to progression. Type, severity and frequency of adverse events were recorded in a standardised way to assess safety. RESULTS Twenty patients, predominantly female (90%), were included. Fifty-five per cent of lesions were located in the mandible; most classified as aggressive lesions (90%). Thirty-five per cent (7/20) of cases were either recurrent after prior treatment or progressive, while on other drug treatment. Objective tumour response rate was 100% after 12 months of treatment. Median PFS was 50.4 months (95% CI 38.0-62.8) with a cumulative PFS rate of 22.6% (95% CI 1.8-43.4) at 5 years follow-up. Median time to progression was 38.4 months (95% CI 26.0-50.8). Treatment was well tolerated, and none of the patients had to interrupt therapy for toxicity. CONCLUSION High-dose denosumab is effective and safe in achieving a complete response in GCLJ within 12 months. The high long-term relapse rate after treatment cessation is the main obstacle for denosumab to become standard treatment for GCLJ.
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Affiliation(s)
- Willem H Schreuder
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC (Location AMC) and Academic Center for Dentistry, University of Amsterdam, Amsterdam, the Netherlands; Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Astrid Lipplaa
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjen H G Cleven
- Department of Pathology, University Medical Center Groningen, Groningen, the Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Henk van den Berg
- Department of Pediatric Oncology, Amsterdam University Medical Centers Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter H Bisschop
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine, Endocrine section, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Peter A W H Kessler
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery and IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands; Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Esther Edelenbos
- Department of Pediatric Oncology, Amsterdam University Medical Centers Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC (Location AMC) and Academic Center for Dentistry, University of Amsterdam, Amsterdam, the Netherlands
| | - Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC (Location AMC) and Academic Center for Dentistry, University of Amsterdam, Amsterdam, the Netherlands
| | - Anneke M Westermann
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jacqueline M Tromp
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Henriette Levenga
- Department of Internal Medicine, Groene Hart Ziekenhuis, Gouda, the Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC (Location AMC) and Academic Center for Dentistry, University of Amsterdam, Amsterdam, the Netherlands
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9
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Brijs K, Veys K, Schepers S, Segers H, Politis C. Treatment of central giant cell granuloma with denosumab: A case report of a complicated treatment course. Pediatr Blood Cancer 2022; 69:e29436. [PMID: 34767309 DOI: 10.1002/pbc.29436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/26/2021] [Accepted: 10/18/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Katrien Brijs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Koenraad Veys
- Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Serge Schepers
- Department of Oral and Maxillofacial Surgery, Ziekenhuis Oost-Limburg Genk, Genk, Belgium
| | - Heidi Segers
- Department of Pediatric Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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10
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Vanderniet JA, Wall CL, Mullins A, London K, Lim L, Hibbert S, Briody J, Padhye B, Poon M, Biggin A, Dalla-Pozza L, Munns CF. Denosumab for central giant cell granuloma in an Australian tertiary paediatric centre. Bone 2022; 159:116395. [PMID: 35331976 DOI: 10.1016/j.bone.2022.116395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/26/2022] [Accepted: 03/17/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Central giant cell granulomas (CGCG) are rare osteolytic, benign but often locally aggressive tumours of bone. Surgical curettage may not be possible in extensive lesions and resection carries high morbidity, especially in growing children, and previous medical therapies have had variable efficacy and high recurrence rates. Interruption of receptor activator of nuclear factor-kappa B ligand (RANKL) signalling holds promise as an effective therapeutic strategy for these tumours. AIMS To evaluate the efficacy and safety of our protocol for denosumab treatment of CGCG in children. METHODS Retrospective review of 4 patients treated with denosumab using a standardised protocol for CGCG in a tertiary paediatric centre. Denosumab 70 mg/m2 was given 4-weekly, followed by 2 doses of zoledronate 0.025 mg/kg, aimed at preventing rebound hypercalcaemia. RESULTS Treatment of CGCG resulted in metabolic remission in all patients, but recurrence, detected by positron emission tomography (PET), occurred at 6 months in three patients and 12 months in one patient. Three patients developed symptomatic hypercalcaemia 4-5 months and one patient asymptomatic hypercalcaemia 7 months after cessation of denosumab, with 3 requiring additional bisphosphonate treatment. CONCLUSIONS Denosumab produced a radiological and metabolic response in our patients, but metabolic recurrence occurred in all patients. PET imaging was effective for monitoring treatment response and early detection of recurrence. Incidence of rebound hypercalcaemia in this paediatric cohort was high. We present proposed changes to our protocol with the aim of producing sustained remission and preventing rebound hypercalcaemia.
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Affiliation(s)
- Joel A Vanderniet
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Christie-Lee Wall
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anna Mullins
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Kevin London
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Lydia Lim
- Department of Oral and Maxillofacial Surgery, Westmead Hospital, Sydney, NSW, Australia; Department of Paediatric Dentistry and Oral and Maxillofacial Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sally Hibbert
- Department of Paediatric Dentistry and Oral and Maxillofacial Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia; Department of Paediatric Dentistry, Westmead Centre for Oral Health, Sydney, NSW, Australia
| | - Julie Briody
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Bhavna Padhye
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Myra Poon
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Andrew Biggin
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Craig F Munns
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia; Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, QLD, Australia
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11
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Drug Treatment of Low Bone Mass and Other Bone Conditions in Pediatric Patients. Paediatr Drugs 2022; 24:103-119. [PMID: 35013997 DOI: 10.1007/s40272-021-00487-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
Osteoporosis may affect young individuals, albeit infrequently. In childhood, bone mass increases, reaching its peak between the second and third decades; then, after a period of stability, it gradually declines. Several conditions, including genetic disorders, chronic diseases, and some medications, can have an impact on bone homeostasis. Diagnosis in young patients is based on the criteria defined by the International Society for Clinical Densitometry (ISCD), published in 2013. High risk factors should be identified and monitored. Often simple interventions aimed to eliminate the underlying cause, to minimize the negative bone effects linked to drugs, or to increase calcium and vitamin D intake can protect bone mass. However, in selected cases, pharmacological treatment should be considered. Bisphosphonates remain the main therapeutic agent for children with significant skeletal fragility and are also useful in a large number of other bone conditions. Denosumab, an anti-RANKL antibody, could become a potential alternative treatment. Clinical trials to evaluate the long-term effects and safety of denosumab in children are ongoing.
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Deodati A, Fintini D, Levtchenko E, Rossi M, Ubertini G, Segers H, Battafarano G, Cappa M, Del Fattore A. Mechanisms of acute hypercalcemia in pediatric patients following the interruption of Denosumab. J Endocrinol Invest 2022; 45:159-166. [PMID: 34216372 DOI: 10.1007/s40618-021-01630-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Denosumab is a fully human monoclonal anti-RANK-L antibody that is clinically used to counteract the bone loss induced by exacerbated osteoclast activity. Indeed, its binding to RANK-L prevents the interaction RANK-L/receptor RANK that is essential for osteoclastogenesis and bone resorbing activity. Although there are many medications available to treat bone loss diseases, including bisphosphonates, Denosumab is highly effective since it reduces the bone erosion. The use in pediatric patients is safe. However, some concerns are related to the interruption of the treatment. Indeed, in this study, we reported hypercalcemia in two pediatric patients and alterations of circulating osteoclast precursors. METHODS Peripheral Blood Mononuclear Cells (PBMC) were isolated from two pediatric patients with hypercalcemia after Denosumab interruption and from 10 controls. Cytofluorimetric analysis and in vitro osteoclastogenesis experiments were performed. RESULTS Increase of CD16-CD14+CD11b+ cells was revealed in PBMC from patients reflecting the enhanced in vitro osteoclastogenesis. CONCLUSION Our data suggest that precautions must be taken when Denosumab therapy is interrupted and gradual decrease of dose and/or timing of treatment should be performed. To prevent the onset of hypercalcemia that could be in the discontinuation phase, cytofluorimetric analysis of PBMC should be performed to evaluate osteoclast precursors.
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Affiliation(s)
- A Deodati
- Endocrinology Unit, University Pediatric Clinical Department, Bambino Gesù Children's Hospital, IRCCS, 00146, Rome, Italy
| | - D Fintini
- Endocrinology Unit, University Pediatric Clinical Department, Bambino Gesù Children's Hospital, IRCCS, 00146, Rome, Italy
| | - E Levtchenko
- Department of Pediatrics, University Hospitals Leuven, 3000, Leuven, Belgium
| | - M Rossi
- Bone Physiopathology Research Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - G Ubertini
- Endocrinology Unit, University Pediatric Clinical Department, Bambino Gesù Children's Hospital, IRCCS, 00146, Rome, Italy
| | - H Segers
- Department of Pediatrics, University Hospitals Leuven, 3000, Leuven, Belgium
| | - G Battafarano
- Bone Physiopathology Research Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - M Cappa
- Endocrinology Unit, University Pediatric Clinical Department, Bambino Gesù Children's Hospital, IRCCS, 00146, Rome, Italy
| | - A Del Fattore
- Bone Physiopathology Research Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy.
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Hypercalcemia following discontinuation of denosumab therapy: A systematic review. Bone Rep 2021; 15:101148. [PMID: 34825020 PMCID: PMC8605220 DOI: 10.1016/j.bonr.2021.101148] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 01/19/2023] Open
Abstract
Denosumab is a monoclonal antibody that has been approved to treat osteoporosis, skeletal metastasis, and giant cell tumor of bone in skeletally mature patients. Due to its potential adverse effects on normal bone growth, its use has not yet been approved in skeletally immature patients; however, the use of this agent in such patients with overt or dysregulated bone resorptive conditions has been explored in recent years. While most studies have proven the effectiveness of denosumab in controlling the progression of various disorders in skeletally immature patients, they have also revealed that refractory hypercalcemia often follows the discontinuation of denosumab treatment, raising a concern over the use of this agent in these patients. Thus, this study was designed to better understand the pathology of this condition through a systematic review of the published literature. Our analysis suggests that this condition has a potential male predisposition, that there is a correlation between the duration of denosumab treatment and patient age, and that this condition often occurs within 3 months after the last administration of denosumab in skeletally immature patients but is significantly less likely in adults. These results may further underscore that high bone formation and bone turnover rates are critically associated with hypercalcemia after the discontinuation of denosumab. In contrast, given that not all skeletally immature patients develop hypercalcemia, it is probable that other unidentified factors are involved in the pathology of this condition. Rebound hypercalcemia often follows denosumab cessation in juveniles. Although relatively rare, rebound hypercalcemia can occur in adults. Rebound hypercalcemia may have a male predisposition in juveniles. Treatment duration of denosumab required to trigger hypercalcemia correlates with age. Onset of hypercalcemia is significantly earlier in juveniles than in adults.
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Medication Management of Selected Pathological Jaw Lesions. Oral Maxillofac Surg Clin North Am 2021; 34:179-187. [PMID: 34602322 DOI: 10.1016/j.coms.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Most jaw lesions are treated surgically. Areas of abnormal proliferation or destruction in bone are commonly treated by regional curettage, excision, or resection. However, surgery is invasive and leaves a defect where the lesion was removed. Surgical trauma to adjacent healthy tissue, including vital neurovascular bundles is often unavoidable, and can be especially traumatizing to the pediatric patient. Select jaw lesions with well-studied nonsurgical pharmaceutical treatments are presented here.
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