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Brivio E, Pennesi E, Willemse ME, Huitema AD, Jiang Y, van Tinteren HD, van der Velden VH, Beverloo BH, den Boer ML, Rammeloo LA, Hudson C, Heerema N, Kowalski K, Zhao H, Kuttschreuter L, Bautista Sirvent FJ, Bukowinski A, Rizzari C, Pollard J, Murillo-Sanjuán L, Kutny M, Zarnegar-Lumley S, Redell M, Cooper S, Bertrand Y, Petit A, Krystal J, Metzler M, Lancaster D, Bourquin JP, Motwani J, van der Sluis IM, Locatelli F, Roth ME, Hijiya N, Zwaan CM. Bosutinib in Resistant and Intolerant Pediatric Patients With Chronic Phase Chronic Myeloid Leukemia: Results From the Phase I Part of Study ITCC054/COG AAML1921. J Clin Oncol 2024; 42:821-831. [PMID: 38033284 PMCID: PMC10906575 DOI: 10.1200/jco.23.00897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/29/2023] [Accepted: 10/02/2023] [Indexed: 12/02/2023] Open
Abstract
PURPOSE Bosutinib is approved for adults with chronic myeloid leukemia (CML): 400 mg once daily in newly diagnosed (ND); 500 mg once daily in resistant/intolerant (R/I) patients. Bosutinib has a different tolerability profile than other tyrosine kinase inhibitors (TKIs) and potentially less impact on growth (preclinical data). The primary objective of this first-in-child trial was to determine the recommended phase II dose (RP2D) for pediatric R/I and ND patients. PATIENTS AND METHODS In the phase I part of this international, open-label trial (ClinicalTrials.gov identifier: NCT04258943), children age 1-18 years with R/I (per European LeukemiaNet 2013) Ph+ CML were enrolled using a 6 + 4 design, testing 300, 350, and 400 mg/m2 once daily with food. The RP2D was the dose resulting in 0/6 or 1/10 dose-limiting toxicities (DLTs) during the first cycle and achieving adult target AUC levels for the respective indication. As ND participants were only enrolled in phase II, the ND RP2D was selected based on data from R/I patients. RESULTS Thirty patients were enrolled; 27 were evaluable for DLT: six at 300 mg/m2, 11 at 350 mg/m2 (one DLT), and 10 at 400 mg/m2 (one DLT). The mean AUCs at 300 mg/m2, 350 mg/m2, and 400 mg/m2 were 2.20 μg h/mL, 2.52 μg h/mL, and 2.66 μg h/mL, respectively. The most common adverse event was diarrhea (93%; ≥grade 3: 11%). Seven patients stopped because of intolerance and eight because of insufficient response. Complete cytogenetic and major molecular response to bosutinib appeared comparable with other published phase I/II trials with second-generation TKIs in children. CONCLUSION Bosutinib was safe and effective. The pediatric RP2D was 400 mg/m2 once daily (max 600 mg/d) with food in R/I patients and 300 mg/m2 once daily (max 500 mg/d) with food in ND patients, which achieved targeted exposures as per adult experience.
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Affiliation(s)
- Erica Brivio
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Edoardo Pennesi
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marieke E. Willemse
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Alwin D.R. Huitema
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- The Netherlands Cancer Institute, Amsterdam, the Netherlands
- University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Yilin Jiang
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | - Berna H. Beverloo
- Department of Clinical Genetics, Erasmus MC, Rotterdam, the Netherlands
| | - Monique L. den Boer
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lukas A.J. Rammeloo
- Department of Pediatric Cardiology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands
| | | | | | | | | | | | - Francisco J. Bautista Sirvent
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology and Hematology Department, Hospital Niño Jesús, Madrid, Spain
| | - Andrew Bukowinski
- Pediatric Hematology and Oncology Alabama, University of Alabama at Birmingham, Birmingham, AL
| | - Carmelo Rizzari
- Department of Pediatrics, University of Milano-Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | | | | | | | - Michele Redell
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | - Stacy Cooper
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | | | | | - Julie Krystal
- The Steven and Alexandra Cohen Children's Medical Center of New York, New York, NY
| | | | - Donna Lancaster
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Inge M. van der Sluis
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Franco Locatelli
- IRCCS Ospedale Pediatrico Bambino Gesù, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Nobuko Hijiya
- Columbia University Irving Medical Center, New York, NY
| | - Christian M. Zwaan
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Abstract
The phenomenon of consistent male dominance in typhoid ileal perforation (TIP) is not well understood. It cannot be explained on the basis of microbial virulence, Peyer’s patch anatomy, ileal wall thickness, gastric acidity, host genetic factors, or sex-linked bias in hospital attendance. The cytokine response to an intestinal infection in males is predominantly proinflammatory as compared with that in females, presumably due to differences in the sex hormonal milieu. Sex hormone receptors have been detected on lymphocytes and macrophages, including on Peyer’s patches, inflammation of which (probably similar to the Shwartzman reaction/Koch phenomenon) is the forerunner of TIP, and is not excluded from the regulatory effects of sex hormones. Hormonal control of host-pathogen interaction may override genetic control. Environmental exposure to Salmonella typhi may be more frequent in males, presumably due to sex-linked differences in hygiene practices and dining-out behavior. A plausible explanation of male dominance in TIP could include sex-linked differences in the degree of natural exposure of Peyer’s patches to S. typhi. An alternative explanation may include sexual dimorphism in host inflammatory response patterns in Peyer’s patches that have been induced by S. typhi. Both hypotheses are testable.
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Affiliation(s)
- Mohammad Khan
- Department of Microbiology, College of Medicine, Chichiri, Blantyre, Malawi
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Weiss M, Gerber A, Dullenkopf A. Nitrous oxide does not affect automated air tonometry in children. Can J Anaesth 2003; 50:930-2. [PMID: 14617592 DOI: 10.1007/bf03018742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the effects of nitrous oxide on automated air tonometry in the clinical setting. MATERIAL AND METHODS With approval of the Hospital Ethical Committee and after obtaining informed parental consent, an 8-F tonometry catheter was inserted orogastrically in ten children aged one to three years scheduled for elective surgery with combined regional and general anesthesia. A standardized general anesthesia technique with tracheal intubation was used in all patients and consisted of sevoflurane in oxygen/nitrous oxide (30%/70%; n = 5 patients) or in oxygen/air (FIO(2) 0.3; n = 5 patients). After obtaining steady state gastric CO(2) values (PrCO(2)), fresh gas mixtures were rapidly changed from oxygen/nitrous oxide to oxygen/air (A) or vice versa (B). In addition, balloon pressures were recorded using a pressure transducer. Measurements were performed at intervals of ten minutes with recording of balloon pressures, end-tidal CO(2) (PETCO(2)) and PrCO(2) values. Pr-ETCO(2)-gap were calculated to eliminate influences of changes in PaCO(2). RESULTS Changing the fresh gas mixture from N(2)O/O(2) to O(2)/air resulted in a decrease of balloon pressure of -10.4% (113.4 +/- 14.7 mmHg to 101.6 +/- 25.0 mmHg). Changing the fresh gas mixture from O(2)/air to N(2)O/O(2) resulted in an increase of balloon pressures of 6.4% (107.6 +/- 19.3 mmHg to 114.0 +/- 20.3 mmHg). During both fresh gas exchange experiments no significant changes (> 0.2 kPa) in calculated Pr-ETCO(2)-gaps were observed. CONCLUSIONS Based on our in vivo data, nitrous oxide during general anesthesia can be used with automated air tonometry and does not affect air tonometric PrCO(2) reading in clinical practice.
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Affiliation(s)
- Markus Weiss
- Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland.
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Marshall AP, West SH. Gastric Tonometry and Enteral Nutrition: a Possible Conflict in Critical Care Nursing Practice. Am J Crit Care 2003. [DOI: 10.4037/ajcc2003.12.4.349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
• Background Gastric tonometry is used to assess gastrointestinal mucosal perfusion in critically ill patients. However, enteral feeding is withheld during monitoring with gastric tonometry because enteral feeding is thought to influence tonometric measurements.• Objectives To examine the effect of enteral feeding on the tonometric measurement of gastric mucosal carbon dioxide.• Methods Gastric tonometers were placed in 20 critically ill patients, and the Pco2 of the gastric mucosa was measured in both the full and the empty stomach during a 48-hour period.• Results The Pco2 measured by the tonometer increased after enteral feeding, and a significant difference in the Pco2 of the full versus the empty stomach was evident at 24 and 48 hours. Pco2 at 4, 24, and 48 hours differed significantly in the full stomach and in the empty stomach. However, the data did not reveal a significant difference in either the full stomach or the empty stomach between Pco2 at 24 hours and Pco2 at 48 hours.• Conclusion After 24 hours of feeding, the initial increase in Pco2 observed at 4 hours was not evident, suggesting stabilization of the intragastric environment. However, a higher Pco2 was evident in the empty stomach, indicating that the presence of the feeding solution may reduce the diffusion of carbon dioxide into the tonometer balloon. Consequently, measurements of intragastric Pco2 obtained after 24 hours of feeding may be reliable if the stomach is emptied by aspiration via the tonometer immediately before measurement.
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Affiliation(s)
- Andrea P. Marshall
- Department of Clinical Nursing, Faculty of Nursing, University of Sydney (APM, SHW), and Department of Critical Care, Manly Hospital, Manly, NSW, Australia (APM)
| | - Sandra H. West
- Department of Clinical Nursing, Faculty of Nursing, University of Sydney (APM, SHW), and Department of Critical Care, Manly Hospital, Manly, NSW, Australia (APM)
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Abstract
Maintenance of adequate perfusion is essential for health of the intestinal mucosa. Methods available to assess intestinal perfusion provide information on mesenteric blood flow, which may differ from mucosal flow. Intramucosal pH (pH(i)) is influenced by tissue oxygenation and perfusion. Gastric pH(i) can be measured using the technique of tonometry. A prospective observational clinical study was performed to examine relationships between measured gastric pH(i) and mucosal CO(2) (mCO(2)), and acid-base balance, gastrointestinal complications (necrotizing enterocolitis and perforation), and death in infants <1500 g birth weight. A nasogastric tonometry catheter (size 5F) was inserted into the stomach of infants, and pH(i) was calculated from mCO(2) levels measured using saline tonometry. Measurements were performed at 3, 12, 24, and 48 h, then daily until arterial access was unavailable. Two hundred eleven sets of measurements were performed on 38 infants [birth weight (mean +/-SD), 863 +/- 241 g; gestation, 26.5 +/- 1.8 wk; and median Clinical Risk Index for Babies score, 8.0 (interquartile range, 5.0-10.75)]. Mean pH(i) was 7.27 (95% confidence interval, 7.26-7.28) and mean mCO(2) was 47.0 mm Hg (95% confidence interval, 45.7-48.3 mm Hg). pH(i) and mCO(2) correlated significantly with arterial pH (pH(a)), arterial PCO(2) (PaCO(2)), and arterial base excess. There were no significant relationships between pH(a) and pH gap (pH(a)-pH(i)) or CO(2) gap (mCO(2)-PaCO(2)). Recurrent low pH(i) (<7.2 on more than one occasion) and an mCO(2)/PaCO(2) ratio of > or =1.29 were significantly associated with an increase in gastrointestinal complications. There were no statistically significant associations with death. In conclusion, changes in pH gap and CO(2) gap can occur without alteration in pH(a). Abnormalities in pH(i) might predict gastrointestinal complications in infants <1500 g.
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Affiliation(s)
- M E Campbell
- Academic Department of Child Health, St. Bartholomew's and the Royal London School of Medicine and Dentistry, Neonatal Unit, Homerton Hospital, London, United Kingdom E9 6SR
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