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Zhang G, Fan R, Yang H, Su H, Yu X, Wang Y, Feng F, Zhu L. Safety and efficacy of sirolimus in recurrent intravenous leiomyomatosis, pulmonary benign metastatic leiomyomatosis, and leiomyomatosis peritonealis disseminata: a pilot study. BMC Med 2024; 22:119. [PMID: 38481209 PMCID: PMC10938730 DOI: 10.1186/s12916-024-03344-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Intravenous leiomyomatosis (IVL), pulmonary benign metastatic leiomyomatosis (PBML), and leiomyomatosis peritonealis disseminata (LPD) are leiomyomas with special growth patterns and high postoperative recurrence rates. We report the safety and efficacy of a pilot study of sirolimus in the treatment of recurrent IVL, PBML, and recurrent LPD. METHODS This was a pilot study to evaluate the safety and efficacy of sirolimus in the treatment of leiomyomatosis (ClinicalTrials.gov identifier NCT03500367) conducted in China. Patients received oral sirolimus 2 mg once a day for a maximum of 60 months or until disease progression, intolerable toxicity, withdrawal of consent, or investigator decision to stop. The primary end point of this study was the objective response rate. Secondary end points included safety and tolerability, disease control rate, and progression-free survival. RESULTS A total of 15 patients with leiomyomatosis were included in the study, including five with recurrent IVL, eight with PBML and two with recurrent LPD. The median follow-up time was 15 months (range 6-54 months), nine patients (60%) had treatment-related adverse events (including all levels), and two patients had treatment-related grade 3 or 4 adverse events. The objective response rate was 20.0% (95% CI, 7.1-45.2%), and the disease control rate was 86.7% (95% CI, 62.1-96.3%). Partial response was achieved in three patients. The median response time in the three partial response patients was 33 months (range 29-36 months), and the sustained remission time of these three patients reached 0, 18, and 25 months, respectively. CONCLUSIONS Sirolimus was safe and effective in the treatment of recurrent IVL, PBML, and recurrent LPD. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03500367. Registered on 18 April 2018.
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Affiliation(s)
- Guorui Zhang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China
| | - Rong Fan
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China
| | - Hua Yang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China
| | - Hao Su
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China
| | - Xin Yu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China
| | - Yutong Wang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China
| | - Fengzhi Feng
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China.
| | - Lan Zhu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China.
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Rose M, Ritter D, Gupta N, Tolusso L, Horn P, Wakefield E, Glass J. Healthcare provider recognition of pregnancy related risks and management considerations in patients with tuberous sclerosis complex. Orphanet J Rare Dis 2024; 19:4. [PMID: 38166979 PMCID: PMC10763101 DOI: 10.1186/s13023-023-03015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Patients with tuberous sclerosis complex (TSC) face an increased risk of maternal health complications and worsening disease manifestations during pregnancy. There are no established consensus guidelines that address the management of pregnancy in patients with TSC and healthcare providers rely on their individual experiences and preferences to derive treatment decisions. We sought to obtain provider opinion of pregnancy related maternal complications in patients with TSC, and the common evaluation and management strategies used to address these issues. METHODS We conducted a cross-sectional survey of healthcare providers with diverse areas of expertise related to the multisystem nature of involvement in TSC. Descriptive analyses were used to analyze our three primary variables: (1) provider recognition of maternal risks/complications; (2) provider recommendations before and during pregnancy; and (3) provider/clinic protocols. RESULTS We received responses from 87 providers from 11 countries, with 40.7% (n = 35) seeing > 30 TSC patients yearly. The majority of providers (n = 70, 88.6%) deemed that a patient with TSC needed expert care beyond the standard of care for a typical pregnancy, with over 25% of providers reporting that they have seen lymphangioleiomyomatosis (LAM) exacerbation, seizures, and preterm labor in pregnant patients with TSC. Providers who managed patients treated with mTOR inhibitors (mTORi) also agreed that mTORi use should be stopped prior to pregnancy (n = 45, 68.2%) but there was uncertainty about when to stop the mTORi (one month 28.9%, two months 11.1%, three months 42.2%, and 6-12 months 2.2%). Additionally, there were mixed opinions on restarting mTORi in response to disease progression during pregnancy. When asked about provider or clinic specific protocols, 71.6% (n = 53) of providers stated that they do not have a clear protocol for management decisions for patients with TSC before or during pregnancy. CONCLUSION Healthcare providers recognize that patients with TSC are at an increased risk for maternal health complications during pregnancy. However, there are wide inter-individual variances in practice, especially pertaining to decisions regarding mTORi use. There is a critical need to better understand the implications of pregnancy for patients with TSC, and to draft consensus recommendations to guide management decisions.
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Affiliation(s)
- Meredith Rose
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
- Medical Genetics Clinic, Mary Bridge Children's/MultiCare Health System, Tacoma, USA.
| | - David Ritter
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, USA
| | - Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, USA
- Medical Service, Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Leandra Tolusso
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Cincinnati Children's Fetal Care Center, Cincinnati, USA
| | - Paul Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, USA
| | - Emily Wakefield
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Jennifer Glass
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
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Seront E, Biard JM, Van Damme A, Revencu N, Lengelé B, Schmitz S, de Toeuf C, Clapuyt P, Veyckemans F, Prégardien C, Vikkula M, Bernard P, Boon LM. A case report of sirolimus use in early fetal management of lymphatic malformation. NATURE CARDIOVASCULAR RESEARCH 2023; 2:595-599. [PMID: 39195878 DOI: 10.1038/s44161-023-00280-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/02/2023] [Indexed: 08/29/2024]
Abstract
Sirolimus, by targeting the mammalian target of rapamycin (mTOR) pathway, has demonstrated efficacy on lymphatic malformations (LMs) in adults and neonates. The current hypothesis is that the earlier the lesion is treated, the better it responds. This has prompted the idea that sirolimus administration might be efficacious to treat fetal LMs as well. Here we report a successful management of a cervicofacial fetal LM with sirolimus taken orally by the mother from the 22nd week of pregnancy until 2 weeks before planned delivery. Repeated cordocentesis recorded a 30% transplacental crossing of sirolimus. Continuation of sirolimus after birth allowed resection of the residual mass. We have followed the physical and neurological evolution of the child for 6 years since the fetal administration of sirolimus. We conclude that early administration of sirolimus during pregnancy with maternal serum monitoring may be proposed to high-risk fetal LMs in selected cases.
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Affiliation(s)
- Emmanuel Seront
- Institut Roi Albert II, Department of Medical Oncology, Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Jean Marc Biard
- Fetal Medicine Unit, Department of Obstetrics, Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - An Van Damme
- Institut Roi Albert II, Department of Pediatric Hematology & Oncology, Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Nicole Revencu
- Center for Human Genetics, Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Benoit Lengelé
- Division of Plastic Surgery, Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Sandra Schmitz
- Division of ENT, Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Caroline de Toeuf
- Division of ENT, Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Philippe Clapuyt
- Department of Pediatric Radiology, Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Francis Veyckemans
- Department of Anesthesiology, Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Caroline Prégardien
- Department of Anesthesiology, Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, UCLouvain, Brussels, Belgium & Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Pierre Bernard
- Fetal Medicine Unit, Department of Obstetrics, Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Laurence M Boon
- Division of Plastic Surgery, Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain, VASCERN VASCA European Reference Centre, Brussels, Belgium.
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Will JC, Siedentopf N, Schmid O, Gruber TM, Henrich W, Hertzberg C, Weschke B. Successful Prenatal Treatment of Cardiac Rhabdomyoma in a Fetus with Tuberous Sclerosis. Pediatr Rep 2023; 15:245-253. [PMID: 36976727 PMCID: PMC10059978 DOI: 10.3390/pediatric15010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Cardiac rhabdomyomas are a possible early manifestation of the Tuberous Sclerosis Complex (TSC). They often regress spontaneously but may grow and cause cardiac dysfunction, threatening the child's life. Treatment with rapalogs can stop the growth of these cardiac tumors and even make them shrink. Here, we present the case of a successful treatment of a cardiac rhabdomyoma in a fetus with TSC by administering sirolimus to the mother. The child's father carries a TSC2 mutation and the family already had a child with TSC. After we confirmed the TSC diagnosis and growth of the tumor with impending heart failure, we started treatment at 27 weeks of gestation. Subsequently, the rhabdomyoma shrank and the ventricular function improved. The mother tolerated the treatment very well. Delivery was induced at 39 weeks and 1 day of gestation and proceeded without complications. The length, weight, and head circumference of the newborn were normal for the gestational age. Rapalog treatment was continued with everolimus. Metoprolol and vigabatrin were added because of ventricular preexcitation and epileptic discharges in the EEG, respectively. We provide the follow-up data on the child's development in her first two years of life and discuss the efficacy and safety of this treatment.
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Affiliation(s)
| | | | - Oliver Schmid
- Praxis für Pränataldiagnostik, Schloßstr. 2, 13507 Berlin, Germany
| | | | | | - Christoph Hertzberg
- Diagnose-und Behandlungszentrum für Kinder und Jugendliche, Vivantes Klinikum Neukölln, 12351 Berlin, Germany
| | - Bernhard Weschke
- Department of Pediatric Neurology and Center for Chronically Sick Children, 13353 Berlin, Germany
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Grgat D, Dilber D, Hrabak Paar M. Common benign primary pediatric cardiac tumors: a primer for radiologists. Jpn J Radiol 2022; 41:477-487. [PMID: 36495370 DOI: 10.1007/s11604-022-01371-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
Cardiac tumors are neoplasms arising from or located in the heart or the pericardium. Although rare, primary cardiac tumors in children require an accurate and timely diagnosis. Most pediatric primary cardiac tumors are benign (around 90%). Echocardiography is the first imaging modality used due to its availability, noninvasiveness, inexpensiveness, and absence of ionizing radiation. Computed tomography (CT) and magnetic resonance imaging (MRI) offer better soft tissue visualization as well as better visualization of extracardiac structures. A great advantage of MRI is the possibility of measuring cardiac function and blood flow, which can be important for obstructing cardiac tumors. In this article, we will offer a brief review of clinical, echocardiographic, CT, and MRI features of cardiac rhabdomyomas, fibromas, teratomas, and lipomas providing their differential diagnosis.
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Affiliation(s)
- Dora Grgat
- Institute for Emergency Medicine of Zagreb County, Velika Gorica, Croatia
| | - Daniel Dilber
- School of Medicine, Department of Pediatrics, University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - Maja Hrabak Paar
- School of Medicine, Department of Diagnostic and Interventional Radiology, University of Zagreb, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
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