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Prete A, Pieroni E, Marrama E, Bruschini L, Ferrari M, Scioti G, Aprile V, Guarracino F, Ambrosini CE, Molinaro E, Elisei R, Lucchi M, Materazzi G. Management of patients with extensive locally advanced thyroid cancer: results of multimodal treatments. J Endocrinol Invest 2024; 47:1165-1173. [PMID: 38032454 PMCID: PMC11035473 DOI: 10.1007/s40618-023-02234-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Surgery plays a key role in the treatment of thyroid cancer (TC) patients. Locally advanced cases, however, can require an extensive surgical approach with technical issues and a high risk of complications. In these cases, a multidisciplinary evaluation should be carried out to evaluate pros and cons. The aim of this study was to share our experience, as a multidisciplinary team, in the management of patients with locally advanced TC with a particularly extensive local disease, whose surgical approach could be challenging and part of a multimodal treatment. METHODS We retrospectively evaluated clinical, surgical, and oncologic features of all patients with locally advanced TC who had undergone multidisciplinary surgery from January 2019 to June 2020. RESULTS Six patients (two cases each of poorly differentiated, papillary, and medullary TC) were included. Four out of six were suffering from symptoms related to the advanced disease. At pre-surgical evaluation, a multidisciplinary team proposed extended surgery with radical intent via cervicotomy and sternotomy, considering other therapies not feasible or probably ineffective without it. No one passed away in intra- or perioperative time. At the end of follow-up (median 2.6 years), all patients presented a remission of symptoms due to the advanced disease, four patients were submitted to adjuvant therapies and only one patient died for a cause unrelated to the disease. CONCLUSION This series of very advanced TCs shows the effectiveness of a surgery performed by a multidisciplinary team in controlling symptoms, allowing adjuvant therapies, and improving the survival of patients whose cases would otherwise be very difficult to manage.
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Affiliation(s)
- A Prete
- Endocrine Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - E Pieroni
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - E Marrama
- Thoracic Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - L Bruschini
- Ear Nose Throat (ENT) Audiology and Phoniatric Unit, Department of Surgical Pathology, Medical, Molecular and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - M Ferrari
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University Hospital of Pisa, Pisa, Italy
| | - G Scioti
- Section of Cardiac Surgery, University Hospital of Pisa, Pisa, Italy
| | - V Aprile
- Thoracic Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - F Guarracino
- Cardiothoracic and Vascular Anaesthesia and Intensive Care, Department of Anaesthesia and Critical Care Medicine, University Hospital of Pisa, Pisa, Italy
| | - C E Ambrosini
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - E Molinaro
- Endocrine Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - R Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - M Lucchi
- Thoracic Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - G Materazzi
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
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Muratore E, Belotti T, Gottardi F, Sagramoso C, Prete A, Masetti R. Miliary leukemia cutis as extramedullary relapse of KMT2A rearranged pediatric AML. Leuk Lymphoma 2023; 64:1494-1496. [PMID: 37221837 DOI: 10.1080/10428194.2023.2214650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023]
Affiliation(s)
- E Muratore
- Pediatric Oncology and Hematology "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - T Belotti
- Pediatric Oncology and Hematology "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - F Gottardi
- Pediatric Oncology and Hematology "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - C Sagramoso
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - A Prete
- Pediatric Oncology and Hematology "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - R Masetti
- Pediatric Oncology and Hematology "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Matrone A, Prete A, Nervo A, Ragni A, Agate L, Molinaro E, Giani C, Valerio L, Minaldi E, Piovesan A, Elisei R. Correction to: Lenvatinib as a salvage therapy for advanced metastatic medullary thyroid cancer. J Endocrinol Invest 2021; 44:2859. [PMID: 34089498 DOI: 10.1007/s40618-021-01592-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Matrone
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - A Prete
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - A Nervo
- Department of Oncology, Oncological Endocrinology Unit, Azienda Ospedaliero Universitaria Città Della Salute E Della Scienza Di Torino, Corso Bramante, 88, 10126, Turin, Italy
| | - A Ragni
- Department of Oncology, Oncological Endocrinology Unit, Azienda Ospedaliero Universitaria Città Della Salute E Della Scienza Di Torino, Corso Bramante, 88, 10126, Turin, Italy
| | - L Agate
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - E Molinaro
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - C Giani
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - L Valerio
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - E Minaldi
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - A Piovesan
- Department of Oncology, Oncological Endocrinology Unit, Azienda Ospedaliero Universitaria Città Della Salute E Della Scienza Di Torino, Corso Bramante, 88, 10126, Turin, Italy
| | - R Elisei
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy.
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Matrone A, Prete A, Nervo A, Ragni A, Agate L, Molinaro E, Giani C, Valerio L, Minaldi E, Piovesan A, Elisei R. Lenvatinib as a salvage therapy for advanced metastatic medullary thyroid cancer. J Endocrinol Invest 2021; 44:2139-2151. [PMID: 33594641 DOI: 10.1007/s40618-020-01491-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/19/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Patients with advanced progressive metastatic medullary thyroid cancer (MTC), show poor prognosis and few available systemic therapeutic options. After the loss of clinical benefit with other tyrosine kinase inhibitors (TKI), we evaluated the use of lenvatinib as salvage therapy. METHODS Ten patients who experienced the loss of clinical benefit after treatment with at least one previous TKI, were treated with lenvatinib. We assessed patient's response immediately before, at the first (first-EV) and last (last-EV) evaluation, after the beginning of treatment. RESULTS At first-EV, one patient died, while all the remaining 9 showed a stable disease (SD) in the target lesions. At last-EV, SD was still observed in seven patients, while partial response (PR) and progressive disease (PD), in one patient each. Conversely, analyzing all target and non-target lesions, at first-EV, we observed PR in one patient and SD in eight patients. At last-EV, PR was shown in two patients and SD was shown in seven. Bone metastases showed stable disease control at both first-EV and last-EV in only approximately 60% of cases. Tumor markers (CTN and CEA) decreased at first-EV, while they increased at last-EV. Seven patients experienced at least one dose reduction during treatment with lenvatinib. CONCLUSIONS In this real-life clinical experience, lenvatinib showed interesting results as salvage therapy in patients with advanced progressive metastatic MTC patients. Its usefulness could be effective in patients without any other available treatment, because previously used or unsuitable, especially with negative RET status with no access to the new highly selective targeted therapies.
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Affiliation(s)
- A Matrone
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - A Prete
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - A Nervo
- Department of Oncology, Oncological Endocrinology Unit, Azienda Ospedaliero Universitaria Città Della Salute E Della Scienza Di Torino, Corso Bramante, 88, 10126, Turin, Italy
| | - A Ragni
- Department of Oncology, Oncological Endocrinology Unit, Azienda Ospedaliero Universitaria Città Della Salute E Della Scienza Di Torino, Corso Bramante, 88, 10126, Turin, Italy
| | - L Agate
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - E Molinaro
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - C Giani
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - L Valerio
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - E Minaldi
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - A Piovesan
- Department of Oncology, Oncological Endocrinology Unit, Azienda Ospedaliero Universitaria Città Della Salute E Della Scienza Di Torino, Corso Bramante, 88, 10126, Turin, Italy
| | - R Elisei
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy.
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Matrone A, Prete A, Sartini MS, Elisei R. Significant response of medullary thyroid cancer choroidal metastases to highly selective RET inhibitor selpercatinib: a case report. Ann Oncol 2021; 32:1447-1449. [PMID: 34419556 DOI: 10.1016/j.annonc.2021.08.1987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/14/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- A Matrone
- Department of Clinical and Experimental Medicine, Endocrine Unit, Pisa University Hospital, Pisa, Italy
| | - A Prete
- Department of Clinical and Experimental Medicine, Endocrine Unit, Pisa University Hospital, Pisa, Italy
| | - M S Sartini
- Ophthalmology Unit, Pisa University Hospital, Pisa, Italy
| | - R Elisei
- Department of Clinical and Experimental Medicine, Endocrine Unit, Pisa University Hospital, Pisa, Italy.
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Thiel U, Schober SJ, Ranft A, Gassmann H, Jabar S, Gall K, von Lüttichau I, Wawer A, Koscielniak E, Diaz MA, Ussowicz M, Kazantsev I, Afanasyev B, Merker M, Klingebiel T, Prete A, Gruhn B, Bader P, Jürgens H, Dirksen U, Handgretinger R, Burdach S, Lang P. Correction to: No difference in survival after HLA mismatched versus HLA matched allogeneic stem cell transplantation in Ewing sarcoma patients with advanced disease. Bone Marrow Transplant 2021; 56:2320. [PMID: 34373590 PMCID: PMC8410592 DOI: 10.1038/s41409-021-01421-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- U Thiel
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany.
| | - S J Schober
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany
| | - A Ranft
- Pediatrics III, West German Cancer Centre Essen, University Hospital Essen, Essen, Germany
| | - H Gassmann
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany
| | - S Jabar
- Pediatrics III, West German Cancer Centre Essen, University Hospital Essen, Essen, Germany
| | - K Gall
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany
| | - I von Lüttichau
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany
| | - A Wawer
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany
| | - E Koscielniak
- Department of Pediatric Oncology, Hematology and Immunology, Olgahospital, Stuttgart, Germany
| | - M A Diaz
- Department of Pediatric Hematology-Oncology and Hematopoietic Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - M Ussowicz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - I Kazantsev
- Raisa Gorbacheva Memorial Institute for Pediatric Oncology, Hematology and Transplantat, Pavlov First St. Petersburg State Universityion, St. Petersburg, Russia
| | - B Afanasyev
- Raisa Gorbacheva Memorial Institute for Pediatric Oncology, Hematology and Transplantat, Pavlov First St. Petersburg State Universityion, St. Petersburg, Russia
| | - M Merker
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - T Klingebiel
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - A Prete
- Department of Pediatric Hematology and Oncology, Ospedale S Orsola Malpighi, Bologna, Italy
| | - B Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - P Bader
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - H Jürgens
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Münster, Münster, Germany
| | - U Dirksen
- Pediatrics III, West German Cancer Centre Essen, University Hospital Essen, Essen, Germany
| | - R Handgretinger
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Tübingen, Tübingen, Germany
| | - S Burdach
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany
| | - P Lang
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Tübingen, Tübingen, Germany
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Ronchi L, Donati C, Donati C, Mondardini M, Prete A, Alfieri M, Rombi B, Bertini F, Buwenge M, Morganti A, Cammelli S. PO-1445 Pediatric palliative radiotherapy: a systematic review. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07896-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rombi B, Ruggi A, Ronchi L, Buwenge M, Ammendolia I, Cammelli S, Melchionda F, Prete A, Fracchiolla F, Zucchelli M, Morganti G, Amichetti M. PO-1241: Clinical results and toxicities in pediatric CNS tumors treated with proton pencil-beam scanning. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Colecchia A, Marasco G, Ravaioli F, Kleinschmidt K, Masetti R, Prete A, Pession A, Festi D. Usefulness of liver stiffness measurement in predicting hepatic veno-occlusive disease development in patients who undergo HSCT. Bone Marrow Transplant 2016; 52:494-497. [PMID: 27941774 DOI: 10.1038/bmt.2016.320] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- A Colecchia
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - G Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - F Ravaioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - K Kleinschmidt
- Pediatric Oncology and Hematology Unit, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - R Masetti
- Pediatric Oncology and Hematology Unit, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - A Prete
- Pediatric Oncology and Hematology Unit, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - A Pession
- Pediatric Oncology and Hematology Unit, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - D Festi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Manna G, Di Lisa F, Speranza I, Losanno T, Giuli A, Emiliani A, Prete A, Prelaj A, Pecorari S, Giron Berrios J, Fusto C, Seminara P. The power of traditional prognostic factor and immunohistochemical (IHC) surrogate molecular subtypes of breast cancer (BC) in predicting neoadjuvant chemotherapy response: results of a retrospective study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chiereghin A, Prete A, Belotti T, Gibertoni D, Piccirilli G, Gabrielli L, Pession A, Lazzarotto T. Prospective Epstein-Barr virus-related post-transplant lymphoproliferative disorder prevention program in pediatric allogeneic hematopoietic stem cell transplant: virological monitoring and first-line treatment. Transpl Infect Dis 2016; 18:44-54. [DOI: 10.1111/tid.12485] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 09/11/2015] [Accepted: 09/27/2015] [Indexed: 02/07/2023]
Affiliation(s)
- A. Chiereghin
- Operative Unit of Clinical Microbiology; Laboratory of Virology; St. Orsola-Malpighi University Hospital; Bologna Italy
| | - A. Prete
- Pediatric Oncology and Haematology Unit “Lalla Seràgnoli”; Department of Pediatrics; St. Orsola-Malpighi University Hospital; Bologna Italy
| | - T. Belotti
- Pediatric Oncology and Haematology Unit “Lalla Seràgnoli”; Department of Pediatrics; St. Orsola-Malpighi University Hospital; Bologna Italy
| | - D. Gibertoni
- Department of Biomedical and Neuromotor Sciences; Unit of Hygiene and Biostatistics; University of Bologna; Bologna Italy
| | - G. Piccirilli
- Operative Unit of Clinical Microbiology; Laboratory of Virology; St. Orsola-Malpighi University Hospital; Bologna Italy
| | - L. Gabrielli
- Operative Unit of Clinical Microbiology; Laboratory of Virology; St. Orsola-Malpighi University Hospital; Bologna Italy
| | - A. Pession
- Pediatric Oncology and Haematology Unit “Lalla Seràgnoli”; Department of Pediatrics; St. Orsola-Malpighi University Hospital; Bologna Italy
| | - T. Lazzarotto
- Department of Specialised, Experimental, and Diagnostic Medicine; Operative Unit of Clinical Microbiology; Laboratory of Virology; St. Orsola-Malpighi University Hospital; University of Bologna; Bologna Italy
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Locatelli F, Masetti R, Rondelli R, Zecca M, Fagioli F, Rovelli A, Messina C, Lanino E, Bertaina A, Favre C, Giorgiani G, Ripaldi M, Ziino O, Palumbo G, Pillon M, Pession A, Rutella S, Prete A. Erratum: Outcome of children with high-risk acute myeloid leukemia given autologous or allogeneic hematopoietic cell transplantation in the AIEOP AML-2002/01 study. Bone Marrow Transplant 2015. [DOI: 10.1038/bmt.2014.291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Tronconi E, Miniaci A, Prete A, Masetti R, Pession A. Juvenile arthritis after haematopoietic stem cell transplantation. Bone Marrow Transplant 2014; 49:1244-5. [DOI: 10.1038/bmt.2014.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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14
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Vermeulen S, Barreto M, La Penna F, Prete A, Martella S, Biagiarelli F, Villa MP. Exhaled breath temperature in children: reproducibility and influencing factors. J Asthma 2014; 51:743-50. [PMID: 24654705 DOI: 10.3109/02770903.2014.906606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study will investigate the reproducibility and influencing factors of exhaled breath temperature measured with the tidal breathing technique in asthmatic patients and healthy children. METHODS Exhaled breath temperature, fractional exhaled nitric oxide, and spirometry were assessed in 124 children (63 healthy and 61 asthmatic), aged 11.2 ± 2.5 year, M/F 73/51. A modified version of the American Thoracic Society questionnaire on the child's present and past respiratory history was obtained from parents. Parents were also asked to provide detailed information on their child's medication use during the previous 4 weeks. Ear temperature, ambient temperature, and relative-ambient humidity were also recorded. RESULTS Exhaled breath temperature measurements were highly reproducible; the second measurement was higher than the first measurement, consistent with a test-retest situation. In 13 subjects, between-session within-day reproducibility of exhaled breath temperature was still high. Exhaled breath temperature increased with age and relative-ambient humidity. Exhaled breath temperature was comparable in healthy and asthmatic children; when adjusted for potential confounders (i.e. ambient conditions and subject characteristics), thermal values of asthmatic patients exceeded those of the healthy children by 1.1 °C. Normalized exhaled breath temperature, by subtracting ambient temperature, was lower in asthmatic patients treated with inhaled corticosteroids than in those who were corticosteroid-naive. CONCLUSION Measurements of exhaled breath temperature are highly reproducible, yet influenced by several factors. Corrected values, i.e. normalized exhaled breath temperature, could help us to assess the effect of therapy with inhaled corticosteroids. More studies are needed to improve the usefulness of the exhaled breath temperature measured with the tidal breathing technique in children.
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Affiliation(s)
- S Vermeulen
- Faculty of Medical Sciences, University of Groningen , Groningen , The Netherlands and
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15
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Bagattoni S, D'Alessandro G, Prete A, Piana G, Pession A. Oral health and dental late adverse effects in children in remission from malignant disease. A pilot case-control study in Italian children. Eur J Paediatr Dent 2014; 15:45-50. [PMID: 24745592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To investigate with a reliable method the oral features in Italian patients in remission from cancer, highlighting the relationship with age at cancer therapy and to compare the data with healthy controls. MATERIALS AND METHODS Twenty five childhood cancer survivors treated under the age of 10 years with chemotherapy w/wo Haemopoietic Stem Cell Transplantation and/or head-neck Radiotherapy, in remission from cancer for at least 3 years, were examined for dental caries and enamel defects. To assess dental age and dental abnormalities a panoramic radiograph was taken. Patients were grouped according to age at cancer therapy (<3 years: subgroup Y; 3.1-5 years: subgroup M; >5 years: subgroup O). A control group of 26 healthy children was included. RESULTS There was not a statistically significant difference in caries prevalence between the two groups. A statistically significant difference between the two groups was found for enamel defects, dental abnormalities and dental age. The chi-squared test revealed a relationship between age at therapy and specific dental abnormalities. CONCLUSION This study shows that cancer therapy may increase the risk of development of enamel defects and dental abnormalities, especially in children treated under the age of 3 years.
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Affiliation(s)
- S Bagattoni
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Unit of Dental Care for Special Needs Patients and Paediatric Dentistry, University of Bologna, Bologna, Italy
| | - G D'Alessandro
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Unit of Dental Care for Special Needs Patients and Paediatric Dentistry, University of Bologna, Bologna, Italy
| | - A Prete
- Unit of Paediatric Oncology, Sant'Orsola Hospital University of Bologna, Bologna, Italy
| | - G Piana
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Unit of Dental Care for Special Needs Patients and Paediatric Dentistry, University of Bologna, Bologna, Italy
| | - A Pession
- Unit of Paediatric Oncology, Sant'Orsola Hospital University of Bologna, Bologna, Italy
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16
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Ianni F, Perotti G, Prete A, Paragliola RM, Ricciato MP, Carrozza C, Salvatori M, Pontecorvi A, Corsello SM. Thyroid scintigraphy: an old tool is still the gold standard for an effective diagnosis of autonomously functioning thyroid nodules. J Endocrinol Invest 2013; 36:233-6. [PMID: 22732299 DOI: 10.3275/8471] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with autonomously functioning thyroid nodules (AFTN) may not have an abnormal TSH value, particularly in iodine-deficient areas. AIM To verify the accuracy of TSH as screening test in detecting AFTN and to evaluate ultrasonographic features of thyroid nodules which have resulted autonomously functioning at thyroid scintigraphy (TS). METHODS Seventy-eight patients with nodular goiter, no marker of autoimmunity and at least one AFTN at TS were selected and divided in: Group 1 (no.=25) with TSH>0.35 IU/l, and Group 2 (no.=53) with TSH≤0.35 IU/l. RESULTS In Group1 the mean nodule diameter was 19.8±9.4 mm; 12 nodules were isoechoic, 2 hyperechoic, and 11 hypoechoic. Vascular pattern was type I in 4, type II in 6 and type III in 15 nodules. In Group 2 the mean nodule diameter was 28.6±14.2 mm; 27 nodules were isoechoic, 9 hyperechoic and 17 hypoechoic. Vascular pattern was type I in 14, type II in 15 and type III in 24 nodules. CONCLUSION In our study TSH alone was not able to identify AFTN in 32% of the patients. All hot nodules predominantly showed an isoechoic pattern with peri-intranodular vascularization; however, the presence of this pattern was not statistically significant. Moreover, we noticed a weak inverse correlation between the diameter of AFTN and TSH level. In conclusion, TS is the most sensitive tool to detect AFTN, allowing a precocious diagnosis even in the presence of a normal TSH value.
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Affiliation(s)
- F Ianni
- Unit of Endocrinology, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy
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17
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Luksch R, Tienghi A, Hall KS, Fagioli F, Picci P, Barbieri E, Gandola L, Eriksson M, Ruggieri P, Daolio P, Lindholm P, Prete A, Bisogno G, Tamburini A, Grignani G, Abate ME, Podda M, Smeland S, Ferrari S. Primary metastatic Ewing's family tumors: results of the Italian Sarcoma Group and Scandinavian Sarcoma Group ISG/SSG IV Study including myeloablative chemotherapy and total-lung irradiation. Ann Oncol 2012; 23:2970-2976. [PMID: 22771824 DOI: 10.1093/annonc/mds117] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The Italian Sarcoma Group and the Scandinavian Sarcoma Group designed a joint study to improve the prognosis for patients with Ewing's family tumors and synchronous metastatic disease limited to the lungs, or the pleura, or a single bone. PATIENTS AND METHODS The study was opened in 1999 and closed to the enrollment in 2008. The program consisted of intensive five-drug combination chemotherapy, surgery and/or radiotherapy as local treatment, and consolidation treatment with high-dose busulfan/melphalan plus autologous stem cell rescue and total-lung irradiation. RESULTS During the study period, 102 consecutive patients were enrolled. The median follow-up was 62 months (range 24-124). The 5-year event-free survival probability was 0.43 [standard deviation (SD) = 0.05] and the 5-year overall survival probability was 0.52 (SD = 0.052). Unfavorable prognostic factors emerging on multivariate analysis were a poor histological/radiological response at the site of the primary tumor [relative risk (RR) = 3.4], and incomplete radiological remission of lung metastases after primary chemotherapy (RR = 2.6). One toxic death and one secondary leukemia were recorded. CONCLUSIONS This intensive approach is feasible and long-term survival is achievable in ∼50% of patients. New treatment approaches are warranted for patients responding poorly to primary chemotherapy.
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Affiliation(s)
- R Luksch
- Department of Pediatrics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan.
| | - A Tienghi
- Department of Oncology, S. Maria delle Croci Hospital, Ravenna, Italy
| | - K Sundby Hall
- Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - F Fagioli
- Department of Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Turin
| | - P Picci
- Department of Musculoskeletal Oncology, Experimental Oncology Division, Istituto Ortopedico Rizzoli, Bologna
| | - E Barbieri
- Department of Radiotherapy, University of Bologna, Policlinico Sant'Orsola, Bologna
| | - L Gandola
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Eriksson
- Skane Onkologiska Klinik, Lund University Hospital and Lund University, Lund, Sweden
| | - P Ruggieri
- Department of Musculoskeletal Oncology, Division of Surgery, Istituto Ortopedico Rizzoli, Bologna
| | - P Daolio
- Oncologic/Orthopedic Surgery, Istituto Ortopedico G. Pini, Milan, Italy
| | - P Lindholm
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - A Prete
- Department of Pediatric Oncology, University of Bologna, Policlinico Sant'Orsola, Bologna
| | - G Bisogno
- Department of Pediatric Oncology, University of Padua, Padua
| | - A Tamburini
- Department of Pediatric Onco-Hematology, Ospedale Meyer, Florence
| | - G Grignani
- Department of Medical Oncology, Institute for Cancer Research and Treatment, Candiolo
| | - M E Abate
- Department of Musculoskeletal Oncology, Division of Chemotherapy, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Podda
- Department of Pediatrics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - S Smeland
- Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - S Ferrari
- Department of Musculoskeletal Oncology, Division of Chemotherapy, Istituto Ortopedico Rizzoli, Bologna, Italy
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18
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D'Amore V, Santolini I, van Rijn CM, Biagioni F, Molinaro G, Prete A, Conn PJ, Lindsley CW, Zhou Y, Vinson PN, Rodriguez AL, Jones CK, Stauffer SR, Nicoletti F, van Luijtelaar G, Ngomba RT. Potentiation of mGlu5 receptors with the novel enhancer, VU0360172, reduces spontaneous absence seizures in WAG/Rij rats. Neuropharmacology 2012; 66:330-8. [PMID: 22705340 DOI: 10.1016/j.neuropharm.2012.05.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/25/2012] [Accepted: 05/29/2012] [Indexed: 11/27/2022]
Abstract
Absence epilepsy is generated by the cortico-thalamo-cortical network, which undergoes a finely tuned regulation by metabotropic glutamate (mGlu) receptors. We have shown previously that potentiation of mGlu1 receptors reduces spontaneous occurring spike and wave discharges (SWDs) in the WAG/Rij rat model of absence epilepsy, whereas activation of mGlu2/3 and mGlu4 receptors produces the opposite effect. Here, we have extended the study to mGlu5 receptors, which are known to be highly expressed within the cortico-thalamo-cortical network. We used presymptomatic and symptomatic WAG/Rij rats and aged-matched ACI rats. WAG/Rij rats showed a reduction in the mGlu5 receptor protein levels and in the mGlu5-receptor mediated stimulation of polyphosphoinositide hydrolysis in the ventrobasal thalamus, whereas the expression of mGlu5 receptors was increased in the somatosensory cortex. Interestingly, these changes preceded the onset of the epileptic phenotype, being already visible in pre-symptomatic WAG/Rij rats. SWDs in symptomatic WAG/Rij rats were not influenced by pharmacological blockade of mGlu5 receptors with MTEP (10 or 30 mg/kg, i.p.), but were significantly decreased by mGlu5 receptor potentiation with the novel enhancer, VU0360172 (3 or 10 mg/kg, s.c.), without affecting motor behaviour. The effect of VU0360172 was prevented by co-treatment with MTEP. These findings suggest that changes in mGlu5 receptors might lie at the core of the absence-seizure prone phenotype of WAG/Rij rats, and that mGlu5 receptor enhancers are potential candidates to the treatment of absence epilepsy. This article is part of a Special Issue entitled 'Metabotropic Glutamate Receptors'.
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Affiliation(s)
- V D'Amore
- I.R.C.C.S., NEUROMED, Neuropharmacology Unit, Parco Tecnologico, Località Camerelle 86077, Pozzilli, Isernia, Italy
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19
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Thiel U, Wawer A, Wolf P, Badoglio M, Santucci A, Klingebiel T, Basu O, Borkhardt A, Laws HJ, Kodera Y, Yoshimi A, Peters C, Ladenstein R, Pession A, Prete A, Urban EC, Schwinger W, Bordigoni P, Salmon A, Diaz MA, Afanasyev B, Lisukov I, Morozova E, Toren A, Bielorai B, Korsakas J, Fagioli F, Caselli D, Ehninger G, Gruhn B, Dirksen U, Abdel-Rahman F, Aglietta M, Mastrodicasa E, Torrent M, Corradini P, Demeocq F, Dini G, Dreger P, Eyrich M, Gozdzik J, Guilhot F, Holler E, Koscielniak E, Messina C, Nachbaur D, Sabbatini R, Oldani E, Ottinger H, Ozsahin H, Schots R, Siena S, Stein J, Sufliarska S, Unal A, Ussowicz M, Schneider P, Woessmann W, Jürgens H, Bregni M, Burdach S. No improvement of survival with reduced- versus high-intensity conditioning for allogeneic stem cell transplants in Ewing tumor patients. Ann Oncol 2011; 22:1614-1621. [PMID: 21245159 DOI: 10.1093/annonc/mdq703] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Outcomes of Ewing tumor (ET) patients treated with allogeneic stem cell transplantation (allo-SCT) were compared regarding the use of reduced-intensity conditioning (RIC) and high-intensity conditioning (HIC) regimens as well as human leukocyte antigen (HLA)-matched and HLA-mismatched grafts. PATIENTS AND METHODS We retrospectively analyzed data of 87 ET patients from the European Group for Blood and Marrow Transplantation, Pediatric Registry for Stem Cell Transplantations, Asia Pacific Blood and Marrow Transplantation and MetaEICESS registries treated with allo-SCT. Fifty patients received RIC (group A) and 37 patients received HIC (group B). Twenty-four patients received HLA-mismatched grafts and 63 received HLA-matched grafts. RESULTS Median overall survival was 7.9 months [±1.24, 95% confidence interval (CI) 5.44-10.31] for group A and 4.4 months (±1.06, 95% CI 2.29-6.43) for group B patients (P = 1.3). Death of complications (DOC) occurred in 4 of 50 (0.08) and death of disease (DOD) in 33 of 50 (0.66) group A and in 16 of 37 (0.43) and 17 of 37 (0.46) group B patients, respectively. DOC incidence was decreased (P < 0.01) and DOD/relapse increased (P < 0.01) in group A compared with group B. HLA mismatch was not generally associated with graft-versus-Ewing tumor effect (GvETE). CONCLUSIONS There was no improvement of survival with RIC compared with HIC due to increased DOD/relapse incidence after RIC despite less DOC incidence. This implicates general absence of a clinically relevant GvETE with current protocols.
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Affiliation(s)
- U Thiel
- Department of Pediatrics and Wilhelm Sander Sarcoma Unit MRI, Pediatric Oncology Center, Technische Universität München
| | - A Wawer
- Department of Pediatrics and Wilhelm Sander Sarcoma Unit MRI, Pediatric Oncology Center, Technische Universität München
| | - P Wolf
- Institute for Medical Statistics and Epidemiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - M Badoglio
- EBMT Data & Study Office, Hopital Saint-Antoine, Assistance Publique des Hôpitaux de Paris and UPMC Univ Paris 06, Paris, France
| | - A Santucci
- Section of Pediatric Hematology & Oncology, University of Perugia, Perugia, Italy
| | - T Klingebiel
- Children's Hospital III, Department of Pediatrics, Johann Wolfgang Goethe University, Frankfurt
| | - O Basu
- Children's Hospital III, Department of Pediatrics, Johann Wolfgang Goethe University, Frankfurt
| | - A Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Düsseldorf, Germany
| | - H-J Laws
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Düsseldorf, Germany
| | - Y Kodera
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University, Aichi; APBMT Data Center, Nagoya University School of Medicine, Nagoya, Japan
| | - A Yoshimi
- APBMT Data Center, Nagoya University School of Medicine, Nagoya, Japan
| | - C Peters
- Department of Pediatrics, St. Anna Kinderspital, Vienna, Austria
| | - R Ladenstein
- Department of Pediatrics, St. Anna Kinderspital, Vienna, Austria
| | - A Pession
- Department of Scienze Pediatriche Mediche e Chirurgiche, Ospedale S Orsola Malpighi, Bologna, Italy
| | - A Prete
- Department of Scienze Pediatriche Mediche e Chirurgiche, Ospedale S Orsola Malpighi, Bologna, Italy
| | - E-C Urban
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - W Schwinger
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - P Bordigoni
- Service de Transplantation Medullaire, CHU de Nancy Brabois, Vandoeuvre-les-Nancy, France
| | - A Salmon
- Service de Transplantation Medullaire, CHU de Nancy Brabois, Vandoeuvre-les-Nancy, France
| | - M A Diaz
- Department of Pediatrics, Division of Pediatric Hematology-Oncology and Hematopoietic Stem Cell Transplantation and Cell Therapy Unit, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - B Afanasyev
- St. Petersburg State Medical Pavlov University, Ratsa Gorbacheva Memorial Children`s Institute, Department of Hematology and Transplantology, St. Petersburg, Russia
| | - I Lisukov
- St. Petersburg State Medical Pavlov University, Ratsa Gorbacheva Memorial Children`s Institute, Department of Hematology and Transplantology, St. Petersburg, Russia
| | - E Morozova
- St. Petersburg State Medical Pavlov University, Ratsa Gorbacheva Memorial Children`s Institute, Department of Hematology and Transplantology, St. Petersburg, Russia
| | - A Toren
- Pediatric Hemato-Oncology Unit, Sheba Medical Center (affiliated to the Sackler Faculty of Medicine), Tel Hashomer, Israel
| | - B Bielorai
- Pediatric Hemato-Oncology Unit, Sheba Medical Center (affiliated to the Sackler Faculty of Medicine), Tel Hashomer, Israel
| | - J Korsakas
- Department of Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania
| | - F Fagioli
- Stem Cell Transplantation and Cellular Therapy Unit, Pediatric Onco-Hematology Division, "Regina Margherita" Children's Hospital, Turin
| | - D Caselli
- Department of Oncoematologia Pediatrica, Azienda Ospedaliero-Universitaria Meyer, Florence, Italy
| | - G Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden
| | - B Gruhn
- Department of Pediatrics, University of Jena, Jena
| | - U Dirksen
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Münster, Germany
| | - F Abdel-Rahman
- The Bone Marrow and Stem Cell Transplantation Program, King Hussein Cancer Center, Amman, Jordan
| | - M Aglietta
- Department of Istituto per la Ricerca e la Cura del Cancro, Turin, Italy
| | - E Mastrodicasa
- Section of Pediatric Hematology & Oncology, University of Perugia, Perugia, Italy
| | - M Torrent
- Hospital de la Santa Creu i Sant Pau, Department of Pediatrics, Barcelona, Spain
| | - P Corradini
- Department of Hematology - Bone Marrow Transplantation Unit, Istituto Nazionale dei Tumori, University of Milano, Milan, Italy
| | - F Demeocq
- Centre Hospitalier et Universitaire de Clermont-Ferrand, Service de Pédiatrie B et Unité Bioclinique de Thérapie Cellulaire, Clermont-Ferrand, France
| | - G Dini
- Department of UO Ematologia ed Oncologia Pediatrica, Istituto G Gaslini, Genova, Italy
| | - P Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg
| | - M Eyrich
- Children's Hospital, Department of Paediatric Stem Cell Transplantation, University of Würzburg, Würzburg, Germany
| | - J Gozdzik
- Transplantation Centre, University Children's Hospital, Cracow, Poland
| | - F Guilhot
- Department of Hematology, University Hospital, Poitiers, France
| | - E Holler
- Department of Hematology and Oncology, University of Regensburg, Regensburg
| | - E Koscielniak
- Department of Pediatrics 5 (Oncology, Hematology, Immunology), Olga Hospital, Klinikum Stuttgart, Stuttgart, Germany
| | - C Messina
- Hemo/Oncology, Department of Pediatrics, Hospital-University of Padova, Padova, Italy
| | - D Nachbaur
- University Hospital of Innsbruck, Internal Medicine V, Department of Hematology and Oncology, Innsbruck, Austria
| | - R Sabbatini
- Department of Oncology, Haematology, and Respiratory Diseases, Policlinico di Modena, Modena
| | - E Oldani
- Department of U.S.C. Ematologia, Ospedali Riuniti, Bergamo, Italy
| | - H Ottinger
- Department of Bone Marrow Transplantation, University Hospital of Essen, Essen, Germany
| | - H Ozsahin
- Paediatric Oncology Unit, University of Geneva Children's Hospital, Geneva, Switzerland
| | - R Schots
- Division of Clinical Hematology and BMT Unit, University Hospital Brussels, Brussels, Belgium
| | - S Siena
- Department of S. C. Divisione Oncologia Falck and S. C. Divisione Anatomia Patologica, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - J Stein
- Bone marrow Transplant Unit, Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - S Sufliarska
- Bone Marrow Transplantation Unit, Department of Pediatrics, Comenius University Medical School, Bratislava, Slovak Republic
| | - A Unal
- Institutions Erciyes Medical School, Department of Hematology and Oncology, Kapadokya BMT Center, Kayseri, Turkey
| | - M Ussowicz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - P Schneider
- Department of Pediatric Hematology and Oncology, Hôpital Charles Nicolle, Rouen, France
| | - W Woessmann
- Department of Pediatric Hematology and Oncology, University Hospital, Giessen, Germany
| | - H Jürgens
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Münster, Germany
| | - M Bregni
- Unit of Medical Oncology, Ospedale San Giuseppe, Milan, Italy
| | - S Burdach
- Department of Pediatrics and Wilhelm Sander Sarcoma Unit MRI, Pediatric Oncology Center, Technische Universität München.
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Ferrari S, Sundby Hall K, Luksch R, Tienghi A, Wiebe T, Fagioli F, Alvegard TA, Brach Del Prever A, Tamburini A, Alberghini M, Gandola L, Mercuri M, Capanna R, Mapelli S, Prete A, Carli M, Picci P, Barbieri E, Bacci G, Smeland S. Nonmetastatic Ewing family tumors: high-dose chemotherapy with stem cell rescue in poor responder patients. Results of the Italian Sarcoma Group/Scandinavian Sarcoma Group III protocol. Ann Oncol 2010; 22:1221-1227. [PMID: 21059639 DOI: 10.1093/annonc/mdq573] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND High-dose chemotherapy (HDT) was added to conventional chemotherapy in Ewing sarcoma family tumor (EFT) patients, poor responders (PRs) to induction chemotherapy in order to improve their survival. PATIENTS AND METHODS Patients aged ≤40 years with nonmetastatic Ewing sarcoma (ES) received vincristine (V), doxorubicin (A), cyclofosfamide (C), actinomycin (Ac), ifosfamide (I) and etoposide (E) (VACAc-IE regimen) as induction chemotherapy. As maintenance treatment, good responders (GR) received nine cycles of VACAc-IE regimen. PRs received three cycles of VAC-IE, mobilizing cycle with CE and HDT with Busulfan and Melphalan with stem cell support. RESULTS Three hundred patients [median age 15 years (3-40 years)] entered the study. One patient refused local treatment, 242 (81%) underwent surgery [with radiotherapy (RT) in 80] and 57 (19%) RT alone. No toxic deaths were recorded. Overall GR were 146 (49%). Twenty-eight PR did not receive HDT. At a median follow-up of 64 months (21-116 months), 5-year overall and event-free survival (EFS) were 75% and 69%, respectively. Five-year EFS was 75% for GR, 72% for PR treated with HDT and 33% for PR who did not receive HDT. CONCLUSIONS High-dose therapy added to the VACA-IE regimen in PR patients is feasible and effective. Selected groups of patients with ES can benefit from HDT.
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Affiliation(s)
- S Ferrari
- Department of Chemotherapy, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - K Sundby Hall
- Oncology Department, The Norwegian Radium Hospital, Oslo, Norway
| | - R Luksch
- Pediatric Oncology Division, Istituto Nazionale Tumori, Milan
| | - A Tienghi
- Department of Medical Oncology, S.Maria delle Croci Hospital, Ravenna, Italy
| | - T Wiebe
- Department of Cancer Epidemiology, and Paediatric Oncology, Lund University Hospital, Lund, Sweden
| | - F Fagioli
- Department of Pediatric Oncology, Ospedale Regina Margherita, Torino
| | - T A Alvegard
- Department of Cancer Epidemiology, and Paediatric Oncology, Lund University Hospital, Lund, Sweden
| | | | - A Tamburini
- Pediatric Oncology Division, Meyer Hospital, Firenze
| | - M Alberghini
- Department of Pathology, Istituto Ortopedico Rizzoli, Bologna
| | - L Gandola
- Radiotherapy Unit, Istituto Nazionale Tumori, Milano
| | - M Mercuri
- Department of Surgery, Istituto Ortopedico Rizzoli, Bologna
| | - R Capanna
- Oncologic/Orthopaedic Surgery Division, Centro Traumatologico Ortopedico, Firenze
| | - S Mapelli
- Oncologic/Orthopaedic Surgery, Istituto Gaetano Pini, Milan
| | - A Prete
- Department of Pediatric Oncology, University Hospital, Bologna
| | - M Carli
- Department of Pediatric Oncology, University Hospital, Padova
| | - P Picci
- Experimental Oncology Divisions, Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna
| | - E Barbieri
- Radiotherapy Division, University Hospital, Bologna, Italy
| | - G Bacci
- Department of Chemotherapy, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Smeland
- Oncology Department, The Norwegian Radium Hospital, Oslo, Norway
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Prete A. Reduced-intensity conditioning regimen and allogeneic stem cell transplantation from related or unrelated HLA identical donor in high-risk neuroblastoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Prete A, Rondelli R, Locatelli F, Lanino E, Favre C, Rabusin M, Pession A, Fagioli F. 4108 Reduced intensity conditioning regimen and allogeneic stem cell transplantation from related or unrelated HLA identical donor in high risk neuroblastoma. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70761-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kleinschmidt K, Martoni A, Masetti R, Melchionda F, Prete A, Pession A. 4118 Clofarabine: safety and efficacy profile for treatment of pediatric patients with refractory or relapsed acute leukemias. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70771-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Palmerini E, Brach Del Prever A, Fagioli F, Luksch R, Prete A, Tamburini A, Abate ME, Picci P, Ferrari S, Tienghi A. High-dose chemotherapy with autologous stem cell transplantation for relapsed Ewing's sarcoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.10545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10545 Background: Nearly 30–40% of patients with newly diagnosed, non-metastatic Ewing's Sarcoma (EWS) relapse. Post-relapse survival (PRS) in EWS is very poor, with less than 15–20% alive 5-years after recurrence. The role of high-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) is under investigation in metastatic and high risk localized EWS patients. In order to improve PRS, we employed HDCT with ASCT in EWS patients at 1st relapse. Methods: All non-metastatic EWS patients treated in Italian Sarcoma Group centers who relapsed between 1999 and June 2008 were offered HDCT (busulfan 4 mg/kg × 4 days orally and melphalan 140 mg/m2) with ASCT whenever possible (no previous HDCT; stable or responding disease after standard dose chemotherapy; adequate peripheral blood stem cells harvest). Results: 72 EWS patients experienced disease recurrence. Fifty (62%) were male. Twenty-eight (39%) of patients had previously received HDCT. Median relapse free interval (RFI) was 16 months (2.8–64). Pattern of relapse was: lung metastases in 20 (28%) patients, bone metastases in 12 (16%), local recurrence in 11 (15%) and multiple sites in 29 (40%). Treatment at 1st relapse was: standard dose chemotherapy in 31 (43%) patients; HDCT followed by ASCT in 24 (33%); palliative treatment in 12 (17%) and surgery only in 5 (7%). Three patients died of treatment-related toxicity. With a median follow-up of 24 months (1–64), the 3-year post-relapse survival (PRS) was 21% (95%CI 7–35). 3-year PRS was better for patients with a lung only relapse [48%, (95%CI 21–74)] and a RFI > 2 years [51%, (95%CI 27–76)]. 3-year PRS was 33% (95%CI 13–54) for patients treated with HDCT and 22% (95%CI 6–39) for those receiving standard dose chemotherapy. A significant (P 0.02) advantage was observed in the subgroup of patients with a shorter RFI treated with HDCT [3-year PRS 29% (95%CI 5–52)] compared to those treated with standard dose chemotherapy [3-years PRS 13%, (95%CI 2–29)]. Conclusions: Pattern of recurrence and RFI are the main factors influencing PRS in EWS. The use of HDCT with ASCT in recurrent EWS is investigational. Patients with shorter RFI could more likely benefit from HDCT. No significant financial relationships to disclose.
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Affiliation(s)
- E. Palmerini
- Istituto Ortopedico Rizzoli, Bologna, Italy; Ospedale Regina Margherita, Torino, Italy; Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Orsola Malpighi, Bologna, Italy; Ospedale A. Meyer, Firenze, Italy; Ospedale S. Maria Delle Croci, Ravenna, Italy
| | - A. Brach Del Prever
- Istituto Ortopedico Rizzoli, Bologna, Italy; Ospedale Regina Margherita, Torino, Italy; Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Orsola Malpighi, Bologna, Italy; Ospedale A. Meyer, Firenze, Italy; Ospedale S. Maria Delle Croci, Ravenna, Italy
| | - F. Fagioli
- Istituto Ortopedico Rizzoli, Bologna, Italy; Ospedale Regina Margherita, Torino, Italy; Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Orsola Malpighi, Bologna, Italy; Ospedale A. Meyer, Firenze, Italy; Ospedale S. Maria Delle Croci, Ravenna, Italy
| | - R. Luksch
- Istituto Ortopedico Rizzoli, Bologna, Italy; Ospedale Regina Margherita, Torino, Italy; Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Orsola Malpighi, Bologna, Italy; Ospedale A. Meyer, Firenze, Italy; Ospedale S. Maria Delle Croci, Ravenna, Italy
| | - A. Prete
- Istituto Ortopedico Rizzoli, Bologna, Italy; Ospedale Regina Margherita, Torino, Italy; Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Orsola Malpighi, Bologna, Italy; Ospedale A. Meyer, Firenze, Italy; Ospedale S. Maria Delle Croci, Ravenna, Italy
| | - A. Tamburini
- Istituto Ortopedico Rizzoli, Bologna, Italy; Ospedale Regina Margherita, Torino, Italy; Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Orsola Malpighi, Bologna, Italy; Ospedale A. Meyer, Firenze, Italy; Ospedale S. Maria Delle Croci, Ravenna, Italy
| | - M. E. Abate
- Istituto Ortopedico Rizzoli, Bologna, Italy; Ospedale Regina Margherita, Torino, Italy; Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Orsola Malpighi, Bologna, Italy; Ospedale A. Meyer, Firenze, Italy; Ospedale S. Maria Delle Croci, Ravenna, Italy
| | - P. Picci
- Istituto Ortopedico Rizzoli, Bologna, Italy; Ospedale Regina Margherita, Torino, Italy; Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Orsola Malpighi, Bologna, Italy; Ospedale A. Meyer, Firenze, Italy; Ospedale S. Maria Delle Croci, Ravenna, Italy
| | - S. Ferrari
- Istituto Ortopedico Rizzoli, Bologna, Italy; Ospedale Regina Margherita, Torino, Italy; Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Orsola Malpighi, Bologna, Italy; Ospedale A. Meyer, Firenze, Italy; Ospedale S. Maria Delle Croci, Ravenna, Italy
| | - A. Tienghi
- Istituto Ortopedico Rizzoli, Bologna, Italy; Ospedale Regina Margherita, Torino, Italy; Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Orsola Malpighi, Bologna, Italy; Ospedale A. Meyer, Firenze, Italy; Ospedale S. Maria Delle Croci, Ravenna, Italy
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Prete A, Rondelli R, Fagioli F, Luksch R, Morello W, Pession A. Matched pair analysis comparing intravenous busulfan and oral busulfan as part of conditioning regimen in autologous stem cell transplantation in high risk neuroblastoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.18003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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Nisi L, Tripaldi R, Simonetti I, Matarrese G, Lopresto G, Prete A, Conserva R. PREVALENZA DEI GENOTIPI HCV E APPROPRIATEZZA DELLA RICHIESTA. Microbiol Med 2007. [DOI: 10.4081/mm.2007.2811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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27
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Luksch R, Grignani G, Fagioli F, Brach del Prever A, Podda M, Aliberti S, Casanova M, Prete A, Hanau G, Tamburini A, Allione P, Tienghi A, Ferrari S, Collini P, Marchianò A, Gandola L, Aglietta M, Madon E, Picci P, Fossati-Bellani F. Response to melphalan in up-front investigational window therapy for patients with metastatic Ewing's family tumours. Eur J Cancer 2007; 43:885-90. [PMID: 17254770 DOI: 10.1016/j.ejca.2006.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2006] [Accepted: 09/23/2006] [Indexed: 11/20/2022]
Abstract
The aim of the study was to determine the activity and toxicity of melphalan as a single agent given in up-front therapy for patients with newly-diagnosed Ewing's family tumours with bone/bone marrow metastases. Nineteen patients were enrolled from 2001 to 2004. The treatment consisted of up-front therapy with melphalan (two courses of 50 mg/m2, 3 weeks apart). The overall rate of response to melphalan (complete response+partial response, according to the RECIST criteria) was 78%. Transient grade 3-4 neutropenia, thrombocytopenia and anaemia were recorded in 97%, 81% and 28% of melphalan courses, respectively. No other relevant toxicities were recorded. Melphalan proved to be active in up-front treatment at non-myeloablative doses, and its toxicity was predictable and manageable. The schedule adopted did not interfere with any further intensive chemotherapy or myeloablative treatment in the majority of cases.
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Affiliation(s)
- R Luksch
- Istituto Nazionale per lo Studio e la Cura dei Tumori di Milano, Milan, Italy.
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Bacigalupo A, Locatelli F, Lanino E, Marsh J, Socié G, Maury S, Prete A, Locasciulli A, Cesaro S, Passweg J. Fludarabine, cyclophosphamide and anti-thymocyte globulin for alternative donor transplants in acquired severe aplastic anemia: a report from the EBMT-SAA Working Party. Bone Marrow Transplant 2006; 36:947-50. [PMID: 16205733 DOI: 10.1038/sj.bmt.1705165] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We have developed a reduced-intensity conditioning regimen for patients with severe aplastic anemia (SAA) undergoing alternative donor transplants, which includes fludarabine (120 mg/m(2)), cyclophosphamide (1,200 mg/m(2)) and antithymocyte globulin (7.5 mg/kg). Graft-versus-host disease (GvHD) prophylaxis consisted of cyclosporine and methotrexate. We have enrolled 38 SAA patients in this trial: median age of 14 (3-37) years, transplanted from unrelated (n=33) or family mismatched (n=5) donors, with unmanipulated marrow (n=36) or peripheral blood (n=2). Seven patients (18%) had evidence of graft failure, 11% developed grade II-III acute GvHD and 27% developed chronic GvHD. The actuarial 2-year survival is 73%, with a median follow-up of 621 days. Younger patients (<or=14 years) had a lower risk of rejection (5%) and improved actuarial survival (84%). Causes of death were infections (n=3), graft failure (n=2), Epstein-Barr virus lymphoma (n=2) and hemorrhage (n=2). In conclusion, the actuarial 2-year survival is encouraging in young SAA patients receiving a radiation-free conditioning regimen. The significant risk of graft failure in patients 15 years or older may require modification of the conditioning regimen in adults.
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Affiliation(s)
- A Bacigalupo
- Department of Hematology 2, Azienda Ospedaliera Universitaria San Martino, Largo Benzi, Genova, Italy.
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Luksch R, Fagioli F, Grignani E, Aliberti S, Casanova M, Hanau G, Tamburini A, Prete A, Ferrari S, Picci P. Up-front melphalan in Ewing's family tumors with bone/bone marrow metastases at onset (very-high risk EFTs). A report from ISG/AIEOP “Very High Risk EFTs Cooperative Study”. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Luksch
- Istituto Nazionale Tumori, Milano, Italy; OIRM S.Anna, Torino, Italy; IRCC, Candiolo, Italy; Istituto Giannina Gaslini, Genova, Italy; Ospedale Meyer, Firenze, Italy; Policlinico S.Orsola, Bologna, Italy; Istituti Ortopedici Rizzoli, Bologna, Italy
| | - F. Fagioli
- Istituto Nazionale Tumori, Milano, Italy; OIRM S.Anna, Torino, Italy; IRCC, Candiolo, Italy; Istituto Giannina Gaslini, Genova, Italy; Ospedale Meyer, Firenze, Italy; Policlinico S.Orsola, Bologna, Italy; Istituti Ortopedici Rizzoli, Bologna, Italy
| | - E. Grignani
- Istituto Nazionale Tumori, Milano, Italy; OIRM S.Anna, Torino, Italy; IRCC, Candiolo, Italy; Istituto Giannina Gaslini, Genova, Italy; Ospedale Meyer, Firenze, Italy; Policlinico S.Orsola, Bologna, Italy; Istituti Ortopedici Rizzoli, Bologna, Italy
| | - S. Aliberti
- Istituto Nazionale Tumori, Milano, Italy; OIRM S.Anna, Torino, Italy; IRCC, Candiolo, Italy; Istituto Giannina Gaslini, Genova, Italy; Ospedale Meyer, Firenze, Italy; Policlinico S.Orsola, Bologna, Italy; Istituti Ortopedici Rizzoli, Bologna, Italy
| | - M. Casanova
- Istituto Nazionale Tumori, Milano, Italy; OIRM S.Anna, Torino, Italy; IRCC, Candiolo, Italy; Istituto Giannina Gaslini, Genova, Italy; Ospedale Meyer, Firenze, Italy; Policlinico S.Orsola, Bologna, Italy; Istituti Ortopedici Rizzoli, Bologna, Italy
| | - G. Hanau
- Istituto Nazionale Tumori, Milano, Italy; OIRM S.Anna, Torino, Italy; IRCC, Candiolo, Italy; Istituto Giannina Gaslini, Genova, Italy; Ospedale Meyer, Firenze, Italy; Policlinico S.Orsola, Bologna, Italy; Istituti Ortopedici Rizzoli, Bologna, Italy
| | - A. Tamburini
- Istituto Nazionale Tumori, Milano, Italy; OIRM S.Anna, Torino, Italy; IRCC, Candiolo, Italy; Istituto Giannina Gaslini, Genova, Italy; Ospedale Meyer, Firenze, Italy; Policlinico S.Orsola, Bologna, Italy; Istituti Ortopedici Rizzoli, Bologna, Italy
| | - A. Prete
- Istituto Nazionale Tumori, Milano, Italy; OIRM S.Anna, Torino, Italy; IRCC, Candiolo, Italy; Istituto Giannina Gaslini, Genova, Italy; Ospedale Meyer, Firenze, Italy; Policlinico S.Orsola, Bologna, Italy; Istituti Ortopedici Rizzoli, Bologna, Italy
| | - S. Ferrari
- Istituto Nazionale Tumori, Milano, Italy; OIRM S.Anna, Torino, Italy; IRCC, Candiolo, Italy; Istituto Giannina Gaslini, Genova, Italy; Ospedale Meyer, Firenze, Italy; Policlinico S.Orsola, Bologna, Italy; Istituti Ortopedici Rizzoli, Bologna, Italy
| | - P. Picci
- Istituto Nazionale Tumori, Milano, Italy; OIRM S.Anna, Torino, Italy; IRCC, Candiolo, Italy; Istituto Giannina Gaslini, Genova, Italy; Ospedale Meyer, Firenze, Italy; Policlinico S.Orsola, Bologna, Italy; Istituti Ortopedici Rizzoli, Bologna, Italy
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Dini G, Valsecchi MG, Micalizzi C, Busca A, Balduzzi A, Arcese W, Cesaro S, Prete A, Rabusin M, Mazzolari E, Di Bartolomeo P, Sacchi N, Pession A, Giorgiani G, Lanino E, Lamparelli T, Favre C, Bosi A, Manzitti C, Galimberti S, Locatelli F. Impact of marrow unrelated donor search duration on outcome of children with acute lymphoblastic leukemia in second remission. Bone Marrow Transplant 2003; 32:325-31. [PMID: 12858206 DOI: 10.1038/sj.bmt.1704132] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We analyzed the outcome of 167 consecutive children with second CR acute lymphoblastic leukemia (ALL), for whom an unrelated donor (UD) search was activated between 1989 and 1998 at a median time of 2 months after relapse. A suitable donor was identified for 70 patients at 1 year and 6.5 months before and after 1995 from search activation, respectively; a further leukemia relapse occurred during the search in 94 children at a median of 4 months after search activation, 36 of whom underwent UD (14) or other types of transplant (22), beyond second CR, while 58 died of progressive disease. Of 73 patients not experiencing a second relapse, 64 underwent UD (46) or other types of transplant (18), while nine proceeded with chemotherapy, and only four of them survived. The 3-year disease-free survival (DFS) from second CR for the 167 patients is 15.1%, whereas 3-year DFS after transplant for the 60 UD and 40 alternative donor transplanted children is 31.6 and 25.4%, respectively. In conclusion, a further relapse is the main factor adversely affecting outcome of children with second CR ALL. Thus, for these patients, the search should be activated early after relapse and either a UD or an alternative transplant should be performed as early as possible.
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Affiliation(s)
- G Dini
- UO Ematologia ed Oncologia Pediatrica, Istituto G Gaslini, Genova, Italy
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31
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La Nasa G, Giardini C, Locatelli F, Argiolu F, Vassallo E, Prete A, Caocci G, Floris R, Garau P, Littera R, Mantovani D, Oppi S, Piras E, De Stefano P, Sanna MA, Mulargia M, Carcassi C, Contu L. Unrelated bone marrow transplantation in thalassemia. The experience of the Italian Bone Marrow Transplant Group (GITMO). Haematologica 2002; 87:58-61. [PMID: 12412392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Allogeneic bone marrow transplantation (BMT) is a widely accepted therapeutic approach in homozygous beta-thalassemia. However, the majority of patients do not have a genotypically identical donor within the family. This prompted us to conduct a pilot study to investigate the feasibility of matched unrelated bone marrow transplantation in thalassemia. The major drawback was the high risk of immunologic and transplant-related complications, mainly graft-versus-host disease (GvHD) and graft failure. DESIGN AND METHODS Our aim was to reduce this risk through careful selection of donor/recipient pairs. HLA haplotypes that show a high linkage disequilibrium among their class I, class II and class III alleles are considered extended or ancestral haplotypes. RESULTS These haplotypes are conserved and can be shared by apparently unrelated individuals. Our study shows that matching for these haplotypes significantly improves the outcome of unrelated bone marrow transplantation in thalassemia. In fact, results were comparable to those obtained in transplants using HLA-identifical family donors. INTERPRETATION AND CONCLUSIONS Better results were obtained in patients with lesser iron overload and when the donor shared an identity for the DPB1 alleles.
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Affiliation(s)
- G La Nasa
- Centro Trapianti Midollo Osseo, Ospedale R. Binaghi, Cattedra di Genetica Medica, Università di Cagliari, Italy.
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Montaguti M, Brandolini C, Ferri GG, Hatzopoulos S, Prete A, Pession A. [Cisplatin and carboplatin-induced ototoxicity in children: clinical aspects and perspectives for prevention]. Acta Otorhinolaryngol Ital 2002; 22:14-8. [PMID: 12236007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
In 70% of the cases of malignant neoplasms in pediatric patients antiblast therapy is used. The administration of platinum compounds, Cisplatin (CDDP) or Carboplatin (CBDCA), often at high cumulative doses, necessarily implies a certain degree of toxicity which normally takes on secondary significance in the healing of the child. Among the side effects, early and delayed ototoxicity is well known and, in the child, take on particular aspects. While not abandoning the treatment of the base pathology, the therapeutic findings, increasingly comforting in terms of long-term survival, require more accurate evaluation and overall control of the quality of life of these young patients. Since initial cochlear damage can be reversible, auditory function must be carefully monitored in order to prevent the lesions from becoming permanent, in particular prior to the onset of speech. For this reason a retrospective study was made of a group of 26 children affected by malignant neoplasms all of whom had undergone a polychemotherapy protocol with the administration of CDDP in 14 cases and CBDCA in 12 cases. All these young patients were monitored with conventional audiometry. The presence of different variables (antiblastic drug administration schedule, course of the disease, general conditions) only permitted evaluation of a single correlation: between auditory function at the end of the treatment (or after a few cycles of therapy) and the overall dose of CDDP or CBDCA administered. In 16 cases (62%) typical bilateral perceptive deafness was detected progressively involving the hyperacute and acute frequencies. The finding of hearing loss was significantly greater in the patients treated with CDDP (86%) vs. those treated with CBDCA (33%). Moreover, analysis of the results showed that, within certain limits, ototoxicity can depend more on individual sensitivity to the drug than to the total dose administered. The results confirm the well-known ototoxicity of platinum compounds, in particular CDDP. As ever improved therapeutic results are achieved in the treatment of malignant neoplasms in pediatric patients, greater attention can be paid to the quality of life of these young patients after the disease has been healed. Careful monitoring of auditory function can be extremely important in the pursuit this objective; indeed, this makes it possible to adjust antiblast drug administration, particularly in the later stages of treatment, customizing the treatment schedule to individual patient sensitivity.
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Affiliation(s)
- M Montaguti
- Dipartimento di Scienze Chirurgiche ed Anestesiologiche, Sezione di Otorinolaringoiatria, Ospedale S. Orsola-Malpighi, Università di Bologna
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Balduzzi A, Valsecchi MG, Silvestri D, Locatelli F, Manfredini L, Busca A, Iori AP, Messina C, Prete A, Andolina M, Porta F, Favre C, Ceppi S, Giorgiani G, Lanino E, Rovelli A, Fagioli F, De Fusco C, Rondelli R, Uderzo C. Transplant-related toxicity and mortality: an AIEOP prospective study in 636 pediatric patients transplanted for acute leukemia. Bone Marrow Transplant 2002; 29:93-100. [PMID: 11850701 DOI: 10.1038/sj.bmt.1703337] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2001] [Accepted: 10/19/2001] [Indexed: 11/08/2022]
Abstract
Hematopoietic stem cell transplantation can cure high-risk acute leukemia (AL), but the occurrence of non-leukemic death is still high. The AIEOP conducted a prospective study in order to assess incidence and relationships of early toxicity and transplant-related mortality (TRM) in a pediatric population. Between 1990 and 1997 toxicities reported in eight organs (central nervous system, heart, lungs, liver, gut, kidneys, bladder, mucosa) were classified into three grades (mild, moderate, severe) and prospectively registered for 636 consecutive children who underwent autologous (216) or allogeneic (420) transplantation, either from an HLA compatible related (294), or alternative (126) donor in 13 AIEOP transplant centers. Overall, 47% of the patients are alive in CR (3-year EFS: 45.2%, s.e.: 2.1), 19% died in CR at a median of 60 days (90-day TRM: 14.3%, s.e.: 1.4), 34% relapsed. Toxicity of any organ, but mucosa and gut, was positively correlated with early death; moderate and severe toxicity to heart, lungs, liver and kidneys significantly increased early TRM, with estimated relative risks of 9.1, 5.5, 2.7 and 2.8, respectively, as compared to absent or mild toxicity. Patients with grade III-IV aGVHD experienced more than double (56% vs. 19%) TRM than patients with grade 0-II aGVHD. A higher cumulative toxicity score, estimating the impact of toxicity on TRM, was significantly associated with transplantation from an alternative donor. Quantitative assessment allowed us to describe the extent to which 'grade' of toxicity and 'type' of involved organs were related to mortality and pre-transplant characteristics and yielded a prognostic score potentially useful to compare different conditioning regimens and predict probability of early death.
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MESH Headings
- Adolescent
- Child
- Child, Preschool
- Female
- Hematopoietic Stem Cell Transplantation/adverse effects
- Hematopoietic Stem Cell Transplantation/mortality
- Humans
- Infant
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Organ Specificity
- Prospective Studies
- Registries
- Risk Factors
- Severity of Illness Index
- Survival Analysis
- Transplantation, Autologous
- Transplantation, Homologous
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Affiliation(s)
- A Balduzzi
- Clinica Pediatrica, Università degli Studi di Milano-Bicocca, Centro Trapianto Midollo Osseo, Monza, Italy
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Prete A, Rondelli R, Rosito P, Pession A. Dose intensive therapy and myeloablative chemotherapy with haematopoietic stem cell rescue in childhood poor prognosis Ewing's sarcoma. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81476-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rondelli R, Magnani C, Pession A, Prete A, De Rosa M, Rago S, Basso G, Paolucci G. The Italian hospital-based registry of pediatric cancer: 11 years' experience. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mastrangelo S, Tornesello A, Diociaiuti L, Pession A, Prete A, Rufini V, Troncone L, Mastrangelo R. Treatment of advanced neuroblastoma: feasibility and therapeutic potential of a novel approach combining 131-I-MIBG and multiple drug chemotherapy. Br J Cancer 2001; 84:460-4. [PMID: 11207038 PMCID: PMC2363758 DOI: 10.1054/bjoc.2000.1645] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Biological and clinical observations suggest that initial marked reduction of resistant clones may be critical in any attempt to improve long-term results in advanced neuroblastoma (NB). The aim of this pilot study is to determine short-term toxicity and efficacy of a new therapeutic model based on the simultaneous use of multiple drug chemotherapy and specific irradiation using 131-I-MIBG. The study population consisted of 21 patients, from 1 to 8 years of age with good 131-I-MIBG uptake. 16 extensively pre-treated patients with refractory or relapsed disease were divided into 2 groups. In Group 1 (9 patients) the basic chemotherapy regimen consisted in cisplatin at the dose of 20 mg/m(2) i.v. per day infused over 2 h, for 4 consecutive days; on day 4 Cy 2 g/m(2) i.v. was administered over 2 h followed by Mesna. Group 2 (7 patients) was treated with basic chemotherapeutic regimen plus VP16 and Vincristine. VP16 at the dose of 50 mg/m(2) i.v. per day was administered as a 24 h infusion on days 1-3; Vincristine 1.5 mg/m(2) i.v. was administered on days 1 and 6. On day 10 a single dose of 131-I-MIBG (200 mCi) with a high specific activity (>1.1 GBq/mg) was administered to both Groups by i.v. infusion over 4-6 hours. A further 5 patients were treated at diagnosis: 2 with the same regimen as Group 1 and 3 with the same as Group 2. The severity of toxicity was graded according to World Health Organization (WHO) criteria. Assessment of tumour response was monitored 4-6 weeks after the beginning of combined therapy (CO-TH). Response was defined according to INSS (International Neuroblastoma Staging System) criteria. No extra-medullary toxicity was observed in any patient. Haematological toxicity was the only toxicity observed and seemed mainly related to chemotherapy. Myelosuppression was mild in the 5 patients treated at diagnosis. No serious infections or significant bleeding problems were observed. In the 16 resistant patients, 12 PR, 1 mixed response and 3 SD were obtained. In the 5 patients treated at diagnosis 2 PR, 1 CR and 2 VGPR were observed. No alteration in 131-I-MIBG uptake was observed after the chemotherapy preceding radio-metabolic treatment. The therapeutic results of this pilot regimen of CO-TH resulted in a high percentage of major response after only a single course in both resistant patients and patients treated at diagnosis. Because of the minimal toxicity observed in patients studied at diagnosis so far, there is room for gradual intensification of the treatment. It is to be hoped that this suggested novel approach may represent an important route of investigation to improve final outcome in patients with advanced NB.
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Affiliation(s)
- S Mastrangelo
- Pediatric Oncology, Catholic University, Rome, Italy
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Urbini B, Castellini C, Rondelli R, Prete A, Pierinelli S, Pession A. Cryptococcal meningitis during front-line chemotherapy for acute lymphoblastic leukemia. Haematologica 2000; 85:1103-4. [PMID: 11025610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Pession A, Castellini C, Prete A, Locatelli F, Urbini B, Paolucci G. Method using urokinase and an antibiotic to avoid device removal in central venous catheter-related infections. Med Pediatr Oncol 2000; 35:434-5. [PMID: 11025478 DOI: 10.1002/1096-911x(20001001)35:4<434::aid-mpo10>3.0.co;2-e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A Pession
- Department of Pediatrics, University of Bologna, Ospedale Sant'Orsola, Bologna, Italy.
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Tonelli R, Scardovi AL, Pession A, Strippoli P, Bonsi L, Vitale L, Prete A, Locatelli F, Bagnara GP, Paolucci G. Compound heterozygosity for two different amino-acid substitution mutations in the thrombopoietin receptor (c-mpl gene) in congenital amegakaryocytic thrombocytopenia (CAMT). Hum Genet 2000; 107:225-33. [PMID: 11071383 DOI: 10.1007/s004390000357] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Congenital amegakaryocytic thrombocytopenia (CAMT) without physical anomalies is a rare disease, presenting isolated thrombocytopenia and megakaryocytopenia in infancy, which can evolve into aplastic anemia and leukemia. Recently, two heterozygous truncating mutations of the thrombopoietin (TPO) receptor MPL, coded by the c-mpl gene, were identified in a 10-year-old Japanese patient with CAMT transmitted in an autosomal recessive manner. Here, we report for the first time two different MPL amino-acid substitutions in a 2-year-old Italian boy with CAMT and compound heterozygosis for two (c-mpl point mutations. C-to-T transitions were detected on exons 5 and 12 at the 769 and 1904 cDNA nucleotide positions, respectively. The mutation in exon 5 substitutes an arginine with a cysteine (R257C) in the extracellular domain, 11 amino acids distant from the WSXWS motif conserved in the cytokine-receptor superfamily. The mutation in exon 12 substitutes a proline with a leucine (P635L) in the last amino acid of the C-terminal intracellular domain, responsible for signal transduction. As in the Japanese family, the mutations were both transmitted from the parents. TPO plasma levels were highly increased in the patient. The patient's 7-year-old brother, who was a candidate donor for allografting, turned out to be an asymptomatic heterozygous carrier of P635L and showed defective megakaryocyte colony formation from bone-marrow progenitor cells. The present study provides important confirmation that CAMT can be associated with (c-mpl) mutations.
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Affiliation(s)
- R Tonelli
- Department of Pediatrics, University of Bologna, Italy
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Pession A, Rondelli R, Paolucci P, Pastore G, Dini G, Bonetti F, Madon E, Mandelli F, Zanesco L, Uderzo C, Prete A, Rabusin M, Ugazio A, Di Bartolomeo P, Favre C, Bojd-Faulkner L, Poggi V, Luksch R, Donfrancesco A, Argiolu F, La Nasa G, Amici A, Locatelli F. Hematopoietic stem cell transplantation in childhood: report from the bone marrow transplantation group of the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP). Haematologica 2000; 85:638-46. [PMID: 10870122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Transplantation of hematopoietic stem cells from different sources is being increasingly used to treat a variety of diseases in children. Transplant procedures and indications have changed considerably during recent years. Monitoring of information about these changes is useful for interpretation of nationwide collected data. DESIGN AND METHODS Since 1985, Centers belonging to the AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica), performing hematopoietic stem cell transplants (HSCT) in children, and members of the AIEOP-Bone Marrow Transplant (BMT) Group annually report data on their transplant activity to the AIEOP-BMT Registry employing specially prepared patient-oriented forms. RESULTS From January 1985 to December 1998, a total of 2,474 bone marrow (BM), peripheral blood (PB) or umbilical cord blood (CB) transplants were reported: 1,296 (52%) were allogeneic (Allo) and 1,178 (48%) autologous (Auto) transplants. These transplants were performed in 19 Italian Centers on 2,249 patients aged less than 17 years. Among Allo-transplants, 1,198 (92%) were performed using BM progenitor cells, whereas 49 (4%) CB, 42 (3%) were PB, 4 BM plus PB, and 3 BM plus CB allografts; they were performed using HLA-identical sibling donors in 867 cases (67%) and alternative donors (i.e. partially-matched relatives or unrelated donors) in the remaining 429 (33%) cases. Allogeneic transplants were performed on 786 (67%) patients with malignancy and on 395 (33%) patients with non-malignant disorders. In the last 6 years, the number of Allo-transplants per year exceeded that of Auto-transplants. Of the Auto-transplants, 775 (66%) were performed using BM, and 403 (34%) using PB alone or combined with BM hematopoietic stem cells. Indications for Auto-BMT were myelo-lymphoproliferative disorders in 524 (49%) cases, solid tumor in 533 (50%) cases and non-malignant disease in 11 (1%) cases. In the last 5 years, the use of PB for autografts has increased from 7% to 70%. INTERPRETATION AND CONCLUSIONS These data reflect the development and present status of HSCT in Italy and provide a basis for patient counseling and health care planning.
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Affiliation(s)
- A Pession
- Department of Pediatrics, University of Bologna, Ospedle Sant'Orsola, Bologna, Italy.
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Locatelli F, Zecca M, Rondelli R, Bonetti F, Dini G, Prete A, Messina C, Uderzo C, Ripaldi M, Porta F, Giorgiani G, Giraldi E, Pession A. Graft versus host disease prophylaxis with low-dose cyclosporine-A reduces the risk of relapse in children with acute leukemia given HLA-identical sibling bone marrow transplantation: results of a randomized trial. Blood 2000; 95:1572-9. [PMID: 10688810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Leukemia relapse is a major cause of treatment failure for patients with acute leukemia given allogeneic bone marrow transplantation (BMT). This study evaluated whether a reduction of the dosage of cyclosporine-A (Cs-A) used for graft versus host disease (GVHD) prophylaxis could reduce relapse rate (RR) in children with acute leukemia given BMT. Fifty-nine children who had transplantation from HLA-identical siblings were randomized to receive Cs-A intravenously at a dosage of 1 mg/kg/d (Cs-A1) or of 3 mg/kg/d (Cs-A3) until patients were able to tolerate oral intake. Subsequently, both groups received Cs-A orally at a dosage of 6 mg/kg/d, with discontinuation 5 months after BMT. The probability of developing grade II-IV acute GVHD was 57% for the Cs-A1 group versus 38% for the Cs-A3 group (P =.06); the probability of developing chronic GVHD was 30% for the Cs-A1 group and 26% for the Cs-A3 group (P = NS). Three patients died of grade IV acute GVHD: 2 were in the Cs-A1 and the third in the Cs-A3 group. The RR was 15% for the Cs-A1 group and 41% for the Cs-A3 group (P =.034); 1-year transplant-related mortality estimates were 17% and 7%, respectively (P = NS). With a median observation time of 44 months from BMT, the 5-year event-free survival for children belonging to Cs-A1 and Cs-A3 groups was 70% and 51%, respectively (P =.15). Our data demonstrate that the use of low Cs-A doses is associated with a statistically significant reduction of leukemia relapse, probably due to an increased graft versus leukemia effect. (Blood. 2000;95:1572-1579)
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Affiliation(s)
- F Locatelli
- Department of Pediatrics, University of Pavia, IRCCS Policlinico San Matteo, Pavia, Italy.
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Bonetti F, Zecca M, Pession A, Messina C, Montagna D, Lanino E, Fagioli F, Santoro N, Prete A, Cesaro S, Rondelli R, Giorgiani G, De Stefano P, Locatelli F. Total-body irradiation and melphalan is a safe and effective conditioning regimen for autologous bone marrow transplantation in children with acute myeloid leukemia in first remission. The Italian Association for Pediatric Hematology and Oncology-Bone Marrow Transplantation Group. J Clin Oncol 1999; 17:3729-35. [PMID: 10577844 DOI: 10.1200/jco.1999.17.12.3729] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of a preparative regimen consisting of fractionated total-body radiation (9.9 to 12 Gy) and melphalan (140 mg/m(2) in a single dose) in children with acute myeloid leukemia in first complete remission (CR) given autologous bone marrow transplantation (ABMT). PATIENTS AND METHODS Fifty-three children (30 males and 23 females; age range, 1.5 to 18 years) were enrolled onto the study. The median time from first CR to ABMT was 3.5 months (range, 1.4 to 13 months), with 45 patients (85%) undergoing transplantation within 6 months from the diagnosis. Forty-five patients received in vitro marrow purging with standard-dose mafosfamide (100 microg/mL), seven patients were treated with interleukin-2 before marrow collection, and in the remaining child, the marrow was unmanipulated. The median infused cell dose was 1.8 x 10(8)/kg (range, 0.4 to 5.8 x 10(8)/kg). RESULTS All patients but one achieved hematopoietic engraftment, with a median time to neutrophil recovery of 24 days (range,11 to 66 days). Treatment-related toxicity was moderate and consisted mainly of mucositis. One patient died from cytomegalovirus interstitial pneumonia, and one died from pulmonary hemorrhage. Fourteen patients (26%) relapsed at a median time of 6 months after ABMT (range, 2 to 17 months), with a cumulative relapse probability of 29% (95% confidence interval, 16% to 42%). The 5-year Kaplan-Meier estimate of survival for all 53 patients was 78% (range, 65% to 90%), whereas the overall 5-year disease-free survival was 68% (range, 55% to 81%), with a median follow-up duration of 40 months (range, 7 to 130 months). CONCLUSIONS These data suggest that, in our cohort of patients, the combination of total-body irradiation and melphalan is safe and associated with good antileukemia activity, making ABMT an appealing alternative for postremission therapy in children with acute myeloid leukemia in first CR.
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MESH Headings
- Antineoplastic Agents, Alkylating/adverse effects
- Antineoplastic Agents, Alkylating/therapeutic use
- Bone Marrow Transplantation
- Child
- Child, Preschool
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Humans
- Infant
- Leukemia, Myelomonocytic, Acute/drug therapy
- Leukemia, Myelomonocytic, Acute/mortality
- Leukemia, Myelomonocytic, Acute/radiotherapy
- Leukemia, Myelomonocytic, Acute/therapy
- Male
- Melphalan/adverse effects
- Melphalan/therapeutic use
- Outcome Assessment, Health Care
- Prospective Studies
- Remission Induction
- Transplantation Conditioning
- Transplantation, Autologous
- Transplants/adverse effects
- Whole-Body Irradiation/adverse effects
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Affiliation(s)
- F Bonetti
- Department of Pediatrics, University of Pavia, IRCCS Policlinico San Matteo, Pavia, Italy
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Montanaro L, Pession A, Trerè D, Vici M, Prete A, Paolucci G, Derenzini M. Detection of EWS chimeric transcripts by nested RT-PCR to allow reinfusion of uncontaminated peripheral blood stem cells in high-risk Ewing's tumor in childhood. Haematologica 1999; 84:1012-5. [PMID: 10553162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Ewing's tumors (ET) are primary malignancies of bone and soft tissues characterized in at least 96% of cases by specific fusion transcripts originating from recurrent chromosomal translocations. Clinical protocols for high-risk metastatic ETs include high-dose radiation/chemotherapy followed by autologous peripheral blood stem cell (PBSC) reinfusion. We used nested reverse transcriptase polymerase chain reaction (RT-PCR) to search for the presence of ET-specific transcripts in PBSC collections from patients with high-risk ET in order to collect harvests free from neoplastic cells but still sufficient to obtain early stable engraftment. DESIGN AND METHODS Thirty-seven harvest samples from 15 ET patients treated with mobilizing chemotherapy were analyzed. Nested RT-PCR was performed to detect ET-specific transcripts in RNA extracted from the PBSC collections. RESULTS A total of 30 harvests was performed. On average, 2 harvests (range 1-4) were sufficient to collect the minimum required number of mononuclear cells (2.5
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MESH Headings
- Child
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 22
- Disease-Free Survival
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Oncogene Proteins, Fusion/analysis
- Oncogene Proteins, Fusion/genetics
- Recombinant Fusion Proteins/analysis
- Recombinant Fusion Proteins/genetics
- Recurrence
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Risk Factors
- Sarcoma, Ewing/blood
- Sarcoma, Ewing/epidemiology
- Sarcoma, Ewing/genetics
- Sensitivity and Specificity
- Transcription, Genetic
- Translocation, Genetic/genetics
- Transplantation, Autologous
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Affiliation(s)
- L Montanaro
- Servizio di Citopatologia; Clinica Pediatrica, Università degli Studi di Bologna, Policlinico S. Orsola, Bologna, Italy
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Abstract
Though a relatively rare disease, botulism can be a serious problem of public health, particularly when connected with the consumption of industrial canned food; moreover, in the last years the shortage of botulism antitoxin has caused some concern in the Public Health Authorities. This work presents the results of a five-year surveillance of botulism in Italy, with the distribution of the cases by Regions (first level administrative units which, in Italy, have administrative and legislative competencies in the sanitary field) and by vehicle of transmission. All the relevant and confirmed botulism outbreaks that occurred in the period under consideration are described.
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Affiliation(s)
- S Squarcione
- Azienda Sanitaria Locale Roma F, Civitavecchia, Italy
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Pession A, Prete A, Locatelli F, Bella S, Melchionda F, Garaventa A, Burnelli R, Paolucci G. Phase I study of high-dose thiotepa with busulfan, etoposide, and autologous stem cell support in children with disseminated solid tumors. Med Pediatr Oncol 1999; 33:450-4. [PMID: 10531568 DOI: 10.1002/(sici)1096-911x(199911)33:5<450::aid-mpo3>3.0.co;2-l] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this phase I study was to define the maximum tolerated dose (MTD) of thiotepa (TT), administered with busulfan (BU) 480 mg/m(2) and etoposide 2,400 mg/m(2), followed by autologous bone marrow transplantation (ABMT) or peripheral blood stem cell transplantation (APBSCT) support in children with solid tumors either disseminated at diagnosis or after relapse. PROCEDURE Nineteen patients, between 2 and 16 years of age, received a high-dose chemotherapy regimen including escalating doses of TT starting from 150 mg/m(2). Subsequent dose escalation was determined by a modified Fibonacci scheme. Whenever one patient at one dosage level showed a grade III or grade IV reversible toxicity, additional patients were admitted (one by one) up to a maximum number of 6. Upon observing grade III or IV reversible toxicity in two or more systems, in 3 of the 6 patients, no further escalation was performed, and the corresponding dosage was taken as the MTD. WHO criteria were adopted to assess grade of toxicity. RESULTS All patients had hematological recovery; and neutrophils and platelet engraftment were observed after median times of 12 and 29 days from stem cell infusion, respectively. The MTD of TT was determined to be 750 mg/ m(2). At this level, 3 of 6 patients experienced grade III mucositis and/or grade III gastrointestinal toxicity. No patient died of treatment-related toxicity. CONCLUSIONS A dose of 750 mg/m(2) TT is the MTD when it is associated with BU 480 mg/m(2) and etoposide 2, 400 mg/m(2). This ablative regimen represents a feasible and tolerable combination for high-dose chemotherapy followed by hematopoietic stem cell rescue (HSCR). Phase II studies in children with poor-prognosis solid tumors are required to evaluate the effectiveness of this treatment.
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Affiliation(s)
- A Pession
- Clinica Pediatrica, Università di Bologna, Bologna, Italy
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Zecca M, Pession A, Messina C, Bonetti F, Favre C, Prete A, Cesaro S, Porta F, Mazzarino I, Giorgiani G, Rondelli R, Locatelli F. Total body irradiation, thiotepa, and cyclophosphamide as a conditioning regimen for children with acute lymphoblastic leukemia in first or second remission undergoing bone marrow transplantation with HLA-identical siblings. J Clin Oncol 1999; 17:1838-46. [PMID: 10561223 DOI: 10.1200/jco.1999.17.6.1838] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Allogeneic hematopoietic stem-cell transplantation (HSCT) from HLA-identical siblings can be used to treat children with acute lymphoblastic leukemia (ALL). However, a significant proportion of patients with ALL who undergo HSCT relapse. For this reason, we prospectively evaluated a preparative regimen that included total body irradiation (TBI), thiotepa (TT), and cyclophosphamide (CY) in patients with high-risk ALL in first complete remission (CR) and in children with ALL in second CR. PATIENTS AND METHODS Forty children (median age, 9 years; range, 1 to 18 years) with ALL in first or second CR who underwent allogeneic HSCT from HLA-identical siblings were conditioned with a combination of fractionated TBI, TT (10 mg/kg), and CY (120 mg/kg over 2 days). Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine administered intravenously at a dose of 1 to 3 mg/kg/d for the first 21 days and subsequently orally at a dose of 6 mg/kg/d. RESULTS All assessable patients were engrafted, with a median time of 11 and 24 days for neutrophil and platelet recovery, respectively. The preparative regimen was well tolerated. Only one patient died as a result of regimen-related causes. Eight patients relapsed at a median time of 8 months after transplantation (range, 3 to 9 months), and this determined a cumulative probability of relapse of 23%. Twenty-six of 40 patients (65%) are alive and in complete hematologic remission, with a median observation time of 36 months (range, 14 to 57 months), which results in a disease-free survival (DFS) at 3 years of 65%. The 13 patients who underwent transplantation in first CR had a DFS of 85%, whereas the 27 patients who underwent HSCT in second CR had a DFS of 56%. CONCLUSION These data suggest that TT is an effective cytotoxic drug that can be safely added to the classical TBI-CY regimen. Because of its cell cycle-independent action, good CNS diffusion, and limited extramedullary toxicity, TT may contribute to increasing the percentage of children with ALL who are successfully cured with allogeneic BMT.
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Affiliation(s)
- M Zecca
- Department of Pediatrics, University of Pavia, IRCCS Policlinico San Matteo, Pavia, Italy.
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Pession A, Locatelli F, Rondelli R, Prete A, Paolucci G. Current use and outcome of blood and marrow transplantation in childhood according to the Italian Registry. Bone Marrow Transplant 1998; 22 Suppl 5:S25-7. [PMID: 9989885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Since 1985 data concerning patients affected by malignant and non-malignant diseases, aged <17 years, grafted in 16 centers nationwide, have been collected and stored in a central data base organized at the Associazione Italiana di Ematologia ed Oncologia Pediatrica (AIEOP) Operation Office within the AIEOP BMT Registry. The information, collected and structurally integrated with other specific disease-oriented national data bases, permitted the elaboration and the following publication of several analyses on survival, relapse probability and transplant-related mortality for the different diseases.
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Affiliation(s)
- A Pession
- Clinica Pediatrica, Università di Bologna, Italy
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Prete A, Rosito P, Alvisi P, Rondelli R, Melchionda F, Magrini E, Pession A. G-CSF-primed peripheral blood progenitor cells (PBPC) support in high-risk Ewing sarcoma of childhood. Bone Marrow Transplant 1998; 22 Suppl 5:S21-3. [PMID: 9989884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Since 1993 pediatric patients affected by high-risk Ewing sarcoma for the presence at onset of a large pelvic mass and/or metastatic disease, were enrolled in a national pilot study comprehensive, finally, of a high-dose chemotherapy (HDCT) procedure with hemopoietic stem cell support. The HDCT procedure considered as consolidation of the disease status obtained after the first-line therapy was followed by the reinfusion of granulokine colony-stimulating factor-primed (G-CSF) peripheral blood progenitor cell (PBPCT). Here we present the results in terms of treatment-related toxicity, hospitalization and rescue of the bone marrow function, in 17 pediatric patients enrolled in such a pilot protocol and submitted to HDCT and PBPCT at the end of first-line therapy.
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Affiliation(s)
- A Prete
- Department of Paediatrics, University of Bologna, Italy
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Pession A, Prete A, Locatelli F, Pierinelli S, Pession AL, Maccario R, Magrini E, De Bernardi B, Paolucci P, Paolucci G. Immunotherapy with low-dose recombinant interleukin 2 after high-dose chemotherapy and autologous stem cell transplantation in neuroblastoma. Br J Cancer 1998; 78:528-33. [PMID: 9716039 PMCID: PMC2063104 DOI: 10.1038/bjc.1998.527] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study was to evaluate in a phase I-II trial whether low doses of recombinant human interleukin 2 (rHuIL-2) over a prolonged period of time are safe and effective in eradicating or controlling minimal residual disease in children with neuroblastoma given high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT). From January 1992 to July 1996, 17 consecutive patients, with either stage IV or relapsed neuroblastoma, were enrolled. Patients received rHuIL-2 after a median time interval (min-max) of 105 days (56-153) after HDCT and ASCT. The protocol consisted of 2 'priming' courses of rHuIL-2 at escalating doses administered intravenously at 72-h intervals, followed by 'maintenance' with 11 monthly and six bimonthly boosting 5-day courses administered subcutaneously on an outpatient basis. At April 1997, 7 out of the 17 patients had completed the treatment schedule, four had discontinued treatment because of toxicity and four because of relapse; the remaining two patients are still on treatment, having completed 15 courses. Expansion of T lymphocytes, together with an increase in both natural killer cells and in activated T lymphocytes was evidenced. After a median (min-max) follow-up time of 30 (16-64) months, 12 out of 17 patients are alive and well. Two patients relapsed and died 14 and 35 months after transplant. Three patients are alive after having relapsed at 41, 21 and 13 months. The actuarial 2-year event-free survival and overall survival are 67% and 92% respectively. Intermittent administration of low doses of rHuIL-2 given for a long period of time is well tolerated and seems capable of controlling minimal residual disease after HDCT and ASCT in children with high-risk neuroblastoma.
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Affiliation(s)
- A Pession
- Clinica Pediatrica, Osp. S. Orsola-Malpighi Università di Bologna, Italy
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Avanzini MA, Carrà AM, Maccario R, Zecca M, Zecca G, Pession A, Comoli P, Bozzola M, Prete A, Esposito R, Bonetti F, Locatelli F. Immunization with Haemophilus influenzae type b conjugate vaccine in children given bone marrow transplantation: comparison with healthy age-matched controls. J Clin Immunol 1998; 18:193-201. [PMID: 9624578 DOI: 10.1023/a:1020578921706] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Forty-seven patients (age range, 7 months-18 years) with malignant (38 cases) and nonmalignant (9 cases) disorders given an allogeneic or an autologous bone marrow transplantation (BMT) were immunized with Haemophilus influenzae type b (Hib) polysaccharide-diphtheria toxoid conjugate vaccine administered in a single dose at different time points after transplantation. Results were compared with those of 13 healthy children matched for age and sex who received the same immunization schedule. Serum and saliva samples for measurement of total IgG subclass and specific antibody levels were obtained from patients and healthy controls before and 3 weeks after vaccination. Twenty-five of the 47 patients (53%) had a specific anti-Hib IgG response, while an effective IgA and IgM response was mounted by 23 (49%) and 11 (23%) children, respectively. In the control group, 13 of 13 subjects mounted a specific IgG antibody production (P < 0.005 in comparison to the patients' response rate), while an IgA and IgM response was demonstrated in 12 (92%; P < 0.01 compared to transplanted patients) and 7 (54%; P < 0.05 in comparison to BMT recipients) children, respectively. Lapse of time from BMT to immunization was the most important factor predicting antibody response, as proved by an effective increase in prevaccination specific IgG levels in the majority of patients vaccinated after 2 years from transplant. Our data demonstrate that BMT recipients have a reduced capacity to mount an antibody response to polysaccharide antigens compared to normal controls, even when a protein-conjugated vaccine is employed. Since time after transplant is the major factor influencing the recovery of immune reactivity to polysaccharide antigens, the ontogeny of the B cell repertoire seems to follow a predetermined sequential program of development.
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Affiliation(s)
- M A Avanzini
- Laboratori Sperimentali, IRCCS Policlinico San Matteo, Pavia, Italy
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