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Montalto S, Di Filippo M, Capra V, Manzitti C, Sementa AR, De Marco P, Ognibene M, Sertorio F, Sorrentino S. Abdominal rhabdoid tumor presenting with symptomatic spinal epidural compression in a newborn. A case report. Front Pediatr 2024; 11:1337760. [PMID: 38283400 PMCID: PMC10811000 DOI: 10.3389/fped.2023.1337760] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
The occurrence of an abdominal tumor invading the spinal canal and causing symptoms of epidural compression is rare in an infant, and exceptional at birth. Peripheral neuroblastic tumors are by far the most common cause. Emergency chemotherapy is commonly curative, though permanent sequelae are possible. Although other malignancies may be involved, no case of rhabdoid tumors at birth has been reported. We describe the case of a neonate who presented symptoms of spinal epidural compression at birth secondary to a rhabdoid tumor. As expected with this highly malignant tumor, the patient experienced a rapidly progressive clinical course and died within three months of diagnosis.
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Affiliation(s)
- Shana Montalto
- Pediatric Infectious Diseases Unit, IRCCS IstitutoGianninaGaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Michela Di Filippo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Valeria Capra
- Genomics and Clinical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Carla Manzitti
- Oncology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Patrizia De Marco
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marzia Ognibene
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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2
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Wieczorek A, Manzitti C, Garaventa A, Gray J, Papadakis V, Valteau-Couanet D, Zachwieja K, Poetschger U, Pribill I, Fiedler S, Ladenstein R, Lode HN. Clinical Phenotype and Management of Severe Neurotoxicity Observed in Patients with Neuroblastoma Treated with Dinutuximab Beta in Clinical Trials. Cancers (Basel) 2022; 14:cancers14081919. [PMID: 35454826 PMCID: PMC9026788 DOI: 10.3390/cancers14081919] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023] Open
Abstract
Neurotoxicity is an off-tumour, on-target side effect of GD2-directed immunotherapy with monoclonal antibodies. Here, we report the frequency, management and outcome of patients enrolled in two prospective clinical trials who experienced severe neurotoxicity during immunotherapy with the anti-GD2 antibody dinutuximab beta (DB) administered as short-term infusion (HR-NBL1/SIOPEN study, randomisation R2, EudraCT 2006-001489-17) or as long-term infusion (HR-NBL1/SIOPEN study, randomisation R4, EudraCT 2006-001489-17 and LTI/SIOPEN study, EudraCT 2009-018077-31), either alone or with subcutaneous interleukin-2 (scIL-2). The total number of patients included in this analysis was 1102. Overall, 44/1102 patients (4.0%) experienced Grade 3/4 neurotoxicities (HR-NBL1 R2, 21/406; HR-NBL1 R4, 8/408; LTI study, 15/288), including 27 patients with severe neurotoxicities (2.5%). Events occurred predominantly in patients receiving combined treatment with DB and scIL-2. Neurotoxicity was treated using dexamethasone, prednisolone, intravenous immunoglobulins and, in two patients, plasmapheresis, which was highly effective. While neurological recovery was observed in 16 of 21 patients with severe neurotoxicities, 5/1102 (0.45%) patients experienced persistent and severe neurological deficits. In conclusion, severe neurotoxicity is most commonly observed in patients receiving DB with scIL-2. Considering the lack of clinical benefit for IL-2 in clinical trials so far, the administration of IL-2 alongside DB is not recommended.
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Affiliation(s)
- Aleksandra Wieczorek
- Pediatric Hematology Oncology, Jagiellonian University Medical College, 30-663 Krakow, Poland;
| | - Carla Manzitti
- Oncology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (C.M.); (A.G.)
| | - Alberto Garaventa
- Oncology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (C.M.); (A.G.)
| | - Juliet Gray
- Centre for Cancer Immunology, University of Southampton, Southampton SO16 6YD, UK;
| | - Vassilios Papadakis
- Department of Pediatric Hematology-Oncology, Agia Sofia Children’s Hospital, 11527 Athens, Greece;
| | | | - Katarzyna Zachwieja
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, 30-663 Krakow, Poland;
| | - Ulrike Poetschger
- Department for Studies and Statistics and Integrated Research, Children’s Cancer Research Institute, 1090 Vienna, Austria; (U.P.); (I.P.)
| | - Ingrid Pribill
- Department for Studies and Statistics and Integrated Research, Children’s Cancer Research Institute, 1090 Vienna, Austria; (U.P.); (I.P.)
| | - Stefan Fiedler
- Department for Studies and Statistics and Integrated Research at the Children’s Cancer Research Institute of the St. Anna Children’s Hospital and Department of Paediatrics, Medical University, 1090 Vienna, Austria; (S.F.); (R.L.)
| | - Ruth Ladenstein
- Department for Studies and Statistics and Integrated Research at the Children’s Cancer Research Institute of the St. Anna Children’s Hospital and Department of Paediatrics, Medical University, 1090 Vienna, Austria; (S.F.); (R.L.)
| | - Holger N. Lode
- Pediatric Hematology and Oncology, University Medicine Greifswald, 17475 Greifswald, Germany
- Correspondence: ; Tel.: +49-3834-86-6300
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3
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Palmerini E, Meazza C, Tamburini A, Bisogno G, Ferraresi V, Asaftei SD, Milano GM, Coccoli L, Manzitti C, Luksch R, Serra M, Gambarotti M, Donati DM, Scotlandi K, Bertulli R, Favre C, Longhi A, Abate ME, Perrotta S, Mascarin M, D'Angelo P, Cesari M, Staals EL, Marchesi E, Carretta E, Ibrahim T, Casali PG, Picci P, Fagioli F, Ferrari S. Phase 2 study for nonmetastatic extremity high-grade osteosarcoma in pediatric and adolescent and young adult patients with a risk-adapted strategy based on ABCB1/P-glycoprotein expression: An Italian Sarcoma Group trial (ISG/OS-2). Cancer 2022; 128:1958-1966. [PMID: 35201621 PMCID: PMC9305236 DOI: 10.1002/cncr.34131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/27/2021] [Accepted: 01/07/2022] [Indexed: 12/02/2022]
Abstract
Background According to retrospective osteosarcoma series, ABCB1/P‐glycoprotein (Pgp) overexpression predicts for poor outcomes. A prospective trial to assess a risk‐adapted treatment strategy using mifamurtide in Pgp+ patients was performed. Methods This was a phase 2, multicenter, uncontrolled trial including patients 40 years old or younger with nonmetastatic extremity high‐grade osteosarcoma stratified according to Pgp expression. All patients received high‐dose methotrexate, doxorubicin, and cisplatin (MAP) preoperatively. In Pgp+ patients, mifamurtide was added postoperatively and combined with MAP for a good histologic response (necrosis ≥ 90%; good responders [GRs]) or with high‐dose ifosfamide (HDIFO) at 3 g/m2/d on days 1 to 5 for a histologic response < 90% (poor responders [PRs]). Pgp– patients received MAP postoperatively. After an amendment, the cumulative dose of methotrexate was increased from 60 to 120 g/m2 (from 5 to 10 courses). The primary end point was event‐free survival (EFS). A postamendment analysis was performed. Results In all, 279 patients were recruited, and 194 were included in the postamendment analysis: 70 (36%) were Pgp–, and 124 (64%) were Pgp+. The median follow‐up was 51 months. For Pgp+ patients, 5‐year EFS after definitive surgery (null hypothesis, 40%) was 69.8% (90% confidence interval [CI], 62.2%‐76.2%): 59.8% in PRs and 83.7% in GRs. For Pgp– patients, the 5‐year EFS rate was 66.4% (90% CI, 55.6%‐75.1%). Conclusions This study showed that adjuvant mifamurtide, combined with HDIFO for a poor response to induction chemotherapy, could improve EFS in Pgp+ patients. Overall, the outcomes compared favorably with previous series. Mifamurtide and HDIFO as salvage chemotherapy are worth further study. The expression of ABCB1/P‐glycoprotein (Pgp) at diagnosis has been used to stratify patients with high‐grade osteosarcoma. Adjuvant mifamurtide, combined with high‐dose ifosfamide for a poor response to induction chemotherapy, can improve event‐free survival in Pgp+ patients.
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Affiliation(s)
- Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | | | | | - Giuseppe M Milano
- Pediatric Oncology Department, Regina Margherita Children's Hospital, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luca Coccoli
- IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Carla Manzitti
- IRCCS Istituto G. Gaslini-Ospedale Pediatrico, Genoa, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Serra
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Gambarotti
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide M Donati
- Third Orthopedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Katia Scotlandi
- Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rossella Bertulli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Favre
- Azienda Ospedaliera Universitaria A. Meyer, Florence, Italy
| | - Alessandra Longhi
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimo E Abate
- Pediatric Oncology, National Medical Specialization Center Santobono-Pausilipon, Napoli, Italy
| | - Silverio Perrotta
- Ematologia ed Oncologia Pediatrica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Maurizio Mascarin
- AYA Oncology and Pediatric Radiotherapy Unit, IRCCS Centro di Riferimento Oncologico, Aviano, Italy
| | | | - Marilena Cesari
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric L Staals
- Third Orthopedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Elisa Carretta
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Toni Ibrahim
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo G Casali
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Franca Fagioli
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Stefano Ferrari
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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4
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Bisogno G, Congiu G, Affinita MC, Milano GM, Zanetti I, Coppadoro B, Manzitti C, Basso E, Tamburini A, Melchionda F, Cellini M, Pericoli R, D'Angelo P, Cataldo AD, De Leonardis F, Rabusin M, De Corti F, Zin A, Alaggio R, Scarzello G, Ferrari A. Role of centers with different patient volumes in the management of rhabdomyosarcoma. An analysis by the Italian Pediatric Soft Tissue Sarcoma Committee. Pediatr Blood Cancer 2021; 68:e29234. [PMID: 34260145 DOI: 10.1002/pbc.29234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/14/2022]
Abstract
PROCEDURE The survival of children with rhabdomyosarcoma (RMS) has gradually improved as a result of the adoption of multidisciplinary treatments. Dedicated skills and facilities are indispensable and more readily available at reference centers. In this study, we examined the role of centers' experience (based on the number of patients treated) in their management of patients with RMS. METHODS We analyzed 342 patients with localized RMS enrolled in the European RMS 2005 protocol from October 2005 to December 2016 at 31 Italian centers that are part of the Soft Tissue Sarcoma Committee (STSC). We grouped the centers by the number of patients each one enrolled (Group 1: >40; Group 2: <40 and >10; and Group 3: <10), and compared a number of indicators to assess the appropriateness of patients' diagnostic workup and treatment and their survival. RESULTS Overall, 74.6% of patients were treated at 10 centers, and only three of them classifiable as high-volume centers. Only minor differences emerged between the three patient groups in terms of diagnostic investigations and treatment modalities. Survival was similar in the three groups. Approximately, one in four children treated at the centers in Groups 2 and 3 traveled to another center for surgery or radiotherapy. CONCLUSION Patients treated at STSC centers with different amounts of experience had similar results in terms of survival. This is attributable to all centers in the network adhering to protocol recommendations and receiving the STSC's support on diagnostics and multidisciplinary treatments for RMS.
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Affiliation(s)
- Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Giovanna Congiu
- Pediatric Hematology Oncology, Ospedale Microcitemico "A. Cao," A.O. Brotzu, Cagliari, Italy
| | - Maria Carmen Affinita
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | | | - Ilaria Zanetti
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Beatrice Coppadoro
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Carla Manzitti
- Department of Pediatric Hematology/Oncology, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Eleonora Basso
- Pediatric Oncology-Hematology Unit, Hospital Maggiore della Carità, Novara, Italy
| | - Angela Tamburini
- Hematology Oncology Unit, A. Meyer Children's Hospital, Firenze, Italy
| | - Fraia Melchionda
- Pediatric Hematology and Oncology Unit, S. Orsola-University Hospital, IRCCS, Bologna, Italy
| | - Monica Cellini
- Pediatric Oncology-Hematology Unit, Modena University Hospital, Modena, Italy
| | - Roberta Pericoli
- Pediatric Onco-Hematology Unit, Ospedale Infermi, Azienda della Romagna, Rimini, Italy
| | - Paolo D'Angelo
- Pediatric Hematology and Oncology Unit, Ospedali Civico, Di Cristina and Benfratelli, Palermo, Italy
| | - Andrea Di Cataldo
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, Catania University Hospital, Catania, Italy
| | - Francesco De Leonardis
- Pediatric Hematology-Oncology Division, Department of Pediatrics, Bari University Hospital, Bari, Italy
| | - Marco Rabusin
- Hemato-Oncology Unit, Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Federica De Corti
- Pediatric Surgery Unit, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Angelica Zin
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Rita Alaggio
- Hematology/Oncology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | | | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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5
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Luksch R, Milano GM, Barretta F, Longhi A, Palmerini E, Puma N, Asaftei SD, Podda MG, Grignani G, Bisogno G, Bertulli R, Coccoli L, Tamburini A, Manzitti C, Ferraresi V, Mascarin M, Rabusin M, Ferrari S, Picci P, Fagioli F. Efficacy of dose intensification in induction therapy for localized Ewing sarcoma: Italian Sarcoma Group (ISG) and Associazione Italiana Ematologia ed Oncologia Pediatrica (AIEOP) ISG/AIEOP EW-1 study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
11501 Background: The role of dose intensification of chemotherapy in Ewing sarcoma (ES) is under evaluation in prospective trials. This is a controlled, randomized phase III study evaluating the impact on event-free survival (EFS) of two arms at different intensity of induction therapy in localized ES at onset. Methods: Newly diagnosed localized ES patients aged 2-40 were eligible. They were randomized to receive 4-courses induction therapy - 1 every 21 days - either with a standard arm (arm A) as per ISG/SSGIII protocol (Ferrari S, et at, Ann Oncol. 2011;22(5):1221) or with an intense arm B, consisting of vincristine 1,5mg/sqm+ doxorubicin 80mg/sqm+ifosfamide 9g/sqm for each course. After induction, patients underwent surgery and/or radiotherapy,followed by an adaptive treatment. Good responders received standard courses chemotherapy: arm A pts received 9 courses, while arm B pts received 5 courses. Poor responders in both arms received 4 courses followed by high-dose busulfan/melphalan+autologous stem cell rescue. The primary outcome measure was EFS for the 2 arms in the intention-to-treat population. Kaplan-Meier curves compared with log-rank test and Cox model were performed to assess differences between study arms. A secondary outcome was toxicity differences, assessed by means of the Fisher’s exact test. Initial sample size was 230 pts, type I error rate 5%, power 80%. Results: Between 2009 and 2019, 234 patients were randomized (arm A-115; arm B-119). M:F ratio was 1.8; median age 14 years (range 2-40); tumour site extremity in 55%, axial/pelvis in 45%; tumour volume < 200ml in 31% and ≥200ml in 69%. A good response was obtained in 56% in arm A and 60% in arm B. Median follow-up was 68 months. EFS was not significantly different between arms; HR: 0.85; 95% CI: 0,51-1,41, 5-year EFS (95% CI) was 73% (64-82%) in arm A and 75% (67-83%) in arm B ( p = 0.526). Good responders in arm A and in arm B and poor responders in arm B had comparable results: 5-year EFS (95% CI) was 80% (71-91%), 77% (67-88%), and 72% (59-86%), respectively, while poor responders in arm A showed a worse, not statistically significant (p = 0.164) performance (63%; 50-78%). Subgroup analyses showed similar outcome for age, tumour site and volume in both arms. Hematological, gastrointestinal, and cardiovascular grade ≥3 toxicities were more pronounced in arm B (p < 0.05). Conclusions: Intense induction therapy with arm B did not improve 5-year EFS when compared with the standard arm A. The higher toxicity observed in arm B than in arm A was counterbalanced, in good responders, by a similar outcome with a shorter treatment plan. For poor responders, with almost 30 patients per arm event-free and with < 48-month FUP, better 5-year EFS in arm B than in arm A was observed but needs further observation. Clinical trial information: NCT02063022.
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Affiliation(s)
- Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Maria Milano
- Department of Hematology/Oncology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Barretta
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Nadia Puma
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sebastian Dorin Asaftei
- Pediatric Onco-Hematology, A.O.U Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Marta Giorgia Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | - Gianni Bisogno
- Hematology and Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Rossella Bertulli
- Adult Mesenchymal Tumor Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luca Coccoli
- Pediatric Hematology Oncology Unit, S. Chiara-Pisa University Hospital AOUP, Pisa, Italy
| | - Angela Tamburini
- Pediatric Onco-Hematology Unit, Centro di Eccellenza di Oncologia ed Ematologia, AUOM, Florence, Italy
| | | | | | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Marco Rabusin
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | - Franca Fagioli
- Department of Sciences of Public Health and Pediatrics - University of Turin & Division of Pediatric Onco-Hematology, Regina Margherita Hospital, Turin, Italy
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6
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Barone G, Barry A, Bautista F, Brichard B, Defachelles AS, Herd F, Manzitti C, Reinhardt D, Rubio PM, Wieczorek A, van Noesel MM. Managing Adverse Events Associated with Dinutuximab Beta Treatment in Patients with High-Risk Neuroblastoma: Practical Guidance. Paediatr Drugs 2021; 23:537-548. [PMID: 34541620 PMCID: PMC8563639 DOI: 10.1007/s40272-021-00469-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
Neuroblastoma is the most common extracranial solid tumour in children, accounting for 15% of all paediatric cancer deaths. High-risk neuroblastoma is a particularly challenging-to-treat form of disease that requires multimodality treatment, consisting of chemotherapy, surgery, high-dose chemotherapy with autologous haematopoietic stem cell rescue, radiotherapy and differentiation therapy. However, despite intense multimodal treatment regimens, the prognosis for this patient population remains poor. In recent years, immunotherapy with anti-disialoganglioside 2 (anti-GD2) antibodies was found to improve survival rates for patients with high-risk neuroblastoma. Based on studies led by the SIOPEN (International Society of Paediatric Oncology European Neuroblastoma) group, the anti-GD2 antibody dinutuximab beta was approved for use in high-risk neuroblastoma by the European Medicines Agency and has been implemented into the standard of care in many countries across Europe. However, immunotherapy with dinutuximab beta is associated with a number of adverse events that may be challenging for clinicians, such as pain, fever, hypersensitivity reactions and capillary leak syndrome. While these adverse events are considered manageable, there are currently no formal guidelines to support clinicians with their management. The aim of this article is to discuss the management of the most common adverse events encountered in clinical practice and to provide practical guidance to assist clinicians in minimising toxicity associated with dinutuximab beta.
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Affiliation(s)
- Giuseppe Barone
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children, London, UK
| | - Ailish Barry
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children, London, UK
| | - Francisco Bautista
- Department of Paediatric Haematology and Oncology, Hospital Universitario Niño Jesus, Madrid, Spain
| | - Bénédicte Brichard
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Fiona Herd
- Department of Paediatric Oncology, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | | | - Dirk Reinhardt
- Pediatrics III, Pediatric Hematology/Oncology, University Hospital Essen, Essen, Germany
| | - Pedro M Rubio
- Pediatric Hemato-Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Aleksandra Wieczorek
- Pediatric Oncology-Hematology Department, Institute of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Max M van Noesel
- Department of Solid Tumors, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
- Division Cancer and Imaging, University Medical Center Utrecht, Utrecht, The Netherlands.
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7
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Puma N, Sebastian AD, Paioli A, Bisogno G, Rabusin M, Coccoli L, Tamburini A, Milano GM, Mascarin M, Bertulli R, Grignani G, Manzitti C, De Leonardis F, Podda MG, Prete A, Picci P, Mura R, Fagioli F, Longhi A, Luksch R. Maintenance therapy with oral cyclophosphamide plus celecoxib in patients with metastatic Ewing sarcoma: Results of the Italian Sarcoma Group/AIEOP EW-2 study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
10517 Background: The prognosis of patients with metastatic Ewing sarcoma remains poor. The primary aim of the ISG/AIEOP EW2 Study (EUDRACT# 2009-011197-15) was to evaluate the feasibility and efficacy of maintenance therapy with oral cyclophosphamide plus celecoxib. Methods: From June 1st 2009 to Nov 22nd 2019, 112 patients with metastatic Ewing sarcoma at onset entered the ISG/AIEOP EW2 study, consisting of induction chemotherapy, radiotherapy and/or surgery at the site of the primary tumor, a consolidation phase with high-dose busulphan/melphalan + autologous stem cell rescue, whole-lung irradiation (12-15Gy), and a maintenance phase of 180 days with cyclophosphamide 50 mg daily (35 mg/mq daily if age < 14 years) plus celecoxib 400 mg twice daily (250 mg/mq twice daily if age < 14 years). Exclusion criteria from the maintenance phase were disease progression, cardiac or gastro-intestinal comorbidity. For CTCAE v4.0 grade 3-4 toxicities a temporary interruption was planned. Results: Seventy-one patients were eligible and entered the maintenance phase. Median age was 16 years (range 13-41); sites of metastases were lung or single bone (n = 56) and multicentric metastatic spread (n = 15). Sixty-one patients terminated the maintenance phase, 4 patients are still on treatment, 1 patient interrupted the treatment due to auto-immune thrombocytopenia at 4 months, 5 patients were withdrawn throughout maintenance due to disease progression/relapse. The duration of maintenance therapy was 89% of the scheduled days, with a median suspension length of 12 days (range 1-44 days). Causes of temporary suspension were hematological toxicity (19 episodes), infections (12 episodes), gastrointestinal disorders (9 episodes), fluid retention/distal oedema (3 episodes), renal disorders (3 episodes). Median follow-up was 42 months. The 3-year EFS of patients who entered the maintenance phase was 0.79 ± 0.09 for lung or single bone, and 0.19 ± 0.11 for those with multicentric metastatic spread. Conclusions: This schedule of maintenance phase is feasible, despite previous intensive treatment. A longer follow-up is needed to monitor side effects and to evaluate clinical outcome of patients with lung or single bone metastases, while the outcome remains dismal for multicentric metastatic Ewing sarcoma. Clinical trial information: NCT02727387.
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Affiliation(s)
- Nadia Puma
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Asaftei Dorin Sebastian
- Pediatric Onco-Hematology, A.O.U Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Anna Paioli
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gianni Bisogno
- Hematology and Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Marco Rabusin
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Luca Coccoli
- Pediatric Hematology Oncology Unit, S. Chiara-Pisa University Hospital AOUP, Pisa, Italy
| | - Angela Tamburini
- Pediatric Onco-Hematology Unit, Centro di Eccellenza di Oncologia ed Ematologia, AUOM, Florence, Italy
| | - Giuseppe Maria Milano
- Department of Hematology/Oncology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Rossella Bertulli
- Adult Mesenchymal Tumor Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Carla Manzitti
- Department of Haematology-Oncology, IRCCS G. Gaslini Children’s Hospital, Genoa, Italy
| | | | - Marta Giorgia Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Arcangelo Prete
- Pediatric Hematology and Oncology Unit, S.Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Rosamaria Mura
- Paediatric Haematology and Oncology Unit, Ospedale Pediatrico Microcitemico, Cagliari, Italy
| | - Franca Fagioli
- Pediatric Onco-Hematology, A.O.U Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alessandra Longhi
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Sebastian AD, Puma N, Paioli A, Petraz M, Morosi C, Podda MG, Tamburini A, Coccoli L, Grignani G, Manzitti C, Bertulli R, De Leonardis F, Rabusin M, Picci P, Prete A, Longhi A, Fagioli F, Luksch R. Activity of front-line window therapy with temozolomide plus irinotecan in patients with primary multifocal Ewing sarcoma: ISG/AIEOP EW-2 protocol. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
10516 Background: The prognosis of patients with primary multifocal metastatic Ewing sarcoma (PMES) remains dismal. So far, combination with temozolomide and irinotecan (TEMIRI) was tested in patients with refractory or relapsed disease. This study evaluates the activity and the tolerability of TEMIRI as front-line treatment in PMES. Methods: In the study-period 2012-2018, a front-line window therapy with 2 courses TEMIRI (temozolomide 100 mg/sqm/day + irinotecan 50 mg/sqm/day for 5 days every three weeks) was introduced as amendment to the ISG/AIEOP EW-2 protocol ( EUDRACT#2009-011197-15, Vers. 1.02 ) for patients with PMES. Main objective was to test the activity of TEMIRI evaluated by RECIST 1.1 criteria, with centralized revision of the radiological response. Secondary objectives included assessment of the toxicity profile and clinical benefit of the combination. A two-step study design by Simon was planned. Results: Thirty-four patients were enrolled. Median age at diagnosis was 19 years (range 3-55); males/females ratio was 2.4. Primary axial tumour was present in 24 (70%). After TEMIRI, RECIST response was as follows: partial response -20 (59%), stable disease -11 (32%), progression disease -3 (9%). After TEMIRI, amelioration in ECOG/Lansky score was achieved in 25/34 (73,5%), and reduction or disappearance of pain was observed in 31/34 patients (91%). TEMIRI toxicity was manageable: incidence of grade 3-4 nonhaematological and haematological toxicity was 3% and 3%, respectively (67/68 evaluable courses). At the time of the present analysis, 11 patients are alive; 7 of them are in complete remission and completed their treatment program (5-drug standard chemotherapy). With a median follow-up of 31 months (range 23-75), the 3-year survival estimate is 36,5%±0.09. Conclusions: Upfront TEMIRI x 2 courses showed an encouraging activity, with response rate 59% and deserves further evaluation combined with conventional treatments also in non-metastatic patients. In PMES new treatment strategies are urgently needed. Clinical trial information: NCT02727387.
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Affiliation(s)
- Asaftei Dorin Sebastian
- Pediatric Onco-Hematology, A.O.U Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Nadia Puma
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Paioli
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Petraz
- Pediatric Radiology, A.O.U Città della Salute e della Scienza, Turin, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Giorgia Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Angela Tamburini
- Pediatric Onco-Hematology Unit, Centro di Eccellenza di Oncologia ed Ematologia, AUOM, Florence, Italy
| | - Luca Coccoli
- Pediatric Hematology Oncology Unit, S. Chiara-Pisa University Hospital AOUP, Pisa, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Carla Manzitti
- Department of Haematology-Oncology, IRCCS G. Gaslini Children’s Hospital, Genoa, Italy
| | - Rossella Bertulli
- Adult Mesenchymal Tumor Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Marco Rabusin
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Arcangelo Prete
- Pediatric Hematology and Oncology Unit, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Alessandra Longhi
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Franca Fagioli
- Pediatric Onco-Hematology, A.O.U Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Di Carlo D, Ferrari A, Toffolutti T, Milano GM, Manzitti C, Ruggiero A, Dall'Igna P, Melchionda F, Zanetti I, Scarzello G, Bisogno G. Prognostic role of pleural effusion or ascites in localized rhabdomyosarcoma. Pediatr Blood Cancer 2019; 66:e27932. [PMID: 31385434 DOI: 10.1002/pbc.27932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 07/03/2019] [Accepted: 07/06/2019] [Indexed: 11/06/2022]
Abstract
PURPOSE The presence of pleural effusion or ascites at the time of diagnosis is generally considered a poor prognostic factor for children with rhabdomyosarcoma (RMS), and treatment is usually intensified despite the fact that there are no published studies to support this decision. We investigated the prognostic role of the presence of pleural effusion or ascites at diagnosis in patients with localized RMS consecutively enrolled in the Italian Soft Tissue Sarcoma Committee protocols over a 30-year period. METHODS We reviewed the radiological reports at diagnosis of 150 children with supradiaphragmatic and infradiaphragmatic RMS, noting any presence of effusion and its extent (minimal, moderate, or massive). All patients received intensive chemotherapy, surgery, and standard or hyperfractionated radiotherapy. RESULTS Effusion was identified in 32 children (21.3%), 14 with pleural effusion and 18 with ascites. As for its extent, 13 children presented with minimal, 12 with moderate, and 7 with massive effusion. The 5-year progression-free survival (PFS) rate was 49.8% (confidence interval [CI] 31.7-65.5) and 49.5% (CI 40-58.2) for patients with and without effusion, respectively (P = .5). When only patients with moderate or massive effusion were considered, however, their PFS was 36.8% (CI 16.5-57.5) versus 51.2% (CI 42.2-59.5) in patients with minimal or no effusion (P = .01). On the whole, patients with pleural effusion had a very poor outcome with a 5-year PFS of 35.7% (CI 13-59.4). CONCLUSIONS The presence of moderate or massive effusion seems to be an unfavorable prognostic factor in children with RMS, and justifies their inclusion in experimental studies.
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Affiliation(s)
- Daniela Di Carlo
- Hematology/Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Tiziana Toffolutti
- Department of Medicine, Pediatric Radiology Unit, Radiology Institute, University Hospital of Padova, Padova, Italy
| | - Giuseppe Maria Milano
- Department of Hematology, Oncology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Carla Manzitti
- Department of Pediatric Hematology/Oncology, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Division, Catholic University of Rome, Rome, Italy
| | | | - Fraia Melchionda
- Pediatric Hematology and Oncology Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Ilaria Zanetti
- Hematology/Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Giovanni Scarzello
- Radiotherapy Department, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Gianni Bisogno
- Hematology/Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
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10
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Lode HN, Valteau-Couanet D, Gray J, Luksch R, Wieczorek A, Castel V, Ash S, Laureys G, Papadakis V, Owens C, Garaventa A, Manzitti C, Siebert N, Troschke-Meurer S, Glogova E, Poetschger U, Ladenstein RL. Randomized use of anti-GD 2 antibody dinutuximab beta (DB) long-term infusion with and without subcutaneous interleukin-2 (scIL-2) in high-risk neuroblastoma patients with relapsed and refractory disease: Results from the SIOPEN LTI-trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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
10014 Background: We determined the role of scIL-2 combined with long term infusion (LTI) of DB in patients (pts) with high-risk relapsed/refractory neuroblastoma. Methods: 160 pts were enrolled into an open label SIOPEN Phase II clinical trial (EudraCT 2009-018077-31). Pts were randomly assigned to receive up to 5 cycles of 100 mg/m2 DB-LTI (d8-17) and 160 mg/m2 oral isotretinoin (d19-32) (81 pts) with and without 6x106IU/m2 scIL-2 (d1-5; 8-12) (79 pts). Endpoints were toxicity, response rates and 2yrs-event free and -overall survival. Results: Between 07/2014 and 07/2017, 160 pts from 11 countries were randomised. Median follow-up is 2.6 years. Pts were well balanced between arms according to stage, age, MYCN amplification, patients with relapse and remission status. The 2yrs-EFS and -OS for DB (81 pts) vs. DB combined with scIL-2 (79 pts) was 59%±6% vs 65%±6% (p = 0.721) and 79%±5% vs 84%±4% (p = 0.904). In 97 pts with evaluable disease, a response rate of 49% (9% CR, 40% PR) vs 52% (26% CR, 26% PR) after treatment with DB vs DB and scIL-2 was observed. Grade 3&4 fever (16% vs 46%, P = 0.000), allergic reaction (1% vs 14%, P = 0.004), hematological toxicity (46% vs 66%, P = 0.013) and neurotoxicity (0% vs 8%, p = 0.003) were significantly worse in the combination arm, but no difference was seen for capillary leak, gastrointestinal, liver enzyme elevation and pain. Paraplegia possibly related to the treatment was observed in 2 pts in the combination arm, none in the arm without scIL-2, and one resolved to baseline. A subgroup of 34 pts who had a relapse and measurable disease at treatment start, showed a 2yrs-EFS and -OS in DB (17 pts) vs DB combined with scIL-2 (17 pts) of 35%±12% vs 69%±12% (p = 0.116) and 59%±12% vs 81%±10% (p = 0.167). However, this trend was statistically not significant. Pharmacokinetic and HACA response between both arms was not different with overlapping antibody concentration-time curves and a HACA response of 15/81 (19%) (DB) vs 16/79 (20%) (DB and scIL-2). Conclusions: No significant difference in efficacy of DB combined with scIL-2 and increased toxicity in this arm suggests that this schedule of scIL-2 is of no additional benefit. Clinical trial information: 2009-018077-31.
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Affiliation(s)
| | | | - Juliet Gray
- University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Roberto Luksch
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Aleksandra Wieczorek
- Pediatric Hematology Oncology, Jagiellonia University Medical College, Krakow, Poland
| | - Victoria Castel
- Hospital Universiario y Politecnico La Fe Valencia, Valencia, Spain
| | - Shifra Ash
- Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine Tel Aviv University, Petach Tikvah, Israel
| | | | - Vassilios Papadakis
- Department of Pediatric Hematology/Oncology, Agia Sofia Children's Hospital Athens, Athens, Greece
| | | | | | | | - Nikolai Siebert
- Pediatric Hematology/Oncology, University Medicine Greifswald, Greifswald, Germany
| | | | | | | | - Ruth Lydia Ladenstein
- St. Anna Children's Hospital and Department of Paediatrics, Medical University Vienna, Vienna, Austria
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11
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Siebert N, Troschke-Meurer S, Marx M, Zumpe M, Ehlert K, Gray J, Garaventa A, Manzitti C, Ash S, Klingebiel T, Beck J, Castel V, Valteau-Couanet D, Loibner H, Ladenstein R, Lode HN. Impact of HACA on Immunomodulation and Treatment Toxicity Following ch14.18/CHO Long-Term Infusion with Interleukin-2: Results from a SIOPEN Phase 2 Trial. Cancers (Basel) 2018; 10:cancers10100387. [PMID: 30336605 PMCID: PMC6210332 DOI: 10.3390/cancers10100387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/17/2018] [Accepted: 10/11/2018] [Indexed: 12/24/2022] Open
Abstract
GD2-directed immunotherapies improve survival of high-risk neuroblastoma (NB) patients (pts). Treatment with chimeric anti-GD2 antibodies (Ab), such as ch14.18, can induce development of human anti-chimeric Ab (HACA). Here, we report HACA effects on ch14.18/CHO pharmacokinetics, pharmacodynamics and pain intensity in pts treated by long-term infusion (LTI) of ch14.18/CHO combined with IL-2. 124 pts received up to 5 cycles of ch14.18/CHO 10 days (d) infusion (10 mg/m2/d; d8–18) combined with s.c. IL-2 (6 × 106 IU/m2/d; d1–5, d8–12). HACA, treatment toxicity, ch14.18/CHO levels, Ab-dependent cellular- (ADCC) and complement-dependent cytotoxicity (CDC) were assessed using respective validated assays. HACA-negative pts showed a steadily decreased pain in cycle 1 (74% pts without morphine by d5 of LTI) with further decrease in subsequent cycles. Ch14.18/CHO peak concentrations of 11.26 ± 0.50 µg/mL found in cycle 1 were further elevated in subsequent cycles and resulted in robust GD2-specific CDC and ADCC. Development of HACA (21% of pts) resulted in strong reduction of ch14.18/CHO levels, abrogated CDC and ADCC. Surprisingly, no difference in pain toxicity between HACA-positive and -negative pts was found. In conclusion, ch14.18/CHO LTI combined with IL-2 results in strong activation of Ab effector functions. Importantly, HACA response abrogated CDC but did not affect pain intensity indicating CDC-independent pain induction.
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Affiliation(s)
- Nikolai Siebert
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Sascha Troschke-Meurer
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Madlen Marx
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Maxi Zumpe
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Karoline Ehlert
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Juliet Gray
- Department of Paediatric Oncology, University Hospital Southampton, Southampton SO14 0YG, UK.
| | | | - Carla Manzitti
- Oncology Unit, Istituto Giannina Gaslini, 16147 Genova, Italy.
| | - Shifra Ash
- Pediatric Hemato-Oncology Division, Schneider Children Medical Center, Kaplan 14, Petach Tikva 4920235, Israel.
| | - Thomas Klingebiel
- University Children's Hospital, Goethe University Frankfurt, 60596 Frankfurt, Germany.
| | - James Beck
- University Children's Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany.
| | - Victoria Castel
- Pediatric Hemato-Oncology Unit, University Hospital La Fe, 46026 Valencia, Spain.
| | | | - Hans Loibner
- Advisor to Apeiron Biologics AG, 1030 Vienna, Austria.
| | - Ruth Ladenstein
- St. Anna Children's Hospital and Children's Cancer Research Institute (CCRI), Department of Paediatrics, Medical University, Kinderspitalgasse 6, 1090 Vienna, Austria.
| | - Holger N Lode
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, 17475 Greifswald, Germany.
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12
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Compostella A, Affinita MC, Casanova M, Milano GM, Scagnellato A, Dall'Igna P, Chiaravalli S, Pierobon M, Manzitti C, Zanetti I, Schiavetti A, Sorbara S, Mura RM, Ruggiero A, Ferrari A, Bisogno G. Topotecan/carboplatin regimen for refractory/recurrent rhabdomyosarcoma in children: Report from the AIEOP Soft Tissue Sarcoma Committee. Tumori 2018; 105:138-143. [PMID: 30131003 DOI: 10.1177/0300891618792479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION From 2002 to 2011, the Italian Soft Tissue Sarcoma Committee explored a combination of topotecan and carboplatin as a second-line strategy for children with resistant or relapsing rhabdomyosarcoma. METHODS Patients received two blocks of topotecan 2 mg/m2 on days 1, 2, and 3, and carboplatin 250 mg/m2 on days 4 and 5, followed by alternating blocks of topotecan-cyclophosphamide and carboplatin-etoposide for a total of six courses with 3-week intervals. Tumor response was assessed after two cycles, and local control was implemented when feasible. RESULTS A total of 38 patients were included in this study: 18/38 had alveolar rhabdomyosarcoma (RMS), 10/38 had metastatic disease at diagnosis, 8/38 had tumor progression during first-line chemotherapy, 21/38 had locoregional relapses, and 9/38 had distant relapses. Thirty-two patients could be assessed for tumor response to topotecan-carboplatin, and 9 (28%) showed a complete or partial response. Twenty-four patients experienced grade IV hematologic toxicity, while transient grade 1 tubulopathy, grade 3 mucositis, transient grade 2 nephrotoxicity, and a grade 2 decline in cardiac function occurred in one patient each. The 5-year overall and progression-free survival rates were 17% and 14%, respectively. CONCLUSION the prognosis for children with resistant or relapsing RMS remains unsatisfactory. The topotecan-carboplatin regimen was well-tolerated. Though in case of late relapse the response rate was similar to those reported for other regimes, the result achieved remains unsatisfactory. New approaches, possibly including target agents, seem more attractive for future studies.
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Affiliation(s)
- Alessia Compostella
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Maria Carmen Affinita
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Michela Casanova
- 2 Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | | | - Angela Scagnellato
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | | | - Stefano Chiaravalli
- 2 Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Marta Pierobon
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Carla Manzitti
- 5 Department of Pediatric Hematology/Oncology, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Ilaria Zanetti
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Amalia Schiavetti
- 6 Pediatric Oncology Unit, Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Silvia Sorbara
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Rosella Maria Mura
- 7 Pediatric Hematology-Oncology, Ospedale Pediatrico Microcitemico, Cagliari, Italy
| | - Antonio Ruggiero
- 8 Pediatric Oncology Division, Catholic University of Rome, Rome, Italy
| | - Andrea Ferrari
- 2 Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Gianni Bisogno
- 1 Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
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13
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Bergamaschi L, Bisogno G, Manzitti C, D'Angelo P, Milano GM, Scagnellato A, Cappelletti M, Chiaravalli S, Dall'Igna P, Alaggio R, Ruggiero A, Di Martino M, Affinita MC, Pierobon M, Garaventa A, Casanova M, Ferrari A. Salvage rates and prognostic factors after relapse in children and adolescents with malignant peripheral nerve sheath tumors. Pediatr Blood Cancer 2018; 65. [PMID: 28926683 DOI: 10.1002/pbc.26816] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/02/2017] [Accepted: 08/12/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumor (MPNST) is one of the most common nonrhabdomyosarcoma soft tissue sarcomas encountered in pediatric age, and it is generally characterized by poor outcome, particularly for relapsing patients. MATERIALS AND METHODS This study considered 73 patients <21 years of age with relapsing MPNST observed among 120 patients enrolled in Italian pediatric protocols from 1979 to 2004. With the aim of possibly establishing a risk-adapted stratification, patients' outcome was examined using univariate and multivariate analysis based on clinical features at onset, first-line treatments, clinical findings at the time of first relapse, and second-line treatments. RESULTS The time to relapse ranged from 1 to 204 months after first diagnosis (median 7 months). The first relapse event was mainly local. At the time of our analysis, nine patients were alive in remission. The median overall survival after first relapse was 11 months, and the survival rates were 39.2% at 1 year and 15.8% at 5 years. The factors revealing the greatest impact on prognosis were as follows: initial tumor invasiveness, time of relapse, and achievement of a secondary complete remission (which was related to the feasibility of radical surgery). CONCLUSIONS Our study confirmed the unsatisfactory prognosis for pediatric patients with relapsing MPNST and pointed to a risk-adapted stratification model for the purposes of deciding second-line treatments. For the time being, an aggressive surgical approach seems to be the only effective salvage treatment and should be recommended. New therapeutic approaches are under evaluation with a view to improving current outcomes.
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Affiliation(s)
- Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Gianni Bisogno
- Pediatric Hemathology and Oncology Division, Padova University Hospital, Padova, Italy
| | - Carla Manzitti
- Department of Pediatric Hematology/Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Paolo D'Angelo
- Pediatric Oncology Unit, G. Di Cristina Children's Hospital, Palermo, Italy
| | - Giuseppe Maria Milano
- Department of Hematology/Oncology, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Angela Scagnellato
- Pediatric Hemathology and Oncology Division, Padova University Hospital, Padova, Italy
| | - Mirko Cappelletti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | | | - Rita Alaggio
- Pathology Department, Padova University Hospital, Padova, Italy
| | - Antonio Ruggiero
- Division of Pediatric Oncology, Catholic University of Roma, Roma, Italy
| | - Martina Di Martino
- Pediatric Oncology Service, Department of Pediatrics Second University, Napoli, Italy
| | - Maria Carmen Affinita
- Pediatric Hemathology and Oncology Division, Padova University Hospital, Padova, Italy
| | - Marta Pierobon
- Pediatric Hemathology and Oncology Division, Padova University Hospital, Padova, Italy
| | - Alberto Garaventa
- Department of Pediatric Hematology/Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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14
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Ferrari A, Magni C, Bergamaschi L, Cecchetto G, Alaggio R, Milano GM, Bertolini P, Basso E, Manzitti C, Di Martino M, Giurici N, Melchionda F, Cecinati V, Chiaravalli S, Affinita MC, Scagnellato A, Casanova M, Bisogno G. Pediatric nonrhabdomyosarcoma soft tissue sarcomas arising at visceral sites. Pediatr Blood Cancer 2017; 64. [PMID: 28233470 DOI: 10.1002/pbc.26490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pediatric nonrhabdomyosarcoma soft tissue sarcomas (NRSTS) may rarely occur in visceral tissues, and little is known about their clinical history. The present study retrospectively analyzed a group of patients prospectively registered in Italian pediatric protocols conducted between 1979 and 2004. METHODS Inclusion criteria for the study were as follows: a pathological diagnosis of "adult-type NRSTS," arising at visceral sites (lung-pleurae, liver, kidney, and mesentery-bowel); age under 18 years; no previous treatment except for primary surgery; available clinical data; and written consent. RESULTS Thirty cases with visceral NRSTS were collected and analyzed. Sites of origin were as follows: mesentery-bowel in 12 cases, lung-pleurae in 11, liver in 5, and kidney in 2. According to the Intergroup Rhabdomyosarcoma Study (IRS) surgical grouping system, patients were classified as follows: nine IRS group I, three group II, 12 group III, and six group IV. Patients were treated with a multimodal approach including surgery, radiotherapy, and/or chemotherapy, according to their characteristics. For the series as a whole, the 5-year event-free and overall survival rates were 33.3% and 40.0%, respectively. The IRS group (reflecting the feasibility of initial complete resection) emerged as the main prognostic factor. Survival rates also correlated with tumor size and local invasiveness, histological subtype, and tumor sites (the worst outcome was seen for tumors arising in the lung and pleurae). CONCLUSIONS This study confirmed that visceral NRSTS are aggressive tumors carrying a worse prognosis than pediatric NRSTS arising in soft tissues of the extremities. Local treatment remains the main challenge for these tumors.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Chiara Magni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | | | - Rita Alaggio
- Pathology Department, Padova University, Padova, Italy
| | | | - Patrizia Bertolini
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
| | - Eleonora Basso
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Turin, Italy
| | - Carla Manzitti
- Department of Pediatric Hematology/Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Martina Di Martino
- Pediatric Oncology Service, Department of Pediatrics, Second University, Napoli, Italy
| | | | - Fraia Melchionda
- Department of Pediatrics, University of Bologna, S. Orsola-Malpighi Hospital, Bologna
| | - Valerio Cecinati
- Pediatric Hematology and Oncology Unit, Department of Hematology, Transfusion Medicine and Biotechnology, Pescara
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | | | - Angela Scagnellato
- Pediatric Hematology and Oncology Division, Padova University, Padova, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Gianni Bisogno
- Pediatric Hematology and Oncology Division, Padova University, Padova, Italy
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15
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Lode HN, Valteau-Couanet D, Troschke-Meurer S, Manzitti C, Gray J, Castel V, Yaniv I, Loibner H, Siebert N, Glogova E, Poetschger U, Ladenstein R. Phase II clinical trial with long-term infusion of anti-GD 2 antibody ch14.18/CHO in combination with interleukin-2 (IL2) in patients with high risk neuroblastoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
| | - Dominique Valteau-Couanet
- Pediatric and Adolescent Oncology, Gustave Roussy Institute, Universite Paris-Sud, Villejuif, France
| | | | | | - Juliet Gray
- University of Southampton, Southampten, United Kingdom
| | - Victoria Castel
- Pediatric Hematology and Oncology, Pediatric Oncology Unit Hospital La Fe Valencia, Valencia, Spain
| | - Isaac Yaniv
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petah-Tikva, Israel
| | | | | | | | | | - Ruth Ladenstein
- St. Anna Children's Hospital and Research Institute for the SIOP Europe Neuroblastoma Group, Paediatric Haematology/Oncology, Vienna, Austria
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16
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Moreno L, Casanova M, Chisholm JC, Berlanga P, Chastagner PB, Baruchel S, Manzitti C, Gallego Mélcon S, Gerber NU, Bisogno G, Fagioli F, Geoerger B, Glade Bender J, Aerts I, Bergeron C, Hingorani P, Elias I, Simcock M, Slepetis R, Vassal G. Phase 1/2 study of weekly nab-paclitaxel (nab-P) in pediatric patients (pts) with recurrent/refractory solid tumors (STs): Dose-finding and pharmacokinetics (PK). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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)
- Lucas Moreno
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | - Pablo Berlanga
- Unidad de Oncologia Pediatrica, Hospital Universitario la Fe, Valencia, Spain
| | | | | | | | | | | | - Gianni Bisogno
- Department of Pediatrics, Hematology/Oncology Division, Padova, Italy
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17
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Lode HN, Valteau-Couanet D, Garaventa A, Gray J, Castel V, Yaniv I, Siebert N, Jensen C, Endres S, Pill L, Eger C, Seidel D, Jüttner M, Kietz S, Ehlert K, Janzek E, Manzitti C, Müller I, Loibner H, Ladenstein R. Abstract A032: Immunotherapy with ch14.18/CHO in combination with IL2 is active and effective in high-risk relapsed/refractory neuroblastoma patients. Cancer Immunol Res 2016. [DOI: 10.1158/2326-6074.cricimteatiaacr15-a032] [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: 11/16/2022]
Abstract
Abstract
Background: Ganglioside GD2 is a glycolipid highly expressed on neuro-ectodermal tumors including melanoma and neuroblastoma (NB). It is ranked on position 12 of the list of tumor associated antigens by the NCI. Anti-GD2 antibody (Ab) ch14.18/CHO targets this antigen and effectively orchestrates innate immune effector mechanisms against GD2 expressing malignancies. However, one on target effect of anti-GD2 Abs is the induction of neuropathic pain when applied as short term infusion (STI) requiring co-medication with intravenous morphine. Here we investigated whether long-term infusion (LTI) of anti-GD2 Ab ch14.18/CHO may have an improved pain toxicity profile and at the same time mediate an effective immune response in patients (pts) with high risk relapsed/refractory NB which translates to objective clinical responses and an improved survival.
Methods: 97 pts received 6x106 IU/m2 sc IL2 (d1-5; 8-12), LTI of 100 mg/m2 ch14.18/CHO (d8-17) and 160 mg/m2 oral 13-cis-RA (d19-32) in an ongoing SIOPEN Phase II study (APN311-202) (NCT01701479) (44 pts) and a closed single center program (53 pts) (APN311-303). Response assessments followed INRG criteria. Serum ch14.18/CHO concentration-time curves were determined by validated ELISA methods and pharmacokinetics parameter were analyzed using standard non-compartmental methods. Fcγ;-receptor polymorphisms FCGR2A (H131R), -3A (V158F) and -3B (NA1/NA2) and patient-specific antibody-dependent cell-mediated cytotoxicity (ADCC), complement-dependent cytotoxicity (CDC) and whole blood cytotoxicity (WBT) responses were determined.
Results: LTI was associated with low pain scores and a decreasing morphine usage compared to STI. Clinical overall responses were 30% (APN311-303) and 31% (APN311-202). The survival update of the APN311-303 cohort revealed a 1-y & 4-y OS of 94.2±3.2% & 60.9±9.0% (median FU 2.9y [0.7-5.2y]) and a 1-y & 4-y PFS of 54.4±6.9% & 32.3%±6.9% (median FU 2.8y [0.7 - 4.9y]). Median TTP was 571d (95% CI: 232.7d). The comparator is the reported historical gold standard for relapsed refractory NB patients with 1-y & 4-y PFS of 19±2% & 8±3% and OS of 56±3% & 14±4% and a median TTP of 63 d (95% CI: 56.8d). NB pts with high affinity FCGR alleles and an increase in ADCC (cut off 15%) are associated with longer PFS and OS rates (p<0.03; p<0.005), supporting NK-cell mediated ADCC as the mechanism of action.
Parameters of immune modulation (CDC, and WBT) and PK of ch14.18/CHO were comparable between APN311-202 and -303 cohorts. PK of ch14.18/CHO was analyzed in cycle 1: Cmax=12.2±0.4μg/ml, t½=8.4±1.1 d, AUC=145.3± 5.8 μg*d/ml, Vdss=9.3±0.5L/m2. A pro-inflammatory cytokine response (IL-2, IL-6, IL-8, IFNγ) translated into the expansion of effector NK- (3x) and T-cells (2x). We observed HACA in 17/97 pts (17.5%) of which only 9/97 (9.3%) were neutralizing with respect to the inhibition of CDC and WBT activity. In HACA negative patients, levels of ch14.18/CHO and functional parameters (CDC and WBT) analyzed before subsequent treatment cycles indicate persistent anti-NB activity for the entire treatment period.
Conclusion: LTI of ch14.18/CHO has an improved pain toxicity profile and at the same time is active and effective in high-risk relapsed/refractory NB.
Citation Format: Holger N. Lode, Dominique Valteau-Couanet, Alberto Garaventa, Juliet Gray, Victoria Castel, Isaac Yaniv, Nikolai Siebert, Christian Jensen, Stefanie Endres, Lena Pill, Christin Eger, Diana Seidel, Madlen Jüttner, Silke Kietz, Karoline Ehlert, Evelyne Janzek, Carla Manzitti, Ina Müller, Hans Loibner, Ruth Ladenstein. Immunotherapy with ch14.18/CHO in combination with IL2 is active and effective in high-risk relapsed/refractory neuroblastoma patients. [abstract]. In: Proceedings of the CRI-CIMT-EATI-AACR Inaugural International Cancer Immunotherapy Conference: Translating Science into Survival; September 16-19, 2015; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(1 Suppl):Abstract nr A032.
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Affiliation(s)
| | | | | | - Juliet Gray
- 4University Hospital Southampton, Southampton, United Kingdom,
| | | | - Isaac Yaniv
- 6Schneider Children's Medical Centre of Israel, Petach Tikvah, Israel,
| | | | | | | | - Lena Pill
- 1University Medicine Greifswald, Greifswald, Germany,
| | - Christin Eger
- 1University Medicine Greifswald, Greifswald, Germany,
| | - Diana Seidel
- 1University Medicine Greifswald, Greifswald, Germany,
| | | | - Silke Kietz
- 1University Medicine Greifswald, Greifswald, Germany,
| | | | | | | | - Ina Müller
- 1University Medicine Greifswald, Greifswald, Germany,
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18
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Mattioli G, Avanzini S, Pini Prato A, Pio L, Granata C, Garaventa A, Conte M, Manzitti C, Montobbio G, Buffa P. Laparoscopic resection of adrenal neuroblastoma without image-defined risk factors: a prospective study on 21 consecutive pediatric patients. Pediatr Surg Int 2014; 30:387-94. [PMID: 24477777 DOI: 10.1007/s00383-014-3476-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Over the last 20 years MIS has progressively gained popularity in children with cancer. We therefore aimed at evaluating the safety of Minimally Invasive Surgery (MIS) resection in a series of children affected by adrenal neuroblastoma (NB) presenting without Image-Defined Risk Factors (IDRFs). METHODS An Institutional protocol for MIS resection of adrenal NB in pediatric patients without IDRFs has been applied since 2008. Absence of IDRFs represented the main indication for MIS in NB, regardless of tumor size. All pediatric patients who underwent MIS for NB between January 2008 and May 2013 were included. Specific technical considerations, demographic data, and outcome have been recorded. RESULTS Twenty-one patients underwent MIS resection for IDRFs-negative adrenal NB. Nine of these patients experienced preoperative downgrading of IDRFs after chemotherapy. Radiological median diameter of the mass was 30 mm (range 10-83 mm). Median operative time was 90 min. Median hospital stay was 4 days. All patients were treated successfully, without serious intraoperative complications. One mild intraoperative hemorrhage occurred and was treated without the need for conversion to open surgery nor blood transfusion was required. No postoperative complications, including port-site or peritoneal metastases were experienced. CONCLUSIONS This study demonstrated the safety and effectiveness of MIS for the resection of adrenal NB without IDRFs in children. Pediatric surgeons dedicated to oncology should be aware of this alternative approach to open resection.
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Affiliation(s)
- Girolamo Mattioli
- Pediatric Surgery Department, G. Gaslini Children's Hospital and DINOGMI University of Genoa, Largo G. Gaslini 5, 16147, Genoa, Italy,
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19
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De Ioris MA, Prete A, Cozza R, Podda M, Manzitti C, Pession A, Schiavello E, Contoli B, Balter R, Fagioli F, Bisogno G, Amoroso L, Locatelli F, Luksch R. Ewing sarcoma of the bone in children under 6 years of age. PLoS One 2013; 8:e53223. [PMID: 23382839 PMCID: PMC3561359 DOI: 10.1371/journal.pone.0053223] [Citation(s) in RCA: 9] [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] [Received: 07/06/2012] [Accepted: 11/26/2012] [Indexed: 11/23/2022] Open
Abstract
Background Ewing Sarcoma Family Tumours (ESFT) are rare in early childhood. The aim of this study was to report the clinical characteristics and outcome of children under 6 years of age affected by ESFT of the bone in Italy. Methods The records of all the children diagnosed with osseous ESFT in centres members of the Associazione Italiana di Ematologia ed Oncologia Pediatrica (AIEOP) from 1990 to 2008 were reviewed. The Kaplan–Meier method was used for estimating overall and progression-free survival (OS, PFS) curves; multivariate analyses were performed using Cox proportional hazards regression model. Results This study includes 62 patients. An axial primary localization was present in 66% of patients, with the primary site in the chest wall in 34%. Fourteen (23%) patients presented metastatic disease. The 5-year OS and PFS were 73% (95% confidence interval, CI, 58–83%) and 72% (95% CI 57–83%) for patients with localized disease and 38% (95% CI 17–60%) and 21% (95% CI 5–45%) for patients with metastatic disease. Metastatic spread, skull/pelvis/spine primary localization, progression during treatment and no surgery predicted worse survival (P<0.01), while patients treated in the last decade had better survival (P = 0.002). In fact, the 5-year OS and PFS for patients diagnosed in the period 2000–2008 were 89% (95% CI 71–96%) and 86% (95% CI 66–94%), respectively. Conclusion The axial localization is the most common site of ESFT in pre-scholar children. Patients treated in the most recent period have an excellent outcome.
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Affiliation(s)
| | - Arcangelo Prete
- Paediatric Haematology-Oncology Department, University of Bologna, Bologna, Italy
| | - Raffaele Cozza
- Haematology-Oncology Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy
| | - Marta Podda
- Paediatrics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carla Manzitti
- Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini-IRCCS, Genoa, Italy
| | - Andrea Pession
- Paediatric Haematology-Oncology Department, University of Bologna, Bologna, Italy
| | | | - Benedetta Contoli
- Epidemiology Unit, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy
| | - Rita Balter
- Paediatric Haematology-Oncology Department, University of Verona, Verona, Italy
| | - Franca Fagioli
- Paediatric Haematology-Oncology Department, Regina Margherita Hospital, Turin, Italy
| | - Gianni Bisogno
- Paediatric Haematology-Oncology Department, University of Padua, Padua, Italy
| | - Loredana Amoroso
- Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini-IRCCS, Genoa, Italy
| | - Franco Locatelli
- Haematology-Oncology Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy
- Pediatrics, University of Pavia, Pavia, Italy
| | - Roberto Luksch
- Paediatrics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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20
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Ferrari A, Salvo GLD, Dall’Igna P, Meazza C, Leonardis FD, Manzitti C, Ioris MAD, Casanova M, Carli M, Bisogno G. Salvage rates and prognostic factors after relapse in children and adolescents with initially localised synovial sarcoma. Eur J Cancer 2012; 48:3448-55. [DOI: 10.1016/j.ejca.2012.06.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 05/19/2012] [Accepted: 06/18/2012] [Indexed: 01/09/2023]
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21
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D'Angelo P, Carli M, Ferrari A, Manzitti C, Mura R, Miglionico L, Di Cataldo A, Grigoli A, Cecchetto G, Bisogno G. Breast metastases in children and adolescents with rhabdomyosarcoma: Experience of the Italian Soft Tissue Sarcoma Committee. Pediatr Blood Cancer 2010; 55:1306-9. [PMID: 20730885 DOI: 10.1002/pbc.22729] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 06/03/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Breast metastasis from rhabdomyosarcoma (RMS) is an uncommon event but may be problematic in treatment decision-making. Aim of the study was to evaluate clinical characteristics, treatment, and subsequent outcome, of patients with RMS metastasis in the breast, enrolled in four consecutive Associazione Italiana di Ematologia ed Oncologia Pediatrica (AIEOP) Soft Tissue Sarcoma Committee protocols during the last 20 years, in order to obtain information to establish a more adequate diagnostic and therapeutic approach. PROCEDURES Data were derived from the AIEOP STSC database and reviewed for the purpose of this study. RESULTS From 1988 to 2008, among 189 patients with metastatic RMS, we identified 7 (3.7%) patients with RMS with breast involvement at diagnosis. All patients were females, aged 13-17 years with alveolar histology and multiple metastasis sites (2-5). The primary tumor was located in the extremities in 3/7 patients. In spite of intensive treatment no patient survived. The cause of treatment failure was distant relapse in six patients, including two on the mammary region. Treatment data analysis revealed that local measures to control breast lesions were used in only two patients. CONCLUSIONS Our data suggest that investigations of the mammary region should be part of the usual diagnostic workup in adolescent girls with alveolar RMS, especially if the primary tumor arises in the extremities. New and more effective strategies are needed to improve the outcome of these patients including aggressive local measures to control breast disease.
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Affiliation(s)
- Paolo D'Angelo
- Pediatric Hematology and Oncology Unit, G. Di Cristina Children's Hospital, Palermo, Italy.
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22
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Garaventa A, Parodi S, De Bernardi B, Dau D, Manzitti C, Conte M, Casale F, Viscardi E, Bianchi M, D'Angelo P, Zanazzo GA, Luksch R, Favre C, Tamburini A, Haupt R. Outcome of children with neuroblastoma after progression or relapse. A retrospective study of the Italian neuroblastoma registry. Eur J Cancer 2009; 45:2835-42. [PMID: 19616426 DOI: 10.1016/j.ejca.2009.06.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 06/05/2009] [Accepted: 06/10/2009] [Indexed: 11/29/2022]
Abstract
The Italian Neuroblastoma Registry was investigated to describe 781 children with neuroblastoma experiencing tumour recurrence (424 progressions and 357 relapses). Ten-year overall survival (OS) was 6.8% (95% confidence interval (CI) 4.3-10.0) after progression and 14.4% (95% CI 10.5-18.9) after relapse. For both circumstances, OS was better for age at diagnosis <18 months, less advanced International Neuroblastoma Staging System (INSS) stage, normal lactate dehydrogenase (LDH) serum level, normal MYCN gene status (P<0.001) and a non-abdominal primary site (P=0.034 for progression, and P=0.004 for relapses). A local type of recurrence had a significantly better outcome only in case of relapse (P<0.001). Probability of survival increased by era of diagnosis. Survival of children with recurrent neuroblastoma is very poor. A small cohort of patients, mainly represented by children with stages 1 and 2 who underwent local recurrence or developed late relapse may still benefit from further conventional treatment. For the remaining larger proportion of patients, experimental therapies should be proposed.
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Affiliation(s)
- Alberto Garaventa
- Department of Pediatric Hematology-Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
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23
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Bandettini R, Castagnola E, Calvillo M, Micalizzi C, Ravegnani M, Pescetto L, Manzitti C, Soro O, Ricagni L, Lanino E, Miano M, Cuzzubbo D, Conte M, Morreale G, Faraci M. Voriconazole for cryptococcal meningitis in children with leukemia or receiving allogeneic hemopoietic stem cell transplant. J Chemother 2009; 21:108-9. [PMID: 19297284 DOI: 10.1179/joc.2009.21.1.108] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
Lymphomas are the third most frequent type of childhood cancer after acute leukemias and brain tumors. Symptoms at diagnosis are extremely different depending on several factors such as histological subtype, disease extent, and site of tumor. We report an unusual presentation describing a case of epistaxis of the posterior nasal fossa with severe hematemesis.
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Affiliation(s)
- Carla Manzitti
- Department of Pediatric Hematology-Oncology, G. Gaslini Institute, Genoa, Italy.
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25
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Affiliation(s)
- Carla Manzitti
- Department of Pediatric Hematology-Oncology, G. Gaslini Institute, Genoa, Italy
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Abstract
Abdominal irradiation, especially if associated with doxorubicin administration, increases the risk of a secondary malignant neoplasm (SMN) after treatment of nephroblastoma. Secondary malignant salivary tumors are rare and usually occur in patients with previous cranial irradiation. The authors describe the case of a parotid mucoepidermoid carcinoma arising 13 years after diagnosis of nephroblastoma. This patient showed no characteristics reported in the literature as statistically significant for the development of an SMN. The authors believe that long-term, regular clinical examination is necessary even in patients at low risk of developing an SMN.
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Affiliation(s)
- Carla Manzitti
- Department of Pediatric Hematology/Oncology, G Gaslini Children's Hospital, Genoa, Italy
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27
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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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28
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Dallorso S, Manzitti C, Dodero P, Faraci M, Rosanda C, Castagnola E. Uneventful outcome of unrelated hematopoietic stem cell transplantation in a patient with leukemic transformation of Kostmann syndrome and long-lasting invasive pulmonary mycosis. Eur J Haematol 2003; 70:322-5. [PMID: 12694170 DOI: 10.1034/j.1600-0609.2003.00062.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 11/23/2022]
Abstract
Kostmann syndrome (KS) is an inherited hematological disorder characterized by an absolute neutrophil count (ANC) <0.2 x 109/L and life-threatening bacterial infections. Granulocyte-colony stimulating factor (G-CSF) makes it possible to reach an ANC of 1.0 x 109/L and consequently to reduce significantly the occurrence of severe infections. Absence of response to G-CSF, G-CSF receptor mutation, and leukemic transformation are absolute indications to perform hematopoietic stem cell transplantation (HSCT). Pulmonary mycosis does not represent an absolute contraindication to bone marrow transplantation (BMT), although a relapse rate of 30-50% has been reported, despite adequate medical and surgical treatment. Mycotic pneumonia recurrence shows a mortality rate above 80%, especially in the presence of persisting immunosuppression. We report on a KS patient with long-lasting fungal pneumonia who developed myelodysplasia and subsequent acute myeliod leukemia (AML) conversion resistant to antiblastic therapy. Despite surgical excision and secondary prophylaxis, recurrence of the pulmonary lesion occurred prior to the unrelated HSCT. In spite of these poor prognostic characteristics, outcome was uneventful and the patient is alive and well in continuous complete remission with no signs of fungal infection.
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Affiliation(s)
- Sandro Dallorso
- Department of Hematology/Oncology, Surgical Emergency Unit, Infectious Diseases Unit, G. Gaslini Children's Hospital, Genova, Italy.
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29
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Miano M, Manfredini L, Garaventa A, Fieramosca S, Tanasini R, Morreale G, Manzitti C, Dini G. Home care for children following haematopoietic stem cell transplantation. Bone Marrow Transplant 2003; 31:607-10. [PMID: 12692629 DOI: 10.1038/sj.bmt.1703892] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The quality of life of patients who undergo haematopoietic stem cell transplantation (HSCT) is affected by long periods of hospitalisation for the treatment of several complications. On this basis, 28 children who underwent 29 HSCTs were included in the Home Care (HC) programme of the Paediatric Haematology and Oncology Department of the Gaslini Children's Hospital to be discharged earlier. A total of 17 children were assisted for haematologic follow-up and support therapy administration. The remaining children were followed up for graft- versus-host disease and/or cytomegalovirus infection. Overall activity consisted of 1232 i.v. therapies, 501 blood tests, 58 red blood cell or platelet transfusions, 107 procedures on Central Venous Catheter. Median duration of the assistance per child was 25 days (range 1235) for a total of 1598 days. A total of 822 accesses at home replaced 459 and 363 out-patient and in-patient days of hospitalisation. The average cost per patient receiving HC (EUR 4,252) was significantly lower (P<0.01) when compared to the average cost per patient admitted to the hospital to undergo the same procedures (EUR 14,693). This report shows that HC is feasible for children following HSCT, that it reduces the discomfort of the patients and their families, and that it reduces costs.
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MESH Headings
- Adolescent
- Central Nervous System Neoplasms/economics
- Central Nervous System Neoplasms/psychology
- Central Nervous System Neoplasms/therapy
- Child
- Child, Preschool
- Cost Savings
- Female
- Hematopoietic Stem Cell Transplantation/economics
- Home Care Services/economics
- Home Care Services/organization & administration
- Hospitals, Pediatric/economics
- Hospitals, Pediatric/organization & administration
- Humans
- Infant
- Length of Stay
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/economics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/psychology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Patient Discharge
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/economics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/psychology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Quality of Life
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Affiliation(s)
- M Miano
- Department of Pediatric Haematology and Oncology, G Gaslini Children's Hospital, Genova, Italy
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30
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Faraci M, Lanino E, Dini G, Fondelli MP, Morreale G, Dallorso S, Manzitti C, Calevo MG, Gaggero R, Castagnola E, Haupt R. Severe neurologic complications after hematopoietic stem cell transplantation in children. Neurology 2002; 59:1895-904. [PMID: 12499480 DOI: 10.1212/01.wnl.0000036608.42104.b9] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [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: 11/15/2022] Open
Abstract
OBJECTIVE To describe and evaluate the incidence and risk factors of severe neurologic events (SNE) in pediatric recipients of allogeneic or autologous hematopoietic stem cell transplantation (HSCT) for hematologic or nonhematologic diseases. METHODS Retrospective analysis of 272 consecutive children admitted to the G. Gaslini Children's Research Institute and given HSCT (70 from unrelated donors, 115 from related donors, and 87 autologous) between June 1985 and January 2001. RESULTS Thirty-seven children (13.6%) developed SNE after a median of 90 days (range, 5 days to 8.8 years) after HSCT. Cyclosporine A (CSA) neurotoxicity was the most frequent SNE (n = 21), followed by irradiation or chemotherapy injury (n = 7), CNS infections (n = 7), cerebrovascular events (n = 3), and immune-mediated etiology SNE (n = 2). Eleven patients (30%) died because of the neurologic complications. Type of HSCT, treatment with total body irradiation (TBI), acute graft-vs-host disease (GvHD), GvHD >grade 2, and treatment with CSA were associated with a significant increased risk of SNE. CONCLUSIONS Severe neurologic complications are frequent (14%) among children receiving HSCT, causing 8.5% of deaths after transplant. Transplant from allogeneic donor, especially if unrelated, the development of severe acute GvHD grade >2, and the use of TBI in the preparative regimen are the main risk factors for such complications.
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Affiliation(s)
- M Faraci
- Department of Hematology/Oncology, Bone Marrow Transplant Unit, G. Gaslini Children's Research Institute, Genova, Italy.
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31
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Dallorso S, Rondelli R, Messina C, Pession A, Giorgiani G, Fagioli F, Locatelli F, Manzitti C, Balduzzi A, Prete A, Cesaro S, Lanino E, Dini G. Clinical benefits of granulocyte colony-stimulating factor therapy after hematopoietic stem cell transplant in children: results of a prospective randomized trial. Haematologica 2002; 87:1274-80. [PMID: 12495901] [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: 02/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hematopoietic stem cell transplantation (HSCT) is associated with profound neutropenia and significant morbidity and mortality. To evaluate the safety and efficacy of non-glycosylated recombinant human granulocyte colony-stimulating factor (rHuG-CSF) in accelerating myeloid recovery and its influence on infections, supportive therapy, and transplant-related mortality we carried out a randomized study in pediatric patients receiving HSCT. DESIGN AND METHODS Two hundred and twenty-one consecutive children, recipients of an allogeneic or autologous bone marrow (BM) or peripheral blood progenitor cell (PBPC) transplant, were randomized to either receive rHuG-CSF 10 mg/kg (n=110) or not (n=111). RESULTS Myeloid engraftment was faster in the treated arm (14 vs 20 days, p=0.0001). Neutrophil recovery was accelerated both in the BM subgroups (allogeneic and autologous, p=0.002) and in the PBPC group (p=0.0005). All the other evaluated variables showed an advantage in favor of rHuG-CSF treated patients that was significant for platelet transfusion independence and time to discharge (p=0.02 and p=0.04, respectively) only in the BM subgroup. INTERPRETATION AND CONCLUSIONS We conclude that faster neutrophil recovery in BM recipients receiving rHuG-CSF led to clinical benefits, while, in the PBPC subgroup, it did not translate into clinical advantages.
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Affiliation(s)
- Sandro Dallorso
- U.O. Ematologia ed Oncologia Pediatrica, Istituto G. Gaslini, Genoa, Italy
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32
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Castagnola E, Micalizzi C, Manzitti C, Tasso L. The desire to be fashionable. Should we consider it a risk factor for infection in adolescents with acute leukaemia? Support Care Cancer 2001; 9:207-8. [PMID: 11401106 DOI: 10.1007/s005200000200] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Three cases of skin infection, two with Pseudomonas aeruginosa and one with Staphylococcus aureus in three adolescents with acute leukaemia are described. In all cases the infection was clearly related to the latest fashion in shoes. This report underline the fact that factors related to everyday life and less frequently considered than those related to the underlying illness can also put increase the risk of developing severe infections in immunocompromised patients.
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Affiliation(s)
- E Castagnola
- Infectious Diseases Unit, G. Gaslini Children's Hospital, Genoa, Italy.
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33
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Dini G, Cancedda R, Locatelli F, Bosi A, Bandini G, Alessandrino EP, Porta F, Uderzo C, Messina C, Fagioli F, Arcese W, Marenco P, Fanin R, Falda M, Soligo D, La Nasa G, Giardini C, Pession A, Scimè R, Di Bartolomeo P, Bruno B, Garbarino L, Lamparelli T, Giorgiani G, Lanino E, Manzitti C, Bacigalupo A. Unrelated donor marrow transplantation: an update of the experience of the Italian Bone Marrow Group (GITMO). Haematologica 2001; 86:451-6. [PMID: 11410406] [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: 02/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Unrelated donor bone marrow transplant (UD-BMT) has become an attractive alternative source of hematopoietic cells for patients lacking a matched sibling. The aim of this paper was to report on results of the 696 UD BMTs performed in 31 Italian institutions during the first 10 years of activity of the Italian Bone Marrow Donor Registry (IBMDR). EVIDENCE AND INFORMATION SOURCES In 1989 the Italian Bone Marrow Transplant Group (GITMO) established the IBMDR to facilitate donor search and marrow procurement for patients lacking an HLA identical sibling. By end of December 1999, 260,000 HLA-A, B typed volunteer donors had been cumulatively registered and 2,620 searches had been activated for Italian patients. At least one HLA-A, B, DRB1 matched donor was found for 54% of the patients and 696 UD BMTs were performed. In 50% of cases the donor was found in the IBMDR and in 50% in 15 other Registries. The average time from search activation to transplant was 6 months for disease other than CML. For CML it was 14 months. Actuarial 12-month transplant-related mortality (TRM) was 68% in patients grafted between 1979 and 1992 and 44% for patients grafted after 1993. Twenty-eight per cent of patients developed grade III or IV acute GvHD and 24% developed extensive chronic GvHD. The rate of disease free survival at three years was 57% for patients with 1st chronic phase CML, 37% for patients with 1st or 2nd CR ALL, 31% for AML or MDS patients 18 years of age and 54% for patients with inborn errors. PERSPECTIVES We conclude that the IBMDR has benefited a substantial number of patients lacking a matched sibling and has facilitated the recruitment of UDs into the international donor pool. The long time required for the search is the major obstacle to the success of this programme. This suggests that early transplant and a decrease in TRM could further improve these encouraging results.
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Affiliation(s)
- G Dini
- Department of Pediatric Hematology and Oncology, G. Gaslini Children's Hospital, l.go G. Gaslini 5, 16148 Genoa, Italy.
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34
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Faraci M, Haupt R, Dallorso S, Lanino E, Morreale G, Calevo M, Manzitti C, Fondelli P, Gaggero R, Dini G. 1. Severe neurological events (SNE) after bone marrow Transplantation (BMT) in children. Rep Pract Oncol Radiother 2001. [DOI: 10.1016/s1507-1367(01)70472-5] [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: 10/18/2022] Open
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35
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Dini G, Cancedda R, Locatelli F, Bosi A, Bandini G, Alessandrino EP, Porta F, Uderzo C, Messina C, Fagioli F, Arcese W, Marenco P, Fanin R, Falda M, Soligo D, La Nasa G, Giardini C, Pession A, Scimè R, Di Bartolomeo P, Bruno B, Garbarino L, Lamparelli T, Giorgiani G, Lanino E, Manzitti C, Bacigalupo A. Unrelated donor marrow transplantation: an update of the experience of the Italian Bone Marrow Transplant Group (GITMO). Haematologica 2000; 85:30-6. [PMID: 11268321] [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: 02/19/2023] Open
Abstract
Unrelated donor bone marrow transplant (UD-BMT) has become an attractive alternative source of hematopoietic cells for patients lacking a matched sibling. The aim of this paper was to report on results of the 696 UD BMTs performed in 31 Italian institutions during the first 10 years of activity of the Italian Bone Marrow Donor Registry (IBMDR). In 1989 the Italian Bone Marrow Transplant Group (GITMO) established the IBMDR to facilitate donor search and marrow procurement for patients lacking an HLA identical sibling. By end of December 1999, 260,000 HLA-A, B typed volunteer donors had been cumulatively registered and 2,620 searches had been activated for Italian patients. At least one HLA-A, B, DRB1 matched donor was found for 54% of the patients and 696 UD BMTs were performed. In 50% of cases the donor was found in the IBMDR and in 50% in 15 other Registries. The average time from search activation to transplant was 6 months for disease other than CML. For CML it was 14 months. Actuarial 12-month transplant-related mortality (TRM) was 68% in patients grafted between 1979 and 1992 and 44% for patients grafted after 1993. Twenty-eight per cent of patients developed grade III or IV acute GvHD and 24% developed extensive chronic GvHD. The rate of disease free survival at three years was 57% for patients with 1st chronic phase CML, 37% for patients with 1st or 2nd CR ALL, 31% for AML or MDS patients < or = 18 years of age and 54% for patients with inborn errors. We conclude that the IBMDR has benefited a substantial number of patients lacking a matched sibling and has facilitated the recruitment of UDs into the international donor pool. The long time required for the search is the major obstacle to the success of this programme. This suggests that early transplant and a decrease in TRM could further improve these encouraging results.
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Affiliation(s)
- G Dini
- U.O. Ematologia-Oncologia Pediatrica, IRCCS G. Gaslini, Genova, Italy.
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36
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Dallorso S, Manzitti C, Morreale G, Faraci M. High dose therapy and autologous hematopoietic stem cell transplantation in poor risk solid tumors of childhood. Haematologica 2000; 85:66-70. [PMID: 11268328] [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: 02/19/2023] Open
Abstract
In the last two decades autologous hematopoietic stem cell transplantation (HSCT) has been increasingly used in the treatment of several poor risk solid tumors of childhood. Examples are recurrent or resistant cancers, metastatic presentation at diagnosis, incomplete surgical resection, unfavorable histologic and biological features. Results from the Children's Cancer Group randomized trial confirm the data from retrospective studies which reported the superiority of HSCT over standard chemotherapy for neuroblastoma. Several retrospective analyses support the use of HSCT in Ewing's sarcoma and in some brain tumors. No evidence of utility has been reported for rhabdomyosarcoma. The most widely utilized source of stem cells is peripheral blood, while there are conflicting data regarding the use of total body irradiation and purging of stem cells.
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Affiliation(s)
- S Dallorso
- BMT Unit, Department of Hematology/Oncology, G. Gaslini Children's Hospital IRCCS, Iargo G. Gaslini 5, 16148 Genova, Italy
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