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Caselli D, Mariani M, Colomba C, Ferrecchi C, Cafagno C, Trotta D, Carloni I, Dibello D, Castagnola E, Aricò M. Real-World Use of Dalbavancin for Treatment of Soft Tissue and Bone Infection in Children: Safe, Effective and Hospital-Time Sparing. Children (Basel) 2024; 11:78. [PMID: 38255391 PMCID: PMC10814822 DOI: 10.3390/children11010078] [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] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
Acute bacterial skin and skin structure infections (ABSSSI) and osteoarticular infections compound the burden of morbidity, mortality and prolonged hospitalizations among gram-positive infections. Dalbavancin, a second-generation, intravenous lipoglycopeptide, due to its prolonged half-life, can be a valuable alternative in their treatment when administered as inpatient treatment at the price of an extended hospital stay. Between October 2019 and September 2023, 31 children and adolescents were treated with dalbavancin because of bone and joint infections (n = 12 patients, 39%), ABSSSI (n = 13 patients, 42%), mainly for the limbs, facial cellulitis or complicated ABSSSI (n = 6 patients, 19%), at five Italian pediatric centers. Microbiological study provided gram-positive bacterial isolate in 16 cases, in 11 cases from a positive blood culture; 9 of them were MRSA. Twenty-five patients were initially treated with a different antibiotic therapy: beta-lactam-based in 18 patients (58%), glycopeptide-based in 15 patients (48%) and daptomycin in 6 (19%). The median time that elapsed between admission and start of dalbavancin was 18 days. A total of 61 doses of dalbavancin were administered to the 31 patients: 16 received a single dose while the remaining 15 patients received between two (n = 9) and nine doses. The frequency of administration was weekly in five cases or fortnightly in nine patients. Median length of stay in hospital was 16 days. Median time to discharge after the first dose of dalbavancin was 1 day. Treatment was very well-tolerated: of the 61 administered doses, only four doses, administered to four patients, were associated with an adverse event: drug extravasation during intravenous administration occurred in two patients, with no sequelae; however, in two patients the first administration was stopped soon after infusion start: in one (ID #11), due to headache and vomiting; in another (ID #12) due to a systemic reaction. In both patients, drug infusion was not repeated. None of the remaining 29 patients reported treatment failure (resistant or recurrent disease) or an adverse effect during a median follow-up time of two months. The use of dalbavancin was safe, feasible and also effective in shortening the hospital stay in children and adolescents.
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Affiliation(s)
- Désirée Caselli
- Infectious Diseases, Children’s Hospital Giovanni XXIII, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy; (D.C.); (C.C.)
| | - Marcello Mariani
- Pediatrics and Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Claudia Colomba
- Department of Health Promotion, Maternal and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy;
- Division of Pediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy
| | - Chiara Ferrecchi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy;
| | - Claudio Cafagno
- Infectious Diseases, Children’s Hospital Giovanni XXIII, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy; (D.C.); (C.C.)
| | - Daniela Trotta
- Pediatrics, S. Spirito Hospital, A.S.L. Pescara, 65124 Pescara, Italy; (D.T.); (M.A.)
| | - Ines Carloni
- Department of Mother and Child Health, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Daniela Dibello
- Pediatric Orthopedics and Traumatology, Children’s Hospital Giovanni XXIII, 70125 Bari, Italy;
| | - Elio Castagnola
- Pediatrics and Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Maurizio Aricò
- Pediatrics, S. Spirito Hospital, A.S.L. Pescara, 65124 Pescara, Italy; (D.T.); (M.A.)
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Caselli D, Aricò M, Fiasca F, Tafuri S. Policy of vaccination of "fragile children": Results of a survey of 14 Italian children's hospitals. Hum Vaccin Immunother 2023; 19:2245701. [PMID: 37614161 PMCID: PMC10453964 DOI: 10.1080/21645515.2023.2245701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/13/2023] [Accepted: 07/29/2023] [Indexed: 08/25/2023] Open
Abstract
Children with chronic disease are at higher risk of invasive infectious disease, including several vaccine-preventable infections. The Italian Association of Pediatric Hospitals (AOPI) carried out a survey of immunization practices: 14/16 AOPI hospitals completed the survey; 50% of them include 100-199 beds, while 21% have <100 beds. In 12/14 hospitals (86%) all vaccinations included in the National Immunization Plan (plus influenza e COVID-19 vaccines) are available for inpatients, in selected wards (n = 4), on single pediatrician initiative (n = 3), by a centralized in-hospital immunization service (n = 2), and the remaining 3 in a "protected vaccination area" or in a COVID-19 pathway. The wards in which vaccination is more frequently offered to in-patients are: General Pediatrics, Neonatology, Pediatric Hematology & Oncology, Pediatric Diabetology, Pediatric Cardiology, and Pediatric Infectious Diseases (range, 58% to 83%). In 58% of vaccinating hospitals, <500 vaccinations/year are reported, while in 17% this number is >2,000/year. A COVID-19 vaccination team is in place for any inpatient child older than 12 years in 42% of hospitals, in 42% only for "fragile" children. A centralized in-hospital immunization service is an emerging model that may contribute to increase compliance to vaccination of fragile patients and to fight against vaccination hesitancy.
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Affiliation(s)
- Désirée Caselli
- Infectious Diseases, Children’s Hospital Giovanni XXIII, A.O.U.C. Policlinico di Bari, Bari, Italy
| | - Maurizio Aricò
- Department of Pediatrics, S.Spirito Hospital, U.O.C. Pediatria A.S.L. Pescara, Pescara, Italy
| | - Fabiana Fiasca
- Department of Life, Health and Environmental Sciences, Università dell’Aquila, L'Aquila, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
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Guerriero S, Giannini A, Cafagno C, Fusco F, Grandolfo R, Carone M, Orlandi A, Caselli D. A Boy With Visual Loss. Pediatr Infect Dis J 2023; 42:528-530. [PMID: 37200513 DOI: 10.1097/inf.0000000000003756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Silvana Guerriero
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro," Medical School; Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy
| | - Annamaria Giannini
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy
| | - Claudio Cafagno
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy
| | - Francesca Fusco
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy
| | - Rita Grandolfo
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy
| | - Maurizio Carone
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy
| | - Azzurra Orlandi
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy
| | - Désirée Caselli
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy
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Aricò MO, Valletta E, Caselli D. Appropriate Use of Antibiotic and Principles of Antimicrobial Stewardship in Children. Children (Basel) 2023; 10:740. [PMID: 37189989 PMCID: PMC10137055 DOI: 10.3390/children10040740] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
Antibiotics account for over 10% of the overall drug expense of the National Health System in Italy in 2021. Their use in children is of particular interest on one side, because acute infections are very common in children, while they build their immunologic library of competence; on the other side, although many acute infections are expected and turn out to be of viral origin, caregivers will often ask the family doctor or primary care attending to reassure them by prescribing antibiotic treatment, although it may often be unnecessary. The inappropriate prescription of antibiotics in children may likely be a source not only of undue economic burden for the public health system but also of increasing development of antimicrobial resistance (AMR). Based on those issues, the inappropriate use of antibiotics in children should be avoided to reduce the risks of unnecessary toxicity, increase in health costs, lifelong effects, and selection of resistant organisms causing undue deaths. Antimicrobial stewardship (AMS) describes a coherent set of actions that ensure an optimal use of antimicrobials to improve patient outcomes while limiting the risk of adverse events including AMR. The aim of this paper is to spread some concept of good use of antibiotics for pediatricians or every other physician involved in the choice to prescribe, or not, antibiotics in children. Several actions could be of help in this process, including the following: (1) identify patients with high probability of bacterial infection; (2) collect samples for culture study before starting antibiotic treatment if invasive bacterial infection is suspected; (3) select the appropriate antibiotic molecule based on local resistance and narrow spectrum for the suspected pathogen(s); avoid multi-antibiotic association; prescribe correct dosage; (4) choose the best route of administration (oral vs. parenteral) and the best schedule of administration for every prescription (i.e., multiple administration for beta lactam); (5) schedule clinical and laboratory re-evaluation with the aim to consider therapeutic de-escalation; (6) stop antibiotic administration as soon as possible, avoiding the application of "antibiotic course".
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Affiliation(s)
- Melodie O. Aricò
- U.O. Pediatria, Ospedale G.B. Morgagni—L. Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (M.O.A.); (E.V.)
| | - Enrico Valletta
- U.O. Pediatria, Ospedale G.B. Morgagni—L. Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (M.O.A.); (E.V.)
| | - Désirée Caselli
- U.O.C. Malattie Infettive, Ospedale Pediatrico Giovanni XXIII, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70100 Bari, Italy
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Caselli D, Cafagno C, Loconsole D, Giannini A, Tansella F, Saracino A, Chironna M, Aricò M. Limited Additive Diagnostic Impact of Isolated Gastrointestinal Involvement for the Triage of Children with Suspected COVID-19. Children 2022; 9:children9010041. [PMID: 35053666 PMCID: PMC8773987 DOI: 10.3390/children9010041] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/12/2021] [Accepted: 12/28/2021] [Indexed: 01/08/2023]
Abstract
The strategy for the selection of patients with a suspected SARS-CoV-2 infection is relevant for the organization of a children’s hospital to provide optimal separation into COVID-19 and non-COVID-19 areas and pathways. We analyzed the proportion of children with COVID-19 presenting with gastrointestinal (GI) symptoms in 137 consecutive patients admitted between January 2020 and August 2021. GI symptoms were present as follows: diarrhea in 35 patients (26%), vomiting in 16 (12%), and both of them in five (3%); the combination of fever, respiratory symptoms, and diarrhea was observed in 16 patients (12%). Of the 676 adult patients with COVID-19 admitted to our hospital in the same time interval, 62 (9.2%) had diarrhea, 30 (4.4%) had vomiting, and 11 (1.6%) had nausea; only one patient, a 38-year-old male, presented with isolated GI symptoms at the diagnosis. Although diarrhea was observed in one quarter of cases, one-half of them had the complete triad of fever, respiratory syndrome, and diarrhea, and only five had isolated diarrhea, of which two were diagnosed with a Campylobacter infection. The occurrence of either respiratory symptoms or gastrointestinal symptoms in our patients was not related to the patient age, while younger children were more likely to have a fever. Of the 137 patients, 73 (53%) could be tested for their serum level of SARS-CoV-2 specific IgG antibodies. The observed titer ranged between 0 (n = 3) and 1729 BAU/mL (median, 425 BAU/mL). Of 137 consecutive patients with COVID-19 admitted to our referral children’s hospital, only three presented with an isolated GI manifestation. It is interesting to note that this finding turned out to be fully in keeping with what was observed on adult patients with COVID-19 in our hospital. The additive diagnostic impact of gastrointestinal involvement for the triage of children with suspected COVID-19 appears limited.
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Affiliation(s)
- Désirée Caselli
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy; (D.C.); (C.C.); (A.G.); (F.T.)
| | - Claudio Cafagno
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy; (D.C.); (C.C.); (A.G.); (F.T.)
| | - Daniela Loconsole
- Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari, 70124 Bari, Italy; (D.L.); (M.C.)
| | - Annamaria Giannini
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy; (D.C.); (C.C.); (A.G.); (F.T.)
| | - Francesco Tansella
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy; (D.C.); (C.C.); (A.G.); (F.T.)
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy;
| | - Maria Chironna
- Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari, 70124 Bari, Italy; (D.L.); (M.C.)
| | - Maurizio Aricò
- Strategic Control, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy
- Correspondence:
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Abstract
The Covid-19 pandemic is still raging [...].
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Caselli D, Chironna M, Loconsole D, Aricò M. Response to 'No evidence of SARS-CoV-2 infection by polymerase chain reaction or serology in children with pseudo-chilblain'. Reply from the authors. Br J Dermatol 2020; 183:1156-1157. [PMID: 32974916 PMCID: PMC7537176 DOI: 10.1111/bjd.19563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D Caselli
- Pediatric Infectious Diseases, Azienda, Piazza G., 70124, Bari, Italy
| | - M Chironna
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - D Loconsole
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - M Aricò
- COVID Emergency Task Force, Giovanni XXIII Children's Hospital, Azienda Ospedaliero Universitaria, Consorziale Policlinico, Bari, Piazza G. Cesare 11, 70124, Bari, Italy
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Caselli D, Chironna M, Loconsole D, Nigri L, Mazzotta F, Bonamonte D, Aricò M. No evidence of SARS-CoV-2 infection by polymerase chain reaction or serology in children with pseudo-chilblain. Br J Dermatol 2020; 183:784-785. [PMID: 32613638 PMCID: PMC7361942 DOI: 10.1111/bjd.19349] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- D Caselli
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - M Chironna
- Department of Biomedical Sciences and Human Oncology - Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - D Loconsole
- Department of Biomedical Sciences and Human Oncology - Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - L Nigri
- Italian Federation of Pediatricians (FIMP), Rome, Italy
| | - F Mazzotta
- Pediatric Dermatology, ASL Barletta, Barletta, Italy
| | - D Bonamonte
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - M Aricò
- COVID Emergency Task Force, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Piazza G. Cesare 11, 70124, Bari, Italy
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Abstract
A novel epidemic is challenging the global health care system. Starting from probably November to December 2019, another Coronavirus entered the arena of human pathogens, to be then defined 2019-nCoV.[...]
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Affiliation(s)
- Désirée Caselli
- Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy
| | - Maurizio Aricò
- Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy
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Girmenia C, Annino L, Bertaina A, Mariotti B, Caselli D, Fanci R, Barberi W, Marchesi F, Carotti A, Ferrari A, Cerchiara E, Cupelli L, Arcioni F, Ribersani M, Proia A, Cartoni C, Girardi K, Venditti A, Cassetta MI, Fallani S, Novelli A. Voriconazole treatment in adults and children with hematological diseases: can it be used without measurement of plasma concentration? Med Mycol 2019; 56:263-278. [PMID: 28992093 DOI: 10.1093/mmy/myx053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/30/2017] [Indexed: 01/09/2023] Open
Abstract
Indication and timing of trough plasma-voriconazole (VCZ)-concentration (t-PVC) measurement during VCZ treatment is a debated issue. Patterns of t-PVC were prospectively evaluated in pediatric (50 courses) and adult (95 courses) hematologic patients. Efficacy patterns were defined: adequate, t-PVC always ≥1 mcg/ml; borderline, at least one t-PVC measurement <1 mcg/ml but median value of the measurements ≥1 mcg/ml; inadequate, median value of the measurements <1 mcg/ml. Toxicity patterns were defined: favorable, t-PVC always ≤5 mcg/ml; borderline, one or more t-PVC measurements >5 mcg/ml but median value of the measurements ≤5 mcg/ml; unfavorable, median value of the measurements >5 mcg/ml. In children and adults the mean t-PVCs were higher during intravenous treatments. The t-PVC efficacy pattern was adequate, borderline and inadequate in 48%, 12%, and 40% of courses, respectively, in children, and in 66.3%, 16.8%, and 16.8% of courses, respectively, in adults. Adequate efficacy pattern was more frequent in children with body weight above the median (≥25 kg) (OR 4.8; P = .011) and in adults with active hematological disease receiving intravenous therapy (OR 3.93; P = .006). Favorable toxicity pattern was more frequent in children receiving VCZ daily dosage below the median (<14 mg/kg) (OR 4.18; P = .027) and in adults with body weight below the median (<68 kg) (OR 0.22; P = .004). T-PVC measurement is generally needed, however, a non t-PVC guided approach may be considered in heavier adults receiving intravenous VCZ. The risk of supratherapeutic levels does not seem an absolute indication for t-PVC monitoring.
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Affiliation(s)
- Corrado Girmenia
- Dipartimento di Ematologia, Oncologia e Dermatologia, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Luciana Annino
- Unità Operativa di Ematologia, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Alice Bertaina
- Dipartimento di Oncoematologia, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Benedetta Mariotti
- Unità di Trapianto Cellule Staminali, Dipartimento di Biomedicina e Prevenzione, University Tor Vergata, Rome, Italy
| | | | - Rosa Fanci
- Unità Funzionale di Ematologia, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Walter Barberi
- Dipartimento di Ematologia, Oncologia e Dermatologia, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Francesco Marchesi
- UOSD di Ematologia e Trapianti, Istituto Nazionale Tumori Regina Elena, IFO, Rome, Italy
| | - Alessandra Carotti
- Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliera e Universita' degli Studi di Perugia, Perugia, Italy
| | | | - Elisabetta Cerchiara
- UOC Ematologia Trapianto Cellule Staminali, Medicina Trasfusionale e Terapia Cellulare, Università Campus Biomedico, Rome, Italy
| | - Luca Cupelli
- Divisione di Ematologia, Ospedale S.Eugenio, Rome, Italy
| | - Francesco Arcioni
- Onco Ematologia Pediatrica con Trapianto di Midollo Osseo, Azienda Ospedalera Santa Maria della Misericordia, Perugia, Italy
| | - Michela Ribersani
- Istituto Mediterraneo di Ematologia, Policlinico Tor Vergata, Rome, Italy
| | - Anna Proia
- UOC di Ematologia e Trapianti di Cellule Staminali, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy
| | - Claudio Cartoni
- Dipartimento di Ematologia, Oncologia e Dermatologia, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Katia Girardi
- Dipartimento di Oncoematologia, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Adriano Venditti
- Ematologia, Dipartimento di Biomedicina e Prevenzione, University Tor Vergata, Rome, Italy
| | - Maria Iris Cassetta
- Dipartimento di Scienze della Salute, Sezione di farmacologia Clinica e Oncologia, Università degli Studi di Firenze oppure Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Italy
| | - Stefania Fallani
- Dipartimento di Scienze della Salute, Sezione di farmacologia Clinica e Oncologia, Università degli Studi di Firenze oppure Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Italy
| | - Andrea Novelli
- Dipartimento di Scienze della Salute, Sezione di farmacologia Clinica e Oncologia, Università degli Studi di Firenze oppure Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Italy
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Caselli D, Galli L, Tondo A, Cuzzubbo D, Casini T, Simone LD, Tamburini A, Bambi F, Tucci F, Aricò M. Use of Micafungin for the Management of a Cluster of Invasive Aspergillosis in Children with Cancer. ACTA ACUST UNITED AC 2019. [DOI: 10.9734/jamps/2019/v20i330112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Progressive increase of the capacity to cure children with cancer makes their rescue from life-threatening infectious complications, such as invasive fungal infections, a compelling challenge. Local outbreak among patients at risk may occur, and the optimal strategy for their management, including prophylactic regimens, is not defined.
Purpose: We describe our experience in the use of micafungin to break a cluster of invasive aspergillosis in children and adolescent with cancer.
Methods: Since study start, all in-patients who had severe neutropenia (<500/mm3) received prophylaxis with micafungin (1 mg/kg; ≤50 mg) daily i.v. until discharge. Serial testing of galactomannan was used as screening test for invasive aspergillosis; lung computed tomography was performed in patients who tested positive at repeated assay.
Results: Among 27 patients enrolled, one was excluded due to breakthrough invasive aspergillosis diagnosed on day 2. The remaining 26 patients were observed for a minimum of 90 days. Four patients had one positive galactomannan test; this was confirmed at second (but not at third) serial assay in a single patient. None of the patients developed invasive aspergillosis. The drug was very well tolerated, with no side effects related to micafungin administration. The total cost of the drug used for this “prophylaxis” in the study patients was €30.451, with a mean cost per patient of €1.133.
Conclusions: “Prophylactic” use of micafungin was safe, feasible and turned out to be associated with breaking the cluster of invasive aspergillosis in neutropenic patients exposed to an environmental risk. The pharmaco-economic evaluation also turned to be highly favorable.
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Cesaro S, Tridello G, Castagnola E, Calore E, Carraro F, Mariotti I, Colombini A, Perruccio K, Decembrino N, Russo G, Maximova N, Baretta V, Caselli D. Retrospective study on the incidence and outcome of proven and probable invasive fungal infections in high-risk pediatric onco-hematological patients. Eur J Haematol 2017; 99:240-248. [DOI: 10.1111/ejh.12910] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2017] [Indexed: 10/25/2022]
Affiliation(s)
- Simone Cesaro
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - Gloria Tridello
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - Elio Castagnola
- Pediatric Infectious Disease; Istituto Giannina Gaslini; Genoa Italy
| | - Elisabetta Calore
- Department of Women's and Children's Health; Clinic of Pediatric Hemato-Oncology; University Hospital of Padova; Padova Italy
| | - Francesca Carraro
- Pediatric Onco-Hematology; Stem Cell Transplantation and Cellular Therapy Division; AOU Città della Salute e della Scienza; Regina Margherita Childrens Hospital; Turin Italy
| | - Ilaria Mariotti
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria; Modena Italy
| | | | - Katia Perruccio
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria; Perugia Italy
| | - Nunzia Decembrino
- Pediatric Hematology Oncology; IRCCS Policlinico San Matteo; University of Pavia; Pavia Italy
| | - Giovanna Russo
- Pediatric Hematology Oncology; A.O.U. Policlinico-Vittorio Emanuele Catania; Catania Italy
| | - Natalia Maximova
- Bone Marrow Transplant Unit; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Valentina Baretta
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - Désirée Caselli
- Pediatric Hematology Oncology; Meyer Hospital; University of Florence; Firenze Italy
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Abstract
Advances in chemotherapy and surgery allows the majority of patients to survive cancer diseases. Yet, the price may be a proportion of patients dying of complications due to treatment-induced infectious complications, such as neutropenia. With the aim of decreasing morbidity and mortality related to infectious complications, recombinant human granulocyte colony-stimulating factor (G-CSF), filgrastim, and pegylated filgrastim have been used to reduce time and degree of neutropenia. A biosimilar is a copy of an approved original biologic medicine whose data protection has expired. The patent for filgrastim expired in Europe in 2006 and in the US in 2013. This review analyses the available evidence to be considered in order to design a strategy of use of G-CSF and its biosimilars. The clinical and safety outcomes of biosimilars are well within the range of historically reported data for originator filgrastim. This underscores the clinical effectiveness and safety of biosimilar filgrastim in daily clinical practice. Biosimilars can play an important role by offering the opportunity to reduce costs, thus contributing to the financial sustainability of treatment programs.
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Affiliation(s)
- Désirée Caselli
- Medical Department, Pediatric Unit, Azienda Sanitaria Provinciale Ragusa, Ragusa, Italy
| | - Simone Cesaro
- Department of Pediatrics, Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maurizio Aricò
- Medical Department, Pediatric Unit, Azienda Sanitaria Provinciale Ragusa, Ragusa, Italy
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14
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Caselli D, Tamburini A, La Torre A, Pollazzi L, Tintori V, Bambi F, Caputo R, Aricò M. High-dose chemotherapy with autologous stem cell rescue for treatment of retinoblastoma: report of five cases. Pediatr Transplant 2014; 18:631-6. [PMID: 25039687 DOI: 10.1111/petr.12321] [Citation(s) in RCA: 4] [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] [Accepted: 06/17/2014] [Indexed: 11/27/2022]
Abstract
RB is a primarily pediatric cancer arising from the retina, initiated by biallelic loss of the RB1 gene. We report five children with bilateral RB (n = 3), extra-ocular disseminated RB, or disseminated relapsed RB, who were treated with tandem high-dose chemotherapy and autologous stem cell rescue. All patients received at least 2.2 × 10(6) /kg CD34(+) (median, 3.9 × 10(6) /kg) cells. The preparative regimen for course 1 was carboplatin, thiotepa, etoposide, and for course 2, CM and melphalan. ANC of at least 0.5 × 10(9) /L occurred at a median of 11 days (range, 10-12) and 15 days (range, 12-16) after the first and second procedure, respectively. Platelet engraftment occurred at a median of 13 days (range, 12-17) and 15 days (range, 14-22) after the first and second procedure, respectively. All of the five patients treated remain alive and disease free at the last follow-up time, ranging between 21 and 44 months after completion of autologous transplant. Additional therapy was required in one patient, in whom enucleation had to be performed because of early disease relapse, refractory to local therapy. Intensification of chemotherapy with repeated high-dose chemotherapy and autologous rescue appears an acceptable choice in selected cases with bilateral or extra-ocular disease, either recurrent or refractory.
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Affiliation(s)
- Désirée Caselli
- Medical Direction, Azienda Ospedaliero Universitaria Meyer Children Hospital, Firenze, Italy
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15
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Cesaro S, Tridello G, Prete A, Dallorso S, Cannata E, Massaccesi E, Risso M, De Bortoli M, Caselli D. Biosimilar granulocyte-colony-stimulating factor for mobilization of autologous peripheral blood stem cells in pediatric hematology-oncology patients. Transfusion 2014; 55:246-52. [DOI: 10.1111/trf.12789] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/23/2014] [Accepted: 05/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Simone Cesaro
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - Gloria Tridello
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - Arcangelo Prete
- Pediatric Hematology Oncology; Ospedale Lalla Seragnoli; Bologna Italy
| | - Sandro Dallorso
- Pediatric Hematology Oncology; Istituto G. Gaslini; Genova Italy
| | - Elisa Cannata
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - Erika Massaccesi
- Pediatric Hematology Oncology; Ospedale Lalla Seragnoli; Bologna Italy
| | - Marco Risso
- Immunohematology and Transfusion Service; Istituto G. Gaslini; Genova Italy
| | | | - Désirée Caselli
- Medical Direction Department; Azienda Ospedaliero-Universitaria Meyer Children Hospital; Firenze Italy
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16
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Lehrnbecher T, Aplenc R, Pereira FR, Lassaletta A, Caselli D, Kowalczyk J, Chisholm J, Sung L. Variations in non-pharmacological anti-infective measures in childhood leukemia - results of an international survey. Haematologica 2014. [DOI: 10.3324/haematol.2014.112615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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17
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Caselli D, Petris MG, Rondelli R, Carraro F, Colombini A, Muggeo P, Ziino O, Melchionda F, Russo G, Pierani P, Soncini E, DeSantis R, Zanazzo G, Barone A, Cesaro S, Cellini M, Mura R, Milano GM, Meazza C, Cicalese MP, Tropia S, De Masi S, Castagnola E, Aricò M. Single-day trimethoprim/sulfamethoxazole prophylaxis for Pneumocystis pneumonia in children with cancer. J Pediatr 2014; 164:389-92.e1. [PMID: 24252793 DOI: 10.1016/j.jpeds.2013.10.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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: 06/06/2013] [Revised: 09/09/2013] [Accepted: 10/08/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether a simplified, 1-day/week regimen of trimethoprim/sulfamethoxazole is sufficient to prevent Pneumocystis (jirovecii [carinii]) pneumonia (PCP). Current recommended regimens for prophylaxis against PCP range from daily administration to 3 consecutive days per week dosing. STUDY DESIGN A prospective survey of the regimens adopted for the PCP prophylaxis in all patients treated for childhood cancer at pediatric hematology-oncology centers of the Associazione Italiana Ematologia Oncologia Pediatrica. RESULTS The 20 centers participating in the study reported a total of 2466 patients, including 1093 with solid tumor and 1373 with leukemia/lymphoma (or primary immunodeficiency; n = 2). Of these patients, 1371 (55.6%) received the 3-day/week prophylaxis regimen, 406 (16.5%) received the 2-day/week regimen, and 689 (27.9%), including 439 with leukemia/lymphoma, received the 1-day/week regimen. Overall, only 2 cases of PCP (0.08%) were reported, both in the 2-day/week group. By intention to treat, the cumulative incidence of PCP at 3 years was 0.09% overall (95% CI, 0.00-0.40%) and 0.51% for the 2-day/week group (95% CI, 0.10%-2.00%). Remarkably, both patients who failed had withdrawn from prophylaxis. CONCLUSION A single-day course of prophylaxis with trimethoprim/sulfamethoxazole may be sufficient to prevent PCP in children with cancer undergoing intensive chemotherapy regimens. This simplified strategy might have implications for the emerging need for PCP prophylaxis in other patients subjected to the increased use of biological and nonbiological agents that induce higher levels of immune suppression, such as those with rheumatic diseases.
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Affiliation(s)
- Désirée Caselli
- Department of Pediatric Hematology-Oncology, Azienda Ospedaliero Universitaria Meyer Children Hospital, Florence, Italy
| | | | - Roberto Rondelli
- Pediatric Oncology and Hematology, Lalla Seràgnoli Unit, University of Bologna, Bologna, Italy
| | - Francesca Carraro
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Turin, Italy
| | | | | | - Ottavio Ziino
- Pediatric Hematology-Oncology, ARNAS Civico, Palermo, Italy
| | - Fraia Melchionda
- Pediatric Oncology and Hematology, Lalla Seràgnoli Unit, University of Bologna, Bologna, Italy
| | | | - Paolo Pierani
- Division of Pediatric Hematology/Oncology, G Salesi Women's and Children's Hospital, Ancona, Italy
| | - Elena Soncini
- Pediatric Hematology-Oncology, BMT Unit, Spedali Civili, Brescia, Italy
| | - Raffaella DeSantis
- Pediatric Hematology-Oncology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giulio Zanazzo
- Pediatric Hematology-Oncology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Angelica Barone
- Pediatric and Hematology-Oncology, University Hospital Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Simone Cesaro
- Pediatric Hematology-Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Monica Cellini
- Pediatric Hematology-Oncology, University Hospital, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | | | - Giuseppe M Milano
- Pediatric Oncology/Hematology, BMT Unit, Section of Hematology, Department of Internal and Experimental Medicine, University of Perugia, Perugia, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionaledei Tumori, Milan, Italy
| | - Maria P Cicalese
- Pediatric Immunology, San Raffaele Telethon Institute for Gene Therapy, Milan, Italy
| | - Serena Tropia
- Pediatric Hematology-Oncology, ARNAS Civico, Palermo, Italy
| | - Salvatore De Masi
- Epidemiology, Azienda Ospedaliero Universitaria Meyer Children Hospital, Florence, Italy
| | - Elio Castagnola
- Infectious Disease Unit, Gaslini Institute, Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Aricò
- Department of Pediatric Hematology-Oncology, Azienda Ospedaliero Universitaria Meyer Children Hospital, Florence, Italy.
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18
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Caselli D, Rosati A, Faraci M, Podda M, Ripaldi M, Longoni D, Cesaro S, Lo Nigro L, Paolicchi O, Maximova N, Menconi MC, Ziino O, Cicalese MP, Santarone S, Nesi F, Aricò M, Locatelli F, Prete A. Risk of Seizures in Children Receiving Busulphan-Containing Regimens for Stem Cell Transplantation. Biol Blood Marrow Transplant 2014; 20:282-5. [DOI: 10.1016/j.bbmt.2013.10.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
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Caselli D, Tondo A, Tucci F, Casini T, Paolicchi O, Savelli S, Aricò M. Adenovirus pneumonia during induction therapy for childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2013; 60:1390-1. [PMID: 23630183 DOI: 10.1002/pbc.24550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/07/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Désirée Caselli
- Department of Pediatric Hematology-Oncology; Azienda Ospedaliero-Universitaria Meyer Children Hospital; Firenze Italy
| | - Annalisa Tondo
- Department of Pediatric Hematology-Oncology; Azienda Ospedaliero-Universitaria Meyer Children Hospital; Firenze Italy
| | - Fabio Tucci
- Department of Pediatric Hematology-Oncology; Azienda Ospedaliero-Universitaria Meyer Children Hospital; Firenze Italy
| | - Tommaso Casini
- Department of Pediatric Hematology-Oncology; Azienda Ospedaliero-Universitaria Meyer Children Hospital; Firenze Italy
| | - Olivia Paolicchi
- Department of Pediatric Hematology-Oncology; Azienda Ospedaliero-Universitaria Meyer Children Hospital; Firenze Italy
| | - Sara Savelli
- Department of Radiology; Azienda Ospedaliero-Universitaria Meyer Children Hospital; Firenze Italy
| | - Maurizio Aricò
- Department of Pediatric Hematology-Oncology; Azienda Ospedaliero-Universitaria Meyer Children Hospital; Firenze Italy
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20
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Caselli D, Cesaro S, Ziino O, Ragusa P, Pontillo A, Pegoraro A, Santoro N, Zanazzo G, Poggi V, Giacchino M, Livadiotti S, Melchionda F, Chiodi M, Aricò M. A prospective, randomized study of empirical antifungal therapy for the treatment of chemotherapy-induced febrile neutropenia in children. Br J Haematol 2012; 158:249-255. [DOI: 10.1111/j.1365-2141.2012.09156.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 03/27/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Désirée Caselli
- Department Paediatric Haematology Oncology; Azienda Ospedaliero-Universitaria Meyer; Firenze Italy
| | - Simone Cesaro
- Oncoematologia Pediatrica; Dipartimento di Pediatria; Università di Padova; Padova Italy
| | - Ottavio Ziino
- Paediatric Haematology and Oncology Unit; G. Di Cristina Children's Hospital; Palermo Italy
| | - Pietro Ragusa
- Dipartimento di Scienze Statistiche e Matematiche Silvio Vianelli; Palermo Italy
| | - Alfredo Pontillo
- Dipartimento di Scienze Statistiche e Matematiche Silvio Vianelli; Palermo Italy
| | - Anna Pegoraro
- Oncoematologia Pediatrica; Dipartimento di Pediatria; Università di Padova; Padova Italy
| | - Nicola Santoro
- Dipartimento Biomedicina Età Evolutiva; U.O Pediatrica I Policlinico; Bari Italy
| | - Giulio Zanazzo
- Institute for Maternal and Child Health IRCCS Burlo Garofolo; Trieste Italy
| | - Vincenzo Poggi
- Dipartimento di Oncologia; A.O.R.N. Santobono - Pausilipon; Napoli Italy
| | - Mareva Giacchino
- Dip. Scienze Pediatriche e dell'Adolescenza; Ospedale Infantile Regina Margherita; Torino Italy
| | | | - Fraia Melchionda
- Clinica Pediatrica; Oncologia ed Ematologia Lalla Seràgnoli; Policlinico Sant'Orsola Malpighi; Bologna Italy
| | - Marcello Chiodi
- Dipartimento di Scienze Statistiche e Matematiche Silvio Vianelli; Palermo Italy
| | - Maurizio Aricò
- Department Paediatric Haematology Oncology; Azienda Ospedaliero-Universitaria Meyer; Firenze Italy
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21
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Lehrnbecher T, Aplenc R, Rivas Pereira F, Lassaletta A, Caselli D, Kowalczyk J, Chisholm J, Sung L. Variations in non-pharmacological anti-infective measures in childhood leukemia--results of an international survey. Haematologica 2012; 97:1548-52. [PMID: 22419572 DOI: 10.3324/haematol.2012.062885] [Citation(s) in RCA: 12] [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: 12/23/2022] Open
Abstract
BACKGROUND Standardization in clinical practice may lead to improved outcomes. Unfortunately, little is known about the variability of non-pharmacological anti-infective measures in children with cancer. DESIGN AND METHODS A web-based survey assessed institutional recommendations regarding restrictions of social contacts, pets and food and instructions on wearing face masks in public for children with standard- risk acute lymphoblastic leukemia and acute myeloid leukemia during intensive chemotherapy. RESULTS A total of 336 institutions in 27 countries responded to the survey (range, 1-76 institutions per country; overall response rate 61%). Most institutions recommend that patients with acute myeloid leukemia avoid indoor public places and daycare, kindergarten and school, whereas recommendations for patients with acute lymphoblastic leukemia differ considerably by institution. In terms of restrictions related to pets, there was a wide variability between institutions for both acute lymphoblastic and acute myeloid leukemia patients. Most, but not all institutions do not allow children with either acute lymphoblastic or acute myeloid leukemia to eat raw meat, raw seafood or unpasteurized milk. Whereas most institutions do not routinely recommend that patients with acute lymphoblastic leukemia wear face masks in public, advice on this matter varies for patients with acute myeloid leukemia. CONCLUSIONS The survey demonstrates that there is a wide variation in recommendations on non-pharmacological anti-infective measures between different institutions, countries and continents. This information may be used to encourage harmonization of supportive care practices and future clinical trials.
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Caselli D, Morfini M, Paolicchi O, Frenos S, Casini T, Aricò M. Cord blood hematopoietic stem cell transplantation in an adolescent with haemophilia. Haemophilia 2012; 18:e48-9. [PMID: 22226228 DOI: 10.1111/j.1365-2516.2011.02734.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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23
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Caselli D, Cesaro S, Livadiotti S, Ziino O, Paolicchi O, Zanazzo G, Milano GM, Licciardello M, Barone A, Cellini M, Raffaella DS, Giacchino M, Rossi MR, Aricò M, Castagnola E. Preventing transmission of infectious agents in the pediatric in-patients hematology-oncology setting: what is the role for non-pharmacological prophylaxis? Pediatr Rep 2011; 3:e9. [PMID: 21647282 PMCID: PMC3103128 DOI: 10.4081/pr.2011.e9] [Citation(s) in RCA: 8] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 03/16/2011] [Indexed: 11/23/2022] Open
Abstract
The most intensive chemotherapy regimens were used in the past for leukemia patients who were the main focus of trials on infections; today there are increasing numbers of children with solid cancer and considerable risk of infection who do receive intensive standard-dose chemotherapy. Despite a continuous will to protect the immune-compromised child from infections, evidence-based indications for intervention by non-pharmacological tools is still lacking in the pediatric hematology-oncology literature. Guidelines on standard precautions as well as precautions to avoid transmission of specific infectious agents are available. As a result of a consensus discussion, the Italian Association for Pediatric Hematology-Oncology (AIEOP) Cooperative Group centers agree that for children treated with chemotherapy both of these approaches should be implemented and vigorously enforced, while additional policies, including strict environmental isolation, should be restricted to patients with selected clinical conditions or complications. We present here a study by the working group on infectious diseases of AIEOP.
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Affiliation(s)
- Désirée Caselli
- Dipartimento Oncoematologia Pediatrica, Azienda Ospedaliero-Universitaria Meyer, Firenze
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24
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Thiel U, Wawer A, Wolf P, Badoglio M, Santucci A, Klingebiel T, Basu O, Borkhardt A, Laws HJ, Kodera Y, Yoshimi A, Peters C, Ladenstein R, Pession A, Prete A, Urban EC, Schwinger W, Bordigoni P, Salmon A, Diaz MA, Afanasyev B, Lisukov I, Morozova E, Toren A, Bielorai B, Korsakas J, Fagioli F, Caselli D, Ehninger G, Gruhn B, Dirksen U, Abdel-Rahman F, Aglietta M, Mastrodicasa E, Torrent M, Corradini P, Demeocq F, Dini G, Dreger P, Eyrich M, Gozdzik J, Guilhot F, Holler E, Koscielniak E, Messina C, Nachbaur D, Sabbatini R, Oldani E, Ottinger H, Ozsahin H, Schots R, Siena S, Stein J, Sufliarska S, Unal A, Ussowicz M, Schneider P, Woessmann W, Jürgens H, Bregni M, Burdach S. No improvement of survival with reduced- versus high-intensity conditioning for allogeneic stem cell transplants in Ewing tumor patients. Ann Oncol 2011; 22:1614-1621. [PMID: 21245159 DOI: 10.1093/annonc/mdq703] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Outcomes of Ewing tumor (ET) patients treated with allogeneic stem cell transplantation (allo-SCT) were compared regarding the use of reduced-intensity conditioning (RIC) and high-intensity conditioning (HIC) regimens as well as human leukocyte antigen (HLA)-matched and HLA-mismatched grafts. PATIENTS AND METHODS We retrospectively analyzed data of 87 ET patients from the European Group for Blood and Marrow Transplantation, Pediatric Registry for Stem Cell Transplantations, Asia Pacific Blood and Marrow Transplantation and MetaEICESS registries treated with allo-SCT. Fifty patients received RIC (group A) and 37 patients received HIC (group B). Twenty-four patients received HLA-mismatched grafts and 63 received HLA-matched grafts. RESULTS Median overall survival was 7.9 months [±1.24, 95% confidence interval (CI) 5.44-10.31] for group A and 4.4 months (±1.06, 95% CI 2.29-6.43) for group B patients (P = 1.3). Death of complications (DOC) occurred in 4 of 50 (0.08) and death of disease (DOD) in 33 of 50 (0.66) group A and in 16 of 37 (0.43) and 17 of 37 (0.46) group B patients, respectively. DOC incidence was decreased (P < 0.01) and DOD/relapse increased (P < 0.01) in group A compared with group B. HLA mismatch was not generally associated with graft-versus-Ewing tumor effect (GvETE). CONCLUSIONS There was no improvement of survival with RIC compared with HIC due to increased DOD/relapse incidence after RIC despite less DOC incidence. This implicates general absence of a clinically relevant GvETE with current protocols.
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Affiliation(s)
- U Thiel
- Department of Pediatrics and Wilhelm Sander Sarcoma Unit MRI, Pediatric Oncology Center, Technische Universität München
| | - A Wawer
- Department of Pediatrics and Wilhelm Sander Sarcoma Unit MRI, Pediatric Oncology Center, Technische Universität München
| | - P Wolf
- Institute for Medical Statistics and Epidemiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - M Badoglio
- EBMT Data & Study Office, Hopital Saint-Antoine, Assistance Publique des Hôpitaux de Paris and UPMC Univ Paris 06, Paris, France
| | - A Santucci
- Section of Pediatric Hematology & Oncology, University of Perugia, Perugia, Italy
| | - T Klingebiel
- Children's Hospital III, Department of Pediatrics, Johann Wolfgang Goethe University, Frankfurt
| | - O Basu
- Children's Hospital III, Department of Pediatrics, Johann Wolfgang Goethe University, Frankfurt
| | - A Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Düsseldorf, Germany
| | - H-J Laws
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Düsseldorf, Germany
| | - Y Kodera
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University, Aichi; APBMT Data Center, Nagoya University School of Medicine, Nagoya, Japan
| | - A Yoshimi
- APBMT Data Center, Nagoya University School of Medicine, Nagoya, Japan
| | - C Peters
- Department of Pediatrics, St. Anna Kinderspital, Vienna, Austria
| | - R Ladenstein
- Department of Pediatrics, St. Anna Kinderspital, Vienna, Austria
| | - A Pession
- Department of Scienze Pediatriche Mediche e Chirurgiche, Ospedale S Orsola Malpighi, Bologna, Italy
| | - A Prete
- Department of Scienze Pediatriche Mediche e Chirurgiche, Ospedale S Orsola Malpighi, Bologna, Italy
| | - E-C Urban
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - W Schwinger
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - P Bordigoni
- Service de Transplantation Medullaire, CHU de Nancy Brabois, Vandoeuvre-les-Nancy, France
| | - A Salmon
- Service de Transplantation Medullaire, CHU de Nancy Brabois, Vandoeuvre-les-Nancy, France
| | - M A Diaz
- Department of Pediatrics, Division of Pediatric Hematology-Oncology and Hematopoietic Stem Cell Transplantation and Cell Therapy Unit, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - B Afanasyev
- St. Petersburg State Medical Pavlov University, Ratsa Gorbacheva Memorial Children`s Institute, Department of Hematology and Transplantology, St. Petersburg, Russia
| | - I Lisukov
- St. Petersburg State Medical Pavlov University, Ratsa Gorbacheva Memorial Children`s Institute, Department of Hematology and Transplantology, St. Petersburg, Russia
| | - E Morozova
- St. Petersburg State Medical Pavlov University, Ratsa Gorbacheva Memorial Children`s Institute, Department of Hematology and Transplantology, St. Petersburg, Russia
| | - A Toren
- Pediatric Hemato-Oncology Unit, Sheba Medical Center (affiliated to the Sackler Faculty of Medicine), Tel Hashomer, Israel
| | - B Bielorai
- Pediatric Hemato-Oncology Unit, Sheba Medical Center (affiliated to the Sackler Faculty of Medicine), Tel Hashomer, Israel
| | - J Korsakas
- Department of Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania
| | - F Fagioli
- Stem Cell Transplantation and Cellular Therapy Unit, Pediatric Onco-Hematology Division, "Regina Margherita" Children's Hospital, Turin
| | - D Caselli
- Department of Oncoematologia Pediatrica, Azienda Ospedaliero-Universitaria Meyer, Florence, Italy
| | - G Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden
| | - B Gruhn
- Department of Pediatrics, University of Jena, Jena
| | - U Dirksen
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Münster, Germany
| | - F Abdel-Rahman
- The Bone Marrow and Stem Cell Transplantation Program, King Hussein Cancer Center, Amman, Jordan
| | - M Aglietta
- Department of Istituto per la Ricerca e la Cura del Cancro, Turin, Italy
| | - E Mastrodicasa
- Section of Pediatric Hematology & Oncology, University of Perugia, Perugia, Italy
| | - M Torrent
- Hospital de la Santa Creu i Sant Pau, Department of Pediatrics, Barcelona, Spain
| | - P Corradini
- Department of Hematology - Bone Marrow Transplantation Unit, Istituto Nazionale dei Tumori, University of Milano, Milan, Italy
| | - F Demeocq
- Centre Hospitalier et Universitaire de Clermont-Ferrand, Service de Pédiatrie B et Unité Bioclinique de Thérapie Cellulaire, Clermont-Ferrand, France
| | - G Dini
- Department of UO Ematologia ed Oncologia Pediatrica, Istituto G Gaslini, Genova, Italy
| | - P Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg
| | - M Eyrich
- Children's Hospital, Department of Paediatric Stem Cell Transplantation, University of Würzburg, Würzburg, Germany
| | - J Gozdzik
- Transplantation Centre, University Children's Hospital, Cracow, Poland
| | - F Guilhot
- Department of Hematology, University Hospital, Poitiers, France
| | - E Holler
- Department of Hematology and Oncology, University of Regensburg, Regensburg
| | - E Koscielniak
- Department of Pediatrics 5 (Oncology, Hematology, Immunology), Olga Hospital, Klinikum Stuttgart, Stuttgart, Germany
| | - C Messina
- Hemo/Oncology, Department of Pediatrics, Hospital-University of Padova, Padova, Italy
| | - D Nachbaur
- University Hospital of Innsbruck, Internal Medicine V, Department of Hematology and Oncology, Innsbruck, Austria
| | - R Sabbatini
- Department of Oncology, Haematology, and Respiratory Diseases, Policlinico di Modena, Modena
| | - E Oldani
- Department of U.S.C. Ematologia, Ospedali Riuniti, Bergamo, Italy
| | - H Ottinger
- Department of Bone Marrow Transplantation, University Hospital of Essen, Essen, Germany
| | - H Ozsahin
- Paediatric Oncology Unit, University of Geneva Children's Hospital, Geneva, Switzerland
| | - R Schots
- Division of Clinical Hematology and BMT Unit, University Hospital Brussels, Brussels, Belgium
| | - S Siena
- Department of S. C. Divisione Oncologia Falck and S. C. Divisione Anatomia Patologica, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - J Stein
- Bone marrow Transplant Unit, Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - S Sufliarska
- Bone Marrow Transplantation Unit, Department of Pediatrics, Comenius University Medical School, Bratislava, Slovak Republic
| | - A Unal
- Institutions Erciyes Medical School, Department of Hematology and Oncology, Kapadokya BMT Center, Kayseri, Turkey
| | - M Ussowicz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - P Schneider
- Department of Pediatric Hematology and Oncology, Hôpital Charles Nicolle, Rouen, France
| | - W Woessmann
- Department of Pediatric Hematology and Oncology, University Hospital, Giessen, Germany
| | - H Jürgens
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Münster, Germany
| | - M Bregni
- Unit of Medical Oncology, Ospedale San Giuseppe, Milan, Italy
| | - S Burdach
- Department of Pediatrics and Wilhelm Sander Sarcoma Unit MRI, Pediatric Oncology Center, Technische Universität München.
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Lamanna C, Baroni M, Bisin S, Gianassi S, Bambi F, Caselli D, Aricò M. Key role of staff competencies for patient and donor safety in a bone marrow transplantation unit: design and implementation of an accredited training and self-assessment program. Transplant Proc 2011; 42:2254-6. [PMID: 20692458 DOI: 10.1016/j.transproceed.2010.05.027] [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: 11/30/2022]
Abstract
Human resources represent at the moment the most critical factor in an hospital setting characterized by a high rate of staff turnover. It is important to ensure a consistent level of expertise and knowledge of professionals who work in health care facilities to provide quality services and simultaneously support the implementation of strategies for patient safety. Unfortunately, the development of effective interventions for training newly added staff and self-evaluation of skills possessed by trained staff are closely related to understanding critical aspects of the organization. At the new Center for Bone Marrow Transplantation and Blood Transfusion Service in Meyer Hospital, during the last year, a group of professional nurses and technicians completed a specific plan to train new staff and, at the same time, a program of self-assessment of skills for experienced staff. The main purpose of this project was to promote skills development by newly added as well as experienced staff, to identify areas of weaknesses, and to correct them with training (organized by the hospital, departmental, or individual) designed to improve performance.
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Affiliation(s)
- C Lamanna
- Quality Assurance, Azienda Ospedaliero-Universitaria A. Meyer, Firenze, Italy.
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26
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Caselli D, Cesaro S, Castagnola E, Arico M. Multidrug resistant Pseudomonas aeruginosa bloodstream infection: comparison between children and adult patients with cancer (reply). Haematologica 2010. [DOI: 10.3324/haematol.2010.037523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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27
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Caselli D, Carraro F, Castagnola E, Ziino O, Frenos S, Milano GM, Livadiotti S, Cesaro S, Marra N, Zanazzo G, Meazza C, Cellini M, Aricò M. Morbidity of pandemic H1N1 influenza in children with cancer. Pediatr Blood Cancer 2010; 55:226-8. [PMID: 20582951 DOI: 10.1002/pbc.22619] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND To define the mortality and the current impact of the H1N1 pandemic in pediatric hematology-oncology centers, we performed a specific survey. PROCEDURE Pharyngeal swabs from patients with fevers of unknown origin, flu-like symptoms or bronchopneumonia were screened for H1N1 using PCR. RESULTS Sixty-two patients with documented H1N1 infection were reported: 16 had recently stopped therapy, 2 were at the diagnosis stage, and 44 were receiving therapy. The clinical course was severe (requiring ICU admission) in only 1 patient, moderate (requiring hospital admission) in 38, and mild in the remaining 23 (37%), treated as outpatients. While none of the patients died of H1N1-related complications, two patients died of progressive cancer; in all of the remaining cases, symptoms resolved within 11 days. The clinical course was complicated by respiratory distress or bronchopneumonia in 10 cases. Oseltamivir was given to 82% of patients. Chemotherapy was temporarily withdrawn in 54% of cases for a median time of 21 days (range, 4-43 days). CONCLUSION H1N1 infection in children with cancer was not reported as the cause of death in any case but resulted in reduced intensity of anti-cancer therapy.
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Affiliation(s)
- Désirée Caselli
- Department of Pediatric Hematology Oncology, Azienda Ospedaliero-Universitaria Meyer, Florence, Italy
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28
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Caselli D, Cesaro S, Ziino O, Zanazzo G, Manicone R, Livadiotti S, Cellini M, Frenos S, Milano GM, Cappelli B, Licciardello M, Beretta C, Aricò M, Castagnola E. Multidrug resistant Pseudomonas aeruginosa infection in children undergoing chemotherapy and hematopoietic stem cell transplantation. Haematologica 2010; 95:1612-5. [PMID: 20305140 DOI: 10.3324/haematol.2009.020867] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Pseudomonas aeruginosa is one leading gram-negative organism associated with nosocomial infections. Bacteremia is life-threatening in the immunocompromised host. Increasing frequency of multi-drug-resistant (MDRPA) strains is concerning. We started a retrospective survey in the pediatric hematology oncology Italian network. Between 2000 and 2008, 127 patients with Pseudomonas aeruginosa bacteremia were reported from 12 centers; 31.4% of isolates were MDRPA. Death within 30 days of a positive blood culture occurred in 19.6% (25/127) of total patients; in patients with MDRPA infection it occurred in 35.8% (14/39). In the multivariate analysis, only MDRPA had significant association with infection-related death. This is the largest series of Pseudomonas aeruginosa bacteremia cases from pediatric hematology oncology centers. Monitoring local bacterial isolates epidemiology is mandatory and will allow empiric antibiotic therapy to be tailored to reduce fatalities.
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Affiliation(s)
- Désirée Caselli
- U.O. Cure Domiciliari - Terapia Cellulare, Dipartimento di Oncoematologia, Azienda Ospedaliero-Universitaria Meyer, Viale Pieraccini, 24 50139 Firenze, Italy.
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29
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Caselli D, Tintori V, Messeri A, Frenos S, Bambi F, Aricò M. Respiratory depression and somnolence in children receiving dimethylsulfoxide and morphine during hematopoietic stem cells transplantation. Haematologica 2008; 94:152-3. [PMID: 19001279 DOI: 10.3324/haematol.13828] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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30
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Burgio GR, Aricó M, Marconi M, Lanfranchi A, Caselli D, Ugazio AG. Spontaneous NBT reduction by monocytes as a marker of disease activity in children with histiocytosis. Br J Haematol 2008. [DOI: 10.1111/j.1365-2141.1990.00086.x-i1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Caselli D, Farruggia P, Trizzino A, Cannella S, Santoro A, Locatelli F, Aricò M. Split chimerism may be enough to cure Evans syndrome. Bone Marrow Transplant 2006; 38:311. [PMID: 16785863 DOI: 10.1038/sj.bmt.1705427] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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32
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D'Angelo P, Farruggia P, Lo Bello A, Trizzino A, Tropia S, Caselli D, Aricò M. Reversible posterior leukoencephalopathy syndrome: report of 2 simultaneous cases in children. J Pediatr Hematol Oncol 2006; 28:177-81. [PMID: 16679945 DOI: 10.1097/01.mph.0000210406.82050.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare complication of cancer chemotherapy. We have recently observed two cases occurred simultaneously in children receiving different chemotherapy regimens, for hepatoblastoma and acute lymphoblastic leukaemia, respectively. Both children presented with altered mental status, severe visual disturbances, headache, seizures, backpain and hypertension. Magnetic resonance imaging showed cortical and subcortical lesions especially in the occipital and parietal regions, strongly consistent with RPLS. Both patients completely recovered from their neuropsychologic deficits in about ten days only with anticonvulsant and antihypertensive therapy, and chemotherapy regimen was promptly restarted according to the planned protocol, without any neuropsychological sequela. A mild left midriasis was the only neurologic defect that persisted in the patient with acute lymphoblastic leukemia.
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Affiliation(s)
- Paolo D'Angelo
- Oncoematologia Pediatrica, Ospedale dei Bambini G. Di Cristina, Palermo, Italy
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33
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Cesaro S, Spiller M, Giacchino M, Buldini B, Castellini C, Caselli D, Giraldi E, Tucci F, Tridello G, Locatelli F, Rossi M, Castagnola E. 107 Safety and efficacy of a caspofungin-based combination therapy for the treatment of invasive mycoses in pediatric hematological patients. Int J Infect Dis 2006. [DOI: 10.1016/s1201-9712(06)80104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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34
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Piazza F, Maccabruni A, Rossi G, Chiappedi M, Caselli D, Bonforte F, Lanzi G. [Neurological and psychological evolution of adolescents with vertical transmission HIV infection]. Minerva Pediatr 2004; 56:411-7. [PMID: 15457138] [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: 04/30/2023]
Abstract
AIM Personal experience in a sample group of children with AIDS vertically transmitted followed from birth to adolescence (out of 56 cases with documented HIV infection, 9 who have reached the age of 13 have been studied) is presented. METHODS The evaluation protocol includes: hematochemical, serological and virological tests to monitor the infectious status, as well as annual EEG, CT/MRI scan to detect anatomical alteration of CNS, neurological examination, intelligence test (WISC-R), interview and projective test (Blacky Pictures) to investigate emotional situation. RESULTS As to the status of the disease, according to the CDC classification, 2 patients are asymptomatic, 2 paucisymptomatic, 2 with moderate symptoms, 2 severely symptomatic; 1 patient died due to progressive encephalopathy. Of the 2 severely symptomatic cases, 1 presents cortical atrophy and the other basal nuclei calcifications. No one of them has clinical signs of encephalopathy. All patients receive anti-retroviral medications. From tests and interviews emotional problem-emerge, future is seen as menacing and insidious, and defensive mechanisms are fragile and inconstant; denial can lead to a refusal of the pharmacological therapy; families themselves often refuse medical staff the consent to communicate the diagnosis fearing that this could induce unbearable anguish. CONCLUSIONS It seems important that patients are informed, considering their capacity to make front to the communication, even if one must bear in mind that understanding and accepting the diagnosis may be a long and painful process requiring a long time.
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Affiliation(s)
- F Piazza
- Cattedra di Neuropsichiatria Infantile, Università degli Studi di Pavia, Pavia
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35
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Giacomet V, Albano F, Starace F, de Franciscis A, Giaquinto C, Gattinara GC, Bruzzese E, Gabiano C, Galli L, Viganò A, Caselli D, Guarino A. Adherence to antiretroviral therapy and its determinants in children with human immunodeficiency virus infection: a multicentre, national study. Acta Paediatr 2004; 92:1398-402. [PMID: 14971789 DOI: 10.1080/08035250310006737] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
AIM To investigate rates and determinants of adherence to antiretroviral therapy in Italian children infected with the human immunodeficiency virus (HIV). METHODS An observational, cross-sectional multicentre study was performed through a structured interview with the caregivers of HIV-infected children. The interview included quantitative information on adherence in the 4 d before interview. Sociodemographic, clinical and psychosocial characteristics of children were recorded. RESULTS 129 children (median age 96 mo) were enrolled, of whom 94 were on highly active antiretroviral therapy (HAART). Twenty-one (16%) omitted more than 5% of total doses in 4 d and were considered non-adherent. However, only 11% of caregivers reported that therapy had been administered at the correct times. No significant difference was found between age and the stage of HIV infection. Children aware of their HIV status were less adherent. Individual drugs showed a broad adherence pattern and children who received HAART were more adherent. Children receiving therapy from foster parents were more adherent than those receiving drugs from biological parents or relatives. CONCLUSIONS Adherence is a major problem in children. Psychological rather than clinical or sociodemographic features and types of drug are major determinants of adherence.
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Affiliation(s)
- V Giacomet
- Department of Paediatrics, Federico II University, Naples, Italy
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36
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Affiliation(s)
- Maurizio Aricò
- Onco Ematologia Pediatrica, Ospedale dei Bambini G. Di Cristina, Via Benedettini 1, 90134 Palermo, Italy.
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37
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Aricò M, Zecca M, Santoro N, Caselli D, Maccario R, Danesino C, de Saint Basile G, Locatelli F. Successful treatment of Griscelli syndrome with unrelated donor allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2002; 29:995-8. [PMID: 12098069 DOI: 10.1038/sj.bmt.1703567] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2001] [Accepted: 02/18/2002] [Indexed: 01/17/2023]
Abstract
Griscelli syndrome (GS) is a rare autosomal recessive disorder, characterized by pigmentary dilution of the skin and hair and in most patients by abnormal regulation of the immune system, which results in a syndrome of macrophage hyperactivation, known as hemophagocytic lymophohistiocytosis (HLH). Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative treatment available for genetically induced HLH. Few cases of successful HSCT from a compatible donor have been reported in children with GS. We describe the first patient with GS cured with an allograft from a compatible unrelated bone marrow donor. We used a novel preparative regimen consisting of busulfan, thiotepa and fludarabine. The demonstrated curative effect of HSCT from an unrelated donor in a patient with genetically determined HLH also supports the use of a systematic diagnostic approach in these patients, in order to identify those with a worse prognosis and needing an urgent allograft in a timely manner.
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Affiliation(s)
- M Aricò
- Onco Ematologia Pediatrica, Ospedale dei Bambini 'G Di Cristina', Palermo, Italy
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38
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Maccabruni A, Bagassi A, Pacati I, Caselli D, Michelone G. [HIV-infected children become adolescents: the Pavia's experience]. Minerva Pediatr 2001; 53:483-4. [PMID: 11668280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- A Maccabruni
- IRCCS Policlinico S. Matteo, Clinica Malattie Infettive, Università degli Studi, Pavia, Italy
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39
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de Martino M, Tovo PA, Galli L, Gabiano C, Chiarelli F, Zappa M, Gattinara GC, Bassetti D, Giacomet V, Chiappini E, Duse M, Garetto S, Caselli D. Puberty in perinatal HIV-1 infection: a multicentre longitudinal study of 212 children. AIDS 2001; 15:1527-34. [PMID: 11504985 DOI: 10.1097/00002030-200108170-00010] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To define age at entry into Tanner stages in children with perinatal HIV-1 infection. DESIGN Multicentre longitudinal study including 212 perinatally HIV-1-infected children (107 girls and 105 boys) followed-up during puberty (from 8 and 9 years onwards in girls and boys, respectively). Healthy children (843 girls and 821 boys) provided reference percentiles. P2 or B2 stages in girls and P2 or G2 stages in boys defined onset of puberty. METHODS The cumulative probability [95% confidence limit (CI)] of entry into each stage at different ages was estimated by the Kaplan-Meier product-limit method; differences were evaluated by log rank test. Relationships were tested using the Spearman's rank correlation coefficient. RESULTS Ages of girls [years (95%CI)] at P2 [12.9 (12.6-13.2)], P3 [13.4 (13.0-13.8)], P4 [14.6 (14.0-15.2)], B2 [12.7 (12.2-13.2)], B3 [13.3 (12.8-14.0)] and B4 [14.6 (14.0-15.2)] stages were > 97th percentile (> or = 21 month delay) of controls. Ages of boys [years (95%CI)] at P2 [12.6 (12.1-13.1)], P3 [13.9 (13.4-14.4)], P4 [14.9 (14.2-15.6)], G2 [12.1 (11.5-12.7)], G3 [13.6 (13.1-14.1)] and G4 [14.9 (14.1-15.7)] stages were at the 75-97th percentiles (< or = 15 month delay). Age at onset of puberty was not related to clinical and immunological condition, antiretroviral treatment, weigh for height and age at onset of severe disease or immune suppression. CONCLUSION Perinatal HIV-1 infection interferes with sexual maturation. The mechanisms by which this occurs should be elucidated and intervention strategies designed. Intervention could save much psychological distress, since associated linear growth failure can exacerbate adolescents' feelings of being different and unwell.
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Affiliation(s)
- M de Martino
- Department of Paediatrics, University of Florence, Florence, Italy
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40
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Beluffi G, De Palma M, Pacati I, Maccabruni A, Caselli D. [LIP (Lymphoid Interstitial Pneumonitis) and HIV infection in children. Case report]. Radiol Med 2001; 101:505-8. [PMID: 11479450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- G Beluffi
- Sezione di Radiologia Pediatrica, Servizio di Radiodiagnostica, Università degli Studi di Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy.
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41
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Rossi E, Piccini F, Zollino M, Neri G, Caselli D, Tenconi R, Castellan C, Carrozzo R, Danesino C, Zuffardi O, Ragusa A, Castiglia L, Galesi O, Greco D, Romano C, Pierluigi M, Perfumo C, Di Rocco M, Faravelli F, Dagna Bricarelli F, Bonaglia M, Bedeschi M, Borgatti R. Cryptic telomeric rearrangements in subjects with mental retardation associated with dysmorphism and congenital malformations. J Med Genet 2001; 38:417-20. [PMID: 11424927 PMCID: PMC1734891 DOI: 10.1136/jmg.38.6.417] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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42
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Beluffi G, Bassi L, Vitali MC, Meloni G, Caselli D. [Parry-Romberg syndrome and odontogenic cyst. A case report]. Radiol Med 2001; 101:88-90. [PMID: 11360760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- G Beluffi
- Sezione di Radiologia Pediatrica, Servizio di Radiodiagnostica, IRCCS Policlinico S. Matteo, Pavia.
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Caselli D, Klersy C, de Martino M, Gabiano C, Galli L, Tovo PA, Aricò M. Human immunodeficiency virus-related cancer in children: incidence and treatment outcome--report of the Italian Register. J Clin Oncol 2000; 18:3854-61. [PMID: 11078499 DOI: 10.1200/jco.2000.18.22.3854] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To outline the incidence, presenting features, treatment response, and outcome of human immunodeficiency virus (HIV)-associated malignancies in infancy and childhood, together with the estimated risk of HIV-associated cancer in children born to mothers infected with HIV. PATIENTS AND METHODS The Italian Register for HIV Infection in Children collected data by specific registration and follow-up forms. By March 1999, 5,060 children were recruited, including 4,889 with perinatal exposure to HIV-1. Overall, 1,331 infected children were enrolled onto the Register and classified according to current Centers for Disease Control criteria; of them, 1,163 were vertically infected (24% of those with perinatal exposure). Of these 1,163, 569 (49%) were considered to have been prospectively followed-up since they had been registered at birth or within the first 3 months of age. RESULTS Of the 1,331 children observed for a median time of 6.5 years, 35 developed 36 malignancies, four of which occurred in patients with blood-borne risk. For the 1,163 vertically infected children, the cumulative number of years of observation was 7,178 child-years and the cumulative incidence of HIV-associated tumors was 4.18 per 1,000 children/yr (95% confidence interval [CI], 2.92 to 5.98). When only the 569 vertically infected children prospectively followed up since birth were considered, the cumulative number of years of observation was 2,803 child-years. In this group, 10 tumors were observed, with a cumulative incidence of HIV-associated tumors of 3.57 per 1,000 children per year (95% CI, 1.92 to 6.63). CONCLUSION The risk of cancer was significantly higher but not restricted to symptomatic and/or immune-compromised children. Cancer-directed treatment should be given promptly to these patients, who have a fair chance to survive their tumor in view of potential highly aggressive antiretroviral therapy-associated improvement in survival and quality of life.
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Affiliation(s)
- D Caselli
- Clinica Pediatrica, Direzione Scientifica, Instituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Pavia, Italy.
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44
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Cattaneo E, Zavattoni M, Baldanti F, Sarasini A, Caselli D, Maccabruni A, Martegani R, Torre D, Revello MG, Gerna G. Diagnostic value of viral culture, polymerase chain reaction and western blot for HIV-1 infection in 218 infants born to HIV-infected mothers and examined at different ages. New Microbiol 1999; 22:281-91. [PMID: 10555197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
In a prospective longitudinal 10-year (1988 to 1998) study, 308 sequential blood samples from 218 infants born to HIV-1 seropositive women were examined by blood culture, polymerase chain reaction (PCR) and Western Blot (WB) for HIV-1 infection within the first month of life (no. 47 specimens), at 2-6 (no. 125), 7-18 (no. 80), and > 18 (no. 56) months after birth. Clinical status at follow-up after the initial diagnosis of HIV infection was also evaluated. Vertically transmitted HIV infection was diagnosed in 45 children (24 children were diagnosed before 18 months of age), whereas 173 were found to be uninfected (transmission rate 20.6%). Sensitivities of viral culture, PCR and WB were 95.2%, 97.8%, 94.4%, and specificities were 99.5%, 97.6% and 20.7%, respectively. Thus, cumulative positive predictive values (PPV) of blood culture, PCR and WB were 97.5%, 88.2% and 23.4%, while negative predictive values (NPV) were 99.0%, 99.6% and 100.0%, respectively. In view of defining the optimal time of sampling for a correct diagnosis of HIV infection, a PPV of 100.0% was achieved earlier by viral culture (2-6 months of age) than by PCR (7-18 months of age). Meanwhile, a NPV of 100% was obtained earlier by PCR (within the first month of age) than by viral culture (2-6 months). These results indicate that a combination test strategy requiring two blood samples analyzed by viral culture and PCR may confirm or exclude HIV perinatal infection within the first 2 months of life rather than being delayed to later times. Clinical follow-up was performed in 35 children, of whom 7 developed a rapidly progressive disease, 23 showed a slow progression, while 5 children are still younger than 5 years and do not present severe clinical symptoms.
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Affiliation(s)
- E Cattaneo
- Servizio di Virologia, IRCCS Policlinico San Matteo, Pavia, Italy
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45
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Caselli D, Comolli G, Maccabruni A, Klersy C, Minoli L. CD38/CD8 expression and HAART failure. Lancet 1999; 353:840-1. [PMID: 10459982 DOI: 10.1016/s0140-6736(05)76500-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Affiliation(s)
- D Caselli
- Department of Paediatrics, University of Pavia, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Italy
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47
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Aricò M, Bissolati M, Bossi G, Asti M, Cerino A, Caselli D, Ricci A, Klersy C, Silini E, Mondelli MU. GB virus type C infection in patients treated for childhood acute lymphoblastic leukemia. Transfusion 1999; 39:212-7. [PMID: 10037134 DOI: 10.1046/j.1537-2995.1999.39299154738.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of GB virus type C (GBV-C) infection in subjects treated for childhood acute lymphoblastic leukemia (ALL) or non-Hodgkin's lymphoma. STUDY DESIGN AND METHODS One hundred forty patients (82 males) aged 4 to 27 years (median, 11) diagnosed with ALL between 1976 and 1993, were prospectively followed for a median of 5 years (range, 0.1-17) after completion of therapy. Stored sera were tested for antibody to hepatitis C virus (HCV), HCV RNA, antibody to GBV-C E2 (anti-E2), and GBV-C RNA. RESULTS Thirty-eight patients (27%) were exposed to GBV-C: 30 were positive for GBV-C RNA (mostly type 2) and 8 were positive for anti-E2. Anti-E2 and GBV-C RNA were mutually exclusive: 61 patients (43%) were positive for HCV RNA, 16 (11%) were coinfected with GBV-C and HCV. Alanine aminotransferase (ALT) levels were increased (>35 mU/mL) in 32 (23%) of 137: 3 of 20 who were positive for GBV-C and negative for HCV, 7 of 15 who were positive for GBV-C and HCV, 15 of 44 who were negative for GBV-C and positive for HCV, and 7 of 58 who were negative for GBV-C and HCV (p<0.001). Median ALT values were significantly higher in patients positive for GBV-C and HCV than in those who were positive for GBV-C and negative for HCV (35 vs. 13 mU/mL, p = 0.003). Thirty-one of 38 patients with GBV-C markers were retested: GBV-C RNA was lost in 16 of 30 tested, but 7 were still GBV-C RNA positive up to 50 months later, 3 tested positive for anti-E2 up to 27 months later, and 1 was positive for GBV-C RNA and anti-E2 26 months later, while 20 tested negative for both. CONCLUSION GBV-C did not behave as a liver pathogen, because ALT alterations were unrelated to GBV-C status, but, rather, were related to HCV infection or coinfection. GBV-C RNA was frequently lost over a relatively short period, though in some cases, it was retained for a longer time. Anti-E2 rarely coexisted with GBV-C RNA and might be short-term.
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Affiliation(s)
- M Aricò
- Department of Pediatrics, IRCCS Policlinico San Matteo, Pavia, Italy
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48
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Caselli D, Comolli G, Maccabruni A, Campisi D, Klersy C, Minoli L. Flow cytometric evaluation of CD38, CD45 RO and CD45 RA in HIV-infected children. Eur J Histochem 1998; 41 Suppl 2:193-4. [PMID: 9859844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- D Caselli
- Clinica Pediatrica, IRCCS Policlinico San Matteo, Università di Pavia
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49
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Rondanelli M, Caselli D, Maccabruni A, Maghnie M, Bacchella L, DeStefano A, Solerte SB, Minoli L, Ferrari E. Involvement of hormonal circadian secretion in the growth of HIV-infected children. AIDS 1998; 12:1845-50. [PMID: 9792385 DOI: 10.1097/00002030-199814000-00016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the circadian secretion of hormones involved in the regulation of growth in childhood, namely growth hormone, insulin-like growth factor (IGF)-I, cortisol, adrenocorticotropin hormone (ACTH), and thyroid-stimulating hormone (TSH) in HIV-infected children. DESIGN The circadian secretory pattern of growth hormone, IGF-I, cortisol, ACTH and TSH was evaluated in 14 HIV-infected children; 13 healthy age- and sex-matched children were chosen as controls. METHODS Sampling was performed every 4 h from 0400 h to 2000 h and every 2 h from 2000 h to 0400 h. Rhythmometric data were analysed by single and population mean cosinor methods and by analysis of variance. RESULTS A statistically significant circadian rhythm for growth hormone, IGF-I and cortisol was detectable in HIV-seropositive children, but the mean basal IGF-I levels were below the normal range for age in 12 patients. A statistically significant circadian rhythm was not detectable for ACTH or TSH. CONCLUSION These results show that there is a loss of the physiological regulation of growth hormone-IGF-I axis and a modification of 24 h TSH profile in our HIV-infected children. These abnormalities might be involved in the altered growth mechanism leading to the failure to thrive that is a peculiar feature of HIV-infected children.
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Affiliation(s)
- M Rondanelli
- Department of Internal Medicine and Medical Therapy, IRCCS San Matteo Hospital, Pavia, Italy
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50
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Rondanelli M, Caselli D, Maccabruni A, Arlandi L, Livio L. [HIV infection and the endocrine system in children]. MINERVA ENDOCRINOL 1997; 22:67-74. [PMID: 9557473] [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: 02/07/2023]
Abstract
HIV infected children characteristically develop a failure to thrive in 25% to 100% of symptomatic cases, with a significantly reduced survival time. The pathogenic mechanism for HIV-driven failure to thrive is not yet understood. Likely it is multifactorial, endocrine dysregulation surely plays a major, even if not yet fully clarified, role in this complication. Global evaluation of endocrine data could allow to better understand the mechanisms underlying the failure to thrive in HIV-infected children, also in relationship with the current manifestations of the HIV infection. The results of the endocrine studies could also be related with additional features of the children, as their immunological status. It is well known that endocrine and immune functions are closely related in animals and in humans. Thus, the evaluation of the results of studies could provide some interesting information about the relationships between them in the HIV-infected child. Such relationships, if present, also could help to better define therapeutic interventions in these children.
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Affiliation(s)
- M Rondanelli
- Dipartimento di Medicina Interna e Terapia Medica, Università degli Studi, Pavia
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