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Hord JD, Dandoy CE. Are we certain that chlorhexidine gluconate bathing is not beneficial in reducing central line associated blood stream infections among children with cancer or undergoing hematopoietic stem cell transplantation? Cancer 2021; 127:2811-2812. [PMID: 33945633 DOI: 10.1002/cncr.33572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/19/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Jeffrey D Hord
- Showers Family Center for Childhood Cancer and Blood Disorders, Akron Children's Hospital, Akron, Ohio
| | - Christopher E Dandoy
- Division of Stem Cell Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio
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Hakim H, Billett AL, Xu J, Tang L, Richardson T, Winkle C, Werner EJ, Hord JD, Bundy DG, Gaur AH. Mucosal barrier injury-associated bloodstream infections in pediatric oncology patients. Pediatr Blood Cancer 2020; 67:e28234. [PMID: 32386095 DOI: 10.1002/pbc.28234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/28/2020] [Accepted: 02/12/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Single-center reports of central line-associated bloodstream infection (CLABSI) and the subcategory of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) in pediatric hematology oncology transplant (PHO) patients have focused on the inpatient setting. Characterization of MBI-LCBI across PHO centers and management settings (inpatient and ambulatory) is urgently needed to inform surveillance and prevention strategies. METHODS Prospectively collected data from August 1, 2013, to December 31, 2015, on CLABSI (including MBI-LCBI) from a US PHO multicenter quality improvement network database was analyzed. CDC National Healthcare Safety Network definitions were applied for inpatient events and adapted for ambulatory events. RESULTS Thirty-five PHO centers reported 401 ambulatory and 416 inpatient MBI-LCBI events. Ambulatory and inpatient MBI-LCBI rates were 0.085 and 1.01 per 1000 line days, respectively. Fifty-three percent of inpatient CLABSIs were MBI-LCBIs versus 32% in the ambulatory setting (P < 0.01). Neutropenia was the most common criterion defining MBI-LCBI in both settings, being present in ≥90% of events. The most common organisms isolated in MBI-LCBI events were Escherichia coli (in 28% of events), Klebsiella spp. (23%), and viridans streptococci (12%) in the ambulatory setting and viridans streptococci (in 29% of events), E. coli (14%), and Klebsiella spp. (14%) in the inpatient setting. CONCLUSION In this largest study of PHO MBI-LCBI inpatient events and the first such study in the ambulatory setting, the burden of MBI-LCBI across the continuum of care of PHO patients was substantial. These data should raise awareness of MBI-LCBI among healthcare providers for PHO patients, help benchmarking across centers, and help inform prevention and treatment strategies.
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Affiliation(s)
- Hana Hakim
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Amy L Billett
- Department of Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Jiahui Xu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Li Tang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Cynthia Winkle
- Nursing Department, Children's Medical Center, Dallas, Texas
| | - Eric J Werner
- Department of Oncology, Children's Specialty Group, Norfolk, Virginia
| | - Jeffrey D Hord
- Department of Oncology, Akron Children's Hospital, Akron, Ohio
| | - David G Bundy
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Aditya H Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
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Hord JD, Lawlor J, Werner E, Billett AL, Bundy DG, Winkle C, Gaur AH. Central Line Associated Blood Stream Infections in Pediatric Hematology/Oncology Patients With Different Types of Central Lines. Pediatr Blood Cancer 2016; 63:1603-7. [PMID: 27198806 DOI: 10.1002/pbc.26053] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/15/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Central line associated bloodstream infections (CLABSIs) are a significant cause of morbidity and mortality in pediatric hematology/oncology (PHO) patients. Understanding the differences in CLABSI rates by central line (CL) type is important to inform clinical decisions. PROCEDURE CLABSI, using similar definitions, noted with three commonly used CL types (totally implanted catheter [port], tunneled externalized catheter [TEC], peripherally inserted central catheter [PICC]) and CL-specific line days were prospectively tracked across 15 US PHO centers from May 2012 until April 2015 and CLABSI rates (CLABSI per 1,000 CL-specific line days) were calculated. Host and organism characterstics associated with the CLABSI events were analyzed. RESULTS Over the course of 2.8 million line days, 1,113 CLABSI events (397 in inpatients and 716 in ambulatory patients) were noted. The inpatient CLABSI rate was higher than the ambulatory CLABSI rate for each of the CL types: 1.48 versus 0.16 for ports, 3.51 versus 1.38 for TECs, and 3.07 versus 1.16 for PICCs, respectively. TECs and PICCs were associated with higher CLABSI rates than ports, inpatient and ambulatory. CONCLUSIONS We found that CLABSI rates were significantly higher for inpatients compared to ambulatory PHO patients for all CL types. Among ambulatory patients, TECs had the highest CLABSI rate and ports the lowest. Among inpatients, TECs and PICCs had higher CLABSI rates than ports but were not statistically different from one another. Cognizant that host and underlying disease attributes may contribute to these differences, these results can still inform CL choice in clinical practice.
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Affiliation(s)
- Jeffrey D Hord
- Showers Family Center for Childhood Cancer and Blood Disorders, Akron Children's Hospital, Akron, Ohio
| | - John Lawlor
- Children's Hospital Association, Alexandria, Virginia
| | - Eric Werner
- Children's Hospital of the King's Daughters and Children's Specialty Group, Norfolk, Virginia
| | - Amy L Billett
- Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
| | - David G Bundy
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Aditya H Gaur
- St. Jude Children's Research Hospital, Memphis, Tennessee
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Barysauskas C, Bundy DG, Gaur AH, Hord JD, Miller MR, Werner EJ, Winkle C, Billett A. Burden of bloodstream infections among ambulatory pediatric hematology/oncology patients with a central line. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
262 Background: Pediatric hematology/oncology (PHO) patients are at high risk of bloodstream infections (BSI). The burden of BSI in PHO patients in the ambulatory setting has not been well documented. Methods: The Children’s Hospital Association leads the Childhood Cancer and Blood Disorders Network, a multicenter United States quality improvement collaborative, working to reduce the incidence of inpatient and ambulatory Central Line-Associated BSI (CLABSI) among PHO patients. Positive blood culture events (+BCE) were adjudicated as CLABSI, single positive blood cultures (SPBC) with potential commensals, or secondary BSI (attributed to source other than the central line) following standardized National Healthcare Safety Network definitions. Our study investigated the prevalence of +BCE among all centers with 90% complete monthly reporting of both +BCE and central line days (CLD) for at least one year (n=25) between January 2012 and September 2014. Ambulatory and inpatient BSI rates and 95% confidence intervals (CI) were calculated as the number of +BCE per 1,000 CLD per month. Results: A total of 1,747 +BCE and 4,883,413 CLD were reported among our target ambulatory population, whereas 1,095 +BCE and 353,259 CLD were reported among our corresponding inpatient population [Table]. While the CLABSI and SPBC rates were significantly lower in the ambulatory setting compared to inpatient (p<0.001), the total number of ambulatory CLABSI and SPBC events was 2.0 and 1.6 times higher than inpatient events, respectively. Conclusions: Our findings from a large multicenter collaborative demonstrate the burden of BSI among ambulatory PHO patients and identify benchmarks for future quality improvement work.Further investigation is necessary to develop effective infection reduction strategies for ambulatory PHO patients with central lines. [Table: see text]
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Affiliation(s)
| | | | - Aditya H. Gaur
- St. Jude Children's Research Hospital, Infectious Diseases, Memphis, TN
| | | | | | - Eric J. Werner
- Children's Hospital of The King's Daughters, Pediatric Hematology/Oncology; Eastern Virginia Medical School, Pediatric Hematology/Oncology, Norfolk, VA
| | - Cindi Winkle
- The University of Texas Southwestern Medical Center, Pediatrics, Dallas, TX
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Audino AN, Blatt J, Carcamo B, Castaneda V, Dinndorf P, Wang WC, Whitlock JA, Hord JD. High-dose cyclophosphamide treatment for refractory severe aplastic anemia in children. Pediatr Blood Cancer 2010; 54:269-72. [PMID: 19827142 DOI: 10.1002/pbc.22312] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine if high-dose cyclophosphamide is an effective therapy for children with refractory severe aplastic anemia (SAA). BACKGROUND SAA is an illness characterized by the depletion of hematopoietic precursors associated with life-threatening complications. Hematopoietic stem cell transplant (HSCT) is the treatment of choice if a human leukocyte antigen (HLA)-related donor is available. Immunosuppression with anti-thymocyte globulin (ATG) and cyclosporine A (CSA) is an option for patients who are not HSCT candidates. Unrelated donor HSCT has been used with limited success. High-dose cyclophosphamide has been used successfully in the treatment of adults with SAA, but experience in children is limited. PROCEDURE Five pediatric patients who had failed previous immunosuppressive therapy for SAA were treated with high-dose cyclophosphamide (45 mg/kg/day x 4 days). RESULTS After 12 months of treatment, two of five patients experienced a complete response with high-dose cyclophosphamide therapy. The two complete responders achieved red cell recovery with a hematocrit of >36% at days 212 and 112 and platelet recovery with a platelet count of >100 x 10(9)/L at days 126 and 324. Of the remaining patients, one patient failed to respond, and two patients expired from infectious complications. CONCLUSIONS High-dose cyclophosphamide can lead to complete responses in children with SAA who have failed to respond to traditional immunosuppressive therapy.
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Hord JD, Rehman W, Hannon P, Anderson-Shaw L, Schmidt ML. Do Parents Have the Right to Refuse Standard Treatment for Their Child With Favorable-Prognosis Cancer? Ethical and Legal Concerns. J Clin Oncol 2006; 24:5454-6. [PMID: 17135648 DOI: 10.1200/jco.2006.06.4709] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jeffrey D Hord
- Children's Hospital Medical Center of Akron, Pediatric Hematology/Oncology, Akron, OH 44308, USA.
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Razzouk BI, Hord JD, Hockenberry M, Hinds PS, Feusner J, Williams D, Rackoff WR. Double-Blind, Placebo-Controlled Study of Quality of Life, Hematologic End Points, and Safety of Weekly Epoetin Alfa in Children With Cancer Receiving Myelosuppressive Chemotherapy. J Clin Oncol 2006; 24:3583-9. [PMID: 16877725 DOI: 10.1200/jco.2005.03.4371] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the effects of once-weekly epoetin alfa (EPO) on health-related quality of life (HRQOL), hemoglobin (Hb), transfusions, and tolerability in children with cancer. Methods Anemic patients 5 years to 18 years of age receiving myelosuppressive chemotherapy for nonmyeloid malignancies, excluding brain tumors, received intravenous EPO 600 units/kg to 900 units/kg or placebo once-weekly for 16 weeks. Patients and parents completed the pediatric health-related quality-of-life generic scales (GS) and cancer-specific scales (CS). Results One hundred eleven patients received EPO and 111 patients received placebo. Mean final values for GS total score (P = .763 among patients; P = .219 among parents) and CS domain scores (P ≥ .238; P ≥ .081, respectively) were not significantly different between treatment groups. EPO-treated patients had greater increases in Hb overall (P = .002) and were more likely to be transfusion free after 4 weeks (38.7% v 22.5%; P = .010). Change in Hb was correlated with change in PedsQL-GCS total score in the EPO group (r = 0.242; P = .018), but was not in the placebo group (r = 0.086; P = .430). Adverse events were comparable between treatment groups. Conclusion This study confirmed the tolerability and hematologic benefits of once-weekly EPO in children with cancer. No significant difference in HRQOL was detected between treatment groups, but a significant positive correlation was observed between Hb changes and HRQOL changes in the EPO group. Additional studies are warranted to assess HRQOL when anemia is managed optimally in children with cancer.
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Hinds PS, Hockenberry M, Feusner J, Hord JD, Rackoff W, Rozzouk BI. Hemoglobin response and improvements in quality of life in anemic children with cancer receiving myelosuppressive chemotherapy. J Support Oncol 2005; 3:10-1. [PMID: 16355549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Cockrell EM, Gorman J, Hord JD. Endogenous interleukin-11 (IL-11) levels in newly diagnosed children with acquired severe aplastic anemia (SAA). Cytokine 2004; 28:55-8. [PMID: 15381181 DOI: 10.1016/j.cyto.2004.06.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Revised: 06/04/2004] [Accepted: 06/14/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Impaired hematopoietic growth factor production is a hypothetical contributing factor to the development of acquired severe aplastic anemia (SAA). The serum levels of most hematopoietic cytokines in SAA patients are elevated. OBJECTIVE To measure interleukin-11 levels in newly diagnosed SAA children and attempt to correlate levels with disease severity and response to therapy. DESIGN/METHODS Following enrollment into a clinical study but prior to treatment, serum samples were obtained from 11 newly diagnosed children with acquired SAA. These samples were collected between May 2000 and September 2002. IL-11 levels were quantified utilizing an ELISA technique. RESULTS Ten of the 11 patients had low or normal levels of IL-11 (<85 pg/mL) and one had an elevated level of 409 pg/mL (normal range 15-200 pg/mL). CONCLUSIONS The production of IL-11 does not increase in response to thrombocytopenia in most children with SAA. The significance of this laboratory observation is not clear at this time. Further studies are warranted to determine what, if any, role this plays in the development of this disorder and if the administration of recombinant human IL-11 might be beneficial in the treatment of acquired SAA.
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Affiliation(s)
- Erin M Cockrell
- Department of Pediatrics, Children's Hospital Medical Center of Akron, One Perkins Square, Akron, OH 44308, USA
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Hummel T, Hord JD. Favorable response to soft tissue sarcoma therapy in an adolescent with embryonal renal sarcoma. Pediatr Blood Cancer 2004; 43:70-2. [PMID: 15170893 DOI: 10.1002/pbc.20058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Embryonal renal sarcomas were first identified in 1995 among banked tumor samples originally classified as adult Wilms tumor. Few long-term remissions were observed when these rare tumors were treated with chemotherapy usually used for childhood Wilms. Data were collected from the medical record of an adolescent female with embryonal renal sarcoma and treated with sarcoma-directed chemotherapy and radiation. At 66 months following diagnosis, the patient has no evidence of tumor but has experienced severe renal dysfunction and ovarian failure. We believe there is a subset of patients with disseminated embryonal renal sarcoma that respond to intense sarcoma-directed therapy.
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Affiliation(s)
- Trent Hummel
- Department of Pediatrics, Children's Hospital Medical Center of Akron, One Perkins Square, Akron, Ohio 44308, USA
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Hord JD. Anemia and coagulation disorders in adolescents. Adolesc Med 1999; 10:359-67, ix. [PMID: 10611933] [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: 02/15/2023]
Abstract
The transition of childhood to adulthood includes many changes to nearly all parts of the body and that is certainly true of blood and the coagulation system. Some disorders, like iron deficiency anemia, develop as the result of rapid growth. Approximately 10% of American adolescents are anemic and the prevalence is far greater in high-risk populations, such as urban, indigent African-American adolescents, in which 40-50% of young women are anemic. Adolescents at greater-than-average risk for developing iron deficiency anemia, such as athletes involved in lengthy, intense physical activities and pregnant adolescents, should be screened for anemia. Other blood problems are inherited but the first manifestations may not emerge until adolescence, as in the case of an adolescent girl discovered to have von Willebrand's disease during the evaluation of excessive menstrual bleeding. Besides iron deficiency anemia and von Willebrand's disease, this review focuses on management of other common hematologic disorders seen in adolescent patients, including immune thrombocytopenic purpura, hemophilia, thrombocytosis, and hypercoagulable disorders.
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Affiliation(s)
- J D Hord
- Division of Hematology/Oncology, Children's Hospital Medical Center, Akron, Ohio 44308, USA
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Abstract
PURPOSE We studied the significance, identification and management of acquired von Willebrand disease and polycythemia associated with benign renal tumors in children. MATERIALS AND METHODS Two patients who presented with polycythemia and a renal mass were also found to have acquired von Willebrand disease. One patient was treated with radical nephrectomy and 1 was treated with partial nephrectomy. The patients have been followed for 19 and 10 months, respectively. RESULTS Excision of the renal mass resulted in prompt resolution of polycythemia and von Willebrand disease in each patient. Perioperatively 1-deamino-(8-D-arginine)-vasopressin was given to control bleeding. Each patient had benign embryonal adenoma of the kidney. CONCLUSIONS Polycythemia and von Willebrand disease may be associated with benign kidney neoplasms. Children and adolescents with a renal mass may benefit from preoperative screening for coagulopathy.
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Affiliation(s)
- B R Konety
- Department of Pediatric Urology, Children's Hospital of Pittsburgh, Pennsylvania, USA
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Whitlock JA, Wells RJ, Hord JD, Janco RL, Greer JP, Gay JC, Edwards JR, McCurley TL, Lukens JN. High-dose cytosine arabinoside and etoposide: an effective regimen without anthracyclines for refractory childhood acute non-lymphocytic leukemia. Leukemia 1997; 11:185-9. [PMID: 9009078 DOI: 10.1038/sj.leu.2400572] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this report is to describe the tolerability and activity of the combination of high-dose cytosine arabinoside (Ara-C) given at the maximum tolerated dose of 36 g/m2, together with high doses of etoposide in relapsed and refractory childhood acute leukemias. Eighteen children with relapsed or refractory acute leukemia were treated with Ara-C 3 g/m2 every 12 h on days 1-6, followed by etoposide 400 mg/m2 on days 7-9 (HDAC/VP-16). Eight children with refractory disease received HDAC/VP-16 as salvage induction therapy after failing conventional induction regimens; four of five refractory ANLL patients (80%) had a complete response (CR) after HDAC/VP-16 therapy. Ten patients received HDAC/VP-16 as post-remission intensification therapy; five patients (four ANLL, one relapsed ALL) remain in second CR at 56, 26, 9, 5 and 2 months. Toxicities were primarily hematologic and dermatologic. Seven patients (39%) developed bacterial or fungal infections; four patients developed grade 3 or 4 acral erythema. No patient died of therapy-related toxicity. The combination of 36 g/m2 cytosine arabinoside and 1200 mg/m2 etoposide is an effective regimen for children with relapsed or refractory acute nonlymphocytic leukemia, with tolerable toxicities; the absence of anthracyclines makes this regimen suitable for patients who have previously received maximal doses of anthracyclines or who have evidence of cardiac dysfunction. Further evaluation of this regimen in acute nonlymphocytic leukemia is presently being investigated.
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Affiliation(s)
- J A Whitlock
- Vanderbilt University Medical Center, Nashville, TN 37232-6310, USA
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Hord JD, Whitlock JA, Gay JC, Lukens JN. Clinical features of myelokathexis and treatment with hematopoietic cytokines: a case report of two patients and review of the literature. J Pediatr Hematol Oncol 1997; 19:443-8. [PMID: 9329467 DOI: 10.1097/00043426-199709000-00007] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To define the features and course of myelokathexis, a rare congenital neutropenia resulting from impaired release of granulocytes from bone marrow. METHODS The clinical features, granulocyte function, lymphocyte function, and response to granulocyte colony-stimulating factor (G-CSF) of two patients (mother/son) with myelokathexis were studied. This experience and 14 previous reports lead to a composite description of myelokathexis. RESULTS Both patients had chronic neutropenia, recurrent pulmonary infections, bone marrow consistent with myelokathexis, hypogammaglobulinemia, and elevated endogenous G-CSF. Patient 15 had normal granulocyte function, a rise in absolute neutrophil count (ANC) with epinephrine and hydrocortisone, and normal numbers of T- and B-lymphocytes; she also had numerous warts during childhood. Both patients experienced a transient increase in ANC with infection, a significant increase in ANC within 5 hours following a single dose of G-CSF, and fewer infections with daily G-CSF. CONCLUSIONS Based on 16 cases, myelokathexis occurs more often in females and frequently affects multiple members of a family. The usual number of circulating granulocytes is low although function is normal. Mature marrow granulocytes are mobilized with infection, corticosteroids, epinephrine, G-CSF, and granulocyte-macrophage colony-stimulating factor (GM-CSF). Lymphocyte number is normal but lymphocyte function is abnormal as evidenced by hypogammaglobulinemia and papillomavirus infection.
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Affiliation(s)
- J D Hord
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pennsylvania, USA
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Affiliation(s)
- J D Hord
- Division of Pediatric Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN 37232-2588, USA
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Hord JD, Gay JC, Whitlock JA, Janco RL, Edwards JR, Greer JP, Lukens JN. Long-term granulocyte-macrophage colony-stimulating factor and immunosuppression in the treatment of acquired severe aplastic anemia. J Pediatr Hematol Oncol 1995; 17:140-4. [PMID: 7749763 DOI: 10.1097/00043426-199505000-00007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [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: 01/26/2023]
Abstract
PURPOSE Seven children with newly diagnosed acquired severe aplastic anemia (SAA) were treated with a combination of long-term granulocyte-macrophage colony-stimulating factor (GM-CSF) and immunosuppression to assess the potential for GM-CSF to induce sustained neutrophil recovery, reduce the incidence of infection, and enhance the therapeutic efficacy of immunosuppression. METHODS Patients received a 14-day course of i.v. antithymocyte globulin 15 mg/kg/day with oral prednisone 1 mg/kg/day, long-term daily oral cyclosporine A 10 mg/kg/day, and long-term daily s.c. GM-CSF 5 micrograms/kg/day. RESULTS All seven children recovered an absolute neutrophil count of > 1.0 x 10(9)/L within 3.5 months of diagnosis (mean 60 days). Of the six children followed throughout their entire illness (follow-up 10-27 months), five are platelet and red cell transfusion independent (three off-therapy, two on tapering therapy) and one continues on therapy with a diminishing transfusion requirement. Compared with seven children treated previously with immunosuppression alone, children who received GM-CSF spent fewer days in the hospital and were less likely to develop infection. CONCLUSIONS The addition of GM-CSF to immunosuppressive therapy appears to be beneficial in the treatment of children with acquired SAA with GM-CSF stimulating granulopoiesis. The children are better protected from infectious complications while immunosuppressive agents achieve full therapeutic potential.
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Affiliation(s)
- J D Hord
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2588, USA
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Affiliation(s)
- J D Hord
- Division of Pediatric Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN 37232
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Abstract
Debate continues over the most appropriate treatment for children with acute immune thrombocytopenic purpura (ITP). An institutional review of all admissions for acute ITP between 1986 and 1991 found 61 children treated with intravenous (i.v.) IgG or i.v. steroids with a bone marrow aspirate consistent with ITP, an age of 21 years or younger, and an admission platelet count of < or = 20,000/mm3. The efficacy of these two agents was compared in the described population. A response was defined as achieving a platelet count of > or = 50,000/mm3. A significantly greater percentage of patients responded to i.v. IgG compared to i.v. steroids during the first 36 hr of therapy; however, by 72 hr of treatment there was no significant difference. The cost of hospitalization was 3 1/2 times greater for the patients responding to i.v. IgG vs. i.v. steroids.
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Affiliation(s)
- J D Hord
- Department of Pediatric Hematology-Oncology, Children's Hospital, Columbus, Ohio 43205
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Ehmann WD, Markesbery WR, Kasarskis EJ, Vance DE, Khare SS, Hord JD, Thompson CM. Applications of neutron activation analysis to the study of age-related neurological diseases. Biol Trace Elem Res 1987; 13:19-33. [PMID: 24254662 DOI: 10.1007/bf02796618] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although the etiology and pathogenesis of Alzheimer's disease, Pick's disease, and amyotrophic lateral sclerosis are still unknown, it has been suggested that perturbations in element metabolism may play a role. Even if not causative factors, these imbalances may prove to be markers that could aid in diagnosis. We have employed a sequential neutron activation analysis (NAA) procedure to determine elemental concentrations in brain, hair, fingernails, blood, and cerebrospinal fluid (CSF) of these patients and age-matched controls. Samples are first irradiated with accelerator-produced 14-MeV neutrons for determination of nitrogen and phosphorus, then with reactor thermal neutrons for the instrumental determination of 16-18 minor and trace elements, and, finally, reactor-irradiated again, followed by a rapid radiochemical separation procedure (RNAA) to determine four additional elements. Major advantages of NAA are: (1) its simultaneous multielement capability; (2) the relative freedom from reagent and laboratory contamination; (3) the absence of major matrix effects; and (4) an adequate sensitivity for most elements of interest. Ranges of concentrations by INAA and RNAA in selected control tissues and interelement correlations in control brain are presented to illustrate results obtained by the procedure. Longitudinal studies of tissues from Alzheimer's disease (AD) and amyotrophic lateral sclerosis (ALS) patients are still in progress.
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Affiliation(s)
- W D Ehmann
- Department of Chemistry, Brown Research Center on Aging, University of Kentucky, 40506, Lexington, KY
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