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Sultan N, Pelland-Marcotte MC, Remy M, Champagne J, Laverdière C, Winikoff R, Tran TH. Real-world data of the use of rivaroxaban in pediatric patients with hematologic malignancies. Leuk Lymphoma 2024; 65:538-540. [PMID: 38170575 DOI: 10.1080/10428194.2023.2300719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Noémie Sultan
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montréal, QC, Canada
| | | | - Meredith Remy
- Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Josette Champagne
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montréal, QC, Canada
| | - Caroline Laverdière
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montréal, QC, Canada
| | - Rochelle Winikoff
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montréal, QC, Canada
| | - Thai Hoa Tran
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montréal, QC, Canada
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Pelland-Marcotte MC, Kulkarni K, Tran TH, Stammers D, Gupta S, Sung L, Athale UH. Risk factors and clinical impact of thrombosis during induction chemotherapy for pediatric acute lymphoblastic leukemia: A report from CYP-C. Am J Hematol 2024; 99:274-283. [PMID: 38164978 DOI: 10.1002/ajh.27171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024]
Abstract
Thromboembolism (TE) is associated with reduced survival in pediatric acute lymphoblastic leukemia (ALL). It has been hypothesized that TE might signal leukemic aggressiveness. The objective was to determine risk factors for TE during ALL induction (TEind ) therapy and whether TEind is associated with treatment refractoriness. This retrospective cohort study using the population-based Cancer in Young People Canada (CYP-C) registry included children <15 years of age diagnosed with ALL (2000-2019) and treated at one of 12 Canadian pediatric centers outside of Ontario. Univariate and multivariable logistic regression models were used to determine risk factors for TEind and whether TEind predicted induction failure and ALL treatment intensification. The impact of TEind on overall and event-free survival was estimated using Cox proportional hazard regression models. The study included 2589 children, of which 45 (1.7%) developed a TEind . Age (<1 year and ≥10 years vs. 1-<10 years), T-cell phenotype, high-risk ALL, and central nervous system involvement were all associated with TEind in univariate analysis. Age and T-cell phenotype remained independent predictors of TEind in multivariable analysis. Induction failure occurred in 53 patients (2.1%). TEind was not associated with induction failure (OR: not estimable) or treatment intensification (adjusted OR [95% CI]: 0.66 [0.26-1.69]). TEind was independently associated with overall survival (adjusted HR [95% CI]: 2.54 [1.20-5.03]) but not event-free survival (adjusted HR [95% CI] 1.86 [0.98-3.51]). In this population-based study of children treated with contemporary chemotherapy protocols, TEind was associated with age and T-cell phenotype and mortality but did not predict induction failure.
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Affiliation(s)
| | - Ketan Kulkarni
- Division of Hematology-Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Thai Hoa Tran
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montréal, Quebec, Canada
- Axis of Immune Diseases and Cancer, CHU Sainte-Justine Research Center, Montréal, Quebec, Canada
| | - David Stammers
- Division of Immunology, Hematology, Oncology& Palliative Care, Stollery's Children Hospital, Edmonton, Alberta, Canada
| | - Sumit Gupta
- Division of Hematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Lillian Sung
- Division of Hematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Uma H Athale
- Division of Haematology/Oncology, McMaster Children's Hospital, and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Pelland-Marcotte MC, Stavrakoukas A, Wong G, Santiago R, Avila L. French Canadian cross-cultural adaptation of CAPTSure©, an index for the Clinical Assessment of Post-Thrombotic Syndrome in children. J Patient Rep Outcomes 2023; 7:83. [PMID: 37594628 PMCID: PMC10439081 DOI: 10.1186/s41687-023-00622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/30/2023] [Indexed: 08/19/2023] Open
Abstract
PURPOSE Post-thrombotic syndrome (PTS) is the most common complication of deep venous thrombosis (DVT). The index for the Clinical Assessment of Post-Thrombotic Syndrome in children (CAPTSure©) is a clinical tool for the diagnosis and severity rating of PTS in pediatric patients. The purpose of this study was to translate and adapt CAPTSure© for French-speaking patients. METHODS We conducted a cross-sectional study to perform linguistic and cultural adaptation of CAPTSure©, using a rigorous translation process followed by cognitive debriefings in twenty French-speaking pediatric patients aged up to 18 years old with a history of upper or lower extremity DVT at least 6 months prior. RESULTS Forward and backward translations were used to produce a pre-final French version of CAPTSure©, followed by cognitive debriefings in twenty participants (median age: 11.5 years, 55% male, median CAPTSure© score: 26). The participants felt that the questionnaire was thorough, with an adequate length. Eight out of fourteen (57%) items in the LE questionnaire and 7/12 (58%) of the items in the UE questionnaire were modified following participants' and a multidisciplinary expert committee's input, leading to the final French version of CAPTSure©. CONCLUSIONS CAPTSure© was successfully adapted for French-speaking pediatric patients. This will ease the diagnosis and severity rating of PTS in children in clinical practice and allow international research collaborations for additional non-English-speaking patients.
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Affiliation(s)
- Marie-Claude Pelland-Marcotte
- Division of Pediatric Hematology-Oncology, Centre Hospitalier Universitaire de Québec - Centre Mère-Enfant Soleil, Quebec City, QC, Canada.
- Centre de recherche du Centre Hospitalier Universitaire de Québec, Quebec City, QC, Canada.
| | - Angelika Stavrakoukas
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gina Wong
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Raoul Santiago
- Division of Pediatric Hematology-Oncology, Centre Hospitalier Universitaire de Québec - Centre Mère-Enfant Soleil, Quebec City, QC, Canada
- Centre de recherche du Centre Hospitalier Universitaire de Québec, Quebec City, QC, Canada
| | - Laura Avila
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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4
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Pelland-Marcotte MC, Bouchard V, Bégin E, Bouhêlier È, Santiago R, Monagle P. Biomarkers in pediatric venous thromboembolism: a systematic review of the literature. J Thromb Haemost 2023; 21:1831-1848. [PMID: 36958517 DOI: 10.1016/j.jtha.2023.03.012] [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: 11/22/2022] [Revised: 02/17/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Accurate prediction of the individual risk of venous thromboembolism (VTE) remains suboptimal in children, and biomarkers are currently not used to stratify the risk of VTE in children. OBJECTIVES This study aimed to assess which biological or radiological biomarkers may predict VTE or VTE complications in children. PATIENTS/METHODS A literature search was performed for peer-reviewed publications (1990-2022). We included studies addressing the use of biomarkers for patients aged 29 days to 18 years to predict VTE or its complications, including but not limited to TE-related death, VTE recurrence, or postthrombotic syndrome. Given the heterogeneity of the study designs, populations, and outcomes, no quantitative data synthesis was performed. RESULTS Forty studies were included, totaling 10,987 participants (median age: 4.7 years). Reports were often lacking critical methodological data, including blood collection method (68% of studies) and timepoints, laboratory testing technique (41%), or primary outcome definition (20%). Forty-six individual biomarkers were assessed for VTE prediction (32 studies, 9525 participants), including d-dimers, fibrinogen, platelet count, white blood cell count, and factor VIII. Albumin, C-reactive protein, d-dimers, factor VIII, and thrombin-antithrombin levels showed promising results for VTE prediction. In 9 studies (1606 participants), no biomarker was consistently predictive of postthrombotic syndrome, VTE persistence, or VTE recurrence in children. CONCLUSIONS Several candidate biomarkers were promising in the prediction of VTE in children. Still, discrepancies between different studies and the high risk of bias from the current literature prevent their widespread use in the clinical setting. Further prospective research in various pediatric subpopulations is required.
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Affiliation(s)
- Marie-Claude Pelland-Marcotte
- Division of Pediatric Hematology-Oncology, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada; Research Center of the CHU de Québec, Axe Reproduction, Santé de la Mère et de l'Enfant, Quebec City, Canada.
| | - Valérie Bouchard
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Evelyne Bégin
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Ève Bouhêlier
- Centre de recherche du CHU de Québec, Quebec City, Quebec, Canada
| | - Raoul Santiago
- Division of Pediatric Hematology-Oncology, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada; Research Center of the CHU de Québec, Axe Reproduction, Santé de la Mère et de l'Enfant, Quebec City, Canada
| | - Paul Monagle
- Department of Paediatrics, University of Melbourne, Murdoch Children's Research Institute, Department of Haematology, Royal Children's Hospital Melbourne, Kids Cancer Centre, Sydney Children's Hospital, Australia
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Desjardins MP, Naccache L, Hébert A, Auger I, Teira P, Pelland-Marcotte MC. Very Early Diagnosis and Management of Congenital Erythropoietic Porphyria. Clin Pediatr (Phila) 2023; 62:399-403. [PMID: 36217751 PMCID: PMC10170564 DOI: 10.1177/00099228221128661] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Congenital erythropoietic porphyria (CEP), a rare form of porphyria, is caused by a defect in the heme biosynthesis pathway of the enzyme uroporphyrinogen III synthase (UROS). Uroporphyrinogen III synthase deficiency leads to an accumulation of nonphysiological porphyrins in bone marrow, red blood cells, skin, bones, teeth, and spleen. Consequently, the exposure to sunlight causes severe photosensitivity, long-term intravascular hemolysis, and eventually, irreversible mutilating deformities. Several supportive therapies such as strict sun avoidance, physical sunblocks, red blood cells transfusions, hydroxyurea, and splenectomy are commonly used in the management of CEP. Currently, the only available curative treatment of CEP is hematopoietic stem cell transplantation (HSCT). In this article, we present a young girl in which precocious genetic testing enabled early diagnosis and allowed curative treatment with HSCT for CEP at the age of 3 months of age, that is, the youngest reported case thus far.
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Affiliation(s)
- Marie-Pier Desjardins
- CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, Québec City, QC, Canada
- Marie-Pier Desjardins, CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, 2705 Boulevard Laurier, Quebec City, QC G1V 4G2, Canada.
| | - Lamia Naccache
- CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, Québec City, QC, Canada
| | - Audrey Hébert
- CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, Québec City, QC, Canada
| | - Isabelle Auger
- CHU de Québec, Centre Hospitalier de l’Université Laval, Division of Dermatology, Department of Medicine, Université Laval, Québec City, QC, Canada
| | - Pierre Teira
- CHU Sainte-Justine, Division of Hematology/Oncology, Department of Pediatrics, University of Montréal, Montréal, QC, Canada
| | - Marie-Claude Pelland-Marcotte
- CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, Québec City, QC, Canada
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El Maamari J, Amid A, Pelland-Marcotte MC, Tole S. Between Scylla and Charybdis: thrombosis in children with hemophilia. Front Pediatr 2023; 11:1173549. [PMID: 37287631 PMCID: PMC10242037 DOI: 10.3389/fped.2023.1173549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/27/2023] [Indexed: 06/09/2023] Open
Abstract
Thromboembolism is an infrequent complication in children with hemophilia that has been traditionally associated with the presence of a central venous access device. Novel rebalancing agents have shown promising results as prophylactic therapies to minimize the risk of bleeding but both thromboembolism and thrombotic microangiopathy have been reported as complications. The management of thrombosis in children with hemophilia is particularly challenging given the inherent risk of bleeding. In this paper, we present clinical vignettes to review the literature, highlight challenges, and describe our approach to managing thromboembolism in children with hemophilia.
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Affiliation(s)
- Jad El Maamari
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, BC Children’s Hospital, Vancouver, BC, Canada
| | - Ali Amid
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, BC Children’s Hospital, Vancouver, BC, Canada
| | - Marie-Claude Pelland-Marcotte
- Division of Pediatric Hematology-Oncology, CHU deQuébec—Centre Mère-Enfant Soleil, Quebec City, QC, Canada
- Research Center of the CHU de Québec, Axe Reproduction, Santé de la Mère et de l’Enfant, Quebec City, Canada
| | - Soumitra Tole
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Pediatrics, Division of Hematology/Oncology, London Health Sciences Centre, London, ON, Canada
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Tibout P, Ledjiar O, Athale U, Rayar M, Kulkarni K, Truong T, Cellot S, Bittencourt H, Pelland-Marcotte MC, Tran TH. Prognostic factors and outcomes of infant acute lymphoblastic leukemia (ALL), hypodiploid ALL, and mixed-phenotype acute leukemia (MPAL) in Canada: a report from CYP-C. Leuk Lymphoma 2022; 63:3208-3216. [PMID: 36067507 DOI: 10.1080/10428194.2022.2118536] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The epidemiology of infant acute lymphoblastic leukemia (ALL), hypodiploid ALL, and mixed-phenotype acute leukemia (MPAL) in Canada is unknown. The main objective was to describe the prevalence, prognostic factors, and outcomes of three rare and high-risk ALL subtypes in Canada. This is a retrospective study using the Cancer in Young People-Canada (CYP-C) database. Event-free survival (EFS) and overall survival (OS) were described by the Kaplan-Meier method and compared using the log-rank test. Among 2626 children aged 0-14 years diagnosed with B-cell acute lymphoblastic leukemia (B-ALL) between 2001 and 2018, 227 (8.6%) patients were identified to be infant ALL (n = 139), hypodiploid ALL (n = 43), or MPAL (n = 45). The 5-year EFS/OS was significantly worse in the infant ALL subgroup compared to that of hypodiploid ALL and MPAL. For the entire cohort, presenting White blood cells (WBCs) ≥50 × 109/L was independently associated with worse EFS/OS.
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Affiliation(s)
- Pauline Tibout
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Omar Ledjiar
- Unité de recherche clinique appliquée, Research Centre, CHU Sainte-Justine, Montreal, Canada
| | - Uma Athale
- Division of Pediatric Hematology-Oncology, McMaster Children's Hospital, Hamilton, Canada
| | - Meera Rayar
- Division of Pediatric Hematology-Oncology, B.C. Children's Hospital, Vancouver, Canada
| | - Ketan Kulkarni
- Division of Pediatric Hematology-Oncology, IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Tony Truong
- Division of Pediatric Hematology-Oncology, Alberta Children's Hospital, Calgary, Canada
| | - Sonia Cellot
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Henrique Bittencourt
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | | | - Thai Hoa Tran
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, University of Montreal, Montreal, Canada
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Pelland-Marcotte MC, Tole S, Bouhelier E, Lee S, Halparin J, Mammen C, Lyons K, Amid A. Rivaroxaban for Management of Venous Thromboembolism in Pediatric Nephrotic Syndrome; a Case Report and Review of Literature. Pediatr Hematol Oncol 2022; 40:688-695. [PMID: 36427068 DOI: 10.1080/08880018.2022.2150797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/04/2022] [Accepted: 11/12/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Soumitra Tole
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, ON, Canada
| | - Eve Bouhelier
- Research Center of the CHU de Quebec, Quebec City, QC, Canada
| | - Susan Lee
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
| | - Jessica Halparin
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
| | - Cherry Mammen
- Division of Pediatric Nephrology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
| | - Karen Lyons
- Department of Radiology, BC Children's Hospital, Vancouver, BC, Canada
| | - Ali Amid
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
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Champagne PA, Bourassa M, Desjardins MP, Cloutier S, Demers C, Singbo NU, Néron H, Pelland-Marcotte MC. Post-procedural bleeding rate and haemostatic treatment use for dental procedures before and after the implementation of a standardized protocol for people with inherited bleeding disorders. Haemophilia 2022; 28:806-813. [PMID: 35751905 DOI: 10.1111/hae.14609] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Persons with inherited bleeding disorders are at a substantial risk of bleeding following dental procedures. AIM To compare the outcomes and use of haemostatic treatment pre- and post-implementation of a standardized protocol for dental procedures at a Hemophilia Treatment Centre. METHODS We conducted a retrospective cohort study of outpatient and inpatient dental procedures and maxillofacial surgeries sustained by people with bleeding disorders treated at a comprehensive Hemophilia Treatment Centre (2013-2020), comparing patients' outcomes before and after the introduction of the protocol in 2018. The protocol, built using a multidisciplinary approach, suggested haemostatic treatment based on the invasiveness of the dental procedure and the proposed anaesthesia. Our primary outcome was the rate of procedural bleeding leading to medical or dental reintervention within 10 days. Secondary outcomes included the use of systemic haemostatic treatment and treatment-related adverse effects. RESULTS Overall, 137 dental procedures in 95 patients (median age: 29 years; 78% males; 74% haemophilia, 14% von Willebrand disease, 12% other disorders) were included. Seventeen procedural bleedings were reported (12.4%). Procedural bleeding occurred in 14.8% and 8.9% of patients in the control and intervention groups (p = .304). No major bleeding occurred. Tranexamic acid was used more consistently after protocol implementation (72.8% vs. 89.3%, p = .019), while factor concentrates use decreased (65.4% vs. 44.6%, p = .016), and desmopressin use remained constant (46.4% vs. 32.1%, p = .100). No treatment-related adverse effects were reported. CONCLUSION The use of a standardized protocol increased the use of tranexamic acid, with a nonstatistically significant reduction in procedural bleeding rate.
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Affiliation(s)
| | - Michelle Bourassa
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Medicine and Dental Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada
| | - Marie-Pier Desjardins
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
| | - Stéphanie Cloutier
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Department of Hematology, CHU de Québec, Quebec City, Quebec, Canada
| | - Christine Demers
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Department of Hematology, CHU de Québec, Quebec City, Quebec, Canada
| | - Narcisse Ulrich Singbo
- Recherche Clinique et Évaluative, CHU de Québec Research Center, Quebec City, Quebec, Canada
| | - Hélène Néron
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada
| | - Marie-Claude Pelland-Marcotte
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Division of Pediatric Hematology-Oncology, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
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Pelland-Marcotte MC, Rémy MM, Ma Y, Liu J, Jimenez-Cortes C, Sontag T, Caron M, Saint-Onge P, Langlois S, Joly-Beauparlant C, Sinnett D, Droit A, Tran TH, Santiago R. Abstract 3897: Ribosomal translational regulation is a potential mechanism for leukemia-related thrombo-embolic event in childhood acute lymphoblastic leukemia. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3897] [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: 11/16/2022]
Abstract
Abstract
Introduction: Thrombo-embolic event (TE) is a frequent complication of childhood acute lymphoblastic leukemia (cALL) and is associated with reduced survival. Overexpression of podoplanin or coagulome genes and coagulation pathway activation have been identified in cancer-induced TE but the role of leukemia environment in TE occurrence has not been fully elucidated in ALL. We assessed whether leukemia gene expression (GE) signature at diagnosis was associated with TE development in cALL.
Methods: We included children aged 0-18 years old (y.o.), from two hospitals, with newly diagnosed ALL and available RNA sequencing data from bone marrow at diagnosis. The primary outcome was the occurrence of grade ≥2 TE during ALL therapy using the Ponte Di Legno Working Group classification. TEs were classified as early (ET) if they occurred within 6 weeks from treatment start, or late (LT) otherwise. We compared differential gene expression (DE) in children with and without TE, adjusted for age (<10 or ≥10 y.o.) and ALL type (T or B-ALL). A secondary analysis stratified children between ET, LT and no TE. Gene set enrichment analysis (GSEA) was performed on KEGG and gene ontology (GO) databases. DE with absolute fold change ≥2 and p-values <0.05 were considered significant.
Results: We included 80 patients (median age: 5 years [interquartile range, IQR: 3-11 years], 53% male, 83% precursor B-cell ALL) of whom 19 (23.8%) developed a TE (7 ET and 12 LT) at a median of 76 days (IQR: 31-133 days) following cancer diagnosis. Patients with TE were more likely to be ≥10 y.o., while other demographic and clinical characteristics were similar. No genes from the coagulome, podoplanin or Hallmark coagulation pathways were differentially expressed in children with and without TE. The KEGG Ribosome pathway was the most upregulated pathway in the group with TE (normalized enrichment score (NES) = 2.35, adjusted p-value= 0.012) and ET (NES = 2.63, adjusted p-value < 0.001). LT was not significantly associated with ribosome pathway dysregulation. Interestingly, prior reports identified functional enrichment in ribosomal pathway as a biomarker for venous TE. A heatmap classification for ribosomal genes revealed 3 distinct signatures: ribosomal downregulation, moderate and high ribosomal activation. High ribosomal activation profile was seen in 6/7 ET and 9/12 LT, corresponding to a positive and negative predictive value of 0.55 and 0.92 for TE, respectively.
Conclusion: TEs in cALL were not associated with dysregulation in coagulation pathways or podoplanin gene at the RNA level. However, ribosomal translational pathway was highly upregulated in the group with thrombosis, particularly with ET. Dysregulation of posttranscriptional machinery might explain the pro-thrombotic effect of leukemia environment in cALL and warrants further investigation including proteomic exploration.
Citation Format: Marie-Claude Pelland-Marcotte, Meredith Michelle Rémy, Yan Ma, Jessica Liu, Camille Jimenez-Cortes, Thomas Sontag, Maxime Caron, Pascal Saint-Onge, Sylvie Langlois, Charles Joly-Beauparlant, Daniel Sinnett, Arnaud Droit, Thai Hoa Tran, Raoul Santiago. Ribosomal translational regulation is a potential mechanism for leukemia-related thrombo-embolic event in childhood acute lymphoblastic leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3897.
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Affiliation(s)
| | | | - Yan Ma
- 2Laval University, Quebec, Quebec, Canada
| | - Jessica Liu
- 3Sherbrooke University, Sherbrooke, Quebec, Canada
| | | | - Thomas Sontag
- 5Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Maxime Caron
- 4Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montréal, Quebec, Canada
| | - Pascal Saint-Onge
- 6Charles-Bruneau Cancer Center, CHU Sainte-Justine, Quebec, Quebec, Canada
| | - Sylvie Langlois
- 5Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montreal, Quebec, Canada
| | | | - Daniel Sinnett
- 5Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Arnaud Droit
- 7CHU of Quebec, Laval University, Quebec, Quebec, Canada
| | - Thai Hoa Tran
- 5Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Raoul Santiago
- 1CHU of Quebec, Laval University - Charles Bruneau Cancer Center, Quebec, Quebec, Canada
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Ilinca AP, Dakhallah N, Souza AM, Liu J, Bérubé S, Brossard J, Vézina C, Pelland-Marcotte MC, Santiago R, Tran TH. Clinical characteristics and outcomes of SARS-CoV-2 infection in pediatric oncology patients in the province of Quebec. Pediatr Blood Cancer 2022; 69:e29572. [PMID: 35084108 DOI: 10.1002/pbc.29572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/19/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 01/09/2023]
Affiliation(s)
- André P Ilinca
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Nawar Dakhallah
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Amalia M Souza
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Jessica Liu
- Division of Pediatric Hematology-Oncology, CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Samuel Bérubé
- Division of Pediatric Hematology-Oncology, CHUL, Université Laval, Quebec City, Québec, Canada
| | - Josée Brossard
- Division of Pediatric Hematology-Oncology, CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Catherine Vézina
- Division of Pediatric Hematology-Oncology, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
| | | | - Raoul Santiago
- Division of Pediatric Hematology-Oncology, CHUL, Université Laval, Quebec City, Québec, Canada
| | - Thai Hoa Tran
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
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Ross C, Kumar R, Pelland-Marcotte MC, Mehta S, Kleinman ME, Thiagarajan RR, Ghbeis MB, VanderPluym CJ, Friedman KG, Porras D, Fynn-Thompson F, Goldhaber SZ, Brandão LR. Acute Management of High-Risk and Intermediate-Risk Pulmonary Embolism in Children: A Review. Chest 2022; 161:791-802. [PMID: 34587483 PMCID: PMC8941619 DOI: 10.1016/j.chest.2021.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/09/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022] Open
Abstract
Severe forms of pulmonary embolism (PE) in children, althought rare, cause significant morbidity and mortality. We review the pathophysiologic features of severe (high-risk and intermediate-risk) PE and suggest novel pediatric-specific risk stratifications and an acute treatment algorithm to expedite emergent decision-making. We defined pediatric high-risk PE as causing cardiopulmonary arrest, sustained hypotension, or normotension with signs or symptoms of shock. Rapid primary reperfusion should be pursued with either surgical embolectomy or systemic thrombolysis in conjunction with a heparin infusion and supportive care as appropriate. We defined pediatric intermediate-risk PE as a lack of systemic hypotension or compensated shock, but with evidence of right ventricular strain by imaging, myocardial necrosis by elevated cardiac troponin levels, or both. The decision to pursue primary reperfusion in this group is complex and should be reserved for patients with more severe disease; anticoagulation alone also may be appropriate in these patients. If primary reperfusion is pursued, catheter-based therapies may be beneficial. Acute management of severe PE in children may include systemic thrombolysis, surgical embolectomy, catheter-based therapies, or anticoagulation alone and may depend on patient and institutional factors. Pediatric emergency and intensive care physicians should be familiar with the risks and benefits of each therapy to expedite care. PE response teams also may have added benefit in streamlining care during these critical events.
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Affiliation(s)
- Catherine Ross
- Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Riten Kumar
- Harvard Medical School, Boston, MA,Department of Pediatrics, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
| | | | - Shivani Mehta
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA,College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY
| | - Monica E. Kleinman
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Ravi R. Thiagarajan
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Muhammad B. Ghbeis
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Christina J. VanderPluym
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Kevin G. Friedman
- Department of Pediatric Cardiology, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Diego Porras
- Division of Invasive Cardiology, Department of Cardiology, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Francis Fynn-Thompson
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Samuel Z. Goldhaber
- Harvard Medical School, Boston, MA,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Leonardo R. Brandão
- Department of Paediatrics, Haematology/Oncology Division, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Pelland-Marcotte MC, Xie L, Barber R, Elkhalifa S, Frechette M, Kaur J, Onysko J, Bouffet E, Fernandez CV, Mitchell D, Rayar M, Randall A, Stammers D, Larouche V, Airhart A, Fidler-Benaoudia M, Cohen-Gogo S, Sung L, Gibson P. Incidence of childhood cancer in Canada during the COVID-19 pandemic. CMAJ 2021; 193:E1798-E1806. [PMID: 34844937 PMCID: PMC8654886 DOI: 10.1503/cmaj.210659] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The COVID-19 pandemic has had a major impact on access to health care resources. Our objective was to estimate the impact of the COVID-19 pandemic on the incidence of childhood cancer in Canada. We also aimed to compare the proportion of patients who enrolled in clinical trials at diagnosis, presented with metastatic disease or had an early death during the first 9 months of the COVID-19 pandemic compared with previous years. Methods: We conducted an observational study that included children younger than 15 years with a new diagnosis of cancer between March 2016 and November 2020 at 1 of 17 Canadian pediatric oncology centres. Our primary outcome was the monthly age-standardized incidence rates (ASIRs) of cancers. We evaluated level and trend changes using interventional autoregressive integrated moving average models. Secondary outcomes were the proportion of patients who were enrolled in a clinical trial, who had metastatic or advanced disease and who died within 30 days. We compared the baseline and pandemic periods using rate ratios (RRs) and 95% confidence intervals (CIs). Results: Age-standardized incidence rates during COVID-19 quarters were 157.7, 164.6, and 148.0 per million, respectively, whereas quarterly baseline ASIRs ranged between 150.3 and 175.1 per million (incidence RR 0.93 [95% CI 0.78 to 1.12] to incidence RR 1.04 [95% CI 0.87 to 1.24]). We found no statistically significant level or slope changes between the projected and observed ASIRs for all new cancers (parameter estimate [β], level 4.98, 95% CI −15.1 to 25.04, p = 0.25), or when stratified by cancer type or by geographic area. Clinical trial enrolment rate was stable or increased during the pandemic compared with baseline (RR 1.22 [95% CI 0.70 to 2.13] to RR 1.71 [95% CI 1.01 to 2.89]). There was no difference in the proportion of patients with metastatic disease (RR 0.84 [95% CI 0.55 to 1.29] to RR 1.22 [0.84 to 1.79]), or who died within 30 days (RR 0.16 [95% CI 0.01 to 3.04] to RR 1.73 [95% CI 0.38 to 15.2]). Interpretation: We did not observe a statistically significant change in the incidence of childhood cancer, or in the proportion of children enrolling in a clinical trial, presenting with metastatic disease or who died early during the first 9 months of the COVID-19 pandemic, which suggests that access to health care in pediatric oncology was not reduced substantially in Canada.
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Affiliation(s)
- Marie-Claude Pelland-Marcotte
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont.
| | - Lin Xie
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Randy Barber
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Sulaf Elkhalifa
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Mylene Frechette
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Jaskiran Kaur
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Jay Onysko
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Eric Bouffet
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Conrad V Fernandez
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - David Mitchell
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Meera Rayar
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Alicia Randall
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - David Stammers
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Valérie Larouche
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Alexandra Airhart
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Miranda Fidler-Benaoudia
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Sarah Cohen-Gogo
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Lillian Sung
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
| | - Paul Gibson
- Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont
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14
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Desjardins MP, Hébert A, Pelland-Marcotte MC. 74 Central venous line-related thrombosis in neonates: A population-based study. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.059] [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: 11/13/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
The incidence of central venous line (CVL)-related thromboembolism (TE) in neonates is rising dramatically. The mainstay of treatment in neonatal thrombosis is anticoagulant therapy. However, management of neonatal CVL-related TE is particularly complex, as the higher risk of systemic and intracranial bleeding, especially in premature babies, must be balanced with the thrombotic risks, including death, or morbidity such as organ dysfunction, post-thrombotic syndrome, and neurodevelopmental sequelae. There is a paucity of evidence regarding the epidemiology of neonatal CVL-related thrombosis, to help clinicians identify neonates at high-risk of CVL-related thrombosis, as well as to tailor treatment based on the risks and benefits of anticoagulants in neonates.
Objectives
The objectives of this retrospective cohort study are: 1) to determine the main risk factors of CVL-related TE in neonates admitted to the neonatal intensive care unit (NICU); and 2) to compare the effectiveness and safety between different antithrombotic treatment modalities for neonatal CVL-related TE using the Canadian Neonatal Network (CNN) database and electronic medical chart review.
Design/Methods
Neonates ≤ 28 days of life admitted to the NICU for ≥ 24 hours requiring a CVL with TE confirmed by imaging were included in the study. The main effectiveness outcome is the resolution of TE, whereas the main safety outcome is the apparition of a major bleeding. In this study (n=39), we compared the effectiveness and safety outcomes according to antithrombotic treatment modalities (conservative vs. anticoagulation).
Results
The median gestational age is 35[26-38] weeks, and the mean birth weight is 2096±1110 g. CVL responsible for TE was umbilical venous catheter (28%), umbilical arterial catheter (46%), peripherally inserted central catheter (PICC line) (8%), and peripheral arterial catheter (18%). The anticoagulation therapy is more effective to achieve a partial and complete resolution of TE than the conservative treatment after a mean follow-up of 7 weeks (p=0.02). However, there were no differences according to antithrombotic treatment group regarding safety outcome assessed by major bleedings (p=0.2).
Conclusion
Our results tend to suggest that anticoagulation therapy is more effective to achieve resolution of CVLs-related TE than conservative treatment without compromising the safety of neonates. However, a large multicentric study is required to evaluate the risks and benefits of anticoagulants in neonates.
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15
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Lemieux-Sarrasin D, Pelland-Marcotte MC, Simonyan D, Martineau É, Desbiens B, Michon B. Distance to the pediatric oncology center does not affect survival in children with acute lymphoblastic leukemia: a report from CYP-C. Leuk Lymphoma 2020; 62:960-966. [PMID: 33231123 DOI: 10.1080/10428194.2020.1849673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Remoteness is associated with worse survival in adults with cancer. We aimed to determine whether remoteness is associated with cancer outcomes in pediatric acute lymphoblastic leukemia (ALL). Canadian children with ALL entered in the CYP-C registry were included. The predictive impact of remoteness on overall survival (OS), relapse, and treatment-related complications (infections, thrombosis, bleeding, and osteonecrosis) was estimated using multivariate regression models. We included 1383 children, of whom 277 (20.0%) lived remotely (>200 km from the pediatric oncology center). The median latency to see a pediatric oncologist was longer in children living remotely. The 5-year OS (95% CI) was similar for both groups (remote: 95.2% [93.7-96.3%] vs close: 94.1% [90.5-95.2%]). No difference was found in the relapse rate between both groups and in treatment-related complications. Remoteness did not affect survival in pediatric ALL. Further research is needed to determine which models of healthcare organization optimize cancer outcomes and patients' satisfaction.
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Affiliation(s)
- Daphné Lemieux-Sarrasin
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
| | - Marie-Claude Pelland-Marcotte
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Quebec City, Quebec, Canada
| | - David Simonyan
- Centre de recherche du CHU de Québec, Quebec City, Quebec, Canada
| | - Émilie Martineau
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
| | - Barbara Desbiens
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
| | - Bruno Michon
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Quebec City, Quebec, Canada
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16
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Larouche V, Pelland-Marcotte MC, Blanchet MÈ, Simonyan D, Bélanger RE. The Management of Young Children With a Likely Infectious Condition Presenting Moderate to Severe Neutropenia. J Pediatr Hematol Oncol 2020; 42:e778-e782. [PMID: 32079987 DOI: 10.1097/mph.0000000000001749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this study was to describe the outcome of healthy children presenting with newly-diagnosed neutropenia in an infectious context. RESULTS A total of 184 episodes of neutropenia were included in children 3 months to 5 years of age. There were 118 (64%) episodes of moderate neutropenia and 66 (36%) of severe neutropenia (SN). SN episodes were more likely related to intensification of antibiotic regimen used and further investigations. The median duration of neutropenia was 8.5 days. Chronic benign neutropenia occurred in 7 (4%) patients. CONCLUSION SN led to intensification of antibiotic therapy, but no children encountered an unfavorable outcome and the neutropenia episodes were short-lived.
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Affiliation(s)
| | | | | | - David Simonyan
- Clinical and Evaluative Research Platform, Research Center, CHU de Québec-Université Laval
| | - Richard E Bélanger
- Department of Pediatrics.,Population Health and Optimal Health Practices Research Branch, CHU de Québec Research Centre, Québec City, QC, Canada
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17
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Caron CP, Turcotte B, Pelland-Marcotte MC, Schultz KAP, Harvey I, Bolduc S. Case - Bilateral and recurrent pediatric cystic nephroma associated with DICER1 mutation. Can Urol Assoc J 2020; 15:E290-E292. [PMID: 33119505 DOI: 10.5489/cuaj.6836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Cindy Pelletier Caron
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Bruno Turcotte
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | | | - Kris Ann P Schultz
- International PPB/DICER1 Registry, Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN, United States
| | - Isabelle Harvey
- Division of Pathology, Department of Laboratory Medicine, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Stéphane Bolduc
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada.,Division of Regenerative Medicine, CHU de Québec-Université Laval Research Centre, Quebec City, QC, Canada
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18
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Maser B, Pelland-Marcotte MC, Alexander S, Sung L, Gupta S. Levofloxacin prophylaxis in hospitalized children with leukemia: A cost-utility analysis. Pediatr Blood Cancer 2020; 67:e28643. [PMID: 32785971 DOI: 10.1002/pbc.28643] [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: 04/27/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Infections are common and are a major cause of morbidity and mortality during treatment of childhood leukemia. We evaluated the cost effectiveness of levofloxacin antibiotic prophylaxis, compared to no prophylaxis, in children receiving chemotherapy for acute myeloid leukemia (AML) or relapsed acute lymphoblastic leukemia (ALL). PROCEDURES A cost-utility analysis was conducted from the perspective of the single-payer health care system using a lifetime horizon. A comprehensive literature review identified available evidence for effectiveness, safety, costs of antibiotic prophylaxis in children with leukemia, and health utilities associated with the relevant health states. The effects of levofloxacin prophylaxis on health outcomes, quality-adjusted life-years (QALY), and direct health costs were derived from a combined decision tree and state-transition model. One-way deterministic and probabilistic sensitivity analyses were performed to test the sensitivity of results to parameter uncertainty. RESULTS The literature review revealed one randomized controlled trial on levofloxacin prophylaxis in childhood AML and relapsed ALL, by Alexander et al, that showed a significant reduction in rates of fever and neutropenia (71.2% vs 82.1%) and bacteremia (21.9% vs 43.4%) with levofloxacin compared to no prophylaxis. In our cost-utility analysis, levofloxacin prophylaxis was dominant over no prophylaxis, resulting in cost savings of $542.44 and increased survival of 0.13 QALY. In probabilistic sensitivity analysis, levofloxacin prophylaxis was dominant in 98.8% of iterations. CONCLUSIONS The present analysis suggests that levofloxacin prophylaxis, compared to no prophylaxis, is cost saving in children receiving intensive chemotherapy for AML or relapsed ALL.
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Affiliation(s)
- Brandon Maser
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Marie-Claude Pelland-Marcotte
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
| | | | - Lillian Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Sumit Gupta
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
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19
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Pelland-Marcotte MC, Pole JD, Nathan PC, Sutradhar R, Sung L. Severe infections following treatment for childhood cancer: a report from CYP-C. Leuk Lymphoma 2020; 61:2876-2884. [PMID: 32654563 DOI: 10.1080/10428194.2020.1789626] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Little is known about infections occurring after childhood cancer treatment. We assessed the risk of severe infection postcancer therapy in survivors of leukemia compared to other cancer types. We performed a population-based cohort study of children <15 years of age diagnosed with cancer (2001-2016), alive and relapse-free 30 days after treatment completion. The risk of severe infection in both groups was estimated using subdistribution proportional hazard regression. We identified 6148 survivors (1960 with leukemia). The cumulative incidence (95% confidence interval) of severe infections at 3 years was 0.70% (0.40-1.2%) in leukemia and 0.51% (0.32-0.79%) in other cancers. The risk of severe infection was not statistically different in leukemia survivors compared to other cancer types in univariate and multivariate analysis (adjusted hazard ratio: 1.40, 95% CI: 0.69-2.85). No significant association was found between a history of leukemia and an increased risk of severe infection after treatment, compared to other cancer types.
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Affiliation(s)
- Marie-Claude Pelland-Marcotte
- Division of Hematology/Oncology, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Jason D Pole
- ICES, Toronto, Canada.,Centre for Health Services Research, University of Queensland, Woolloongabba, Australia
| | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Canada
| | | | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Canada
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20
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Abstract
BACKGROUND The prevalence of children diagnosed with thrombotic events has been increasing in the last decades. The most common thrombosis risk factor in neonates, infants and children is the placement of a central venous catheter (CVC). It is unknown if anticoagulation prophylaxis with low molecular weight heparin (LMWH) decreases CVC-related thrombosis in children. This is an update of the Cochrane Review published in 2014. OBJECTIVES To determine the effect of LMWH prophylaxis on the incidence of CVC-related thrombosis and major and minor bleeding complications in children. Further objectives were to determine the effect of LMWH on occlusion of CVCs, number of days of CVC patency, episodes of catheter-related bloodstream infection (CRBSI), other side effects of LMWH (allergic reactions, abnormal coagulation profile, heparin-induced thrombocytopaenia and osteoporosis) and mortality during therapy. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 7 May 2019. We undertook reference checking of identified trials to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-randomised trials comparing LMWH to no prophylaxis (placebo or no treatment), or low-dose unfractionated heparin (UFH) either as continuous infusion or flushes (low-dose UFH aims to ensure the patency of the central line but has no systemic anticoagulation activity), given to prevent CVC-related thrombotic events in children. We selected studies conducted in children aged 0 to 18 years. DATA COLLECTION AND ANALYSIS Two review authors independently identified eligible studies, which were assessed for study methodology including bias, and extracted unadjusted data where available. In the data analysis step, all outcomes were analysed as binary or dichotomous outcomes. The effects of interventions were summarised with risk ratios (RR) and their respective 95% confidence intervals (CI). We assessed the certainty of evidence for each outcome using the GRADE approach. MAIN RESULTS One additional study was included for this update bringing the total to two included studies (with 1135 participants). Both studies were open-label RCTs comparing LMWH with low-dose UFH to prevent CVC-related thrombosis in children. We identified no studies comparing LMWH with placebo or no treatment. Meta-analysis found insufficient evidence of an effect of LMWH prophylaxis in reducing the incidence of CVC-related thrombosis in children with CVC, compared to low-dose UFH (RR 0.68, 95% CI 0.27 to 1.75; 2 studies; 787 participants; low-certainty evidence). One study (158 participants) reported symptomatic and asymptomatic CVC-related thrombosis separately and detected no evidence of a difference between LMWH and low-dose UFH (RR 1.03, 95% CI 0.21 to 4.93; low-certainty evidence; RR 1.17, 95% CI 0.45 to 3.08; low-certainty evidence; for symptomatic and asymptomatic participants respectively). There was insufficient evidence to determine whether LMWH impacts the risk of major bleeding (RR 0.27, 95% CI 0.05 to 1.67; 2 studies; 813 participants; low-certainty evidence); or minor bleeding. One study reported minor bleeding in 53.3% of participants in the LMWH arm and in 44.7% of participants in the low-dose UFH arm (RR 1.20, 95% CI 0.91 to 1.58; 1 study; 158 participants; very low-certainty evidence), and the other study reported no minor bleeding in either group (RR: not estimable). Mortality during the study period was reported in one study, where two deaths occurred during the study period. Both were unrelated to thrombotic events and occurred in the low-dose UFH arm. The second study did not report mortality during therapy per arm but showed similar 5-year overall survival (low-certainty evidence). No additional adverse effects were reported. Other pre-specified outcomes (including CVC occlusion, patency and CRBSI) were not reported. AUTHORS' CONCLUSIONS Pooling data from two RCTs did not provide evidence to support the use of prophylactic LWMH for preventing CVC-related thrombosis in children (low-certainty evidence). Evidence was also insufficient to confirm or exclude a difference in the incidence of major and minor bleeding complications in the LMWH prophylaxis group compared to low-dose UFH (low and very low certainty respectively). No evidence of a clear difference in overall mortality was seen. Studies did not report on the outcomes catheter occlusion, days of catheter patency, episodes of CRBSI and other side effects of LMWH (allergic reactions, abnormal coagulation profile, heparin-induced thrombocytopaenia and osteoporosis). The certainty of the evidence was downgraded due to risk of bias of the included studies, imprecision and inconsistency, preventing conclusions in regards to the efficacy of LMWH prophylaxis to prevent CVC-related thrombosis in children.
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Affiliation(s)
| | - Nour Amiri
- Division of Haematology-Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Maria L Avila
- Division of Haematology-Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Leonardo R Brandão
- Division of Haematology-Oncology, The Hospital for Sick Children, Toronto, Canada
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21
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Pelland-Marcotte MC, Pole JD, Sutradhar R, Nathan PC, Sung L. Infections as a potential long-term risk following childhood leukemia. Med Hypotheses 2020; 137:109554. [PMID: 31945656 DOI: 10.1016/j.mehy.2020.109554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/19/2019] [Accepted: 01/05/2020] [Indexed: 12/01/2022]
Abstract
Leukemia is the most common childhood cancer. While infections are a frequent and potentially severe complication while on treatment, less is known about the risk for infections following therapy completion. In this article, we propose that leukemia survivors might be at increased risk of infections following therapy completion than the general population, independently of potential confounders such as age, sex and Down syndrome. This association is conceivably due to several factors. First, therapy-induced immune dysfunction of both the humoral and cellular compartments appears to last for several years following anti-cancer therapy and after hematopoietic stem cell transplantation. Second, clinical and epidemiological research has shown leukemia survivors are disproportionally affected by comorbidities related to leukemia treatment and its complications, such as diabetes and obesity, which may induce secondary immunodeficiency and infections. Last, differences in health-related behaviors between leukemia survivors and the general population (such as re-vaccination practices) may affect the baseline risk of infections. Although under-represented in the epidemiological literature as a possible late effect of childhood leukemia and its treatment, it is plausible that leukemia survivors are at increased risk of infections for several years when compared to the general population and their siblings. Further research is needed to empirically test these hypotheses.
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Affiliation(s)
- Marie-Claude Pelland-Marcotte
- Department of Pediatrics, CHU de Québec, 2705 Boulevard Laurier, Quebec City, Quebec, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Jason D Pole
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, Ontario, Canada; Pediatric Oncology Group of Ontario, 480, University Ave, Toronto, Ontario, Canada; ICES, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, Ontario, Canada; ICES, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Paul C Nathan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, 555, University Avenue, Toronto, Ontario M5G 1X8, Canada; Program in Child Health Evaluative Sciences, The Hospital for Sick Children, 686, Bay St., Toronto, Ontario, Canada
| | - Lillian Sung
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, 555, University Avenue, Toronto, Ontario M5G 1X8, Canada; Program in Child Health Evaluative Sciences, The Hospital for Sick Children, 686, Bay St., Toronto, Ontario, Canada
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22
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Pelland-Marcotte MC, Tole S, Pechlivanoglou P, Brandão LR. Effectiveness and Safety of Primary Thromboprophylaxis in Children with Cancer: A Systematic Review of the Literature and Network Meta-Analysis. Thromb Haemost 2019; 119:2034-2042. [DOI: 10.1055/s-0039-1697027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AbstractThromboembolism (TE) is a well-recognized complication of pediatric cancer and can lead to mortality and excess morbidity. There is conflicting evidence about the effectiveness and safety of thromboprophylaxis in children. We conducted a systematic literature review and network meta-analysis of primary pharmacological thromboprophylaxis in children and adolescents (0–21 years) with cancer. The primary outcomes were objectively proven TE and major bleeding. The network meta-analysis included comparisons of multiple alternatives simultaneously: antithrombin (AT) replacement, low molecular weight heparin (LMWH), vitamin K antagonists (VKAs), and standard of care (SOC) defined as no thromboprophylaxis or low-dose heparin for catheter patency. Six articles describing 1,318 patients were included (mean age: 6.7 years, 56.7% male). Acute lymphoblastic leukemia was the underlying diagnosis in 97.5% of patients. All studies were considered at moderate or high risk of bias. LMWH was the only agent associated with lower odds of TE compared with SOC (odds ratio [OR]: 0.23, 95% confidence interval [CI]: 0.06–0.81). No statistically significant difference was detected between other thromboprophylaxis modalities and SOC. Tau2 and I
2 suggested a high degree of heterogeneity. No statistically significant differences in the odds of major bleeding were found between AT replacement, LMWH, VKA, and SOC. Current evidence suggests that low-dose LMWH is effective and safe to prevent TE in children with cancer but is insufficient to conclude if AT replacement or VKA are effective thromboprophylaxis options. Further research, notably randomized controlled trials enrolling children with diverse types of cancer, is crucially needed.
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Affiliation(s)
- Marie-Claude Pelland-Marcotte
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Soumitra Tole
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Petros Pechlivanoglou
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Leonardo Rodrigues Brandão
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
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23
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Pelland-Marcotte MC, Pole JD, Hwee J, Sutradhar R, Science M, Nathan PC, Sung L. Long-Term Risk of Infections After Treatment of Childhood Leukemia: A Population-Based Cohort Study Using Administrative Health Data. J Clin Oncol 2019; 37:2651-2660. [PMID: 31393747 DOI: 10.1200/jco.19.00570] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Infections are a frequent complication during childhood leukemia treatment. Little is known about the infectious risk in survivors. We compared the relative rate (RR) of infections after treatment completion between pediatric leukemia survivors and the general population. METHODS We performed a retrospective, population-based cohort study of children diagnosed with leukemia between 1992 and 2015 in Ontario, Canada, who were alive and relapse free 30 days after treatment completion (index date). Leukemia survivors were matched 5:1 with the general population by year of birth, sex, and rural status and stratified by initial treatment, including and excluding hematopoietic stem-cell transplantation (HSCT). The primary outcome was time to infections, as identified using validated diagnostic codes from administrative databases. Individuals were censored at the earliest of death, first relapse, loss to follow-up, or end of study. RESULTS A total of 2,204 leukemia survivors were included and matched with 11,020 controls. The rate of infections was elevated after treatment completion compared with controls (RR, 1.51; 95% CI, 1.45 to 1.57) and at less than 1 year (RR, 1.77; 95% CI, 1.69 to 1.86); 1 to 4.99 years (RR, 1.66; 95% CI, 1.62 to 1.71), and 5 or more years (RR, 1.29; 95% CI, 1.22 to 1.36) from the index date. Among those whose initial treatment excluded HSCT, the rate remained elevated more than 5 years from the index date (RR, 1.29; 95% CI, 1.23 to 1.35). Infection-related death was significantly increased in leukemia survivors both among the entire cohort (hazard ratio, 149.3; 95% CI, 20.4 to 1,091.9) and among those without HSCT (hazard ratio, 92.7; 95% CI, 12.4 to 690.7). CONCLUSION A significant association was found between a history of leukemia therapy and an increased risk of infections. Additional study is needed to establish which exposures in patients with leukemia lead to late infections.
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Affiliation(s)
| | - Jason D Pole
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Services, Toronto, Ontario, Canada
| | - Jeremiah Hwee
- University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Services, Toronto, Ontario, Canada.,Trillium Health Partners, Mississauga, Ontario, Canada
| | - Rinku Sutradhar
- University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Services, Toronto, Ontario, Canada
| | | | - Paul C Nathan
- The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Lillian Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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24
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Abstract
The mainstay of hemophilia management has been the regular, prophylactic infusion of missing coagulation factors VIII/IX. This approach is limited by the need for frequent intravenous infusions, high cost, limited availability, and the development of inhibitory antibodies to factors VIII/IX. Numerous recent breakthroughs are addressing many of these limitations. These include the development of extended half-life factors that require less frequent infusions and the development of various novel agents that can be given subcutaneously and infrequently, including FVIII-mimetic antibody and downregulators of natural anticoagulants. Finally, gene therapy is set to offer patients a possibility for a cure.
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Affiliation(s)
- Marie-Claude Pelland-Marcotte
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto M5G 1X8, Canada.
| | - Manuel D Carcao
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto M5G 1X8, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada
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25
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Pelland-Marcotte MC, Tucker C, Klaassen A, Avila ML, Amid A, Amiri N, Williams S, Halton J, Brandão LR. Outcomes and risk factors of massive and submassive pulmonary embolism in children: a retrospective cohort study. The Lancet Haematology 2019; 6:e144-e153. [DOI: 10.1016/s2352-3026(18)30224-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 01/13/2023]
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Pelland-Marcotte MC, Hwee J, Pole JD, Nathan PC, Sung L. Incidence of infections after therapy completion in children with acute lymphoblastic leukemia or acute myeloid leukemia: a systematic review of the literature. Leuk Lymphoma 2019; 60:2104-2114. [PMID: 30774019 DOI: 10.1080/10428194.2019.1573369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Infections are a common complication of treatment for pediatric acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML). Less is known about infections occurring after treatment. We performed a systematic review of the literature to assess the incidence of infections after therapy completion in children and young adults with ALL or AML. Twenty-eight studies, with 4138 patients, were included. Four studies reported infections in patients who did not undergo hematopoietic stem cell transplant (HSCT). Respiratory tract and urinary tract infections affected 9.9-72.5% and 2.9-19.8% of patients, respectively. Twelve studies reported infections in patients treated with HSCT. Late bacterial, viral and fungal infections affected 3.9-38.5%, 16.1-66.7%, and 0.2-41.7% of patients, respectively. Viral hepatitis affected 0.8-75.4% of patients from 12 studies. Our review suggests that infections are a frequent complication after treatment for leukemia in children, especially after HSCT and identifies several knowledge gaps in the current literature.
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Affiliation(s)
| | - Jeremiah Hwee
- Dalla Lana School of Public Health, University of Toronto , Toronto , Canada.,Trillium Health Partners, Institute for Better Health , Mississauga , Canada
| | - Jason D Pole
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children , Toronto , Canada.,Pediatric Oncology Group of Ontario , Ontario , Canada
| | - Paul C Nathan
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children , Toronto , Canada.,Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning , Toronto , Canada
| | - Lillian Sung
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children , Toronto , Canada.,Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning , Toronto , Canada
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Pelland-Marcotte MC, Humpl T, James PD, Rand ML, Bouskill V, Reyes JT, Bowman ML, Carcao MD. Idiopathic pulmonary arterial hypertension - a unrecognized cause of high-shear high-flow haemostatic defects (otherwise referred to as acquired von Willebrand syndrome) in children. Br J Haematol 2018; 183:267-275. [PMID: 30141279 DOI: 10.1111/bjh.15530] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023]
Abstract
Acquired von Willebrand syndrome (AVWS) is reported in high-flow high-shear congenital cardiac disorders. We hypothesized that the narrowed pulmonary vasculature in idiopathic pulmonary arterial hypertension (IPAH) may induce AVWS. We conducted a cross-sectional evaluation of children with IPAH. Patients with bleeding symptoms and/or laboratory abnormalities (thrombocytopenia, anomalies in coagulation screening tests) were tested in-depth for haemostatic defects. Fourteen children were followed with IPAH of which 8 were eligible. Four children exhibited abnormal bleeding scores (International Society on Thrombosis and Haemostasis Bleeding Assessment Tool: 3-5). All 8 patients showed very prolonged platelet function analyser (PFA)-100 closure times. Six children demonstrated either mild thrombocytopenia or low-normal von Willebrand factor (VWF) antigen (VWF:Ag) or VWF activity [mean (range), in iu/dl: VWF:Ag: 70 (61-91); VWF activity: 57 (34-70)]. Average VWF collagen binding capacity (VWF:CB) was 64 iu/dl (range: 53-123 iu/dl), with low-normal VWF activity/VWF:Ag or VWF:CB/VWF:Ag ratios occurring in five patients. All children had normal multimers distribution patterns. One patient underwent a lung transplantation, with normalization of haemostatic abnormalities post-surgery. Overall, 8 out of 14 children with IPAH had mild to moderate bleeding symptoms and/or laboratory abnormalities in keeping with AVWS. Normalization of the haemostatic defects following lung transplantation and lack of family history of bleeding attests to the acquired nature of their defects.
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Affiliation(s)
- Marie-Claude Pelland-Marcotte
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Tilman Humpl
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Paula D James
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Margaret L Rand
- Division of Haematology/Oncology, Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Departments of Laboratory Medicine & Pathobiology, Biochemistry and Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Vanessa Bouskill
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.,Department of Nursing, The Hospital for Sick Children, Toronto, ON, Canada
| | - Janette T Reyes
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.,Department of Nursing, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mackenzie L Bowman
- Department of Medicine, Queen's University, Kingston, ON, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - Manuel D Carcao
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
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Pelland-Marcotte MC, Pole J, Kulkarni K, Athale U, Stammers D, Sabapathy C, Halparin J, Brandão L, Sung L. Thromboembolism Incidence and Risk Factors in Children with Cancer: A Population-Based Cohort Study. Thromb Haemost 2018; 118:1646-1655. [DOI: 10.1055/s-0038-1668543] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AbstractThere is conflicting information about the epidemiology of thromboembolism (TE) in paediatric oncology. Objectives were to describe the incidence and risk factors of TE in children with cancer. We included all children with cancer less than 15 years of age diagnosed from 2001 to 2016, treated at one of the 12 Canadian paediatric centres outside of Ontario and entered into the Cancer in Young People-Canada database. Potential risk factors for TE were evaluated using Cox proportional hazards regression stratified by haematological malignancies versus solid tumours. Factors associated with vascular access- and non-vascular access-related TE were compared using chi-square or Fisher's exact tests. Of the 7,471 children included, 283 experienced TE requiring medical intervention; cumulative incidence of TE at 5 years was 3.8 ± 0.2% and 0.36% ± 0.07% for life-threatening or fatal TE. For haematological malignancies, the following factors were associated with TE in multivariable regression: age < 1 year, 5 to 9.99 years and 10 to 14.99 years (relative to age 1–4.99 years), haematopoietic stem cell transplant (hazard ratio [HR] = 1.49, 95% confidence interval [CI], 1.00–2.32), anthracyclines (HR = 2.21, 95% CI, 1.12–4.37) and asparaginase (HR = 1.68, 95% CI, 1.15–2.44). For solid tumours, obesity (HR = 1.92, 95% CI, 1.01–3.68), surgery (HR = 2.70, 95% CI, 1.44–5.08), radiation (HR = 47.51, 95% CI, 24.01–94.01), anthracyclines (HR = 2.74, 95% CI, 1.29–5.82) and platinum agents (HR = 2.26, 95% CI, 1.19–4.28) were associated with TE. Life-threatening and fatal TEs were more common among non-vascular access TEs (14.5% vs. 3.3% p = 0.001). In a population-based cohort, 4% of children with cancer developed a clinically significant TE. Accurate risk stratification tools are needed specific to malignancy type.
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Affiliation(s)
- Marie-Claude Pelland-Marcotte
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jason Pole
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Ketan Kulkarni
- Division of Haematology-Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Uma Athale
- Division of Haematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - David Stammers
- Division of Pediatric Haematology/Oncology, Department of Pediatrics, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada
| | - Christine Sabapathy
- Division of Pediatric Haematology/Oncology, Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Jessica Halparin
- Division of Haematology/Oncology/BMT, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Leonardo Brandão
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
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Abstract
The design and quality of 30 recent hypnotherapy trials (years 2000-2008) were assessed using the checklist for evaluating a report of nonpharmacological treatment (CLEAR NPT). Randomization was adequately reported in 53% of studies. The masking of participants and care providers is not feasible in hypnotherapy studies. Assessor masking is rarely introduced in randomized, controlled trials (27%). Reporting and quality of published hypnotherapy trials need to be improved. Investigators may consider using CLEAR NPT to evaluate study quality but attention should be paid to document intervention adherence, standardization of cointerventions, participant and care-provider expectations and beliefs, and, finally, hypnotizability.
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Affiliation(s)
- Isabelle Marc
- Centre de recherche, CHUQ, Laval University, Québec City, Canada.
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