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Zawitkowska J, Drabko K, Lejman M, Kowalczyk A, Czyżewski K, Dziedzic M, Jaremek K, Zalas-Więcek P, Szmydki-Baran A, Hutnik Ł, Czogała W, Balwierz W, Żak I, Salamonowicz-Bodzioch M, Kazanowska B, Wróbel G, Frączkiewicz J, Kałwak K, Tomaszewska R, Szczepański T, Zając-Spychała O, Wachowiak J, Płonowski M, Krawczuk-Rybak M, Królak A, Ociepa T, Urasiński T, Pierlejewski F, Młynarski W, Urbańska-Rakus J, Machnik K, Pająk S, Badowska W, Brzeski T, Mycko K, Mańko-Glińska H, Urbanek-Dądela A, Karolczyk G, Mizia-Malarz A, Stolpa W, Skowron-Kandzia K, Musiał J, Chaber R, Irga-Jaworska N, Bień E, Styczyński J. Incidence of bacterial and fungal infections in Polish pediatric patients with acute lymphoblastic leukemia during the pandemic. Sci Rep 2023; 13:22619. [PMID: 38114744 PMCID: PMC10730514 DOI: 10.1038/s41598-023-50093-5] [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: 09/10/2023] [Accepted: 12/15/2023] [Indexed: 12/21/2023] Open
Abstract
The most common complications related to the treatment of childhood acute lymphoblastic leukemia (ALL) are infections. The aim of the study was to analyze the incidence and mortality rates among pediatric patients with ALL who were treated in 17 Polish pediatric hematology centers in 2020-2021 during the pandemic. Additionally, we compared these results with those of our previous study, which we conducted in the years 2012-2017. The retrospective analysis included 460 patients aged 1-18 years with newly diagnosed ALL. In our study, 361/460 (78.5%) children were reported to have microbiologically documented bacterial infections during chemotherapy. Ten patients (2.8%) died due to sepsis. Fungal infections were reported in 99 children (21.5%), of whom five (5.1%) died due to the infection. We especially observed an increase in bacterial infections during the pandemic period compared to the previous study. The directions of our actions should be to consider antibiotic prophylaxis, shorten the duration of hospitalization, and educate parents and medical staff about complications (mainly infections) during anticancer therapy. It is necessary to continue clinical studies evaluating infection prophylaxis to improve outcomes in childhood ALL patients.
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Affiliation(s)
- Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland.
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Monika Lejman
- Independent Laboratory of Genetic Diagnostics, Medical University of Lublin, Lublin, Poland
| | - Adrian Kowalczyk
- Student Scientific Society of Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Kamila Jaremek
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Patrycja Zalas-Więcek
- Department of Microbiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Anna Szmydki-Baran
- Department of Hematology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Hutnik
- Department of Hematology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Czogała
- Department of Pediatric Oncology and Hematology, Intitute of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Intitute of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Iwona Żak
- Department of Microbiology, University Children's Hospital, Jagiellonian University Medical College, Kraków, Poland
| | | | - Bernarda Kazanowska
- Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Grażyna Wróbel
- Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Renata Tomaszewska
- Department of Pediatrics, Hematology and Oncology, Medical University of Silesia, Katowice, Poland
| | - Tomasz Szczepański
- Department of Pediatrics, Hematology and Oncology, Medical University of Silesia, Katowice, Poland
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Płonowski
- Department of Pediatric Oncology, Hematology, Medical University of Bialystok, Bialystok, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology, Hematology, Medical University of Bialystok, Bialystok, Poland
| | - Aleksandra Królak
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Filip Pierlejewski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | | | - Katarzyna Machnik
- Unit of Pediatric Hematology and Oncology, City Hospital, Chorzow, Poland
| | - Sonia Pająk
- Unit of Pediatric Hematology and Oncology, City Hospital, Chorzow, Poland
| | - Wanda Badowska
- Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Tomasz Brzeski
- Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Katarzyna Mycko
- Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Hanna Mańko-Glińska
- Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Agnieszka Urbanek-Dądela
- Department of Pediatric Oncology and Hematology, Collegium Medium of Jan Kochanowski University in Kielce, Kielce, Poland
| | - Grażyna Karolczyk
- Department of Pediatric Oncology and Hematology, Collegium Medium of Jan Kochanowski University in Kielce, Kielce, Poland
| | - Agnieszka Mizia-Malarz
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children's Care Health, Medical University of Silesia, Katowice, Poland
| | - Weronika Stolpa
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children's Care Health, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Skowron-Kandzia
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children's Care Health, Medical University of Silesia, Katowice, Poland
| | - Jakub Musiał
- Clinic of Pediatric Oncology and Hematology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | - Radosław Chaber
- Clinic of Pediatric Oncology and Hematology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Gdańsk, Poland
| | - Ewa Bień
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Gdańsk, Poland
| | - Jan Styczyński
- Student Scientific Society of Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
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Stolpa W, Mizia-Malarz A, Zapała M, Zwiernik B. Can CD34 +CD38 - lymphoblasts, as likely leukemia stem cells, be a prognostic factor in B-cell precursor acute lymphoblastic leukemia in children? Front Pediatr 2023; 11:1213009. [PMID: 37675394 PMCID: PMC10478575 DOI: 10.3389/fped.2023.1213009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023] Open
Abstract
Background CD34+CD38- lymphoblasts as likely leukemia stem cells (LSCs) may be responsible for a worse response to treatment and may be a risk factor for recurrence in B-cell precursor acute lymphoblastic leukemia (BCP-ALL). Objective The study objective was to assess the prognostic role of CD34+CD38- lymphoblasts in bone marrow on the day of BCP-ALL diagnosis. Methods 115 patients with BCP-ALL, the median age of 4.5 years (range 1.5-17.9 years), gender: female 63 (54.8%) with BCP-ALL were enrolled; Group I (n = 90)-patients with CD34+CD38+ antigens and Group II (n = 20)-patients with CD34+CD38- antigens on the lymphoblast surface. Results A worse response on Days 8, 15, and 33 of therapy and at the end of treatment in Group II (CD34+CD38-) was more often observed but these differences were not statistically significant. A significantly higher incidence of BCP-ALL recurrence was in Group II. Conclusions 1.In BCP-ALL in children, the presence of CD34+CD38- lymphoblasts at the diagnosis does not affect the first remission.2.In BCP-ALL in children, the presence of CD34+CD38- lymphoblasts at the diagnosis may be considered an unfavorable prognostic factor for disease recurrence.3.It is necessary to further search for prognostic factors in BCP-ALL in children.
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Affiliation(s)
- Weronika Stolpa
- Department of Oncology, Hematology, and Chemotherapy, Upper Silesia Children’s Care Health Centre, Katowice, Poland
| | - Agnieszka Mizia-Malarz
- Department of Oncology, Hematology, and Chemotherapy, Upper Silesia Children’s Care Health Centre, Katowice, Poland
- Department of Pediatrics, Medical University of Silesia, Upper Silesia Children’s Care Health Centre, Katowice, Poland
| | - Magdalena Zapała
- Students’ Research Group, Department of Pediatrics, Medical University of Silesia, Katowice, Poland
| | - Bartosz Zwiernik
- Students’ Research Group, Department of Pediatrics, Medical University of Silesia, Katowice, Poland
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Stolpa W, Zapała M, Zwiernik B, Mizia-Malarz A. Relapses Children's Acute Lymphoblastic Leukemia, Single Center Experience. Children (Basel) 2022; 9:children9121874. [PMID: 36553318 PMCID: PMC9776902 DOI: 10.3390/children9121874] [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] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
The prognosis in children and adolescents with relapsed ALL, despite intensive therapy, including hematopoietic stem cell transplantation, is still challenging. This study aims to analyze the incidence of relapsed ALL and survival rates in correlation to the risk factors. Materials and methods: 125 pediatric patients with ALL diagnosed in our department between 2000-2018; age 1−18 years old (median 6.4); female 53.6% vs. male 46.4%. Results: 19 pts (15.2%) were diagnosed with a relapse. Three pts (15.8%) had been diagnosed with very early relapses (2/3 T-ALL), 12 pts (63.1%) as an early relapse, and 4 pts (21.1%) as a late relapse. Bone marrow was the most frequent relapses localization. The five-year survival has been achieved by six patients (31.6%). A significant difference was found in regard to the five-year overall survival and relapse type (p < 0.05). The group with very early relapses (3/3; 100%) has not reached the five-year survival. Conclusions: 1. The main prognostic factor in children’s ALL relapses is still the time of the onset of the relapse. 2. The T lineage acute lymphoblastic leukemia is a worse prognostic factor. 3. The analysis of the above relapse risk factors alongside cytogenethic markers and flow cytometry or polymerase chain reaction minimal residual disease is very important for first-line chemotherapy improvement and a more personalized choice of therapy for ALL patients.
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Affiliation(s)
- Weronika Stolpa
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children’s Care Heatlh Centre, 16 Medykow Street, 40-752 Katowice, Poland
| | - Magdalena Zapała
- Student Scientific Club, Medical University of Silesia, 40-055 Katowice, Poland
| | - Bartosz Zwiernik
- Student Scientific Club, Medical University of Silesia, 40-055 Katowice, Poland
| | - Agnieszka Mizia-Malarz
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children’s Care Heatlh Centre, 16 Medykow Street, 40-752 Katowice, Poland
- Department of Pediatrics, Upper Silesia Children’s Care Heatlh Centre, Medical University of Silesia, 16 Medykow Street, 40-752 Katowice, Poland
- Correspondence: or
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Zawitkowska J, Drabko K, Czyżewski K, Dziedzic M, Jaremek K, Zalas-Więcek P, Szmydki-Baran A, Hutnik Ł, Matysiak M, Czogała W, Balwierz W, Żak I, Salamonowicz-Bodzioch M, Kazanowska B, Wróbel G, Kałwak K, Tomaszewska R, Szczepański T, Zając-Spychała O, Wachowiak J, Płonowski M, Krawczuk-Rybak M, Królak A, Ociepa T, Urasiński T, Pierlejewski F, Młynarski W, Urbańska-Rakus J, Machnik K, Pająk S, Badowska W, Brzeski T, Mycko K, Mańko-Glińska H, Urbanek-Dądela A, Karolczyk G, Mizia-Malarz A, Stolpa W, Skowron-Kandzia K, Musiał J, Chaber R, Irga-Jaworska N, Bień E, Styczyński J. Viral Infection Profile in Children Treated for Acute Lymphoblastic Leukemia—Results of Nationwide Study. Pathogens 2022; 11:pathogens11101091. [PMID: 36297147 PMCID: PMC9609456 DOI: 10.3390/pathogens11101091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/10/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Viral infections can be a serious complication of therapy in children with acute lymphoblastic leukemia (ALL). In this study, we focused on the incidence and the profile of viral infection in children with ALL treated in 17 pediatric oncology centers in Poland in the two-year periods of 2018–2019 and 2020–2021. We also compared the frequency of viral infections in 2018–2019 to that in 2020–2021. In 2020–2021, a total of 192 children with ALL had a viral infection during intensive chemotherapy. A total number of 312 episodes of viral infections were diagnosed. The most common infections detected in the samples were: COVID-19 (23%), rhinovirus (18%), and respiratory syncytial virus (14%). COVID-19 and BK virus infections were the reason for the death 1% of all patients. In 2018–2019, a total of 53 ALL patients who had a viral infection were reported and 72 viral events were observed, mainly adenovirus (48.6%), rotavirus (31.9%), and herpes zoster (8.3%). No deaths were reported during this period. The cumulative incidence of viral infections in 2018–2019 was 10.4%, while for 2020–2021, it was 36.7%. In conclusion, a high incidence of COVID-19 infection was observed among pediatric patients with ALL in Poland. The mortality rate in our material was low. The viral profile in ALL children undergoing chemotherapy can be useful for clinicians to improve prophylactic and therapeutic strategies.
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Affiliation(s)
- Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, 20-059 Lublin, Poland
- Correspondence:
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, 20-059 Lublin, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland
| | - Kamila Jaremek
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland
| | - Patrycja Zalas-Więcek
- Department of Microbiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland
| | - Anna Szmydki-Baran
- Department of Hematology and Pediatrics, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Łukasz Hutnik
- Department of Hematology and Pediatrics, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Michał Matysiak
- Department of Hematology and Pediatrics, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Wojciech Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Iwona Żak
- Department of Microbiology, University Children’s Hospital, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Małgorzata Salamonowicz-Bodzioch
- Department of Paediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Bernarda Kazanowska
- Department of Paediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Grażyna Wróbel
- Department of Paediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Krzysztof Kałwak
- Department of Paediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Renata Tomaszewska
- Department of Pediatrics, Hematology and Oncology, Medical University of Silesia, 40-752 Katowice, Poland
| | - Tomasz Szczepański
- Department of Pediatrics, Hematology and Oncology, Medical University of Silesia, 40-752 Katowice, Poland
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Marcin Płonowski
- Department of Pediatric Oncology, Hematology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology, Hematology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Aleksandra Królak
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Filip Pierlejewski
- Department of Pediatrics, Oncology & Hematology, Medical University of Lodz, 90-647 Lodz, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology & Hematology, Medical University of Lodz, 90-647 Lodz, Poland
| | | | - Katarzyna Machnik
- Unit of Pediatric Hematology and Oncology, City Hospital, 41-500 Chorzow, Poland
| | - Sonia Pająk
- Unit of Pediatric Hematology and Oncology, City Hospital, 41-500 Chorzow, Poland
| | - Wanda Badowska
- Clinical Department of Pediatric Oncology and Hematology, Department of Clinical Pediatrics, University of Warmia and Mazury in Olsztyn, Regional Specialized Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Tomasz Brzeski
- Clinical Department of Pediatric Oncology and Hematology, Department of Clinical Pediatrics, University of Warmia and Mazury in Olsztyn, Regional Specialized Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Katarzyna Mycko
- Clinical Department of Pediatric Oncology and Hematology, Department of Clinical Pediatrics, University of Warmia and Mazury in Olsztyn, Regional Specialized Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Hanna Mańko-Glińska
- Clinical Department of Pediatric Oncology and Hematology, Department of Clinical Pediatrics, University of Warmia and Mazury in Olsztyn, Regional Specialized Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Agnieszka Urbanek-Dądela
- Department of Pediatric Oncology and Hematology, Collegium Medium of Jan Kochanowski University in Kielce, 25-317 Kielce, Poland
| | - Grażyna Karolczyk
- Department of Pediatric Oncology and Hematology, Collegium Medium of Jan Kochanowski University in Kielce, 25-317 Kielce, Poland
| | - Agnieszka Mizia-Malarz
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children’s Care Health, Medical University of Silesia, 40-752 Katowice, Poland
| | - Weronika Stolpa
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children’s Care Health, Medical University of Silesia, 40-752 Katowice, Poland
| | - Katarzyna Skowron-Kandzia
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children’s Care Health, Medical University of Silesia, 40-752 Katowice, Poland
| | - Jakub Musiał
- Clinic of Paediatric Oncology and Haematology, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Radosław Chaber
- Clinic of Paediatric Oncology and Haematology, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Ewa Bień
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland
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Napieralska A, Mizia-Malarz A, Stolpa W, Pawłowska E, Krawczyk MA, Konat-Bąska K, Kaczorowska A, Brąszewski A, Harat M. Polish Multi-Institutional Study of Children with Ependymoma-Clinical Practice Outcomes in the Light of Prospective Trials. Diagnostics (Basel) 2021; 11:diagnostics11122360. [PMID: 34943596 PMCID: PMC8700631 DOI: 10.3390/diagnostics11122360] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/29/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022] Open
Abstract
We performed a multi-institutional analysis of 74 children with ependymoma to evaluate to what extent the clinical outcome of prospective trials could be reproduced in routine practice. The evaluation of factors that correlated with outcome was performed with a log rank test and a Cox proportional-hazard model. Survival was estimated with the Kaplan–Meier method. The majority of patients had brain tumours (89%). All had surgery as primary treatment, with adjuvant radiotherapy (RTH) and chemotherapy (CTH) applied in 78% and 57%, respectively. Median follow-up was 80 months and 18 patients died. Five- and 10-year overall survival (OS) was 83% and 73%. Progression was observed in 32 patients, with local recurrence in 28 cases. The presence of metastases was a negative prognostic factor for OS. Five- and 10-year progression-free survival (PFS) was 55% and 40%, respectively. The best outcome in patients with non-disseminated brain tumours was observed when surgery was followed by RTH (+/−CTH afterwards; p = 0.0001). Children under 3 years old who received RTH in primary therapy had better PFS (p = 0.010). The best outcome of children with ependymoma is observed in patients who received radical surgery followed by RTH, and irradiation should not be omitted in younger patients. The role of CTH remains debatable.
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Affiliation(s)
- Aleksandra Napieralska
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland
- Correspondence:
| | - Agnieszka Mizia-Malarz
- Department of Pediatrics, Medical University of Silesia, 40-752 Katowice, Poland; (A.M.-M.); (W.S.)
| | - Weronika Stolpa
- Department of Pediatrics, Medical University of Silesia, 40-752 Katowice, Poland; (A.M.-M.); (W.S.)
| | - Ewa Pawłowska
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Małgorzata A. Krawczyk
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Katarzyna Konat-Bąska
- Wroclaw Comprehensive Cancer Center, 53-413 Wrocław, Poland;
- Department of Oncology, Wroclaw Medical University, 53-413 Wrocław, Poland
| | - Aneta Kaczorowska
- Department of Children Oncology and Haematology, Wroclaw Medical University, 53-413 Wrocław, Poland;
| | - Arkadiusz Brąszewski
- Department of Neurooncology and Radiosurgery, Franciszek Lukaszczyk Memorial Oncology Center, 85-796 Bydgoszcz, Poland; (A.B.); (M.H.)
| | - Maciej Harat
- Department of Neurooncology and Radiosurgery, Franciszek Lukaszczyk Memorial Oncology Center, 85-796 Bydgoszcz, Poland; (A.B.); (M.H.)
- Department of Oncology and Brachytherapy, Nicolas Copernicus University, Collegium Medicum, 85-067 Bydgoszcz, Poland
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Zawitkowska J, Lejman M, Szmydki-Baran A, Zaucha-Prażmo A, Czyżewski K, Dziedzic M, Zalas-Więcek P, Gryniewicz-Kwiatkowska O, Czajńska-Deptuła A, Gietka A, Semczuk K, Hutnik Ł, Chełmecka-Wiktorczyk L, Żak I, Frączkiewicz J, Salamonowicz M, Tomaszewska R, Zając-Spychała O, Irga-Jaworska N, Bień E, Płonowski M, Bartnik M, Ociepa T, Pierlejewski F, Machnik K, Gamrot-Pyka Z, Badowska W, Brzeski T, Urbanek-Dądela A, Stolpa W, Mizia-Malarz A, Skowron-Kandzia K, Musiał J, Styczyński J. Varicella-zoster virus infection in the pediatric population with acute lymphoblastic leukemia in Poland. J Med Virol 2020; 92:3645-3649. [PMID: 32406935 DOI: 10.1002/jmv.26008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/20/2020] [Accepted: 05/11/2020] [Indexed: 11/10/2022]
Abstract
Varicella-zoster virus (VZV) infection in pediatric hemato-oncology patients can be a therapeutic problem when children are exposed to immunosuppression. The aim of this study is to evaluate the incidence of VZV infection, antiviral therapy and outcome in children with ALL treated in polish hemato-oncological centers between 2012 and 2019 years. This study included medical records of 1874 patients, aged 1 to 18 years, with newly diagnosed acute lymphoblastic leukemia. During chemotherapy, 406 children out of 1874 (21.6%) experienced viral infections. The incidence of VZV infection in the whole group children with ALL was 1.8%. Among them, 34 (8.4%) patients were diagnosed with VZV infection. Thirty-five episodes of viral infections were identified. The median time of VCV therapy was 12 days. Herpes zoster infection occurred in 24 (70.6%) children, and varicella in 10 (29.4%) ones. The average time from the start of chemotherapy to the appearance of herpes zoster was 7.26 ± 4.05 months. VZV infection occurred mainly during the maintenance therapy, the reinduction and induction phases. There was no correlation between steroid dosage or type and subsequent zoster. The total lymphocyte count of these patients on the first day of zoster was reduced. No serious complications were observed due to this infection. All patients survived. In conclusion, a low incidence of VZV infection was observed among pediatric patients with ALL in Poland. This analysis indicates that currently used therapeutic methods are effective in children with cancer and VZV infection. The main focus should be on the prevention of delayed chemotherapy.
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Affiliation(s)
- Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, Lublin, Poland
| | - Monika Lejman
- Genetic Diagnostic Laboratory, Department of Pediatric Hematology, Oncology, and Transplantation, University Children's Hospital, Lublin, Poland
| | - Anna Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, Lublin, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | - Patrycja Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | | | | | - Agnieszka Gietka
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | - Katarzyna Semczuk
- Department of Microbiology, Children's Memorial Health Institute, Warszawa, Poland
| | - Łukasz Hutnik
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Liliana Chełmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Iwona Żak
- Department of Microbiology, University Children's Hospital, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wrocław, Poland
| | - Małgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wrocław, Poland
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology, and Transplantology, University of Medical Sciences, Poznań, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdańsk, Poland
| | - Ewa Bień
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdańsk, Poland
| | - Marcin Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, Białystok, Poland
| | - Magdalena Bartnik
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Ociepa
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Filip Pierlejewski
- Department of Pediatric Oncology, Hematology, and Diabetology, Medical University, Łódź, Poland
| | - Katarzyna Machnik
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzów, Poland
| | - Zuzanna Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzów, Poland
| | - Wanda Badowska
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - Tomasz Brzeski
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | | | - Weronika Stolpa
- Division of Pediatric Oncology, Hematology, and Chemotherapy, Silesian Medical University, Katowice, Poland
| | - Agnieszka Mizia-Malarz
- Division of Pediatric Oncology, Hematology, and Chemotherapy, Silesian Medical University, Katowice, Poland
| | - Katarzyna Skowron-Kandzia
- Division of Pediatric Oncology, Hematology, and Chemotherapy, Silesian Medical University, Katowice, Poland
| | - Jakub Musiał
- Division of Pediatric Onoco-hematology, St. Queen Jadwiga's Regional Clinical Hospital No. 2, Rzeszów, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
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Zając-Spychała O, Pieczonka A, Wachowiak J, Frączkiewicz J, Salamonowicz M, Kałwak K, Gorczyńska E, Kazanowska B, Wróbel G, Chybicka A, Czyżewski K, Dziedzic M, Wysocki M, Zalas-Więcek P, Szmydki-Baran A, Hutnik Ł, Matysiak M, Irga-Jaworska N, Bień E, Drożyńska E, Stolpa W, Sobol-Milejska G, Pierlejewski F, Młynarski W, Gryniewicz-Kwiatkowska O, Gietka A, Dembowska-Bagińska B, Semczuk K, Dzierżanowska-Fangrat K, Gamrot-Pyka Z, Woszczyk M, Urbanek-Dądela A, Karolczyk G, Płonowski M, Krawczuk-Rybak M, Zaucha-Prażmo A, Kowalczyk J, Goździk J, Styczyński J. Adenovirus infection among pediatric patients with cancer and in pediatric recipients of hematopoietic stem cell: A multicenter nationwide study. J Med Virol 2020; 92:3187-3193. [PMID: 32162698 DOI: 10.1002/jmv.25756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/03/2019] [Revised: 02/26/2020] [Accepted: 03/04/2020] [Indexed: 01/07/2023]
Abstract
The aim was to evaluate the incidence, clinical course, and outcome of adenoviral infection (AdVI) in pediatric patients diagnosed and treated due to cancer and in pediatric recipients of hematopoietic stem cell. Over a 72-month period, all-in 5599 children with cancer: 2441 patients with hematological malignancy (HM) and 3158 with solid tumors (ST), and 971 patients after transplantation: 741 after allogeneic (allo-HSCT) and 230 after autologous (auto-HSCT) were enrolled into the study. Among cancer patients, 67 episodes of AdVI appeared in 63 (1.1%) children, including 45 (1.8%) with HM and 18 (0.6%; P < .001) with ST. Within transplanted patients, AdVIs were responsible for 88 episodes in 81 (8.3%) children (P < .001), including 78 (10.5%) patients after allo-HSCT and 3 (1.3%) after auto-HSCT. Time to develop AdVI was short, especially after allo-HSCT. The most common clinical manifestation in cancer patients was enteritis diagnosed in 63 (94.0%) cases, while among HSCT recipient asymptomatic adenoviremia was found in 36 (40.9%) cases and the most common clinical manifestation was urinary tract infection. Cancer patients with disseminated disease, as well as HSCT recipients with either asymptomatic viremia or disseminated disease, received antiviral treatment. The most commonly used first-line therapy was cidofovir. None of the cancer patients died due to AdVI, while within HSCT recipients three patients developed disseminated adenoviral disease and died despite antiviral treatment. In cancer patients, AdVIs are rare and associated with very good prognosis even without specific treatment. However, in allo-HSCT recipients, disseminated disease with fatal outcome is more likely to occur.
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Affiliation(s)
- O Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - A Pieczonka
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - J Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - J Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - M Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - K Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - E Gorczyńska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - B Kazanowska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - G Wróbel
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - A Chybicka
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - K Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - P Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland
| | - A Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University Torun, Bydgoszcz, Poland
| | - Ł Hutnik
- Department of Pediatric Hematology and Oncology, Medical University Torun, Bydgoszcz, Poland
| | - M Matysiak
- Department of Pediatric Hematology and Oncology, Medical University Torun, Bydgoszcz, Poland
| | - N Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - E Bień
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - E Drożyńska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - W Stolpa
- Department of Pediatric, Division of Pediatric Oncology, Hematology and Chemotherapy, Silesian Medical University, Katowice, Poland
| | - G Sobol-Milejska
- Department of Pediatric, Division of Pediatric Oncology, Hematology and Chemotherapy, Silesian Medical University, Katowice, Poland
| | - F Pierlejewski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | - W Młynarski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | | | - A Gietka
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - K Semczuk
- Department of Microbiology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - Z Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - M Woszczyk
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - A Urbanek-Dądela
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Poland
| | - G Karolczyk
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Poland
| | - M Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - M Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - A Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - J Kowalczyk
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - J Goździk
- Department of Clinical Immunology and Transplantology, Stem Cell Transplant Center, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - J Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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Zajac-Spychala O, Wachowiak J, Gryniewicz-Kwiatkowska O, Gietka A, Dembowska-Baginska B, Semczuk K, Dzierzanowska-Fangrat K, Czyzewski K, Dziedzic M, Wysocki M, Zalas-Wiecek P, Szmydki-Baran A, Hutnik L, Matysiak M, Pierlejewski F, Mlynarski W, Małas Z, Badowska W, Irga-Jaworska N, Bien E, Drozynska E, Bartnik M, Ociepa T, Urasiński T, Wawrykow P, Peregud-Pogorzelski J, Stolpa W, Sobol-Milejska G, Fraczkiewicz J, Salamonowicz M, Kazanowska B, Chybicka A, Chelmecka-Wiktorczyk L, Balwierz W, Zak I, Gamrot-Pyka Z, Woszczyk M, Tomaszewska R, Szczepanski T, Plonowski M, Krawczuk-Rybak M, Urbanek-Dadela A, Karolczyk G, Musial J, Chaber R, Kowalczyk J, Styczynski J. Prevalence, Epidemiology, Etiology, and Sensitivity of Invasive Bacterial Infections in Pediatric Patients Undergoing Oncological Treatment: A Multicenter Nationwide Study. Microb Drug Resist 2020; 27:53-63. [PMID: 32434455 DOI: 10.1089/mdr.2019.0393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/26/2022] Open
Abstract
Background: Infectious complications (IC) caused by bacterial strains often impede anticancer therapy. The study aimed to retrospectively analyze bacterial IC that could help predict the risk and optimize the empirical treatment for bacterial infections in pediatric cancer patients. Patients and Methods: Over a 72-month period, all-in 5,599 children with cancer: 2,441 patients with hematological malignancy (HM including acute leukemias, Hodgkin and non-Hodgkin lymphomas [NHLs], and Langerhans cell histiocytosis) and 3,158 with solid tumors (STs including central nervous system tumors, neuroblastoma, Wilms' tumor, soft tissue sarcoma, germ cell tumors, Ewing sarcoma, osteosarcoma, hepatoblastoma, and others) were enrolled into the study. Episodes of bacterial infectious complications (EBICs) confirmed by microbiological findings were reported by each hospital and analyzed centrally. Results: At least 1 EBIC was diagnosed in 2,155 (36.8%) children (1,281 [59.4%] with HM and 874 [40.6%] with ST; p < 0.001). All-in 4,860 EBICs were diagnosed including 62.2% episodes in children with HM and 37.8% in children with ST (p < 0.001). Having analyzed the source of infections, blood stream infections predominated, apart from NHL patients in whom the most common type was gut infections. The profile of bacteria strains was different in HM and ST groups (p < 0.001). However, in both groups the most common Gram-negative pathogen was Enterobacteriaceae, with the rate being higher in the HM group. Among Gram-negative strains low susceptibility to ceftazidime, whereas among Enterococcus spp. low susceptibility to vancomycin was noticed. The rate of multidrug-resistant (MDR) pathogens was high, especially for Gram negatives (47.7% vs. 23.9%; p < 0.001). The survival after infections was comparable for HM and ST patients (p = 0.215). Conclusions: The risk of bacterial IC in HM patients was higher than in the ST group. The high rate of MDR strains was detected in pediatric cancer patients, especially in those with HM.
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Affiliation(s)
- Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | | | - Aneta Gietka
- Department of Oncology and Children's Memorial Health Institute, Warszawa, Poland
| | | | - Katarzyna Semczuk
- Department of Microbiology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - Krzysztof Czyzewski
- Department of Pediatric Hematology and Oncology and Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology and Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Mariusz Wysocki
- Department of Pediatric Hematology and Oncology and Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Patrycja Zalas-Wiecek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Anna Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Lukasz Hutnik
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Michal Matysiak
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Filip Pierlejewski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | - Wojciech Mlynarski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | - Zofia Małas
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - Wanda Badowska
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - Elzbieta Drozynska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - Magdalena Bartnik
- Department of Pediatrics, Hemato-Oncology and Gastroenterology and Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hemato-Oncology and Gastroenterology and Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hemato-Oncology and Gastroenterology and Pomeranian Medical University, Szczecin, Poland
| | - Pawel Wawrykow
- Department of Pediatrics and Oncology, Pomeranian Medical University, Szczecin, Poland
| | | | - Weronika Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - Grazyna Sobol-Milejska
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - Jowita Fraczkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Malgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Bernarda Kazanowska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Alicja Chybicka
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Liliana Chelmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology and University Children's Hospital, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology and University Children's Hospital, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Iwona Zak
- Department of Microbiology, University Children's Hospital, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Zuzanna Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - Mariola Woszczyk
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - Tomasz Szczepanski
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - Marcin Plonowski
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | | | - Grazyna Karolczyk
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Poland
| | - Jakub Musial
- Department of Pediatric Oncohematology, Children Hospital, Rzeszow, Poland
| | - Radoslaw Chaber
- Department of Pediatric Oncohematology, Children Hospital, Rzeszow, Poland
| | - Jerzy Kowalczyk
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology and Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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9
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Zając-Spychała O, Wachowiak J, Czyżewski K, Dziedzic M, Wysocki M, Zalas-Więcek P, Szmydki-Baran A, Hutnik Ł, Matysiak M, Małas Z, Badowska W, Gryniewicz-Kwiatkowska O, Gietka A, Dembowska-Bagińska B, Semczuk K, Dzierżanowska-Fangrat K, Bartnik M, Ociepa T, Urasiński T, Frączkiewicz J, Salamonowicz M, Kałwak K, Gorczyńska E, Chybicka A, Irga-Jaworska N, Bień E, Drożyńska E, Chełmecka-Wiktorczyk L, Balwierz W, Zak I, Pierlejewski F, Młynarski W, Urbanek-Dądela A, Karolczyk G, Stolpa W, Sobol-Milejska G, Płonowski M, Krawczuk-Rybak M, Musiał J, Chaber R, Gamrot-Pyka Z, Woszczyk M, Tomaszewska R, Szczepański T, Kowalczyk J, Styczyński J. Hematopoietic stem cell transplantation does not increase the risk of infection-related complications for pediatric patients with Hodgkin and non-Hodgkin lymphomas: A multicenter nationwide study. Transpl Infect Dis 2020; 22:e13292. [PMID: 32285579 DOI: 10.1111/tid.13292] [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: 06/24/2019] [Revised: 01/31/2020] [Accepted: 03/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hodgkin (HL) and non-Hodgkin lymphoma (NHL) represent a spectrum of lymphoid malignancies that are often curable with currently applied treatment regimens; however, 15%-30% of lymphoma patients still suffer from relapsed or refractory (rel/ref) disease. Although hematopoietic stem cell transplantation (HSCT) improves outcomes of second-line therapy for lymphoma in childhood, the complication rates in this group of patients, especially infectious complications (IC), remain unclear. OBJECTIVE The aim of this population-based cohort study was a retrospective analysis of incidence, epidemiology and profile of bacterial infections (BI), invasive fungal disease (IFD), and viral infections (VI) in primary or rel/ref lymphoma patients, both HL and NHL. PATIENTS AND METHODS We subdivided lymphoma patients into three groups: patients with primary conventional chemotherapy/radiotherapy regimens (group A), patients with rel/ref lymphoma treated with second-line chemotherapy (group B), and rel/ref lymphoma patients who underwent HSCT (group C). The medical records of the patients were biannually reported by each pediatric oncology center, and the data were analyzed centrally. RESULTS Within 637 patients with primary lymphoma, at least one IC was diagnosed in 255 (40.0%), among 52 patients with rel/ref lymphoma 24 (46.2%) ICs were observed, and in transplanted group, 28 (57.1%) out of 49 children were diagnosed with IC (P = .151). The distribution of etiology of IC differed between the patient groups (A, B, C), with a predominance of BI in group A (85.6% vs 72.0% and 47.9%, respectively), VI in group C (9% and 16.0% vs 46.6%, respectively), and IFD in group B (5.4% vs 12.0% vs 5.5%, respectively). Overall, 500 (68.0%) episodes of bacterial IC were diagnosed in the entire group. Apart from HL patients treated with chemotherapy, in all the other subgroups of patients Gram-positives were predominant. The rate of multidrug-resistant bacteria was high, especially for Gram-negatives (41.1% in group A, 62.5% in group B, and 84.6% in group C). The infection-related mortality was comparable for each group. CONCLUSIONS The incidence of IC was comparable during first- and second-line chemotherapy and after HSCT, but their profile was different for primary or re/ref lymphoma and depended on the type of therapy.
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Affiliation(s)
- O Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - J Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - K Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - P Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - A Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Ł Hutnik
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - M Matysiak
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Z Małas
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - W Badowska
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | | | - A Gietka
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - K Semczuk
- Department of Microbiology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - M Bartnik
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - T Ociepa
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - T Urasiński
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - J Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - M Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - K Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - E Gorczyńska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - A Chybicka
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - N Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - E Bień
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - E Drożyńska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - L Chełmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology, Collegium Medicum, University Children's Hospital, Jagiellonian University, Krakow, Poland
| | - W Balwierz
- Department of Pediatric Oncology and Hematology, Collegium Medicum, University Children's Hospital, Jagiellonian University, Krakow, Poland
| | - I Zak
- Department of Microbiology, Collegium Medicum, University Children's Hospital, Jagiellonian University, Krakow, Poland
| | - F Pierlejewski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | - W Młynarski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | - A Urbanek-Dądela
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Poland
| | - G Karolczyk
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Poland
| | - W Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - G Sobol-Milejska
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - M Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - M Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - J Musiał
- Department of Pediatric Oncohematology, Children Hospital, Rzeszow, Poland
| | - R Chaber
- Department of Pediatric Oncohematology, Children Hospital, Rzeszow, Poland
| | - Z Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - M Woszczyk
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - R Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - T Szczepański
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - J Kowalczyk
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - J Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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Czyżewski K, Gałązka P, Frączkiewicz J, Salamonowicz M, Szmydki-Baran A, Zając-Spychała O, Gryniewicz-Kwiatkowska O, Zalas-Więcek P, Chełmecka-Wiktorczyk L, Irga-Jaworska N, Bień E, Ociepa T, Wawryków P, Tomaszewska R, Płonowski M, Pierlejewski F, Gamrot-Pyka Z, Małas Z, Urbanek-Dądela A, Stolpa W, Zaucha-Prażmo A, Goździk J, Chaber R, Gil L, Styczyński J. Epidemiology and outcome of invasive fungal disease in children after hematopoietic cell transplantation or treated for malignancy: Impact of national programme of antifungal prophylaxis. Mycoses 2020; 62:990-998. [PMID: 31429997 DOI: 10.1111/myc.12990] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/04/2019] [Accepted: 08/13/2019] [Indexed: 12/01/2022]
Abstract
The objective of the study was the analysis of incidence and outcome of invasive fungal disease (IFD) in children treated for malignancy (PHO, paediatric hematology-oncology) or undergoing hematopoietic cell transplantation (HCT) over a period of six consecutive years in nationwide study. A total number of 5628 patients with newly diagnosed malignancies and 971 patients after HCT (741 allo-HCT and 230 auto-HCT) were screened for infectious complications in biennial reports. IFD incidence was lower among PHO patients: 8.8% vs 21.2% (P < .0001) and survival from IFD was better: 94.2% vs 84.1% (P < .0001). Auto-HCT patients had lower incidence (10.9% vs 24.4%) and lower mortality than allo-HCT patients. Introduction of national antifungal prophylaxis programme in HCT and acute leukaemia patients decreased incidence of IFD in HCT (from 23.1% to 13.4%) and AML on conventional chemotherapy (from 36% to 23%) but not in ALL patients during chemotherapy. In multivariate analysis, the incidence of IFD was higher in patients after HCT, diagnosed for ALL, AML or NHL, and in patients > 10 years old. Factors contributing to death with infection were as follows: undergoing HCT, diagnosis of acute leukaemia (ALL or AML) and duration of treatment of infection > 21 days. In conclusion, the incidence of IFD in allo-HCT and in AML patients on chemotherapy has decreased after introduction of national programme of antifungal prophylaxis, while the incidence of IFD in ALL patients on chemotherapy did not change significantly. The outcome of IFD both in PHO and HCT patients has largely improved in comparison with historical international data.
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Affiliation(s)
- Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Przemysław Gałązka
- Department of Pediatric Surgery, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Małgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Anna Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | | | - Patrycja Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Liliana Chełmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - Ewa Bień
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - Tomasz Ociepa
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Paweł Wawryków
- Department of Pediatric Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - Marcin Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - Filip Pierlejewski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | - Zuzanna Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - Zofia Małas
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | | | - Weronika Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - Jolanta Goździk
- Stem Cell Transplant Center, Department of Clinical Immunology and Transplantology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Radosław Chaber
- Department of Pediatric Oncohematology, University Rzeszów, Rzeszów, Poland
| | - Lidia Gil
- Department of Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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Czyzewski K, Galazka P, Zalas-Wiecek P, Gryniewicz-Kwiatkowska O, Gietka A, Semczuk K, Chelmecka-Wiktorczyk L, Zak I, Salamonowicz M, Fraczkiewicz J, Zajac-Spychala O, Bien E, Plonowski M, Wawrykow P, Pierlejewski F, Gamrot Z, Malas Z, Stolpa W, Musial J, Styczynski J. Infectious complications in children with malignant bone tumors: a multicenter nationwide study. Infect Drug Resist 2019; 12:1471-1480. [PMID: 31213862 PMCID: PMC6549759 DOI: 10.2147/idr.s199657] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/29/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives: The analysis of epidemiology, risk factors and outcome of infections in children with malignant bone tumors (MBT) undergoing chemotherapy. Methods: In this retrospective nationwide multicenter cross-sectional study, a total number of 126 children with MBT including 70 with Ewing sarcoma (ES) and 56 with osteosarcoma (OSA) were screened for infections over a period of 72 consecutive months. Results: The risk of infection was 7.15-fold higher in patients with ES as compared to the OSA group, especially concerning bacterial infections (4.1-fold increase risk). Bacterial infections occurred in 74.3% patients with ES and in 41.1% with OSA. The median time from diagnosis to first infection was 4.9 months. 33.0% of bacterial episodes were diagnosed as bloodstream (BSI), 31.1% as gastrointestinal tract, 30.1% as urinary tract infection. Infection-related mortality (IRM) from bacterial infection was 6% and 15% in ES and OSA patients, respectively. Cumulative incidence was 7.1% for invasive fungal disease and 6.3% for viral infections. The only significant risk factor for IRM was time to infection ≥5 months since the beginning of chemotherapy. All patients who have died from infection had BSI and were in neutropenia. Conclusions: Infections in the children with MBT in our study occurred with high frequency, especially in patients with ES. The most frequent were bacterial infections, while fungal and viral infections were episodic. Among the bacterial infections, bloodstream, urinary tract and gastrointestinal tract infections occurred with similar frequency. All deceased patients died due to BSI. Bacterial infection occurring ≥5 months since the beginning of chemotherapy was a risk factor for death.
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Affiliation(s)
- Krzysztof Czyzewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Przemyslaw Galazka
- Department of General and Oncological Surgery for Children and Adolescents, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Patrycja Zalas-Wiecek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | | | - Agnieszka Gietka
- Department of Oncology, Children's Memorial Health Institute, Warsaw, Poland
| | - Katarzyna Semczuk
- Department of Microbiology, Children's Memorial Health Institute, Warsaw, Poland
| | - Liliana Chelmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Iwona Zak
- Department of Microbiology, University Children's Hospital, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Malgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Jowita Fraczkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - Marcin Plonowski
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - Pawel Wawrykow
- Department of Pediatrics and Pediatric Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Filip Pierlejewski
- Department of Pediatric Oncology and Hematology, Medical University, Lodz, Poland
| | - Zuzanna Gamrot
- Division of Pediatric Hematology and Oncology, Chorzow City Hospital, Chorzow, Poland
| | - Zofia Malas
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - Weronika Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - Jakub Musial
- Department of Pediatric Oncohematology, Medical Faculty University of Rzeszow, Clinical Provincial Hospital No. 2, Rzeszow, Poland
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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12
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Zając-Spychała O, Skalska-Sadowska J, Wachowiak J, Szmydki-Baran A, Hutnik Ł, Matysiak M, Pierlejewski F, Młynarski W, Czyżewski K, Dziedzic M, Wysocki M, Zalas-Więcek P, Bartnik M, Ociepa T, Urasiński T, Małas Z, Badowska W, Gamrot-Pyka Z, Woszczyk M, Tomaszewska R, Szczepański T, Irga-Jaworska N, Drożyńska E, Urbanek-Dądela A, Karolczyk G, Płonowski M, Krawczuk-Rybak M, Frączkiewicz J, Salamonowicz M, Chybicka A, Stolpa W, Sobol-Milejska G, Chełmecka-Wiktorczyk L, Balwierz W, Zak I, Gryniewicz-Kwiatkowska O, Gietka A, Dembowska-Bagińska B, Semczuk K, Dzierżanowska-Fangrat K, Musiał J, Chaber R, Kowalczyk J, Styczyński J. Infections in children with acute myeloid leukemia: increased mortality in relapsed/refractory patients. Leuk Lymphoma 2019; 60:3028-3035. [PMID: 31132917 DOI: 10.1080/10428194.2019.1616185] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The aim of this nationwide study was to describe the epidemiology and profile of bacterial infections (BI), invasive fungal disease (IFD) and viral infections (VI) in patients with de novo and relapsed/refractory (rel/ref) acute myeloid leukemia (AML). Within the studied group of 250 children with primary AML, at least one infectious complication (IC) was diagnosed in 76.0% (n = 190) children including 85.1% (n = 504) episodes of BI, 8.3% (n = 49) - IFD and 6.6% (n = 39) - VI. Among 61 patients with rel/ref AML, at least one IC was found in 67.2% (n = 41) of children including 78.8% (n = 78) of BI, 14.1% (n = 14) of IFD and 7.1% (n = 7) of VI. In all AML patients, within BI Gram-negative strains were predominant. Half of these strains were multi-drug resistant. Characteristics of IFD and VI were comparable for de novo and rel/ref AML. The infection-related mortality was significantly higher, while survival from infection was significantly lower in patients with rel/ref disease.
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Affiliation(s)
- Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Jolanta Skalska-Sadowska
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Anna Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Łukasz Hutnik
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Michał Matysiak
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Filip Pierlejewski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | - Wojciech Młynarski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Mariusz Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Patrycja Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Magdalena Bartnik
- Department of Pediatrics and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Ociepa
- Department of Pediatrics and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Zofia Małas
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - Wanda Badowska
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - Zuzanna Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - Mariola Woszczyk
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - Nina Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - Elżbieta Drożyńska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | | | - Grażyna Karolczyk
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Poland
| | - Marcin Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Malgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Alicja Chybicka
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Weronika Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatrics, Silesian Medical University, Katowice, Poland
| | - Grazyna Sobol-Milejska
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatrics, Silesian Medical University, Katowice, Poland
| | - Liliana Chełmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Iwona Zak
- Department of Microbiology, University Children's Hospital, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | | | - Aneta Gietka
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - Katarzyna Semczuk
- Department of Microbiology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - Jakub Musiał
- Department of Pediatric Oncohematology, Children Hospital, Rzeszow, Poland
| | - Radoslaw Chaber
- Department of Pediatric Oncohematology, Children Hospital, Rzeszow, Poland
| | - Jerzy Kowalczyk
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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13
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Zawitkowska J, Drabko K, Szmydki-Baran A, Zaucha-Prażmo A, Lejman M, Czyżewski K, Zalas-Więcek P, Gryniewicz-Kwiatkowska O, Czajńska-Deptuła A, Kulicka E, Semczuk K, Hutnik Ł, Chełmecka-Wiktorczyk L, Klepacka J, Frączkiewicz J, Salamonowicz M, Tomaszewska R, Zając-Spychała O, Irga-Jaworska N, Bień E, Płonowski M, Bartnik M, Ociepa T, Pierlejewski F, Woszczyk M, Gamrot-Pyka Z, Małas Z, Urbanek-Dądela A, Stolpa W, Musiał J, Styczyński J. Infectious profile in children with ALL during chemotherapy: A report of study group for infections. J Infect Chemother 2019; 25:774-779. [PMID: 31101529 DOI: 10.1016/j.jiac.2019.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/18/2019] [Revised: 03/20/2019] [Accepted: 04/06/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The treatment-related mortality in currently published studies of acute lymphoblastic leukemia (ALL) in children is 2-4%, mainly due to infections. The aim of the study was to analyse the incidence, epidemiology, profile of infection and the death rate in children with ALL. PATIENTS AND METHODS The retrospective analysis included 1363 patients, aged 1-18 years, with newly diagnosed ALL, who were treated in 17 pediatric hematology centers between 2012 and 2017 in Poland. The patients received therapy according to the ALL IC-BFM 2002 and 2009 (International Berlin-Frankfurt-Munster Study Group) protocols. RESULTS In our study, 726 out of 1363 (53.2%) children were reported to have a microbiologically documented bacterial infection during chemotherapy. 1511 episodes of these infection were diagnosed. A total number of 251/1363 (18.4%) children experienced a viral infection. 304 episodes were documented by PCR test (polymerase chain reaction). A fungal infection was reported in 278 (20.4%) children, including 10.1% of probable, 6.0% of proven, 83% of possible diagnosis. A higher frequency of fungal infection was noted in the recent years. In our material, the rate of death was 2.4%, mainly due to fungal infection. CONCLUSIONS Our results present the epidemiology of infectious disease in the Polish ALL patient population. The most frequent were bacterial infections, followed by fungal and viral ones. Similar to the previously published data, the mortality rate in our material was 2.4%.
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Affiliation(s)
- Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, Lublin, Poland.
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, Lublin, Poland
| | - Anna Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, Lublin, Poland
| | - Monika Lejman
- Department of Pediatric Hematology, Oncology and Transplantation, University Children's Hospital, Genetic Diagnostic Laboratory, Lublin, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | - Patrycja Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | | | | | - Elwira Kulicka
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | - Katarzyna Semczuk
- Department of Microbiology, Children's Memorial Health Institute, Warszawa, Poland
| | - Łukasz Hutnik
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Liliana Chełmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Joanna Klepacka
- Department of Microbiology, University Children's Hospital, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wrocław, Poland
| | - Małgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wrocław, Poland
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznań, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdańsk, Poland
| | - Ewa Bień
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdańsk, Poland
| | - Marcin Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, Białystok, Poland
| | - Magdalena Bartnik
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Ociepa
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Filip Pierlejewski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Łódź, Poland
| | - Mariola Woszczyk
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzów, Poland
| | - Zuzanna Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzów, Poland
| | - Zofia Małas
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | | | - Weronika Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - Jakub Musiał
- Division of Pediatric Onoco-hematology, St. Queen Jadwiga's Regional Clinical Hospital No. 2, Rzeszów, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
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14
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Zajac-Spychala O, Wachowiak J, Szmydki-Baran A, Hutnik L, Salamonowicz M, Matysiak M, Czyzewski K, Wysocki M, Zalas-Wiecek P, Malas Z, Badowska W, Gryniewicz-Kwiatkowska O, Czajnska-Deptuła A, Kulicka E, Dembowska-Baginska B, Perek D, Semczuk K, Dzierzanowska-Fangrat K, Ociepa T, Bartnik M, Chelmecka-Wiktorczyk L, Balwierz W, Klepacka J, Irga-Jaworska N, Bien E, Adamkiewicz-Drozynska E, Urbanek-Dadela A, Karolczyk G, Pierlejewski F, Mlynarski W, Plonowski M, Krawczuk-Rybak M, Stolpa W, Sobol G, Tomaszewska R, Szczepanski T, Gamrot Z, Woszczyk M, Wieczorek M, Kowalczyk J, Styczynski J. Infectious complications in children treated for hodgkin and non-hodgkin lymphomas in polish pediatric leukemia/lymphoma study group: incidence, epidemiology and etiology. Leuk Lymphoma 2018; 60:124-132. [PMID: 30392426 DOI: 10.1080/10428194.2018.1466293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/18/2022]
Abstract
The objective of this nation-wide study was to evaluate the epidemiology and profile of bacterial (BI), viral (VI), and invasive fungal disease (IFD) in patients treated for non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) between the years 2013-2015. In the analyzed period of time, within the studied group of 328 children diagnosed and treated for lymphomas, at least one infectious complication (IC) was diagnosed i.e. 39.3% children. In these patients there were 350 episodes of IC, therein 80.6% episodes of BI, 11.1% episodes of VI, and 8.3% episodes of IFD. In both groups, NHL and HL patients, a stable level of bacterial infections, with an increase in resistance rates, and increased levels of viral and fungal infections were observed. Profile of BI does not depend on lymphoma type, with predominance of Gram-negative bacteria and higher prevalence of MDR pathogens. The overall survival of lymphoma patients with IC was comparable for different types of infections.
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Affiliation(s)
- Olga Zajac-Spychala
- a Department of Pediatric Oncology, Hematology and Transplantology , Poznan University of Medical Sciences , Poznan , Poland
| | - Jacek Wachowiak
- a Department of Pediatric Oncology, Hematology and Transplantology , Poznan University of Medical Sciences , Poznan , Poland
| | - Anna Szmydki-Baran
- b Department of Paediatric Haematology and Oncology , Medical University , Warszawa , Poland
| | - Lukasz Hutnik
- b Department of Paediatric Haematology and Oncology , Medical University , Warszawa , Poland
| | - Malgorzata Salamonowicz
- b Department of Paediatric Haematology and Oncology , Medical University , Warszawa , Poland
| | - Michal Matysiak
- b Department of Paediatric Haematology and Oncology , Medical University , Warszawa , Poland
| | - Krzysztof Czyzewski
- c Department of Paediatric Haematology and Oncology , Collegium Medicum, Nicolaus Copernicus University Torun , Bydgoszcz , Poland
| | - Mariusz Wysocki
- c Department of Paediatric Haematology and Oncology , Collegium Medicum, Nicolaus Copernicus University Torun , Bydgoszcz , Poland
| | - Patrycja Zalas-Wiecek
- d Department of Microbiology , Collegium Medicum, Nicolaus Copernicus University Torun , Bydgoszcz , Poland
| | - Zofia Malas
- e Division of Paediatric Haematology and Oncology , Children Hospital , Olsztyn , Poland
| | - Wanda Badowska
- e Division of Paediatric Haematology and Oncology , Children Hospital , Olsztyn , Poland
| | | | | | - Elwira Kulicka
- f Department of Oncology , Children's Memorial Health Institute , Warszawa , Poland
| | | | - Danuta Perek
- f Department of Oncology , Children's Memorial Health Institute , Warszawa , Poland
| | - Katarzyna Semczuk
- g Department of Microbiology , Children's Memorial Health Institute , Warszawa , Poland
| | | | - Tomasz Ociepa
- h Department of Pediatrics Hematology/Oncology and Gastroenterology , Pomeranian Medical University , Szczecin , Poland
| | - Magdalena Bartnik
- h Department of Pediatrics Hematology/Oncology and Gastroenterology , Pomeranian Medical University , Szczecin , Poland
| | - Liliana Chelmecka-Wiktorczyk
- i Department of Paediatric Oncology and Haematology , University Children's Hospital, Jagiellonian University Collegium Medicum , Krakow , Poland
| | - Walentyna Balwierz
- j University Children's Hospital, Jagiellonian University Collegium Medicum , Krakow , Poland
| | - Joanna Klepacka
- k Department of Microbiology , Jagiellonian University Collegium Medicum , Krakow , Poland
| | - Nina Irga-Jaworska
- i Department of Paediatric Oncology and Haematology , University Children's Hospital, Jagiellonian University Collegium Medicum , Krakow , Poland
| | - Ewa Bien
- m Department of Paediatrics, Haematology and Oncology , Medical University , Gdansk , Poland
| | | | | | | | - Filip Pierlejewski
- p Department of Paediatric Oncology Haematology and Diabetology , Medical University , Lodz , Poland
| | - Wojciech Mlynarski
- p Department of Paediatric Oncology Haematology and Diabetology , Medical University , Lodz , Poland
| | - Marcin Plonowski
- q Department of Paediatric Oncology and Haematology , Medical University , Bialystok , Poland
| | - Maryna Krawczuk-Rybak
- q Department of Paediatric Oncology and Haematology , Medical University , Bialystok , Poland
| | - Weronika Stolpa
- r Division of Paediatric Oncology, Haematology and Chemotherapy, Department of Paediatric , Silesian Medical University, Katowice , Katowice , Poland
| | - Grazyna Sobol
- r Division of Paediatric Oncology, Haematology and Chemotherapy, Department of Paediatric , Silesian Medical University, Katowice , Katowice , Poland
| | - Renata Tomaszewska
- s Department of Pediatric Hematology and Oncology , Medical University of Silesia, Katowice , Zabrze , Poland
| | - Tomasz Szczepanski
- t Department of Pediatric Hematology and Oncology , Medical University of Silesia , Zabrze , Poland
| | - Zuzanna Gamrot
- u Division of Paediatric Haematology and Oncology , Chorzow Paediatric and Oncology Center , Chorzow , Poland
| | - Mariola Woszczyk
- u Division of Paediatric Haematology and Oncology , Chorzow Paediatric and Oncology Center , Chorzow , Poland
| | - Maria Wieczorek
- u Division of Paediatric Haematology and Oncology , Chorzow Paediatric and Oncology Center , Chorzow , Poland
| | - Jerzy Kowalczyk
- v Department of Pediatric Hematology and Oncology , Medical University , Lublin , Poland
| | - Jan Styczynski
- c Department of Paediatric Haematology and Oncology , Collegium Medicum, Nicolaus Copernicus University Torun , Bydgoszcz , Poland
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15
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Salamonowicz M, Ociepa T, Frączkiewicz J, Szmydki-Baran A, Matysiak M, Czyżewski K, Wysocki M, Gałązka P, Zalas-Więcek P, Irga-Jaworska N, Drożyńska E, Zając-Spychała O, Wachowiak J, Gryniewicz-Kwiatkowska O, Czajńska-Deptuła A, Dembowska-Bagińska B, Chełmecka-Wiktorczyk L, Balwierz W, Bartnik M, Zielezińska K, Urasiński T, Tomaszewska R, Szczepański T, Płonowski M, Krawczuk-Rybak M, Pierlejewski F, Młynarski W, Gamrot-Pyka Z, Woszczyk M, Małas Z, Badowska W, Urbanek-Dądela A, Karolczyk G, Stolpa W, Sobol-Milejska G, Zaucha-Prażmo A, Kowalczyk J, Goździk J, Gorczyńska E, Jermakow K, Król A, Chybicka A, Ussowicz M, Kałwak K, Styczyński J. Incidence, course, and outcome of Clostridium difficile infection in children with hematological malignancies or undergoing hematopoietic stem cell transplantation. Eur J Clin Microbiol Infect Dis 2018; 37:1805-1812. [PMID: 29978303 PMCID: PMC6133038 DOI: 10.1007/s10096-018-3316-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/26/2018] [Indexed: 12/13/2022]
Abstract
Clostridium difficile infection (CDI) is one of the most common causes of nosocomial infectious diarrhea in children during anticancer therapy or undergoing hematopoietic stem cell transplantation (HSCT) in Europe. Immunosuppression in these patients is a risk factor for CDI. Malignant diseases, age, acute graft-versus-host disease (aGVHD), HLA mismatch, or use of total body irradiation may play an important role in CDI course. The aim of this study was to evaluate the incidence, course, and outcome of CDI in children treated for malignancy or undergoing HSCT. Between 2012 and 2015, a total number of 1846 patients were treated for malignancy in Polish pediatric oncological centers (PHO group) and 342 underwent transplantation (HSCT group). In PHO group, episodes of CDI occurred in 210 patients (14%). The incidence of CDI was higher in patients with hematological malignancies in comparison to that with solid tumors. Patients with acute myeloblastic leukemia had shorter time to episode of CDI than those with acute lymphoblastic leukemia. Patients over 5 years and treated for acute leukemia had more severe clinical course of disease in PHO group. In HSCT group, CDI occurred in 29 (8%) patients. The incidence of CDI was higher in patients transplanted for acute leukemia. The recurrence rate was 14.7% in PHO and 20.7% in HSCT patients. CDI incidence was highest in patients with hematological malignancies. Most of patients experienced mild CDI. Age < 5 years and diagnosis other than acute leukemia were the positive prognostic factors influencing clinical CDI course.
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Affiliation(s)
- Małgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland.
| | - T Ociepa
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - J Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - A Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Warszawa, Poland
| | - M Matysiak
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Warszawa, Poland
| | - K Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - P Gałązka
- Department of Pediatric Surgery, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - P Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - N Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Gdansk, Poland
| | - E Drożyńska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Gdansk, Poland
| | - O Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - J Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | | | - A Czajńska-Deptuła
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - L Chełmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - W Balwierz
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - M Bartnik
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - K Zielezińska
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - T Urasiński
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - R Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - T Szczepański
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - M Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Bialystok, Poland
| | - M Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Bialystok, Poland
| | - F Pierlejewski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Lodz, Poland
| | - W Młynarski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Lodz, Poland
| | - Z Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - M Woszczyk
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - Z Małas
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Olsztyn, Poland
| | - W Badowska
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Olsztyn, Poland
| | - A Urbanek-Dądela
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Kielce, Poland
| | - G Karolczyk
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Kielce, Poland
| | - W Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - G Sobol-Milejska
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - A Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Lublin, Poland
| | - J Kowalczyk
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Lublin, Poland
| | - J Goździk
- Stem Cell Transplant Center, University Children's Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - E Gorczyńska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - K Jermakow
- Department of Microbiology, Medical University, Wroclaw, Wroclaw, Poland
| | - A Król
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - A Chybicka
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - M Ussowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - K Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - J Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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16
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Styczynski J, Czyzewski K, Wysocki M, Zajac-Spychala O, Wachowiak J, Ociepa T, Urasinski T, Gryniewicz-Kwiatkowska O, Kolodziejczyk-Gietka A, Dembowska-Baginska B, Perek D, Salamonowicz M, Hutnik L, Matysiak M, Siewiera K, Frackiewicz J, Kalwak K, Badowska W, Malas Z, Gozdzik J, Urbanek-Dadela A, Karolczyk G, Stolpa W, Sobol G, Gamrot Z, Woszczyk M, Gil L. Micafungin in invasive fungal infections in children with acute leukemia or undergoing stem cell transplantation. Leuk Lymphoma 2016; 57:2456-9. [PMID: 26880109 DOI: 10.3109/10428194.2016.1143937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jan Styczynski
- a Department of Pediatric Hematology and Oncology, Collegium Medicum , Nicolaus Copernicus University Torun , Bydgoszcz , Poland
| | - Krzysztof Czyzewski
- a Department of Pediatric Hematology and Oncology, Collegium Medicum , Nicolaus Copernicus University Torun , Bydgoszcz , Poland
| | - Mariusz Wysocki
- a Department of Pediatric Hematology and Oncology, Collegium Medicum , Nicolaus Copernicus University Torun , Bydgoszcz , Poland
| | - Olga Zajac-Spychala
- b Department of Pediatric Oncology , Hematology and Transplantology, University of Medical Sciences , Poznan , Poland
| | - Jacek Wachowiak
- b Department of Pediatric Oncology , Hematology and Transplantology, University of Medical Sciences , Poznan , Poland
| | - Tomasz Ociepa
- c Department of Pediatric Hematology and Oncology , Pomeranian Medical University , Szczecin , Poland
| | - Tomasz Urasinski
- c Department of Pediatric Hematology and Oncology , Pomeranian Medical University , Szczecin , Poland
| | | | | | | | - Danuta Perek
- d Department of Oncology , Children's Memorial Health Institute , Warszawa , Poland
| | | | - Lukasz Hutnik
- e Department of Pediatric Hematology and Oncology , Medical University , Warszawa , Poland
| | - Michal Matysiak
- e Department of Pediatric Hematology and Oncology , Medical University , Warszawa , Poland
| | - Karolina Siewiera
- f Department of Pediatric Stem Cell Transplantation, Hematology and Oncology , Medical University , Wroclaw , Poland
| | - Jowita Frackiewicz
- f Department of Pediatric Stem Cell Transplantation, Hematology and Oncology , Medical University , Wroclaw , Poland
| | - Krzysztof Kalwak
- f Department of Pediatric Stem Cell Transplantation, Hematology and Oncology , Medical University , Wroclaw , Poland
| | - Wanda Badowska
- g Division of Pediatric Hematology and Oncology , Children Hospital , Olsztyn , Poland
| | - Zofia Malas
- g Division of Pediatric Hematology and Oncology , Children Hospital , Olsztyn , Poland
| | - Jolanta Gozdzik
- h Department of Clinical Immunology and Transplantology, Stem Cell Transplant Center , University Children's Hospital, Jagiellonian University Collegium Medicum , Krakow , Poland
| | | | - Grażyna Karolczyk
- i Division of Pediatric Hematology and Oncology , Children Hospital , Kielce , Poland
| | - Weronika Stolpa
- j Department of Pediatric, Division of Pediatric Oncology, Hematology and Chemotherapy , Silesian Medical University , Katowice , Poland
| | - Grazyna Sobol
- j Department of Pediatric, Division of Pediatric Oncology, Hematology and Chemotherapy , Silesian Medical University , Katowice , Poland
| | - Zuzanna Gamrot
- k Division of Paediatric Haematology and Oncology , Chorzow Paediatric and Oncology Center , Chorzow , Poland
| | - Mariola Woszczyk
- k Division of Paediatric Haematology and Oncology , Chorzow Paediatric and Oncology Center , Chorzow , Poland
| | - Lidia Gil
- l Department of Hematology , University of Medical Sciences , Poznan , Poland
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17
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Styczynski J, Czyzewski K, Wysocki M, Gryniewicz-Kwiatkowska O, Kolodziejczyk-Gietka A, Salamonowicz M, Hutnik L, Zajac-Spychala O, Zaucha-Prazmo A, Chelmecka-Wiktorczyk L, Siewiera K, Fraczkiewicz J, Malas Z, Tomaszewska R, Irga-Jaworska N, Plonowski M, Ociepa T, Pierlejewski F, Gamrot Z, Urbanek-Dadela A, Gozdzik J, Stolpa W, Dembowska-Baginska B, Perek D, Matysiak M, Wachowiak J, Kowalczyk J, Balwierz W, Kalwak K, Chybicka A, Badowska W, Szczepanski T, Drozynska E, Krawczuk-Rybak M, Urasinski T, Mlynarski W, Woszczyk M, Karolczyk G, Sobol-Milejska G, Gil L. Increased risk of infections and infection-related mortality in children undergoing haematopoietic stem cell transplantation compared to conventional anticancer therapy: a multicentre nationwide study. Clin Microbiol Infect 2015; 22:179.e1-179.e10. [PMID: 26493843 DOI: 10.1016/j.cmi.2015.10.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 10/06/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
Abstract
This nationwide multicentre study analysed the epidemiology of bacterial, viral and fungal infections in paediatric haematopoietic stem cell transplantation (HSCT) and paediatric haematology and oncology (PHO) patients over a period of 24 consecutive months, including incidence, hazard risk and outcome of infections as well as occurrence of multidrug-resistant bacteria. During this period, 308 HSCTs were performed and 1768 children were newly diagnosed for malignancy. Compared to PHO, the risk in HSCT patients was significantly higher for all infections (hazard ratio (HR) 2.7), bacterial (HR 1.4), fungal (HR 3.5) and viral (HR 15.7) infections. The risk was higher in allo- than auto-HSCT for bacterial (HR 1.4), fungal (HR 3.2) and viral (HR 17.7) infections. The incidence of resistant bacteria was higher in HSCT than in PHO patients for both G-negative (72.5% vs. 59.2%) and G-positive (41.4% vs. 20.5%) strains. Cumulative incidence of bacterial, fungal and viral infections in HSCT patients was 33.9, 22.8 and 38.3%, respectively. Cumulative incidence of viral infections in allo-HSCT was 28.0% for cytomegalovirus, 18.5% for BK virus, 15.5% for Epstein-Barr virus, 9.5% for adenovirus, 2.6% for varicella zoster virus, 0.9% for influenza, 0.9% for human herpesvirus 6 and 0.3% for hepatitis B virus. Survival rates from infections were lower in HSCT than in PHO patients in bacterial (96.0 vs. 98.2%), fungal (75.5 vs. 94.6%) and most viral infections. In conclusion, the risk of any infections and the occurrence of resistant bacterial strains in allo-HSCT patients were higher than in auto-HSCT and PHO patients, while the outcome of infections was better in the PHO setting.
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Affiliation(s)
- J Styczynski
- Department of Paediatric Haematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland.
| | - K Czyzewski
- Department of Paediatric Haematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Wysocki
- Department of Paediatric Haematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | | | | | - M Salamonowicz
- Department of Paediatric Haematology and Oncology, Medical University, Warszawa, Poland
| | - L Hutnik
- Department of Paediatric Haematology and Oncology, Medical University, Warszawa, Poland
| | - O Zajac-Spychala
- Department of Paediatric Oncology, Haematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - A Zaucha-Prazmo
- Department of Paediatric Haematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - L Chelmecka-Wiktorczyk
- Department of Paediatric Oncology and Haematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - K Siewiera
- Department of Paediatric Stem Cell Transplantation, Haematology and Oncology, Medical University, Wroclaw, Poland
| | - J Fraczkiewicz
- Department of Paediatric Stem Cell Transplantation, Haematology and Oncology, Medical University, Wroclaw, Poland
| | - Z Malas
- Division of Paediatric Haematology and Oncology, Children Hospital, Olsztyn, Poland
| | - R Tomaszewska
- Department of Paediatric Haematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - N Irga-Jaworska
- Department of Paediatrics, Haematology and Oncology, Medical University, Gdansk, Poland
| | - M Plonowski
- Department of Paediatric Oncology and Haematology, Medical University, Bialystok, Poland
| | - T Ociepa
- Department of Paediatric Haematology and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - F Pierlejewski
- Department of Paediatric Oncology, Haematology and Diabetology, Medical University, Lodz, Poland
| | - Z Gamrot
- Division of Paediatric Haematology and Oncology, Chorzow Paediatric and Oncology Center, Chorzow, Poland
| | - A Urbanek-Dadela
- Division of Paediatric Haematology and Oncology, Children Hospital, Kielce, Poland
| | - J Gozdzik
- Stem Cell Transplant Center, University Children's Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - W Stolpa
- Division of Paediatric Oncology, Haematology and Chemotherapy, Department of Paediatric, Silesian Medical University, Katowice, Poland
| | | | - D Perek
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | - M Matysiak
- Department of Paediatric Haematology and Oncology, Medical University, Warszawa, Poland
| | - J Wachowiak
- Department of Paediatric Oncology, Haematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - J Kowalczyk
- Department of Paediatric Haematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - W Balwierz
- Department of Paediatric Oncology and Haematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - K Kalwak
- Department of Paediatric Stem Cell Transplantation, Haematology and Oncology, Medical University, Wroclaw, Poland
| | - A Chybicka
- Department of Paediatric Stem Cell Transplantation, Haematology and Oncology, Medical University, Wroclaw, Poland
| | - W Badowska
- Division of Paediatric Haematology and Oncology, Children Hospital, Olsztyn, Poland
| | - T Szczepanski
- Department of Paediatric Haematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - E Drozynska
- Department of Paediatrics, Haematology and Oncology, Medical University, Gdansk, Poland
| | - M Krawczuk-Rybak
- Department of Paediatric Oncology and Haematology, Medical University, Bialystok, Poland
| | - T Urasinski
- Department of Paediatric Haematology and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - W Mlynarski
- Department of Paediatric Oncology, Haematology and Diabetology, Medical University, Lodz, Poland
| | - M Woszczyk
- Division of Paediatric Haematology and Oncology, Chorzow Paediatric and Oncology Center, Chorzow, Poland
| | - G Karolczyk
- Division of Paediatric Haematology and Oncology, Children Hospital, Kielce, Poland
| | - G Sobol-Milejska
- Division of Paediatric Oncology, Haematology and Chemotherapy, Department of Paediatric, Silesian Medical University, Katowice, Poland
| | - L Gil
- Department of Haematology, University of Medical Sciences, Poznan, Poland
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