1
|
Barraud-Lange V, Boissel N, Gille AS, Jean C, Sitbon L, Schubert B, Yakouben K, Fahd M, Peycelon M, Paye-Jaouen A, Chalas C, Vanhaesebrouck A, Doz F, Surun A, Lemelle L, Sarnacki S, Neven B, Philippe-Chomette P, Dufour C, Rigaud C, Leverger G, Tabone MD, Irtan S, Pondarée C, Lezeau H, Lenaour G, Sibony M, Comperat E, Brocheriou I, Wolf JP, Dalle JH, Poirot C. A 10-year experience in testicular tissue cryopreservation for boys under 18 years of age: What can be learned from 350 cases? Andrology 2024; 12:385-395. [PMID: 37418281 DOI: 10.1111/andr.13493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND A growing number of centers worldwide are preserving testicular tissue (TT) of young boys at risk of fertility loss to preserve their fertility. Data in this regard are scarce and experience sharing is essential to the optimization of the process. OBJECTIVES This report of our 10-year activity of pediatric fertility preservation (FP) has the objective to (1) improve knowledge regarding the feasibility, acceptability, safety, and potential usefulness of the procedure; (2) analyze the impact of chemotherapy on spermatogonia in the cryopreserved TT. MATERIALS AND METHODS For this retrospective study of data prospectively recorded, we included all boys under 18 years of age referred to the FP consultation of our academic network between October 2009 and December 2019. Characteristics of patients and cryopreservation of testicular tissue (CTT) were extracted from the clinical database. Univariate and multivariate analyses were used to assess factors associated with the risk of absence of spermatogonia in the TT. RESULTS Three hundred and sixty-nine patients (7.2 years; 0.5-17.0) were referred to the FP consultation for malignant (70%) or non-malignant (30%) disease, of whom 88% were candidates for CTT, after a previous chemotherapy exposure (78%). The rate of recorded immediate adverse events was 3.5%, with painful episodes dominating. Spermatogonia were detected in the majority of TTs: 91.1% of those exposed to chemotherapy and 92.3% of those not exposed (p = 0.962). In multivariate analysis, the risk of absence of spermatogonia was almost three-fold higher in boys > 10 years of age ([OR] 2.74, 95% CI 1.09-7.26, p = 0.035) and four-fold higher in boys exposed to alkylating agents prior to CTT ([OR] 4.09, 95% CI 1.32-17.94, p = 0.028). DISCUSSION/CONCLUSION This large series of pediatric FP shows that this procedure is well accepted, feasible, and safe in the short term, strengthening its place in the clinical care pathway of young patients requiring a highly gonadotoxic treatment. Our results demonstrate that CTT post-chemotherapy does not impair the chance to preserve spermatogonia in the TT except when the treatment includes alkylating agents. More data on post-CTT follow-up are still required to ensure the long-term safety and usefulness of the procedure.
Collapse
Affiliation(s)
- Virginie Barraud-Lange
- Université Paris Cité, Paris, France
- Department of Reproductive Biology CECOS, AP-HP. Center-Université Paris Cite. Cochin Hospital, Paris, France
| | - Nicolas Boissel
- Université Paris Cité, Paris, France
- Department of Hematology, Adolescents and Young Adults Unit, AP-HP. North-Université Paris Cité. Saint-Louis Hospital, Paris, France
| | - Anne-Sophie Gille
- Université Paris Cité, Paris, France
- Department of Reproductive Biology CECOS, AP-HP. Center-Université Paris Cite. Cochin Hospital, Paris, France
| | - Camille Jean
- Université Paris Cité, Paris, France
- Department of Reproductive Biology CECOS, AP-HP. Center-Université Paris Cite. Cochin Hospital, Paris, France
| | - Leslie Sitbon
- Biomega-Bioclinic, Department Intercommunal Hospital of Créteil, Assisted Reproductive Biology, Créteil, France
| | - Benoit Schubert
- Eurofins Biomnis Laboratory, Institut Rhonalpin IVF Center, Clinique du Val d'Ouest, Ecully, France
| | - Karima Yakouben
- Department of Pediatric Immunology and Hematology, APHP. North-Université Paris Cité. Robert Debré Hospital, Paris, France
| | - Mony Fahd
- Department of Pediatric Immunology and Hematology, APHP. North-Université Paris Cité. Robert Debré Hospital, Paris, France
| | - Matthieu Peycelon
- Université Paris Cité, Paris, France
- Department of Pediatric Surgery and Urology, Centre de Référence des Malformations Rares des Voies Urinaires (MARVU), Inserm UMR 1141 NeuroDev, APHP. North-Université Paris Cité. Robert-Debré Hospital, Paris, France
| | - Annabel Paye-Jaouen
- Department of Pediatric Surgery and Urology, Centre de Référence des Malformations Rares des Voies Urinaires (MARVU), Inserm UMR 1141 NeuroDev, APHP. North-Université Paris Cité. Robert-Debré Hospital, Paris, France
| | - Céline Chalas
- Department of Reproductive Biology CECOS, AP-HP. Center-Université Paris Cite. Cochin Hospital, Paris, France
| | - Alexis Vanhaesebrouck
- Interdisciplinary Research Institute on Social issues (IRIS), UMR 8156-997, Sorbonne Paris North University, Aubervilliers, France
- Department of Legal and Social Medicine, AP-HP, Jean-Verdier Hospital, Bondy, France
- Department of Social Epidemiology, Sorbonne University, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - François Doz
- Université Paris Cité, Paris, France
- Curie Institute, SIREDO Center (Care, Innovation, Research in Pediatric, Adolescent and Young Adult Oncology, Paris, France
| | - Aurore Surun
- Curie Institute, SIREDO Center (Care, Innovation, Research in Pediatric, Adolescent and Young Adult Oncology, Paris, France
| | - Lauriane Lemelle
- Curie Institute, SIREDO Center (Care, Innovation, Research in Pediatric, Adolescent and Young Adult Oncology, Paris, France
| | - Sabine Sarnacki
- Université Paris Cité, Paris, France
- Department of Visceral and Urological Pediatric Surgery, AP-HP. Center-Université Paris Cité. Necker Hospital, Paris, France
| | - Bénédicte Neven
- Université Paris Cité, Paris, France
- Department of Immuno-Hematology and Pediatric Rheumatology, APHP. Center-Université Paris Cité. Necker-Enfant Malades Hospital, Paris, France
| | | | - Christelle Dufour
- Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France
| | - Charlotte Rigaud
- Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France
| | - Guy Leverger
- Sorbonne University, Paris, France
- Department of Pediatric Onco-Hematology, AP-HP. Sorbonne University. Armand Trousseau Hospital, Paris, France
| | - Marie-Dominique Tabone
- Department of Pediatric Onco-Hematology, AP-HP. Sorbonne University. Armand Trousseau Hospital, Paris, France
| | - Sabine Irtan
- Sorbonne University, Paris, France
- Department of Pediatric Surgery, AP-HP. Sorbonne University. Armand Trousseau Hospital, Paris, France
| | - Corinne Pondarée
- Pediatric Department Sickle Cell Referral Center, Intercommunal Hospital of Créteil, Créteil, France
- University Paris XII, INSERM U 955, Créteil, France
| | - Harry Lezeau
- Department of Visceral, Urological and Traumatological Surgery, Intercommunal Hospital of Créteil, Créteil, France
| | | | - Mathilde Sibony
- Université Paris Cité, Paris, France
- Department of Pathology, AP-HP. Center-Université Paris Cité. Cochin Hospital, Paris, France
| | - Eva Comperat
- Sorbonne University, Paris, France
- Department of Pathology, AP-HP. Sorbonne University. Pitié-Salpêtrière Hospital, Paris, France
| | - Isabelle Brocheriou
- Sorbonne University, Paris, France
- Department of Pathology, AP-HP. Sorbonne University. Pitié-Salpêtrière Hospital, Paris, France
| | - Jean Philippe Wolf
- Université Paris Cité, Paris, France
- Department of Reproductive Biology CECOS, AP-HP. Center-Université Paris Cite. Cochin Hospital, Paris, France
| | - Jean-Hugue Dalle
- Université Paris Cité, Paris, France
- Department of Pediatric Immunology and Hematology, APHP. North-Université Paris Cité. Robert Debré Hospital, Paris, France
| | - Catherine Poirot
- Department of Reproductive Biology CECOS, AP-HP. Center-Université Paris Cite. Cochin Hospital, Paris, France
- Department of Hematology, Adolescents and Young Adults Unit, AP-HP. North-Université Paris Cité. Saint-Louis Hospital, Paris, France
- Sorbonne University, Paris, France
| |
Collapse
|
2
|
Bidet P, Birgy A, Brethon B, Dalle JH, Mariani-Kurkdjian P, Courroux C, Monjault A, Gits-Museli M, Bonacorsi S. Epidemiological investigation of Pseudomonas aeruginosa isolates including Multidrug-Resistant serogroup O12 isolates, by use of a rapid and simplified Multiple-Locus Variable-Number of Tandem Repeats Analysis and Whole Genome Sequencing. J Hosp Infect 2022; 130:56-62. [PMID: 36181986 DOI: 10.1016/j.jhin.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Clustered cases of Pseudomonas aeruginosa infection in immunocompromised patients' wards require rapid characterization of a potential epidemic to guide investigations and identify the potential source of contamination. AIM To design and evaluate a rapid and simple typing method for P. aeruginosa in comparison to whole genome sequencing (WGS). METHODS We designed and used a simplified PCR based on multiple locus tandem variable number analysis (MLVA) to investigate cases of P. aeruginosa infection and colonization in a paediatric haematology department. The method was compared to WGS by using Illumina method. FINDINGS On the 17 isolates recovered from 15 children (8 from blood cultures, 3 from urinary tract infections, 1 from sputum and 5 stool isolates) MLVA distinguished 10 different profiles and 7 isolates from 6 children shared the same profile. Analysis by WGS revealed that these 7 isolates belonged to sequence type ST111 and serotype O12 and permitted to further distinguish at least 3 different genotypes among them. Five environmental strains had 3 MLVA profiles, one shared with a clinical isolate but WGS excluded any relationship. CONCLUSION The simplified and inexpensive MLVA method permitted to exclude, in less than five hours, most of unrelated isolates and to focus investigations on a small number of cases while WGS, taking several days of work, drew definitive conclusions concerning the outbreak and the genetic relationships of the ST111 isolates circulating in the department. We conclude that sequential use of both methods is the optimal strategy to investigate grouped cases of P. aeruginosa infections.
Collapse
Affiliation(s)
- P Bidet
- Université Paris Cité, IAME, INSERM, F-75018 Paris, France; Service de Microbiologie, Hôpital Robert-Debré, AP-HP, Paris, France.
| | - A Birgy
- Université Paris Cité, IAME, INSERM, F-75018 Paris, France; Service de Microbiologie, Hôpital Robert-Debré, AP-HP, Paris, France
| | - B Brethon
- Service d'Hémato-immunologie, Hôpital Robert-Debré, AP-HP, Paris, France
| | - J H Dalle
- Service d'Hémato-immunologie, Hôpital Robert-Debré, AP-HP, Paris, France
| | - P Mariani-Kurkdjian
- Université Paris Cité, IAME, INSERM, F-75018 Paris, France; Service de Microbiologie, Hôpital Robert-Debré, AP-HP, Paris, France
| | - C Courroux
- Service de Microbiologie, Hôpital Robert-Debré, AP-HP, Paris, France
| | - A Monjault
- Service de Microbiologie, Hôpital Robert-Debré, AP-HP, Paris, France
| | - M Gits-Museli
- Service de Microbiologie, Hôpital Robert-Debré, AP-HP, Paris, France
| | - S Bonacorsi
- Université Paris Cité, IAME, INSERM, F-75018 Paris, France; Service de Microbiologie, Hôpital Robert-Debré, AP-HP, Paris, France
| |
Collapse
|
3
|
Diesch-Furlanetto T, Rovó A, Galimard JE, Szinnai G, Dalissier A, Sedlacek P, Bodova I, Roussou VK, Gibson BE, Poiré X, Fagioli F, Pichler H, Faraci M, Gumy-Pause FG, Dalle JH, Balduzzi A, Bader P, Corbacioglu S. Pregnancy and pregnancy outcomes after hematopoietic stem cell transplantation in childhood: a cross-sectional survey of the EBMT Pediatric Diseases Working Party. Hum Reprod 2021; 36:2871-2882. [PMID: 34529796 DOI: 10.1093/humrep/deab199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What are the characteristics of patients with conceptions transplanted in childhood and adolescence? SUMMARY ANSWER Insemination and conception after hematopoietic stem cell transplantation (HCT) in childhood or adolescence was possible, even after myeloablative conditioning regimes, although some patients required reproductive medicine support. WHAT IS KNOWN ALREADY Preparative regimens of HCT are highly gonadotoxic, which leads to gonadal failure and pubertal development disorders. There are few population-based studies assessing the risk of future infertility in children after HCT. STUDY DESIGN, SIZE, DURATION We conducted a retrospective study to investigate natural or assisted conceptions and their outcomes in patients <18 years old before their first transplantation who received HCT between 1995 and 2016 and were in the European Society for Blood and Marrow Transplantation (EBMT) registry. Adoptions were excluded from the analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Detailed information concerning pregnancy occurrences and outcomes were obtained by a separate questionnaire. Quantitative variables were presented as medians with their interquartile range (IQR) or range, and categorical variables were presented as frequencies and percentages. MAIN RESULTS AND THE ROLE OF CHANCE In total, 62 988 pediatric patients received a first HCT in EBMT centers between 1995 and 2016. Pregnancy was reported in 406 patients in the database. The median age at transplantation was 15.7 (range: 0.7-18) years, and the median age at declared conception was 25.0 (range: 16.3-38.8) years. Details concerning the first pregnancy and pregnancy outcome were obtained from 99 patients (24%) from the returned questionnaires. The median age at delivery or pregnancy interruption of the females was 23.0 (IQR: 20.8-27) years, with a median time after transplant of 10.7 (IQR: 6.6-15.4) years. Compared with the mean age of healthy women at their first child's birth (29 years old), the transplanted women delivered 5 years earlier (mean: 24.3 years). In terms of conception modality, 13/25 (52%) females conditioned with total body irradiation (TBI) and 50/52 (96%) of those conditioned without TBI conceived naturally. All seven male patients who had been conditioned with TBI achieved fatherhood but required assisted fertilization or used their cryopreserved sperm. In the females, 63/70 (90%) of all conceptions resulted in a live birth, 49/63 (84.5%) were at term and 43/46 (93%) had normal birthweight. Cesarean delivery was performed in 9/61 (15%) especially in women who had received a myeloablative regimen. LIMITATIONS, REASONS FOR CAUTION In the EBMT pediatric dataset, the age at last follow-up or death was <17 years for 75% of the patients, therefore a longer follow-up for all patients would be necessary to calculate the cumulative incidence of conception for patients transplanted during childhood and allow all patients to realize their reproductive willingness/potential. WIDER IMPLICATIONS OF THE FINDINGS Reproductive health surveillance and fertility preservation counseling are important in younger transplanted patients. Our results showed that there is a window of opportunity to conceive naturally or with reproductive medicine support. STUDY FUNDING/COMPETING INTEREST(S) Funding was provided by the 'Stiftung für krebskranke Kinder Regio Basiliensis', Basel, Switzerland. All authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- T Diesch-Furlanetto
- Division of Pediatric Oncology/Hematology, University Children's Hospital Basel, UKBB, University of Basel, Basel, Switzerland
| | - A Rovó
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - G Szinnai
- Division of Pediatric Endocrinology/Diabetology, University Children's Hospital Basel, UKBB, University of Basel, Basel, Switzerland
| | | | - P Sedlacek
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - I Bodova
- Pediatric University Teaching Hospital, BMT Unit, II Children's Clinic, Bratislava, Slovakia
| | - V K Roussou
- St. Sophia Children's Hospital, Oncology Center, "MARIANNA V. VARDINOGIANNIS-ELPIDA", BMT Unit, Athens, Greece
| | - B E Gibson
- Department of Hematology, Royal Hospital for Children, Schiehallion Ward (Ward 2A), Glasgow, UK
| | - X Poiré
- Department of Hematology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - F Fagioli
- Onco-Ematologia Pediatrica, Centro Trapianti Cellule Staminali, Ospedale Infantile Regina Margherita, Turin, Italy
| | - H Pichler
- Department of Pediatrics, St. Anna Kinderspital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - M Faraci
- Dipartimento di Emato-Oncologia Pediatrica, Centro Trapianti Cellule Staminali, Institute G. Gaslini, Genova, Italy
| | - F G Gumy-Pause
- Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - J H Dalle
- Department of Pediatric Hematology, Hôpital Robert Debré, GH APHP-Nord Université de Paris,Paris, France
| | - A Balduzzi
- Clinica Pediatrica, Università degli Studi di Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
| | - P Bader
- Division of Stem-Cell Transplantation and Immunology, Hospital for Children and Adolescents of Frankfurt, Frankfurt, Germany
| | - S Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem-Cell Transplantation, University of Regensburg, Regensburg, Germany
| |
Collapse
|
4
|
Daikeler T, Hügle T, Farge D, Andolina M, Gualandi F, Baldomero H, Bocelli-Tyndall C, Brune M, Dalle JH, Ehninger G, Gibson B, Linder B, Lioure B, Marmont A, Matthes-Martin S, Nachbaur D, Schuetz P, Tyndall A, van Laar JM, Veys P, Saccardi R, Gratwohl A. Erratum: Allogeneic hematopoietic SCT for patients with autoimmune diseases. Bone Marrow Transplant 2009. [DOI: 10.1038/bmt.2009.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
5
|
Daikeler T, Hügle T, Farge D, Andolina M, Gualandi F, Baldomero H, Bocelli-Tyndall C, Brune M, Dalle JH, Ehninger G, Gibson B, Linder B, Lioure B, Marmont A, Matthes-Martin S, Nachbaur D, Schuetz P, Tyndall A, van Laar JM, Veys P, Saccardi R, Gratwohl A. Allogeneic hematopoietic SCT for patients with autoimmune diseases. Bone Marrow Transplant 2009; 44:27-33. [DOI: 10.1038/bmt.2008.424] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
6
|
Brazzola P, Duval M, Fournet JC, Gauvin F, Dalle JH, Champagne J, Champagne MA. Fatal diffuse capillaritis after hematopoietic stem-cell transplantation for dyskeratosis congenita despite low-intensity conditioning regimen. Bone Marrow Transplant 2005; 36:1103-5; author reply 1105. [PMID: 16205731 DOI: 10.1038/sj.bmt.1705171] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
Dalle JH, Huot C, Duval M, Rousseau P, Francoeur D, Champagne J, Vachon MF, Champagne MA. Successful pregnancies after bone marrow transplantation for Fanconi anemia. Bone Marrow Transplant 2005; 34:1099-100. [PMID: 15489874 DOI: 10.1038/sj.bmt.1704680] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
8
|
Abstract
Since 1988, allogeneic cord blood transplantations have been used in the hematology and oncology area. Cord blood banks, either public or from non-profit corporations, opened in several countries. They organized themselves into a world-wide network permitting broad and quick graft availability all over the world. Cryopreservation modalities and biological safety were strongly defined according to laboratory good practices. More recently, in the United States, Canada and some European and Asian countries, commercial companies created for-profit cord blood banks. They offer families the possibility of privately storing the cord blood of their children. Then, if a child gets sick and needs a hematopoietic stem cell transplantation, it is possible to use the cord blood for an autograft. These companies present this service, relatively expensive for the families, as a true biological insurance. Also, they capitalize on families' hopes that scientific progress will increase cord blood autografts and other stem cell medical applications. In this work, we review available scientific data, ethical considerations and laws that can contribute to an informed reflection.
Collapse
Affiliation(s)
- J H Dalle
- Unité protégée A, clinique de pédiatrie, hôpital Jeanne-de-Flandre, CHU de Lille, 59037 Lille cedex France.
| |
Collapse
|
9
|
Herr AL, Hatami A, Kokta V, Dalle JH, Champagne MA, Duval M. Successful anti-CD20 antibody treatment of pemphigus foliaceus after unrelated cord blood transplantation. Bone Marrow Transplant 2005; 35:427-8. [PMID: 15640817 DOI: 10.1038/sj.bmt.1704808] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
Dalle JH, Duval M, Moghrabi A, Wagner E, Vachon MF, Barrette S, Bernstein M, Champagne J, David M, Demers J, Rousseau P, Winikoff R, Champagne MA. Results of an unrelated transplant search strategy using partially HLA-mismatched cord blood as an immediate alternative to HLA-matched bone marrow. Bone Marrow Transplant 2004; 33:605-11. [PMID: 14743192 DOI: 10.1038/sj.bmt.1704433] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cord blood (CB) is an alternative to other sources of stem cells for transplantation. However, the impact of including CB in the initial strategy of unrelated graft search in a cohort of patients has been the object of limited analysis. Here, we report the results of such a strategy in 91 consecutive children. Absence of mismatch was required for adult donors, and up to two mismatches were allowed for CB grafts, with a nucleated cell dose over 2.5 x 10(7) cells/kg. A graft was found for 84 of the 85 children who remained available for a 3-month search. In all, 64 patients were transplanted, 36 with CB and 28 with bone marrow (BM). Primary graft failure, acute grade II-IV and extensive chronic graft-versus-host disease occurred in five, five and zero CB, and in three, one and two BM patients, respectively. The 3-year survival was 59% in CB and 57% in BM patients. Accepting CB as a source of stem cells offers a graft to almost every child in need of an unrelated transplantation, with a probability of survival similar to that of unrelated BM transplantation.
Collapse
Affiliation(s)
- J H Dalle
- 1Division of Hematology-Oncology, Hôpital Sainte-Justine, Montréal, Québec, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Dalle JH, Leblond P, Decouvelaere A, Yakoub-Agha I, Preudhomme C, Nelken B, Mazingue F. Efficacy of thalidomide in a child with histiocytic sarcoma following allogeneic bone marrow transplantation for T-ALL. Leukemia 2003; 17:2056-7. [PMID: 14513060 DOI: 10.1038/sj.leu.2403075] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
12
|
Dalle JH, Wall D, Theoret Y, Duval M, Shaw L, Larocque D, Taylor C, Gardiner J, Vachon MF, Champagne MA. Intravenous busulfan for allogeneic hematopoietic stem cell transplantation in infants: clinical and pharmacokinetic results. Bone Marrow Transplant 2003; 32:647-51. [PMID: 13130310 DOI: 10.1038/sj.bmt.1704209] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
SUMMARY High-dose busulfan is an important component of myeloablative regimens. Variable drug exposure may occur following oral administration. Therefore, the use of intravenous busulfan has been advocated. Previous work has suggested a cumulative dosage of 16 mg/kg for haematopoietic transplantation in children less than 3 years of age, but only limited data are available in infants. Pharmacokinetics of intravenous busulfan administered at the suggested dosage were studied in 14 infants (median age 4.7 months). Busulfan plasma concentrations were measured by either GC-MS or HPLC-UV. In seven patients, the dose was decreased to target an area- under- the- curve of 600-1300 micromol min. The median total dose given was 13.8 mg/kg. All patients engrafted. Severe veno-occlusive disease occurred in one patient. Our study demonstrates that a cumulative dosage of 16 mg/kg is associated with higher exposure than expected in infants. We suggest an initial dose of 0.8 mg/kg followed by pharmacokinetically guided dose adjustment.
Collapse
Affiliation(s)
- J H Dalle
- Service d'Hématologie et Oncologie Pédiatrique, Hôpital Sainte Justine, Montréal QC, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Marec-Berard P, Babin A, Thomas C, Dalle JH, Borderon JC, Millot F. Quand vacciner ou revacciner un enfant traité pour une affection maligne par chimiothérapie. Arch Pediatr 2003; 10 Suppl 1:105s-108s. [PMID: 14509761 DOI: 10.1016/s0929-693x(03)90401-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Abstract
As a result of major progresses in anti-cancer treatment, many children with malignancy have to be admitted to an intensive care unit. Therefore it has become a necessity for paediatric oncologists and haematologists and paediatric intensive care physicians to work together. What are the current tools to guide their discussion and decision? There are few useful published studies about the outcome of oncology paediatric patients admitted to intensive care unit. Due to the very specificity of paediatric oncology it is difficult to extrapolate from the available adult studies. Legislative texts specify the limits of the debate but feed it little. Philosophers concentrate on the risk of therapeutic doggedness and the right to dye with dignity. The oncology paediatric patients may be sent to an intensive care unit at different steps of their diseases: at the time of diagnosis, during the curative treatment, or after treatment failure. For each step, there is a need for a wide debate between oncologists, intensivists, nurses, psychologists, and the child's family in order to define the most consensual decisions. The development of validated prognostic scores for this particular population will be very helpful for the decision making. As frequently as possible the decision should be anticipated before the transfer of the child to the intensive care unit.
Collapse
Affiliation(s)
- J H Dalle
- Unité Protégée A, clinique de pédiatrie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille, France.
| |
Collapse
|
15
|
Dalle JH, Mortier L, Roumier C, Laï JL, Catteau B, Delaporte E, Nelken B. [Cutaneous symptoms revealing a monoblastic leukemia]. Arch Pediatr 2002; 9:1046-9. [PMID: 12462835 DOI: 10.1016/s0929-693x(02)00052-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED Leukemia cutis (LC) are not rare in acute myeloid leukaemia (AML) in children but exceptionally reveal it. Most authors think that they have poor prognosis. CASE REPORT We report the case of an infant with isolated cutaneous involvement at the time of diagnosis of leukaemia. Bone marrow aspiration showed AML M5. The child was treated by LAME 91 protocol, arm "infant under one year of age". Complete remission, both in bone marrow and skin, was obtained after induction course. Then the patient received consolidation course and megatherapy followed by autologous bone marrow transplantation. Skin relapse occurred early. The complete remission no. 2 was not obtained by second line treatment: new LC appeared when PMN count increased more than 10(9)/l. Then, the child was treated with oral VP16 but disease progressed with more and more LC, followed by bone marrow relapse. Child's death occurred about one year after diagnosis.
Collapse
Affiliation(s)
- J H Dalle
- Clinique de pédiatrie, unité protégée A, Hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille, France.
| | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
UNLABELLED Methotrexate elimination may be delayed by different drugs. Such a delay may produce severe toxic complications. CASE REPORTS We report two cases of adolescents treated for malignant diseases who presented a delayed methotrexate elimination even though they received ciprofloxacin. The first patient had already received several courses of methotrexate without toxicity before this episode. The second patient tolerated methotrexate when ciprofloxacin was not associated to the treatment. CONCLUSION High-dose methotrexate-ciprofloxacin association should be avoided.
Collapse
Affiliation(s)
- J H Dalle
- Clinique de pédiatrie, unité d'hémato-oncologie pédiatrique, centre hospitalier régional universitaire de Lille, hôpital Jeanne-de-Flandre, 59037 Lille, France.
| | | | | | | | | |
Collapse
|
17
|
Dalle JH, Mechinaud F, Michon J, Gentet JC, de Lumley L, Rubie H, Schmitt C, Patte C. Testicular disease in childhood B-cell non-Hodgkin's lymphoma: the French Society of Pediatric Oncology experience. J Clin Oncol 2001; 19:2397-403. [PMID: 11331318 DOI: 10.1200/jco.2001.19.9.2397] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate whether testicular disease in childhood B-cell lymphoma should continue to be considered a sanctuary site, as it is with other lymphoid malignancies such as acute lymphoblastic leukemia. PATIENTS AND METHODS Seven hundred forty-two children with B-cell non-Hodgkin's lymphoma were included in the LMB protocols of the French Society of Pediatric Oncology from February 1981 to May 1994. Thirty patients (5.3%) had testicular involvement at diagnosis. We describe the clinical presentation and outcome of these 30 patients, who were treated without local radiation therapy. RESULTS Five patients underwent diagnostic orchidectomy. The median patient age was 8.5 years (range, 2 to 14 years), and their cancers were stage III (18 patients), stage IV (five patients), and B-cell acute lymphoblastic leukemia (seven patients). Five patients had central nervous system involvement. Twenty-eight patients (95%) achieved complete remission. Twenty-six patients are alive without progressive disease (median follow-up, 6.5 years). CONCLUSION Testicular disease does not seem to confer a poor prognosis, and it is curable with intensive combination chemotherapy alone. Local treatment (surgery or radiation) is avoidable; therefore, gonadal function can be preserved.
Collapse
Affiliation(s)
- J H Dalle
- Service d'Oncologie Pédiatrique and Département d'Oncologie Pédiatrique, Institut Gustave Roussy, Villejuif, France.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
|
19
|
Dalle JH, Dollfus C, Leverger G, Landman-Parker J, Tabone MD, Adam M, Courpotin C, Lasfargues G. [Hemophagocytic syndrome in children infected by HIV. Apropos of 3 cases]. Arch Pediatr 1995; 2:442-6. [PMID: 7640736 DOI: 10.1016/0929-693x(96)81179-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The hemophagocytic syndrome has previously been reported in different infectious diseases (EBV, CMV, tuberculosis...) but rarely in adults with AIDS and never in children suffering from AIDS. CASE REPORTS A hemophagocytic syndrome was recognized during the follow-up of 3 children with AIDS. The first, a 9-year-old girl developed an acute EBV coinfection and was treated with shots of corticosteroids and vepesid but died shortly afterwards. The second patient, a 3-year-old girl was infected with Aspergillus fumigatus for which she was given amphotericin B with a rapid improvement. The third patient, an 8-year-old boy had multi-resistant Streptococcus pneumoniae otitis and pneumonitis; his condition improved rapidly with adapted antibiotherapy. DISCUSSION The HIV-hemophagocytic syndrome is not exceptional in HIV infection because of the association of immunodeficiency and resulting superinfections. Its diagnosis and treatment should be etiologic. Severe cases without etiology could benefit from chemotherapy. CONCLUSION Management and outcome of this potentially lethal syndrome might depend on the identification of a curable infectious cause.
Collapse
Affiliation(s)
- J H Dalle
- Département de pédiatrie Edmond-Lesné, hôpital d'enfants Armand-Trousseau, Paris, France
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Dalle JH, Dollfus C, Courpotin C, Tabone AM, Landman-Parker J, Leverger G, Lasfargues G. Human immunodeficiency virus-associated hemophagocytic syndrome in children. Pediatr Infect Dis J 1994; 13:1159. [PMID: 7892096 DOI: 10.1097/00006454-199412000-00024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|