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Khan ER, Islam A, Jamal CY, Karim MA, Rahman AA, Hafiz MG, Khaleque A. Outcome and complications of pediatric acute promyelocytic leukemia in Bangladesh. Pediatr Hematol Oncol 2022; 39:406-417. [PMID: 34986070 DOI: 10.1080/08880018.2021.2002486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pediatric acute promyelocytic leukemia (APL) is one of the most curable subtypes of acute myeloid leukemia of childhood. But it may have many early complications, especially in developing countries. This study aims to describe the outcome and complications of pediatric APL patients in Bangladesh. This prospective observational study was conducted in the pediatric hematology and oncology department of Bangabandhu Sheikh Mujib Medical University, Dhaka from September 2017 to March 2019. In this study, PML:RAR-α (Promyelocytic leukemia-retinoic acid receptor-α) positive APL cases were included and observed while being treated with risk-directed ATRA (All-trans-retinoic acid) based chemotherapy. Among twenty PML:RAR-α positive APL cases, 13 children were in the high risk group and hemorrhagic manifestations were present in 95% of patients. Post-induction remission was achieved in 85% of the patients. 3-year overall survival was 70% (45-85% with 95% confidence interval). There was no refractory disease or relapses. Neutropenic sepsis was the most common complication and also the most common cause of mortality. In Bangladesh, the 3-year overall survival of pediatric APL is 70% (45-85% with 95% CI). Post-chemotherapy neutropenic sepsis is the most common complication and also the most common cause of mortality in this potentially curable malignancy in Bangladesh.
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Affiliation(s)
- Eshita Reza Khan
- Department of Pediatrics, Mugda Medical College Hospital, Dhaka, Bangladesh
| | - Afiqul Islam
- Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Chowdhury Yakub Jamal
- Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Anwarul Karim
- Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Atm Atikur Rahman
- Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Golam Hafiz
- Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Abdul Khaleque
- Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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2
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Abstract
Considerable progress has been made in the prevention, diagnosis, and management of pediatric patients with invasive fungal disease (IFD). The reported decreasing trend in the incidence of invasive candidiasis (IC) over the past 15 years in both neonates and children has been encouraging. Nevertheless, due to the growing number of immunocompromised children at risk for IFD, this disease continues to be associated with significant morbidity and death and with increased financial burden to the health care system. Therefore, it is important to understand the contemporary epidemiology of IFD. Incidence rates of IFD in children are affected by geographical, population, and time variability. There is an ongoing effort to constantly document and update the incidence of IFD and species distribution among different pediatric populations as a means to direct preventative, diagnostic, and therapeutic resources to the most appropriate subset of patients. Children with a hematologic malignancy or a primary or secondary immunodeficiency, those undergoing solid organ or hematopoietic stem cell transplantation, and premature neonates are the major subsets of pediatric patients at risk of developing IFD. In this review, we focus on fungal disease epidemiology with a specific emphasis on the 2 most common pediatric IFDs, IC and invasive aspergillosis (IA).
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Affiliation(s)
- Zoi Dorothea Pana
- Hospital Epidemiology and Infection Control Department (HEIC), Division of Infectious Diseases, Johns Hopkins Hospital, Baltimore, Maryland
- Third Department of Paediatrics, Infectious Diseases Unit, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece
| | - Emmanuel Roilides
- Third Department of Paediatrics, Infectious Diseases Unit, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece
| | - Adilia Warris
- Aberdeen Fungal Group, MRC Centre for Medical Mycology, Institute of Medical Sciences and the Royal Aberdeen Children’s Hospital, University of Aberdeen, United Kingdom
| | - Andreas H Groll
- Center for Bone Marrow Transplantation and Department of Paediatric Hematology and Oncology, Infectious Disease Research Program, University Children’s Hospital, Muenster, Germany
| | - Theoklis Zaoutis
- Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness Research, Children’s Hospital of Philadelphia, Pennsylvania; and
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia
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3
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Sung L, Dix D, Cellot S, Gillmeister B, Ethier MC, Roslin NM, Johnston DL, Feusner J, Mitchell D, Lewis V, Aplenc R, Yanofsky R, Portwine C, Price V, Zelcer S, Silva M, Bowes L, Michon B, Stobart K, Traubici J, Allen U, Beyene J, den Hollander N, Paterson AD. Single nucleotide polymorphism in IL1B is associated with infection risk in paediatric acute myeloid leukaemia. Clin Microbiol Infect 2016; 22:563.e9-563.e17. [PMID: 26932518 DOI: 10.1016/j.cmi.2016.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/02/2016] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
Abstract
We evaluated single nucleotide polymorphisms (SNPs) associated with infection risk in children with newly diagnosed acute myeloid leukaemia (AML). We conducted a multicentre, prospective cohort study that included children aged ≤18 years with de novo AML. DNA was isolated from blood lymphocytes or buccal swabs, and candidate gene SNP analysis was conducted. Primary outcome was the occurrence of microbiologically documented sterile site infection during chemotherapy. Secondary outcomes were Gram-positive and -negative infections, viridans group streptococcal infection and proven/probable invasive fungal infection. Interpretation was guided by consistency in risk alleles and microbiologic agent with previous literature. Over the study period 254 children and adolescents with AML were enrolled. Overall, 190 (74.8%) had at least one sterile site microbiologically documented infection. Among the 172 with inferred European ancestry and DNA available, nine significant associations were observed; two were consistent with previous literature. Allele A at IL1B (rs16944) was associated with decreased microbiologically documented infection, and allele G at IL10 (rs1800896) was associated with increased risk of Gram-positive infection. We identified SNPs associated with infection risk in paediatric AML. Genotype may provide insight into mechanisms of infection risk that could be used for supportive-care novel treatments.
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Affiliation(s)
- L Sung
- Division of Haematology/Oncology, Ontario, Canada; Child Health Evaluative Sciences, Ontario, Canada.
| | - D Dix
- Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - S Cellot
- Hematology/Oncology, Hopital Sainte-Justine, Montreal, Quebec, Canada
| | | | - M C Ethier
- Child Health Evaluative Sciences, Ontario, Canada
| | - N M Roslin
- Program in Genetics and Genome Biology, Ontario, Canada
| | - D L Johnston
- Hematology Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - J Feusner
- Department of Hematology/Oncology, Children's Hospital and Research Center, Oakland, CA, USA
| | - D Mitchell
- Hematology/Oncology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - V Lewis
- Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - R Aplenc
- Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - R Yanofsky
- Hematology/Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - C Portwine
- Hematology/Oncology, Chedoke-McMaster Hospitals, Canada
| | - V Price
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - S Zelcer
- Hematology/Oncology, London Health Sciences, Victoria Hospital, London, Ontario, Canada
| | - M Silva
- Hematology/Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada
| | - L Bowes
- Hematology/Oncology, Janeway Child Health Centre, St. John's, Newfoundland, Canada
| | - B Michon
- Pediatric Hematology/OncologyCentre, Hospitalier Universitaire de Quebec, Quebec, Quebec, Canada
| | - K Stobart
- Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - J Traubici
- Department of Diagnostic Imaging, Ontario, Canada
| | - U Allen
- Division of Infectious Diseases, Ontario, Canada
| | - J Beyene
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - N den Hollander
- Histocompatibility Laboratory, University Health Network, Ontario, Canada
| | - A D Paterson
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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4
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Sahbudak Bal Z, Yilmaz Karapinar D, Karadas N, Sen S, Onder Sivis Z, Akinci AB, Balkan C, Kavakli K, Vardar F, Aydinok Y. Proven and probable invasive fungal infections in children with acute lymphoblastic leukaemia: results from an university hospital, 2005-2013. Mycoses 2015; 58:225-32. [PMID: 25728069 DOI: 10.1111/myc.12303] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 01/19/2015] [Accepted: 01/22/2015] [Indexed: 12/16/2022]
Abstract
Despite improvements in diagnosis and treatment, invasive fungal infections (IFIs) are still a major cause of morbidity and mortality in immunocompromised patients. The data on IFI among children with acute lymphoblastic leukaemia (ALL) are still scarce, and our aim was to estimate the risk, aetiology and outcome of proven and probable IFIs in children with ALL who did not receive primary prophylaxis over an 8-year period. Between January 2005 and February 2013, 125 children who were treated for ALL at the Pediatric Hematology Department of the Medical School of Ege University were retrospectively reviewed. Proven and probable IFIs were defined according to revised definitions of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group. The proven and probable IFI incidence was 30/125 (24%). Profound neutropenia was detected in 18 (60%) patients, and prolonged neutropenia was detected in 16 (53.3%) of the patients. The most isolated agents were non-albicans Candida spp. The crude and attributable mortality was 20% and 13.3% respectively. Profound neutropenia was associated with mortality (P < 0.05). The younger patients were especially at risk for proven IFI. Prolonged neutropenia, to be in the induction phase of chemotherapy, and profound neutropenia were found to be the most common predisposing factors for IFI episodes.
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Affiliation(s)
- Zumrut Sahbudak Bal
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
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Pagano L, Stamouli M, Tumbarello M, Verga L, Candoni A, Cattaneo C, Nadali G, Mitra ME, Mancini V, Nosari A, Garzia MG, Delia M, Storti S, Spadea A, Caramatti C, Perriello V, Sanna M, Vacca A, De Paolis MR, Potenza L, Salutari P, Castagnola C, Fanci R, Chierichini A, Melillo L, Picardi M, Facchini L, Martino B, Di Blasi R, Cesarini M, Offidani M, Vianelli N, Caira M, Lessi F, Ferrari A, Venditti A, Pavone V, Lo-Coco F, Aversa F, Busca A. Risk of invasive fungal infection in patients affected by acute promyelocytic leukaemia. A report by the SEIFEM-D registry. Br J Haematol 2015; 170:434-9. [PMID: 25626374 DOI: 10.1111/bjh.13308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Livio Pagano
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maria Stamouli
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,2nd Department of Internal Medicine Propaedeutic, Attikon University Hospital, Athens, Greece
| | - Mario Tumbarello
- Istituto di Malattie Infettive, Università Cattolica Del Sacro Duore, Rome, Italy
| | - Luisa Verga
- Unità di Ematologia, Ospedale San Gerardo, Università di Milano, Monza, Italy
| | - Anna Candoni
- Clinica di Ematologia, Università di Udine, Udine, Italy
| | - Chiara Cattaneo
- Divisione di Ematologia, Spedali Civili di Brescia, Brescia, Italy
| | - Gianpaolo Nadali
- UOC Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Maria Enza Mitra
- Divisione di Ematologia e TMO, Policlinico di Palermo, Palermo, Italy
| | - Valentina Mancini
- Divisione di Ematologia e Centro Trapianti Midollo, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Annamaria Nosari
- Divisione di Ematologia e Centro Trapianti Midollo, Ospedale Niguarda Ca' Granda, Milan, Italy
| | | | - Mario Delia
- Sezione di Ematologia, Università di Bari, Bari, Italy
| | - Sergio Storti
- Divisione di Ematologia, Università Cattolica del S. Cuore, Campobasso, Italy
| | - Antonio Spadea
- Ematologia, Istituti Fisioterapici Ospitalieri, Rome, Italy
| | | | | | - Marco Sanna
- Istituto di Ematologia, Università di Cagliari, Cagliari, Italy
| | - Adriana Vacca
- Istituto di Ematologia, Università di Cagliari, Cagliari, Italy
| | | | - Leonardo Potenza
- Sezione di Ematologia, Dipartimento di Scienze Mediche Materno Infantili e dell'Adulto, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Prassede Salutari
- Dipartimento di Ematologia Clinica, Ospedale Spirito Santo, Pescara, Italy
| | - Carlo Castagnola
- Dipartimento Onco-Ematologico, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rosa Fanci
- Unità Operativa di Ematologia, Università di Firenze, Firenze, Italy
| | - Anna Chierichini
- Divisione di Ematologia, Ospedale S. Giovanni Addolorata, Rome, Italy
| | - Lorella Melillo
- Divisione di Ematologia, IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Napoli, Italy
| | - Marco Picardi
- Divisione di Ematologia, Università Federico II di Napoli, Napoli, Italy
| | - Luca Facchini
- Divisione di Ematologia, Arciospedale S. Maria Nuova, Reggio Emilia, Italy
| | - Bruno Martino
- Divisione di Ematologia, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Roberta Di Blasi
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Monica Cesarini
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Nicola Vianelli
- Istituto di Ematologia ed Oncologia Clinica, Ospedale S. Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Morena Caira
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Lessi
- Ematologia ed Immunologia Clinica, Dipartimento di Medicina, Università di Padova, Padova, Italy
| | | | | | | | | | - Franco Aversa
- Sezione di Ematologia, Università di Parma, Parma, Italy
| | - Alessandro Busca
- Dipartimento di Ematologia, Ospedale S.Giovanni Battista, Torino, Italy
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