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Consiglieri G, Tucci F, De Pellegrin M, Guerrini B, Cattoni A, Risca G, Scarparo S, Sarzana M, Pontesilli S, Mellone R, Gasperini S, Galimberti S, Silvani P, Filisetti C, Darin S, Forni G, Miglietta S, Santi L, Facchini M, Corti A, Fumagalli F, Cicalese MP, Calbi V, Migliavacca M, Barzaghi F, Ferrua F, Gallo V, Recupero S, Canarutto D, Doglio M, Tedesco L, Volpi N, Rovelli A, la Marca G, Valsecchi MG, Zancan S, Ciceri F, Naldini L, Baldoli C, Parini R, Gentner B, Aiuti A, Bernardo ME. Early skeletal outcomes after hematopoietic stem and progenitor cell gene therapy for Hurler syndrome. Sci Transl Med 2024; 16:eadi8214. [PMID: 38691622 DOI: 10.1126/scitranslmed.adi8214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
Mucopolysaccharidosis type I Hurler (MPSIH) is characterized by severe and progressive skeletal dysplasia that is not fully addressed by allogeneic hematopoietic stem cell transplantation (HSCT). Autologous hematopoietic stem progenitor cell-gene therapy (HSPC-GT) provides superior metabolic correction in patients with MPSIH compared with HSCT; however, its ability to affect skeletal manifestations is unknown. Eight patients with MPSIH (mean age at treatment: 1.9 years) received lentiviral-based HSPC-GT in a phase 1/2 clinical trial (NCT03488394). Clinical (growth, measures of kyphosis and genu velgum), functional (motor function, joint range of motion), and radiological [acetabular index (AI), migration percentage (MP) in hip x-rays and MRIs and spine MRI score] parameters of skeletal dysplasia were evaluated at baseline and multiple time points up to 4 years after treatment. Specific skeletal measures were retrospectively compared with an external cohort of HSCT-treated patients. At a median follow-up of 3.78 years after HSPC-GT, all patients treated with HSPC-GT exhibited longitudinal growth within WHO reference ranges and a median height gain greater than that observed in patients treated with HSCT after 3-year follow-up. Patients receiving HSPC-GT experienced complete and earlier normalization of joint mobility compared with patients treated with HSCT. Mean AI and MP showed progressive decreases after HSPC-GT, suggesting a reduction in acetabular dysplasia. Typical spine alterations measured through a spine MRI score stabilized after HSPC-GT. Clinical, functional, and radiological measures suggested an early beneficial effect of HSPC-GT on MPSIH-typical skeletal features. Longer follow-up is needed to draw definitive conclusions on HSPC-GT's impact on MPSIH skeletal dysplasia.
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Affiliation(s)
- Giulia Consiglieri
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesca Tucci
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | | | | | - Alessandro Cattoni
- Paediatrics, IRCCS San Gerardo dei Tintori Foundation, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Giulia Risca
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, 20854 Vedano al Lambro, Italy
| | - Stefano Scarparo
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Marina Sarzana
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Silvia Pontesilli
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Renata Mellone
- Radiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Serena Gasperini
- Paediatrics, IRCCS San Gerardo dei Tintori Foundation, 20900 Monza, Italy
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, 20854 Vedano al Lambro, Italy
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Paolo Silvani
- Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Chiara Filisetti
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- "Vita-Salute" San Raffaele University, 20132 Milan, Italy
| | - Silvia Darin
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giulia Forni
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
| | - Simona Miglietta
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Ludovica Santi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Marcella Facchini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Ambra Corti
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Francesca Fumagalli
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Maria Pia Cicalese
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- "Vita-Salute" San Raffaele University, 20132 Milan, Italy
| | - Valeria Calbi
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Maddalena Migliavacca
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Federica Barzaghi
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Francesca Ferrua
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Vera Gallo
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Salvatore Recupero
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Daniele Canarutto
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Matteo Doglio
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Lucia Tedesco
- Paediatrics, IRCCS San Gerardo dei Tintori Foundation, 20900 Monza, Italy
| | - Nicola Volpi
- Department of Life Sciences, University of Modena and Reggio Emilia, Laboratory of Biochemistry and Glycobiology, 41125 Modena, Italy
| | - Attilio Rovelli
- Paediatrics, IRCCS San Gerardo dei Tintori Foundation, 20900 Monza, Italy
| | - Giancarlo la Marca
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
- Newborn Screening, Clinical Chemistry and Pharmacology Laboratory, Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, 20854 Vedano al Lambro, Italy
- Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Stefano Zancan
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Fabio Ciceri
- "Vita-Salute" San Raffaele University, 20132 Milan, Italy
- Department of Haematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- "Vita-Salute" San Raffaele University, 20132 Milan, Italy
| | - Cristina Baldoli
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Rossella Parini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Bernhard Gentner
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- Ludwig Institute for Cancer Research and Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), 1015 Lausanne, Switzerland
| | - Alessandro Aiuti
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- "Vita-Salute" San Raffaele University, 20132 Milan, Italy
| | - Maria Ester Bernardo
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- "Vita-Salute" San Raffaele University, 20132 Milan, Italy
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Molinari S, Fossati C, Nicolosi ML, Di Marco S, Faraguna MC, Limido F, Ocello L, Pellegrinelli C, Lattuada M, Gazzarri A, Lazzerotti A, Sala D, Vimercati C, Capitoli G, Daolio C, Biondi A, Balduzzi A, Cattoni A. Endocrine, auxological and metabolic profile in children and adolescents with Down syndrome: from infancy to the first steps into adult life. Front Endocrinol (Lausanne) 2024; 15:1348397. [PMID: 38654931 PMCID: PMC11036865 DOI: 10.3389/fendo.2024.1348397] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Down syndrome (DS) is the most common chromosomal disorder worldwide. Along with intellectual disability, endocrine disorders represent a remarkable share of the morbidities experienced by children, adolescents and young adults with DS. Auxological parameters are plotted on syndrome-specific charts, as growth rates are reduced compared to healthy age- and gender-matched peers. Furthermore, children with DS are at increased risk for thyroid dysfunctions, diabetes mellitus, osteopenia and obesity compared to general population. Additionally, male individuals with DS often show infertility, while women tend to experience menopause at an overall younger age than healthy controls. Given the recent outstanding improvements in the care of severe DS-related comorbidities, infant mortality has dramatically decreased, with a current average life expectancy exceeding 60 years. Accordingly, the awareness of the specificities of DS in this field is pivotal to timely detect endocrine dysfunctions and to undertake a prompt dedicated treatment. Notably, best practices for the screening and monitoring of pediatric endocrine disorders in DS are still controversial. In addition, specific guidelines for the management of metabolic issues along the challenging period of transitioning from pediatric to adult health care are lacking. By performing a review of published literature, we highlighted the issues specifically involving children and adolescent with DS, aiming at providing clinicians with a detailed up-to-date overview of the endocrine, metabolic and auxological disorders in this selected population, with an additional focus on the management of patients in the critical phase of the transitioning from childhood to adult care.
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Affiliation(s)
- Silvia Molinari
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Chiara Fossati
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maria Laura Nicolosi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Santo Di Marco
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Francesca Limido
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Laura Ocello
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Martina Lattuada
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Alessandra Gazzarri
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Debora Sala
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Chiara Vimercati
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giulia Capitoli
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Cecilia Daolio
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Andrea Biondi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Adriana Balduzzi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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3
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Vallée TC, Glasmacher JS, Buchner H, Arkwright PD, Behrends U, Bondarenko A, Browning MJ, Buchbinder DK, Cattoni A, Chernyshova L, Ciznar P, Cole T, Czogala W, Dueckers G, Edgar JDM, Erbey F, Fasth A, Ferrua F, Formankova R, Gambineri E, Gennery AR, Goldman FD, Gonzalez-Granado LI, Heilmann C, Heiskanen-Kosma T, Juntti H, Kainulainen L, Kanegane H, Karaca NE, Sebnem Kilic S, Klein C, Koltan S, Kondratenko I, Meyts I, Nasrullayeva GM, Notarangelo LD, Pasic S, Pellier I, Pignata C, Misbah SA, Schulz AS, Segundo GR, Shcherbina A, Slatter MA, Sokolic R, Soler-Palacin P, Stepensky P, van Montfrans JM, Ryhänen S, Wolska-Kuśnierz B, Ziegler JB, Zhao X, Aiuti A, Ochs HD, Albert MH. Wiskott-Aldrich Syndrome: A study on 577 patients defining the genotype as a predictive biomarker for disease severity. Blood 2024:blood.2023021411. [PMID: 38579284 DOI: 10.1182/blood.2023021411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 04/07/2024] Open
Abstract
WAS is a multifaceted monogenic disorder with a broad disease spectrum and variable disease severity and a variety of treatment options including allogeneic hematopoietic stem cell transplantation (HSCT) and gene therapy (GT). No reliable biomarker exists to predict disease course and outcome for individual patients. A total of 577 patients with a WAS variant from 26 countries and a median follow-up of 8.9 years (0.3-71.1), totaling 6118 patient-years, were included in this international retrospective study. Overall survival (OS) of the cohort (censored at HSCT or GT) was 82% (95% CI 78-87) at 15 years and 70% (61-80) at 30 years of age. The type of variant was predictive of outcome: patients with a missense variant in exons 1 or 2 or with the intronic hotspot variant c.559+5G>A (class I variants) had a 15-year OS of 93% (89-98) and a 30-year OS of 91% (86-97), compared to 71% (62-81) and 48% (34-68) in patients with any other variant (class II; p<0.0001). The cumulative incidence rates of disease-related complications such as severe bleeding (p=0.007), life-threatening infection (p<0.0001), and autoimmunity (p=0.004) occurred significantly later in patients with a class I variant. The cumulative incidence of malignancy (p=0.6) was not different between classes I and II. This study represents the largest cohort of WAS patients studied so far. It confirms the spectrum of disease severity and quantifies the risk for specific disease-related complications. The class of variant is a biomarker to predict the outcome for WAS patients.
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Affiliation(s)
- Tanja C Vallée
- Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Jannik S Glasmacher
- Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Uta Behrends
- Faculty of Medicine, Technical University Munich, Munich, Germany
| | | | | | | | | | | | - Peter Ciznar
- Faculty of Medicine, Comenius University, Bratislava, Bratislava, Slovak Republic
| | | | - Wojciech Czogala
- Jagiellonian University Medical College, Institute of Pediatrics, Krakow, Poland
| | | | - John David M Edgar
- St James's Hospital & School of Medicine Trinity College Dublin, Dublin, Ireland
| | - Fatih Erbey
- Koc University School of Medicine, Istanbul, Turkey
| | | | | | | | - Eleonora Gambineri
- University of Florence; 'Anna Meyer' Children's Hospital, IRCCS, Florence, Italy
| | - Andrew R Gennery
- Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | | | | | | | | | - Hanna Juntti
- Research Unit of Clinical Medicine, University of Oulu, Finland
| | | | | | | | | | - Christoph Klein
- Dr. von Hauner Childrens Hospital, LMU Klinikum, Munich, Germany
| | - Sylwia Koltan
- Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Irina Kondratenko
- Russian Children's Clinical Hospital, Pirogov National Research Medical University, Moscow, Moscow, Russian Federation
| | | | | | | | - Srdjan Pasic
- Mother and Child Health Institute of Serbia, Medical Faculty, University of Belgrade, Serbia., Belgrade, Serbia
| | | | | | - Siraj Ahmed Misbah
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | | | - Anna Shcherbina
- Dmitry Rogachev National Research and Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Mary A Slatter
- Newcastle upon Tyne NHS Foundation trust, Newcastle Upon Tyne, United Kingdom
| | - Robert Sokolic
- Food and Drug Administration, SHaron, Massachusetts, United States
| | | | | | | | - Samppa Ryhänen
- University of Helsinki and Helsinki University Hospital, ChildrenÂ's Hospital, and Pediatric Research Center, Helsinki, Finland
| | | | | | - Xiaodong Zhao
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | | | - Hans D Ochs
- University of Washington, Seattle, Washington, United States
| | - Michael H Albert
- Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
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Saglio F, Pagliara D, Zecca M, Balduzzi A, Cattoni A, Prete A, Tambaro FP, Faraci M, Calore E, Locatelli F, Fagioli F. Long-Term Complications after Allogeneic Hematopoietic Stem Cell Transplantation with Treosulfan- or Busulfan-Based Conditioning in Pediatric Patients with Acute Leukemia or Myelodysplastic Syndrome: Results of an Associazione Italiana Ematologia Oncologia Pediatrica Retrospective Study. Transplant Cell Ther 2024; 30:433.e1-433.e10. [PMID: 38176654 DOI: 10.1016/j.jtct.2023.12.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
Patients undergoing hematopoietic stem cell transplantation (HSCT) for hematologic malignancies during childhood have an increased risk of developing long-term sequelae that are in part attributable to the conditioning regimen. The present study aimed to assess the occurrence of long-term toxicities in a population of children who underwent HSCT for hematologic malignancies using either treosulfan or busulfan in the conditioning regimen. The cumulative incidences of growth impairment, altered gonadal function, altered thyroid function, cataracts, secondary malignant neoplasia, and altered pulmonary function were evaluated retrospectively by univariable and multivariable analyses in a population of 521 pediatric patients with acute leukemias or myelodysplastic syndromes treated in 20 Italian transplant centers affiliated with the Associazione Italiana Ematologia ed Oncologia Pediatrica (AIEOP). The median duration of follow-up for the entire study population was 7.1 years (range, 1 to 16 years). Overall, a larger proportion of patients given busulfan developed long-term toxicities compared to patients treated with treosulfan (34% versus 20%; P = .01). In univariable analysis, gonadal toxicity developed in 10% of patients who received treosulfan (95% confidence interval [CI], 3% to 15%), compared with 38% (95% CI, 24% to 39%) of busulfan-treated patients (P = .02), and this finding was confirmed by multivariable analysis (relative risk, .51; 95% CI, .34 to .76; P = .0009). We did not find any statistically significant associations between the occurrence of other long-term toxicities and the use of either busulfan or treosulfan. This study provides evidence that the use of treosulfan is correlated with a reduced incidence of gonadal toxicity in children undergoing HSCT for hematologic malignancies.
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Affiliation(s)
- Francesco Saglio
- Paediatric Onco-Haematology Division, Regina Margherita Children's Hospital AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Daria Pagliara
- Department of Hematology/Oncology, Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Adriana Balduzzi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; School of Medicine and Surgery, University of di Milano-Bicocca, Monza, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; School of Medicine and Surgery, University of di Milano-Bicocca, Monza, Italy
| | - Arcangelo Prete
- Pediatric Oncology and Hematology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Maura Faraci
- Hematopoietic stem cell Transplant Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Elisabetta Calore
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, University Hospital of Padua, Padua, Italy
| | - Franco Locatelli
- Department of Hematology/Oncology, Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Franca Fagioli
- Paediatric Onco-Haematology Division, Regina Margherita Children's Hospital AOU Città della Salute e della Scienza di Torino, Turin, Italy; Università degli Studi di Torino, Turin, Italy.
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5
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Gibellato E, Cianci P, Mariani M, Parma B, Huisman S, Śmigiel R, Bisgaard AM, Massa V, Gervasini C, Moretti A, Cattoni A, Biondi A, Selicorni A. SMC1A epilepsy syndrome: clinical data from a large international cohort. Am J Med Genet A 2024:e63577. [PMID: 38421079 DOI: 10.1002/ajmg.a.63577] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
SMC1A epilepsy syndrome or developmental and epileptic encephalopathy-85 with or without midline brain defects (DEE85, OMIM #301044) is an X-linked neurologic disorder associated with mutations of the SMC1A gene, which is also responsible for about 5% of patients affected by Cornelia de Lange syndrome spectrum (CdLS). Only described in female patients, SMC1A epilepsy syndrome is characterized by the onset of severe refractory epileptic seizures in the first year of life, global developmental delay, a variable degree of intellectual disability, and dysmorphic facial features not typical of CdLS. This was a descriptive observational study for the largest international cohort with this specific disorder. The main goal of this study was to improve the knowledge of the natural history of this phenotype with particular attention to the psychomotor development and the epilepsy data. The analyzed cohort shows normal prenatal growth with the subsequent development of postnatal microcephaly. The incidence of neonatal problems (seizures and respiratory compromise) is considerable (51.4%). There is a significant prevalence of central nervous system (20%) and cardiovascular malformations (20%). Motor skills are generally delayed. The presence of drug-resistant epilepsy is confirmed; the therapeutic role of a ketogenic diet is still uncertain. The significant regression of previously acquired skills following the onset of seizures has been observed. Facial dysmorphisms are variable and no patient shows a classic CdLS phenotype. To sum up, SMC1A variants caused drug-resistant epilepsy in these patients, more than two-thirds of whom were shown to progress to developmental and epileptic encephalopathy. The SMC1A gene variants are all different from each other (apart from a couple of monozygotic twins), demonstrating the absence of a mutational hotspot in the SMC1A gene. Owing to the absence of phenotypic specificity, whole-exome sequencing is currently the diagnostic gold standard.
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Affiliation(s)
- Elisabetta Gibellato
- Pediatric Department, "Mariani" Center for Fragile Child, ASST Lariana, Sant'Anna Hospital, Como, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paola Cianci
- Pediatric Department, "Mariani" Center for Fragile Child, ASST Lariana, Sant'Anna Hospital, Como, Italy
| | - Milena Mariani
- Pediatric Department, "Mariani" Center for Fragile Child, ASST Lariana, Sant'Anna Hospital, Como, Italy
| | - Barbara Parma
- Pediatric Department, "Mariani" Center for Fragile Child, ASST Lariana, Sant'Anna Hospital, Como, Italy
| | - Sylvia Huisman
- Pediatric Department, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Robert Śmigiel
- Pediatric Department, Endocrinology, Diabetology and Metabolic Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Anne-Marie Bisgaard
- Pediatric Department and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Valentina Massa
- Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Alex Moretti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alessandro Cattoni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Andrea Biondi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Angelo Selicorni
- Pediatric Department, "Mariani" Center for Fragile Child, ASST Lariana, Sant'Anna Hospital, Como, Italy
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Passoni P, Inzoli A, De Ponti E, Polizzi S, Ceccherelli A, Fantauzzi M, Procaccianti C, Cattoni A, Villa S, Riva A, Righetti S, Landoni F, Fruscio R. Association between physical activity and menstrual cycle disorders in young athletes. Int J Sports Med 2024. [PMID: 38417813 DOI: 10.1055/a-2278-3253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Our study aims at evaluating clinical predictors of menstrual cycle disorders in female athletes who compete in running disciplines. This is a prospective observational study. Women were recruited between January and May 2022. 53 patients were enrolled and completed a questionnaire about menstrual cycle, physical activity and food habits characteristics. 39,6% of women in our population had menstrual irregularities and reported a significantly higher number of kilometres run per week (67 vs 35, p:0.02). The number of kilometres run per week was associated with menstrual irregularities (for 10 km, OR 1,35; IC95% 1,05-1,73; p: 0,02) after adjusting for BMI, age, level of sport and caloric intake. The variable of "km run per week" appeared as a diagnostic indicator of irregular menstrual cycle with statistical significance (AUC ROC curve 0,71, IC95% 0,54-0,86, p-value = 0,01) and the cut off-of 65 km run per week is a good indicator of the presence of irregular menstrual cycle (sensitivity (SE) and specificity (SP) of 55% and 81,48%). Menstrual cycle disorders are very frequent in female athletes and the variable of km run per week may have a role in screening endurance athletes at high risk for them.
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Affiliation(s)
- Paolo Passoni
- UO Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alessandra Inzoli
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| | - Elena De Ponti
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
- Department of Physical Medicine, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Serena Polizzi
- UO Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Anna Ceccherelli
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| | - Martina Fantauzzi
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| | - Chiara Procaccianti
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| | - Alessandro Cattoni
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Silvia Villa
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| | - Anna Riva
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Stefano Righetti
- Interventional Cardiology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
- UO Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
- UO Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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7
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Cattoni A, Nicolosi ML, Capitoli G, Gadda A, Molinari S, Louka S, Buonsante A, Orlandi S, Salierno G, Bellani I, Vendemini F, Ottaviano G, Gaiero A, Fichera G, Biondi A, Balduzzi A. Pubertal attainment and Leydig cell function following pediatric hematopoietic stem cell transplantation: a three-decade longitudinal assessment. Front Endocrinol (Lausanne) 2023; 14:1292683. [PMID: 38152128 PMCID: PMC10751351 DOI: 10.3389/fendo.2023.1292683] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/01/2023] [Indexed: 12/29/2023] Open
Abstract
Introduction Impaired testosterone secretion is a frequent sequela following hematopoietic stem cell transplantation (HSCT) in pediatrics, but long-term longitudinal trendlines of clinical and biochemical findings are still scanty. Methods Monocentric, retrospective analysis. Male patients transplanted <18 years between 1992 and 2021, surviving ≥2 years after HSCT and showing, upon enrollment, clinical and biochemical signs consistent with pubertal onset and progression were included. Clinical and biochemical data collected every 6-12 months were recorded. Results Of 130 patients enrolled, 56% were prepubertal, while 44% were peri-/postpubertal upon HSCT. Overall, 44% showed spontaneous progression into puberty and normal gonadal profile, while the remaining experienced pubertal arrest (1%), isolated increase of FSH (19%), compensated (23%) or overt (13%) hypergonadotropic hypogonadism. Post-pubertal testicular volume (TV) was statistically smaller among patients still pre-pubertal upon HSCT (p 0.049), whereas no differences were recorded in adult testosterone levels. LH and testosterone levels showed a specular trend between 20 and 30 years, as a progressive decrease in sexual steroids was associated with a compensatory increase of the luteinizing hormone. A variable degree of gonadal dysfunction was reported in 85%, 51%, 32% and 0% of patients following total body irradiation- (TBI), busulfan-, cyclophosphamide- and treosulfan-based regimens, respectively. TBI and busulfan cohorts were associated with the lowest probability of gonadal event-free course (p<0.0001), while it achieved 100% following treosulfan. A statistically greater gonadotoxicity was detected after busulfan than treosulfan (p 0.024). Chemo-only regimens were associated with statistically larger TV (p <0.001), higher testosterone (p 0.008) and lower gonadotropin levels (p <0.001) than TBI. Accordingly, the latter was associated with a 2-fold increase in the risk of gonadal failure compared to busulfan (OR 2.34, CI 1.08-8.40), whereas being pre-pubertal upon HSCT was associated with a reduced risk (OR 0.15, CI 0.08-0.30). Conclusions a) patients pre-pubertal upon HSCT showed a reduced risk of testicular endocrine dysfunction, despite smaller adult TV; b) patients showed downwards trend in testosterone levels after full pubertal attainment, despite a compensatory increase in LH; c) treosulfan was associated to a statistically lower occurrence of hypogonadism than busulfan, with a trend towards larger TV, higher testosterone levels and lower gonadotropins.
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Affiliation(s)
- Alessandro Cattoni
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Laura Nicolosi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giulia Capitoli
- Bicocca Bioinformatics, Biostatistics and Bioimaging B4 Centre, University of Milano-Bicocca, Monza, Italy
| | - Alberto Gadda
- Bicocca Bioinformatics, Biostatistics and Bioimaging B4 Centre, University of Milano-Bicocca, Monza, Italy
| | - Silvia Molinari
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Sotiris Louka
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Andrea Buonsante
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Simona Orlandi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Gianluca Salierno
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Iacopo Bellani
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesca Vendemini
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giorgio Ottaviano
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alberto Gaiero
- Department of Pediatrics and Neonatology, IRCCS Gaslini Savona e Pietra Ligure, Savona, Italy
| | | | - Andrea Biondi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Adriana Balduzzi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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8
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Terenziani M, Tozzi AE, Diaco L, Biasin E, Cattoni A, Croci I, Fraschini D, Giorgiani G, Haupt R, Muraca M, Pillon M, Sironi G, Valsecchi MG, Mastronuzzi A. Current practices of follow-up programs for childhood cancer survivors in Italy. Tumori 2023; 109:555-561. [PMID: 37434559 DOI: 10.1177/03008916231185981] [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] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Quality of life in childhood cancer survivors is largely affected by survivorship care and transition from treatment to long-term follow-up (LTFU). Referring to evidence-based recommendations, we wanted to evaluate LTFU care for survivors through a survey among the Italian Association for Pediatric Hematology-Oncology (AIEOP) centers. The project aimed to evaluate the availability of services in Italy, investigate strengths and weaknesses, analyze improvements of awareness in the field, and identify the gaps that need to be addressed by different centers. METHODS Together with the family representatives, on behalf of AIEOP's Late Effects Working Group, we developed a questionnaire on assisting childhood cancer survivors. All AIEOP centers received one questionnaire including information on local health system organizations; LTFU for childhood cancer survivors; services for adult survivors of childhood cancer; information provided to survivors/caregivers and care plan delivery. RESULTS Forty-eight AIEOP centers were contacted and 42 replied, with a response rate of 87.5%. The majority of respondents confirmed their interest in assisting patients with a survivorship care plan (95.2%), regardless of a clinic or dedicated staff. DISCUSSION This is the first overview of LTFU in Italy, which provides detailed results at national levels, prompting consideration of improvements in the last decade. Although there is a high level of interest in survivorship care, many centers lack resources to implement such programs. The identification of these challenges is useful for planning future strategies.
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Affiliation(s)
- Monica Terenziani
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Alberto Eugenio Tozzi
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Lazio, Italy
| | - Laura Diaco
- FIAGOP - Federazione Italiana Associazioni Genitori e Guariti Oncoematologia Pediatrica, Rome, Italy
| | - Eleonora Biasin
- Pediatric Onco-Hematology, Regina Margherita Children Hospital, Turin, Piemonte, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Monza, Lombardia, Italy
| | - Ileana Croci
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Lazio, Italy
| | - Donatella Fraschini
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Monza, Lombardia, Italy
| | - Giovanna Giorgiani
- Pediatric Onco-Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | - Riccardo Haupt
- DOPO Clinic, Division of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Liguria, Italy
| | - Monica Muraca
- DOPO Clinic, Division of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Liguria, Italy
| | - Marta Pillon
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy
| | - Giovanna Sironi
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Maria Grazia Valsecchi
- Bicocca Centre of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano Bicocca, Milan, Lombardia, Italy
| | - Angela Mastronuzzi
- Department of Onco-Hematology, Gene Therapy, Cell Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital IRCCS, Rome, Lazio, Italy
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9
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Cattoni A, Molinari S, Capitoli G, Masera N, Nicolosi ML, Barzaghi S, Marziali G, Lazzerotti A, Gazzarri A, Vimercati C, Sala D, Biondi A, Galimberti S, Fossati C. Thyroid Function Tests in Children and Adolescents With Trisomy 21: Definition of Syndrome-Specific Reference Ranges. J Clin Endocrinol Metab 2023; 108:2779-2788. [PMID: 37279507 DOI: 10.1210/clinem/dgad333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023]
Abstract
CONTEXT The lack of syndrome-specific reference ranges for thyroid function tests (TFT) among pediatric patients with Down syndrome (DS) results in an overestimation of the occurrence of hypothyroidism in this population. OBJECTIVE To (a) outline the age-dependent distribution of TFT among pediatric patients with DS; (b) describe the intraindividual variability of TFT over time; and (c) assess the role of elevated thyrotropin (TSH) in predicting the future onset of overt hypothyroidism. METHODS In this retrospective, monocentric, observational analysis, we included 548 patients with DS (0-18 years) longitudinally assessed between 1992 and 2022. Exclusion criteria were abnormal thyroid anatomy, treatments affecting TFT, and positive thyroid autoantibodies. RESULTS We determined the age-dependent distribution of TSH, FT3, and FT4 and outlined the relative nomograms for children with DS. Compared with non-syndromic patients, median TSH levels were statistically greater at any age (P < .001). Median FT3 and FT4 levels were statistically lower than controls (P < .001) only in specific age classes (0-11 for FT3, 11-18 years for FT4). TSH levels showed a remarkable fluctuation over time, with a poor (23%-53%) agreement between the TSH centile classes at 2 sequential assessments. Finally, the 75th centile was the threshold above which TSH values predicted future evolution into overt hypothyroidism with the best statistical accuracy, with a satisfactory negative predictive value (0.91), but poor positive predictive value (0.15). CONCLUSION By longitudinally assessing TFT in a wide pediatric DS population, we outlined the syndrome-specific reference nomograms for TSH, FT3, and FT4 and demonstrated a persistent upward shift of TSH compared to non-syndromic children.
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Affiliation(s)
- Alessandro Cattoni
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza (MB), Italy
| | - Silvia Molinari
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | - Giulia Capitoli
- B4 Center of Bioinformatics, Biostatistics e Bioimaging, University of Milano-Bicocca, 20854 Vedano al Lambro (MB), Italy
| | - Nicoletta Masera
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | | | - Silvia Barzaghi
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | - Giulia Marziali
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | | | - Alessandra Gazzarri
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | - Chiara Vimercati
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | - Debora Sala
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | - Andrea Biondi
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza (MB), Italy
| | - Stefania Galimberti
- B4 Center of Bioinformatics, Biostatistics e Bioimaging, University of Milano-Bicocca, 20854 Vedano al Lambro (MB), Italy
| | - Chiara Fossati
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
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10
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Rodari G, Federici S, Todisco T, Ubertini G, Cattoni A, Pagano M, Giacchetti F, Profka E, Citterio V, Messetti D, Collini V, Soranna D, Carbone E, Arosio M, Mantovani G, Persani L, Cappa M, Bonomi M, Giavoli C. Towards an individualized management of pubertal induction in girls with hypogonadism: insight into the best replacement outcomes from a large multicentre registry. Eur J Endocrinol 2023:7180093. [PMID: 37232247 DOI: 10.1093/ejendo/lvad056] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/08/2023] [Accepted: 04/05/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE An evidence-based pubertal induction scheme in hypogonadal girls is still to be established. Interestingly, literature data reports suboptimal uterine longitudinal diameter (ULD) in >50% of treated hypogonadal women, negatively influencing their pregnancy outcomes. This study aims to investigate auxological and uterine outcomes of pubertal induction in girls in the light of underlying diagnosis and therapeutic schemes used. DESIGN Retrospective analysis of longitudinal data from a multicentric registry. METHODS Auxological, biochemical and radiological data were collected at baseline and during follow-up in 95 hypogonadal girls (chronological age>10.9 years, Tanner stage≤2) treated with transdermal 17β-oestradiol patches for at least one year. Induction was started at a median dose of 0.14 mcg/kg/day with a six-monthly increase and was considered completed for 49/95 patients who started progesterone with concomitant oestrogen adult dose. RESULTS At the end of induction, the achievement of the complete breast maturation was associated with 17β-oestradiol dose at progesterone introduction. ULD showed a significant correlation with 17β-oestradiol dosage. Final ULD was>65 mm in only 17/45 girls. At multiple regression analysis, pelvic irradiation represented the major determinant of reduced final ULD. After correction for uterine irradiation, ULD was associated with the 17β-oestradiol dose at progesterone introduction. Final ULD was not significantly different from the one assessed after progesterone introduction. CONCLUSIONS Our results provide evidence that progestins, hampering further changes in uterine volume and breast development, should be introduced only in the presence of a concomitant adequate 17β-oestradiol dose and an appropriate clinical response.
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Affiliation(s)
- Giulia Rodari
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Silvia Federici
- University of Milan, Department of Medical Biotechnology and Translational Medicine, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Department of Endocrine and Metabolic Diseases, Milan, Italy
| | - Tommaso Todisco
- Endocrinology Unit, University-Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Graziamaria Ubertini
- Endocrinology Unit, University-Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Cattoni
- Pediatric Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, Milano-Bicocca University, Italy
| | - Marta Pagano
- Pediatric Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, Milano-Bicocca University, Italy
| | - Federico Giacchetti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Eriselda Profka
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Valeria Citterio
- University of Milan, Department of Medical Biotechnology and Translational Medicine, Milan, Italy
| | - Dario Messetti
- University of Milan, Department of Medical Biotechnology and Translational Medicine, Milan, Italy
| | - Valentina Collini
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Davide Soranna
- IRCCS Istituto Auxologico Italiano, Biostatistics Unit, Milan, Italy
| | - Erika Carbone
- IRCCS Istituto Auxologico Italiano, Department of Endocrine and Metabolic Diseases, Milan, Italy
| | - Maura Arosio
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Giovanna Mantovani
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Luca Persani
- University of Milan, Department of Medical Biotechnology and Translational Medicine, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Department of Endocrine and Metabolic Diseases, Milan, Italy
| | - Marco Cappa
- Research Unit for Innovative Therapies in Endocrinopathies, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Bonomi
- University of Milan, Department of Medical Biotechnology and Translational Medicine, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Department of Endocrine and Metabolic Diseases, Milan, Italy
| | - Claudia Giavoli
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
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11
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Cattoni A, Capitoli G, Casagranda S, Corti P, Adavastro M, Molinaro A, Di Gennaro F, Bonanomi S, Biondi A, Galimberti S, Balduzzi A. Iron Overload Following Hematopoietic Stem Cell Transplantation: Prevalence, Severity, and Management in Children and Adolescents with Malignant and Nonmalignant Diseases. Transplant Cell Ther 2023; 29:271.e1-271.e12. [PMID: 36708803 DOI: 10.1016/j.jtct.2023.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/13/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
Iron overload (IOL) is a frequently reported complication following hematopoietic stem cell transplantation (HSCT) that has been investigated extensively in the field of hemoglobinopathies but has not been thoroughly characterized after HSCT in pediatric malignancies. Our aim was to assess prevalence, severity, risk factors, and management of IOL, as defined using biochemical (serum ferritin) and radiologic tools (T2*-weighted magnetic resonance imaging [MRI]), in a cohort of pediatric patients who underwent HSCT for either malignant or benign diseases. This monocentric, retrospective, observational study included all the 163 patients alive and in continuous remission at 24 months post-HSCT out of the 219 consecutive children and adolescents who underwent HSCT at our institution between 2012 and 2018, were included in the study. IOL was classified into 4 categories: absent, mild, moderate, and severe. Among the 163 patients, 73% had some degree of IOL (mild in 37%, moderate in 29%, and severe in 7%). Moderate/severe IOL was more frequent among patients diagnosed with a malignant disease versus those with a benign disease (43% versus 19%; P = .0065). Trend lines for serum ferritin showed a "bell-shaped" distribution, with the highest levels recorded during the first 6 months post-HSCT, followed by a spontaneous reduction. Both pre-HSCT (1659 ng/mL versus 617 ng/mL; P < .001) and maximum post-HSCT (2473 ng/mL versus 1591 ng/mL; P < .001) median ferritin levels were statistically higher in the patients with malignancies. Radiologic assessment of IOL confirmed a more severe degree in patients with malignant disorders compared to those with benign disorders (median T2*-MRI, 4.20 msec [interquartile range (IQR), 3.0 to 6.40 msec] versus 7.40 msec [IQR, 4.90 to 11.00 msec]; P = .008). T2* levels were associated with the number of transfusions performed (P = .0006), with a steeper drop in T2* values for the first 20 transfusions and a milder slope for subsequent transfusions. T2* and ferritin values showed a statistically significant negative exponential relationship (P < .0001), although a ferritin level ≥1000 ng/mL showed poor specificity (48%) and low positive predictive value (53%) for discriminating moderate-to-severe IOL from absent-mild IOL as assessed by T2*-MRI, but with high sensitivity (92%) and negative predictive value (91%). In a multivariable model, >20 transfusions (odds ratio [OR], 4.07; 95% confidence interval [CI], 1.61 to 10.68; P = .003) and higher pre-HSCT ferritin level (P < .001) were associated with the risk of developing moderate-to-severe IOL. Use of a sibling donor (OR, .29; 95% CI, .10 to .77; P = .015) and a nonmalignancy (OR, .27; 95% CI, .08 to .82; P = .026) were protective factors. Phlebotomy (66%), low-dose oral chelators (9%), or a combined approach (25%) were started at a median of 12 months after HSCT in 78% of the patients with IOL. Six percent of the patients treated exclusively with phlebotomy (median, 14, significantly higher in patients >40 kg) discontinued phlebotomy owing to poor venous access, lack of compliance, or hypotension, whereas 39% of patients treated with chelators developed mild renal or hepatic side effects that resolved after tapering or discontinuation. Patients with malignancies showed statistically higher pre-HSCT and post-HSCT ferritin levels and lower T2* values. High ferritin level recorded on T2*-MRI showed unsatisfactory diagnostic accuracy in predicting IOL; thus, T2*-MRI should be considered a key tool for confirming IOL after HSCT in patients with an elevated serum ferritin level. IOL treatment is feasible after HSCT.
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Affiliation(s)
- Alessandro Cattoni
- Pediatria, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Dipartimento di Medicina e Chirurgia, Università degli Studi Milano-Bicocca, Milan, Italy.
| | - Giulia Capitoli
- Dipartimento di Medicina e Chirurgia, Università degli Studi Milano-Bicocca, Milan, Italy; Centro B4 di Bioinformatica, Biostatistica e Bioimaging, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Sara Casagranda
- Pediatria, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Paola Corti
- Pediatria, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Marta Adavastro
- Pediatria, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | | | - Sonia Bonanomi
- Pediatria, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Andrea Biondi
- Pediatria, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Dipartimento di Medicina e Chirurgia, Università degli Studi Milano-Bicocca, Milan, Italy
| | - Stefania Galimberti
- Dipartimento di Medicina e Chirurgia, Università degli Studi Milano-Bicocca, Milan, Italy; Centro B4 di Bioinformatica, Biostatistica e Bioimaging, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Adriana Balduzzi
- Pediatria, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Dipartimento di Medicina e Chirurgia, Università degli Studi Milano-Bicocca, Milan, Italy
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Seminati D, Ceola S, Pincelli AI, Leni D, Gatti A, Garancini M, L'Imperio V, Cattoni A, Pagni F. The Complex Cyto-Molecular Landscape of Thyroid Nodules in Pediatrics. Cancers (Basel) 2023; 15:cancers15072039. [PMID: 37046700 PMCID: PMC10093758 DOI: 10.3390/cancers15072039] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Thyroid fine-needle aspiration (FNA) is a commonly used diagnostic cytological procedure in pediatric patients for the evaluation of thyroid nodules, triaging them for the detection of thyroid cancer. In recent years, greater attention has been paid to thyroid FNA in this setting, including the use of updated ultrasound score algorithms to improve accuracy and yield, especially considering the theoretically higher risk of malignancy of these lesions compared with the adult population, as well as to minimize patient discomfort. Moreover, molecular genetic testing for thyroid disease is an expanding field of research that could aid in distinguishing benign from cancerous nodules and assist in determining their clinical management. Finally, artificial intelligence tools can help in this task by performing a comprehensive analysis of all the obtained data. These advancements have led to greater reliance on FNA as a first-line diagnostic tool for pediatric thyroid disease. This review article provides an overview of these recent developments and their impact on the diagnosis and management of thyroid nodules in children.
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Affiliation(s)
- Davide Seminati
- Department of Medicine and Surgery, Pathology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Stefano Ceola
- Department of Medicine and Surgery, Pathology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Angela Ida Pincelli
- Department of Endocrinology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Davide Leni
- Department of Radiology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Andrea Gatti
- Department of Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Mattia Garancini
- Department of Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Vincenzo L'Imperio
- Department of Medicine and Surgery, Pathology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
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Faraguna MC, Lepri I, Clavenna A, Bonati M, Vimercati C, Sala D, Cattoni A, Melzi ML, Biondi A. The bronchiolitis epidemic in 2021-2022 during the SARS-CoV-2 pandemic: experience of a third level centre in Northern Italy. Ital J Pediatr 2023; 49:26. [PMID: 36803828 PMCID: PMC9942300 DOI: 10.1186/s13052-023-01425-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The aim of this study is to compare the 2021-2022 bronchiolitis season to the four previous years (2017-2018, 2018-2019, 2019-2020, 2020-2021) to see if there was an anticipation of the peak, an overall increase of cases, and an increased need of intensive care. METHODS A retrospective single-centre study in the San Gerardo Hospital Fondazione MBBM, Monza, Italy was performed. Emergency Departments (ED) visits of patients aged < 18 years and ≤ 12 months were analyzed: the incidence of bronchiolitis on total assessments, the urgency level at triage and the hospitalization rate were compared. Data of children admitted to the Pediatric Department due to bronchiolitis were analyzed in terms of need of intensive care, respiratory support (type and duration), length of hospital stay, main etiological agent, patient characteristics. RESULTS During 2020-2021 (first pandemic period) an important reduction in the ED attendance for bronchiolitis was observed, while in 2021-2022 there was an increase in incidence of bronchiolitis (13% of visits in infants < 1 year) and in the rate of urgent accesses (p = 0.0002), but hospitalization rates did not differ compared to previous years. Furthermore, an anticipated peak in November 2021 was observed. In the 2021-2022 cohort of admitted children to the Pediatric Department, a statistically significative increased need of intensive care unit was detected (Odds Ratio 3.1, 95% CI 1.4-6.8 after adjustment for severity and clinical characteristics). Instead, respiratory support (type and duration) and length of hospital stay did not differ. RSV was the main etiological agent and RSV-bronchiolitis determined a more severe infection (type and duration of breathing support, intensive care need and length of hospital stay). CONCLUSIONS During Sars-CoV-2 lockdowns (2020-2021), there was a dramatic decrease of bronchiolitis and others respiratory infections. In the following season, 2021-2022, an overall increase of cases with an anticipated peak was observed and data analysis confirmed that patients in 2021-2022 required more intensive care than children in the four previous seasons.
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Affiliation(s)
| | - Irene Lepri
- Residency in Pediatrics, University of Milano Bicocca, Monza, Italy.
| | - Antonio Clavenna
- grid.4527.40000000106678902Laboratory for Mother and Child Health, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio Bonati
- grid.4527.40000000106678902Laboratory for Mother and Child Health, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Vimercati
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Debora Sala
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Alessandro Cattoni
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Maria Luisa Melzi
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Andrea Biondi
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy ,grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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Lattuada M, Molinari S, Nicolosi ML, Doni D, Lui C, Passoni P, Polizzi S, Ocello L, Evasi V, Calia M, Gustuti V, Cattoni A. Exaggerated mini-puberty in a preterm girl: a case report and review of literature. J Pediatr Endocrinol Metab 2022; 35:1309-1315. [PMID: 35942594 DOI: 10.1515/jpem-2022-0179] [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: 04/10/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Mini-puberty is the physiological and transient activation of the hypothalamic-pituitary-gonadal axis occurring during the first months after birth. In preterm infants, the hormonal surge is more pronounced and longer-lasting than in at-term-peers. To date, only few cases of vaginal bleeding in the setting of an exaggerated mini-puberty have been reported. CASE PRESENTATION At the corrected age of 3 months, an ex-very-preterm girl presented with breast enlargement and recurrent vaginal bleeding. A remarkable increase in gonadotropins and estradiol levels was detected, while pelvic ultrasound highlighted a large right ovarian cyst. As brain and pituitary MRI showed negative findings, an exaggerated mini-puberty was suspected and no additional investigations were undertaken. The subsequent progressive regression of clinical, biochemical and sonographic findings confirmed the diagnosis. CONCLUSIONS Although exaggerated mini-puberty of infancy in ex-preterm girls is a rare event, it is important to raise knowledge of this para-physiological condition in order to avoid unnecessary investigations and treatment.
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Affiliation(s)
- Martina Lattuada
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza MB, Italy
| | - Silvia Molinari
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza MB, Italy
| | - Maria Laura Nicolosi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza MB, Italy
| | - Daniela Doni
- Neonatal Intensive Care Unit, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza MB, Italy
| | - Cristina Lui
- Neonatal Intensive Care Unit, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza MB, Italy
| | - Paolo Passoni
- Department of Obstetrics and Gynecology, Azienda Ospedaliera San Gerardo, Via Pergolesi 33, 20900 Monza, Italy
| | - Serena Polizzi
- Department of Obstetrics and Gynecology, Azienda Ospedaliera San Gerardo, Via Pergolesi 33, 20900 Monza, Italy
| | - Laura Ocello
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza MB, Italy
| | - Veronica Evasi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza MB, Italy
| | - Margherita Calia
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza MB, Italy
| | - Violante Gustuti
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza MB, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza MB, Italy
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15
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Cattoni A, Molinari S, Gaiero A, De Lorenzo P, Fichera G, Riva B, Di Marco S, Tommesani C, Mariani E, Medici F, Pagni F, Nicolosi ML, Fraschini D, Napolitano S, Rovelli A, Biondi A, Valsecchi MG, Balduzzi A. Thyroid disorders following hematopoietic stem cell transplantation in childhood: the impact of the conditioning regimen on thyroid dysfunction, volume changes and occurrence of nodules. Transplant Cell Ther 2022; 28:506.e1-506.e12. [PMID: 35660063 DOI: 10.1016/j.jtct.2022.05.040] [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: 03/27/2022] [Revised: 05/14/2022] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Thyroid late effects are among the most frequent sequelae reported after pediatric hematopoietic stem cell transplantation (HSCT). Though the detrimental effects of radiotherapy on the developing thyroid gland have been extensively assessed, the role of chemotherapy-only conditioning regimens is still controversial. OBJECTIVE We aimed at describing the occurrence, monitoring and management of thyroid function disorders (i.e. Graves' disease, Hashimoto thyroiditis and non-autoimmune hypothyroidism), nodules and volumetric changes over a 20-year observation period in a single pediatric transplant unit. In addition, we assessed the impact of different conditioning regimens on thyroid health. STUDY design Retrospective observational analysis. The study population included 244 patients transplanted for pediatric malignant or non-malignant diseases between 1999 and 2018 and for whom at least four thyroid function tests and one or more thyroid ultrasound(s) assessed sequentially after HSCT were available. RESULTS The 15-year cumulative incidence (CI) of either autoimmune or non-autoimmune thyroid dysfunctions (34%, SE 5.3%) did not statistically differ between total body irradiation- (TBI-) and chemo-based regimens (p 0.23). Indeed, the CI after busulfan (BU) was overall superimposable to that recorded after TBI (10-year CI: 22.2% versus 25.9%, respectively). Nevertheless, the CI of non-autoimmune hypothyroidism was statistically higher after BU- (12.4%, SE 3.7%) than after other chemotherapy only-based-conditionings (3.1%, SE 3.1%; p 0.02, 5-year CI), treosulfan included. The overall CI of nodules was low for the first 5 years after HSCT (1.9%, SE 0.9%), but it showed a subsequent steep increase over time, with a 15-year CI as high as 52.1% (SE 7.5%). TBI-conditioned patients experienced a higher 15-year CI of nodules (66.8%, SE 9.1%) compared to those receiving chemo-only regimens (33.6%, SE 9.5%; p 0.02), whereas age > 10 years upon transplantation showed a protective effect (HR 0.42, 95% confidence interval 0.2-0.88). Finally, a systematic sonographic follow-up highlighted a progressive statistically significant reduction in thyroid antero-posterior diameter among patients conditioned with TBI (p 0.005), but not after chemo-only regimens. CONCLUSIONS TBI and younger age upon HSCT play a remarkable and statistically demonstrated detrimental role on the occurrence of thyroid nodules, both benign and malignant. TBI and BU expose patients to a higher cumulative incidence of thyroid dysfunctions than other chemo-only regimens, treosulfan included. Accordingly, BU can be regarded as the most thyrotoxic agent among those administered as a part of a chemo-only conditioning regimen. Finally, patients conditioned with TBI, but not with other regimens, show a progressive decrease in thyroid volume over time, as assessed by sequential ultrasounds.
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Affiliation(s)
- A Cattoni
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy.
| | - S Molinari
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - A Gaiero
- Department of Pediatrics, Ospedale San Paolo, Via Genova 30, 17100 - Savona, Italy
| | - P De Lorenzo
- Tettamanti Research Center, Department of Pediatrics, Università degli Studi di Milano-Bicocca, Via Pergolesi 33, 20900 - Monza, Italy; Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4), School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Via Pergolesi 33, 20900 - Monza, Italy
| | - G Fichera
- Department of Pediatrics, Ospedale San Paolo, Via Genova 30, 17100 - Savona, Italy
| | - B Riva
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - S Di Marco
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - C Tommesani
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - E Mariani
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - F Medici
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - F Pagni
- Department of Pathology, Università degli Studi di Milano-Bicocca, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - M L Nicolosi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - D Fraschini
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - S Napolitano
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - A Rovelli
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - A Biondi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - M G Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4), School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Via Pergolesi 33, 20900 - Monza, Italy
| | - A Balduzzi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
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16
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Riva A, Falbo M, Passoni P, Polizzi S, Cattoni A, Nacinovich R. High levels of physical activity in female adolescents with anorexia nervosa: medical and psychopathological correlates. Eat Weight Disord 2022; 27:151-162. [PMID: 33704692 DOI: 10.1007/s40519-021-01126-3] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/20/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE While overexercise is commonly described in patients who experience anorexia nervosa (AN), it represents a condition still underestimated, especially in the paediatric population. METHOD The present study aims at assessing the possible associations between levels of physical activity (PA) and clinical features, endocrinological data and psychopathological traits in a sample of 244 female adolescents hospitalised for AN subdivided into two groups according to PA levels (high PA vs. no/low PA). The two groups were compared through multivariate analyses, while multiple regression analysis was conducted to determine whether physical activity predict specific outcomes. RESULTS No significant differences were found between the two groups in terms of last Body Mass Index (BMI) before illness, BMI at admission and disease duration, while a difference emerged in delta BMI(rapidity of weight loss), significantly higher in high-PA group (p = 0.021). Significant differences were observed in Free triiodothyronine- (p < 0.001), Free thyroxine (p = 0.046), Follicle-stimulating hormone (p = 0.019), Luteinising hormone (p = 0.002) levels, with values remarkably lower in high-PA group. Concerning psychopathological scales, the high-PA group showed worst Children's Global Assessment Scale (CGAS) scores (p = 0.035). Regression analyses revealed that higher PA predicts higher delta BMI (p = 0.021), presence of amenorrhea (p = 0.003), lower heart rate (p = 0.012), lower thyroid (Free triiodothyronine p < 0.001, Free thyroxine p = 0.029) and gynaecological hormones' levels (Follicle-stimulating hormone p = 0.023, Luteinising hormone p = 0.003, 17-Beta estradiol p = 0.041). Concerning psychiatric measures, HPA predicts worst scores at CGAS (p = 0.019), and at scales for evaluation of alexithymia (p = 0.028) and depression (p = 0.004). CONCLUSIONS Results suggest that high levels of physical activity in acute AN associate with worst clinical conditions at admission, especially in terms of endocrinological and medical features. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Anna Riva
- Child and Adolescent Mental Health Department, Clinica di Neuropsichiatria dell'Infanzia e dell'Adolescenza, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy.
| | - Mariella Falbo
- Child and Adolescent Mental Health Department, Clinica di Neuropsichiatria dell'Infanzia e dell'Adolescenza, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Paolo Passoni
- Department of Obstetrics and Gynecology, San Gerardo Hospital, ASST Monza, via Pergolesi 33, 20900, Monza, Italy
| | - Serena Polizzi
- Department of Obstetrics and Gynecology, San Gerardo Hospital, ASST Monza, via Pergolesi 33, 20900, Monza, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, University of Milan Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, S. Gerardo Hospital, via Pergolesi 33, 20900, Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, Clinica di Neuropsichiatria dell'Infanzia e dell'Adolescenza, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
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Baronio F, Zucchini S, Zulian F, Salerno M, Parini R, Cattoni A, Deodato F, Gaeta A, Bizzarri C, Gasperini S, Pession A. Proposal of an Algorithm to Early Detect Attenuated Type I Mucopolysaccharidosis (MPS Ia) among Children with Growth Abnormalities. Medicina (Kaunas) 2022; 58:medicina58010097. [PMID: 35056405 PMCID: PMC8780542 DOI: 10.3390/medicina58010097] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/23/2021] [Accepted: 01/05/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives: Diagnostic delay is common in attenuated Mucopolysaccharidosis Type I (MPS Ia) due to the rarity of the disease and the variability of clinical presentation. Short stature and impaired growth velocity are frequent findings in MPS Ia, but they rarely raise suspicion as paediatric endocrinologists are generally poorly trained to detect earlier and milder clinical signs of this condition. Materials and Methods: Following a consensus-based methodology, a multidisciplinary panel including paediatric endocrinologists, paediatricians with expertise in metabolic disorders, radiologists, and rheumatologists shared their experience on a possible clinical approach to the diagnosis of MPS Ia in children with short stature or stunted growth. Results: The result was the formation of an algorithm that illustrates how to raise the suspicion of MPS Ia in a patient older than 5 years with short stature and suggestive clinical signs. Conclusion: The proposed algorithm may represent a useful tool to improve the awareness of paediatric endocrinologists and reduce the diagnostic delay for patients with MPS Ia.
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Affiliation(s)
- Federico Baronio
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (S.Z.); (A.P.)
- Correspondence: ; Tel.: +39-(0)-51-2144816
| | - Stefano Zucchini
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (S.Z.); (A.P.)
| | - Francesco Zulian
- Rheumatology Unit, Department of Woman’s and Child’s Health, University of Padua, 35128 Padua, Italy;
| | - Mariacarolina Salerno
- Pediatric Endocrine Unit, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Rossella Parini
- Department of Pediatrics, Milano-Bicocca University, Fondazione MBBM, San Gerardo Hospital, 20900 Monza, Italy; (R.P.); (A.C.); (S.G.)
| | - Alessandro Cattoni
- Department of Pediatrics, Milano-Bicocca University, Fondazione MBBM, San Gerardo Hospital, 20900 Monza, Italy; (R.P.); (A.C.); (S.G.)
| | - Federica Deodato
- Division of Metabolic Disease, Bambino Gesù Children’s Hospital IRCSS, 00165 Rome, Italy;
| | - Alberto Gaeta
- Radiology Unit, Pediatric Hospital Giovanni XXIII, 70123 Bari, Italy;
| | - Carla Bizzarri
- Unit of Endocrinology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Serena Gasperini
- Department of Pediatrics, Milano-Bicocca University, Fondazione MBBM, San Gerardo Hospital, 20900 Monza, Italy; (R.P.); (A.C.); (S.G.)
| | - Andrea Pession
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (S.Z.); (A.P.)
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Cattoni A, Albanese A. Case report: Fluctuating tumor markers in a boy with gonadotropin-releasing hormone-independent precocious puberty induced by a pineal germ cell tumor. Front Pediatr 2022; 10:940656. [PMID: 36081625 PMCID: PMC9445167 DOI: 10.3389/fped.2022.940656] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
GnRH-independent precocious puberty (GIPP) can be the presenting clinical picture experienced by patients with secreting germ cell tumor (GCT). Indeed, as luteinizing hormone (LH) and human chorionic gonadotropin (hCG) share identical α-subunits and similar β-subunits, an increased secretion of β-hCG may result in a precocious activation of Leydig cells. Though the co-occurrence of raised β-hCG levels and signs of precocious virilization usually prompts a complete oncological work-up, the diagnostic and therapeutic management of GCT-induced GIPP may be challenging. We report the case of a 6.2 year-old boy presenting with clinical and biochemical findings consistent with GIPP (discrepancy between overt virilization and pre-pubertal testicular volume, suppressed gonadotropins and remarkably raised testosterone). Brain imaging detected a bilobed cyst of the pineal gland, while serum and cerebrospinal baseline assessment initially ruled out raised alpha-fetoprotein or β-hCG levels. Nevertheless, a strict biochemical follow-up highlighted a fluctuant trend of tumor markers, with a more aggressive behavior and recurrent erections occurring as a result of unpredictable phases of raised testosterone and serum/cerebrospinal β-hCG, followed by sudden spontaneous decrease. Accordingly, a secreting pineal GCT was suspected. Given the fluctuating trend of tumor markers, surgery was initially kept on hold and a combined treatment with bicalutamide (androgen receptor blocker) and anastrozole (aromatase inhibitor) was undertaken in order to prevent the patient from experiencing further virilization and excessive bone age maturation. Subsequently, a progression in the size of the pineal tumor prompted surgical resection and a diagnosis of secreting GCT was histologically confirmed. Accordingly, the patient was started on adjuvant chemo- and radiotherapy. Antineoplastic treatment was followed by persistent and remarkable decrease of tumor markers and by a complete pubertal arrest. We reported the challenging diagnosis of a secreting pineal GCT in a patient with GIPP and a fluctuating trend of tumor markers, testosterone levels and associated clinical signs, hence prompting the indication for a systematic assessment and a strict monitoring whenever a patient with GnRH-independent precocious puberty shows clinical or radiological markers potentially consistent with a GCT.
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Affiliation(s)
- Alessandro Cattoni
- Department of Pediatrics, The Royal Marsden NHS Foundation Trust, London, United Kingdom.,Department of Pediatrics, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Assunta Albanese
- Department of Pediatrics, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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19
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Cattoni A, Molinari S, Riva B, Di Marco S, Adavastro M, Faraguna MC, Garella V, Medici F, Nicolosi ML, Pellegrinelli C, Lattuada M, Fraschini D, Pagni F, Biondi A, Balduzzi A. Thyroid function disorders and secondary cancer following haematopoietic stem cell transplantation in pediatrics: State of the art and practical recommendations for a risk-based follow-up. Front Endocrinol (Lausanne) 2022; 13:1064146. [PMID: 36619560 PMCID: PMC9811586 DOI: 10.3389/fendo.2022.1064146] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Thyroid disorders (TD) represent a remarkable share of all the late morbidities experienced following pediatric haematopoietic stem cell transplantation (HSCT), with long-term reported occurrence often exceeding 70%. In addition, the data collected on wide cohorts of survivors assessed longitudinally outlined a progressive increase in the cumulative incidence of TD as far as 30 years following transplantation. Accordingly, a life-long monitoring of thyroid health is warranted among patients exposed to HSCT in childhood, in order to early detect TD and undertake a prompt dedicated treatment. Although several national and international consortia have provided recommendations for the early detection of thyroid disorders among childhood cancer survivors exposed to radiotherapy and alkylating agents, no guidelines specifically and thoroughly focused on HSCT-related TD have been published to date. As stem cell transplantation has become the standard-of-care in a growing body of non-oncological conditions, this urge has become pivotal. To highlight the challenging issues specifically involving this cohort of patients and to provide clinicians with the proposal of a practical follow-up protocol, we reviewed published literature in the light of the shared experience of a multidisciplinary team of pediatric oncologists, transplantologists, pathologists and endocrinologists involved in the long-term care of HSCT survivors. As a final result, we hereby present the proposals of a practical and customized risk-based approach to tailor thyroid health follow-up based on HSCT-related detrimental factors.
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Affiliation(s)
- Alessandro Cattoni
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
- *Correspondence: Alessandro Cattoni,
| | - Silvia Molinari
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Benedetta Riva
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Santo Di Marco
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Marta Adavastro
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Martha Caterina Faraguna
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Vittoria Garella
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Francesco Medici
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Maria Laura Nicolosi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Claudia Pellegrinelli
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Martina Lattuada
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Donatella Fraschini
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Fabio Pagni
- Department of Pathology, Università degli Studi di Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Andrea Biondi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
| | - Adriana Balduzzi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Ospedale San Gerardo, Monza, Italy
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20
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Pontesilli S, Baldoli C, Rosa PAD, Cattoni A, Bernardo ME, Meregalli P, Gasperini S, Motta S, Fumagalli F, Tucci F, Baciga F, Consiglieri G, Canonico F, De Lorenzo P, Chiapparini L, Gentner B, Aiuti A, Biondi A, Rovelli A, Parini R. Evidence of Treatment Benefits in Patients with Mucopolysaccharidosis Type I-Hurler in Long-term Follow-up Using a New Magnetic Resonance Imaging Scoring System. J Pediatr 2022; 240:297-301.e5. [PMID: 34547335 DOI: 10.1016/j.jpeds.2021.09.020] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
We developed a brain and spine magnetic resonance scoring system based on a magnetic resonance assessment of 9 patients with mucopolysaccharidosis type I-Hurler who underwent hematopoietic stem-cell transplantation. The score is reliable and correlates with long-term clinical and cognitive outcome in patients with mucopolysaccharidosis type I-Hurler.
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Affiliation(s)
- Silvia Pontesilli
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Cristina Baldoli
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | - Alessandro Cattoni
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Maria Ester Bernardo
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy; Vita-Salute San Raffaele University of Milano, Milano, Italy
| | - Pamela Meregalli
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Serena Gasperini
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Serena Motta
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Francesca Fumagalli
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Francesca Tucci
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Federica Baciga
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Giulia Consiglieri
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Francesco Canonico
- Department of Radiology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Paola De Lorenzo
- Centro Operativo di Ricerca Statistica, Fondazione Tettamanti, University of Milano-Bicocca, Monza, Italy
| | - Luisa Chiapparini
- Neuroradiology Unit, IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Bernhard Gentner
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy; Vita-Salute San Raffaele University of Milano, Milano, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy; Vita-Salute San Raffaele University of Milano, Milano, Italy
| | - Andrea Biondi
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Attilio Rovelli
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Rossella Parini
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy.
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21
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Molinari S, Parissone F, Evasi V, De Lorenzo P, Valsecchi MG, Cesaro S, Fraschini D, Sangalli R, Cacace G, Biondi A, Balduzzi A, Cattoni A. Serum anti-Müllerian hormone as a marker of ovarian reserve after cancer treatment and/or hematopoietic stem cell transplantation in childhood: proposal for a systematic approach to gonadal assessment. Eur J Endocrinol 2021; 185:717-728. [PMID: 34519276 DOI: 10.1530/eje-21-0351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/14/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Female patients treated with alkylating agents in childhood are at risk for ovarian impairment. We aimed at describing the pattern of residual ovarian function in a cohort of survivors of hematological malignancies and/or hematopoietic stem cell transplantation (HSCT) and assessing the relationship between cyclophosphamide equivalent dose (CED) and anti-Müllerian hormone (AMH). DESIGN AND METHODS Gonadal health was clinically and biochemically assessed in 124 post-menarchal survivors who underwent treatment for pediatric hematological malignancies and/or HSCT between 1992 and 2019. RESULTS Overt 'premature ovarian insufficiency' (POI) was detected in 72.1 and 3.7% of transplanted and non-transplanted patients, respectively; milder 'diminished ovarian reserve' (DOR) in 16.3 and 22.2%. In non-transplanted patients, increasing CED values were associated with lower AMH-SDS (P = 0.04), with the threshold of 7200 g/m2 being the best discriminator between DOR/POI and normal ovarian function (AUC: 0.75 on ROC analysis) and with an observed decrease of 0.14 AMH-SDS for each CED increase of 1 g/m2. In addition, age at diagnosis ≥10 years played a detrimental role on ovarian reserve (P = 0.003). In the HSCT group, irradiation was associated with a statistically significant reduction in AMH-SDS (P = 0.04). CONCLUSIONS In non-transplanted patients, CED ≥ 7200 mg/m2 was associated with a DOR, while younger age at diagnosis played a protective role on ovarian reserve. As a result of the data collected, we propose a systematic algorithm to assess iatrogenic gonadal impairment in young female patients exposed to chemo-radiotherapy in childhood for hematological disorders.
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Affiliation(s)
- Silvia Molinari
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Monza, Italy
| | - Francesca Parissone
- Obstetrics and Gynecology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Veronica Evasi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Monza, Italy
| | - Paola De Lorenzo
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
- Tettamanti Research Center, Pediatric Clinic, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Donatella Fraschini
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Monza, Italy
| | | | | | - Andrea Biondi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Monza, Italy
| | - Adriana Balduzzi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Monza, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Monza, Italy
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22
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Cattoni A, Chiaraluce S, Gasperini S, Molinari S, Biondi A, Rovelli A, Parini R. "Growth patterns in children with mucopolysaccharidosis type I-Hurler after hematopoietic stem cell transplantation: Comparison with untreated patients". Mol Genet Metab Rep 2021; 28:100787. [PMID: 34408967 PMCID: PMC8361197 DOI: 10.1016/j.ymgmr.2021.100787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/09/2021] [Revised: 07/26/2021] [Accepted: 07/31/2021] [Indexed: 12/02/2022] Open
Abstract
The impact of hematopoietic stem cell transplantation (HSCT) on growth in patients diagnosed with mucopolysaccharidosis I Hurler (MPS-IH) has been historically regarded as unsatisfactory. Nevertheless, the growth patterns recorded in transplanted patients have always been compared to those of healthy children. The objective of this study was to verify the impact of HSCT on MPS-IH long term growth achievements. The auxological data of 15 patients were assessed longitudinally and compared both to the WHO growth centiles for healthy individuals and to recently published curves of untreated MPS-IH children. Despite a progressive decrease after HSCT when estimated with reference to the WHO growth charts, median height SDS showed a progressive and statistically significant increase when comparing the stature recorded at each timepoint in our population to the curves of untreated MPS-IH individuals (from ‐0.39 SDS at t0 to +1.35 SDS 5 years after HSCT, p value < 0.001 and to +3.67 SDS at the age of 9 years, p value < 0.0001). In conclusion, though not efficient enough to restore a normal growth pattern in MPS-IH patients, we hereby demonstrate that HSCT positively affects growth and provides transplanted patients with a remarkable height gain compared to untreated gender- and age- matched individuals.
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Affiliation(s)
- Alessandro Cattoni
- Department of Pediatrics, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Azienda Ospedaliera San Gerardo, Monza, (MB), Italy
- Corresponding author at: Department of Paediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, San Gerardo Hospital, via Pergolesi 33, 20900 Monza, (MB), Italy.
| | - Sofia Chiaraluce
- Department of Pediatrics, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Azienda Ospedaliera San Gerardo, Monza, (MB), Italy
| | - Serena Gasperini
- Department of Pediatrics, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Azienda Ospedaliera San Gerardo, Monza, (MB), Italy
| | - Silvia Molinari
- Department of Pediatrics, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Azienda Ospedaliera San Gerardo, Monza, (MB), Italy
| | - Andrea Biondi
- Department of Pediatrics, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Azienda Ospedaliera San Gerardo, Monza, (MB), Italy
| | - Attilio Rovelli
- Department of Pediatrics, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Azienda Ospedaliera San Gerardo, Monza, (MB), Italy
| | - Rossella Parini
- Department of Pediatrics, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Azienda Ospedaliera San Gerardo, Monza, (MB), Italy
- TIGET Institute, IRCCS San Raffaele Hospital, Segrate, (MI), Italy
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23
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Saettini F, Cattoni A, Redaelli M, Silvestri D, Ferrari GM, Biondi A, Jankovic M, Spinelli M. Primary immunodeficiencies, autoimmune hyperthyroidism, coeliac disease and systemic lupus erythematosus in childhood immune thrombocytopenia. Acta Paediatr 2021; 110:643-651. [PMID: 33025591 DOI: 10.1111/apa.15593] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/26/2020] [Accepted: 09/21/2020] [Indexed: 01/05/2023]
Abstract
AIM To evaluate the cumulative prevalence of coeliac disease, systemic lupus erythematosus, autoimmune hyperthyroidism and primary immunodeficiencies in children with either newly diagnosed/persistent or chronic immune thrombocytopenia (ITP). METHODS Monocentric retrospective analysis of the clinical and biochemical features of 330 consecutive patients with ITP referred to our Pediatric Hematology Unit between January 2009 and December 2018. RESULTS The prevalence of systemic lupus erythematosus (0.3%), coeliac disease (0.3%) and autoimmune hyperthyroidism (0.6%) was not increased compared to general paediatric population. Of note, the prevalence of underlying primary immunodeficiencies was 2.4%, remarkably higher than the general paediatric population (P = .005). All the patients diagnosed with immunodeficiency developed either bi-/trilinear cytopenia or splenomegaly. CONCLUSION Whilst autoimmune and immunological screening is already recommended at the onset of immune thrombocytopenia, we recommend that primary immunodeficiencies be regularly screened during follow-up, especially in case of additional cytopenia or lymphoproliferation.
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Affiliation(s)
- Francesco Saettini
- Department of Pediatric Onco‐Hematology San Gerardo Hospital Fondazione MBBMUniversità degli Studi di Milano‐Bicocca Monza Italy
| | - Alessandro Cattoni
- Department of Pediatrics San Gerardo Hospital Fondazione MBBMUniversità degli Studi di Milano‐Bicocca Monza Italy
| | - Martina Redaelli
- Department of Pediatric Onco‐Hematology San Gerardo Hospital Fondazione MBBMUniversità degli Studi di Milano‐Bicocca Monza Italy
| | - Daniela Silvestri
- Department of Pediatrics San Gerardo Hospital Fondazione TettamantiUniversità degli Studi di Milano‐Bicocca Monza Italy
| | - Giulia Maria Ferrari
- Department of Pediatric Onco‐Hematology San Gerardo Hospital Fondazione MBBMUniversità degli Studi di Milano‐Bicocca Monza Italy
| | - Andrea Biondi
- Department of Pediatric Onco‐Hematology San Gerardo Hospital Fondazione MBBMUniversità degli Studi di Milano‐Bicocca Monza Italy
- Department of Pediatrics San Gerardo Hospital Fondazione MBBMUniversità degli Studi di Milano‐Bicocca Monza Italy
| | - Momcilo Jankovic
- Department of Pediatric Onco‐Hematology San Gerardo Hospital Fondazione MBBMUniversità degli Studi di Milano‐Bicocca Monza Italy
| | - Marco Spinelli
- Department of Pediatric Onco‐Hematology San Gerardo Hospital Fondazione MBBMUniversità degli Studi di Milano‐Bicocca Monza Italy
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24
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Casale M, Forni GL, Cassinerio E, Pasquali D, Origa R, Serra M, Campisi S, Peluso A, Renni R, Cattoni A, De Michele E, Allò M, Poggi M, Ferrara F, Di Concilio R, Sportelli F, Quarta A, Putti MC, Notarangelo LD, Sau A, Ladogana S, Tartaglione I, Picariello S, Marcon A, Sturiale P, Roberti D, Lazzarino AI, Perrotta S. Risk factors for endocrine complications in transfusion-dependent thalassemia patients on chelation therapy with deferasirox: a risk assessment study from a multicentre nation-wide cohort. Haematologica 2021; 107:467-477. [PMID: 33406815 PMCID: PMC8804575 DOI: 10.3324/haematol.2020.272419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/18/2020] [Indexed: 01/19/2023] Open
Abstract
Transfusion-dependent patients typically develop iron-induced cardiomyopathy, liver disease, and endocrine complications. We aimed to estimate the incidence of endocrine disorders in transfusiondependent thalassemia (TDT) patients during long-term iron-chelation therapy with deferasirox (DFX). We developed a multi-center follow-up study of 426 TDT patients treated with once-daily DFX for a median duration of 8 years, up to 18.5 years. At baseline, 118, 121, and 187 patients had 0, 1, or ≥2 endocrine diseases respectively. 104 additional endocrine diseases were developed during the follow-up. The overall risk of developing a new endocrine complication within 5 years was 9.7% (95% Confidence Interval [CI]: 6.3–13.1). Multiple Cox regression analysis identified three key predictors: age showed a positive log-linear effect (adjusted hazard ratio [HR] for 50% increase 1.2, 95% CI: 1.1–1.3, P=0.005), the serum concentration of thyrotropin showed a positive linear effect (adjusted HR for 1 mIU/L increase 1.3, 95% CI: 1.1–1.4, P<0.001) regardless the kind of disease incident, while the number of previous endocrine diseases showed a negative linear effect: the higher the number of diseases at baseline the lower the chance of developing further diseasess (adjusted HR for unit increase 0.5, 95% CI: 0.4–0.7, P<0.001). Age and thyrotropin had similar effect sizes across the categories of baseline diseases. The administration of levothyroxine as a covariate did not change the estimates. Although in DFX-treated TDT patients the risk of developing an endocrine complication is generally lower than the previously reported risk, there is considerable risk variation and the burden of these complications remains high. We developed a simple risk score chart enabling clinicians to estimate their patients’ risk. Future research will look at increasing the amount of variation explained from our model and testing further clinical and laboratory predictors, including the assessment of direct endocrine magnetic resonance imaging.
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Affiliation(s)
- Maddalena Casale
- Department of Women, Child and General and Specialized Surgery, University " Luigi Vanvitelli", via Luigi De Crecchio n. 4, 80138, Naples.
| | - Gian Luca Forni
- Center of Microcitemia and Congenital Anemias, Galliera Hospital, Mura delle Cappuccine 14 16128, Genoa
| | - Elena Cassinerio
- Rare Diseases Center, General Medicine Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Daniela Pasquali
- Endocrinology, Department of Advanced Medical and Surgical Sciences, University " Luigi Vanvitelli", Naples
| | - Raffaella Origa
- Thalassemia Centre, Pediatric Hospital A CAO, AOG Brotzu, Cagliari
| | - Marilena Serra
- Thalassemia Centre, Department of Internal Medicine, Hospital "V. Fazzi", Lecce
| | | | - Angelo Peluso
- Centre of Microcitemia, POC SS.Annunziata - ASL TA, Taranto
| | - Roberta Renni
- Thalassemia Centre, Department of Internal Medicine, Hospital F.Ferrari, Casarano
| | - Alessandro Cattoni
- Department of Pediatrics, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Azienda Ospedaliera San Gerardo, Monza
| | - Elisa De Michele
- Immunotransfusion Medicine Unit, AOU OO.RR. S. Giovanni di Dio e Ruggi d'Aragona, Salerno
| | | | | | | | | | | | - Antonella Quarta
- Center for Microcythemia, Iron Metabolism disorders, Gaucher disease-Hematology and Transplantation Unit, "A. Perrino" Hospital, Brindisi
| | | | | | - Antonella Sau
- Department of Pediatric Hematology and Oncology, Hospital "Spirito Santo", Pescara
| | - Saverio Ladogana
- Pediatric Oncohematology Unit, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo
| | - Immacolata Tartaglione
- Department of Women, Child and General and Specialized Surgery, University " Luigi Vanvitelli", via Luigi De Crecchio n. 4, 80138, Naples
| | - Stefania Picariello
- Department of Women, Child and General and Specialized Surgery, University " Luigi Vanvitelli", via Luigi De Crecchio n. 4, 80138, Naples
| | - Alessia Marcon
- Rare Diseases Center, General Medicine Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | | | - Domenico Roberti
- Department of Women, Child and General and Specialized Surgery, University " Luigi Vanvitelli", via Luigi De Crecchio n. 4, 80138, Naples
| | - Antonio Ivan Lazzarino
- EPISTATA - Agency for Clinical Research and Medical Statistics, London E8 3SY, United Kingdom
| | - Silverio Perrotta
- Department of Women, Child and General and Specialized Surgery, University " Luigi Vanvitelli", via Luigi De Crecchio n. 4, 80138, Naples
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25
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Diesch-Furlanetto T, Gabriel M, Zajac-Spychala O, Cattoni A, Hoeben BAW, Balduzzi A. Late Effects After Haematopoietic Stem Cell Transplantation in ALL, Long-Term Follow-Up and Transition: A Step Into Adult Life. Front Pediatr 2021; 9:773895. [PMID: 34900873 PMCID: PMC8652149 DOI: 10.3389/fped.2021.773895] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 12/13/2022] Open
Abstract
Haematopoietic stem cell transplant (HSCT) can be a curative treatment for children and adolescents with very-high-risk acute lymphoblastic leukaemia (ALL). Improvements in supportive care and transplant techniques have led to increasing numbers of long-term survivors worldwide. However, conditioning regimens as well as transplant-related complications are associated with severe sequelae, impacting patients' quality of life. It is widely recognised that paediatric HSCT survivors must have timely access to life-long care and surveillance in order to prevent, ameliorate and manage all possible adverse late effects of HSCT. This is fundamentally important because it can both prevent ill health and optimise the quality and experience of survival following HSCT. Furthermore, it reduces the impact of preventable chronic illness on already under-resourced health services. In addition to late effects, survivors of paediatric ALL also have to deal with unique challenges associated with transition to adult services. In this review, we: (1) provide an overview of the potential late effects following HSCT for ALL in childhood and adolescence; (2) focus on the unique challenges of transition from paediatric care to adult services; and (3) provide a framework for long-term surveillance and medical care for survivors of paediatric ALL who have undergone HSCT.
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Affiliation(s)
- Tamara Diesch-Furlanetto
- Division of Pediatric Oncology/Hematology, University Children's Hospital Basel (UKB), University of Basel, Basel, Switzerland
| | - Melissa Gabriel
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznań, Poland
| | - Alessandro Cattoni
- Clinica Pediatrica, University degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza, Italy
| | - Bianca A W Hoeben
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Adriana Balduzzi
- Clinica Pediatrica, University degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza, Italy
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Cattoni A, Parissone F, Porcari I, Molinari S, Masera N, Franchi M, Cesaro S, Gaudino R, Passoni P, Balduzzi A. Hormonal replacement therapy in adolescents and young women with chemo- or radio-induced premature ovarian insufficiency: Practical recommendations. Blood Rev 2020; 45:100730. [PMID: 32654893 DOI: 10.1016/j.blre.2020.100730] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/10/2020] [Accepted: 06/23/2020] [Indexed: 12/27/2022]
Abstract
In women with premature ovarian insufficiency (POI), hormonal therapy (HT) is indicated to decrease the risk of morbidity and to treat symptoms related to prolonged hypoestrogenism. While general recommendations for the management of HT in adults with POI have been published, no systematic suggestions focused on girls, adolescents and young women with POI following gonadotoxic treatments (chemotherapy, radiotherapy, stem cell transplantation) administered for pediatric cancer are available. In order to highlight the challenging issues specifically involving this cohort of patients and to provide clinicians with the proposal of practical therapeutic protocol, we revised the available literature in the light of the shared experience of a multidisciplinary team of pediatric oncologists, gynecologists and endocrinologists. We hereby present the proposals of a practical scheme to induce puberty in prepubertal girls and a decisional algorithm that should guide the clinician in approaching HT in post-pubertal adolescents and young women with iatrogenic POI.
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Affiliation(s)
- A Cattoni
- Department of Pediatrics, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Azienda Ospedaliera San Gerardo, Via Pergolesi 33, 20900 Monza, Italy.
| | - F Parissone
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata di Verona, Università di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - I Porcari
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata di Verona, Università di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - S Molinari
- Department of Pediatrics, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Azienda Ospedaliera San Gerardo, Via Pergolesi 33, 20900 Monza, Italy.
| | - N Masera
- Department of Pediatrics, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Azienda Ospedaliera San Gerardo, Via Pergolesi 33, 20900 Monza, Italy
| | - M Franchi
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata di Verona, Università di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy.
| | - S Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata di Verona, Università di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy.
| | - R Gaudino
- Pediatric Endocrinology, Azienda Ospedaliera Universitaria Integrata di Verona, Università di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy.
| | - P Passoni
- Department of Obstetrics and Gynecology, Azienda Ospedaliera San Gerardo, Via Pergolesi 33, 20900 Monza, Italy
| | - A Balduzzi
- Department of Pediatrics, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Azienda Ospedaliera San Gerardo, Via Pergolesi 33, 20900 Monza, Italy.
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Cattoni A, Rovelli A, Prunotto G, Bonanomi S, Invernizzi P, Perego R, Mariani AM, Balduzzi A. Hepatic focal nodular hyperplasia after pediatric hematopoietic stem cell transplantation: The impact of hormonal replacement therapy and iron overload. Pediatr Blood Cancer 2020; 67:e28137. [PMID: 31889398 DOI: 10.1002/pbc.28137] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/16/2019] [Accepted: 12/02/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The advent of techniques for the assessment of iron overload (liver T2*-MRI) has led to the awareness that focal nodular hyperplasia (FNH) represents a possible incidental finding after hematopoietic stem cell transplantation (HSCT), though its pathogenesis is still unclear. METHODS We performed a retrospective analysis of the liver T2*-MRI scans performed between 2013 and 2018 in a single pediatric HSCT Unit and recorded the number of patients with FNH (group A). Patients incidentally diagnosed with FNH at imaging performed for different clinical indications were included in group B. RESULTS Nine of 105 (8.6%) patients from group A were diagnosed with FNH. Group B included three patients. Overall, 12 patients were diagnosed 4.4 ± 3.1 years after HSCT. At univariate analysis, female gender (odds ratio [OR] 3.77, P = .03), moderate-to-severe iron overload (OR 6.97, P = .01), and hormone replacement therapy (HRT) administered for at least 6 months (OR 18.20, P = .0002) exposed patients to a higher risk of developing FNH. The detrimental effect of HRT was significant also at multivariate analysis (OR 7.93, P = .024). MRI-T2* values in affected patients were statistically lower than healthy controls (P < .001). CONCLUSIONS We confirm the high incidence of FNH among transplanted pediatric patients and demonstrate the potential pathogenic role of HRT and iron overload.
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Affiliation(s)
- Alessandro Cattoni
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Attilio Rovelli
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Giulia Prunotto
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Sonia Bonanomi
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Pietro Invernizzi
- Gastroenterologia, Università degli Studi di Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Rosangela Perego
- Radiologia, Università degli Studi di Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Anna Maria Mariani
- Radiologia, Università degli Studi di Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Adriana Balduzzi
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
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Saettini F, Cattoni A, D'Angio' M, Corti P, Maitz S, Pagni F, Seminati D, Pezzoli L, Iascone M, Biondi A, Bonanomi S. Intermittent granulocyte maturation arrest, hypocellular bone marrow, and episodic normal neutrophil count can be associated with SRP54 mutations causing Shwachman-Diamond-like syndrome. Br J Haematol 2020; 189:e171-e174. [PMID: 32196641 DOI: 10.1111/bjh.16585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Francesco Saettini
- Department of Pediatrics, Fondazione MBBM, University of Milano-Bicocca, Monza, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Fondazione MBBM, University of Milano-Bicocca, Monza, Italy
| | - Mariella D'Angio'
- Department of Pediatrics, Fondazione MBBM, University of Milano-Bicocca, Monza, Italy
| | - Paola Corti
- Department of Pediatrics, Fondazione MBBM, University of Milano-Bicocca, Monza, Italy
| | - Silvia Maitz
- Clinical Pediatric Genetic Unit, Pediatric Clinic, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, San Gerardo Hospital, University of Milano- Bicocca, Monza, Italy
| | - Davide Seminati
- Department of Medicine and Surgery, Pathology, San Gerardo Hospital, University of Milano- Bicocca, Monza, Italy
| | - Laura Pezzoli
- Molecular Genetics Laboratory, USSD LGM, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Maria Iascone
- Molecular Genetics Laboratory, USSD LGM, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Andrea Biondi
- Department of Pediatrics, Fondazione MBBM, University of Milano-Bicocca, Monza, Italy
| | - Sonia Bonanomi
- Department of Pediatrics, Fondazione MBBM, University of Milano-Bicocca, Monza, Italy
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Rodari G, Cattoni A, Albanese A. Final height in growth hormone-deficient childhood cancer survivors after growth hormone therapy. J Endocrinol Invest 2020; 43:209-217. [PMID: 31452114 DOI: 10.1007/s40618-019-01102-w] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Growth hormone deficiency (GHD) is the most prevalent hypothalamic-pituitary (HP) disorder found in childhood cancer survivors (CCS). The published studies assessing GHD in CCS concluded that recombinant human GH (rhGH) does not restore final height (FH) to that predicted from mid-parental height (MPH). Thus, wider analyses on final height outcomes after rhGH in CCS are needed. METHODS Retrospective study on final height (FH) in 87 CCS treated with rhGH. Patients were divided into: Group A (n =48) who underwent cranial radiotherapy or had non-irradiated tumours of HP area, and B (n =39) who were treated with craniospinal or total body irradiation (TBI). 19/87 patients with central precocious/early puberty also received GnRH analogues. RESULTS Height (HT) gain after 1 and 2 years of rhGH was 0.38 ± 0.35 SDS and 0.18 ± 0.30 SDS, respectively (P < 0.0001); mean FH was in the normal range (- 0.85 ± 1.34 SDS), though not significantly different from HT SDS at baseline. 67% overall failed to reach MPH especially in Group B (P < 0.0001). However, height loss (HT SDS-MPH SDS) at FH improved or remained stable compared to baseline in 26/45 patients (58%). On stepwise regression analysis, major determinants of FH were HT at baseline (P < 0.0001) and delay before start of rhGH (P = 0.012). There was no significant difference in FH when GnRHa was added to rhGH. CONCLUSION rhGH and GnRH analogues therapy, when indicated, though failing to induce catch-up growth, prevented further height loss leading to a FH within the normal range but still below MPH, this latter being statistically significant in children who received craniospinal and TBI.
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Affiliation(s)
- G Rodari
- Paediatric Unit, Royal Marsden NHS Foundation Trust, Sutton, UK.
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 28, 20122, Milan, Italy.
| | - A Cattoni
- Paediatric Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
- Paediatric Department, Azienda Ospedaliera San Gerardo, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
| | - A Albanese
- Paediatric Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
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Cattoni A, Molinari S, Medici F, De Lorenzo P, Valsecchi MG, Masera N, Adavastro M, Biondi A. Dexamethasone Stimulation Test in the Diagnostic Work-Up of Growth Hormone Deficiency in Childhood: Clinical Value and Comparison With Insulin-Induced Hypoglycemia. Front Endocrinol (Lausanne) 2020; 11:599302. [PMID: 33362716 PMCID: PMC7757782 DOI: 10.3389/fendo.2020.599302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
CONTEXT dexamethasone has been demonstrated to elicit GH secretion in adults, but few data are available about its effectiveness as a provocative stimulus in the diagnostic work-up of GH deficiency (GHD) in childhood. OBJECTIVE to assess the clinical value of dexamethasone stimulation test (DST) as a diagnostic tool for pediatric GHD. DESIGN AND SETTING retrospective single-center analysis. The study population included 166 patients with a pathological response to arginine stimulation test (AST, first-line test) and subsequently tested with either insulin tolerance test (ITT) or DST as a second-line investigation between 2008 and 2019. MAIN OUTCOME MEASURES comparison between GH peaks and secretory curves induced by ITT and DST; degree of agreement between DST and AST versus ITT and AST. RESULTS the pathological response to AST (GH peak < 8 ng/mL) was confirmed by an ITT in 80.2% (89/111) of patients and by a DST in 76.4% (42/55), with no statistical difference between the two groups (p value 0.69). Mean GH peaks achieved after ITT and DST were entirely comparable (6.59 ± 3.59 versus 6.50 ± 4.09 ng/ml, respectively, p 0.97) and statistically higher than those elicited by arginine (p < 0.01 for both), irrespectively of the average GH peaks recorded for each patient (Bland-Altman method). Dexamethasone elicited a longer lasting and later secretory response than AST and ITT. No side effects were recorded after DST. CONCLUSIONS DST and ITT confirmed GHD in a superimposable percentage of patients with a pathological first-line test. DST and ITT share a similar secretagogue potency, overall greater than AST.
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Affiliation(s)
- Alessandro Cattoni
- Department of Pediatrics, Università degli studi di Milano-Bicocca, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Silvia Molinari
- Department of Pediatrics, Università degli studi di Milano-Bicocca, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
- *Correspondence: Silvia Molinari,
| | - Francesco Medici
- Department of Pediatrics, Università degli studi di Milano-Bicocca, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Paola De Lorenzo
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, Università degli studi di Milano-Bicocca, Monza, Italy
- Tettamanti Research Center, Pediatric Clinic, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, Università degli studi di Milano-Bicocca, Monza, Italy
| | - Nicoletta Masera
- Department of Pediatrics, Università degli studi di Milano-Bicocca, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Marta Adavastro
- Department of Pediatrics, Università degli studi di Milano-Bicocca, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Andrea Biondi
- Department of Pediatrics, Università degli studi di Milano-Bicocca, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
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Cattoni A, Spano A, Tulone A, Boneschi A, Masera N, Maitz S, Di Blasio AM, Persani L, Guizzardi F, Rossetti R. The Potential Synergic Effect of a Complex Pattern of Multiple Inherited Genetic Variants as a Pathogenic Factor for Ovarian Dysgenesis: A Case Report. Front Endocrinol (Lausanne) 2020; 11:540683. [PMID: 33101191 PMCID: PMC7545356 DOI: 10.3389/fendo.2020.540683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/25/2020] [Indexed: 11/13/2022] Open
Abstract
Non-syndromic primary ovarian insufficiency due to ovarian dysgenesis in 46,XX patients is an uncommon finding in the general population, even though several monogenic variants have been reported as causative factors. Here, we describe a 15-year-old patient diagnosed with gonadal dysgenesis possibly due to the interaction of three potentially pathogenic variants of genes involved in ovarian maturation, namely factor in the germline alpha (FIGLA), newborn ovary homeobox-encoding (NOBOX) and nuclear receptor subfamily 5 group A member 1 (NR5A1). We also describe a different degree of residual ovarian function within the proband's family, whose female members carry one to three demonstrated variations in the aforementioned genes in a clinical spectrum potentially dependent on the number of alleles involved. Our results support the hypothesis that the severity of the clinical picture of the proband, resulting in complete ovarian dysgenesis, may be due to a synergic detrimental effect of inherited genetic variants.
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Affiliation(s)
- Alessandro Cattoni
- Department of Pediatrics, Azienda Ospedaliera San Gerardo, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la Sua Mamma, Monza, Italy
- *Correspondence: Alessandro Cattoni
| | - Alice Spano
- Department of Pediatrics, Azienda Ospedaliera San Gerardo, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la Sua Mamma, Monza, Italy
| | - Anna Tulone
- Department of Pediatrics, Azienda Ospedaliera San Gerardo, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la Sua Mamma, Monza, Italy
| | - Annalisa Boneschi
- Department of Gynecology and Obstetrics, Azienda Ospedaliera San Gerardo, Fondazione Monza e Brianza per il Bambino e la Sua Mamma, Monza, Italy
| | - Nicoletta Masera
- Department of Pediatrics, Azienda Ospedaliera San Gerardo, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la Sua Mamma, Monza, Italy
| | - Silvia Maitz
- Department of Pediatrics, Azienda Ospedaliera San Gerardo, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la Sua Mamma, Monza, Italy
| | - Anna Maria Di Blasio
- Molecular Biology Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Auxologico Italiano, Cusano Milanino, Italy
| | - Luca Persani
- Department of Endocrine and Metabolic Diseases and Lab of Endocrine and Metabolic Research, Istituto Auxologico Italiano, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabiana Guizzardi
- Molecular Biology Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Auxologico Italiano, Cusano Milanino, Italy
- Department of Endocrine and Metabolic Diseases and Lab of Endocrine and Metabolic Research, Istituto Auxologico Italiano, Milan, Italy
| | - Raffaella Rossetti
- Department of Endocrine and Metabolic Diseases and Lab of Endocrine and Metabolic Research, Istituto Auxologico Italiano, Milan, Italy
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Cattoni A, Motta S, Masera N, Gasperini S, Rovelli A, Parini R. The use of recombinant human growth hormone in patients with Mucopolysaccharidoses and growth hormone deficiency: a case series. Ital J Pediatr 2019; 45:93. [PMID: 31370860 PMCID: PMC6676577 DOI: 10.1186/s13052-019-0691-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The treatment with recombinant human growth hormone in patients affected by Mucopolysaccharidoses (MPS) is considered whenever a concurrent diagnosis of growth hormone deficiency is demonstrated. The short- and long-term effects of recombinant human growth hormone in this selected cohort is still debated, given the natural progression of disease-related skeletal malformations and the paucity of treated patients reported in literature. The presented case series provides detailed information about the response to recombinant growth hormone in MPS patients diagnosed with growth hormone deficiency. CASES PRESENTATION The growth patterns of 4 MPS female patients (current age: 11.7-14.3 years) treated with recombinant human growth hormone due to growth hormone deficiency have been retrospectively analyzed. Two patients, diagnosed with MPS IH, had undergone haematopoietic stem cell transplantation at an early age; the remaining two patients were affected by MPS IV and VI and were treated with enzyme replacement therapy. 4/4 patients presented with a progressive growth deceleration before the diagnosis of growth hormone deficiency was confirmed. This trend was initially reverted by a remarkable increase in height velocity after the start of recombinant growth hormone. We recorded an average increase in height velocity z-score of + 4.23 ± 2.9 and + 4.55 ± 0.96 respectively after 6 and 12 months of treatment. After the first 12-24 months, growth showed a deceleration in all the patients. While in a girl with MPS IH recombinant human growth hormone was discontinued due to a lack in clinical efficacy, 3/4 patients grew at a stable pace, tracking the height centile achieved after the cited initial increase in height velocity. Furthermore, mineral bone density assessed via bone densitometry, showed a remarkable increase in the two patients who were tested before and after starting treatment. CONCLUSIONS Recombinant human growth hormone appears to have effectively reverted the growth deceleration experienced by MPS patients diagnosed with growth hormone deficiency, at least during the first 12-24 months of treatment.
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Affiliation(s)
- A Cattoni
- Paediatric Department, Azienda Ospedaliera San Gerardo - Fondazione Monza e Brianza per il Bambino e la sua Mamma, Via Pergolesi 33, 20900, Monza, MB, Italy.
| | - S Motta
- Paediatric Department, Azienda Ospedaliera San Gerardo - Fondazione Monza e Brianza per il Bambino e la sua Mamma, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - N Masera
- Paediatric Department, Azienda Ospedaliera San Gerardo - Fondazione Monza e Brianza per il Bambino e la sua Mamma, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - S Gasperini
- Paediatric Department, Azienda Ospedaliera San Gerardo - Fondazione Monza e Brianza per il Bambino e la sua Mamma, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - A Rovelli
- Paediatric Department, Azienda Ospedaliera San Gerardo - Fondazione Monza e Brianza per il Bambino e la sua Mamma, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - R Parini
- Paediatric Department, Azienda Ospedaliera San Gerardo - Fondazione Monza e Brianza per il Bambino e la sua Mamma, Via Pergolesi 33, 20900, Monza, MB, Italy.,TIGET Institute, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Segrate, MI, Italy
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Cattoni A, Clarke E, Albanese A. The Predictive Value of Insulin-Like Growth Factor 1 in Irradiation-Dependent Growth Hormone Deficiency in Childhood Cancer Survivors. Horm Res Paediatr 2019; 90:314-325. [PMID: 30645996 DOI: 10.1159/000495760] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The literature contains conflicting reports on the value of low insulin-like growth factor 1 (IGF-1) levels in predicting radiation-induced growth hormone (GH) deficiency (GHD) in childhood cancer survivors (CCS). These reports often involve small samples of patients who have received irradiation or mixed cohorts including non-irradiated subjects. OBJECTIVE We undertook an analysis of the predictive value of low IGF-1 in CCS at risk for GHD after cranial radiotherapy involving the hypothalamic-pituitary (HP) area in a large single-centre cohort. METHODS We performed a retrospective analysis on 158 CCS diagnosed with GHD between January 1, 2003 and October 31, 2017 and identified 117 patients who received radiation for tumours not direct ly involving the HP area. RESULTS In this cohort, IGF-1 levels <-2 standard deviation scores (SDS) had a sensitivity of 31.9% for GHD; however, they were statistically more frequent (p = 0.0023) and had a higher sensitivity (45.6%) among patients with severe GHD. At final height reassessment, IGF-1 <-2 SDS had a sensitivity of 35.0% for GHD, but a positive predictive value of 100%. Finally, pretreatment IGF-1 values showed no correlation with the number of impaired pituitary hormonal axes in patients with multiple pituitary deficiencies. CONCLUSIONS IGF-1 levels <-2 SDS showed a low sensitivity at predicting radiation-induced GHD both in childhood and in adulthood, but a high positive predictive value for GH status at final height reassessment.
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Affiliation(s)
- Alessandro Cattoni
- Department of Paediatric Endocrinology, Royal Marsden NHS Foundation Trust, London, United Kingdom,
| | - Enrico Clarke
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Assunta Albanese
- Department of Paediatric Endocrinology, Royal Marsden NHS Foundation Trust, London, United Kingdom
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Cattoni A, Jackson C, Bain M, Houghton J, Wei C. Phenotypic variability in two siblings with monogenic diabetes due to the same ABCC8 gene mutation. Pediatr Diabetes 2019; 20:482-485. [PMID: 30734462 DOI: 10.1111/pedi.12826] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/09/2018] [Accepted: 01/17/2019] [Indexed: 12/19/2022] Open
Abstract
ABCC8 gene mutations with different inheritance patterns have been well described to cause transient and permanent forms of neonatal diabetes with onset of hyperglycemia commonly before the age of 6 months, and rare cases between 6 and 12 months. However, recent analyses have also demonstrated ABCC8 gene mutations in patients with monogenic diabetes (maturity onset diabetes of the young, MODY), with milder clinical phenotypes and later onset of hyperglycemia. We report two siblings with diabetes mellitus due to a novel homozygous p.(Phe1068Ile) (c.3202T>A) missense mutation of the ABCC8 gene, but significantly different phenotypes. The index case was diagnosed with diabetes due to an incidental finding of hyperglycemia at the age of 3 years, while her younger sibling presented with severe hyperglycemia and hyperosmolar dehydration at the age of 10 weeks. The possibility of a significant discordance in the correlation between genotype and phenotype needs to be taken into account when ABCC8 mutation dependent diabetes occurs within the same family. Genetic screening in children with diabetes from consanguineous family needs consideration, especially in case of negative autoantibodies and early onset of hyperglycemia.
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Affiliation(s)
- Alessandro Cattoni
- Paediatric Endocrinology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Charlotte Jackson
- Paediatric Endocrinology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Murray Bain
- Paediatric Endocrinology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Jayne Houghton
- Department of Molecular Genetics, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,Department of Molecular Genetics, University of Exeter Medical School, Exeter, UK
| | - Christina Wei
- Paediatric Endocrinology, St George's University Hospital NHS Foundation Trust, London, UK
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Vettori M, Piazza V, Cattoni A, Scaccabarozzi A, Patriarche G, Regreny P, Chauvin N, Botella C, Grenet G, Penuelas J, Fave A, Tchernycheva M, Gendry M. Growth optimization and characterization of regular arrays of GaAs/AlGaAs core/shell nanowires for tandem solar cells on silicon. Nanotechnology 2019; 30:084005. [PMID: 30524074 DOI: 10.1088/1361-6528/aaf3fe] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With a band gap value of 1.7 eV, Al0.2Ga0.8As is one of the ideal III-V alloys for the development of nanowire-based Tandem Solar Cells on silicon. Nevertheless, growing self-catalysed AlGaAs nanowires on silicon by solid-source molecular beam epitaxy is a very difficult task due to the oxidation of Al adatoms by the SiO2 layer present on the surface. Here we propose a nanowire structure including a p.i.n radial junction inside an Al0.2Ga0.8As shell grown on a p-GaAs core. The crystalline structure of such self-catalysed nanowires grown on an epi-ready Si(111) substrate (with a thin native SiO2 layer) was investigated by transmission electronic microscopy and photoluminescence. I(V) measurements performed on single nanowires have shown a diode-like behaviour corresponding to the radial p.i.n junction inside the Al0.2Ga0.8As shell. Moreover, a current generation under the electron beam was evidenced over the entire radial junction along the nanowires by means of electron beam induced current (EBIC) microscopy. The same structure was reproduced on patterned substrates with a SiO2 mask, producing an ordered hexagonal array. High and uniform yields from 83% to 87% of vertical nanowires were obtained on 0.9 × 0.9 cm2 patterned areas. EBIC mapping performed on these nanowires confirmed the good electrical properties of the radial junction within the nanowires.
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Affiliation(s)
- M Vettori
- INL, UMR 5270 CNRS, University of Lyon, Ecole Centrale de Lyon, F-69134, Ecully, France. INL, UMR 5270 CNRS, University of Lyon, INSA de Lyon, F-69621, Villeurbanne, France
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Cattoni A, Cazzaniga G, Perseghin P, Zatti G, Gaddi D, Cossio A, Biondi A, Corti P, Masera N. An Attempt to Induce Transient Immunosuppression Pre-erythrocytapheresis in a Girl With Sickle Cell Disease, a History of Severe Delayed Hemolytic Transfusion Reactions and Need for Hip Prosthesis. Hematol Rep 2013; 5:36-8. [PMID: 23888247 PMCID: PMC3719100 DOI: 10.4081/hr.2013.e11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 03/12/2013] [Revised: 05/19/2013] [Accepted: 06/21/2013] [Indexed: 11/25/2022] Open
Abstract
Abstract We report on a case of delayed hemolytic transfusion reaction (DHTR) occurred 7 days after an erythrocytapheresis or eritroexchange procedure (EEX) treated with rituximab and glucocorticoids in a 15-years old patient with sickle cell disease. EEX was performed despite a previous diagnosis of alloimmunization, in order to reduce hemoglobin S rate before a major surgery for avascular necrosis of the femoral head. A first dose of rituximab was administered before EEX. However, rituximab couldn’t prevent DHTR that occurred with acute hemolysis, hemoglobinuria and hyperbilirubinemia. A further dose of rituximab and three boli of methylprednisolone were given after the onset of the reaction. It is likely that the combined use of rituximab and steroids managed to gradually improve both patient’s general conditions and hemoglobin levels. Nor early or late side effects were registered in a 33-months follow-up period. This report suggests the potential effectiveness and safety of rituximab in combination with steroids in managing and mitigating the symptoms of delayed post-transfusional hemolytic reactions in alloimmunized patients affected by sickle cell disease with absolute need for erythrocytapheresis.
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Masera N, Cattoni A, Decimi V, D’Apolito V, Arosio C, Mariani R, Piperno A. Efficacy of deferasirox for the treatment of iron overload in a child affected by Juvenile Hemochromatosis. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/crcm.2013.22033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Girard J, Scherrer G, Cattoni A, Le Moal E, Talneau A, Cluzel B, de Fornel F, Sentenac A. Far-field optical control of a movable subdiffraction light grid. Phys Rev Lett 2012; 109:187404. [PMID: 23215328 DOI: 10.1103/physrevlett.109.187404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Indexed: 06/01/2023]
Abstract
We demonstrate experimentally a subdiffraction light pattern, with a period down to 150 nm, at the surface of an optimized silicon nanostructured thin film. We show, using near-field and far-field characterization, that this subdiffraction pattern can be translated and rotated just by changing the illumination angle. The movable high frequency light pattern paves the way for subdiffraction resolution surface imaging microscopy without scanning near-field probes.
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Affiliation(s)
- J Girard
- Institut Fresnel, CNRS, Aix-Marseille Université, Marseille, France
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Amman F, Andreani R, Bassetti M, Bernardini M, Cattoni A, Chimenti V, Corazza GF, Fabiani D, Ferlenghi E, Massarotti A, Pellegrini C, Placidi M, Puglisi M, Soso F, Tazzari S, Tazzioli F, Vignola G. Two-beam operation of the 1.5 GeV electron-positron storage ring adone. ACTA ACUST UNITED AC 1969. [DOI: 10.1007/bf02903866] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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