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Agulnik A, Kizyma R, Salek M, Wlodarski MW, Pogorelyy M, Oszer A, Yakimkova T, Nogovitsyna Y, Dutkiewicz M, Dalle JH, Dirksen U, Eggert A, Fernández-Teijeiro A, Greiner J, Kraal K, Mueller A, Sramkova L, Zecca M, Wise PH, Mlynarski W. Global effort to evacuate Ukrainian children with cancer and blood disorders who have been affected by war. Lancet Haematol 2022; 9:e645-e647. [PMID: 36055331 DOI: 10.1016/s2352-3026(22)00259-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Asya Agulnik
- St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Roman Kizyma
- Western Ukrainian Specialized Children's Medical Center, Lviv, Ukraine
| | - Marta Salek
- St Jude Children's Research Hospital, Memphis, TN, USA
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- Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Kathelijne Kraal
- Princess Maxima Centre for Pediatric Oncology, Utrecht, Netherlands
| | | | | | - Marco Zecca
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paul H Wise
- Stanford University School of Medicine, Stanford, CA, USA
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Blom T, Lurvink R, Aleven L, Mensink M, Wolfs T, Dierselhuis M, van Eijkelenburg N, Kraal K, van Noesel M, van Grotel M, Tytgat G. Treatment-Related Toxicities During Anti-GD2 Immunotherapy in High-Risk Neuroblastoma Patients. Front Oncol 2021; 10:601076. [PMID: 33680926 PMCID: PMC7925836 DOI: 10.3389/fonc.2020.601076] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
The introduction of immunotherapy using an anti-GD2 antibody (dinutuximab, ch14.18) has significantly improved survival rates for high-risk neuroblastoma patients. However, this improvement in survival is accompanied by a substantial immunotherapy-related toxicity burden. The primary objective of this study was to describe treatment-related toxicities during immunotherapy with dinutuximab, IL-2, GM-CSF, and isotretinoin. A retrospective, single center analysis of immunotherapy-related toxicities was performed in twenty-six consecutive high-risk neuroblastoma patients who received immunotherapy as maintenance therapy in the Princess Máxima Center (Utrecht, Netherlands). Toxicities were recorded and graded according to the CTCAE. Particular attention was drawn to pain and fever management and toxicities leading to dose modifications of dinutuximab and IL-2. Twenty-three patients (88%) completed all six courses of immunotherapy. Disease progression, isotretinoin-associated liver toxicity, and catheter-related infection in combination with peripheral neuropathy were reasons for immunotherapy discontinuation. The most common grade ≥3 toxicities for courses 1-5, respectively, were pain, catheter-related infections, and fever. In total, 310 grade ≥3 toxicities were recorded in 124 courses. Thirty-three grade 4 toxicities in 19/26 patients and no grade 5 toxicities (death) were seen. Fifty-nine percent of grade ≥3 toxicities were recorded in the two courses with IL-2. Catheter-related bloodstream infections were identified in 81% of patients. Four of these episodes led to intensive care admission followed by full recovery (grade 4).
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Affiliation(s)
- Thomas Blom
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Leonie Aleven
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Maarten Mensink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Tom Wolfs
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | - Kathelijne Kraal
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Max van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Godelieve Tytgat
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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Trahair T, Sorrentino S, Russell SJ, Sampaio H, Selek L, Plantaz D, Freycon C, Simon T, Kraal K, Beck-Popovic M, Haupt R, Ash S, De Bernardi B. Spinal Canal Involvement in Neuroblastoma. J Pediatr 2017. [PMID: 28645442 DOI: 10.1016/j.jpeds.2017.05.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Toby Trahair
- Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia; School of Women's & Children's Health, University of New South Wales Medicine, Randwick, Australia.
| | - Stefania Sorrentino
- Unit of Pediatric Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Susan J Russell
- Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia
| | - Hugo Sampaio
- Department of Neurology, Sydney Children's Hospital, Randwick, Australia
| | - Laurent Selek
- Neurosurgery Department, University Hospital Centre of Grenoble, Grenoble, France
| | - Dominique Plantaz
- Pediatric Department, University Hospital Centre of Grenoble, Grenoble, France
| | - Claire Freycon
- Pediatric Department, University Hospital Centre of Grenoble, Grenoble, France
| | - Thorsten Simon
- Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
| | - Kathelijne Kraal
- Department Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
| | - Maja Beck-Popovic
- Department of Pediatrics, Hematology-Oncology Unit, University Hospital, Lausanne, Switzerland
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Shifra Ash
- The Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Bruno De Bernardi
- Unit of Pediatric Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
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Kraal K, Blom T, van Noesel M, Kremer L, Caron H, Tytgat G, van der Pal H. Treatment and outcome of neuroblastoma with intraspinal extension: A systematic review. Pediatr Blood Cancer 2017; 64. [PMID: 28150396 DOI: 10.1002/pbc.26451] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/09/2022]
Abstract
We performed a systematic review to define the long-term health problems and optimal treatment strategy for patients with neuroblastoma with intraspinal extension. Of 685 identified studies, 28 were included in this review. The burden of long-term health problems is high; a median of 50% of patients suffered from neurological motor deficit, 34% from sphincter dysfunction, and 30% from spinal deformity. The currently available literature remains suboptimal as a guide for treatment of NBL with intraspinal extension. More well-designed, prospective studies are needed to determine the optimal treatment strategy.
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Affiliation(s)
- Kathelijne Kraal
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Thomas Blom
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Max van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Leontien Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Huib Caron
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Godelieve Tytgat
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Heleen van der Pal
- Department of Medical Oncology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
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Kraal K, Blom T, Tytgat L, van Santen H, van Noesel M, Smets A, Bramer J, Caron H, Kremer L, van der Pal H. Neuroblastoma With Intraspinal Extension: Health Problems in Long-Term Survivors. Pediatr Blood Cancer 2016; 63:990-6. [PMID: 26890966 DOI: 10.1002/pbc.25925] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 08/24/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 11/06/2022]
Abstract
AIM To evaluate the prevalence of health problems in 5-year survivors treated for neuroblastoma (NBL) with intraspinal extension. PATIENTS AND METHODS Retrospective, single center cohort study (using data from Childhood Cancer Registry and medical records) of patients treated for NBL with intraspinal extension (between 1980 and 2007) who survived ≥ 5 years after diagnosis. Health problems were graded according to the Common Terminology Criteria for Adverse Events (CTCAEv.3.0). RESULTS All eligible patients (n = 19) were included (n = 7 no neurological symptoms at diagnosis), median age at diagnosis was 1.2 years (0.6-10.8 years), and median follow-up time was 15.6 years (6.3-29.5 years). Ninety-five percent of survivors had ≥1 health problem and 48% of survivors had ≥4 health problem with a mean of 3.8 per survivor. Fifty-three percent of survivors had at least one severe (grade 3) or life-threatening/disabling (grade 4) health problem. The three most prevalent health problems were kyphosis and/or scoliosis (68% of patients), motor neuropathy (32% of patients), and sensory neuropathy (26% of patients). Of the 13 patients who underwent a laminectomy, 54% (seven of 13) developed a grade 3 and 23% (three of 13) developed a grade 4 health problem. Among six patients, without laminectomy, 17% developed (one of six) a grade 3 and in 17% developed (one of six) a grade 4 health problem. CONCLUSIONS Ninety-five percent of 5-year survivors treated for a childhood intraspinal NBL have health problems. The high prevalence of grade 3 and 4 health problems (especially in the laminectomy group) emphasizes the importance of specialized long-term multidisciplinary follow-up and identifies optimal treatment with limited morbidity and maximal efficacy.
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Affiliation(s)
- Kathelijne Kraal
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre (EKZ/AMC), Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Thomas Blom
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre (EKZ/AMC), Amsterdam, the Netherlands
| | - Lieve Tytgat
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre (EKZ/AMC), Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Hanneke van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital (WKZ), Utrecht, the Netherlands
| | - Max van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Anne Smets
- Department of Radiology, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - Jos Bramer
- Department of Orthopedic Surgery, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - Huib Caron
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre (EKZ/AMC), Amsterdam, the Netherlands
| | - Leontien Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre (EKZ/AMC), Amsterdam, the Netherlands
| | - Heleen van der Pal
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre (EKZ/AMC), Amsterdam, the Netherlands.,Department of Medical Oncology, Academic Medical Centre (AMC), Amsterdam, the Netherlands
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Kraal K, Schalij-Delfos N, van Buchem M, Egeler M, Ball L. Optic nerve relapse in a child with common acute lymphoblastic leukemia, treated with systemic anti-CD-20 (rituximab). Haematologica 2005; 90 Suppl:ECR24. [PMID: 16266915] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
We describe a two- year old boy who was diagnosed with pre-B acute lymphoblastic leukemia (ALL). He developed a central nervous system (CNS) relapse with optic nerve involvement. Initially he was treated according to the ALL relapse protocol, including CNS radiotherapy. Despite an initial complete reponse, relapse occurred within six weeks of treatment. The leukemic blast cells were CD-20 positive and he was treated with systemic anti CD-20 therapy (rituximab) with no CNS recurrence over a six-month period. He died due to a CD-20 negative bone marrow relapse. This case illustrates a potential role for rituximab in pediatric CD-20 positive malignancies.
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Affiliation(s)
- Kathelijne Kraal
- Division of Hematology and Oncology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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