1
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Bauch T, Hempel G. Proof of concept of physiologically based pharmacokinetic modelling in paediatric acute lymphoblastic leukaemia. Br J Haematol 2024. [PMID: 38494194 DOI: 10.1111/bjh.19410] [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] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
Physiologically based pharmacokinetic (PBPK) modelling is an alternative modelling technique that is increasingly used in pharmacokinetics. Due to its nature, it can be complementarily employed to population pharmacokinetics, especially when it comes to small population size. Here, we report the proof of concept of its application to accurately describe the pharmacokinetics of a recombinant L-asparaginase in paediatric patients with acute lymphoblastic leukaemia. Data from two randomized, double-blind, phase II/III clinical studies (MC-ASP.4/ALL; MC-ASP.5/ALL) were included to setup and evaluate the final model, respectively. Final population values for basic pharmacokinetic parameters were calculated (clearance: 0.0569 L/h/19.5 kg, volume of distribution: 1.251 L, half-life: 18.5 h, trough concentration: 140.9 IU/L). Pharmacokinetic parameter prediction as well as predictive performance of the model proofed to be comparable to a separately developed population pharmacokinetic model with 13% deviation in predicted median L-asparaginase trough levels. To the best of our knowledge, this is the first whole-body PBPK model of a non-antibody therapeutic protein.
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Affiliation(s)
- Thomas Bauch
- Department of Clinical Pharmacy, Institute for Pharmaceutical and Medical Chemistry, University of Münster, Münster, Germany
| | - Georg Hempel
- Department of Clinical Pharmacy, Institute for Pharmaceutical and Medical Chemistry, University of Münster, Münster, Germany
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2
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Borrill R, Poulton K, Kusyk L, Routledge A, Bonney D, Hanasoge-Nataraj R, Powys M, Mustafa O, Campbell H, Senthil S, Dillon R, Jovanovic J, Morton S, James B, Rao K, Stanworth S, Konkel J, Wynn R. Granulocyte transfusion during cord blood transplant for relapsed, refractory AML is associated with massive CD8 + T-cell expansion, significant cytokine release syndrome and induction of disease remission. Br J Haematol 2023; 202:589-598. [PMID: 37211883 DOI: 10.1111/bjh.18863] [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: 02/16/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/23/2023]
Abstract
In high-risk myeloid malignancy, relapse is reduced using cord blood transplant (CBT) but remains the principal cause of treatment failure. We previously described T-cell expansion in CBT recipients receiving granulocyte transfusions. We now report the safety and tolerability of such transfusions, T-cell expansion data, immunophenotype, cytokine profiles and clinical response in children with post-transplant relapsed acute leukaemia who received T-replete, HLA-mismatched CBT and pooled granulocytes within a phase I/II trial (ClinicalTrials.Gov NCT05425043). All patients received the transfusion schedule without significant clinical toxicity. Nine of ten patients treated had detectable measurable residual disease (MRD) pre-transplant. Nine patients achieved haematological remission, and eight became MRD negative. There were five deaths: transplant complications (n = 2), disease (n = 3), including two late relapses. Five patients are alive and in remission with 12.7 months median follow up. Significant T-cell expansion occurred in nine patients with a greater median lymphocyte count than a historical cohort between days 7-13 (median 1.73 × 109 /L vs. 0.1 × 109 /L; p < 0.0001). Expanded T-cells were predominantly CD8+ and effector memory or TEMRA phenotype. They exhibited markers of activation and cytotoxicity with interferon-gamma production. All patients developed grade 1-3 cytokine release syndrome (CRS) with elevated serum IL-6 and interferon-gamma.
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Affiliation(s)
- Roisin Borrill
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Kay Poulton
- Transplantation Laboratory, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Laura Kusyk
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Amy Routledge
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Denise Bonney
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ramya Hanasoge-Nataraj
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Madeleine Powys
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Omima Mustafa
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen Campbell
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Srividhya Senthil
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Dillon
- Department of Medical and Molecular Genetics, Kings College London, London, UK
| | - Jelena Jovanovic
- Department of Medical and Molecular Genetics, Kings College London, London, UK
| | | | - Beki James
- Leeds Children's Hospital, Leeds General Infirmary, Leeds, UK
| | - Kanchan Rao
- Department of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Joanne Konkel
- Lydia Becker Institute of Immunology and Inflammation, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Robert Wynn
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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3
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Li J, Liu L, Zhang R, Wan Y, Gong X, Zhang L, Yang W, Chen X, Zou Y, Chen Y, Guo Y, Ruan M, Zhu X. Development and validation of a prognostic scoring model to risk stratify childhood acute myeloid leukaemia. Br J Haematol 2022; 198:1041-1050. [PMID: 35880261 PMCID: PMC9543487 DOI: 10.1111/bjh.18354] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
To create a personal prognostic model and modify the risk stratification of paediatric acute myeloid leukaemia, we downloaded the clinical data of 597 patients from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database as a training set and included 189 patients from our centre as a validation set. In the training set, age at diagnosis, -7/del(7q) or -5/del(5q), core binding factor fusion genes, FMS-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD)/nucleophosmin 1 (NPM1) status, Wilms tumour 1 (WT1) mutation, biallelic CCAAT enhancer binding protein alpha (CEBPA) mutation were strongly correlated with overall survival and included to construct the model. The prognostic model demonstrated excellent discriminative ability with the Harrell's concordance index of 0.68, 3- and 5-year area under the receiver operating characteristic curve of 0.71 and 0.72 respectively. The model was validated in the validation set and outperformed existing prognostic systems. Additionally, patients were stratified into three risk groups (low, intermediate and high risk) with significantly distinct prognosis, and the model successfully identified candidates for haematopoietic stem cell transplantation. The newly developed prognostic model showed robust ability and utility in survival prediction and risk stratification, which could be helpful in modifying treatment selection in clinical routine.
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Affiliation(s)
- Jun Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Lipeng Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Ranran Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yang Wan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xiaowen Gong
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Li Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Wenyu Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xiaojuan Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yao Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yumei Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Ye Guo
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Min Ruan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xiaofan Zhu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
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Becker M, Gscheidmeier T, Groß HJ, Cario H, Woelfle J, Rauh M, Metzler M, Zierk J. Differences between capillary and venous blood counts in children-A data mining approach. Int J Lab Hematol 2022; 44:729-737. [PMID: 35485526 DOI: 10.1111/ijlh.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Capillary sampling of blood counts is a well-established alternative to venipuncture in paediatrics. However, the sampling method has to be considered when interpreting test results, as measurements differ. Ethical and practical considerations prevent simultaneous venous and capillary sample acquisition in comprehensive paediatric cohorts that span all ages for the purpose of a direct method comparison, resulting in uncertainty regarding the interpretation of capillary test results. METHODS We applied a data mining method to calculate the differences between capillary and venous blood count analytes using laboratory data collected during patient care. We examined 486 401 blood counts performed between 2010 and 2017 in two German paediatric tertiary care centers in children from birth to 18 years analysed on SYSMEX XE-2100 and SYSMEX XE-5000 devices, and analysed the differences between capillary and venous test results in 15 218 paired samples performed within 24 h. RESULTS We identified the mean systematic differences between capillary and venous (capillary-venous) test results for haemoglobin (+6.5 g/L), haematocrit (+2.38%), platelet count (-7.01 × 109 /l), red cell count (+0.18 × 1012 /L), white cell count (-0.64 × 109 /L), mean corpuscular cell volume (+2.07 fl), mean corpuscular haemoglobin (+0.33 pg), mean corpuscular haemoglobin concentration (-4.4 g/L) and red cell distribution width (+0.40%). The effect of age on these mean deltas is negligible, while the levels of test results influence the difference between capillary and venous test results in most analytes. CONCLUSIONS Our results improve guidance regarding the interpretation of capillary test results for children of all ages and in both physiological and pathological ranges.
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Affiliation(s)
- Mathias Becker
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas Gscheidmeier
- Core Facility of Clinical Chemistry, University Medical Centre Ulm, Ulm, Germany
| | - Hans-Jürgen Groß
- Core Facility of Clinical Chemistry, University Medical Centre Ulm, Ulm, Germany
| | - Holger Cario
- Department of Pediatrics and Adolescent Medicine, University Medical Centre, Ulm, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Markus Metzler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Jakob Zierk
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
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5
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Soliman R, Heneghan C, Bolous NS, Sidhom I, Ahmed S, Roberts N, Oke J, Elhaddad A. Systematic review of costs and cost-effectiveness of treatment for relapsed/refractory acute leukaemia in children and young adults. Expert Rev Hematol 2022; 15:345-357. [PMID: 35485262 DOI: 10.1080/17474086.2022.2069096] [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] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Survival outcomes of children with relapsed/refractory (r/r) acute leukaemia remain poor. Novel expensive treatments have been developed to improve their outcomes, yet, limited evidence exists about cost-effectiveness of alternative treatment strategies. AREAS COVERED A systematic review was conducted to summarize the health-economic evidence about costs/cost-effectiveness of treating r/r acute leukaemia in children/young adults. We searched Medline, Embase, and Cochrane databases until August 13th, 2021. Eligible articles included peer-reviewed original studies addressing r/r paediatric/young-adult acute lymphoblastic leukaemia (ALL), and acute myeloid leukaemia (AML). Quality assessment was conducted using Consolidated Health Economics Evaluation Reporting Standards (CHEERS) checklist. EXPERT OPINION The majority of papers focused on CAR-T cell therapy, which is still a novel treatment for r/r ALL, and was found to be cost-effective, yet, there remain concerns over its long-term effectiveness, affordability, and equity in access. The next best treatment option is Blinatumomab, followed by Clofarabine therapy, whereas FLA-IDA salvage chemotherapy provides least value for money. The quality of evidence is moderate to high, with limited generalizability of findings due to high variability in outcomes obtained from modelling studies. Limited studies evaluated r/r AML. We provide recommendations to deliver cost-effective treatments in real-world contexts, with implications for healthcare policy and practice.
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Affiliation(s)
- Ranin Soliman
- Department for Continuing Education, University of Oxford, UK.,Health Economics and Value Unit, Children's Cancer Hospital 57357 Egypt (CCHE), Egypt
| | - Carl Heneghan
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nancy S Bolous
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, USA
| | - Iman Sidhom
- Department of Pediatric Oncology, Children's Cancer Hospital 57357 Egypt (CCHE), Egypt.,Department of Pediatric Oncology, National Cancer Institute, Cairo University, Egypt
| | - Sonia Ahmed
- Department of Pediatric Oncology, Children's Cancer Hospital 57357 Egypt (CCHE), Egypt.,Department of Pediatric Oncology, National Cancer Institute, Cairo University, Egypt
| | - Nia Roberts
- Oxford Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Jason Oke
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alaa Elhaddad
- Department of Pediatric Oncology, Children's Cancer Hospital 57357 Egypt (CCHE), Egypt.,Department of Pediatric Oncology, National Cancer Institute, Cairo University, Egypt
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6
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Biss TT, Chalmers EA. Addendum to British Society for Haematology guideline on the investigation, management and prevention of venous thrombosis in children (Br. J. Haematol. 2011; 154: 196-207). Br J Haematol 2021; 194:996-998. [PMID: 34462907 DOI: 10.1111/bjh.17794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tina T Biss
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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7
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Abstract
Epstein-Barr virus (EBV) infections have variable presentations ranging from asymptomatic to the triad of fever, pharyngitis, and adenopathy in infectious mononucleosis. Although haematological abnormalities are commonly seen in EBV infections, severe EBV-associated thrombocytopenia is a rare presentation, complicating clinical diagnosis and requiring appropriate management. Here we describe a case of a 14-year-old female with severe thrombocytopenia (platelet count of 5 x109/L) and spontaneous haemorrhage, accompanied by periorbital oedema, an uncommon symptom in EBV-associated infectious mononucleosis. She was treated with intravenous immunoglobulins and a four-day course of methylprednisolone. Treatment resulted in progressive platelet count recovery, and the patient was discharged seven days post-admission with a platelet count of 143 x109/L. The case highlights the need to consider EBV infection as a differential diagnosis in patients presenting with acute severe thrombocytopenia.
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Affiliation(s)
- Chen Zhang
- Medicine, University of Cambridge School of Clinical Medicine, Cambridge, GBR
| | - Anne M Kelly
- Paediatric Haematology, Addenbrooke's Hospital, Cambridge, GBR
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Bartram J, Balasch-Carulla M, Bhojaraja S, Adams S, Cheng D, Inglott S, Kulkarni N, Mahendrayogam A, O'Connor O, Pavasovic V, Vora A. Blinatumomab for paediatric mixed phenotype acute leukaemia. Br J Haematol 2021; 195:289-292. [PMID: 34254287 DOI: 10.1111/bjh.17707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jack Bartram
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK.,SIHMDS-Haematology, Great Ormond Street Hospital for Children, London, UK
| | | | - Shashank Bhojaraja
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Stuart Adams
- SIHMDS-Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Danny Cheng
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Sarah Inglott
- SIHMDS-Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Nimish Kulkarni
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
| | | | - Olya O'Connor
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Vesna Pavasovic
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Ajay Vora
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
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9
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Groarke EM, Patel BA, Gutierrez-Rodrigues F, Rios O, Lotter J, Baldoni D, St Pierre A, Shalhoub R, Wu CO, Townsley DM, Young NS. Eltrombopag added to immunosuppression for children with treatment-naïve severe aplastic anaemia. Br J Haematol 2021; 192:605-614. [PMID: 33410523 DOI: 10.1111/bjh.17232] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/23/2020] [Indexed: 01/21/2023]
Abstract
Acquired severe aplastic anaemia (SAA) has an immune pathogenesis, and immunosuppressive therapy (IST) with anti-thymocyte globulin and cyclosporine is effective therapy. Eltrombopag (EPAG) added to standard IST was associated with higher overall and complete response rates in patients with treatment-naïve SAA compared to a historical IST cohort. We performed a paediatric subgroup analysis of this trial including all patients aged <18 years who received EPAG plus standard IST (n = 40 patients) compared to a historical cohort (n = 87) who received IST alone. Response, relapse, clonal evolution, event-free survival (EFS), and overall survival were assessed. There was no significant difference in either the overall response rate (ORR) or complete response rate at 6 months (ORR 70% in EPAG group, 72% in historical group, P = 0·78). Adults (≥18 years) had a significantly improved ORR of 82% with EPAG compared to 58% historically (P < 0·001). Younger children had lower response rates than did adolescents. The trend towards relapse was higher and EFS significantly lower in children who received EPAG compared to IST alone. Addition of EPAG added to standard IST did not improve outcomes in children with treatment-naïve SAA. EPAG in the paediatric population should not automatically be considered standard of care. Registration: clinicaltrials.gov (NCT01623167).
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Affiliation(s)
- Emma M Groarke
- Hematology Branch, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Bhavisha A Patel
- Hematology Branch, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Fernanda Gutierrez-Rodrigues
- Hematology Branch, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Olga Rios
- Hematology Branch, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jennifer Lotter
- Hematology Branch, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Daniela Baldoni
- Pharmacokinetic Sciences, Novartis Institute for BioMedical Research (NIBR), Basel, Switzerland
| | - Annie St Pierre
- Pharmacokinetic Sciences, Novartis Institute for BioMedical Research (NIBR), Basel, Switzerland
| | - Ruba Shalhoub
- Office of Biostatistics, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Colin O Wu
- Office of Biostatistics, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Danielle M Townsley
- Hematology Branch, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Neal S Young
- Hematology Branch, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
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10
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Yacobovich J, Barzilai-Birenboim S, Steinberg-Shemer O, Stark P, Pazgal I, Tamary H. Splenectomy in childhood for non-malignant haematologic disorders - long-term follow-up shows minimal adverse effects. Br J Haematol 2020; 190:909-915. [PMID: 32342506 DOI: 10.1111/bjh.16657] [Citation(s) in RCA: 8] [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: 01/31/2020] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 12/15/2022]
Abstract
Splenectomy is considered therapeutic in various non-malignant haematologic diseases. Adverse events - specifically infections and thromboembolism - are not extensively documented in the paediatric population, maintaining the concern over risks-versus-benefits of the procedure. We studied a cohort of paediatric haematology patients undergoing splenectomy between 1977 and 2015 to determine short- and long-term complications. We summarised all the patients of the haematology clinic in our major Israeli tertiary centre undergoing splenectomy for therapeutic reasons, capturing infectious and thromboembolic events. The data of 103 patients, comprising 1657 follow-up years, were analysed. The cohort included 33 patients with transfusion-dependent thalassaemia, seven with non-transfusion-dependent thalassaemia, four with sickle-thalassaemia, 41 with hereditary spherocytosis, and 18 with immune thrombocytopenia. Standard presplenectomy vaccinations were noted in most. No typical cases of overwhelming postsplenectomy infection (OPSI) were identified, nor were typical OPSI bacteria isolated. Thalassaemics with central lines were most prone to infection and thrombosis. Beyond this subgroup, thrombotic events were anecdotal. This is the largest study to date to comprehensively analyse infectious and thrombotic complications of childhood splenectomy for the treatment of haematologic diseases. The use of splenectomy appears to be a relatively safe therapeutic option in paediatric patients with proper preoperative vaccination and follow-up care; use of central venous lines or catheters increase the risk in thalassaemic patients and should be avoided if possible.
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Affiliation(s)
- Joanne Yacobovich
- Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Barzilai-Birenboim
- Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orna Steinberg-Shemer
- Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pinhas Stark
- The Comprehensive Center of Thalassemia, Hemoglobinopathies & Rare Anemias, Institute of Hematology, Petah Tikva, Israel
| | - Idit Pazgal
- The Comprehensive Center of Thalassemia, Hemoglobinopathies & Rare Anemias, Institute of Hematology, Petah Tikva, Israel
| | - Hannah Tamary
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Molecular Diagnostic Laboratory, Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
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11
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Au-Yeung RKH, Arias Padilla L, Zimmermann M, Oschlies I, Siebert R, Woessmann W, Burkhardt B, Klapper W. Experience with provisional WHO-entities large B-cell lymphoma with IRF4-rearrangement and Burkitt-like lymphoma with 11q aberration in paediatric patients of the NHL-BFM group. Br J Haematol 2020; 190:753-763. [PMID: 32239695 DOI: 10.1111/bjh.16578] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 12/24/2019] [Accepted: 02/24/2020] [Indexed: 02/06/2023]
Abstract
Large B-cell lymphoma with IRF4 rearrangement, and Burkitt-like lymphoma with 11q aberration are two provisional lymphoma entities in the 2017 revision of the WHO classification of lymphoid neoplasms. Despite being more frequent in young patients, knowledge regarding their true incidence and clinical features in unselected cohorts of paediatric and adolescent patients is limited. We screened for both entities among paediatric patients (<18 years of age) in the German NHL-BFM (Non-Hodgkin lymphoma Berlin-Frankfurt-Münster) group. Among follicular lymphomas and diffuse large B-cell lymphomas (DLBCL), 7/34 cases (21%) showed an IRF4 break-apart pattern by fluorescence in situ hybridisation (FISH) and are associated with stages I and II disease (P = 0·043). Among lymphomas morphologically resembling Burkitt lymphoma, DLBCL and high-grade B-cell lymphoma, unclassifiable, 13/102 cases (13%) lacked a MYC break-apart pattern but were positive for 11q proximal gain and telomeric loss by FISH. MYC-negative Burkitt-like lymphomas with the typical 11q gain-loss pattern by FISH were older (P = 0·004), showed less male predominance (P = 0·003), lower stage (P = 0·040), lower serum LDH level (P = 0·01) and less abdominal involvement (P = 0·008) compared to high grade B-cell lymphomas without 11q gain-loss pattern. Both entities showed excellent outcome with overall survival of 100% when managed according to NHL-BFM strategies and may provide candidates for future therapy de-escalation in clinical trials.
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Affiliation(s)
- Rex K H Au-Yeung
- Department of Pathology, Hematopathology Section, University Hospital Schleswig-Holstein, Christian-Albrecht-University of Kiel, Kiel, Germany.,Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Laura Arias Padilla
- Department of Paediatric Haematology and Oncology, University Children's Hospital, Münster, Germany
| | - Martin Zimmermann
- Department of Paediatric Haematology and Oncology, Hannover Medical School, Hanover, Germany
| | - Ilske Oschlies
- Department of Pathology, Hematopathology Section, University Hospital Schleswig-Holstein, Christian-Albrecht-University of Kiel, Kiel, Germany
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University & Ulm University Medical Center, Ulm, Germany
| | - Wilhelm Woessmann
- Department of Paediatric Haematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Burkhardt
- Department of Paediatric Haematology and Oncology, University Children's Hospital, Münster, Germany
| | - Wolfram Klapper
- Department of Pathology, Hematopathology Section, University Hospital Schleswig-Holstein, Christian-Albrecht-University of Kiel, Kiel, Germany
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12
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Juul-Dam KL, Ommen HB, Nyvold CG, Walter C, Vålerhaugen H, Kairisto V, Abrahamsson J, Alm SJ, Jahnukainen K, Lausen B, Reinhardt D, Zeller B, von Neuhoff N, Fogelstrand L, Hasle H. Measurable residual disease assessment by qPCR in peripheral blood is an informative tool for disease surveillance in childhood acute myeloid leukaemia. Br J Haematol 2020; 190:198-208. [PMID: 32175599 DOI: 10.1111/bjh.16560] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 10/05/2019] [Accepted: 02/12/2020] [Indexed: 12/29/2022]
Abstract
Serial assessments of measurable (or minimal) residual disease (MRD) by qPCR may identify nascent relapse in children with acute myeloid leukaemia (AML) and enable pre-emptive therapy. We investigated the kinetics and prognostic impact of recurrent fusion transcripts (RUNX1-RUNX1T1, CBFB-MYH11, KMT2A-MLLT3 or KMT2A-ELL) in 774 post-induction samples from bone marrow (BM, 347) and peripheral blood (PB, 427) from 75 children with AML. BM MRD persistence during consolidation did not increase the risk of relapse, and MRD at therapy completion did not correlate to outcome (HR = 0·64/MRD log reduction (CI: 0·32-1·26), P = 0·19). In contrast, 8/8 patients with detectable MRD in PB after first consolidation relapsed. Persistence (n = 4) and shifting from negative to positive (n = 10) in PB during follow-up predicted relapse in 14/14 patients. All 253 PB samples collected during follow-up from 36 patients in continuous complete remission were MRD negative. In core-binding factor AML, persistent low-level MRD positivity in BM during follow-up was frequent but an increment to above 5 × 10-4 heralded subsequent haematological relapse in 12/12 patients. We demonstrate that MRD monitoring in PB after induction therapy is highly informative and propose an MRD increment above 5 × 10-4 in PB and BM as a definition of molecular relapse since it always leads to haematological relapse.
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Affiliation(s)
| | - Hans B Ommen
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte G Nyvold
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark.,Haematology-Pathology Research Laboratory, Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Christiane Walter
- Department of Paediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Helen Vålerhaugen
- Department of Pathology, The Norwegian Radium Hospital, Oslo, Norway
| | - Veli Kairisto
- Laboratory of Molecular Haematology and Pathology, Turku University Central Hospital, Turku, Finland
| | - Jonas Abrahamsson
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Sofie J Alm
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Kirsi Jahnukainen
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Birgitte Lausen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dirk Reinhardt
- Department of Paediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bernward Zeller
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Nils von Neuhoff
- Department of Paediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Linda Fogelstrand
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Hasle
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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13
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Partanen M, Kang G, Wang WC, Krull K, King AA, Schreiber JE, Porter JS, Hodges J, Hankins JS, Jacola LM. Association between hydroxycarbamide exposure and neurocognitive function in adolescents with sickle cell disease. Br J Haematol 2020; 189:1192-1203. [PMID: 32103506 DOI: 10.1111/bjh.16519] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 10/07/2019] [Accepted: 01/10/2020] [Indexed: 12/14/2022]
Abstract
Patients with sickle cell disease (SCD) are at increased risk for neurocognitive impairments. While disease-modifying treatment, such as hydroxycarbamide (hydroxyurea), may decrease this risk, it has not been systematically investigated in children with SCD. We screened neurocognitive functioning in 103 adolescents with SCD (16-17 years, 50% female) and compared outcomes between patients with a history of exposure to hydroxycarbamide (n = 12 HbSC/HbSβ+ thalassaemia; n = 52 HbSS/HbSβ0 thalassaemia) and those never treated with hydroxycarbamide (n = 31 HbSC/HbSβ+ thalassaemia; n = 8 HbSS/HbSβ0 thalassaemia). Demographic distributions were similar between the groups. After adjusting for socioeconomic status, the hydroxycarbamide group had significantly higher scores on nonverbal IQ (HbSC/HbSβ thalassaemia: P = 0·036, effect size [d] = 0·65), reaction speed (HbSS/HbSβ0 thalassaemia: P = 0·002, d = 1·70), sustained attention (HbSS/HbSβ0 thalassaemia: P = 0·014, d = 1·30), working memory (HbSC/HbSβ+ thalassaemia: P = 0·034, d = 0·71) and verbal memory (HbSC/HbSβ+ thalassaemia: P = 0·038, d = 0·84) when compared to those who did not receive hydroxycarbamide. In patients with HbSS/HbSβ0 thalassaemia, longer treatment duration with hydroxycarbamide was associated with better verbal memory (P = 0·009) and reading (P = 0·002). Markers of hydroxycarbamide effect, including higher fetal haemoglobin (HbF), higher mean corpuscular volume (MCV) and lower white blood cell count (WBC), were associated with better verbal fluency (HbF: P = 0·014, MCV: P = 0·006, WBC: P = 0·047) and reading (MCV: P = 0·021, WBC: P = 0·037). Cognitive impairment may be mitigated by exposure to hydroxycarbamide in adolescents with SCD.
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Affiliation(s)
- Marita Partanen
- Departments of, Department of, Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Guolian Kang
- Department of, Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Winfred C Wang
- Department of, Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin Krull
- Department of, Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Allison A King
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Jane E Schreiber
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jerlym S Porter
- Departments of, Department of, Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jason Hodges
- Department of, Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane S Hankins
- Department of, Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lisa M Jacola
- Departments of, Department of, Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
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14
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O'Reilly MA, Govender D, Kirkwood AA, Vora A, Samarasinghe S, Khwaja A, Grandage V, Rao A, Ancliff P, Pavasovic V, Cheng D, Carpenter B, Daw S, Hough R, O'Connor D. The incidence of invasive fungal infections in children, adolescents and young adults with acute lymphoblastic leukaemia/lymphoma treated with the UKALL2011 protocol: a multicentre retrospective study. Br J Haematol 2019; 186:327-329. [PMID: 30768682 DOI: 10.1111/bjh.15798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Maeve A O'Reilly
- Department of Adolescent Haematology, University College London Hospital (UCLH), London, UK
| | - Dinisha Govender
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - Ajay Vora
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Sujith Samarasinghe
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Asim Khwaja
- Department of Young Adult Haematology, University College London Hospital (UCLH), London, UK
| | - Victoria Grandage
- Department of Adolescent Haematology, University College London Hospital (UCLH), London, UK
| | - Anupama Rao
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Philip Ancliff
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Vesna Pavasovic
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Danny Cheng
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Ben Carpenter
- Department of Adolescent Haematology, University College London Hospital (UCLH), London, UK
| | - Stephen Daw
- Department of Adolescent Haematology, University College London Hospital (UCLH), London, UK
| | - Rachael Hough
- Department of Adolescent Haematology, University College London Hospital (UCLH), London, UK
| | - David O'Connor
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
- Department of Haematology, University College London Cancer Institute, London, UK
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15
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Fazio G, Massa V, Grioni A, Bystry V, Rigamonti S, Saitta C, Galbiati M, Rizzari C, Consarino C, Biondi A, Selicorni A, Cazzaniga G. First evidence of a paediatric patient with Cornelia de Lange syndrome with acute lymphoblastic leukaemia. J Clin Pathol 2019; 72:558-561. [PMID: 30948435 DOI: 10.1136/jclinpath-2019-205707] [Citation(s) in RCA: 10] [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: 01/07/2019] [Revised: 03/15/2019] [Accepted: 03/16/2019] [Indexed: 11/04/2022]
Abstract
Cornelia de Lange syndrome (CdLS) is a rare autosomal-dominant genetic disorder characterised by prenatal and postnatal growth and mental retardation, facial dysmorphism and upper limb abnormalities. Germline mutations of cohesin complex genes SMC1A, SMC3, RAD21 or their regulators NIPBL and HDAC8 have been identified in CdLS as well as somatic mutations in myeloid disorders. We describe the first case of a paediatric patient with CdLS with B-cell precursor Acute Lymphoblastic Leukaemia (ALL). The patient did not show any unusual cytogenetic abnormality, and he was enrolled into the high risk arm of AIEOP-BFM ALL2009 protocol because of slow early response, but 3 years after discontinuation, he experienced an ALL relapse. We identified a heterozygous mutation in exon 46 of NIPBL, causing frameshift and a premature stop codon (RNA-Targeted Next generation Sequencing Analysis). The analysis of the family indicated a de novo origin of this previously not reported deleterious variant. As for somatic cohesin mutations in acute myeloid leukaemia, also this ALL case was not affected by aneuploidy, thus suggesting a major impact of the non-canonical role of NIPBL in gene regulation. A potential biological role of NIPBL in leukaemia has still to be dissected.
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Affiliation(s)
- Grazia Fazio
- Centro di Ricerca Tettamanti, Clinica Pediatrica, Università di Milano, Bicocca, Monza, Italy
| | - Valentina Massa
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Andrea Grioni
- Centro di Ricerca Tettamanti, Clinica Pediatrica, Università di Milano, Bicocca, Monza, Italy.,Central European Institute of Technology, Masarykova Univerzita, Brno, Czech Republic
| | - Vojtech Bystry
- Central European Institute of Technology, Masarykova Univerzita, Brno, Czech Republic
| | - Silvia Rigamonti
- Centro di Ricerca Tettamanti, Clinica Pediatrica, Università di Milano, Bicocca, Monza, Italy.,Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Claudia Saitta
- Centro di Ricerca Tettamanti, Clinica Pediatrica, Università di Milano, Bicocca, Monza, Italy
| | - Marta Galbiati
- Centro di Ricerca Tettamanti, Clinica Pediatrica, Università di Milano, Bicocca, Monza, Italy
| | - Carmelo Rizzari
- Pediatric Department, Monza Brianza per il Bambino e la sua Mamma (MBBM) Foundation, Monza, Italy
| | - Caterina Consarino
- Ematologia ed Oncologia Pediatrica, Presidio Ospedaliero Ciaccio-De Lellis, Catanzaro, Italy
| | - Andrea Biondi
- Centro di Ricerca Tettamanti, Clinica Pediatrica, Università di Milano, Bicocca, Monza, Italy.,Pediatric Department, Monza Brianza per il Bambino e la sua Mamma (MBBM) Foundation, Monza, Italy
| | - Angelo Selicorni
- Department of Pediatrics, Presidio S. Fermo, ASST Lariana, Como, Italy
| | - Giovanni Cazzaniga
- Centro di Ricerca Tettamanti, Clinica Pediatrica, Università di Milano, Bicocca, Monza, Italy .,Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy
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16
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Bate J, Baker S, Breuer J, Chisholm JC, Gray J, Hambleton S, Houlton A, Jit M, Lowis S, Makin G, O'Sullivan C, Patel SR, Phillips R, Ransinghe N, Ramsay ME, Skinner R, Wheatley K, Heath PT. PEPtalk2: results of a pilot randomised controlled trial to compare VZIG and aciclovir as postexposure prophylaxis (PEP) against chickenpox in children with cancer. Arch Dis Child 2019; 104:25-29. [PMID: 29730641 DOI: 10.1136/archdischild-2017-314212] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/16/2018] [Accepted: 04/17/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the likely rate of patient randomisation and to facilitate sample size calculation for a full-scale phase III trial of varicella zoster immunoglobulin (VZIG) and aciclovir as postexposure prophylaxis against chickenpox in children with cancer. DESIGN Multicentre pilot randomised controlled trial of VZIG and oral aciclovir. SETTING England, UK. PATIENTS Children under 16 years of age with a diagnosis of cancer: currently or within 6 months of receiving cancer treatment and with negative varicella zoster virus (VZV) serostatus at diagnosis or within the last 3 months. INTERVENTIONS Study participants who have a significant VZV exposure were randomised to receive PEP in the form of VZIG or aciclovir after the exposure. MAIN OUTCOME MEASURES Number of patients registered and randomised within 12 months of the trial opening to recruitment and incidence of breakthrough varicella. RESULTS The study opened in six sites over a 13-month period. 482 patients were screened for eligibility, 32 patients were registered and 3 patients were randomised following VZV exposure. All three were randomised to receive aciclovir and there were no cases of breakthrough varicella. CONCLUSIONS Given the limited recruitment to the PEPtalk2 pilot, it is unlikely that the necessary sample size would be achievable using this strategy in a full-scale trial. The study identified factors that could be used to modify the design of a definitive trial but other options for defining the best means to protect such children against VZV should be explored. TRIAL REGISTRATION NUMBER ISRCTN48257441, EudraCT number: 2013-001332-22, sponsor: University of Birmingham.
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Affiliation(s)
- Jessica Bate
- Department of Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stephen Baker
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, UK
| | - Julia C Chisholm
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Juliet Gray
- Department of Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Cancer Sciences Academic Unit, University of Southampton, Southampton, UK
| | - Sophie Hambleton
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aimee Houlton
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen Lowis
- School of Clinical Sciences, University of Bristol, London, UK
| | - Guy Makin
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Catherine O'Sullivan
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St. Georges, University of London, London, UK
| | - Soonie R Patel
- Department of Paediatrics, Croydon Health Services NHS Trust, London, UK
| | | | - Neil Ransinghe
- Parent representative, Paediatric Oncology Reference Team, UK
| | | | - Roderick Skinner
- Great North Children's Hospital, Department of Paediatric and Adolescent Haematology/Oncology, Newcastle upon Tyne, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St. Georges, University of London, London, UK
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17
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Ljung R, Auerswald G, Benson G, Dolan G, Duffy A, Hermans C, Jiménez-Yuste V, Lambert T, Morfini M, Zupančić-Šalek S, Santagostino E. Inhibitors in haemophilia A and B: Management of bleeds, inhibitor eradication and strategies for difficult-to-treat patients. Eur J Haematol 2018; 102:111-122. [PMID: 30411401 PMCID: PMC6936224 DOI: 10.1111/ejh.13193] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 12/12/2022]
Abstract
The standard therapy for patients with haemophilia is prophylactic treatment with replacement factor VIII (FVIII) or factor IX (FIX). Patients who develop inhibitors against FVIII/FIX face an increased risk of bleeding, and the likelihood of early development of progressive arthropathy, alongside higher treatment-related costs. Bypassing agents can be used to prevent and control bleeding, as well as the recently licensed prophylaxis, emicizumab, but their efficacy is less predictable than that of factor replacement therapy. Antibody eradication, by way of immune tolerance induction (ITI), is still the preferred management strategy for treating patients with inhibitors. This approach is successful in most patients, but some are difficult to tolerise and/or are unresponsive to ITI, and they represent the most complicated patients to treat. However, there are limited clinical data and guidelines available to help guide physicians in formulating the next treatment steps in these patients. This review summarises currently available treatment options for patients with inhibitors, focussing on ITI regimens and those ITI strategies that may be used in difficult-to-treat patients. Some alternative, non-ITI approaches for inhibitor management, are also proposed.
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Affiliation(s)
- Rolf Ljung
- Department of Clinical Sciences-Paediatrics, Lund University, Lund, Sweden.,Malmö Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
| | - Guenter Auerswald
- Klinikum Bremen-Mitte, Professor Hess Children's Hospital, Bremen, Germany
| | - Gary Benson
- Haemophilia and Thrombosis Centre, Belfast City Hospital, Belfast, UK
| | - Gerry Dolan
- Centre for Haemostasis and Thrombosis, St Thomas' Hospital, London, UK
| | - Anne Duffy
- WFH Psychosocial Committee, Irish Haemophilia Society, Dublin, Ireland
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Thierry Lambert
- Hemophilia Care Center, Faculté de Médecine Paris XI, Bicêtre AP-HP Hospital, Paris, France
| | | | - Silva Zupančić-Šalek
- University Hospital Centre Zagreb, School of Medicine, University of Osijek and Medical School University of Zagreb, Zagreb, Croatia
| | - Elena Santagostino
- Foundation IRCCS Cà Granda, Maggiore Hospital Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
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18
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Thielen FW, Blommestein HM, Oosten LEM, Calkoen FG, Lankester AC, Zwaginga JJ, Le Blanc K, Redondo A, Sánchez-Guijo F, Algeri M, Locatelli F, Fibbe WE, Uyl-de Groot CA. Second-line treatment for acute graft-versus-host disease with mesenchymal stromal cells: A decision model. Eur J Haematol 2018; 101:676-683. [PMID: 30084111 DOI: 10.1111/ejh.13158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE No standard second-line treatment exists for acute graft-versus-host disease steroid-refractory (SR-aGvHD), and long-term outcomes remain poor. Mesenchymal stromal cells (MSCs) have been evaluated as treatment, but no disease model (DM) exists that integrates and extrapolates currently available evidence. The aim of this study was to develop such a DM to describe the natural history of SR-aGvHD and to predict long-term outcomes. METHOD The DM was developed in collaboration with experts in haematology-oncology. Subsequently, a model simulation was run. Input parameters for transition and survival estimates were informed by published data of clinical trials on MSC treatment for SR-aGvHD. Parametric distributions were used to estimate long-term survival rates after MSCs. RESULTS The newly developed DM is a cohort model that consists of eight health states. For the model simulation, we obtained data on 327 patients from 14 published phase II trials. Due to limited evidence, DM structure was simplified and several assumptions had to be made. Median overall survival was 3.2 years for complete response and 0.5 years for no complete response. CONCLUSION The DM provides a comprehensive overview on the second-line treatment pathway for aGvHD and enables long-term predictions that can be used to perform a cost-effectiveness analysis comparing any treatment for SR-aGvHD.
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Affiliation(s)
- Frederick W Thielen
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Hedwig M Blommestein
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
- Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Liesbeth E M Oosten
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Friso G Calkoen
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjan C Lankester
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap J Zwaginga
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - Katarina Le Blanc
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alba Redondo
- IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | | | - Wim E Fibbe
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
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19
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Kager L, Jimenez Heredia R, Hirschmugl T, Dmytrus J, Krolo A, Müller H, Bock C, Zeitlhofer P, Dworzak M, Mann G, Holter W, Haas O, Boztug K. Targeted mutation screening of 292 candidate genes in 38 children with inborn haematological cytopenias efficiently identifies novel disease-causing mutations. Br J Haematol 2018; 182:251-258. [PMID: 29797310 PMCID: PMC6079646 DOI: 10.1111/bjh.15389] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/06/2018] [Accepted: 03/19/2018] [Indexed: 12/16/2022]
Abstract
Establishing a precise diagnosis is essential in inborn haematological cytopenias to enable appropriate treatment decisions and avoid secondary organ damage. However, both diversity and phenotypic overlap of distinct disease entities may make the identification of underlying genetic aetiologies by classical Sanger sequencing challenging. Instead of exome sequencing, we established a systematic next generation sequencing‐based panel targeting 292 candidate genes and screened 38 consecutive patients for disease‐associated mutations. Efficient identification of the underlying genetic cause in 17 patients (44·7%), including 13 novel mutations, demonstrates that this approach is time‐ and cost‐efficient, enabling optimal management and genetic counselling.
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Affiliation(s)
- Leo Kager
- St Anna Children's Hospital, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Children's Cancer Research Institute, Vienna, Austria
| | | | - Tatjana Hirschmugl
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Jasmin Dmytrus
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Ana Krolo
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Heiko Müller
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Christoph Bock
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria.,CeMM Research Centre for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | | | - Michael Dworzak
- St Anna Children's Hospital, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Children's Cancer Research Institute, Vienna, Austria
| | - Georg Mann
- St Anna Children's Hospital, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Holter
- St Anna Children's Hospital, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Oskar Haas
- St Anna Children's Hospital, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Children's Cancer Research Institute, Vienna, Austria.,medgen.at GmbH, Vienna, Austria
| | - Kaan Boztug
- St Anna Children's Hospital, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Children's Cancer Research Institute, Vienna, Austria.,Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria.,CeMM Research Centre for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
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20
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Kucine N, Al-Kawaaz M, Hajje D, Bussel J, Orazi A. Difficulty distinguishing essential thrombocythaemia from polycythaemia vera in children with JAK2 V617F-positive myeloproliferative neoplasms. Br J Haematol 2018; 185:136-139. [PMID: 29767848 DOI: 10.1111/bjh.15386] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nicole Kucine
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Mustafa Al-Kawaaz
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Daher Hajje
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - James Bussel
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Attilio Orazi
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
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21
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Abstract
Manual examination of the peripheral blood smear (PBS) is currently performed on a fraction of samples sent for automated complete cell count. 39 children (age range 0-16.2 years) referred to a private paediatric practice during a 16-month period were retrospectively reviewed. Clinical scenarios, haematological features, laboratory-initiated PBS review, haematologist's PBS review and final diagnosis were described. Clinical indications included isolated thrombocytopenia (n = 10), unexplained bruises (n = 5), acute febrile illnesses (n = 11), anaemia (n = 8) and others (n = 5). The laboratory reviewed the PBS in 30 cases according to preset criteria and made no conclusive remarks. All slides were reviewed by a haematologist and a diagnosis was made in 27 (69%) cases, including 7 (78%) of the nine slides the laboratory did not review. The practice of laboratory-initiated PBS review requires re-evaluation. Haematologist-reviewed PBS is an important diagnostic tool for children with anaemia, bleeding disorders and acute febrile illnesses.
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Affiliation(s)
- Anselm Chi-wai Lee
- Correspondence: Dr Anselm Lee, Senior Consultant, Children’s Haematology and Cancer Centre, Mount Elizabeth Hospital, Level 4, 3 Mount Elizabeth, Singapore 228510.
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22
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Hinnouho GM, Barffour MA, Wessells KR, Brown KH, Kounnavong S, Chanhthavong B, Ratsavong K, Kewcharoenwong C, Hess SY. Comparison of haemoglobin assessments by HemoCue and two automated haematology analysers in young Laotian children. J Clin Pathol 2017; 71:532-538. [PMID: 29197856 PMCID: PMC5969348 DOI: 10.1136/jclinpath-2017-204786] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 09/11/2017] [Accepted: 11/14/2017] [Indexed: 11/30/2022]
Abstract
Background Haemoglobin (Hb) assessment by Hemocue is used widely for anaemia screening in both adults and children. However, few studies have compared the diagnostic accuracy of Hemocue with an automated haematology analyser in young children. Aim To compare Hb concentrations by Hemocue Hb301 and two automated haematology analysers in young children in rural communities of Lao PDR. Methods Capillary blood was collected from 6-month-old to 23-month-old children (n=1487) for determination of Hb concentration by Hemocue Hb301. On the same day, venous blood was collected for complete blood count using one of two haematology analysers (XT-1800i, Sysmex, and BC-3000Plus, Mindray Medical International). In a subsample of children (n=129), venous Hb was also measured by HemoCue Hb301. Agreement between the two methods was estimated using Bland-Altman plots. Results Mean capillary Hb by Hemocue was significantly higher than mean venous Hb by haematology analysers combined (108.4±10.3 g/L vs 102.3±13.1 g/L; P<0.001), resulting in a significantly lower anaemia prevalence (Hb <110 g/L) by Hemocue (53.7% vs 73.9%; P<0.001). The Bland-Altman assessment of agreement showed a bias of 6.1 g/L and limits of agreement were −11.5 g/L to 23.7 g/L. Mean venous Hb concentration by Hemocue Hb301 (113.6±14.0 g/L) was significantly higher than mean capillary Hb concentration by Hemocue Hb301 (110.0±10.7; P=0.03 g/L), which in turn was significantly higher than mean venous Hb concentration by the Mindray BC-3000Plus (102.3±17.4 g/L). Conclusion Capillary and venous Hb concentrations assessed by Hemocue Hb301 showed poor agreement compared with venous Hb by automated haematology analysers, resulting in significantly different anaemia prevalences.
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Affiliation(s)
- Guy-Marino Hinnouho
- Department of Nutrition, Program in International and Community Nutrition, University of California, Davis, California, USA
| | - Maxwell A Barffour
- Department of Nutrition, Program in International and Community Nutrition, University of California, Davis, California, USA
| | - K Ryan Wessells
- Department of Nutrition, Program in International and Community Nutrition, University of California, Davis, California, USA
| | - Kenneth H Brown
- Department of Nutrition, Program in International and Community Nutrition, University of California, Davis, California, USA.,Nutrition and Global Development, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | | | | | | | - Chidchamai Kewcharoenwong
- Faculty of Associated Medical Sciences, Centre for Research and Development of Medical Diagnostic Laboratories, Khon Kaen University, Khon Kaen, Thailand
| | - Sonja Y Hess
- Department of Nutrition, Program in International and Community Nutrition, University of California, Davis, California, USA
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23
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Butler GH, Flood K, Doyle E, Geary MP, Betts DR, Foran A, O'Marcaigh A, Cotter M. Similar but different: identical pathology with differing outcome in 'Not-so-identical' twins. Br J Haematol 2016; 178:152-153. [PMID: 27102370 DOI: 10.1111/bjh.14117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/29/2016] [Accepted: 03/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Karen Flood
- Department of Obstetrics, Rotunda Hospital, Dublin, Ireland
| | - Emma Doyle
- Department of Pathology, Rotunda Hospital, Dublin, Ireland
| | - Mike P Geary
- Department of Obstetrics, Rotunda Hospital, Dublin, Ireland
| | - David R Betts
- Our Lady's Childrens Hospital, Crumlin, Dublin, Ireland
| | - Adrienne Foran
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
| | | | - Melanie Cotter
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland.,Our Lady's Childrens Hospital, Crumlin, Dublin, Ireland
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24
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Kawadler JM, Clark CA, McKinstry RC, Kirkham FJ. Brain atrophy in paediatric sickle cell anaemia: findings from the silent infarct transfusion (SIT) trial. Br J Haematol 2016; 177:151-153. [PMID: 27061199 DOI: 10.1111/bjh.14039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jamie M Kawadler
- Developmental Neurosciences, UCL Institute of Child Health, London, UK
| | - Chris A Clark
- Developmental Neurosciences, UCL Institute of Child Health, London, UK
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Institute of Child Health, London, UK
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25
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Hough R, Danby R, Russell N, Marks D, Veys P, Shaw B, Wynn R, Vora A, Mackinnon S, Peggs KS, Crawley C, Craddock C, Pagliuca A, Cook G, Snowden JA, Clark A, Marsh J, Querol S, Parkes G, Braund H, Rocha V. Recommendations for a standard UK approach to incorporating umbilical cord blood into clinical transplantation practice: an update on cord blood unit selection, donor selection algorithms and conditioning protocols. Br J Haematol 2015; 172:360-70. [PMID: 26577457 DOI: 10.1111/bjh.13802] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 08/31/2015] [Indexed: 01/26/2023]
Abstract
Allogeneic haemopoietic stem cell transplantation offers a potentially curative treatment option for a wide range of life-threatening malignant and non-malignant disorders of the bone marrow and immune system in patients of all ages. With rapidly emerging advances in the use of alternative donors, such as mismatched unrelated, cord blood and haploidentical donors, it is now possible to find a potential donor for almost all patients in whom an allograft is indicated. Therefore, for any specific patient, the transplant physician may be faced with a myriad of potential choices, including decisions concerning which donor to prioritize where there is more than one, the optimal selection of specific umbilical cord blood units and which conditioning and graft-versus-host disease prophylactic schedule to use. Donor choice may be further complicated by other important factors, such as urgency of transplant, the presence of alloantibodies, the disease status (homozygosity or heterozygosity) of sibling donors affected by inherited disorders and the cytomegalovirus serostatus of patient and donor. We report UK consensus guidelines on the selection of umbilical cord blood units, the hierarchy of donor selection and the preferred conditioning regimens for umbilical cord blood transplantation, with a summary of rationale supporting these recommendations.
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Affiliation(s)
| | - Robert Danby
- NHSBT, Churchill Hospital, Oxford University, Oxford, UK
| | | | - David Marks
- Adult BMT Unit, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Paul Veys
- Great Ormond Street Hospital, London, UK
| | - Bronwen Shaw
- Froedtert & the Medical College of Wisconsin, CIBMTR, Wauwatosa, WI, USA
| | - Rob Wynn
- Manchester Children's Hospital, Manchester, UK
| | - Ajay Vora
- Sheffield Children's Hospital, Sheffield, UK
| | | | | | | | | | | | | | - John A Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, UK
| | - Andrew Clark
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Sergio Querol
- Anthony Nolan, London, UK.,Banc Sang i Teixits, Barcelona, Spain
| | | | | | - Vanderson Rocha
- NHSBT, Churchill Hospital, Oxford University and Eurocord, Oxford, UK
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26
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Ben Hamadi D, Calvet C. [Management of treatment-induced pain in paediatric haematology]. Soins Pediatr Pueric 2015; 36:28-30. [PMID: 26183097 DOI: 10.1016/j.spp.2015.05.006] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Invasive procedures are frequent and painful in children treated in paediatric haematology. It is therefore essential to take into consideration and anticipate the pain induced by these procedures. The caregiver has various effective methods of providing a high quality care management.
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Affiliation(s)
- Donia Ben Hamadi
- Service de réanimation pédiatrique, CHU Robert Debré, AP-HP, 48 boulevard Sérurier, 75019 Paris, France
| | - Clémence Calvet
- Service de réanimation pédiatrique, CHU Robert Debré, AP-HP, 48 boulevard Sérurier, 75019 Paris, France.
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27
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Seidel MG, Urban C, Sipurzynski J, Beham-Schmid C, Lackner H, Benesch M. High response rate but short-term effect of romiplostim in paediatric refractory chronic immune thrombocytopenia. Br J Haematol 2014; 165:419-21. [PMID: 24484542 DOI: 10.1111/bjh.12766] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Markus G Seidel
- Division of Paediatric Haematology-Oncology, Department of Paediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria.
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