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Caccuri F, Bugatti A, Meini A, Bonfanti C, Motta M, Savarè L, Arrighini A, Bondioni MP, Lougaris V, Caruso A, Plebani A. Temporal viral loads in respiratory and gastrointestinal tract and serum antibody responses during SARS-CoV-2 infection in an Italian pediatric cohort. Clin Immunol 2021; 225:108695. [PMID: 33601017 PMCID: PMC7883682 DOI: 10.1016/j.clim.2021.108695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Francesca Caccuri
- Department of Molecular and Translational Medicine, Section of Microbiology, University of Brescia, Medical School, Brescia, Italy
| | - Antonella Bugatti
- Department of Molecular and Translational Medicine, Section of Microbiology, University of Brescia, Medical School, Brescia, Italy
| | - Antonella Meini
- Pediatrics Clinic, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Carlo Bonfanti
- Department of Molecular and Translational Medicine, Section of Microbiology, University of Brescia, Medical School, Brescia, Italy
| | - Mario Motta
- Neonatology and Neonatal Intensive Care, Children's Hospital, ASST-Spedali Civili, Brescia, Italy
| | - Lucia Savarè
- Pediatrics Clinic, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Alberto Arrighini
- Pediatric Emergency Department, Children's Hospital, ASST-Spedali Civili, Brescia, Italy
| | - Maria Pia Bondioni
- Pediatric Radiology, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Vassilios Lougaris
- Pediatrics Clinic, Department of Clinical and Experimental Sciences, University of Brescia and Children's Hospital, ASST-Spedali Civili, Brescia, Italy.
| | - Arnaldo Caruso
- Department of Molecular and Translational Medicine, Section of Microbiology, University of Brescia, Medical School, Brescia, Italy
| | - Alessandro Plebani
- Pediatrics Clinic, Department of Clinical and Experimental Sciences, University of Brescia and Children's Hospital, ASST-Spedali Civili, Brescia, Italy
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Parri N, Lenge M, Cantoni B, Arrighini A, Romanengo M, Urbino A, Da Dalt L, Verdoni L, Giacchero R, Lanari M, Musolino AM, Biban P, La Fauci G, Pilotto C, Buonsenso D, Chiossi M, Agostiniani R, Plebani A, Zampogna S, Barbieri MA, De Masi S, Agostoni C, Masi S. COVID-19 in 17 Italian Pediatric Emergency Departments. Pediatrics 2020; 146:peds.2020-1235. [PMID: 32968031 DOI: 10.1542/peds.2020-1235] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Variability in presentation of children with coronavirus disease 2019 (COVID-19) is a challenge in emergency departments (EDs) in terms of early recognition, which has an effect on disease control and prevention. We describe a cohort of 170 children with COVID-19 and differences with the published cohorts. METHODS Retrospective chart reviews on children (0-18 years) evaluated in 17 Italian pediatric EDs. RESULTS In our cohort (median age of 45 months; interquartile range of 4 months-10.7 years), we found a high number of patients <1 year with COVID-19 disease. The exposure happened mainly (59%) outside family clusters; 22% had comorbidities. Children were more frequently asymptomatic (17%) or with mild diseases (63%). Common symptoms were cough (43%) and difficulty feeding (35%). Chest computed tomography, chest radiograph, and point-of-care lung ultrasound were used in 2%, 36%, and 8% of cases, respectively. Forty-three percent of patients were admitted because of their clinical conditions. The minimal use of computed tomography and chest radiograph may have led to a reduced identification of moderate cases, which may have been clinically classified as mild cases. CONCLUSIONS Italian children evaluated in the ED infrequently have notable disease symptoms. For pediatrics, COVID-19 may have rare but serious and life-threatening presentations but, in the majority of cases, represents an organizational burden for the ED. These data should not lower the attention to and preparedness for COVID-19 disease because children may represent a source of viral transmission. A clinically driven classification, instead of a radiologic, could be more valuable in predicting patient needs and better allocating resources.
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Affiliation(s)
| | - Matteo Lenge
- Clinical Trial Office.,Child Neurology Unit and Laboratories, Neuroscience Department, and.,Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Barbara Cantoni
- Healthcare Professional Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Arrighini
- Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | - Marta Romanengo
- Istituto di Ricovero e Cura a Carattere Scientifico Istituto Gaslini, Genova, Italy
| | - Antonio Urbino
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Liviana Da Dalt
- Department for Woman and Child Health, Pediatric Emergency Department, University of Padua, Padua, Italy
| | - Lucio Verdoni
- Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Marcello Lanari
- Pediatric Emergency Unit, Sant'Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy
| | - Anna Maria Musolino
- Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital and
| | - Paolo Biban
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
| | - Giovanna La Fauci
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
| | - Chiara Pilotto
- Division of Paediatrics, Department of Medicine, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Massimo Chiossi
- Department of Pediatrics, Azienda Sanitaria Locale 4 Liguria, Lavagna, Italy
| | | | - Anna Plebani
- Pediatric Emergency Unit, Filippo Del Ponte Hospital, Azienda Socio Sanitaria Territoriale Settelaghi, Varese, Italy
| | | | | | | | - Carlo Agostoni
- University of Milan, Milan, Italy; and.,Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefano Masi
- Department of Emergency Medicine and Trauma Center
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Parri N, Magistà AM, Marchetti F, Cantoni B, Arrighini A, Romanengo M, Felici E, Urbino A, Da Dalt L, Verdoni L, Armocida B, Covi B, Mariani I, Giacchero R, Musolino AM, Binotti M, Biban P, Fasoli S, Pilotto C, Nicoloso F, Raggi M, Miorin E, Buonsenso D, Chiossi M, Agostiniani R, Plebani A, Barbieri MA, Lanari M, Arrigo S, Zoia E, Lenge M, Masi S, Barbi E, Lazzerini M. Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks. Eur J Pediatr 2020; 179:1315-1323. [PMID: 32495147 PMCID: PMC7269687 DOI: 10.1007/s00431-020-03683-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 02/07/2023]
Abstract
Detailed data on clinical presentations and outcomes of children with COVID-19 in Europe are still lacking. In this descriptive study, we report on 130 children with confirmed COVID-19 diagnosed by 28 centers (mostly hospitals), in 10 regions in Italy, during the first months of the pandemic. Among these, 67 (51.5%) had a relative with COVID-19 while 34 (26.2%) had comorbidities, with the most frequent being respiratory, cardiac, or neuromuscular chronic diseases. Overall, 98 (75.4%) had an asymptomatic or mild disease, 11 (8.5%) had moderate disease, 11 (8.5%) had a severe disease, and 9 (6.9%) had a critical presentation with infants below 6 months having significantly increased risk of critical disease severity (OR 5.6, 95% CI 1.3 to 29.1). Seventy-five (57.7%) children were hospitalized, 15 (11.5%) needed some respiratory support, and nine (6.9%) were treated in an intensive care unit. All recovered.Conclusion:This descriptive case series of children with COVID-19, mostly encompassing of cases enrolled at hospital level, suggest that COVID-19 may have a non-negligible rate of severe presentations in selected pediatric populations with a relatively high rates of comorbidities. More studies are needed to further understand the presentation and outcomes of children with COVID-19 in children with special needs. What is Known: • There is limited evidence on the clinical presentation and outcomes of children with COVID-19 in Europe, and almost no evidence on characteristics and risk factors of severe cases. What is New: • Among a case series of 130 children, mostly diagnosed at hospital level, and with a relatively high rate (26.2%) of comorbidities, about three-quarter had an asymptomatic or mild disease. • However, 57.7% were hospitalized, 11.5% needed some respiratory support, and 6.9% were treated in an intensive care unit.
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Affiliation(s)
- Niccolò Parri
- Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy
| | | | | | - Barbara Cantoni
- Healthcare Professional Department Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Arrighini
- Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | | | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Urbino
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Liviana Da Dalt
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua, Italy
| | - Lucio Verdoni
- Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Benedetta Armocida
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Benedetta Covi
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | | | - Anna Maria Musolino
- Department of Pediatric Emergency Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Binotti
- Neonatal and Pediatric Intensive Care Unit, Maggiore della Carità University Hospital, Novara, Italy
| | - Paolo Biban
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
| | | | - Chiara Pilotto
- Division of Paediatrics, Department of Medicine DAME, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
| | | | | | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Anna Plebani
- Pediatric Emergency Unit, Filippo Del Ponte Hospital, ASST-Settelaghi, Varese, Italy
| | | | - Marcello Lanari
- Pediatric Emergency Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Serena Arrigo
- Department of Pediatrics, Hospital Filippo Del Ponte, Varese, Italy
| | - Elena Zoia
- Department of Pediatrics, Hospital V. Buzzi, Milan, Italy
| | - Matteo Lenge
- Clinical Trial Office, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Child Neurology Unit and Laboratories, Neuroscience Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
| | - Stefano Masi
- Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- Department of Medicine, Surgery and Health Science, Department of Pediatrics, University of Trieste, Trieste, Italy
| | - Marzia Lazzerini
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - on behalf of the CONFIDENCE and COVID-19 Italian Pediatric Study Networks
- Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy
- Department of Pediatrics, Community Pediatrics, Ravenna, Italy
- Department of Pediatrics, Ravenna Hospital, Ravenna, Italy
- Healthcare Professional Department Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
- IRCCS Istituto Gaslini, Genoa, Italy
- Pediatric and Pediatric Emergency Unit, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua, Italy
- Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- Department of Pediatrics, Lodi Hospital, Lodi, Italy
- Department of Pediatric Emergency Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Neonatal and Pediatric Intensive Care Unit, Maggiore della Carità University Hospital, Novara, Italy
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
- Paediatric Unit, Carlo Poma Hospital, Mantua, Italy
- Division of Paediatrics, Department of Medicine DAME, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
- Family Pediatrician, Udine, Italy
- ICU, Pain Therapy Unit, Rovereto Hospital, Trento, Italy
- Department of Pediatrics, Latisana-Palmanova, ASUFC, Udine, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Pediatrics, ASL 4 Liguria, Lavagna, Italy
- Department of Pediatrics, Ospedale San Jacopo, Pistoia, Italy
- Pediatric Emergency Unit, Filippo Del Ponte Hospital, ASST-Settelaghi, Varese, Italy
- Pediatric Emergency Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
- Department of Pediatrics, Hospital Filippo Del Ponte, Varese, Italy
- Department of Pediatrics, Hospital V. Buzzi, Milan, Italy
- Clinical Trial Office, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Child Neurology Unit and Laboratories, Neuroscience Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Department of Medicine, Surgery and Health Science, Department of Pediatrics, University of Trieste, Trieste, Italy
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4
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Marchetti F, Bonati M, Maestro A, Zanon D, Rovere F, Arrighini A, Barbi E, Bertolani P, Biban P, Da Dalt L, Guala A, Mazzoni E, Pazzaglia A, Perri PF, Reale A, Renna S, Urbino AF, Valletta E, Vitale A, Zangardi T, Clavenna A, Ronfani L. Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial. PLoS One 2016; 11:e0165441. [PMID: 27880811 PMCID: PMC5120790 DOI: 10.1371/journal.pone.0165441] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/07/2016] [Indexed: 01/28/2023] Open
Abstract
The use of antiemetics for vomiting in acute gastroenteritis in children is still a matter of debate. We conducted a double-blind randomized trial to evaluate whether a single oral dose of ondansetron vs domperidone or placebo improves outcomes in children with gastroenteritis. After failure of initial oral rehydration administration, children aged 1–6 years admitted for gastroenteritis to the pediatric emergency departments of 15 hospitals in Italy were randomized to receive one oral dose of ondansetron (0.15 mg/kg) or domperidone (0.5 mg/kg) or placebo. The primary outcome was the percentage of children receiving nasogastric or intravenous rehydration. A p value of 0.014 was used to indicate statistical significance (and 98.6% CI were calculated) as a result of having carried out two interim analyses. 1,313 children were eligible for the first attempt with oral rehydration solution, which was successful for 832 (63.4%); 356 underwent randomization (the parents of 125 children did not give consent): 118 to placebo, 119 to domperidone, and 119 to ondansetron. Fourteen (11.8%) needed intravenous rehydration in the ondansetron group vs 30 (25.2%) and 34 (28.8%) in the domperidone and placebo groups, respectively. Ondansetron reduced the risk of intravenous rehydration by over 50%, both vs placebo (RR 0.41, 98.6% CI 0.20–0.83) and domperidone (RR 0.47, 98.6% CI 0.23–0.97). No differences for adverse events were seen among groups. In a context of emergency care, 6 out of 10 children aged 1–6 years with vomiting due to gastroenteritis and without severe dehydration can be managed effectively with administration of oral rehydration solution alone. In children who fail oral rehydration, a single oral dose of ondansetron reduces the need for intravenous rehydration and the percentage of children who continue to vomit, thereby facilitating the success of oral rehydration. Domperidone was not effective for the symptomatic treatment of vomiting during acute gastroenteritis.
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Affiliation(s)
- Federico Marchetti
- Department of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo”, Trieste, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Alessandra Maestro
- Pharmacy and Clinical Pharmacology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo”, Trieste, Italy
| | - Davide Zanon
- Pharmacy and Clinical Pharmacology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo”, Trieste, Italy
| | - Francesca Rovere
- Pharmacy and Clinical Pharmacology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo”, Trieste, Italy
| | - Alberto Arrighini
- Pediatric Emergency Department, Presidio Ospedale dei Bambini, A.O. Spedali Civili, Brescia, Italy
| | - Egidio Barbi
- Pediatric Emergency Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo”, Trieste, Italy
| | - Paolo Bertolani
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Biban
- Pediatric Emergency Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Andrea Guala
- Department of Pediatrics, Ospedale Castelli, Verbania, Italy
| | - Elisa Mazzoni
- Department of Pediatrics, Ospedale Maggiore, Bologna, Italy
| | - Anna Pazzaglia
- Emergency Department, Pediatric Hospital A. Meyer, Firenze, Italy
| | | | - Antonino Reale
- Emergency Department, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - Salvatore Renna
- Emergency Room and Emergency Medicine Division, G. Gaslini Institute, Genova, Italy
| | | | - Enrico Valletta
- Department of Pediatrics, Ospedale G.B. Morgagni - L. Pierantoni, Forlì, Italy
| | - Antonio Vitale
- Department of Pediatrics and Pediatric Emergency, "San Giuseppe Moscati" National Hospital (AORN), Avellino, Italy
| | - Tiziana Zangardi
- Pediatric Emergency Department, Azienda Ospedaliera - University of Padova, Padova, Italy
| | - Antonio Clavenna
- Laboratory for Mother and Child Health, Department of Public Health, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo”, Trieste, Italy
- * E-mail:
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Zanon D, Gallelli L, Rovere F, Paparazzo R, Maximova N, Lazzerini M, Reale A, Corsetti T, Renna S, Emanueli T, Mannelli F, Manteghetti F, Da Dalt L, Palleria C, Banchieri N, Urbino A, Miglietta M, Cardoni G, Pompilio A, Arrighini A, Lazzari C, Messi G. Off-label prescribing patterns of antiemetics in children: a multicenter study in Italy. Eur J Pediatr 2013. [PMID: 23207736 DOI: 10.1007/s00431-012-1894-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED Acute gastroenteritis (AG) represents both the main cause of acute vomiting in children under 3 years old and a major cause of access to the emergency department. Even if several drugs may be able to reduce the emesis, the pharmacological treatment of vomiting in children remains a controversial issue, and several drugs are prescribed outside their authorized drug label with respect dosage, age, indication, or route of administration and are named as off-label. The aim of present study was to assess the off-label use of antiemetic drugs in patients less than 18 years with vomiting related to AG. This study was carried out in eight pediatric emergency departments in Italy. The following data were obtained crossing the pharmacy distribution records with emergency departments' patient data: sex and age of the patients and detailed information for each drug used (indication, dose, frequency, and route of administration). We recorded that antiemetic drugs were prescribed in every year, particularly in children up to 2 years old, and compared with both literature data and data sheet; 30 % of the administered antiemetics were used off-label. In particular, domperidone was the only antiemetic used labeled for AG treatment in pediatric patients, while metoclopramide and ondansetron have been off-label for both age and indications (i.e., AG treatment). CONCLUSIONS In conclusion, we documented an off-label use of antiemetics in children, and this could represents a problem of safety for the patient and a legal risk for the prescribing physician if patients have an unwanted or bad outcome from treatment.
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Affiliation(s)
- Davide Zanon
- Pharmacy, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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6
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Marchetti F, Maestro A, Rovere F, Zanon D, Arrighini A, Bertolani P, Biban P, Da Dalt L, Di Pietro P, Renna S, Guala A, Mannelli F, Pazzaglia A, Messi G, Perri F, Reale A, Urbino AF, Valletta E, Vitale A, Zangardi T, Tondelli MT, Clavenna A, Bonati M, Ronfani L. Oral ondansetron versus domperidone for symptomatic treatment of vomiting during acute gastroenteritis in children: multicentre randomized controlled trial. BMC Pediatr 2011; 11:15. [PMID: 21310051 PMCID: PMC3045958 DOI: 10.1186/1471-2431-11-15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 02/10/2011] [Indexed: 12/05/2022] Open
Abstract
Background Vomiting in children with acute gastroenteritis (AG) is not only a direct cause of fluid loss but it is also a major factor of failure of oral rehydration therapy (ORT). Physicians who provide care to paediatric patients in the emergency department (ED) usually prescribe intravenous fluid therapy (IVT) for mild or moderate dehydration when vomiting is the major symptom. Thus, effective symptomatic treatment of vomiting would lead to an important reduction in the use of IVT and, consequently, of the duration of hospital stay and of frequency of hospital admission. Available evidence on symptomatic treatment of vomiting shows the efficacy of the most recently registered molecule (ondansetron) but a proper evaluation of antiemetics drugs largely used in clinical practice, such as domperidone, is lacking. Objectives To compare the efficacy of ondansetron and domperidone for the symptomatic treatment of vomiting in children with AG who have failed ORT. Methods/Design Multicentre, double-blind randomized controlled trial conducted in paediatric EDs. Children aged from 1 to 6 years who vomiting, with a presumptive clinical diagnosis of AG, and without severe dehydration will be included. After the failure of a initial ORS administration in ED, eligible children will be randomized to receive: 1) ondansetron syrup (0,15 mg/Kg of body weight); 2) domperidone syrup (0,5 mg/Kg of body weight); 3) placebo. The main study outcome will be the percentage of patients needing nasogastric or IVT after symptomatic oral treatment failure, defined as vomiting or fluid refusal after a second attempt of ORT. Data relative to study outcomes will be collected at 30 minute intervals for a minimum of 6 hours. A telephone follow up call will be made 48 hours after discharge. A total number of 540 children (i.e. 180 patients in each arm) will be enrolled. Discussion The trial results would provide evidence on the efficacy of domperidone, which is largely used in clinical practice despite the lack of proper evaluation and a controversial safety profile, as compared to ondansetron, which is not yet authorized in Italy despite evidence supporting its efficacy in treating vomiting. The trial results would contribute to a reduction in the use of IVT and, consequently, in hospital admissions in children with AG. The design of this RCT, which closely reflect current clinical practice in EDs, will allow immediate transferability of results. Trial Registration ClinicalTrials.gov: NCT01257672
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Affiliation(s)
- Federico Marchetti
- Department of Pediatrics and Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
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7
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De Mattia D, Del Principe D, Del Vecchio GC, Jankovic M, Arrighini A, Giordano P, Menichelli A, Mori P, Zecca M, Pession A. Acute childhood idiopathic thrombocytopenic purpura: AIEOP consensus guidelines for diagnosis and treatment. Associazione Italiana di Ematologia e Oncologia Pediatrica. Haematologica 2000; 85:420-4. [PMID: 10756369] [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: 02/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVE A recent evaluation carried out by the Associazione Italiana di Ematologia e Oncologia Pediatrica (AIEOP) about practice management of acute childhood idiopathic thrombocytopenic purpura (ITP) revealed a remarkable difference of behaviors among the different AIEOP centers. A need for common practice guidelines for this frequent illness arose from this observation. Our aim was to make the diagnosis and treatment of childhood ITP uniform. In the future we will evaluate the influence of these guidelines on practice behaviors. DATA SOURCES AND METHODS Our main reference was the 1996 document produced by the American Society of Hematology (ASH). Their recommendations were updated with information from literature searched for in the MEDLINE database (June 1996-October 1998); search terms included: thrombocytopenia, ITP, diagnosis, therapy, children. The computerized search retrieved 83 articles. DATA EXTRACTION the scientific validity of the literature was evaluated by a panel of members using published guidelines. The strength of the evidence was assessed using level of evidence criteria. Only data from level I and level II studies were taken in account. Only one study out of the 83 retrieved articles met these selection criteria and it was considered in addition to the 11 out of 581 articles selected in the ASH ITP guidelines. This preliminary work pointed out each issue about ITP not addressed by clinical studies and all participants in a Consensus Conference expressed their opinion about these issues. RESULTS Diagnosis is essentially based on history, physical examination, a complete blood count and an examination of the peripheral blood smear. Treatment is recommended taking into account the clinical picture and number of platelets. The main difference between these guidelines and those from ASH are: AIEOP guidelines rely on the opinion of the members of the consensus conference, ASH ones on a panel of experts; therapeutic options include only products available in Italy; the indications to treatment rely more on clinical picture than on platelet number. INTERPRETATION AND CONCLUSIONS These are explicitly developed, evidence-based practice guidelines to assist Italian pediatricians in making decisions about diagnosis and appropriate health care for patients with acute childhood ITP.
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Affiliation(s)
- D De Mattia
- Dipartimento di Biomedicina dell'Età Evolutiva, Università di Bari. Azienda Ospedliera Policlinico, piazza G. Cesare 11, 70124 Bari, Italy.
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8
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Bergonzini R, Betti A, Arrighini A, Tincani A. [E pluribus unum]. Radiol Med 2000; 99:210-3. [PMID: 10879178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- R Bergonzini
- Servizio di Radiologia I, Spedali Civili, Brescia
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10
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Schumacher RF, Arrighini A, Alberti D, Badolato R, Fiorini M, Notarangelo L, Notarangelo LD, Ugazio AG. Ureteral obstruction in a patient with chronic granulomatous disease, receiving combined prophylaxis with IFN-gamma and antibiotics. Eur J Pediatr 1998; 157:352-3. [PMID: 9578979 DOI: 10.1007/s004310050828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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11
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Messina C, Valsecchi MG, Aricò M, Locatelli F, Rossetti F, Rondelli R, Cesaro S, Uderzo C, Conter V, Pession A, Sotti G, Loiacono G, Santoro N, Miniero R, Dini G, Favre C, Meloni G, Testi AM, Werner B, Silvestri D, Arrighini A, Varotto S, Pillon M, Basso G, Zanesco L. Autologous bone marrow transplantation for treatment of isolated central nervous system relapse of childhood acute lymphoblastic leukemia. AIEOP/FONOP-TMO group. Associzione Italiana Emato-Oncologia Pediatrica. Bone Marrow Transplant 1998; 21:9-14. [PMID: 9486488 DOI: 10.1038/sj.bmt.1701052] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to assess the role of ABMT in children with ALL who are in 2nd CR after an early isolated CNS relapse. All children experiencing an isolated CNS relapse at 10 AIEOP centers (Associazione Italiana Emato-Oncologia Pediatrica) from 1986 to 1992 were eligible for this study. The series included 69 patients who relapsed within 3 years from diagnosis: 19 underwent ABMT, nine patients underwent ALLO-BMT from an HLA-identical sibling, and 41 received conventional chemotherapy (CHEMO). Statistical analysis was performed using a Cox's regression model, adjusting for the waiting time before transplantation and prognostic factors. The 5 years DFS was 56.3% (s.e. 12.3) for patients in the ABMT group. This compared favorably with the poor result (12.6% (s.e. 5.9)) seen in the CHEMO group. The risk of failures was reduced by one-third in the ABMT group as compared to the CHEMO group in the multivariate analysis (P < 0.01). In the ALLO group four out of nine patients were in CCR 4-5 years post-transplant. This study suggests that ABMT may also represent a valuable therapeutic choice for patients lacking a matched familiar donor in 2nd CR after an early isolated CNS relapse.
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Affiliation(s)
- C Messina
- Centro Leucemie Infantili, Università di Padova, Italy
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12
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Messina C, Rondelli R, Valsecchi MG, Rossetti F, Miniero R, Meloni G, Locatelli F, Aricò M, Testi AM, Dini G, Arrighini A, Manfredini L, Dallorso S, Porta F, Uderzo C, Santoro N, Werner B, De Rossi G, Loiacono G, Andolina M, Lippi A, Favre C, Amici A, Lo Curto M, Masera G. Autologous bone marrow transplantation for extramedullary relapse in childhood leukemia. The AIEOP Group and the FONOP. Italian Association of Pediatric Hemato/Oncology. Bone Marrow Transplant 1996; 18 Suppl 2:40-2. [PMID: 8932797] [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: 02/03/2023]
Abstract
The role of autologous bone marrow transplantation (ABMT) in childhood ALL after an isolated extramedullary (IE) relapse is controversial. Between December 1984 and November 1995, 52 children underwent ABMT because of an IE relapse. The data were stored in the AIEOP-BMT Registry. Thirty four children were transplanted in 2nd CR; eighteen > 2nd CR. The median duration of 1st CR was 24 (range 3-69) and 18 (range 3-59) months, respectively. The median interval from last CR to ABMT was 6 (range 1-28) and 3 (range 1-81) months, respectively. The 5 year EFS for patients transplanted in 2nd CR was 67.7%, while the 3 year EFS for patients in > 2nd CR was 16.7%. In conclusion, ABMT was an effective treatment in early IE relapse only if performed in 2nd CR.
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Affiliation(s)
- C Messina
- Centro leucemie Infantili, Università di Padova
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13
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Garaventa A, Rondelli R, Lanino E, Dallorso S, Dini G, Bonetti F, Arrighini A, Santoro N, Rossetti F, Miniero R, Andolina M, Amici A, Indolfi P, Lo Curto M, Favre C, Paolucci P, Pession A, De Bernardi B. Myeloablative therapy and bone marrow rescue in advanced neuroblastoma. Report from the Italian Bone Marrow Transplant Registry. Italian Association of Pediatric Hematology-Oncology, BMT Group. Bone Marrow Transplant 1996; 18:125-30. [PMID: 8832005] [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: 02/02/2023]
Abstract
This study reports a large cooperative experience in myeloablative therapy and bone marrow rescue undertaken to define better the outcome of children with disseminated neuroblastoma after megatherapy. Between 1984 and 1993, 135 children underwent myeloablative therapy with bone marrow transplantation (BMT) in nine Italian Centres. One hundred and seventeen children received unpurged autologous BMT, five allogeneic BMT and 13 peripheral blood progenitor cells as rescue. Of these 135 children, 57 were in 1st CR, 11 in 2nd or subsequent CR, 42 in 1st PR, and 25 had more advanced disease. Twelve children (9%) died of toxicity, 86 relapsed or progressed at 1-68 months (median 7 months) and 80 of these subsequently died of progressive disease. Forty-three children are still alive with 37 in continuous remission at a median of 65 months (30-123 months) after BMT. Overall and disease-free survival at 8 years are 28.5% (s.e. 4.3) and 26% (s.e. 4), respectively. Disease-free survival is 34.6% (s.e. 6.7) for the patients grafted in 1st complete remission, 23.6% (s.e. 6.6) for patients grafted in 1st partial remission, 36.4% (s.e. 14.5) for patients grafted in 2nd or subsequent CR, and 8% (5.4) for patients with advanced disease. We conclude these data confirm that early toxicity of myeloablative therapy is manageable and that myeloablative therapy with bone marrow rescue may contribute to an improved long-term survival of children with disseminated neuroblastoma but the objective of cure of all patients remains distant.
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Affiliation(s)
- A Garaventa
- Department of Hematology-Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
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14
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Agnoletti G, Bonazza A, Pennacchio M, Porta F, Arrighini A. [Early and late anthracycline-induced cardiotoxicity in childhood: non-invasive evaluation of contractility in 116 patients]. G Ital Cardiol 1995; 25:1295-305. [PMID: 8682225] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In order to evaluate the incidence and the characteristics of anthracycline-induced cardiotoxicity we studied 116 children treated with anthracyclines with echocardiography, by using load dependent and independent indexes of contractility (respectively: 1-shortening fraction of the left ventricle (D%), velocity of circumpherential shortening (VCF), telesystolic wall stress (Ses) and 2-the regression curves between D% and Ses VCF and Ses). Eighty-six were off therapy, and 30 were evaluated during induction and reinduction. Off therapy patients had a D% lower than that of controls (37.5 +/- 5.7 vs 41.3 +/- 5.0, p<0.001), but it was clearly depressed only in 8% of them. VCF was also lower than in controls (1.7% +/- 0.5 vs 2.0 +/- 0.6, p<0.001), but in no patient it was clearly depressed. Ses was higher than in controls (63.8 +/- 20.6 vs 44.5 +/- 10.5, p<0.001) and elevated in 47% of them; it was positively related to the dose of anthracyclines administered (r = 0.25, p<0.05). The regression curves between D% and Ses and VCF and Ses showed a depressed contractility in off therapy patients. Dilated cardiomyopathy was present only in 1 of them (1.16%) and regional hypokinesia in 3 (3.5%). Children studied during the acute phase had normal D%, VCF, Ses and regional wall motion during the all period of study. These results indicate that 1) anthracycline-induced cardiotoxicity in childhood is mostly a late event, 2) a long term follow-up of these patients is necessary, 3) the use of Ses and of load independent indexes, more than that of D% and VCF, is mandatory to detect the cardiac damage.
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Affiliation(s)
- G Agnoletti
- Servizio di Policardiografia, Ospedale Umberto I, Brescia
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15
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Rosso P, Terracini B, Fears TR, Jankovic M, Fossati Bellani F, Arrighini A, Carli M, Cordero di Montezemolo L, Garrè ML, Guazzelli C. Second malignant tumors after elective end of therapy for a first cancer in childhood: a multicenter study in Italy. Int J Cancer 1994; 59:451-6. [PMID: 7960210 DOI: 10.1002/ijc.2910590402] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To evaluate the incidence of second malignant tumors in a cohort of subjects previously treated for childhood cancer, we analyzed data from the Off-Therapy Registry (OTR) of the Italian Association of Pediatric Hematology/Oncology, which collects information on children treated for Hodgkin's disease, non-Hodgkin's lymphoma, Wilms' tumor, acute lymphoblastic leukemia (ALL) and acute non-lymphatic leukemia and who had been removed from treatment in the absence of clinical signs of disease, i.e. the off-therapy stage. Second malignant tumors (SMT), diagnosed before December 31, 1988, were identified through a special enquiry to the 36 institutions cooperating in the registry. Observed cases were compared to expected numbers estimated from age- and sex-specific incidence rates derived from the Cancer Registry of the Province of Varese. In a total of 3,310 study subjects, 27 SMTs have been registered. The Cumulative Risk (CR) of SMT was 2.9% 15 years after the end of treatment and the Standard Incidence Ratio (SIR) was 10.8. The ALL sub-cohort had the highest risk of SMT (SIR 13.6) and 9 cases of CNS tumor occurred in this group (SIR 58.9). All 9 had received prophylactic cranial radiotherapy (CRT) and 5 had been treated on one protocol, characterized by low-dose intrathecal methotrexate (IT MTX) given monthly for 2 years after CRT. The Off-Therapy Registry has unique criteria for inclusion; direct comparisons with similar studies are therefore somewhat problematic. However, our data suggest that the risk of SMT in childhood ALL cancer survivors may be greater than previously reported, and that CNS tumors are the most common SMT in this group. The administration schedule of IT MTX may be an important risk factor.
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Affiliation(s)
- P Rosso
- Division of Pediatric Oncology, University of Turin, Italy
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16
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Miniero R, Massara FM, Saroglia EM, Soldano S, Barisone E, Leone L, Arrighini A, Andolina M, Brach del Prever A, Madon E. [Use of cyclosporin and verapamil in association with chemotherapy in the treatment of pediatric patients with advanced-stage neoplasms. A pilot study]. Minerva Pediatr 1994; 46:463-70. [PMID: 7808368] [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: 01/27/2023]
Abstract
Multidrug resistance represents one of the most important factors that may lead to a therapeutic failure in some patients affected by malignancies. One of the best known mechanisms is linked to the genic amplification or the overproduction of a membrane glycoprotein, GP170, that is the product of the gene MDR1. The existence of drugs (calcium blockers, cyclosporine, tamoxifen, reserpine, quinidine) able to bind themselves to gp170 and to paralyze its activity in vitro is well known. We studied 20 pediatric patients (median age 9 years) affected by acute lymphoblastic leukemia (ALL), osteosarcoma, neuroblastoma and medulloblastoma, in advanced stage of disease. We employed in all cases the association of cytostatics with verapamil (50-70 mg/m2 i.v.) and cyclosporine (5-8 mg/kg i.v.) with different infusion schedules. In leukemias we administered vincristine (1.5 mg/m2), and daunomycin (40 mg/m2), in solid tumors VP16 (150 mg/m2) and adriamycin (60 mg/m2). Seventy-two therapeutic courses were performed: 39 in ALL, 16 in osteosarcoma, 16 in neuroblastoma and 1 in medulloblastoma. On the whole 5 complete remissions were achieved in ALL patients and 1 in an osteosarcoma patient. We did not observe a significant myelosuppression during treatment, therefore few infectious complications occurred; furthermore electrocardiographic changes have been mild and promptly resolved after temporary discontinuation of verapamil infusion. Our data suggest a synergy of verapamil and cyclosporine in the inhibition of multidrug resistance induced by gp170, without the occurrence of heavy toxicity. The results obtained in ALL patients are encouraging., especially in view of a possible subsequent bone marrow transplantation, while in solid tumors they are not as satisfying.
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Affiliation(s)
- R Miniero
- Divisione di Pediatria Oncologica, Università degli Studi di Torino
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17
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Garaventa A, De Bernardi B, Pianca C, Donfrancesco A, Cordero di Montezemolo L, Di Tullio MT, Bagnulo S, Mancini A, Carli M, Pession A, Arrighini A, Di Cataldo A, Tamaro P, Iasonni V, Taccone A, Rogers D, Boni L. Localized but unresectable neuroblastoma: treatment and outcome of 145 cases. Italian Cooperative Group for Neuroblastoma. J Clin Oncol 1993; 11:1770-9. [PMID: 8355044 DOI: 10.1200/jco.1993.11.9.1770] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To define factors that influence outcome in children with localized but unresectable neuroblastoma by retrospective investigation of response to therapy and outcome in 21 Italian institutions. PATIENTS AND METHODS Of 145 assessable children diagnosed between 1979 and 1990, 77 were treated between 1979 and 1984 with three consecutive standard-dose (SD) protocols, and 68 between 1985 and 1990 with a high-dose (HD) protocol. All protocols included chemotherapy, followed by resection of primary tumor if feasible. If at least partial resection was achieved, consolidation therapy followed, except that from 1985 onward, patients considered disease-free following surgery received no further treatment. RESULTS Ninety-four of 145 patients (65%) achieved a complete response (CR) or partial response (PR) with chemotherapy and 75 (52%) subsequently underwent complete resection of the primary tumor. Eighty-one patients are alive (73 without disease, eight with disease), 63 have died, and one is lost to follow-up. The 5-year overall survival (OS) rate is 55% and progression-free survival (PFS) rate 50%. Both OS and PFS correlated with response to chemotherapy, removal of primary tumor, HD therapy, and serum lactate dehydrogenase (LDH) levels. Infants (< 1 year), independent of primary tumor site, and children aged 1 to 15 years with a nonabdominal primary tumor, did better compared with children aged 1 to 15 years with an abdominal primary tumor (PFS, 72% and 64% v 30%; P < .001 and < .01, respectively). Outcome of this last group improved with the HD protocol (PFS, 40% v 23%; P = .01). CONCLUSION In children with unresectable neuroblastoma, risk categories can be defined by age and primary tumor site. HD chemotherapy should be investigated for the poor-risk category age 1 to 15 years with an abdominal primary tumor.
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Affiliation(s)
- A Garaventa
- Department of Hematology-Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
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Jankovic M, Fraschini D, Amici A, Aricò M, Arrighini A, Basso G, Colella R, DiTullio MT, Haupt R, Macchia P. Outcome after cessation of therapy in childhood acute lymphoblastic leukaemia. The Associazione Italiana Ematologia ed Oncologia Pediatrica (AIEOP). Eur J Cancer 1993; 29A:1839-43. [PMID: 8260237 DOI: 10.1016/0959-8049(93)90533-l] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A total of 2192 children with acute lymphoblastic leukaemia who had reached cessation of therapy in complete remission were followed for a median time of 52 months after treatment suspension. Of the 485 relapses observed, 62.3% occurred in the first year off therapy and 68.9% involved the bone marrow. Eight relapses were reported more than 5 years (62-143 months) after treatment withdrawal. Males fared worse than females consistently, experiencing 1.5 times more relapses (P < 0.0001). Thirteen patients died in continuous complete remission, 5 because of non-neoplastic central nervous system complications. There were 11 second solid malignancies, 8 of them in the central nervous system; 9 subjects presented an haematopoietic malignancy after ALL. The projected event-free survival at 8 years is 73%. Twenty-two of the 171 young adults (age > 20 years) were married and 16 have had 21 healthy children. Twenty-four per cent of patients experienced an unfavourable event. Relapses accounted for 93% of failures. Central nervous system late effects and second malignancies were the major causes of non-leukaemic morbidity and mortality.
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Affiliation(s)
- M Jankovic
- Department of Pediatrics, Ospedale Nuovo San Gerardo, Monza, MI, Italy
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Porta F, Candotti F, Arrighini A, Lanfranchi A, Ugazio AG. [Cellular and molecular therapy in severe combined immunodeficiencies]. Pediatr Med Chir 1991; 13:135-8. [PMID: 1896378] [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: 12/29/2022] Open
Abstract
Severe combined immunodeficiencies are usually fatal diseases unless affected children are admitted to protective isolation unit or unless the underlying immunological defect is treated by transplanting bone marrow from an healthy donor. The patients present, with early onset, life-threatening infections from fungal, viral or bacterial agents. Since only a minority of patients has an HLA-identical donor, recently other strategies have been devised including bone marrow transplantation from donors other than HLA-identical within the family or from HLA-non identical family members or from HLA-matched unrelated donors included in the International Bone Marrow Volunteers' Registry. In these cases, in order to realize this approach the "purging" of T-cells of the HLA-non identical donor bone marrow is necessary. Overall survival after HLA-identical BMT is 76%, when all BMT of the European multicenter analysis are considered, while in BMT from non-identical donors is 56%. Recently particular cases of SCID caused by enzyme deficiency, such as adenosine-deaminase (ADA), have been treated by molecular therapy with administration of polyethylene glycol (PEG) conjugated ADA: PEG protects from degradation and inhibits clearance of the enzyme. This approach, already realized in 15 children, allows reconstitution of cellular and humoral immunity, as demonstrated by one case treated by our group.
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Affiliation(s)
- F Porta
- Clinica Pediatrica, Università degli Studi di Brescia, Italia
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Garaventa A, Guerra P, Arrighini A, Bertolazzi L, Bestagno M, De Bernardi B, Lanino E, Villavecchia GP, Claudiani F. Treatment of advanced neuroblastoma with I-131 meta-iodobenzylguanidine. Cancer 1991; 67:922-8. [PMID: 1991264 DOI: 10.1002/1097-0142(19910215)67:4<922::aid-cncr2820670411>3.0.co;2-d] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
From February 1986 to December 1988, 31 children with advanced pretreated neuroblastoma were treated with 131-I meta-Iodobenzylguanidine (131-MIBG). Thirteen children had been resistant to first-line therapy, three had suffered a local relapse, and fourteen had suffered a disseminated relapse without over bone marrow infiltration. One child was treated initially because of resistance to first-line therapy, and subsequently for a local relapse. A total of 72 courses of 131-MIBG was administered, with doses ranging from 2.8 to 6.0 GBq (median, 3.7 GBq). One child received five courses, two four courses, 13 three courses, four two courses, and 12 one course of 131-MIBG. The most common toxic effect was thrombocytopenia, with a platelet level of less than 50,000/cmm occurring after 19 of 60 evaluable courses. A leukocyte count less than 1000/cmm was seen only once. There were six major responses (two complete) lasting 4 to 9 months, and two minor responses lasting longer than 38 and 44 months. Responses were seen more commonly in children whose only lesion was a residual primary tumor and in children who had not been pretreated who experienced disseminated relapse. Further studies of the role of 131-I meta-Iodobenzylguanidine in treatment of neuroblastoma are needed.
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Affiliation(s)
- A Garaventa
- Department of Pediatric Hematology-Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
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Foschini M, De Toni A, Padula D, Pizzocolo G, Arrighini A, Zunin C. Prevention of perinatally transmitted hepatitis B virus infection by hepatitis B immunoglobulin immunoprophylaxis: an account of 201 newborn babies of hepatitis Bs antigen carrier mothers. J Pediatr Gastroenterol Nutr 1985; 4:523-7. [PMID: 4032162 DOI: 10.1097/00005176-198508000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Of 5,327 pregnant women who were screened between July 1981 and July 1983, 5.2% were found to be hepatitis Bs antigen (HBsAg) carriers. This high percentage of carriers accentuates the importance of vertical transmission of hepatitis B virus in our area. In view of this we sought to verify the effectiveness of hyperimmune immunoglobulins in the prevention of infection. We studied 201 babies born to HBsAg-positive mothers. These babies had regular checkups until 12 months of age. One hundred forty-nine received prophylactic hyperimmune globulin (two to seven doses according to risk ranking), while 52 did not. A higher percentage of infection was found in the babies who had no prophylaxis (25%) than in the babies who had prophylaxis (7.4%). Furthermore, hepatitis appeared earlier (from the 2nd to the 6th month) in the babies who had no prophylaxis than in the babies who had prophylaxis (from the 9th to the 12th month). No infection was observed during prophylaxis or up to 6 months.
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