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Caroleo AM, Rotulo S, Agolini E, Macchiaiolo M, Boccuto L, Antonelli M, Colafati GS, Cacchione A, Megaro G, Carai A, De Ioris MA, Lodi M, Tornesello A, Simone V, Torroni F, Cinalli G, Mastronuzzi A. SHH medulloblastoma and very early onset of bowel polyps in a child with PTEN hamartoma tumor syndrome. Front Mol Neurosci 2023; 16:1228389. [PMID: 37692099 PMCID: PMC10483120 DOI: 10.3389/fnmol.2023.1228389] [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: 05/24/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome (PHTS) is a cancer predisposition syndrome characterized by an increased risk of developing benign and malignant tumors, caused by germline pathogenic variants of the PTEN tumour suppressor gene. PTEN gene variants often present in childhood with macrocephaly, developmental delay, and/or autism spectrum disorder while tumors and intestinal polyps are commonly detected in adults. PHTS is rarely associated with childhood brain tumors with only two reported cases of medulloblastoma (MB). We report the exceptional case of an infant carrying a germline and somatic pathogenic variant of PTEN and a germline and somatic pathogenic variant of CHEK2 who developed a MB SHH in addition to intestinal polyposis.
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Affiliation(s)
- Anna Maria Caroleo
- Department of Onco-Hematology, Cell Therapy, Gene Therapy and Hemopoietic Transplant, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Silvia Rotulo
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marina Macchiaiolo
- Rare Diseases and Medical Genetics Unit, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Luigi Boccuto
- School of Nursing, College of Behavioral, Social and Health Sciences Healthcare Genetics Interdisciplinary Doctoral Program, Clemson University, Clemson, SC, United States
| | - Manila Antonelli
- Faculty of Medicine and Dentistry, Department of Radiological, Oncological, and Pathological Anatomy Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Antonella Cacchione
- Department of Onco-Hematology, Cell Therapy, Gene Therapy and Hemopoietic Transplant, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Giacomina Megaro
- Department of Onco-Hematology, Cell Therapy, Gene Therapy and Hemopoietic Transplant, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Maria Antonietta De Ioris
- Department of Onco-Hematology, Cell Therapy, Gene Therapy and Hemopoietic Transplant, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Mariachiara Lodi
- Department of Onco-Hematology, Cell Therapy, Gene Therapy and Hemopoietic Transplant, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | | | - Valeria Simone
- Pediatric Oncology Unit, Ospedale Vito Fazzi, Lecce, Italy
| | - Filippo Torroni
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Giuseppe Cinalli
- Pediatric Neurosurgery Unit, Department of Neuroscience, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Angela Mastronuzzi
- Department of Onco-Hematology, Cell Therapy, Gene Therapy and Hemopoietic Transplant, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
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2
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Giordano P, Lassandro G, Barone A, Cesaro S, Fotzi I, Giona F, Gorio C, Maggio A, Miano M, Marzollo A, Nardi M, Pession A, Ruggiero A, Russo G, Saracco P, Spinelli M, Tolva A, Tornesello A, Palladino V, Del Vecchio GC. Long term use of eltrombopag in children with chronic immune thrombocytopenia: extended real life retrospective multicenter experience of the Italian Association of Pediatric Hematology and Oncology. Front Med (Lausanne) 2023; 10:1214308. [PMID: 37521342 PMCID: PMC10375288 DOI: 10.3389/fmed.2023.1214308] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/02/2023] [Indexed: 08/01/2023] Open
Abstract
Background The present multicenter retrospective study on eltrombopag administration in Italian children with chronic ITP aims to extend follow-up of our previous study. Materials and methods This retrospective multicenter study was conducted in 17 centers affiliated to the Italian Association of Pediatric Hematology and Oncology (AIEOP). Patients were classified into three subgroups: group 1 included patients who discontinued treatment due to a stable platelet count; group 2 included patients who discontinued treatment due to ineffectiveness; group 3 included patients who did not permanently discontinue treatment. Results 56 patients were eligible for analysis. The median duration of eltrombopag treatment was 40 months (7-71 months). Twenty patients (36%) discontinued permanently eltrombopag. The reasons of permanent discontinuation were adverse effects (n = 1), inefficacy (n = 10), stable platelet count (n = 9). All patients of group 1 maintained a durable response without additional treatments after eltrombopag discontinuation. We found that patients of group 2 were on treatment for less time (median treatment time: 13.5 months, min: 6.0 - max: 56.0) than patients of group 1 (median treatment time: 34 months, min: 16.0 - max: 62.0) (p < 0.05). Patients of group 2 mostly did not achieve a stable platelet count in the first 6 months of treatment and underwent concomitant therapies during follow-up respect of group 1 and group 3 (p < 0.01). Conclusion Our study found that the benefits of eltrombopag treatment, in terms of platelet count improvement and use of additional therapies, are identifiable from the first 6 months of treatment.
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Affiliation(s)
- Paola Giordano
- Interdisciplinary Department of Medicine, Pediatric Unit “B. Trambusti”, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Lassandro
- Interdisciplinary Department of Medicine, Pediatric Unit “B. Trambusti”, University of Bari Aldo Moro, Bari, Italy
| | - Angelica Barone
- Department of Pediatric Onco-Hematology, University Hospital of Parma, Parma, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Ilaria Fotzi
- Department Pediatric Hematology Oncology, Azienda Ospedaliero Universitaria A. Meyer Children Hospital, Florence, Italy
| | - Fiorina Giona
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Chiara Gorio
- Hemato-Oncology Unit, Children Hospital, Spedali Civili, Brescia, Italy
| | - Angela Maggio
- Department of Hematology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maurizio Miano
- Clinical and Experimental Hematology Unit, “G. Gaslini” Children's Hospital, Genoa, Italy
| | - Antonio Marzollo
- Pediatric Hematology-Oncology Unit, Department of Women's and Children's Health, Azienda Ospedaliera-University of Padova, Padua, Italy
| | - Margherita Nardi
- Pediatric Hematology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Andrea Pession
- Department of Pediatrics, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanna Russo
- Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Paola Saracco
- Pediatric Hematology, Department of Pediatrics, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Marco Spinelli
- Clinica Pediatrica, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alessandra Tolva
- Pediatric Hematology/Oncology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Assunta Tornesello
- Pediatric Hematology Oncology, Presidio Ospedaliero Vito Fazzi, Lecce, Italy
| | - Valentina Palladino
- Interdisciplinary Department of Medicine, Pediatric Unit “B. Trambusti”, University of Bari Aldo Moro, Bari, Italy
| | - Giovanni Carlo Del Vecchio
- Interdisciplinary Department of Medicine, Pediatric Unit “B. Trambusti”, University of Bari Aldo Moro, Bari, Italy
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Quarello P, Ferrari A, Mascarin M, Milano GM, Tornesello A, Bertolotti M, Spinelli M, Pierobon M, Perillo T, Maule M, Zecca M, Pession A, Fagioli F. Diagnostic Delay in Adolescents with Cancer During COVID-19 Pandemic: A New Price for Our Patients to Pay. J Adolesc Young Adult Oncol 2021; 11:316-319. [PMID: 34677087 DOI: 10.1089/jayao.2021.0057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Worldwide, the coronavirus 19 disease pandemic caused a worse chance of a timely diagnosis for cancer patients. We conducted a retrospective analysis of new diagnoses registered in the national pediatric oncology database, comparing the first lockdown period (March-May 2020) with the same period of 2015-2019. The total number of cases (0-19 years) dropped by 20.8% (from 441 between 2015 and 2019 to 349 in 2020). A major reduction was observed for adolescents (15-19 years) (-32.9%) and for adolescents with solid tumors (-56.4%, p = 0.03). Our data suggest that the enforced lockdown reduced the possibility for these already vulnerable patients to access the referral centers.
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Affiliation(s)
- Paola Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Department, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Regina Margherita Children's Hospital, Torino, Italy.,University of Torino, Torino, Italy
| | - Andrea Ferrari
- Pediatric Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Department, Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Giuseppe M Milano
- Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy, Scientific Institute for Research and Healthcare (IRCCS), Bambino Gesù Childrens' Hospital, Rome, Italy
| | | | - Marina Bertolotti
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Department, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Regina Margherita Children's Hospital, Torino, Italy
| | - Marco Spinelli
- Department of Pediatrics, University of Milano-Bicocca, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy
| | - Marta Pierobon
- Hematology and Oncology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Teresa Perillo
- Pediatric Hematology-Oncology Division, Department of Pediatrics, University of Bari, Bari, Italy
| | - Milena Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marco Zecca
- Pediatric/Hematology/Oncology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Pession
- Pediatric Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Franca Fagioli
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Department, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Regina Margherita Children's Hospital, Torino, Italy.,University of Torino, Torino, Italy
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Guarina A, Marinoni M, Lassandro G, Saracco P, Perrotta S, Facchini E, Notarangelo LD, Russo G, Giordano P, Romano F, Bertoni E, Gorio C, Boscarol G, Motta M, Spinelli M, Barone A, Zecca M, Compagno F, Ladogana S, Maggio A, Miano M, Dell'Orso G, Chiocca E, Fotzi I, Petrone A, Tornesello A, D'Alba I, Salvatore S, Casale M, Puccio G, Ramenghi U, Farruggia P. Association of Immune Thrombocytopenia and Celiac Disease in Children: A Retrospective Case Control Study. Turk J Haematol 2021; 38:175-180. [PMID: 34002598 PMCID: PMC8386315 DOI: 10.4274/tjh.galenos.2021.2021.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: The association between celiac disease (CD) and immune thrombocytopenia (ITP) is still uncertain. The aim of this study was to characterize the coexistence of these two diseases in Italian children. Materials and Methods: This is a retrospective multicenter study investigating the occurrence of CD in 28 children with ITP diagnosed from January 1, 2000, to December 31, 2019. Results: The first diagnosis was ITP in 57.1% and CD in 32.1% of patients. In 3 patients (10.7%), the two diagnoses were simultaneous. All the potential and silent cases of CD in our cohort were diagnosed in the groups of “ITP first” and “simultaneous diagnosis”. In all children ITP was mild, and in 2 out of 8 not recovered from ITP at the time of CD diagnosis a normalization of platelet counts (>100,000/μL) occurred 3 and 5 months after starting a gluten-free diet, respectively. Conclusion: We think that screening for CD should be considered in children with ITP regardless of the presence of gastrointestinal symptoms. Furthermore, some patients may recover from ITP after starting a gluten-free diet.
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Affiliation(s)
- Angela Guarina
- U.O.C. Oncoematologia Pediatrica, ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Maddalena Marinoni
- Pediatria-DH Oncoematologico Pediatrico, SSD Oncoematologia Pediatrica-Ospedale Filippo Del Ponte, Varese ASST Settelaghi, Varese, Italy
| | - Giuseppe Lassandro
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Paola Saracco
- SC Pediatria Specialistica Universitaria, AOU Città della Salute e della Scienza, Presidio Ospedale Infantile Regina Margherita, Torin, Italy
| | - Silverio Perrotta
- U.O. S.D. Ematologia e Oncologia Pediatrica Dai Materno Infantile - Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Elena Facchini
- Clinica Pediatrica Oncologia Ed Ematologia Pediatrica “Lalla Seràgnoli - Policlinico Sant’Orsola Malpighi,” Bologna, Italy
| | - Lucia Dora Notarangelo
- U.O. Oncoematologia Pediatrica, Presidio Ospedale dei Bambini, Spedali Civili, Brescia, Italy
| | - Giovanna Russo
- UOC Ematologia ed Oncologia Pediatrica con TMO - AOU Policlinico “Rodolico-San Marco,” Università di Catania, Catania, Italy
| | - Paola Giordano
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Francesca Romano
- SC Pediatria Specialistica Universitaria, AOU Città della Salute e della Scienza, Presidio Ospedale Infantile Regina Margherita, Torin, Italy
| | - Elisa Bertoni
- U.O. Oncoematologia Pediatrica, Presidio Ospedale dei Bambini, Spedali Civili, Brescia, Italy
| | - Chiara Gorio
- U.O. Oncoematologia Pediatrica, Presidio Ospedale dei Bambini, Spedali Civili, Brescia, Italy
| | | | - Milena Motta
- UOC Ematologia ed Oncologia Pediatrica con TMO - AOU Policlinico “Rodolico-San Marco,” Università di Catania, Catania, Italy
| | - Marco Spinelli
- Fondazione MBBM/AO San Gerardo Clinica Pediatrica Universitaria, Monza, Italy
| | | | - Marco Zecca
- SC Oncoematologia Pediatrica - Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Francesca Compagno
- SC Oncoematologia Pediatrica - Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Saverio Ladogana
- UOC Oncoematologia Pediatrica - IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Angela Maggio
- UOC Oncoematologia Pediatrica - IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maurizio Miano
- Dipartimento di Scienze Pediatriche Generali e Specialistiche, U.O.C. Oncologia IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gianluca Dell'Orso
- Dipartimento di Scienze Pediatriche Generali e Specialistiche, U.O.C. Oncologia IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elena Chiocca
- Oncologia, Ematologia e TCSE - Centro di Eccellenza di Oncologia ed Ematologia - AOU A. Mayer, Firenze, Italy
| | - Ilaria Fotzi
- Oncologia, Ematologia e TCSE - Centro di Eccellenza di Oncologia ed Ematologia - AOU A. Mayer, Firenze, Italy
| | | | | | - Irene D'Alba
- S.O.S.D., Oncomematologia Pediatrica, A.O.U. Azienda Ospedali Riuniti, Ospedale Pediatrico Salesi, Ancona, Italy
| | - Silvia Salvatore
- Dipartimento di Pediatria, Università degli Studi dell’Insubria, Varese, Italy
| | - Maddalena Casale
- U.O. S.D. Ematologia e Oncologia Pediatrica Dai Materno Infantile - Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Puccio
- U.O.C. Oncoematologia Pediatrica, ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Ugo Ramenghi
- SC Pediatria Specialistica Universitaria, AOU Città della Salute e della Scienza, Presidio Ospedale Infantile Regina Margherita, Torin, Italy
| | - Piero Farruggia
- U.O.C. Oncoematologia Pediatrica, ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
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5
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Civino A, Alighieri G, Prete E, Caroleo AM, Magni-Manzoni S, Vinti L, Romano M, Santoro N, Filocamo G, Belotti T, Santarelli F, Gorio C, Ricci F, Colombini A, Pastore S, Cesaro S, Barone P, Verzegnassi F, Olivieri AN, Ficara M, Miniaci A, Russo G, Gallizzi R, Pericoli R, Breda L, Mura R, Podda RA, Onofrillo D, Lattanzi B, Tirtei E, Maggio MC, De Santis R, Consolini R, Arlotta A, La Torre F, Mainardi C, Pelagatti MA, Coassin E, Capolsini I, Burnelli R, Tornesello A, Soscia F, De Fanti A, Rigante D, Pizzato C, De Fusco C, Abate ME, Roncadori A, Rossi E, Stabile G, Biondi A, Lepore L, Conter V, Rondelli R, Pession A, Ravelli A. Musculoskeletal manifestations of childhood cancer and differential diagnosis with juvenile idiopathic arthritis (ONCOREUM): a multicentre, cross-sectional study. Lancet Rheumatol 2021; 3:e507-e516. [PMID: 38279403 DOI: 10.1016/s2665-9913(21)00086-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 10/08/2023]
Abstract
BACKGROUND Presenting symptoms of childhood cancers might mimic those of rheumatic diseases. However, the evidence available to guide differential diagnosis remains scarce. Preventing wrong or delayed diagnosis is therefore important to avoid incorrect administration of glucocorticoid or immunosuppressive therapy and worsening of prognosis. As such, we aimed to assess the prevalence and characteristics of presenting musculoskeletal manifestations in patients at cancer onset and to identify the factors that differentiate childhood malignancies with arthropathy from juvenile idiopathic arthritis. METHODS We did a multicentre, cross-sectional study at 25 paediatric haemato-oncology centres and 22 paediatric rheumatology centres in Italy. We prospectively recruited patients who were younger than 16 years that were newly diagnosed with cancer or juvenile idiopathic arthritis. We excluded patients with glucocorticoid pre-treatment (>1 mg/kg per day of oral prednisone or equivalent for ≥2 consecutive weeks). We collected data for patients with a new diagnosis of cancer or juvenile idiopathic arthritis using an electronic case report form on a web-based platform powered by the Cineca Interuniversity Consortium. The primary outcome was to describe the frequency and characteristics of musculoskeletal manifestations at cancer onset; and the secondary outcome was to identify factors that could discriminate malignancies presenting with arthropathy, with or without other musculoskeletal symptoms, from juvenile idiopathic arthritis using multivariable logistic regression analysis. FINDINGS Between May 1, 2015, and May 31, 2018, 1957 patients were eligible, of which 1277 (65%) had cancer and 680 (35%) had juvenile idiopathic arthritis. Musculoskeletal symptoms occurred in 324 (25% [95% CI 23·0-27·8]) of 1277 patients with cancer, of whom 207 had arthropathy. Patients with malignant bone tumours had the highest frequency of musculoskeletal symptoms (53 [80%] of 66), followed by patients with Langerhans histiocytosis (16 [47%] of 34), leukaemia (189 [32%] of 582), soft-tissue sarcomas (16 [24%] of 68), and neuroblastoma (21 [19%] of 109). In the 324 patients with cancer and musculoskeletal symptoms, the most common complaints were joint pain (199 [61%]), followed by limb bone pain (112 [35%]). Joint involvement had a prevalent monoarticular pattern (100 [48%] of 207) and oligoarticular pattern (86 [42%] had 2-4 joints involved and 20 [10%] had >4 joints involved), with the most frequently involved joints being the hip (88 [43%] of 207) and knee (81 [39%]). On multivariable analysis, limb bone pain was the independent variable most strongly associated with cancer (odds ratio [OR] 87·80 [95% CI 18·89-408·12]), followed by weight loss (59·88 [6·34-565·53]), thrombocytopenia (12·67 [2·40-66·92]), monoarticular involvement (11·30 [4·09-31·19]), hip involvement (3·30 [1·13-9·61]), and male sex (2·40 [1·03-5·58]). Factors independently associated with juvenile idiopathic arthritis were morning stiffness (OR 0·04 [95% CI 0·01-0·20]), joint swelling (0·03 [0·01-0·09]), and involvement of the small hand joints (0·02 [0-1·05]). INTERPRETATION Our study provides detailed information about presenting musculoskeletal manifestations of childhood cancers and highlights the clinical and laboratory features that are most helpful in the differential diagnosis with juvenile idiopathic arthritis. FUNDING Associazione Lorenzo Risolo.
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Affiliation(s)
- Adele Civino
- Unità di Reumatologia e Immunologia Pediatrica, Ospedale Vito Fazzi, Lecce, Italy.
| | - Giovanni Alighieri
- Unità di Pediatra-UTIN, Azienda Ospedaliera Cardinale G Panico, Tricase, Italy
| | - Eleonora Prete
- Dipartimento di Ematologia, Azienda Ospedaliera Cardinale G Panico, Tricase, Italy
| | - Anna Maria Caroleo
- Dipartimento di Oncoematologia Pediatrica, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Luciana Vinti
- Dipartimento di Oncoematologia Pediatrica, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Micol Romano
- Divisione di Reumatologia, ASST G Pini-CTO, Milano, Italy
| | - Nicola Santoro
- Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Giovanni Filocamo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tamara Belotti
- Clinica Pediatrica, Oncologia ed Ematologia Pediatrica Lalla Seràgnoli, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Francesca Santarelli
- Dipartimento di Pediatria, Ospedale Pediatrico Regina Margherita, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Gorio
- Unità di Oncoematologia Pediatrica e TMO, Spedali Civili, Brescia, Italy
| | | | - Antonella Colombini
- Unità di Oncoematologia Pediatrica, Fondazione MBBM/AO San Gerardo Clinica Pediatrica Universitaria, Monza, Italy
| | - Serena Pastore
- Dipartimento di Pediatria, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy
| | - Simone Cesaro
- Oncoematologia Pediatrica, Dipartimento di Assistenza Integrata Materno Infantile, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy
| | - Patrizia Barone
- Dipartimento di Pediatria, Azienda Ospedaliero Universitaria, Policlinico di Catania, Catania, Italy
| | - Federico Verzegnassi
- Unità di Oncoematologia Pediatrica, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Alma Nunzia Olivieri
- Dipartimento della donna, del bambino e di chirurgia generale e specialistica, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Monica Ficara
- Divisione di Oncoematologia Pediatrica, Ospedale Policlinico, Modena, Italy
| | - Angela Miniaci
- Clinica Pediatrica, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Giovanna Russo
- Unità di Oncoematologia Pediatrica, Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Italy
| | - Romina Gallizzi
- Unità di Pediatria, Azienda Ospedaliera Universitaria Gaetano Martino, Messina, Italy
| | | | - Luciana Breda
- Reumatologia Pediatrica, Università di Chieti, Italy
| | - Rossella Mura
- Oncoematologia Pediatrica, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | | | - Daniela Onofrillo
- Unità di Oncoematologia Pediatrica, Dipartimento di Ematologia, Ospedale di Pescara, Italy
| | - Bianca Lattanzi
- Azienda Ospedaliera Universitaria, Ospedale Pediatrico G Salesi, Ancona, Italy
| | - Elisa Tirtei
- SC Oncologia Pediatrica, Ospedale Infantile Regina Margherita, AOU Città della Salute e della scienza, Università di Torino, Italy
| | | | - Raffaela De Santis
- Dipartimento di Pediatria, Unità di Oncoematologia Pediatrica, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Rita Consolini
- Dipartimento di Pediatria, Università di Pisa, Pisa, Italy
| | - Annalisa Arlotta
- Unità di Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria di Parma, Italy
| | - Francesco La Torre
- Reumatologia Pediatrica, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari-Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Chiara Mainardi
- DIDAS Salute della Donna e del Bambino, Divisione di Oncoematologia Pediatrica e Trapianto di cellule ematopoietiche, Azienda Ospedaliera Universitaria di Padova, Padova, Italy
| | | | - Elisa Coassin
- SOSD Oncologia del Giovane e Radioterapia Pediatrica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Ilaria Capolsini
- A O U S M Della Misericordia, Oncoematologia Pediatrica con TCSE, Perugia, Italy
| | - Roberta Burnelli
- Unità di Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria Sant'Anna di Ferrara, Cona, Italy
| | | | - Francesca Soscia
- Unità di Pediatria, Ospedale Santa Maria della Stella, Orvieto, Italy
| | | | - Donato Rigante
- Dipartimento di Scienze della Vita e Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy; Università Cattolica Sacro Cuore, Roma, Italy
| | | | - Carmela De Fusco
- Dipartimento di Oncologia Pediatrica, AORN Santobono-Pausilipon, Napoli, Italy
| | | | - Andrea Roncadori
- Healthcare Administration, IRCCS-Istituto Romagnolo per lo Studio dei Tumori Dino Amadori-IRST, Meldola, FC, Italy
| | - Elisa Rossi
- Consorzio Interuniversitario Cineca, Casalecchio di Reno, Italy
| | - Giulia Stabile
- Consorzio Interuniversitario Cineca, Casalecchio di Reno, Italy
| | - Andrea Biondi
- Unità di Oncoematologia Pediatrica, Fondazione MBBM/AO San Gerardo Clinica Pediatrica Universitaria, Monza, Italy
| | - Loredana Lepore
- Dipartimento di Pediatria, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy
| | - Valentino Conter
- Unità di Oncoematologia Pediatrica, Fondazione MBBM/AO San Gerardo Clinica Pediatrica Universitaria, Monza, Italy
| | - Roberto Rondelli
- Clinica Pediatrica, Oncologia ed Ematologia Pediatrica Lalla Seràgnoli, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Andrea Pession
- Clinica Pediatrica, Oncologia ed Ematologia Pediatrica Lalla Seràgnoli, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Angelo Ravelli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genova, Italy; Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Pediatric Rheumatology, Sechenov First Moscow State Medical University, Moscow, Russian
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Simone V, Rizzo D, Cocciolo A, Caroleo AM, Carai A, Mastronuzzi A, Tornesello A. Infantile Brain Tumors: A Review of Literature and Future Perspectives. Diagnostics (Basel) 2021; 11:diagnostics11040670. [PMID: 33917833 PMCID: PMC8068230 DOI: 10.3390/diagnostics11040670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 01/08/2023] Open
Abstract
Brain tumors in infants including those diagnosed in fetal age, newborns and under a year old represent less than 10% of pediatric nervous system tumors and present differently when compared with older children in terms of clinical traits, location and histology. The most frequent clinical finding is a macrocephaly but non-specific symptoms can also be associated. The prognosis is usually poor and depends on several factors. Surgery continues to be the main option in terms of therapeutic strategies whereas the role of chemotherapy is not yet well defined and radiotherapy is exceptionally undertaken. In view of this situation, a molecular characterization could assist in providing therapeutic options for these tumors. This review highlights the recent advances in the diagnosis and treatment of brain tumors in infants with a particular focus on the molecular landscape and future clinical applications.
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Affiliation(s)
- Valeria Simone
- Pediatric Oncology Unit, Ospedale Vito Fazzi, Piazza Filippo Muratore, 1, 73100 Lecce, Italy; (D.R.); (A.C.)
- Correspondence: (V.S.); (A.T.)
| | - Daniela Rizzo
- Pediatric Oncology Unit, Ospedale Vito Fazzi, Piazza Filippo Muratore, 1, 73100 Lecce, Italy; (D.R.); (A.C.)
| | - Alessandro Cocciolo
- Pediatric Oncology Unit, Ospedale Vito Fazzi, Piazza Filippo Muratore, 1, 73100 Lecce, Italy; (D.R.); (A.C.)
| | - Anna Maria Caroleo
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), Piazza Sant’Onofrio 4, 00146 Rome, Italy; (A.M.C.); (A.M.)
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, Bambino Gesù Children’s Hospital (IRCCS), Piazza Sant’Onofrio 4, 00146 Rome, Italy;
| | - Angela Mastronuzzi
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), Piazza Sant’Onofrio 4, 00146 Rome, Italy; (A.M.C.); (A.M.)
| | - Assunta Tornesello
- Pediatric Oncology Unit, Ospedale Vito Fazzi, Piazza Filippo Muratore, 1, 73100 Lecce, Italy; (D.R.); (A.C.)
- Correspondence: (V.S.); (A.T.)
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7
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Lassandro G, Palmieri VV, Barone A, Farruggia P, Giona F, Licciardello M, Marinoni M, Marzollo A, Notarangelo LD, Palumbo G, Ramenghi U, Russo G, Saracco P, Spinelli M, Tolva A, Tornesello A, Palladino V, Noviello D, Giordano P. Fatigue perception in a cohort of children with chronic immune thrombocytopenia and their caregivers using the PedsQL MFS: Real-life multicenter experience of the Italian Association of Pediatric Hematology and Oncology (AIEOP). Pediatr Blood Cancer 2021; 68:e28840. [PMID: 33274837 DOI: 10.1002/pbc.28840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Fatigue is an important clinical and psychological aspect for a significant number of children affected by immune thrombocytopenia (ITP). To date, few studies have explored fatigue and its relationship with chronic ITP in pediatric age. The aim of the present multicentric pilot study is to determine fatigue perception in a large group of children with chronic ITP and their caregivers using the PedsQL Multidimensional Fatigue Scale (PedsQL MFS), and to compare the results with those of healthy control subjects. PROCEDURE Children with chronic ITP aged 5-18 years and/or caregivers of children aged 2-18 years were enrolled. Child/adolescent self-report was used for patients aged 5-18 years, and parent proxy-report for patients aged 2-18 years. The questionnaire was offered as online survey. PedsQL MFS is composed of 18 items covering three dimensions: General Fatigue Scale, Sleep/Rest Fatigue Scale, and Cognitive Fatigue Scale. RESULTS One hundred ninety-one patients affected by chronic ITP and 248 caregivers answered the PedsQL MFS. We have highlighted that lower values of PedsQL MFS scores are obtained in the 13-18 age group. Moreover, sleep/rest fatigue domain appears to be more compromised in all age groups. For all PedsQL MFS scores, pediatric patients with chronic ITP and their caregivers reported statistically significant worse fatigue than healthy children. CONCLUSIONS This study suggests that fatigue is relevant among children and adolescents affected by chronic ITP. The PedsQL MFS represents an adequate instrument for measuring fatigue in patients with chronic ITP. Therefore, symptoms of fatigue should be routinely assessed in clinical practice.
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Affiliation(s)
- Giuseppe Lassandro
- Department of Biomedical Science and Human Oncology, Pediatric Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Viviana Valeria Palmieri
- Department of Biomedical Science and Human Oncology, Pediatric Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Angelica Barone
- Department of Pediatric Onco-Hematology, University Hospital of Parma, Parma, Italy
| | - Piero Farruggia
- Pediatric Hematology and Oncology Unit, A.R.N.A.S. Ospedale Civico, Palermo, Italy
| | - Fiorina Giona
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Licciardello
- Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Maddalena Marinoni
- Paediatric Department, ASST-Sette Laghi, "F. Del Ponte" Hospital, Varese, Italy
| | - Antonio Marzollo
- Pediatric Hematology-Oncology Unit, Department of Women's and Children's Health, Azienda Ospedaliera-University of Padova, Padua, Italy
| | | | - Giuseppe Palumbo
- Regional Reference Centre for Haemostasis and Thrombosis, IRCCS Paediatric Hospital "Bambino Gesù,", Rome, Italy
| | - Ugo Ramenghi
- Department of Pediatric and Public Health Sciences, University of Torino, Turin, Italy
| | - Giovanna Russo
- Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Paola Saracco
- Department of Pediatric and Public Health Sciences, University of Torino, Turin, Italy
| | - Marco Spinelli
- Hemato-Oncology Unit, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Alessandra Tolva
- Pediatric Hematology/Oncology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Assunta Tornesello
- Pediatric Hematology Oncology, Presidio Ospedaliero Vito Fazzi, Lecce, Italy
| | - Valentina Palladino
- Department of Biomedical Science and Human Oncology, Pediatric Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Domenico Noviello
- Department of Biomedical Science and Human Oncology, Pediatric Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Paola Giordano
- Department of Biomedical Science and Human Oncology, Pediatric Unit, University of Bari "Aldo Moro", Bari, Italy
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8
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Mascarin M, Milano GM, Bertolotti M, Quarello P, Spinelli M, Tornesello A, Bomben F, Ferrari A. Discussing communication issues and needs with adolescents with cancer. Tumori 2020; 107:360-363. [PMID: 33243095 DOI: 10.1177/0300891620977036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adolescents with cancer face unique medical and psychosocial challenges and it is important for their doctors to understand the psychological manifestations of cancer diagnosis and treatment in this age group. Using patient dialogues, we describe how simultaneous participation of physicians and patients could help to give voice to patient needs, in particular concerning communication.
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Affiliation(s)
- Maurizio Mascarin
- AYA Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Giuseppe M Milano
- Hematology/Oncology Unit, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Marina Bertolotti
- Pediatric Onco-Hematology Unit, Stem Cell Transplantation and Cellular Therapy Division, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Ospedale Regina Margherita, Torino, Piemonte, Italy
| | - Paola Quarello
- Pediatric Onco-Hematology Unit, Stem Cell Transplantation and Cellular Therapy Division, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Ospedale Regina Margherita, Torino, Piemonte, Italy
| | - Marco Spinelli
- Pediatric Hematology-Oncology Department and "Tettamanti" Research Center, Università Milano-Bicocca, "Fondazione MBBM," Ospedale San Gerardo, Monza, Lombardia, Italy
| | | | - Francesca Bomben
- AYA Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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9
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Rigante D, Stellacci E, Leoni C, Onesimo R, Radio FC, Pizzi S, Giorgio V, Tornesello A, Tartaglia M, Zampino G. Biallelic TRNT1 variants in a child with B cell immunodeficiency, periodic fever and developmental delay without sideroblastic anemia (SIFD variant). Immunol Lett 2020; 225:64-65. [PMID: 32592741 DOI: 10.1016/j.imlet.2020.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
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10
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Ceglie G, Vinci M, Carai A, Rossi S, Colafati GS, Cacchione A, Tornesello A, Miele E, Locatelli F, Mastronuzzi A. Infantile/Congenital High-Grade Gliomas: Molecular Features and Therapeutic Perspectives. Diagnostics (Basel) 2020; 10:E648. [PMID: 32872331 PMCID: PMC7555400 DOI: 10.3390/diagnostics10090648] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 07/20/2020] [Revised: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 11/17/2022] Open
Abstract
Brain tumors in infants account for less than 10% of all pediatric nervous system tumors. They include tumors diagnosed in fetal age, neonatal age and in the first years of life. Among these, high-grade gliomas (HGGs) are a specific entity with a paradoxical clinical course that sets them apart from their pediatric and adult counterparts. Currently, surgery represents the main therapeutic strategy in the management of these tumors. Chemotherapy does not have a well-defined role whilst radiotherapy is rarely performed, considering its late effects. Information about molecular characterization is still limited, but it could represent a new fundamental tool in the therapeutic perspective of these tumors. Chimeric proteins derived from the fusion of several genes with neurotrophic tyrosine receptor kinase mutations have been described in high-grade gliomas in infants as well as in neonatal age and the recent discovery of targeted drugs may change the long-term prognosis of these tumors, along with other target-driven therapies. The aim of this mini review is to highlight the recent advances in the diagnosis and treatment of high-grade gliomas in infants with a particular focus on the molecular landscape of these neoplasms and future clinical applications.
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Affiliation(s)
- Giulia Ceglie
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), Piazza Sant’Onofrio 4, 00146 Rome, Italy; (M.V.); (A.C.); (E.M.); (F.L.)
| | - Maria Vinci
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), Piazza Sant’Onofrio 4, 00146 Rome, Italy; (M.V.); (A.C.); (E.M.); (F.L.)
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, Bambino Gesù Children’s Hospital (IRCCS), Piazza Sant’Onofrio 4, 00146 Rome, Italy;
| | - Sabrina Rossi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children’s Hospital (IRCCS), Piazza Sant’Onofrio 4, 00146 Rome, Italy;
| | - Giovanna Stefania Colafati
- Neuroradiology Unit, Department of Imaging, Bambino Gesù Children’s Hospital (IRCCS), Piazza Sant’Onofrio 4, 00146 Rome, Italy;
| | - Antonella Cacchione
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), Piazza Sant’Onofrio 4, 00146 Rome, Italy; (M.V.); (A.C.); (E.M.); (F.L.)
| | - Assunta Tornesello
- Pediatric Oncology Unit, Ospedale Vito Fazzi, Piazza Filippo Muratore, 1, 73100 Lecce, Italy;
| | - Evelina Miele
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), Piazza Sant’Onofrio 4, 00146 Rome, Italy; (M.V.); (A.C.); (E.M.); (F.L.)
| | - Franco Locatelli
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), Piazza Sant’Onofrio 4, 00146 Rome, Italy; (M.V.); (A.C.); (E.M.); (F.L.)
- Department of Maternal, Infantile, and Urological Sciences, University of Rome La Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Angela Mastronuzzi
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), Piazza Sant’Onofrio 4, 00146 Rome, Italy; (M.V.); (A.C.); (E.M.); (F.L.)
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11
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Capoluongo E, De Matteis E, Cucinotto I, Ronzino G, Santonocito C, Tornesello A, De Giorgio MR, Lucci Cordisco E, Minucci A, Genuardi M. A new founder BRCA1 haplotype identified in the Puglia region is associated with a specific age-related cancer onset in three unrelated families. Clin Chem Lab Med 2020; 59:e95-e98. [PMID: 32396136 DOI: 10.1515/cclm-2020-0389] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Ettore Capoluongo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II - CEINGE, Biotecnologie Avanzate, Naples, Italy
| | | | - Iole Cucinotto
- Medical Affairs Italy, Galapagos Biopharma, Milan, Italy
| | | | - Concetta Santonocito
- Molecular and Genomic Diagnostics Laboratory, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Angelo Minucci
- Molecular and Genomic Diagnostics Laboratory, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maurizio Genuardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Genetica Medica, Rome, Italy.,Istituto di MEdicina Genomica Univarsità Cattolica del Sacro Cuore, Rome, Italy
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12
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Di Ruscio V, Del Baldo G, De Pasquale MD, De Vito R, Miele E, Colafati GS, Deodati A, De Ioris MA, Tornesello A, Milano GM, Mastronuzzi A. Ectopic ACTH Secretion in a Child With Metastatic Ewing's Sarcoma: A Case Report. Front Oncol 2020; 10:574. [PMID: 32411598 PMCID: PMC7198717 DOI: 10.3389/fonc.2020.00574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/30/2020] [Indexed: 11/17/2022] Open
Abstract
Ectopic ACTH syndrome is rare in pediatric age. Sarcomas that cause Ectopic ACTH Syndrome (EAS) are even more uncommon. Currently, only three cases of EAS caused by Ewing' sarcoma have been reported. We detail a 10-year-old boy with Cushing's syndrome symptoms caused by ectopic ACTH production by a metastatic Ewing's sarcoma of the right ischio-pubic and ileo-pubic branches. The rapid appearance of cushingoid symptoms, with significant weight gain, acne, hirsutism, and hypercortisolism were implications of ectopic ACTH production as paraneoplastic Cushing's Syndrome. The very high levels of ACTH and non-suppression at the high dose dexamethasone test confirmed the clinical suspicion. We underline the possibility EAS was caused by an ACTH-secreting tumor, including soft tissue sarcomas.
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Affiliation(s)
- Valentina Di Ruscio
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.,Department of Paediatric, Sapienza University of Rome, Rome, Italy
| | - Giada Del Baldo
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Debora De Pasquale
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Rita De Vito
- Department of Pathology, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Evelina Miele
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Annalisa Deodati
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Giuseppe Maria Milano
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Angela Mastronuzzi
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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13
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Giordano P, Lassandro G, Barone A, Cesaro S, Fotzi I, Giona F, Ladogana S, Miano M, Marzollo A, Nardi M, Notarangelo LD, Pession A, Ruggiero A, Russo G, Saracco P, Spinelli M, Tolva A, Tornesello A, Palladino V, Del Vecchio GC. Use of Eltrombopag in Children With Chronic Immune Thrombocytopenia (ITP): A Real Life Retrospective Multicenter Experience of the Italian Association of Pediatric Hematology and Oncology (AIEOP). Front Med (Lausanne) 2020; 7:66. [PMID: 32181255 PMCID: PMC7059456 DOI: 10.3389/fmed.2020.00066] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/13/2020] [Indexed: 01/19/2023] Open
Abstract
Background: The thrombopoietin receptor agonist eltrombopag has been shown to be safe and effective for children with chronic immune thrombocytopenia (ITP). The aim of the present study was to characterize eltrombopag use in current clinical practice. Material and Methods: This is a retrospective multicenter study conducted in 17 centers affiliated to the Italian Association of Pediatric Hematology and Oncology (AIEOP). The primary objective of the study was to determine the prevalence of eltrombopag use in Italian children affected by chronic ITP, after EMA authorization for pediatric age. The secondary objective was to assess efficacy in the first 6 months and safety during the whole period of eltrombopag treatment in current clinical practice. A total of 386 children with chronic ITP were retrospectively enrolled and eligible for analysis. Among these patients, 71 received eltrombopag. Results: The prevalence of eltrombopag use was 19% (95% CI 0.15–0.23). Thirty-one patients (44%) were male and 40 patients (56%) were female. The median age at the first dose of eltrombopag was 12 years (3–17 years). The median duration of eltrombopag treatment was 11 months (1–32 months) and the median starting dose was 50 mg/day (12, 5–75 mg/day). Thirty-two patients (45%) required one or more concomitant ITP medications during the first 6 months of treatment with eltrombopag. Thirty-nine patients (55%) never required concomitant medications. Median platelet counts and proportion of patients achieving the target platelet count of at least 30 × 109/L and 100 × 109/L significantly increased during the first 6 months of treatment (p < 0.0001). Additionally, eltrombopag has been proved effective in the absence of concomitant therapies. The most common Adverse Events were headache (7%) and thrombocytosis (6%). Conclusion: Our study highlighted the crucial role of eltrombopag as second line treatment in children with chronic ITP.
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Affiliation(s)
- Paola Giordano
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe Lassandro
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Angelica Barone
- Department of Pediatric Onco-Hematology, University Hospital of Parma, Parma, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Ilaria Fotzi
- Department Pediatric Hematology Oncology, Azienda Ospedaliero Universitaria A. Meyer Children Hospital, Florence, Italy
| | - Fiorina Giona
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Saverio Ladogana
- Department of Hematology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maurizio Miano
- Clinical and Experimental Hematology Unit, "G. Gaslini" Children's Hospital, Genoa, Italy
| | - Antonio Marzollo
- Pediatric Hematology-Oncology Unit, Department of Women's and Children's Health, Azienda Ospedaliera-University of Padova, Padua, Italy
| | - Margherita Nardi
- Pediatric Hematology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Andrea Pession
- Department of Pediatrics, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanna Russo
- Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Paola Saracco
- Pediatric Hematology, Department of Pediatrics, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Marco Spinelli
- Hemato-Oncology Unit, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Alessandra Tolva
- Pediatric Hematology/Oncology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Assunta Tornesello
- Pediatric Hematology Oncology, Presidio Ospedaliero Vito Fazzi, Lecce, Italy
| | - Valentina Palladino
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni Carlo Del Vecchio
- Pediatric Unit, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
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14
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Ferrari A, Bernasconi A, Sironi G, Bergamaschi L, Botta L, Chiaravalli S, Casanova M, Bisogno G, Milano GM, Mascarin M, Tornesello A, Quarello P, Massimino M, Gatta G, Trama A. Where Are Adolescents with Soft Tissue Sarcomas Treated? An Italian Nationwide Study on Referrals Based on Hospital Discharge Records. J Adolesc Young Adult Oncol 2019; 9:190-195. [PMID: 31660779 DOI: 10.1089/jayao.2019.0117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescents (15-19 years) with soft tissue sarcomas (STS) have worse survival than children. One reason is the former's limited access to expert centers. We investigated where adolescents with STS are treated in Italy, analyzing hospital discharge records (HDRs) countrywide. Methods: We applied to the Health Ministry to obtain the HDRs of all adolescents hospitalized in 2002-2015. We excluded prevalent cases hospitalized with STS in 2002-2006 to obtain a cohort of incident cases 2007-2014. We defined main treatments observing 12 months from diagnosis. Thus, the cohorts end in 2014 rather than 2015. We computed "hospital volume" as the number of adolescents treated by a hospital in 8 years. Patient migration across geographical areas was investigated comparing patients' place of residence and of hospitalization. Results: We identified 381 adolescents with STS, 63% of them were treated at AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica [Italian Association of Pediatric Hematology and Oncology]) centers. These patients were treated at 44 different AIEOP centers, with 1 center treating 62 adolescents (26% of all those treated by AIEOP centers). The remaining 142 adolescents with STS were treated at 66 non-AIEOP centers, one of which managed 17 adolescents. Centers in the north of Italy were more likely to attract patients from other regions. Conclusion: Although HDRs have some limitations, they are the only tool for investigating access to care in countries without national cancer registries. Our findings support the use of HDRs for such purposes, confirm the efficacy of the Italian pediatric oncology network, and make the case for closer collaboration between pediatric and adult oncologists.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Department of Research in Epidemiological and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Research in Epidemiological and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Gianni Bisogno
- Hematology-Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | | | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | | | - Paola Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Department of Research in Epidemiological and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research in Epidemiological and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
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15
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Massimino M, Barretta F, Modena P, Giangaspero F, Chiapparini L, Erbetta A, Boschetti L, Antonelli M, Ferroli P, Bertin D, Pecori E, Biassoni V, Garrè ML, Schiavello E, Sardi I, Viscardi E, Scarzello G, Mascarin M, Quaglietta L, Cinalli G, Genitori L, Peretta P, Mussano A, Barra S, Mastronuzzi A, Giussani C, Marras CE, Balter R, Bertolini P, Tornesello A, La Spina M, Buttarelli FR, Ruggiero A, Caldarelli M, Poggi G, Gandola L. Pediatric intracranial ependymoma: correlating signs and symptoms at recurrence with outcome in the second prospective AIEOP protocol follow-up. J Neurooncol 2018; 140:457-465. [PMID: 30109673 DOI: 10.1007/s11060-018-2974-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022]
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16
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Massimino M, Barretta F, Giangaspero F, Chiapparini L, Erbetta A, Boschetti L, Modena P, Antonelli M, Ferroli P, Bertin D, Pecori E, Biassoni V, Garrè ML, Schiavello E, Sardi I, Viscardi E, Scarzello G, Mascarin M, Quaglietta L, Cinalli G, Genitori L, Peretta P, Mussano A, Barra S, Mastronuzzi A, Giussani C, Marras CE, Balter R, Bertolini P, Tornesello A, Spina ML, Buttarelli FR, Ruggiero A, Caldarelli M, Poggi G, Gandola L. EPEN-03. PEDIATRIC INTRACRANIAL EPENDYMOMA: CORRELATION OF SYMPTOMS AND SIGNS AT RECURRENCE WITH OUTCOME IN THE SECOND PROSPECTIVE AIEOP PROTOCOL FOLLOW-UP. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.204] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Maura Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | - Luna Boschetti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Paolo Ferroli
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Daniele Bertin
- A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Emilia Pecori
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | | | | | - Maurizio Mascarin
- IRCCS Centro di Riferimento Oncologico, Aviano, Italy, Aviano, Italy
| | | | | | | | - Paola Peretta
- A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Anna Mussano
- A.O.U. Città della Salute e della Scienza, Torino, Italy
| | | | | | | | | | - Rita Balter
- Ospedale della Donna e del Bambino, Verona, Italy
| | | | | | | | | | | | | | | | - Lorenza Gandola
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Ospedale Microcitemico, Azienda Brotzu, Cagliari, Italy
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17
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Colafati GS, Voicu IP, Carducci C, Miele E, Carai A, Di Loreto S, Marrazzo A, Cacchione A, Cecinati V, Tornesello A, Mastronuzzi A. MRI features as a helpful tool to predict the molecular subgroups of medulloblastoma: state of the art. Ther Adv Neurol Disord 2018; 11:1756286418775375. [PMID: 29977341 PMCID: PMC6024494 DOI: 10.1177/1756286418775375] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 10/30/2017] [Accepted: 02/28/2018] [Indexed: 12/20/2022] Open
Abstract
Medulloblastoma is the most common malignant pediatric brain tumor. Medulloblastoma should not be viewed as a single disease, but as a heterogeneous mixture of various subgroups with distinct characteristics. Based on genomic profiles, four distinct molecular subgroups are identified: Wingless (WNT), Sonic Hedgehog (SHH), Group 3 and Group 4. Each of these subgroups are associated with specific genetic aberrations, typical age of onset as well as survival prognosis. Magnetic resonance imaging (MRI) is performed for all patients with brain tumors, and has a key role in the diagnosis, surgical guidance and follow up of patients with medulloblastoma. Several studies indicate MRI as a promising tool for early detection of medulloblastoma subgroups. The early identification of the subgroup can influence the extent of surgical resection, radiotherapy and chemotherapy targeted treatments. In this article, we review the state of the art in MRI-facilitated medulloblastoma subgrouping, with a summary of the main MRI features in medulloblastoma and a brief discussion on molecular characterization of medulloblastoma subgroups. The main focus of the article is MRI features that correlate with medulloblastoma subtypes, as well as features suggestive of molecular subgroups. Finally, we briefly discuss the latest trends in MRI studies and latest developments in molecular characterization.
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Affiliation(s)
| | - Ioan Paul Voicu
- Department of Imaging, Neuroradiology Unit and Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Chiara Carducci
- Department of Imaging, Neuroradiology Unit, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Evelina Miele
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Carai
- Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Simona Di Loreto
- Dipartimento di Pediatria, Università degli studi di Chieti, Chieti, Italy
| | - Antonio Marrazzo
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonella Cacchione
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Valerio Cecinati
- Pediatric Hematology and Oncology Unit, Department of Hematology, Transfusion Medicine and Biotechnology, Pescara, Italy
| | | | - Angela Mastronuzzi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
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18
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Esposito G, dell'Anna VA, Marrazzo A, Carai A, Messina R, De Benedictis A, Randi F, Cacchione A, Miele E, Colafati GS, Tornesello A, Po A, Ferretti E, Mastronuzzi A, Fontanella MM, Marras CE. NS-25IMPACT OF MEDULLOBLASTOMA MOLECULAR SUBGROUP ON POST-OPERATIVE PSEUDOMENINGOCELE AND NEED FOR VENTRICULAR SHUNTING. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now078.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Moavero R, Folgiero V, Carai A, Miele E, Ferretti E, Po A, Diomedi Camassei F, Lepri FR, Vigevano F, Curatolo P, Valeriani M, Colafati GS, Locatelli F, Tornesello A, Mastronuzzi A. Metastatic Group 3 Medulloblastoma in a Patient With Tuberous Sclerosis Complex: Case Description and Molecular Characterization of the Tumor. Pediatr Blood Cancer 2016; 63:719-22. [PMID: 26626406 DOI: 10.1002/pbc.25851] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 01/23/2023]
Abstract
Medulloblastoma is the most common pediatric brain tumor. We describe a child with tuberous sclerosis complex that developed a Group 3, myc overexpressed, metastatic medulloblastoma (MB). Considering the high risk of treatment-induced malignancies, a tailored therapy, omitting radiation, was given. Based on the evidence of mammalian target of rapamycin mTORC, mTOR Complex; RAS, Rat sarcoma; RAF, rapidly accelerated fibrosarcoma (mTOR) pathway activation in the tumor, targeted therapy was applied resulting in complete remission of disease. Although the PI3K/AKT/mTOR signaling pathway plays a role in MB, we did not find TSC1/TSC2 (TSC, tuberous sclerosis complex) mutation in our patient. We speculate that a different pathway resulting in mTOR activation is the basis of both TSC and MB in this child; H&E, haematoxilin and eosin; Gd, gadolinium.
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Affiliation(s)
- Romina Moavero
- Neuroscience and Neurorehabilitation Department, Neurology Unit, Bambino Gesù Children's Hospital, , IRCCS, Rome, Italy.,Systems Medicine Department, Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Valentina Folgiero
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, , IRCCS, Rome, Italy
| | - Andrea Carai
- Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital, , IRCCS, Rome, Italy
| | - Evelina Miele
- Department of Molecular Medicine, Sapienza University, Rome, Italy.,Center for Life NanoScience@Sapienza, Istituto Italiano di Tecnologia, Rome, Italy
| | | | - Agnese Po
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | | | - Francesca Romana Lepri
- Department of Laboratories, Medical Genetics laboratory, Bambino Gesù Children's Hospital, , IRCCS, Rome, Italy
| | - Federico Vigevano
- Neuroscience and Neurorehabilitation Department, Neurology Unit, Bambino Gesù Children's Hospital, , IRCCS, Rome, Italy
| | - Paolo Curatolo
- Systems Medicine Department, Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Massimiliano Valeriani
- Neuroscience and Neurorehabilitation Department, Neurology Unit, Bambino Gesù Children's Hospital, , IRCCS, Rome, Italy
| | - Giovanna S Colafati
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, , IRCCS, Rome, Italy
| | - Franco Locatelli
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, , IRCCS, Rome, Italy.,Department of Pediatric Science, University of Pavia, Italy
| | - Assunta Tornesello
- Department of Pediatrics, "Università Cattolica del Sacro Cuore,", Rome, Italy
| | - Angela Mastronuzzi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, , IRCCS, Rome, Italy
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20
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Forcignanò R, Petrucelli L, Cazzaniga ME, Lupo LI, Chiuri VE, Cairo G, De Matteis E, Febbraro A, Giordano G, Campidoglio S, Fabi A, Giampaglia M, Bilancia D, La Verde N, Maiello E, Morritti M, Giotta F, Lorusso V, Scavelli C, Romito S, Cusmai A, Palmiotti G, Tornesello A, Ciccarese M. Abstract P4-13-15: Dose intensity and efficacy of the combination of everolimus and exemestane (EVE/EXE) in a real world population of hormone receptor positive advanced breast cancer: A multicenter Italian experience. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-13-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Everolimus, an mTOR inhibitor, in combination with exemestane is approved for hormone receptor (HR) positive advanced breast cancer (ABC), after failure of treatment with non-steroidal aromatase inhibitor (NSAI). We assessed the toxicity of the combination and the correlation between dose intensity and response to therapy, in a real world population of ABC from 11 Italian centers. Moreover, we evaluated OS of the whole population, RR and PFS according to line of treatment (from 1rd to 3th and from 4th on).
METHODS: 154 pts were treated with combination of everolimus 10 mg and exemestane 25 mg daily from 05/2011 today. Median age was 62 (47-82). Median time to metastatic disease was 49 months (0-269). Median number of metastatic sites was 2 (55.2% of pts visceral versus 44.8% non visceral disease). N=117 (75.9%) pretreated with HT as adjuvant; N=126 pts (81.8%) treated with HT for advanced disease prior to EVE/EXE, with a median of one line (0-5). N=102 pts (66.2%) treated with chemotherapy for metastatic disease, with a median of one line (0-6) before everolimus treatment.
RESULTS: Sixteen pts received EVE/EXE as 1st line (10.4%), 39 as 2nd (25.3%), 37 as 3rd (24%), 62 as 4th or more (40,3%). Response was evaluable in 127 out of 154 pts; CR/PR/SD respectively 5/27/56 pts. RR according to line (from 1st to 3rd vs ≥ 4th) was respectively 22.8% vs 26.4% (p=0,864). The median PFS for all population (150 pts) was 38 weeks (95% CI: 33-42). The PFS according to line (1st- 3rd vs ≥ 4th) was 38 wks in both subgroups, p=0.73. OS (126/154 pts) was 28 mths (95% CI: 31-38). The most frequent adverse events were collected in the table.
Adverse eventsOverall %Grade 3-4 %Stomatitis55.810.4Hypercholesterolemia47.40.0Asthenia42.95.2Hyperglycemia36.45.8Hypertriglyceridemia29.20.6Anemia28.63.9Peripheral edema24.71.3Rash23.40.6Increased ALT/AST/GGT21.46.5Thrombocytopenia19.53.9Diarrhea18.81.9Weight loss18.21.3Dysgeusia17.50.6Pneumonitis15.61.9Cutaneous toxicity14.90.6Infection14.33.2Neutropenia11.71.9Nausea11.70.0Anorexia (without stomatitis)10.41.3Electrolyte alterations9.71.3Urea/creatinine increase6.51.3Vomiting6.50.0Uric acid increase4.50.0
Median duration of treatment with everolimus 10 mg and 5 mg was respectively 180 (9-854) and 129 days (3-738). Fifty-eight pts (37,6%) never stopped treatment with everolimus 10 mg; 16 pts (10,4%) definitively stopped everolimus for toxicity; 80 pts (52,0%) temporarily interrupted the treatment, resuming at dose level 10 mg (31 pts) or reducing at 5 mg (49 pts). Main reason for discontinuation/interruption was stomatitis G2-G3. RR and PFS evaluated according to dose intensity, 10 mg vs 5 mg, were respectively 25.9% vs 30% p=0.779, 38 wks (27-44) vs 40 wks (31-48) P=0.614
CONCLUSIONS: efficacy in terms of RR and PFS of the combination EVE/EXE is not related to dose intensity (10 mg vs 5 mg), the discontinuation of the treatment is high with the starting dose of 10 mg, the toxicity is consistent with previous phase II-III studies although we collected some different toxicities.
Citation Format: Forcignanò R, Petrucelli L, Cazzaniga ME, Lupo LI, Chiuri VE, Cairo G, De Matteis E, Febbraro A, Giordano G, Campidoglio S, Fabi A, Giampaglia M, Bilancia D, La Verde N, Maiello E, Morritti M, Giotta F, Lorusso V, Scavelli C, Romito S, Cusmai A, Palmiotti G, Tornesello A, Ciccarese M. Dose intensity and efficacy of the combination of everolimus and exemestane (EVE/EXE) in a real world population of hormone receptor positive advanced breast cancer: A multicenter Italian experience. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-13-15.
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Affiliation(s)
- R Forcignanò
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - L Petrucelli
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - ME Cazzaniga
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - LI Lupo
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - VE Chiuri
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - G Cairo
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - E De Matteis
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Febbraro
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - G Giordano
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - S Campidoglio
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Fabi
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - M Giampaglia
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - D Bilancia
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - N La Verde
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - E Maiello
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - M Morritti
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - F Giotta
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - V Lorusso
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - C Scavelli
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - S Romito
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Cusmai
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - G Palmiotti
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - A Tornesello
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
| | - M Ciccarese
- "Vito Fazzi" Hospital, Lecce, Italy; "AO San Gerardo", Monza, Italy; "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy; "Regina Elena" National Cancer Institute, Roma, Italy; "San Carlo" Hospital, Potenza, Italy; "AO Fatebenefratelli e Oftalmico", Milano, Italy; "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo (Foggia), Italy; "Giovanni Paolo II" Institute, Bari, Italy; "S. Cuore di Gesù" Hospital, Gallipoli (Lecce), Italy; "Ospedali Riuniti" Hospital, Foggia, Italy; "Di Venere" Hospital, Bari, Italy
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21
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Bianchi M, Giannantonio C, Spartano S, Fioretti M, Landini A, Molisso A, Tesfagabir GM, Tornesello A, Barbagallo O, Valentini CG, Vento G, Zini G, Romagnoli C, Papacci P, Teofili L. Allogeneic umbilical cord blood red cell concentrates: an innovative blood product for transfusion therapy of preterm infants. Neonatology 2015; 107:81-6. [PMID: 25401961 DOI: 10.1159/000368296] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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] [Received: 07/07/2014] [Accepted: 09/11/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preterm infants often receive blood transfusions early in life. In this setting, umbilical cord blood (UCB) might be safer than adult blood (A) with respect to infectious and immunologic threats. OBJECTIVES To evaluate, as a first objective, the feasibility of fulfilling transfusion needs of preterm infants with allogeneic UCB red blood cell (RBC) concentrates and, as a secondary objective, to assess the safety of allogeneic cord blood transfusions. METHODS At the Neonatal Intensive Care Unit and the UNICATT Cord Blood Bank of 'A. Gemelli' Hospital in Rome, a prospective study was carried out over a 1-year period, enrolling newborns with gestational age ≤30 weeks and/or birth weight ≤1,500 g requiring RBC transfusions within the first 28 days of life. At first transfusion, patients were assigned to receive UCB-RBCs or A-RBCs depending on the availability of ABO-Rh(D)-matched UCB-RBC units. The same regimen (UCB-RBC or A-RBC units) was thereafter maintained, unless ABO-Rh(D)-matched UCB-RBC units were not available. RESULTS Overall, 23 UCB-RBC units were transfused to 9 patients; the requests for UCB-RBC units were met in 45% of patients at the first transfusion and in 78% at the subsequent transfusions. At a median follow-up of 57 days (range 6-219), no acute or delayed transfusion-related adverse events occurred. Hematocrit gain after transfusion and time intervals between transfusions were similar in the UCB-RBC and A-RBC group, as well. CONCLUSIONS Transfusing allogeneic UCB-RBC units in preterm infants appears a feasible and safe approach, although the transfusion needs of our study population were not completely covered. More data are necessary to validate this novel transfusion practice.
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Affiliation(s)
- Maria Bianchi
- UNICATT Cord Blood Bank, 'A. Gemelli' Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
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22
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Forcignanò R, Bria E, Fabi A, Petrucelli L, Furlanetto J, Carbognin L, Gambino A, Vicentini C, Saracino V, Lupo L, Chiuri V, Cairo G, Tortora G, De Matteis E, Ronzino G, Tornesello A, Sperduti I, Giannarelli D, Ciccarese M. Overall Prognosis of Advanced Breast Cancer (Abc) According to Chemotherapy (Ct) Treatment Lines: Correlation Analysis Between Progression-Free-, Post-Progression- and Overall- Survival (Pfs, Pps and Os). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu329.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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23
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Flex E, Petrangeli V, Stella L, Chiaretti S, Hornakova T, Knoops L, Ariola C, Fodale V, Clappier E, Paoloni F, Martinelli S, Fragale A, Sanchez M, Tavolaro S, Messina M, Cazzaniga G, Camera A, Pizzolo G, Tornesello A, Vignetti M, Battistini A, Cavé H, Gelb BD, Renauld JC, Biondi A, Constantinescu SN, Foà R, Tartaglia M. Somatically acquired JAK1 mutations in adult acute lymphoblastic leukemia. ACTA ACUST UNITED AC 2008; 205:751-8. [PMID: 18362173 PMCID: PMC2292215 DOI: 10.1084/jem.20072182] [Citation(s) in RCA: 278] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aberrant signal transduction contributes substantially to leukemogenesis. The Janus kinase 1 (JAK1) gene encodes a cytoplasmic tyrosine kinase that noncovalently associates with a variety of cytokine receptors and plays a nonredundant role in lymphoid cell precursor proliferation, survival, and differentiation. We report that somatic mutations in JAK1 occur in individuals with acute lymphoblastic leukemia (ALL). JAK1 mutations were more prevalent among adult subjects with the T cell precursor ALL, where they accounted for 18% of cases, and were associated with advanced age at diagnosis, poor response to therapy, and overall prognosis. All mutations were missense, and some were predicted to destabilize interdomain interactions controlling the activity of the kinase. Three mutations that were studied promoted JAK1 gain of function and conferred interleukin (IL)-3-independent growth in Ba/F3 cells and/or IL-9-independent resistance to dexamethasone-induced apoptosis in T cell lymphoma BW5147 cells. Such effects were associated with variably enhanced activation of multiple downstream signaling pathways. Leukemic cells with mutated JAK1 alleles shared a gene expression signature characterized by transcriptional up-regulation of genes positively controlled by JAK signaling. Our findings implicate dysregulated JAK1 function in ALL, particularly of T cell origin, and point to this kinase as a target for the development of novel antileukemic drugs.
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Affiliation(s)
- Elisabetta Flex
- Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Rome, 00161, Italy
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24
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Rigante D, Spanu T, Nanni L, Tornesello A, Sanguinetti M, D'Inzeo T, Stabile A, Fadda G. Deep neck infection complicating lymphadenitis caused by Streptococcus intermedius in an immunocompetent child. BMC Infect Dis 2006; 6:61. [PMID: 16553945 PMCID: PMC1435756 DOI: 10.1186/1471-2334-6-61] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Accepted: 03/22/2006] [Indexed: 11/11/2022] Open
Abstract
Background Streptococcus intermedius belongs to the Streptococcus anginosus group. It is part of the normal flora of the human mouth, but it can be etiologically associated with deep-site infections. Case presentation We present a case of deep neck infection complicating Streptococcus intermedius lymphadenitis, which developed in an immunocompetent 14-year-old boy with a history of recent dental work. The infection was ultimately eradicated by a combined medical and surgical approach. Conclusion Our report suggests that combined medical and surgical therapy is essential for the complete resolution of deep infections caused by Streptococcus intermedius. Molecular biological techniques can be useful in guiding the diagnostic investigation and providing insight into the possibility of occult abscesses, which are particularly common with Streptococcus intermedius infections.
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Affiliation(s)
- Donato Rigante
- Department of Pediatric Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Teresa Spanu
- Institute of Microbiology, Università Cattolica Sacro Cuore, Rome, Italy
| | - Lorenzo Nanni
- Division of Pediatric Surgery, Università Cattolica Sacro Cuore, Rome, Italy
| | - Assunta Tornesello
- Department of Pediatric Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Tiziana D'Inzeo
- Institute of Microbiology, Università Cattolica Sacro Cuore, Rome, Italy
| | - Achille Stabile
- Department of Pediatric Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Giovanni Fadda
- Institute of Microbiology, Università Cattolica Sacro Cuore, Rome, Italy
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Mastrangelo S, Tornesello A, Diociaiuti L, Pession A, Prete A, Rufini V, Troncone L, Mastrangelo R. Treatment of advanced neuroblastoma: feasibility and therapeutic potential of a novel approach combining 131-I-MIBG and multiple drug chemotherapy. Br J Cancer 2001; 84:460-4. [PMID: 11207038 PMCID: PMC2363758 DOI: 10.1054/bjoc.2000.1645] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Biological and clinical observations suggest that initial marked reduction of resistant clones may be critical in any attempt to improve long-term results in advanced neuroblastoma (NB). The aim of this pilot study is to determine short-term toxicity and efficacy of a new therapeutic model based on the simultaneous use of multiple drug chemotherapy and specific irradiation using 131-I-MIBG. The study population consisted of 21 patients, from 1 to 8 years of age with good 131-I-MIBG uptake. 16 extensively pre-treated patients with refractory or relapsed disease were divided into 2 groups. In Group 1 (9 patients) the basic chemotherapy regimen consisted in cisplatin at the dose of 20 mg/m(2) i.v. per day infused over 2 h, for 4 consecutive days; on day 4 Cy 2 g/m(2) i.v. was administered over 2 h followed by Mesna. Group 2 (7 patients) was treated with basic chemotherapeutic regimen plus VP16 and Vincristine. VP16 at the dose of 50 mg/m(2) i.v. per day was administered as a 24 h infusion on days 1-3; Vincristine 1.5 mg/m(2) i.v. was administered on days 1 and 6. On day 10 a single dose of 131-I-MIBG (200 mCi) with a high specific activity (>1.1 GBq/mg) was administered to both Groups by i.v. infusion over 4-6 hours. A further 5 patients were treated at diagnosis: 2 with the same regimen as Group 1 and 3 with the same as Group 2. The severity of toxicity was graded according to World Health Organization (WHO) criteria. Assessment of tumour response was monitored 4-6 weeks after the beginning of combined therapy (CO-TH). Response was defined according to INSS (International Neuroblastoma Staging System) criteria. No extra-medullary toxicity was observed in any patient. Haematological toxicity was the only toxicity observed and seemed mainly related to chemotherapy. Myelosuppression was mild in the 5 patients treated at diagnosis. No serious infections or significant bleeding problems were observed. In the 16 resistant patients, 12 PR, 1 mixed response and 3 SD were obtained. In the 5 patients treated at diagnosis 2 PR, 1 CR and 2 VGPR were observed. No alteration in 131-I-MIBG uptake was observed after the chemotherapy preceding radio-metabolic treatment. The therapeutic results of this pilot regimen of CO-TH resulted in a high percentage of major response after only a single course in both resistant patients and patients treated at diagnosis. Because of the minimal toxicity observed in patients studied at diagnosis so far, there is room for gradual intensification of the treatment. It is to be hoped that this suggested novel approach may represent an important route of investigation to improve final outcome in patients with advanced NB.
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Affiliation(s)
- S Mastrangelo
- Pediatric Oncology, Catholic University, Rome, Italy
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26
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Affiliation(s)
- S Mastrangelo
- Division of Pediatric Oncology, Università Cattolica, Rome, Italy
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27
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Tornesello A, Mastrangelo S, Piciacchia D, Bembo V, Colosimo C, Di Rocco C, Mastrangelo R. Progressive disease in children with medulloblastoma/PNET during preradiation chemotherapy. J Neurooncol 2000; 45:135-40. [PMID: 10778729 DOI: 10.1023/a:1006133404936] [Citation(s) in RCA: 8] [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: 11/12/2022]
Abstract
The overall prognosis in children with medulloblastoma/PNET has not significantly improved over the past decade. Intensive neoadjuvant chemotherapy has not yet adequately explored. We evaluated the short-term clinical results of an intensive chemotherapy regimen in high risk children with newly diagnosed MB/PNET, after surgery and before radiation. Twelve previously untreated patients with high-risk medulloblastoma/PNET, according to Chang's classification, were treated with the following chemotherapy regimen: high dose carboplatin 600 mg/m2/day on days 1 and 2; the same course was administered 4 weeks later. One month later, high dose cyclophosphamide 2 g/m2/day on days 1 and 2, followed by an identical course 4 weeks later. Vincristine 1, 5 mg/m2 i.v. was given on the first day of each course. Systemic evaluation of the disease included imaging of the entire neuraxis, including MRI of the entire spine. Out of 12 enrolled, 7 patients were able to be evaluated for a residual disease after surgery. After two cycles of high dose carboplatin, we noted 1 CR, 4 PR and 2 MR. After the subsequent two cycles of high dose cyclophosphamide we observed an additional response in 4 cases. On the other hand, 4 patients clearly showed evidence of PD immediately after the first course of cyclophosphamide (2 cases) or following the second course. Three of the 4 patients had shown respectively 1 CR and 2 PR after the second course of carboplatin. Whereas it was confirmed that 2 courses of high dose carboplatin is effective in high risk MB/PNET children, we observed an unacceptable number of PD during the subsequent high dose cyclophosphamide therapy. A review from the literature also suggests that, in general, the longer radiotherapy is delayed, the higher the incidence of PD. In the search for the optimal drug combination in "sandwich chemotherapy" for children with high risk MB/PNET, PD must be reduced to an acceptable incidence, since a high number of PD may significantly lower the probability of long-term survival.
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Affiliation(s)
- A Tornesello
- Division of Pediatric Oncology, Catholic University, Rome, Italy
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Affiliation(s)
- S Mastrangelo
- Division of Pediatric Oncology, Catholic University, Rome, Italy
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29
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Abstract
Veno-occlusive disease of the liver (VOD) is an important complication in children with Wilms' tumour. Although in most patients this complication resolves uneventfully, fatal cases have been reported. Several observations strongly suggest that actinomycin-D is the likeliest cause of VOD in Wilms' tumour, but VOD seems to be rather uncommon in other malignancies treated with chemotherapy including actinomycin-D. The present case of VOD and the review of the literature stress the pathogenetic and clinical implications of VOD in the presence of a Wilms' tumour treated with actinomycin-D, originating in the right kidney. Greater awareness of this 'predisposing factor' may alert paediatricians to the presence of minimal signs of the syndrome.
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Affiliation(s)
- A Tornesello
- Division of Paediatric Oncology, Catholic University, Rome, Italy
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30
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Abstract
BACKGROUND Standard chemo-radiotherapy methods for the treatment of children with advanced neuroblastoma (NBL) including bone marrow transplant approaches have been disappointing. These poor results can be ascribed to the evolution of residual drug-resistant cell populations. Curative attempts should therefore be directed to their elimination during induction treatment. This can best be accomplished through the use of multiple, non-cross-resistant agents early in therapy. 131I-Metaiodobenzylguanidine (131I-MIBG) provides a mechanism for the delivery of high doses of radiation to NBL lesions. Experience reported from several institutions indicates an approximate 50% response rate in previously treated children with advanced NBL. CONCLUSIONS A better strategy is to employ 131I-MIBG together with intensive chemotherapy at the time of diagnosis. A pilot study adopting these principles and supported by laboratory data has been designed and is underway.
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Affiliation(s)
- R Mastrangelo
- Division of Pediatric Oncology, Catholic University of Rome, Italy
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31
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Butera G, Piciacchia D, Chessa M, Condoluci C, Tornesello A, Delogu AB, Mastrangelo S, Cipriani A. [Evaluation of late cardiac toxicity of anthracycline in childhood]. Minerva Pediatr 1998; 50:111-9. [PMID: 9808963] [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: 02/09/2023]
Abstract
OBJECTIVES To examine left ventricular function in patients previously treated with anthracycline for childhood malignancies. To evaluate the importance of age at the beginning of therapy, of total cumulative dose and of length of follow-up on late cardiac effects of anthracyclines. DESIGN Cross sectional echocardiography study of left ventricular function. PATIENTS Eighteen patients surviving between 1 and 9 years (median 2 years) from end of chemotherapy. Cumulative doses were between 120 and 550 mg/mq (median 275 mg/mq). Age at the beginning of chemotherapy was between 1.8 and 12.25 years (median 5.17 years). Nineteen healthy subjects were also studied as control group. METHODS Assessment of transmitral diastolic pulsed wave Doppler flow patterns and of transaortic pulsed wave Doppler flow patterns. Evaluation of systolic function measured by M-mode echocardiography. RESULTS Patients compared to controls showed a significative reduction of Ejection Fraction, of Shortening Fraction, of peak early phase to peak atrial phase filling velocity ratio and an increase of peak atrial phase filling velocity and of time-velocity integral of peak filling atrial phase. These alterations were more evident at doses higher than 250 mg/m2, in patients whose therapy started before 5 years of age and in patients whose follow-up was longer than 5 years. CONCLUSIONS Significant abnormalities of systolic and diastolic function may appear some years after the end of anthracycline therapy for childhood malignancies. Therefore patient's continued follow-up is necessary in order to guide patient care and to better chemotherapeutic protocols.
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Affiliation(s)
- G Butera
- Sezione Autonoma di Cardiologia Pediatrica, Università Cattolica del Sacro Cuore, Roma
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Mastrangelo R, Tornesello A, Mastrangelo S, Bembo V, Zollino M, Neri G. Cytogenetic evidence for a less malignant leukemic cell population in the central nervous system in a critical case of acute myeloblastic leukemia. Med Pediatr Oncol 1998; 30:91-4. [PMID: 9403016 DOI: 10.1002/(sici)1096-911x(199802)30:2<91::aid-mpo4>3.0.co;2-v] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND With the exception of a single study the cytogenetic aspects of leukemic cells in the central nervous system (CNS) have not been investigated. PATIENTS AND RESULTS During the course of a work-in-progress on the chromosomal constitution both of the spinal fluid and of bone marrow (BM) in children with acute myeloblastic leukemia (AML), we have observed a unique case of AML and CNS leukemia (CNSL) at diagnosis. The patient showed the simultaneous presence at diagnosis of a 46 cytogenetic line in the spinal fluid and a 47 (+8) cell line in the BM, present in the great majority of the metaphases examined. DISCUSSION This observation allows hypotheses on the relationship between BM and CNS disease in AML. Regardless of the pathogenetic mechanism, the cytogenetic findings of the present case clearly suggest that the leukemic population in the CNS compartment represents a less malignant cell process compared to the BM leukemic population. This easily fits in with the usually less malignant course of CNSL in AML. CONCLUSION The foregoing findings may have critical pathogenetic and therapeutic implications.
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Affiliation(s)
- R Mastrangelo
- Division of Pediatric Oncology, Catholic University, Rome, Italy
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Mastrangelo R, Tornesello A, Lasorella A, Iavarone A, Mastrangelo S, Riccardi R, Diociaiuti L, Rufini V, Pession A, Troncone L. Optimal use of the 131-I-metaiodobenzylguanidine and cisplatin combination in advanced neuroblastoma. J Neurooncol 1997; 31:153-8. [PMID: 9049843 DOI: 10.1023/a:1005770405844] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [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: 02/03/2023]
Abstract
Neuroblastoma (NB), a childhood radiosensitive tumor, is very aggressive and malignant, in its disseminated form, despite very intensive chemotherapy, prognosis continues to be dismal. Owing to its capacity to concentrate in NB lesions, large doses of 131-I-MIBG, have given very encouraging therapeutic results in patients resistant to conventional therapy as well as at diagnosis. We recently reported the first attempt in combination therapy (CO-TH) using 131-I-MIBG and cisplatin. This new form of CO-TH appears very effective in obtaining a rapid and excellent response in relapsed patients. In this report, we describe the results of further experience with CO-TH in disseminated NB. We have attempted to verify to what extent interaction between the effects of the two agents may produce therapeutic benefit, and we have sought the optimization of CO-TH use. Three stage IV NB patients were treated with CO-TH. The following treatment schedule, was planned: day 1, cisplatin 50 mg/m3 i.v. over 6 h; day 2, 131-I-MIBG 100-130 mCi at high specific activity (-1.1 Gbq/mg) i.v. over 6 h followed, a week later, by the same treatment combination. The therapeutic results were encouraging. However, hematological toxicity continued to represent a major limiting factor. In view of the overall effectiveness of CO-TH, at the price of lasting hematological toxicity, it may be indicated as a consolidation regimen some time before conditioning chemotherapy for autologous bone marrow transplantation.
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Affiliation(s)
- R Mastrangelo
- Division of Pediatric Oncology, Catholic University, Rome, Italy
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34
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Lavitrano M, Servidei T, Mastrangelo S, Tornesello A, Fioretti D, Di Stefano C, Riccardi A, Franceschini R, Riccardi R. A human neuroblastoma xenograft model for 125-I-metaiodobenzylguanidine biodistribution studies. J Neurooncol 1997; 31:159-64. [PMID: 9049844 DOI: 10.1023/a:1005722522683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We developed an animal model to evaluate the 125-I-metaiodobenzylguanidine (125-I-mIBG) biodistribution in tumor bearing mice. Six weeks old nude-atimic mice were subcutaneously injected with 30 x 10(6) cells of the human neuroblastoma (NB) cell line SH-SY5Y. TE-671, a rhabdomyosarcoma cell line, was used as a control tumor without a specific mIBG uptake mechanism. In order to prevent possible tumor rejection mediated by NK activity the anti asialo GM1 antiserum was administered intraperitoneally once a week for 4 weeks. The maximum anti asialo mediated effect was obtained by administering the first dose the same day as the cell implant. In this group of animals by 9 weeks 98% of mice had a measurable tumor. We have utilized this model to evaluate the biodistribution of 125-I-mIBG given as two different formulations: standard preparation with a specific activity of 84 mCi/mg and the no carrier added (n.c.a) formulation with a specific activity of approximately 8,000 mCi/mg. Our preliminary results indicate that the biodistribution of the two different formulations in the various organs are similar. Therefore it appears that n.c.a. mIBG should not cause an increased toxicity in possible normal target organs such as heart or adrenals. Additional experiments will be performed in this model to ascertain if there is a potential advantage of the clinical use of n.c.a. mIBG over the standard preparation.
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Affiliation(s)
- M Lavitrano
- Dipartimento di Medicina Sperimentale, Università La Sapienza, Rome, Italy
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35
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Mastrangelo R, Lasorella A, Tornesello A, Riccardi R. Carboplatin and cisplatin in medulloblastoma at diagnosis: "comparable efficacy?". J Clin Oncol 1996; 14:1741. [PMID: 8622095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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36
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Mastrangelo S, Tornesello A, Diociaiuti L, Riccardi R, Rufini V, Troncone L. Treatment with meta-[131I]iodobenzylguanidine and cisplatin in stage IV neuroblastoma. Q J Nucl Med 1995; 39:69-71. [PMID: 9002754] [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: 02/03/2023]
Abstract
Metastatic neuroblastoma (NB) continues to have a dismal prognosis. NB is a radiosensitive tumor. Owing to its high concentration in the NB lesions, Metaiodobenzylguanidine (MIBG) has the potential for specifically delivering very large radiation doses to the malignant cells. Encouraging results have been reported with [131I]MIBG used alone in patients resistant to conventional therapy and at diagnosis. We report the first attempts to explore the integration of this new treatment modality with chemotherapy. Among the drugs effective in NB, cisplatin was chosen because of its high degree of activity against NB, its mild hematologic toxicity and the known synergism between cisplatin and radiation. Four patients, 3 with relapsed, heavily pre-treated, progressive stage IV NB, and 1 with stage IV NB at diagnosis, all with a good [131I]MIBG uptake, were investigated with the combined therapy. Two complete remissions and one partial remission were observed in the relapsed patients 4-6 weeks following only one single course of both cisplatin and [131I]MIBG at the "standard" dosage. The only toxicity was hematologic, which was significant and relatively long-lasting, but was not associated with any serious infections or bleeding tendency. The general condition of these patients during the entire study period was excellent. The 4th patient, investigated at diagnosis with a modified less intensive treatment, obtained a partial remission with a mild hematologic toxicity. The provisional conclusion of this preliminary study is that this new form of combined therapy appears very effective in heavily pretreated relapsed patients with progressive disease, and could also be investigated in refractory patients and in patients at diagnosis.
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Affiliation(s)
- S Mastrangelo
- Division of Pediatric Oncology, Catholic University of the Sacred Heart, Rome, Italy
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37
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Zollino M, Genuardi M, Bajer J, Tornesello A, Mastrangelo S, Zampino G, Mastrangelo R, Neri G. Constitutional trisomy 8 and myelodysplasia: report of a case and review of the literature. Leuk Res 1995; 19:733-6. [PMID: 7500650 DOI: 10.1016/0145-2126(95)00050-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [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: 01/25/2023]
Abstract
A diagnosis of myelodysplastic syndrome was made in an 18-year-old patient with Warkany syndrome due to constitutional trisomy 8 mosaicism. The possible causal role of this particular chromosome constitution with respect to myelodysplasia and embryonal childhood tumors is discussed.
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Affiliation(s)
- M Zollino
- Istituto di Genetica Medica, Università Cattolica del Sacro Cuore, Roma, Italy
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38
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Di Rocco C, Iannelli A, La Marca F, Tornesello A, Mastrangelo S, Riccardi R. Preoperative chemotherapy with carboplatin alone in high risk medulloblastoma. Childs Nerv Syst 1995; 11:574-8. [PMID: 8556723 DOI: 10.1007/bf00300995] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Few studies have been carried out regarding preoperative chemotherapy utilized in the treatment of primitive neuroectodermal tumors/medulloblastomas (PNET/MB). In this paper, the authors report 3 cases of children under three years of age, with a presumed diagnosis of PNET/MB, who were preoperatively treated with chemotherapy consisting of high doses of carboplatin alone. The treatment improved the childrens' clinical condition prior to surgery and facilitated tumor removal, resulting in partial regression of the tumor. The preoperative single-drug therapy did not affect the histological diagnosis or prevent the presence of an effective degree of tumor sensitivity to the drug. All three children are still disease-free, after a mean follow-up period of 42 months.
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Affiliation(s)
- C Di Rocco
- Department of Neurosurgery, Catholic University Medical School, Rome, Italy
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39
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Mastrangelo R, Lasorella A, Riccardi R, Colosimo C, Iavarone A, Tornesello A, Mastrangelo S, Ausili-Cefaro G, Di Rocco C. Carboplatin in childhood medulloblastoma/PNET: feasibility of an in vivo sensitivity test in an "up-front" study. Med Pediatr Oncol 1995; 24:188-96. [PMID: 7838041 DOI: 10.1002/mpo.2950240309] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Sixteen patients with high risk MB/PNET at diagnosis were included in a pilot study employing carboplatin (CBDCA) as a single drug prior to conventional therapy. The main goal of the study was to identify in a short-term trial a significant response that would predict further response to CBDCA in the single patient. Exploration of CBDCA activity was focused on response after the first course as compared to the response following the second course. A course consisted of CBDCA 600 mg/m2 on days 1 and 2 administered in a 1 h infusion to be repeated 3-4 weeks later. After two cycles we observed 1 CR and 9 PR, that is a 62% response rate. The first course resulted in 5 PR, 5 MR, 5 SD, and 1 PD; after the subsequent course in all responding patients, response persisted or improved whereas in no patient with SD any improvement was observed. The correlation of response to the first course with response to the second course was statistically significant (P = 0.0009). The main toxicity of the single course was hematologic and consisted of rapidly reversible grade 3-4 neutropenia and thrombocytopenia in 94% of patients. Pharmacokinetic studies showed a very limited interpatient variability of both Cmax 57.6 +/- 9.9 micrograms/ml) and AUC (15.3 +/- 1.5 mg/ml.min) of free CBDCA, which eliminates an important variable in the evaluation of response. In conclusion, this "in vivo test" appears effective, reasonably safe, and reproducible in identifying patients likely to benefit from CBCDA: after a period of time as short as 3-4 weeks following the first course, multidrug chemotherapy including CBDCA may be employed in the responding patients, whereas an alternative regimen would be indicated in the non-responding patients.
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Affiliation(s)
- R Mastrangelo
- Division of Pediatric Oncology, Catholic University of Rome, Italy
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40
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Riccardi A, Servidei T, Tornesello A, Puggioni P, Mastrangelo S, Rumi C, Riccardi R. Cytotoxicity of paclitaxel and docetaxel in human neuroblastoma cell lines. Eur J Cancer 1995; 31A:494-9. [PMID: 7576952 DOI: 10.1016/0959-8049(95)00056-o] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [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: 01/26/2023]
Abstract
Taxanes are an important new class of anticancer agents that inhibit cell division by the unique mechanism of increasing the rate of microtubule assembly and preventing microtubule depolymerisation. Using the colony inhibition assay, we compared the cytotoxicity of paclitaxel and docetaxel in three human neuroblastoma (NB) cell lines, SH-SY5Y, BE(2)M17 and CHP100. Different exposure times (3, 6, 12, 24, 48 and 72 h) and different concentrations ranging from 0.1 nM to 10 microM were tested. Both paclitaxel and docetaxel show antineoplastic activity in human NB cell lines. Taxanes' antitumour activity varied among the different cell lines, CHP100 being the most sensitive and SH-SY5Y the least sensitive. Paclitaxel cytotoxicity appears schedule-dependent, with marked cell kill observed only for exposures of 24 h or longer. Docetaxel cytotoxicity was dependent upon prolonged exposure only in the SH-SY5Y cell line, while an exposure time of 3-6 h resulted in exponential cell kill in the other two cell lines. Docetaxel was more cytotoxic than paclitaxel with a mean ratio of (paclitaxel/docetaxel) IC50 values ranging from 2 to 11. For both taxanes, we observed good correlation between cytotoxic effect and percentage of cells blocked in G2/M phase. A cytotoxic effect occurred at concentrations comparable with those achieved in the plasma of patients treated with these agents in initial clinical trials. The full potential of prolonged infusion or repeated daily administrations of taxanes should be explored in clinical studies, and responses to taxanes in neuroblastoma should be assessed in paediatric phase II studies.
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Affiliation(s)
- A Riccardi
- Division of Pediatric Oncology, Catholic University, Rome, Italy
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41
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Mastrangelo R, Tornesello A, Mastrangelo S, Zollino M, Neri G. Constitutional trisomy 8 mosaicism evolving to primary myelodysplastic syndrome: a new subset of biologically related patients? Am J Hematol 1995; 48:67-8. [PMID: 7832204 DOI: 10.1002/ajh.2830480122] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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42
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Mastrangelo R, Tornesello A, Riccardi R, Lasorella A, Mastrangelo S, Mancini A, Rufini V, Troncone L. A new approach in the treatment of stage IV neuroblastoma using a combination of [131I]meta-iodobenzylguanidine (MIBG) and cisplatin. Eur J Cancer 1995; 31A:606-11. [PMID: 7576979 DOI: 10.1016/0959-8049(95)00048-n] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [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: 01/26/2023]
Abstract
The outlook for disseminated neuroblastoma (NB) continues to be dismal. NB is a radiosensitive tumour. Owing to its high concentration in NB lesions, [131I]meta-iodobenzylguanidine [131I]MIBG has the potential for specifically delivering very large radiation doses to the malignant cells. Encouraging results have been reported with [131I]MIBG used alone in patients resistant to conventional therapy and at diagnosis. We report the first attempt to explore the integration of this new treatment modality with chemotherapy. Among the drugs effective in NB, cisplatin was chosen because of its high degree of activity against NB, its mild haematological toxicity and the known synergism between cisplatin and radiation. 4 patients, 3 with relapsed, heavily pre-treated, progressive stage IV NB, and 1 with stage IV NB at diagnosis, all with a good [131I]MIBG uptake, were investigated with combined therapy (CO-TH). Two complete remissions and one partial remission were observed in these patients 4-6 weeks following only a single course of both cisplatin and [131I]MIBG at "standard" dosage. The only toxicity was haematological, which was significant and relatively long-lasting, but was not associated with any serious infections or bleeding tendency. The general condition of these patients during the entire study period was excellent. The fourth patient, investigated at diagnosis with a modified less intensive treatment, obtained a partial remission with mild haematological toxicity. During the subsequent courses of intensive multidrug chemotherapy, this patient showed haematological toxicity comparable with that experienced by patients treated with an identical drug combination, but without previous treatment with CO-TH. The provisional conclusion of this ongoing study is that this new form of CO-TH appears most effective in obtaining a rapid and excellent response in heavily pretreated relapsed patients with progressive disease, and should be further investigated in earlier stages of the disease.
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Affiliation(s)
- R Mastrangelo
- Divisione di Oncologia Pediatrica, Università Cattolica, Rome, Italy
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43
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Zuppa AA, Tornesello A, Mastrangelo R. Failure of immunoglobulins to prevent neonatal thrombocytopenia in mothers with immunothrombocytopenic purpura. Biol Neonate 1995; 67:450-2. [PMID: 7578629 DOI: 10.1159/000244198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report the case of a full-term (gestational age: 39 weeks) female newborn of a mother affected by immunothrombocytopenic purpura, treated with a high total dose (2 g/kg) of intravenous IgG, administered over a 3-day period starting 3 days before delivery. Infant platelet count at birth was 20,000/mm3 and she showed a great number of petechiae on the first day of life. After a random donor platelet transfusion and treatment with intravenous high-dose IgG (400 mg/kg for 5 days), platelet count began to increase. We conclude that exogenous IgG, even at high concentrations, apparently does not significantly cross the placenta, despite adequate maternal blood levels.
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Affiliation(s)
- A A Zuppa
- Divisione di Neonatologia, Università Cattolica del Sacro Cuore, Policlinico Universitario A. Gemelli, Roma, Italia
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44
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Riccardi R, Riccardi A, Lasorella A, Di Rocco C, Carelli G, Tornesello A, Servidei T, Iavarone A, Mastrangelo R. Clinical pharmacokinetics of carboplatin in children. Cancer Chemother Pharmacol 1994; 33:477-83. [PMID: 8137457 DOI: 10.1007/bf00686504] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [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
The present study was undertaken to evaluate in children the plasma pharmacokinetics of free carboplatin given at different doses and schedules and to evaluate the inter- and intrapatient variability and the possible influence of schedule on drug exposure. A total of 35 children (age range, 1-17 years) with malignant tumors were studied. All patients had normal renal function (creatinine clearance corrected for surface body area, above 70 ml min-1 m-2; range, 71-151 ml min-1 m-2) and none had renal involvement by malignancy. Carboplatin was given at the following doses and schedules: 175, 400, 500, and 600 mg/m2 given as as a 1-h infusion; 1,200 mg/m2 divided into equal doses and infused over 1 h on 2 consecutive days; and 875 and 1,200 mg/m2 given as a 5-day continuous infusion. A total of 57 courses were studied. Carboplatin levels in plasma ultrafiltrate (UF) samples were measured both by high-performance liquid chromatography and by atomic absorption spectrophotometry. Following a 1-h infusion, carboplatin free plasma levels decayed biphasically; the disappearance half-lives, total body clearance, and apparent volume of distribution were similar for different doses. In children with normal renal function as defined by creatinemia and blood urea nitrogen (BUN) and creatinine clearance, we found at each dose studied a limited interpatient variability of the peak plasma concentration (Cmax) and the area under the concentration-time curve (AUC) and a linear correlation between the dose and both Cmax (r = 0.95) and AUC (r = 0.97). The mean value +/- SD for the dose-normalized AUC was 13 +/- 2 min m2 l-1 (n = 57).2+ The administration schedule does not seem to influence drug exposure, since prolonged i.v. infusion or bolus administration of 1,200 mg/m2 achieved a similar AUC (13.78 +/- 2.90 and 15.05 +/- 1.44 mg ml-1 min, respectively). In the nine children studied during subsequent courses a limited interpatient variability was observed and no correlation (r = 0.035) was found between AUC and subsequent courses by a multivariate analysis of dose, AUC, and course number. The pharmacokinetic parameters were similar to those previously reported in adults; however, a weak correlation (r = 0.52, P = 0.03) between carboplatin total body clearance and creatinine clearance varying within the normal range was observed.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- R Riccardi
- Division of Pediatric Oncology, Catholic University of Rome, Italy
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45
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Mastrangelo R, Tornesello A, Mastrangelo S, Riccardi R. Immunocompromised children with cancer. Rays 1994; 19:424-34. [PMID: 7871219] [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: 01/27/2023]
Affiliation(s)
- R Mastrangelo
- Istituto di Clinica Pediatrica, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy
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46
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Affiliation(s)
- A Tornesello
- Division of Oncology, Universitá Cattolica del Sacro Cuore, Policlinico Agostino Gemelli, Rome, Italy
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47
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Zuppa AA, Vento G, Tornesello A, Papacci P, Micanti M, Coviello C, Palusci A, Mazzotta M, Fundarò C, Romagnoli C. [Current validity of the exchange transfusion intervention by the classic indication. Our 15 years' experience]. Minerva Pediatr 1990; 42:135-41. [PMID: 2115969] [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: 12/30/2022]
Abstract
In this paper the Authors report their personal experience of the use of exchange transfusion, secondary to classic indication, in the treatment of neonatal hyperbilirubinemia, in order to: 1) determine the trend over the past wears in the number of exchange transfused neonates, both from a global point of view and in relation to indications; 2) critically assess the risks, in terms of complications and mortality, correlated to exchange transfusion. Four hundred and eighty-eight neonates, who were subjected to 693 exchange transfusions in the Pediatric Clinic and Neonatal Division of the Policlinico Gemelli in Roma, were studied over a period of 15 years (1972-1986), according to the following indications: 214 cases of neonatal hyperbilirubinemia with MEN-Rh, 106 cases of neonatal hyperbilirubinemia with MEN-ABO and 168 cases of idiopathic hyperbilirubinemia. The total number of exchange transfused neonates decreased drastically from 304 in the period 1972-76 to 65 in the period 1982-86. The frequency of exchange transfused neonates because of idiopathic hyperbilirubinemia decreased significantly (p greater than 0.001), booth in comparison to the number of live births and in comparison to the number of exchange transfused neonates, probably due to the gradual introduction of phototherapy. The frequency of exchange transfused neonates with iso-Rh and iso-ABO decreased or remained stationary on account of the confirmed relative lesser efficacy of phototherapy on hemolytic jaundice. With regard to mortality and morbidity, 27 out of 488 neonates died during the neonatal period, but only 4 within six hours of exchange transfusion; the majority of those who died had a reduced gestational age and low birthweight, and were affected by a severe associated pathology.
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Affiliation(s)
- A A Zuppa
- Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, Roma
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48
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Zuppa AA, Tornesello A, Papacci P, Tortorolo G, Segni G, Lafuenti G, Moneta E, Diodato A, Sorcini M, Carta S. Relationship between maternal parity, basal prolactin levels and neonatal breast milk intake. Biol Neonate 1988; 53:144-7. [PMID: 3370259 DOI: 10.1159/000242775] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Basal serum levels of prolactin (PRL) in 21 nursing mothers were measured by radioimmunoassay on the 2nd, 3rd and 4th days of the puerperium. The quantity of breast milk suckled during the 4th day of life was also evaluated by calculating the difference in the baby's weight before and after each feeding. During the first postpartum days, mean basal levels of PRL did not change. However these levels were noted to be significantly lower in the multiparas (p less than 0.05) than in the primiparas. In addition, the milk intake in neonates of multiparous mothers was significantly greater (p less than 0.05) than that in neonates of primiparous mothers. The author's hypothesis, based on the results of animal experimentation described in the literature, is that initiation of breast-feeding is facilitated in multiparas by the increased number of occupied PRL receptors in the mammary glands reflected by the lowered serum levels of the hormone.
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Affiliation(s)
- A A Zuppa
- Department of Pediatrics-Neonatology, Catholic University of Sacred Heart, Rome, Italy
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49
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Zuppa AA, Papacci P, Tornesello A, Pisa B, Perrone PA, Romagnoli C, Tortorolo G. [Type of nutrition and growth in the low weight newborn infant]. Minerva Pediatr 1987; 39:437-43. [PMID: 3657735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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50
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Zuppa AA, Perrone PA, Castorina M, Tornesello A, Papacci P, Ceschin F, Luisa-Vissat G. [Type of diet and "ambulatory" pathology in the first 6 months of life]. Pediatr Med Chir 1987; 9:63-8. [PMID: 3628054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This work is a contribution to the investigation that mainly in the last year have been widely performed to evaluate the protecting action of breast feeding against some typical pathological occurrences in the first months of life. Authors studied, for six months, 117 babies. The respiratory and intestinal illness have been found (in progress or anamnestically) during pediatric monthly or occasionally visits. 33% of the babies were fed with milk formula since the first life months; the remainder 67% were breastfed during one month at least. By statistic correlation of type of feeding and disease frequency, there is evidence of the following: 1) Babies, breastfed during 6 months, have lower frequency of respiratory pathology, when compared (p 0.05) with 6 months bottle fed ones. 2) Babies, breastfed during 2 months have lower frequency of intestinal pathology when compared (p 0.05) with bottle fed ones. Therefore, it seems that the most interesting results coming out from this study is that the protective action of breast feeding concerns not only the intestinal disease, but the respiratory ones too, when, however, the breast feeding period is enough extended.
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