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Juan-Ribelles A, Bautista F, Cañete A, Rubio-San-Simón A, Alonso-Saladrigues A, Hladun R, Rives S, Dapena JL, Fernández JM, Lassaletta Á, Cruz O, Ramírez-Villar G, Fuster JL, de Heredia CD, García-Ariza M, Quiroga E, Del Mar Andrés M, Verdú-Amorós J, Molinés A, Herrero B, López M, Márquez C, Toboso M, Lendínez F, Sirvent JG, Tallón M, Rodríguez G, Acha T, Moreno L, Fernández-Teijeiro A. ECLIM-SEHOP: how to develop a platform to conduct academic trials for childhood cancer. Clin Transl Oncol 2024:10.1007/s12094-024-03445-0. [PMID: 38600340 DOI: 10.1007/s12094-024-03445-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION ECLIM-SEHOP platform was created in 2017. Its main objective is to establish the infrastructure to allow Spanish participation into international academic collaborative clinical trials, observational studies, and registries in pediatric oncology. The aim of this manuscript is to describe the activity conducted by ECLIM-SEHOP since its creation. METHODS The platform's database was queried to provide an overview of the studies integrally and partially supported by the organization. Data on trial recruitment and set-up/conduct metrics since its creation until November 2023 were extracted. RESULTS ECLIM-SEHOP has supported 47 studies: 29 clinical trials and 18 observational studies/registries that have recruited a total of 5250 patients. Integral support has been given to 25 studies: 16 trials recruiting 584 patients and nine observational studies/registries recruiting 278 patients. The trials include front-line studies for leukemia, lymphoma, brain and solid extracranial tumors, and other key transversal topics such as off-label use of targeted therapies and survivorship. The mean time from regulatory authority submission to first patient recruited was 12.2 months and from first international site open to first Spanish site open was 31.3 months. DISCUSSION ECLIM-SEHOP platform has remarkably improved the availability and accessibility of international academic clinical trials and has facilitated the centralization of resources in childhood cancer treatment. Despite the progressive improvement on clinical trial set-up metrics, timings should still be improved. The program has contributed to leveling survival rates in Spain with those of other European countries that presented major differences in the past.
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Affiliation(s)
- Antonio Juan-Ribelles
- Pediatric Oncology and Hematology Unit, Hospital Universitari y Politécnic La Fe, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | | | - Adela Cañete
- Pediatric Oncology and Hematology Unit, Hospital Universitari y Politécnic La Fe, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Alba Rubio-San-Simón
- Pediatric Oncology, Hematology and Stem Cell Transplant Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Anna Alonso-Saladrigues
- Pediatric Cancer Center Barcelona (PCCB), Hospital Sant Joan de Déu, Institut de Recerca San Joan de Déu (IRSJD), Barcelona, Spain
| | - Raquel Hladun
- Division of Pediatric Hematology and Oncology, Vall d'Hebron Comprehensive Cancer Center, Hospital Universitari Vall d'Hebrón, Passeig Vall d'Hebron 119, 08172, Barcelona, Spain
| | - Susana Rives
- Pediatric Cancer Center Barcelona (PCCB), Hospital Sant Joan de Déu, Institut de Recerca San Joan de Déu (IRSJD), Barcelona, Spain
| | - Jose Luís Dapena
- Pediatric Cancer Center Barcelona (PCCB), Hospital Sant Joan de Déu, Institut de Recerca San Joan de Déu (IRSJD), Barcelona, Spain
| | - Jose María Fernández
- Pediatric Oncology and Hematology Unit, Hospital Universitari y Politécnic La Fe, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Álvaro Lassaletta
- Pediatric Oncology, Hematology and Stem Cell Transplant Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ofelia Cruz
- Pediatric Cancer Center Barcelona (PCCB), Hospital Sant Joan de Déu, Institut de Recerca San Joan de Déu (IRSJD), Barcelona, Spain
| | - Gemma Ramírez-Villar
- Department of Pediatric Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Jose Luís Fuster
- Hospital Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Cristina Diaz de Heredia
- Division of Pediatric Hematology and Oncology, Vall d'Hebron Comprehensive Cancer Center, Hospital Universitari Vall d'Hebrón, Passeig Vall d'Hebron 119, 08172, Barcelona, Spain
| | - Miguel García-Ariza
- Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, Spain
| | - Eduardo Quiroga
- Department of Pediatric Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - María Del Mar Andrés
- Pediatric Oncology and Hematology Unit, Hospital Universitari y Politécnic La Fe, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Jaime Verdú-Amorós
- INCLIVA - Biomedical Research Institute, Hospital Clínico Universitario, Valencia, Spain
| | - Antonio Molinés
- Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Blanca Herrero
- Pediatric Oncology, Hematology and Stem Cell Transplant Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Mónica López
- Hematology Department, University Hospital Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Catalina Márquez
- Department of Pediatric Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - María Toboso
- Pediatric Oncology and Hematology Unit, Hospital Universitari y Politécnic La Fe, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Frencisco Lendínez
- Unidad de Oncohematologia Pediatrica. Hospital Infantil Universitario Torrecárdenas, Almeria, Spain
| | - Jose Gómez Sirvent
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Guiomar Rodríguez
- Sofpromed, CRO para ensayos clínicos en España, Palma de Mallorca, Spain
| | - Tomás Acha
- Unidad de Oncología Pediátrica, Hospital Materno-Infantil Carlos Haya, Málaga, Spain
| | - Lucas Moreno
- Division of Pediatric Hematology and Oncology, Vall d'Hebron Comprehensive Cancer Center, Hospital Universitari Vall d'Hebrón, Passeig Vall d'Hebron 119, 08172, Barcelona, Spain.
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Molinos-Quintana Á, Alonso-Saladrigues A, Herrero B, Caballero-Velázquez T, Galán-Gómez V, Panesso M, Torrebadell M, Delgado-Serrano J, Pérez de Soto C, Faura A, González-Martínez B, Castillo-Robleda A, Diaz-de-Heredia C, Pérez-Martínez A, Pérez-Hurtado JM, Rives S, Pérez-Simón JA. Corrigendum: Impact of disease burden and late loss of B cell aplasia on the risk of relapse after CD19 chimeric antigen receptor T Cell (Tisagenlecleucel) infusion in pediatric and young adult patients with relapse/refractory acute lymphoblastic leukemia: role of B-cell monitoring. Front Immunol 2024; 15:1373852. [PMID: 38384474 PMCID: PMC10880015 DOI: 10.3389/fimmu.2024.1373852] [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: 01/20/2024] [Accepted: 01/25/2024] [Indexed: 02/23/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2023.1280580.].
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Affiliation(s)
- Águeda Molinos-Quintana
- Pediatric Unit, Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Anna Alonso-Saladrigues
- CAR T-cell Unit. Leukemia and Lymphoma Department. Pediatric Cancer Center Barcelona (PCCB). Hospital Sant Joan de Déu de Barcelona, Barcelona, Spain
| | - Blanca Herrero
- Pediatric Hemato-Oncology Department, Peditric University Hospital del Niño Jesús, Madrid, Spain
| | - Teresa Caballero-Velázquez
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Víctor Galán-Gómez
- Pediatric Hemato-Oncology Department, University Hospital La Paz, Institute for Health Research (IdiPAZ), Universidad Autónoma de Madrid, Madrid, Spain
| | - Melissa Panesso
- Division of Pediatric Hematology and Oncology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | - Montserrat Torrebadell
- CAR T-cell Unit. Leukemia and Lymphoma Department. Pediatric Cancer Center Barcelona (PCCB). Hospital Sant Joan de Déu de Barcelona, Barcelona, Spain
| | - Javier Delgado-Serrano
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Concepción Pérez de Soto
- Pediatric Unit, Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Anna Faura
- CAR T-cell Unit. Leukemia and Lymphoma Department. Pediatric Cancer Center Barcelona (PCCB). Hospital Sant Joan de Déu de Barcelona, Barcelona, Spain
| | - Berta González-Martínez
- Pediatric Hemato-Oncology Department, University Hospital La Paz, Institute for Health Research (IdiPAZ), Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Castillo-Robleda
- Pediatric Hemato-Oncology Department, Peditric University Hospital del Niño Jesús, Madrid, Spain
| | - Cristina Diaz-de-Heredia
- Division of Pediatric Hematology and Oncology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | - Antonio Pérez-Martínez
- Pediatric Hemato-Oncology Department, University Hospital La Paz, Institute for Health Research (IdiPAZ), Universidad Autónoma de Madrid, Madrid, Spain
| | - José María Pérez-Hurtado
- Pediatric Unit, Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Susana Rives
- Pediatric Cancer Center Barcelona (PCCB), Institut de Recerca Sant Joan de Déu, Leukemia and Pediatric Hematology Disorders, Developmental Tumors Biology Group, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red De Enfermedades Raras (CIBERER), Madrid, Spain
| | - José Antonio Pérez-Simón
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
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Molinos-Quintana Á, Alonso-Saladrigues A, Herrero B, Caballero-Velázquez T, Galán-Gómez V, Panesso M, Torrebadell M, Delgado-Serrano J, Pérez de Soto C, Faura A, González-Martínez B, Castillo-Robleda A, Diaz-de-Heredia C, Pérez-Martínez A, Pérez-Hurtado JM, Rives S, Pérez-Simón JA. Impact of disease burden and late loss of B cell aplasia on the risk of relapse after CD19 chimeric antigen receptor T Cell (Tisagenlecleucel) infusion in pediatric and young adult patients with relapse/refractory acute lymphoblastic leukemia: role of B-cell monitoring. Front Immunol 2024; 14:1280580. [PMID: 38292483 PMCID: PMC10825008 DOI: 10.3389/fimmu.2023.1280580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Loss of B-cell aplasia (BCA) is a well-known marker of functional loss of CD19 CAR-T. Most relapses and loss of BCA occur in the first months after CD19 CAR-T infusion. In addition, high tumor burden (HTB) has shown to have a strong impact on relapse, especially in CD19-negative. However, little is known about the impact of late loss of BCA or the relationship between BCA and pre-infusion tumor burden in patients infused with tisagenlecleucel for relapsed/refractory B-cell acute lymphoblastic leukemia. Therefore, the optimal management of patients with loss of BCA is yet to be defined. Methods We conducted a Spanish, multicentre, retrospective study in patients infused with tisagenlecleucel after marketing authorization. A total of 73 consecutively treated patients were evaluated. Results Prior to infusion, 39 patients had HTB (≥ 5% bone marrow blasts) whereas 34 had a low tumor burden (LTB) (<5% blasts). Complete remission was achieved in 90.4% of patients, of whom 59% relapsed. HTB was associated with inferior outcomes, with a 12-month EFS of 19.3% compared to 67.2% in patients with LTB (p<0.001) with a median follow-up of 13.5 months (95% CI 12.4 - 16.2). In the HTB subgroup relapses were mainly CD19-negative (72%) whereas in the LTB subgroup they were mainly CD19-positive (71%) (p=0.017). In the LTB group, all CD19-positive relapses were preceded by loss of BCA whereas only 57% (4/7) of HTB patients experienced CD19-positive relapse. We found a positive correlation between loss of BCA and CD19-positive relapse (R-squared: 74) which persisted beyond six months post-infusion. We also explored B-cell recovery over time using two different definitions of loss of BCA and found a few discrepancies. Interestingly, transient immature B-cell recovery followed by BCA was observed in two pediatric patients. In conclusion, HTB has an unfavorable impact on EFS and allo-SCT might be considered in all patients with HTB, regardless of BCA. In patients with LTB, loss of BCA preceded all CD19-positive relapses. CD19-positive relapse was also frequent in patients who lost BCA beyond six months post-infusion. Therefore, these patients are still at significant risk for relapse and close MRD monitoring and/or therapeutic interventions should be considered.
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Affiliation(s)
- Águeda Molinos-Quintana
- Pediatric Unit, Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Anna Alonso-Saladrigues
- CAR T-cell Unit. Leukemia and Lymphoma Department. Pediatric Cancer Center Barcelona (PCCB). Hospital Sant Joan de Déu de Barcelona, Barcelona, Spain
| | - Blanca Herrero
- Pediatric Hemato-Oncology Department, Peditric University Hospital del Niño Jesús, Madrid, Spain
| | - Teresa Caballero-Velázquez
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Víctor Galán-Gómez
- Pediatric Hemato-Oncology Department, University Hospital La Paz, Institute for Health Research (IdiPAZ), Universidad Autónoma de Madrid, Madrid, Spain
| | - Melissa Panesso
- Division of Pediatric Hematology and Oncology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | - Montserrat Torrebadell
- CAR T-cell Unit. Leukemia and Lymphoma Department. Pediatric Cancer Center Barcelona (PCCB). Hospital Sant Joan de Déu de Barcelona, Barcelona, Spain
| | - Javier Delgado-Serrano
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Concepción Pérez de Soto
- Pediatric Unit, Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Anna Faura
- CAR T-cell Unit. Leukemia and Lymphoma Department. Pediatric Cancer Center Barcelona (PCCB). Hospital Sant Joan de Déu de Barcelona, Barcelona, Spain
| | - Berta González-Martínez
- Pediatric Hemato-Oncology Department, University Hospital La Paz, Institute for Health Research (IdiPAZ), Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Castillo-Robleda
- Pediatric Hemato-Oncology Department, Peditric University Hospital del Niño Jesús, Madrid, Spain
| | - Cristina Diaz-de-Heredia
- Division of Pediatric Hematology and Oncology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | - Antonio Pérez-Martínez
- Pediatric Hemato-Oncology Department, University Hospital La Paz, Institute for Health Research (IdiPAZ), Universidad Autónoma de Madrid, Madrid, Spain
| | - José María Pérez-Hurtado
- Pediatric Unit, Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Susana Rives
- Pediatric Cancer Center Barcelona (PCCB), Institut de Recerca Sant Joan de Déu, Leukemia and Pediatric Hematology Disorders, Developmental Tumors Biology Group, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red De Enfermedades Raras (CIBERER), Madrid, Spain
| | - José Antonio Pérez-Simón
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
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Alonso-Cadenas JA, Sancosmed Ron M, Herrero B, Lera Carballo E, Lassaletta A, Rodrigo R, de la Torre M. Role of urine culture in paediatric patients with cancer with fever and neutropenia: a prospective observational study. Arch Dis Child 2023; 108:982-986. [PMID: 37553208 DOI: 10.1136/archdischild-2023-325992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To evaluate the need for routine urine studies in children with febrile neutropenia with cancer. DESIGN A prospective, observational study was conducted in two hospitals between November 2019 and October 2021. PATIENTS We recruited 205 patients in total. MAIN OUTCOME MEASURES The primary outcome was presence of positive urine culture (UC). Urinary tract infection (UTI) was defined as urinary signs/symptoms and positive UC with or without pyuria. A descriptive analysis of data is provided.We conducted a prospective study of paediatric patients with cancer with urinary continence. Data were analysed using descriptive statistics. The diagnostic performance of urinalysis was calculated using positive UC as the gold standard. RESULTS Positive UC was found in 7 of the 205 patients (3.4%; 95% CI 1.4% to 6.9%), 2 presenting urinary symptoms. UTI prevalence was 1.0% (95% CI 0.1% to 3.5%). A 23.8% prevalence of positive UC was found in patients with urinary symptoms and/or history of urinary tract disease (95% CI 8.2% to 47.2%) as compared with 1.1% of those without symptoms or history (95% CI 0.1% to 3.9%) (p<0.001). The sensitivity, specificity, negative predictive value, and area under the curve for urinalysis were 16.7% (95% CI 3.0% to 56.4%), 98.4% (95% CI 95.3% to 99.4%), 97.3% (95% CI 93.9% to 98.9%), and 0.65 (95% CI 0.51 to 0.79), respectively. CONCLUSIONS UTI is an infrequent cause of infection in these patients. Urinalysis is indicated only in children with febrile neutropenia with urinary signs/symptoms and in asymptomatic patients with a history of urinary tract disease or unknown history. When urine is collected, UC should be requested regardless of the result of the urinalysis.
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Affiliation(s)
- Jose Antonio Alonso-Cadenas
- Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital La Princesa, Madrid, Spain
| | | | - Blanca Herrero
- Paediatric Oncology Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | | | - Alvaro Lassaletta
- Pediatric Neuro-oncology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Rocio Rodrigo
- Paediatric Emergency Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Mercedes de la Torre
- Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital La Princesa, Madrid, Spain
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Sánchez-Bayona R, Alva M, López de sa A, Gilarranz YJ, Sánchez de torre A, Tolosa P, de luna A, López-Tarruella S, Lema L, Moreno F, Echavarria I, Madariaga A, Benítez J, Herrero B, Rey M, Ortega J, Gámez S, Modrego A, Lozano RM, Figuero-Pérez L, Jiménez R, Sevilla MG, González I, Beranek MB, de toro M, Massarrah T, del Monte-Millán M, Pinardo M, Manso L, Bueno-Muiño C, García-Sáenz JÁ, Martín M, Ciruelos E. Abstract P3-01-04: A real-world evidence study of everolimus plus endocrine therapy beyond CDK4/6 inhibitors for HR+/HER2- advanced breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p3-01-04] [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: 03/06/2023]
Abstract
Abstract
Introduction Since the approval a decade ago of everolimus in combination with endocrine therapy (ET), the treatment landscape of metastatic breast cancer (mBC) has changed dramatically. Endocrine monotherapy after progression to CDK4/6 inhibitors has shown a limited progression-free survival (PFS) below 3 months. Evidence of the efficacy of everolimus plus ET after CDK4/6 inhibitors is scarce. Methods We performed a retrospective observational study of patients with mBC treated with everolimus between September 2011 and April 2022 in 4 Spanish hospitals. Clinical and demographic data were collected from medical records. Our main objective was to estimate the median progression-free survival (mPFS) for everolimus + ET in patients previously treated with a CDK4/6 inhibitor. We also collected the adverse events (AE) related to everolimus. Quantitative variables were summarized with medians (range), and qualitative variables with proportions. We used the Kaplan-Meier method for survival estimates. Results We identified a total of 297 mBC patients treated with everolimus plus ET. The median follow-up time was 20 months (interquartile range: 1 – 97 months). In this cohort, the median age at diagnosis was 49 years (26 – 84 years). At the moment of starting everolimus, the median number of previous lines of treatment was 2 (0 – 12), 22% of patients were ‘de novo’ metastatic, 67% presented visceral involvement, 40% had received previous chemotherapy for advanced disease, and 51% (n=152) had received a previous CDK4/6 inhibitor. The ET combined with everolimus was exemestane (77%), fulvestrant (18%), and tamoxifen (5%). 45% of patients were alive at data cut-off. In patients previously treated with a CDK4/6 inhibitor, the estimated median PFS (mPFS) was 5.9 months (95%CI: 5.0 – 7.8 months). In patients without visceral involvement (n=52), mPFS was 7.2 months (95%CI: 5.5 – 11.0 months), and 5.6 months (95%CI: 3.9 – 7.8 months) in the presence of visceral metastasis (n=100). In patients without previous chemotherapy in the metastatic setting (n=109), mPFS was 7.2 months (95%CI: 5.9 – 8.4 months), and 4.6 months (95%CI: 3.1 – 5.7 months) for patients who had received previous chemotherapy (n=43). For patients without a previous CDK4/6 inhibitor (n=145), the median PFS was 8.3 months (95%CI: 6.4 – 10.3 months). Everolimus starting doses were 10 mg (83%), 5 mg (15%), and 7.5 mg (2%). Dexamethasone mouthwash was used by 44% of patients. The most frequent AE were mucositis (51%; 3% grade 3), anemia (41%; 3% grade 3), hyperglycemia (34%; 2% grade 3), rash (28%; 2% grade 3), neumonitis (21%; 2% grade 3), and diarrhea (17%; 1% grade 3). There were no grade 4-5 adverse events. Dose reduction was made in 35% of patients, and in 16% of patients the treatment was discontinued due to toxicity. Conclusions In our cohort, the use of everolimus plus ET in mBC patients previously treated with a CDK4/6 inhibitor showed a clinically significant benefit in terms of PFS, especially in patients without visceral metastasis, and no previous chemotherapy for advanced disease. In this real-world study, the toxicity profile of everolimus was manageable.
Citation Format: Rodrigo Sánchez-Bayona, Manuel Alva, Alfonso López de sa, Yolanda Jerez Gilarranz, Ana Sánchez de torre, Pablo Tolosa, Alicia de luna, Sara López-Tarruella, Laura Lema, Fernando Moreno, Isabel Echavarria, Ainhoa Madariaga, Javier Benítez, Blanca Herrero, Macarena Rey, Justo Ortega, Salvador Gámez, Andrea Modrego, Rocío Martín Lozano, Luis Figuero-Pérez, Roberto Jiménez, Marta González Sevilla, Irene González, Marianela Bringas Beranek, María de toro, Tatiana Massarrah, María del Monte-Millán, Marina Pinardo, Luis Manso, Coralia Bueno-Muiño, José Ángel García-Sáenz, Miguel Martín, Eva Ciruelos. A real-world evidence study of everolimus plus endocrine therapy beyond CDK4/6 inhibitors for HR+/HER2- advanced breast cancer. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-01-04.
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Affiliation(s)
- Rodrigo Sánchez-Bayona
- 1Medical Oncology Department, Hospital 12 de Octubre, Madrid. SOLTI Cancer Research Group, Barcelona, Spain
| | - Manuel Alva
- 2Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | - Pablo Tolosa
- 6SOLTI Cancer Research Group, Barcelona, Spain/Medical Oncology Department, Hospital 12 de Octubre, Madrid, Madrid, Spain
| | | | - Sara López-Tarruella
- 8Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Laura Lema
- 9Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | - Isabel Echavarria
- 11Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio M2arañón, CiberOnc, Madrid, Spain
| | | | | | - Blanca Herrero
- 14Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | - Salvador Gámez
- 17Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Rocío Martín Lozano
- 19Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid
| | - Luis Figuero-Pérez
- 20Medical Oncology Department, Complejo Asistencial Universitario de Salamanca, Castilla y Leon, Spain
| | - Roberto Jiménez
- 21Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Irene González
- 23Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - María de toro
- 25Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Tatiana Massarrah
- 26Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - María del Monte-Millán
- 27Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Marina Pinardo
- 28Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Luis Manso
- 29Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Coralia Bueno-Muiño
- 30Medical Oncology Department, Hospital Infanta Cristina (Parla), Fundación de Investigación Biomédica del H.U. Puerta de Hierro, Majadahonda, 28009 Madrid, spail, Spain
| | | | - Miguel Martín
- 32Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eva Ciruelos
- 33SOLTI Breast Cancer Research Group, Barcelona, Spain/Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
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6
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Bueno-Muiño C, Echavarria I, López-Tarruella S, Marta RM, del Monte-Millán M, Massarrah T, Gilarranz YJ, Herrero B, Gámez S, Márquez-Rodas I, Cebollero-Presmanes M, Manuel NS, de la Morena Barrio P, de la Peña FA, García-Sáenz JÁ, Antón FM, Rodríguez Lescure Á, Quintanar T, Malón-Giménez D, Rodriguez-Lajusticia L, García AIB, Torres DB, Villarejo L, Lobato N, Arias A, Ocaña I, Álvarez E, Paré L, Marín-Aguilera M, Galván P, Brasó-Maristany F, Vivancos A, Villagrasa P, Parker JS, Perou CM, Prat A, Martín M. Abstract P6-01-46: Independent validation of the HER2DX genomic test in HER2-positive breast cancer treated with neoadjuvant docetaxel, carboplatin, trastuzumab +/- pertuzumab (TCH/TCHP): a correlative analysis from a multicenter academic study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-01-46] [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: 03/06/2023]
Abstract
Abstract
Background: HER2DX (Prat et al. EBiomedicine 2022) is a 27-gene prognostic (risk-score) and predictive (pathological complete response [pCR]-score) assay in early-stage HER2+ breast cancer based on clinical data and the expression of 4 gene signatures (immune, proliferation, luminal differentiation and HER2 amplicon). Here, we aim to evaluate, for the first time, the ability of HER2DX to predict pCR following neoadjuvant TCH or TCHP in HER2+ disease. Methods: Standardized HER2DX was performed in a central lab on baseline pre-treatment FFPE tumor biopsies from the GOM-HGUGM-2018-05 study in Spain, a consecutive retrospective series of patients (pts) with newly diagnosed stage I-III HER2+ breast cancer eligible for neoadjuvant therapy. Pts received standard 6 cycles of docetaxel, carboplatin and trastuzumab (TCH) or TCH with pertuzumab (TCHP) regimens. Primary aim was to test the ability of HER2DX pCR score to predict pCR (ypT0/is ypN0). Secondary objectives were to test the ability of HER2DX pCR score to predict pCR independently of clinical-pathological variables and the PAM50 subtype (HER2-enriched versus not), and to evaluate the association of HER2DX pCR score with the HER2DX risk-score. Logistic regression and receiver-operator curve (ROC) analysis were assessed. Statistical analyses were performed in R code 4.0.5. Results: HER2DX was evaluated in 155 pts (97%) enrolled in the study with available RNA (as of June 2022). Mean age of pts was 50 (range 22-74) and 55.2% of pts (n=85) were pre-menopausal. Clinical T2-4 disease represented 77.4% of cases (n=120), clinical node-positive disease (cN1-3) represented 63.9% of cases (n=99), and 68.0% of tumors (n=105) were hormone receptor-positive. The overall pCR rate was 57.4% (95% confidence interval [CI] 50-65): 52.2% (95% CI 40-64) with TCH (n=67) and 61.4% (95% CI 50-72) with TCHP (n=88). The proportion of HER2DX low-, medium- and high-pCR groups was 34.2%, 34.8% and 31.0%, respectively. HER2DX pCR score (as a continuous variable from 0 to 100) was significantly associated with pCR (odd ratio [OR]=1.03, p=5.91e-07). The pCR rates in HER2DX pCR-high and pCR-low groups were 75.0% and 28.0% (OR=7.6, 95% CI 3.2-19.1, p=7.14e-06), respectively. In pts treated with TCHP, the pCR rates in HER2DX pCR-high and pCR-low groups were 85.7% and 27.3% (OR=16.0, 95% CI 4.3-59.01, p=3.2e-05), respectively. The AUC ROC of HER2DX pCR score (as a continuous variable) and pCR status was 0.746 (in all pts) and 0.812 (in pts treated with TCHP). HER2DX pCR score was significantly associated with pCR independently of hormone receptor status, Ki67, age, menopausal status, pertuzumab use, clinical stage and PAM50 HER2-enriched subtype. The proportion of HER2DX low- and high-risk of relapse disease was 32.0% and 68.0%, respectively. The correlation of HER2DX pCR score and HER2DX risk-score was weak (coefficient=-0.17), as previously described. Proportion of cases according to both HER2DX scores and absolute difference of pCR rates between TCHP and TCH in each combined group is shown in Table. Conclusion: The HER2DX genomic test predicts pCR following neoadjuvant TCH or TCHP regimens independently of clinical-pathological variables and intrinsic subtype. The combination of both HER2DX scores might help better tailor systemic therapy in patients with newly diagnosed stage I-III HER2+ breast cancer.
Citation Format: Coralia Bueno-Muiño, Isabel Echavarria, Sara López-Tarruella, Roche-Molina Marta, María del Monte-Millán, Tatiana Massarrah, Yolanda Jerez Gilarranz, Blanca Herrero, Salvador Gámez, Iván Márquez-Rodas, María Cebollero-Presmanes, Nevado Santos Manuel, Pilar de la Morena Barrio, Francisco Ayala de la Peña, José Ángel García-Sáenz, Fernando Moreno Antón, Álvaro Rodríguez Lescure, Teresa Quintanar, Diego Malón-Giménez, Laura Rodriguez-Lajusticia, Ana Isabel Ballesteros García, Dulce Bañón Torres, Lucía Villarejo, Nerea Lobato, Ainhoa Arias, Inmaculada Ocaña, Enrique Álvarez, Laia Paré, Mercedes Marín-Aguilera, Patricia Galván, Fara Brasó-Maristany, Ana Vivancos, Patricia Villagrasa, Joel S Parker, Charles M. Perou, Aleix Prat, Miguel Martín. Independent validation of the HER2DX genomic test in HER2-positive breast cancer treated with neoadjuvant docetaxel, carboplatin, trastuzumab +/- pertuzumab (TCH/TCHP): a correlative analysis from a multicenter academic study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-01-46.
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Affiliation(s)
- Coralia Bueno-Muiño
- 1Medical Oncology Department, Hospital Infanta Cristina (Parla), Fundación de Investigación Biomédica del H.U. Puerta de Hierro, Majadahonda, 28009 Madrid, spail, Madrid, Spain
| | - Isabel Echavarria
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Sara López-Tarruella
- 3Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain, Madrid, Spain
| | - Roche-Molina Marta
- 4Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - María del Monte-Millán
- 5Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain, Madrid, Spain
| | - Tatiana Massarrah
- 6Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain, Madrid, Spain
| | | | - Blanca Herrero
- 8Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - Salvador Gámez
- 9Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - Iván Márquez-Rodas
- 10Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain, Madrid, Spain
| | | | - Nevado Santos Manuel
- 12Pathology Service, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain, Madrid, Spain
| | - Pilar de la Morena Barrio
- 13Hematology and Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain., Murcia, Spain
| | - Francisco Ayala de la Peña
- 14Hematology and Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain., Murcia, Spain
| | | | - Fernando Moreno Antón
- 16Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), CIBERONC, Madrid, Spain, Madrid, Spain
| | | | - Teresa Quintanar
- 18Medical Oncology Department, General Universitario de Elche, Alicante, Spain., Andalucia, Spain
| | | | | | | | - Dulce Bañón Torres
- 22Department of Medical Oncology, Hospital Universitario de La Princesa, Madrid, Spain, Madrid, Spain
| | - Lucía Villarejo
- 23Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - Nerea Lobato
- 24Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - Ainhoa Arias
- 25Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - Inmaculada Ocaña
- 26Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | - Enrique Álvarez
- 27Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Madrid, Spain
| | | | | | - Patricia Galván
- 30Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain, Catalonia, Spain
| | - Fara Brasó-Maristany
- 31Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS)
| | - Ana Vivancos
- 32Cancer Genomics Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain., Barcelona, Spain
| | | | - Joel S Parker
- 34Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Charles M. Perou
- 35Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Miguel Martín
- 37Hospital General Universitario Gregorio Marañón, Madrid, Spain, Spain
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7
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Ghorashian S, Jacoby E, De Moerloose B, Rives S, Bonney D, Shenton G, Bader P, Bodmer N, Quintana AM, Herrero B, Algeri M, Locatelli F, Vettenranta K, Gonzalez B, Attarbaschi A, Harris S, Bourquin JP, Baruchel A. Tisagenlecleucel therapy for relapsed or refractory B-cell acute lymphoblastic leukaemia in infants and children younger than 3 years of age at screening: an international, multicentre, retrospective cohort study. Lancet Haematol 2022; 9:e766-e775. [PMID: 36084658 DOI: 10.1016/s2352-3026(22)00225-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Children aged younger than 3 years were excluded from the ELIANA phase 2 trial of tisagenlecleucel in children with acute lymphoblastic leukaemia. The feasibility, safety, and activity of tisagenlecleucel have not been defined in this group, the majority of whom have high-risk (KMT2A-rearranged) infant acute lymphoblastic leukaemia and historically poor outcomes despite intensification of chemotherapy, and for whom novel therapies are urgently needed. We aimed to provide real-world outcome analysis of the feasibility, activity, and safety of tisagenlecleucel in younger children and infants with acute lymphoblastic leukaemia. METHODS We did an international, multicentre, retrospective cohort study at 15 hospitals across ten countries in Europe. Eligible patients were children aged younger than 3 years at screening between Sept 1, 2018, and Sept 1, 2021, who were screened for tisagenlecleucel therapy for relapsed or refractory B-cell precursor acute lymphoblastic leukaemia according to licensed indications. Patients received a single intravenous infusion of tisagenlecleucel. We tracked chimeric antigen receptor T-cell therapy outcomes using a standardised data reporting form. Overall survival, event-free survival, stringent event-free survival, B-cell aplasia, and toxicity were assessed in all patients who received a tisagenlecleucel infusion. FINDINGS 38 eligible patients were screened, of whom 35 (92%) received a tisagenlecleucel infusion. 29 (76%) of 38 patients had KMT2A-rearranged acute lymphoblastic leukaemia, and 25 (66%) had relapsed after previous allogeneic haematopoietic stem-cell transplantation (HSCT). Patients had previously received a median of 2 lines (IQR 2-3) of (non-HSCT) therapy. Seven (18%) of 38 patients had received inotuzumab and 14 (37%) had received blinatumomab. After a median of 14 months (IQR 9-21) of follow-up, overall survival at 12 months after tisagenlecleucel infusion was 84% (64-93; five patients had died), event-free survival was 69% (47-83; nine events), and stringent event-free survival was 41% (23-58; 18 events). The probability of ongoing B-cell aplasia was 70% (95% CI 46-84; seven events) at 12 months. Adverse events included cytokine release syndrome, which occurred at any grade in 21 (60%) of 35 patients and at grade 3 or worse in five (14%), and neurotoxicity at any grade in nine (26%), none of which were severe. Measurable residual disease-negative complete response with or without haematological recovery occurred in 24 (86%) of 28 patients who had measurable disease. INTERPRETATION These data suggest that tisagenlecleucel has antitumour activity and has an acceptable safety profile for young children and infants with B-cell precursor acute lymphoblastic leukaemia. FUNDING None.
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Affiliation(s)
- Sara Ghorashian
- Department of Developmental Biology and Cancer, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Elad Jacoby
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Susana Rives
- Department of Haematology and Department of Oncology, Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Denise Bonney
- Department of Haematology and Department of Bone Marrow Transplantation, Royal Manchester Children's Hospital, Manchester, UK
| | - Geoff Shenton
- Department of Haematology and Department of Bone Marrow Transplantation, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Peter Bader
- Division of Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Nicole Bodmer
- Department of Oncology, University Children's Hospital Zürich, Zürich, Switzerland
| | - Agueda Molinos Quintana
- Department of Hematology, Pediatric Hematology Section, University Hospital Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS/CISC), Seville, Spain
| | - Blanca Herrero
- Department of Haematology-Oncology and Stem Cell Transplantation, Pediatric University Hospital Niño Jesús, Madrid, Spain
| | - Mattia Algeri
- Department of Pediatric Haematology/Oncology and Cell and Gene Therapy, IRCCS Ospedale Pediatrico Bambino Gesù, Sapienza University of Rome, Rome, Italy
| | - Franco Locatelli
- Department of Pediatric Haematology/Oncology and Cell and Gene Therapy, IRCCS Ospedale Pediatrico Bambino Gesù, Sapienza University of Rome, Rome, Italy
| | - Kim Vettenranta
- Department of Pediatrics, New Children's Hospital, University of Helsinki, Helsinki, Finland
| | - Berta Gonzalez
- Department of Haematology-Oncology and Stem Cell transplantation, Pediatric University Hospital La Paz, Madrid, Spain
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Stephen Harris
- UCL Institute of Health Informatics, University College London, London, UK
| | - Jean Pierre Bourquin
- Department of Oncology, University Children's Hospital Zürich, Zürich, Switzerland
| | - André Baruchel
- Department of Pediatric Hemato-Immunology, Hôpital Universitaire Robert Debré (APHP and Université Paris Cité), Paris, France.
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del Valle R, Ballesteros Á, Calvo C, Sainz T, Mendez A, Grasa C, Molina PR, Mellado MJ, Sanz‐Santaeufemia FJ, Herrero B, Calleja L, Soriano‐Arandes A, Melendo S, Rincón‐López E, Hernánz A, Epalza C, García‐Baeza C, Rupérez‐García E, Berzosa A, Ocaña A, Villarroya‐Villalba A, Barrios A, Otheo E, Galán JC, Rodríguez MJ, Mesa JM, Domínguez‐Rodríguez S, Moraleda C, Tagarro A. Comparison of pneumonia features in children caused by SARS-CoV-2 and other viral respiratory pathogens. Pediatr Pulmonol 2022; 57:2374-2382. [PMID: 35754093 PMCID: PMC9349806 DOI: 10.1002/ppul.26042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/01/2022] [Accepted: 06/23/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pneumonia is a frequent manifestation of coronavirus disease 2019 (COVID-19) in hospitalized children. METHODS The study involved 80 hospitals in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spanish Pediatric National Cohort. Participants were children <18 years, hospitalized with SARS-CoV-2 community-acquired pneumonia (CAP). We compared the clinical and radiological characteristics of SARS-CoV-2-associated CAP with CAP due to other viral etiologies from ValsDance (retrospective) cohort. RESULTS In total, 151 children with SARS-CoV-2-associated CAP and 138 with other viral CAP were included. Main clinical features of SARS-CoV-2-associated CAP were cough, fever, or dyspnea. Lymphopenia was found in 43% patients and 15% required admission to the pediatric intensive care unit (PICU). Chest X-ray revealed condensation (42%) and other infiltrates (58%). Compared with CAP from other viral pathogens, COVID-19 patients were older, with lower C-reactive protein (CRP) levels, less wheezing, and greater need of mechanical ventilation (MV). There were no differences in the use of continuous positive airway pressure (CPAP) or HVF, or PICU admission between groups. CONCLUSION SARS-CoV-2-associated CAP in children presents differently to other virus-associated CAP: children are older and rarely have wheezing or high CRP levels; they need less oxygen but more CPAP or MV. However, several features overlap and differentiating the etiology may be difficult. The overall prognosis is good.
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Affiliation(s)
- Rut del Valle
- Pediatrics Department, Pediatrics Research Group, Hospital Universitario Infanta SofíaUniversidad Europea de MadridMadridSpain
| | - Álvaro Ballesteros
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Cristina Calvo
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Talía Sainz
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
- Research Center, Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC)Instituto de Salud Carlos III, Madrid, SpainMadridSpain
| | - Ana Mendez
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Carlos Grasa
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Paula R. Molina
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - María J. Mellado
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | | | - Blanca Herrero
- Pediatrics DepartmentHospital Universitario Niño JesúsMadridSpain
| | - Lourdes Calleja
- Pediatrics DepartmentHospital Universitario Niño JesúsMadridSpain
| | - Antoni Soriano‐Arandes
- Infectious Diseases and Pediatric Immunology Unit, Department of PediatricsHospital Universitario Vall d'HebronBarcelonaSpain
| | - Susana Melendo
- Infectious Diseases and Pediatric Immunology Unit, Department of PediatricsHospital Universitario Vall d'HebronBarcelonaSpain
| | - Elena Rincón‐López
- Pediatric Infectious Diseases Unit, Department of PediatricsHospital Universitario Gregorio MarañónMadridSpain
| | - Alicia Hernánz
- Pediatric Infectious Diseases Unit, Department of PediatricsHospital Universitario Gregorio MarañónMadridSpain
- Research CenterGregorio Marañón Research Institute (IiSGM)MadridSpain
| | - Cristina Epalza
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
- Pediatric Infectious Diseases Unit, Department of PediatricsHospital Universitario 12 de OctubreMadridSpain
| | - Carmen García‐Baeza
- Pediatric Infectious Diseases Unit, Department of PediatricsHospital Universitario 12 de OctubreMadridSpain
| | | | - Arantxa Berzosa
- Pediatrics DepartmentHospital Universitario Clínico San CarlosMadridSpain
| | - Angustias Ocaña
- Pediatric Intensive Care Unit DepartmentHospital La MoralejaMadridSpain
| | - Alvaro Villarroya‐Villalba
- Pediatric Infectious Diseases Unit, Pediatrics DepartmentHospital Universitari i Politècnic La FeValenciaSpain
| | - Ana Barrios
- Pediatrics Department, Pediatrics Research Group, Hospital Universitario Infanta SofíaUniversidad Europea de MadridMadridSpain
| | - Enrique Otheo
- Pediatrics Department, Hospital Universitario Ramón y CajalUniversidad de Alcalá MadridMadridSpain
| | - Juan C. Galán
- Microbiology Department, Hospital Universitario Ramón y CajalInstituto Ramón y Cajal para la Investigación Sanitaria (IRYCIS)MadridSpain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP)MadridSpain
| | - Mario José Rodríguez
- Microbiology Department, Hospital Universitario Ramón y CajalInstituto Ramón y Cajal para la Investigación Sanitaria (IRYCIS)MadridSpain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP)MadridSpain
| | - Juan M. Mesa
- Pediatrics Department, Pediatrics Research Group, Hospital Universitario Infanta SofíaUniversidad Europea de MadridMadridSpain
| | - Sara Domínguez‐Rodríguez
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Cinta Moraleda
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Alfredo Tagarro
- Pediatrics Department, Pediatrics Research Group, Hospital Universitario Infanta SofíaUniversidad Europea de MadridMadridSpain
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
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9
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Ramia JM, Cabello A, Garijo J, Hernandez-Salvan J, Herrero B, Jover JM, Vaquero MA, Unda A, Jimenez A, Martinez-Meco L, Nicolas S, Sanchez-Cabezudo F, Alvarez E, Torres J. Benefica chirurgia. A global surgery project focusing on hernia surgery. Surgeon 2022; 20:309-313. [PMID: 34483056 DOI: 10.1016/j.surge.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/19/2021] [Accepted: 08/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of international health cooperation projects is to alleviate the deficiencies in the area of health in low resource settings. Hernia surgery is a procedure that is well suited to these missions, due to its low morbidity, the fact that it can be performed on an outpatient basis, and the improvement in quality of life that it provides. OBJECTIVE To describe the results of Benefica Chirurgia (BC), a Spanish non-profit humanitarian association in hernia pathology. METHODS Five one-week surgical campaigns were carried out in Ecuador between 2015 and 2019, involving anesthetists, general and pediatric surgeons. Surgical and medical equipment was provided and transported by BC. ASA I/II patients underwent surgery. RESULTS Surgery was performed on 240 patients with hernia pathology on 27 days. Sixty-three per cent of patients were male and the mean age was 48.2 years (range: 1-83). Hernia location was inguinal in 113 patients, umbilical in 101, and other in 26. The anesthetic technique used was spinal in 185 patients (77.1%), local plus intravenous sedation in 31 (12.9%), and general in 24 (10%). The surgical technique used was hernioplasty in 191 patients, herniorrhaphy in 31, incisional hernia repair in 15 and herniotomy in three. Surgery was performed on an outpatient basis in 98.4% of cases. Morbidity was 2%. Long-term postoperative evaluation is very complex. CONCLUSION These campaigns make a significant contribution to health in low resource settings and provide great personal satisfaction for those involved. Standards achieved in the immediate postoperative period were similar to those obtained at the surgeons' centers in Europe. However, it is difficult to establish the rates of recurrence and chronic pain.
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Affiliation(s)
- J M Ramia
- Department of Surgery, Hospital Universitario de Alicante, ISABIAL, Alicante, Spain.
| | - A Cabello
- Department of Surgery, Hospital Regional Carlos Haya, Malaga, Spain
| | - J Garijo
- Department of Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - J Hernandez-Salvan
- Department of Anesthesia, Hospital Universitario Principes de Asturias, Alcalá de Henares, Spain
| | - B Herrero
- Department of Anesthesia, Hospital Universitario Principes de Asturias, Alcalá de Henares, Spain
| | - J M Jover
- Department of Surgery, Hospital Universitario de Getafe, Getafe, Spain
| | - M A Vaquero
- Department of Anesthesia, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - A Unda
- Department of Surgery, Hospital Regional Carlos Haya, Malaga, Spain
| | - A Jimenez
- Department of Anesthesia, Hospital Universitario Principes de Asturias, Alcalá de Henares, Spain
| | - Laura Martinez-Meco
- Department of Anesthesia, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - S Nicolas
- Department of Surgery, Hospital Regional Carlos Haya, Malaga, Spain
| | - F Sanchez-Cabezudo
- Department of Surgery, Hospital Infanta Sofía, San Sebastian de Los Reyes, Madrid, Spain
| | - E Alvarez
- Department of Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - J Torres
- Department of Surgery, Hospital Infanta Sofía, San Sebastian de Los Reyes, Madrid, Spain; President of Benefica Chirugia, Spain
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10
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Epalza C, Prieto-Tato L, Pino R, Escartín-Paredes P, Leoz I, Grasa C, Vivanco-Allende A, Rivière JG, Carrasco-Colom J, Villate O, Fumadó V, Hermoso-Ibañez C, Herrero B, Aguilera-Alonso D, Tagarro A, Moraleda C. Safety and Acceptance of COVID-19 Vaccination After Multisystem Inflammatory Syndrome in Children (MIS-C) in Spain. J Pediatric Infect Dis Soc 2022; 11:471-473. [PMID: 35904132 PMCID: PMC9384566 DOI: 10.1093/jpids/piac076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In this cohort of 42 adolescents with a previous multisystem inflammatory syndrome (MIS-C) diagnosis, 32 (76.2%) were vaccinated with COVID-19 vaccines, with a low incidence of relevant adverse events. More importantly, no new MIS-C or myocarditis occurred after a median of 10 weeks (range 5.3-19.7) post-vaccination.
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Affiliation(s)
- Cristina Epalza
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain
| | - Luis Prieto-Tato
- Corresponding Author: Luis Prieto-Tato, PhD, Hospital Universitario 12 de Octubre, Servicio de Pediatría, Avenida de Córdoba s/n, 28041 Madrid, Spain. E-mail:
| | - Rosa Pino
- Department of Pediatrics, Hospital Universitario Sant Joan de Deu, Barcelona, Spain
| | - Paula Escartín-Paredes
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Inés Leoz
- Pediatric Intensive Care Unit, Pediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Carlos Grasa
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain,RITIP (Translational Research Network in Pediatric Infectious Diseases), CIBER en Enfermedades Infecciosas (CIBERINFEC) (ISCIII), Madrid, Spain
| | - Ana Vivanco-Allende
- Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Jacques G Rivière
- Infection in Immunocompromised Pediatric Patients Research Group, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Barcelona, Spain,Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain,Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Jaume Carrasco-Colom
- Pediatric Infectious Diseases Unit, Pediatric Department, Hospital Universitario Son Espases, Palma (Illes Balears), Spain
| | - Olatz Villate
- Pediatric Oncology Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Victoria Fumadó
- Pediatric Infectious Diseases Unit, Pediatric Department, Hospital Universitario Sant Joan de Deu, Barcelona, Spain
| | - Concepción Hermoso-Ibañez
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Blanca Herrero
- Pediatric Hemato-Oncology Unit, Pediatric Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - David Aguilera-Alonso
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain,Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiGM), Madrid, Spain,CIBER en Enfermedades Infecciosas (CIBERINFEC) (ISCIII), Madrid, Spain
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11
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Tagarro A, Sanz-Santaeufemia FJ, Grasa C, Cobos E, Yebra J, Alonso-Cadenas JA, Baquero-Artigao F, Mesa-Guzmán JM, Pérez-Seoane B, Calvo C, Herreros ML, Epalza C, Melendo S, Dominguez-Rodriguez S, Vidal P, Pacheco M, Ballesteros A, Bernardino M, Villanueva-Medina S, Rodríguez-Molino P, Miragaya Castro S, Rivière J, Garcés R, Santiago B, Fumadó V, Urretavizcaya-Martínez M, García-García ML, Penín M, Cava F, Sáez E, Iglesias-Bouzas MI, Herrero B, Reinoso TDJ, Moraleda C. Dynamics of Reverse Transcription-Polymerase Chain Reaction and Serologic Test Results in Children with SARS-CoV-2 Infection. J Pediatr 2022; 241:126-132.e3. [PMID: 34571020 PMCID: PMC8463102 DOI: 10.1016/j.jpeds.2021.09.029] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the time to reverse transcription-polymerase chain reaction (RT-PCR) negativity after the first positive RT-PCR test, factors associated with longer time to RT-PCR negativity, proportion of children seroconverting after proven severe acute respiratory syndrome coronavirus 2 infection, and factors associated with the lack of seroconversion. STUDY DESIGN The Epidemiological Study of Coronavirus in Children of the Spanish Society of Pediatrics is a multicenter study conducted in Spanish children to assess the characteristics of coronavirus disease 2019. In a subset of patients, 3 serial RT-PCR tests on nasopharyngeal swab specimens were performed after the first RT-PCR test, and immunoglobulin G serology for severe acute respiratory syndrome coronavirus 2 antibodies was performed in the acute and follow-up (<14 and ≥14 days after diagnosis) phase. RESULTS In total, 324 patients were included in the study. The median time to RT-PCR negativity was 17 days (IQR, 8-29 days), and 35% of patients remained positive more than 4 weeks after the first RT-PCR test. The probability of RT-PCR negativity did not differ across groups defined by sex, disease severity, immunosuppressive drugs, or clinical phenotype. Globally, 24% of children failed to seroconvert after infection. Seroconversion was associated with hospitalization, persistence of RT-PCR positivity, and days of fever. CONCLUSIONS Time to RT-PCR negativity was long, regardless of the severity of symptoms or other patient features. This finding should be considered when interpreting RT-PCR results in a child with symptoms, especially those with mild symptoms. Seroprevalence and postimmunization studies should consider that 11 in 4 infected children fail to seroconvert.
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Affiliation(s)
- Alfredo Tagarro
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain,Pediatrics Research Group, Europea University of Madrid, Madrid, Spain,Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | | | - Carlos Grasa
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Elena Cobos
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Julia Yebra
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | | | - Fernando Baquero-Artigao
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Juan Miguel Mesa-Guzmán
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Beatriz Pérez-Seoane
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Cristina Calvo
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - María Luisa Herreros
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Cristina Epalza
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain,Pediatrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Susana Melendo
- Infectious Diseases and Pediatric Immunology Unit, Department of Pediatrics, Hospital Universitario Vall d’Hebron, Madrid, Spain
| | - Sara Dominguez-Rodriguez
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Paula Vidal
- Pediatrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Aragón, Spain
| | - Mónica Pacheco
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Alvaro Ballesteros
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - María Bernardino
- Pediatrics Research Group, Europea University of Madrid, Madrid, Spain
| | | | - Paula Rodríguez-Molino
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | | | - Jacques Rivière
- Infectious Diseases and Pediatric Immunology Unit, Department of Pediatrics, Hospital Universitario Vall d’Hebron, Madrid, Spain
| | - Rosa Garcés
- Pediatrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Aragón, Spain
| | - Begoña Santiago
- Pediatric Infectious Diseases Unit. Department of Pediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Victoria Fumadó
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario Sant Joan de Deu Barcelona, Barcelona, Spain
| | | | | | - María Penín
- Pediatrics Departament, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Fernando Cava
- Microbiology Department, UR Salud, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Elena Sáez
- Microbiology Department, UR Salud, Hospital Universitario Infanta Sofía, Madrid, Spain
| | | | - Blanca Herrero
- Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Teresa de Jesús Reinoso
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
| | - Cinta Moraleda
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain,Pediatrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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12
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Lopez-Tarruella S, Echavarria I, Jerez Y, Herrero B, Gamez S, Martin M. How we treat HR-positive, HER2-negative early breast cancer. Future Oncol 2022; 18:1003-1022. [PMID: 35094535 DOI: 10.2217/fon-2021-0668] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The present goal of therapy for early hormone receptor-positive (HR+)/human EGF receptor 2-negative (HER2-) BC is to optimize disease-free survival (DFS) and overall survival (OS) rates with the currently available therapies while avoiding any relevant long-term sequalae. Local therapies have evolved toward less aggressive techniques (i.e. breast-preserving surgery, sentinel lymph node biopsy and intraoperative radiotherapy), which significantly reduce the long-term sequalae observed with more radical treatments. Endocrine therapy (ET) is still the cornerstone of adjuvant treatment because it significantly reduces BC relapse and mortality. Adjuvant chemotherapy is today recommended only for a particular subset of patients with a high risk of recurrence with ET alone, identified through genomic assays, age and/or disease stage. Bisphosphonates reduce the risk of bone metastasis and produce a slight although statistically significant improvement in survival in postmenopausal women. The CDK 4/6 inhibitor abemaciclib has been recently approved by the US FDA for patients at high risk of relapse.
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Affiliation(s)
- Sara Lopez-Tarruella
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, CiberOnc, GEICAM, Madrid, 28007, Spain
| | - Isabel Echavarria
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, 28007, Spain
| | - Yolanda Jerez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, CiberOnc, GEICAM, Madrid, 28007, Spain
| | - Blanca Herrero
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, 28007, Spain
| | - Salvador Gamez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, 28007, Spain
| | - Miguel Martin
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, CiberOnc, GEICAM, Madrid, 28007, Spain
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13
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Tagarro A, Cobos-Carrascosa E, Villaverde S, Sanz-Santaeufemia FJ, Grasa C, Soriano-Arandes A, Hernanz A, Navarro ML, Pino R, Epalza C, Batista R, Rizo J, Iglesias-Bouzas MI, Rodríguez-Molino P, Villanueva-Medina S, Carrasco-Colom J, Alonso-Cadenas JA, Mellado MJ, Herrero B, Melendo S, De La Torre M, Calleja L, Calvo C, Urretavizcaya-Martínez M, Astigarraga I, Menasalvas A, Penin M, Neth O, Berzosa A, De Ceano-Vivas M, Vidal P, Romero I, González R, García ML, Mesa JM, Ballesteros Á, Bernardino M, Moraleda C. Clinical spectrum of COVID-19 and risk factors associated with severity in Spanish children. Eur J Pediatr 2022; 181:1105-1115. [PMID: 34738173 PMCID: PMC8568563 DOI: 10.1007/s00431-021-04306-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/06/2021] [Accepted: 10/28/2021] [Indexed: 12/13/2022]
Abstract
We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs). We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-inflammatory syndrome (MIS-C) younger than 18 years old, attended during the first year of the pandemic. We enrolled 1200 children. A total of 666 (55.5%) were hospitalised, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were mild syndrome (including upper respiratory tract infection and flu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma flare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalised children, the proportions were 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were age in months (OR: 1.007; 95% CI 1.004 to 1.01), MIS-C (OR: 14.4, 95% CI 8.9 to 23.8), chronic cardiac disease (OR: 4.8, 95% CI 1.8 to 13), asthma or recurrent wheezing (OR: 2.5, 95% CI 1.2 to 5.2) and after excluding MIS-C patients, moderate/severe liver disease (OR: 8.6, 95% CI 1.6 to 47.6). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma flare.Conclusion: Hospitalised children with COVID-19 usually present as one of five major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of inflammation biomarkers, asthma, moderate or severe liver disease and cardiac disease. What is Known: • All studies suggest that children are less susceptible to serious SARS-CoV-2 infection when compared to adults. Most studies describe symptoms at presentation. However, it remains unclear how these symptoms group together into clinically identifiable syndromes and the severity associated with them. What is New: • We have gathered the primary diagnoses into five major syndromes of decreasing severity: MIS-C, bronchopulmonary syndrome, gastrointestinal syndrome, fever without a source and mild syndrome. Classification of the children in one of the syndromes is unique and helps to assess the risk of critical illness and to define the spectrum of the disease instead of just describing symptoms and signs.
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Affiliation(s)
- Alfredo Tagarro
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain. .,Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain. .,Pediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain.
| | - Elena Cobos-Carrascosa
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
| | - Serena Villaverde
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
| | | | - Carlos Grasa
- grid.81821.320000 0000 8970 9163Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Antoni Soriano-Arandes
- grid.411083.f0000 0001 0675 8654Infectious Diseases and Paediatric Immunology Unit, Department of Paediatrics, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Alicia Hernanz
- grid.410526.40000 0001 0277 7938Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Navarro
- grid.410526.40000 0001 0277 7938Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Rosa Pino
- grid.411160.30000 0001 0663 8628Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu Barcelona, Barcelona, Spain
| | - Cristina Epalza
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain ,grid.144756.50000 0001 1945 5329Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rosa Batista
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - Jana Rizo
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - María-Isabel Iglesias-Bouzas
- grid.411107.20000 0004 1767 5442Paediatric Intensive Care Unit, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Paula Rodríguez-Molino
- grid.81821.320000 0000 8970 9163Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Sara Villanueva-Medina
- grid.144756.50000 0001 1945 5329Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jaime Carrasco-Colom
- grid.144756.50000 0001 1945 5329Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - María-José Mellado
- grid.81821.320000 0000 8970 9163Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Blanca Herrero
- grid.411107.20000 0004 1767 5442Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Susana Melendo
- grid.411083.f0000 0001 0675 8654Infectious Diseases and Paediatric Immunology Unit, Department of Paediatrics, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Mercedes De La Torre
- grid.411107.20000 0004 1767 5442Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Lourdes Calleja
- grid.411107.20000 0004 1767 5442Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Cristina Calvo
- grid.81821.320000 0000 8970 9163Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | | | - Itziar Astigarraga
- Department of Pediatrics, Hospital Universitario Cruces, Biocruces Bizkaia Health Research Institute, University of the Basque Country UPV/EHU, OsakidetzaBarakaldo, Spain
| | - Ana Menasalvas
- grid.411372.20000 0001 0534 3000Paediatrics Department, Hospital Universitario Virgen de La Arrixaca, Murcia, Spain
| | - María Penin
- grid.411336.20000 0004 1765 5855Paediatrics Department, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Olaf Neth
- grid.411109.c0000 0000 9542 1158Paediatrics Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Arantxa Berzosa
- grid.411068.a0000 0001 0671 5785Paediatrics Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - María De Ceano-Vivas
- grid.81821.320000 0000 8970 9163Emergency Pediatrics Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Paula Vidal
- grid.411050.10000 0004 1767 4212Paediatrics Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Isabel Romero
- Paediatrics Department, Hospitales HM, Madrid, Spain
| | - Raúl González
- Paediatrics Department, Hospital Universitario Sant Joan, Comunidad Valenciana, AlacantAlicante, Spain
| | - María Luz García
- grid.411361.00000 0001 0635 4617Paediatrics Department, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Juan-Miguel Mesa
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - Álvaro Ballesteros
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
| | - María Bernardino
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - Cinta Moraleda
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain ,grid.144756.50000 0001 1945 5329Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain
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14
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Gómez-Santos C, González-Vicent M, Molina B, Deltoro N, Herrero B, Ruiz J, Pérez-Martínez A, Diaz MA. Comparison of clinical outcomes between unrelated single umbilical cord blood and "ex-vivo" T-cell depleted haploidentical transplantation in children with hematological malignancies. World J Pediatr 2021; 17:609-618. [PMID: 34590210 DOI: 10.1007/s12519-021-00461-w] [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] [Received: 05/24/2021] [Accepted: 08/31/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Over the last two decades, umbilical cord blood (UCB) and haploidentical transplantation (HaploHSCT) have emerged as alternative sources of hematopoietic stem cell for allogeneic transplantation. There are few retrospective studies and no prospective studies comparing both types of alternative transplantation in pediatric patients. RESULTS We analyzed the data of 134 children with hematological malignancies who received a hematopoietic stem cell transplantation from a single umbilical cord blood (UCB) (n = 42) or an "ex-vivo" T-cell depleted transplant from a haploidentical-related donor (HaploHSCT) (n = 92) between 1996 and 2014. Hematological recovery was faster after HaploHSCT than the UCB transplant group (median times to neutrophil and platelet recovery: 13 vs. 16 days, 10 vs. 57 days, respectively) (P < 0.001). The HaploHSCT group had a significantly early immune reconstitution based on NK and CD8 + T cells compared with the UCB group. However, after the first year post-transplantation, HaploHSCT had a lower number of CD4 + T and B lymphocytes compared with the UCB transplant recipients. The cumulative incidence of TRM was 29±8% in the HaploHSCT group versus 40±5% in the UCB group. Relapse incidence was 21±7% in the HaploHSCT group and 19±8% in the UCB group. Probability of DFS was 58±8% in the HaploHSCT group versus 40±9% in the UCB group (P = 0.051). CONCLUSIONS TCD haploidentical transplant is associated with advantages in terms of engraftment and early immune reconstitution kinetics. TCD haploidentical transplant was associated with lower incidence of infectious and non-infectious complications, especially in the early phases of the transplant compared with UCB transplant recipients. However, there are no advantages in transplant outcomes compared with UCB transplant.
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Affiliation(s)
- Carmen Gómez-Santos
- Department of Pediatrics, Hematopoietic Stem Cell Transplantation Unit, Hospital Infantil Universitario "Niño Jesus", Menedez Pelayo 65, 28009, Madrid, Spain
| | - Marta González-Vicent
- Department of Pediatrics, Hematopoietic Stem Cell Transplantation Unit, Hospital Infantil Universitario "Niño Jesus", Menedez Pelayo 65, 28009, Madrid, Spain
| | - Blanca Molina
- Department of Pediatrics, Hematopoietic Stem Cell Transplantation Unit, Hospital Infantil Universitario "Niño Jesus", Menedez Pelayo 65, 28009, Madrid, Spain
| | - Natalia Deltoro
- Department of Pediatrics, Hematopoietic Stem Cell Transplantation Unit, Hospital Infantil Universitario "Niño Jesus", Menedez Pelayo 65, 28009, Madrid, Spain
| | - Blanca Herrero
- Department of Pediatrics, Hematopoietic Stem Cell Transplantation Unit, Hospital Infantil Universitario "Niño Jesus", Menedez Pelayo 65, 28009, Madrid, Spain
| | - Julia Ruiz
- Department of Pediatrics, Hematopoietic Stem Cell Transplantation Unit, Hospital Infantil Universitario "Niño Jesus", Menedez Pelayo 65, 28009, Madrid, Spain
| | - Antonio Pérez-Martínez
- Department of Pediatrics, Hematopoietic Stem Cell Transplantation Unit, Hospital Infantil Universitario "Niño Jesus", Menedez Pelayo 65, 28009, Madrid, Spain.,Hospital Infantil Universitario "La Paz" Madrid, Madrid, Spain
| | - Miguel A Diaz
- Department of Pediatrics, Hematopoietic Stem Cell Transplantation Unit, Hospital Infantil Universitario "Niño Jesus", Menedez Pelayo 65, 28009, Madrid, Spain.
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Domínguez-Rodríguez S, Villaverde S, Sanz-Santaeufemia FJ, Grasa C, Soriano-Arandes A, Saavedra-Lozano J, Fumadó V, Epalza C, Serna-Pascual M, Alonso-Cadenas JA, Rodríguez-Molino P, Pujol-Morro J, Aguilera-Alonso D, Simó S, Villanueva-Medina S, Iglesias-Bouzas MI, Mellado MJ, Herrero B, Melendo S, De la Torre M, Del Rosal T, Soler-Palacin P, Calvo C, Urretavizcaya-Martínez M, Pareja M, Ara-Montojo F, Ruiz Del Prado Y, Gallego N, Illán Ramos M, Cobos E, Tagarro A, Moraleda C. A Bayesian Model to Predict COVID-19 Severity in Children. Pediatr Infect Dis J 2021; 40:e287-e293. [PMID: 34250967 DOI: 10.1097/inf.0000000000003204] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/24/2022]
Abstract
BACKGROUND We aimed to identify risk factors causing critical disease in hospitalized children with COVID-19 and to build a predictive model to anticipate the probability of need for critical care. METHODS We conducted a multicenter, prospective study of children with SARS-CoV-2 infection in 52 Spanish hospitals. The primary outcome was the need for critical care. We used a multivariable Bayesian model to estimate the probability of needing critical care. RESULTS The study enrolled 350 children from March 12, 2020, to July 1, 2020: 292 (83.4%) and 214 (73.7%) were considered to have relevant COVID-19, of whom 24.2% required critical care. Four major clinical syndromes of decreasing severity were identified: multi-inflammatory syndrome (MIS-C) (17.3%), bronchopulmonary (51.4%), gastrointestinal (11.6%), and mild syndrome (19.6%). Main risk factors were high C-reactive protein and creatinine concentration, lymphopenia, low platelets, anemia, tachycardia, age, neutrophilia, leukocytosis, and low oxygen saturation. These risk factors increased the risk of critical disease depending on the syndrome: the more severe the syndrome, the more risk the factors conferred. Based on our findings, we developed an online risk prediction tool (https://rserver.h12o.es/pediatria/EPICOAPP/, username: user, password: 0000). CONCLUSIONS Risk factors for severe COVID-19 include inflammation, cytopenia, age, comorbidities, and organ dysfunction. The more severe the syndrome, the more the risk factor increases the risk of critical illness. Risk of severe disease can be predicted with a Bayesian model.
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Affiliation(s)
- Sara Domínguez-Rodríguez
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | - Serena Villaverde
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | | | - Carlos Grasa
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Jesús Saavedra-Lozano
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Victoria Fumadó
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu Barcelona, Barcelona, Spain
| | - Cristina Epalza
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | - Miquel Serna-Pascual
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | | | - Paula Rodríguez-Molino
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Joan Pujol-Morro
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - David Aguilera-Alonso
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Silvia Simó
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu Barcelona, Barcelona, Spain
| | - Sara Villanueva-Medina
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | | | | | | | - Susana Melendo
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | | | - Teresa Del Rosal
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | | | | | - Marta Pareja
- Paediatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Fátima Ara-Montojo
- Paediatrics Department, Hospital Universitario Quironsalud Madrid, Madrid, Spain
| | | | - Nerea Gallego
- Paediatrics Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Marta Illán Ramos
- Paediatrics Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Elena Cobos
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | - Alfredo Tagarro
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
- Paediatrics Department, Hospital Universitario Infanta Sofía, Paediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
| | - Cinta Moraleda
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
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Noriega ÍD, García-Salido A, Martino R, Herrero B. Palliative home-based care to pediatric cancer patients: characteristics and healthcare delivered. Support Care Cancer 2021; 30:59-67. [PMID: 34228173 DOI: 10.1007/s00520-021-06412-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cancer patients constitute an important group in pediatric palliative care. Though the patients' home is the preferred place of care, little is known about the characteristics of patients attended by units that provide home assistance. Our objective is to describe the characteristics of cancer patients and healthcare delivered by a pediatric palliative care unit with a home hospitalization program. METHODS Retrospective study based on clinical records of deceased patients attended by the pediatric palliative care unit of Madrid over 10 years. Data collected included general characteristics, type of cancer, whether they received home assistance, place of death, healthcare delivered (hospitalizations, devices, oncological treatments…), and symptom prevalence. RESULTS After excluding 47 patients, the clinical records of 144 patients were analyzed. The median age at referral was 9.4 years (IQR: 5.6-14.1), 61.2% were males; 44.2% had solid non-CNS tumors, 35.4% CNS tumors, and 20.4% hematological malignancies; 137 received home care with 89 not requiring further hospital admissions and 70.1% dying at home. The median follow-up time was 1.6 months (IQR: 0.5-2.9). The most used devices were venous ports (71.4%) and oxygen (49.4%); 53.5% of the patients received oncological support therapies. The most common symptoms were pain (91.8%) dyspnea (49.0%) and fatigue (46.9%). CONCLUSIONS Home assistance was provided in a high number of patients, with a large proportion needing one or no hospital admissions and 70.1% of them dying at home. Further studies characterizing these patients and the factors which promote early access to palliative care are needed.
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Affiliation(s)
- Íñigo de Noriega
- Pediatric Palliative Care Unit, Hospital Infantil Universitario Niño Jesús, Av. Menéndez Pelayo 65, 28009, Madrid (Madrid), Spain.
| | - Alberto García-Salido
- Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid (Madrid), Spain
| | - Ricardo Martino
- Pediatric Palliative Care Unit, Hospital Infantil Universitario Niño Jesús, Av. Menéndez Pelayo 65, 28009, Madrid (Madrid), Spain
| | - Blanca Herrero
- Pediatric Oncology Unit, Hospital Infantil Universitario Niño Jesús, Madrid (Madrid), Spain
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17
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López-Tarruella S, del Monte-Millán M, Alvarez E, Jerez Y, Saenz JÁG, Echavarria I, Moreno F, Márquez-Rodas I, Bueno-Muiño C, Herrero B, Cebollero M, Ramos-Medina R, Lobato N, González del Val R, Palomero MI, Lizarraga S, Bohn U, Ballesteros AI, Rincón P, Massarrah T, Ocaña I, Villarejo L, Perou CM, Martin M. Abstract PS4-12: Potential value of FOXA1 expression as genomic predictor of response to docetaxel and carboplatin neoadjuvant (NA) chemotherapy in patients with triple negative breast cancer (TNBC). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps4-12] [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: TNBC is a particularly aggressive subtype with high recurrence rates and poor long-term survival. Anthracycline-free regimens based on docetaxel plus carboplatin (TCb) achieve around 50-55% pathologic complete responses (pCR) which correlates with better survival outcomes. Identification of genomic predictors of response is key to individualize therapies for this heterogeneous breast cancer (BC) subgroup. FOXA1 is a pioneer factor for androgen (AR) and estrogen receptors (ER). Its under-expression has been linked to cancer stemness in TNBC and better prognosis in ER-positive BC. The differential expression of AR, FOXA1 and BRCA1 is associated with sensitivity to chemotherapy in TNBC patients. Data support the plasticity role of FOXA1 driving basal to luminal BC cells by inducing luminal genes but also by repressing the basal phenotype and thus, tumor aggressiveness, although its role as a biomarker in TNBC is still controversial. We have analyzed RNAseq data of FOXA1 and AR in a series of TNBC tumors homogenously treated with neoadjuvant TCb to study their correlation with survival and response. Methodology: 300 TNBC patients have been included in a multicenter, prospective, non-randomized trial aimed to identify predictors of response to TCb in the neoadjuvant setting (NCT01560663). 278/300 patients were evaluable. PAM50 subtypes (NanoString nCounter) and RNAseq (HiSeq2500) were analyzed for those patients with both available samples and evaluable pathological response (n=208). Correlations were studied by the Kendall method. Linear or logistic regressions were adjusted for univariant analysis depending on numerical or categorical response variables, respectively. Results: FOXA1 and AR were differentially expressed between basal and non-basal tumor subtypes (PAM50), being overexpressed in non-basal (p<0.001 for both FOXA1 and AR). FOXA1 and AR were significantly overexpressed in non-basal subtypes from the Vanderbilt TNBC-type classification (36/208) as well. Both genes expression showed a significant correlation with several luminal marker genes. AR was significantly associated with ANXA9 (p=0,008), GATA3 (p=0,00002) and XBP1 (p<0.001), while FOXA1 expression was positively associated with ANXA9 (p=0,03), ESR1 (p<0.001),GATA3 (p<0.001) and XBP1 (p<0.001). In terms of response, significant differences in FOXA1 expression levels were found between responders and non-responders by Residual Disease Burden (RCB) classification taking response as binary variable of PCR vs RCB-I/II/III (p=0.003) as well as pCR/RCB-I vs RCB-II/III (p=0.008) with responders showing a lower FOXA1 expression level. The same analysis for AR expression did not show statistically significant differences. Within the PAM50 basal subgroup, neither AR nor FOXA1 individual gene expression (172/208) showed association with response. For survival, with a median follow-up of 36 months, neither FOXA1 nor AR showed significant impact on EFS or OS per univariate Cox regression analysis (EFS: HRFOXA1 1.076; p=0.307; HRAR 1.156, p=0.084 and OS: HRFOXA11.120, p=0.140; HRAR 1.152, p=0.121). Conclusions: Within our cohort, FOXA1 expression is a better predictor of response to NA chemotherapy than AR. FOXA1 is overexpressed in TNBC tumors who do not achieve pCR with neoadjuvant TCb chemotherapy, correlating with non-basal tumor subtypes. This suggests that measuring FOXA1 expression levels in patients with TNBC could be useful to predict response to TCb regimen enabling physicians to select more effective alternative NA schemes in this population.
Citation Format: Sara López-Tarruella, María del Monte-Millán, Enrique Alvarez, Yolanda Jerez, José Ángel García Saenz, Isabel Echavarria, Fernando Moreno, Ivan Márquez-Rodas, Coralia Bueno-Muiño, Blanca Herrero, Maria Cebollero, Rocío Ramos-Medina, Nerea Lobato, Ricardo González del Val, Maria Isabel Palomero, Santiago Lizarraga, Uriel Bohn, Ana Isabel Ballesteros, Patricia Rincón, Tatiana Massarrah, Inmaculada Ocaña, Lucía Villarejo, Charles M Perou, Miguel Martin. Potential value of FOXA1 expression as genomic predictor of response to docetaxel and carboplatin neoadjuvant (NA) chemotherapy in patients with triple negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS4-12.
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Affiliation(s)
- Sara López-Tarruella
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - María del Monte-Millán
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Enrique Alvarez
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Yolanda Jerez
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | | | - Isabel Echavarria
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Fernando Moreno
- 3Department of Medical Oncology, Hospital Clínico San Carlos, CIBERONC, Madrid, Spain
| | - Ivan Márquez-Rodas
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Coralia Bueno-Muiño
- 4Medical Oncology Department, Hospital Infanta Cristina, Parla, Madrid, Spain
| | - Blanca Herrero
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Maria Cebollero
- 5Pathology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain 5Gynecology Service, Hospital General Universitario Gregorio Marañón, IiSGM, Universidad Complutense, Madrid, Spain
| | - Rocío Ramos-Medina
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Nerea Lobato
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ricardo González del Val
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Maria Isabel Palomero
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Santiago Lizarraga
- 6Gynecology Service, Hospital General Universitario Gregorio Marañón, IiSGM, Universidad Complutense, Madrid, Spain
| | - Uriel Bohn
- 7Department of Medical Oncology, Hospital Universitario Dr Negrin, Las Palmas de Gran Canaria, Spain
| | | | - Patricia Rincón
- 6Gynecology Service, Hospital General Universitario Gregorio Marañón, IiSGM, Universidad Complutense, Madrid, Spain
| | - Tatiana Massarrah
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
| | - Inmaculada Ocaña
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Lucía Villarejo
- 2Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Charles M Perou
- 9Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC
| | - Miguel Martin
- 1Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid, Spain
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Antolín E, Herrero B, Rodríguez R, Illescas T, Duyos I, Gimeno A, Sotillo L, Abascal A, Orensanz I, Hernández A, Bartha JL. [How to organize a Fetal Medicine Unit in the context of COVID-19 pandemic. Safe measures for obstetric scans and equipment cleaning]. Clin Invest Ginecol Obstet 2021; 48:3-13. [PMID: 32836610 PMCID: PMC7328539 DOI: 10.1016/j.gine.2020.06.013] [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] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 11/05/2022]
Abstract
During a pandemic, the three basic principles are. to prioritize medical resources, ensure patients' lockdown in order to avoid community transmission and prevent healthcare collapse, and keep the number of visits to an absolute minimum to avoid patient exposure and safeguard healthcare workers. Antenatal care must be maintained during a health crisis, regardless of the COVID-19 state of alert. Routine and specialist obstetric ultrasound scans are essential for clinical decision-making during pregnancy, as it has a direct impact on the management of mothers and fetuses and on the perinatal outcome. In an attempt to minimize in-person visits, these will be organized according to the established ultrasound schedule. Based on scientific evidence, and on existing main national and international guidelines, this document has been prepared, in which proposals and options are provided for managing pregnant women in the context of the SARS-CoV-2 pandemic. It includes how a Fetal Medicine Unit facing this health crisis should be restructured, what safety measures should be followed in the performance of obstetric scans and invasive procedures, and how ultrasound rooms, equipment and transducers should be cleaned and disinfected. These recommendations should be adapted to different units based on their resources and infrastructure.
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Affiliation(s)
- E Antolín
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
- Red de Salud Materno Infantil y del Desarrollo (SAMID), España
| | - B Herrero
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - R Rodríguez
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - T Illescas
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - I Duyos
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - A Gimeno
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - L Sotillo
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - A Abascal
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - I Orensanz
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - A Hernández
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - J L Bartha
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
- Red de Salud Materno Infantil y del Desarrollo (SAMID), España
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19
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de Noriega Í, Pérez Martin MÁ, Martino Alba R, Herrero B. [Coverage of pediatric patients with palliative needs in the Region of Madrid]. An Pediatr (Barc) 2020; 94:124-125. [PMID: 32891580 DOI: 10.1016/j.anpedi.2020.07.018] [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] [Received: 06/26/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Íñigo de Noriega
- Unidad de Atención Integral Paliativa Pediátrica, Hospital Infantil Universitario del Niño Jesús, Madrid.
| | | | - Ricardo Martino Alba
- Servicio de Hemato-Oncología, Hospital Infantil Universitario del Niño Jesús, Madrid, España
| | - Blanca Herrero
- Servicio de Hemato-Oncología, Hospital Infantil Universitario del Niño Jesús, Madrid, España
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Jerez Y, Herrero B, Arregui M, Morón B, Martín M, Echavarría I. Neratinib for the treatment of early-stage, hormone receptor-positive, HER2-overexpressed breast cancer. Future Oncol 2020; 16:1165-1177. [PMID: 32458702 DOI: 10.2217/fon-2020-0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
HER2-positive breast cancer accounts for 18-20% of all breast cancers. Despite significant advances and the currently available adjuvant treatments for management of the disease, approximately 25% of HER2-positive early-stage breast cancer patients show relapse and die. Neratinib is an irreversible tyrosine kinase inhibitor. Multiple studies have reported its significant antitumor activity in metastatic HER2-positive breast cancer. It is administered orally and has also been tested in the adjuvant setting. In this article, we present a comprehensive review of the pharmacokinetics and pharmacodynamics of neratinib as well as its clinical efficacy, with an emphasis on early HER2-positive breast cancer and suggestions for future directions for neratinib research.
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Affiliation(s)
- Yolanda Jerez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Departamento de Medicina, Universidad Complutense, CiberOnc, Madrid, Spain
| | - Blanca Herrero
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Departamento de Medicina, Universidad Complutense, CiberOnc, Madrid, Spain
| | - Marta Arregui
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
| | - Blanca Morón
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
| | - Miguel Martín
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Departamento de Medicina, Universidad Complutense, CiberOnc, Madrid, Spain
| | - Isabel Echavarría
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Departamento de Medicina, Universidad Complutense, CiberOnc, Madrid, Spain
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Lusignan MF, Li X, Herrero B, Delbes G, Chan PTK. Effects of different cryopreservation methods on DNA integrity and sperm chromatin quality in men. Andrology 2018; 6:829-835. [PMID: 30175448 DOI: 10.1111/andr.12529] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/12/2018] [Accepted: 07/09/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cryopreserved human sperm are used in assisted reproductive technology. However, the effect of cryopreservation on sperm DNA integrity is unclear. OBJECTIVES The objectives of this study were to: (i) determine the impact of semen cryopreservation on human sperm DNA integrity and chromatin structure; (ii) test if parameters obtained from TUNEL and SCSA® correlate; and (iii) verify correlation between sperm motility, morphology and viability with TUNEL and SCSA® parameters. MATERIALS AND METHODS Men attending a fertility clinic were recruited and grouped according to their sperm parameters (n = 9/group): normozoospermia, oligoasthenoteratozoospermia and teratozoospermia. Each semen sample was processed as follow: (i) directly frozen at -80 °C; (ii) diluted in Sperm Maintenance Medium, cooled for 30 min at 4 °C and frozen at -80 °C; (iii) diluted in Sperm Maintenance Medium; or (iv) in SpermFreeze. Each mixture from method (iii) and (iv) was then suspended for 30 min in liquid nitrogen vapor and plunged into liquid nitrogen. After at least two months of storage, samples were thawed at room temperature and analyzed for motility and viability, TUNEL and SCSA® assays. RESULTS Progressive motility and viability decreased after freeze-thawing. TUNEL scores increased significantly in all samples after freezing-thawing while no significant change in the DNA fragmentation index (DFI) from SCSA® was observed. No change in the percentage high DNA stainability (HDS) was observed in normozoospermic samples; however it was significantly increased in all the methods in oligoasthenoteratozoospermic and in the methods (ii)-(iv) in teratozoospermic samples. The DFI and TUNEL scores correlated significantly with each other and inversely with sperm motility, viability and morphology. DISCUSSION AND CONCLUSION Cryopreservation seems to be deleterious for the integrity of human sperm DNA and compaction. However, the sperm DFI was not affected during cryopreservation under the various methods of storage tested. Clinicians and investigators should take this information into consideration when using cryopreserved sperm for assisted reproduction.
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Affiliation(s)
- M F Lusignan
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - X Li
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - B Herrero
- MUHC Reproductive Centre, McGill University Health Centre, Montreal, QC, Canada
| | - G Delbes
- INRS - Institut Armand Frappier, Laval, QC, Canada
| | - P T K Chan
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada.,MUHC Reproductive Centre, McGill University Health Centre, Montreal, QC, Canada
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Núñez Cerezo V, Romo Muñoz M, Encinas JL, Jiménez J, Elorza Fernández MD, Herrero B, Antolín E, Martínez Martínez L, López Santamaría M. [Study of pulmonary hypertension and long-term respiratory clinic in children with congenital diaphragmatic hernia]. Cir Pediatr 2018; 31:76-80. [PMID: 29978958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study is to identify respiratory clinic and pulmonary arterial hypertension (PAH) in congenital diaphragmatic hernia (CDH) and whether these could be predicted by prenatal measures. MATERIAL AND METHODS We studied fetal ultrasound: Observed/expected Lung to Head Ratio (O/E LHR) and classified patients according to their outcome (group 1: O/E LHR <25%, group 2: 26-35%, group 3: 36-45%, group 4: >55%) as well as the severity of PAH (group 0: non-PAH, group 1: mild, group 2: moderate, group 3: severe) in echocardiograms at birth, 1st, 6th, 12th and 24 months of life. We also evaluated gestational age, weight, bronchodilator treatment and number of hospital admissions. RESULTS 58 patients with CDH, 13 without prenatal diagnosis. 36 patients out of 45 had O/E LHR calculated at 22.4 ± 5.8 weeks. O/E LHR had significant association with the severity of PAH at birth and in the 1st, 6th, 12th and 24th months (p <0.05). At 6 months, only 30.4% had PAH without any association with a higher risk of hospital admission [OR 1.07 (0.11-10.1)] and only three patients (5.1%) required bronchodilator treatment. CONCLUSION In CDH, PAH and the respiratory clinic improve over time, being uncommon the need for treatment as of the 6th month. O/E LHR predicts the presence and severity of PAH in short and long term.
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Affiliation(s)
- V Núñez Cerezo
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - M Romo Muñoz
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - J L Encinas
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - J Jiménez
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | | | - B Herrero
- Servicio de Obstetricia y Ginecología. Hospital Universitario La Paz. Madrid
| | - E Antolín
- Servicio de Obstetricia y Ginecología. Hospital Universitario La Paz. Madrid
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Núñez V, Romo M, Encinas JL, Bueno A, Herrero B, Antolín E, Parrón M, Martínez L, López Santamaría M. [The role of fetal magnetic resonance imaging in the study of congenital diaphragmatic hernia]. Cir Pediatr 2018; 31:15-20. [PMID: 29419953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES Different echographic and fetal magnetic resonance (MRI) measurements have been described in the diagnosis of associated malformations and the prognosis of congenital diaphragmatic hernia (CDH). We have reviewed our experience searching for useful isolated or combined parameters and how MRI can complement ultrasound. MATERIAL AND METHODS We evaluated 29 fetuses with CDH. We examined ultrasonography: Lung to Head (LHR o/e) and in MRI: ipsilateral lung volume (IPV) and total expressed as percentage of observed / expected lung volume (VPT o/e) and percentage of herniated liver (PHH). We studied: survival, ECMO and associated malformations. RESULTS LHR o/e was the measure that best predicted survival (p< 0.05). VPT o/e did not predict survival or the need of ECMO (p> 0.05). PHH ≥19% was related to the need of ECMO. IPV < 2 cc required ECMO more frequently (p< 0.018) and when it was 0 cc in all cases. No combination of MR measurements was superior to LHR o/e in prediction of survival. MRI complemented the ultrasound in 4 cases: diaphragmatic eventration diagnosed with HDC, right HDC with fluid in the sac that suggested thoracic cyst, differentiation between spleen and lung that measured together overestimated the LHR and/or suspicion of Cornelia de Lange due to facial malformations. CONCLUSIONS Not a single or combined MRI measurement exceeds LHR o/e in survival prediction. MRI is related to prognosis and can be used to support ultrasound in making decisions. MRI occasionally provides complementary morphological information.
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Affiliation(s)
- V Núñez
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - M Romo
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - J L Encinas
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - A Bueno
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - B Herrero
- Servicio de Obstetricia y Ginecología. Hospital Universitario La Paz. Madrid
| | - E Antolín
- Servicio de Obstetricia y Ginecología. Hospital Universitario La Paz. Madrid
| | - M Parrón
- Servicio de Radiología Pediátrica
| | - L Martínez
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
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Herrero B, Lusignan M, Son W, Buckett W, Chan P. Effects of sperm quality on the success of intracytoplasmic sperm injection (ICSI) with testicular sperm in couples with recurrent ICSI failure with ejaculated sperm. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.655] [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: 11/25/2022]
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Diaz MA, Pérez-Martínez A, Herrero B, Deltoro N, Martinez I, Ramirez M, Abad L, Sevilla J, Merino E, Ruiz J, Vicario JL, Gonzalez-Vicent M. Prognostic factors and outcomes for pediatric patients receiving an haploidentical relative allogeneic transplant using CD3/CD19-depleted grafts. Bone Marrow Transplant 2016; 51:1211-6. [DOI: 10.1038/bmt.2016.101] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/07/2016] [Accepted: 03/11/2016] [Indexed: 11/09/2022]
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26
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Calle MDL, Arrieta S, Herrero B, Omenaca F, Bartha J. Dichorionic twin pregnancy discordant for anencephaly: two cases with different management. CLIN EXP OBSTET GYN 2014. [DOI: 10.12891/ceog16192014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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27
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Carceller F, Oñoro G, Buitrago MJ, Herrero B, Lassaletta Á, Pérez-Martínez A, González-Vicent M, Madero L. Cunninghamella bertholletiae infection in children: review and report of 2 cases with disseminated infection. J Pediatr Hematol Oncol 2014; 36:e109-14. [PMID: 23887023 DOI: 10.1097/mph.0b013e31829eec5a] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mucormycosis is an emerging fungal infection affecting mainly immunosuppressed hosts. Cunninghamella bertholletiae causes the highest mortality among all mucormycetes. Infection by C. bertholletiae has rarely been reported in children. We present 2 children with acute leukemia and disseminated infection by C. bertholletiae, and review the relevant literature.
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Affiliation(s)
- Fernando Carceller
- *Pediatric Hematology-Oncology Unit †Pediatric Intensive Care Unit §Hematopoietic Transplant Unit, Niño Jesús Children's Hospital ‡Mycology Reference Laboratory, National Centre of Microbiology Carlos III, Madrid, Spain
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De la Calle M, Arrieta S, Herrero B, Omeñaca F, Bartha JL. Dichorionic twin pregnancy discordant for anencephaly: two cases with different management. CLIN EXP OBSTET GYN 2014; 41:208-210. [PMID: 24779254] [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: 06/03/2023]
Abstract
BACKGROUND Prevalence ofanencephaly in dichorionic twins is higher than in singleton pregnancies. The authors report two cases with two different management strategies. CASE 1 Spontaneous dichorionic diamniotic twin pregnancy with the second twin diagnosed with anencephaly at 12 weeks gestation. Selective feticide was performed at the age of 13.2 weeks. Vaginal delivery occurred at 39 weeks, and birth weight was 2,850 g. CASE 2 Dichorionic diamniotic twin pregnancy discordant for anencephaly in the second twin was diagnosed at 13 weeks gestation. An expectant management was decided. Preterm delivery occurred at 35 weeks due to hydramnios of the affected fetus, delivering a healthy newborn weighing 2,300 g and an anencephalic neonate who died immediately after delivery. CONCLUSION Anencephaly should be diagnosed as soon as possible, idealistically at 11-13+6 weeks ultrasound (US) scan, in order to offer the most appropriate counselling to the parents, ranging from selective feticide or expectant management. This short series suggests that selective early feticide may increase gestational age and birth weight.
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González-Vicent M, Herrero B, Guillén M, Sevilla J, Díaz MÁ. Using Rheopheresis for stem cell Transplantation-Associated Thrombotic Microangiopathy (TA-TMA). Transfus Apher Sci 2013; 49:234-7. [DOI: 10.1016/j.transci.2013.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 02/25/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
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Guillén M, Madero L, Parra L, Hernández C, Herrero B, Carceller F, Lassaletta A, Sevilla J. [Transformation of myelodysplastic syndrome to acute lymphoblastic leukemia: 2 new cases]. An Pediatr (Barc) 2012. [PMID: 23182617 DOI: 10.1016/j.anpedi.2012.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are clonal disorders of hematopoietic stem cells, with a variable risk of transformation to acute myeloid leukemia. Progression into acute lymphoblastic leukemia (ALL) is an extremely rare event, with very few cases published in children. In this report, we describe two cases of myelodysplastic syndromes that progressed to ALL. Moreover, we review previously reported cases of MDS transformation to acute lymphoblastic leukemia in the pediatric population whose prognosis seems to be similar to that for adults.
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Affiliation(s)
- M Guillén
- Servicio de Hemato-Oncología Pediátrica, Hospital Infantil Universitario Niño Jesús, Madrid, España.
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Molina B, Gonzalez-Vicent M, Albi G, Andión M, Herrero B, Sevilla J, Díaz MA. Varicella zoster central nervous system vasculitis after allogeneic hematopoietic stem cell transplant successfully treated with cyclophosphamide. Transpl Infect Dis 2012; 14:E107-10. [PMID: 22967359 DOI: 10.1111/j.1399-3062.2012.00783.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 06/09/2012] [Accepted: 06/20/2012] [Indexed: 11/29/2022]
Abstract
We report the first case of varicella zoster central nervous system vasculitis, to our knowledge, which responded to intravenous pulses of cyclophosphamide in an immunocompromised child with severe and progressive disease, without sequelae.
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Affiliation(s)
- B Molina
- Stem Cell Transplant Unit, Hospital Niño Jesus, Madrid, Spain
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Herrero B, de la Fuente JR, Aleo E, Carceller F, Lassaletta Á, Orellana MR, Pérez-Martínez A. Spontaneous resolution of hypereosinophilic syndrome in an infant without treatment. J Pediatr Hematol Oncol 2012; 34:450-2. [PMID: 22510769 DOI: 10.1097/mph.0b013e318249579b] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report on a 4-month-old boy with hypereosinophilic syndrome (HES) and spontaneous progressive resolution without treatment. Differential diagnosis excluded myeloproliferative, lymphocytic, familiar, associated, and overlap HES. The final diagnosis was undefined HES. Repeated measurements of blood eosinophil counts, monitoring of clonal T cells, and observation of skin lesions and organ involvement were carefully performed as an outpatient.
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Affiliation(s)
- Blanca Herrero
- Department of Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Espiñeira M, Herrero B, Vieites J, Santaclara F. Detection and identification of anisakids in seafood by fragment length polymorphism analysis and PCR–RFLP of ITS-1 region. Food Control 2010. [DOI: 10.1016/j.foodcont.2009.12.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vivas S, Ruiz de Morales JG, Riestra S, Arias L, Fuentes D, Alvarez N, Calleja S, Hernando M, Herrero B, Casqueiro J, Rodrigo L. Duodenal biopsy may be avoided when high transglutaminase antibody titers are present. World J Gastroenterol 2009; 15:4775-80. [PMID: 19824110 PMCID: PMC2761554 DOI: 10.3748/wjg.15.4775] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the predictive value of tissue transglutaminase (tTG) antibodies for villous atrophy in adult and pediatric populations to determine if duodenal biopsy can be avoided.
METHODS: A total of 324 patients with celiac disease (CD; 97 children and 227 adults) were recruited prospectively at two tertiary centers. Human IgA class anti-tTG antibody measurement and upper gastrointestinal endoscopy were performed at diagnosis. A second biopsy was performed in 40 asymptomatic adults on a gluten-free diet (GFD) and with normal tTG levels.
RESULTS: Adults showed less severe histopathology (26% vs 63%, P < 0.0001) and lower tTG antibody titers than children. Levels of tTG antibody correlated with Marsh type in both populations (r = 0.661, P < 0.0001). Multiple logistic regression revealed that only tTG antibody was an independent predictor for Marsh type 3 lesions, but clinical presentation type and age were not. A cut-off point of 30 U tTG antibody yielded the highest area under the receiver operating characteristic curve (0.854). Based on the predictive value of this cut-off point, up to 95% of children and 53% of adults would be correctly diagnosed without biopsy. Despite GFDs and decreased tTG antibody levels, 25% of the adults did not recover from villous atrophy during the second year after diagnosis.
CONCLUSION: Strongly positive tTG antibody titers might be sufficient for CD diagnosis in children. However, duodenal biopsy cannot be avoided in adults because disease presentation and monitoring are different.
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Son WY, Chung JT, Herrero B, Dean N, Demirtas E, Holzer H, Elizur S, Chian RC, Tan SL. Selection of the optimal day for oocyte retrieval based on the diameter of the dominant follicle in hCG-primed in vitro maturation cycles. Hum Reprod 2008; 23:2680-5. [DOI: 10.1093/humrep/den332] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [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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Vivas S, Ruiz de Morales JM, Fernandez M, Hernando M, Herrero B, Casqueiro J, Gutierrez S. Age-related clinical, serological, and histopathological features of celiac disease. Am J Gastroenterol 2008; 103:2360-5; quiz 2366. [PMID: 18702652 DOI: 10.1111/j.1572-0241.2008.01977.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Celiac disease (CD) is a common disorder in children and adults. However, limited data are available when comparing differences between both populations. AIMS To prospectively evaluate and compare the clinical and histological features present at diagnosis in a cohort of celiac children and adults. METHODS Consecutive new cases diagnosed between 2000 and 2006 were prospectively included (66 children and 54 adults). The clinical spectrum was categorized in two groups: (a) typical (malabsorption, chronic diarrhea, or failure to thrive) and (b) oligosymptomatic (abdominal pain, anemia, hypertransaminasemia, or screening in risk groups or in relatives). The histological results were divided into mild (i.e., Marsh I, II, and IIIA) and severe (i.e., Marsh IIIB, IIIC). In all cases, the human antitissue transglutaminase IgA antibodies (TTGA) were determined. RESULTS Overall, a female/male ratio (2.6:1) was observed. This ratio was significantly higher in adults (5.7:1) than in children (1.6:1) (P= 0.009). Typical symptoms were present in 62.5% children versus 31% adults (P= 0.01). The average time to diagnosis after the appearance of symptoms was 7.6 months for children and 90 months for adults (P < 0.001). TTGA levels were higher in children and correlated with age (P < 0.001) and with the degree of villous atrophy (P < 0.001). Histological analysis revealed a marked atrophy in 86% children versus 52% adults (P < 0.001). The degree of villous atrophy was inversely correlated with age (P < 0.001). Classic symptoms were also associated with more severe villous atrophy. CONCLUSIONS At initial diagnosis, CD shows age-related differences, which consist of more evident clinical and histological features in children. Furthermore, IgA TTGA levels correlate both with the degree of villous atrophy and with the patient's age.
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Affiliation(s)
- Santiago Vivas
- Department of Gastroenterology, Instituto de Biomedicina, University of León, León, Spain
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37
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López-Manchado MA, Herrero B, Arroyo M. Organoclay–natural rubber nanocomposites synthesized by mechanical and solution mixing methods. POLYM INT 2004. [DOI: 10.1002/pi.1573] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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López-Manchado MA, Herrero B, Arroyo M. Preparation and characterization of organoclay nanocomposites based on natural rubber. POLYM INT 2003. [DOI: 10.1002/pi.1161] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Affiliation(s)
- V Puigdevall
- Unidad de Endocrinología, Hospital General del INSALUD, Soria
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Angulo JC, Lopez-Rubio M, Guil M, Herrero B, Burgaleta C, Sanchez-Chapado M. The value of comparative volumetric analysis of urinary and blood erythrocytes to localize the source of hematuria. J Urol 1999; 162:119-26. [PMID: 10379753 DOI: 10.1097/00005392-199907000-00028] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluate comparative volumetric analysis of blood and urinary red blood cells (RBCs) to identify the source of hematuria. Comparative volumetric analysis is defined as the difference between mean corpuscular erythrocyte volume in peripheral blood (MCVB) diluted in urine supernatant after centrifugation and mean corpuscular volume of urinary erythrocytes (MCVU). The potential of MCVB-MCVU to distinguish the origin of hematuria is compared to MCVU alone. The fundamental hypothesis is that RBCs that can go through the glomerulus will be smaller than those from the collecting system or lower urinary tract, thus having a smaller MCVU and larger difference between MCVB and MCVU. MATERIALS AND METHODS A prospective detailed urological evaluation was performed on 210 patients with glomerular or nonglomerular hematuria detected by urinary sediment, clinical radiological evaluation, endoscopy, cytology and sometimes bladder or renal biopsy. After evaluation 24 cases with an uncertain source of hematuria were excluded from study. Specialized urinalysis, volumetric analysis and clinical investigation were performed in a blind fashion. MCVU and MCVB-MCVU were registered for every patient. The Technicon H-3 system with angle laser scattering dual system allowed measurement of mean corpuscular volume in a minimal number of RBCs, and resuspension of RBC pellets in the same urinary supinate avoided effects of osmolarity and pH on RBC size and shape. Reproducibility in assessing the index was tested in 50 cases in which comparative volumetric analysis was repeated on 2 consecutive days. Unpaired t test was performed, and a threshold value of MCVB-MCVU with maximum sensitivity and specificity to detect glomerular hematuria was identified. The potential of urinary and comparative volumetric analysis to distinguish the source of hematuria was evaluated and compared by receiver operating characteristics curve analysis. RESULTS Hematuria was nonglomerular in 53 (28.4%) and glomerular in 133 (71.6%) patients. Mean MCVB-MCVU was significantly different for nonglomerular (0.6 fl.) and glomerular (30.5 fl.) sources (p<0.0001). There was a correlation between repeat independent measures of MCVU and MCVB-MCVU. The highest positive predictive value to detect a glomerular origin is desirable so that unnecessary investigation can be obviated without the risk of missing a nonglomerular source. With a limit of 16 fl. specificity and positive predictive value were 98 and 99%, respectively. Receiver operating characteristics curve analysis to localize the source of hematuria revealed significant differences in favor of comparative volumetric analysis versus urinary volumetric analysis alone. CONCLUSIONS MCVB-MCVU using the Technicon H-3 system is a useful noninvasive and accurate method to locate the source of hematuria. A value of 16 fl. or greater practically rules out a nonglomerular origin and obviates further urological investigation. We have incorporated this investigation in our diagnostic algorithm for hematuria.
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Affiliation(s)
- J C Angulo
- Department of Urology, Hospital Principe de Asturias, Madrid, Spain
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Sierra M, Herrera MF, Herrero B, Jiménez F, Sepúlveda J, Lozano RR, Gamino R, González O, Correa-Rotter R. Prospective biochemical and scintigraphic evaluation of autografted normal parathyroid glands in patients undergoing thyroid operations. Surgery 1998; 124:1005-10. [PMID: 9854576 DOI: 10.1067/msy.1998.92003] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [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: 11/22/2022]
Abstract
BACKGROUND Parathyroid autotransplantation has been widely used in thyroid operations. Few studies have assessed the function of the autotransplanted glands. The aim of this study was to evaluate the success rate, pattern of biochemical function, and scintigraphic appearance of parathyroid autografts in patients undergoing thyroid operations. METHODS Twelve patients in whom 1 parathyroid gland was removed during thyroid operation were included. Glands were fragmented and autografted into individual pockets in the brachioradialis muscle of the nondominant forearm. Parathyroid hormone levels were measured in both arms the day of autotransplantation and 2 weeks and 1, 2, 3, and 6 months after operation. Serum calcium levels were also measured at each interval. Sestamibi scanning was performed 6 months after operation in 7 patients. RESULTS All patients were women with a mean age of 50 +/- 15 years. Serum calcium levels were normal during follow-up. A gradient of parathyroid hormone level of 1.5 or greater between the autotransplanted and nontransplanted arm was found in 10 patients. Isotope uptake at the site of the parathyroid autotransplant was demonstrated in the 7 patients evaluated. CONCLUSIONS Biochemical function of autotransplanted normal parathyroid tissue was documented in 83% of the patients. Sestamibi scintiscans were able to identify the autotransplanted tissue.
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Affiliation(s)
- M Sierra
- Department of Surgery, Instituto Nacional de la Nutrición, Mexico City, Mexico
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Abstract
Myelodysplastic syndrome (MDS) with erythroid hypoplasia/aplasia has not yet been clearly defined, and in most patients it is mistaken for acquired pure red cell aplasia (PRCA). We report a patient with severe transfusion-dependent anemia (Hb 6.9 g/dl) and reticulocytopenia. WBC and platelet counts were normal. Bone marrow examination showed a marked trilineage dysplasia and a low percentage of erythroid precursors (3%). A diagnosis of MDS (refractory anemia according to FAB classification) with erythroid hypoplasia/aplasia was made. Repeated cytogenetic analysis of bone marrow showed normal karyotypes. Moreover, serial IgM serology and DNA analysis of the patient's sera for B19 parvovirus were negative. Other conditions known to be associated with erythroid aplasia were also absent. The patient failed hematinics and prednisone therapy. He next received r-HuEPO (200 U/kg three times weekly). This form of therapy achieved a rapid and complete erythroid response. He has remained in complete erythroid response after a 7-month period on maintenance therapy of 100 U/kg three times weekly. A review of the literature revealed only 15 well-documented cases of MDS with erythroid hypoplasia/aplasia. All had morphological evidence of myelodysplasia. These patients were predominantly elderly males, all required regular packed red cell transfusions, and had an unfavorable prognosis, mainly because of a high rate of blastic transformation (frequently preceded by a myeloproliferative phase). The mechanism of erythroid hypoplasia in this subgroup of MDS remains uncertain. However, laboratory and clinical data suggest the existence of an intrinsic stem cell defect. None of the patients received hematopoietic growth factors. To our knowledge, our patient is the first case of MDS with erythroid hypoplasia where r-HuEPO was successfully attempted. The description of more cases is necessary to delineate the value of r-HuEPO therapy in this rare variant of MDS.
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Affiliation(s)
- J García-Suárez
- Department of Hematology, Príncipe de Asturias University Hospital, University of Alcalá de Henares, Madrid, Spain
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Herrero B. Weekly variation of fungal colonies in the atmosphere of Palencia (Spain) throughout the year 1992. J Investig Allergol Clin Immunol 1997; 7:611-8. [PMID: 9491203] [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: 02/06/2023] Open
Abstract
We have carried out a qualitative and quantitative study of the fungal colonies developed in two different culture media: Czapecdox and Sabouraud, throughout the year 1992 in Palencia city. A volumetric trap was used. We collected daily samples of aerovagans spore from the atmosphere through a cellulose esther filter, half of which was cultivated on Petri dishes. The following genera were identified: 26 Deuteromycetes (54%), four Zygomycetes (28%), and three bacteria, which along with Actinomycetes, reached 18% of all the registered colonies. Fifty-two percent of the colonies were developed in Czapecdox culture medium and 48% in Sabouraud medium. Most of the bacteria were grown in Sabouraud medium. The highest number of colonies recorded belonged to the following three genera: Mucor (25%), Aspergillus (23%) and Penicillium (16%). Most colonies were grown in autumn (32%), while spring was the second most frequent season when 28% of the colonies were registered.
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Affiliation(s)
- B Herrero
- Department of Agroforestry Sciences, University of Valladolid, Palencia, Spain
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Garcia-Suarez J, Dominguez-Franjo P, Del Campo F, Herrero B, Munoz MA, Piris MA, Pardo A. EBV-positive non-Hodgkin's lymphoma developing after phenytoin therapy. Br J Haematol 1996; 95:376-9. [PMID: 8904896 DOI: 10.1046/j.1365-2141.1996.d01-1905.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report the first case of Epstein Barr virus (EBV) positive non-Hodgkin's lymphoma occurring 20 years after continuous phenytoin therapy for idiopathic epilepsy. This malignant lymphoproliferative disease was preceded by an phenytoin-associated benign reactive lymphadenopathy. Serological findings suggested a chronic active EBV infection. Immunohistochemistry showed that neoplastic cells expressed B antigens (CD20, lambda) and the bcl-2 protein. The presence of EBV-encoded latent membrane protein 1 (LMP 1) was also expressed on neoplastic cells. Cytotoxic chemotherapy (CHOP) reversed the non-Hodgkin's lymphoma.
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Affiliation(s)
- J Garcia-Suarez
- Department of Haematology, Principe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
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Vanneuville G, Herrero B, Poumarat G, Monnet JP, Ferry B, Chandezon R, Garcier JM, Filaire M, Escande G. [Preliminary analysis of the modifications of spinal curves, in extreme amplitudes, observed in rhythmic and athletic gymnastics]. Bull Assoc Anat (Nancy) 1996; 80:33-5. [PMID: 9004868] [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
Trained users of Rhythmic and Athletic Gymnastic, present kinetic spinal vast extents. Analysis, with pasted cutaneous markers, shows that, according to the codified movement, various segments of the vertebral column are requested and realized important displacements. Nevertheless, to have an homogeneous attitude, some subjects request more either lumbar or thoracic segments, of both. To prevent frequent spinal pain, it is important to realize a preliminary subject selection using their total spine and to improve protection by adapted gymnastic.
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Affiliation(s)
- G Vanneuville
- Laboratoire d'Anatomie, Université d'Auvergne, Faculté de Médecine, Clermont-Ferrand
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Velasquez-Forero F, Mondragón A, Herrero B, Peña JC. Adynamic bone lesion in renal transplant recipients with normal renal function. Nephrol Dial Transplant 1996; 11 Suppl 3:58-64. [PMID: 8840319 DOI: 10.1093/ndt/11.supp3.58] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [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: 02/02/2023] Open
Abstract
Adynamic bone lesion has been defined as low bone turnover, normal or low osteoid volume and decreased bone formation rate (BFR). A prospective cross-sectional study was performed in 16 asymptomatic post-transplant kidney patients with normal renal function, to evaluate low bone mineral density. The mean age of the nine women and seven men was 33.9 +/- 7.3 years, the mean serum creatinine was 1.1 +/- 0.2 mg/dl and the mean creatinine clearance 71.5 +/- 13.8 ml/min/1.73 m2. Six patients received triple immunosuppressive therapy for a period of 10.3 +/- 3.7 months and nine received double therapy. Eighty-four months after renal grafting, we carried out bone densitometry, biochemical markers and bone biopsy. Bone densitometry showed 78 +/- 8.7% and 80.4 +/- 8% for hip and lumbar spine, with a mean Z score of 1.79 +/- 0.72 and 1.88 +/- 0.78 (SD), significantly less than normal in the Hispanic young population for those two regions. Serum PTH (0.83 +/- 0.23 microgram/ml normal range 0.32-0.65), urine cAMP (4.1 +/- 1.3, normal range 0.5-4.7 nmol/mg Cr) and total and nephrogenic fraction (3.1 +/- 1.1, normal range 0.29-2.9 nmol/100 ml GFR) were significantly greater than normal (P < 0.01). The bone biopsy in 12/16 patients showed decreased percentage osteoid area (1.59 +/- 0.86% vs 3.19 +/- 0.82%), percentage mineralized area (13 +/- 4.7% vs 21.03 +/- 3.36%) and bone formation rate (505 +/- 237 vs 1275 +/- 168 microns2/mm2/day), with a P value < 0.05 compared with 10 normal bone biopsies. The remaining four patients exhibited low bone turnover image with normal bone formation rate (1442 +/- 206 microns2/mm2/ day). Iron deposits were demonstrated at the mineralization front in 10/16 patients. No aluminium or amyloid deposits were observed. The histomorphometric results showed the presence of adynamic bone lesion in 12 renal transplant recipients with normal renal function and osteopenia, which explains the low bone density. The long-term use of glucocorticoids and the presence of iron deposits may contribute to this bone lesion. The biochemical markers of bone remodelling showed abnormalities compatible with moderate increase in parathyroid function. The adynamic lesion in the presence of hyperparathyroid function may suggest down-regulation of PTH bone receptors, alterations of the bone microenvironment or both.
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Pedraza-Chaverrí J, Herrero B, Ibarra-Rubio ME, Cruz C, Tapia E, Pena JC. Lack of correlation between human serum angiotensin converting enzyme activity and the renin-angiotensin-aldosterone system. Clin Chim Acta 1990; 190:105-6. [PMID: 2170063 DOI: 10.1016/0009-8981(90)90284-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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