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Filbert AL, Kremer L, Ladenstein R, Chronaki C, Degelsegger-Márquez A, van der Pal H, Bardi E, Uyttebroeck A, Langer T, Muraca M, Nieto AC, Rascon J, Bagnasco F, Beyer S, Te Dorsthorst J, Essiaf S, Galan AO, Kienesberger A, O'Brien K, Palau MC, Pluijm SMF, di Profio S, Saraceno D, Schneider C, Schreier G, Trinkūnas J, Zamberlan I, Grabow D, Haupt R. Scaling up and implementing the digital Survivorship Passport tool in routine clinical care - The European multidisciplinary PanCareSurPass project. Eur J Cancer 2024; 202:114029. [PMID: 38513384 DOI: 10.1016/j.ejca.2024.114029] [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: 12/21/2023] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Childhood cancer survivors (CCS), of whom there are about 500,000 living in Europe, are at an increased risk of developing health problems [1-6] and require lifelong Survivorship Care. There are information and knowledge gaps among CCS and healthcare providers (HCPs) about requirements for Survivorship Care [7-9] that can be addressed by the Survivorship Passport (SurPass), a digital tool providing CCS and HCPs with a comprehensive summary of past treatment and tailored recommendations for Survivorship Care. The potential of the SurPass to improve person-centred Survivorship Care has been demonstrated previously [10,11]. METHODS The EU-funded PanCareSurPass project will develop an updated version (v2.0) of the SurPass allowing for semi-automated data entry and implement it in six European countries (Austria, Belgium, Germany, Italy, Lithuania and Spain), representative of three infrastructure healthcare scenarios typically found in Europe. The implementation study will investigate the impact on person-centred care, as well as costs and processes of scaling up the SurPass. Interoperability between electronic health record systems and SurPass v2.0 will be addressed using the Health Level Seven (HL7) International interoperability standards. RESULTS PanCareSurPass will deliver an interoperable digital SurPass with comprehensive evidence on person-centred outcomes, technical feasibility and health economics impacts. An Implementation Toolkit will be developed and freely shared to promote and support the future implementation of SurPass across Europe. CONCLUSIONS PanCareSurPass is a novel European collaboration that will improve person-centred Survivorship Care for CCS across Europe through a robust assessment of the implementation of SurPass v2.0 in different healthcare settings.
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Affiliation(s)
- Anna-Liesa Filbert
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Leontien Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Ruth Ladenstein
- St. Anna Children's Cancer Research Institute, Vienna, Austria; St Anna Children's Hospital, Vienna, Austria
| | | | | | | | - Edit Bardi
- St Anna Children's Hospital, Vienna, Austria; Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | | | - Thorsten Langer
- Universitatsklinikum Schleswig-Holstein, Campus Lubeck, Germany
| | | | | | - Jelena Rascon
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Clinics for Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | | | - Stefan Beyer
- AIT Austrian Institute of Technology, Graz, Austria
| | | | | | | | | | | | | | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Sonia di Profio
- Clinical Psychology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | | | - Justas Trinkūnas
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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Fioredda F, Beccaria A, Casartelli P, Turrini E, Contratto C, Giarratana MC, Bagnasco F, Saettini F, Pillon M, Marzollo A, Zanardi S, Civino A, Onofrillo D, Lanciotti M, Ceccherini I, Grossi A, Coviello D, Terranova P, Lupia M, Del Borrello G, Uva P, Cangelosi D, Cavalca G, Miano M, Dufour C. Late-onset and long-lasting neutropenias in the young: A new entity anticipating immune-dysregulation disorders. Am J Hematol 2024; 99:534-542. [PMID: 38282561 DOI: 10.1002/ajh.27221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/09/2023] [Accepted: 01/01/2024] [Indexed: 01/30/2024]
Abstract
This study identifies a new chronic form of immune neutropenia in the young with or without detectable indirect anti-neutrophil antibodies, characterized by mild/moderate neutropenia low risk of severe infection (14%), tendency to develop autoimmune phenomena over the course of the disease (cumulative incidence of 58.6% after 20 years of disease duration), leukopenia, progressive reduction of absolute lymphocyte count and a T- and B-cell profile similar to autoimmune disorders like Sjogren syndrome, rheumatoid arthritis, and systemic lupus erythematosus (increased HLADR+ and CD3 + TCRγδ cells, reduced T regulatory cells, increased double-negative B and a tendency to reduced B memory cells). In a minority of patients, P/LP variants related to primary immuno-regulatory disorders were found. This new form may fit the group of "Likely acquired neutropenia," a provisional category included in the recent International Guidelines on Diagnosis and Management of Neutropenia of EHA and EUNET INNOCHRON ACTION 18233. The early recognition of this form of neutropenia would help clinicians to delineate better specific monitoring plans, genetic counseling, and potentially targeted therapies.
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Affiliation(s)
- F Fioredda
- Haematology Unit-IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - A Beccaria
- Epidemiology and Biostatistics Unit and DOPO Clinic-IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - P Casartelli
- Haematology Unit-IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - E Turrini
- Unit of Pediatric and OncoHematology, Department of Mother and Child, Azienda Ospedaliera Universitaria, Parma, Italy
| | - C Contratto
- Haematology Unit-IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - M C Giarratana
- Haematology Unit-IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - F Bagnasco
- Biostatistics Unit, Scientific Directorate, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - F Saettini
- Department of Pediatric Onco-Hematology, San Gerardo Hospital, Fondazione MBBM, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - M Pillon
- Pediatric Hematology-Oncology Unit, Department of Women's and Children's Health, AziendaOspedaliera-University of Padova, Padua, Italy
| | - A Marzollo
- Pediatric Hematology-Oncology Unit, Department of Women's and Children's Health, AziendaOspedaliera-University of Padova, Padua, Italy
| | - S Zanardi
- Haematology Unit-IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - A Civino
- Unit of Rheumathology and Immunology-ospedale Vito Fazzi, Lecce, Italy
| | - D Onofrillo
- Pediatric Hematology and Oncology Unit, Department of Hematology, Spirito Santo Hospital, Pescara, Italy
| | - M Lanciotti
- Haematology Unit-IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - I Ceccherini
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - A Grossi
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - D Coviello
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - P Terranova
- Haematology Unit-IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - M Lupia
- Haematology Unit-IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - G Del Borrello
- Haematology Unit-IRCCS Istituto Giannina Gaslini, Genova, Italy
- Pediatric OncoHematology, Pediatrics Department, Hospital Città Della Salute e Della Scienza, University of Turin, Turin, Italy
| | - P Uva
- Clinical Bioinformatics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - D Cangelosi
- Clinical Bioinformatics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - G Cavalca
- Clinical Bioinformatics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
- University of Bologna, Bologna, Italy
| | - M Miano
- Haematology Unit-IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - C Dufour
- Haematology Unit-IRCCS Istituto Giannina Gaslini, Genova, Italy
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Heymer EJ, Hawkins MM, Winter DL, Teepen JC, Sunguc C, Ronckers CM, Allodji RS, Alessi D, Sugden E, Belle FN, Bagnasco F, Byrne J, Bárdi E, Garwicz S, Grabow D, Jankovic M, Kaatsch P, Kaiser M, Michel G, Schindera C, Haddy N, Journy N, Česen Mazić M, Skinner R, Kok JL, Gunnes MW, Wiebe T, Sacerdote C, Maule MM, Terenziani M, Jakab Z, Winther JF, Lähteenmäki PM, Zadravec Zaletel L, Haupt R, Kuehni CE, Kremer LC, de Vathaire F, Hjorth L, Reulen RC. Risk of subsequent gliomas and meningiomas among 69,460 5-year survivors of childhood and adolescent cancer in Europe: the PanCareSurFup study. Br J Cancer 2024; 130:976-986. [PMID: 38243010 PMCID: PMC10951281 DOI: 10.1038/s41416-024-02577-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Childhood cancer survivors are at risk of subsequent gliomas and meningiomas, but the risks beyond age 40 years are uncertain. We quantified these risks in the largest ever cohort. METHODS Using data from 69,460 5-year childhood cancer survivors (diagnosed 1940-2008), across Europe, standardized incidence ratios (SIRs) and cumulative incidence were calculated. RESULTS In total, 279 glioma and 761 meningioma were identified. CNS tumour (SIR: 16.2, 95% CI: 13.7, 19.2) and leukaemia (SIR: 11.2, 95% CI: 8.8, 14.2) survivors were at greatest risk of glioma. The SIR for CNS tumour survivors was still 4.3-fold after age 50 (95% CI: 1.9, 9.6), and for leukaemia survivors still 10.2-fold after age 40 (95% CI: 4.9, 21.4). Following cranial radiotherapy (CRT), the cumulative incidence of a glioma in CNS tumour survivors was 2.7%, 3.7% and 5.0% by ages 40, 50 and 60, respectively, whilst for leukaemia this was 1.2% and 1.7% by ages 40 and 50. The cumulative incidence of a meningioma after CRT in CNS tumour survivors doubled from 5.9% to 12.5% between ages 40 and 60, and in leukaemia survivors increased from 5.8% to 10.2% between ages 40 and 50. DISCUSSION Clinicians following up survivors should be aware that the substantial risks of meningioma and glioma following CRT are sustained beyond age 40 and be vigilant for symptoms.
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Affiliation(s)
- Emma J Heymer
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ceren Sunguc
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Rodrigue S Allodji
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Elaine Sugden
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Fabiën N Belle
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Julianne Byrne
- Boyne Research Institute, c/o no. 1, The Maples, Bettystown, Co Meath, A92 C635, Ireland
| | - Edit Bárdi
- St Anna Children's Hospital, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Momcilo Jankovic
- Pediatric Clinic, University of Milano-Bicocca, Hospital San Gerardo, Via Donizetti 33, Monza, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Oncology/Haematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Neige Journy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Maja Česen Mazić
- University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Judith L Kok
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Maria W Gunnes
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Thomas Wiebe
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Milena M Maule
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | | | - Riccardo Haupt
- DOPO Clinic, Division of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Hematology/Oncology, Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Leontien C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Lars Hjorth
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Heymer EJ, Jóźwiak K, Kremer LC, Winter DL, de Vathaire F, Sunguc C, Sugden E, Kok JL, van der Pal HJH, Hjorth L, Jakab Z, Maule MM, Haupt R, Bagnasco F, Terenziani M, Diallo I, Gunnes MW, Sommer G, Zadravec Zaletel L, Kuehni CE, Winther JF, Lähteenmäki PM, Gudmundsdottir T, Allodji RS, Skinner R, Ronckers CM, Hawkins MM, Reulen RC, Teepen JC. Cumulative Absolute Risk of Subsequent Colorectal Cancer After Abdominopelvic Radiotherapy Among Childhood Cancer Survivors: A PanCareSurFup Study. J Clin Oncol 2024; 42:336-347. [PMID: 37972325 DOI: 10.1200/jco.23.00452] [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: 02/27/2023] [Revised: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Childhood cancer survivors are at the risk of developing subsequent colorectal cancers (CRCs), but the absolute risks by treatment modality are uncertain. We quantified the absolute risks by radiotherapy treatment characteristics using clinically accessible data from a Pan-European wide case-control study nested within a large cohort of childhood cancer survivors: the PanCareSurFup Study. METHODS Odds ratios (ORs) from a case-control study comprising 143 CRC cases and 143 controls nested within a cohort of 69,460 survivors were calculated. These, together with standardized incidence ratios for CRC for this cohort and European general population CRC incidence rates and survivors' mortality rates, were used to estimate cumulative absolute risks (CARs) by attained age for different categories of radiation to the abdominopelvic area. RESULTS Overall, survivors treated with abdominopelvic radiotherapy treatment (ART) were three times more likely to develop a subsequent CRC than those who did not receive ART (OR, 3.1 [95% CI, 1.4 to 6.6]). For male survivors treated with ART, the CAR was 0.27% (95% CI, 0.17 to 0.59) by age 40 years, 1.08% (95% CI, 0.69 to 2.34) by age 50 years (0.27% expected in the general population), and 3.7% (95% CI, 2.36 to 7.80) by age 60 years (0.95% expected). For female survivors treated with ART, the CAR was 0.29% (95% CI, 0.18 to 0.62) by age 40 years, 1.03% (95% CI, 0.65 to 2.22) by age 50 years (0.27% expected), and 3.0% (95% CI, 1.91 to 6.37) by age 60 years (0.82% expected). CONCLUSION We demonstrated that by age 40 years survivors of childhood cancer treated with ART already have a similar risk of CRC as those age 50 years in the general population for whom population-based CRC screening begins in many countries. This information should be used in the development of survivorship guidelines for the risk stratification of survivors concerning CRC risk.
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Affiliation(s)
- Emma J Heymer
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Leontien C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - Ceren Sunguc
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Elaine Sugden
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Judith L Kok
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Lars Hjorth
- Department of Clinical Sciences Lund, Paediatrics,Skane University Hospital, Lund University, Lund, Sweden
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Milena M Maule
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Riccardo Haupt
- Division of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, DOPO Clinic, Genova, Italy
| | | | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ibrahima Diallo
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - Maria W Gunnes
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Grit Sommer
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Hematology/Oncology, Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Rodrigue S Allodji
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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5
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Pezzato S, Govindan RB, Bagnasco F, Panagopoulos EM, Robba C, Beqiri E, Smielewski P, Munoz RA, d'Udekem Y, Moscatelli A, du Plessis A. Cerebral autoregulation monitoring using the cerebral oximetry index after neonatal cardiac surgery: A single-center retrospective cohort study. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01132-7. [PMID: 38065519 DOI: 10.1016/j.jtcvs.2023.12.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/31/2023] [Accepted: 12/03/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To investigate whether cerebral autoregulation is impaired after neonatal cardiac surgery and whether changes in autoregulation metrics are associated with different congenital heart defects or the incidence of postoperative neurologic events. METHODS This is a retrospective observational study of neonates undergoing monitoring during the first 72 hours after cardiac surgery. Archived data were processed to calculate the cerebral oximetry index (COx) and derived metrics. Acute neurologic events were identified by an electronic medical record review. The Skillings-Mack test and the Wilcoxon signed-rank test were used to analyze the evolution of autoregulation metrics over time; the Mann-Whitney U test was used for comparison between groups. RESULTS We included 28 neonates, 7 (25%) with hypoplastic left heart syndrome and 21 (75%) with transposition of the great arteries. Overall, the median percentage of time spent with impaired autoregulation, defined as percentage of time with a COx >0.3, was 31.6% (interquartile range, 21.1%-38.3%). No differences in autoregulation metrics between different cardiac defects subgroups were observed. Seven patients (25%) experienced a postoperative acute neurologic event. Compared to the neonates without an acute neurologic event, those with an acute neurologic event had a higher COx (0.16 vs 0.07; P = .035), a higher percentage of time with a COx >0.3 (39.4% vs 29.2%; P = .017), and a higher percentage of time with a mean arterial pressure below the lower limit of autoregulation (13.3% vs 6.9%; P = .048). CONCLUSIONS COx monitoring after cardiac surgery allowed for the detection of impaired cerebral autoregulation, which was more frequent in neonates with postoperative acute neurologic events.
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Affiliation(s)
- Stefano Pezzato
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy; Division of Cardiovascular Surgery, Children's National Hospital, Washington, DC.
| | | | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Chiara Robba
- Anesthesia and Critical Care, IRCCS Policlinico San Martino, Genova, Italy
| | - Erta Beqiri
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Peter Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Ricardo A Munoz
- Division of Cardiac Critical Care Medicine, Children's National Hospital, Washington, DC
| | - Yves d'Udekem
- Division of Cardiovascular Surgery, Children's National Hospital, Washington, DC
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Adre du Plessis
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC
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6
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Reulen RC, Winter DL, Diallo I, Veres C, Llanas D, Allodji RS, Bagnasco F, Bárdi E, Feijen EAM, Alessi D, Fidler-Benaoudia MM, Høgsholt S, Teepen JC, Linge H, Haddy N, Byrne J, Debiche G, Grabow D, Gudmundsdottir T, Fauchery R, Zrafi W, Michel G, Øfstaas H, Kaatsch P, Vu-Bezin G, Jenkinson H, Kaiser M, Skinner R, Cole T, Waespe N, Sommer G, Nordenfelt S, Jankovic M, Lähteenmäki Taalas T, Maule MM, van der Pal HJH, Ronckers CM, van Leeuwen FE, Kok JL, Terenziani M, Winther Gunnes M, Wiebe T, Sacerdote C, Jakab Z, Haupt R, Lähteenmäki PM, Zadravec Zaletel L, Kuehni CE, Winther JF, Kremer LCM, Hjorth L, de Vathaire F, Hawkins MM. Risk Factors for Primary Bone Cancer After Childhood Cancer: A PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies Nested Case-Control Study. J Clin Oncol 2023; 41:3735-3746. [PMID: 37235821 DOI: 10.1200/jco.22.02045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/09/2023] [Accepted: 04/10/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Radiation to the bone and exposure to alkylating agents increases the risk of bone cancer among survivors of childhood cancer, but there is uncertainty regarding the risks of bone tissue radiation doses below 10 Gy and the dose-response relationship for specific types of chemotherapy. METHODS Twelve European countries contributed 228 cases and 228 matched controls to a nested case-control study within a cohort of 69,460 5-year survivors of childhood cancer. Odds ratios (ORs) of developing bone cancer for different levels of cumulative radiation exposure and cumulative doses of specific types of chemotherapy were calculated. Excess ORs were calculated to investigate the shape and extent of any dose-response relationship. RESULTS The OR associated with bone tissue exposed to 1-4 Gy was 4.8-fold (95% CI, 1.2 to 19.6) and to 5-9 Gy was 9.6-fold (95% CI, 2.4 to 37.4) compared with unexposed bone tissue. The OR increased linearly with increasing dose of radiation (Ptrend < .001) up to 78-fold (95% CI, 9.2 to 669.9) for doses of ≥40 Gy. For cumulative alkylating agent doses of 10,000-19,999 and ≥20,000 mg/m2, the radiation-adjusted ORs were 7.1 (95% CI, 2.2 to 22.8) and 8.3 (95% CI, 2.8 to 24.4), respectively, with independent contributions from each of procarbazine, ifosfamide, and cyclophosphamide. Other cytotoxics were not associated with bone cancer. CONCLUSION To our knowledge, we demonstrate-for the first time-that the risk of bone cancer is increased 5- to 10-fold after exposure of bone tissue to cumulative radiation doses of 1-9 Gy. Alkylating agents exceeding 10,000 mg/m2 increase the risk 7- to 8-fold, particularly following procarbazine, ifosfamide, and cyclophosphamide. These substantially elevated risks should be used to develop/update clinical follow-up guidelines and survivorship care plans.
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Affiliation(s)
- Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Ibrahim Diallo
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Cristina Veres
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Damien Llanas
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Rodrigue S Allodji
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | - Edit Bárdi
- St Anna Children's Hospital, Vienna, Austria
| | | | | | | | | | | | | | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | - Ghazi Debiche
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | | | - Romain Fauchery
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Wael Zrafi
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | | | | | - Giao Vu-Bezin
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jeanette F Winther
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | | | | | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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7
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Dudley IM, Sunguc C, Heymer EJ, Winter DL, Teepen JC, Belle FN, Bárdi E, Bagnasco F, Gudmundsdottir T, Skinner R, Michel G, Byrne J, Øfstaas H, Jankovic M, Mazić MČ, Mader L, Loonen J, Garwicz S, Wiebe T, Alessi D, Allodji RS, Haddy N, Grabow D, Kaatsch P, Kaiser M, Maule MM, Jakab Z, Gunnes MW, Terenziani M, Zaletel LZ, Kuehni CE, Haupt R, de Vathaire F, Kremer LC, Lähteenmäki PM, Winther JF, Hjorth L, Hawkins MM, Reulen RC. Risk of subsequent primary lymphoma in a cohort of 69,460 five-year survivors of childhood and adolescent cancer in Europe: The PanCareSurFup study. Cancer 2023; 129:426-440. [PMID: 36444554 PMCID: PMC10099796 DOI: 10.1002/cncr.34561] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Survivors of Hodgkin lymphoma (HL) are at risk of developing non-Hodgkin lymphoma (NHL) after treatment; however, the risks of developing subsequent primary lymphomas (SPLs), including HL and NHL, after different types of childhood cancer are unknown. The authors quantified the risk of SPLs using the largest cohort of childhood cancer survivors worldwide. METHODS The Pan-European Network for Care of Survivors After Childhood and Adolescent Cancer (PanCare) Survivor Care and Follow-Up Studies (PanCareSurFup) cohort includes 69,460 five-year survivors of childhood cancer, diagnosed during 1940 through 2008, from 12 European countries. Risks of SPLs were quantified by standardized incidence ratios (SIRs) and relative risks (RRs) using multivariable Poisson regression. RESULTS Overall, 140 SPLs, including 104 NHLs and 36 HLs, were identified. Survivors were at 60% increased risk of an SPL compared with the general population (SIR, 1.6; 95% confidence interval [CI], 1.4-1.9). Survivors were twice as likely to develop NHL (SIR, 2.3; 95% CI, 1.9-2.8), with the greatest risks among survivors of HL (SIR, 7.1; 95% CI, 5.1-10.0), Wilms tumor (SIR, 3.1; 95% CI, 1.7-5.7), leukemia (SIR, 2.8; 95% CI, 1.8-4.4), and bone sarcoma (SIR, 2.7; 95% CI, 1.4-5.4). Treatment with chemotherapy for any cancer doubled the RR of NHL (RR, 2.1; 95% CI, 1.2-3.9), but treatment with radiotherapy did not (RR, 1.2; 95% CI, 0.7-2.0). Survivors were at similar risk of developing a subsequent HL as the general population (SIR, 1.1; 95% CI, 0.8-1.5). CONCLUSIONS In addition to HL, the authors show here for the first time that survivors of Wilms tumor, leukemia, and bone sarcoma are at risk of NHL. Survivors and health care professionals should be aware of the risk of NHL in these survivors and in any survivors treated with chemotherapy.
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Affiliation(s)
- Isabelle M. Dudley
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Ceren Sunguc
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Emma J. Heymer
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - David L. Winter
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Jop C. Teepen
- Princess Maxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Fabiën N. Belle
- Childhood Cancer Research GroupInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Center for Primary Care and Public Health (Unisante)University of LausanneLausanneSwitzerland
| | - Edit Bárdi
- St Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineJohannes Kepler University LinzKepler University HospitalLinzAustria
| | | | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research CenterChildhood Cancer Research GroupCopenhagenDenmark
- Children's HospitalLandspitali University HospitalReykjavikIceland
| | - Roderick Skinner
- Great North Children's HospitalNewcastle upon Tyne Hospitals National Health Service Foundation TrustNewcastle upon TyneUK
- Newcastle University Center for CancerNewcastle UniversityNewcastle upon TyneUK
| | - Gisela Michel
- Department of Health Sciences and MedicineUniversity of LucerneLucerneSwitzerland
| | | | - Hilde Øfstaas
- Division of Pediatric and Adolescent MedicineOslo University Hospital RikshospitaletOsloNorway
| | - Momcilo Jankovic
- Pediatric ClinicUniversity of Milano‐BicoccaHospital San GerardoMonzaItaly
| | - Maja Česen Mazić
- University Children's Hospital LjubljanaUniversity Medical Center LjubljanaLjubljanaSlovenia
| | - Luzius Mader
- Childhood Cancer Research GroupInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Jaqueline Loonen
- Department of HematologyRadboud University Medical CenterNijmegenNetherlands
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, PediatricsLund UniversitySkane University HospitalLundSweden
| | - Thomas Wiebe
- Department of Clinical Sciences Lund, PediatricsLund UniversitySkane University HospitalLundSweden
| | - Daniela Alessi
- Childhood Cancer Registry of PiedmontCancer Epidemiology UnitDepartment of Medical SciencesUniversity of TurinTurinItaly
- Reference Center for Epidemiology and Cancer Prevention‐PiemonteUniversity Hospital Citta della Salute e della Scienza di TorinoTurinItaly
| | - Rodrigue S. Allodji
- Radiation Epidemiology TeamCenter for Research in Epidemiology and Population HealthNational Institute of Health and Medical Research Unit 1018University Paris SaclayGustave RoussyVillejuifFrance
| | - Nadia Haddy
- Radiation Epidemiology TeamCenter for Research in Epidemiology and Population HealthNational Institute of Health and Medical Research Unit 1018University Paris SaclayGustave RoussyVillejuifFrance
| | - Desiree Grabow
- German Childhood Cancer RegistryDivision of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and InformaticsJohannes‐Gutenberg University MainzMainzGermany
| | - Peter Kaatsch
- German Childhood Cancer RegistryDivision of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and InformaticsJohannes‐Gutenberg University MainzMainzGermany
| | - Melanie Kaiser
- German Childhood Cancer RegistryDivision of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and InformaticsJohannes‐Gutenberg University MainzMainzGermany
| | - Milena M. Maule
- Childhood Cancer Registry of PiedmontCancer Epidemiology UnitDepartment of Medical SciencesUniversity of TurinTurinItaly
- Reference Center for Epidemiology and Cancer Prevention‐PiemonteUniversity Hospital Citta della Salute e della Scienza di TorinoTurinItaly
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer RegistrySecond Department of PediatricsSemmelweis UniversityBudapestHungary
| | - Maria Winther Gunnes
- Division of Pediatric and Adolescent MedicineOslo University Hospital RikshospitaletOsloNorway
- Department of RegistrationCancer Registry of NorwayOsloNorway
| | - Monica Terenziani
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | | | - Claudia E. Kuehni
- Childhood Cancer Research GroupInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Division of Pediatric Hematology/OncologyDepartment of PediatricsUniversity Children's Hospital of BernUniversity of BernBernSwitzerland
| | - Riccardo Haupt
- Diagnosis, Observation, Prevention After Oncologic Treatment (DOPO) ClinicDivision of Hematology/OncologyIRCCS Istituto Giannina GasliniGenovaItaly
| | - Florent de Vathaire
- Radiation Epidemiology TeamCenter for Research in Epidemiology and Population HealthNational Institute of Health and Medical Research Unit 1018University Paris SaclayGustave RoussyVillejuifFrance
| | - Leontien C. Kremer
- Princess Maxima Center for Pediatric OncologyUtrechtThe Netherlands
- Emma Children's HospitalAmsterdamNetherlands
| | - Päivi M. Lähteenmäki
- Department of Pediatrics and Adolescent MedicineTurku University and Turku University HospitalTurkuFinland
| | - Jeanette F. Winther
- Danish Cancer Society Research CenterChildhood Cancer Research GroupCopenhagenDenmark
- Department of Clinical MedicineFaculty of HealthAarhus University and University HospitalAarhusDenmark
| | - Lars Hjorth
- Department of Clinical Sciences Lund, PediatricsLund UniversitySkane University HospitalLundSweden
| | - Michael M. Hawkins
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Raoul C. Reulen
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
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8
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Sunguc C, Hawkins MM, Winter DL, Dudley IM, Heymer EJ, Teepen JC, Allodji RS, Belle FN, Bagnasco F, Byrne J, Bárdi E, Ronckers CM, Haddy N, Gudmundsdottir T, Garwicz S, Jankovic M, van der Pal HJH, Mazić MČ, Schindera C, Grabow D, Maule MM, Kaatsch P, Kaiser M, Fresneau B, Michel G, Skinner R, Wiebe T, Sacerdote C, Jakab Z, Gunnes MW, Terenziani M, Winther JF, Lähteenmäki PM, Zaletel LZ, Kuehni CE, Kremer LC, Haupt R, de Vathaire F, Hjorth L, Reulen RC. Risk of subsequent primary oral cancer in a cohort of 69,460 5-year survivors of childhood and adolescent cancer in Europe: the PanCareSurFup study. Br J Cancer 2023; 128:80-90. [PMID: 36319851 DOI: 10.1038/s41416-022-02016-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Survivors of childhood cancer are at risk of subsequent primary malignant neoplasms (SPNs), but the risk for rarer types of SPNs, such as oral cancer, is uncertain. Previous studies included few oral SPNs, hence large-scale cohorts are required to identify groups at risks. METHODS The PanCareSurFup cohort includes 69,460 5-year survivors of childhood cancer across Europe. Risks of oral SPNs were defined by standardised incidence ratios (SIRs), absolute excess risks and cumulative incidence. RESULTS One hundred and forty-five oral SPNs (64 salivary gland, 38 tongue, 20 pharynx, 2 lip, and 21 other) were ascertained among 143 survivors. Survivors were at 5-fold risk of an oral SPN (95% CI: 4.4-5.6). Survivors of leukaemia were at greatest risk (SIR = 19.2; 95% CI: 14.6-25.2) followed by bone sarcoma (SIR = 6.4, 95% CI: 3.7-11.0), Hodgkin lymphoma (SIR = 6.2, 95% CI: 3.9-9.9) and soft-tissue sarcoma (SIR = 5.0, 95% CI: 3.0-8.5). Survivors treated with radiotherapy were at 33-fold risk of salivary gland SPNs (95% CI: 25.3-44.5), particularly Hodgkin lymphoma (SIR = 66.2, 95% CI: 43.6-100.5) and leukaemia (SIR = 50.5, 95% CI: 36.1-70.7) survivors. Survivors treated with chemotherapy had a substantially increased risk of a tongue SPN (SIR = 15.9, 95% CI: 10.6-23.7). CONCLUSIONS Previous radiotherapy increases the risk of salivary gland SPNs considerably, while chemotherapy increases the risk of tongue SPNs substantially. Awareness of these risks among both health-care professionals and survivors could play a crucial role in detecting oral SPNs early.
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Affiliation(s)
- Ceren Sunguc
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Isabelle M Dudley
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma J Heymer
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Rodrigue S Allodji
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Fabiën N Belle
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Julianne Byrne
- Boyne Research Institute, c/o no. 1, The Maples, Bettystown, Co Meath, A92 C635, Ireland
| | - Edit Bárdi
- St Anna Children's Hospital, Vienna, Austria and Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Momcilo Jankovic
- Pediatric Clinic, University of Milano-Bicocca, Hospital San Gerardo, Via Donizetti, 33, Monza, Italy
| | | | - Maja Česen Mazić
- University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Oncology/Haematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Desiree Grabow
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Milena M Maule
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Brice Fresneau
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
- Department of Children and Adolescents Oncology, Gustave Roussy, F-94805, Villejuif, France
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas Wiebe
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Maria Winther Gunnes
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | | | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Hematology/Oncology, Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Leontien C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Department of Pediatrics, Amsterdam, the Netherlands
| | - Riccardo Haupt
- DOPO clinic, Division of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Lars Hjorth
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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9
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de Baat EC, Feijen EA, Reulen RC, Allodji RS, Bagnasco F, Bardi E, Belle FN, Byrne J, van Dalen EC, Debiche G, Diallo I, Grabow D, Hjorth L, Jankovic M, Kuehni CE, Levitt G, Llanas D, Loonen J, Zaletel LZ, Maule MM, Miligi L, van der Pal HJ, Ronckers CM, Sacerdote C, Skinner R, Jakab Z, Veres C, Haddy N, Winter DL, de Vathaire F, Hawkins MM, Kremer LC. Risk Factors for Heart Failure Among Pan-European Childhood Cancer Survivors: A PanCareSurFup and ProCardio Cohort and Nested Case-Control Study. J Clin Oncol 2023; 41:96-106. [PMID: 36075007 PMCID: PMC9788976 DOI: 10.1200/jco.21.02944] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Heart failure (HF) is a potentially life-threatening complication of treatment for childhood cancer. We evaluated the risk and risk factors for HF in a large European study of long-term survivors. Little is known of the effects of low doses of treatment, which is needed to improve current treatment protocols and surveillance guidelines. METHODS This study includes the PanCareSurFup and ProCardio cohort of ≥ 5-year childhood cancer survivors diagnosed between 1940 and 2009 in seven European countries (N = 42,361). We calculated the cumulative incidence of HF and conducted a nested case-control study to evaluate detailed treatment-related risk factors. RESULTS The cumulative incidence of HF was 2% (95% CI, 1.7 to 2.2) by age 50 years. The case-control study (n = 1,000) showed that survivors who received a mean heart radiation therapy (RT) dose of 5 to < 15 Gy have an increased risk of HF (odds ratio, 5.5; 95% CI, 2.5 to 12.3), when compared with no heart RT. The risk associated with doses 5 to < 15 Gy increased with exposure of a larger heart volume. In addition, the HF risk increased in a linear fashion with higher mean heart RT doses. Regarding total cumulative anthracycline dose, survivors who received ≥ 100 mg/m2 had a substantially increased risk of HF and survivors treated with a lower dose showed no significantly increased risk of HF. The dose-response relationship appeared quadratic with higher anthracycline doses. CONCLUSION Survivors who received a mean heart RT dose of ≥ 5 Gy have an increased risk of HF. The risk associated with RT increases with larger volumes exposed. Survivors treated with < 100 mg/m2 total cumulative anthracycline dose have no significantly increased risk of HF. These new findings might have consequences for new treatment protocols for children with cancer and for cardiomyopathy surveillance guidelines.
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Affiliation(s)
- Esmée C. de Baat
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands,Esmée C. de Baat, MD, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands; e-mail:
| | | | - Raoul C. Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Rodrigue S. Allodji
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Edit Bardi
- St Anna Children's Hospital, Vienna, Austria,Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Fabiën N. Belle
- Childhood Cancer Research Group, ISPM Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,PMU Unisanté, University of Lausanne, Lausanne, Switzerland
| | | | | | - Ghazi Debiche
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Ibrahima Diallo
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Paediatrics, Lund, Sweden
| | - Momcilo Jankovic
- Pediatric Clinic University of Milano-Bicocca, Foundation MBBM, Monza, Italy
| | - Claudia E. Kuehni
- Childhood Cancer Research Group, ISPM Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gill Levitt
- Department of Paediatric and Oncology, Great Ormond St Hospital for Children NHS Foundation Trust London, United Kingdom
| | - Damien Llanas
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Milena M. Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza, CPO-Piemonte, Turin, Italy
| | - Lucia Miligi
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Firenze, Italy
| | | | | | - Carlotta Sacerdote
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza, CPO-Piemonte, Turin, Italy
| | - Roderick Skinner
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom,Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, Semmelweis University, Budapest Hungary
| | - Cristina Veres
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Nadia Haddy
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - David L. Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Florent de Vathaire
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Michael M. Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Leontien C.M. Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands,Emma Children's Hospital, Amsterdam UMC, the Netherlands
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10
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Dell'Orso G, Bagnasco F, Giardino S, Pierri F, Ferrando G, Di Martino D, Micalizzi C, Guardo D, Volpi S, Sabatini F, Miano M, Gattorno M, Dufour C, Faraci M. Hematopoietic stem cell transplantation for inborn errors of immunity: 30-year single-center experience. Front Immunol 2023; 14:1103080. [PMID: 36825011 PMCID: PMC9941625 DOI: 10.3389/fimmu.2023.1103080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) represents an effective treatment for a variety of inborn errors of immunity (IEI). We report the experience of children affected by IEI who received allo-HSCT over a period of 32 years at IRCCS Istituto Giannina Gaslini, Genoa, Italy. HSCTs were performed in 67 children with IEI. Kaplan-Meier estimates of overall survival (OS) rate at 5 years in the whole group of patients was 83.4% after a median follow-up of 4 years. Median age at transplant was 2.5 years. Eight allo-HSCTs were complicated by either primary or secondary graft failure (GF), the overall incidence of this complication being 10.9%. Incidence of grade 3-4 acute GvHD (aGvHD) was 18.7%, significantly lower in the haploidentical transplant cohort (p = 0.005). Year of transplant (≤2006 vs. >2006) was the main factor influencing the outcome. In fact, a significant improvement in 5-year OS was demonstrated (92.5% >2006 vs. 65% ≤2006, p = 0.049). Frequency of severe aGvHD was significantly reduced in recent years (≤2006 61.5%, vs. >2006 20%, p = 0.027). A significant progress has been the introduction of the TCR αβ/CD19-depleted haploidentical platform, which was associated with the absence of severe aGvHD. However, it was associated with 23.5% incidence of GF. All but one patient experiencing GF in the this specific cohort were successfully retransplanted. In summary, allo-HSCT is confirmed to be an effective treatment for children with IEI, even in the absence of an HLA-matched donor.
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Affiliation(s)
- Gianluca Dell'Orso
- Hematopoietic Stem Cell Transplantation Unit, Department of Hematology-Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Bagnasco
- Scientific Directorate, Epidemiology and Biostatistics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Stefano Giardino
- Hematopoietic Stem Cell Transplantation Unit, Department of Hematology-Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Filomena Pierri
- Hematopoietic Stem Cell Transplantation Unit, Department of Hematology-Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giulia Ferrando
- Infectious Diseases Unit and COVID-Hospital, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Daniela Guardo
- Hematology Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Stefano Volpi
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Federica Sabatini
- Stem Cells and Cell Therapies Laboratory, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Miano
- Hematology Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Gattorno
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Carlo Dufour
- Hematology Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Maura Faraci
- Hematopoietic Stem Cell Transplantation Unit, Department of Hematology-Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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11
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Parodi S, Verda D, Bagnasco F, Muselli M. The clinical meaning of the area under a receiver operating characteristic curve for the evaluation of the performance of disease markers. Epidemiol Health 2022; 44:e2022088. [PMID: 36265519 PMCID: PMC10089712 DOI: 10.4178/epih.e2022088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The area under a receiver operating characteristic (ROC) curve (AUC) is a popular measure of pure diagnostic accuracy that is independent from the proportion of diseased subjects in the analysed sample. However, its actual usefulness in the clinical context has been questioned, because it does not seem to be directly related to the actual performance of a diagnostic marker in identifying diseased and non-diseased subjects in real clinical settings. This study evaluates the relationship between the AUC and the proportion of correct classifications (global diagnostic accuracy, GDA) in relation to the shape of the corresponding ROC curves. METHODS We demonstrate that AUC represents an upward-biased measure of GDA at an optimal accuracy cut-off for balanced groups. The magnitude of bias depends on the shape of the ROC plot and on the proportion of diseased and non-diseased subjects. In proper curves, the bias is independent from the diseased/non-diseased ratio and can be easily estimated and removed. Moreover, a comparison between 2 partial AUCs can be replaced by a more powerful test for the corresponding whole AUCs. RESULTS Applications to 3 real datasets are provided: a marker for a hormone deficit in children, 2 tumour markers for malignant mesothelioma, and 2 gene expression profiles in ovarian cancer patients. CONCLUSIONS The AUC is a measure of accuracy with potential clinical relevance for the evaluation of disease markers. The clinical meaning of ROC parameters should always be evaluated with an analysis of the shape of the corresponding ROC curve.
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Affiliation(s)
- Stefano Parodi
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Marco Muselli
- Rulex Innovation Labs, Genoa, Italy.,Institute of Electronics, Computer and Telecommunication Engineering, National Research Council of Italy, Genoa, Italy
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12
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Bagnasco F, Zimmermann SY, Egeler RM, Nanduri VR, Cammarata B, Donadieu J, Lehrnbecher T, Haupt R. Langerhans cell histiocytosis and associated malignancies: A retrospective analysis of 270 patients. Eur J Cancer 2022; 172:138-145. [PMID: 35772351 DOI: 10.1016/j.ejca.2022.03.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 12/21/2021] [Revised: 02/25/2022] [Accepted: 03/29/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The frequency of Langerhans cell histiocytosis (LCH) and associated malignancies (AM) is greater than statistically expected. Here, we analyze LCH-AM co-occurrence in both children and adults. METHODS Between 1991 and 2015, data were collected by regular questionnaires to members of the Histiocyte Society and searches in PubMed and Abstract Books. Patients were grouped by age at LCH diagnosis (≤ and >18 years), and types and timing of AM occurrence were plotted with respect to the LCH diagnosis. For the statistical analysis, only the first AM were considered. RESULTS A total of 285 LCH-AM in 270 patients were identified, 116 (43%) ≤ 18 years, and 154 (57%) >18 years. In childhood LCH-AM pairs, leukemias and myeloproliferative disorders (n = 58; 50.0%) prevailed over solid tumors (n = 43; 37.1%) and lymphoma (n = 15; 12.9%). In adults, solid tumors were reported in 61 patients (39.6%), lymphoma, and leukemias and myeloproliferative disorders in 56 (36.4%) and 37 (24.0%) patients, respectively. In most children, AM followed LCH (n = 69, 59.5%), whereas in adults, LCH and AM occurred concurrently in 69 patients (44.8%). In children, T-lineage acute lymphoblastic leukemia (ALL) and promyelocytic acute myeloid leukemia (AML) and retinoblastoma were over-represented and thyroid carcinoma in adults. CONCLUSIONS The largest collection of data on LCH-AM to date clearly indicates inherent relationships between specific types of AM and LCH, which may be due to therapy effects, clonal evolution, and germ-line predisposition, respectively. Prospective thorough genetic analysis is warranted and will hopefully shed light on the association of LCH and second neoplasms.
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Affiliation(s)
| | - Stefanie Yvonne Zimmermann
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | | | - Vasanta Rao Nanduri
- Department of Paediatrics, Watford General Hospital, Watford, United Kingdom
| | - Bruna Cammarata
- DOPO Clinic, Division of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Jean Donadieu
- Service D'Hémato-oncologie Pédiatrique, Hôpital Armand Trousseau Aphp, Paris, France
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Riccardo Haupt
- DOPO Clinic, Division of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy.
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13
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Bagnasco F, Piaggio G, Mesini A, Mariani M, Russo C, Saffioti C, Losurdo G, Palmero C, Castagnola E. Epidemiology of Antibiotic Resistant Pathogens in Pediatric Urinary Tract Infections as a Tool to Develop a Prediction Model for Early Detection of Drug-Specific Resistance. Antibiotics (Basel) 2022; 11:antibiotics11060720. [PMID: 35740127 PMCID: PMC9220059 DOI: 10.3390/antibiotics11060720] [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: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Antibiotic resistance is an increasing problem, especially in children with urinary tract infections. Rates of drug-specific resistant pathogens were reported, and an easy prediction model to guide the clinical decision-making process for antibiotic treatment was proposed. Data on microbiological isolation from urinoculture, between January 2007−December 2018 at Istituto Gaslini, Italy, in patients aged <19 years were extracted. Logistic regression-based prediction scores were calculated. Discrimination was determined by the area under the receiver operating characteristic curve; calibration was assessed by the Hosmer and Lemeshow test and the Spiegelhalterz test. A total of 9449 bacterial strains were isolated in 6207 patients; 27.2% were <6 months old at the first episode. Enterobacteriales (Escherichia coli and other Enterobacteriales) accounted for 80.4% of all isolates. Amoxicillin-clavulanate (AMC) and cefixime (CFI) Enterobacteriales resistance was 32.8% and 13.7%, respectively, and remained quite stable among the different age groups. On the contrary, resistance to ciprofloxacin (CIP) (overall 9.6%) and cotrimoxazole (SXT) (overall 28%) increased with age. After multivariable analysis, resistance to AMC/CFI could be predicted by the following: sex; age at sampling; department of admission; previous number of bacterial pathogens isolated. Resistance to CIP/SXT could be predicted by the same factors, excluding sex. The models achieved very good calibration but moderate discrimination performance. Specific antibiotic resistance among Enterobacteriales could be predicted using the proposed scoring system to guide empirical antibiotic choice. Further studies are needed to validate this tool.
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Affiliation(s)
- Francesca Bagnasco
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
- Correspondence:
| | - Giorgio Piaggio
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Alessio Mesini
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
| | - Marcello Mariani
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genova, Italy
| | - Chiara Russo
- Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, 16132 Genova, Italy;
| | - Carolina Saffioti
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
| | - Giuseppe Losurdo
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
| | - Candida Palmero
- Clinical Pathology Laboratory and Microbiology, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Elio Castagnola
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
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14
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Giardino S, Bagnasco F, Falco M, Miano M, Pierri F, Risso M, Terranova P, Martino DD, Massaccesi E, Ricci M, Chianucci B, Dell'Orso G, Sabatini F, Podestà M, Lanino E, Faraci M. HAPLOIDENTICAL STEM CELL TRANSPLANTATION AFTER TCR αβ +AND CD19 + CELLS DEPLETION IN CHILDREN WITH CONGENITAL NON-MALIGNANT DISEASE. Transplant Cell Ther 2022; 28:394.e1-394.e9. [PMID: 35405368 DOI: 10.1016/j.jtct.2022.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND . Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) represents a valuable alternative for children with non-malignant disease and ex-vivo negative selection of TCR αβ+-cells is an emerging graft manipulation option that carries several potential advantages in terms of reduced risk of Graft versus Host Disease (GvHD) and improved immune reconstitution. METHODS . We reported all consecutive patients with a diagnosis of non-malignant disease who received a TCR-αβ+ and CD19+depleted haplo-HSCT at "IRCCS Istituto Giannina Gaslini" from 2013 to 2019; the conditioning regimen was myeloablative or non-myeloablative, depending on underlying disease; all patients received anti-thymocyte globulin and rituximab. No post-transplant GvHD prophylaxis was given in presence of a TCR-αβ+ cell-dose in the graft lower than the threshold of 1 × 105/kg of the recipient's weight. RESULTS . Among 20 HSCTs, engraftment occurred in 17 (85%) after a median of 14 and 12 days from graft infusion for neutrophils and platelets respectively. Primary graft failure was diagnosed in 3 (15%) patients, two (10%) experienced secondary rejection; all of these underwent a second HSCT. The cumulative incidence of a-GvHD and c-GvHD was 15% (2 grade 1, 1 grade 4) at 90 days and 5% (1 grade 1) at 7 months, respectively. Cytomegalovirus reactivation requiring pre-emptive treatment was observed in 9 patients (45%). One patient developed a JC virus-related progressive multifocal leukoencephalopathy, successfully managed with donor-derived virus-specific T-cell infusions. A complete immunological recovery was reached in most patients within 6 months. After a median follow-up of 4 years, 18 patients are alive, with a cumulative survival probability of 90%. CONCLUSION . Haplo-HSCT after ex-vivo TCR-αβ+/CD19+ negative selection may be considered a good option for children with non-malignant diseases since it ensures a high engraftment rate with an acceptable risk of graft failure, very low incidence of significant GvHD, and good immune reconstitution with low frequency of severe virus-related disease. However, the control of viral infection/reactivation should be kept high in order to promptly provide pre-emptive treatments and approaches of antiviral adoptive immunotherapy.
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Affiliation(s)
- Stefano Giardino
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy.
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Michela Falco
- Laboratory of Clinical and Experimental Immunology, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Miano
- Hematology Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Filomena Pierri
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Risso
- Immunohematology and Transfusional Department, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Terranova
- Laboratory of Hematology, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Margherita Ricci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Liguria, Italy
| | - Benedetta Chianucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Liguria, Italy
| | - Gianluca Dell'Orso
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Federica Sabatini
- Stem Cells and Cell Therapies Laboratory, IRCSS IstitutoGianninaGaslini, Genoa, Italy
| | - Marina Podestà
- Stem Cells and Cell Therapies Laboratory, IRCSS IstitutoGianninaGaslini, Genoa, Italy
| | - Edoardo Lanino
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Maura Faraci
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
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15
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Giancane G, Papa R, Vastert S, Bagnasco F, Swart JF, Quartier P, Antón J, Kamphuis S, Sanner H, Glerup M, De Benedetti F, Tsitsami E, Remesal A, Moreno E, De Inocencio J, Myrup C, Pallotti C, Koné-Paut I, Franck-Larsson K, Malmström H, Cederholm S, Pistorio A, Wulffraat N, Ruperto N. Anakinra in Patients With Systemic Juvenile Idiopathic Arthritis: Long-term Safety From the Pharmachild Registry. J Rheumatol 2022; 49:398-407. [PMID: 35105709 DOI: 10.3899/jrheum.210563] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the long-term safety profile of anakinra in patients with systemic juvenile idiopathic arthritis (sJIA). METHODS Data from patients with sJIA enrolled in the Pharmachild registry (ClinicalTrials.gov: NCT03932344) prior to September 30, 2018, and treated with anakinra were analyzed. The study endpoints were the occurrence of non-serious adverse events (SAEs) of at least moderate severity and SAEs, including macrophage activation syndrome (MAS), and the duration of anakinra treatment with reasons for discontinuation. All endpoints were analyzed overall by 6-month time windows, and in different treatment sets represented by those patients treated continuously with anakinra for at least 12, 18, and 24 months (set-12, -18, and -24, respectively). RESULTS Three hundred six patients were enrolled. Of these patients, 46%, 34%, and 28% had been treated for at least 12, 18, and 24 months, respectively. Two hundred and one AEs, mostly represented by infections, were reported for 509.3 patient-years (PY) with an overall incidence rate (IR) of 39.5 per 100 PY. Among 56 SAEs (IR 11.0/100 PY), 23.2% were infections and 19.6% MAS episodes. The IR of AEs was higher during the first 6 months of anakinra treatment, followed by decreasing IRs in the long-term treatment sets. Treatment discontinuation occurred in 76% of patients, most frequently in the first 6 months, because of inefficacy (43%), remission (31%), or AEs/intolerance (15%). No deaths or malignancies occurred during anakinra treatment. CONCLUSION The results of the present study confirm the long-term safety profile of anakinra in patients with sJIA and demonstrate an overall decreasing incidence of AEs over time. [ClinicalTrials.gov: NCT01399281 and NCT03932344].
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Affiliation(s)
- Gabriella Giancane
- G. Giancane, MD, PhD, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, and Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy;
| | - Riccardo Papa
- R. Papa, MD, C. Pallotti, MA, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sebastiaan Vastert
- S. Vastert, MD, Department of Pediatric Immunology and Rheumatology, Wilhelmina Kinderziekenhuis, Utrecht, the Netherlands
| | - Francesca Bagnasco
- F. Bagnasco, MSc, A. Pistorio, MD, Servizio di Epidemiologia e Biostatistica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Joost F Swart
- J.F. Swart, MD, N. Wulffraat, Professor, Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Pierre Quartier
- P. Quartier, MD, Université de Paris, Institut IMAGINE, Centre de référence national pour les Rhumatismes inflammatoires et les maladies Auto-Immunes Systémiques rares de l'Enfant (RAISE), Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Jordi Antón
- J. Antón, MD, Division of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat (Barcelona), Spain
| | - Sylvia Kamphuis
- S. Kamphuis, MD, Department of Paediatric Rheumatology/Department of Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Helga Sanner
- H. Sanner, MD, Department of Rheumatology - Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo University Hospital, Oslo, Norway
| | - Mia Glerup
- M. Glerup, MD, Pediatric rheumatology unit, Aarhus University Hospital, Aarhus, Denmark
| | - Fabrizio De Benedetti
- F. De Benedetti, MD, Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Elena Tsitsami
- E. Tsitsami, MD, First Department of Pediatrics, Aghia Sophia Children's Hospital, University of Athens Medical School, Athens, Greece
| | - Agustin Remesal
- A. Remesal, MD, Rheumatology Unit, University Hospital La Paz, Madrid, Spain
| | - Estefania Moreno
- E. Moreno, MD, Rheumatology Unit, University Hospital Valle de Hebron, Barcelona, Spain
| | - Jaime De Inocencio
- J. De Inocencio, MD, Department of Pediatric Rheumatology, 12 de Octubre University Hospital, Madrid, Spain
| | - Charlotte Myrup
- C. Myrup, MD, Pediatric rheumatology unit 4272, Rigshospitalet, Copenhagen, Denmark
| | - Chiara Pallotti
- R. Papa, MD, C. Pallotti, MA, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Isabelle Koné-Paut
- I. Koné-Paut, MD, Department of Pediatric Rheumatology, National Referral Centre of Auto-Inflammatory Diseases and inflammatory amyloidosis, CEREMAIA, CHU de Biĉetre, AP-HP, University of Paris Sud Saclay, le Kremlin Bicêtre, France
| | - Karin Franck-Larsson
- K. Franck-Larsson, MD, PhD, H. Malmström, PhD, S. Cederholm, MSc Pharm, Sobi, Stockholm, Sweden
| | - Håkan Malmström
- K. Franck-Larsson, MD, PhD, H. Malmström, PhD, S. Cederholm, MSc Pharm, Sobi, Stockholm, Sweden
| | - Susanna Cederholm
- K. Franck-Larsson, MD, PhD, H. Malmström, PhD, S. Cederholm, MSc Pharm, Sobi, Stockholm, Sweden
| | - Angela Pistorio
- F. Bagnasco, MSc, A. Pistorio, MD, Servizio di Epidemiologia e Biostatistica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nico Wulffraat
- J.F. Swart, MD, N. Wulffraat, Professor, Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
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Byrne J, Schmidtmann I, Rashid H, Hagberg O, Bagnasco F, Bardi E, De Vathaire F, Essiaf S, Winther JF, Frey E, Gudmundsdottir T, Haupt R, Hawkins MM, Jakab Z, Jankovic M, Kaatsch P, Kremer LCM, Kuehni CE, Harila-Saari A, Levitt G, Reulen R, Ronckers CM, Maule M, Skinner R, Steliarova-Foucher E, Terenziani M, Zaletel LZ, Hjorth L, Garwicz S, Grabow D. Impact of era of diagnosis on cause-specific late mortality among 77 423 five-year European survivors of childhood and adolescent cancer: The PanCareSurFup consortium. Int J Cancer 2022; 150:406-419. [PMID: 34551126 DOI: 10.1002/ijc.33817] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 02/03/2023]
Abstract
Late mortality of European 5-year survivors of childhood or adolescent cancer has dropped over the last 60 years, but excess mortality persists. There is little information concerning secular trends in cause-specific mortality among older European survivors. PanCareSurFup pooled data from 12 cancer registries and clinics in 11 European countries from 77 423 five-year survivors of cancer diagnosed before age 21 between 1940 and 2008 followed for an average age of 21 years and a total of 1.27 million person-years to determine their risk of death using cumulative mortality, standardized mortality ratios (SMR), absolute excess risks (AER), and multivariable proportional hazards regression analyses. At the end of follow-up 9166 survivors (11.8%) had died compared to 927 expected (SMR 9.89, 95% confidence interval [95% CI] 9.69-10.09), AER 6.47 per 1000 person-years, (95% CI 6.32-6.62). At 60 to 68 years of attained age all-cause mortality was still higher than expected (SMR = 2.41, 95% CI 1.90-3.02). Overall cumulative mortality at 25 years from diagnosis dropped from 18.4% (95% CI 16.5-20.4) to 7.3% (95% CI 6.7-8.0) over the observation period. Compared to the diagnosis period 1960 to 1969, the mortality hazard ratio declined for first neoplasms (P for trend <.0001) and for infections (P < .0001); declines in relative mortality from second neoplasms and cardiovascular causes were less pronounced (P = .1105 and P = .0829, respectively). PanCareSurFup is the largest study with the longest follow-up of late mortality among European childhood and adolescent cancer 5-year survivors, and documents significant mortality declines among European survivors into modern eras. However, continuing excess mortality highlights survivors' long-term care needs.
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Affiliation(s)
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Humayra Rashid
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Edit Bardi
- St. Anna Children's Hospital, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital GmbH, Linz, Austria
| | - Florent De Vathaire
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Université Paris-Sud Orsay, Villejuif, France
- Department of Research, Gustave Roussy, Villejuif, France
| | - Samira Essiaf
- SIOPE, c/o BLSI, Clos Chapelle-aux-Champs 30, Brussels, Belgium
| | - Jeanette Falck Winther
- Danish Cancer Society Research Center, Strandboulevarden, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Eva Frey
- St. Anna Children's Hospital, Vienna, Austria
| | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research Center, Strandboulevarden, Copenhagen, Denmark
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Momcilo Jankovic
- Pediatric Clinic, University of Milano-Bicocca, Foundation MBBM, Milan, Italy
- Italian Off-Therapy Register (OTR), Monza, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University Mainz, Mainz, Germany
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam UMC, Amsterdam, The Netherlands
- Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Oncology, Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Arja Harila-Saari
- Department of Women and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gill Levitt
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Raoul Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Cécile M Ronckers
- Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
- Brandenburg Medical School, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - Milena Maule
- Childhood Cancer Registry of Piedmont, Department of Medical Science, University of Turin and Center for Cancer Prevention (CPO-Piemonte), Torino, Italy
| | - Roderick Skinner
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon Cedex, France
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Lars Hjorth
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Pediatrics, Lund, Sweden
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Pediatrics, Lund, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University Mainz, Mainz, Germany
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Papa R, Giancane G, Lachmann HJ, Brogan P, Legger E, Lindqvist D, Cederholm S, Bagnasco F, Ruperto N, Gattorno M. POS1330 SAFETY OF ANAKINRA IN PATIENTS WITH CRYOPYRIN ASSOCIATED PERIODIC SYNDROMES (CAPS) USING A GRADUATED PRE-FILLED SYRINGE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Cryopyrin associated periodic syndromes (CAPS) are a group of ultra-rare autoinflammatory diseases caused by mutations in the NLRP3 gene, leading to overproduction of IL-1β. CAPS includes the following subdiagnoses: familial cold autoinflammatory syndrome (FCAS), Muckle-Wells syndrome (MWS) and chronic infantile neurological cutaneous articular syndrome/neonatal-onset multisystem inflammatory disease (CINCA/NOMID), where FCAS is the mildest form of CAPS and CINCA/NOMID the most severe. A graduated pre-filled syringe of the IL-1 receptor antagonist anakinra was introduced to meet the need of smaller and varying doses when treating children with CAPS.Objectives:To evaluate the safety of anakinra in CAPS patients using the novel pre-filled syringe.Methods:Investigators managing patients with CAPS treated with anakinra were identified via the Eurofever registry. Follow-up data of at least 3 years for each patient were prospectively collected and analyzed (EUPAS6366). The primary study endpoints were the occurrence of adverse events (AEs) with focus on serious infections, malignancies, injection site reactions, allergic reactions and medication errors, including re-use of the syringe. Secondary endpoints included dose at specific time points, discontinuations, and switch to other IL-1 blocking treatment.Results:12 patients with CAPS were included in the study, 8 with MWS, 2 with FCAS and 2 with CINCA/NOMID. The majority were male (75%) and white (83.3%). At baseline, all but one patient were already using the graduated prefilled syringe with anakinra. 5 patients required a median dose of 2 to 3 mg/kg/day and 6 patients below 2 mg/kg/day. During a total of 26.1 patient years of treatment, there were 7 AEs with rate of 26.8 (95% CI 4.2-169.6) per 100 patient years. All AEs were infections from 1 patient with CINCA/NOMID and were considered unrelated to anakinra by the investigator. Two of the AEs were considered serious as hospitalization was required (1 tonsillitis and 1 urinary tract infection). No AEs were severe, 6 of the AEs were of moderate severity and 1 was of mild severity. In total, 6 patients discontinued anakinra permanently, 2 during the first year of treatment, 3 during the second year and 1 after the third year of follow-up. The reasons for discontinuation included switch to canakinumab (4 patients), switch to canakinumab and inefficacy (1 patient) and non-compliance (1 patient). The remaining 5 patients continued anakira until the end of the study. 1 patient discontinued anakinra temporarily during the second year of treatment due to non-compliance. No deaths, malignancies, injection site reactions, allergic reactions or medication errors, including re-use of the pre-filled syringe, were observed.Table 1.Study resultsPatients12 (100)Gender, M:F9:3 (75:25)Ethnicity, white:black10:2 (83.3:16.7)Age at baseline, median (range), years25.3 (1.4-54.9)Age at disease onset, median (range), years2.5 (0-29.5)Age at diagnosis, median (range), years24.4 (0.6-54.6)Disease duration, median (range), years15.5 (1.4-51.3)Patients already using anakinra at baseline11 (91.7)Patients with history of other IL-1 blocking treatments at baseline3 (25)Anakinra dose at baseline, median (range), mg/kg/day1.7 (1.1-2.5)Anakinra dose during follow-up years 1:2:3:>3, median (range), mg/kg/day1.6:1.6:2.6:1.4 (1.1-3.9:1-4.4:1.7-3.7:1-3.2)Patients with AEs1 (8.3)Patients with permanent discontinuation of anakinra6 (50)Patients with continuation of anakinra until the end of the study5 (41.7)Patients with temporary discontinuation of anakinra1 (8.3)Total duration of anakinra exposure, median (range), years1.3 (0.5-7)Any AE7 (100)Urinary tract infection1 (14.3)Upper respiratory tract infection1 (14.3)Tonsillitis5 (71.4)Results are shown as number (%) unless stated otherwise.Conclusion:The results of the present study confirm the safety profile of anakinra treatment in CAPS patients using the graduated pre-filled syringe. No new safety findings were identified.Disclosure of Interests:Riccardo Papa: None declared, Gabriella Giancane: None declared, Helen J. Lachmann: None declared, Paul Brogan: None declared, Elizabeth Legger: None declared, Daniel Lindqvist Shareholder of: Sobi employee and holder of Sobi shares, Speakers bureau: Sobi employee and holder of Sobi shares, Paid instructor for: Sobi employee and holder of Sobi shares, Consultant of: Sobi employee and holder of Sobi shares, Grant/research support from: Sobi employee and holder of Sobi shares, Employee of: Sobi employee and holder of Sobi shares, Susanna Cederholm Shareholder of: Sobi employee and holder of Sobi shares, Speakers bureau: Sobi employee and holder of Sobi shares, Paid instructor for: Sobi employee and holder of Sobi shares, Consultant of: Sobi employee and holder of Sobi shares, Grant/research support from: Sobi employee and holder of Sobi shares, Employee of: Sobi employee and holder of Sobi shares, Francesca Bagnasco: None declared, Nicolino Ruperto: None declared, Marco Gattorno: None declared
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Giancane G, Papa R, Vastert S, Bagnasco F, Swart JF, Quartier P, Hofer M, Anton J, Kamphuis S, Sanner H, Glerup M, De Benedetti F, Tsitsami E, Remesal A, Moreno Ruzafa E, De Inocencio J, Myrup C, Pallotti C, Koné-Paut I, Franck-Larsson K, Malmstrom H, Cederholm S, Pistorio A, Wulffraat N, Ruperto N. OP0164 LONG-TERM SAFETY OF ANAKINRA IN PATIENTS WITH SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS FROM THE PHARMACHILD REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic juvenile idiopathic arthritis (SJIA) is characterized by extra-articular manifestations, as fever and rash, and rarely associated by a potentially lethal complication as macrophage activation syndrome (MAS). Anakinra is a recombinant human interleukin (IL)-1 receptor antagonist whose efficacy and safety profile has been studied for patients with SJIA.Objectives:To evaluate the long-term safety profile of anakinra in patients with SJIA.Methods:Data from patients with SJIA enrolled in the Pharmachild registry before 30 September 2018 and treated with anakinra were analyzed. The study endpoints were the occurrence of non-serious adverse events (AEs) of at least moderate severity and serious AEs (SAEs), including macrophage activation syndrome (MAS), and the duration of anakinra treatment with reasons for discontinuation. All endpoints were analyzed overall, by 6 month-time windows and in different treatment sets represented by those patients continuously treated with anakinra for at least 12, 18 and 24 months (set-12, -18, -24, respectively).Results:306 patients were enrolled. 46%, 34% and 28% of them had been treated for at least 12, 18 and 24 months, respectively. 201 AEs, mostly represented by infections, were reported for 509.3 patient-years (py) with an overall incidence rate (IR) of 39.5/100 py. Among 56 SAEs (IR 11.0/100 py), (Table 1) 23.2% were infections and 19.6% MAS episodes. The IR of AEs was higher during the first 6 months of anakinra, followed by decreasing IR in the different long-term treatment sets. Treatment discontinuation occurred in 76% of patients, most in the first 6 months, due to inefficacy (43%), remission (31%) or AEs/intolerance (15%). No deaths or malignancies occurred during anakinra treatment.Table 1.Number of SAEs and incidence rates (95% CI) by overall PT decreasing order and time window in the complete set (events with a frequency >1 by overall SOC and >1 by overall PT were reported) Only time windows <13 months were reported in the present table.Time window1-6 months7-12 monthsOverallN306194306Patient-time (years)117.380.2509.3SOCPTnRate (95% CI)nRate (95% CI)nRate(95% CI)AllAll3328.1 (19.1-41.5)45.0 (1.9-13.2)5611.0 (7.9-15.2)Infections and infestationsAll76.0 (2.9- 12.4)11.2 (0.2- 8.8)132.6 (1.4- 4.8)Pneumonia21.7 (0.4- 6.8)11.2 (0.2- 8.8)40.8 (0.3- 2.1)Immune system disordersAll76.0 (2.8- 12.5)11.2 (0.2- 8.8)112.2 (1.1- 4.1)Haemophagocytic lymphohistiocytosis76.0 (2.8- 12.5)11.2 (0.2- 8.8)112.2 (1.1- 4.1)Injury, poisoning and procedural complicationsAll54.3 (1.8- 10.2)--91.8 (0.9- 3.4)Infusion related reaction10.9 (0.1- 6.0)--20.4 (0.1- 1.6)Injection related reaction43.4 (1.3- 9.1)--61.2 (0.5- 2.6)Metabolism and nutrition disordersAll32.6 (0.8- 7.9)--40.8 (0.3- 2.1)Skin and subcutaneous tissue disordersAll32.6 (0.8- 7.9)11.2 (0.2- 8.8)40.8 (0.3- 2.1)Blood and lymphatic system disordersAll10.9 (0.1- 6.1)--20.4 (0.1- 1.6)General disorders and administration site conditionsAll10.9 (0.1- 6.1)11.2 (0.2- 8.8)20.4 (0.1- 1.6)InvestigationsAll21.7 (0.4- 6.8)--20.4 (0.1- 1.6)Nervous system disordersAll10.9 (0.1- 6.0)--20.4 (0.1- 1.6)Surgical and medical proceduresAll10.9 (0.1- 6.0)--20.4 (0.1- 1.5)Abbreviations: SAE, serious adverse event; SOC, system organ class; PT, preferred term, MedDRA version 21.1; N, number of patients ever treated with anakinra during the time window irrespectively of the length of any unexposed periods; 95% CI, 95% Confidence Interval.Conclusion:The results of the present study confirm the long-term safety profile of anakinra in SJIA patients and show a decreasing overall incidence rate of AEs over time.Disclosure of Interests:Gabriella Giancane Grant/research support from: The study was funded by SOBI Swedish, Riccardo Papa Grant/research support from: The study was funded by SOBI Swedish, Sebastian Vastert Grant/research support from: The study was funded by SOBI Swedish, Francesca Bagnasco Grant/research support from: The study was funded by SOBI Swedish, Joost F. Swart Grant/research support from: The study was funded by SOBI Swedish, Pierre Quartier Grant/research support from: The study was funded by SOBI Swedish, michael hofer Grant/research support from: The study was funded by SOBI Swedish, Jordi Anton Grant/research support from: The study was funded by SOBI Swedish, Sylvia Kamphuis Grant/research support from: The study was funded by SOBI Swedish, Helga Sanner Grant/research support from: The study was funded by SOBI Swedish, Mia Glerup Grant/research support from: The study was funded by SOBI Swedish, Fabrizio De Benedetti Grant/research support from: The study was funded by SOBI Swedish, Elena Tsitsami Grant/research support from: The study was funded by SOBI Swedish, Agustin Remesal Grant/research support from: The study was funded by SOBI Swedish, Estefania Moreno Ruzafa Grant/research support from: The study was funded by SOBI Swedish, Jaime de Inocencio Grant/research support from: The study was funded by SOBI Swedish, Charlotte Myrup Grant/research support from: The study was funded by SOBI Swedish, Chiara Pallotti Grant/research support from: The study was funded by SOBI Swedish, Isabelle Koné-Paut Grant/research support from: The study was funded by SOBI Swedish, Karin Franck-Larsson Employee of: I am employee of SOBI pharmaceutical company, Hakan Malmstrom Employee of: I am employee of SOBI pharmaceutical company, Susanna Cederholm Employee of: I am employee of SOBI pharmaceutical company, Angela Pistorio Grant/research support from: The study was funded by SOBI Swedish, Nico Wulffraat Grant/research support from: The study was funded by SOBI Swedish, Nicolino Ruperto Speakers bureau: NR has received honoraria for consultancies or speaker bureaus (< 10.000 USD each) from the following pharmaceutical companies in the past 3 years: Ablynx, Astrazeneca-Medimmune, Bayer, Biogen, Boehringer, Bristol Myers and Squibb, Celgene, Eli-Lilly, EMD Serono, Glaxo Smith and Kline, Hoffmann-La Roche,Janssen, Merck, Novartis, Pfizer, R-Pharma, Sinergie, Sobi and UCB., Consultant of: NR has received honoraria for consultancies or speaker bureaus (< 10.000 USD each) from the following pharmaceutical companies in the past 3 years: Ablynx, Astrazeneca-Medimmune, Bayer, Biogen, Boehringer, Bristol Myers and Squibb, Celgene, Eli-Lilly, EMD Serono, Glaxo Smith and Kline, Hoffmann-La Roche,Janssen, Merck, Novartis, Pfizer, R-Pharma, Sinergie, Sobi and UCB., Grant/research support from: The IRCCS Istituto Giannina Gaslini (IGG), where NR works as full-time public employee has received contributions (> 10.000 USD each) from the following industries in the last 3 years: BMS, Eli-Lilly, GlaxoSmithKline, F Hoffmann-La Roche, Janssen, Novartis, Pfizer, Sobi. This funding has been reinvested for the research activities of the hospital in a fully independent manner, without any commitment with third parties.
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Morana G, Bagnasco F, Leoni M, Pasquini L, Gueli I, Tortora D, Severino M, Giardino S, Pierri F, Micalizzi C, Verrina E, Ravelli A, Mancardi MM, Rossi A, Faraci M. Multifactorial Posterior Reversible Encephalopathy Syndrome in Children: Clinical, Laboratory, and Neuroimaging Findings. Journal of Pediatric Neurology 2021. [DOI: 10.1055/s-0040-1714109] [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: 10/23/2022]
Abstract
AbstractThe aim of this study was to investigate the association of neuroimaging, clinical, and laboratory findings in children with different underlying diseases who developed posterior reversible encephalopathy syndrome (PRES). All consecutive pediatric patients referred to our institute between 2000 and 2017 were retrospectively evaluated for newly diagnosed PRES. Clinical data, medical history, and therapies administered at the time of PRES and laboratory findings were reviewed as the magnetic resonance imaging (MRI) obtained at PRES presentation and during follow-up. Statistics included Mann–Whitney U, Chi-square, and Fisher's exact tests. A total of 39 pediatric patients (25 males, median age = 8.8 years) with a confirmed diagnosis of PRES were included. The patients were divided into four groups based on the underlying disease: (1) patients with hemato-oncological diseases not transplanted (n = 15, 38.5%), (2) who underwent hematopoietic stem cell transplantation (HSCT; n = 12, 30.8%), (3) affected by renal (n = 8, 20.5%), and (4) by autoimmune diseases (n = 4, 10.2%). Hemato-oncological patients and those undergoing HSCT presented a higher incidence of involvement of deep gray matter structures and hemorrhagic lesions when compared with patients with renal and autoimmune disorders (p = 0.036 and p = 0.036, respectively). No differences emerged among different groups of patients regarding presenting PRES symptoms, arterial blood pressure, laboratory findings, and extent of MRI abnormalities and these parameters did not show association with outcome.In conclusion, in pediatric patients with different diseases who develop PRES, involvement of deep gray matter structures and hemorrhagic lesions are more common in hemato-oncological patients and those undergoing HSCT. Clinical and radiologic outcome is favorable independently of clinical data and extent of MRI abnormalities.
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Affiliation(s)
- Giovanni Morana
- Neuroradiology Unit, IRCSS Istituto Giannina Gaslini, Genova, Italy
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Luca Pasquini
- Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital, La Sapienza University, Roma, Italy
| | - Ilaria Gueli
- Department of Pediatric, IRCSS Istituto Giannina Gaslini, Genova, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCSS Istituto Giannina Gaslini, Genova, Italy
| | | | - Stefano Giardino
- Hematopoietic Stem Cell Transplantation Unit, IRCSS Istituto Giannina Gaslini, Genova, Italy
| | - Filomena Pierri
- Hematopoietic Stem Cell Transplantation Unit, IRCSS Istituto Giannina Gaslini, Genova, Italy
| | | | - Enrico Verrina
- Dialysis Unit, IRCSS Istituto Giannina Gaslini, Genova, Italy
| | - Angelo Ravelli
- Pediatric Rheumatology Unit, IRCSS Istituto Giannina Gaslini, Genova, Italy
| | | | - Andrea Rossi
- Neuroradiology Unit, IRCSS Istituto Giannina Gaslini, Genova, Italy
| | - Maura Faraci
- Hematopoietic Stem Cell Transplantation Unit, IRCSS Istituto Giannina Gaslini, Genova, Italy
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Castagnola E, Bagnasco F, Mesini A, Agyeman PKA, Ammann RA, Carlesse F, Santolaya de Pablo ME, Groll AH, Haeusler GM, Lehrnbecher T, Simon A, D’Amico MR, Duong A, Idelevich EA, Luckowitsch M, Meli M, Menna G, Palmert S, Russo G, Sarno M, Solopova G, Tondo A, Traubici Y, Sung L. Antibiotic Resistant Bloodstream Infections in Pediatric Patients Receiving Chemotherapy or Hematopoietic Stem Cell Transplant: Factors Associated with Development of Resistance, Intensive Care Admission and Mortality. Antibiotics (Basel) 2021; 10:antibiotics10030266. [PMID: 33807654 PMCID: PMC8000765 DOI: 10.3390/antibiotics10030266] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/21/2021] [Accepted: 03/01/2021] [Indexed: 01/01/2023] Open
Abstract
Bloodstream infections (BSI) are a severe complication of antineoplastic chemotherapy or hematopoietic stem cell transplantation (HSCT), especially in the presence of antibiotic resistance (AR). A multinational, multicenter retrospective study in patients aged ≤ 18 years, treated with chemotherapy or HSCT from 2015 to 2017 was implemented to analyze AR among non-common skin commensals BSI. Risk factors associated with AR, intensive care unit (ICU) admission and mortality were analyzed by multilevel mixed effects or standard logistic regressions. A total of 1291 BSIs with 1379 strains were reported in 1031 patients. Among Gram-negatives more than 20% were resistant to ceftazidime, cefepime, piperacillin-tazobactam and ciprofloxacin while 9% was resistant to meropenem. Methicillin-resistance was observed in 17% of S. aureus and vancomycin resistance in 40% of E. faecium. Previous exposure to antibiotics, especially to carbapenems, was significantly associated with resistant Gram-negative BSI while previous colonization with methicillin-resistant S. aureus was associated with BSI due to this pathogen. Hematological malignancies, neutropenia and Gram-negatives resistant to >3 antibiotics were significantly associated with higher risk of ICU admission. Underlying disease in relapse/progression, previous exposure to antibiotics, and need of ICU admission were significantly associated with mortality. Center-level variation showed a greater impact on AR, while patient-level variation had more effect on ICU admission and mortality. Previous exposure to antibiotics or colonization by resistant pathogens can be the cause of AR BSI. Resistant Gram-negatives are significantly associated with ICU admission and mortality, with a significant role for the treating center too. The significant evidence of center-level variations on AR, ICU admission and mortality, stress the need for careful local antibiotic stewardship and infection control programs.
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Affiliation(s)
- Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
- Correspondence:
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Alessio Mesini
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Philipp K. A. Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Roland A. Ammann
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
- Kinderaerzte KurWerk, 3400 Burgdorf, Switzerland
| | - Fabianne Carlesse
- Pediatric Oncology Institute, GRAACC/Federal University of Sao Paulo, Sao Paulo 04023-062, Brazil;
| | | | - Andreas H. Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Paediatric Haematology and Oncology, University Children’s Hospital Muenster, 48149 Muenster, Germany;
| | - Gabrielle M. Haeusler
- The Paediatric Integrated Cancer Service, Parkville, VIC 3052, Australia;
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Johann Wolfgang Goethe University, 60323 Frankfurt am Main, Germany; (T.L.); (M.L.)
| | - Arne Simon
- Pediatric Oncology and Hematology, Children’s Hospital Medical Center, University Clinics, 6642 Homburg, Germany;
| | - Maria Rosaria D’Amico
- Department Hemato-Oncology, AORN Santobono-Pausilipon, 80129 Napoli, Italy; (M.R.D.); (G.M.)
| | - Austin Duong
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, Toronto, ON M5G 0A4, Canada; (A.D.); (S.P.); (Y.T.); (L.S.)
| | - Evgeny A. Idelevich
- Institute of Medical Microbiology, University Hospital Munster, 48149 Munster, Germany;
| | - Marie Luckowitsch
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Johann Wolfgang Goethe University, 60323 Frankfurt am Main, Germany; (T.L.); (M.L.)
| | - Mariaclaudia Meli
- Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.M.); (G.R.)
| | - Giuseppe Menna
- Department Hemato-Oncology, AORN Santobono-Pausilipon, 80129 Napoli, Italy; (M.R.D.); (G.M.)
| | - Sasha Palmert
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, Toronto, ON M5G 0A4, Canada; (A.D.); (S.P.); (Y.T.); (L.S.)
| | - Giovanna Russo
- Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.M.); (G.R.)
| | - Marco Sarno
- Pediatric Unit, Santa Maria Delle Grazie Hospital, ASL Napoli 2 Nord, Pozzuoli, 80027 Napoli, Italy;
| | - Galina Solopova
- Dmitry Rogachev Federal Scientific-Clinical Center of Children’s Hematology, Oncology and Immunology, 117997 Moscow, Russia;
| | - Annalisa Tondo
- Paediatric Haematology/Oncology Department, Meyer Children’s University Hospital, 50134 Florence, Italy;
| | - Yona Traubici
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, Toronto, ON M5G 0A4, Canada; (A.D.); (S.P.); (Y.T.); (L.S.)
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, Toronto, ON M5G 0A4, Canada; (A.D.); (S.P.); (Y.T.); (L.S.)
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21
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Reulen RC, Wong KF, Bright CJ, Winter DL, Alessi D, Allodji RM, Bagnasco F, Bárdi E, Bautz A, Byrne J, Feijen EA, Fidler-Benaoudia MM, Diallo I, Garwicz S, Grabow D, Gudmundsdottir T, Guha J, Haddy N, Høgsholt S, Jankovic M, Kaatsch P, Kaiser M, Kuonen R, Linge H, Øfstaas H, Ronckers CM, Hau EM, Skinner R, van Leeuwen FE, Teepen JC, Veres C, Zrafi W, Debiche G, Llanas D, Terenziani M, Vu-Bezin G, Wesenberg F, Wiebe T, Sacerdote C, Jakab Z, Haupt R, Lähteenmäki PM, Zadravec Zaletel L, Kuehni CE, Winther JF, de Vathaire F, Kremer LC, Hjorth L, Hawkins MM. Risk of digestive cancers in a cohort of 69 460 five-year survivors of childhood cancer in Europe: the PanCareSurFup study. Gut 2020; 70:gutjnl-2020-322237. [PMID: 33139271 DOI: 10.1136/gutjnl-2020-322237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/11/2020] [Accepted: 09/28/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Survivors of childhood cancer are at risk of subsequent primary neoplasms (SPNs), but the risk of developing specific digestive SPNs beyond age 40 years remains uncertain. We investigated risks of specific digestive SPNs within the largest available cohort worldwide. METHODS The PanCareSurFup cohort includes 69 460 five-year survivors of childhood cancer from 12 countries in Europe. Risks of digestive SPNs were quantified using standardised incidence ratios (SIRs), absolute excess risks and cumulative incidence. RESULTS 427 digestive SPNs (214 colorectal, 62 liver, 48 stomach, 44 pancreas, 59 other) were diagnosed in 413 survivors. Wilms tumour (WT) and Hodgkin lymphoma (HL) survivors were at greatest risk (SIR 12.1; 95% CI 9.6 to 15.1; SIR 7.3; 95% CI 5.9 to 9.0, respectively). The cumulative incidence increased the most steeply with increasing age for WT survivors, reaching 7.4% by age 55% and 9.6% by age 60 years (1.0% expected based on general population rates). Regarding colorectal SPNs, WT and HL survivors were at greatest risk; both seven times that expected. By age 55 years, 2.3% of both WT (95% CI 1.4 to 3.9) and HL (95% CI 1.6 to 3.2) survivors had developed a colorectal SPN-comparable to the risk among members of the general population with at least two first-degree relatives affected. CONCLUSIONS Colonoscopy surveillance before age 55 is recommended in many European countries for individuals with a family history of colorectal cancer, but not for WT and HL survivors despite a comparable risk profile. Clinically, serious consideration should be given to the implementation of colonoscopy surveillance while further evaluation of its benefits, harms and cost-effectiveness in WT and HL survivors is undertaken.
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Affiliation(s)
- Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
| | - Kwok F Wong
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Chloe J Bright
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Italy, Childhood cancer registry of piedmont, Turin, Italy
| | - Rodrigue M Allodji
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, Instituto Giannina Gaslini, Genova, Italy
| | - Edit Bárdi
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
- Kepler Universitätsklinikum, Linz, Austria
| | - Andrea Bautz
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Miranda M Fidler-Benaoudia
- Epidemiology and Prevention Research, Departments of Oncology and Community Health Sciences, Calgary, Alberta, Canada
| | - Ibrahim Diallo
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Stanislaw Garwicz
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry, University Medical Centre Mainz, Mainz, Germany
| | - Thorgerdur Gudmundsdottir
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Joyeeta Guha
- Public Health England and NHS England & Improvement, Birmingham, UK
| | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Stine Høgsholt
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Moncilo Jankovic
- Pediatric Clinic, University of Milan-Bicocca, Hospital San Gerardo, Monza, Lombardia, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Rahel Kuonen
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
| | - Helena Linge
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden
| | - Hilde Øfstaas
- Norwegian National Advisory Unit on solid tumors in children, Oslo, Norway
| | - Cecile M Ronckers
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of pediatric Oncology, Emma Children's Hospital & Academic Medical Center, Amsterdam, The Netherlands
| | - Eva-Maria Hau
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
- Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, BE, Switzerland
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle University Centre for Cancer, Newcastle Upon Tyne, UK
| | - Flora E van Leeuwen
- Department of Epidemiology, Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jop C Teepen
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Cristina Veres
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Wael Zrafi
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Ghazi Debiche
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Damien Llanas
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Giao Vu-Bezin
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Finn Wesenberg
- Norwegian Cancer Registry and Dept. of Pediatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, Faculty of medicine, University of Oslo, Oslo, Norway
| | - Thomas Wiebe
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Italy, Childhood cancer registry of piedmont, Turin, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, Semmelweis University, 2nd Department of Pediatrics, Budapest, Hungary
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | | | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
- Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, BE, Switzerland
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Leontien C Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of pediatric Oncology, Emma Children's Hospital & Academic Medical Center, Amsterdam, The Netherlands
| | - Lars Hjorth
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
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22
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Giancane G, Swart JF, Castagnola E, Groll AH, Horneff G, Huppertz HI, Lovell DJ, Wolfs T, Herlin T, Dolezalova P, Sanner H, Susic G, Sztajnbok F, Maritsi D, Constantin T, Vargova V, Sawhney S, Rygg M, K Oliveira S, Cattalini M, Bovis F, Bagnasco F, Pistorio A, Martini A, Wulffraat N, Ruperto N. Opportunistic infections in immunosuppressed patients with juvenile idiopathic arthritis: analysis by the Pharmachild Safety Adjudication Committee. Arthritis Res Ther 2020; 22:71. [PMID: 32264969 PMCID: PMC7136994 DOI: 10.1186/s13075-020-02167-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/27/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To derive a list of opportunistic infections (OI) through the analysis of the juvenile idiopathic arthritis (JIA) patients in the Pharmachild registry by an independent Safety Adjudication Committee (SAC). METHODS The SAC (3 pediatric rheumatologists and 2 pediatric infectious disease specialists) elaborated and approved by consensus a provisional list of OI for use in JIA. Through a 5 step-procedure, all the severe and serious infections, classified as per MedDRA dictionary and retrieved in the Pharmachild registry, were evaluated by the SAC by answering six questions and adjudicated with the agreement of 3/5 specialists. A final evidence-based list of OI resulted by matching the adjudicated infections with the provisional list of OI. RESULTS A total of 772 infectious events in 572 eligible patients, of which 335 serious/severe/very severe non-OI and 437 OI (any intensity/severity), according to the provisional list, were retrieved. Six hundred eighty-two of 772 (88.3%) were adjudicated as infections, of them 603/682 (88.4%) as common and 119/682 (17.4%) as OI by the SAC. Matching these 119 opportunistic events with the provisional list, 106 were confirmed by the SAC as OI, and among them infections by herpes viruses were the most frequent (68%), followed by tuberculosis (27.4%). The remaining events were divided in the groups of non-OI and possible/patient and/or pathogen-related OI. CONCLUSIONS We found a significant number of OI in JIA patients on immunosuppressive therapy. The proposed list of OI, created by consensus and validated in the Pharmachild cohort, could facilitate comparison among future pharmacovigilance studies. TRIAL REGISTRATION Clinicaltrials.gov NCT01399281; ENCePP seal: awarded on 25 November 2011.
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Affiliation(s)
- Gabriella Giancane
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, University Utrecht, European Reference Network-RITA, Utrecht, The Netherlands
| | - Elio Castagnola
- Department of Infectious Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andreas H Groll
- Infectious Disease Research Program, Department of Pediatric Hematology and Oncology, University Children's Hospital, Münster, Germany
| | - Gerd Horneff
- Asklepios Clinic Sankt Augustin, Department of General Paediatrics, Sankt Augustin, Germany
- Medical Faculty, Department of Paediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany
| | - Hans-Iko Huppertz
- Clinic Bremen-Mitte, Prof.-Hesse Children's Hospital and Pediatric Intensive Care Medicine, Bremen, Germany
| | - Daniel J Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tom Wolfs
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, University Utrecht, European Reference Network-RITA, Utrecht, The Netherlands
| | - Troels Herlin
- Pediatric Rheumatology Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Pavla Dolezalova
- 1st Faculty of Medicine, Department of Pediatrics and Adolescent Medicine, Charles University in Prague and General University Hospital, Praha, Czech Republic
| | - Helga Sanner
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo, Norway
| | - Gordana Susic
- Institute of Rheumatology of Belgrade, Division of Pediatric Rheumatology, Belgrade, Serbia
| | - Flavio Sztajnbok
- Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Despoina Maritsi
- 2nd Department of Pediatrics Athens Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Tamas Constantin
- Unit of Pediatric Rheumatology-Immunology, Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Veronika Vargova
- Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, Pavol Jozef Šafárik University in Košice, Kosice, Slovakia
| | - Sujata Sawhney
- Sir Ganga Ram Hospital Marg, Centre for Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs University Hospital of Trondheim, Trondheim, Norway
| | - Sheila K Oliveira
- Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marco Cattalini
- Clinica Pediatrica dell'Università di Brescia, Spedali Civili, Unità di Immunologia e Reumatologia Pediatrica, Brescia, Italy
| | - Francesca Bovis
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Francesca Bagnasco
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Angela Pistorio
- IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy
| | - Alberto Martini
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Nico Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, University Utrecht, European Reference Network-RITA, Utrecht, The Netherlands
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy.
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23
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Faraci M, Ricci E, Bagnasco F, Pierri F, Giardino S, Girosi D, Olcese R, Castagnola E, Michele Magnano G, Lanino E. Imatinib melylate as second-line treatment of bronchiolitis obliterans after allogenic hematopoietic stem cell transplantation in children. Pediatr Pulmonol 2020; 55:631-637. [PMID: 31951682 DOI: 10.1002/ppul.24652] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/04/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The onset of bronchiolitis obliterans (BO) as a pulmonary manifestation of chronic graft vs host disease dramatically changes the prognosis of children undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study aimed to evaluate the overall survival (OS) of children with BO treated with imatinib mesylate (IM). METHODS This study included children who underwent allo-HSCTs between January 2000 and December 2016. RESULTS Among 345 patients who underwent HSCTs, 293 were evaluable for BO and 26 (8.9%) developed BO. The cumulative incidence of BO was 4.8% (95% confidence interval [CI], 2.8-7.5) at 1 year and 7.7% (95% CI, 5.1-11.1) at 3 years after transplantation. In the group of HSCTs (n = 67) complicated by chronic GvHD (c-GVHD), the incidence rate of BO was 38.8%. In total, 96.1% of patients with BO had c-GvHD worse than moderate grade, which was present in 70.7% of patients without BO (P = .011). The mortality rates were 46.1% in the BO group and 27.4% in the group without BO. Half of the patients with BO (n = 13) received IM, and the overall response rate was 76.9%. Four years after HSCT, OS was 42.6% (95% CI, 18.2-65.3) in the group without IM and 83.3% (95% CI, 27.3-97.5) in the group with IM. CONCLUSIONS BO after HSCT in the pediatric population has a high incidence and mortality rate. In terms of overall response and tolerability, this study showed relevant improvements in the prognosis of children with BO after the introduction of IM. Further prospective studies among children are needed to confirm these results.
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Affiliation(s)
- Maura Faraci
- SCT Unit- Paediatric Haematology, Oncology Department, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Erica Ricci
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Children's Sciences, University of Genova, Genova, Italy
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Filomena Pierri
- SCT Unit- Paediatric Haematology, Oncology Department, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Stefano Giardino
- SCT Unit- Paediatric Haematology, Oncology Department, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Donata Girosi
- Pediatric Pulmonology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Roberta Olcese
- Pediatric Pulmonology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Edoardo Lanino
- SCT Unit- Paediatric Haematology, Oncology Department, IRCCS Istituto Giannina Gaslini, Genova, Italy
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24
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Giancane G, Muratore V, Marzetti V, Quilis N, Benavente BS, Bagnasco F, Alongi A, Civino A, Quartulli L, Consolaro A, Ravelli A. Disease activity and damage in juvenile idiopathic arthritis: methotrexate era versus biologic era. Arthritis Res Ther 2019; 21:168. [PMID: 31287015 PMCID: PMC6615271 DOI: 10.1186/s13075-019-1950-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/24/2019] [Indexed: 11/25/2022] Open
Abstract
Objective To compare the long-term disease state, in terms of activity and damage, of children with juvenile idiopathic arthritis (JIA) who had their disease onset in methotrexate (MTX) or biologic eras. Methods Patients were included in MTX or biologic era cohort depending on whether their disease presentation occurred before or after January 2000. All patients had disease duration ≥ 5 years and underwent a prospective cross-sectional assessment, which included measurement of disease activity and damage. Inactive disease (ID) and low disease activity (LDA) states were defined according to Wallace, JADAS10, and cJADAS10 criteria. Articular and extraarticular damage was assessed with the Juvenile Arthritis Damage Index (JADI). Results MTX and biologic era cohorts included 239 and 269 patients, respectively. Patients were divided in the “functional phenotypes” of oligoarthritis and polyarthritis. At cross-sectional visit, patients in the biologic era cohort with either oligoarthritis or polyarthritis had consistently higher frequencies of ID and LDA by all criteria. The measurement of disease damage at cross-sectional visit revealed that the frequency of impairment of > 1 JADI-Articular items was higher in MTX than in biologic era cohort (17.6% versus 11% in oligoarthritis and 52.6% versus 21.8% in polyarthritis). Likewise, frequency of involvement of > 1 JADI-Extraarticular items was higher in the MTX than in the biologic era cohort (26.5% versus 16.2% in oligoarthritis and 31.4% versus 13.5% in polyarthritis). Conclusion Our study provides evidence of the remarkable outcome improvement obtained with the recent therapeutic advance in JIA.
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Affiliation(s)
- Gabriella Giancane
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy. .,Clinica Pediatrica e Reumatologia, IRCCS G. Gaslini, via G. Gaslini 5, 16147, Genoa, Italy.
| | - Valentina Muratore
- Clinica Pediatrica, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Valentina Marzetti
- Clinica Pediatrica e Reumatologia, IRCCS G. Gaslini, via G. Gaslini 5, 16147, Genoa, Italy
| | - Neus Quilis
- Clinica Pediatrica e Reumatologia, IRCCS G. Gaslini, via G. Gaslini 5, 16147, Genoa, Italy
| | | | - Francesca Bagnasco
- Clinica Pediatrica e Reumatologia, IRCCS G. Gaslini, via G. Gaslini 5, 16147, Genoa, Italy
| | - Alessandra Alongi
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy.,Clinica Pediatrica e Reumatologia, IRCCS G. Gaslini, via G. Gaslini 5, 16147, Genoa, Italy
| | | | - Lorenzo Quartulli
- UOC Pediatria, Azienda Ospedaliera Cardinale G. Panico, Tricase, Italy
| | - Alessandro Consolaro
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy.,Clinica Pediatrica e Reumatologia, IRCCS G. Gaslini, via G. Gaslini 5, 16147, Genoa, Italy
| | - Angelo Ravelli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy.,Clinica Pediatrica e Reumatologia, IRCCS G. Gaslini, via G. Gaslini 5, 16147, Genoa, Italy.,Sechenov First Moscow State Medical University, Moscow, Russian Federation
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25
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Furnari M, De Alessandri A, Cresta F, Haupt M, Bassi M, Calvi A, Haupt R, Bodini G, Ahmed I, Bagnasco F, Giannini EG, Casciaro R. The role of small intestinal bacterial overgrowth in cystic fibrosis: a randomized case-controlled clinical trial with rifaximin. J Gastroenterol 2019; 54:261-270. [PMID: 30232597 DOI: 10.1007/s00535-018-1509-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/08/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Scientific literature shows a high prevalence of Small Intestinal Bacterial Overgrowth (SIBO) in patients with Cystic Fibrosis (CF). The role of SIBO in nutritional status and gastrointestinal symptoms in CF is not known. Our aim was to study epidemiology and clinical impact of SIBO while assessing the efficacy of rifaximin in eradicating SIBO in CF patients. METHODS Symptoms questionnaire and Glucose Breath Test (GBT) were given to 79 CF patients (median age 19.6 years; 9.2-36.9). Subjects with a positive GBT were enrolled in a randomized controlled trial and received rifaximin 1200 mg for 14 days or no treatment. Questionnaire and GBT were repeated 1 month after the end of treatment or 45 days after the first negative GBT. RESULTS Out of 79 patients, 25 were affected by SIBO (31.6%) with a significant correlation with lower BMI, SDS-BMI (p < 0.05) and serum albumin levels (p < 0.05), independently from pancreas insufficiency. Twenty-three patients took part in the randomized trial, 13 patients (56.5%) in rifaximin group and 10 patients (43.5%) in control group. Eradication rate of SIBO was 9/10 (90%) in rifaximin group and 2/6 (33.3%) in control group (p < 0.05). In the rifaximin group, gastrointestinal symptom improvement was observed in 4/5 patients aged ≤ 14 years and in 0/5 patients aged > 14 years (p < 0.05); in 2/6 patients in the control group. CONCLUSIONS CF patients show a high prevalence of SIBO, related to a poorer nutritional status. Rifaximin therapy is well tolerated and the results are promising in terms of efficacy in eradicating small intestinal bacterial overgrowth in CF.
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Affiliation(s)
- Manuele Furnari
- Department of Internal Medicine, Gastroenterology Unit, Policlinico "San Martino", University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy.
| | | | - Federico Cresta
- Cystic Fibrosis Center, IRCCS G. Gaslini Institute, Genoa, Italy
| | - Maria Haupt
- Cystic Fibrosis Center, IRCCS G. Gaslini Institute, Genoa, Italy
| | - Marta Bassi
- Cystic Fibrosis Center, IRCCS G. Gaslini Institute, Genoa, Italy
| | - Angela Calvi
- Gastroenterology and Pediatric Endoscopy Unit, IRCCS G. Gaslini Institute, Genoa, Italy
| | - Riccardo Haupt
- Epidemiology and Biostatistic Service, IRCCS G. Gaslini Institute, Genoa, Italy
| | - Giorgia Bodini
- Department of Internal Medicine, Gastroenterology Unit, Policlinico "San Martino", University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Iftikhar Ahmed
- Department of Gastroenterology, Aldara Hospital and Medical Centre, Riyadh, Kingdom of Saudi Arabia
| | - Francesca Bagnasco
- Epidemiology and Biostatistic Service, IRCCS G. Gaslini Institute, Genoa, Italy
| | - Edoardo Giovanni Giannini
- Department of Internal Medicine, Gastroenterology Unit, Policlinico "San Martino", University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Rosaria Casciaro
- Cystic Fibrosis Center, IRCCS G. Gaslini Institute, Genoa, Italy
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26
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Saccomanno B, Tibaldi J, Minoia F, Bagnasco F, Pistorio A, Guariento A, Caorsi R, Consolaro A, Gattorno M, Ravelli A. Predictors of Effectiveness of Anakinra in Systemic Juvenile Idiopathic Arthritis. J Rheumatol 2019; 46:416-421. [PMID: 30647180 DOI: 10.3899/jrheum.180331] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To seek predictors of therapeutic response to the interleukin (IL)-1 inhibitor anakinra in children with systemic-onset juvenile idiopathic arthritis (sJIA). METHODS The clinical charts of all patients with sJIA who were newly treated with anakinra at our center between 2004 and 2017 were reviewed retrospectively. Predictors included baseline demographic, clinical, and laboratory variables as well as previous or concomitant therapies. The effectiveness of anakinra was assessed at 1 year after treatment start. Complete clinical response (CCR) was defined as absence of fever, physician's global assessment ≤ 1, count of active joints ≤ 1, negative C-reactive protein, and ≥ 75% reduction of corticosteroid dose. According to the intention-to-treat principle, patients who had anakinra discontinued before 1 year for any reasons other than disease remission were classified as nonresponders. Statistics included univariate and multivariable analyses. RESULTS Of the 62 patients included in the study, 24 (39%) met the criteria for CCR at 1 year, whereas 38 (61%) did not. On multivariable analysis, independent correlations with achievement of CCR were identified for shorter disease duration, lower active joint count, higher ferritin level, and greater activity of systemic manifestations. The area under the curve of the model was 0.83. CONCLUSION Our findings help to delineate the clinical profile of patients with sJIA who are more likely to benefit from IL-1 blockade. They also underscore the need for studies aimed at examining the therapeutic role of early IL-1 inhibition and to identify biomarkers predicting response to either IL-1 or IL-6 antagonists.
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Affiliation(s)
- Benedetta Saccomanno
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Jessica Tibaldi
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Francesca Minoia
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Francesca Bagnasco
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Angela Pistorio
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Andressa Guariento
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Roberta Caorsi
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Alessandro Consolaro
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Marco Gattorno
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Angelo Ravelli
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil. .,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini.
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Swart J, Giancane G, Horneff G, Magnusson B, Hofer M, Alexeeva Е, Panaviene V, Bader-Meunier B, Anton J, Nielsen S, De Benedetti F, Kamphuis S, Staņēviča V, Tracahana M, Ailioaie LM, Tsitsami E, Klein A, Minden K, Foeldvari I, Haas JP, Klotsche J, Horne AC, Consolaro A, Bovis F, Bagnasco F, Pistorio A, Martini A, Wulffraat N, Ruperto N. Pharmacovigilance in juvenile idiopathic arthritis patients treated with biologic or synthetic drugs: combined data of more than 15,000 patients from Pharmachild and national registries. Arthritis Res Ther 2018; 20:285. [PMID: 30587248 PMCID: PMC6307151 DOI: 10.1186/s13075-018-1780-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The availability of methotrexate and the introduction of multiple biological agents have revolutionized the treatment of juvenile idiopathic arthritis (JIA). Several international and national drug registries have been implemented to accurately monitor the long-term safety/efficacy of these agents. This report aims to present the combined data coming from Pharmachild/PRINTO registry and the national registries from Germany (BiKeR) and Sweden. METHODS Descriptive statistics was used for demographic, clinical data, drug exposure, adverse events (AEs) and events of special interest (ESIs). For the Swedish register, AE data were not available. RESULTS Data from a total of 15,284 patients were reported: 8274 (54%) from the Pharmachild registry and 3990 (26%) and 3020 (20%) from the German and the Swedish registries, respectively. Pharmachild children showed a younger age (median of 5.4 versus 7.6 years) at JIA onset and shorter disease duration at last available visit (5.3 versus 6.1-6.8) when compared with the other registries. The most frequent JIA category was the rheumatoid factor-negative polyarthritis (range of 24.6-29.9%). Methotrexate (61-84%) and etanercept (24%-61.8%) were the most frequently used synthetic and biologic disease-modifying anti-rheumatic drugs (DMARDs), respectively. There was a wide variability in glucocorticoid use (16.7-42.1%). Serious AEs were present in 572 (6.9%) patients in Pharmachild versus 297 (7.4%) in BiKeR. Infection and infestations were the most frequent AEs (29.4-30.1%) followed by gastrointestinal disorders (11.5-19.6%). The most frequent ESIs were infections (75.3-89%). CONCLUSIONS This article is the first attempt to present a very large sample of data on JIA patients from different national and international registries and represents the first proposal for data merging as the most powerful tool for future analysis of safety and effectiveness of immunosuppressive therapies in JIA. REGISTRY REGISTRATION The Pharmachild registry is registered at ClinicalTrials.gov ( NCT01399281 ) and at the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) ( http://www.encepp.eu/encepp/viewResource.htm?id=19362 ). The BiKeR registry is registered at ENCePP ( http://www.encepp.eu/encepp/viewResource.htm?id=20591 ).
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Affiliation(s)
- Joost Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Lundlaan, 6 PO box 85090, Utrecht, The Netherlands
| | - Gabriella Giancane
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via Gaslini, 5, 16147, Genoa, Italy
| | - Gerd Horneff
- Asklepios Clinic Sankt Augustin, Arnold-Janssen strasse 29, Sankt Augustin, Germany.,Department of Pediatric and Adolescents medicine, Medical faculty, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany
| | - Bo Magnusson
- Karolinska University Hospital, Pediatric Rheumatology Unit, Stockholm, Sweden
| | - Michael Hofer
- Unité Romande d'Immuno-Rhumatologie Pediatrique/Centre Hospitalier Universitaire Vaudois (CHUV), Pediatrie, University of Lausanne, Av Bugnon 46, Lausanne, Switzerland.,University Hospital of Geneva, Geneva, Switzerland
| | - Еkaterina Alexeeva
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" of the Ministry of Health of the Russian Federation, LOMONOSOVSKIJ PR-T,2/62, Moscow, Russia.,Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Violeta Panaviene
- Vilnius University, Clinic of Children's Diseases, Vilnius, Lithuania and Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Santariskiu, 4, Vilnius, Lithuania
| | - Brigitte Bader-Meunier
- Université Paris-Descartes, Institut IMAGINE, Centre de référence national pour les Rhumatismes inflammatoires et les maladies Auto-Immunes Systémiques rares de l'Enfant (RAISE), Unité d'Immunologie, Hématologie et Rhumatologie Pediatrique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, 149 Rue De Sevres, Paris, France
| | - Jordi Anton
- Hospital Sant Joan de Déu, Universitat de Barcelona, Unidad de Reumatología Pediátrica, Esplugues de Llobregat, Passeig Sant Joan de Deu 2, Barcelona, Spain
| | - Susan Nielsen
- Juliane Marie Centret, Rigshospitalet, Paediatric Rheumatology Unit, Blegdamsvej 9, Copenhagen, Denmark
| | - Fabrizio De Benedetti
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza S. Onofrio, 4, Rome, Italy
| | - Sylvia Kamphuis
- Sophia Children's Hospital, Department of Paediatric Rheumatology, Erasmus University Medical Centre, Dr Molewaterplein 60, Rotterdam, The Netherlands.,Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Valda Staņēviča
- Riga Stradins University, Department of Pediatrics, Children University Hospital, Vienibas gatve 45, Riga, LV, Latvia
| | - Maria Tracahana
- Hippokration General Hospital, First Department of pediatrics, Thessaloniki University School of Medicine, Konstantinoupoleos 49, Thessaloniki, Greece
| | | | - Elena Tsitsami
- Aghia Sophia Childrens Hospital, First Department of Pediatrics, University of Athens Medical School, Thivon 1, Athens, Greece
| | - Ariane Klein
- Asklepios Clinic Sankt Augustin, Arnold-Janssen strasse 29, Sankt Augustin, Germany
| | - Kirsten Minden
- German Rheumatism Research Centre, Berlin, Germany.,Charité University Medicine, Charitéplatz 1, Berlin, Germany
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Dehnhaide 120, Hamburg, Germany
| | - Johannes Peter Haas
- German Center for Pediatric and Adolescent Rheumatology, Deutsches Zentrum für Kinder- und Jugendrheumatologie, Zentrum für Schmerztherapie junger Menschen, Gehfeldstrasse 24, Garmisch-Partenkirchen, Germany
| | - Jens Klotsche
- German Rheumatism Research Centre, Berlin, Germany.,Charité University Medicine, Charitéplatz 1, Berlin, Germany
| | - Anna Carin Horne
- Karolinska University Hospital, Pediatric Rheumatology Unit, Stockholm, Sweden
| | - Alessandro Consolaro
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, via Gaslini 5, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Francesca Bovis
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via Gaslini, 5, 16147, Genoa, Italy
| | - Francesca Bagnasco
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via Gaslini, 5, 16147, Genoa, Italy
| | - Angela Pistorio
- IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, via Gaslini 5, Genoa, Italy
| | - Alberto Martini
- IRCCS Istituto Giannina Gaslini, Direzione Scientifica, via Gaslini 5, Genoa, Italy
| | - Nico Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Lundlaan, 6 PO box 85090, Utrecht, The Netherlands
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via Gaslini, 5, 16147, Genoa, Italy.
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Haupt R, Essiaf S, Dellacasa C, Ronckers CM, Caruso S, Sugden E, Zadravec Zaletel L, Muraca M, Morsellino V, Kienesberger A, Blondeel A, Saraceno D, Ortali M, Kremer LCM, Skinner R, Roganovic J, Bagnasco F, Levitt GA, De Rosa M, Schrappe M, Hjorth L, Ladenstein R. The 'Survivorship Passport' for childhood cancer survivors. Eur J Cancer 2018; 102:69-81. [PMID: 30138773 DOI: 10.1016/j.ejca.2018.07.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [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: 03/13/2018] [Revised: 06/15/2018] [Accepted: 07/12/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Currently, there are between 300,000 and 500,000 childhood cancer survivors (CCSs) in Europe. A significant proportion is at high risk, and at least 60% of them develop adverse health-related outcomes that can appear several years after treatment completion. Many survivors are unaware of their personal risk, and there seems to be a general lack of information among healthcare providers about pathophysiology and natural history of treatment-related complications. This can generate incorrect or delayed diagnosis and treatments. METHOD The Survivorship Passport (SurPass) consists of electronic documents, which summarise the clinical history of the childhood or adolescent cancer survivor. It was developed by paediatric oncologists of the PanCare and SIOPE networks and IT experts of Cineca, together with parents, patients, and survivors' organisations within the European Union-funded European Network for Cancer research in Children and Adolescents. It consists of a template of a web-based, simply written document, translatable in all European languages, to be given to each CCS. The SurPass provides a summary of each survivor's clinical history, with detailed information about the original cancer and of treatments received, together with personalised follow-up and screening recommendations based on guidelines published by the International Guidelines Harmonization Group and PanCareSurFup. RESULTS The SurPass data schema contains a maximum of 168 variables and uses internationally approved nomenclature, except for radiotherapy fields, where a new classification was defined by radiotherapy experts. The survivor-specific screening recommendations are mainly based on treatment received and are automatically suggested, thanks to built-in algorithms. These may be adapted and further individualised by the treating physician in case of special disease and survivor circumstances. The SurPass was tested at the Istituto Giannina Gaslini, Italy, and received positive feedback. It is now being integrated at the institutional, regional and national level. CONCLUSIONS The SurPass is potentially an essential tool for improved and more harmonised follow-up of CCS. It also has the potential to be a useful tool for empowering CCSs to be responsible for their own well-being and preventing adverse events whenever possible. With sufficient commitment on the European level, this solution should increase the capacity to respond more effectively to the needs of European CCS.
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Affiliation(s)
- Riccardo Haupt
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.
| | - Samira Essiaf
- The European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - Chiara Dellacasa
- Inter-University Consortium Cineca, Casalecchio di Reno (BO), Italy
| | - Cecile M Ronckers
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Silvia Caruso
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | | | - Monica Muraca
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Vera Morsellino
- Department of Hematology and Oncology, Istituto Giannina Gaslini, Genova, Italy
| | - Anita Kienesberger
- Austrian Childhood Cancer Organisation on behalf of CCI (Childhood Cancer International), Vienna, Austria
| | - Anne Blondeel
- The European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - Davide Saraceno
- Inter-University Consortium Cineca, Casalecchio di Reno (BO), Italy
| | - Maurizio Ortali
- Inter-University Consortium Cineca, Casalecchio di Reno (BO), Italy
| | - Leontien C M Kremer
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology and Oncology, Children's BMT Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Jelena Roganovic
- Department of Pediatrics, Division of Hematology and Oncology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Gill A Levitt
- Department of Haematology/Oncology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, UK
| | - Marisa De Rosa
- Inter-University Consortium Cineca, Casalecchio di Reno (BO), Italy
| | - Martin Schrappe
- Department of Paediatrics, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Paediatrics, Lund, Sweden
| | - Ruth Ladenstein
- St. Anna Children's Cancer Research Institute, Vienna, Austria
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29
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Bright CJ, Hawkins MM, Winter DL, Alessi D, Allodji RS, Bagnasco F, Bárdi E, Bautz A, Byrne J, Feijen EAM, Fidler MM, Garwicz S, Grabow D, Gudmundsdottir T, Guha J, Haddy N, Jankovic M, Kaatsch P, Kaiser M, Kuehni CE, Linge H, Øfstaas H, Ronckers CM, Skinner R, Teepen JC, Terenziani M, Vu-Bezin G, Wesenberg F, Wiebe T, Sacerdote C, Jakab Z, Haupt R, Lähteenmäki P, Zaletel LZ, Kuonen R, Winther JF, de Vathaire F, Kremer LC, Hjorth L, Reulen RC. Risk of Soft-Tissue Sarcoma Among 69 460 Five-Year Survivors of Childhood Cancer in Europe. J Natl Cancer Inst 2018; 110:649-660. [PMID: 29165710 PMCID: PMC6005019 DOI: 10.1093/jnci/djx235] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/09/2017] [Accepted: 10/10/2017] [Indexed: 12/20/2022] Open
Abstract
Background Childhood cancer survivors are at risk of subsequent primary soft-tissue sarcomas (STS), but the risks of specific STS histological subtypes are unknown. We quantified the risk of STS histological subtypes after specific types of childhood cancer. Methods We pooled data from 13 European cohorts, yielding a cohort of 69 460 five-year survivors of childhood cancer. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) were calculated. Results Overall, 301 STS developed compared with 19 expected (SIR = 15.7, 95% confidence interval [CI] = 14.0 to 17.6). The highest standardized incidence ratios were for malignant peripheral nerve sheath tumors (MPNST; SIR = 40.6, 95% CI = 29.6 to 54.3), leiomyosarcomas (SIR = 29.9, 95% CI = 23.7 to 37.2), and fibromatous neoplasms (SIR = 12.3, 95% CI = 9.3 to 16.0). SIRs for MPNST were highest following central nervous system tumors (SIR = 80.5, 95% CI = 48.4 to 125.7), Hodgkin lymphoma (SIR = 81.3, 95% CI = 35.1 to 160.1), and Wilms tumor (SIR = 76.0, 95% CI = 27.9 to 165.4). Standardized incidence ratios for leiomyosarcoma were highest following retinoblastoma (SIR = 342.9, 95% CI = 245.0 to 466.9) and Wilms tumor (SIR = 74.2, 95% CI = 37.1 to 132.8). AERs for all STS subtypes were generally low at all years from diagnosis (AER < 1 per 10 000 person-years), except for leiomyosarcoma following retinoblastoma, for which the AER reached 52.7 (95% CI = 20.0 to 85.5) per 10 000 person-years among patients who had survived at least 45 years from diagnosis of retinoblastoma. Conclusions For the first time, we provide risk estimates of specific STS subtypes following childhood cancers and give evidence that risks of MPNSTs, leiomyosarcomas, and fibromatous neoplasms are particularly increased. While the multiplicative excess risks relative to the general population are substantial, the absolute excess risk of developing any STS subtype is low, except for leiomyosarcoma after retinoblastoma. These results are likely to be informative for both survivors and health care providers.
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Affiliation(s)
- Chloe J Bright
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Mike M Hawkins
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - David L Winter
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Rodrigue S Allodji
- Cancer and Radiation Team, U1018 INSERM, Gustave Roussy, Villejuif, France
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy
| | - Edit Bárdi
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
- Kepler Universitätsklinikum, Linz, Austria
| | - Andrea Bautz
- Danish Cancer Society Research Center, Survivorship Unit, Copenhagen, Denmark
| | | | - Elizabeth A M Feijen
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Miranda M Fidler
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Stanislaw Garwicz
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research Center, Survivorship Unit, Copenhagen, Denmark
- Childreńs Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Joyeeta Guha
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Nadia Haddy
- Cancer and Radiation Team, U1018 INSERM, Gustave Roussy, Villejuif, France
| | - Momcilo Jankovic
- Foundation MBBM, Hemato-Oncology Center, University of Milano-Bicocca, Monza, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Helena Linge
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - Hilde Øfstaas
- Norwegian National Advisory Unit on Solid Tumors in Children, Oslo, Norway
| | - Cecile M Ronckers
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Jop C Teepen
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giao Vu-Bezin
- Cancer and Radiation Team, U1018 INSERM, Gustave Roussy, Villejuif, France
| | - Finn Wesenberg
- Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Thomas Wiebe
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, Semmelweis University, Budapest, Hungary
| | - Riccardo Haupt
- Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy
| | - Päivi Lähteenmäki
- Department of Pediatric and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | | | | | - Jeanette F Winther
- Danish Cancer Society Research Center, Survivorship Unit, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Leontien C Kremer
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
- Department of Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - Raoul C Reulen
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
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30
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Grabow D, Kaiser M, Hjorth L, Byrne J, Alessi D, Allodji RS, Bagnasco F, Bárdi E, Bautz A, Bright CJ, de Vathaire F, Feijen EAM, Garwicz S, Hagberg O, Haupt R, Hawkins MM, Jakab Z, Kremer LCM, Kuehni CE, Kuonen R, Lähteenmäki PM, Reulen RC, Ronckers CM, Sacerdote C, Vu-Bezin G, Wesenberg F, Wiebe T, Winter DL, Winther JF, Zaletel LZ, Kaatsch P. The PanCareSurFup cohort of 83,333 five-year survivors of childhood cancer: a cohort from 12 European countries. Eur J Epidemiol 2018; 33:335-349. [PMID: 29497894 PMCID: PMC5889790 DOI: 10.1007/s10654-018-0370-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 02/15/2018] [Indexed: 11/30/2022]
Abstract
Childhood cancer survivors face risks from a variety of late effects, including cardiac events, second cancers, and late mortality. The aim of the pan-European PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies (PanCareSurFup) Consortium was to collect data on incidence and risk factors for these late effects among childhood cancer survivors in Europe. This paper describes the methodology of the data collection for the overall PanCareSurFup cohort and the outcome-related cohorts. In PanCareSurFup 13 data providers from 12 countries delivered data to the data centre in Mainz. Data providers used a single variable list that covered all three outcomes. After validity and plausibility checks data was provided to the outcome-specific working groups. In total, we collected data on 115,596 patients diagnosed with cancer from 1940 to 2011, of whom 83,333 had survived 5 years or more. Due to the eligibility criteria and other requirements different numbers of survivors were eligible for the analysis of each of the outcomes. Thus, 1014 patients with at least one cardiac event were identified from a cohort of 39,152 5-year survivors; for second cancers 3995 survivors developed at least one second cancer from a cohort of 71,494 individuals, and from the late mortality cohort of 79,441 who had survived at least 5 years, 9247 died subsequently. Through the close cooperation of many European countries and the establishment of one central data collection and harmonising centre, the project succeeded in generating the largest cohort of children with cancer to date.
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Affiliation(s)
- Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Melanie Kaiser
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lars Hjorth
- Department of Clinical Sciences, Skane University Hospital, Lund University, Pediatrics, Lund, Sweden
| | - Julianne Byrne
- Boyne Research Institute, 5 Bolton Square, East, Drogheda, Co. Louth, A92 RY6K, Ireland
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Citta' della Salute e della Scienza Hospital-University of Turin and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy
| | - Rodrigue S Allodji
- Cancer and Radiation, Unit 1018 INSERM, University Paris-Saclay, Gustave Roussy, 39, rue Camille Desmoulins, 94805, Villejuif Cedex, France
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, Gaslini Children's Hospital, Via Gerolamo Gaslini, 5, 16148, Genova, Italy
| | - Edit Bárdi
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
- Kepler Universitätsklinikum, Linz, Austria
| | - Andrea Bautz
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Florent de Vathaire
- Cancer and Radiation, Unit 1018 INSERM, University Paris-Saclay, Gustave Roussy, 39, rue Camille Desmoulins, 94805, Villejuif Cedex, France
| | - Elizabeth A M Feijen
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Stanislaw Garwicz
- Department of Clinical Sciences, Skane University Hospital, Lund University, Pediatrics, Lund, Sweden
| | | | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, Gaslini Children's Hospital, Via Gerolamo Gaslini, 5, 16148, Genova, Italy
| | - Mike M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Rahel Kuonen
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Päivi Maria Lähteenmäki
- Department of Pediatric and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Cécile M Ronckers
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Citta' della Salute e della Scienza Hospital-University of Turin and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy
| | - Giao Vu-Bezin
- Cancer and Radiation, Unit 1018 INSERM, University Paris-Saclay, Gustave Roussy, 39, rue Camille Desmoulins, 94805, Villejuif Cedex, France
| | - Finn Wesenberg
- Norwegian Cancer Register Department of Pediatric Medicine, Faculty of Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas Wiebe
- Department of Clinical Sciences, Skane University Hospital, Lund University, Pediatrics, Lund, Sweden
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | | | - Lorna Zadravec Zaletel
- Division of Radiotherapy, Institute of Oncology, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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31
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Faraci M, Bagnasco F, Leoni M, Giardino S, Terranova P, Subissi L, Di Duca M, Di Martino D, Lanino E. Evaluation of Chimerism Dynamics after Allogeneic Hematopoietic Stem Cell Transplantation in Children with Nonmalignant Diseases. Biol Blood Marrow Transplant 2017; 24:1088-1093. [PMID: 29292059 DOI: 10.1016/j.bbmt.2017.12.801] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/20/2017] [Indexed: 11/16/2022]
Abstract
It is recognized that chimerism following hematopoietic stem cell transplantation (HSCT) is a dynamic process. The aims of this study were to describe the evolution of chimerism in children with nonmalignant diseases who underwent allogeneic HSCT, and to analyze the risk factors influencing chimerism status. A total of 101 HSCTs were performed in 85 patients with nonmalignant diseases. The donor was unrelated in 62.4% of HSCTs. Reduced-intensity conditioning (RIC) regimen was administered in 48.5% of patients. Acute graft-versus-host disease (aGVHD) occurred in 51.7% and chronic GVHD (cGVHD) in 39.7% of patients. Analysis of chimerism was performed through amplification of 9 specific short tandem repeats by polymerase chain reaction at engraftment and 1, 6, and 12 months after HSCT. Upon first evaluation, complete chimerism (CC) was detected in 34.7% and mixed chimerism (MC) in 55.4%, whereas graft failure occurred in 9.9% of patients. Severe aGVHD was associated with CC (P = .031). The last chimerism evaluation showed CC in 72.1%, stable MC in 12.8%, and progressive MC in 3.5%. CC was associated with a higher incidence of aGVHD (P = .016) and cGVHD (P = .022), whereas the RIC regimen was associated with graft failure (P = .026). One- and 3-year overall survival (OS) was 87.4% and 80.5%, respectively, with a lower OS at 3 years in patients with CC compared with those with MC (P = .008). aGVHD and cGVHD represent factors favoring CC, thus close, careful follow-up of chimerism is recommended in patients affected by nonmalignant disease.
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Affiliation(s)
- Maura Faraci
- Hematopoetic Stem Cell Transplant Unit, Hematology-Oncology, G. Gaslini Institute, Genoa, Italy.
| | | | - Massimiliano Leoni
- Hematopoetic Stem Cell Transplant Unit, Hematology-Oncology, G. Gaslini Institute, Genoa, Italy
| | - Stefano Giardino
- Hematopoetic Stem Cell Transplant Unit, Hematology-Oncology, G. Gaslini Institute, Genoa, Italy
| | - Paola Terranova
- Clinical and Experimental Hematology Unit, G. Gaslini Institute, Genoa, Italy
| | - Lorenzo Subissi
- Department of Epidemiology, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Marco Di Duca
- Laboratory of Pathophysiology of Uremia, G. Gaslini Institute, Genoa, Italy
| | - Daniela Di Martino
- Hematopoetic Stem Cell Transplant Unit, Hematology-Oncology, G. Gaslini Institute, Genoa, Italy
| | - Edoardo Lanino
- Hematopoetic Stem Cell Transplant Unit, Hematology-Oncology, G. Gaslini Institute, Genoa, Italy
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32
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Fidler MM, Reulen RC, Winter DL, Allodji RS, Bagnasco F, Bárdi E, Bautz A, Bright CJ, Byrne J, Feijen EAM, Garwicz S, Grabow D, Gudmundsdottir T, Guha J, Haddy N, Jankovic M, Kaatsch P, Kaiser M, Kuonen R, Linge H, Maule M, Merletti F, Øfstaas H, Ronckers CM, Skinner R, Teepen J, Terenziani M, Vu-Bezin G, Wesenberg F, Wiebe T, Jakab Z, Haupt R, Lähteenmäki P, Zaletel LZ, Kuehni CE, Winther JF, de Vathaire F, Kremer LC, Hjorth L, Hawkins MM. Risk of Subsequent Bone Cancers Among 69 460 Five-Year Survivors of Childhood and Adolescent Cancer in Europe. J Natl Cancer Inst 2017; 110:4237499. [PMID: 28954302 DOI: 10.1093/jnci/djx165] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/19/2017] [Indexed: 01/28/2023] Open
Abstract
Introduction We investigate the risks of subsequent primary bone cancers after childhood and adolescent cancer in 12 European countries. For the first time, we satisfactorily address the risks beyond 40 years from diagnosis and beyond 40 years of age among all survivors. Methods This largest-ever assembled cohort comprises 69 460 five-year survivors of cancer diagnosed before age 20 years. Standardized incidence ratios, absolute excess risks, and multivariable-adjusted relative risks and relative excess risks were calculated. All statistical tests were two-sided. Results Overall, survivors were 21.65 times (95% confidence interval = 18.97 to 24.60 times) more likely to be diagnosed with a subsequent primary bone cancer than expected from the general population. The greatest excess numbers of bone cancers were observed after retinoblastoma, bone sarcoma, and soft tissue sarcoma. The excess number of bone cancers declined linearly with both years since diagnosis and attained age (all P < .05). Beyond 40 years from diagnosis and age 40 years, there were at most 0.45 excess bone cancers among all survivors per 10 000 person-years at risk; beyond 30 years from diagnosis and age 30 years, there were at most 5.02 excess bone cancers after each of retinoblastoma, bone sarcoma, and soft tissue sarcoma, per 10 000 person-years at risk. Conclusions For all survivors combined and the cancer groups with the greatest excess number of bone cancers, the excess numbers observed declined with both age and years from diagnosis. These results provide novel, reliable, and unbiased information about risks and risk factors among long-term survivors of childhood and adolescent cancer.
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Affiliation(s)
- Miranda M Fidler
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Rodrigue S Allodji
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Francesca Bagnasco
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Edit Bárdi
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Andrea Bautz
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Julianne Byrne
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Elizabeth A M Feijen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Stanislaw Garwicz
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Desiree Grabow
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Thorgerdur Gudmundsdottir
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Joyeeta Guha
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Nadia Haddy
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Momcilo Jankovic
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Peter Kaatsch
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Melanie Kaiser
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Rahel Kuonen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Helena Linge
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Milena Maule
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Franco Merletti
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Hilde Øfstaas
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Cecile M Ronckers
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Roderick Skinner
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jop Teepen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Monica Terenziani
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Giao Vu-Bezin
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Finn Wesenberg
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Thomas Wiebe
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Zsuzsanna Jakab
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Riccardo Haupt
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Päivi Lähteenmäki
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Lorna Zadravec Zaletel
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jeanette F Winther
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Florent de Vathaire
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Leontien C Kremer
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Lars Hjorth
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
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Faraci M, Giardino S, Bagnasco F, Morreale G, Terranova MP, Di Martino D, Lanino E. Allogeneic hematopoietic stem cell transplantation in congenital disorders: A single-center experience. Pediatr Transplant 2017. [PMID: 28649784 DOI: 10.1111/petr.12997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the treatment of choice for a variety of congenital disorders. We report the experience of children affected by congenital diseases other than bone marrow failure syndromes who received allo-HSCT over a period of 25 years at G. Gaslini Paediatric Research Institute. HSCTs were performed in 57 children with congenital diseases (25 with congenital immunodeficiencies, 10 with severe combined immunodeficiencies, and 22 with metabolic diseases). Overall survival rate at 3 years in the whole group of patients was 76.9%, with a trend in favor of better outcome in children with metabolic diseases and in those who received cord blood cells (85.9%) vs bone marrow cells (72.4%).
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Affiliation(s)
- Maura Faraci
- Hematopoietic Stem Cell Transplantation Unit, Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini, Genoa, Italy
| | - Stefano Giardino
- Hematopoietic Stem Cell Transplantation Unit, Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Bagnasco
- Epidemiology, Biostatistics and Committees Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppe Morreale
- Hematopoietic Stem Cell Transplantation Unit, Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini, Genoa, Italy
| | - M Paola Terranova
- Hematopoietic Stem Cell Transplantation Unit, Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini, Genoa, Italy
| | - Daniela Di Martino
- Hematopoietic Stem Cell Transplantation Unit, Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini, Genoa, Italy
| | - Edoardo Lanino
- Hematopoietic Stem Cell Transplantation Unit, Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini, Genoa, Italy
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Svahn J, Bagnasco F, Cappelli E, Onofrillo D, Caruso S, Corsolini F, De Rocco D, Savoia A, Longoni D, Pillon M, Marra N, Ramenghi U, Farruggia P, Locasciulli A, Addari C, Cerri C, Mastrodicasa E, Casazza G, Verzegnassi F, Riccardi F, Haupt R, Barone A, Cesaro S, Cugno C, Dufour C. Somatic, hematologic phenotype, long-term outcome, and effect of hematopoietic stem cell transplantation. An analysis of 97 Fanconi anemia patients from the Italian national database on behalf of the Marrow Failure Study Group of the AIEOP (Italian Association of Pediatric Hematology-Oncology). Am J Hematol 2016; 91:666-71. [PMID: 27013026 DOI: 10.1002/ajh.24373] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 03/11/2016] [Accepted: 03/17/2016] [Indexed: 12/24/2022]
Abstract
We analyzed 97 Fanconi anemia patients from a clinic/biological database for genotype, somatic, and hematologic phenotype, adverse hematological events, solid tumors, and treatment. Seventy-two patients belonged to complementation group A. Eighty percent of patients presented with mild/moderate somatic phenotype and most with cytopenia. No correlation was seen between somatic/hematologic phenotype and number of missense mutations of FANCA alleles. Over follow-up, 33% of patients improved or maintained mild/moderate cytopenia or normal blood count, whereas remaining worsened cytopenia. Eleven patients developed a hematological adverse event (MDS, AML, pathological cytogenetics) and three developed solid tumors. 10 years cumulative risk of death of the whole cohort was 25.6% with median follow-up 5.8 years. In patients eligible to hematopoietic stem cell transplantation because of moderate cytopenia, mortality was significantly higher in subjects transplanted from matched unrelated donor over nontransplanted subjects, whereas there was no significant difference between matched sibling donor transplants and nontransplanted patients. In patients eligible to transplant because of severe cytopenia and clonal disease, mortality risk was not significantly different in transplanted from matched unrelated versus matched sibling donor versus nontransplanted subjects. The decision to transplant should rely on various elements including, type of donor, HLA matching, patient comorbidities, impairment, and clonal evolution of hematopoiesis. Am. J. Hematol. 91:666-671, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | | | | | - Silvia Caruso
- Epidemiology and Statistics; Gaslini Institute; Genova Italy
| | - Fabio Corsolini
- Cell Repository and Bio Bank, Gaslini Institute; Genova Italy
| | | | - Anna Savoia
- Medical Genetics, Burlo Garofalo Institute; Trieste Italy
| | | | - Marta Pillon
- Pediatric Hemato-Oncology; University of Padova; Italy
| | | | - Ugo Ramenghi
- Pediatric Hematology; Regina Margherita Hospital; Torino Italy
| | - Piero Farruggia
- Pediatric Hematology-Oncology; a.R.N.A.S. Civico Fatebenefratelli; Palermo Italy
| | - Anna Locasciulli
- Pediatric Hematology; San Camillo- Forlanini Hospital; Rome Italy
| | - Carmen Addari
- Bone Marrow Transplantation Unit; Hospital of Microcytemia; Cagliari Italy
| | - Carla Cerri
- Pediatric Onco-Hematology; Hospital of Perugia; Perugia Italy
| | | | | | | | | | - Riccardo Haupt
- Epidemiology and Statistics; Gaslini Institute; Genova Italy
| | | | - Simone Cesaro
- Pediatric Onco-Hematology Hospital of Verona; Verona Italy
| | - Chiara Cugno
- Pediatric Onco-Hematology; San Matteo Hospital; Pavia Italy
| | - Carlo Dufour
- Hematology Unit; Gaslini Institute; Genova Italy
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Castagnola E, Caviglia I, Pescetto L, Bagnasco F, Haupt R, Bandettini R. Antibiotic susceptibility of Gram-negatives isolated from bacteremia in children with cancer. Implications for empirical therapy of febrile neutropenia. Future Microbiol 2016; 10:357-64. [PMID: 25812459 DOI: 10.2217/fmb.14.144] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Monotherapy is recommended as the first choice for initial empirical therapy of febrile neutropenia, but local epidemiological and antibiotic susceptibility data are now considered pivotal to design a correct management strategy. AIM To evaluate the proportion of Gram-negative rods isolated in bloodstream infections in children with cancer resistant to antibiotics recommended for this indication. MATERIALS & METHODS The in vitro susceptibility to ceftazidime, piperacillin-tazobactam, meropenem and amikacin of Gram-negatives isolated in bacteremic episodes in children with cancer followed at the Istituto "Giannina Gaslini", Genoa, Italy in the period of 2001-2013 was retrospectively analyzed using the definitions recommended by EUCAST in 2014. Data were analyzed for any single drug and to the combination of amikacin with each β-lactam. The combination was considered effective in absence of concomitant resistance to both drugs, and not evaluated by means of in vitro analysis of antibiotic combinations (e.g., checkerboard). RESULTS A total of 263 strains were evaluated: 27% were resistant to piperacillin-tazobactam, 23% to ceftazidime, 12% to meropenem and 13% to amikacin. Concomitant resistance to β-lactam and amikacin was detected in 6% of strains for piperacillin-tazobactam, 5% for ceftazidime and 5% for meropenem. During the study period there was a nonsignificant increase in the proportions of strains resistant to β-lactams indicated for monotherapy, and also increase in the resistance to combined therapies. CONCLUSION in an era of increasing resistance to antibiotics guideline-recommended monotherapy could be not appropriate for initial empirical therapy of febrile neutropenia. Strict local survey on etiology and antibiotic susceptibility is mandatory for a correct management of this complication in cancer patients.
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Affiliation(s)
- Elio Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini, Genoa, Italy
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Di Iorgi N, Allegri AEM, Napoli F, Calcagno A, Calandra E, Fratangeli N, Vannati M, Rossi A, Bagnasco F, Haupt R, Maghnie M. Central diabetes insipidus in children and young adults: etiological diagnosis and long-term outcome of idiopathic cases. J Clin Endocrinol Metab 2014; 99:1264-72. [PMID: 24276447 DOI: 10.1210/jc.2013-3724] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [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: 11/19/2022]
Abstract
CONTEXT Central diabetes insipidus (CDI) is considered idiopathic in 20% to 50% of affected subjects. OBJECTIVE The purpose of this study was to determine whether a systematic diagnostic workup could achieve better etiologic diagnosis in children and adolescents presenting with polyuria and polydipsia. DESIGN AND SETTING This is a prospective study conducted at a tertiary referral center. Patients underwent clinical and endocrine evaluations every 6 months and neuroimaging every 6 months for 2 years and yearly for 3 years. Endocrine function and neuroimaging were also reassessed after adult height achievement. PARTICIPANTS A total of 85 consecutive patients with CDI were enrolled at a median age of 7.5 years; those with idiopathic CDI were stratified based on pituitary stalk thickness. MAIN OUTCOME MEASURES To establish the etiology of CDI, we determined the time lag between its onset and the specific diagnosis, the long-term impact on pituitary function, and the overall long-term outcomes. RESULTS Of the subjects, 24 (28.2%) received an etiologic diagnosis at presentation and 11 (13%) within 2.5 years (n = 7 germinomas and n = 4 Langerhans cell histiocytosis), 7 (8.2%) were lost to follow-up, and 43 (50.6%) were considered to have idiopathic disease and were followed until the median age of 17.3 years. Neuroimaging identified 40 of 43 patients with self-limited inflammatory/autoimmune pituitary stalk thickness within the first 6 months, the severity of which was significantly correlated to pituitary dysfunction. The probability of >10-year-survival without an anterior pituitary defect was related to the severity of pituitary stalk thickness, and 53% showed permanent anterior pituitary defects. Three patients developed Langerhans cell histiocytosis and 1 developed Hodgkin lymphoma after a median of 9 and 13 years, respectively. CONCLUSIONS A diagnostic etiology was achieved in 96% of patients with CDI. Risk stratification based on the degree of pituitary stalk thickness is of prognostic value for long-term outcomes including permanent pituitary dysfunction. New guidance is provided for the management of these patients.
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Affiliation(s)
- Natascia Di Iorgi
- Department of Pediatrics (N.D.I., A.C., E.C., N.F., M.V., M.M.), Istituto Giannina Gaslini, University of Genova, 16147 Genova, Italy; and Department of Pediatrics (A.E.M.A., F.N.), Pediatric Neuroradiology (A.R.), and Epidemiology, Biostatistics and Committee's Unit (F.B., R.H.), Istituto Giannina Gaslini, 16147 Genova, Italy
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Napoli F, Di Iorgi N, Bagnasco F, Cangemi G, D'Amico B, Boschetti M, Allegri AEM, Bruzzone Ichim IA, Traggiai C, Allodi A, Polo Perucchin P, Ghezzi M, Noli S, Giaccardi M, Roviglione B, De Miglio L, Calcagno A, Lorini R, Maghnie M. Growth factors and metabolic markers in cord blood: relationship to birth weight and length. J BIOL REG HOMEOS AG 2014; 28:237-249. [PMID: 25001656] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Low birth weight and length for gestational age are associated with a high risk of short stature and metabolic syndrome in adulthood. The mechanisms that link prenatal growth to adult stature and metabolic syndrome have not yet been entirely clarified. The aim of our study was to evaluate the relationship between standardized anthropometric measures at birth and insulin-like growth factor (IGF)-I, IGF-II, insulin, adiponectin, and non-esterified fatty acid (NEFA) cord blood levels in the general population. One hundred fifty-eight random newborn subjects (77F, 81M) from Genoa, Italy, were analyzed. Anthropometric parameters were measured and standardized according to standard Italian tables. Insulin values were treated as categorical, since in several cases the results fell below detection cut-off. Mean birth weight was 3,214.23∓488.99 gr and mean length was 49.82∓2.17 cm. Females had higher mean IGF-I (p=0.04), and were more likely to have insulin values either <2 μU/ml or >4.5μU/ml (p= 0.04) compared to males. Weight and length SD scores (SDS) were higher in subjects with elevated insulin levels (p=0.002). A moderate correlation was found between weight and IGF-II (r=0.354). Multivariable analysis demonstrated that standardized birth weight was associated with IGFII and insulin values. Our data highlight the importance of IGF-II in fetal growth and suggest that gender differences should be taken into consideration when evaluating prenatal growth.
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Affiliation(s)
- F Napoli
- Pediatric Clinic, IRCCS G. Gaslini, University of Genova, Genova, Italy
| | - N Di Iorgi
- Pediatric Clinic, IRCCS G. Gaslini, University of Genova, Genova, Italy
| | - F Bagnasco
- Epidemiology, Biostatistics and Committee Unit, Istituto G. Gaslini, Genova, Italy
| | - G Cangemi
- Clinical Pathology Laboratory Unit, Istituto G. Gaslini, Genova, Italy
| | - B D'Amico
- Pediatric Clinic, IRCCS G. Gaslini, University of Genova, Genova, Italy
| | - M Boschetti
- Department of Endocrinology and Medical Sciences, University of Genova, Genova, Italy
| | - A E M Allegri
- Pediatric Clinic, IRCCS G. Gaslini, University of Genova, Genova, Italy
| | | | - C Traggiai
- Neonatal Intensive Care Unit, Istituto G.Gaslini, Genova, Italy
| | - A Allodi
- Neonatology, S. Martino Hospital, Genova, Italy
| | - P Polo Perucchin
- Pediatric Clinic, IRCCS G. Gaslini, University of Genova, Genova, Italy
| | - M Ghezzi
- Pediatric Clinic, IRCCS G. Gaslini, University of Genova, Genova, Italy
| | - S Noli
- Pediatric Clinic, IRCCS G. Gaslini, University of Genova, Genova, Italy
| | - M Giaccardi
- Pediatric Clinic, IRCCS G. Gaslini, University of Genova, Genova, Italy
| | - B Roviglione
- Pediatric Clinic, IRCCS G. Gaslini, University of Genova, Genova, Italy
| | - L De Miglio
- Pediatric Clinic, IRCCS G. Gaslini, University of Genova, Genova, Italy
| | - A Calcagno
- Pediatric Clinic, IRCCS G. Gaslini, University of Genova, Genova, Italy
| | - R Lorini
- Pediatric Clinic, IRCCS G. Gaslini, University of Genova, Genova, Italy
| | - M Maghnie
- Pediatric Clinic, IRCCS G. Gaslini, University of Genova, Genova, Italy
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Bagnasco F, Haupt R, Fontana V, Valsecchi MG, Rebora P, Caviglia I, Caruso S, Castagnola E. Risk of repeated febrile episodes during chemotherapy-induced granulocytopenia in children with cancer: a prospective single center study. J Chemother 2012; 24:155-60. [PMID: 22759760 DOI: 10.1179/1973947812y.0000000002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Febrile neutropenia (FN) is a possible complication of antineoplastic chemotherapy. Aim of the study was to estimate the risk of developing fever at the beginning of any neutropenic period based on the previous history of FN. PROCEDURE The conditional frailty model was used to estimate the risk of developing fever during neutropenia separately for children with acute leukaemia/non-Hodgkin lymphoma (AL/NHL), or solid tumour (ST). The total number of previous FN episodes (PFNE), age, gender, type of tumour, calendar year of granulocytopenic period, phase of treatment, and granulocyte count were included in the model. RESULTS A total of 901 granulocytopenic periods was observed in 223 children: 306 in 66 AL/NHL and 595 in 157 ST. Fever developed in 328 cases: 125 in 53 AL/NHL and 203 in 92 ST. The PFNE variable was not significantly associated to the risk of fever [hazard ratio (HR) of 0.87, 95% confidence interval (CI) of 0.62-1.22 in children with AL/NHL, and HR of 0.98, 95% CI of 0.70-1.37 in those with ST]. The hazard of FN was significantly affected by the phase of treatment in AL/NHL (P<0.01), and by the level of neutropenia at onset in ST (P<0.01). CONCLUSIONS Previous history of FN does not increase the risk of further febrile episodes in any new subsequent granulocytopenic period. The aggressiveness of chemotherapy and the level of neutropenia at onset are the most important risk factors in children with AL/NHL and with ST respectively.
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Affiliation(s)
- Francesca Bagnasco
- Epidemiology and Biostatistics Section, Scientific Directorate, G. Gaslini Children's Hospital, Genoa, Italy
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39
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Minicucci L, Haupt M, Casciaro R, De Alessandri A, Bagnasco F, Lucidi V, Notarnicola S, Lorini R, Bertasi S, Raia V, Cialdella P, Haupt R. Slow-release insulin in cystic fibrosis patients with glucose intolerance: a randomized clinical trial. Pediatr Diabetes 2012; 13:197-202. [PMID: 22060105 DOI: 10.1111/j.1399-5448.2011.00810.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [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: 11/30/2022] Open
Abstract
BACKGROUND Early stages of glucose metabolism impairment are a period at risk in the long-term prognosis of cystic fibrosis (CF). Slow-release synthetic insulin glargine can be a therapeutic tool in this metabolic condition. METHODS In this phase 3 multicenter, controlled, two-arm, randomized clinical study, glargine was administered up to a dosage of 0.15 U/kg/die for a period of 18 months. Primary endpoint was the improvement of nutritional status [body mass index (BMI) Z score], while glucose tolerance [hemoglobin A1c (HbA1C) and respiratory function (FEV1 predicted] improvement were the secondary endpoints. RESULTS Thirty-four subjects (18 in the glargine arm and 16 in the control arm) were evaluated. Adherence to insulin treatment was excellent. No significant adverse events were reported. There were no significant differences in BMI, HbA1C and FEV1 values between the two groups nor within groups, except for HbA1C improvement in the glargine arm at month +18 (p = 0.04). CONCLUSIONS Glargine treatment was well accepted and tolerated. No real efficacy in improving clinical and glycometabolic conditions was demonstrated. Further studies are necessary to test glargine at higher dosage and for a longer follow-up period.
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Affiliation(s)
- Laura Minicucci
- Pediatric Department, CF Center, G. Gaslini Children Hospital, 16147 Genova, Italy.
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40
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Faraci M, Morana G, Bagnasco F, Barra S, Polo P, Hanau G, Fioredda F, Caruso S, Rossi A, Spaziante R, Haupt R. Magnetic resonance imaging in childhood leukemia survivors treated with cranial radiotherapy: a cross sectional, single center study. Pediatr Blood Cancer 2011; 57:240-6. [PMID: 21671360 DOI: 10.1002/pbc.22923] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 10/19/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children treated with cranial radiotherapy (CRT) for leukemia are at risk of developing central nervous system injuries. Magnetic resonance imaging (MRI) represents the examination method of choice for evaluating radiation-induced brain complications. The purpose of this report is to describe the spectrum of MRI abnormalities detected in a group of survivors of leukemia treated with cranial irradiation. PROCEDURES In this cross-sectional, single center study, 56 patients (median age at follow-up 19 years) receiving CRT as cranial prophylaxis (CP) included in the leukemia protocol (total dose 1,800-2,400 cGy) and/or in the total body irradiation regimen (990-1,200 cGy) before hematopoietic stem cell transplant, were evaluated by MRI after a median interval of 11 years (range 2-27) following CRT. RESULTS Fifty-nine MRI abnormalities (32 cavernomas, nine focal areas of gliosis, seven dystrophic mineralizations, five cerebral atrophies, four pituitary atrophies, one diffuse radiation leukoencephalopathy, and one meningioma) were found in 43 patients. The longest interval between CRT and MRI and oldest age at follow-up represented the two risk factors that were statistically associated with MRI lesions (P = 0.032 and 0.033, respectively). Cerebral cavernomas (CC) were the most frequent MRI abnormalities (57%). All patients with CC were asymptomatic at diagnosis and during follow-up, except one who had aspecific neurological manifestations and micro hemorrhages. CONCLUSIONS These results confirm that total doses and modalities of fractionation dose of CRT were not significantly associated with MRI abnormalities. Moreover, in our experience none of the patients developed neurological symptoms related to MRI abnormalities, and furthermore, the CC remained substantially stable during follow-up.
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Affiliation(s)
- Maura Faraci
- Hematology-Oncology Department, G. Gaslini Children's Research Institute, Genova, Italy.
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41
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Dufour C, Ferretti E, Bagnasco F, Burlando O, Lanciotti M, Ramenghi U, Saracco P, Van Lint MT, Longoni D, Torelli GF, Pillon M, Locasciulli A, Misuraca A, La Spina M, Bacigalupo A, Pistoia V, Corcione A, Svahn J. Changes in cytokine profile pre- and post-immunosuppression in acquired aplastic anemia. Haematologica 2009; 94:1743-7. [PMID: 19586939 DOI: 10.3324/haematol.2009.007815] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Cytokine expression assessed by flow cytometry in 53 acquired aplastic anemia patients before and after combined immunosuppression (EBMT WPSAA protocols) showed that CD3(+) marrow cells containing TNF-alpha, IFN-gamma and IL4 were similar in subjects with disease at onset (DO) and responsive to treatment who had more CD3(+)/TNF-alpha(+) and CD 3(+)/IFN-gamma(+) cells than normal controls. In vitro block of TNF-alpha and/or IFN-gamma significantly increased BFU-e over baseline in 28 patients. In responsive to treatment patients only TNF-alpha block significantly incremented colonies over normal controls. Absolute marrow CD3(+)/TNF-alpha(+) and CD3(+)/IFN-gamma(+) cells prospectively tested in a group of 21 subjects declined significantly more in Responders than in Non Responders to immunosuppression at Response Evaluation Time respect to Diagnosis. Both in Responders and in Non Responders these cells remained higher than in normal controls. This study suggests that immunosuppression does not fully clear excess TNF-alpha and IFN-gamma from marrow of patients with good outcome and raises the hypothesis that additional cytokine blockade might be useful in immunosuppression for acquired aplastic anemia.
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Affiliation(s)
- Carlo Dufour
- Haematology Unit, G. Gaslini Children's Hospital, Genoa, Italy.
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42
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Garrè ML, Cama A, Bagnasco F, Morana G, Giangaspero F, Brisigotti M, Gambini C, Forni M, Rossi A, Haupt R, Nozza P, Barra S, Piatelli G, Viglizzo G, Capra V, Bruno W, Pastorino L, Massimino M, Tumolo M, Fidani P, Dallorso S, Schumacher RF, Milanaccio C, Pietsch T. Medulloblastoma variants: age-dependent occurrence and relation to Gorlin syndrome--a new clinical perspective. Clin Cancer Res 2009; 15:2463-71. [PMID: 19276247 DOI: 10.1158/1078-0432.ccr-08-2023] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [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
PURPOSE We aimed to test the hypothesis that medulloblastoma (MB) variants show a different age distribution and clinical behavior reflecting their specific biology, and that MB occurring at very young age is associated with cancer predisposition syndromes such as Gorlin syndrome (GS). EXPERIMENTAL DESIGN We investigated the frequency, age distribution, location, response to treatment, outcome, and association with familial cancer predisposition syndromes in a series of 82 cases of MB in patients ages <14 years diagnosed at the Giannina Gaslini Children's Hospital, Genoa, between 1987 and 2004. RESULTS Desmoplastic MB and MB with extensive nodularity (MBEN), were present in 22 of 82 cases (27%) and were more frequent in children ages <or=3 years (13 of 25; 52%). In this age group, MBEN was significantly more frequent than desmoplastic MB and classic MB (P < 0.001) and had a good prognosis. MBEN was associated with GS in 5 of 12 cases. Overall, 8 cases occurred in the context of familial tumor predisposition syndromes (5 GS, 1 each NF1, Li-Fraumeni, and Fragile X) and 7 of these patients were ages <or=3 years at diagnosis. Desmoplastic histology and a more intensive treatment represented independent favorable prognostic factors in multivariate analysis (P = 0.003 and P = 0.0139, respectively). Metastasis was a predictor of bad outcome (P = 0.0001). CONCLUSIONS Our data indicate that biologically different MB entities warrant risk-adapted treatment and that MBEN is strongly associated with GS. Patients, ages <or=3 years, with MB and their families should be investigated for tumor predisposition syndromes such as GS.
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Affiliation(s)
- Maria Luisa Garrè
- Department of Scientific Direction, Epidemiology and Biostatistics Unit, University of Genoa, Genoa, Italy.
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43
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Castagnola E, Faraci M, Moroni C, Bandettini R, Granata C, Caruso S, Bagnasco F, Caviglia I, Malgorzata M, Furfaro E, Natalizia AR, de Fazio V, Morreale G, Lanino E, Haupt R, Dini G, Viscoli C. Invasive mycoses in children receiving hemopoietic SCT. Bone Marrow Transplant 2008; 41 Suppl 2:S107-11. [DOI: 10.1038/bmt.2008.67] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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44
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Castagnola E, Bagnasco F, Faraci M, Caviglia I, Caruso S, Cappelli B, Moroni C, Morreale G, Timitilli A, Tripodi G, Lanino E, Haupt R. Incidence of bacteremias and invasive mycoses in children undergoing allogeneic hematopoietic stem cell transplantation: a single center experience. Bone Marrow Transplant 2007; 41:339-47. [PMID: 18026151 DOI: 10.1038/sj.bmt.1705921] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We performed a retrospective single center study to define the epidemiology of bacteremias or invasive mycoses in pediatric allogeneic hematopoietic SCT (HSCT) from matched related donors (MRD) or alternative donors (AD). During 119 213 days of follow-up, 156 infections were observed: 130 bacteremias (27 in MRD-HSCT and 103 in AD-HSCT recipients) and 26 invasive mycoses (8 in MRD-HSCT and 18 in AD-HSCT recipients). Overall, the risk of bacteremia was fivefold that of invasive mycosis (P<0.001). AD-HSCT recipients had a higher percentage of infections (89 vs 27%; P<0.001), a higher rate/100 days of immunosuppression (infection rate (IR): 0.21 vs 0.06; P<0.001) and a higher proportion of repeated infections (44 vs 9%; P=0.001). In AD-HSCT, the relative risk of bacteremia was 2.87 in the pre-engraftment period, 5.84 in the early post-engraftment period and 6.46 in the late post-engraftment period (P<0.001) compared to MRD-HSCT. Only after 1 year did the epidemiology become similar. The epidemiology of invasive mycoses did not differ significantly between the two types of transplant.
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Affiliation(s)
- E Castagnola
- Infectious Diseases Unit, Department of Hematology and Oncology, G Gaslini Children Hospital, Genoa, Italy.
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45
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Ruperto N, Ravelli A, Pistorio A, Ferriani V, Calvo I, Ganser G, Brunner J, Dannecker G, Silva CA, Stanevicha V, Cate RT, van Suijlekom-Smit LWA, Voygioyka OLGA, Fischbach M, Foeldvari I, Hilario O, Modesto C, Saurenmann RK, Sauvain MJ, Scheibel I, Sommelet D, Tambic-Bukovac L, Barcellona R, Brik R, Ehl S, Jovanovic M, Rovensky J, Bagnasco F, Lovell DJ, Martini A. The provisional Paediatric Rheumatology International Trials Organisation/American College of Rheumatology/european League Against Rheumatism Disease activity core set for the evaluation of response to therapy in juvenile dermatomyositis: A prospective validation study. ACTA ACUST UNITED AC 2007; 59:4-13. [DOI: 10.1002/art.23248] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [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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46
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Bronzino P, Abbo L, Bagnasco F, Barisone P, Dezzani C, Genovese AM, Iannucci P, Ippoliti M, Sacchi M, Aimo I. [Spontaneous rupture of common iliac artery: a case of Ehlers-Danlos syndrome and review of the literature]. G Chir 2006; 27:324-7. [PMID: 17064493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Authors report an uncommon case of spontaneous rupture of common iliac artery in a man 43 years old with Ehlers-Danlos syndrome. The clinical presentation was devious in the beginning and catastrophic after few hours with a haemo-peritoneum and haemorragic shock. The Ehlers-Danlos syndrome is a rare affection of the connective tissue with an incidence of 1/5000, representing one of the most common disorders of the connective tissue. This disease is characterized by the fragility of arteries, intestine and uterus. Its presentation is often catastrophic, with rupture of a big artery, rupture of uterus during pregnancy or bowel perforation. The mean age of death in subjects with Ehlers-Danlos syndrome is 45 years. This syndrome is inherited in most cases in an autosomal dominant manner; 50% of the cases are due to new mutations. A minority of cases, due to deficit of tenascina X, is inherited in an autosomal recessive manner.
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Affiliation(s)
- P Bronzino
- Ospedale "Santa Croce" Mondovi (CN) Struttura Complessa Chirurgia Generale, Italy
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47
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Bronzino P, Abbo L, Bagnasco F, Barisone P, Dezzani C, Genovese AM, Iannucci P, Ippoliti M, Sacchi M, Aimo I. [Appendiceal mucocele due to mucinous cystadenoma: case report and review of the literature]. G Chir 2006; 27:97-9. [PMID: 16681869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Mucinous cystadenomas of the appendix are rare tumours. In this article we describe the case of a young woman who presented with abdominal pain and a clinical pattern likely to a chronic appendicitis. At laparotomy we found a dilatation of the appendix which contained an abundant quantity of mucus. Histological examination showed a mucinous cystadenoma of the appendix. This neoplasm requires a surgical treatment, usually only appendectomy and right hemicolectomy in case of involvement of the caecum. During operation, the surgeon must take care in handling the appendix because of the risk of rupture with consequent dissemination of epithelial cells in the peritoneal cavity (pseudomyxoma peritonei).
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Affiliation(s)
- P Bronzino
- Struttura Complessa Chirurgia Generale, Ospedale Santa Croce, Mondovi (CN)
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48
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Bronzino P, Abbo L, Bagnasco F, Barisone P, Dezzani C, Genovese AM, Iannucci P, Ippoliti M, Sacchi M, Aimo I. [Endovascular laser ablation of the greater saphenous vein for varicose veins: our initial experience]. G Chir 2005; 26:446-8. [PMID: 16472426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Laser treatment of primary varicose veins of the legs is a new mini-invasive technique which represent an alternative to the safenectomy. Endovascular laser treatment is based on the employ of laser to destroying the vascular wall and inducing fibrosis. This technique is not without complications: burns, paraesthesias, haematomas, but most of all disappear in few days. Encouraged by the promising results reported in literature, we have performed 18 laser ablation of greater saphenous vein since 2003 till today. Our patients had a good post-operative course and a follow up without troubles (3-17 months). We think that laser treatment is effective in the treatment of the primary varicose veins of the legs. It requests attention and experience in dosing the laser energy for minimizing the complications. Today there isn't long term follow up in literature.
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Affiliation(s)
- P Bronzino
- Struttura Complessa Chirurgia Generale, Ospedale Santa Croce, Mondovì
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49
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Bronzino P, Abbo L, Bagnasco F, Barisone P, Dezzani C, Genovese AM, Iannucci P, Ippoliti M, Sacchi M, Aimo I. [Splenic marginal zone lymphoma: case report and review of the literature]. G Chir 2005; 26:419-21. [PMID: 16472419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Splenic marginal zone lymphomas are rare tumors which take origin from the B cells. More common in the elderly, often asymptomatic, they can present with abdominal pain, splenomegaly and cytopenia and have an indolent clinical course. We describe a case of a women 79 years old who presented with abdominal pain, fever and splenomegaly. Computed tomography demonstrated splenomegaly with an area of low density in the spleen. Only by laparotomy and splenectomy the correct diagnosis was possible. Because of the indolent course of this kind of lymphomas, splenectomy is the main treatment for patients with abdominal pain, splenomegaly and cytopenia. If there is no pain and no cytopenia, the treatment can be only wait and see. Only in case of progression of disease chemotherapy can be employed.
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Affiliation(s)
- P Bronzino
- Struttura Complessa Chirurgia Generale, Ospedale Santa Croce, Mondovì
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50
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Bronzino P, Abbo L, Bagnasco F, Barisone P, Dezzani C, Genovese AM, Iannucci P, Ippoliti M, Sacchi M, Aimo I. Intra-abdominal inflammatory myofibroblastic pseudotumor: case report and review of the literature. G Chir 2005; 26:362-4. [PMID: 16371186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Inflammatory myofibroblastic pseudotumors (IPM) are very rare tumor characterized by unpredictable clinical behaviour. They arise in soft tissues of almost every organ and the most common site is the lung. Over 200 cases of inflammatory myofibroblastic pseudotumor of the lung have been described in literature. Intra-abdominal IMP are very rare. We describe a case of intra-abdominal IMP in a boy of 15 years old who presented symptoms and signs of acute appendicitis. Exploratory laparotomy revealed a mass in the peritoneal cavity. The mass was removed. The histologic examination showed that it was an IMP. Surgical treatment was the only therapy. Six months after the surgical operation the patient has no sign of illness.
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Affiliation(s)
- P Bronzino
- Struttura Complessa Chirurgia Generale, Ospedale Santa Croce, Mondovi (CN)
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