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Giardino S, Eikema DJ, Piepenbroek B, Algeri M, Ayas M, Faraci M, Tbakhi A, Zecca M, Essa M, Neven B, Bertrand Y, Kharya G, Bykova T, Lawson S, Petrini M, Mohseny A, Rialland F, James B, Colita A, Fahd M, Cesaro S, Schulz A, Kleinschmidt K, Kałwak K, Corbacioglu S, Dufour C, Risitano A, de Latour RP. HLA-haploidentical stem cell transplantation in children with inherited bone marrow failure syndromes: A retrospective analysis on behalf of EBMT severe aplastic Anemia and pediatric diseases working parties. Am J Hematol 2024; 99:1066-1076. [PMID: 38497679 DOI: 10.1002/ajh.27293] [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: 10/11/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Abstract
Haploidentical stem cell transplantation (haplo-SCT) represents the main alternative for children with inherited bone marrow failure syndrome (I-BMF) lacking a matched donor. This retrospective study, conducted on behalf of the EBMT SAAWP and PDWP, aims to report the current outcomes of haplo-SCT in I-BMFs, comparing the different in vivo and ex vivo T-cell depletion approaches. One hundred and sixty-two I-BMF patients who underwent haplo-SCT (median age 7.4 years) have been registered. Fanconi Anemia was the most represented diagnosis (70.1%). Based on different T-cell depletion (TCD) approaches, four categories were identified: (1) TCRαβ+/CD19+-depletion (43.8%); (2) T-repleted with post-transplant Cyclophosphamide (PTCy, 34.0%); (3) In-vivo T-depletion with ATG/alemtuzumab (14.8%); (4) CD34+ positive selection (7.4%). The cumulative incidences (CI) of neutrophil and platelet engraftment were 84% and 76% respectively, while that of primary and secondary graft failure was 10% and 8% respectively. The 100-day CI of acute GvHD grade III-IV(95% CI) was 13%, while the 24-month CI of extensive chronic GvHD was 4%. After a median follow-up of 43.4 months, the 2-year overall survival(OS) and GvHD/Rejection-free Survival (GRFS) probabilities are 67% and 53%, respectively. The TCR CD3+αβ+/CD19+ depletion group showed a significantly lower incidence of both acute and chronic GvHD and higher OS (79%; p0.013) and GRFS (71%; p < .001), while no significant differences in outcomes have been observed by different diagnosis and conditioning regimens. This large retrospective study supports the safety and feasibility of haplo-SCT in I-BMF patients. TCRαβ+/CD19+ depletion offers higher chances of patients' survival, with a significantly lower risk of severe a- and c-GvHD in I-BMFs compared to other platforms.
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Affiliation(s)
- Stefano Giardino
- Hematopoietic Stem Cell Transplantation Unit, Department of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Dirk-Jan Eikema
- Statistical Unit and Data Office, European Society for Blood and Marrow Transplantation (EBMT), Leiden, The Netherlands
| | | | - Mattia Algeri
- Department of Pediatric Haematology and Oncology & Stem and Gene Therapy, IRRCS Bambino Gesù Children's Hospital, Rome, Italy
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Center, Department of Pediatric Hematology Oncology, Riyadh, Saudi Arabia
| | - Maura Faraci
- Hematopoietic Stem Cell Transplantation Unit, Department of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mohammed Essa
- King Abdullah Specialist Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Bénédicte Neven
- Pediatric Immune-Hematology Unit, Necker Children Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Yves Bertrand
- Institut d'hémato oncologie Pédiatrique, Hospice Civil de Lyon, Paris, France
| | - Gaurav Kharya
- Centre for Bone Marrow Transplant & Cellular Therapy, Indraprastha Apollo Hospital, New Delhi, India
| | - Tatiana Bykova
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Sarah Lawson
- Department of Haematology, Birmingham Children's Hospital, Birmingham, UK
| | - Mario Petrini
- Unit of Hematology, Santa Chiara University Hospital, University of Pisa, Pisa, Italy
| | - Alexander Mohseny
- Willem-Alexander Children's Hospital, Pediatric SCT program, Leiden University Medical Center, Leiden, The Netherlands
| | - Fanny Rialland
- Hôpital de la mère et l'enfant, Service d'hématologie pédiatrique, Nantes, France
| | - Beki James
- Leeds General Infirmary, Leeds Children's Hospital, Leeds, UK
| | - Anca Colita
- "Carol Davila" University of Medicine and Pharmacy, Fundeni Clinical Institute, Bucharest, Romania
| | - Mony Fahd
- Hematology and Immunology Pediatric Department, GHU APHP Nord-Université Paris Cité, Paris, France
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Ansgar Schulz
- Department of Pediatric Medicine, University Hospital Ulm, Eythstraße 24, Ulm, Germany
| | - Katharina Kleinschmidt
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children's Hospital Regensburg, Regensburg, Germany
| | - Krzysztof Kałwak
- Supraregional Center of Pediatric Oncology "Cape of Hope", Wroclaw Medical University, Wroclaw, Poland
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children's Hospital Regensburg, Regensburg, Germany
| | - Carlo Dufour
- Hematology Unit, Department of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Antonio Risitano
- Hematology and Hematopoietic Transplant Unit, Azienda Ospedaliera di Rilievo Nazionale "San Giuseppe Moscati" (A.O.R.N. Giuseppe Moscati), Avellino, Italy
| | - Régis Peffault de Latour
- Bone Marrow Transplant Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
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Montoro J, Eikema DJ, Tuffnell J, Potter V, Kałwak K, Halkes CJJ, Kulagin A, Collin M, Wynn RF, Robinson S, Nicholson E, Sengeloev H, Halahleh K, Skorobogatova E, Sanz J, Passweg JR, Mielke S, Ryhänen SJ, Carpenter B, Gedde-Dahl T, Tholouli E, Fanin R, Lewalle P, Kulasekararaj AG, Risitano AM, Peffault de Latour R. Alternative donor transplantation for severe aplastic anemia: a comparative study of the SAAWP EBMT. Blood 2024:blood.2024024173. [PMID: 38643511 DOI: 10.1182/blood.2024024173] [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: 02/02/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/23/2024] Open
Abstract
Selecting the most suitable alternative donor becomes challenging in severe aplastic anemia (SAA) when a matched sibling donor (MSD) is unavailable. We compared outcomes in SAA patients undergoing SCT from matched unrelated donors (MUD, n=1106), mismatched unrelated donors (MMUD, n=340), and haploidentical donors (Haplo, n=206) registered in the EBMT database (2012-2021). For Haplo-SCT, only those receiving post-transplant cyclophosphamide (PT-Cy) for graft-versus-host disease (GVHD) prophylaxis were included. Median age was 20 years, and the median time from diagnosis to transplantation 8.7 months. Compared to MUD, MMUD (HR, 2.93; 95% CI, 1.52-5.6) and Haplo (HR, 5.15; 95% CI, 2.5-10.58) showed significantly higher risks of primary graft failure. MUD had lower rates of acute GVHD compared to MMUD and Haplo, grade II-IV (13%, 22%, and 19%, respectively, p<0.001) and III-IV (5%, 9%, and 7%, respectively, p=0.028). The 3-year non-relapse mortality was 14% for MUD, 19% for MMUD, and 27% for Haplo (p<0.001), while overall survival (OS) and GVHD and relapse-free survival (GRFS) were 81% and 73% for MUD, 74% and 65% for MMUD, and 63% and 54% for Haplo, respectively (p<0.001). In addition to donor type, multivariable analysis identified other factors like patient age, performance status, and interval between diagnosis and transplant associated with GRFS. For SAA patients lacking an MSD, our findings support MUD transplantation as the preferable alternative donor. However, selecting between a MMUD or Haplo donor remains uncertain and requires further exploration.
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Affiliation(s)
- Juan Montoro
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | | | | | | | | | - Matthew Collin
- Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Robert F Wynn
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | - Emma Nicholson
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Jaime Sanz
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Stephan Mielke
- Karolinska Institute & University Hospital, Stockholm, Sweden
| | - Samppa Johannes Ryhänen
- University of Helsinki and Helsinki University Hospital, ChildrenÂ's Hospital, and Pediatric Research Center, Helsinki, Finland
| | | | | | | | | | - Philippe Lewalle
- institut jules Bordet uUiversite Libre de Bruxelles, Brussels, Belgium
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Musiał K, Stojanowski J, Augustynowicz M, Miśkiewicz-Migoń I, Kałwak K, Ussowicz M. Assessment of Risk Factors for Acute Kidney Injury with Machine Learning Tools in Children Undergoing Hematopoietic Stem Cell Transplantation. J Clin Med 2024; 13:2266. [PMID: 38673539 PMCID: PMC11050842 DOI: 10.3390/jcm13082266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Although acute kidney injury (AKI) is a common complication in patients undergoing hematopoietic stem cell transplantation (HSCT), its prophylaxis remains a clinical challenge. Attempts at prevention or early diagnosis focus on various methods for the identification of factors influencing the incidence of AKI. Our aim was to test the artificial intelligence (AI) potential in the construction of a model defining parameters predicting AKI development. Methods: The analysis covered the clinical data of children followed up for 6 months after HSCT. Kidney function was assessed before conditioning therapy, 24 h after HSCT, 1, 2, 3, 4, and 8 weeks after transplantation, and, finally, 3 and 6 months post-transplant. The type of donor, conditioning protocol, and complications were incorporated into the model. Results: A random forest classifier (RFC) labeled the 93 patients according to presence or absence of AKI. The RFC model revealed that the values of the estimated glomerular filtration rate (eGFR) before and just after HSCT, as well as methotrexate use, acute graft versus host disease (GvHD), and viral infection occurrence, were the major determinants of AKI incidence within the 6-month post-transplant observation period. Conclusions: Artificial intelligence seems a promising tool in predicting the potential risk of developing AKI, even before HSCT or just after the procedure.
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Affiliation(s)
- Kinga Musiał
- Department of Pediatric Nephrology, Wrocław Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Jakub Stojanowski
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, 50-556 Wrocław, Poland;
| | - Monika Augustynowicz
- Clinic of Pediatric Nephrology, University Clinical Hospital, Borowska 213, 50-556 Wroclaw, Poland
| | - Izabella Miśkiewicz-Migoń
- Clinical Department of Pediatric Oncology and Hematology, Mother and Child Health Center, Karol Marcinkowski University Hospital, 65-046 Zielona Góra, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, 50-556 Wrocław, Poland; (K.K.); (M.U.)
| | - Marek Ussowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, 50-556 Wrocław, Poland; (K.K.); (M.U.)
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Frączkiewicz J, Pawińska-Wąsikowska K, Szymbor K, Balwierz W, Skoczeń S, Czyżewski K, Kołtan S, Styczyński J, Małecka A, Irga-Jaworska N, Trelińska J, Młynarski W, Zając-Spychała O, Sobkowiak-Sobierajska A, Derwich K, Bal W, Chaber R, Książek A, Szczepański T, Zawitkowska J, Drabko K, Chodała-Grzywacz A, Karolczyk G, Kobierzycki C, Kałwak K. Pre-Exposure Prophylaxis and Treatment with Tixagevimab/Cilgavimab for COVID-19 among Immunocompromised Pediatric Patients. J Clin Med 2024; 13:2029. [PMID: 38610794 PMCID: PMC11012437 DOI: 10.3390/jcm13072029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Patients treated with hemato-oncological malignancies (HO) or undergoing cellular therapies such as hematopoietic stem cell transplantation (HSCT) or chimeric antigen receptor T cells (CAR-T) were significantly affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the success of SARS-CoV-2 vaccination, immunocompromised patients remain at increased risk for severe coronavirus disease (COVID-19), rendering this group of population a high priority for additional prevention and treatment options. Tixagevimab and Cilgavimab (TIXA/CILGA, AZD7442, Evusheld®) is a combination of two fully human, long-acting monoclonal antibodies. TIXA/CILGA have been approved as pre-exposure prophylaxis and treatment in patients at risk of severe disease with impaired vaccine response. Our objective was to describe the efficacy and safety among immunocompromised pediatric patients. Methods: This was an observational multicenter cohort study of immunocompromised pediatric patients receiving TIXA/CILGA conducted at nine Polish centers of Pediatric Oncology, Hematology and Bone Marrow Transplantation. We analyzed patients in two groups; those treated with HO and those undergoing cellular therapies: HSCT or CAR-T cells. In addition, two other cohorts were identified: patients given TIXA/CILGA as pre-exposure prophylactic and therapeutic intervention. Results: A total of 78 patients were evaluated during the study period: 69 (88.5%) received TIXA/CILGA as pre-exposure prophylaxis and 9 (11.5%) as a treatment strategy. A total of 52 (66.6%) patients were treated with standard chemotherapy at HO departments; 21 (27%) underwent HSCT, and 5 (6.4%) received CAR-T cell therapy. All children with COVID-19 receiving TIXA/CILGA presented a mild degree of severity. The most common clinical manifestations were fever, cough and coryza. At least one adverse event (AE) was reported in two (3.8%) patients excluding standard injection site reactions. Reported AEs were mild or moderate in intensity. One child reported mild myalgia and one reported moderate bone pain and weakness. Conclusions: In our observational multicenter cohort study, we explored the use of TIXA/CILGA as pre-exposure prophylaxis and treatment for COVID-19 among immunocompromised pediatric patients. While our findings suggest a potential benefit in preventing and managing COVID-19 in this vulnerable population, it is important to note the study's non-comparative design. Our results highlight the need for well-designed clinical trials to confirm these observations and further assess the efficacy and safety of TIXA/CILGA in immunocompromised children.
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Affiliation(s)
- Jowita Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Katarzyna Pawińska-Wąsikowska
- Department of Pediatric Oncology and Hematology, University Children’s Hospital, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.-W.); (K.S.); (W.B.); (S.S.)
| | - Katarzyna Szymbor
- Department of Pediatric Oncology and Hematology, University Children’s Hospital, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.-W.); (K.S.); (W.B.); (S.S.)
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, University Children’s Hospital, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.-W.); (K.S.); (W.B.); (S.S.)
| | - Szymon Skoczeń
- Department of Pediatric Oncology and Hematology, University Children’s Hospital, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.-W.); (K.S.); (W.B.); (S.S.)
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum Nicolaus Copernicus University, 87-100 Torun, Poland; (K.C.); (S.K.); (J.S.)
| | - Sylwia Kołtan
- Department of Pediatric Hematology and Oncology, Collegium Medicum Nicolaus Copernicus University, 87-100 Torun, Poland; (K.C.); (S.K.); (J.S.)
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum Nicolaus Copernicus University, 87-100 Torun, Poland; (K.C.); (S.K.); (J.S.)
| | - Anna Małecka
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-211 Gdansk, Poland; (A.M.); (N.I.-J.)
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-211 Gdansk, Poland; (A.M.); (N.I.-J.)
| | - Joanna Trelińska
- Department of Pediatric Oncology and Hematology, Medical University of Lodz, 90-549 Lodz, Poland; (J.T.); (W.M.)
| | - Wojciech Młynarski
- Department of Pediatric Oncology and Hematology, Medical University of Lodz, 90-549 Lodz, Poland; (J.T.); (W.M.)
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (O.Z.-S.); (A.S.-S.); (K.D.)
| | - Agnieszka Sobkowiak-Sobierajska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (O.Z.-S.); (A.S.-S.); (K.D.)
| | - Katarzyna Derwich
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (O.Z.-S.); (A.S.-S.); (K.D.)
| | - Wioletta Bal
- Department of Pediatric Oncohematology, University of Rzeszow, 35-310 Rzeszow, Poland; (W.B.); (R.C.)
| | - Radosław Chaber
- Department of Pediatric Oncohematology, University of Rzeszow, 35-310 Rzeszow, Poland; (W.B.); (R.C.)
| | - Agnieszka Książek
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (A.K.)
| | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (A.K.)
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-093 Lublin, Poland; (J.Z.); (K.D.)
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-093 Lublin, Poland; (J.Z.); (K.D.)
| | - Agnieszka Chodała-Grzywacz
- Division of Pediatric Hematology and Oncology, Children Hospital, 25-734 Kielce, Poland; (A.C.-G.); (G.K.)
| | - Grażyna Karolczyk
- Division of Pediatric Hematology and Oncology, Children Hospital, 25-734 Kielce, Poland; (A.C.-G.); (G.K.)
| | - Christopher Kobierzycki
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Krzysztof Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
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Marjańska A, Pawińska-Wąsikowska K, Wieczorek A, Drogosiewicz M, Dembowska-Bagińska B, Bobeff K, Młynarski W, Adamczewska-Wawrzynowicz K, Wachowiak J, Krawczyk MA, Irga-Jaworska N, Węcławek-Tompol J, Kałwak K, Sawicka-Żukowska M, Krawczuk-Rybak M, Raciborska A, Mizia-Malarz A, Sobocińska-Mirska A, Łaguna P, Balwierz W, Styczyński J. Anti-PD-1 Therapy in Advanced Pediatric Malignancies in Nationwide Study: Good Outcome in Skin Melanoma and Hodgkin Lymphoma. Cancers (Basel) 2024; 16:968. [PMID: 38473329 DOI: 10.3390/cancers16050968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND/AIM The role of immune checkpoint inhibitors (ICIs; anti-PD1) in the treatment of childhood cancers is still evolving. The aim of this nationwide retrospective study was to assess the safety and effectiveness of ICIs used in a group of 42 patients, with a median age of 13.6 years, with various types of advanced malignancies treated in pediatric oncology centers in Poland between 2015 and 2023. RESULTS The indications for treatment with anti-PD1 were as follows: Hodgkin lymphoma (11); malignant skin melanoma (9); neuroblastoma (8); and other malignancies (14). At the end of follow-up, complete remission (CR) was observed in 37.7% (15/42) of children and disease stabilization in 9.5% (4/42), with a mean survival 3.6 (95% CI = 2.6-4.6) years. The best survival (OS = 1.0) was observed in the group of patients with Hodgkin lymphoma. For malignant melanoma of the skin, neuroblastoma, and other rare malignancies, the estimated 3-year OS values were, respectively, 0.78, 0.33, and 0.25 (p = 0.002). The best progression-free survival value (0.78) was observed in the group with malignant melanoma. Significantly better effects of immunotherapy were confirmed in patients ≥ 14 years of age and good overall performance ECOG status. Severe adverse events were observed in 30.9% (13/42) patients.
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Affiliation(s)
- Agata Marjańska
- Department of Pediatric, Hematology and Oncology, Jurasz University Hospital, Collegium Medicum, Nicolaus Copernicus University Toruń, 85-094 Bydgoszcz, Poland
| | | | - Aleksandra Wieczorek
- Department of Pediatric, Oncology and Hematology, Jagiellonian University Medical College, 30-663 Cracow, Poland
| | - Monika Drogosiewicz
- Department of Oncology, The Children's Memorial Health Institute, 04-730 Warsaw, Poland
| | | | - Katarzyna Bobeff
- Department of Pediatrics, Oncology and Hematology, Medical University of Łodz, 91-738 Łodz, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Łodz, 91-738 Łodz, Poland
| | - Katarzyna Adamczewska-Wawrzynowicz
- Department of Pediatric Oncology, Hematology and Transplantology, Jonscher Clinical Hospital, Marcinkowski University of Medical Sciences in Poznań, 60-572 Poznań, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Jonscher Clinical Hospital, Marcinkowski University of Medical Sciences in Poznań, 60-572 Poznań, Poland
| | - Małgorzata A Krawczyk
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Jadwiga Węcławek-Tompol
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Mikulicz-Radecki University Clinical Hospital, 50-556 Wrocław, Poland
| | - Krzysztof Kałwak
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Mikulicz-Radecki University Clinical Hospital, 50-556 Wrocław, Poland
| | | | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University of Białystok, 15-274 Białystok, Poland
| | - Anna Raciborska
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Agnieszka Mizia-Malarz
- Department of Pediatric, Oncology, Hematology and Chemotherapy, Upper Silesia Children's Care Health Centre, Medical University of Silesia, 40-752 Katowice, Poland
| | - Agata Sobocińska-Mirska
- Department of Oncology, Children's Hematology, Clinical Transplantology and Pediatrics, University Clinical Center, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Paweł Łaguna
- Department of Oncology, Children's Hematology, Clinical Transplantology and Pediatrics, University Clinical Center, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Walentyna Balwierz
- Department of Pediatric, Oncology and Hematology, Jagiellonian University Medical College, 30-663 Cracow, Poland
| | - Jan Styczyński
- Department of Pediatric, Hematology and Oncology, Jurasz University Hospital, Collegium Medicum, Nicolaus Copernicus University Toruń, 85-094 Bydgoszcz, Poland
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Samborska M, Skalska-Sadowska J, Achkar R, Wachowiak J, Derwich K, Czogała M, Balwierz W, Skoczeń S, Dobaczewski G, Chybicka A, Kałwak K, Krawczuk-Rybak M, Muszyńska-Rosłan K, Adamkiewicz-Drożyńska E, Maciejka-Kapuscińska L, Irga-Jaworska N, Pohorecka J, Chodała-Grzywacz A, Karolczyk G, Wójcik B, Kowalczyk JR, Drabko K, Zawitkowska J, Mycko K, Badowska W, Ociepa T, Urasiński T, Sikorska-Fic B, Matysiak M, Laguna P, Dąbrowska-Pawliszyn A, Tomaszewska R, Szczepański T, Sobol G, Mizia-Malarz A, Ciebiera M, Chaber R, Kołtan S, Wysocki M, Styczyński J, Woszczyk M, Wieczorek M, Karpińska-Derda I, Urbańska-Rakus J, Bobeff K, Trelińska J, Młynarski W. Characteristics and treatment results of refractory and relapsed acute myeloid leukaemia in paediatric patients treated in Polish Paediatric Leukaemia/Lymphoma Study Group institutions according to the Protocol Acute Myeloid Leukaemia Berlin-Frankfurt-Munster 2012 and a review of novel treatment possibilities in paediatric acute myeloid leukaemia. Contemp Oncol (Pozn) 2024; 27:249-254. [PMID: 38405205 PMCID: PMC10883198 DOI: 10.5114/wo.2023.135327] [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: 11/26/2023] [Accepted: 01/26/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction This study aimed to present the clinical features and results of treatment of patients diagnosed with refractory or relapsed acute myeloid leukaemia (AML) in Polish Paediatric Leukaemia/Lymphoma Study Group (PPL/LSG) institutions, treated in accordance with the Protocol Acute Myeloid Leukaemia Berlin-Frankfurt-Munster 2012, as their first-line therapy. Material and methods The outcome data of 10 patients with refractory AML (median age 9.5 years) and 30 with relapsed AML (median age 12 years) were analysed retrospectively. Re-induction was usually based on idarubicin, fludarabine, and cytarabine along with allogeneic haematopoietic stem cell transplant (allo-HSCT) in 5 patients with refractory AML and 7 relapsed AML children. Results 37.5% (3/8) of refractory AML patients achieved second complete remission second complete remission (CRII). One of ten patients (1/10; 10%) was alive and stayed in complete remission for 34 months after the allo-HSCT. The probability of 3-year event-free survival (pEFS) in this group was 0.125 ±0.11. In the group of relapsed AML patients, the CRII was achieved in 9 patients (34%), and the probability of survival was: pEFS = 0.24 ±0.08; probability overall survival (pOS) = 0.34 ±0.09, with significantly better results achieved in patients who underwent allo-HSCT (pOS = 0.54 ±0.14 vs. 0.08 ±0.08, p < 0.0001). Conclusions The prognosis of refractory AML and the first AML recurrence in children who were first-line treated in PPL/LSG centres according to Protocol Acute Myeloid Leukaemia Berlin-Frankfurt-Munster 2012 is poor. Failures of re-induction treatment particularly result from difficulties in achieving remission. Allogeneic HSCT improves prognosis in children with refractory and first recurrent AML, under the condition it is performed in complete remission. Novel therapeutic approaches are needed to increase the remission rate and improve the outcomes.
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Affiliation(s)
- Magdalena Samborska
- Department of Pediatric Hematology, Oncology and Transplantology, University of Medical Sciences, Poznań, Poland
| | - Jolanta Skalska-Sadowska
- Department of Pediatric Hematology, Oncology and Transplantology, University of Medical Sciences, Poznań, Poland
| | | | - Jacek Wachowiak
- Department of Pediatric Hematology, Oncology and Transplantology, University of Medical Sciences, Poznań, Poland
| | - Katarzyna Derwich
- Department of Pediatric Hematology, Oncology and Transplantology, University of Medical Sciences, Poznań, Poland
| | - Małgorzata Czogała
- Department of Pediatric Oncology and Hematology, University Children Hospital, Kraków, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, University Children Hospital, Kraków, Poland
| | - Szymon Skoczeń
- Department of Pediatric Oncology and Hematology, University Children Hospital, Kraków, Poland
| | - Grzegorz Dobaczewski
- Clinical Department of Pediatric Bone Marrow Transplantation, Oncology and Haematologu, Wrocław Medical University, Wrocław, Poland
| | - Alicja Chybicka
- Clinical Department of Pediatric Bone Marrow Transplantation, Oncology and Haematologu, Wrocław Medical University, Wrocław, Poland
| | - Krzysztof Kałwak
- Clinical Department of Pediatric Bone Marrow Transplantation, Oncology and Haematologu, Wrocław Medical University, Wrocław, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University, Białystok, Poland
| | | | | | | | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdańsk, Poland
| | - Joanna Pohorecka
- Department of Pediatric Hematology and Oncology, Regional Polyclinic Hospital, Kielce, Poland
| | | | - Grażyna Karolczyk
- Department of Pediatric Hematology and Oncology, Regional Polyclinic Hospital, Kielce, Poland
| | - Beata Wójcik
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Lublin, Poland
| | - Jerzy R. Kowalczyk
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Lublin, Poland
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Lublin, Poland
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Lublin, Poland
| | - Katarzyna Mycko
- Department of Pediatrics and Hematology and Oncology, Province Children’s Hospital, Olsztyn, Poland
| | - Wanda Badowska
- Department of Pediatrics and Hematology and Oncology, Province Children’s Hospital, Olsztyn, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Barbara Sikorska-Fic
- Department of Oncology, Pediatric Hematology, Transplantology and Pediatrics, Medical University, Warsaw, Poland
| | - Michał Matysiak
- Department of Oncology, Pediatric Hematology, Transplantology and Pediatrics, Medical University, Warsaw, Poland
| | - Paweł Laguna
- Department of Oncology, Pediatric Hematology, Transplantology and Pediatrics, Medical University, Warsaw, Poland
| | - Anna Dąbrowska-Pawliszyn
- Department of Pediatric Hematology and Oncology, Medical University of Silesia, Katowice, Zabrze, Poland
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Medical University of Silesia, Katowice, Zabrze, Poland
| | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Medical University of Silesia, Katowice, Zabrze, Poland
| | | | | | - Małgorzata Ciebiera
- Department of Pediatric Oncohematology, Clinical Province Hospital, Rzeszów, Poland
| | - Radosław Chaber
- Department of Pediatric Oncohematology, Clinical Province Hospital, Rzeszów, Poland
| | - Sylwia Kołtan
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | - Mariusz Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
| | - Mariola Woszczyk
- Department of Pediatric Hematology and Oncology, Pediatric Center, Chorzów, Poland
| | - Maria Wieczorek
- Department of Pediatric Hematology and Oncology, Pediatric Center, Chorzów, Poland
| | | | | | - Katarzyna Bobeff
- Department of Pediatrics, Oncology and Hematology, Medical University, Łódź, Poland
| | - Joanna Trelińska
- Department of Pediatrics, Oncology and Hematology, Medical University, Łódź, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University, Łódź, Poland
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7
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Łyżwa MP, Kędziora K, Kałamarz N, Frączkiewicz J, Panasiuk A, Owoc-Lempach J, Piątosa B, Hennig M, Irga-Jaworska N, Kałwak K. Hematopoietic stem cell transplantation in a patient with activated phosphoinositide 3-kinase δ syndrome: A case report and literature review. Cent Eur J Immunol 2023; 48:350-357. [PMID: 38558560 PMCID: PMC10976654 DOI: 10.5114/ceji.2023.133949] [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: 08/05/2023] [Accepted: 10/10/2023] [Indexed: 04/04/2024] Open
Abstract
Activated phosphoinositide 3-kinase δ syndrome (APDS) is a recently described disease characterized by recurrent infections, lymphoproliferation with a high risk of malignancy, early-onset cytopenia, and a propensity for autoimmune diseases. Hematopoietic stem cell transplantation (HSCT) has proven to be an effective treatment method; however, the recovery process after HSCT is prolonged and accompanied by complications. In this study, we present the case of a patient with APDS type 1. Despite showing signs of immunodeficiency at the age of 6 months, it took almost 6 years to reach a definitive diagnosis. The patient experienced recurrent infections, often accompanied by anemia requiring transfusions, and multifocal nonmalignant lymphoproliferation. Only after receiving the appropriate diagnosis was it possible to implement proper and accurate treatment. HSCT was performed when the patient was 6 years old, leading to significant improvement in his condition. At the 17-month post-HSCT follow-up, the boy is asymptomatic and in good general health, although close monitoring continues due to mixed chimerism and delayed humoral immune recovery. Applying HSCT before the patient develops malignancy contributes to expanding the use of HSCT as a treatment option for APDS type 1.
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Affiliation(s)
| | | | | | - Jowita Frączkiewicz
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Panasiuk
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Owoc-Lempach
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Barbara Piątosa
- Histocompatibility Laboratory, Children’s Memorial Health Institute, Warsaw, Poland
| | - Marcin Hennig
- Department of Pediatric Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatric Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
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8
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Zawitkowska J, Drabko K, Lejman M, Kowalczyk A, Czyżewski K, Dziedzic M, Jaremek K, Zalas-Więcek P, Szmydki-Baran A, Hutnik Ł, Czogała W, Balwierz W, Żak I, Salamonowicz-Bodzioch M, Kazanowska B, Wróbel G, Frączkiewicz J, Kałwak K, Tomaszewska R, Szczepański T, Zając-Spychała O, Wachowiak J, Płonowski M, Krawczuk-Rybak M, Królak A, Ociepa T, Urasiński T, Pierlejewski F, Młynarski W, Urbańska-Rakus J, Machnik K, Pająk S, Badowska W, Brzeski T, Mycko K, Mańko-Glińska H, Urbanek-Dądela A, Karolczyk G, Mizia-Malarz A, Stolpa W, Skowron-Kandzia K, Musiał J, Chaber R, Irga-Jaworska N, Bień E, Styczyński J. Incidence of bacterial and fungal infections in Polish pediatric patients with acute lymphoblastic leukemia during the pandemic. Sci Rep 2023; 13:22619. [PMID: 38114744 PMCID: PMC10730514 DOI: 10.1038/s41598-023-50093-5] [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: 09/10/2023] [Accepted: 12/15/2023] [Indexed: 12/21/2023] Open
Abstract
The most common complications related to the treatment of childhood acute lymphoblastic leukemia (ALL) are infections. The aim of the study was to analyze the incidence and mortality rates among pediatric patients with ALL who were treated in 17 Polish pediatric hematology centers in 2020-2021 during the pandemic. Additionally, we compared these results with those of our previous study, which we conducted in the years 2012-2017. The retrospective analysis included 460 patients aged 1-18 years with newly diagnosed ALL. In our study, 361/460 (78.5%) children were reported to have microbiologically documented bacterial infections during chemotherapy. Ten patients (2.8%) died due to sepsis. Fungal infections were reported in 99 children (21.5%), of whom five (5.1%) died due to the infection. We especially observed an increase in bacterial infections during the pandemic period compared to the previous study. The directions of our actions should be to consider antibiotic prophylaxis, shorten the duration of hospitalization, and educate parents and medical staff about complications (mainly infections) during anticancer therapy. It is necessary to continue clinical studies evaluating infection prophylaxis to improve outcomes in childhood ALL patients.
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Affiliation(s)
- Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland.
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Monika Lejman
- Independent Laboratory of Genetic Diagnostics, Medical University of Lublin, Lublin, Poland
| | - Adrian Kowalczyk
- Student Scientific Society of Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Kamila Jaremek
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Patrycja Zalas-Więcek
- Department of Microbiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Anna Szmydki-Baran
- Department of Hematology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Hutnik
- Department of Hematology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Czogała
- Department of Pediatric Oncology and Hematology, Intitute of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Intitute of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Iwona Żak
- Department of Microbiology, University Children's Hospital, Jagiellonian University Medical College, Kraków, Poland
| | | | - Bernarda Kazanowska
- Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Grażyna Wróbel
- Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Renata Tomaszewska
- Department of Pediatrics, Hematology and Oncology, Medical University of Silesia, Katowice, Poland
| | - Tomasz Szczepański
- Department of Pediatrics, Hematology and Oncology, Medical University of Silesia, Katowice, Poland
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Płonowski
- Department of Pediatric Oncology, Hematology, Medical University of Bialystok, Bialystok, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology, Hematology, Medical University of Bialystok, Bialystok, Poland
| | - Aleksandra Królak
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Filip Pierlejewski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | | | - Katarzyna Machnik
- Unit of Pediatric Hematology and Oncology, City Hospital, Chorzow, Poland
| | - Sonia Pająk
- Unit of Pediatric Hematology and Oncology, City Hospital, Chorzow, Poland
| | - Wanda Badowska
- Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Tomasz Brzeski
- Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Katarzyna Mycko
- Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Hanna Mańko-Glińska
- Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Agnieszka Urbanek-Dądela
- Department of Pediatric Oncology and Hematology, Collegium Medium of Jan Kochanowski University in Kielce, Kielce, Poland
| | - Grażyna Karolczyk
- Department of Pediatric Oncology and Hematology, Collegium Medium of Jan Kochanowski University in Kielce, Kielce, Poland
| | - Agnieszka Mizia-Malarz
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children's Care Health, Medical University of Silesia, Katowice, Poland
| | - Weronika Stolpa
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children's Care Health, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Skowron-Kandzia
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children's Care Health, Medical University of Silesia, Katowice, Poland
| | - Jakub Musiał
- Clinic of Pediatric Oncology and Hematology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | - Radosław Chaber
- Clinic of Pediatric Oncology and Hematology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Gdańsk, Poland
| | - Ewa Bień
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Gdańsk, Poland
| | - Jan Styczyński
- Student Scientific Society of Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
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Musiał K, Stojanowski J, Miśkiewicz-Bujna J, Kałwak K, Ussowicz M. KIM-1, IL-18, and NGAL, in the Machine Learning Prediction of Kidney Injury among Children Undergoing Hematopoietic Stem Cell Transplantation-A Pilot Study. Int J Mol Sci 2023; 24:15791. [PMID: 37958774 PMCID: PMC10648899 DOI: 10.3390/ijms242115791] [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: 09/27/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Children undergoing allogeneic hematopoietic stem cell transplantation (HSCT) are prone to developing acute kidney injury (AKI). Markers of kidney damage: kidney injury molecule (KIM)-1, interleukin (IL)-18, and neutrophil gelatinase-associated lipocalin (NGAL) may ease early diagnosis of AKI. The aim of this study was to assess serum concentrations of KIM-1, IL-18, and NGAL in children undergoing HSCT in relation to classical markers of kidney function (creatinine, cystatin C, estimated glomerular filtration rate (eGFR)) and to analyze their usefulness as predictors of kidney damage with the use of artificial intelligence tools. Serum concentrations of KIM-1, IL-18, NGAL, and cystatin C were assessed by ELISA in 27 children undergoing HSCT before transplantation and up to 4 weeks after the procedure. The data was used to build a Random Forest Classifier (RFC) model of renal injury prediction. The RFC model established on the basis of 3 input variables, KIM-1, IL-18, and NGAL concentrations in the serum of children before HSCT, was able to effectively assess the rate of patients with hyperfiltration, a surrogate marker of kidney injury 4 weeks after the procedure. With the use of the RFC model, serum KIM-1, IL-18, and NGAL may serve as markers of incipient renal dysfunction in children after HSCT.
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Affiliation(s)
- Kinga Musiał
- Department of Pediatric Nephrology, Wrocław Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Jakub Stojanowski
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, 50-556 Wrocław, Poland
| | - Justyna Miśkiewicz-Bujna
- Clinical Department of Pediatric Oncology and Hematology, Mother and Child Health Center, Karol Marcinkowski University Hospital, 65-046 Zielona Góra, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, 50-556 Wrocław, Poland
| | - Marek Ussowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, 50-556 Wrocław, Poland
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Kowaluk A, Siewierska K, Choniawkova M, Sedlacek P, Kałwak K, Malicka I. Physical Activity Level and Quality of Life of Children Treated for Malignancy, Depending on Their Place of Residence: Poland vs. the Czech Republic: An Observational Study. Cancers (Basel) 2023; 15:4695. [PMID: 37835387 PMCID: PMC10571542 DOI: 10.3390/cancers15194695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
This study aimed to assess the level of physical activity (PA) and quality of life of cancer-treated children, depending on their place of residence (Poland vs. the Czech Republic, where incidence and mortality rates of childhood malignancies are similar). A total of 68 school-age children (7-18 years) undergoing oncological treatment were included in this study. This study used the quality of life questionnaire (KIDSCREEN-10) and the HBSC questionnaire. This study showed statistically significant differences in the level of PA between Polish and Czech children. In Poland, 93.75% of children exhibited no weekly physical effort at the level of moderate to vigorous PA. In the Czech Republic, 69.44% of children engaged in PA lasting at least 60 min per day, or at least 1 day weekly. Physically active children engaging in more frequent effort, at least 60 min daily, reported higher physical performance (rho = 0.41), higher energy levels (rho = 0.41), and less mood disturbance (rho = -0.31). Children with good relationships with parents were more likely to engage in submaximal PA and spend less time on stationary games. Our study showed that an appropriate level of PA improves well-being and quality of life. It is crucial to promote attractive PA programs tailored for cancer-treated children.
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Affiliation(s)
- Aleksandra Kowaluk
- Department of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland (I.M.)
- Supraregional Center of Paediatric Oncology “Cape of Hope”, Wroclaw University Clinical Hospital, 50-556 Wroclaw, Poland;
| | - Katarzyna Siewierska
- Department of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland (I.M.)
| | - Marie Choniawkova
- Department of Paediatric Haematology and Oncology, University Hospital Motol, 150 06 Prague, Czech Republic (P.S.)
| | - Petr Sedlacek
- Department of Paediatric Haematology and Oncology, University Hospital Motol, 150 06 Prague, Czech Republic (P.S.)
| | - Krzysztof Kałwak
- Supraregional Center of Paediatric Oncology “Cape of Hope”, Wroclaw University Clinical Hospital, 50-556 Wroclaw, Poland;
| | - Iwona Malicka
- Department of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland (I.M.)
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11
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Czogała M, Czogała W, Pawińska-Wąsikowska K, Książek T, Bukowska-Strakova K, Sikorska-Fic B, Łaguna P, Fałkowska A, Drabko K, Muszyńska-Rosłan K, Krawczuk-Rybak M, Kozłowska M, Irga-Jaworska N, Zielezińska K, Urasiński T, Bartoszewicz N, Styczyński J, Skalska-Sadowska J, Wachowiak J, Rodziewicz-Konarska A, Kałwak K, Ciebiera M, Chaber R, Mizia-Malarz A, Chodała-Grzywacz A, Karolczyk G, Bobeff K, Młynarski W, Mycko K, Badowska W, Tomaszewska R, Szczepański T, Machnik K, Zamorska N, Balwierz W, Skoczeń S. Characteristics and Outcome of FLT3-ITD-Positive Pediatric Acute Myeloid Leukemia-Experience of Polish Pediatric Leukemia and Lymphoma Study Group from 2005 to 2022. Cancers (Basel) 2023; 15:4557. [PMID: 37760526 PMCID: PMC10526903 DOI: 10.3390/cancers15184557] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The FMS-like tyrosine kinase 3 (FLT3) gene mutated in 10-15% of pediatric acute myeloid leukemia (AML) is associated with an inferior outcome. The aim of the study was to analyze the outcome and characteristics of FLT3-ITD-positive pediatric AML. METHODS We retrospectively analyzed the nationwide pediatric AML database from between 2005 and 2022. FLT3-ITD was found in 54/497 (10.7%) patients with available analysis. Three consecutive treatment protocols were used (AML-BFM 2004 Interim, AML-BFM 2012 Registry, AML-BFM 2019 recommendations). RESULTS Probabilities of 5-year overall (OS), event-free (EFS) and relapse-free survival were significantly lower in the FLT3-ITD-positive patients compared to FLT3-ITD-negative (0.54 vs. 0.71, p = 0.041; 0.36 vs. 0.59, p = 0.0004; 0.47 vs. 0.70, p = 0.0029, accordingly). An improvement in the outcome was found in the analyzed period of time, with a trend of better survival in patients treated under the AML-BFM 2012 and AML-BFM 2019 protocols compared to the AML-BFM 2004 protocol (5-year EFS 0.52 vs. 0.27, p = 0.069). There was a trend of improved outcomes in patients treated with FLT3 inhibitors (n = 9, 2-year EFS 0.67 vs. 0.33, p = 0.053) and those who received stem cell transplantation (SCT) (n = 26; 5-year EFS 0.70 vs. 0.27, p = 0.059). The co-occurrence of the WT1 mutation had a dismal impact on the prognosis (5-year EFS 0.23 vs. 0.69, p = 0.002), while the NPM1 mutation improved survival (5-year OS 1.0 vs. 0.44, p = 0.036). CONCLUSIONS It seems that SCT and FLT3 inhibitors have a beneficial impact on the prognosis. Additional genetic alterations, like the WT1 and NPM1 mutations, significantly influence the outcome.
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Affiliation(s)
- Małgorzata Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland; (W.C.); (K.P.-W.); (W.B.); (S.S.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-683 Krakow, Poland;
| | - Wojciech Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland; (W.C.); (K.P.-W.); (W.B.); (S.S.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-683 Krakow, Poland;
| | - Katarzyna Pawińska-Wąsikowska
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland; (W.C.); (K.P.-W.); (W.B.); (S.S.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-683 Krakow, Poland;
| | - Teofila Książek
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-683 Krakow, Poland;
- Department of Medical Genetics, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland
| | - Karolina Bukowska-Strakova
- Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland;
| | - Barbara Sikorska-Fic
- Department of Pediatrics, Oncology, Hematology and Transplantology, Medical University of Warsaw, 02-091 Warszawa, Poland; (B.S.-F.); (P.Ł.)
| | - Paweł Łaguna
- Department of Pediatrics, Oncology, Hematology and Transplantology, Medical University of Warsaw, 02-091 Warszawa, Poland; (B.S.-F.); (P.Ł.)
| | - Anna Fałkowska
- Department of Paediatric Haematology and Oncology and Transplantology, Medical University of Lublin, 20-095 Lublin, Poland; (A.F.); (K.D.)
| | - Katarzyna Drabko
- Department of Paediatric Haematology and Oncology and Transplantology, Medical University of Lublin, 20-095 Lublin, Poland; (A.F.); (K.D.)
| | - Katarzyna Muszyńska-Rosłan
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-089 Bialystok, Poland; (K.M.-R.); (M.K.-R.)
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-089 Bialystok, Poland; (K.M.-R.); (M.K.-R.)
| | - Marta Kozłowska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland; (M.K.); (N.I.-J.)
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland; (M.K.); (N.I.-J.)
| | - Karolina Zielezińska
- Department of Paediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland; (K.Z.); (T.U.)
| | - Tomasz Urasiński
- Department of Paediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland; (K.Z.); (T.U.)
| | - Natalia Bartoszewicz
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, 85-094 Bydgoszcz, Poland; (N.B.); (J.S.)
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, 85-094 Bydgoszcz, Poland; (N.B.); (J.S.)
| | - Jolanta Skalska-Sadowska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 60-572 Poznan, Poland; (J.S.-S.); (J.W.)
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 60-572 Poznan, Poland; (J.S.-S.); (J.W.)
| | - Anna Rodziewicz-Konarska
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Medical University of Wroclaw, 50-556 Wroclaw, Poland; (A.R.-K.); (K.K.)
| | - Krzysztof Kałwak
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Medical University of Wroclaw, 50-556 Wroclaw, Poland; (A.R.-K.); (K.K.)
| | - Małgorzata Ciebiera
- Clinic of Pediatric Oncology and Hematology, State Hospital 2, 35-301 Rzeszów, Poland; (M.C.); (R.C.)
| | - Radosław Chaber
- Clinic of Pediatric Oncology and Hematology, State Hospital 2, 35-301 Rzeszów, Poland; (M.C.); (R.C.)
- Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszów, Poland
| | - Agnieszka Mizia-Malarz
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children’s Care Health Centre, 40-752 Katowice, Poland;
- Department of Pediatrics, Medical University of Silesia, Upper Silesia Children’s Care Health Centre, 40-752 Katowice, Poland
| | - Agnieszka Chodała-Grzywacz
- Department of Pediatric Hematology and Oncology, Regional Polyclinic Hospital in Kielce, 25-736 Kielce, Poland; (A.C.-G.); (G.K.)
| | - Grażyna Karolczyk
- Department of Pediatric Hematology and Oncology, Regional Polyclinic Hospital in Kielce, 25-736 Kielce, Poland; (A.C.-G.); (G.K.)
| | - Katarzyna Bobeff
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 91-738 Lodz, Poland; (K.B.); (W.M.)
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 91-738 Lodz, Poland; (K.B.); (W.M.)
| | - Katarzyna Mycko
- Department of Pediatrics and Hematology and Oncology, Province Children’s Hospital, 10-561 Olsztyn, Poland; (K.M.); (W.B.)
| | - Wanda Badowska
- Department of Pediatrics and Hematology and Oncology, Province Children’s Hospital, 10-561 Olsztyn, Poland; (K.M.); (W.B.)
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (R.T.); (T.S.)
| | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (R.T.); (T.S.)
| | - Katarzyna Machnik
- Department of Pediatrics, Hematology and Oncology, City Hospital, 41-500 Chorzow, Poland;
| | - Natalia Zamorska
- Student Scientific Group of Pediatric Oncology and Hematology, Jagiellonian University Medical College, 30-663 Krakow, Poland;
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland; (W.C.); (K.P.-W.); (W.B.); (S.S.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-683 Krakow, Poland;
| | - Szymon Skoczeń
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland; (W.C.); (K.P.-W.); (W.B.); (S.S.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-683 Krakow, Poland;
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Grzegorczyk A, Marczyńska Z, Matkowski R, Ziętek M, Pietras W, Latos-Grażyńska E, Kałwak K, Dachowska-Kałwak I. Severe complications of nivolumab monotherapy in an adolescent with malignant melanoma. Cent Eur J Immunol 2023; 48:251-256. [PMID: 37901868 PMCID: PMC10604638 DOI: 10.5114/ceji.2023.130864] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/12/2023] [Indexed: 10/31/2023] Open
Abstract
This study presents a case of a 17-year-old female patient who had previously undergone surgical resection of melanoma in the right periscapular area. She was administered adjuvant treatment with the PD-1 inhibitor nivolumab as monotherapy. The mechanism of action of this drug is based on increased stimulation of the immune system. The patient developed a series of complications including capillary leak syndrome and hypothyroidism after the fifth cycle of therapy, as a result of dysregulation of immunity. Nivolumab treatment had to be discontinued and glucocorticosteroids were administered as a salvage therapy. After several months, two relapses developed in the subcutaneous tissue - first in the left and then in the right iliac region, confirmed as distant metastases of malignant melanoma, treated with resections of the lesions and intensity-modulated radiation therapy. Follow-up imaging studies and clinical examinations showed no metastases or pathologically enlarged lymph nodes.
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Affiliation(s)
- Aleksandra Grzegorczyk
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Zuzanna Marczyńska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Rafał Matkowski
- Departament of Oncology, Wrocław Medical University, Wrocław, Poland
- Lower Silesian Oncology, Pulmonology and Hematology Center, Wrocław, Poland
| | - Marcin Ziętek
- Departament of Oncology, Wrocław Medical University, Wrocław, Poland
- Lower Silesian Oncology, Pulmonology and Hematology Center, Wrocław, Poland
| | - Wojciech Pietras
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Elżbieta Latos-Grażyńska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Iwona Dachowska-Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Wroclaw Medical University, Wrocław, Poland
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13
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Sienkiewicz-Oleszkiewicz B, Salamonowicz-Bodzioch M, Słonka J, Kałwak K. Antifungal Drug-Drug Interactions with Commonly Used Pharmaceutics in European Pediatric Patients with Acute Lymphoblastic Leukemia. J Clin Med 2023; 12:4637. [PMID: 37510753 PMCID: PMC10380616 DOI: 10.3390/jcm12144637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Leukemia is one of the leading childhood malignancies, with acute lymphoblastic leukemia (ALL) being the most common type. Invasive fungal disease is a concerning problem also at pediatric hemato-oncology units. Available guidelines underline the need for antifungal prophylaxis and give recommendations for proper treatment in various clinical scenarios. Nonetheless, antifungal agents are often involved in drug-drug interaction (DDI) occurrence. The prediction of those interactions in the pediatric population is complicated because of the physiological differences in adults, and the lack of pharmacological data. In this review, we discuss the potential DDIs between antifungal agents and commonly used pharmaceutics in pediatric hemato-oncology settings, with special emphasis on the use of liposomal amphotericin B and ALL treatment. We obtained information from Micromedex® and Drugs.com® interaction checking databases and checked the EudraVigilance® database to source the frequency of severe adverse drug reactions that resulted from antifungal drug interactions. Several major DDIs were identified, showing a favorable safety profile of echinocandins and liposomal amphotericin B. Interestingly, although there are numerous available drug interaction checking tools facilitating the identification of potential serious DDIs, it is important to use more than one tool, as the presented searching results may differ between particular checking programs.
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Affiliation(s)
- Beata Sienkiewicz-Oleszkiewicz
- Department of Clinical Pharmacology, Faculty of Pharmacy, Wrocław Medical University, ul. Borowska 211a, 50-556 Wrocław, Poland
| | - Małgorzata Salamonowicz-Bodzioch
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wrocław Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Justyna Słonka
- Gilead Sciences Poland Sp. z o.o., ul. Postepu 17A, 02-676 Warsaw, Poland
| | - Krzysztof Kałwak
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wrocław Medical University, Borowska 213, 50-556 Wrocław, Poland
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14
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Siemaszko J, Ussowicz M, Rybka B, Ryczan-Krawczyk R, Kałwak K, Bogunia-Kubik K. The impact of NKG2A and NKG2D receptors and HLA-E and MICA ligands polymorphisms on post-transplant complications after paediatric allogeneic HSCT: a single-centre experience. Front Genet 2023; 14:1186123. [PMID: 37351346 PMCID: PMC10282657 DOI: 10.3389/fgene.2023.1186123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/16/2023] [Indexed: 06/24/2023] Open
Abstract
Introduction: Natural Killer cells are the first subpopulation of lymphocytes that reconstitute after allogeneic haematopoietic stem cell transplantation (HSCT). Their activity is regulated by various receptor-ligand interactions, including stimulation of the activating NKG2D receptor by the MICA molecule, and inhibitory NKG2A receptor interacting with the HLA-E. In this study the research effort focused on the effect of selected NKG2A and NKG2D receptors and their ligands (HLA-E and MICA molecules) polymorphisms that may affect the pathomechanisms of post-transplant complications after HSCT in children. Methods: One hundred donor-recipient pairs from a single paediatric transplantation centre were investigated. Altogether six single nucleotide substitutions (NKG2A rs7301582; NKG2D rs1049174, rs1154831; HLA-E rs1264457; MICA rs1051792, rs1063635) were genotyped, and the influence of polymorphisms was analysed on acute and chronic graft-versus-host disease (GvHD), cytomegalovirus (CMV) infection incidence, disease relapse and survival. Results: The distribution of the evaluated polymorphisms did not differ between patients and their donors. The results showed a significant influence of HLA-E rs1264457 polymorphism in patients' HLA-E*01:01 allele, which was associated with increased risk of CMV infection (p = 0.050), especially in children positive for CMV IgG before transplantation (p = 0.001). Furthermore, the effect of HLA-E*01:01 allele on CMV infections was more evident in children above the age of 7 years (p = 0.031). Strong tendencies (0.05 < p < 0.10) towards association with the risk of acute GvHD were also observed for the NKG2A or MICA polymorphisms of the recipients. In addition, NKG2D rs1154831 AA and MICA rs1063635 GG might play a protective role as they were not present in any recipient who died after transplantation. Conclusion: In summary, there is emerging evidence that genotyping results of NKG2 receptors and their ligands, may have prognostic value for the outcome of paediatric allogeneic HSCT, but more extensive studies performed on larger groups of donors and transplant recipients are required to confirm these observations.
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Affiliation(s)
- Jagoda Siemaszko
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Marek Ussowicz
- Department and Clinic of Paediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Blanka Rybka
- Department and Clinic of Paediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Renata Ryczan-Krawczyk
- Department and Clinic of Paediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Kałwak
- Department and Clinic of Paediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Bogunia-Kubik
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
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15
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Matkowska-Kocjan A, Owoc-Lempach J, Ludwikowska K, Szenborn F, Moskwa N, Kurek K, Kałwak K, Szenborn L, Ussowicz M. COVID-19 mRNA Vaccine Tolerance and Immunogenicity in Hematopoietic Stem Cell Transplantation Recipients Aged 5-11 Years Old-Non-Randomized Clinical Trial. Vaccines (Basel) 2023; 11:vaccines11010195. [PMID: 36680039 PMCID: PMC9866698 DOI: 10.3390/vaccines11010195] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/28/2022] [Revised: 12/28/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
The SARS-CoV-2 pandemic had a devastating impact on the world’s population in the years 2020−2022. The rapid development of vaccines enabled a reduction in the mortality and morbidity of COVID-19, but there are limited data about their effects on immunocompromised children. The aim of this prospective study was to evaluate the safety and efficacy of the mRNA BNT162b2 (Pfizer/Biontech) vaccine in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Material and methods: Two cohorts of 34 children after allo-HSCT and 35 healthy children aged 5−11 years were vaccinated with two doses of the mRNA BNT162b2 (10 µg) vaccine. All children were evaluated for adverse effects with electronic surveys and the immunogenicity of the vaccine was assessed with anti-SARS-CoV-2 IgG titer measurements. Results: All reported adverse events (AEs) were classified as mild. The most common AE was pain at the injection site. All the other AEs (both local and systemic) were rarely reported (<15% patients). Both groups showed a similar response in anti-SARS-CoV-2 IgG production. Patients after allo-HSCT that were undergoing immunosuppressive treatment presented a poorer immunological response than patients off of treatment. Time since HSCT, patient age, lymphocyte count, and total IgG concentration did not correlate with initial/post-vaccination anti-SARS-CoV-2 IgG titers. Most patients who were eligible for a third dose of the vaccine had an excellent humoral response observed after two vaccine doses. Conclusions: The COVID-19 mRNA BNT162b2 vaccine is very well tolerated and highly immunogenic in 5−11-year-old children after HSCT. Children >2 years of age after HSCT who did not receive immunosuppressive treatment presented excellent antibody production after two doses of the vaccine, but children on immunosuppression may require a more intense vaccination schedule.
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Affiliation(s)
- Agnieszka Matkowska-Kocjan
- Department and Clinic of Pediatric Infectious Diseases, Wroclaw Medical University, 50-368 Wrocław, Poland
- Correspondence:
| | - Joanna Owoc-Lempach
- Department and Clinic of Paediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, 50-556 Wrocław, Poland
| | - Kamila Ludwikowska
- Department and Clinic of Pediatric Infectious Diseases, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Filip Szenborn
- Faculty of Electronics, Wroclaw University of Science and Technology, 50-370 Wrocław, Poland
| | - Natalia Moskwa
- Department and Clinic of Pediatric Infectious Diseases, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Katarzyna Kurek
- Department and Clinic of Pediatric Infectious Diseases, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Krzysztof Kałwak
- Department and Clinic of Paediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, 50-556 Wrocław, Poland
| | - Leszek Szenborn
- Department and Clinic of Pediatric Infectious Diseases, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Marek Ussowicz
- Department and Clinic of Paediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, 50-556 Wrocław, Poland
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Dąbrowska-Leonik N, Piątosa B, Słomińska E, Bohynikova N, Bernat-Sitarz K, Bernatowska E, Wolska-Kuśnierz B, Kałwak K, Kołtan S, Dąbrowska A, Goździk J, Ussowicz M, Pac M. National experience with adenosine deaminase deficiency related SCID in Polish children. Front Immunol 2023; 13:1058623. [PMID: 36685585 PMCID: PMC9853035 DOI: 10.3389/fimmu.2022.1058623] [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: 09/30/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Deficiency of adenosine deaminase (ADA) manifests as severe combined immunodeficiency (SCID), caused by accumulation of toxic purine degradation by-products. Untreated patients develop immune and non-immune symptoms with fatal clinical course. According to ESID and EBMT recommendations enzyme replacement therapy (ERT) should be implemented as soon as possible to stabilize the patient's general condition, normalize transaminases, treat pulmonary proteinosis, bone dysplasia, and protect from neurological damage. Hematopoietic stem cell transplantation (HSCT) from a matched related donor (MRD) is a treatment of choice. In absence of such donor, gene therapy (GT) should be considered. HSCT from a matched unrelated donor (MUD) and haploidentical hematopoietic stem cell transplantation (hHSCT) are associated with worse prognosis. Material and methods We retrospectively evaluated the clinical course and results of biochemical, immunological and genetic tests of 7 patients diagnosed in Poland with ADA deficiency since 2010 to 2022. Results All patients demonstrated lymphopenia affecting of T, B and NK cells. Diagnosis was made on the basis of ADA activity in red blood cells and/or genetic testing. Patients manifested with various non-immunological symptoms including: lung proteinosis, skeletal dysplasia, liver dysfunction, atypical hemolytic-uremic syndrome, and psychomotor development disorders. Five patients underwent successful HSCT: 3 patients from matched unrelated donor, 2 from matched sibling donor, and 1 haploidentical from a parental donor. In 4 patients HSCT was preceded by enzyme therapy (lasting from 2 to 5 months). One patient with multiple organ failure died shortly after admission, before the diagnosis was confirmed. None of the patients had undergone gene therapy. Conclusions It is important to diagnose ADA SCID as early as possible, before irreversible multi-organ failure occurs. In Poland HSCT are performed according to international immunological societies recommendations, while ERT and GT are less accessible. Implementation of Newborn Screening (NBS) for SCID in Poland could enable recognition of SCID, including ADA-SCID.
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Affiliation(s)
- Nel Dąbrowska-Leonik
- Department of Immunology, Children’s Memorial Health Institute, Warsaw, Poland,*Correspondence: Nel Dąbrowska-Leonik,
| | - Barbara Piątosa
- Histocompatibility Laboratory, Children’s Memorial Health Institute (IPCZD), Warsaw, Masovian, Poland
| | - Ewa Słomińska
- Biochemistry Department, Medical University of Gdansk, Gdansk, Poland
| | - Nadezda Bohynikova
- Department of Immunology, Children’s Memorial Health Institute, Warsaw, Poland
| | | | - Ewa Bernatowska
- Department of Immunology, Children’s Memorial Health Institute, Warsaw, Poland
| | | | - Krzysztof Kałwak
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Sylwia Kołtan
- Department of Pediatrics, Hematology and Oncology, Faculty of Medicine, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Anna Dąbrowska
- Department of Pediatrics, Hematology and Oncology, Faculty of Medicine, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Jolanta Goździk
- Department of Clinical Immunology and Transplantology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Ussowicz
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Małgorzata Pac
- Department of Immunology, Children’s Memorial Health Institute, Warsaw, Poland
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Zawitkowska J, Drabko K, Czyżewski K, Dziedzic M, Jaremek K, Zalas-Więcek P, Szmydki-Baran A, Hutnik Ł, Matysiak M, Czogała W, Balwierz W, Żak I, Salamonowicz-Bodzioch M, Kazanowska B, Wróbel G, Kałwak K, Tomaszewska R, Szczepański T, Zając-Spychała O, Wachowiak J, Płonowski M, Krawczuk-Rybak M, Królak A, Ociepa T, Urasiński T, Pierlejewski F, Młynarski W, Urbańska-Rakus J, Machnik K, Pająk S, Badowska W, Brzeski T, Mycko K, Mańko-Glińska H, Urbanek-Dądela A, Karolczyk G, Mizia-Malarz A, Stolpa W, Skowron-Kandzia K, Musiał J, Chaber R, Irga-Jaworska N, Bień E, Styczyński J. Viral Infection Profile in Children Treated for Acute Lymphoblastic Leukemia—Results of Nationwide Study. Pathogens 2022; 11:pathogens11101091. [PMID: 36297147 PMCID: PMC9609456 DOI: 10.3390/pathogens11101091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/10/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Viral infections can be a serious complication of therapy in children with acute lymphoblastic leukemia (ALL). In this study, we focused on the incidence and the profile of viral infection in children with ALL treated in 17 pediatric oncology centers in Poland in the two-year periods of 2018–2019 and 2020–2021. We also compared the frequency of viral infections in 2018–2019 to that in 2020–2021. In 2020–2021, a total of 192 children with ALL had a viral infection during intensive chemotherapy. A total number of 312 episodes of viral infections were diagnosed. The most common infections detected in the samples were: COVID-19 (23%), rhinovirus (18%), and respiratory syncytial virus (14%). COVID-19 and BK virus infections were the reason for the death 1% of all patients. In 2018–2019, a total of 53 ALL patients who had a viral infection were reported and 72 viral events were observed, mainly adenovirus (48.6%), rotavirus (31.9%), and herpes zoster (8.3%). No deaths were reported during this period. The cumulative incidence of viral infections in 2018–2019 was 10.4%, while for 2020–2021, it was 36.7%. In conclusion, a high incidence of COVID-19 infection was observed among pediatric patients with ALL in Poland. The mortality rate in our material was low. The viral profile in ALL children undergoing chemotherapy can be useful for clinicians to improve prophylactic and therapeutic strategies.
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Affiliation(s)
- Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, 20-059 Lublin, Poland
- Correspondence:
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University, 20-059 Lublin, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland
| | - Kamila Jaremek
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland
| | - Patrycja Zalas-Więcek
- Department of Microbiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland
| | - Anna Szmydki-Baran
- Department of Hematology and Pediatrics, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Łukasz Hutnik
- Department of Hematology and Pediatrics, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Michał Matysiak
- Department of Hematology and Pediatrics, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Wojciech Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Iwona Żak
- Department of Microbiology, University Children’s Hospital, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Małgorzata Salamonowicz-Bodzioch
- Department of Paediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Bernarda Kazanowska
- Department of Paediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Grażyna Wróbel
- Department of Paediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Krzysztof Kałwak
- Department of Paediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Renata Tomaszewska
- Department of Pediatrics, Hematology and Oncology, Medical University of Silesia, 40-752 Katowice, Poland
| | - Tomasz Szczepański
- Department of Pediatrics, Hematology and Oncology, Medical University of Silesia, 40-752 Katowice, Poland
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Marcin Płonowski
- Department of Pediatric Oncology, Hematology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology, Hematology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Aleksandra Królak
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Filip Pierlejewski
- Department of Pediatrics, Oncology & Hematology, Medical University of Lodz, 90-647 Lodz, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology & Hematology, Medical University of Lodz, 90-647 Lodz, Poland
| | | | - Katarzyna Machnik
- Unit of Pediatric Hematology and Oncology, City Hospital, 41-500 Chorzow, Poland
| | - Sonia Pająk
- Unit of Pediatric Hematology and Oncology, City Hospital, 41-500 Chorzow, Poland
| | - Wanda Badowska
- Clinical Department of Pediatric Oncology and Hematology, Department of Clinical Pediatrics, University of Warmia and Mazury in Olsztyn, Regional Specialized Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Tomasz Brzeski
- Clinical Department of Pediatric Oncology and Hematology, Department of Clinical Pediatrics, University of Warmia and Mazury in Olsztyn, Regional Specialized Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Katarzyna Mycko
- Clinical Department of Pediatric Oncology and Hematology, Department of Clinical Pediatrics, University of Warmia and Mazury in Olsztyn, Regional Specialized Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Hanna Mańko-Glińska
- Clinical Department of Pediatric Oncology and Hematology, Department of Clinical Pediatrics, University of Warmia and Mazury in Olsztyn, Regional Specialized Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Agnieszka Urbanek-Dądela
- Department of Pediatric Oncology and Hematology, Collegium Medium of Jan Kochanowski University in Kielce, 25-317 Kielce, Poland
| | - Grażyna Karolczyk
- Department of Pediatric Oncology and Hematology, Collegium Medium of Jan Kochanowski University in Kielce, 25-317 Kielce, Poland
| | - Agnieszka Mizia-Malarz
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children’s Care Health, Medical University of Silesia, 40-752 Katowice, Poland
| | - Weronika Stolpa
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children’s Care Health, Medical University of Silesia, 40-752 Katowice, Poland
| | - Katarzyna Skowron-Kandzia
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children’s Care Health, Medical University of Silesia, 40-752 Katowice, Poland
| | - Jakub Musiał
- Clinic of Paediatric Oncology and Haematology, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Radosław Chaber
- Clinic of Paediatric Oncology and Haematology, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Ewa Bień
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland
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Szmit Z, Frączkiewicz J, Salamonowicz-Bodzioch M, Król A, Ussowicz M, Mielcarek-Siedziuk M, Liszka K, Marschollek P, Gorczyńska E, Kałwak K. The Impact of High CMV Viral Load and Refractory CMV Infection on Pediatric HSCT Recipients with Underlying Non-Malignant Disorder. J Clin Med 2022; 11:jcm11175187. [PMID: 36079123 PMCID: PMC9456677 DOI: 10.3390/jcm11175187] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a curative therapy for an increasing number of nonmalignant indications. Its use is restricted by severe transplant-related complications, including CMV infection; despite various prophylactic and therapeutic strategies, CMV reactivation has remarkable morbidity and mortality. The analysis included 94 children with nonmalignant disorder who underwent allogeneic HSCT in the Department of Pediatric Hematology, Oncology, and Bone Marrow Transplantation in Wrocław during years 2016–2020. Twenty-seven (29%) children presented with CMV infection, including ten (10/27; 37%) with high level CMV viremia (10,000 copies/mL). Six patients experienced subsequent CMV reactivation. The first-line ganciclovir-based (GCV) treatment was insufficient in 40% (11/27) of children. Overall survival (OS) was significantly lower in children with high CMV viremia compared to those with low levels/no CMV [1yrOS High CMV = 0.80 (95% CI 0.41–0.95) vs. 1yrOS others = 0.96 (95% CI 0.89–0.99)]. Similarly, patients with resistant and recurrent infections had greater risk of death. CMV reactivation at any level relevantly prolonged the hospital stay. CMV reactivation with high viremia load and resistant/recurrent CMV infections lead to a significant decrease in OS in children with nonmalignant disorders treated with HSCT. Our data proves there is an urgent need to introduce an effective anti-CMV prophylaxis in this cohort of patients.
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Miśkiewicz-Bujna J, Miśkiewicz-Migoń I, Szmit Z, Przystupski D, Rosa M, Król A, Kałwak K, Ussowicz M, Gorczyńska E. Short- and long-term outcome of allogeneic stem cell transplantation in infants: A single-center experience over 20 years. Front Pediatr 2022; 10:956108. [PMID: 36071886 PMCID: PMC9441786 DOI: 10.3389/fped.2022.956108] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a treatment method for a wide range of malignant and non-malignant diseases. Infants constitute a distinct patient group, especially due to their organ immaturity and differences in drug metabolism. The present paper aims to analyse the short- and long-term outcomes after allo-HSCT in infants. MATERIAL AND METHODS In the study period, 67 patients under 12 months of age underwent allo-HSCT. This study is a retrospective analysis of patient medical records, in the form of paper and electronic documentation. RESULTS The probability of 5-year OS was 69% and 72% in patients with malignant and non-malignant diseases, respectively. The allo-HSCT from a matched donor was associated with improved OS in comparison to haploidentical donor (0.8 vs. 0.58%, p = 0.0425). The overall incidence of acute graft-vs.-host disease (aGVHD) was 59.3%, and grade III-IV aGVHD was diagnosed in 23% of patients. The 100-day non-relapse mortality (NRM) in the study cohort was 17.9%, while the 5-year NRM was 26.9%. Among the causes of NRM, infections occurred in 83.3% of patients, and aGVHD in 16.3% of individuals. Twenty-two children (32.8%) required hospitalization in the pediatric intensive care unit (PICU). The median length of PICU hospitalization was 6 days (range 1 to 12 days). Late sequelae diagnosed during post-transplant surveillance included ocular disorders in 26.8% of patients, cardiac complications in 4.4%, as well as endocrinopathy with short stature (<3rd percentile) in 37.2% and overt hypothyroidism in 35.4%. In the long-term perspective, 83.3% of survivors were able to attend a regular school. CONCLUSIONS Improvements in unrelated donor availability, and better supportive care resulted in better outcomes. Management of infant allo-HSCT recipients requires the formation of multi-disciplinary specialist teams. In addition, the role of parental empowerment must be acknowledged; for example, in speech therapy and rehabilitation.
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Affiliation(s)
- Justyna Miśkiewicz-Bujna
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Izabella Miśkiewicz-Migoń
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Zofia Szmit
- Department of Paediatric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland
| | - Dawid Przystupski
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Rosa
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Król
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Ussowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Gorczyńska
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
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20
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Jarmoliński T, Rosa M, Rybka B, Ryczan-Krawczyk R, Gajek K, Bogunia-Kubik K, Klaudel-Dreszler M, Czubkowski P, Kaliciński P, Teisseyre J, Stefanowicz M, Gorczyńska E, Kałwak K, Ussowicz M. Case Report: Liver as a Source of Hematopoietic Stem Cells After Liver Transplantation Following Hematopoietic Stem Cell Transplantation. Front Pediatr 2022; 10:861692. [PMID: 35402365 PMCID: PMC8984257 DOI: 10.3389/fped.2022.861692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Abstract
We report a child with Fanconi anemia who, after hematopoietic stem cell transplantation (HSCT) complicated by acute graft-versus-host disease (GVHD), underwent orthotopic liver transplantation (OLT). Approximately 1 month after OLT, the presence of third-party genetic material from the liver donor was noted and in the next few weeks, the chimerism assessment revealed 100% liver donor leukocytes in the peripheral blood. The rapidly progressing GVHD with gut involvement resulted in patient's death 6 months after OLT. The liver can act as a clinically significant source of hematopoietic stem cells, and the liver donor's young age must be emphasized as potentially predisposing to this phenomenon. Transfer of OLT hematopoietic stem cells may not have clinical significance unless the patient is not immunocompetent or develops liver-transplantation associated GVHD, that can result in lymphocyte mediated elimination of original hematopoiesis. Patients with preexisting immunity disorder (such as primary or secondary immunodeficiency) might require intensified immunosuppressive therapy in peritransplant period as a prevention of liver-transplantation associated GVHD. Close monitoring of hematopoietic chimerism after OLT is warranted in patients at risk, because cytopenia or OLT hematopoiesis can reflect subclinical GVHD and further studies are necessary to elucidate this phenomenon.
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Affiliation(s)
- Tomasz Jarmoliński
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
| | - Monika Rosa
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
| | - Blanka Rybka
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
| | - Renata Ryczan-Krawczyk
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
| | - Kornelia Gajek
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
| | - Katarzyna Bogunia-Kubik
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Laboratory of Tissue Immunology of the Medical Center, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland
| | - Maja Klaudel-Dreszler
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr Czubkowski
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - Joanna Teisseyre
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - Marek Stefanowicz
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - Ewa Gorczyńska
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
| | - Krzysztof Kałwak
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
| | - Marek Ussowicz
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
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21
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Bąbol-Pokora K, Wołowiec M, Popko K, Jaworowska A, Bryceson YT, Tesi B, Henter JI, Młynarski W, Badowska W, Balwierz W, Drabko K, Kałwak K, Maciejka-Kembłowska L, Pieczonka A, Sobol-Milejska G, Kołtan S, Malinowska I. Molecular Genetics Diversity of Primary Hemophagocytic Lymphohistiocytosis among Polish Pediatric Patients. Arch Immunol Ther Exp (Warsz) 2021; 69:31. [PMID: 34677667 PMCID: PMC8536594 DOI: 10.1007/s00005-021-00635-4] [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: 04/16/2021] [Accepted: 09/10/2021] [Indexed: 08/30/2023]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a clinical syndrome of life-threatening inflammation caused by an excessive, prolonged and ineffective immune response. An increasing number of HLH cases is recognized in Poland, but the genetic causes of familial HLH (FHL) have not been reported. We investigated the molecular genetics and associated outcomes of pediatric patients who met HLH criteria. We studied 54 patients with HLH, 36 of whom received genetic studies. Twenty-five patients were subjected to direct sequencing of the PRF1, UNC13D, STX11, XIAP and SH2D1A genes. Additionally, 11 patients were subjected to targeted next-generation sequencing. In our study group, 17 patients (31%) were diagnosed with primary HLH, with bi-allelic FHL variants identified in 13 (36%) patients whereas hemizygous changes were identified in 4 patients with X-linked lymphoproliferative diseases. In addition, one patient was diagnosed with X-linked immunodeficiency with magnesium defect, Epstein–Barr virus infection and neoplasia due to a hemizygous MAGT1 variant; another newborn was diagnosed with auto-inflammatory syndrome caused by MVK variants. The majority (65%) of FHL patients carried UNC13D pathogenic variants, whereas PRF1 variants occurred in two patients. Novel variants in UNC13D, PRF1 and XIAP were detected. Epstein–Barr virus was the most common trigger noted in 23 (65%) of the patients with secondary HLH. In three patients with secondary HLH, heterozygous variants of FHL genes were found. Overall survival for the entire study group was 74% with a median of 3.6 years of follow-up. Our results highlight the diversity of molecular causes of primary HLH in Poland.
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Affiliation(s)
- Katarzyna Bąbol-Pokora
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Magdalena Wołowiec
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland
| | - Katarzyna Popko
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Jaworowska
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Yenan T Bryceson
- Department of Medicine, Centre for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Bianca Tesi
- Department of Medicine, Centre for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jan-Inge Henter
- Department of Medicine, Centre for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Wanda Badowska
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - Walentyna Balwierz
- Department of Pediatrics Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | | | - Anna Pieczonka
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Grażyna Sobol-Milejska
- Department of Pediatrics, Hematology and Oncology, Medical University of Silesia, Silesia, Poland
| | - Sylwia Kołtan
- Department of Pediatrics, Hematology and Oncology, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Iwona Malinowska
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland.
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22
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Salamonowicz-Bodzioch M, Rosa M, Frączkiewicz J, Gorczyńska E, Gul K, Janeczko-Czarnecka M, Jarmoliński T, Kałwak K, Mielcarek-Siedziuk M, Olejnik I, Owoc-Lempach J, Panasiuk A, Gajek K, Rybka B, Ryczan-Krawczyk R, Ussowicz M. Fludarabine-Cyclophosphamide-Based Conditioning with Antithymocyte Globulin Serotherapy Is Associated with Durable Engraftment and Manageable Infections in Children with Severe Aplastic Anemia. J Clin Med 2021; 10:jcm10194416. [PMID: 34640434 PMCID: PMC8509585 DOI: 10.3390/jcm10194416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 01/18/2023] Open
Abstract
Severe aplastic anemia (SAA) is a bone marrow failure syndrome that can be treated with hematopoietic cell transplantation (HCT) or immunosuppressive (IS) therapy. A retrospective cohort of 56 children with SAA undergoing transplantation with fludarabine-cyclophosphamide-ATG-based conditioning (FluCyATG) was analyzed. The endpoints were overall survival (OS), event-free survival (EFS), cumulative incidence (CI) of graft versus host disease (GVHD) and CI of viral replication. Engraftment was achieved in 53/56 patients, and four patients died (two due to fungal infection, and two of neuroinfection). The median time to neutrophil engraftment was 14 days and to platelet engraftment was 16 days, and median donor chimerism was above 98%. The overall incidence of acute GVHD was 41.5%, and that of grade III-IV acute GVHD was 14.3%. Chronic GVHD was diagnosed in 14.2% of children. The probability of 2-year GVHD-free survival was 76.1%. In the univariate analysis, a higher dose of cyclophosphamide and previous IS therapy were significant risk factors for worse overall survival. Episodes of viral replication occurred in 33/56 (58.9%) patients, but did not influence OS. The main advantages of FluCyATG include early engraftment with a very high level of donor chimerism, high overall survival and a low risk of viral replication after HCT.
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Affiliation(s)
- Małgorzata Salamonowicz-Bodzioch
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
- Correspondence: ; Tel.: +48-71-7332700; Fax: +48-71-7332709
| | - Monika Rosa
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Jowita Frączkiewicz
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Ewa Gorczyńska
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Katarzyna Gul
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Małgorzata Janeczko-Czarnecka
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Tomasz Jarmoliński
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Krzysztof Kałwak
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Monika Mielcarek-Siedziuk
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Igor Olejnik
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Joanna Owoc-Lempach
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Anna Panasiuk
- Department of Oncology, Hematolgy and Transplantology, University Hospital USK in Wroclaw, 50-556 Wroclaw, Poland;
| | - Kornelia Gajek
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Blanka Rybka
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Renata Ryczan-Krawczyk
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Marek Ussowicz
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
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Czogała M, Balwierz W, Pawińska-Wąsikowska K, Książek T, Bukowska-Strakova K, Czogała W, Sikorska-Fic B, Matysiak M, Skalska-Sadowska J, Wachowiak J, Moj-Hackemer M, Kałwak K, Muszyńska-Rosłan K, Krawczuk-Rybak M, Grabowski D, Kowalczyk J, Maciejka-Kembłowska L, Irga-Jaworska N, Bobeff K, Młynarski W, Tomaszewska R, Szczepański T, Chodała-Grzywacz A, Karolczyk G, Mizia-Malarz A, Mycko K, Badowska W, Zielezińska K, Urasiński T, Urbańska-Rakus J, Ciebiera M, Chaber R, Bartoszewicz N, Wysocki M, Skoczeń S. Advances in the First Line Treatment of Pediatric Acute Myeloid Leukemia in the Polish Pediatric Leukemia and Lymphoma Study Group from 1983 to 2019. Cancers (Basel) 2021; 13:cancers13184536. [PMID: 34572762 PMCID: PMC8472575 DOI: 10.3390/cancers13184536] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/31/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary We retrospectively analyzed the results of the five consecutive treatment protocols for pediatric acute myeloid leukemia (AML) used in Poland from 1983 to 2019 (excluding promyelocytic, secondary, biphenotypic, and Down syndrome AML). The study included 899 children. The probability of three-year overall, event-free, and relapse-free survival increased from 0.34 ± 0.03 to 0.75 ± 0.05, 0.31 ± 0.03 to 0.67 ± 0.05, and 0.52 ± 0.03 to 0.78 ± 0.05, respectively. A systematic reduction of early deaths and deaths in remission was achieved, while the percentage of relapses decreased only in the last therapeutic period. Surprisingly good results were obtained in the group of patients with unfavorable genetic abnormalities like KMT2A-MLLT10/t(10;11)(p12;q23) and DEK-NUP214/t(6;9)(p23;q24) who were treated in the AML-BFM 2012 Registry, while an unsatisfactory outcome was found in patients with FLT3-ITD. The use of standardized therapeutic protocols with the successive consideration of genetic prognostic factors and advances in supportive care led to a significant improvement in AML treatment outcomes over the last 40 years. Abstract Background: From 1983, standardized therapeutic protocols for pediatric acute myeloid leukemia (AML) based on the BFM group experience were introduced in Poland. We retrospectively analyzed the results of pediatric AML treatment in Poland from 1983 to 2019 (excluding promyelocytic, therapy-related, biphenotypic, and Down syndrome AML). Methods: The study included 899 children suffering from AML treated with the following: AML-PPPLBC 83 (1983–1993, n = 187), AML-PPGLBC 94 (1994–1997, n = 74), AML-PPGLBC 98 (1998–2004, n = 151), AML-BFM 2004 Interim (2004–2015, n = 356), and AML-BFM 2012 (2015–2019, n = 131). Results: The probability of three-year overall survival was 0.34 ± 0.03, 0.37 ± 0.05, 0.54 ± 0.04, 0.67 ± 0.03, and 0.75 ± 0.05; event-free survival was 0.31 ± 0.03, 0.34 ± 0.05, 0.44 ± 0.04, 0.53 ± 0.03, and 0.67 ± 0.05; and relapse-free survival was 0.52 ± 0.03, 0.65 ± 0.05, 0.58 ± 0.04, 0.66 ± 0.03, and 0.78 ± 0.05, respectively, in the subsequent periods. A systematic reduction of early deaths and deaths in remission was achieved, while the percentage of relapses decreased only in the last therapeutic period. Surprisingly good results were obtained in the group of patients treated with AML-BFM 2012 with unfavorable genetic abnormalities like KMT2A-MLLT10/t(10;11)(p12;q23) and DEK-NUP214/t(6;9)(p23;q24), while unsatisfactory outcomes were found in the patients with FLT3-ITD. Conclusions: The use of standardized, systematically modified therapeutic protocols, with the successive consideration of genetic prognostic factors, and advances in supportive care led to a significant improvement in AML treatment outcomes over the last 40 years.
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Affiliation(s)
- Małgorzata Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-663 Krakow, Poland; (M.C.); (W.B.); (K.P.-W.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-663 Krakow, Poland;
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-663 Krakow, Poland; (M.C.); (W.B.); (K.P.-W.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-663 Krakow, Poland;
| | - Katarzyna Pawińska-Wąsikowska
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-663 Krakow, Poland; (M.C.); (W.B.); (K.P.-W.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-663 Krakow, Poland;
| | - Teofila Książek
- Department of Medical Genetics, Institute of Pediatrics, Jagiellonian University Medical College, 31-663 Krakow, Poland;
| | - Karolina Bukowska-Strakova
- Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, 31-663 Krakow, Poland;
| | - Wojciech Czogała
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-663 Krakow, Poland;
| | - Barbara Sikorska-Fic
- Department of Oncology, Pediatric Hematology, Transplantology and Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland; (B.S.-F.); (M.M.)
| | - Michał Matysiak
- Department of Oncology, Pediatric Hematology, Transplantology and Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland; (B.S.-F.); (M.M.)
| | - Jolanta Skalska-Sadowska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 60-572 Poznan, Poland; (J.S.-S.); (J.W.)
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 60-572 Poznan, Poland; (J.S.-S.); (J.W.)
| | - Małgorzata Moj-Hackemer
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Wroclaw Medical University, 50-556 Wrocław, Poland; (M.M.-H.); (K.K.)
| | - Krzysztof Kałwak
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Wroclaw Medical University, 50-556 Wrocław, Poland; (M.M.-H.); (K.K.)
| | - Katarzyna Muszyńska-Rosłan
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-276 Bialystok, Poland; (K.M.-R.); (M.K.-R.)
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-276 Bialystok, Poland; (K.M.-R.); (M.K.-R.)
| | - Dominik Grabowski
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-090 Lublin, Poland; (D.G.); (J.K.)
| | - Jerzy Kowalczyk
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-090 Lublin, Poland; (D.G.); (J.K.)
| | - Lucyna Maciejka-Kembłowska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-211 Gdansk, Poland; (L.M.-K.); (N.I.-J.)
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-211 Gdansk, Poland; (L.M.-K.); (N.I.-J.)
| | - Katarzyna Bobeff
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 91-738 Lodz, Poland; (K.B.); (W.M.)
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 91-738 Lodz, Poland; (K.B.); (W.M.)
| | - Renata Tomaszewska
- Department of Pediatrics Hematology and Oncology, Medical University of Silesia, 41-800 Zabrze, Poland; (R.T.); (T.S.)
| | - Tomasz Szczepański
- Department of Pediatrics Hematology and Oncology, Medical University of Silesia, 41-800 Zabrze, Poland; (R.T.); (T.S.)
| | - Agnieszka Chodała-Grzywacz
- Department of Pediatric Hematology and Oncology, Regional Polyclinic Hospital in Kielce, 25-736 Kielce, Poland; (A.C.-G.); (G.K.)
| | - Grażyna Karolczyk
- Department of Pediatric Hematology and Oncology, Regional Polyclinic Hospital in Kielce, 25-736 Kielce, Poland; (A.C.-G.); (G.K.)
| | - Agnieszka Mizia-Malarz
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children’s Care Health Centre, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Katarzyna Mycko
- Department of Pediatrics and Hematology and Oncology, Province Children’s Hospital, 10-561 Olsztyn, Poland; (K.M.); (W.B.)
| | - Wanda Badowska
- Department of Pediatrics and Hematology and Oncology, Province Children’s Hospital, 10-561 Olsztyn, Poland; (K.M.); (W.B.)
| | - Karolina Zielezińska
- Department of Pediatrics, Hematology and Oncology, Pomeranian Medical University, 71-252 Szczecin, Poland; (K.Z.); (T.U.)
| | - Tomasz Urasiński
- Department of Pediatrics, Hematology and Oncology, Pomeranian Medical University, 71-252 Szczecin, Poland; (K.Z.); (T.U.)
| | - Justyna Urbańska-Rakus
- Department of Pediatrics, Hematology and Oncology, City Hospital, 41-500 Chorzow, Poland;
| | - Małgorzata Ciebiera
- Department of Pediatric Oncohematology, Clinical Province Hospital of Rzeszow, 35-301 Rzeszów, Poland; (M.C.); (R.C.)
| | - Radosław Chaber
- Department of Pediatric Oncohematology, Clinical Province Hospital of Rzeszow, 35-301 Rzeszów, Poland; (M.C.); (R.C.)
- Department of Pediatrics, Institute of Medical Sciences, Medical College, University of Rzeszow, 35-310 Rzeszow, Poland
| | - Natalia Bartoszewicz
- Department of Paediatrics, Haematology and Oncology, Nicolaus Copernicus University in Toruń Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (N.B.); (M.W.)
| | - Mariusz Wysocki
- Department of Paediatrics, Haematology and Oncology, Nicolaus Copernicus University in Toruń Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (N.B.); (M.W.)
| | - Szymon Skoczeń
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-663 Krakow, Poland; (M.C.); (W.B.); (K.P.-W.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-663 Krakow, Poland;
- Correspondence: ; Tel.: +48-123339220
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Jarmoliński T, Matkowska‐Kocjan A, Rosa M, Olejnik I, Gorczyńska E, Kałwak K, Ussowicz M. SARS-CoV-2 viral clearance during bone marrow aplasia after allogeneic hematopoietic stem cell transplantation-A case report. Pediatr Transplant 2021; 25:e13875. [PMID: 32949079 PMCID: PMC7537051 DOI: 10.1111/petr.13875] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/30/2020] [Accepted: 09/09/2020] [Indexed: 12/23/2022]
Abstract
Respiratory viral infections are known causes of mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Here, we report a unique case of a child with viral pneumonia caused by coinfection with human metapneumovirus (MPV), respiratory syncytial virus (RSV), and SARS-CoV-2 after HSCT. A 9-year-old girl with acute lymphoblastic leukemia underwent allogeneic HSCT from a matched, unrelated donor. During the post-transplant period, in profound leukopenia (below 10 leukocytes/µL), she was diagnosed with SARS-CoV-2, MPV, and RSV pneumonia and was treated with ribavirin and chloroquine. Before leukocyte recovery, the girl became asymptomatic, and SARS-CoV-2 and RSV clearance was achieved. The shedding of SARS-CoV-2 stopped before immune system recovery, and one may hypothesize that the lack of an inflammatory response might have been a contributing factor to the mild clinical course. Post-transplant care in HSCT recipients with COVID-19 infection is feasible in regular transplant units, provided the patient does not present with respiratory failure. Early and repeated testing for SARS-CoV-2 in post-transplant patients with concomitant infection mitigation strategies should be considered in children after HSCT who develop fever, respiratory symptoms, and perhaps gastrointestinal symptoms to control the spread of COVID-19 both in patients and in healthcare workers in hospital environments. Training of staff and the availability of personal protective equipment are crucial for containing SARS-CoV-2 infection.
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Affiliation(s)
- Tomasz Jarmoliński
- Department of Pediatric Bone Marrow Transplantation, Oncology, and HematologyWroclaw Medical UniversityWroclawPoland
| | | | - Monika Rosa
- Department of Pediatric Bone Marrow Transplantation, Oncology, and HematologyWroclaw Medical UniversityWroclawPoland
| | - Igor Olejnik
- Department of Pediatric Bone Marrow Transplantation, Oncology, and HematologyWroclaw Medical UniversityWroclawPoland
| | - Ewa Gorczyńska
- Department of Pediatric Bone Marrow Transplantation, Oncology, and HematologyWroclaw Medical UniversityWroclawPoland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology, and HematologyWroclaw Medical UniversityWroclawPoland
| | - Marek Ussowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology, and HematologyWroclaw Medical UniversityWroclawPoland
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25
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Miśkiewicz-Bujna J, Miśkiewicz-Migoń I, Panasiuk A, Kubica-Cielińska A, Zielińska M, Waszczuk Ł, Bladowska J, Miś M, Bąbol-Pokora K, Młynarski W, Ociepa T, Kałwak K, Gorczyńska E, Ussowicz M. Severe and fatal toxicity after hematopoietic stem cell transplantation in GNE defect-associated thrombocytopenia. Bone Marrow Transplant 2021; 56:1714-1716. [PMID: 33637881 DOI: 10.1038/s41409-021-01235-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Justyna Miśkiewicz-Bujna
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Izabella Miśkiewicz-Migoń
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Panasiuk
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Kubica-Cielińska
- Department of Paediatric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland
| | - Marzena Zielińska
- Department of Paediatric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland
| | - Łukasz Waszczuk
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Bladowska
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Miś
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Bąbol-Pokora
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Łódź, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Łódź, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Gorczyńska
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Ussowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland.
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26
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Wolska-Kusnierz B, Pastorczak A, Fendler W, Wakulinska A, Dembowska-Baginska B, Heropolitanska-Pliszka E, Piątosa B, Pietrucha B, Kałwak K, Ussowicz M, Pieczonka A, Drabko K, Lejman M, Koltan S, Gozdzik J, Styczynski J, Fedorova A, Miakova N, Deripapa E, Kostyuchenko L, Krenova Z, Hlavackova E, Gennery AR, Sykora KW, Ghosh S, Albert MH, Balashov D, Eapen M, Svec P, Seidel MG, Kilic SS, Tomaszewska A, Wiesik-Szewczyk E, Kreins A, Greil J, Buechner J, Lund B, Gregorek H, Chrzanowska K, Mlynarski W. Hematopoietic Stem Cell Transplantation Positively Affects the Natural History of Cancer in Nijmegen Breakage Syndrome. Clin Cancer Res 2021; 27:575-584. [PMID: 33082212 DOI: 10.1158/1078-0432.ccr-20-2574] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/26/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Nijmegen breakage syndrome (NBS) is a DNA repair disorder with a high predisposition to hematologic malignancies. EXPERIMENTAL DESIGN We describe the natural history of NBS, including cancer incidence, risk of death, and the potential effectiveness of hematopoietic stem cell transplantation (HSCT) in preventing both pathologies: malignancy and immunodeficiency. RESULTS Among 241 patients with NBS enrolled in the study from 11 countries, 151 (63.0%) patients were diagnosed with cancer. Incidence rates for primary and secondary cancer, tumor characteristics, and risk factors affecting overall survival (OS) were estimated. The cumulative cancer incidence was 40.21% ± 3.5% and 77.78% ± 3.4% at 10 years and 20 years of follow-up, respectively. Most of the tumors n = 95 (62.9%) were non-Hodgkin lymphomas. Overall, 20 (13.2%) secondary malignancies occurred at a median age of 18 (interquartile range, 13.7-21.5) years. The probability of 20-year overall survival (OS) for the whole cohort was 44.6% ± 4.5%. Patients who developed cancer had a shorter 20-year OS than those without malignancy (29.6% vs. 86.2%; P < 10-5). A total of 49 patients with NBS underwent HSCT, including 14 patients transplanted before malignancy. Patients with NBS with diagnosed cancer who received HSCT had higher 20-year OS than those who did not (42.7% vs. 30.3%; P = 0.038, respectively). In the group of patients who underwent preemptive transplantation, only 1 patient developed cancer, which is 6.7 times lower as compared with nontransplanted patients [incidence rate ratio 0.149 (95% confidence interval, 0.138-0.162); P < 0.0001]. CONCLUSIONS There is a beneficial effect of HSCT on the long-term survival of patients with NBS transplanted in their first complete remission of cancer.
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Affiliation(s)
| | - Agata Pastorczak
- Department Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anna Wakulinska
- Department of Oncology, Children's Memorial Health Institute, Warsaw, Poland
| | | | | | - Barbara Piątosa
- Histocompatibility Laboratory, Children's Memorial Health Institute, Warsaw, Poland
| | - Barbara Pietrucha
- Department of Immunology, Children's Memorial Health Institute, Warsaw, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Ussowicz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Pieczonka
- Department of Pediatric Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Poland
| | - Monika Lejman
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Poland
| | - Sylwia Koltan
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Jolanta Gozdzik
- Department of Transplantation, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Alina Fedorova
- Belarusian Research Center for Pediatric Oncology and Hematology, Minsk, Belarus
| | - Natalia Miakova
- Department of Pediatric Oncology and Hematology, Federal Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Elena Deripapa
- Department of Immunology and Hematopoietic Stem Cell Transplantation, Federal Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Larysa Kostyuchenko
- Department of Pediatric Immunology, Western Ukrainian Specialized Children's Medical Centre, Lviv, Ukraine
| | - Zdenka Krenova
- Department of Pediatric Oncology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Eva Hlavackova
- Department of Pediatric Oncology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Clinical Immunology and Allergology, St. Anne's University Hospital in Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Andrew R Gennery
- Translational and Clinical Research Institute, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Karl-Walter Sykora
- Department of Pediatrics, Hannover Medical School (MHH), Hannover, Germany
| | - Sujal Ghosh
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
| | - Michael H Albert
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Dmitry Balashov
- Department of Hematopoietic Stem Cell Transplantation, Dmitriy Rogachev National Center for Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Mary Eapen
- Center for International Blood and Marrow Transplant, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter Svec
- Department of Pediatric Hematology and Oncology, Comenius University and National Institute of Children's Diseases, Bratislava, Slovakia
| | - Markus G Seidel
- Research Unit Pediatric Hematology and Immunology, Division of Pediatric Hematology-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Sara S Kilic
- Pediatric Immunology Division, Department of Pediatrics, Uludag University Medical Faculty, Bursa, Turkey
| | - Agnieszka Tomaszewska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Wiesik-Szewczyk
- Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland
| | - Alexandra Kreins
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Johann Greil
- Department of Pediatric Hematology and Oncology, University Hospital, Heidelberg, Germany
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Bendik Lund
- Pediatric Department, St Olav University Hospital, Trondheim, Norway
| | - Hanna Gregorek
- Department of Microbiology and Clinical Immunology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Krystyna Chrzanowska
- Department of Medical Genetics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Wojciech Mlynarski
- Department Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland.
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Augustynowicz M, Kałwak K, Zwolińska D, Musiał K. The incidence of acute kidney injury in children undergoing allogenic hematopoietic stem cell transplantation: A pilot study. ADV CLIN EXP MED 2021; 30:87-92. [PMID: 33529512 DOI: 10.17219/acem/130355] [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] [Indexed: 11/24/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common feature in adults undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT). However, accurate assessment of AKI incidence in the pediatric population still seems a challenge. OBJECTIVES To evaluate the incidence of AKI according to the pRIFLE criteria in children undergoing alloHSCT, with special focus on differences between patients transplanted due to oncological and non-oncological indications. MATERIAL AND METHODS A retrospective analysis of data, concerning 135 children undergoing alloHSCT due to oncological (89 patients) or other (46 patients) reasons, was performed. The values of estimated glomerular filtration rate (eGFR) were measured before alloHSCT, 24 h after, 1, 2, 3, 4, 8 weeks, 3 and 6 months after alloHSCT, and the AKI incidence was analyzed. RESULTS Acute kidney injury was diagnosed in 54% of all patients. The Risk stage (R) was noticed at least once in 46% of oncological and 37% of non-oncological children. The Injury stage (I) concerned 12% of oncological and 6% of non-oncological patients undergoing alloHSCT. The incidence of AKI in both groups was comparable. The mean eGFR values in oncological children were higher than those in the non-oncological patients even before transplantation and until the 4th week after alloHSCT. The eGFR increased significantly in all patients 24 h after alloHSCT and returned to pre-transplantation records after 2-3 weeks. Then, oncological patients demonstrated a gradual decrement of eGFR. Six months after transplantation, eGFR values in oncological children were significantly lower compared to pre-transplantation records, whereas in non-oncological children, these values were comparable. CONCLUSIONS Although the type of indication for alloHSCT has no impact on the AKI incidence, children undergoing alloHSCT due to oncological reasons are at greater risk of renal impairment 6 months after transplantation than non-oncological patients.
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Affiliation(s)
| | - Krzysztof Kałwak
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Wroclaw Medical University, Poland
| | - Danuta Zwolińska
- Department of Pediatric Nephrology, Wroclaw Medical University, Poland
| | - Kinga Musiał
- Department of Pediatric Nephrology, Wroclaw Medical University, Poland
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28
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Zając-Spychała O, Pieczonka A, Wachowiak J, Frączkiewicz J, Salamonowicz M, Kałwak K, Gorczyńska E, Kazanowska B, Wróbel G, Chybicka A, Czyżewski K, Dziedzic M, Wysocki M, Zalas-Więcek P, Szmydki-Baran A, Hutnik Ł, Matysiak M, Irga-Jaworska N, Bień E, Drożyńska E, Stolpa W, Sobol-Milejska G, Pierlejewski F, Młynarski W, Gryniewicz-Kwiatkowska O, Gietka A, Dembowska-Bagińska B, Semczuk K, Dzierżanowska-Fangrat K, Gamrot-Pyka Z, Woszczyk M, Urbanek-Dądela A, Karolczyk G, Płonowski M, Krawczuk-Rybak M, Zaucha-Prażmo A, Kowalczyk J, Goździk J, Styczyński J. Adenovirus infection among pediatric patients with cancer and in pediatric recipients of hematopoietic stem cell: A multicenter nationwide study. J Med Virol 2020; 92:3187-3193. [PMID: 32162698 DOI: 10.1002/jmv.25756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/03/2019] [Revised: 02/26/2020] [Accepted: 03/04/2020] [Indexed: 01/07/2023]
Abstract
The aim was to evaluate the incidence, clinical course, and outcome of adenoviral infection (AdVI) in pediatric patients diagnosed and treated due to cancer and in pediatric recipients of hematopoietic stem cell. Over a 72-month period, all-in 5599 children with cancer: 2441 patients with hematological malignancy (HM) and 3158 with solid tumors (ST), and 971 patients after transplantation: 741 after allogeneic (allo-HSCT) and 230 after autologous (auto-HSCT) were enrolled into the study. Among cancer patients, 67 episodes of AdVI appeared in 63 (1.1%) children, including 45 (1.8%) with HM and 18 (0.6%; P < .001) with ST. Within transplanted patients, AdVIs were responsible for 88 episodes in 81 (8.3%) children (P < .001), including 78 (10.5%) patients after allo-HSCT and 3 (1.3%) after auto-HSCT. Time to develop AdVI was short, especially after allo-HSCT. The most common clinical manifestation in cancer patients was enteritis diagnosed in 63 (94.0%) cases, while among HSCT recipient asymptomatic adenoviremia was found in 36 (40.9%) cases and the most common clinical manifestation was urinary tract infection. Cancer patients with disseminated disease, as well as HSCT recipients with either asymptomatic viremia or disseminated disease, received antiviral treatment. The most commonly used first-line therapy was cidofovir. None of the cancer patients died due to AdVI, while within HSCT recipients three patients developed disseminated adenoviral disease and died despite antiviral treatment. In cancer patients, AdVIs are rare and associated with very good prognosis even without specific treatment. However, in allo-HSCT recipients, disseminated disease with fatal outcome is more likely to occur.
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Affiliation(s)
- O Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - A Pieczonka
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - J Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - J Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - M Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - K Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - E Gorczyńska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - B Kazanowska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - G Wróbel
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - A Chybicka
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - K Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - P Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland
| | - A Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University Torun, Bydgoszcz, Poland
| | - Ł Hutnik
- Department of Pediatric Hematology and Oncology, Medical University Torun, Bydgoszcz, Poland
| | - M Matysiak
- Department of Pediatric Hematology and Oncology, Medical University Torun, Bydgoszcz, Poland
| | - N Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - E Bień
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - E Drożyńska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - W Stolpa
- Department of Pediatric, Division of Pediatric Oncology, Hematology and Chemotherapy, Silesian Medical University, Katowice, Poland
| | - G Sobol-Milejska
- Department of Pediatric, Division of Pediatric Oncology, Hematology and Chemotherapy, Silesian Medical University, Katowice, Poland
| | - F Pierlejewski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | - W Młynarski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | | | - A Gietka
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - K Semczuk
- Department of Microbiology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - Z Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - M Woszczyk
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - A Urbanek-Dądela
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Poland
| | - G Karolczyk
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Poland
| | - M Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - M Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - A Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - J Kowalczyk
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - J Goździk
- Department of Clinical Immunology and Transplantology, Stem Cell Transplant Center, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - J Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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Janeczko-Czarnecka M, Raciborska A, Gos M, Kordowska O, Gajek K, Rybka B, Ryczan-Krawczyk R, Kałwak K, Ussowicz M. Successful Salvage Treosulfan-Based Megachemotherapy With Allogeneic Stem Cell Transplantation in Nonsyndromic, Therapy-Resistant Disseminated Juvenile Xanthogranuloma: A Case Report. Transplant Proc 2020; 52:2844-2848. [DOI: 10.1016/j.transproceed.2020.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/12/2020] [Indexed: 12/29/2022]
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30
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Jarmoliński T, Rosa M, Puziewicz-Zmonarska A, Kałwak K. Short Course of Eculizumab May Be Effective in Dialysis-Dependent Transplantation-Associated Thrombotic Microangiopathy After Hematopoietic Stem Cell Transplantation: A Case Report. Transplant Proc 2020; 52:2544-2547. [PMID: 32917392 DOI: 10.1016/j.transproceed.2020.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (alloHSCT) could induce several complications. The most frequent viral infections and graft-vs-host disease (GvHD) sometimes lead to thrombotic microangiopathy (TMA). It is associated with significant morbidity and mortality with the risk of death reaching 90%. Effective prevention and treatment are not available to date. Recent attempts at using antibody against C5 have been made. CASE REPORT A 19-year-old girl with acute myeloid leukemia twice underwent alloHSCTs from her 10/10 HLA-matched sister. After the second HSCT severe acute steroid-resistant grade 4 GvHD occurred. Despite treatment with high doses of steroids, mycophenolate mofetil, biological therapy, and extracorporeal photopheresis, the patient developed TMA with acute kidney injury and the need for renal replacement therapy. The concentration of complement component 3 and activity of ADAMTS 13 were normal, and infection with Escherichia coli (E. coli) 0157H7 was excluded. Due to failure of all ordered therapies and severity of the condition, an attempt was taken to use eculizumab. Two 900-mg doses of eculizumab (Soliris) were administered at an interval of 2 weeks, which resulted in the improvement of renal function and amelioration of hemolysis and thrombocytopenia. Dialysis therapy was finished after 5 weeks, and then a third dose of the drug was administered. Eighteen months later, the patient is alive and well, with limited chronic GvHD. eGFR remains stable at 40 to 46 mL/min/1.73 m2, and mild hypertension requires treatment with angiotensin converting enzyme inhibitors and furosemide. CONCLUSION Even a short course of eculizumab can be sufficient in controlling the TMA after HSCT, provided that the TMA-triggering factors are well controlled.
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Affiliation(s)
- Tomasz Jarmoliński
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wroclaw, Poland; Department of Pediatrics and Pediatric Neurology, District Hospital, Gorzów Wielkopolski, Poland
| | - Monika Rosa
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wroclaw, Poland.
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31
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Szmit Z, Kośmider-Żurawska M, Król A, Łobos M, Miśkiewicz-Bujna J, Zielińska M, Kałwak K, Mielcarek-Siedziuk M, Salamonowicz-Bodzioch M, Frączkiewicz J, Ussowicz M, Owoc-Lempach J, Gorczyńska E. Factors affecting survival in children requiring intensive care after hematopoietic stem cell transplantation. A retrospective single-center study. Pediatr Transplant 2020; 24:e13765. [PMID: 32558076 DOI: 10.1111/petr.13765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
Allo-HSCT is associated with life-threatening complications. Therefore, a considerable number of patients require admission to a PICU. We evaluated the incidence and outcome of PICU admissions after allo-HSCT in children, along with the potential factors influencing PICU survival. A retrospective chart review of 668 children who underwent first allo-HSCT in the Department of Pediatric Hematology/Oncology and BMT in Wrocław during years 2005-2017, particularly focusing on patients admitted to the PICU within 1-year post-HSCT. Fifty-eight (8.7%) patients required 64 admissions to the PICU. Twenty-four (41.5%) were discharged, and 34 (58.6%) patients died. Among the discharged patients, 6-month survival was 66.7%. Compared with survivors, death cases were more likely to have required MV (31/34; 91.2% vs. 16/24; 66.7% P = .049), received more aggressive cardiac support (17/34; 50% vs. 2/24; 8.3% P = .002), and had a lower ANC on the last day of their PICU stay (P = .004). Five patients were successfully treated with NIV and survived longer than 6 months post-discharge. The intensity of cardiac support and ANC on the last day of PICU treatment was independent factors influencing PICU survival. Children admitted to the PICU after allo-HSCT have a high mortality rate. Mainly those who needed a more aggressive approach and had a lower ANC on the last day of treatment had a greater risk of death. While requiring MV is associated with decreased PICU survival, early implementation of NIV might be considered.
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Affiliation(s)
- Zofia Szmit
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland.,Department of Anesthesiology and Intensive Care, Wrocław Medical University, Wrocław, Poland
| | | | - Anna Król
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Monika Łobos
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Justyna Miśkiewicz-Bujna
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Marzena Zielińska
- Department of Anesthesiology and Intensive Care, Wrocław Medical University, Wrocław, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Monika Mielcarek-Siedziuk
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Małgorzata Salamonowicz-Bodzioch
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Marek Ussowicz
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Joanna Owoc-Lempach
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Ewa Gorczyńska
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
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Zając-Spychała O, Zaucha-Prażmo A, Zawitkowska J, Wachowiak J, Kowalczyk JR, Frączkiewicz J, Salamonowicz M, Kałwak K, Gorczyńska E, Chybicka A, Czyżewski K, Dziedzic M, Wysocki M, Zalas-Więcek P, Goździk J, Styczyński J. Infectious complications after hematopoietic stem cell transplantation for primary immunodeficiency in children: A multicenter nationwide study. Pediatr Allergy Immunol 2020; 31:537-543. [PMID: 32150770 DOI: 10.1111/pai.13239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this nationwide study was to evaluate the characteristics of bacterial infections (BI), invasive fungal disease (IFD), and viral infections (VI) in pediatric patients with PID after allogeneic hematopoietic stem cell transplantation (allo-HSCT). PATIENTS AND METHODS In total, 114 HSCT recipients were enrolled into the study. At least one infectious complication (IC) was diagnosed in 60 (52.6%) patients aged 0.1-17.7 years, that is, 59.5% with SCID and 49.4% with non-SCID. RESULTS Among 60 HSCT recipients diagnosed with at least one IC, 188 episodes of infectious complications (EIC) were recorded, that is, 46.8% of BI, 41.5% of VI, and 11.7% of proven/probable IFD. According to PID and HSCT donor type, the incidence of EIC was comparable (P = .679). The localization of infections differed significantly due to PID type (P = .002). After each HSCT donor type, the most common site of infection was GI. Overall, BI caused by Gram-positive strains (59.1%) were prevalent, especially Staphylococcaceae. The multidrug-resistant (MDR) pathogens were diagnosed in 52.3%, especially ESBL + Enterobacteriaceae. The profile of VI was comparable for SCID and non-SCID patients (P = .839). The incidence of IFD was comparable for each PID and HSCT donor type. Survival after infection was 91.5% and was comparable for PID and HSCT donor type. CONCLUSIONS The rate of patients diagnosed with IC among pediatric PID-HSCT recipients did not depend on PID type, but rather on HSCT donor type. The localization of IC depended on PID and HSCT donor type. Within bacterial infections, predominated Gram-positive strains and the MDR pathogens were responsible for more than half of EIC.
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Affiliation(s)
- Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Jerzy R Kowalczyk
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Malgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Ewa Gorczyńska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Alicja Chybicka
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Mariusz Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Patrycja Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Jolanta Goździk
- Stem Cell Transplant Center, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, University Children's Hospital, Krakow, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Szmit Z, Gorczynska E, Król A, Ussowicz M, Mielcarek-Siedziuk M, Olejnik I, Panasiuk A, Kałwak K. Introduction of new pediatric EBMT criteria for VOD diagnosis: is it time-saving or money-wasting? : Prospective evaluation of pediatric EBMT criteria for VOD. Bone Marrow Transplant 2020; 55:2138-2146. [PMID: 32398785 DOI: 10.1038/s41409-020-0918-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022]
Abstract
Hepatic veno-occlusive disease (VOD) is a potentially fatal complication following hematopoietic stem cell transplantation (HSCT). We evaluated in prospective analysis the usefulness of the pediatric EBMT criteria for VOD diagnosis and their presumable impact on cost effectiveness and patients' outcome. Study included all 282 HSCT procedures performed in Department of Pediatric Hematology/Oncology and BMT in Wrocław between January 2016 and March 2019. Data were compared with previous VOD research conducted in our center before year 2016. Twenty-five (8.9%) patients (median age 3.5 years) were diagnosed with VOD. Duration of defibrotide (DF) administration varied from 4 to 34 days (median: 16.5), with 96% response rate. Overall survival was 88%. If applying Baltimore and modified Seattle criteria, VOD incidence was 2.13% and 5.7%, respectively. Median diagnosis delay based on modified Seattle criteria was 3 days. Before 2016, VOD incidence was 4.9%, with 74% DF response rate (p = 0.033) and 56.2% OS (p = 0.008). After implementing new criteria length of hospitalization for VOD patients decreased by median of 12 days (p = 0.009). Earlier VOD diagnosis, facilitated by EBMT criteria, resulting in implementing immediate treatment significantly improved patients' outcome. Furthermore, it allows shortening of DF administration and minimizes length of hospital stay.
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Affiliation(s)
- Zofia Szmit
- Department of Pediatric Hematology/Oncology and BMT, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław, Poland.
| | - Ewa Gorczynska
- Department of Pediatric Hematology/Oncology and BMT, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław, Poland
| | - Anna Król
- Department of Pediatric Hematology/Oncology and BMT, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław, Poland
| | - Marek Ussowicz
- Department of Pediatric Hematology/Oncology and BMT, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław, Poland
| | - Monika Mielcarek-Siedziuk
- Department of Pediatric Hematology/Oncology and BMT, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław, Poland
| | - Igor Olejnik
- Department of Pediatric Hematology/Oncology and BMT, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław, Poland
| | - Anna Panasiuk
- Department of Pediatric Hematology/Oncology and BMT, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Hematology/Oncology and BMT, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław, Poland
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Zając-Spychała O, Wachowiak J, Czyżewski K, Dziedzic M, Wysocki M, Zalas-Więcek P, Szmydki-Baran A, Hutnik Ł, Matysiak M, Małas Z, Badowska W, Gryniewicz-Kwiatkowska O, Gietka A, Dembowska-Bagińska B, Semczuk K, Dzierżanowska-Fangrat K, Bartnik M, Ociepa T, Urasiński T, Frączkiewicz J, Salamonowicz M, Kałwak K, Gorczyńska E, Chybicka A, Irga-Jaworska N, Bień E, Drożyńska E, Chełmecka-Wiktorczyk L, Balwierz W, Zak I, Pierlejewski F, Młynarski W, Urbanek-Dądela A, Karolczyk G, Stolpa W, Sobol-Milejska G, Płonowski M, Krawczuk-Rybak M, Musiał J, Chaber R, Gamrot-Pyka Z, Woszczyk M, Tomaszewska R, Szczepański T, Kowalczyk J, Styczyński J. Hematopoietic stem cell transplantation does not increase the risk of infection-related complications for pediatric patients with Hodgkin and non-Hodgkin lymphomas: A multicenter nationwide study. Transpl Infect Dis 2020; 22:e13292. [PMID: 32285579 DOI: 10.1111/tid.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 01/31/2020] [Accepted: 03/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hodgkin (HL) and non-Hodgkin lymphoma (NHL) represent a spectrum of lymphoid malignancies that are often curable with currently applied treatment regimens; however, 15%-30% of lymphoma patients still suffer from relapsed or refractory (rel/ref) disease. Although hematopoietic stem cell transplantation (HSCT) improves outcomes of second-line therapy for lymphoma in childhood, the complication rates in this group of patients, especially infectious complications (IC), remain unclear. OBJECTIVE The aim of this population-based cohort study was a retrospective analysis of incidence, epidemiology and profile of bacterial infections (BI), invasive fungal disease (IFD), and viral infections (VI) in primary or rel/ref lymphoma patients, both HL and NHL. PATIENTS AND METHODS We subdivided lymphoma patients into three groups: patients with primary conventional chemotherapy/radiotherapy regimens (group A), patients with rel/ref lymphoma treated with second-line chemotherapy (group B), and rel/ref lymphoma patients who underwent HSCT (group C). The medical records of the patients were biannually reported by each pediatric oncology center, and the data were analyzed centrally. RESULTS Within 637 patients with primary lymphoma, at least one IC was diagnosed in 255 (40.0%), among 52 patients with rel/ref lymphoma 24 (46.2%) ICs were observed, and in transplanted group, 28 (57.1%) out of 49 children were diagnosed with IC (P = .151). The distribution of etiology of IC differed between the patient groups (A, B, C), with a predominance of BI in group A (85.6% vs 72.0% and 47.9%, respectively), VI in group C (9% and 16.0% vs 46.6%, respectively), and IFD in group B (5.4% vs 12.0% vs 5.5%, respectively). Overall, 500 (68.0%) episodes of bacterial IC were diagnosed in the entire group. Apart from HL patients treated with chemotherapy, in all the other subgroups of patients Gram-positives were predominant. The rate of multidrug-resistant bacteria was high, especially for Gram-negatives (41.1% in group A, 62.5% in group B, and 84.6% in group C). The infection-related mortality was comparable for each group. CONCLUSIONS The incidence of IC was comparable during first- and second-line chemotherapy and after HSCT, but their profile was different for primary or re/ref lymphoma and depended on the type of therapy.
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Affiliation(s)
- O Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - J Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - K Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - P Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - A Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Ł Hutnik
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - M Matysiak
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Z Małas
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - W Badowska
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | | | - A Gietka
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - K Semczuk
- Department of Microbiology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - M Bartnik
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - T Ociepa
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - T Urasiński
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - J Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - M Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - K Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - E Gorczyńska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - A Chybicka
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - N Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - E Bień
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - E Drożyńska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - L Chełmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology, Collegium Medicum, University Children's Hospital, Jagiellonian University, Krakow, Poland
| | - W Balwierz
- Department of Pediatric Oncology and Hematology, Collegium Medicum, University Children's Hospital, Jagiellonian University, Krakow, Poland
| | - I Zak
- Department of Microbiology, Collegium Medicum, University Children's Hospital, Jagiellonian University, Krakow, Poland
| | - F Pierlejewski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | - W Młynarski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | - A Urbanek-Dądela
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Poland
| | - G Karolczyk
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Poland
| | - W Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - G Sobol-Milejska
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - M Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - M Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - J Musiał
- Department of Pediatric Oncohematology, Children Hospital, Rzeszow, Poland
| | - R Chaber
- Department of Pediatric Oncohematology, Children Hospital, Rzeszow, Poland
| | - Z Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - M Woszczyk
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - R Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - T Szczepański
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - J Kowalczyk
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - J Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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Szmit Z, Gorczyńska E, Mielcarek-Siedziuk M, Ussowicz M, Owoc-Lempach J, Kałwak K. Veno-occlusive disease in children and adolescents after hematopoietic stem cell transplantation: Did the Modified Seattle Criteria fit the characteristics of pediatric population? ADV CLIN EXP MED 2020; 29:339-344. [PMID: 32207590 DOI: 10.17219/acem/115070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hepatic veno-occlusive disease (VOD) is a life-threatening complication following hematopoietic stem cell transplantation (HSCT) and associated with a high mortality rate. Therefore, accurate and immediate diagnosis is crucial for implementing appropriate treatment. OBJECTIVES In our single-center retrospective study, we assessed the accuracy of the Modified Seattle Criteria in children and adolescents undergoing HSCT, and compared them to the diagnostic criteria recently established by the European Society for Blood and Marrow Transplantation (EBMT). MATERIAL AND METHODS Retrospective analysis of medical records of 951 HSCT procedures performed in 850 children and young adults in the years 2001-2015 in the Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation of Wroclaw Medical University Supraregional Center of Pediatric Oncology "Cape of Hope" in Wrocław, Poland. RESULTS Among the 850 children, 48 were diagnosed with VOD according to the Modified Seattle Criteria (5.05%). Thirteen patients (27%) developed VOD later than within 20 days after transplantation, as required in the diagnostic criteria. Five of the 6 patients who died from VOD were diagnosed with late-onset VOD. Using the categories of symptoms described in the Modified Seattle Criteria, hepatomegaly and weight gain were the most common symptoms in the analyzed cohort (81.25% and 68.75%). Fourteen patients (29%) never demonstrated elevated plasma bilirubin level (>2 mg/dL), as suggested in the Modified Seattle Criteria. Twenty-nine patients (64%) had increased platelet consumption requiring daily transfusions. Only 5 patients with decreased plasma antithrombin III (ATIII) activity level (<80%) on the day of HSCT developed VOD despite supplementation of ATIII. CONCLUSIONS The Modified Seattle Criteria seemed to not meet the special needs of the pediatric population. The new diagnostic criteria proposed by the EBMT appear to be more adequately tailored to the pediatric population and may significantly change the conception of VOD in the future. The surprisingly low incidence of VOD in our cohort may suggest a beneficial role of monitoring and early supplementation of ATIII.
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Affiliation(s)
- Zofia Szmit
- Department of Pediatric Hematology/Oncology and Bone Marrow Transplantation, Wroclaw Medical University Supraregional Center of Pediatric Oncology "Cape of Hope", Poland
| | - Ewa Gorczyńska
- Department of Pediatric Hematology/Oncology and Bone Marrow Transplantation, Wroclaw Medical University Supraregional Center of Pediatric Oncology "Cape of Hope", Poland
| | - Monika Mielcarek-Siedziuk
- Department of Pediatric Hematology/Oncology and Bone Marrow Transplantation, Wroclaw Medical University Supraregional Center of Pediatric Oncology "Cape of Hope", Poland
| | - Marek Ussowicz
- Department of Pediatric Hematology/Oncology and Bone Marrow Transplantation, Wroclaw Medical University Supraregional Center of Pediatric Oncology "Cape of Hope", Poland
| | - Joanna Owoc-Lempach
- Department of Pediatric Hematology/Oncology and Bone Marrow Transplantation, Wroclaw Medical University Supraregional Center of Pediatric Oncology "Cape of Hope", Poland
| | - Krzysztof Kałwak
- Department of Pediatric Hematology/Oncology and Bone Marrow Transplantation, Wroclaw Medical University Supraregional Center of Pediatric Oncology "Cape of Hope", Poland
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Zaucha-Prażmo A, Zawitkowska J, Lejman M, Kowalczyk JR, Czyżewski K, Dziedzic M, Pieczonka A, Zając-Spychała O, Goździk J, Frączkiewicz J, Salamonowicz M, Gorczyńska E, Kałwak K, Wachowiak J, Styczyński J. Infection profile in children and adolescents with bone marrow failures treated with allogeneic hematopoietic stem cell transplantation. Pediatr Transplant 2019; 23:e13592. [PMID: 31587440 DOI: 10.1111/petr.13592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/11/2019] [Revised: 08/18/2019] [Accepted: 09/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The objective of the study was to analyze the profile of infections in children with BMF following alloHCT. METHODS Data of 169 consecutive children with inherited and acquired BMF treated with alloHCT between 2012 and 2017 in Polish pediatric transplant departments were analyzed in registry-based retrospective study, with respect to the type of infection, and clinical outcome. RESULTS At least 1 infection was diagnosed in 107/169 patients (60.4%). In total, 182 infections were diagnosed. The most common were VI (96; 52.7%), followed by BI (71; 39.0%), and FI (15; 8.2%), P < .001. The most common etiological factors of VI were as follows: CMV (38.5%), EBV (22.9%), and BK virus (24%); while of BI were as follows: Staphylococcus spp. (17; 23.9%), Enterococcus faecium (10; 14.1%), and Klebsiella pneumoniae (9; 12.7%). No difference was found between the occurrence of infections with respect to donor type, graft source, and conditioning type. GvHD had no impact on the incidence of VI, BI, and FI. Fifteen FI were diagnosed in 12 patients, of which 14 FI were diagnosed in children transplanted for FA. Of total 107 children, 9 died (8.4%), of which 4 (3.7%) due to infections: bacterial sepsis (2) and invasive FI (2). CONCLUSION Infections in children with BMF following alloHCT remain an important cause of morbidity. Children with FA had high incidence of FI. In our analysis, aGvHD had no impact on the occurrence on infections, although the study was not strong enough to prove such a difference.
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Affiliation(s)
- Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, University Children Hospital, Lublin, Poland
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, University Children Hospital, Lublin, Poland
| | - Monika Lejman
- Department of Pediatric Hematology, Oncology and Transplantology, Laboratory of Genetic Diagnostics, Medical University of Lublin, University Children Hospital, Lublin, Poland
| | - Jerzy R Kowalczyk
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, University Children Hospital, Lublin, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Anna Pieczonka
- Department of Pediatric Oncology, Hematology and Transplantology, Medical University, Poznań, Poland
| | - Olga Zając-Spychała
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Poznań, Poland
| | - Jolanta Goździk
- Department of Transplantation Children's University Hospital, Clinical Immunology and Transplantation Polish-American Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Transplantology, Hematology and Oncology, Medical University, Wrocław, Poland
| | - Małgorzata Salamonowicz
- Department of Pediatric Transplantology, Hematology and Oncology, Medical University, Wrocław, Poland
| | - Ewa Gorczyńska
- Department of Pediatric Transplantology, Hematology and Oncology, Medical University, Wrocław, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Transplantology, Hematology and Oncology, Medical University, Wrocław, Poland
| | - Jacek Wachowiak
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Poznań, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Sienkiewicz-Oleszkiewicz B, Urbańczyk K, Stachowiak M, Rodziewicz A, Zięba A, Kałwak K, Wiela-Hojeńska A. Factors Influencing the Safety and Efficiency of Antifungal Prophylaxis with Posaconazole in Children with Hematological Diseases: From Genetics to Polypharmacotherapy. Indian J Hematol Blood Transfus 2019; 35:699-706. [PMID: 31741622 PMCID: PMC6825114 DOI: 10.1007/s12288-019-01134-5] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 05/06/2019] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to determine the impact of ABCB1 polymorphism, BMI, age and drug co-administration on safety and efficiency of posaconazole (PCZ) oral suspension treatment in children with hematological diseases. Seventy children were included in the study. ABCB1 polymorphism in fifty-eight children was determined using a PCR–RFLP method. A protocol with data on the health condition, treatment and adverse events (AE), as well as a survey on treatment tolerance for the legal guardians was evaluated. Liver function tests were observed for the first 20 days, and AE during the complete medication period. For statistical analysis a χ2 test with Yates’s correction, a Pearson’s or Spearman’s correlation test was performed (p < 0.05). Genetic testing showed 24% CC, 46% CT and 30% of TT variants. PCZ prophylaxis failed in twenty cases, where change in prophylactic treatment was needed. Fifty-two children suffered from at least one mild to moderate adverse event. Sixty-five legal guardians completed the survey, most of them reported the treatment to be well tolerated. ABCB1 polymorphism had no impact on AE occurrence and posaconazole prophylaxis efficiency. Age influenced the number of gastrointestinal (p = 0.02), visual (p = 0.05), neurological (p = 0.01), dermatological (p = 0.002) and flu-like (p = 0.02) complications. AST (p = 0.03) and LDH (p = 0.008) activity presented age dependency. The concomitant use of proton pump inhibitors (PPI) had impact on liver health parameters elevation (p = 0.009) and circulatory system complications (p = 0.008). High incidence of mild to moderate AE, and other factors influencing PCZ pharmacokinetics (PPI co-administration, obesity), suggest a need for careful pediatric onco-hematology patient evaluation.
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Affiliation(s)
- Beata Sienkiewicz-Oleszkiewicz
- 1Department of Clinical Pharmacology, Faculty of Pharmacy, Wrocław Medical University, 211a Borowska St., 50-556 Wrocław, Poland
| | - Kamila Urbańczyk
- 1Department of Clinical Pharmacology, Faculty of Pharmacy, Wrocław Medical University, 211a Borowska St., 50-556 Wrocław, Poland
| | - Mateusz Stachowiak
- 2Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, 213 Borowska St., 50-556 Wrocław, Poland
| | - Anna Rodziewicz
- 2Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, 213 Borowska St., 50-556 Wrocław, Poland
| | - Aleksander Zięba
- 1Department of Clinical Pharmacology, Faculty of Pharmacy, Wrocław Medical University, 211a Borowska St., 50-556 Wrocław, Poland
| | - Krzysztof Kałwak
- 2Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, 213 Borowska St., 50-556 Wrocław, Poland
| | - Anna Wiela-Hojeńska
- 1Department of Clinical Pharmacology, Faculty of Pharmacy, Wrocław Medical University, 211a Borowska St., 50-556 Wrocław, Poland
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Martuszewski A, Paluszkiewicz P, Wawrzyniak-Dzierżek E, Drożyńska-Duklas M, Bąbol-Pokora K, Myśliwiec M, Szymczak D, Irga-Jaworska N, Młynarski W, Kałwak K, Ussowicz M. Successful Salvage Haploidentical Alpha-Beta T Cell-Depleted Stem Cell Transplantation After Busulfan-Based Myeloablation in a Patient With IPEX Syndrome: A Case Report. Transplant Proc 2019; 51:3150-3154. [PMID: 31611124 DOI: 10.1016/j.transproceed.2019.07.007] [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: 06/30/2019] [Accepted: 07/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND X-linked immunodysregulation syndrome with polyendocrinopathy and enteropathy (IPEX) is caused by FOXP3 gene mutations that block the generation of regulatory T lymphocytes. We report an 18-month-old boy with classic IPEX who underwent 2 hematopoietic stem cell transplantations (HSCTs). METHODS The first HSCT from an unrelated 8/10 HLA-matched umbilical cord blood donor (UCB) was performed after a conditioning regimen consisting of treosulfan, fludarabine, thiotepa, and thymoglobulin. Due to complete rejection of the UCB transplant, a second transplantation from a 6/10 HLA-matched mother was performed after alpha-beta T-cell depletion. The second conditioning regimen consisted of busulfan, fludarabine, a single dose of cyclophosphamide 1 g/m2, and Grafalon (Neovii Pharmaceuticals, Rapperswil, Switzerland). The T-cell depletion product contained 15.06 x 106 CD34+ cells per kilogram body weight (BW) and 4.19 x 105 alpha-beta T lymphocytes per kilogram BW. Due to acute graft rejection, the boy was treated with thymoglobulin, and full donor chimerism in both T lymphocytes and mononuclear cells was achieved. The immunosuppressive therapy was stopped 1 year after transplantation. To date, the patient remains free from graft-vs-host disease (GVHD) and immunosuppression. CONCLUSIONS HSCT after busulfan-based reduced-toxicity conditioning in patients with IPEX syndrome is feasible and well tolerated and can result in full donor engraftment. Monitoring of chimerism and aggressive therapy in cases of graft rejection are warranted due to the high reactivity of residual autologous T lymphocytes. T-cell depletion reduces the risk of GVHD and the need for steroid therapy, which is especially challenging in patients with diabetes.
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Affiliation(s)
- Adrian Martuszewski
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, Wrocław, Poland
| | - Patrycja Paluszkiewicz
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, Wrocław, Poland
| | - Elżbieta Wawrzyniak-Dzierżek
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, Wrocław, Poland
| | | | - Katarzyna Bąbol-Pokora
- Laboratory of Immunopathology and Genetics, Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Małgorzata Myśliwiec
- Department of Paediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, Gdańsk, Poland
| | - Donata Szymczak
- Department and Clinic of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
| | - Ninela Irga-Jaworska
- Department of Paediatrics, Haematology and Oncology, Medical University of Gdańsk, Gdańsk, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Krzysztof Kałwak
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, Wrocław, Poland
| | - Marek Ussowicz
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, Wrocław, Poland.
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Janeczko-Czarnecka M, Kałwak K, Ussowicz M. Familial Celiac Disease Remission as a Result of a Full Donor Immunologic Recovery After Sibling Cord Blood Transplantation for Chronic Granulomatous Disease: A Case Report. Transplant Proc 2019; 51:3155-3158. [PMID: 31611125 DOI: 10.1016/j.transproceed.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/25/2019] [Accepted: 06/24/2019] [Indexed: 10/25/2022]
Abstract
We present a case report of a boy diagnosed with both chronic granulomatous disease (CGD) and familial celiac disease (CD) who underwent cord blood transplantation from a partially matched sibling donor. The presentation of CD resembled Crohn-like enteropathy, which is a canonical manifestation of CGD. Nearly 1 year post-hematopoietic stem cell transplantation (HSCT), a gluten-containing diet was reintroduced, and no reappearance of clinical, serologic, or histologic markers of CD was observed. The relatively high incidence of rare genetic diseases in pediatric patients suggests the need for additional caution in the interpretation of symptoms mimicking already known hallmarks of more common conditions. In addition, the presented data confirm the previous rare observations that allogeneic HSCT leads to durable induction of gluten tolerance in patients with CD, which can warrant its use in patients with refractory subtypes of CD.
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Affiliation(s)
| | - Krzysztof Kałwak
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Poland
| | - Marek Ussowicz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Poland
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40
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Zając-Spychała O, Wachowiak J, Frączkiewicz J, Salamonowicz M, Kałwak K, Gorczyńska E, Chybicka A, Czyżewski K, Dziedzic M, Wysocki M, Zalas-Wiącek P, Zaucha-Prażmo A, Kowalczyk JR, Goździk J, Styczyński J. Multidrug-resistant bacterial infections in children undergoing haematopoietic stem cell transplantation over a 6-year period: analysis of the Polish Pediatric Group for Hematopoietic Stem Cell Transplantation. J Appl Microbiol 2019; 128:292-300. [PMID: 31529556 DOI: 10.1111/jam.14452] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 12/31/2022]
Abstract
AIMS Multidrug-resistant (MDR) bacteria are an emerging cause of morbidity and mortality after haematopoietic stem cell transplantation (HSCT). The aim of the study was to analyse the incidence, clinical characteristics and survival from bacterial infections (BI) caused by MDR pathogens in paediatric HSCT recipients. METHODS AND RESULTS Among 971 transplanted patients, BI were found in 416 children between the years 2012 and 2017. Overall, there were 883 bacterial episodes, which includes 85·8% after allo-HSCT and 14·2% after auto-HSCT. MDR strains were responsible for half of the total number of bacterial episodes. Over 50% of MDR pathogens were Enterobacteriaceae causing mainly gut infections or urinary tract infections. CONCLUSIONS Regarding HSCT type, we did not find differences in the profile of MDR BI between allo- and auto-HSCT recipients. However, survival in MDR and non-MDR infections was comparable. SIGNIFICANCE AND IMPACT OF THE STUDY The large sample size enables unique analysis and makes our data more applicable to other paediatric HSCT centres. In the absence of local epidemiological data, presented clinical characteristics of MDR-caused infections may be used to optimize the prophylactic strategies, early identification of infectious complications of MDR aetiology and thus promptly initiate adequate antibiotic therapy and further improve patients' outcome.
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Affiliation(s)
- O Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - J Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - J Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - M Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - K Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - E Gorczyńska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - A Chybicka
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - K Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - M Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - M Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - P Zalas-Wiącek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - A Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - J R Kowalczyk
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - J Goździk
- Stem Cell Transplant Center, University Children's Hospital Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - J Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Czyżewski K, Styczyński J, Giebel S, Frączkiewicz J, Salamonowicz M, Zając-Spychala O, Zaucha-Prażmo A, Drozd-Sokołowska J, Waszczuk-Gajda A, Dybko J, Mańko J, Zalas-Więcek P, Gałązka P, Wysocki M, Kowalczyk J, Wachowiak J, Goździk J, Basak GW, Kałwak K, Adamska M, Hus M, Piekarska A, Sadowska-Klasa A, Mensah-Glanowska P, Kyrcz-Krzemień S, Biernat M, Wierzbowska A, Rzepecki P, Tomaszewska A, Hałaburda K, Gil L. Age-dependent determinants of infectious complications profile in children and adults after hematopoietic cell transplantation: lesson from the nationwide study. Ann Hematol 2019; 98:2197-2211. [PMID: 31321454 PMCID: PMC6700048 DOI: 10.1007/s00277-019-03755-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 04/06/2019] [Accepted: 07/02/2019] [Indexed: 12/16/2022]
Abstract
Incidence and outcome of microbiologically documented bacterial/viral infections and invasive fungal disease (IFD) in children and adults after hematopoietic cell transplantation (HCT) were compared in 650 children and 3200 adults in multicenter cross-sectional nationwide study. Infections were diagnosed in 60.8% children and 35.0% adults, including respectively 69.1% and 63.5% allo-HCT, and 33.1% and 20.8% auto-HCT patients. The incidence of bacterial infections was higher in children (36.0% vs 27.6%; p < 0.0001). Infections with Gram-negative bacteria were more frequent than Gram-positives in adults (64.6% vs 44.8%; p < 0.0001). Outcome of bacterial infections was better in children (95.5% vs 91.4%; p = 0.0011). The IFD incidence (25.3% vs 6.3%; p < 0.0001) and outcome (88.0% vs 74.9%; p < 0.0001) were higher in children. The incidence of viral infections was higher in children after allo-HCT (56.3% vs 29.3%; p < 0.0001), and auto-HCT (6.6% vs 0.8%; p < 0.0001). Outcome of viral infections was better in children (98.6% vs 92.3%; p = 0.0096). Infection-related mortality was 7.8% in children and 18.4% in adults (p < 0.0001). No child after auto-HCT died of infection. Adult age, mismatched transplants, acute leukemia, chronic GVHD, CMV reactivation, infection with Gram-negatives, and duration of infection > 21 days were risk factors for death from infection. In conclusion, pediatric patients have 2.9-fold higher incidence and 2.5-fold better outcome of infections than adults after HCT.
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Affiliation(s)
- Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, ul. Sklodowskiej-Curie 9, 85-094, Bydgoszcz, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, ul. Sklodowskiej-Curie 9, 85-094, Bydgoszcz, Poland.
| | - Sebastian Giebel
- Department of Hematology, Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Transplantology, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Małgorzata Salamonowicz
- Department of Pediatric Transplantology, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Olga Zając-Spychala
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Poznan, Poland
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Lublin, Poland
| | | | | | - Jarosław Dybko
- Department of Hematology, Medical University, Wroclaw, Poland
- Department and Clinic of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Medical University, Wroclaw, Poland
| | - Joanna Mańko
- Department of Hematology, Medical University, Lublin, Poland
| | - Patrycja Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Przemysław Gałązka
- Department of Pediatric Surgery, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Mariusz Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, ul. Sklodowskiej-Curie 9, 85-094, Bydgoszcz, Poland
| | - Jerzy Kowalczyk
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Lublin, Poland
| | - Jacek Wachowiak
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Poznan, Poland
| | - Jolanta Goździk
- Department of Pediatric Transplantology, Clinical Immunology and Transplantology, Collegium Medicum, Jagiellonian University, Krakow, Poland
| | | | - Krzysztof Kałwak
- Department of Pediatric Transplantology, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Monika Adamska
- Department of Hematology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Hus
- Department of Hematology, Medical University, Lublin, Poland
| | | | | | | | | | - Monika Biernat
- Department of Hematology, Medical University, Wroclaw, Poland
| | | | - Piotr Rzepecki
- Department of Hematology, Military Institute of Medicine, Warsaw, Poland
| | - Agnieszka Tomaszewska
- Department of Hematology, Medical University, Warsaw, Poland
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Kazimierz Hałaburda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Lidia Gil
- Department of Hematology, Poznan University of Medical Sciences, Poznan, Poland
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Szmit Z, Kałwak K, Król A, Mielcarek-Siedziuk M, Salamonowicz M, Frączkiewicz J, Ussowicz M, Owoc-Lempach J, Gorczyńska E. Premature cyclosporine cessation and TBI-containing conditioning regimen increase the risk of acute GvHD in children undergoing unrelated donor hematopoietic stem cell transplantation. ADV CLIN EXP MED 2019; 28:1185-1192. [PMID: 31430073 DOI: 10.17219/acem/103069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/24/2022]
Abstract
BACKGROUND Acute graft-versus-host disease (aGvHD) is a potentially fatal complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Identifying its risk factors would enable the proper prophylaxis and management, which may significantly improve the general outcome of children treated with HSCT. OBJECTIVES The aim of this single-center, retrospective cohort study was to assess the potential risk factors for grades II-IV of aGvHD in children after the 1st allo-HSCT from an unrelated donor (UD), performed as a result of an underlying malignant disease. MATERIAL AND METHODS From among patients who received HSCT in our center in the years 2004-2015, 237 were included in the study cohort. All the patients received standard aGvHD prophylaxis consisting of cyclosporine (CsA) and a short course of methotrexate (MTX). Various clinical and epidemiological features, the transplant proceedings, graft composition, conditioning regimens, as well as the duration and coherence of aGvHD prophylaxis were analyzed as potential risk factors for aGvHD. RESULTS The incidence of II-IV aGvHD in the study cohort was 58.6%. The median time of the diagnosis of aGvHD was 18 days post-HSCT. In the multivariate analysis, risk factors significantly associated with grades II-IV of aGvHD were: myeloablative conditioning regimen containing total body irradiation (TBI-MAC) (RR (relative risk): 1.69; p = 0.03), premature termination of CsA administration due to its toxicity (RR: 1.99; p = 0.0003) and HSCT performed before the year 2009 (RR: 1.97; p = 0.0001). Donor and recipient age, donor-recipient sex mismatch, stem cell source, risk of disease, and amount of infused CD34+ cells seem to be insignificant as risk factors for aGvHD. The overall survival (OS) of patients with aGvHD was noticeably worse that in those who were aGvHD-free: 60.8% vs 74.1% (p = 0.08). CONCLUSIONS The conditioning regimen and the proper aGvHD prophylaxis, including continuous CsA administration, have a major impact on aGvHD occurrence. According to our results, the termination of CsA therapy should be carefully considered, and avoided if possible.
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Affiliation(s)
- Zofia Szmit
- Department and Clinic of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope"
| | - Krzysztof Kałwak
- Department and Clinic of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope"
| | - Anna Król
- Department and Clinic of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope"
| | - Monika Mielcarek-Siedziuk
- Department and Clinic of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope"
| | - Małgorzata Salamonowicz
- Department and Clinic of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope"
| | - Jowita Frączkiewicz
- Department and Clinic of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope"
| | - Marek Ussowicz
- Department and Clinic of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope"
| | - Joanna Owoc-Lempach
- Department and Clinic of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope"
| | - Ewa Gorczyńska
- Department and Clinic of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Supraregional Center of Pediatric Oncology "Cape of Hope"
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Wawrzyniak-Dzierżek E, Gajek K, Ślęzak A, Rybka B, Ryczan-Krawczyk R, Gorczyńska E, Kałwak K, Ussowicz M. Pediatric unmanipulated haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide and reduced intensity, TBI-free conditioning regimens in salvage transplantations. ADV CLIN EXP MED 2019; 28:1223-1228. [PMID: 31430069 DOI: 10.17219/acem/104688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 11/24/2022]
Abstract
BACKGROUND Unmanipulated haploidentical stem cell transplantation (haploSCT) with post-transplant cyclophosphamide is an option for patients with advanced hematologic malignancies. It offers a platform both for non-major histocompatibility complex-restricted alloimmunity due to killer-like immunoglobulin receptor (KIR)-mediated mechanisms of natural killer lymphocyte regulation and for classical T-cell mediated antileukemic effects. OBJECTIVES The devastating long-term sequelae after total body irradiation (TBI) in children are encouraging omission of irradiation techniques in pediatric stem cell transplantations (SCT). MATERIAL AND METHODS Five children, 4 with acute leukemia and 1 with hemophagocytic lymphohistiocytosis, aged from 1 to 10 years, underwent haploSCT with post-transplantation cyclophosphamide. In all children, the conditioning regimen consisted of chemotherapy without TBI. The graft material was bone marrow (BM) in 4 cases and peripheral blood stem cells in 1 case. Three out of 5 leukemic patients showed better KIR haplotype associated with augmented alloreactivity. RESULTS Engraftment with complete donor chimerism was achieved in 4 patients, and 1 recipient died before leukocyte recovery. Three patients developed skin acute graft-versus-host-disease (aGvHD), 1 gut aGvHD and 1 liver aGvHD. In 2 recipients, chronic graft-versus-host-disease (cGvHD) was observed (1 limited and 1 extensive). The 4 engrafted patients were alive and in complete remission 3, 9, 32, and 36 months after transplantation. A T-cell count of 200 cells/uL was reached 90 days after haploSCT in all patients. CONCLUSIONS HaploSCT with TBI-free protocols can be a viable option for heavily pretreated patients with advanced malignancies.
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Affiliation(s)
- Elżbieta Wawrzyniak-Dzierżek
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Poland
| | - Kornelia Gajek
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Poland
| | - Aleksandra Ślęzak
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Poland
| | - Blanka Rybka
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Poland
| | - Renata Ryczan-Krawczyk
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Poland
| | - Ewa Gorczyńska
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Poland
| | - Marek Ussowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Poland
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Augustynowicz M, Bargenda-Lange A, Kałwak K, Zwolińska D, Musiał K. Markers of acute kidney injury in children undergoing hematopoietic stem cell transplantation. ADV CLIN EXP MED 2019; 28:1111-1118. [PMID: 30740947 DOI: 10.17219/acem/101573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 11/24/2022]
Abstract
Acute kidney injury (AKI), one of the major complications in children undergoing hematopoietic stem cell transplantation (HSCT), is an independent predictor of the patient's survival and a prognostic factor of progression to chronic kidney disease (CKD). Despite the multifaceted role of AKI, its early diagnosis in the course of HSCT remains a challenge. These difficulties may result from the inefficiency of traditional methods used to assess kidney function, like serum creatinine or estimated glomerular filtration rate. Moreover, the list of potential AKI markers tested in HSCT conditions is limited and does not involve indexes evaluated in the pediatric population. This review summarizes current knowledge on the pathophysiology of AKI developing in the course of HSCT; presents well-known markers of AKI that are potentially applicable in children who have undergone HSCT; discusses the role of new markers in diagnosing AKI and predicting the renal outcome in children undergoing HSCT; and analyzes the prospects for the use of new tools for assessing kidney injury in everyday clinical practice.
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Affiliation(s)
| | | | - Krzysztof Kałwak
- Department of Bone Marrow Transplantation, Oncology and Pediatric Hematology, Wroclaw Medical University, Poland
| | - Danuta Zwolińska
- Department of Pediatric Nephrology, Wroclaw Medical University, Poland
| | - Kinga Musiał
- Department of Pediatric Nephrology, Wroclaw Medical University, Poland
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Wawrzyniak-Dzierżek E, Gajek K, Rybka B, Ryczan-Krawczyk R, Węcławek-Tompol J, Raciborska A, Mielcarek-Siedziuk M, Frączkiewicz J, Salamonowicz M, Kałwak K, Rosa M, Ślęzak A, Ussowicz M. Feasibility and Safety of Treosulfan, Melphalan, and Thiotepa-Based Megachemotherapy with Autologous or Allogeneic Stem Cell Transplantation in Heavily Pretreated Children with Relapsed or Refractory Neuroblastoma. Biol Blood Marrow Transplant 2019; 25:1792-1797. [PMID: 31085306 DOI: 10.1016/j.bbmt.2019.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 12/22/2022]
Abstract
The prognosis of resistant or relapsing children with neuroblastoma remains very poor, and the search for new therapies is ongoing. In this analysis, we assessed the toxicity of a treosulfan, melphalan, and thiotepa (TMT) regimen in 17 children with recurrent or refractory neuroblastoma who underwent stem cell transplantation (SCT). For allogeneic SCT, fludarabine and antithymocyte globulin were added. The stem cell source was autologous in 8 patients, haploidentical in 8 patients, and a matched unrelated donor in 1 patient. The reported nonhematologic toxicities included grade 3 mucositis, grade 1 to 3 hypertransaminasemia, and in 3 patients, veno-occlusive disease. No neurologic, cardiac, or dermatologic toxicities were observed. The probability of overall survival (OS) in patients with primary resistance was superior to that in patients with relapsed disease (100% versus 22.6%; P = .046). Post-transplantation dinutuximab beta immunotherapy was associated with superior 5-year OS (66.7% versus 11.4%; P = .0007). The use of an allogeneic donor, previous autologous SCT with busulfan and melphalan, and pretreatment with high-dose metaiodobenzylguanidine therapy demonstrated no effect on outcomes. In 4 patients, TMT megatherapy alone was enough to achieve complete remission. The TMT conditioning regimen was well tolerated in heavily pretreated patients with neuroblastoma. The manageable toxicity and addition of new anticancer drugs with optional post-SCT immunotherapy or chemotherapy support further trials with the TMT regimen in patients with neuroblastoma.
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Affiliation(s)
- Elżbieta Wawrzyniak-Dzierżek
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Kornelia Gajek
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Blanka Rybka
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Renata Ryczan-Krawczyk
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Jadwiga Węcławek-Tompol
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Raciborska
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| | - Monika Mielcarek-Siedziuk
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Małgorzata Salamonowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Rosa
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Aleksandra Ślęzak
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Ussowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland.
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Dawidowska M, Jaksik R, Drobna M, Szarzyńska-Zawadzka B, Kosmalska M, Sędek Ł, Machowska L, Lalik A, Lejman M, Ussowicz M, Kałwak K, Kowalczyk JR, Szczepański T, Witt M. Comprehensive Investigation of miRNome Identifies Novel Candidate miRNA-mRNA Interactions Implicated in T-Cell Acute Lymphoblastic Leukemia. Neoplasia 2019; 21:294-310. [PMID: 30763910 PMCID: PMC6372882 DOI: 10.1016/j.neo.2019.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Received: 11/14/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 02/08/2023] Open
Abstract
T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy originating from T-cell precursors. The genetic landscape of T-ALL has been largely characterized by next-generation sequencing. Yet, the transcriptome of miRNAs (miRNome) of T-ALL has been less extensively studied. Using small RNA sequencing, we characterized the miRNome of 34 pediatric T-ALL samples, including the expression of isomiRs and the identification of candidate novel miRNAs (not previously annotated in miRBase). For the first time, we show that immunophenotypic subtypes of T-ALL present different miRNA expression profiles. To extend miRNome characteristics in T-ALL (to 82 T-ALL cases), we combined our small RNA-seq results with data available in Gene Expression Omnibus. We report on miRNAs most abundantly expressed in pediatric T-ALL and miRNAs differentially expressed in T-ALL versus normal mature T-lymphocytes and thymocytes, representing candidate oncogenic and tumor suppressor miRNAs. Using eight target prediction algorithms and pathway enrichment analysis, we identified differentially expressed miRNAs and their predicted targets implicated in processes (defined in Gene Ontology and Kyoto Encyclopedia of Genes and Genomes) of potential importance in pathogenesis of T-ALL, including interleukin-6-mediated signaling, mTOR signaling, and regulation of apoptosis. We finally focused on hsa-mir-106a-363 cluster and functionally validated direct interactions of hsa-miR-20b-5p and hsa-miR-363-3p with 3' untranslated regions of their predicted targets (PTEN, SOS1, LATS2), overrepresented in regulation of apoptosis. hsa-mir-106a-363 is a paralogue of prototypic oncogenic hsa-mir-17-92 cluster with yet unestablished role in the pathogenesis of T-ALL. Our study provides a firm basis and data resource for functional analyses on the role of miRNA-mRNA interactions in T-ALL.
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Affiliation(s)
- Małgorzata Dawidowska
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszyńska 32, 60-479 Poznań, Poland.
| | - Roman Jaksik
- Silesian University of Technology, Akademicka 16, 44-100 Gliwice, Poland.
| | - Monika Drobna
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszyńska 32, 60-479 Poznań, Poland.
| | - Bronisława Szarzyńska-Zawadzka
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszyńska 32, 60-479 Poznań, Poland; Institute of Human Genetics, Polish Academy of Sciences, Strzeszyńska 32, 60-479 Poznań, Poland.
| | - Maria Kosmalska
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszyńska 32, 60-479 Poznań, Poland.
| | - Łukasz Sędek
- Department of Microbiology and Immunology, Medical University of Silesia in Katowice, Jordana 19, 41-808 Zabrze, Poland.
| | - Ludomiła Machowska
- Clinic of Pediatric Oncology Hematology and Transplantology, Poznań University of Medical Sciences, Szpitalna 27/33, 60-572 Poznań, Poland.
| | - Anna Lalik
- Silesian University of Technology, Akademicka 16, 44-100 Gliwice, Poland.
| | - Monika Lejman
- Laboratory of Genetic Diagnostics, Medical University of Lublin, Children's University Hospital, Gębali 6, 20-093 Lublin, Poland.
| | - Marek Ussowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
| | - Jerzy R Kowalczyk
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Gębali 6, 20-093 Lublin, Poland.
| | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia in Katowice, 3 Maja 13-15, 41-800 Zabrze, Poland.
| | - Michał Witt
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszyńska 32, 60-479 Poznań, Poland.
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Ferrua F, Galimberti S, Courteille V, Slatter MA, Booth C, Moshous D, Neven B, Blanche S, Cavazzana M, Laberko A, Shcherbina A, Balashov D, Soncini E, Porta F, Al-Mousa H, Al-Saud B, Al-Dhekri H, Arnaout R, Formankova R, Bertrand Y, Lange A, Smart J, Wolska-Kusnierz B, Aquino VM, Dvorak CC, Fasth A, Fouyssac F, Heilmann C, Hoenig M, Schuetz C, Kelečić J, Bredius RGM, Lankester AC, Lindemans CA, Suarez F, Sullivan KE, Albert MH, Kałwak K, Barlogis V, Bhatia M, Bordon V, Czogala W, Alonso L, Dogu F, Gozdzik J, Ikinciogullari A, Kriván G, Ljungman P, Meyts I, Mustillo P, Smith AR, Speckmann C, Sundin M, Keogh SJ, Shaw PJ, Boelens JJ, Schulz AS, Sedlacek P, Veys P, Mahlaoui N, Janda A, Davies EG, Fischer A, Cowan MJ, Gennery AR. Hematopoietic stem cell transplantation for CD40 ligand deficiency: Results from an EBMT/ESID-IEWP-SCETIDE-PIDTC study. J Allergy Clin Immunol 2019; 143:2238-2253. [PMID: 30660643 DOI: 10.1016/j.jaci.2018.12.1010] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND CD40 ligand (CD40L) deficiency, an X-linked primary immunodeficiency, causes recurrent sinopulmonary, Pneumocystis and Cryptosporidium species infections. Long-term survival with supportive therapy is poor. Currently, the only curative treatment is hematopoietic stem cell transplantation (HSCT). OBJECTIVE We performed an international collaborative study to improve patients' management, aiming to individualize risk factors and determine optimal HSCT characteristics. METHODS We retrospectively collected data on 130 patients who underwent HSCT for CD40L deficiency between 1993-2015. We analyzed outcome and variables' relevance with respect to survival and cure. RESULTS Overall survival (OS), event-free survival (EFS), and disease-free survival (DFS) were 78.2%, 58.1%, and 72.3% 5 years after HSCT. Results were better in transplantations performed in 2000 or later and in children less than 10 years old at the time of HSCT. Pre-existing organ damage negatively influenced outcome. Sclerosing cholangitis was the most important risk factor. After 2000, superior OS was achieved with matched donors. Use of myeloablative regimens and HSCT at 2 years or less from diagnosis associated with higher OS and DFS. EFS was best with matched sibling donors, myeloablative conditioning (MAC), and bone marrow-derived stem cells. Most rejections occurred after reduced-intensity or nonmyeloablative conditioning, which associated with poor donor cell engraftment. Mortality occurred mainly early after HSCT, predominantly from infections. Among survivors who ceased immunoglobulin replacement, T-lymphocyte chimerism was 50% or greater donor in 85.2%. CONCLUSION HSCT is curative in patients with CD40L deficiency, with improved outcome if performed before organ damage development. MAC is associated with better OS, EFS, and DFS. Prospective studies are required to compare the risks of HSCT with those of lifelong supportive therapy.
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Affiliation(s)
- Francesca Ferrua
- Department of Pediatric Immunology and HSCT, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom; San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Stefania Galimberti
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Virginie Courteille
- Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France; French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Enfants Malades University Hospital, AP-HP, Paris, France
| | - Mary Anne Slatter
- Department of Pediatric Immunology and HSCT, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Claire Booth
- Department of Pediatric Immunology, Great Ormond Street Hospital, London, United Kingdom
| | - Despina Moshous
- Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Enfants Malades University Hospital, AP-HP, Paris, France
| | - Benedicte Neven
- Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Enfants Malades University Hospital, AP-HP, Paris, France
| | - Stephane Blanche
- Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Enfants Malades University Hospital, AP-HP, Paris, France
| | - Marina Cavazzana
- Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France; Biotherapy Department, Necker Children's Hospital, AP-HP, Paris, France; Biotherapy Clinical Investigation Center, Groupe Hospitalier Universitaire Ouest, AP-HP, INSERM, Paris, France; INSERM UMR 1163, Laboratory of Human Lymphohematopoiesis, Paris, France
| | - Alexandra Laberko
- Dmitry Rogachev Federal Research Centre of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Anna Shcherbina
- Dmitry Rogachev Federal Research Centre of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Dmitry Balashov
- Dmitry Rogachev Federal Research Centre of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Elena Soncini
- Pediatric Oncology-Hematology and BMT Unit, Spedali Civili di Brescia, Brescia, Italy
| | - Fulvio Porta
- Pediatric Oncology-Hematology and BMT Unit, Spedali Civili di Brescia, Brescia, Italy
| | - Hamoud Al-Mousa
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Bandar Al-Saud
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Hasan Al-Dhekri
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Rand Arnaout
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Renata Formankova
- Department of Pediatric Hematology and Oncology, University Hospital Motol Prague, Prague, Czech Republic
| | - Yves Bertrand
- Institut d'Hematologie et d'Oncologie Pediatrique, Hospices Civils de Lyon, Lyon, France
| | - Andrzej Lange
- L. Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland; Lower Silesian Center for Cellular Transplantation & National Bone Marrow Donor Registry, Wrocław, Poland
| | - Joanne Smart
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia
| | | | - Victor M Aquino
- Department of Pediatrics, University of Texas Southwestern Medical Center Dallas, Dallas, Tex
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology & Bone Marrow Transplantation, University of California, San Francisco, Calif
| | - Anders Fasth
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg and Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Fanny Fouyssac
- Pediatric Oncology and Hematology Unit, Children Hospital, University Hospital Nancy, Vandoeuvre-les-Nancy, France; French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Enfants Malades University Hospital, AP-HP, Paris, France
| | | | - Manfred Hoenig
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Catharina Schuetz
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Jadranka Kelečić
- Department of Pediatrics, Division of Allergology, Clinical Immunology, Respiratory Diseases and Rheumatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Robbert G M Bredius
- Department of Pediatrics/Willem-Alexander Children's hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjan C Lankester
- Department of Pediatrics/Willem-Alexander Children's hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Caroline A Lindemans
- Department of Pediatrics, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Felipe Suarez
- Hématologie Adulte, Hôpital Necker, AP-HP, Paris, France; French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Enfants Malades University Hospital, AP-HP, Paris, France
| | - Kathleen E Sullivan
- Division of Allergy Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Michael H Albert
- Pediatric Hematology/Oncology, Dr. von Hauner University Children's Hospital, Munich, Germany
| | - Krzysztof Kałwak
- Department of Pediatric Hematology and Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Vincent Barlogis
- Service d'hématologie pédiatrique, Hôpital de la Timone Enfants, Marseille, France; French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Enfants Malades University Hospital, AP-HP, Paris, France
| | - Monica Bhatia
- Pediatric Stem Cell Transplantation, Columbia University College of Physicians and Surgeons, New York, NY
| | - Victoria Bordon
- Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | | | - Laura Alonso
- Pediatric Hematology and Oncology Department, Hospital Universitario MaternoInfantil Vall d'Hebron, Barcelona, Spain
| | - Figen Dogu
- Department of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Jolanta Gozdzik
- Department of Clinical Immunology and Transplantology, Jagiellonian University, Medical Collage, Transplantation Center, University Children's Hospital, Cracow, Poland
| | - Aydan Ikinciogullari
- Department of Pediatric Immunology-Allergy and BMT Unit, Ankara University Medical School, Ankara, Turkey
| | - Gergely Kriván
- Department of Pediatric Hematology and Stem Cell Transplantation United St. István and St László Hospital, Budapest, Hungary
| | - Per Ljungman
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Isabelle Meyts
- Department of Pediatrics, University Hospitals Leuven, Division of Pediatric Immunology, Department of Immunology and Microbiology, Catholic University Leuven, Leuven, Belgium
| | | | - Angela R Smith
- Pediatric Blood and Marrow Transplant, University of Minnesota, Minneapolis, Minn
| | - Carsten Speckmann
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mikael Sundin
- Division of Pediatrics, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Pediatric Blood Disorders, Immunodeficiency and SCT, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Steven John Keogh
- Cancer Centre for Children, Children's Hospital at Westmead, Sydney, Australia
| | - Peter John Shaw
- Cancer Centre for Children, Children's Hospital at Westmead, Sydney, Australia; University of Sydney Medical Program, Sydney, Australia
| | - Jaap Jan Boelens
- Department of Pediatrics, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, BMT and Cell Therapies Program, New York, NY; Laboratory for Translational Immunology, Tumor-immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ansgar S Schulz
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Petr Sedlacek
- Department of Pediatric Hematology and Oncology, University Hospital Motol Prague, Prague, Czech Republic
| | - Paul Veys
- Department of BMT, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Nizar Mahlaoui
- Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Enfants Malades University Hospital, AP-HP, Paris, France; INSERM UMR 1163, Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Paris, France
| | - Ales Janda
- Center for Pediatrics and Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Freiburg, Germany
| | - E Graham Davies
- Department of Pediatric Immunology, Great Ormond Street Hospital, London, United Kingdom
| | - Alain Fischer
- Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Enfants Malades University Hospital, AP-HP, Paris, France; College de France, Paris, France
| | - Morton J Cowan
- Division of Pediatric Allergy, Immunology & Bone Marrow Transplantation, University of California, San Francisco, Calif
| | - Andrew Richard Gennery
- Department of Pediatric Immunology and HSCT, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
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Salamonowicz M, Ociepa T, Frączkiewicz J, Szmydki-Baran A, Matysiak M, Czyżewski K, Wysocki M, Gałązka P, Zalas-Więcek P, Irga-Jaworska N, Drożyńska E, Zając-Spychała O, Wachowiak J, Gryniewicz-Kwiatkowska O, Czajńska-Deptuła A, Dembowska-Bagińska B, Chełmecka-Wiktorczyk L, Balwierz W, Bartnik M, Zielezińska K, Urasiński T, Tomaszewska R, Szczepański T, Płonowski M, Krawczuk-Rybak M, Pierlejewski F, Młynarski W, Gamrot-Pyka Z, Woszczyk M, Małas Z, Badowska W, Urbanek-Dądela A, Karolczyk G, Stolpa W, Sobol-Milejska G, Zaucha-Prażmo A, Kowalczyk J, Goździk J, Gorczyńska E, Jermakow K, Król A, Chybicka A, Ussowicz M, Kałwak K, Styczyński J. Incidence, course, and outcome of Clostridium difficile infection in children with hematological malignancies or undergoing hematopoietic stem cell transplantation. Eur J Clin Microbiol Infect Dis 2018; 37:1805-1812. [PMID: 29978303 PMCID: PMC6133038 DOI: 10.1007/s10096-018-3316-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/26/2018] [Indexed: 12/13/2022]
Abstract
Clostridium difficile infection (CDI) is one of the most common causes of nosocomial infectious diarrhea in children during anticancer therapy or undergoing hematopoietic stem cell transplantation (HSCT) in Europe. Immunosuppression in these patients is a risk factor for CDI. Malignant diseases, age, acute graft-versus-host disease (aGVHD), HLA mismatch, or use of total body irradiation may play an important role in CDI course. The aim of this study was to evaluate the incidence, course, and outcome of CDI in children treated for malignancy or undergoing HSCT. Between 2012 and 2015, a total number of 1846 patients were treated for malignancy in Polish pediatric oncological centers (PHO group) and 342 underwent transplantation (HSCT group). In PHO group, episodes of CDI occurred in 210 patients (14%). The incidence of CDI was higher in patients with hematological malignancies in comparison to that with solid tumors. Patients with acute myeloblastic leukemia had shorter time to episode of CDI than those with acute lymphoblastic leukemia. Patients over 5 years and treated for acute leukemia had more severe clinical course of disease in PHO group. In HSCT group, CDI occurred in 29 (8%) patients. The incidence of CDI was higher in patients transplanted for acute leukemia. The recurrence rate was 14.7% in PHO and 20.7% in HSCT patients. CDI incidence was highest in patients with hematological malignancies. Most of patients experienced mild CDI. Age < 5 years and diagnosis other than acute leukemia were the positive prognostic factors influencing clinical CDI course.
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Affiliation(s)
- Małgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland.
| | - T Ociepa
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - J Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - A Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Warszawa, Poland
| | - M Matysiak
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Warszawa, Poland
| | - K Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - P Gałązka
- Department of Pediatric Surgery, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - P Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - N Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Gdansk, Poland
| | - E Drożyńska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Gdansk, Poland
| | - O Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - J Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | | | - A Czajńska-Deptuła
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - L Chełmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - W Balwierz
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - M Bartnik
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - K Zielezińska
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - T Urasiński
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - R Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - T Szczepański
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - M Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Bialystok, Poland
| | - M Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Bialystok, Poland
| | - F Pierlejewski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Lodz, Poland
| | - W Młynarski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Lodz, Poland
| | - Z Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - M Woszczyk
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - Z Małas
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Olsztyn, Poland
| | - W Badowska
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Olsztyn, Poland
| | - A Urbanek-Dądela
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Kielce, Poland
| | - G Karolczyk
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Kielce, Poland
| | - W Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - G Sobol-Milejska
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - A Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Lublin, Poland
| | - J Kowalczyk
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Lublin, Poland
| | - J Goździk
- Stem Cell Transplant Center, University Children's Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - E Gorczyńska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - K Jermakow
- Department of Microbiology, Medical University, Wroclaw, Wroclaw, Poland
| | - A Król
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - A Chybicka
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - M Ussowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - K Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - J Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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Zaucha-Prażmo A, Kowalczyk JR, Drabko K, Czyżewski K, Goździk J, Zając-Spychała O, Wachowiak J, Frączkiewicz J, Gorczyńska E, Kałwak K, Styczyński J. Incidence of Infectious Complications in Children With Acute Lymphoblastic Leukemia Treated With Hematopoietic Stem Cell Transplantation. Transplant Proc 2018; 49:2183-2187. [PMID: 29149980 DOI: 10.1016/j.transproceed.2017.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/31/2017] [Accepted: 09/02/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We analyzed incidence and profile of infections in children with acute lymphoblastic leukemia (ALL) treated with hematopoietic stem cell transplantation (HSCT) in Polish pediatric HSCT departments, over a 2-year period. PATIENTS AND METHODS Hospital records of 67 patients, who underwent allogeneic HSCT for ALL, were analyzed retrospectively for microbiologically documented infection: bacterial infection (BI), viral infection (VI), and fungal infection (FI). The majority of patients (40/67; 59.7%) underwent HSCT from matched unrelated donors (MUD). RESULTS In total, 84 BI in 31 patients, 93 VI in 50 patients, and 27 FI in 22 patients were diagnosed. No differences were found in the frequency of occurrence of BI according to the type of transplant (P = .16); the occurrence of VI was statistically more frequent in MUD transplant recipients as compared with matched sibling donors (MSD) and mismatched related donors (MMFD; P = .001) and there was a trend in MUD patients for the higher occurrence of FI in comparison with MSD and MMFD transplants (P = .08). Regarding disease status, the occurrence of BI, VI, and FI was statistically more frequent in children who underwent transplantation in their first complete remission (CR1), rather than those who underwent transplantation in ≥CR2 (P < .05). In conclusion, infectious complications are an important cause of morbidity in children with ALL treated with allogeneic HSCT and the incidence of infections is high in this group of patients.
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Affiliation(s)
- A Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Lublin, University Children Hospital, Lublin, Poland.
| | - J R Kowalczyk
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Lublin, University Children Hospital, Lublin, Poland
| | - K Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Lublin, University Children Hospital, Lublin, Poland
| | - K Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - J Goździk
- Clinical Immunology and Transplantation Polish-American Institute of Pediatrics, Jagiellonian University Medical College, Department of Transplantation, Children's University Hospital, Krakow, Poland
| | - O Zając-Spychała
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Poznań, Poland
| | - J Wachowiak
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Poznań, Poland
| | - J Frączkiewicz
- Department of Pediatric Transplantology, Hematology and Oncology, Medical University, Wrocław, Wrocław, Poland
| | - E Gorczyńska
- Department of Pediatric Transplantology, Hematology and Oncology, Medical University, Wrocław, Wrocław, Poland
| | - K Kałwak
- Department of Pediatric Transplantology, Hematology and Oncology, Medical University, Wrocław, Wrocław, Poland
| | - J Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Wachowiak J, Chybicka A, Kowalczyk JR, Wysocki M, Goździk J, Gorczyńska E, Kałwak K, Styczyński J, Drabko K, Pieczonka A. Development and current use of in hematopoietic stem cell transplantation in children and adolescents in Poland: Report of the Polish pediatric study group for hematopoietic stem cell transplantation of the Polish society for pediatric oncology and hematology. Transfus Apher Sci 2018; 57:316-322. [DOI: 10.1016/j.transci.2018.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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