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Vogt AJ, Bartels L, Bertschi IC, Mahler F, Grotzer M, Konrad D, Leibundgut K, Rössler J, Bodenmann G, Landolt MA. Assessing We-Disease Appraisals of Health Problems: Development and Validation of the We-Disease Questionnaire. Eur J Investig Health Psychol Educ 2024; 14:941-953. [PMID: 38667816 PMCID: PMC11049654 DOI: 10.3390/ejihpe14040061] [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: 01/05/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
In couples dealing with health problems, we-disease appraisals can influence dyadic coping strategies to alleviate distress. This study describes the development and validation of a self-report scale to assess we-disease appraisals of health problems. The newly developed We-Disease Questionnaire (WDQ) was administered in three samples: parents of children with type 1 diabetes (n = 240) or cancer (n = 125) and individuals with visual impairment and their partners (n = 216). Reliability was measured by coefficient omega. To assess construct validity, correlations with other measures of individual and dyadic adjustment were examined. Descriptive statistics across all samples were compared. A 4-item version of the WDQ demonstrated good reliability and validity and showed meaningful associations with established scales. We-disease appraisals were highest among parents of children with cancer and lowest among couples with visual impairment. The WDQ is a reliable and valid measure that can be used across different health problems.
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Affiliation(s)
- Alexandra J. Vogt
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
- Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
- Children’s Research Centre, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (M.G.)
| | - Lasse Bartels
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
- Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
- Children’s Research Centre, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (M.G.)
| | - Isabella C. Bertschi
- Division of Clinical Psychology for Children/Adolescents and Couples/Families, Department of Psychology, University of Zurich, 8050 Zurich, Switzerland (G.B.)
| | - Fiona Mahler
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
- Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
- Children’s Research Centre, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (M.G.)
| | - Michael Grotzer
- Children’s Research Centre, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (M.G.)
| | - Daniel Konrad
- Children’s Research Centre, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (M.G.)
- Department of Paediatric Endocrinology and Diabetology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Kurt Leibundgut
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Berne, 3010 Berne, Switzerland; (K.L.); (J.R.)
| | - Jochen Rössler
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Berne, 3010 Berne, Switzerland; (K.L.); (J.R.)
| | - Guy Bodenmann
- Division of Clinical Psychology for Children/Adolescents and Couples/Families, Department of Psychology, University of Zurich, 8050 Zurich, Switzerland (G.B.)
| | - Markus A. Landolt
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
- Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
- Children’s Research Centre, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (M.G.)
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2
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Everts R, Muri R, Leibundgut K, Siegwart V, Wiest R, Steinlin M. Fear and discomfort of children and adolescents during MRI: ethical consideration on research MRIs in children. Pediatr Res 2022; 91:720-723. [PMID: 33879848 PMCID: PMC9064788 DOI: 10.1038/s41390-020-01277-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Regula Everts
- Division of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. .,Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. .,Department of Pediatric Hematology and Oncology, Children's University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Raphaela Muri
- grid.411656.10000 0004 0479 0855Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland ,grid.411656.10000 0004 0479 0855Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kurt Leibundgut
- grid.411656.10000 0004 0479 0855Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Valerie Siegwart
- grid.411656.10000 0004 0479 0855Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland ,grid.411656.10000 0004 0479 0855Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- grid.411656.10000 0004 0479 0855Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maja Steinlin
- grid.411656.10000 0004 0479 0855Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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3
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Siegwart V, Steiner L, Pastore-Wapp M, Benzing V, Spitzhuttl J, Schmidt M, Kiefer C, Slavova N, Grotzer M, Roebers C, Steinlin M, Leibundgut K, Everts R. The Working Memory Network and Its Association with Working Memory Performance in Survivors of non-CNS Childhood Cancer. Dev Neuropsychol 2021; 46:249-264. [PMID: 33969767 DOI: 10.1080/87565641.2021.1922410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Childhood cancer and its treatment puts survivors at risk of low working memory capacity. Working memory represents a core cognitive function, which is crucial in daily life and academic tasks. The aim of this functional MRI (fMRI) study was to examine the working memory network of survivors of childhood cancer without central nervous system (CNS) involvement and its relation to cognitive performance. Thirty survivors (aged 7-16 years, ≥ 1 year after cancer treatment) and 30 healthy controls performed a visuospatial working memory task during MRI, including a low- and a high-demand condition. Working memory performance was assessed using standardized tests outside the scanner. When cognitive demands increased, survivors performed worse than controls and showed evidence for slightly atypical working memory-related activation. The survivor group exhibited hyperactivation in the right-hemispheric superior parietal lobe (SPL) in the high- compared to the low-demand working memory condition, while maintaining their performance levels. Hyperactivation in the right SPL coincided with poorer working memory performance outside the scanner in survivors. Even in survivors of childhood cancer without CNS involvement, we find neural markers pointing toward late effects in the cerebral working memory network.AbbreviationsfMRI: Functional magnetic resonance imaging; CNS: Central nervous system; MNI: Montreal Neurological Institute; SES: Socioeconomic status; SPL: Superior parietal lobe.
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Affiliation(s)
- Valerie Siegwart
- Division of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, University of Bern, Bern, Switzerland.,Department of Pediatric Hematology and Oncology, Children's University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Leonie Steiner
- Division of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Manuela Pastore-Wapp
- Support Center for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Valentin Benzing
- Division of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, University of Bern, Bern, Switzerland.,Department of Pediatric Hematology and Oncology, Children's University Hospital, Inselspital, University of Bern, Bern, Switzerland.,Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Janine Spitzhuttl
- Division of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, University of Bern, Bern, Switzerland.,Department of Pediatric Hematology and Oncology, Children's University Hospital, Inselspital, University of Bern, Bern, Switzerland.,Department of Psychology, University of Bern, Bern, Switzerland
| | - Mirko Schmidt
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Claus Kiefer
- Support Center for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nedelina Slavova
- Support Center for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Grotzer
- Department of Pediatric Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Claudia Roebers
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Maja Steinlin
- Division of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Kurt Leibundgut
- Department of Pediatric Hematology and Oncology, Children's University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Regula Everts
- Division of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, University of Bern, Bern, Switzerland.,Department of Pediatric Hematology and Oncology, Children's University Hospital, Inselspital, University of Bern, Bern, Switzerland.,Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, Bern, Switzerland
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Spitzhüttl JS, Kronbichler M, Kronbichler L, Benzing V, Siegwart V, Schmidt M, Pastore-Wapp M, Kiefer C, Slavova N, Grotzer M, Steinlin M, Roebers CM, Leibundgut K, Everts R. Cortical Morphometry and Its Relationship with Cognitive Functions in Children after non-CNS Cancer. Dev Neurorehabil 2021; 24:266-275. [PMID: 33724900 DOI: 10.1080/17518423.2021.1898059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Childhood cancer survivors (Ccs) are at risk for cognitive late-effects, which might result from cortical alterations, even if cancer does not affect the brain. The study aimed to examine gray and white matter volume and its relationship to cognition. Methods: Forty-three Ccs of non-central nervous system cancers and 43 healthy controls, aged 7-16 years, were examined. Cognitive functions and fine motor coordination were assessed and T1-weighted images were collected for voxel-based morphometry. Results: Executive functions (p = .024, d = .31) were poorer in Ccs than controls, however still within the normal range. The volume of the amygdala (p = .011, ŋ2 = .117) and the striatum (p = .03, ŋ2 = .102) was reduced in Ccs. No significant structure-function correlations were found, neither in patients nor controls. Conclusion: Non-CNS childhood cancer and its treatment impacts on brain structures relevant to emotion processing.
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Affiliation(s)
- Janine S Spitzhüttl
- Division of Neuropediatrics, Development and Rehabilitation Development, University Children's Hospital Bern, and University of Bern, Bern, Switzerland.,Department of Psychology, University of Bern, Bern, Switzerland.,Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, and University of Bern, Bern, Switzerland
| | - Martin Kronbichler
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria.,Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Lisa Kronbichler
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria.,Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Valentin Benzing
- Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, and University of Bern, Bern, Switzerland.,Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Valerie Siegwart
- Division of Neuropediatrics, Development and Rehabilitation Development, University Children's Hospital Bern, and University of Bern, Bern, Switzerland.,Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, and University of Bern, Bern, Switzerland
| | - Mirko Schmidt
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Manuela Pastore-Wapp
- Support Center for Advanced Neuroimaging (SCAN), Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Claus Kiefer
- Support Center for Advanced Neuroimaging (SCAN), Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Nedelina Slavova
- Support Center for Advanced Neuroimaging (SCAN), Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Michael Grotzer
- Department of Pediatric Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Maja Steinlin
- Division of Neuropediatrics, Development and Rehabilitation Development, University Children's Hospital Bern, and University of Bern, Bern, Switzerland
| | | | - Kurt Leibundgut
- Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, and University of Bern, Bern, Switzerland
| | - Regula Everts
- Division of Neuropediatrics, Development and Rehabilitation Development, University Children's Hospital Bern, and University of Bern, Bern, Switzerland.,Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, and University of Bern, Bern, Switzerland.,Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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5
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Benzing V, Spitzhüttl J, Siegwart V, Schmid J, Grotzer M, Heinks T, Roebers CM, Steinlin M, Leibundgut K, Schmidt M, Everts R. Effects of Cognitive Training and Exergaming in Pediatric Cancer Survivors-A Randomized Clinical Trial. Med Sci Sports Exerc 2021; 52:2293-2302. [PMID: 33064404 PMCID: PMC7556245 DOI: 10.1249/mss.0000000000002386] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental digital content is available in the text. Purpose Although most pediatric cancer patients survive, those who undergo anticancer treatments like chemotherapy and/or radiotherapy are at a high risk for late effects, such as cognitive deficits. To counteract these deficits, feasible and effective interventions are needed. The aim of this study was to compare the effects of working memory training, exergaming, and a wait-list control condition on cognitive functions in pediatric cancer survivors. Methods In a parallel-group randomized trial, 69 pediatric cancer survivors aged 7–16 yr (mean = 11.35, SD = 3.53) were randomly assigned to 8-wk working memory training, exergaming, or a wait-list control group. Each training course consisted of three 45-min training sessions per week. The primary outcome comprised the core executive functions (visual working memory, inhibition, switching), and the secondary outcomes included other cognitive domains (intelligence, planning, memory, attention, processing speed), motor abilities, and parent rating on their children’s executive functions. Assessments were conducted both before and immediately after the interventions, and at 3-month follow-up. Results Linear mixed models revealed that participants in the working memory training group showed a linear improvement in visual working memory after training and at follow-up compared with the control group. No other intervention effects of either type of training could be detected. Conclusion This study presents evidence that working memory training improves visual working memory in pediatric cancer survivors. Results show that near-transfer, but no far-transfer effects can be expected from working memory training. Multiple-component interventions tailored to fit the individual’s cognitive profile are needed to best support cognitive development after cancer and its treatment.
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Affiliation(s)
| | | | | | - Jürg Schmid
- Institute of Sport Science, University of Bern, Bern, SWITZERLAND
| | - Michael Grotzer
- Division of Pediatric Oncology, University Children's Hospital Zurich, Zurich, SWITZERLAND
| | - Theda Heinks
- Division of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, SWITZERLAND
| | | | - Maja Steinlin
- Division of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, SWITZERLAND
| | - Kurt Leibundgut
- Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, SWITZERLAND
| | - Mirko Schmidt
- Institute of Sport Science, University of Bern, Bern, SWITZERLAND
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Benzing V, Siegwart V, Spitzhüttl J, Schmid J, Grotzer M, Roebers CM, Steinlin M, Leibundgut K, Everts R, Schmidt M. Motor ability, physical self-concept and health-related quality of life in pediatric cancer survivors. Cancer Med 2021; 10:1860-1871. [PMID: 33527768 PMCID: PMC7940246 DOI: 10.1002/cam4.3750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/05/2020] [Accepted: 12/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background Cancer survivorship is frequently associated with severe late effects. However, research into pediatric cancer survivors on late effects in motor ability, physical self‐concept and their relationship to quality of life is limited. Methods Using multiple regression analyses, 78 pediatric cancer survivors and 56 typically developing children were compared in motor ability, physical self‐concept and health‐related quality of life. In addition, mediational multi‐group analyses between motor ability (independent variable), physical self‐concept (mediator) and quality of life (dependent variable) were calculated. Results Pediatric cancer survivors had a lower motor ability (gHedges = 0.863), a lower physical self‐concept with regard to several scales of the PSDQ‐S (gHedges = 0.318–0.764) and a higher relative risk for a below average quality of life than controls (RR = 1.44). Children with a history of cancer involving the central nervous system showed poorer motor ability compared to those without central nervous system involvement (gHedges = 0.591). Furthermore, the physical self‐concept significantly mediated the relationship between motor ability and quality of life in pediatric cancer survivors but not in typically developing children. Conclusions Results show the importance of monitoring and supporting the development of motor ability in the aftercare of pediatric cancer survivors. Physical activity interventions may be advisable to prevent physical activity‐related late effects and potentially improve related psychosocial variables such as quality of life.
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Affiliation(s)
- Valentin Benzing
- Institute of Sport Science, University of Bern, Bern, Switzerland.,Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Division of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Valerie Siegwart
- Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Division of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Janine Spitzhüttl
- Division of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Psychology, University of Bern, Bern, Switzerland
| | - Jürg Schmid
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Michael Grotzer
- Division of Pediatric Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Maja Steinlin
- Division of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kurt Leibundgut
- Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Regula Everts
- Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Division of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirko Schmidt
- Institute of Sport Science, University of Bern, Bern, Switzerland
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Spitzhüttl JS, Kronbichler M, Kronbichler L, Benzing V, Siegwart V, Pastore‐Wapp M, Kiefer C, Slavova N, Grotzer M, Roebers CM, Steinlin M, Leibundgut K, Everts R. Impact of non-CNS childhood cancer on resting-state connectivity and its association with cognition. Brain Behav 2021; 11:e01931. [PMID: 33205895 PMCID: PMC7821559 DOI: 10.1002/brb3.1931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/10/2020] [Accepted: 10/09/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Non-central nervous system cancer in childhood (non-CNS CC) and its treatments pose a major threat to brain development, with implications for functional networks. Structural and functional alterations might underlie the cognitive late-effects identified in survivors of non-CNS CC. The present study evaluated resting-state functional networks and their associations with cognition in a mixed sample of non-CNS CC survivors (i.e., leukemia, lymphoma, and other non-CNS solid tumors). METHODS Forty-three patients (off-therapy for at least 1 year and aged 7-16 years) were compared with 43 healthy controls matched for age and sex. High-resolution T1-weighted structural magnetic resonance and resting-state functional magnetic resonance imaging were acquired. Executive functions, attention, processing speed, and memory were assessed outside the scanner. RESULTS Cognitive performance was within the normal range for both groups; however, patients after CNS-directed therapy showed lower executive functions than controls. Seed-based connectivity analyses revealed that patients exhibited stronger functional connectivity between fronto- and temporo-parietal pathways and weaker connectivity between parietal-cerebellar and temporal-occipital pathways in the right hemisphere than controls. Functional hyperconnectivity was related to weaker memory performance in the patients' group. CONCLUSION These data suggest that even in the absence of brain tumors, non-CNS CC and its treatment can lead to persistent cerebral alterations in resting-state network connectivity.
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Affiliation(s)
- Janine S. Spitzhüttl
- Department of PsychologyUniversity of BernBernSwitzerland
- Neuropediatrics, Development and RehabilitationUniversity Children's Hospital Bern, and University of BernBernSwitzerland
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
| | - Martin Kronbichler
- Centre for Cognitive Neuroscience and Department of PsychologyUniversity of SalzburgSalzburgAustria
- Neuroscience InstituteChristian‐Doppler Medical CentreParacelsus Medical UniversitySalzburgAustria
| | - Lisa Kronbichler
- Centre for Cognitive Neuroscience and Department of PsychologyUniversity of SalzburgSalzburgAustria
- Neuroscience InstituteChristian‐Doppler Medical CentreParacelsus Medical UniversitySalzburgAustria
- Department of Psychiatry, Psychotherapy and PsychosomaticsChristian‐Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
| | - Valentin Benzing
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
- Institute of Sport ScienceUniversity of BernBernSwitzerland
| | - Valerie Siegwart
- Neuropediatrics, Development and RehabilitationUniversity Children's Hospital Bern, and University of BernBernSwitzerland
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
| | - Manuela Pastore‐Wapp
- Support Center for Advanced Neuroimaging (SCAN)Institute of Diagnostic and Interventional Neuroradiology, InselspitalBern University Hospital, and University of BernBernSwitzerland
| | - Claus Kiefer
- Support Center for Advanced Neuroimaging (SCAN)Institute of Diagnostic and Interventional Neuroradiology, InselspitalBern University Hospital, and University of BernBernSwitzerland
| | - Nedelina Slavova
- Support Center for Advanced Neuroimaging (SCAN)Institute of Diagnostic and Interventional Neuroradiology, InselspitalBern University Hospital, and University of BernBernSwitzerland
| | - Michael Grotzer
- Department of Pediatric OncologyUniversity Children's Hospital ZurichZurichSwitzerland
| | | | - Maja Steinlin
- Neuropediatrics, Development and RehabilitationUniversity Children's Hospital Bern, and University of BernBernSwitzerland
| | - Kurt Leibundgut
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
| | - Regula Everts
- Neuropediatrics, Development and RehabilitationUniversity Children's Hospital Bern, and University of BernBernSwitzerland
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
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Siegwart V, Benzing V, Spitzhuettl J, Schmidt M, Grotzer M, Steinlin M, Leibundgut K, Roebers C, Everts R. Cognition, psychosocial functioning, and health-related quality of life among childhood cancer survivors. Neuropsychol Rehabil 2020; 32:922-945. [DOI: 10.1080/09602011.2020.1844243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Valerie Siegwart
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Valentin Benzing
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Janine Spitzhuettl
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Mirko Schmidt
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Michael Grotzer
- Department of Pediatric Oncology, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Maja Steinlin
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Kurt Leibundgut
- Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Claudia Roebers
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Regula Everts
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
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9
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Karow A, Wilhelm A, Ammann RA, Baerlocher GM, Pabst T, Mansouri Taleghani B, Roessler J, Leibundgut K. Peripheral blood progenitor cell collection in pediatric patients optimized by high pre-apheresis count of circulating CD34+ cells and high blood flow. Bone Marrow Transplant 2018; 54:885-893. [DOI: 10.1038/s41409-018-0353-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/05/2018] [Accepted: 09/20/2018] [Indexed: 01/09/2023]
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10
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Abstract
Historically linked to sea voyagers in the 18th century, scurvy has become extremely rare during the last century in developed countries. However, it is still present in some at-risk populations and often overlooked in pediatric patients with restricted diets due to behavioral, neurodevelopmental, or psychiatric problems. So far, the only known etiology of developing scurvy is nutritional deficiency of vitamin C. In this report, we describe the case of a 3-year-old previously healthy Swiss girl without any history of previous poor dietary intake, who presented a picture of systemic inflammation including persisting fever, palpable purpura located on the extensor sides of the extremities, refusal to bear weight, and gingival bleeding. Blood tests revealed a significant increase of inflammatory markers and hypoalbuminemia. Full-body MRI revealed symmetrical bone marrow edema consistent with findings in previously reported cases of children with scurvy. After starting a high-dose oral vitamin C supplementation, the patient showed rapid clinical, laboratory, and radiologic improvement, but after stopping the treatment 4 months later, the patient developed relapse symptoms with pronounced fatigue, refusing to walk, and hair loss. These symptoms led us to restart the oral supplementation, which resulted in secondary normalization of her condition. The cause of her symptoms still remains unclear and presents the first case to our knowledge describing scurvy symptoms that are not directly linked to deficient dietary intake.
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Affiliation(s)
- Nina Vaezipour
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kurt Leibundgut
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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11
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von Allmen AN, Zermatten MG, Leibundgut K, Agyeman P, Ammann RA. Pediatric patients at risk for fever in chemotherapy-induced neutropenia in Bern, Switzerland, 1993-2012. Sci Data 2018. [PMID: 29534058 PMCID: PMC5849221 DOI: 10.1038/sdata.2018.38] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Fever in neutropenia (FN) is the most frequent potentially life threatening complication of chemotherapy for cancer. Prediction of the risk to develop FN during chemotherapy would allow for targeted prophylaxis. This retrospective, single centre cohort study in pediatric patients diagnosed with cancer before 17 years covered two decades, 1993 to 2012. The 583 (73%) of 800 patients diagnosed with cancer who had received chemotherapy were studied here. Data on 2113 observation periods was collected, defined by stable combinations of 11 predefined characteristics potentially associated with FN. They covered 692 years of cumulative chemotherapy exposure time, during which 712 FN episodes were diagnosed, 154 (22%) of them with bacteremia. The risk to develop FN and FN with bacteremia remained stable over time. These data can mainly be used to study FN risks over time and between centers, and to derive or externally validate FN risk prediction rules.
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Affiliation(s)
- Annina N von Allmen
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Maxime G Zermatten
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Kurt Leibundgut
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Philipp Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Roland A Ammann
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
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12
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Passweg JR, Baldomero H, Ansari M, Baerlocher GM, Bargetzi M, Chalandon Y, Duchosal MA, Gerull S, Güngör T, Halter JP, Heim D, Hess U, Leibundgut K, Masouridi-Levrat S, Müller A, Nair G, Pabst T, Renner C, Schmidt A, Stussi G, Nicoloso de Faveri G, Schanz U, For The Swiss Blood Stem Cell Transplantation Group Sbst. Haematopoietic cell transplantation in Switzerland, changes and results over 20 years: a report from the Swiss Blood Stem Cell Transplantation Working Group for Blood and Marrow Transplantation registry 1997-2016. Swiss Med Wkly 2018; 148:w14589. [PMID: 29493715 DOI: 10.4414/smw.2018.14589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 1997, the Swiss Blood Stem Cell Transplantation Group (SBST) initiated a mandatory national registry for all haematopoietic stem cell transplants (HCTs) in Switzerland. As of 2016, after 20 years, information was available for 7899 patients who had received an HCT (2781 allogeneic [35%] and 5118 autologous [65%]). As some patients had more than one transplant the total number of transplants was 3067 allogeneic and 6448 autologous. We compared patient characteristics and outcome of the first decade (1997-2006) and second decade (2007-2016) of the registry. There were numerous changes over time. For allogeneic HCT, transplant rates, and therefore use of HCT technology, increased from 14 to 21.8 HCTs per 1 million inhabitants per year from the first to the second decade. Likewise autologous HCTs increased from 24.8 to 37.2 annually corrected for population growth. Allogeneic transplant recipients were older (38.4 vs 48.3 years) and more frequently had unrelated donors in the second decade. Similarly, age increased for recipients of autologous HCT (50.8 vs 56.4 years). Analysis of outcome showed that the probabilities of overall and progression-free survival were stable over time, in spite of the treatment of older and higher risk patients. In multivariate analysis, nonrelapse mortality decreased in recipients of allogeneic HCT (relative risk 0.68, 95% confidence interval 0.52-0.87) over the two decades. Improvement in adjusted nonrelapse mortality compensated for the fact that higher risk patients were treated in more recent years, resulting in similar overall survival. Five-year survival probabilities were 56% (53-59%) in the first and 54% (51-57%) in the second decade for allogeneic HCT, and 59% (57-61%) in the first and 61% (59-63%) in the second decade for autologous HCT. Detailed analyses of changes over time are presented. This study included all HCTs performed in Switzerland during the period of observation and the data are useful for quality assurance programmes, healthcare cost estimation and healthcare planning. Between 50 and 60% of patients were long-term survivors after both types of HCT, indicating growing populations of surviving patients requiring long-term care and observation.
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Affiliation(s)
- Jakob R Passweg
- Stem Cell Transplant Team, University Hospital and the Children's University Hospital, Basel, Switzerland
| | - Helen Baldomero
- SBST Data Registry Office, University Hospital, Basel, Switzerland
| | - Marc Ansari
- Division of Haematology/Oncology, Department of Paediatrics, Geneva University Hospital and University of Geneva, Switzerland
| | - Gabriela M Baerlocher
- Department of Haematology, University Hospital/Inselspital Bern and University of Bern, Switzerland
| | - Mario Bargetzi
- Division of Haematology/Oncology, Kantonsspital, Aarau, Switzerland
| | - Yves Chalandon
- Division of Haematology, University Hospital, Geneva and University of Geneva, Switzerland
| | - Michel A Duchosal
- Service and Central Laboratory of Haematology, Departments of Oncology and of Laboratories, University Hospital of Lausanne, Switzerland
| | - Sabine Gerull
- Stem Cell Transplant Team, University Hospital and the Children's University Hospital, Basel, Switzerland
| | - Tayfun Güngör
- Division of Immunology/Haematology/Oncology, University Children's Hospital, Zurich, Switzerland
| | - Jörg P Halter
- Stem Cell Transplant Team, University Hospital and the Children's University Hospital, Basel, Switzerland
| | - Dominik Heim
- Stem Cell Transplant Team, University Hospital and the Children's University Hospital, Basel, Switzerland
| | - Urs Hess
- Division of Medical Oncology and Haematology, Kantonsspital, St Gallen, Switzerland
| | - Kurt Leibundgut
- Division of Haematology/Oncology, Department of Paediatrics, University Hospital, Bern, Switzerland
| | | | - Antonia Müller
- Clinic of Oncology and Division of Haematology, University Hospital, Zurich, Switzerland
| | - Gayathri Nair
- Clinic of Oncology and Division of Haematology, University Hospital, Zurich, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, University Hospital/Inselspital Bern and University of Bern, Switzerland
| | | | | | - Georg Stussi
- Division of Haematology, Hospital San Giovanni, Bellinzona, Switzerland
| | | | - Urs Schanz
- Clinic of Oncology and Division of Haematology, University Hospital, Zurich, Switzerland
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13
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Wagner S, Brack EK, Stutz-Grunder E, Agyeman P, Leibundgut K, Teuffel O, Ammann RA. The influence of different fever definitions on diagnostics and treatment after diagnosis of fever in chemotherapy-induced neutropenia in children with cancer. PLoS One 2018; 13:e0193227. [PMID: 29462193 PMCID: PMC5819814 DOI: 10.1371/journal.pone.0193227] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 02/07/2018] [Indexed: 11/18/2022] Open
Abstract
Background There is no evidence-based definition of the temperature limit defining fever (TLDF) in children with neutropenia. Lowering the TLDF is known to increase the number of episodes of fever in neutropenia (FN). This study aimed to investigate the influence of a lower versus standard TLDF on diagnostics and therapy. Methods In a single pediatric cancer center using a high standard TLDF (39°C tympanic-temperature) patients were observed prospectively (NCT01683370). The effect of applying lower TLDFs (range 37.5°C to 38.9°C) versus 39.0°C on these measures was simulated in silicon. Results In reality, 45 FN episodes were diagnosed. Of 3391 temperatures measured, 193 were ≥39.0°C, and 937 ≥38.0°C. For persisting fever ≥24 hours, additional blood cultures were taken in 31 (69%) episodes in reality. This number decreased to 22 (49%) when applying 39.0°C, and increased to 33 for 38.0°C (73%; plus 11 episodes; plus 24%). For persisting fever ≥48 hours, i.v.-antibiotics were escalated in 25 (56%) episodes. This number decreased to 15 (33%) when applying 39.0°C, and increased to 26 for 38.0°C (58%; plus 11 episodes; plus 24%). For persisting fever ≥120 hours, i.v.-antifungals were added in 4 (9%) episodes. This number increased to 6 (13%) by virtually applying 39.0°C, and to 11 for 38.0°C (24%; plus 5 episodes; plus 11%). The median length of stay was 5.7 days (range, 0.8 to 43.4). In 43 episodes with hospital discharge beyond 24 hours, applying 38.0°C led to discharge delay by ≥12 hours in 24 episodes (56%; 95% CI, 40 to 71), with a median delay of 13 hours, and a cumulative delay of 68 days. Conclusion Applying a low versus standard TLDF led to relevant increases of diagnostics, antimicrobial therapy, and length of stay. The differences between management in reality versus simply applying 39.0° as TLDF reflect the important impact of clinical assessment.
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Affiliation(s)
- Stéphanie Wagner
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva K. Brack
- Department of Infectious Disease and Cancer Research, Children´s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eveline Stutz-Grunder
- Department of Pediatric Oncology, Children´s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kurt Leibundgut
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Oliver Teuffel
- Division of Oncology, Medical Services of the Statutory Health Insurance Baden-Württemberg, Tübingen, Germany
| | - Roland A. Ammann
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
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14
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Zimmermann K, Cignacco E, Engberg S, Ramelet AS, von der Weid N, Eskola K, Bergstraesser E, Ansari M, Aebi C, Baer R, Popovic MB, Bernet V, Brazzola P, Bucher HU, Buder R, Cagnazzo S, Dinten B, Dorsaz A, Elmer F, Enriquez R, Fahrni-Nater P, Finkbeiner G, Frey B, Frey U, Greiner J, Hassink RI, Keller S, Kretschmar O, Kroell J, Laubscher B, Leibundgut K, Malaer R, Meyer A, Stuessi C, Nelle M, Neuhaus T, Niggli F, Perrenoud G, Pfammatter JP, Plecko B, Rupf D, Sennhauser F, Stade C, Steinlin M, Stoffel L, Thomas K, Vonarburg C, von Vigier R, Wagner B, Wieland J, Wernz B. Patterns of paediatric end-of-life care: a chart review across different care settings in Switzerland. BMC Pediatr 2018; 18:67. [PMID: 29452600 PMCID: PMC5816353 DOI: 10.1186/s12887-018-1021-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paediatric end-of-life care is challenging and requires a high level of professional expertise. It is important that healthcare teams have a thorough understanding of paediatric subspecialties and related knowledge of disease-specific aspects of paediatric end-of-life care. The aim of this study was to comprehensively describe, explore and compare current practices in paediatric end-of-life care in four distinct diagnostic groups across healthcare settings including all relevant levels of healthcare providers in Switzerland. METHODS In this nationwide retrospective chart review study, data from paediatric patients who died in the years 2011 or 2012 due to a cardiac, neurological or oncological condition, or during the neonatal period were collected in 13 hospitals, two long-term institutions and 10 community-based healthcare service providers throughout Switzerland. RESULTS Ninety-three (62%) of the 149 reviewed patients died in intensive care units, 78 (84%) of them following withdrawal of life-sustaining treatment. Reliance on invasive medical interventions was prevalent, and the use of medication was high, with a median count of 12 different drugs during the last week of life. Patients experienced an average number of 6.42 symptoms. The prevalence of various types of symptoms differed significantly among the four diagnostic groups. Overall, our study patients stayed in the hospital for a median of six days during their last four weeks of life. Seventy-two patients (48%) stayed at home for at least one day and only half of those received community-based healthcare. CONCLUSIONS The study provides a wide-ranging overview of current end-of-life care practices in a real-life setting of different healthcare providers. The inclusion of patients with all major diagnoses leading to disease- and prematurity-related childhood deaths, as well as comparisons across the diagnostic groups, provides additional insight and understanding for healthcare professionals. The provision of specialised palliative and end-of-life care services in Switzerland, including the capacity of community healthcare services, need to be expanded to meet the specific needs of seriously ill children and their families.
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Affiliation(s)
- Karin Zimmermann
- Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland. .,Paediatric Palliative Care, University Children's Hospital Zurich, Children's Research Center CRC, Steinwiesstrasse 75, 8032, Zurich, Switzerland. .,Department of Pediatrics, Inselspital Bern University Hospital, Bern, Switzerland.
| | - Eva Cignacco
- Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Health Division, University of Applied Sciences Bern, Bern, Switzerland
| | - Sandra Engberg
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare - IUFRS, University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland.,Nurse Research Consultant, Department of Woman-Mother-Child, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Nicolas von der Weid
- Paediatric Haematology-Oncology, University Children's Hospital UKBB, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Katri Eskola
- Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Triemli Hospital Zurich, Zurich, Switzerland
| | - Eva Bergstraesser
- Department of Pediatrics, Inselspital Bern University Hospital, Bern, Switzerland
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15
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Benzing V, Eggenberger N, Spitzhüttl J, Siegwart V, Pastore-Wapp M, Kiefer C, Slavova N, Grotzer M, Heinks T, Schmidt M, Conzelmann A, Steinlin M, Everts R, Leibundgut K. The Brainfit study: efficacy of cognitive training and exergaming in pediatric cancer survivors - a randomized controlled trial. BMC Cancer 2018; 18:18. [PMID: 29298678 PMCID: PMC5753470 DOI: 10.1186/s12885-017-3933-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cancer survival comes at a price: pediatric cancer survivors bear a high risk for a wide range of cognitive difficulties. Therefore, interventions targeting these difficulties are required. The aim of the present clinical trial is to extend empirical evidence about efficacy of cognitive and physical training in pediatric cancer survivors. It is hypothesized that early cognitive and physical interventions affect the remediation of pediatric cancer survivors in terms of improved executive functions (primary outcome). Additional positive effects of cognitive and physical intervention to other areas such as memory and attention are expected (secondary outcome). Changes in cognitive performance are expected to be associated with structural and functional changes in the brain. METHODS Overall, 150 pediatric cancer survivors and 50 matched controls will be included in this trial. The cancer survivors will be randomly assigned to either a computerized cognitive training, a physical training (exergaming) or a waiting control group. They will be assessed with neuropsychological tests, tests of sport motor performance and physical fitness before and after 8 weeks of training and again at a 3-months follow-up. Moreover, neuroimaging will be performed at each of the three time points to investigate the training impact on brain structure and function. DISCUSSION With increasing cancer survival rates, evidence-based interventions are of particular importance. New insights into training-related plasticity in the developing brain will further help to develop tailored rehabilitation programs for pediatric cancer survivors. TRIAL REGISTRATION KEK BE 196/15; KEK ZH 2015-0397; ICTRP NCT02749877 ; date of registration: 30.11.2016; date of first participant enrolment: .18.01.2017.
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Affiliation(s)
- Valentin Benzing
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Noëmi Eggenberger
- Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Janine Spitzhüttl
- Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Insitute of Psychology, University of Bern, Bern, Switzerland
| | - Valerie Siegwart
- Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuela Pastore-Wapp
- Division of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claus Kiefer
- Division of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nedelina Slavova
- Division of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Grotzer
- Division of Pediatric Oncology, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Theda Heinks
- Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirko Schmidt
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Achim Conzelmann
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Maja Steinlin
- Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Center for Cognition, Learning and Memory, CCLM, University of Bern, Bern, Switzerland
| | - Regula Everts
- Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Center for Cognition, Learning and Memory, CCLM, University of Bern, Bern, Switzerland
| | - Kurt Leibundgut
- Division of Pediatric Hematology and Oncology, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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16
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Blum V, Heini AD, Novak U, Taleghani BM, Baerlocher GM, Leibundgut K, Seipel K, Banz Y, Bargetzi M, Pabst T. Hematopoietic stem cell remobilization with vinorelbine and filgrastim in AML. Bone Marrow Transplant 2017; 52:786-788. [PMID: 28194031 DOI: 10.1038/bmt.2017.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- V Blum
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - A D Heini
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - U Novak
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - B M Taleghani
- Department of Hematology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - G M Baerlocher
- Department of Hematology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.,Department of Clinical Research, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - K Leibundgut
- Department of Pediatric Hemato-Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - K Seipel
- Department of Clinical Research, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Y Banz
- Institute of Pathology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - M Bargetzi
- Department of Hematology, Kantonsspital, Aarau, Switzerland
| | - T Pabst
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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17
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Gilli S, Novak U, Taleghani BM, Baerlocher GM, Leibundgut K, Banz Y, Zander T, Betticher D, Egger T, Rauch D, Pabst T. BeEAM conditioning with bendamustine-replacing BCNU before autologous transplantation is safe and effective in lymphoma patients. Ann Hematol 2016; 96:421-429. [DOI: 10.1007/s00277-016-2900-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 12/09/2016] [Indexed: 11/29/2022]
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18
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Heini AD, Berger MD, Seipel K, Taleghani BM, Baerlocher GM, Leibundgut K, Banz Y, Novak U, Pabst T. Consolidation with autologous stem cell transplantation in first remission is safe and effective in AML patients above 65 years. Leuk Res 2016; 53:28-34. [PMID: 27978458 DOI: 10.1016/j.leukres.2016.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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] [Received: 08/16/2016] [Revised: 12/05/2016] [Accepted: 12/08/2016] [Indexed: 01/01/2023]
Abstract
The outcome of AML patients ≥65 years remains disappointing. Current post-induction strategies for elderly AML patients fit for intensive treatment involve additional cycles of chemotherapy or allogeneic transplantation. Consolidation with autologous transplantation (ASCT) is poorly studied in these patients. In this single-center retrospective analysis, we determined survival rates of AML patients ≥65 years undergoing busulfan/cyclophosphamide conditioning before ASCT in first remission between 2007 and 2015. We found elderly AML patients with ASCT to have longer progression-free survival (PFS; 16.3 vs. 5.1 months, P=0.0166) and overall survival (OS; n.r. vs. 8.2 months; P=0.0255) than elderly AML patients without ASCT consolidation. In addition, elderly AML patients undergoing ASCT had comparable PFS (P=0.9462) and OS (P=0.7867) as AML patients below 65 years receiving ASCT consolidation in CR1. Our data suggest that ASCT is an option in elderly fit AML patients who appear to benefit from autologous consolidation similarly to younger AML patients.
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Affiliation(s)
- Alexander D Heini
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Martin D Berger
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Katja Seipel
- Department of Clinical Research, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | | | - Gabriela M Baerlocher
- Department of Hematology, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Kurt Leibundgut
- Department of Pediatric Hemato-Oncology, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Yara Banz
- Institute of Pathology, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Urban Novak
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Switzerland.
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19
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Affiliation(s)
- Nicole M. R. Schmitz
- Department of Clinical Research, Tiefemustrasse 120, 3004 Bern, University of Bern, Switzerland
- Department of Pediatrics, Inselspital 3010 Bern, University of Bern, Switzerland
| | - Kurt Leibundgut
- Department of Pediatrics, Inselspital 3010 Bern, University of Bern, Switzerland
| | - Andreas Hirt
- Department of Clinical Research, Tiefemustrasse 120, 3004 Bern, University of Bern, Switzerland
- Department of Pediatrics, Inselspital 3010 Bern, University of Bern, Switzerland
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20
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Zimmermann K, Eggenberger N, Leibundgut K, Steinlin M, Heinks T. QOS-16THE INFLUENCE OF YOUNG AGE AT DIAGNOSIS FOR COGNITIVE PERFORMANCE IN BRAIN TUMOR PATIENTS BEFORE TREATMENT. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now081.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Heinks T, Eggenberger N, Steinlin M, Leibundgut K. QOS-09EFFICACY OF COGNITIVE AND PHYSICAL TRAININGS IN PEDIATRIC CANCER SURVIVORS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now081.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Margelisch K, Studer M, Ritter BC, Steinlin M, Leibundgut K, Heinks T. Cognitive dysfunction in children with brain tumors at diagnosis. Pediatr Blood Cancer 2015; 62:1805-12. [PMID: 26053691 PMCID: PMC5054885 DOI: 10.1002/pbc.25596] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/21/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Survivors of brain tumors have a high risk for a wide range of cognitive problems. These dysfunctions are caused by the lesion itself and its surgical removal, as well as subsequent treatments (chemo- and/or radiation therapy). Multiple recent studies have indicated that children with brain tumors (BT) might already exhibit cognitive problems at diagnosis, i.e., before the start of any medical treatment. The aim of the present study was to investigate the baseline neuropsychological profile in children with BT compared to children with an oncological diagnosis not involving the central nervous system (CNS). METHODS Twenty children with BT and 27 children with an oncological disease without involvement of the CNS (age range: 6.1-16.9 years) were evaluated with an extensive battery of neuropsychological tests tailored to the patient's age. Furthermore, the child and his/her parent(s) completed self-report questionnaires about emotional functioning and quality of life. In both groups, tests were administered before any therapeutic intervention such as surgery, chemotherapy, or irradiation. Groups were comparable with regard to age, gender, and socioeconomic status. RESULTS Compared to the control group, patients with BTs performed significantly worse in tests of working memory, verbal memory, and attention (effect sizes between 0.28 and 0.47). In contrast, the areas of perceptual reasoning, processing speed, and verbal comprehension were preserved at the time of measurement. CONCLUSION Our results highlight the need for cognitive interventions early in the treatment process in order to minimize or prevent academic difficulties as patients return to school.
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Affiliation(s)
- Katja Margelisch
- Department of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Bern, Switzerland
- Center of Cognition, Learning and Memory, University of Berne, Bern, Switzerland
| | - Martina Studer
- Department of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Bern, Switzerland
- Center of Cognition, Learning and Memory, University of Berne, Bern, Switzerland
| | - Barbara Catherine Ritter
- Department of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Bern, Switzerland
- Center of Cognition, Learning and Memory, University of Berne, Bern, Switzerland
| | - Maja Steinlin
- Department of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Bern, Switzerland
- Center of Cognition, Learning and Memory, University of Berne, Bern, Switzerland
| | - Kurt Leibundgut
- Department of Pediatric Hematology/Oncology, Children's University Hospital, Bern, Switzerland
| | - Theda Heinks
- Department of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Bern, Switzerland
- Center of Cognition, Learning and Memory, University of Berne, Bern, Switzerland
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Keller S, Seipel K, Novak U, Mueller BU, Taleghani BM, Leibundgut K, Pabst T. Neurotoxicity of stem cell mobilization chemotherapy with vinorelbine in myeloma patients after bortezomib treatment. Leuk Res 2015; 39:786-92. [DOI: 10.1016/j.leukres.2015.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/13/2015] [Accepted: 03/20/2015] [Indexed: 11/30/2022]
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Berger MD, Branger G, Leibundgut K, Baerlocher GM, Seipel K, Mueller BU, Gregor M, Ruefer A, Pabst T. CD34+ selected versus unselected autologous stem cell transplantation in patients with advanced-stage mantle cell and diffuse large B-cell lymphoma. Leuk Res 2015; 39:561-7. [PMID: 25890431 DOI: 10.1016/j.leukres.2015.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/02/2015] [Accepted: 03/05/2015] [Indexed: 11/16/2022]
Abstract
Novel strategies aiming to increase survival rates in patients with advanced-stage mantle cell lymphoma (MCL) and relapsing diffuse large B-cell lymphoma (DLBCL) are a clinical need. High-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) has improved progression-free (PFS) and overall survival (OS) in MCL and relapsed DLBCL. However, the role of CD34+ cell selection before ASCT in MCL and DLBCL is unclear. We retrospectively analyzed the outcome of 62 consecutive patients with advanced-stage MCL or relapsed DLBCL undergoing ASCT with (n=31) or without (n=31) prior CD34+ selection. All patients had stage III or IV disease, with 47% having DLBCL and 53% MCL. The median duration for neutrophil and platelet recovery was 12 and 16 days in CD34+ selected patients, and 11 (P<.001) and 14 days (P=.012) in the group without selection, respectively. No differences in toxicities were observed. The 5-year PFS for CD34+ selected versus not selected patients was 67% and 39% (P=.016), and the 5-year OS was 86% and 54% (P=.007). Our data suggest that using CD34+ selected autografts for ASCT in advanced stage MCL and DLBCL is associated with longer PFS and OS without increased toxicity.
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Affiliation(s)
- Martin D Berger
- Department of Medical Oncology, University Hospital and University of Berne, Berne, Switzerland
| | - Giacomo Branger
- Department of Medical Oncology, University Hospital and University of Berne, Berne, Switzerland
| | - Kurt Leibundgut
- Department of Pediatrics, University Hospital and University of Berne, Berne, Switzerland
| | - Gabriela M Baerlocher
- Department of Hematology, University Hospital and University of Berne, Berne, Switzerland
| | - Katja Seipel
- Department of Clinical Research, University Hospital and University of Berne, Berne, Switzerland
| | - Beatrice U Mueller
- Department of Clinical Research, University Hospital and University of Berne, Berne, Switzerland
| | - Michael Gregor
- Department of Hematology, Kantonsspital, Lucerne, Switzerland
| | - Axel Ruefer
- Department of Hematology, Kantonsspital, Lucerne, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, University Hospital and University of Berne, Berne, Switzerland; Department of Clinical Research, University Hospital and University of Berne, Berne, Switzerland.
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Laemmle A, Hahn D, Hu L, Rüfenacht V, Gautschi M, Leibundgut K, Nuoffer JM, Häberle J. Fatal hyperammonemia and carbamoyl phosphate synthetase 1 (CPS1) deficiency following high-dose chemotherapy and autologous hematopoietic stem cell transplantation. Mol Genet Metab 2015; 114:438-44. [PMID: 25639153 DOI: 10.1016/j.ymgme.2015.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/19/2015] [Accepted: 01/19/2015] [Indexed: 11/16/2022]
Abstract
Fatal hyperammonemia secondary to chemotherapy for hematological malignancies or following bone marrow transplantation has been described in few patients so far. In these, the pathogenesis of hyperammonemia remained unclear and was suggested to be multifactorial. We observed severe hyperammonemia (maximum 475 μmol/L) in a 2-year-old male patient, who underwent high-dose chemotherapy with carboplatin, etoposide and melphalan, and autologous hematopoietic stem cell transplantation for a neuroblastoma stage IV. Despite intensive care treatment, hyperammonemia persisted and the patient died due to cerebral edema. The biochemical profile with elevations of ammonia and glutamine (maximum 1757 μmol/L) suggested urea cycle dysfunction. In liver homogenates, enzymatic activity and protein expression of the urea cycle enzyme carbamoyl phosphate synthetase 1 (CPS1) were virtually absent. However, no mutation was found in CPS1 cDNA from liver and CPS1 mRNA expression was only slightly decreased. We therefore hypothesized that the acute onset of hyperammonemia was due to an acquired, chemotherapy-induced (posttranscriptional) CPS1 deficiency. This was further supported by in vitro experiments in HepG2 cells treated with carboplatin and etoposide showing a dose-dependent decrease in CPS1 protein expression. Due to severe hyperlactatemia, we analysed oxidative phosphorylation complexes in liver tissue and found reduced activities of complexes I and V, which suggested a more general mitochondrial dysfunction. This study adds to the understanding of chemotherapy-induced hyperammonemia as drug-induced CPS1 deficiency is suggested. Moreover, we highlight the need for urgent diagnostic and therapeutic strategies addressing a possible secondary urea cycle failure in future patients with hyperammonemia during chemotherapy and stem cell transplantation.
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Affiliation(s)
- Alexander Laemmle
- Division of Metabolism and Children's Research Center (CRC), University Children's Hospital, Zurich, Switzerland; Department of Pediatrics, University Children's Hospital, Bern, Switzerland.
| | - Dagmar Hahn
- University Institute of Clinical Chemistry, University of Bern, Switzerland.
| | - Liyan Hu
- Division of Metabolism and Children's Research Center (CRC), University Children's Hospital, Zurich, Switzerland.
| | - Véronique Rüfenacht
- Division of Metabolism and Children's Research Center (CRC), University Children's Hospital, Zurich, Switzerland.
| | - Matthias Gautschi
- Department of Pediatrics, University Children's Hospital, Bern, Switzerland; University Institute of Clinical Chemistry, University of Bern, Switzerland.
| | - Kurt Leibundgut
- Department of Pediatrics, University Children's Hospital, Bern, Switzerland.
| | - Jean-Marc Nuoffer
- Department of Pediatrics, University Children's Hospital, Bern, Switzerland; University Institute of Clinical Chemistry, University of Bern, Switzerland.
| | - Johannes Häberle
- Division of Metabolism and Children's Research Center (CRC), University Children's Hospital, Zurich, Switzerland.
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Wetzel D, Mueller BU, Mansouri Taleghani B, Baerlocher GM, Seipel K, Leibundgut K, Pabst T. Delayed Haematological recovery after autologous stem cell transplantation is associated with favourable outcome in acute myeloid leukaemia. Br J Haematol 2014; 168:268-73. [DOI: 10.1111/bjh.13118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/29/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Dana Wetzel
- Department of Medical Oncology; University Hospital and University of Berne; Berne Switzerland
| | - Beatrice U. Mueller
- Department of Clinical Research; University Hospital and University of Berne; Berne Switzerland
| | | | - Gabriela M. Baerlocher
- Department of Haematology; University Hospital and University of Berne; Berne Switzerland
| | - Katja Seipel
- Department of Clinical Research; University Hospital and University of Berne; Berne Switzerland
| | - Kurt Leibundgut
- Department of Paediatric Haemato-Oncology; University Hospital and University of Berne; Berne Switzerland
| | - Thomas Pabst
- Department of Medical Oncology; University Hospital and University of Berne; Berne Switzerland
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Schmid A, Friess D, Mansouri Taleghani B, Keller P, Mueller BU, Baerlocher GM, Leibundgut K, Pabst T. Role of plerixafor in autologous stem cell mobilization with vinorelbine chemotherapy and granulocyte-colony stimulating factor in patients with myeloma: a phase II study (PAV-trial). Leuk Lymphoma 2014; 56:608-14. [DOI: 10.3109/10428194.2014.927454] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ammann RA, Niggli FK, Leibundgut K, Teuffel O, Bodmer N. Exploring the association of hemoglobin level and adverse events in children with cancer presenting with fever in neutropenia. PLoS One 2014; 9:e101696. [PMID: 25020130 PMCID: PMC4096594 DOI: 10.1371/journal.pone.0101696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 06/10/2014] [Indexed: 11/25/2022] Open
Abstract
Background In children and adolescents with fever in neutropenia (FN) during chemotherapy for cancer, hemoglobin ≥90 g/L at presentation with FN had been associated with adverse events (AE). This analysis explored three hypothetical pathophysiological mechanisms potentially explaining this counterintuitive finding, and further analyzed the statistical association between hemoglobin and AE. Methods Two of 8 centers, reporting on 311 of 421 FN episodes in 138 of 215 patients participated in this retrospective analysis based on prospectively collected data from three databases (SPOG 2003 FN, transfusion and hematology laboratories). Associations with AE were analyzed using mixed logistic regression. Results Hemoglobin was ≥90 g/L in 141 (45%) of 311 FN episodes, specifically in 59/103 (57%) episodes with AE, and in 82/208 (39%) without (OR, 2.3; 99%CI, 1.1–4.9; P = 0.004). In FN with AE, hemoglobin was bimodally distributed with a dip around 85 g/L. There were no significant interactions for center, age and sex. In multivariate mixed logistic regression, AE was significantly and independently associated with leukopenia (leukocytes <0.3 G/L; OR, 3.3; 99%CI, 1.1–99; P = 0.004), dehydration (hemoglobinPresentation/hemoglobin8–72 hours ≥1.10 in untransfused patients; OR, 3.5; 99%CI, 1.1–11.4; P = 0.006) and non-moderate anemia (difference from 85 g/L; 1.6 per 10 g/L; 1.0–2.6; P = 0.005), but not with recent transfusion of packed red blood cells (pRBC), very recent transfusion of pRBC or platelets, or with hemoglobin ≥90 g/L as such. Conclusions Non-moderate anemia and dehydration were significantly and relevantly associated with the risk of AE in children with cancer and FN. These results need validation in prospective cohorts before clinical implementation.
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Affiliation(s)
- Roland A. Ammann
- Department of Pediatrics, University of Bern, Bern, Switzerland
- * E-mail:
| | - Felix K. Niggli
- Division of Oncology, Department of Pediatrics, University of Zurich, Zurich, Switzerland
| | - Kurt Leibundgut
- Department of Pediatrics, University of Bern, Bern, Switzerland
| | - Oliver Teuffel
- Department of Pediatrics, University of Bern, Bern, Switzerland
- Division of Oncology, Medical Services of the Statutory Health Insurance Baden-Württemberg, Tübingen, Germany
| | - Nicole Bodmer
- Division of Oncology, Department of Pediatrics, University of Zurich, Zurich, Switzerland
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Schucht P, Seidel K, Murek M, Stieglitz L, Urwyler N, Wiest R, Steinlin M, Leibundgut K, Raabe A, Beck J. Low Threshold Monopolar Motor Mapping for Resection of Motor-eloquent Brain Lesions in Children and Adolescents. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1383753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Julmy F, Ammann RA, Fontana S, Taleghani BM, Hirt A, Leibundgut K. Transfusion efficacy of apheresis platelet concentrates irradiated at the day of transfusion is significantly superior compared to platelets irradiated in advance. Transfus Med Hemother 2014; 41:176-81. [PMID: 25053930 PMCID: PMC4086758 DOI: 10.1159/000363484] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 03/25/2014] [Accepted: 05/08/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gamma irradiation is currently the standard care to avoid transfusion-associated graft-versus-host disease. Guidelines on gamma irradiation of blood components state that platelets (PLTs) can be irradiated at any stage in their 5-day storage and can thereafter be stored up to their normal shelf life of 5 days after collection. In this study, we explored whether the timing of irradiation has an effect on transfusion efficacy of apheresis PLT concentrates (APCs). METHODS Based on the 1-hour percent PLT recovery (PPR1h), transfusion efficacy of 1,000 eligible APCs transfused to 144 children were evaluated retrospectively. PPR1h was compared in transfused APCs irradiated at the day of transfusion and APCs irradiated in advance. RESULTS In univariate analysis, transfusion efficacy of APCs irradiated in advance was significantly lower than that of APCs irradiated at the day of transfusion (mean PPR1h 27.7 vs. 35.0%; p = 0.007). This was confirmed in multivariate analysis (p = 0.030). Compared to non-irradiated APCs, transfusion efficacy of APCs irradiated at the day of transfusion was not significantly inferior (mean difference -2.8%; 95% CI -6.1 to 0.5%; p = 0.092), but APCs irradiated in advance were clearly less efficient (mean difference -8.1%; 95% CI -12.2 to -4.0%; p < 0.001). CONCLUSION Our data strongly support that APCs should not be irradiated in advance, 1.e., ≥24 h before transfusion.
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Affiliation(s)
- Friedgard Julmy
- Department of Pediatrics, University of Bern, Bern, Switzerland
| | | | - Stefano Fontana
- Blood Transfusion Service of the Swiss Red Cross, Bern, Switzerland
| | - Behrouz Mansouri Taleghani
- Department of Hematology, University of Bern, Bern, Switzerland
- Blood Transfusion Service of the Swiss Red Cross, Bern, Switzerland
| | - Andreas Hirt
- Department of Pediatrics, University of Bern, Bern, Switzerland
| | - Kurt Leibundgut
- Department of Pediatrics, University of Bern, Bern, Switzerland
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Boman KK, Hornquist L, Rickardsson J, Lannering B, Gustafsson G, Pitchford N, Davis E, Walker D, Hoang DH, Pagnier A, Cousin E, Guichardet K, Schiff I, Dubois-Teklali F, Krainik A, Lazar MB, Resnik K, Olsson IT, Perrin S, Burtscher IB, Lundgren J, Kahn A, Johanson A, Korzeniewska J, Dembowska-Baginska B, Perek-Polnik M, Walsh K, Gioia A, Wells E, Packer R, de Speville ED, Dufour C, Bolle S, Giraudat K, Longaud A, Kieffer V, Grill J, Puget S, Valteau-Couanet D, Hetz-Pannier L, Noulhiane M, Chieffo D, Tamburrini G, Caldarelli M, Di Rocco C, Margelisch K, Studer M, Steinlin M, Leibundgut K, Heinks T, Longaud-Vales A, Chevignard M, Dufour C, Grill J, Pujet S, Sainte-Rose C, Valteau-Couanet D, Dellatolas G, Kahalley L, Grosshans D, Paulino A, Ris MD, Chintagumpala M, Okcu F, Moore B, Stancel H, Minard C, Guffey D, Mahajan A, Herrington B, Raiker J, Manning E, Criddle J, Karlson C, Guerry W, Finlay J, Sands S, Dockstader C, Skocic J, Bouffet E, Laughlin S, Tabori U, Mabbott D, Moxon-Emre I, Scantlebury N, Taylor MD, Bouffet E, Malkin D, Laughlin S, Law N, Kumabe T, Leonard J, Rubin J, Jung S, Kim SK, Gupta N, Weiss W, Faria C, Vibhakar R, Spiegler B, Janzen L, Liu F, Decker L, Mabbott D, Lemiere J, Vercruysse T, Haers M, Vandenabeele K, Geuens S, Jacobs S, Van Gool S, Riggs L, Piscione J, Bouffet E, Timmons B, Laughlin S, Cunningham T, Bartels U, Skocic J, Liu F, Mabbott D, Riggs L, Bouffet E, Chakravarty M, Laughlin S, Laperriere N, Liu F, Skocic J, Pipitone J, Strother D, Hukin J, Fryer C, McConnell D, Mabbott D, Secco DE, Cappelletti S, Gentile S, Chieffo D, Cacchione A, Del Bufalo F, Staccioli S, Spagnoli A, Messina R, Carai A, Marras CE, Mastronuzzi A, Brinkman T, Armstrong G, Kimberg C, Gajjar A, Srivastava DK, Robison L, Hudson M, Krull K, Hardy K, Hostetter S, Hwang E, Walsh K, Leiss U, Bemmer A, Pletschko T, Grafeneder J, Schwarzinger A, Deimann P, Slavc I, Batchelder P, Wilkening G, Hankinson T, Foreman N, Handler M. NEUROPSYCHOLOGY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schucht P, Seidel K, Murek M, Stieglitz LH, Urwyler N, Wiest R, Steinlin M, Leibundgut K, Raabe A, Beck J. Low-threshold monopolar motor mapping for resection of lesions in motor eloquent areas in children and adolescents. J Neurosurg Pediatr 2014; 13:572-8. [PMID: 24635135 DOI: 10.3171/2014.1.peds13369] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Resection of lesions close to the primary motor cortex (M1) and the corticospinal tract (CST) is generally regarded as high-risk surgery due to reported rates of postoperative severe deficits of up to 50%. The authors' objective was to determine the feasibility and safety of low-threshold motor mapping and its efficacy for increasing the extent of lesion resection in the proximity of M1 and the CST in children and adolescents. METHODS The authors analyzed 8 consecutive pediatric patients in whom they performed 9 resections for lesions within or close (≤ 10 mm) to M1 and/or the CST. Monopolar high-frequency motor mapping with train-of-five stimuli (pulse duration 500 μsec, interstimulus interval 4.0 msec, frequency 250 Hz) was used. The motor threshold was defined as the minimal stimulation intensity that elicited motor evoked potentials (MEPs) from target muscles (amplitude > 30 μV). Resection was performed toward M1 and the CST at sites negative to 1- to 3-mA high-frequency train-of-five stimulation. RESULTS The M1 was identified through high-frequency train-of-five via application of varying low intensities. The lowest motor thresholds after final resection ranged from 1 to 9 mA in 8 cases and up to 18 mA in 1 case, indicating proximity to motor neurons. Intraoperative electroencephalography documented an absence of seizures during all surgeries. Two transient neurological deficits were observed, but there were no permanent deficits. Postoperative imaging revealed complete resection in 8 patients and a very small remnant (< 0.175 cm3) in 1 patient. CONCLUSIONS High-frequency train-of-five with a minimal threshold of 1-3 mA is a feasible and safe procedure for resections in the proximity of the CST. Thus, low-threshold motor mapping might help to expand the area for safe resection in pediatric patients with lesions located within the precentral gyrus and close to the CST, and may be regarded as a functional navigational tool. The additional use of continuous MEP monitoring serves as a safety feedback for the functional integrity of the CST, especially because the true excitability threshold in children is unknown.
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Ammann RA, Bodmer N, Simon A, Agyeman P, Leibundgut K, Schlapbach LJ, Niggli FK. Serum Concentrations of Mannan-Binding Lectin (MBL) and MBL-Associated Serine Protease-2 and the Risk of Adverse Events in Pediatric Patients With Cancer and Fever in Neutropenia. J Pediatric Infect Dis Soc 2013; 2:155-61. [PMID: 26619462 DOI: 10.1093/jpids/pit005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/01/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND It is unknown whether serum concentrations of mannan-binding lectin (MBL) and MBL-associated serine protease-2 (MASP-2) influence the risk of adverse events (AEs) in children with cancer presenting with fever in neutropenia (FN). METHODS Pediatric patients with cancer presenting with FN after non-myeloablative chemotherapy were observed in a prospective multicenter study. Mannan-binding lectin and MASP-2 were measured using commercially available enzyme-linked immunosorbent assay in serum taken at cancer diagnosis. Multiple FN episodes per patient were allowed. Associations of MBL and MASP-2 with AE in general, with bacteremia, and with serious medical complications (SMC) during FN were analyzed using mixed logistic regression. RESULTS Of 278 FN episodes, AE was reported in 84 (30%), bacteremia was reported in 42 (15%), and SMC was reported in 16 (5.8%). Median MBL was 2152 ng/mL (range, 7-10 060). It was very low (<100) in 11 (9%) patients, low (100-999) in 36 (29%) patients, and normal (≥1000) in 79 (63%) patients. Median MASP-2 was 410 ng/mL (range, 68-2771). It was low (<200) in 18 (14%) patients and normal in the remaining 108 (86%) patients. Mannan-binding lectin and MASP-2 were not significantly associated with AE or bacteremia. Normal versus low MBL was independently associated with a significantly higher risk of SMC (multivariate odds ratio, 12.8; 95% confidence interval, 1.01-163; P = .050). CONCLUSIONS Mannan-binding lectin and MASP-2 serum concentrations were not found to predict the risk to develop AEs or bacteremia during FN. Normal MBL was associated with an increased risk of SMC during FN. This finding, in line with earlier studies, does not support the concept of MBL supplementation in MBL-deficient children with cancer presenting with FN.
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Affiliation(s)
| | | | - Arne Simon
- Department of Pediatrics, University of Bonn, and Pediatric Oncology, Saarland University Hospital, Homburg, Germany
| | - Philipp Agyeman
- Department of Pediatrics and Institute for Infectious Diseases, University of Bern, and
| | | | - Luregn J Schlapbach
- Department of Pediatrics and Pediatric Critical Care Research Group, Pediatric Intensive Care Unit, Mater Children's Hospital, Brisbane, Australia
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Binz P, Bodmer N, Leibundgut K, Teuffel O, Niggli FK, Ammann RA. Different fever definitions and the rate of fever and neutropenia diagnosed in children with cancer: a retrospective two-center cohort study. Pediatr Blood Cancer 2013. [PMID: 23193083 DOI: 10.1002/pbc.24380] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The definition of fever, and thus fever and neutropenia (FN), varies between different pediatric oncology centers. Higher temperature limit should reduce FN rates, but may increase rates of FN with complications by delaying therapy. This study determined if different fever definitions are associated with different FN rates. PROCEDURE Two pediatric oncology centers had used three fever definitions in 2004-2011: ear temperature ≥38.5 °C persisting ≥2 hours (low definition); axillary temperature ≥38.5 °C ≥ 2 hours or ≥39.0 °C once (middle); and ear temperature ≥39.0 °C once (high). Clinical information was retrospectively extracted from charts. FN rates were compared using mixed Poisson regression. RESULTS In 521 pediatric patients with cancer, 783 FN were recorded during 6,009 months cumulative chemotherapy exposure time (501 years; rate, 0.13/month [95% CI, 0.12-0.14]), 124 of them with bacteremia (16%; 0.021/month [0.017-0.025]). In univariate analysis, the high versus low fever definition was associated with a lower FN rate (0.10/month [0.08-0.11] vs. 0.15/month [0.13-0.16]; rate ratio, 0.66 [0.45-0.97]; P = 0.036), the middle definition was intermediate (0.13/month [0.11-0.15]). This difference was not confirmed in multivariate analysis (rate ratio, 0.94 [0.67-1.33]; P = 0.74). The high versus low definition was not associated with an increased rate of FN with bacteremia (multivariate rate ratio, 1.39 [0.53-3.62]; P = 0.50). CONCLUSION A higher fever definition was not associated with a lower FN rate, nor with an increased rate of FN with bacteremia. These may be false negative findings due to methodological limitations. These questions, with their potential impact on health-related quality of life, and on costs, need to be assessed in prospective studies.
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Affiliation(s)
- Patrizia Binz
- Department of Pediatrics, University of Bern, Bern, Switzerland
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Passweg JR, Baldomero H, Bargetzi M, Bucher C, Chalandon Y, Duchosal MA, Gratwohl A, Güngör T, Hess U, Leibundgut K, de Faveri GN, Ozsahin H, Pabst T, Renner C, Stern M, Stussi G, Schanz U. Haematopoietic stem cell transplantation: activity in Switzerland compared with surrounding European countries. Swiss Med Wkly 2013; 143:w13757. [PMID: 23443995 DOI: 10.4414/smw.2013.13757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Haematopoietic stem cell transplantation (HSCT) is a highly specialised procedure used to treat malignancies of the lymphohaematopoietic system as well as some acquired and inherited disorders of the blood. This analysis by the Swiss Blood Stem Cell Transplantation Group, based on data from 2008-2011, describes, treatment rates in Switzerland for specific indications and compares this with data from Germany, France, Italy and the Netherlands, corrected for the size of the population. Differences in transplant rates, in rates for particular indications, and in the use of specific transplant technologies such as use of unrelated donors, use of cord blood or mismatched family donors are described. These data are put in correlation with donor availability from international registries and with number of transplant teams and number of procedures per team all corrected for population size.
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Teuffel O, Leibundgut K, Lehrnbecher T, Alonzo TA, Beyene J, Sung L. Anthracyclines during induction therapy in acute myeloid leukaemia: a systematic review and meta-analysis. Br J Haematol 2013; 161:192-203. [DOI: 10.1111/bjh.12233] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 12/17/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Oliver Teuffel
- Division of Haematology/Oncology; University Children's Hospital Berne; Berne; Switzerland
| | - Kurt Leibundgut
- Division of Haematology/Oncology; University Children's Hospital Berne; Berne; Switzerland
| | - Thomas Lehrnbecher
- Paediatric Haematology and Oncology; Children's University Hospital; Johann Wolfgang Goethe University; Frankfurt am Main; Germany
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Brack E, Bodmer N, Simon A, Leibundgut K, Kühne T, Niggli FK, Ammann RA. First-day step-down to oral outpatient treatment versus continued standard treatment in children with cancer and low-risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study. Pediatr Blood Cancer 2012; 59:423-30. [PMID: 22271702 DOI: 10.1002/pbc.24076] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 12/21/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND The standard treatment of fever in chemotherapy-induced neutropenia (FN) includes emergency hospitalization and empirical intravenous antimicrobial therapy. This study determined if first-day step-down to oral outpatient treatment is not inferior to continued standard regarding safety and efficacy in children with low-risk FN. PROCEDURE In a randomized controlled non-blinded multicenter study, pediatric patients with FN after non-myeloablative chemotherapy were reassessed after 8-22 hours of inpatient intravenous antimicrobial therapy. Low-risk patients were randomized to first-day step-down to experimental (outpatient, oral amoxicillin plus ciprofloxacin) versus continued standard treatment. Exact non-inferiority tests were used for safety (no serious medical complication; non-inferiority margin of difference, 3.5%) and efficacy (resolution of infection without recurrence, no modification of antimicrobial therapy, no adverse event; 10%). RESULTS In 93 (26%) of 355 potentially eligible FN episodes low-risk criteria were fulfilled, and 62 were randomized, 28 to experimental (1 lost to follow-up) and 34 to standard treatment. In intention-to-treat analyses, non-inferiority was not proven for safety [27 of 27 (100%) vs. 33 of 34 (97%; 1 death) episodes; 95% upper confidence border, 6.7%; P = 0.11], but non-inferiority was proven for efficacy [23 of 27 (85%) vs. 26 of 34 (76%) episodes; 95% upper confidence border, 9.4%; P = 0.045]. Per-protocol analyses confirmed these results. CONCLUSIONS In children with low-risk FN, the efficacy of first-day step-down to oral antimicrobial therapy with amoxicillin and ciprofloxacin in an outpatient setting was non-inferior to continued hospitalization and intravenous antimicrobial therapy. The safety of this procedure, however, was not assessable with sufficient power.
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Affiliation(s)
- Eva Brack
- Department of Pediatrics, University of Bern, Bern, Switzerland
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Lüthi F, Leibundgut K, Niggli FK, Nadal D, Aebi C, Bodmer N, Ammann RA. Serious medical complications in children with cancer and fever in chemotherapy-induced neutropenia: results of the prospective multicenter SPOG 2003 FN study. Pediatr Blood Cancer 2012; 59:90-5. [PMID: 21837771 DOI: 10.1002/pbc.23277] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 06/21/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fever and chemotherapy-induced neutropenia (FN) is the most frequent potentially lethal complication of therapy in children with cancer. This study aimed to describe serious medical complications (SMC) in children with FN regarding incidence, clinical spectrum, and associated characteristics. PROCEDURE Pediatric patients presenting with FN induced by non-myeloablative chemotherapy were observed in a prospective multicenter study. SMC was defined as potentially life-threatening complication (PLTC), transfer to the pediatric intensive care unit (PICU), or death. RESULTS A total of 443 FN episodes were reported from 8 centers. Of these, 411 episodes were reported from 4 centers recruiting consecutively and without bias regarding the risk of complications. They were used for calculation of proportions. An SMC was reported in 23 episodes [5.6%; 95% confidence interval (CI): 3.7-8.1], usually defined by more than one criterion. These were PLTC in 13 episodes, PICU in 22, and death in 3 (mortality, 0.7%; 95% CI: 0.2-2.1). Both a delayed onset of SMC (14 of 23 episodes, 61%) and a biphasic clinical course (11 of 23, 48%) were frequently observed. In a multivariate logistic regression analysis, 4 characteristics were significantly and independently associated with the risk of SMC: diagnosis of acute myeloid leukemia, interval since chemotherapy ≤7 days, severely reduced general condition, and hemoglobin ≥9.0 g/dl at presentation. CONCLUSIONS In children with FN, SMC were rare, and mortality was very low. Those with SMC often had a delayed onset and biphasic clinical course with secondary deterioration.
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Affiliation(s)
- Fabienne Lüthi
- Department of Pediatrics, University of Bern, Bern, Switzerland
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Brinkman T, Liu W, Armstrong G, Gajjar A, Merchant T, Kimberg C, Kun L, Srivastava DK, Gurney J, Robison L, Hudson M, Krull K, Rubens J, Lulla RR, Lai JS, Fangusaro J, Wolfe K, Madan-Swain A, Reddy A, Hunter G, Banos J, Kana R, Resch A, von Hoff K, von Buren AO, Friedrich C, Treulieb W, Lindow C, Kwiecien R, Ottensmeier H, Rutkowski S, Armstrong CL, Phillips PC, Lustig RA, Stamos C, Li Y, Belasco J, Minturn JE, Fisher MJ, Heinks-Maldonado T, Wingeier K, Lory V, Schafer C, Studer M, Steinlin M, Leibundgut K, de Ruiter M, Schouten N, Greidanus J, Grootenhuis M, Oosterlaan J, A ALV, Grill J, Puget S, Sainte-Rose C, Dufour C, Kieffer V, Dellatolas G, -Shkedi EB, Ben Arush MW, Kaplinsky H, Ash S, Goshen Y, Yaniv I, Cohen IJ, Levy JM, Tello T, Lu X, Gao D, Wilkening G, Donson A, Foreman N, Liu A, Korzeniewska J, Baginska BD, Perek D, Staccioli S, Chieffo D, Petrarca M, Moxon-Emre I, Taylor M, Bouffet E, Malkin D, Hawkins C, Scantlebury N, Mabbott D, Cunningham T, Bouffet E, Scantlebury N, Piscione J, Igoe D, Orfus M, Bartels U, Laughlin S, Tabori U, Mabbott D, Hardy K, Carlson-Green B, Conklin H, Dockstader C, Bouffet E, Wang F, Mabbott D, Bostan S, Dockstader C, Scantlebury N, Bouffet E, Liu F, Wang F, Mabbott D, Zou P, Li Y, Conklin HM, Mulhern RK, Butler RW, Ogg RJ, Diver T, Manley P, Kieran M, Chordas C, Liptak C, Delaney B, Brand S, Rey-Casserly C. NEUROPSYCHOLOGY. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Brack E, Leibundgut K. [Acute lymphatic leukemia in childhood]. Praxis (Bern 1994) 2011; 100:1211-1219. [PMID: 21971613 DOI: 10.1024/1661-8157/a000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- E Brack
- Abteilungsleiter Hämato-Onkologie, Universitätsklinik für Kinderheilkunde, Bern
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Schlapbach LJ, Thiel S, Aebi C, Hirt A, Leibundgut K, Jensenius JC, Ammann RA. M-ficolin in children with cancer. Immunobiology 2011; 216:633-8. [PMID: 21112665 DOI: 10.1016/j.imbio.2010.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 09/20/2010] [Accepted: 09/20/2010] [Indexed: 01/17/2023]
Abstract
OBJECTIVES M-ficolin (ficolin-1) is a complement-activating pattern-recognition molecule structurally related to mannan-binding lectin. It is produced by monocytes and neutrophils, and is found in serum. Its biological role is largely unknown. We assessed M-ficolin concentration in serum from pediatric cancer patients. The aim of this study was to explore association of M-ficolin with clinical and hematological parameters, and to investigate whether the risk of chemotherapy-related infections was related to M-ficolin concentrations in serum. METHODS M-ficolin was measured by time-resolved immunofluorometric assay in serum taken at cancer diagnosis and was correlated with peripheral blood counts and bone marrow examinations performed at the same time. RESULTS Median M-ficolin concentration in 94 children with cancer was 1.6 μg/mL (interquartile range, 0.57-2.7; range, 0.055-25.8), and was not different from age-matched controls (median, 1.7 μg/mL; p=0.92). M-ficolin was strongly associated with absolute counts of neutrophils (Spearman's rho, 0.45; 95%-CI, 0.26-0.65; p<0.001), monocytes (0.34; 0.12-0.55; p<0.001), and thus phagocytes (0.42; 0.20-0.63; p<0.001) in peripheral blood. Similarly, M-ficolin correlated strongly with neutrophils (0.36; 0.14-0.59; p=0.002) and phagocytes (0.31; 0.08-0.54; p=0.009) in bone marrow. Low serum M-ficolin (≤0.5 μg/mL) was not associated with an increased incidence of fever in neutropenia during chemotherapy (multivariate Poisson rate ratio, 1.04; 95%-CI, 0.68-1.60; p=0.85). CONCLUSIONS The concentration of M-ficolin in serum from children with cancer was strongly associated with neutrophil and monocyte counts in blood and bone marrow. These results suggest that M-ficolin concentrations in serum reflect the pool of phagocytes.
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Affiliation(s)
- Luregn J Schlapbach
- Department of Pediatrics, Inselspital, University of Bern, CH-3010 Bern, Switzerland.
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Hirt A, Schmid AM, Ammann RA, Leibundgut K. In pediatric lymphoblastic leukemia of B-cell origin, a small population of primitive blast cells is noncycling, suggesting them to be leukemia stem cell candidates. Pediatr Res 2011; 69:194-9. [PMID: 21135757 DOI: 10.1203/pdr.0b013e3182092716] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Kinetic investigations in pediatric acute lymphoblastic leukemia (ALL) are based on all blast cells and, therefore, reflect the proliferative characteristics of the predominant immunophenotype of leukemic cells. Nothing is known about proliferation of immunologically defined rare subpopulations of leukemic cells. In this study, mononuclear cells from the bone marrow of 15 children with untreated CD19 B-cell precursor ALL were examined for proliferative features according to the immunophenotype. After exclusion of highly proliferating residual normal hematopoietic cells, ∼ 3% of blast cells were CD19 and showed a low percentage of cells in S-phase assessed by the bromodeoxyuridine labeling index (BrdU-LI): median BrdU-LI, 0.19% [interquartile range (IQR), 0.15-0.40%]. In contrast, a median BrdU-LI of 7.2% (IQR, 5.7-8.8%) was found for the major CD19 blast cell compartment. Staining smears of sorted CD19 cells for CD10 or CD34 revealed a small fraction of CD19CD10 or CD19CD34 blast cells. These cells were almost nonproliferating with a median BrdU-LI of <0.1% (IQR, 0-0.2%). This proliferative behavior is suggestive of a stem/progenitor cell function and, in addition, the low proliferative activity might render them more resistant to an antiproliferation-based chemotherapy. However, xenotransplantation experiments will be necessary to demonstrate a possible stem cell function.
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Affiliation(s)
- Andreas Hirt
- Department of Pediatrics, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland.
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Schlapbach L, Thiel S, Aebi C, Hirt A, Leibundgut K, Jensenius J, Ammann R. Serum M-ficolin in children with cancer. Mol Immunol 2010. [DOI: 10.1016/j.molimm.2010.05.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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44
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Passweg J, Baldomero H, Stern M, Bargetzi M, Ghielmini M, Leibundgut K, Duchosal M, Hess U, Seger R, Buhrfeind E, Schanz U, Gratwohl A. Hematopoietic stem cell transplantation in Switzerland: a comprehensive quality control report on centre effect. Swiss Med Wkly 2010; 140:326-34. [PMID: 20349362 DOI: 10.4414/smw.2010.12978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
QUESTIONS UNDER STUDY / PRINCIPLES Interest groups advocate centre-specific outcome data as a useful tool for patients in choosing a hospital for their treatment and for decision-making by politicians and the insurance industry. Haematopoietic stem cell transplantation (HSCT) requires significant infrastructure and represents a cost-intensive procedure. It therefore qualifies as a prime target for such a policy. METHODS We made use of the comprehensive database of the Swiss Blood Stem Cells Transplant Group (SBST) to evaluate potential use of mortality rates. Nine institutions reported a total of 4717 HSCT - 1427 allogeneic (30.3%), 3290 autologous (69.7%) - in 3808 patients between the years 1997 and 2008. Data were analysed for survival- and transplantation-related mortality (TRM) at day 100 and at 5 years. RESULTS The data showed marked and significant differences between centres in unadjusted analyses. These differences were absent or marginal when the results were adjusted for disease, year of transplant and the EBMT risk score (a score incorporating patient age, disease stage, time interval between diagnosis and transplantation, and, for allogeneic transplants, donor type and donor-recipient gender combination) in a multivariable analysis. CONCLUSIONS These data indicate comparable quality among centres in Switzerland. They show that comparison of crude centre-specific outcome data without adjustment for the patient mix may be misleading. Mandatory data collection and systematic review of all cases within a comprehensive quality management system might, in contrast, serve as a model to ascertain the quality of other cost-intensive therapies in Switzerland.
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Affiliation(s)
- Jakob Passweg
- Haematology, University Hospital, Geneva (HUG), Switzerland.
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Zahnd D, Leibundgut K, Zenhäusern R, Pabst T, Fontana S, Schneider R, Tobler A, Zwicky C. Implementation of the JACIE standards for a haematopoietic progenitor cell transplantation programme: a cost analysis. Bone Marrow Transplant 2009; 34:847-53. [PMID: 15517005 DOI: 10.1038/sj.bmt.1704649] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of the present project was to analyse the costs incurred by the implementation of JACIE standards at a University Hospital with 1000 beds, performing some 40 autologous transplants per year. The cost analysis was performed on the basis of a prospective assessment of the time spent by all staff members involved with the implementation over a 14-month period of the quality management system (QMS) required by the JACIE standards. Two physicians worked on JACIE Section A (management=82 h), one physician and two nurses for section Ba (clinical unit adults=125.75 h), two physicians and three nurses for section Bp (clinical unit paediatrics=206 h), one physician, two nurses and one technician for section C (progenitor cell collection facility=105.75 h), and one physician and two technicians for section D (progenitor cell processing facility=426 h). The total time spent on the project amounted to 945.5 h with a total salary cost of \[euro]150 000. We concluded that implementation of the JACIE standards was accomplished within a 14-month period with a financial impact of approximately \[euro]150 000. The impact on quality parameters (eg clinical and laboratory end points, side effects) on HPC transplantation will be assessed in a second report after the first year of practical implementation.
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Affiliation(s)
- D Zahnd
- Oncology Department, University Hospital Inselspital, CH-3010 Bern, Switzerland
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Julmy F, Ammann RA, Taleghani BM, Fontana S, Hirt A, Leibundgut K. Transfusion efficacy of ABO major-mismatched platelets (PLTs) in children is inferior to that of ABO-identical PLTs. Transfusion 2009; 49:21-33. [DOI: 10.1111/j.1537-2995.2008.01914.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wicki S, Keisker A, Aebi C, Leibundgut K, Hirt A, Ammann RA. Risk prediction of fever in neutropenia in children with cancer: a step towards individually tailored supportive therapy? Pediatr Blood Cancer 2008; 51:778-83. [PMID: 18726920 DOI: 10.1002/pbc.21726] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Fever in severe chemotherapy-induced neutropenia (FN) is the most frequent manifestation of a potentially lethal complication of current intensive chemotherapy regimens. This study aimed at establishing models predicting the risk of FN, and of FN with bacteremia, in pediatric cancer patients. METHODS In a single-centre cohort study, characteristics potentially associated with FN and episodes of FN were retrospectively extracted from charts. Poisson regression accounting for chemotherapy exposure time was used for analysis. Prediction models were constructed based on a derivation set of two thirds of observations, and validated based on the remaining third of observations. RESULTS In 360 pediatric cancer patients diagnosed and treated for a cumulative chemotherapy exposure time of 424 years, 629 FN were recorded (1.48 FN per patient per year, 95% confidence interval (CI), 1.37-1.61), 145 of them with bacteremia (23% of FN; 0.34; 0.29-0.40). More intensive chemotherapy, shorter time since diagnosis, bone marrow involvement, central venous access device (CVAD), and prior FN were significantly and independently associated with a higher risk to develop both FN and FN with bacteremia. The prediction models explained more than 30% of the respective risks. CONCLUSIONS The two models predicting FN and FN with bacteremia were based on five easily accessible clinical variables. Before clinical application, they need to be validated by prospective studies.
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Affiliation(s)
- Silvia Wicki
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Bern, Bern, Switzerland
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Hirt A, Schmid AM, Julmy F, Schmitz NMR, Leibundgut K. Expression of cyclin A in childhood acute lymphoblastic leukemia cells reveals undisturbed G1–S phase transition and passage through the S phase. Leukemia 2008; 23:414-7. [DOI: 10.1038/leu.2008.200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Julmy F, Ammann RA, Mansouri Taleghani B, Fontana S, Hirt A, Leibundgut K. Effects of high-yield thrombocytapheresis on the quality of platelet products. Transfusion 2008; 48:442-50. [DOI: 10.1111/j.1537-2995.2007.01548.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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50
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Steiner I, Aebi C, Ridolfi Lüthy A, Wagner B, Leibundgut K. Fatal adenovirus hepatitis during maintenance therapy for childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2008; 50:647-9. [PMID: 17278117 DOI: 10.1002/pbc.21120] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Disseminated adenoviral infection with hepatitis is rare in children undergoing standard chemotherapy. We report on a 3(1/2)-year-old male with fatal adenovirus hepatitis receiving maintenance chemotherapy for acute lymphoblastic leukemia (ALL). Adenoviral hepatitis was proven by histology, viral culture, and PCR in a liver biopsy. Quantitative real-time PCR in the peripheral blood showed adenoviral DNA copy number >10(9)/ml. Despite aggressive supportive care and antiviral treatment with cidofovir, the patient died rapidly due to fulminant liver failure. Diagnostic and treatment options for adenovirus infection remain unsatisfactory for these patients. We propose suggestions for diagnosis and therapy.
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Affiliation(s)
- Isabelle Steiner
- Division of Pediatric Hematology/Oncology, University Children's Hospital, Inselspital, Bern, Switzerland
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