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Otth M, Brack E, Kearns PR, Kozhaeva O, Ocokoljic M, Schoot RA, Vassal G, Balduzzi A, Beck Popovic M, Beishuizen A, Bergamaschi L, Biondi A, Bourdeaut F, Braicu E, Brok J, Brugières L, Burke A, Calaminus G, Casanova M, Choucair ML, Cleirec M, Corbaciouglu S, Correa Llano MG, De Rojas T, Domínguez Pinilla N, Elmaraghi C, Ferrari A, Fossa A, Gaspar N, Herold N, Karapiperi K, Karu M, Kjærsgaar M, Knörr F, Koenig C, Kranjcec I, Krawczyk M, Lehmberg K, Lehrnbecher T, Lunesink M, Massano D, Matijasic N, Merks H, Metzler M, Michalski A, Minkov M, Morland B, Niktoreh N, Oltenau E, Orbach D, Owens C, Papachristidou S, Pasqualini C, Pavlovic M, Perez Albert P, Poyer F, Radulovic I, Reinhardt D, Rebelo J, Roser E, Russo I, Scheinemann K, Schindera C, Schrappe M, Sehested A, Sehouli J, Spreafico F, Strauss SJ, Stutterheim J, Svojgr K, Tzotzola V, Van Ewijk R, Verschuur A, Vora A, Woessmann W, Zajac-Spychala O, Zwaan M. Essential medicines for childhood cancer in Europe: a pan-European, systematic analysis by SIOPE. Lancet Oncol 2022; 23:1537-1546. [PMID: 36332647 DOI: 10.1016/s1470-2045(22)00623-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Shortages and unequal access to anticancer medicines for children and adolescents are a reality in Europe. The aim of the European Society for Paediatric Oncology (SIOPE) Essential Anticancer Medicines Project was to provide a list of anticancer medicines that are considered essential in the treatment of paediatric cancers to help ensure their continuous access to all children and adolescents with cancer across Europe. METHODS This pan-European project, done between Jan 20, 2020, and Feb 18, 2022, was designed to be a systematic collection and review of treatment protocols and strategies that are used to treat childhood cancer in Europe. We formed 16 working groups on the basis of paediatric cancer types, and which were based on the existing SIOPE Clinical Trial Groups. Workings groups consisted of representatives from the SIOPE Clinical Trial Groups, Young SIOPE members, and senior paediatric oncology experts. Each group collected existing treatment protocols that are used to treat the respective cancer types in Europe. Medicines from the standard group of each protocol were extracted. For medicines not on the WHO Essential Medicines List for children (EMLc) 2017, working groups did a literature search to determine whether the medicines should be defined as essential, promising, or neither essential nor promising. Each group provided an individual summary, and all medicines that were considered essential by at least one group were combined in a joint list. FINDINGS The working groups identified 73 treatment protocols used in Europe and defined 66 medicines as essential. For several newer medicines, such as kinase inhibitors or tisagenlecleucel, the supporting evidence was insufficient to consider them essential, so these medicines were defined as promising. 25 medicines were considered promising by at least one working group. 22 (33%) of the 66 essential and none of the promising medicines were included in the WHO EMLc 2017. The WHO EMLc 2021 included two new medicines (everolimus and vinorelbine) following applications we made as a result of this project. INTERPRETATION Medicines that were defined as essential within this project should be available for the treatment of childhood and adolescent cancer continuously and across Europe. This list can be used to support and guide stakeholders and policy makers in negotiations on a national and European level regarding shortages, accessibility, and affordability of these medicines. FUNDING None.
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Affiliation(s)
- Maria Otth
- Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland; Department of Oncology, Haematology, Immunology, Stem Cell Transplantation and Somatic Gene Therapy, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Eva Brack
- Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, Bern, Switzerland
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Olga Kozhaeva
- Policy Department, European Society for Paediatric Oncology, SIOP Europe, Brussels, Belgium
| | - Marko Ocokoljic
- Policy Department, European Society for Paediatric Oncology, SIOP Europe, Brussels, Belgium
| | - Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Gilles Vassal
- Department of Children and Adolescent Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
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Gabriel M, Hoeben BAW, Uhlving HH, Zajac-Spychala O, Lawitschka A, Bresters D, Ifversen M. A Review of Acute and Long-Term Neurological Complications Following Haematopoietic Stem Cell Transplant for Paediatric Acute Lymphoblastic Leukaemia. Front Pediatr 2021; 9:774853. [PMID: 35004543 PMCID: PMC8734594 DOI: 10.3389/fped.2021.774853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/02/2021] [Indexed: 12/02/2022] Open
Abstract
Despite advances in haematopoietic stem cell transplant (HSCT) techniques, the risk of serious side effects and complications still exists. Neurological complications, both acute and long term, are common following HSCT and contribute to significant morbidity and mortality. The aetiology of neurotoxicity includes infections and a wide variety of non-infectious causes such as drug toxicities, metabolic abnormalities, irradiation, vascular and immunologic events and the leukaemia itself. The majority of the literature on this subject is focussed on adults. The impact of the combination of neurotoxic drugs given before and during HSCT, radiotherapy and neurological complications on the developing and vulnerable paediatric and adolescent brain remains unclear. Moreover, the age-related sensitivity of the nervous system to toxic insults is still being investigated. In this article, we review current evidence regarding neurotoxicity following HSCT for acute lymphoblastic leukaemia in childhood. We focus on acute and long-term impacts. Understanding the aetiology and long-term sequelae of neurological complications in children is particularly important in the current era of immunotherapy for acute lymphoblastic leukaemia (such as chimeric antigen receptor T cells and bi-specific T-cell engager antibodies), which have well-known and common neurological side effects and may represent a future treatment modality for at least a fraction of HSCT-recipients.
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Affiliation(s)
- Melissa Gabriel
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Bianca A W Hoeben
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Hilde Hylland Uhlving
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | - Anita Lawitschka
- Haematopoietic Stem Cell Transplant Unit, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Marianne Ifversen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Zajac-Spychala O, Kampmeier S, Lehrnbecher T, Groll AH. Infectious Complications in Paediatric Haematopoetic Cell Transplantation for Acute Lymphoblastic Leukemia: Current Status. Front Pediatr 2021; 9:782530. [PMID: 35223707 PMCID: PMC8866305 DOI: 10.3389/fped.2021.782530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/15/2021] [Indexed: 12/02/2022] Open
Abstract
Haematopoietic stem cell transplantation (HSCT) in paediatric patients with acute lymphoblastic leukaemia (ALL) is associated with a variety of infectious complications which result in significant morbidity and mortality. These patients are profoundly immunocompromised, and immune reconstitution after HSCT generally occurs in astrictly defined order. During the early phase after HSCT until engraftment, patients are at risk of infections due to presence of neutropenia and mucosal damage, with Gramme-positive and Gramme-negative bacteria and fungi being the predominant pathogens. After neutrophil recovery, the profound impairment of cell-mediated immunity and use of glucocorticosteroids for control of graft-vs.-host disease (GvHD) increases the risk of invasive mould infection and infection or reactivation of various viruses, such as cytomegalovirus, varicella zoster virus, Epstein-Barr virus and human adenovirus. In the late phase, characterised by impaired cellular and humoral immunity, particularly in conjunction with chronic GvHD, invasive infections with encapsulated bacterial infections are observed in addition to fungal and viral infections. HSCT also causes a loss of pretransplant naturally acquired and vaccine-acquired immunity; therefore, complete reimmunization is necessary to maintain long-term health in these patients. During the last two decades, major advances have been made in our understanding of and in the control of infectious complications associated with HSCT. In this article, we review current recommendations for the diagnosis, prophylaxis and treatment of infectious complications following HSCT for ALL in childhood.
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Affiliation(s)
- Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
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Diesch-Furlanetto T, Gabriel M, Zajac-Spychala O, Cattoni A, Hoeben BAW, Balduzzi A. Late Effects After Haematopoietic Stem Cell Transplantation in ALL, Long-Term Follow-Up and Transition: A Step Into Adult Life. Front Pediatr 2021; 9:773895. [PMID: 34900873 PMCID: PMC8652149 DOI: 10.3389/fped.2021.773895] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 12/13/2022] Open
Abstract
Haematopoietic stem cell transplant (HSCT) can be a curative treatment for children and adolescents with very-high-risk acute lymphoblastic leukaemia (ALL). Improvements in supportive care and transplant techniques have led to increasing numbers of long-term survivors worldwide. However, conditioning regimens as well as transplant-related complications are associated with severe sequelae, impacting patients' quality of life. It is widely recognised that paediatric HSCT survivors must have timely access to life-long care and surveillance in order to prevent, ameliorate and manage all possible adverse late effects of HSCT. This is fundamentally important because it can both prevent ill health and optimise the quality and experience of survival following HSCT. Furthermore, it reduces the impact of preventable chronic illness on already under-resourced health services. In addition to late effects, survivors of paediatric ALL also have to deal with unique challenges associated with transition to adult services. In this review, we: (1) provide an overview of the potential late effects following HSCT for ALL in childhood and adolescence; (2) focus on the unique challenges of transition from paediatric care to adult services; and (3) provide a framework for long-term surveillance and medical care for survivors of paediatric ALL who have undergone HSCT.
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Affiliation(s)
- Tamara Diesch-Furlanetto
- Division of Pediatric Oncology/Hematology, University Children's Hospital Basel (UKB), University of Basel, Basel, Switzerland
| | - Melissa Gabriel
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznań, Poland
| | - Alessandro Cattoni
- Clinica Pediatrica, University degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza, Italy
| | - Bianca A W Hoeben
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Adriana Balduzzi
- Clinica Pediatrica, University degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza, Italy
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Zajac-Spychala O, Wachowiak J, Gryniewicz-Kwiatkowska O, Gietka A, Dembowska-Baginska B, Semczuk K, Dzierzanowska-Fangrat K, Czyzewski K, Dziedzic M, Wysocki M, Zalas-Wiecek P, Szmydki-Baran A, Hutnik L, Matysiak M, Pierlejewski F, Mlynarski W, Małas Z, Badowska W, Irga-Jaworska N, Bien E, Drozynska E, Bartnik M, Ociepa T, Urasiński T, Wawrykow P, Peregud-Pogorzelski J, Stolpa W, Sobol-Milejska G, Fraczkiewicz J, Salamonowicz M, Kazanowska B, Chybicka A, Chelmecka-Wiktorczyk L, Balwierz W, Zak I, Gamrot-Pyka Z, Woszczyk M, Tomaszewska R, Szczepanski T, Plonowski M, Krawczuk-Rybak M, Urbanek-Dadela A, Karolczyk G, Musial J, Chaber R, Kowalczyk J, Styczynski J. Prevalence, Epidemiology, Etiology, and Sensitivity of Invasive Bacterial Infections in Pediatric Patients Undergoing Oncological Treatment: A Multicenter Nationwide Study. Microb Drug Resist 2020; 27:53-63. [PMID: 32434455 DOI: 10.1089/mdr.2019.0393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Infectious complications (IC) caused by bacterial strains often impede anticancer therapy. The study aimed to retrospectively analyze bacterial IC that could help predict the risk and optimize the empirical treatment for bacterial infections in pediatric cancer patients. Patients and Methods: Over a 72-month period, all-in 5,599 children with cancer: 2,441 patients with hematological malignancy (HM including acute leukemias, Hodgkin and non-Hodgkin lymphomas [NHLs], and Langerhans cell histiocytosis) and 3,158 with solid tumors (STs including central nervous system tumors, neuroblastoma, Wilms' tumor, soft tissue sarcoma, germ cell tumors, Ewing sarcoma, osteosarcoma, hepatoblastoma, and others) were enrolled into the study. Episodes of bacterial infectious complications (EBICs) confirmed by microbiological findings were reported by each hospital and analyzed centrally. Results: At least 1 EBIC was diagnosed in 2,155 (36.8%) children (1,281 [59.4%] with HM and 874 [40.6%] with ST; p < 0.001). All-in 4,860 EBICs were diagnosed including 62.2% episodes in children with HM and 37.8% in children with ST (p < 0.001). Having analyzed the source of infections, blood stream infections predominated, apart from NHL patients in whom the most common type was gut infections. The profile of bacteria strains was different in HM and ST groups (p < 0.001). However, in both groups the most common Gram-negative pathogen was Enterobacteriaceae, with the rate being higher in the HM group. Among Gram-negative strains low susceptibility to ceftazidime, whereas among Enterococcus spp. low susceptibility to vancomycin was noticed. The rate of multidrug-resistant (MDR) pathogens was high, especially for Gram negatives (47.7% vs. 23.9%; p < 0.001). The survival after infections was comparable for HM and ST patients (p = 0.215). Conclusions: The risk of bacterial IC in HM patients was higher than in the ST group. The high rate of MDR strains was detected in pediatric cancer patients, especially in those with HM.
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Affiliation(s)
- Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | | | - Aneta Gietka
- Department of Oncology and Children's Memorial Health Institute, Warszawa, Poland
| | | | - Katarzyna Semczuk
- Department of Microbiology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - Krzysztof Czyzewski
- Department of Pediatric Hematology and Oncology and Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology and Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Mariusz Wysocki
- Department of Pediatric Hematology and Oncology and Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Patrycja Zalas-Wiecek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Anna Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Lukasz Hutnik
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Michal Matysiak
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland
| | - Filip Pierlejewski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | - Wojciech Mlynarski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland
| | - Zofia Małas
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - Wanda Badowska
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - Elzbieta Drozynska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - Magdalena Bartnik
- Department of Pediatrics, Hemato-Oncology and Gastroenterology and Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hemato-Oncology and Gastroenterology and Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hemato-Oncology and Gastroenterology and Pomeranian Medical University, Szczecin, Poland
| | - Pawel Wawrykow
- Department of Pediatrics and Oncology, Pomeranian Medical University, Szczecin, Poland
| | | | - Weronika Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - Grazyna Sobol-Milejska
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - Jowita Fraczkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Malgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Bernarda Kazanowska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Alicja Chybicka
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Liliana Chelmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology and University Children's Hospital, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology and University Children's Hospital, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Iwona Zak
- Department of Microbiology, University Children's Hospital, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Zuzanna Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - Mariola Woszczyk
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - Tomasz Szczepanski
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - Marcin Plonowski
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | | | - Grazyna Karolczyk
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Poland
| | - Jakub Musial
- Department of Pediatric Oncohematology, Children Hospital, Rzeszow, Poland
| | - Radoslaw Chaber
- Department of Pediatric Oncohematology, Children Hospital, Rzeszow, Poland
| | - Jerzy Kowalczyk
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology and Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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Czyzewski K, Dziedzic M, Salamonowicz M, Fraczkiewicz J, Zajac-Spychala O, Zaucha-Prazmo A, Gozdzik J, Galazka P, Bartoszewicz N, Demidowicz E, Styczynski J. Epidemiology, Outcome and Risk Factors Analysis of Viral Infections in Children and Adolescents Undergoing Hematopoietic Cell Transplantation: Antiviral Drugs Do Not Prevent Epstein-Barr Virus Reactivation. Infect Drug Resist 2019; 12:3893-3902. [PMID: 31908501 PMCID: PMC6925545 DOI: 10.2147/idr.s224291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/05/2019] [Indexed: 12/28/2022] Open
Abstract
Objective The analysis of epidemiology, risk factors and outcome of viral infections in children and adolescents after hematopoietic cell transplantation (HCT). Methods In this multicenter nationwide study a total of 971 HCT procedures (741 allo-HCT; 230 auto-HCT) over a period of 6 years were analyzed. Results During this period 801 episodes of viral infections were diagnosed in 442 patients. The incidence of viral infections was 57.9% in allo-HCT and 4.8% in auto-HCT patients. The most frequent infections after allo-HCT were caused by cytomegalovirus (CMV), polyoma BK virus (BKV) and Epstein-Barr virus (EBV). The majority of infections occurred within the first 4 months after allo-HCT and over 80% required pharmacotherapy or symptomatic therapy. The median time of treatment of specific viral infection ranged from 7 (for EBV) to 24 (for CMV) days. The highest mortality was observed in case of CMV infection. The risk factors for viral infections were allo-HCT, acute leukemia, acute and chronic graft versus host disease (a/cGVHD), and matched unrelated donor (MUD)/mismatched unrelated donor (MMUD)-HCT. The risk factor for death from viral infection were CMV-IgG seropositivity in acute lymphoblastic leukemia recipient, and MUD/MMUD-HCT. The incidence of EBV infection requiring pre-emptive treatment with rituximab in allo-HCT children was 19.3%. In 30.8% cases of EBV infection, these episodes were preceded by other viral infection and treated with antivirals, which did not prevent development of EBV-DNA-emia with need of rituximab treatment in 81.5% cases. In 47.7% of these cases, GVHD was a factor enabling development of significant EBV-DNA-emia during antiviral therapy of other infection. Conclusion We have shown that antiviral drugs do not prevent EBV reactivation in allo-HCT pediatric patients.
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Affiliation(s)
- Krzysztof Czyzewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Malgorzata Salamonowicz
- Department of Pediatric Transplantation, Oncology and Hematology, Medical University, Wroclaw, Poland
| | - Jowita Fraczkiewicz
- Department of Pediatric Transplantation, Oncology and Hematology, Medical University, Wroclaw, Poland
| | - Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Agnieszka Zaucha-Prazmo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - Jolanta Gozdzik
- Stem Cell Transplant Center, University Children's Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Przemyslaw Galazka
- Department of General and Oncological Surgery for Children and Adolescents, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Natalia Bartoszewicz
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Ewa Demidowicz
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
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Czyzewski K, Fraczkiewicz J, Salamonowicz M, Pieczonka A, Zajac-Spychala O, Zaucha-Prazmo A, Gozdzik J, Styczynski J. Low seroprevalence and low incidence of infection with Toxoplasma gondii (Nicolle et Manceaux, 1908) in pediatric hematopoietic cell transplantation donors and recipients: Polish nationwide study. Folia Parasitol (Praha) 2019; 66. [DOI: 10.14411/fp.2019.019] [Citation(s) in RCA: 8] [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: 11/16/2018] [Accepted: 08/21/2019] [Indexed: 12/24/2022]
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Czyzewski K, Galazka P, Zalas-Wiecek P, Gryniewicz-Kwiatkowska O, Gietka A, Semczuk K, Chelmecka-Wiktorczyk L, Zak I, Salamonowicz M, Fraczkiewicz J, Zajac-Spychala O, Bien E, Plonowski M, Wawrykow P, Pierlejewski F, Gamrot Z, Malas Z, Stolpa W, Musial J, Styczynski J. Infectious complications in children with malignant bone tumors: a multicenter nationwide study. Infect Drug Resist 2019; 12:1471-1480. [PMID: 31213862 PMCID: PMC6549759 DOI: 10.2147/idr.s199657] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/29/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives: The analysis of epidemiology, risk factors and outcome of infections in children with malignant bone tumors (MBT) undergoing chemotherapy. Methods: In this retrospective nationwide multicenter cross-sectional study, a total number of 126 children with MBT including 70 with Ewing sarcoma (ES) and 56 with osteosarcoma (OSA) were screened for infections over a period of 72 consecutive months. Results: The risk of infection was 7.15-fold higher in patients with ES as compared to the OSA group, especially concerning bacterial infections (4.1-fold increase risk). Bacterial infections occurred in 74.3% patients with ES and in 41.1% with OSA. The median time from diagnosis to first infection was 4.9 months. 33.0% of bacterial episodes were diagnosed as bloodstream (BSI), 31.1% as gastrointestinal tract, 30.1% as urinary tract infection. Infection-related mortality (IRM) from bacterial infection was 6% and 15% in ES and OSA patients, respectively. Cumulative incidence was 7.1% for invasive fungal disease and 6.3% for viral infections. The only significant risk factor for IRM was time to infection ≥5 months since the beginning of chemotherapy. All patients who have died from infection had BSI and were in neutropenia. Conclusions: Infections in the children with MBT in our study occurred with high frequency, especially in patients with ES. The most frequent were bacterial infections, while fungal and viral infections were episodic. Among the bacterial infections, bloodstream, urinary tract and gastrointestinal tract infections occurred with similar frequency. All deceased patients died due to BSI. Bacterial infection occurring ≥5 months since the beginning of chemotherapy was a risk factor for death.
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Affiliation(s)
- Krzysztof Czyzewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Przemyslaw Galazka
- Department of General and Oncological Surgery for Children and Adolescents, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Patrycja Zalas-Wiecek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | | | - Agnieszka Gietka
- Department of Oncology, Children's Memorial Health Institute, Warsaw, Poland
| | - Katarzyna Semczuk
- Department of Microbiology, Children's Memorial Health Institute, Warsaw, Poland
| | - Liliana Chelmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Iwona Zak
- Department of Microbiology, University Children's Hospital, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Malgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Jowita Fraczkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - Marcin Plonowski
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland
| | - Pawel Wawrykow
- Department of Pediatrics and Pediatric Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Filip Pierlejewski
- Department of Pediatric Oncology and Hematology, Medical University, Lodz, Poland
| | - Zuzanna Gamrot
- Division of Pediatric Hematology and Oncology, Chorzow City Hospital, Chorzow, Poland
| | - Zofia Malas
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - Weronika Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - Jakub Musial
- Department of Pediatric Oncohematology, Medical Faculty University of Rzeszow, Clinical Provincial Hospital No. 2, Rzeszow, Poland
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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9
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Zajac-Spychala O, Wachowiak J, Szmydki-Baran A, Hutnik L, Salamonowicz M, Matysiak M, Czyzewski K, Wysocki M, Zalas-Wiecek P, Malas Z, Badowska W, Gryniewicz-Kwiatkowska O, Czajnska-Deptuła A, Kulicka E, Dembowska-Baginska B, Perek D, Semczuk K, Dzierzanowska-Fangrat K, Ociepa T, Bartnik M, Chelmecka-Wiktorczyk L, Balwierz W, Klepacka J, Irga-Jaworska N, Bien E, Adamkiewicz-Drozynska E, Urbanek-Dadela A, Karolczyk G, Pierlejewski F, Mlynarski W, Plonowski M, Krawczuk-Rybak M, Stolpa W, Sobol G, Tomaszewska R, Szczepanski T, Gamrot Z, Woszczyk M, Wieczorek M, Kowalczyk J, Styczynski J. Infectious complications in children treated for hodgkin and non-hodgkin lymphomas in polish pediatric leukemia/lymphoma study group: incidence, epidemiology and etiology. Leuk Lymphoma 2018; 60:124-132. [PMID: 30392426 DOI: 10.1080/10428194.2018.1466293] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The objective of this nation-wide study was to evaluate the epidemiology and profile of bacterial (BI), viral (VI), and invasive fungal disease (IFD) in patients treated for non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) between the years 2013-2015. In the analyzed period of time, within the studied group of 328 children diagnosed and treated for lymphomas, at least one infectious complication (IC) was diagnosed i.e. 39.3% children. In these patients there were 350 episodes of IC, therein 80.6% episodes of BI, 11.1% episodes of VI, and 8.3% episodes of IFD. In both groups, NHL and HL patients, a stable level of bacterial infections, with an increase in resistance rates, and increased levels of viral and fungal infections were observed. Profile of BI does not depend on lymphoma type, with predominance of Gram-negative bacteria and higher prevalence of MDR pathogens. The overall survival of lymphoma patients with IC was comparable for different types of infections.
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Affiliation(s)
- Olga Zajac-Spychala
- a Department of Pediatric Oncology, Hematology and Transplantology , Poznan University of Medical Sciences , Poznan , Poland
| | - Jacek Wachowiak
- a Department of Pediatric Oncology, Hematology and Transplantology , Poznan University of Medical Sciences , Poznan , Poland
| | - Anna Szmydki-Baran
- b Department of Paediatric Haematology and Oncology , Medical University , Warszawa , Poland
| | - Lukasz Hutnik
- b Department of Paediatric Haematology and Oncology , Medical University , Warszawa , Poland
| | - Malgorzata Salamonowicz
- b Department of Paediatric Haematology and Oncology , Medical University , Warszawa , Poland
| | - Michal Matysiak
- b Department of Paediatric Haematology and Oncology , Medical University , Warszawa , Poland
| | - Krzysztof Czyzewski
- c Department of Paediatric Haematology and Oncology , Collegium Medicum, Nicolaus Copernicus University Torun , Bydgoszcz , Poland
| | - Mariusz Wysocki
- c Department of Paediatric Haematology and Oncology , Collegium Medicum, Nicolaus Copernicus University Torun , Bydgoszcz , Poland
| | - Patrycja Zalas-Wiecek
- d Department of Microbiology , Collegium Medicum, Nicolaus Copernicus University Torun , Bydgoszcz , Poland
| | - Zofia Malas
- e Division of Paediatric Haematology and Oncology , Children Hospital , Olsztyn , Poland
| | - Wanda Badowska
- e Division of Paediatric Haematology and Oncology , Children Hospital , Olsztyn , Poland
| | | | | | - Elwira Kulicka
- f Department of Oncology , Children's Memorial Health Institute , Warszawa , Poland
| | | | - Danuta Perek
- f Department of Oncology , Children's Memorial Health Institute , Warszawa , Poland
| | - Katarzyna Semczuk
- g Department of Microbiology , Children's Memorial Health Institute , Warszawa , Poland
| | | | - Tomasz Ociepa
- h Department of Pediatrics Hematology/Oncology and Gastroenterology , Pomeranian Medical University , Szczecin , Poland
| | - Magdalena Bartnik
- h Department of Pediatrics Hematology/Oncology and Gastroenterology , Pomeranian Medical University , Szczecin , Poland
| | - Liliana Chelmecka-Wiktorczyk
- i Department of Paediatric Oncology and Haematology , University Children's Hospital, Jagiellonian University Collegium Medicum , Krakow , Poland
| | - Walentyna Balwierz
- j University Children's Hospital, Jagiellonian University Collegium Medicum , Krakow , Poland
| | - Joanna Klepacka
- k Department of Microbiology , Jagiellonian University Collegium Medicum , Krakow , Poland
| | - Nina Irga-Jaworska
- i Department of Paediatric Oncology and Haematology , University Children's Hospital, Jagiellonian University Collegium Medicum , Krakow , Poland
| | - Ewa Bien
- m Department of Paediatrics, Haematology and Oncology , Medical University , Gdansk , Poland
| | | | | | | | - Filip Pierlejewski
- p Department of Paediatric Oncology Haematology and Diabetology , Medical University , Lodz , Poland
| | - Wojciech Mlynarski
- p Department of Paediatric Oncology Haematology and Diabetology , Medical University , Lodz , Poland
| | - Marcin Plonowski
- q Department of Paediatric Oncology and Haematology , Medical University , Bialystok , Poland
| | - Maryna Krawczuk-Rybak
- q Department of Paediatric Oncology and Haematology , Medical University , Bialystok , Poland
| | - Weronika Stolpa
- r Division of Paediatric Oncology, Haematology and Chemotherapy, Department of Paediatric , Silesian Medical University, Katowice , Katowice , Poland
| | - Grazyna Sobol
- r Division of Paediatric Oncology, Haematology and Chemotherapy, Department of Paediatric , Silesian Medical University, Katowice , Katowice , Poland
| | - Renata Tomaszewska
- s Department of Pediatric Hematology and Oncology , Medical University of Silesia, Katowice , Zabrze , Poland
| | - Tomasz Szczepanski
- t Department of Pediatric Hematology and Oncology , Medical University of Silesia , Zabrze , Poland
| | - Zuzanna Gamrot
- u Division of Paediatric Haematology and Oncology , Chorzow Paediatric and Oncology Center , Chorzow , Poland
| | - Mariola Woszczyk
- u Division of Paediatric Haematology and Oncology , Chorzow Paediatric and Oncology Center , Chorzow , Poland
| | - Maria Wieczorek
- u Division of Paediatric Haematology and Oncology , Chorzow Paediatric and Oncology Center , Chorzow , Poland
| | - Jerzy Kowalczyk
- v Department of Pediatric Hematology and Oncology , Medical University , Lublin , Poland
| | - Jan Styczynski
- c Department of Paediatric Haematology and Oncology , Collegium Medicum, Nicolaus Copernicus University Torun , Bydgoszcz , Poland
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10
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Styczynski J, Czyzewski K, Wysocki M, Zajac-Spychala O, Wachowiak J, Ociepa T, Urasinski T, Gryniewicz-Kwiatkowska O, Kolodziejczyk-Gietka A, Dembowska-Baginska B, Perek D, Salamonowicz M, Hutnik L, Matysiak M, Siewiera K, Frackiewicz J, Kalwak K, Badowska W, Malas Z, Gozdzik J, Urbanek-Dadela A, Karolczyk G, Stolpa W, Sobol G, Gamrot Z, Woszczyk M, Gil L. Micafungin in invasive fungal infections in children with acute leukemia or undergoing stem cell transplantation. Leuk Lymphoma 2016; 57:2456-9. [PMID: 26880109 DOI: 10.3109/10428194.2016.1143937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jan Styczynski
- a Department of Pediatric Hematology and Oncology, Collegium Medicum , Nicolaus Copernicus University Torun , Bydgoszcz , Poland
| | - Krzysztof Czyzewski
- a Department of Pediatric Hematology and Oncology, Collegium Medicum , Nicolaus Copernicus University Torun , Bydgoszcz , Poland
| | - Mariusz Wysocki
- a Department of Pediatric Hematology and Oncology, Collegium Medicum , Nicolaus Copernicus University Torun , Bydgoszcz , Poland
| | - Olga Zajac-Spychala
- b Department of Pediatric Oncology , Hematology and Transplantology, University of Medical Sciences , Poznan , Poland
| | - Jacek Wachowiak
- b Department of Pediatric Oncology , Hematology and Transplantology, University of Medical Sciences , Poznan , Poland
| | - Tomasz Ociepa
- c Department of Pediatric Hematology and Oncology , Pomeranian Medical University , Szczecin , Poland
| | - Tomasz Urasinski
- c Department of Pediatric Hematology and Oncology , Pomeranian Medical University , Szczecin , Poland
| | | | | | | | - Danuta Perek
- d Department of Oncology , Children's Memorial Health Institute , Warszawa , Poland
| | | | - Lukasz Hutnik
- e Department of Pediatric Hematology and Oncology , Medical University , Warszawa , Poland
| | - Michal Matysiak
- e Department of Pediatric Hematology and Oncology , Medical University , Warszawa , Poland
| | - Karolina Siewiera
- f Department of Pediatric Stem Cell Transplantation, Hematology and Oncology , Medical University , Wroclaw , Poland
| | - Jowita Frackiewicz
- f Department of Pediatric Stem Cell Transplantation, Hematology and Oncology , Medical University , Wroclaw , Poland
| | - Krzysztof Kalwak
- f Department of Pediatric Stem Cell Transplantation, Hematology and Oncology , Medical University , Wroclaw , Poland
| | - Wanda Badowska
- g Division of Pediatric Hematology and Oncology , Children Hospital , Olsztyn , Poland
| | - Zofia Malas
- g Division of Pediatric Hematology and Oncology , Children Hospital , Olsztyn , Poland
| | - Jolanta Gozdzik
- h Department of Clinical Immunology and Transplantology, Stem Cell Transplant Center , University Children's Hospital, Jagiellonian University Collegium Medicum , Krakow , Poland
| | | | - Grażyna Karolczyk
- i Division of Pediatric Hematology and Oncology , Children Hospital , Kielce , Poland
| | - Weronika Stolpa
- j Department of Pediatric, Division of Pediatric Oncology, Hematology and Chemotherapy , Silesian Medical University , Katowice , Poland
| | - Grazyna Sobol
- j Department of Pediatric, Division of Pediatric Oncology, Hematology and Chemotherapy , Silesian Medical University , Katowice , Poland
| | - Zuzanna Gamrot
- k Division of Paediatric Haematology and Oncology , Chorzow Paediatric and Oncology Center , Chorzow , Poland
| | - Mariola Woszczyk
- k Division of Paediatric Haematology and Oncology , Chorzow Paediatric and Oncology Center , Chorzow , Poland
| | - Lidia Gil
- l Department of Hematology , University of Medical Sciences , Poznan , Poland
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11
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Styczynski J, Czyzewski K, Wysocki M, Gryniewicz-Kwiatkowska O, Kolodziejczyk-Gietka A, Salamonowicz M, Hutnik L, Zajac-Spychala O, Zaucha-Prazmo A, Chelmecka-Wiktorczyk L, Siewiera K, Fraczkiewicz J, Malas Z, Tomaszewska R, Irga-Jaworska N, Plonowski M, Ociepa T, Pierlejewski F, Gamrot Z, Urbanek-Dadela A, Gozdzik J, Stolpa W, Dembowska-Baginska B, Perek D, Matysiak M, Wachowiak J, Kowalczyk J, Balwierz W, Kalwak K, Chybicka A, Badowska W, Szczepanski T, Drozynska E, Krawczuk-Rybak M, Urasinski T, Mlynarski W, Woszczyk M, Karolczyk G, Sobol-Milejska G, Gil L. Increased risk of infections and infection-related mortality in children undergoing haematopoietic stem cell transplantation compared to conventional anticancer therapy: a multicentre nationwide study. Clin Microbiol Infect 2015; 22:179.e1-179.e10. [PMID: 26493843 DOI: 10.1016/j.cmi.2015.10.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 10/06/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
Abstract
This nationwide multicentre study analysed the epidemiology of bacterial, viral and fungal infections in paediatric haematopoietic stem cell transplantation (HSCT) and paediatric haematology and oncology (PHO) patients over a period of 24 consecutive months, including incidence, hazard risk and outcome of infections as well as occurrence of multidrug-resistant bacteria. During this period, 308 HSCTs were performed and 1768 children were newly diagnosed for malignancy. Compared to PHO, the risk in HSCT patients was significantly higher for all infections (hazard ratio (HR) 2.7), bacterial (HR 1.4), fungal (HR 3.5) and viral (HR 15.7) infections. The risk was higher in allo- than auto-HSCT for bacterial (HR 1.4), fungal (HR 3.2) and viral (HR 17.7) infections. The incidence of resistant bacteria was higher in HSCT than in PHO patients for both G-negative (72.5% vs. 59.2%) and G-positive (41.4% vs. 20.5%) strains. Cumulative incidence of bacterial, fungal and viral infections in HSCT patients was 33.9, 22.8 and 38.3%, respectively. Cumulative incidence of viral infections in allo-HSCT was 28.0% for cytomegalovirus, 18.5% for BK virus, 15.5% for Epstein-Barr virus, 9.5% for adenovirus, 2.6% for varicella zoster virus, 0.9% for influenza, 0.9% for human herpesvirus 6 and 0.3% for hepatitis B virus. Survival rates from infections were lower in HSCT than in PHO patients in bacterial (96.0 vs. 98.2%), fungal (75.5 vs. 94.6%) and most viral infections. In conclusion, the risk of any infections and the occurrence of resistant bacterial strains in allo-HSCT patients were higher than in auto-HSCT and PHO patients, while the outcome of infections was better in the PHO setting.
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Affiliation(s)
- J Styczynski
- Department of Paediatric Haematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland.
| | - K Czyzewski
- Department of Paediatric Haematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Wysocki
- Department of Paediatric Haematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | | | | | - M Salamonowicz
- Department of Paediatric Haematology and Oncology, Medical University, Warszawa, Poland
| | - L Hutnik
- Department of Paediatric Haematology and Oncology, Medical University, Warszawa, Poland
| | - O Zajac-Spychala
- Department of Paediatric Oncology, Haematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - A Zaucha-Prazmo
- Department of Paediatric Haematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - L Chelmecka-Wiktorczyk
- Department of Paediatric Oncology and Haematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - K Siewiera
- Department of Paediatric Stem Cell Transplantation, Haematology and Oncology, Medical University, Wroclaw, Poland
| | - J Fraczkiewicz
- Department of Paediatric Stem Cell Transplantation, Haematology and Oncology, Medical University, Wroclaw, Poland
| | - Z Malas
- Division of Paediatric Haematology and Oncology, Children Hospital, Olsztyn, Poland
| | - R Tomaszewska
- Department of Paediatric Haematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - N Irga-Jaworska
- Department of Paediatrics, Haematology and Oncology, Medical University, Gdansk, Poland
| | - M Plonowski
- Department of Paediatric Oncology and Haematology, Medical University, Bialystok, Poland
| | - T Ociepa
- Department of Paediatric Haematology and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - F Pierlejewski
- Department of Paediatric Oncology, Haematology and Diabetology, Medical University, Lodz, Poland
| | - Z Gamrot
- Division of Paediatric Haematology and Oncology, Chorzow Paediatric and Oncology Center, Chorzow, Poland
| | - A Urbanek-Dadela
- Division of Paediatric Haematology and Oncology, Children Hospital, Kielce, Poland
| | - J Gozdzik
- Stem Cell Transplant Center, University Children's Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - W Stolpa
- Division of Paediatric Oncology, Haematology and Chemotherapy, Department of Paediatric, Silesian Medical University, Katowice, Poland
| | | | - D Perek
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | - M Matysiak
- Department of Paediatric Haematology and Oncology, Medical University, Warszawa, Poland
| | - J Wachowiak
- Department of Paediatric Oncology, Haematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - J Kowalczyk
- Department of Paediatric Haematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - W Balwierz
- Department of Paediatric Oncology and Haematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - K Kalwak
- Department of Paediatric Stem Cell Transplantation, Haematology and Oncology, Medical University, Wroclaw, Poland
| | - A Chybicka
- Department of Paediatric Stem Cell Transplantation, Haematology and Oncology, Medical University, Wroclaw, Poland
| | - W Badowska
- Division of Paediatric Haematology and Oncology, Children Hospital, Olsztyn, Poland
| | - T Szczepanski
- Department of Paediatric Haematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - E Drozynska
- Department of Paediatrics, Haematology and Oncology, Medical University, Gdansk, Poland
| | - M Krawczuk-Rybak
- Department of Paediatric Oncology and Haematology, Medical University, Bialystok, Poland
| | - T Urasinski
- Department of Paediatric Haematology and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - W Mlynarski
- Department of Paediatric Oncology, Haematology and Diabetology, Medical University, Lodz, Poland
| | - M Woszczyk
- Division of Paediatric Haematology and Oncology, Chorzow Paediatric and Oncology Center, Chorzow, Poland
| | - G Karolczyk
- Division of Paediatric Haematology and Oncology, Children Hospital, Kielce, Poland
| | - G Sobol-Milejska
- Division of Paediatric Oncology, Haematology and Chemotherapy, Department of Paediatric, Silesian Medical University, Katowice, Poland
| | - L Gil
- Department of Haematology, University of Medical Sciences, Poznan, Poland
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12
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Januszkiewicz-Lewandowska D, Rucka A, Kowala-Piaskowska A, Bereszynska I, Mozer-Lisewska I, Zajac-Spychala O, Wysocki J, Nowak J. Mutations in Pol gene of hepatitis B virus in patients with chronic hepatitis B before and after therapy with nucleoside/nucleotide analogues. Acta Virol 2014; 58:185-9. [PMID: 24957725 DOI: 10.4149/av_2014_02_185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic hepatitis B (CHB) is one of the most common infections worldwide. Currently approved treatments of CHB include nucleoside/nucleotide analogues (NAs). However, long-term NA therapy is associated with accumulation of resistant mutations within the hepatitis B virus (HBV) polymerase gene. The incidence of naturally occurring HBV mutations leading to primary antiviral resistance has not been fully elucidated yet. The objective of present study was to detect the frequency of mutations within the HBV polymerase gene in 263 patients naïve to nucleoside/nucleotide analogues. Prevalence of HBV Pol gene mutations secondary to NA treatment in patients without pre-existing antiviral resistance mutations was also examined. Retrospective analysis showed that HBV Pol gene mutations were present in 7 out of 263 patients prior to the treatment. Mutations observed in NA-naïve CHB patients were associated only with resistance to lamivudine and adefovir. Compensatory mutations were observed as well. In the course of antiviral treatment, HBV Pol gene mutations were identified in 65 out of the remaining 256 CHB patients (25.39%), while no mutations of any type were detected in 160 patients (62.5%). The profiles of detected mutations were comparable to those observed in other studies that focused on the analysis of clinically relevant NA-resistant mutations. In conclusion, we found out that antiviral resistance mutations may pre-exist in the overall viral population present in untreated patients, although the incidence of HBV Pol gene mutations in NA-naïve CHB patients was low and reached only up to 2.66%. However, possible circulation and transmission of NAs-resistant HBV mutants in human population should be taken into account.
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13
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Czyzewski K, Styczynski J, Krenska A, Debski R, Zajac-Spychala O, Wachowiak J, Wysocki M. Intrathecal therapy with rituximab in central nervous system involvement of post-transplant lymphoproliferative disorder. Leuk Lymphoma 2012; 54:503-6. [PMID: 22873830 DOI: 10.3109/10428194.2012.718342] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) caused by Epstein-Barr virus (EBV) is a severe complication in high-risk allogeneic hematopoietic stem cell transplant (HSCT) recipients. Central nervous system (CNS) involvement of PTLD is a very rare event in patients with HSCT. As no established standard therapy in CNS-EBV-PTLD is available, the aim of this study was analysis of the safety and efficacy of intrathecal rituximab therapy in a group of eight children and adolescents with CNS-EBV-PTLD. Seven patients responded to therapy: all clinical symptoms and EBV-DNA viral load resolved after a median 2 (range: 1-7) doses of rituximab. However, some magnetic resonance imaging (MRI) changes in brain scan persisted in two patients. In all patients, except one, no adverse events of the therapy were observed. In conclusion, intrathecal rituximab administration seems to be an effective and safe method of treatment of CNS-EBV-PTLD in pediatric stem cell recipients. We recommend this treatment modality for further investigation.
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Affiliation(s)
- Krzysztof Czyzewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
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