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Westrupp N, Berry CD, Cole T, Shanthikumar S, Welsh L. Detection of Bronchiolitis Obliterans Syndrome Using Nitrogen Multiple Breath Washout in Children Posthemopoietic Stem Cell Transplant. Transplant Cell Ther 2024; 30:524.e1-524.e9. [PMID: 38360272 DOI: 10.1016/j.jtct.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
Bronchiolitis obliterans syndrome (BOS) is a severe complication following hemopoietic stem cell transplantation (HSCT) and is often undetected until there is significant deterioration in pulmonary function. Lung clearance index (LCI2.5) derived from the nitrogen multiple breath washout (N2MBW) test may be more feasible and sensitive than spirometry, which is currently used for surveillance and detection of BOS. We aimed to examine the feasibility of performing surveillance N2MBW in children post-HSCT, and in an exploratory analysis, determine if LCI2.5 led to earlier detection of BOS when compared to spirometric indices. Participants aged 5 to 17 years were recruited prior to receiving HSCT into a prospective, single-center, feasibility study at the Royal Children's Hospital, Melbourne. N2MBW and spirometry were performed within the month prior to transplant and repeated at 3, 6, 9, and 12 months post-transplant. Data were also collected on the presence of graft-versus-host (GVHD) disease in any organ, including the lungs. Twenty-one (12 male) children with a mean age of 13.4 (range 9.2 to 17.1) years at recruitment participated in this study. Prior to HSCT, all participants had normal LCI2.5, while 16 (76%) demonstrated normal forced expiratory volume in 1 second (FEV1). Ninety-nine percent of N2MBW tests were technically acceptable, compared with 66% of spirometry tests. Three participants developed BOS, while 2 participants died of other respiratory complications. At 6 and 12 months post-transplant, the BOS group had increases in LCI2.5 ranging from 3 to 5 units and mean reductions in FEV1 % predicted of 40% to 53% relative to pre HSCT values, respectively. In those who developed BOS, post-HSCT LCI2.5 values were significantly worse when compared with the no BOS group (P < .001). Relative changes in LCI2.5 and FEV1 were both predictive of BOS at 6 months post HSCT. This study demonstrates that N2MBW is a more feasible test compared with spirometry in children post HSCT. However, in an exploratory analysis, LCI2.5 did not lead to earlier detection of BOS, when compared to spirometry.
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Affiliation(s)
- Nicole Westrupp
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Cassidy Du Berry
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Theresa Cole
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Shivanthan Shanthikumar
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Liam Welsh
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
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Lum SH, Albert MH, Gilbert P, Sirait T, Algeri M, Muratori R, Fournier B, Laberko A, Karakukcu M, Unal E, Ayas MF, Yadav SP, Fisgin T, Elfeky R, Fernandes JF, Faraci M, Cole T, Schulz AS, Meisel R, Zecca M, Ifversen M, Biffi A, Diana JS, Vallée TC, Giardino S, Ersoy GZ, Moshous D, Gennery AR, Balashov D, Bonfim CMS, Locatelli F, Lankester AC, Neven B, Slatter MA. Outcomes of HLA-mismatched HSCT with TCRαβ/CD19 depletion or post-HSCT cyclophosphamide for inborn errors of immunity. Blood 2024:blood.2024024038. [PMID: 38669631 DOI: 10.1182/blood.2024024038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
HLA-mismatched transplants with either in vitro depletion of CD3+TCRαβ/CD19 (TCRαβ) cells or in vivo T-cell depletion using post-transplant cyclophosphamide (PTCY) have been increasingly used for patients with inborn errors of immunity (IEI). We performed a retrospective multicenter study via the EBMT registry on 306 children with IEI undergoing first transplant between 2010-2019 from an HLA-mismatched donor using TCRαβ (n=167) or PTCY (n=139). Median age at HSCT was 1.2 years (range, 0.03-19.6 years). The 3-year overall survival (OS) was 78% (95% confidence interval (CI), 71-84%) after TCRαβ and 66% (57-74%) after PTCY (p=0.013). Pre-HSCT morbidity score (hazard ratio (HR) 2.27, 1.07-4.80, p=0.032) and non-Busulfan/Treosulfan conditioning (HR 3.12, 1.98-4.92, p<0.001) were the only independent predictors of unfavorable OS. The 3-year event-free survival (EFS) was 58% (50-66%) after TCRαβ and 57% (48-66%) after PTCY (p=0.804). Cumulative incidence of severe acute GvHD was higher after PTCY (15%, 9-21%) than TCRαβ (6%, 2-9%, p=0.007), with no difference in chronic GvHD (PTCY, 11%, 6-17%; TCRαβ, 7%, 3-11%, p=0.173). The 3-year GvHD-free EFS was 53% (44-61%) after TCRαβ and 41% (32-50%) after PTCY (p=0.080). PTCY had significantly higher rates of veno-occlusive disease (14.4% versus TCRαβ 4.9%, p=0.009), acute kidney injury (12.7% versus 4.6%, p=0.032) and pulmonary complications (38.2% versus 24.1%, p=0.017). Adenoviraemia (18.3% versus PTCY 8.0%, p=0.015), primary graft failure (10%, versus 5%, p=0.048), and second HSCT (17.4% versus 7.9%, p=0.023) were significantly higher in TCRαβ. In conclusion, this study demonstrates that both approaches are suitable options in IEI patients, although characterized by different advantages and outcomes.
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Affiliation(s)
- Su Han Lum
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael H Albert
- Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | | | | | | | - Rafaella Muratori
- Hospital de Cli-nicas da Universidade Federal do Parana, Curitiba, Brazil
| | | | - Alexandra Laberko
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | | | - Ekrem Unal
- Erciyes University, Pediatric Hematology Oncology, Kayseri, Turkey
| | - Mouhab F Ayas
- King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Tunc Fisgin
- Altinbas University Faculty of Medicine Medical Park Bahcelievler Hospital, Istanbul, Turkey
| | - Reem Elfeky
- Great Ormond Street (GOS) Hospital for Children NHS Foundation Trust, University College London GOS Institute of Child Health, and NIHR GOSH BRC, London, United Kingdom
| | - Juliana Folloni Fernandes
- ITACI/Instituto da Crianca - Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Roland Meisel
- Center for Child & Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany
| | - Marco Zecca
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Jean-Sebastien Diana
- Hopital Universitaire Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Tanja C Vallée
- Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Gizem Zengin Ersoy
- Altinbas University Faculty of Medicine Medical Park Bahcelievler Hospital, Istanbul, Turkey
| | | | | | - Dmitry Balashov
- Dmitriy Rogachev National Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Carmem M S Bonfim
- Hospital Pequeno Principe/Pele Pequeno Príncipe Research Institute, Curitiba, Brazil
| | - Franco Locatelli
- Bambino Gesù Children's Hospital, Catholic University of Sacred Heart, Rome, Italy
| | | | - Bénédicte Neven
- Hospital Necker-Enfants Malades, Assistance Publique-Hospitaux de Paris, INSERM, paris, France
| | - Mary A Slatter
- Newcastle upon Tyne NHS Foundation trust, Newcastle Upon Tyne, United Kingdom
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Weerdenburg H, Walker H, Curtis N, Duffull S, Haeusler G, Cole T, Gwee A. Posaconazole in paediatric malignancy and haematopoietic stem cell transplant: dosing to achieve therapeutic concentration. J Antimicrob Chemother 2024:dkae099. [PMID: 38637310 DOI: 10.1093/jac/dkae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/05/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES Posaconazole is increasingly used for the treatment and prophylaxis of invasive fungal infections in immunocompromised children. We aimed to review evidence for paediatric posaconazole dosing regimens focusing on attainment of target concentrations and frequency of adverse effects. METHODS In May 2023, the Cochrane, Embase, MEDLINE and PubMed databases were searched for articles reporting posaconazole dosing in children with malignancy or post-haematopoietic stem cell transplantation. Studies reporting the attainment of target serum concentrations were included. RESULTS Overall, 24 studies were included. Eighteen studies of the oral suspension consistently reported poor attainment of target concentrations for prophylaxis (≥0.7 µg/mL, 12%-78%) despite high daily doses of 14-23 mg/kg/day (max. 1200 mg/day). Target attainment was significantly affected by gastric pH and food intake. Six studies of the delayed-release tablet (DRT) reported 58%-94% achieved concentrations ≥0.7 µg/mL, with the majority using lower doses of 4-12 mg/kg/day (max. 300 mg/day). Similarly, one study of powder for oral suspension found 67%-100% achieved target concentrations with a dose of 6 mg/kg/day (max. 300 mg/day). As expected, the IV formulation had high attainment of prophylaxis targets (81%-90%) with 6-10 mg/kg/day (max. 400 mg/day). All formulations were well tolerated, and no relationship between adverse effects and posaconazole concentrations was identified. CONCLUSIONS The required posaconazole dose in immunocompromised children varies depending on the formulation. The IV infusion had the highest attainment of therapeutic concentration followed by the DRT and powder for suspension. By contrast, the oral suspension had low attainment of target concentrations despite higher daily doses.
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Affiliation(s)
- Heather Weerdenburg
- Department of Pharmacy, Children's Cancer Centre, General Medicine and Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Antimicrobials and Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hannah Walker
- Department of Pharmacy, Children's Cancer Centre, General Medicine and Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Antimicrobials and Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel Curtis
- Department of Pharmacy, Children's Cancer Centre, General Medicine and Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Antimicrobials and Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Gabrielle Haeusler
- Department of Pharmacy, Children's Cancer Centre, General Medicine and Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Antimicrobials and Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- The Victorian Paediatric Integrated Cancer Service, Victoria State Government, Melbourne, Victoria, Australia
| | - Theresa Cole
- Department of Pharmacy, Children's Cancer Centre, General Medicine and Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amanda Gwee
- Department of Pharmacy, Children's Cancer Centre, General Medicine and Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Antimicrobials and Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Vallée TC, Glasmacher JS, Buchner H, Arkwright PD, Behrends U, Bondarenko A, Browning MJ, Buchbinder DK, Cattoni A, Chernyshova L, Ciznar P, Cole T, Czogala W, Dueckers G, Edgar JDM, Erbey F, Fasth A, Ferrua F, Formankova R, Gambineri E, Gennery AR, Goldman FD, Gonzalez-Granado LI, Heilmann C, Heiskanen-Kosma T, Juntti H, Kainulainen L, Kanegane H, Karaca NE, Kilic SS, Klein C, Koltan S, Kondratenko I, Meyts I, Nasrullayeva GM, Notarangelo LD, Pasic S, Pellier I, Pignata C, Misbah SA, Schulz AS, Segundo GR, Shcherbina A, Slatter MA, Sokolic R, Soler-Palacin P, Stepensky P, van Montfrans JM, Ryhänen S, Wolska-Kuśnierz B, Ziegler JB, Zhao X, Aiuti A, Ochs HD, Albert MH. Wiskott-Aldrich Syndrome: A study on 577 patients defining the genotype as a predictive biomarker for disease severity. Blood 2024:blood.2023021411. [PMID: 38579284 DOI: 10.1182/blood.2023021411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 04/07/2024] Open
Abstract
WAS is a multifaceted monogenic disorder with a broad disease spectrum and variable disease severity and a variety of treatment options including allogeneic hematopoietic stem cell transplantation (HSCT) and gene therapy (GT). No reliable biomarker exists to predict disease course and outcome for individual patients. A total of 577 patients with a WAS variant from 26 countries and a median follow-up of 8.9 years (0.3-71.1), totaling 6118 patient-years, were included in this international retrospective study. Overall survival (OS) of the cohort (censored at HSCT or GT) was 82% (95% CI 78-87) at 15 years and 70% (61-80) at 30 years of age. The type of variant was predictive of outcome: patients with a missense variant in exons 1 or 2 or with the intronic hotspot variant c.559+5G>A (class I variants) had a 15-year OS of 93% (89-98) and a 30-year OS of 91% (86-97), compared to 71% (62-81) and 48% (34-68) in patients with any other variant (class II; p<0.0001). The cumulative incidence rates of disease-related complications such as severe bleeding (p=0.007), life-threatening infection (p<0.0001), and autoimmunity (p=0.004) occurred significantly later in patients with a class I variant. The cumulative incidence of malignancy (p=0.6) was not different between classes I and II. This study represents the largest cohort of WAS patients studied so far. It confirms the spectrum of disease severity and quantifies the risk for specific disease-related complications. The class of variant is a biomarker to predict the outcome for WAS patients.
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Affiliation(s)
- Tanja C Vallée
- Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Jannik S Glasmacher
- Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Uta Behrends
- Faculty of Medicine, Technical University Munich, Munich, Germany
| | | | | | | | | | | | - Peter Ciznar
- Faculty of Medicine, Comenius University, Bratislava, Bratislava, Slovak Republic
| | | | - Wojciech Czogala
- Jagiellonian University Medical College, Institute of Pediatrics, Krakow, Poland
| | | | - John David M Edgar
- St James's Hospital & School of Medicine Trinity College Dublin, Dublin, Ireland
| | - Fatih Erbey
- Koc University School of Medicine, Istanbul, Turkey
| | | | | | | | - Eleonora Gambineri
- University of Florence; 'Anna Meyer' Children's Hospital, IRCCS, Florence, Italy
| | - Andrew R Gennery
- Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | | | | | | | | | | | | | | | | | - Sara S Kilic
- Medical Faculty, Bursa Uludag University, Bursa, Turkey
| | - Christoph Klein
- Dr. von Hauner Childrens Hospital, LMU Klinikum, Munich, Germany
| | - Sylwia Koltan
- Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Irina Kondratenko
- Russian Children's Clinical Hospital, Pirogov National Research Medical University, Moscow, Moscow, Russian Federation
| | | | | | | | - Srdjan Pasic
- Mother and Child Health Institute of Serbia, Medical Faculty, University of Belgrade, Serbia., Belgrade, Serbia
| | | | | | - Siraj Ahmed Misbah
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | | | - Anna Shcherbina
- Dmitry Rogachev National Research and Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Mary A Slatter
- Newcastle upon Tyne NHS Foundation trust, Newcastle Upon Tyne, United Kingdom
| | - Robert Sokolic
- Food and Drug Administration, SHaron, Massachusetts, United States
| | | | | | | | - Samppa Ryhänen
- University of Helsinki and Helsinki University Hospital, Children's Hospital, and Pediatric Research Center, Helsinki, Finland
| | | | | | - Xiaodong Zhao
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | | | - Hans D Ochs
- University of Washington, Seattle, Washington, United States
| | - Michael H Albert
- Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
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Hamad N, Bilmon I, Chee L, Henden A, Johnston A, Purtill D, Bajel A, Tey SK, Yeung D, Cole T, Lewis C, Butler J. ANZTCT consensus position statement on ruxolitinib in steroid-refractory acute and chronic graft-versus-host disease. Intern Med J 2023; 53:2319-2329. [PMID: 38014511 DOI: 10.1111/imj.16255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/01/2023] [Indexed: 11/29/2023]
Abstract
This position paper provides an overview of the assessment and management of both acute and chronic graft-versus-host disease (GvHD). There is a focus on the use of ruxolitinib, a selective inhibitor of Janus kinase (JAK)1 and JAK2, for the treatment of corticosteroid-refractory and corticosteroid-dependent GvHD.
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Affiliation(s)
- Nada Hamad
- St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- School of Medicine, Sydney University of Notre Dame, Sydney, New South Wales, Australia
| | - Ian Bilmon
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Lynette Chee
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Andrea Henden
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | | | - Duncan Purtill
- Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Ashish Bajel
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Siok-Keen Tey
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - David Yeung
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Theresa Cole
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Jason Butler
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Diamond Y, Gilsenan M, Wang SS, Hanna D, Conyers R, Cole T, Hughes D, Fleming J, Meyran D, Toro C, Malalasekera V, Khaw SL, Haeusler GM. Infections in children following chimeric antigen receptor T-cell therapy for B-cell acute lymphoblastic leukemia. Transpl Infect Dis 2023; 25:e14202. [PMID: 38041799 DOI: 10.1111/tid.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/17/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND CD19-directed chimeric antigen receptor T-cell (CAR-T) therapy is transforming care for pediatric patients with relapsed or refractory B-cell acute lymphoblastic leukemia (B-ALL). There are limited pediatric-specific data concerning the infection risks associated with CD19 CAR-T therapy and the adequacy of current antimicrobial prophylaxis guidelines for these patients. METHODS We describe the antimicrobial prophylaxis used and the types of infectious occurring in the first 100 days following CAR-T therapy for relapsed or refractory B-cell ALL in children and adolescents (≤18 years) at our centre. RESULTS Twenty-seven patients received their first CAR-T infusion (CTI) during the study period. Almost all patients (96%) had a comprehensive Infectious Diseases review prior to CTI, which informed a personalised prophylaxis or fever/sepsis plan in six (22%). Overall, six (22%) patients had one or more infections during the study period including five (19%, 0.9 per 100 days-at-risk) from days 0-30 and three (n = 20, 15%, 0.6 per 100 days-at-risk) from days 31-100. Bacterial blood stream infections were the most common type of infection encountered during both time periods, and one patient had probable pulmonary aspergillosis. There were no infection-related deaths. CONCLUSION Our study contributes important information on the spectrum of infections encountered in pediatric patients with B-ALL post CAR-T therapy. Overall, the burden of infectious complications post CAR-T therapy in our cohort is lower than previously reported in the literature. Results suggest that our prophylaxis recommendations are effective in this population.
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Affiliation(s)
- Yonatan Diamond
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Maddie Gilsenan
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stacie Shiqi Wang
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Diane Hanna
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Rachel Conyers
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Theresa Cole
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Hughes
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jacqueline Fleming
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Deborah Meyran
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Claudia Toro
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Paediatric Integrated Cancer Service, Victoria, Victoria, Australia
| | | | - Seong Lin Khaw
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Gabrielle M Haeusler
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Paediatric Integrated Cancer Service, Victoria, Victoria, Australia
- Department of Infectious Diseases, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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7
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Phuong LK, Cheung A, Agrawal R, Butters C, Buttery J, Clark J, Connell T, Curtis N, Daley AJ, Dobinson HC, Frith C, Hameed NS, Hernstadt H, Krieser DM, Loke P, Ojaimi S, McMullan B, Pinzon-Charry A, Sharp EG, Sinnappurajar P, Templeton T, Wen S, Cole T, Gwee A. Inborn Errors of Immunity in Children With Invasive Pneumococcal Disease: A Multicenter Prospective Study. Pediatr Infect Dis J 2023; 42:908-913. [PMID: 37463351 DOI: 10.1097/inf.0000000000004004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND In settings with universal conjugate pneumococcal vaccination, invasive pneumococcal disease (IPD) can be a marker of an underlying inborn error of immunity. The aim of this study was to determine the prevalence and characterize the types of immunodeficiencies in children presenting with IPD. METHODS Multicenter prospective audit following the introduction of routinely recommended immunological screening in children presenting with IPD. The minimum immunological evaluation comprised a full blood examination and film, serum immunoglobulins (IgG, IgA and IgM), complement levels and function. Included participants were children in whom Streptococcus pneumoniae was isolated from a normally sterile site (cerebrospinal fluid, pleura, peritoneum and synovium). If isolated from blood, features of sepsis needed to be present. Children with predisposing factors for IPD (nephrotic syndrome, anatomical defect or malignancy) were excluded. RESULTS Overall, there were 379 episodes of IPD of which 313 (83%) were eligible for inclusion and 143/313 (46%) had an immunologic evaluation. Of these, 17/143 (12%) were diagnosed with a clinically significant abnormality: hypogammaglobulinemia (n = 4), IgA deficiency (n = 3), common variable immunodeficiency (n = 2), asplenia (n = 2), specific antibody deficiency (n = 2), incontinentia pigmenti with immunologic dysfunction (n = 1), alternative complement deficiency (n = 1), complement factor H deficiency (n = 1) and congenital disorder of glycosylation (n = 1). The number needed to investigate to identify 1 child presenting with IPD with an immunologic abnormality was 7 for children under 2 years and 9 for those 2 years old and over. CONCLUSIONS This study supports the routine immune evaluation of children presenting with IPD of any age, with consideration of referral to a pediatric immunologist.
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Affiliation(s)
- Linny Kimly Phuong
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Microbiology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Abigail Cheung
- Department of Allergy and Clinical Immunology, Women's and Children's Hospital, South Australia
- General Paediatric and Adolescent Medicine, John Hunter Children's Hospital, New Lambton, Australia
| | - Rishi Agrawal
- Department of General Medicine, Women's and Children's Hospital, South Australia
| | - Coen Butters
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- General Paediatric and Adolescent Medicine, John Hunter Children's Hospital, New Lambton, Australia
| | - Jim Buttery
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Julia Clark
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Tom Connell
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Nigel Curtis
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew J Daley
- Department of Microbiology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Hazel C Dobinson
- Department of Paediatrics and Child Health, Te Whatu Ora Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Catherine Frith
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick
| | | | - Hayley Hernstadt
- Department of Paediatrics, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia
| | - David M Krieser
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatric Emergency Medicine, Sunshine Hospital, St Albans, Victoria, Australia
| | - Paxton Loke
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Allergy & Immunology, Murdoch Children's Research Institute, Melbourne, Australia
- Monash Pathology, Monash Health; Clayton, Victoria, Australia
| | - Samar Ojaimi
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Allergy & Immunology, Murdoch Children's Research Institute, Melbourne, Australia
- Monash Pathology, Monash Health; Clayton, Victoria, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick
| | - Alberto Pinzon-Charry
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- Queensland Paediatric Immunology & Allergy Service, Queensland Children's Hospital, Queensland, Australia
- Griffith University, Brisbane, Queensland, Australia
| | - Ella Grace Sharp
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick
| | | | - Tiarni Templeton
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Sophie Wen
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Theresa Cole
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Amanda Gwee
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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8
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Leiding JW, Vogel TP, Santarlas VGJ, Mhaskar R, Smith MR, Carisey A, Vargas-Hernández A, Silva-Carmona M, Heeg M, Rensing-Ehl A, Neven B, Hadjadj J, Hambleton S, Ronan Leahy T, Meesilpavikai K, Cunningham-Rundles C, Dutmer CM, Sharapova SO, Taskinen M, Chua I, Hague R, Klemann C, Kostyuchenko L, Morio T, Thatayatikom A, Ozen A, Scherbina A, Bauer CS, Flanagan SE, Gambineri E, Giovannini-Chami L, Heimall J, Sullivan KE, Allenspach E, Romberg N, Deane SG, Prince BT, Rose MJ, Bohnsack J, Mousallem T, Jesudas R, Santos Vilela MMD, O'Sullivan M, Pachlopnik Schmid J, Průhová Š, Klocperk A, Rees M, Su H, Bahna S, Baris S, Bartnikas LM, Chang Berger A, Briggs TA, Brothers S, Bundy V, Chan AY, Chandrakasan S, Christiansen M, Cole T, Cook MC, Desai MM, Fischer U, Fulcher DA, Gallo S, Gauthier A, Gennery AR, Gonçalo Marques J, Gottrand F, Grimbacher B, Grunebaum E, Haapaniemi E, Hämäläinen S, Heiskanen K, Heiskanen-Kosma T, Hoffman HM, Gonzalez-Granado LI, Guerrerio AL, Kainulainen L, Kumar A, Lawrence MG, Levin C, Martelius T, Neth O, Olbrich P, Palma A, Patel NC, Pozos T, Preece K, Lugo Reyes SO, Russell MA, Schejter Y, Seroogy C, Sinclair J, Skevofilax E, Suan D, Suez D, Szabolcs P, Velasco H, Warnatz K, Walkovich K, Worth A, Seppänen MRJ, Torgerson TR, Sogkas G, Ehl S, Tangye SG, Cooper MA, Milner JD, Forbes Satter LR. Monogenic early-onset lymphoproliferation and autoimmunity: Natural history of STAT3 gain-of-function syndrome. J Allergy Clin Immunol 2023; 151:1081-1095. [PMID: 36228738 PMCID: PMC10081938 DOI: 10.1016/j.jaci.2022.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In 2014, germline signal transducer and activator of transcription (STAT) 3 gain-of-function (GOF) mutations were first described to cause a novel multisystem disease of early-onset lymphoproliferation and autoimmunity. OBJECTIVE This pivotal cohort study defines the scope, natural history, treatment, and overall survival of a large global cohort of patients with pathogenic STAT3 GOF variants. METHODS We identified 191 patients from 33 countries with 72 unique mutations. Inclusion criteria included symptoms of immune dysregulation and a biochemically confirmed germline heterozygous GOF variant in STAT3. RESULTS Overall survival was 88%, median age at onset of symptoms was 2.3 years, and median age at diagnosis was 12 years. Immune dysregulatory features were present in all patients: lymphoproliferation was the most common manifestation (73%); increased frequencies of double-negative (CD4-CD8-) T cells were found in 83% of patients tested. Autoimmune cytopenias were the second most common clinical manifestation (67%), followed by growth delay, enteropathy, skin disease, pulmonary disease, endocrinopathy, arthritis, autoimmune hepatitis, neurologic disease, vasculopathy, renal disease, and malignancy. Infections were reported in 72% of the cohort. A cellular and humoral immunodeficiency was observed in 37% and 51% of patients, respectively. Clinical symptoms dramatically improved in patients treated with JAK inhibitors, while a variety of other immunomodulatory treatment modalities were less efficacious. Thus far, 23 patients have undergone bone marrow transplantation, with a 62% survival rate. CONCLUSION STAT3 GOF patients present with a wide array of immune-mediated disease including lymphoproliferation, autoimmune cytopenias, and multisystem autoimmunity. Patient care tends to be siloed, without a clear treatment strategy. Thus, early identification and prompt treatment implementation are lifesaving for STAT3 GOF syndrome.
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Affiliation(s)
- Jennifer W Leiding
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St Petersburg.
| | - Tiphanie P Vogel
- Department of Pediatrics, Baylor College of Medicine and William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston
| | | | - Rahul Mhaskar
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa
| | - Madison R Smith
- Department of Pediatrics, Baylor College of Medicine and William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston
| | - Alexandre Carisey
- Department of Cell and Molecular Biology, St Jude Children's Research Hospital, Memphis
| | - Alexander Vargas-Hernández
- Department of Pediatrics, Baylor College of Medicine and William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston
| | - Manuel Silva-Carmona
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Maximilian Heeg
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Anne Rensing-Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Bénédicte Neven
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163-Institut Imagine, Paris
| | - Jérôme Hadjadj
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163-Institut Imagine, Paris
| | - Sophie Hambleton
- Newcastle University Translational and Clinical Research Institute, Newcastle (United Kingdom)
| | | | - Kornvalee Meesilpavikai
- Department of Internal Medicine, Division of Clinical Immunology and Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Cullen M Dutmer
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora
| | - Svetlana O Sharapova
- Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk
| | - Mervi Taskinen
- New Children's Hospital, Pediatric Research Center, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Turku and Kuopio, Finland
| | - Ignatius Chua
- Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Christchurch; Clinical Immunogenomics Research Consortium of Australasia (CIRCA)
| | | | - Christian Klemann
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover
| | - Larysa Kostyuchenko
- Center of Pediatric Immunology, Western Ukrainian Specialized Children's Medical Centre, Lviv
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo
| | - Akaluck Thatayatikom
- Division of Pediatric Allergy/Immunology/Rheumatology, Shands Children's Hospital, University of Florida, Gainesville
| | - Ahmet Ozen
- School of Medicine, Pediatric Allergy and Immunology, Marmara University, Istanbul
| | - Anna Scherbina
- Dmitry Rogachev National Medical and Research Center for Pediatric Hematology, Oncology and Immunology, Moscow
| | - Cindy S Bauer
- Division of Allergy and Immunology, Phoenix Children's Hospital, Phoenix
| | - Sarah E Flanagan
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter
| | - Eleonora Gambineri
- Department of NEUROFARBA, Section of Children's Health, University of Florence, Anna Meyer Children's Hospital, Florence
| | | | - Jennifer Heimall
- Perelman School of Medicine at University of Pennsylvania, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia
| | - Kathleen E Sullivan
- Perelman School of Medicine at University of Pennsylvania, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia
| | - Eric Allenspach
- Pediatric Immunology/Rheumatology, University of Washington, Seattle; Seattle Children's Hospital, Seattle
| | - Neil Romberg
- Perelman School of Medicine at University of Pennsylvania, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia
| | - Sean G Deane
- Department of Allergy, The Permanente Medical Group, Sacramento, and the Division of Rheumatology/Allergy and Clinical Immunology, University of California, Davis, School of Medicine, Sacramento
| | - Benjamin T Prince
- Nationwide Children's Hospital Department of Allergy and Immunology, Columbus; College of Medicine, The Ohio State University, Columbus
| | - Melissa J Rose
- College of Medicine, The Ohio State University, Columbus; Division of Pediatric Hematology-Oncology, Nationwide Children's Hospital, Columbus
| | - John Bohnsack
- Department of Pediatrics, University of Utah, Salt Lake City
| | | | - Rohith Jesudas
- Department of Hematology, St Jude Children's Research Hospital, Memphis
| | - Maria Marluce Dos Santos Vilela
- Pediatric Allergy and Immunology/Center of Investigation in Pediatrics, Faculty of Medical Sciences, State University of Campinas-Unicamp, São Paulo
| | - Michael O'Sullivan
- Clinical Immunogenomics Research Consortium of Australasia (CIRCA); Immunology Department, Perth Children's Hospital, Nedlands
| | - Jana Pachlopnik Schmid
- Division of Immunology, University Children's Hospital Zurich, Children's Research Center (CRC), Zurich
| | - Štěpánka Průhová
- Department of Pediatrics, Charles University in Prague, Second Faculty of Medicine and University Hospital Motol, Prague
| | - Adam Klocperk
- Department of Immunology, Second Faculty of Medicine and University Hospital Motol, Charles University in Prague, Prague
| | - Matthew Rees
- Department of Hematology, St Jude Children's Research Hospital, Memphis
| | - Helen Su
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda
| | - Sami Bahna
- Allergy and Immunology Section, Louisiana State University Health Sciences Center, Shreveport
| | - Safa Baris
- School of Medicine, Pediatric Allergy and Immunology, Marmara University, Istanbul
| | - Lisa M Bartnikas
- Division of Immunology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston
| | - Amy Chang Berger
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco
| | - Tracy A Briggs
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester; NW Genomic Laboratory Hub, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester
| | - Shannon Brothers
- Clinical Immunogenomics Research Consortium of Australasia (CIRCA); Starship Children's Hospital, Auckland
| | - Vanessa Bundy
- Allergy and Immunology, University of California, Los Angeles
| | - Alice Y Chan
- Department of Medicine, University of California, San Francisco
| | - Shanmuganathan Chandrakasan
- Division of Bone Marrow Transplant, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta
| | | | - Theresa Cole
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne
| | - Matthew C Cook
- Department of Immunology and Infectious Diseases, John Curtin School of Medical Research, Australian National University, Canberra
| | | | - Ute Fischer
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty, Heinrich-Heine-University, Düsseldorf
| | - David A Fulcher
- Department of Immunology and Infectious Diseases, John Curtin School of Medical Research, Australian National University, Canberra
| | - Silvanna Gallo
- Department of Pediatrics, Immunology and Rheumatology Section, Puerto Montt Hospital, Puerto Montt
| | - Amelie Gauthier
- Department of Allergy and Immunology, CHU de Québec-CHUL, Laval University Hospital Center, Laval University, Quebec City
| | - Andrew R Gennery
- Newcastle University Translational and Clinical Research Institute, Newcastle (United Kingdom)
| | - José Gonçalo Marques
- Infectious Diseases and Immunodeficiencies Unit, Department of Pediatrics, Hospital de Santa Maria-CHULN and Faculdade de Medicina, Universidade de Lisboa, Lisbon
| | - Frédéric Gottrand
- University Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille
| | - Bodo Grimbacher
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Eyal Grunebaum
- Division of Immunology and Allergy, and the Department of Pediatrics, Developmental and Stem Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto
| | - Emma Haapaniemi
- Centre for Molecular Medicine Norway, Oslo; Department of Pediatric Research, Oslo
| | | | - Kaarina Heiskanen
- New Children's Hospital, Pediatric Research Center, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Turku and Kuopio, Finland
| | | | - Hal M Hoffman
- Department of Pediatrics, University of California San Diego, La Jolla; Rady Children's Hospital San Diego, Division of Pediatric Allergy, Immunology, and Rheumatology, San Diego
| | - Luis Ignacio Gonzalez-Granado
- Pediatrics Department, University Hospital 12 de Octubre, Research Institute Hospital, School of Medicine Complutense University, Madrid
| | - Anthony L Guerrerio
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore
| | - Leena Kainulainen
- Department of Pediatrics and Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Ashish Kumar
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati
| | | | - Carina Levin
- Pediatric Hematology Unit, Emek Medical Centre, Afula, and the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
| | - Timi Martelius
- Adult Immunodeficiency Unit, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki
| | - Olaf Neth
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Peter Olbrich
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Alejandro Palma
- Servicio de Immunología y Reumatología, Hospital Nacional de Pediatría Prof Dr Juan P. Garrahan, Buenos Aires
| | - Niraj C Patel
- Division of Allergy and Immunology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta
| | - Tamara Pozos
- Department of Clinical Immunology, Children's Minnesota, Minneapolis
| | - Kahn Preece
- Clinical Immunogenomics Research Consortium of Australasia (CIRCA); Department of Paediatric Immunology, John Hunter Children's Hospital, Newcastle (Australia)
| | | | | | - Yael Schejter
- Department of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah Ein-Kerem Medical Center and Faculty of Medicine, Hebrew University, Jerusalem
| | - Christine Seroogy
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jan Sinclair
- Clinical Immunogenomics Research Consortium of Australasia (CIRCA); Starship Children's Hospital, Auckland
| | - Effie Skevofilax
- Department of Pediatric Hematology-Oncology (TAO) and First Department of Pediatrics, Aghia Sophia Children's Hospital, Athens
| | - Daniel Suan
- Clinical Immunogenomics Research Consortium of Australasia (CIRCA); Garvan Institute of Medical Research, Darlinghurst; Westmead Clinical School, University of Sydney, Westmead
| | - Daniel Suez
- Allergy, Asthma & Immunology Clinic, PA, Irving
| | - Paul Szabolcs
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh
| | - Helena Velasco
- Division of Allergy and Clinical Immunology, Moinhos de Vento Hospital, Porto Alegre
| | - Klaus Warnatz
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Kelly Walkovich
- Department of Pediatrics, C. S. Mott Children's Hospital, Michigan Medicine, Ann Arbor
| | - Austen Worth
- Great Ormond Street Hospital for Children, London
| | - Mikko R J Seppänen
- Rare Disease Center, Children's Hospital, and Adult Primary Immunodeficiency Outpatient Clinic, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki
| | | | - Georgios Sogkas
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hanover
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Stuart G Tangye
- Clinical Immunogenomics Research Consortium of Australasia (CIRCA); Garvan Institute of Medical Research, Darlinghurst; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney
| | - Megan A Cooper
- Department of Pediatrics, Division of Rheumatology and Immunology, Washington University School of Medicine, St Louis
| | - Joshua D Milner
- Department of Pediatrics, Division of Allergy and Immunology, Columbia University, New York Presbyterian Hospital, New York
| | - Lisa R Forbes Satter
- Department of Pediatrics, Baylor College of Medicine and William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston.
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9
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Coutsouvelis J, Kirkpatrick CM, Dooley M, Spencer A, Kennedy G, Chau M, Huang G, Doocey R, Copeland TS, Do L, Bardy P, Kerridge I, Cole T, Fraser C, Perera T, Larsen SR, Mason K, O'Brien TA, Shaw PJ, Teague L, Butler A, Watson AM, Ramachandran S, Marsh J, Khan Z, Hamad N. Incidence of sinusoidal obstruction syndrome/veno-occlusive disease and treatment with defibrotide in allogeneic transplant: A multicentre Australasian registry study. Transplant Cell Ther 2023:S2666-6367(23)01173-9. [PMID: 36934993 DOI: 10.1016/j.jtct.2023.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is an established complication in patients undergoing allogeneic haemopoietic stem cell transplantation. Defibrotide is an effective and safe pharmacological option for treating diagnosed SOS/VOD. OBJECTIVE By exploring data provided to the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR) by centres from Australia and New Zealand, this study aimed to describe the incidence of SOS/VOD and patterns of defibrotide use from 2016 to 2020. STUDY DESIGN Patients who underwent allogeneic HSCT between 2016 and 2020 were identified from the ABMTRR. Data was extracted for a total of 3346 patients, 2692 from adult centres and 654 from paediatric centres, with a median follow up of 21.5 months and 33.3 months respectively. Descriptive statistics were used to describe the patient population, including the incidence of SOS/VOD and defibrotide use. Comparisons were made between patients not experiencing SOS/VOD, and those with the diagnosis, divided into defibrotide and no-defibrotide cohorts. Associations with overall survival and day 100 survival with variables such as gender, age, disease at transplant, source of stem cells, conditioning agents, SOS/VOD diagnosis and use of defibrotide were determined. RESULTS The reported incidence of SOS/VOD was 4.1% in adult centres and 11.5% in paediatric centres. Defibrotide was administered to 74.8% of adult patients with SOS/VOD and 97.3% of paediatric patients. Significant variability of use, dose and duration of defibrotide was seen across the adult centres. Day 100 survival rate and median overall survival (OS) for patients managed with defibrotide was 51.8% and 103 days respectively for adult patients, and 90.4% and not reached for paediatric patients. In adults, older age at transplant, an HLA matched donor who was a non-sibling relative, and a diagnosis of SOS/VOD treated with defibrotide, were all associated with reduced OS. In paediatrics, the patient and transplant characteristics that were associated with a reduced OS were a diagnosis of SOS/VOD and donor relation as 2 or more HLA mismatched relative. CONCLUSION A collaborative approach across Australasia to diagnose and manage SOS/VOD, in particular with respect to consistent defibrotide use, is recommended.
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Affiliation(s)
- John Coutsouvelis
- Pharmacy Department, Alfred Health, Commercial Road, Melbourne VIC 3004, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville VIC 3052, Australia.
| | - Carl M Kirkpatrick
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville VIC 3052, Australia
| | - Michael Dooley
- Pharmacy Department, Alfred Health, Commercial Road, Melbourne VIC 3004, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville VIC 3052, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Andrew Spencer
- Department of Malignant Haematology and Stem Cell Transplantation, Alfred Health - Monash University, Commercial Road, Melbourne, VIC 3004, Australia
| | - Glen Kennedy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston QLD 4029; University of Queensland Medical School, St Lucia QLD 4072, Australia
| | - Maggie Chau
- Pharmacy Department, Royal Melbourne Hospital, Grattan Street, Parkville VIC 3050, Australia
| | - Gillian Huang
- Blood Transplant and Cellular Therapies, Department of Clinical Haematology & BTCT, Westmead Hospital, Westmead NSW 2145, Australia
| | - Richard Doocey
- Auckland City and Starship Hospitals Stem Cell Transplant Programme, Park Road, Grafton Auckland 1023, New Zealand
| | - Tandy-Sue Copeland
- Pharmacy Department, Fiona Stanley Hospital, Level 7D, 11 Robyn Warren Drive, MURDOCH WA 6150, Australia
| | - Louis Do
- Haematology Department, St Vincent's Hospital & The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst NSW 2010, Australia
| | - Peter Bardy
- Department of Haematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Ian Kerridge
- Haematology Department, Royal North Shore Hospital, St Leonards, NSW 2065; Northern Blood Research Centre, Kolling Institute, St Leonards, NSW 2065; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006
| | - Theresa Cole
- Children's Cancer Centre, Royal Children's Hospital, Parkville, VIC,3052; Murdoch Children's Research Institute, Melbourne, Parkville, VIC,3052; Dept of paediatrics, University of Melbourne, Melbourne VIC, Australia
| | - Chris Fraser
- Blood and Marrow Transplant Program, Queensland Children's Hospital, 501 Stanley Street, South Brisbane QLD 4101, Australia
| | - Travis Perera
- Wellington Blood and Cancer Centre, Wellington Hospital, Riddiford St, Newtown, Wellington 6022, New Zealand
| | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Kate Mason
- Clinical Haematology, Austin Health, 145 Studley Rd, Heidelberg VIC 3084, Australia
| | - Tracey A O'Brien
- Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick NSW 2031, Australia;; School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Australia
| | - Peter J Shaw
- Blood Transplant and Cell Therapies Program, The Children's Hospital, Westmead NSW 2145, Australia; Clinical Professor, Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lochie Teague
- Starship Blood and Cancer Centre, Starship Hospital, 2 Park Rd, Grafton Auckland 1023, New Zealand
| | - Andrew Butler
- Haematology Department, Christchurch Hospital, 2 Riccarton Avenue, Christchurch 8140, New Zealand
| | - Anne-Marie Watson
- Haematology Department, Liverpool Hospital, Elizabeth Street, Liverpool NSW 2170, Australia
| | - Shanti Ramachandran
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Nedlands 6009, WA, Australia,; School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia
| | - Jodie Marsh
- Townsville University Hospital, Angus Smith Drive, Douglas QLD 4814, Australia
| | - Zulekha Khan
- Australasian Bone Marrow Transplant Recipient Registry, Level 6, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst NSW 2010, Australia
| | - Nada Hamad
- Haematology Department, St Vincent's Hospital & The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst NSW 2010, Australia; Australasian Bone Marrow Transplant Recipient Registry, Level 6, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst NSW 2010, Australia; University of New South Wales, Sydney, Australia; University of Notre Dame Australia, Sydney Australia
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Butters C, Thursky K, Hanna DT, Cole T, Davidson A, Buttery J, Haeusler G. Adverse effects of antibiotics in children with cancer: are short-course antibiotics for febrile neutropenia part of the solution? Expert Rev Anti Infect Ther 2023; 21:267-279. [PMID: 36694289 DOI: 10.1080/14787210.2023.2171987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Febrile neutropenia is a common complication experienced by children with cancer or those undergoing hematopoietic stem cell transplantation. Repeated episodes of febrile neutropenia result in cumulative exposure to broad-spectrum antibiotics with potential for a range of serious adverse effects. Short-course antibiotics, even in patients with high-risk febrile neutropenia, may offer a solution. AREAS COVERED This review addresses the known broad effects of antibiotics, highlights developments in understanding the relationship between cancer, antibiotics, and the gut microbiome, and discusses emerging evidence regarding long-term adverse antibiotic effects. The authors consider available evidence to guide the duration of empiric antibiotics in pediatric febrile neutropenia and directions for future research. EXPERT OPINION Broad-spectrum antibiotics are associated with antimicrobial resistance, Clostridioides difficile infection, invasive candidiasis, significant disturbance of the gut microbiome and may seriously impact outcomes in children with cancer or undergoing allogenic hematopoietic stem cell transplant. Short-course empiric antibiotics are likely safe in most children with febrile neutropenia and present a valuable opportunity to reduce the risks of antibiotic exposure.
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Affiliation(s)
- Coen Butters
- Department of General Paediatrics and Adolescent Medicine, John Hunter Children's Hospital, Newcastle, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, Australia.,Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Diane T Hanna
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - Theresa Cole
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Andrew Davidson
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Department of Anaesthesia, Royal Children's Hospital, Parkville, Australia.,Department of Critical Care, The University of Melbourne, Parkville, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Parkville, Australia.,Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Australia
| | - Jim Buttery
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Parkville, Australia.,Centre for Health Analytics, Melbourne Children's Campus, Parkville, Australia.,Health Informatics Group and SAEFVIC, Murdoch Children's Research Institute, Parkville, Australia
| | - Gabrielle Haeusler
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Parkville, Australia
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11
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Andrew EC, Khaw SL, Hanna D, Conyers R, Fleming J, Hughes D, Toro C, Wang SS, Weerdenburg H, Anderson S, Cole T, Haeusler GM. Density of antibiotic use and infectious complications in pediatric allogeneic hematopoietic cell transplantation. Transpl Infect Dis 2023; 25:e14018. [PMID: 36748726 DOI: 10.1111/tid.14018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/16/2022] [Accepted: 12/11/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Antibiotics, while an essential component of supportive care in allogeneic hematopoietic cell transplantation (allo-HCT), can have adverse effects and select for antibiotic resistance. Understanding of patterns of use will inform antimicrobial stewardship (AMS) interventions. METHODS Retrospective, single-center cohort of children undergoing first allo-HCT (n = 125). Antibiotic prescription and infection data were included from the date conditioning was commenced until 30 days post allo-HCT. Antibiotic use was reported as length of therapy (LOT) (number of days a patient received an antibiotic) and days of therapy DOT (aggregating all antibiotics prescribed per day). Infections were classified as microbiologically documented infection (MDI) or clinically documented infections. RESULTS At least one course of antibiotics was administered to 124 (99%) patients. The LOT was 636 per 1000 patient days and DOT was 959 per 1000 patient days. The median duration of cumulative antibiotic exposure per patient was 24 days (interquartile range [IQR] 20-30 days). There were 131 days of fever per 1000 patient days with patients febrile for a median of 4 days (IQR 1-7 days). Piperacillin-tazobactam was used for 116 (94%) of patients with an LOT of 532 per 1000 patient days. A total of 119 MDI episodes occurred in 74 (59%) patients, including blood stream infection in 30 (24%) and a proven/probable invasive fungal infection in 4 (3%). CONCLUSION Pediatric HCT patients receive prolonged courses of broad-spectrum antibiotics relative to the frequency of fever and bacterial infections. This study has identified opportunities for AMS intervention to improve outcomes for our HCT patients.
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Affiliation(s)
- Eden C Andrew
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - Seong Lin Khaw
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Diane Hanna
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Rachel Conyers
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Cardiac Regeneration Laboratory, Murdoch Children's Research Institute, Parkville, Australia
| | - Jacqueline Fleming
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - David Hughes
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - Claudia Toro
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Cardiac Regeneration Laboratory, Murdoch Children's Research Institute, Parkville, Australia
| | - Stacie Shiqi Wang
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Heather Weerdenburg
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Sally Anderson
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - Theresa Cole
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Gabrielle M Haeusler
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Infectious Diseases, Royal Children's Hospital, Parkville, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.,NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.,Paediatric Integrated Cancer Service, Victoria, Australia
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12
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Perram J, Purtill D, Bajel A, Butler J, O'Brien T, Teh B, Gilroy N, Ho PJ, Doocey R, Hills T, Perera T, Douglas G, Ramachandran S, Chee L, Trotman J, Weinkove R, Keogh S, Fraser C, Cochrane T, Watson AM, Diamond P, Latimer M, Irving I, Blyth E, Cheah C, Cole T, Milliken S, Yang H, Greenwood M, Bardy P, Kennedy G, Larsen S, Conyers R, Hamad N. Australia and New Zealand Transplant and Cellular Therapies (ANZTCT) position statement: COVID-19 management in patients with haemopoietic stem cell transplant and chimeric antigen receptor T cell. Intern Med J 2023; 53:119-125. [PMID: 36371767 PMCID: PMC9878098 DOI: 10.1111/imj.15978] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/16/2022] [Indexed: 11/15/2022]
Abstract
Patients with post-haemopoietic stem cell transplant or chimeric antigen receptor T -cell (CAR-T) therapy face a significant risk of morbidity and mortality from coronavirus disease 2019 because of their immunosuppressed state. As case numbers in Australia and New Zealand continue to rise, guidance on management in this high-risk population is needed. Whilst we have learned much from international colleagues who faced high infection rates early in the pandemic, guidance relevant to local health system structures, medication availability and emerging therapies is essential to equip physicians to manage our patients optimally.
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Affiliation(s)
- Jacinta Perram
- Haematology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Duncan Purtill
- Haematology department, Fiona Stanley Hospital, Western Australia, Perth, Australia
| | - Ashish Bajel
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jason Butler
- Haematology department, Royal Brisbane and Women's Hospital, Queensland, Brisbane, Australia
| | - Tracey O'Brien
- Haematology department, Sydney Children's Hospital, New South Wales, Sydney, Australia
| | - Benjamin Teh
- Haematology department, National Centre for Infections in Cancer and Department of Infectious Diseases, Peter MacCallum Cancer Institute, Victoria, Melbourne, Australia
| | - Nicole Gilroy
- Haematology department, Centre for Infectious Diseases and Microbiology, Westmead Hospital, New South Wales, Sydney, Australia
| | - Phoebe J Ho
- Haematology department, Royal Prince Alfred Hospital and the University of Sydney, New South Wales, Sydney, Australia
| | - Richard Doocey
- Haematology department, Auckland City Hospital, Auckland, New Zealand
| | - Thomas Hills
- Haematology department, Auckland City Hospital, Auckland, New Zealand
| | - Travis Perera
- Haematology department, Wellington Blood and Cancer Centre, Wellington, New Zealand
| | - Genevieve Douglas
- Haematology department, Austin Hospital, Victoria, Melbourne, Australia
| | - Shanti Ramachandran
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Lynette Chee
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Judith Trotman
- Haematology department, Concord Repatriation General Hospital and University of Sydney, New South Wales, Sydney, Australia
| | - Robert Weinkove
- Haematology department, Wellington Blood and Cancer Centre and Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Steven Keogh
- Haematology department, University of Sydney and Westmead Hospital, New South Wales, Sydney, Australia
| | - Chris Fraser
- Haematology department, Children's Health Queensland Hospital and Health Service, Queensland, Brisbane, Australia
| | - Tara Cochrane
- Haematology department, Gold Coast University Hospital, Queensland, Gold Coast, Australia
| | - Anne-Marie Watson
- Haematology department, Liverpool Hospital, New South Wales, Sydney, Australia
| | - Peter Diamond
- Leukaemia Foundation, Sydney, New South Wales, Australia
| | - Maya Latimer
- Haematology department, Canberra Hospital, Australian Capital Territory, Canberra, Australia
| | - Ian Irving
- ICON Cancer Centre, Brisbane, Queensland, Australia
| | - Emily Blyth
- Haematology department, University of Sydney and Westmead Hospital, New South Wales, Sydney, Australia
| | - Chan Cheah
- Haematology department, Sir Charles Gairdner Hospital, Western Australia, Perth, Australia
| | - Theresa Cole
- Haematology department, The Royal Children's Hospital Melbourne, Victoria, Melbourne, Australia
| | - Sam Milliken
- Haematology department, St Vincent's Hospital Sydney and School of Clinical Medicine, Faculty of Medicine and Health, UNSW, New South Wales, Sydney, Australia
| | - Hung Yang
- Australian Bone Marrow Donor Registry, Sydney, New South Wales, Australia
| | - Matthew Greenwood
- Haematology department, Royal North Shore Hospital, New South Wales, Sydney, Australia
| | - Peter Bardy
- Haematology department, Royal Adelaide Hospital, South Australia, Adelaide, Australia
| | - Glen Kennedy
- Haematology department, Royal Brisbane and Women's Hospital, Queensland, Brisbane, Australia
| | - Stephen Larsen
- Haematology department, Royal Prince Alfred Hospital and the University of Sydney, New South Wales, Sydney, Australia
| | - Rachel Conyers
- Haematology department, The Royal Children's Hospital Melbourne, Victoria, Melbourne, Australia
| | - Nada Hamad
- Haematology department, St Vincent's Hospital Sydney and School of Clinical Medicine, Faculty of Medicine and Health, UNSW, New South Wales, Sydney, Australia.,Haematology department, School of Medicine Sydney Campus, University of Notre Dame Australia, New South Wales, Sydney, Australia
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13
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El-Sayed ZA, El-Ghoneimy DH, Ortega-Martell JA, Radwan N, Aldave JC, Al-Herz W, Al-Nesf MA, Condino-Neto A, Cole T, Eley B, Erwa NH, Espinosa-Padilla S, Faria E, Rosario Filho NA, Fuleihan R, Galal N, Garabedian E, Hintermeyer M, Imai K, Irani C, Kamal E, Kechout N, Klocperk A, Levin M, Milota T, Ouederni M, Paganelli R, Pignata C, Qamar FN, Quinti I, Qureshi S, Radhakrishnan N, Rezaei N, Routes J, Singh S, Siniah S, Abdel-Hakam Taha I, Tanno LK, Van Dort B, Volokha A, Sullivan K. Allergic manifestations of inborn errors of immunity and their impact on the diagnosis: A worldwide study. World Allergy Organ J 2022; 15:100657. [PMID: 35783543 PMCID: PMC9218584 DOI: 10.1016/j.waojou.2022.100657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Allergies have long been observed in Inborn Errors of Immunity (IEI) and might even be the first presentation resulting in delayed diagnosis or misdiagnosis in some cases. However, data on the prevalence of allergic diseases among IEI patients are limited and contradictory. Objective To provide a worldwide view of allergic diseases, across a broad spectrum of IEI, and their impact on the timely diagnosis of IEI. Methods This is a worldwide study, conceived by the World Allergy Organization (WAO) Inborn Errors of Immunity Committee. A questionnaire was developed and pilot-tested and was sent via email to collect data from 61 immunology centers known to treat pediatric and/or adult IEI patients in 41 countries. In addition, a query was submitted to The United States Immunodeficiency Network (USIDNET) at its website. Results Thirty centers in 23 countries caring for a total 8450 IEI patients responded. The USIDNET dataset included 2332 patients. Data from responders showed that a median (IQR) of 16.3% (10–28.8%) of patients experienced allergic diseases during the course of their IEI as follows: 3.6% (1.3–11.3%) had bronchial asthma, 3.6% (1.9–9.1%) atopic dermatitis, 3.0% (1.0–7.8%) allergic rhinitis, and 1.3% (0.5–3.3%) food allergy. As per the USIDNET data, the frequency of allergy among IEI patients was 68.8% (bronchial asthma in 46.9%). The percentage of IEI patients who presented initially with allergic disorders was 8% (5–25%) and diagnosis delay was reported in 7.5% (0.9–20.6%). Predominantly antibody deficiencies had the highest frequency of allergic disease followed by combined immunodeficiency with a frequency of 40.3% (19.2–62.5%) and 20.0% (10–32%) respectively. As per the data of centers, anaphylaxis occurred in 25/8450 patients (0.3%) whereas per USIDNET dataset, it occurred in 249/2332 (10.6%); drugs and food allergy were the main causes in both datasets. Conclusions This multinational study brings to focus the relation between allergic diseases and IEI. Major allergies do occur in IEI patients but were less frequent than the general population. Initial presentation with allergy could adversely affect the timely diagnosis of IEI. There is a need for policies to raise awareness and educate primary care and other referring specialties on the association of allergic diseases with IEI. This study provides a network among centers for future prospective studies in the field.
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14
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Reynolds S, Devlia D, Stearns R, Cole T. Should all infants with delayed umbilical cord separation be investigated for leucocyte adhesion deficiency? Arch Dis Child 2021; 106:1233-1236. [PMID: 34598939 DOI: 10.1136/archdischild-2020-321313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 09/08/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Sarah Reynolds
- Neonatal Unit, John Radcliffe Hospital, Oxford, Oxfordshire, UK .,Home, Windsor, UK
| | - Devika Devlia
- Department of Paediatrics, Wexham Park Hospital, Slough, UK
| | | | - Theresa Cole
- Allergy and Immunology Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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15
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McCall N, Eng T, Shelton J, Hanasoge S, Patel P, Patel A, McCook A, Switchenko J, Cole T, Khanna N, Han C, Gordon A, Starbuck K, Remick J. Severe Toxicity and Provider-Reported Subjective Symptoms in Patients With Vulvar Cancer Receiving Curative-Intent Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1686] [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: 10/20/2022]
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16
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Debinski C, Goergen S, McLean C, Buckland ME, Kumar B, Tiller G, Cole T, Ojaimi S, Fahey M. Exploring the Intersection of Isolated-CNS Hemophagocytic Lymphohistiocytosis and Pediatric Chronic Lymphocytic Inflammation With Pontine Perivascular Enhancement Responsive to Steroids. J Child Neurol 2021; 36:935-942. [PMID: 34056941 DOI: 10.1177/08830738211009654] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CLIPPERS (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is an extremely rare neurologic inflammatory condition. Fewer than 10 pediatric cases have been described.Debate persists as to whether it is a distinct disease or a clinical, radiologic, and histologic phenotype evolving into another disorder. We propose that CLIPPERS may be a clinical manifestation of an underlying state of immune-dysregulation.We describe the case of the youngest known report of CLIPPERS, an 18-month-old infant from Melbourne, Australia. Reviewing the literature for all reported pediatric cases, we identified that robust investigation and whole exome sequencing was underutilized and proposed diagnostic criteria were frequently unmet. Particular focus should be paid to genes known to cause familial hemophagocytic lymphohistiocytosis (HLH), with the CLIPPERS phenotype manifesting as a form of isolated central nervous system (CNS)-HLH in some patients. Curative treatment options such as hematopoietic stem cell transplantation may be appropriate for some patients and should be considered early.
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Affiliation(s)
| | - Stacy Goergen
- Monash Children's Hospital, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Catriona McLean
- Anatomical Pathology Department, Alfred Hospital, Melbourne, Australia
| | | | - Beena Kumar
- Monash Children's Hospital, Melbourne, Australia
| | | | | | - Samar Ojaimi
- Monash Children's Hospital, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Michael Fahey
- Monash Children's Hospital, Melbourne, Australia.,Monash University, Melbourne, Australia
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17
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Arnold DE, Nofal R, Wakefield C, Lehmberg K, Wustrau K, Albert MH, Morris EC, Heimall JR, Bunin NJ, Kumar A, Jordan MB, Cole T, Choo S, Brettig T, Speckmann C, Ehl S, Salamonowicz M, Wahlstrom J, Rao K, Booth C, Worth A, Marsh RA. Reduced-Intensity/Reduced-Toxicity Conditioning Approaches Are Tolerated in XIAP Deficiency but Patients Fare Poorly with Acute GVHD. J Clin Immunol 2021; 42:36-45. [PMID: 34586554 PMCID: PMC8478634 DOI: 10.1007/s10875-021-01103-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/16/2021] [Indexed: 12/01/2022]
Abstract
X-linked inhibitor of apoptosis (XIAP) deficiency is an inherited primary immunodeficiency characterized by chronic inflammasome overactivity and associated with hemophagocytic lymphohistiocytosis (HLH) and inflammatory bowel disease (IBD). Allogeneic hematopoietic cell transplantation (HCT) with fully myeloablative conditioning may be curative but has been associated with poor outcomes. Reports of reduced-intensity conditioning (RIC) and reduced-toxicity conditioning (RTC) regimens suggest these approaches are well tolerated, but outcomes are not well established. Retrospective data were collected from an international cohort of 40 patients with XIAP deficiency who underwent HCT with RIC or RTC. Thirty-three (83%) patients had a history of HLH, and thirteen (33%) patients had IBD. Median age at HCT was 6.5 years. Grafts were from HLA-matched (n = 30, 75%) and HLA-mismatched (n = 10, 25%) donors. There were no cases of primary graft failure. Two (5%) patients experienced secondary graft failure, and three (8%) patients ultimately received a second HCT. Nine (23%) patients developed grade II–IV acute GVHD, and 3 (8%) developed extensive chronic GVHD. The estimated 2-year overall and event-free survival rates were 74% (CI 55–86%) and 64% (CI 46–77%), respectively. Recipient and donor HLA mismatch and grade II–IV acute GVHD were negatively associated with survival on multivariate analysis with hazard ratios of 5.8 (CI 1.5–23.3, p = 0.01) and 8.2 (CI 2.1–32.7, p < 0.01), respectively. These data suggest that XIAP patients tolerate RIC and RTC with survival rates similar to HCT of other genetic HLH disorders. Every effort should be made to prevent acute GVHD in XIAP-deficient patients who undergo allogeneic HCT.
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Affiliation(s)
- Danielle E Arnold
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | | | - Connor Wakefield
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Kai Lehmberg
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg, Hamburg, Germany
| | - Katharina Wustrau
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg, Hamburg, Germany
| | - Michael H Albert
- Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Emma C Morris
- Institute of Immunity and Transplantation, University College London, London, UK
| | - Jennifer R Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nancy J Bunin
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ashish Kumar
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Michael B Jordan
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Theresa Cole
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sharon Choo
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Tim Brettig
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Carsten Speckmann
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Malgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Justin Wahlstrom
- Blood and Marrow Transplantation Program, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Kanchan Rao
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, UK
| | - Claire Booth
- Department of Pediatric Immunology, Great Ormond Street Hospital, London, UK
| | - Austen Worth
- Department of Pediatric Immunology, Great Ormond Street Hospital, London, UK
| | - Rebecca A Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
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18
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Moseley N, King J, Van Dort B, Williams S, Rodriguez-Casero V, Ramachandran S, Choo S, Cole T, McLean-Tooke A. Anti-voltage-Gated Potassium Channel (VGKC) Antibodies and Acquired Neuromyotonia in Patients with Immune Dysregulation, Polyendocrinopathy, Enteropathy X-Lined (IPEX) Syndrome. J Clin Immunol 2021; 41:1972-1974. [PMID: 34478044 DOI: 10.1007/s10875-021-01128-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
MESH Headings
- Adolescent
- Autoantibodies/blood
- Child
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/congenital
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 1/therapy
- Diarrhea/blood
- Diarrhea/genetics
- Diarrhea/immunology
- Diarrhea/therapy
- Forkhead Transcription Factors/genetics
- Genetic Diseases, X-Linked/blood
- Genetic Diseases, X-Linked/genetics
- Genetic Diseases, X-Linked/immunology
- Genetic Diseases, X-Linked/therapy
- Hematopoietic Stem Cell Transplantation
- Humans
- Immune System Diseases/blood
- Immune System Diseases/congenital
- Immune System Diseases/genetics
- Immune System Diseases/immunology
- Immune System Diseases/therapy
- Infant, Newborn
- Isaacs Syndrome/blood
- Isaacs Syndrome/genetics
- Isaacs Syndrome/immunology
- Isaacs Syndrome/therapy
- Male
- Mutation
- Potassium Channels, Voltage-Gated/immunology
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Affiliation(s)
- Natasha Moseley
- Department of Paediatric Immunology, Perth Children's Hospital, Nedlands, WA, Australia
| | - Jovanka King
- Department of Paediatric Immunology, Perth Children's Hospital, Nedlands, WA, Australia
- Department of Immunology, PP Block, PathWest, QEII, Nedlands, WA, 6008, Australia
| | - Ben Van Dort
- Department of Paediatric Immunology, Children's Cancer Centre, The Royal Children's Hospital Melbourne, VIC, Australia
| | - Simon Williams
- Department of Neurology, Perth Children's Hospital, Nedlands, WA, Australia
| | | | - Shanti Ramachandran
- Department of Oncology, Haematology, Blood and Marrow Transplantation, Perth Children's Hospital, Nedlands, WA, Australia
- School of Paediatrics, University of Western Australia, Perth, WA, Australia
| | - Sharon Choo
- Department of Paediatric Immunology, Children's Cancer Centre, The Royal Children's Hospital Melbourne, VIC, Australia
- Immunology Laboratory, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Theresa Cole
- Department of Paediatric Immunology, Children's Cancer Centre, The Royal Children's Hospital Melbourne, VIC, Australia
| | - Andrew McLean-Tooke
- Department of Paediatric Immunology, Perth Children's Hospital, Nedlands, WA, Australia.
- Department of Immunology, PP Block, PathWest, QEII, Nedlands, WA, 6008, Australia.
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19
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Shanthikumar S, Gower WA, Abts M, Liptzin DR, Fiorino EK, Stone A, Srinivasan S, Vece TJ, Akil N, Cole T, Cooke KR, Goldfarb SB. Pulmonary surveillance in pediatric hematopoietic stem cell transplant: A multinational multidisciplinary survey. Cancer Rep (Hoboken) 2021; 5:e1501. [PMID: 34319008 PMCID: PMC9124519 DOI: 10.1002/cnr2.1501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/16/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
Background Hematopoietic Stem Cell Transplant (HSCT) is an established treatment for malignant and non‐malignant conditions and pulmonary disease is a leading cause of late term morbidity and mortality. Accurate and early detection of pulmonary complications is a critical step in improving long term outcomes. Existing guidelines for surveillance of pulmonary complications post‐HSCT contain conflicting recommendations. Aim To determine the breadth of current practice in monitoring for pulmonary complications of pediatric HSCT. Methods An institutional review board approved, online, anonymous multiple‐choice survey was distributed to HSCT and pulmonary physicians from the United States of America and Australasia using the REDcap platform. The survey was developed by members of the American Thoracic Society Working Group on Complications of Childhood Cancer, and was designed to assess patient management and service design. Results A total of 40 (34.8%) responses were received. The majority (62.5%) were pulmonologists, and 82.5% were from the United States of America. In all, 67.5% reported having a protocol for monitoring pulmonary complications and 50.0% reported adhering “well” or “very well” to protocols. Pulmonary function tests (PFTs) most commonly involved spirometry and diffusion capacity for carbon monoxide. The frequency of PFTs varied depending on time post‐HSCT and presence of complications. In all, 55.0% reported a set threshold for a clinically significant change in PFT. Conclusions These results illustrate current variation in surveillance for pulmonary complications of pediatric HSCT. The results of this survey will inform development of future guidelines for monitoring of pulmonary complications after pediatric HSCT.
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Affiliation(s)
- Shivanthan Shanthikumar
- Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - William A Gower
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew Abts
- Seattle Children's Hospital, Seattle, Washington, USA.,Pediatric Pulmonary and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Deborah R Liptzin
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elizabeth K Fiorino
- Division of Pulmonology, Allergy, and Immunology, Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Anne Stone
- Division of Pulmonology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Saumini Srinivasan
- Division of Pulmonology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Timothy J Vece
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nour Akil
- Division of Pulmonology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Theresa Cole
- Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kenneth R Cooke
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Samuel B Goldfarb
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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20
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Yeoh DK, Cole T, Osowicki J. Reply to "Thoracic conidiobolomycosis: Invasive or allergic?". J Allergy Clin Immunol Pract 2021; 9:2545-2546. [PMID: 34112489 DOI: 10.1016/j.jaip.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Daniel K Yeoh
- Infectious Diseases Department, Perth Children's Hospital, Perth, WA, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic, Australia.
| | - Theresa Cole
- Department of Allergy and Immunology, Royal Children's Hospital Melbourne, Melbourne, Vic, Australia
| | - Joshua Osowicki
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Vic, Australia; Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Vic, Australia
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21
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Akesson LS, Francis D, G de Silva M, Cole T, Simm P, Oliver M, White SM. Microarray diagnosis of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy caused by a novel homozygous intragenic AIRE deletion. J Paediatr Child Health 2021; 57:1109-1112. [PMID: 32866290 DOI: 10.1111/jpc.15124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/11/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Lauren S Akesson
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Parkville Familial Cancer Centre and Department of Genomic Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Francis
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Michelle G de Silva
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Theresa Cole
- Department of Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Peter Simm
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Endocrinology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mark Oliver
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Gastroenterology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan M White
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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22
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Le Voyer T, Sakata S, Tsumura M, Khan T, Esteve-Sole A, Al-Saud BK, Gungor HE, Taur P, Jeanne-Julien V, Christiansen M, Köhler LM, ElGhazali GE, Rosain J, Nishimura S, Sakura F, Bouaziz M, Oleaga-Quintas C, Nieto-Patlán A, Deyà-Martinez À, Altuner Torun Y, Neehus AL, Roynard M, Bozdemir SE, Al Kaabi N, Al Hassani M, Mersiyanova I, Rozenberg F, Speckmann C, Hainmann I, Hauck F, Alzahrani MH, Alhajjar SH, Al-Muhsen S, Cole T, Fuleihan R, Arkwright PD, Badolato R, Alsina L, Abel L, Desai M, Al-Mousa H, Shcherbina A, Marr N, Boisson-Dupuis S, Casanova JL, Okada S, Bustamante J. Genetic, Immunological, and Clinical Features of 32 Patients with Autosomal Recessive STAT1 Deficiency. J Immunol 2021; 207:133-152. [PMID: 34183371 DOI: 10.4049/jimmunol.2001451] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/28/2021] [Indexed: 11/19/2022]
Abstract
Autosomal recessive (AR) STAT1 deficiency is a severe inborn error of immunity disrupting cellular responses to type I, II, and III IFNs, and IL-27, and conferring a predisposition to both viral and mycobacterial infections. We report the genetic, immunological, and clinical features of an international cohort of 32 patients from 20 kindreds: 24 patients with complete deficiency, and 8 patients with partial deficiency. Twenty-four patients suffered from mycobacterial disease (bacillus Calmette-Guérin = 13, environmental mycobacteria = 10, or both in 1 patient). Fifty-four severe viral episodes occurred in sixteen patients, mainly caused by Herpesviridae viruses. Attenuated live measles, mumps, and rubella and/or varicella zoster virus vaccines triggered severe reactions in the five patients with complete deficiency who were vaccinated. Seven patients developed features of hemophagocytic syndrome. Twenty-one patients died, and death was almost twice as likely in patients with complete STAT1 deficiency than in those with partial STAT1 deficiency. All but one of the eight survivors with AR complete deficiency underwent hematopoietic stem cell transplantation. Overall survival after hematopoietic stem cell transplantation was 64%. A diagnosis of AR STAT1 deficiency should be considered in children with mycobacterial and/or viral infectious diseases. It is important to distinguish between complete and partial forms of AR STAT1 deficiency, as their clinical outcome and management differ significantly.
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Affiliation(s)
- Tom Le Voyer
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Paris, France; .,University of Paris, Imagine Institute, Paris, France
| | - Sonoko Sakata
- Department of Pediatrics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Miyuki Tsumura
- Department of Pediatrics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Taushif Khan
- Division of Translational Medicine, Sidra Medicine, Doha, Qatar
| | - Ana Esteve-Sole
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, and Functional Unit of Immunology, Sant Joan de Déu Hospital, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Bandar K Al-Saud
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hatice Eke Gungor
- Department of Pediatrics, Pediatric Allergy and Immunology Unit, Kayseri Education and Research Hospital, Erkilet, Kayseri, Turkey
| | - Prasad Taur
- Department of Pediatric Immunology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Valentine Jeanne-Julien
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Mette Christiansen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus N, Denmark
| | - Lisa-Maria Köhler
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Gehad Eltayeb ElGhazali
- Sheikh Khalifa Medical City-Union71, Abu Dhabi and Department of Immunology, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Jérémie Rosain
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Shiho Nishimura
- Department of Pediatrics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fumiaki Sakura
- Department of Pediatrics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Matthieu Bouaziz
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Carmen Oleaga-Quintas
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Alejandro Nieto-Patlán
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Paris, France.,University of Paris, Imagine Institute, Paris, France.,Research and Development in Bioprocess Unit, National School of Biological Sciences, National Polytechnic Institute, Mexico City, Mexico
| | - Àngela Deyà-Martinez
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, and Functional Unit of Immunology, Sant Joan de Déu Hospital, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Yasemin Altuner Torun
- Pediatric Hematology and Oncology Unit, Istinye University, School of Medicine, İstanbul, Turkey
| | - Anna-Lena Neehus
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Manon Roynard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Sefika Elmas Bozdemir
- Pediatric İnfectious Disease Unit, Department of Pediatrics, Kayseri Education and Research Hospital, Erkilet, Kayseri, Turkey
| | - Nawal Al Kaabi
- Sheikh Khalifa Medical City-Union71, Abu Dhabi and Department of Immunology, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Moza Al Hassani
- Sheikh Khalifa Medical City-Union71, Abu Dhabi and Department of Immunology, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Irina Mersiyanova
- Molecular Biology Laboratory, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Flore Rozenberg
- Department of Virology, Cochin Hospital, University of Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Carsten Speckmann
- Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency, Institute for Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ina Hainmann
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Fabian Hauck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Sami Hussain Alhajjar
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saleh Al-Muhsen
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Immunology Research Laboratory, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Theresa Cole
- Department of Immunology, The Royal Children's Hospital, Melbourne, Australia
| | - Ramsay Fuleihan
- Division of Allergy & Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Peter D Arkwright
- Department of Paediatric Allergy and Immunology, Lydia Becker Institute of Immunology and Inflammation, Royal Manchester Children's Hospital, University of Manchester, Manchester, United Kingdom
| | - Raffaele Badolato
- Institute of Molecular Medicine Angelo Nocivelli, University of Brescia, Civil Hospital of Brescia, Brescia, Italy
| | - Laia Alsina
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, and Functional Unit of Immunology, Sant Joan de Déu Hospital, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Paris, France.,University of Paris, Imagine Institute, Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY
| | - Mukesh Desai
- Department of Pediatric Immunology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Hamoud Al-Mousa
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Anna Shcherbina
- Department of Clinical Immunology and Allergy, Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Nico Marr
- Division of Translational Medicine, Sidra Medicine, Doha, Qatar
| | - Stéphanie Boisson-Dupuis
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Paris, France.,University of Paris, Imagine Institute, Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Paris, France.,University of Paris, Imagine Institute, Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.,Howard Hughes Medical Institute, New York, NY; and
| | - Satoshi Okada
- Department of Pediatrics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jacinta Bustamante
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Paris, France; .,University of Paris, Imagine Institute, Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.,Study Center for Immunodeficiencies, Necker Hospital for Sick Children, Assistance Publique Hôpitaux de Paris, Paris, France
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23
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Bobat A, Anderson V, Barnett N, Beattie V, Bostock L, Clayton K, Cole T, Foreman H, Holden S, Kefyalew S, Overton G, Roberts J, Ross J, Shepherd P, Smerdon E, Ward M. P28.03 An Autoethnographic Study Exploring the Role of the Lung Cancer Nurse Specialist in the National Optimal Lung Cancer Pathway. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Yeoh DK, Saunders T, Butters C, Burgner D, Bryant PA, Cain TM, Ng J, Gwee A, Daley AJ, Cole T, Curtis N, Harrison J, Osowicki J. Refractory thoracic conidiobolomycosis treated with mepolizumab immunotherapy. J Allergy Clin Immunol Pract 2021; 9:2527-2530.e6. [PMID: 33601049 DOI: 10.1016/j.jaip.2021.01.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/12/2021] [Accepted: 01/27/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Daniel K Yeoh
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia; Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Thomas Saunders
- Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Coen Butters
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - David Burgner
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy M Cain
- Department of Medical Imaging, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jessica Ng
- Department of Anatomical Pathology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Amanda Gwee
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew J Daley
- Microbiology Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Nigel Curtis
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Joanne Harrison
- Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Joshua Osowicki
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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25
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Ghosh S, Köstel Bal S, Edwards ESJ, Pillay B, Jiménez Heredia R, Erol Cipe F, Rao G, Salzer E, Zoghi S, Abolhassani H, Momen T, Gostick E, Price DA, Zhang Y, Oler AJ, Gonzaga-Jauregui C, Erman B, Metin A, Ilhan I, Haskologlu S, Islamoglu C, Baskin K, Ceylaner S, Yilmaz E, Unal E, Karakukcu M, Berghuis D, Cole T, Gupta AK, Hauck F, Kogler H, Hoepelman AIM, Baris S, Karakoc-Aydiner E, Ozen A, Kager L, Holzinger D, Paulussen M, Krüger R, Meisel R, Oommen PT, Morris E, Neven B, Worth A, van Montfrans J, Fraaij PLA, Choo S, Dogu F, Davies EG, Burns S, Dückers G, Becker RP, von Bernuth H, Latour S, Faraci M, Gattorno M, Su HC, Pan-Hammarström Q, Hammarström L, Lenardo MJ, Ma CS, Niehues T, Aghamohammadi A, Rezaei N, Ikinciogullari A, Tangye SG, Lankester AC, Boztug K. Extended clinical and immunological phenotype and transplant outcome in CD27 and CD70 deficiency. Blood 2020; 136:2638-2655. [PMID: 32603431 PMCID: PMC7735164 DOI: 10.1182/blood.2020006738] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/10/2020] [Indexed: 12/31/2022] Open
Abstract
Biallelic mutations in the genes encoding CD27 or its ligand CD70 underlie inborn errors of immunity (IEIs) characterized predominantly by Epstein-Barr virus (EBV)-associated immune dysregulation, such as chronic viremia, severe infectious mononucleosis, hemophagocytic lymphohistiocytosis (HLH), lymphoproliferation, and malignancy. A comprehensive understanding of the natural history, immune characteristics, and transplant outcomes has remained elusive. Here, in a multi-institutional global collaboration, we collected the clinical information of 49 patients from 29 families (CD27, n = 33; CD70, n = 16), including 24 previously unreported individuals and identified a total of 16 distinct mutations in CD27, and 8 in CD70, respectively. The majority of patients (90%) were EBV+ at diagnosis, but only ∼30% presented with infectious mononucleosis. Lymphoproliferation and lymphoma were the main clinical manifestations (70% and 43%, respectively), and 9 of the CD27-deficient patients developed HLH. Twenty-one patients (43%) developed autoinflammatory features including uveitis, arthritis, and periodic fever. Detailed immunological characterization revealed aberrant generation of memory B and T cells, including a paucity of EBV-specific T cells, and impaired effector function of CD8+ T cells, thereby providing mechanistic insight into cellular defects underpinning the clinical features of disrupted CD27/CD70 signaling. Nineteen patients underwent allogeneic hematopoietic stem cell transplantation (HSCT) prior to adulthood predominantly because of lymphoma, with 95% survival without disease recurrence. Our data highlight the marked predisposition to lymphoma of both CD27- and CD70-deficient patients. The excellent outcome after HSCT supports the timely implementation of this treatment modality particularly in patients presenting with malignant transformation to lymphoma.
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Affiliation(s)
- Sujal Ghosh
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
| | - Sevgi Köstel Bal
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Emily S J Edwards
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- St. Vincent's Clinical School, UNSW Sydney, Randwick, NSW, Australia
| | - Bethany Pillay
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- St. Vincent's Clinical School, UNSW Sydney, Randwick, NSW, Australia
| | - Raúl Jiménez Heredia
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Funda Erol Cipe
- Department of Pediatric Allergy and Immunology, Istinye University, Istanbul, Turkey
| | - Geetha Rao
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Elisabeth Salzer
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Samaneh Zoghi
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Tooba Momen
- Department of Allergy and Clinical Immunology, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Emma Gostick
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - David A Price
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Vaccine Research Center
| | - Yu Zhang
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research
- Clinical Genomics Program, and
| | - Andrew J Oler
- Clinical Genomics Program, and
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, MD
| | | | - Baran Erman
- Institute of Child Health, Hacettepe University, Ankara, Turkey
- Can Sucak Research Laboratory for Translational Immunology, Center for Genomics and Rare Diseases, Hacettepe University, Ankara, Turkey
| | - Ayse Metin
- Division of Pediatric Allergy and Immunology, University of Health Sciences/Ankara City Hospital/Children's Hospital, Ankara, Turkey
| | - Inci Ilhan
- Division of Pediatric Oncology, University of Health Sciences/Ankara City Hospital/Children's Hospital, Ankara, Turkey
| | - Sule Haskologlu
- Department of Pediatric Allergy and Immunology, School of Medicine, Ankara University, Ankara, Turkey
| | - Candan Islamoglu
- Department of Pediatric Allergy and Immunology, School of Medicine, Ankara University, Ankara, Turkey
| | - Kubra Baskin
- Department of Pediatric Allergy and Immunology, School of Medicine, Ankara University, Ankara, Turkey
| | - Serdar Ceylaner
- Intergen Genetic Diagnosis and Research Center, Ankara, Turkey
| | - Ebru Yilmaz
- Department of Pediatrics, Division of Pediatric Hematology & Oncology & Molecular Biology and Genetic Department, Erciyes University, Kayseri, Turkey
- Gevher Nesibe Genom and Stem Cell Institution, GENKOK Genome and Stem Cell Center, Erciyes University, Kayseri, Turkey
| | - Ekrem Unal
- Department of Pediatrics, Division of Pediatric Hematology & Oncology & Molecular Biology and Genetic Department, Erciyes University, Kayseri, Turkey
- Gevher Nesibe Genom and Stem Cell Institution, GENKOK Genome and Stem Cell Center, Erciyes University, Kayseri, Turkey
| | - Musa Karakukcu
- Department of Pediatrics, Division of Pediatric Hematology & Oncology & Molecular Biology and Genetic Department, Erciyes University, Kayseri, Turkey
- Gevher Nesibe Genom and Stem Cell Institution, GENKOK Genome and Stem Cell Center, Erciyes University, Kayseri, Turkey
| | - Dagmar Berghuis
- Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Theresa Cole
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Aditya K Gupta
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Fabian Hauck
- Dr von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Hubert Kogler
- St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Safa Baris
- Division of Allergy and Immunology, Marmara University, Istanbul, Turkey
- The Isil Berat Barlan Center for Translational Medicine, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
| | - Elif Karakoc-Aydiner
- Division of Allergy and Immunology, Marmara University, Istanbul, Turkey
- The Isil Berat Barlan Center for Translational Medicine, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
| | - Ahmet Ozen
- Division of Allergy and Immunology, Marmara University, Istanbul, Turkey
- The Isil Berat Barlan Center for Translational Medicine, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
| | - Leo Kager
- St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Dirk Holzinger
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Michael Paulussen
- Vestische Kinder-und Jugendklinik, Witten/Herdecke University, Datteln, Germany
| | - Renate Krüger
- Department of Pediatric Pulmonology, Immunology, and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Meisel
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
| | - Prasad T Oommen
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
| | - Emma Morris
- Institute of Immunity & Transplantation, University College London, Royal Free Hospital, London, United Kingdom
| | - Benedicte Neven
- Unité d'Immuno-Hematologie et Rhumatologie, Département de Pédiatrie Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- INSERM U1163, Imagine Institute, Université de Paris, Paris, France
| | - Austen Worth
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Joris van Montfrans
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Pieter L A Fraaij
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision Infectious Diseases and Immunology, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Sharon Choo
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Figen Dogu
- Department of Pediatric Allergy and Immunology, School of Medicine, Ankara University, Ankara, Turkey
| | - E Graham Davies
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Siobhan Burns
- Institute of Immunity & Transplantation, University College London, Royal Free Hospital, London, United Kingdom
- Department of Immunology, Royal Free London National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Gregor Dückers
- Department of Pediatrics, Helios Children's Hospital, Krefeld, Germany
| | - Ruy Perez Becker
- Department of Pediatrics, Helios Children's Hospital, Krefeld, Germany
| | - Horst von Bernuth
- Department of Pediatric Pulmonology, Immunology, and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Immunology, Labor Berlin GmbH, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Berlin, Germany
| | - Sylvain Latour
- Laboratory of Lymphocyte Activation and Susceptibility to EBV infection, INSERM U1163, Imagine Institute, Université de Paris, Paris, France
| | - Maura Faraci
- Hematopoietic Stem Cell Transplantation Unit and Istituto di Ricovero e Cura Pediatrico a Carattere Scientifico (IRCSS) Istituto Giannina Gaslini Research Institute Genova, Italy
| | - Marco Gattorno
- Center for Autoinflammatory Diseases and Immunodeficiency, Istituto di Ricovero e Cura Pediatrico a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genova, Italy
| | - Helen C Su
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research
- Clinical Genomics Program, and
| | - Qiang Pan-Hammarström
- Department of Biosciences and Nutrition (NEO), Karolinska Institutet, Karolinska, Sweden
| | - Lennart Hammarström
- Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
- Beijing Genomics Institute (BGI) Shenzhen, Shenzhen, China
| | - Michael J Lenardo
- Clinical Genomics Program, and
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, NIAID, National Institutes of Health, Bethesda, MD
| | - Cindy S Ma
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- St. Vincent's Clinical School, UNSW Sydney, Randwick, NSW, Australia
| | - Tim Niehues
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran; and
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran; and
| | - Aydan Ikinciogullari
- Department of Pediatric Allergy and Immunology, School of Medicine, Ankara University, Ankara, Turkey
| | - Stuart G Tangye
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- St. Vincent's Clinical School, UNSW Sydney, Randwick, NSW, Australia
| | - Arjan C Lankester
- Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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26
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Mulder PA, van Balkom IDC, Landlust AM, Priolo M, Menke LA, Acero IH, Alkuraya FS, Arias P, Bernardini L, Bijlsma EK, Cole T, Coubes C, Dapia I, Davies S, Di Donato N, Elcioglu NH, Fahrner JA, Foster A, González NG, Huber I, Iascone M, Kaiser AS, Kamath A, Kooblall K, Lapunzina P, Liebelt J, Lynch SA, Maas SM, Mammì C, Mathijssen IB, McKee S, Mirzaa GM, Montgomery T, Neubauer D, Neumann TE, Pintomalli L, Pisanti MA, Plomp AS, Price S, Salter C, Santos-Simarro F, Sarda P, Schanze D, Segovia M, Shaw-Smith C, Smithson S, Suri M, Tatton-Brown K, Tenorio J, Thakker RV, Valdez RM, Van Haeringen A, Van Hagen JM, Zenker M, Zollino M, Dunn WW, Piening S, Hennekam RC. Development, behaviour and sensory processing in Marshall-Smith syndrome and Malan syndrome: phenotype comparison in two related syndromes. J Intellect Disabil Res 2020; 64:956-969. [PMID: 33034087 PMCID: PMC8957705 DOI: 10.1111/jir.12787] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 08/19/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ultrarare Marshall-Smith and Malan syndromes, caused by changes of the gene nuclear factor I X (NFIX), are characterised by intellectual disability (ID) and behavioural problems, although questions remain. Here, development and behaviour are studied and compared in a cross-sectional study, and results are presented with genetic findings. METHODS Behavioural phenotypes are compared of eight individuals with Marshall-Smith syndrome (three male individuals) and seven with Malan syndrome (four male individuals). Long-term follow-up assessment of cognition and adaptive behaviour was possible in three individuals with Marshall-Smith syndrome. RESULTS Marshall-Smith syndrome individuals have more severe ID, less adaptive behaviour, more impaired speech and less reciprocal interaction compared with individuals with Malan syndrome. Sensory processing difficulties occur in both syndromes. Follow-up measurement of cognition and adaptive behaviour in Marshall-Smith syndrome shows different individual learning curves over time. CONCLUSIONS Results show significant between and within syndrome variability. Different NFIX variants underlie distinct clinical phenotypes leading to separate entities. Cognitive, adaptive and sensory impairments are common in both syndromes and increase the risk of challenging behaviour. This study highlights the value of considering behaviour within developmental and environmental context. To improve quality of life, adaptations to environment and treatment are suggested to create a better person-environment fit.
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Affiliation(s)
- P A Mulder
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
| | - I D C van Balkom
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - A M Landlust
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
| | - M Priolo
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - L A Menke
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - I H Acero
- Genetics Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - F S Alkuraya
- Saudi Human Genome Project, King Abdulaziz City for Science and Technology, and Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - P Arias
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - L Bernardini
- Cytogenetics Unit, Casa Sollievo della Sofferenza Foundation, San Giovanni Rotondo, Italy
| | - E K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - T Cole
- Department of Clinical Genetics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - C Coubes
- Département de Génétique Médicale, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - I Dapia
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - S Davies
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - N Di Donato
- Institute for Clinical Genetics, TU Dresden, Dresden, Germany
| | - N H Elcioglu
- Department of Pediatric Genetics, Marmara University Medical School, Istanbul and Eastern Mediterranean University, Mersin, Turkey
| | - J A Fahrner
- McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Foster
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N G González
- Unit Hospital Universitario Central de Asturias, Oviedo, Spain
| | - I Huber
- Sørland Hospital, Kristiansand, Norway
| | - M Iascone
- Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A-S Kaiser
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - A Kamath
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - K Kooblall
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - P Lapunzina
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - J Liebelt
- South Australian Clinical Genetics Services, Women's and Children's Hospital, North Adelaide, Australia
| | - S A Lynch
- UCD Academic Centre on Rare Diseases, School of Medicine and Medical Sciences, University College Dublin, and Clinical Genetics, Temple Street Children's University Hospital, Dublin, Ireland
| | - S M Maas
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - C Mammì
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - I B Mathijssen
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - S McKee
- Northern Ireland Regional Genetics Service, Belfast Health and Social Care Trust, Belfast, UK
| | - G M Mirzaa
- Center for Integrative Brain Research, Seattle Children's Research Institute, and Division of Genetic Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - T Montgomery
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - D Neubauer
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - T E Neumann
- Mitteldeutscher Praxisverbund Humangenetik, Halle, Germany
| | - L Pintomalli
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - M A Pisanti
- Medical Genetic and Laboratory Unit, "Antonio Cardarelli" Hospital, Naples, Italy
| | - A S Plomp
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - S Price
- Department of Clinical Genetics, Northampton General Hospital NHS Trust, Northampton, UK
| | - C Salter
- Wessex Clinical Genetics Service, Princess Ann Hospital, Southampton, UK
| | - F Santos-Simarro
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - P Sarda
- Département de Génétique Médicale, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - D Schanze
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - M Segovia
- CENAGEM, Centro Nacional de Genética, Buenos Aires, Argentina
| | - C Shaw-Smith
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - S Smithson
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - M Suri
- Nottingham Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Tatton-Brown
- Division of Genetics and Epidemiology, Institute of Cancer Research, London and South West Thames Regional Genetics Service, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - J Tenorio
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - R V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - R M Valdez
- Genetics Unit, Hospital Militar Central "Cirujano Mayor Dr. Cosme Argerich", Buenos Aires, Argentina
| | - A Van Haeringen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - J M Van Hagen
- Department of Clinical Genetics, VU University Medical Centre, Amsterdam, Netherlands
| | - M Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - M Zollino
- Department of Laboratory Medicine, Institute of Medical Genetics, Catholic University, Rome, Italy
| | - W W Dunn
- Department of Occupational Therapy Education, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - S Piening
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - R C Hennekam
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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27
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Shanthikumar S, Welsh L, Westrupp N, Cole T, Frayman KB, Robertson CF, Ranganathan SC. Identification of pediatric bronchiolitis obliterans syndrome posthematopoietic stem cell transplantation; surveillance is the key. Pediatr Pulmonol 2020; 55:2840-2841. [PMID: 32816385 DOI: 10.1002/ppul.25023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/06/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Shivanthan Shanthikumar
- Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Liam Welsh
- Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Nicole Westrupp
- Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Theresa Cole
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia
| | - Katherine B Frayman
- Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Colin F Robertson
- Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sarath C Ranganathan
- Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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28
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Richards S, Gennery AR, Davies EG, Wong M, Shaw PJ, Peake J, Fraser C, Gray P, Brothers S, Sinclair J, Prestidge T, Preece K, Quinn P, Ramachandran S, Loh R, McLean-Tooke A, Mitchell R, Cole T. Diagnosis and management of severe combined immunodeficiency in Australia and New Zealand. J Paediatr Child Health 2020; 56:1508-1513. [PMID: 33099818 DOI: 10.1111/jpc.15158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 01/06/2023]
Abstract
This consensus document outlines the recommendations from the Australasian Society of Clinical Immunology and Allergy Transplantation and Primary Immunodeficiency group for the diagnosis and management of patients with severe combined immunodeficiency. It also provides a proposed framework for the early investigation, management and supportive care prior to haematopoietic stem cell transplantation.
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Affiliation(s)
- Stephanie Richards
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andrew R Gennery
- Paediatric Immunology and Haematopoietic Stem Cell Transplantation, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - E Graham Davies
- Department of Immunology, Great Ormond Street Hospital, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melanie Wong
- Department of Allergy and Immunology, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Peter J Shaw
- Bone Marrow Transplant Unit, Children's Hospital Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jane Peake
- Department of Allergy and Immunology, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Discipline of Paediatrics and Child Health, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Chris Fraser
- Oncology Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Paul Gray
- Department of Immunology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Shannon Brothers
- Department of Immunology and Allergy, Starship Children's Hospital, Auckland, New Zealand.,Newborn Metabolic Screening, Specialist Chemical Pathology Department, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Jan Sinclair
- Department of Immunology and Allergy, Starship Children's Hospital, Auckland, New Zealand
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Kahn Preece
- Allergy and Immunology Department, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Patrick Quinn
- Department of Allergy and Clinical Immunology, Women and Children's Hospital, Adelaide, South Australia, Australia.,Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Shanti Ramachandran
- Department of Paediatric and Adolescent Oncology and Haematology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Richard Loh
- Immunology Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Andrew McLean-Tooke
- Immunology Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Richard Mitchell
- School of Women and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Victoria, Australia
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29
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Lau A, Avery DT, Jackson K, Lenthall H, Volpi S, Brigden H, Russell AJ, Bier J, Reed JH, Smart JM, Cole T, Choo S, Gray PE, Berglund LJ, Hsu P, Wong M, O'Sullivan M, Boztug K, Meyts I, Uzel G, Notarangelo LD, Brink R, Goodnow CC, Tangye SG, Deenick EK. Activated PI3Kδ breaches multiple B cell tolerance checkpoints and causes autoantibody production. J Exp Med 2020; 217:132760. [PMID: 31841125 PMCID: PMC7041712 DOI: 10.1084/jem.20191336] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/29/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022] Open
Abstract
In patients, gain-of-function (GOF) mutations in PIK3CD break tolerance, causing highly penetrant secretion of autoreactive IgM. Mouse models reveal that Pik3cd GOF subverts the response to self-antigen, preventing the induction of anergy and instead stimulating plasmablast and GC formation. Antibody-mediated autoimmune diseases are a major health burden. However, our understanding of how self-reactive B cells escape self-tolerance checkpoints to secrete pathogenic autoantibodies remains incomplete. Here, we demonstrate that patients with monogenic immune dysregulation caused by gain-of-function mutations in PIK3CD, encoding the p110δ catalytic subunit of phosphoinositide 3-kinase (PI3K), have highly penetrant secretion of autoreactive IgM antibodies. In mice with the corresponding heterozygous Pik3cd activating mutation, self-reactive B cells exhibit a cell-autonomous subversion of their response to self-antigen: instead of becoming tolerized and repressed from secreting autoantibody, Pik3cd gain-of-function B cells are activated by self-antigen to form plasmablasts that secrete high titers of germline-encoded IgM autoantibody and hypermutating germinal center B cells. However, within the germinal center, peripheral tolerance was still enforced, and there was selection against B cells with high affinity for self-antigen. These data show that the strength of PI3K signaling is a key regulator of pregerminal center B cell self-tolerance and thus represents a druggable pathway to treat antibody-mediated autoimmunity.
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Affiliation(s)
- Anthony Lau
- Immunity and Inflammatory Diseases, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Danielle T Avery
- Immunity and Inflammatory Diseases, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Katherine Jackson
- Immunity and Inflammatory Diseases, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Helen Lenthall
- Immunity and Inflammatory Diseases, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Stefano Volpi
- Clinica Pediatrica e Reumatologia, Centro per le malattie Autoinfiammatorie e Immunodeficienze, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini and Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università degli Studi di Genova, Genova, Italy
| | - Henry Brigden
- Immunity and Inflammatory Diseases, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Amanda J Russell
- Immunity and Inflammatory Diseases, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Julia Bier
- Immunity and Inflammatory Diseases, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Joanne H Reed
- Immunity and Inflammatory Diseases, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Joanne M Smart
- Department of Allergy and Immunology, Royal Children's Hospital Melbourne, Victoria, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, Royal Children's Hospital Melbourne, Victoria, Australia
| | - Sharon Choo
- Department of Allergy and Immunology, Royal Children's Hospital Melbourne, Victoria, Australia
| | - Paul E Gray
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia.,Clinical Immunogenomics Research Consortium of Australasia, Sydney, Australia
| | - Lucinda J Berglund
- Clinical Immunogenomics Research Consortium of Australasia, Sydney, Australia.,Immunopathology Department, Westmead Hospital, Westmead, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Hsu
- Clinical Immunogenomics Research Consortium of Australasia, Sydney, Australia.,Children's Hospital at Westmead, New South Wales, Australia
| | - Melanie Wong
- Clinical Immunogenomics Research Consortium of Australasia, Sydney, Australia.,Children's Hospital at Westmead, New South Wales, Australia
| | - Michael O'Sullivan
- Clinical Immunogenomics Research Consortium of Australasia, Sydney, Australia.,Department of Immunology and Allergy, Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria.,CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.,St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Isabelle Meyts
- Department of Immunology and Microbiology, Inborn Errors of Immunity, Department of Pediatrics, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Gulbu Uzel
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Robert Brink
- Immunity and Inflammatory Diseases, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Clinical Immunogenomics Research Consortium of Australasia, Sydney, Australia
| | - Christopher C Goodnow
- Immunity and Inflammatory Diseases, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,Clinical Immunogenomics Research Consortium of Australasia, Sydney, Australia.,UNSW Cellular Genomics Futures Institute, UNSW Sydney, Sydney, Australia
| | - Stuart G Tangye
- Immunity and Inflammatory Diseases, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Clinical Immunogenomics Research Consortium of Australasia, Sydney, Australia
| | - Elissa K Deenick
- Immunity and Inflammatory Diseases, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,Clinical Immunogenomics Research Consortium of Australasia, Sydney, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, Australia
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Hamad N, Gottlieb D, Ritchie D, Kennedy G, Watson AM, Greenwood M, Doocey R, Perera T, Spencer A, Wong E, O'Brien T, Shaw P, Conyers R, Cole T, Milliken S, Bardy P, Larsen S, Lai H, Butler A, Fraser C, Bajel A, Butler J, Kerridge I, Purtill D. Bone Marrow Transplant Society of Australia and New Zealand COVID-19 consensus position statement. Intern Med J 2020; 50:774-775. [PMID: 32537929 PMCID: PMC7323419 DOI: 10.1111/imj.14867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Nada Hamad
- St Vincent's Hospital Sydney and University of New South Wales, Sydney, New South Wales, Australia
| | - David Gottlieb
- University of Sydney and Westmead Hospital, Sydney, New South Wales, Australia
| | - David Ritchie
- Clinical Haematology, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Glen Kennedy
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Anne M Watson
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | | | - Travis Perera
- Wellington Blood and Cancer Centre, Wellington, New Zealand
| | - Andrew Spencer
- The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Eric Wong
- Austin Hospital, Heidelberg, Victoria, Australia
| | - Tracey O'Brien
- Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Peter Shaw
- University of Sydney and Westmead Hospital, Sydney, New South Wales, Australia
| | - Rachel Conyers
- The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Theresa Cole
- The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sam Milliken
- St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Peter Bardy
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Larsen
- Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia
| | - Hock Lai
- Townsville Hospital, Townsville, Queensland, Australia
| | | | - Chris Fraser
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ashish Bajel
- Clinical Haematology, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jason Butler
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Ian Kerridge
- Royal North Shore Hospital and the University of Sydney, Sydney, New South Wales, Australia
| | - Duncan Purtill
- Fiona Stanley Hospital, Perth, Western Australia, Australia
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31
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Zemrani B, Yap JK, Van Dort B, Evans V, Bartle J, Shandley D, Smart J, Bines JE, Cole T. Nutritional challenges in children with primary immunodeficiencies undergoing hematopoietic stem cell transplant. Clin Nutr 2020; 39:2832-2841. [PMID: 31952894 DOI: 10.1016/j.clnu.2019.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/08/2019] [Accepted: 12/10/2019] [Indexed: 11/25/2022]
Abstract
Nutritional profile and management of patients with primary immunodeficiencies (PID) undergoing hematopoietic stem cell transplant (HSCT) has not been described in the literature. We aim to report the nutritional challenges and practices peculiar to this population before and after HSCT and suggest clinical pathways for their management. We conducted a single-centre retrospective study. Inclusion criteria were children aged less than 20 years with a diagnosis of PID who have undergone HSCT at the Royal Children's Hospital Melbourne since April 2014 with a minimal follow-up of 1 year. Nutritional parameters were collected in the pre-transplant period, at conditioning, and at 1, 3, 6 and 12 months post-HSCT. Descriptive analysis were used. Between April 2014 and December 2018, 27 children received 31 HSCT. Before transplant, 33% had a weight and/or height ≤ -2 standard deviations (SD). Forty percent required nutritional support before transplant: 33% had enteral nutrition (EN) while 7% required long-term parenteral nutrition (PN) due to intestinal failure. After transplant, although most children were started on EN, 82% required PN with a mean duration of 67 days. Mean time to full oral diet was 154 days. Pre-transplant mean weight and height were -0.57 SD and -0.88 SD respectively. After a decrease in anthropometric parameters the first 3 months post-transplant, progressive catch up was noticeable for weight (-0.27 SD) with no catch up for height at 1 year (-0.93 SD). Our work highlights the nutritional challenges and specificities of children with PID in the peri-transplant period. An approach to nutrition assessment and management in the pre- and post-transplant period is proposed.
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Affiliation(s)
- Boutaina Zemrani
- Clinical Nutrition Unit, Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia; Clinical Nutrition, Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Jason K Yap
- Clinical Nutrition Unit, Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia
| | - Ben Van Dort
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Australia
| | - Victoria Evans
- Clinical Nutrition Unit, Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia
| | - Jodie Bartle
- Department of Nutrition and Food Services, The Royal Children's Hospital, Melbourne, Australia
| | - Danielle Shandley
- Department of Nutrition and Food Services, The Royal Children's Hospital, Melbourne, Australia
| | - Joanne Smart
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Australia
| | - Julie E Bines
- Clinical Nutrition Unit, Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Australia
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32
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Butters C, Phuong LK, Cole T, Gwee A. Prevalence of Immunodeficiency in Children With Invasive Pneumococcal Disease in the Pneumococcal Vaccine Era: A Systematic Review. JAMA Pediatr 2019; 173:1084-1094. [PMID: 31566672 DOI: 10.1001/jamapediatrics.2019.3203] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite increasing access to vaccination, invasive pneumococcal disease (IPD) is responsible for approximately 826 000 deaths worldwide in children younger than 5 years each year. To allow early identification and prevention, an improved understanding of risk factors for IPD is needed. OBJECTIVES To review the literature on the prevalence of primary immunodeficiency (PID) in children younger than 18 years presenting with IPD without another predisposing condition and to inform guidelines for immunologic evaluation after the first episode of IPD based on published evidence. EVIDENCE REVIEW A literature search of PubMed, Embase (inception [1974] to February 28, 2019), and MEDLINE (inception [1946] to February 28, 2019) was conducted using the terms Streptococcus pneumonia, Streptococcus pneumoniae, pneumococcal infection, Streptococcus infection, pneumococcal meningitis, immunodeficiency, immune response, immunocompromised, susceptib*, precursor, predispose*, recurren*, newborn, neonat*, infan*, toddler, child, preschooler, adolescen*, and pediatric. Publications reporting original data on immunodeficiency in children with microbiologically confirmed primary or recurrent IPD were included. Strength of clinical data was graded according to the 5-point scale of the Oxford Centre for Evidence-Based Medicine. FINDINGS In 6022 unique children with primary IPD, 5 of 393 (1.3%) to 17 of 162 (10.5%) of all children and 14 of 53 (26.4%) of those older than 2 years had a PID identified. Higher rates of PID, up to 10 of 15 (66.7%), were found in children with recurrent IPD. Antibody deficiency was the most common immunodeficiency, followed by complement deficiency, asplenia, and rarer defects in T-cell signaling. The site of infection was a key indicator for the risk of underlying PID, with the greatest risk of PID in children with meningitis or complicated pneumonia. CONCLUSIONS AND RELEVANCE Results of this study suggest that invasive pneumococcal disease, and particularly recurrent IPD, is an important marker of underlying PID in children without other risk factors. The findings also suggest that children older than 2 years with pneumococcal meningitis or complicated pneumonia and all children with recurrent IPD should be referred for an immune evaluation. TRIAL REGISTRATION PROSPERO identifier: CRD42017075978.
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Affiliation(s)
- Coen Butters
- Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Parkville, Australia
| | - Linny Kimly Phuong
- Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Parkville, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Amanda Gwee
- Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Infectious Diseases & Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Australia
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33
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Pinato D, Cole T, Bengsch B, Tait P, Sayed A, Abomeli F, Gramenitskaya D, Allara E, Thomas R, Ward C, Wong C, Akarca A, Miguens Blanco J, Marafioti T, Marchesi J, Sharma R. A phase Ib study of pembrolizumab following trans-arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC): PETAL. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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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34
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Mitchell R, Cole T, Shaw PJ, Mechinaud F, O'Brien T, Fraser C. TCR α + β + /CD19 + cell-depleted hematopoietic stem cell transplantation for pediatric patients. Pediatr Transplant 2019; 23:e13517. [PMID: 31271477 DOI: 10.1111/petr.13517] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 04/08/2019] [Accepted: 05/06/2019] [Indexed: 02/05/2023]
Abstract
TCR α+ β+ /CD19+ cell depletion is an emerging technique for ex vivo graft manipulation in HSCT. We report 20 pediatric patients who underwent TCR α+ β+ /CD19+ cell-depleted HSCT in four Australian centers. Conditioning regimen was dependent on HSCT indication, which included immunodeficiency (n = 14), Fanconi anemia (n = 3), and acute leukemia (n = 3). Donor sources were haploidentical parent (n = 17), haploidentical sibling (n = 2), or matched unrelated donor (n = 1). Mean cell dose was 8.2 × 108 /kg TNC, 12.1 × 106 /kg CD34+ cells, and 0.4 × 105 /kg TCR α+ β+ cells. All patients achieved primary neutrophil and platelet engraftment, with average time to neutrophil engraftment 11 days (range 8-22) and platelet engraftment 24 days (range 12-69). TRM at 1 year was 15%. Rate of grade II-IV aGVHD at 1 year was 20% with no grade III-IV aGVHD seen. CMV reactivation occurred in 81% of CMV-positive recipients, with one patient developing CMV disease. Average time to CD4 recovery (>400 × 106 /L) was 258 days. Overall survival for the cohort at 5 years was 80%. This report highlights the initial experience of TCR α+ β+ /CD19+ cell-depleted HSCT in Australian centers, with high rates of engraftment, low rates of aGVHD, and acceptable TRM.
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Affiliation(s)
- Richard Mitchell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Peter J Shaw
- Oncology Unit, Children's Hospital Westmead, Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Francoise Mechinaud
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Tracey O'Brien
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Chris Fraser
- Oncology Service, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
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35
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Brettig T, Smart J, Choo S, Mechinaud F, Mitchell R, Raj TS, Cole T. Use of TCR α +β +/CD19 +-Depleted Haploidentical Hematopoietic Stem Cell Transplant Is a Viable Option in Patients With Primary Immune Deficiency Without Matched Sibling Donor. J Clin Immunol 2019; 39:505-511. [PMID: 31172381 DOI: 10.1007/s10875-019-00648-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/17/2019] [Indexed: 11/24/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is curative for many patients with primary immune deficiency (PID). Haploidentical donors have historically been associated with higher rates of graft-versus-host disease (GvHD) and graft failure. Use of T cell receptor (TCR) α+β+/CD19+-depleted grafts has resulted in improved haploidentical HSCT outcomes. We sought to evaluate outcomes of TCR α+β+/CD19+-depleted haploidentical HSCT in pediatric patients with PID at a single center in Australia. Specifically, we evaluated immune reconstitution, looking at time to T cell and B cell reconstitution, and B cell function post-HSCT. Eleven patients with a mean age of 7.92 years (range 0.33-17.17 years) were included. The median time to B cell recovery was 93 days (range 41-205 days), and the median time to cessation of immunoglobulin replacement was 281.5 days (range 41-205 days). All patients who had ceased immunoglobulin replacement had an adequate response to pneumococcal conjugate (Prevenar 13) vaccine. The median time to CD4+ recovery was 132 days (range 30-296 days), and naive T cells were present in all surviving patients by 4 months post-HSCT. Eight of 11 patients are surviving, with six patients having whole blood chimerism greater than 95%, one patient with whole blood chimerism of 82.8%, and another with 76.0%. All of these patients clinically had no evidence of underlying immunodeficiency. Likelihood of overall survival at 2 years post-HSCT was 81.8%. Cumulative incidence of acute GvHD was 27.3%. Cumulative incidence of CMV viremia was 63.6%. All patients previously exposed to CMV had reactivation post-HSCT, but were controlled with pre-emptive CMV treatment. Assuming most children with PID have a haploidentical donor available, use of this technique is likely to result in good outcomes for patients who do not have a suitable matched sibling or matched unrelated donor.
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Affiliation(s)
- Tim Brettig
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, VIC, Australia.
| | - Joanne Smart
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sharon Choo
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Francoise Mechinaud
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Richard Mitchell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women & Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Trisha Soosay Raj
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, VIC, Australia
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36
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Pillay BA, Avery DT, Smart JM, Cole T, Choo S, Chan D, Gray PE, Frith K, Mitchell R, Phan TG, Wong M, Campbell DE, Hsu P, Ziegler JB, Peake J, Alvaro F, Picard C, Bustamante J, Neven B, Cant AJ, Uzel G, Arkwright PD, Casanova JL, Su HC, Freeman AF, Shah N, Hickstein DD, Tangye SG, Ma CS. Hematopoietic stem cell transplant effectively rescues lymphocyte differentiation and function in DOCK8-deficient patients. JCI Insight 2019; 5:127527. [PMID: 31021819 DOI: 10.1172/jci.insight.127527] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Bi-allelic inactivating mutations in DOCK8 cause a combined immunodeficiency characterised by severe pathogen infections, eczema, allergies, malignancy and impaired humoral responses. These clinical features result from functional defects in most lymphocyte lineages. Thus, DOCK8 plays a key role in immune cell function. Hematopoietic stem cell transplantation (HSCT) is curative for DOCK8 deficiency. While previous reports have described clinical outcomes for DOCK8 deficiency following HSCT, the effect on lymphocyte reconstitution and function has not been investigated. Our study determined whether defects in lymphocyte differentiation and function in DOCK8-deficient patients were restored following HSCT. DOCK8-deficient T and B lymphocytes exhibited aberrant activation and effector function in vivo and in vitro. Frequencies of αβ T and MAIT cells were reduced while γδT cells were increased in DOCK8-deficient patients. HSCT improved, abnormal lymphocyte function in DOCK8-deficient patients. Elevated total and allergen-specific IgE in DOCK8-deficient patients decreased over time following HSCT. Our results document the extensive catalogue of cellular defects in DOCK8-deficient patients, and the efficacy of HSCT to correct these defects, concurrent with improvements in clinical phenotypes. Overall, our findings provide mechanisms at a functional cellular level for improvements in clinical features of DOCK8 deficiency post-HSCT, identify biomarkers that correlate with improved clinical outcomes, and inform the general dynamics of immune reconstitution in patients with monogenic immune disorders following HSCT.
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Affiliation(s)
- Bethany A Pillay
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Danielle T Avery
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Joanne M Smart
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Theresa Cole
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sharon Choo
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Damien Chan
- Women and Children's Hosp==ital, Adelaide, South Australia, Australia
| | - Paul E Gray
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia
| | - Katie Frith
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Richard Mitchell
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales Australia
| | - Tri Giang Phan
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia
| | - Melanie Wong
- Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia.,Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Dianne E Campbell
- Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia.,Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Peter Hsu
- Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia.,Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - John B Ziegler
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia
| | - Jane Peake
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Frank Alvaro
- Pediatric Hematology, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Capucine Picard
- Laboratory of Lymphocyte Activation and Susceptibility to EBV Infection, INSERM UMR 1163, Imagine institut, Paris, France.,Study Center for Primary Immunodeficiencies, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker Hospital for Sick Children, Paris, France.,Pediatric Hematology and Immunology Unit, Necker Hospital for Sick Children, AP-HP, Paris, France
| | - Jacinta Bustamante
- Laboratory of Lymphocyte Activation and Susceptibility to EBV Infection, INSERM UMR 1163, Imagine institut, Paris, France.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Institut IMAGINE, Necker Medical School, University Paris Descartes Paris, France.,St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA
| | - Benedicte Neven
- Pediatric Hematology-Immunology Unit, Necker Hospital for Sick Children, AP-HP, Paris, France
| | - Andrew J Cant
- Great North Children's Hospital, Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle upon Tyne University, Newcastle upon Tyne, United Kingdom
| | - Gulbu Uzel
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Peter D Arkwright
- Lydia Becker Institute of Immunology & Inflammation, University of Manchester, Manchester, United Kingdom
| | - Jean-Laurent Casanova
- Pediatric Hematology and Immunology Unit, Necker Hospital for Sick Children, AP-HP, Paris, France.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Institut IMAGINE, Necker Medical School, University Paris Descartes Paris, France.,St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA.,Howard Hughes Medical Institute, New York, New York, USA
| | - Helen C Su
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Alexandra F Freeman
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | | | - Dennis D Hickstein
- Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Stuart G Tangye
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia
| | - Cindy S Ma
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia
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37
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Ardelt M, Cole T. THE POWER OF PURPOSE FOR AGING WELL: CONTRIBUTIONS FROM THE HUMANITIES AND ARTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Ardelt
- University of Florida, Gainesville, Florida
| | - T Cole
- U Texas Health Science Center, Houston, Houston, Texas
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38
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Avery DT, Kane A, Nguyen T, Lau A, Nguyen A, Lenthall H, Payne K, Shi W, Brigden H, French E, Bier J, Hermes JR, Zahra D, Sewell WA, Butt D, Elliott M, Boztug K, Meyts I, Choo S, Hsu P, Wong M, Berglund LJ, Gray P, O'Sullivan M, Cole T, Holland SM, Ma CS, Burkhart C, Corcoran LM, Phan TG, Brink R, Uzel G, Deenick EK, Tangye SG. Germline-activating mutations in PIK3CD compromise B cell development and function. J Exp Med 2018; 215:2073-2095. [PMID: 30018075 PMCID: PMC6080914 DOI: 10.1084/jem.20180010] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/15/2018] [Accepted: 06/20/2018] [Indexed: 11/04/2022] Open
Abstract
Gain-of-function (GOF) mutations in PIK3CD, encoding the p110δ subunit of phosphatidylinositide 3-kinase (PI3K), cause a primary immunodeficiency. Affected individuals display impaired humoral immune responses following infection or immunization. To establish mechanisms underlying these immune defects, we studied a large cohort of patients with PIK3CD GOF mutations and established a novel mouse model using CRISPR/Cas9-mediated gene editing to introduce a common pathogenic mutation in Pik3cd In both species, hyperactive PI3K severely affected B cell development and differentiation in the bone marrow and the periphery. Furthermore, PI3K GOF B cells exhibited intrinsic defects in class-switch recombination (CSR) due to impaired induction of activation-induced cytidine deaminase (AID) and failure to acquire a plasmablast gene signature and phenotype. Importantly, defects in CSR, AID expression, and Ig secretion were restored by leniolisib, a specific p110δ inhibitor. Our findings reveal key roles for balanced PI3K signaling in B cell development and long-lived humoral immunity and memory and establish the validity of treating affected individuals with p110δ inhibitors.
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Affiliation(s)
- Danielle T Avery
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Alisa Kane
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, University of New South Wales (UNSW), New South Wales, Australia.,Department of Immunology and Allergy, Liverpool Hospital, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, UNSW Sydney, Liverpool, New South Wales, Australia.,Clinical Immunogenomics Research Consortia Australia (CIRCA), Sydney, New South Wales, Australia
| | - Tina Nguyen
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, University of New South Wales (UNSW), New South Wales, Australia
| | - Anthony Lau
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, University of New South Wales (UNSW), New South Wales, Australia
| | - Akira Nguyen
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, University of New South Wales (UNSW), New South Wales, Australia
| | - Helen Lenthall
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Kathryn Payne
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Wei Shi
- Molecular Immunology and Bioinformatics Divisions, Walter & Eliza Hall Institute for Medical Research, Parkville, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Henry Brigden
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Elise French
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Julia Bier
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, University of New South Wales (UNSW), New South Wales, Australia
| | - Jana R Hermes
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - David Zahra
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - William A Sewell
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, University of New South Wales (UNSW), New South Wales, Australia.,Immunology Department, SydPath, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Danyal Butt
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, University of New South Wales (UNSW), New South Wales, Australia
| | - Michael Elliott
- Sydney Medical School, University of Sydney, Sydney, Australia.,Chris O'Brien Lifehouse Cancer Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria.,CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.,St. Anna Children's Hospital and Children's Cancer Research Institute, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Isabelle Meyts
- Department of Immunology and Microbiology, Childhood Immunology, Department of Pediatrics, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Sharon Choo
- Department of Allergy and Immunology, Royal Children's Hospital Melbourne, Victoria, Australia
| | - Peter Hsu
- Clinical Immunogenomics Research Consortia Australia (CIRCA), Sydney, New South Wales, Australia.,Children's Hospital at Westmead, New South Wales, Australia
| | - Melanie Wong
- Clinical Immunogenomics Research Consortia Australia (CIRCA), Sydney, New South Wales, Australia.,Children's Hospital at Westmead, New South Wales, Australia
| | - Lucinda J Berglund
- Clinical Immunogenomics Research Consortia Australia (CIRCA), Sydney, New South Wales, Australia.,Immunopathology Department, Westmead Hospital, Westmead, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Gray
- Clinical Immunogenomics Research Consortia Australia (CIRCA), Sydney, New South Wales, Australia.,University of New South Wales School of Women's and Children's Health, New South Wales, Australia
| | - Michael O'Sullivan
- Department of Immunology and Allergy, Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, Royal Children's Hospital Melbourne, Victoria, Australia
| | - Steven M Holland
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Cindy S Ma
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, University of New South Wales (UNSW), New South Wales, Australia.,Clinical Immunogenomics Research Consortia Australia (CIRCA), Sydney, New South Wales, Australia
| | - Christoph Burkhart
- Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Lynn M Corcoran
- Molecular Immunology and Bioinformatics Divisions, Walter & Eliza Hall Institute for Medical Research, Parkville, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Tri Giang Phan
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, University of New South Wales (UNSW), New South Wales, Australia.,Clinical Immunogenomics Research Consortia Australia (CIRCA), Sydney, New South Wales, Australia
| | - Robert Brink
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St. Vincent's Clinical School, University of New South Wales (UNSW), New South Wales, Australia.,Clinical Immunogenomics Research Consortia Australia (CIRCA), Sydney, New South Wales, Australia
| | - Gulbu Uzel
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Elissa K Deenick
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia .,St. Vincent's Clinical School, University of New South Wales (UNSW), New South Wales, Australia.,Clinical Immunogenomics Research Consortia Australia (CIRCA), Sydney, New South Wales, Australia
| | - Stuart G Tangye
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia .,St. Vincent's Clinical School, University of New South Wales (UNSW), New South Wales, Australia.,Clinical Immunogenomics Research Consortia Australia (CIRCA), Sydney, New South Wales, Australia
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Belderbos ME, Gennery AR, Dvorak CC, Blok HJ, Eikema DJ, Silva JMF, Veys P, Neven B, Buckley R, Cole T, Cowan MJ, Goebel WS, Hoenig M, Kuo CY, Stiehm ER, Wynn R, Bierings M. Outcome of domino hematopoietic stem cell transplantation in human subjects: An international case series. J Allergy Clin Immunol 2018; 142:1628-1631.e4. [PMID: 29981805 DOI: 10.1016/j.jaci.2018.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 06/14/2018] [Accepted: 06/27/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Mirjam E Belderbos
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - Andrew R Gennery
- Department of Pediatric Immunology, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Christopher C Dvorak
- Pediatric Allergy Immunology and Blood and Marrow Transplant Division, University of California-San Francisco, Benioff Children's Hospital, San Francisco, Calif
| | - Henric-Jan Blok
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Dirk-Jan Eikema
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Juliana M F Silva
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Paul Veys
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Bénédicte Neven
- Department of Pediatric Hematology-Immunology, Hospital Necker-Enfants Malades, Assistance Publique-Hôspitaux de Paris, INSERM, Paris, France
| | - Rebecca Buckley
- Departments of Pediatrics and Immunology, Duke University School of Medicine, Duke University Medical Center, Durham, NC
| | - Theresa Cole
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia
| | - Morton J Cowan
- Pediatric Allergy Immunology and Blood and Marrow Transplant Division, University of California-San Francisco, Benioff Children's Hospital, San Francisco, Calif
| | - W Scott Goebel
- Department of Pediatrics and the Pediatric Stem Cell Transplantation Program, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Ind
| | - Manfred Hoenig
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Caroline Y Kuo
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, David Geffen School of Medicine, UCLA Medical Center, Los Angeles, Calif
| | - E Richard Stiehm
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, David Geffen School of Medicine, UCLA Medical Center, Los Angeles, Calif
| | - Robert Wynn
- Department of Pediatric Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Marc Bierings
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Pediatric Hematology and Stem Cell Transplantation, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
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Sathishkumar D, Gach JE, Ogboli M, Desai M, Cole T, Högler W, Motwani J, Norton A, Morland B, Colmenero I. Cartilage hair hypoplasia with cutaneous lymphomatoid granulomatosis. Clin Exp Dermatol 2018; 43:713-717. [PMID: 29744913 DOI: 10.1111/ced.13543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 11/30/2022]
Abstract
Cartilage-hair hypoplasia (CHH) is an autosomal recessive chondrodysplasia characterized by short-stature, sparse hair and impaired cellular immunity. We describe a young girl who was diagnosed with CHH based on the findings of recurrent infections, short stature with metaphyseal chondrodysplasia, and a confirmed bi-allelic RMRP gene mutation. At 13 years, the patient developed an Epstein-Barr virus (EBV)-driven lymphoproliferative disorder involving the lung, which responded partially to chemotherapy. Simultaneously, she developed multiple indurated plaques involving her face, which had histological findings of granulomatous inflammation and EBV-associated low-grade lymphomatoid granulomatosis. The patient received a matched unrelated peripheral blood stem cell transplant at 15 years of age, and her immunological parameters and skin lesions improved. Lymphomatoid forms of granulomatosis and cutaneous EBV-associated malignancies have not been described previously in CHH. This case highlights the possibility of EBV-associated cutaneous malignancy in CHH.
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Affiliation(s)
- D Sathishkumar
- Department of Dermatology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - J E Gach
- Department of Dermatology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - M Ogboli
- Department of Dermatology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - M Desai
- Department of Respiratory Medicine, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - T Cole
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - W Högler
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - J Motwani
- Department of Haematology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - A Norton
- Department of Haematology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - B Morland
- Department of Oncology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - I Colmenero
- Department of Pathology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Richards S, Choo S, Mechinaud F, Cole T. Single centre results of targeted busulphan, fludarabine and serotherapy conditioning in haematopoietic stem cell transplantation for haemophagocytic lymphohistiocytosis. Bone Marrow Transplant 2018. [DOI: 10.1038/s41409-018-0125-5] [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] [Indexed: 11/09/2022]
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Foster A, Boyes L, Burgess L, Carless S, Bowyer V, Jenkinson H, Parulekar M, Ainsworth J, Hungerford J, Onadim Z, Sagoo M, Rosser E, Reddy MA, Cole T. Patient understanding of genetic information influences reproductive decision making in retinoblastoma. Clin Genet 2017; 92:587-593. [PMID: 28397259 DOI: 10.1111/cge.13035] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Retinoblastoma is the most common malignant tumour of the eye in childhood, with nearly all bilateral tumours and around 17% to 18% of unilateral tumours due to an oncogenic mutation in the RB1 gene in the germline. Genetic testing enables accurate risk assessment and optimal clinical management for the affected individual, siblings, and future offspring. MATERIAL AND METHODS We carried out the first UK-wide audit of understanding of genetic testing in individuals with retinoblastoma. A total of 292 individuals aged 16 to 45 years were included. RESULTS Patients with bilateral disease were significantly more likely to understand the implications of retinoblastoma for siblings and children. There was a significant association between not knowing the results of genetic testing or not understanding the implications and not having children, particularly in women. Surprisingly, this was also true for individuals treated for unilateral disease with a low risk of retinoblastoma for their offspring. CONCLUSION We are concerned that individuals may be making life choices based on insufficient information regarding risks of retinoblastoma and reproductive options. We suggest that improvement in transition care is needed to enable individuals to make informed reproductive decisions and to ensure optimal care for children born at risk of retinoblastoma.
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Affiliation(s)
- A Foster
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - L Boyes
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - L Burgess
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - S Carless
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - V Bowyer
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - H Jenkinson
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - M Parulekar
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - J Ainsworth
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - J Hungerford
- Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust, London, UK.,Moorfields Eye Hospital NHS Trust, London, UK
| | - Z Onadim
- Retinoblastoma Genetic Screening Unit, Barts Health NHS Trust, London, UK
| | - M Sagoo
- Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust, London, UK.,Moorfields Eye Hospital NHS Trust, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - E Rosser
- Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M A Reddy
- Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust, London, UK.,Moorfields Eye Hospital NHS Trust, London, UK
| | - T Cole
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
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43
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Dempster N, Gajarski R, Fisher L, Missler H, Cole T, Nandi D. Psychosocial Determinants of Health in Young Heart Transplant Recipients: Thinking Outside the Box. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.272] [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: 10/19/2022] Open
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Taylor-Miller T, Chapman M, Connell T, Cole T, Crawford NW. Interesting microorganism. J Paediatr Child Health 2016; 52:1035-1036. [PMID: 27653014 DOI: 10.1111/jpc.13328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/08/2016] [Accepted: 05/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Tashunka Taylor-Miller
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michelle Chapman
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Tom Connell
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nigel W Crawford
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Brettig T, Cole T. CGRA4: VENO-OCCLUSIVE DISEASE WITH IMMUNODEFICIENCY (VODI) TREATED WITH HAPLO-IDENTICAL BONE MARROW TRANSPLANT. Intern Med J 2016. [DOI: 10.1111/imj.4_13198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tim Brettig
- Department of Allergy and Immunology; Royal Children's Hospital; Melbourne Australia
| | - Theresa Cole
- Department of Allergy and Immunology; Royal Children's Hospital; Melbourne Australia
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Shanthikumar S, Clifford A, Massie J, Cole T, Steer A, Marks M, Gwee A. Community-acquired pneumonia in children: what to do when there is no response to standard empirical treatment? Thorax 2016; 71:957-9. [PMID: 27503231 DOI: 10.1136/thoraxjnl-2016-208787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/17/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Shivanthan Shanthikumar
- Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Amelia Clifford
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
| | - John Massie
- Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Theresa Cole
- Murdoch Children's Research Institute, Parkville, Victoria, Australia Department of Immunology, Royal Children's Hospital, Melbourne, Australia
| | - Andrew Steer
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Michael Marks
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amanda Gwee
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Koulouri O, Nicholas AK, Schoenmakers E, Mokrosinski J, Lane F, Cole T, Kirk J, Farooqi IS, Chatterjee VK, Gurnell M, Schoenmakers N. A Novel Thyrotropin-Releasing Hormone Receptor Missense Mutation (P81R) in Central Congenital Hypothyroidism. J Clin Endocrinol Metab 2016; 101:847-51. [PMID: 26735259 PMCID: PMC4803180 DOI: 10.1210/jc.2015-3916] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Isolated central congenital hypothyroidism (CCH) is rare and evades diagnosis on TSH-based congenital hypothyroidism (CH) screening programs in the United Kingdom. Accordingly, genetic ascertainment facilitates diagnosis and treatment of familial cases. Recognized causes include TSH β subunit (TSHB) and Ig superfamily member 1 (IGSF1) mutations, with only two previous reports of biallelic, highly disruptive mutations in the TRH receptor (TRHR) gene. CASE DESCRIPTION A female infant presenting with prolonged neonatal jaundice was found to have isolated CCH, with TSH of 2.2 mU/L (Reference range, 0.4-3.5) and free T4 of 7.9 pmol/L (0.61 ng/dL) (Reference range, 10.7-21.8 pmol/L). Because TSHB or IGSF1 mutations are usually associated with profound or X-linked CCH, TRHR was sequenced, and a homozygous mutation (p.P81R) was identified, substituting arginine for a highly conserved proline residue in transmembrane helix 2. Functional studies demonstrated normal cell membrane expression and localization of the mutant TRHR; however, its ability to bind radio-labelled TRH and signal via Gqα was markedly impaired, likely due to structural distortion of transmembrane helix 2. CONCLUSIONS Two previously reported biallelic, highly disruptive (nonsense; R17*, in-frame deletion and single amino acid substitution; p.[S115-T117del; A118T]) TRHR mutations have been associated with CCH; however, we describe the first deleterious, missense TRHR defect associated with this phenotype. Importantly, the location of the mutated amino acid (proline 81) highlights the functional importance of the second transmembrane helix in mediating hormone binding and receptor activation. Future identification of other naturally occurring TRHR mutations will likely offer important insights into the molecular basis of ligand binding and activation of TRHR, which are still poorly understood.
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Affiliation(s)
- O Koulouri
- Metabolic Research Laboratories (O.K., A.K.N., E.S., J.M., I.S.F., V.K.C., M.G., N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge and National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; West Midlands Regional Genetics Service (F.L., T.C.), Birmingham Women's Hospital NHS Foundation Trust, Birmingham B15 2TG, United Kingdom; and Department of Endocrinology (J.K.), Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | - A K Nicholas
- Metabolic Research Laboratories (O.K., A.K.N., E.S., J.M., I.S.F., V.K.C., M.G., N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge and National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; West Midlands Regional Genetics Service (F.L., T.C.), Birmingham Women's Hospital NHS Foundation Trust, Birmingham B15 2TG, United Kingdom; and Department of Endocrinology (J.K.), Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | - E Schoenmakers
- Metabolic Research Laboratories (O.K., A.K.N., E.S., J.M., I.S.F., V.K.C., M.G., N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge and National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; West Midlands Regional Genetics Service (F.L., T.C.), Birmingham Women's Hospital NHS Foundation Trust, Birmingham B15 2TG, United Kingdom; and Department of Endocrinology (J.K.), Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | - J Mokrosinski
- Metabolic Research Laboratories (O.K., A.K.N., E.S., J.M., I.S.F., V.K.C., M.G., N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge and National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; West Midlands Regional Genetics Service (F.L., T.C.), Birmingham Women's Hospital NHS Foundation Trust, Birmingham B15 2TG, United Kingdom; and Department of Endocrinology (J.K.), Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | - F Lane
- Metabolic Research Laboratories (O.K., A.K.N., E.S., J.M., I.S.F., V.K.C., M.G., N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge and National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; West Midlands Regional Genetics Service (F.L., T.C.), Birmingham Women's Hospital NHS Foundation Trust, Birmingham B15 2TG, United Kingdom; and Department of Endocrinology (J.K.), Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | - T Cole
- Metabolic Research Laboratories (O.K., A.K.N., E.S., J.M., I.S.F., V.K.C., M.G., N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge and National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; West Midlands Regional Genetics Service (F.L., T.C.), Birmingham Women's Hospital NHS Foundation Trust, Birmingham B15 2TG, United Kingdom; and Department of Endocrinology (J.K.), Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | - J Kirk
- Metabolic Research Laboratories (O.K., A.K.N., E.S., J.M., I.S.F., V.K.C., M.G., N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge and National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; West Midlands Regional Genetics Service (F.L., T.C.), Birmingham Women's Hospital NHS Foundation Trust, Birmingham B15 2TG, United Kingdom; and Department of Endocrinology (J.K.), Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | - I S Farooqi
- Metabolic Research Laboratories (O.K., A.K.N., E.S., J.M., I.S.F., V.K.C., M.G., N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge and National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; West Midlands Regional Genetics Service (F.L., T.C.), Birmingham Women's Hospital NHS Foundation Trust, Birmingham B15 2TG, United Kingdom; and Department of Endocrinology (J.K.), Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | - V K Chatterjee
- Metabolic Research Laboratories (O.K., A.K.N., E.S., J.M., I.S.F., V.K.C., M.G., N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge and National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; West Midlands Regional Genetics Service (F.L., T.C.), Birmingham Women's Hospital NHS Foundation Trust, Birmingham B15 2TG, United Kingdom; and Department of Endocrinology (J.K.), Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | - M Gurnell
- Metabolic Research Laboratories (O.K., A.K.N., E.S., J.M., I.S.F., V.K.C., M.G., N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge and National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; West Midlands Regional Genetics Service (F.L., T.C.), Birmingham Women's Hospital NHS Foundation Trust, Birmingham B15 2TG, United Kingdom; and Department of Endocrinology (J.K.), Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | - N Schoenmakers
- Metabolic Research Laboratories (O.K., A.K.N., E.S., J.M., I.S.F., V.K.C., M.G., N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge and National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; West Midlands Regional Genetics Service (F.L., T.C.), Birmingham Women's Hospital NHS Foundation Trust, Birmingham B15 2TG, United Kingdom; and Department of Endocrinology (J.K.), Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
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48
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Xie C, Cole T, McLean C, Su JC. Association Between Discoid Lupus Erythematosus and Chronic Granulomatous Disease--Report of Two Cases and Review of the Literature. Pediatr Dermatol 2016; 33:e114-20. [PMID: 27001332 DOI: 10.1111/pde.12826] [Citation(s) in RCA: 10] [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] [Indexed: 02/06/2023]
Abstract
Discoid lupus erythematosus (DLE) is known to be associated with chronic granulomatous disease (CGD), but most DLE occurs in female carriers of X-linked CGD, with few reports of these lesions in CGD-affected individuals--this observation is unexplained. We describe two cases of DLE-like lesions in boys with CGD: one boy with partial neutrophil function and another whose lesions were related to voriconazole use. Reviewing other previously reported cases, we conclude that the risk of developing DLE-like lesions appears to be greater primarily in two subsets of the population with CGD: those with partial neutrophil function and those with near-absent neutrophil function in whom there is a second trigger. In light of recent literature on the role of neutrophils in lupus pathogenesis, we propose that pathogenesis of DLE in CGD may be related to NETosis, neutrophil dysfunction and a deficiency of reactive oxygen species, which medications such as voriconazole also influence.
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Affiliation(s)
- Charles Xie
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Theresa Cole
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Catriona McLean
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, Victoria, Australia
| | - John C Su
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Dodgshun AJ, Hansford JR, Cole T, Choo S, Sullivan MJ. Carboplatin Hypersensitivity Reactions in Pediatric Low Grade Glioma Are Protocol Specific and Desensitization Shows Poor Efficacy. Pediatr Blood Cancer 2016. [PMID: 26207610 DOI: 10.1002/pbc.25686] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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] [Indexed: 01/06/2023]
Abstract
BACKGROUND The use of carboplatin for the treatment of pediatric low grade gliomas (PLGG) is often limited by the development of carboplatin hypersensitivity. Reported rates of carboplatin hypersensitivity reactions vary between 6% and 32% in these patients. Here we report the frequency of carboplatin hypersensitivity reactions depending on the treatment regimen used, and outcomes of carboplatin desensitization. METHODS The records of all patients in a single institution who were treated with carboplatin for PLGG were accessed and all patients receiving more than one dose of carboplatin are reported. RESULTS Thirty four patients with PLGG were treated with carboplatin according to one of the two different regimens. Carboplatin hypersensitivity was documented in 47% of patients, but the frequency differed by treatment protocol. Those patients treated with 4-weekly single agent carboplatin had carboplatin allergy in 8% of cases whereas 68% of those treated with combined carboplatin and vincristine (every three weeks, according to the SIOP 2004 low grade glioma protocol) had carboplatin reactions (OR 23.6, P < 0.01). Desensitization was only successful in two out of 10 patients in whom it was attempted. CONCLUSIONS Hypersensitivity reactions to carboplatin are more common in this cohort than previously reported and rates are protocol-dependent. Desensitization showed limited effectiveness in this cohort.
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Affiliation(s)
- Andrew J Dodgshun
- Children's Cancer Centre, Royal Children's Hospital, Victoria, Australia
| | - Jordan R Hansford
- Children's Cancer Centre, Royal Children's Hospital, Victoria, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, Royal Children's Hospital, Victoria, Australia
| | - Sharon Choo
- Department of Allergy and Immunology, Royal Children's Hospital, Victoria, Australia
| | - Michael J Sullivan
- Children's Cancer Centre, Royal Children's Hospital, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Dodgshun AJ, Hansford JR, Cole T, Choo S, Sullivan MJ. Reply to Comment on: Carboplatin Hypersensitivity Reactions in Pediatric Low Grade Glioma Are Protocol Specific and Desensitization Shows Poor Efficacy. Pediatr Blood Cancer 2016; 63:175. [PMID: 26398340 DOI: 10.1002/pbc.25747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew J Dodgshun
- Children's Cancer Centre, Royal Children's Hospital, Victoria, Australia
| | - Jordan R Hansford
- Children's Cancer Centre, Royal Children's Hospital, Victoria, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, Royal Children's Hospital, Victoria, Australia
| | - Sharon Choo
- Department of Allergy and Immunology, Royal Children's Hospital, Victoria, Australia
| | - Michael J Sullivan
- Children's Cancer Centre, Royal Children's Hospital, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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