@article {10526, title = {Retrospective study on the incidence and outcome of proven and probable invasive fungal infections in high-risk pediatric onco-hematological patients.}, journal = {Eur J Haematol}, volume = {99}, year = {2017}, month = {2017 Sep}, pages = {240-248}, abstract = {

BACKGROUND: Invasive fungal infection (IFI) is a cause of morbidity, mortality and increased health costs in children undergoing chemotherapy or hematopoietic stem cell transplant (HSCT).

METHODS: Multicenter, retrospective study to assess the incidence, outcome of proven and probable IFI (PP-IFI) in children treated for acute leukemia, non-Hodgkin lymphoma or who underwent HSCT from 2006 to 2012.

RESULTS: Over the 7-year period, 127 PP-IFI were diagnosed in 123 patients, median age of 9.7~years. The 1-year cumulative incidence was 2.5\% (CI 1.8-3.7) after frontline chemotherapy, 9.4\% (CI 5.8-15.0) after relapse, and 5.3\% (CI 3.9-7.1) after HSCT. Severe neutropenia was present in 98 (77\%) patients. Culture-proven agents were Candida spp., mostly non-albicans, 28, mold 23, whereas three proven IFI were identified by histopathology. Favorable response to treatment within 3~months from diagnosis was observed in 77 (89\%). The overall ninety-day probability of survival was 68\% (CI 59-76).

CONCLUSIONS: About two-thirds of pediatric patients with PP-IFI survived, regardless of whether the infection occurred after frontline chemotherapy, reinduction chemotherapy for disease relapse, or after HSCT. Further prospective studies are needed to define the impact of antifungal prophylaxis and early combination therapy on short-term overall survival.

}, keywords = {Adolescent, Antifungal Agents, Antineoplastic Combined Chemotherapy Protocols, Child, Child, Preschool, Drug Therapy, Combination, Female, Hematologic Neoplasms, Hematopoietic Stem Cell Transplantation, Humans, Incidence, Male, Mycoses, Patient Outcome Assessment, Retrospective Studies, Survival Analysis, Treatment Outcome}, issn = {1600-0609}, doi = {10.1111/ejh.12910}, author = {Cesaro, Simone and Tridello, Gloria and Castagnola, Elio and Calore, Elisabetta and Carraro, Francesca and Mariotti, Ilaria and Colombini, Antonella and Perruccio, Katia and Decembrino, Nunzia and Russo, Giovanna and Maximova, Natalia and Baretta, Valentina and Caselli, D{\'e}sir{\'e}e} } @article {3608, title = {Single-day trimethoprim/sulfamethoxazole prophylaxis for Pneumocystis pneumonia in children with cancer.}, journal = {J Pediatr}, volume = {164}, year = {2014}, month = {2014 Feb}, pages = {389-92.e1}, abstract = {

OBJECTIVE: To determine whether a simplified, 1-day/week regimen of trimethoprim/sulfamethoxazole is sufficient to prevent Pneumocystis (jirovecii [carinii]) pneumonia (PCP). Current recommended regimens for prophylaxis against PCP range from daily administration to 3 consecutive days per week dosing.

STUDY DESIGN: A prospective survey of the regimens adopted for the PCP prophylaxis in all patients treated for childhood cancer at pediatric hematology-oncology centers of the Associazione Italiana Ematologia Oncologia Pediatrica.

RESULTS: The 20 centers participating in the study reported a total of 2466 patients, including 1093 with solid tumor and 1373 with leukemia/lymphoma (or primary immunodeficiency; n = 2). Of these patients, 1371 (55.6\%) received the 3-day/week prophylaxis regimen, 406 (16.5\%) received the 2-day/week regimen, and 689 (27.9\%), including 439 with leukemia/lymphoma, received the 1-day/week regimen. Overall, only 2 cases of PCP (0.08\%) were reported, both in the 2-day/week group. By intention to treat, the cumulative incidence of PCP at 3 years was 0.09\% overall (95\% CI, 0.00-0.40\%) and 0.51\% for the 2-day/week group (95\% CI, 0.10\%-2.00\%). Remarkably, both patients who failed had withdrawn from prophylaxis.

CONCLUSION: A single-day course of prophylaxis with trimethoprim/sulfamethoxazole may be sufficient to prevent PCP in children with cancer undergoing intensive chemotherapy regimens. This simplified strategy might have implications for the emerging need for PCP prophylaxis in other patients subjected to the increased use of biological and nonbiological agents that induce higher levels of immune suppression, such as those with rheumatic diseases.

}, keywords = {Anti-Infective Agents, Child, Dose-Response Relationship, Drug, Drug Administration Schedule, Follow-Up Studies, Hematologic Neoplasms, Humans, Incidence, Italy, Pneumocystis carinii, Pneumonia, Pneumocystis, Prospective Studies, Treatment Outcome, Trimethoprim, Sulfamethoxazole Drug Combination}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2013.10.021}, author = {Caselli, D{\'e}sir{\'e}e and Petris, Maria Grazia and Rondelli, Roberto and Carraro, Francesca and Colombini, Antonella and Muggeo, Paola and Ziino, Ottavio and Melchionda, Fraia and Russo, Giovanna and Pierani, Paolo and Soncini, Elena and DeSantis, Raffaella and Zanazzo, Giulio and Barone, Angelica and Cesaro, Simone and Cellini, Monica and Mura, Rossella and Milano, Giuseppe M and Meazza, Cristina and Cicalese, Maria P and Tropia, Serena and De Masi, Salvatore and Castagnola, Elio and Aric{\`o}, Maurizio} } @article {1636, title = {Morbidity of pandemic H1N1 influenza in children with cancer.}, journal = {Pediatr Blood Cancer}, volume = {55}, year = {2010}, month = {2010 Aug}, pages = {226-8}, abstract = {

BACKGROUND: To define the mortality and the current impact of the H1N1 pandemic in pediatric hematology-oncology centers, we performed a specific survey.

PROCEDURE: Pharyngeal swabs from patients with fevers of unknown origin, flu-like symptoms or bronchopneumonia were screened for H1N1 using PCR.

RESULTS: Sixty-two patients with documented H1N1 infection were reported: 16 had recently stopped therapy, 2 were at the diagnosis stage, and 44 were receiving therapy. The clinical course was severe (requiring ICU admission) in only 1 patient, moderate (requiring hospital admission) in 38, and mild in the remaining 23 (37\%), treated as outpatients. While none of the patients died of H1N1-related complications, two patients died of progressive cancer; in all of the remaining cases, symptoms resolved within 11 days. The clinical course was complicated by respiratory distress or bronchopneumonia in 10 cases. Oseltamivir was given to 82\% of patients. Chemotherapy was temporarily withdrawn in 54\% of cases for a median time of 21 days (range, 4-43 days).

CONCLUSION: H1N1 infection in children with cancer was not reported as the cause of death in any case but resulted in reduced intensity of anti-cancer therapy.

}, keywords = {Adolescent, Antineoplastic Agents, Cause of Death, Child, Child, Preschool, Data Collection, Disease Outbreaks, Humans, Influenza A Virus, H1N1 Subtype, Influenza, Human, Leukemia, Lymphoma, Non-Hodgkin, Morbidity, Neoplasms, Treatment Outcome, Young Adult}, issn = {1545-5017}, doi = {10.1002/pbc.22619}, author = {Caselli, D{\'e}sir{\'e}e and Carraro, Francesca and Castagnola, Elio and Ziino, Ottavio and Frenos, Stefano and Milano, Giuseppe Maria and Livadiotti, Susanna and Cesaro, Simone and Marra, Nicoletta and Zanazzo, Giulio and Meazza, Cristina and Cellini, Monica and Aric{\`o}, Maurizio} } @article {1637, title = {Multidrug resistant Pseudomonas aeruginosa infection in children undergoing chemotherapy and hematopoietic stem cell transplantation.}, journal = {Haematologica}, volume = {95}, year = {2010}, month = {2010 Sep}, pages = {1612-5}, abstract = {

Pseudomonas aeruginosa is one leading gram-negative organism associated with nosocomial infections. Bacteremia is life-threatening in the immunocompromised host. Increasing frequency of multi-drug-resistant (MDRPA) strains is concerning. We started a retrospective survey in the pediatric hematology oncology Italian network. Between 2000 and 2008, 127 patients with Pseudomonas aeruginosa bacteremia were reported from 12 centers; 31.4\% of isolates were MDRPA. Death within 30 days of a positive blood culture occurred in 19.6\% (25/127) of total patients; in patients with MDRPA infection it occurred in 35.8\% (14/39). In the multivariate analysis, only MDRPA had significant association with infection-related death. This is the largest series of Pseudomonas aeruginosa bacteremia cases from pediatric hematology oncology centers. Monitoring local bacterial isolates epidemiology is mandatory and will allow empiric antibiotic therapy to be tailored to reduce fatalities.

}, keywords = {Adolescent, Antineoplastic Agents, Bacteremia, Child, Child, Preschool, Drug Resistance, Multiple, Female, Hematopoietic Stem Cell Transplantation, Humans, Immunocompromised Host, Infant, Infant, Newborn, Italy, Male, Pseudomonas aeruginosa, Pseudomonas Infections, Retrospective Studies, Young Adult}, issn = {1592-8721}, doi = {10.3324/haematol.2009.020867}, author = {Caselli, D{\'e}sir{\'e}e and Cesaro, Simone and Ziino, Ottavio and Zanazzo, Giulio and Manicone, Rosaria and Livadiotti, Susanna and Cellini, Monica and Frenos, Stefano and Milano, Giuseppe M and Cappelli, Barbara and Licciardello, Maria and Beretta, Chiara and Aric{\`o}, Maurizio and Castagnola, Elio} }