@article {10766, title = {Complete Remission of a Refractory Acute Myeloid Leukemia with Myelodysplastic- and Monosomy 7-Related Changes after a Combined Conditioning Regimen of Plerixafor, Cytarabine and Melphalan in a 4-Year-Old Boy: A Case Report and Review of Literature.}, journal = {Cancers (Basel)}, volume = {10}, year = {2018}, month = {2018 Aug 27}, abstract = {

Acute myeloid leukemia with myelodysplastic changes and monosomy 7 is a rare form of pediatric leukemia associated with very poor disease-free survival. The refractoriness of the disease is due to the protection offered by the bone marrow niche, making leukemic stem cells impervious to whatever chemotherapy or myeloablative regimen is chosen. Using a mobilizing agent for haematopoietic stem cells, Plerixafor, could sensitise leukemic cells to the myeloablative therapy. This approach was not previously used in a pediatric population, and in adult populations, was used in combination with busulphan with no difference in overall survival. We describe the case of a 4-year-old boy affected by refractory acute myeloid leukemia with myelodysplastic changes and monosomy 7. The child had never achieved a remission. We proposed a combined time-scheduled scheme of therapy with plerixafor and melphalan. Combining pharmacokinetics of plerixafor with pharmacokinetics and rapid and elevated myeloablative potential of melphalan in high dosage (200 mg/m{\texttwosuperior}), we succeeded in mobilizing more than 85\% of stem blasts immediately before infusion of Melphalan. The count of residual blasts after 8 h from melphalan infusion was only 1.3 cells/μL. The child achieved an engraftment at day +32 with full donor chimerism. Sixteen months after haematopoietic stem cell transplantation (HSCT), he is well and in complete remission. Our case suggests that the use of plerixafor before a conditioning therapy with melphalan could induce remission in acute myeloid leukemia refractory to the usual conditioning therapy in pediatric patients. This work adds strength to the body of knowledge regarding the "personalized" conditioning regimen for high-risk leukemic patients.

}, issn = {2072-6694}, doi = {10.3390/cancers10090291}, author = {Grasso, Antonio G and Granzotto, Marilena and Zanon, Davide and Maestro, Alessandra and Loiacono, Stefano and Maximova, Natalia} } @article {10852, title = {Total body irradiation and iron chelation treatment are associated with pancreatic injury following pediatric hematopoietic stem cell transplantation.}, journal = {Oncotarget}, volume = {9}, year = {2018}, month = {2018 Apr 13}, pages = {19543-19554}, abstract = {

Whereas many studies have addressed the risk of organ dysfunction following hematopoietic stem cell transplantation (HSCT), little is known about pancreatic susceptibility in this setting. We aimed to investigate the effect of iron overload (IO) and total body irradiation (TBI) on pancreatic function of children undergoing HSCT. We retrospectively evaluated children admitted between 2012-2016 fulfilling the following criteria: normal pancreatic iron concentration (PIC), regular pancreatic function before HSCT, availability of abdominal magnetic resonance imaging with gradient-recalled-echo sequences and a full set of biochemical markers of IO and pancreatic function performed before HSCT and at discharge. We divided the patients according to the use of TBI or myeloablative chemotherapy (MCHT) in the conditioning regimen. All patients with severe IO or moderate IO with a high risk of engraftment delay or transplantation-related complications underwent chelation therapy with deferoxamine (DFO) from the first day of conditioning to discharge. 63 patients had a HSCT in the study period, 13 did not fulfill the inclusion criteria; 50 (25 in each group) are included in the analysis, and did not show differences at baseline evaluation. At follow up testing the TBI group showed a significantly higher PIC (107,8{\textpm}100,3 μmol/g vs 28,4{\textpm}37,9 in MCHT group, p<0,0001). In the TBI group the patients who had DFO treatment had higher PIC (223,2{\textpm}48,8 μmol/g vs 55,7{\textpm}10,5 without DFO treatment, p<0,0001), and all patients having PIC >100 μmol/g at follow up had DFO-based chelation therapy, versus 26\% of those with lower PIC (p<0,0001). The number of patients presenting exocrine pancreatic dysfunctions one month after transplantation was significantly higher in the TBI group (48\% vs 4\%; p<0.0001). The mean pancreatic volume reduction was significantly greater in the TBI group (39,1\% vs 0,9\% in the MCHT group; p<0,05), and was significantly worse on those who received DFO therapy. Based on our data, we suggest that TBI is detrimental for pancreatic functions, and speculate that DFO may contribute to the rapid pancreatic IO observed in these patients.

}, issn = {1949-2553}, doi = {10.18632/oncotarget.24646}, author = {Maximova, Natalia and Gregori, Massimo and Simeone, Roberto and Sonzogni, Aurelio and Zanon, Davide and Boz, Giulia and D{\textquoteright}Antiga, Lorenzo} } @article {10853, title = {Vanishing Bile Ducts in the Long Term after Pediatric Hematopoietic Stem Cell Transplantation.}, journal = {Biol Blood Marrow Transplant}, volume = {24}, year = {2018}, month = {2018 Nov}, pages = {2250-2258}, abstract = {

There are no structured studies on liver histology after hematopoietic stem cell transplantation (HSCT). We aimed to prospectively describe the clinicopathologic features of liver disease in the long term after HSCT in an observational, longitudinal study of liver histology in a consecutive cohort of children undergoing allogeneic HSCT. First liver biopsy was performed in presence of abnormal liver function tests and repeated per protocol thereafter. A previously reported semiquantitative score evaluating inflammation, cholestasis, and ductopenia (bile ducts-to-portal tracts ratio <= .5) was adopted. Graft-versus-host disease (GVHD) was diagnosed according to standard criteria. We evaluated 131 biopsies taken in 50 HSCTs performed in 47 children (mean age, 9.7 {\textpm} 5.2 years). Pre-HSCT chemotherapy was administered in 36 of 50 (72\%). GVHD was diagnosed in 17 of 50 (34\%). Over time the overall score decreased from a mean of 6 {\textpm} 2.7 to 3.25 {\textpm} .96 (P < .01), inflammation from 1.22 {\textpm} 1.19 to 1 {\textpm} 0 (not significant), and cholestasis from 3.9 {\textpm} 2.08 to 1.5 {\textpm} .58 (P < .01). Ductopenia, found in 113 of 131 biopsies (93\%), worsened from .63 {\textpm} .35 to .16 {\textpm} .14 (P < .01). On multivariate analysis severe ductopenia (ratio <= .2) was associated with previous chemotherapy (P = .04), in particular with thiotepa, but not with history of GVHD. Vanishing bile duct syndrome after HSCT may be due to drug-induced liver disease. Longer follow-up will reveal whether these patients are prone to late liver-related morbidity and mortality.

}, issn = {1523-6536}, doi = {10.1016/j.bbmt.2018.07.009}, author = {Maximova, Natalia and Sonzogni, Aurelio and Matarazzo, Lorenza and Ghirardi, Arianna and D{\textquoteright}Antiga, Lorenzo} } @article {10854, title = {What is known about deferasirox chelation therapy in pediatric HSCT recipients: two case reports of metabolic acidosis.}, journal = {Ther Clin Risk Manag}, volume = {14}, year = {2018}, month = {2018}, pages = {1649-1655}, abstract = {

To date, in pediatric field, various hematological malignancies are increasingly treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Iron overload and systemic siderosis often occur in this particular cohort of patients and are associated with poor prognosis. We describe herein the case of two allo-HSCT patients, on treatment with deferasirox; they showed histopathological elements compatible with venoocclusive disease or vanishing bile duct syndrome in ductopenic evolution before deferasirox started. The first patient developed drug-induced liver damage with metabolic acidosis and the second one a liver impairment with Fanconi syndrome. After withdrawing deferasirox treatment, both patients showed improvement. Measurements of drug plasma concentrations were performed by HPLC assay. The reduction and consequent disappearance of symptoms after the suspension of deferasirox substantiate its role in inducing hepatic damage, probably enabling the diagnosis of drug-induced liver damage. But the difficulties in diagnosing drug-related toxicity must be underlined, especially in compromised subjects. For these reasons, in patients requiring iron-chelating therapy, close and careful drug therapeutic monitoring is strongly recommended.

}, issn = {1176-6336}, doi = {10.2147/TCRM.S170761}, author = {Fucile, Carmen and Mattioli, Francesca and Marini, Valeria and Gregori, Massimo and Sonzogni, Aurelio and Martelli, Antonietta and Maximova, Natalia} } @article {10537, title = {Comparison of Efficacy and Safety of Caspofungin Versus Micafungin in Pediatric Allogeneic Stem Cell Transplant Recipients: A Retrospective Analysis.}, journal = {Adv Ther}, volume = {34}, year = {2017}, month = {2017 05}, pages = {1184-1199}, abstract = {

INTRODUCTION: The high morbidity and mortality associated with invasive fungal infections (IFIs) provide the rationale for antifungal prophylaxis in immuno-compromised pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). Caspofungin and micafungin are antifungal agents of interest for prophylaxis of IFIs because of their potency against Candida and minimal toxicity or interactions with other drugs. Few studies have demonstrated the safety and efficacy of such echinocandins as prophylaxis for IFIs in patients undergoing HSCT.

METHODS: This retrospective cohort study compared caspofungin and micafungin for prevention of IFIs in 93 pediatric patients undergoing HSCT for oncological or non-oncological disease. The observation began with the first dose of antifungal agent and ended 3~months after transplantation.

RESULTS: Patients in the micafungin group had a higher overall treatment success rate of 87.2 versus 84.8\% in the caspofungin group, but the difference was not significant. There were no statistically significant differences in the incidence or type of proven/probable IFIs between the 2 groups. The low incidence of death did not differ statistically between the groups. Patients in the caspofungin group presented more frequently with fever, during and after neutropenia. In both groups, we observed an expected worsening of blood chemistry parameters. There were no adverse events definitely attributable to the two antifungal agents.

CONCLUSION: These results demonstrate good efficacy and tolerability for caspofungin and micafungin. However, better results with respect to the incidence and resolution of fever in the micafungin group may suggest its use in preference to that of caspofungin.

}, keywords = {Adolescent, Antifungal Agents, Caspofungin, Child, Child, Preschool, Cohort Studies, Echinocandins, Female, Hematopoietic Stem Cell Transplantation, Humans, Infant, Infant, Newborn, Lipopeptides, Male, Micafungin, Mycoses, Neutropenia, Retrospective Studies}, issn = {1865-8652}, doi = {10.1007/s12325-017-0534-7}, author = {Maximova, Natalia and Schillani, Giulia and Simeone, Roberto and Maestro, Alessandra and Zanon, Davide} } @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 {10487, title = {Thrombogenesis in Thrombophilic Pregnancy: Evaluation of Low-Molecular-Weight Heparin Prophylaxis.}, journal = {Acta Haematol}, volume = {137}, year = {2017}, month = {2017}, pages = {201-206}, abstract = {

The aim of this study is to investigate thrombogenesis and the hypercoagulable changes in pregnant women affected by thrombophilia who received low-molecular-weight heparin (LWMH) prophylaxis. We included 21 pregnant women affected by thrombophilia treated with LWMH and 20 nontreated normal pregnant women as the control group. The sample group of thrombophilic pregnant women included different conditions (factor V Leiden mutation, protein C deficiency, protein S deficiency, antiphospholipid antibodies syndrome, and combined defects). Three blood samples were collected during pregnancy (i.e., at 16, 20, and 24 weeks) and tested for activated partial thromboplastin time and prothrombin fragment F1 + 2 (F1 + 2); anti-FXa activity was tested only in treated thrombophilic pregnant women. F1 + 2 levels progressively increased during pregnancy in both study groups. However, the F1 + 2 increase in women exposed to heparin prophylaxis was significantly lower than that in normal pregnant women in all 3 measurements carried out during gestation (p < 0.05); a statistically significant inverse correlation between F1 + 2 levels and anti-Xa activity (R = -0.8575, p < 0.05) was observed in treated women during pregnancy. Our findings suggest that F1 + 2 in addition to anti-Xa measurement could be used to adjust LWMH prophylaxis, at least in high-risk pregnant women.

}, keywords = {Adult, Anticoagulants, Case-Control Studies, Factor Xa Inhibitors, Female, Heparin, Low-Molecular-Weight, Humans, Nadroparin, Partial Thromboplastin Time, Peptide Fragments, Pilot Projects, Pregnancy, Pregnancy Complications, Hematologic, Prothrombin, Thrombophilia, Thrombosis}, issn = {1421-9662}, doi = {10.1159/000467385}, author = {Simeone, Roberto and Giacomello, Roberta and Bruno, Germano and Parco, Sergio and Maximova, Natalia and Martinelli, Monica and Zito, Gabriella and Luppi, Stefania and Cervi, Gina and Ricci, Giuseppe} } @article {8510, title = {Hepatic Gadolinium Deposition and Reversibility after Contrast Agent-enhanced MR Imaging of Pediatric Hematopoietic Stem Cell Transplant Recipients.}, journal = {Radiology}, year = {2016}, month = {2016 Jun 8}, pages = {152846}, abstract = {

Purpose To determine if hepatic gadolinium deposition occurs in pediatric patients with iron overload but normal renal and hepatic function who undergo gadolinium-based contrast agent (GBCA)-enhanced magnetic resonance (MR) imaging. Materials and Methods Design and execution of this study was approved by the Ethical Committee of Institute for Research in Maternal and Child Health Burlo Garofolo of Trieste (reference no. 1105/2015). Because of the retrospective nature of the study, the requirement to obtain informed consent was waived. Twenty-one recipients of allogeneic hematopoietic stem cell transplants who underwent GBCA-enhanced MR imaging for suspected infection or relapse followed by liver biopsy comprised the study group. The number of GBCA-enhanced MR examinations and cumulative gadolinium dose for each patient was analyzed by comparing liver histologic analysis and iron and gadolinium liver concentration (GLC). Eight patients had siderosis and underwent chelation therapy. The study group was compared with four control patients who were never exposed to GBCA. Statistical analysis was performed with Spearman rank coefficient for correlation. Results All 21 patients had positive correlations between GLC and total GBCA dose (r = 0.4486; P < .05) and between GLC and liver iron concentration (r = 0.56; P < .05). Patients who underwent deferoxamine therapy had a significant reduction of GLC (from 0.64 μg/g {\textpm} 0.29 to 0.20 μg/g {\textpm} 0.17 [standard deviation]; P < .05). Conclusion In the presence of siderosis, a transmetallation mechanism may be set off between ferric ion and gadoterate meglumine. Deferoxamine appears capable of binding to gadolinium ion. Further studies of the safety of GBCAs in severe siderosis are needed. Chelation should be considered in patients with iron overload and a history of GBCA exposure. ({\textcopyright}) RSNA, 2016.

}, issn = {1527-1315}, doi = {10.1148/radiol.2016152846}, author = {Maximova, Natalia and Gregori, Massimo and Zennaro, Floriana and Sonzogni, Aurelio and Simeone, Roberto and Zanon, Davide} } @article {8492, title = {"Safety and utility of percutaneous liver biopsy in hematopoietic stem cell transplant pediatric recipients: a retrospective study".}, journal = {BMC Cancer}, volume = {16}, year = {2016}, month = {2016}, pages = {590}, abstract = {

BACKGROUND: Liver biopsies in pediatric hematopoietic stem cell transplantation (HSCT) patients are as and effective when performed at bedside in the Bone Marrow Transplant Unit (BMTU) than in the Day Surgery Unit (DSU), with better patient compliance and lower emotional distress for these children.

METHODS: The study group consisted of 45 children who underwent allogeneic HSCT. We reviewed 68 liver biopsies performed between April 2006 and September 2015. 12 (17.6~\%) biopsies were performed in the DSU and 56 (82.3~\%) in the BMTU; nine (13.2~\%) prior to HSCT and 59 (86.7~\%) after HSCT. Pre-procedural behavioral status (subjective score) was evaluated by pediatric transplant physicians by filling in a questionnaire employing a three-point scale: "calm and cooperative", "agitated and non-cooperative" or "frightened and suffering". Objective score was obtained measuring patient{\textquoteright}s heart rate before the procedure and comparing it with mean heart rate.

RESULTS: Patients who underwent the procedure at the BMTU experienced less emotional distress than those who underwent it in the DSU: 58.3~\% of patients treated at the DSU were agitated as compared with 16.1~\% of those treated at the BMTU (p < 0.01). Among the 59 biopsies performed after HSCT, 41 (69.5~\%) were taken from symptomatic patients for a diagnostic purpose and 18 (30.5~\%) in asymptomatic ones in order to rule out hepatic GVHD. Among these 18 procedures, GVHD was diagnosed in 16 (88.9~\%) cases. Minor complications occurred in about 17~\% of procedures (12 biopsies), at a rate of 25~\% for the DSU location compared with 16~\% for the BMTU location. Only two major complications were reported, one in the DSU and one in the BMTU.

CONCLUSION: Liver biopsy performed at bedside in HSCT patients does not carry a higher risk of adverse events than the same procedure performed in the DSU and has lower emotional distress associated with better patient compliance, thus contributing significantly to a higher standard of care.

}, issn = {1471-2407}, doi = {10.1186/s12885-016-2603-8}, author = {Maximova, Natalia and Gregori, Massimo and Barbieri, Francesca and Pizzol, Antonio and Sonzogni, Aurelio} } @article {3598, title = {Complete remission of VZV reactivation treated with valganciclovir in a patient with total lymphocyte depletion and acute kidney injury after allogeneic bone marrow transplantation.}, journal = {APMIS}, volume = {123}, year = {2015}, month = {2015 Jan}, pages = {77-80}, abstract = {

Varicella zoster virus (VZV), a threat for hematopoietic stem cell transplantation (HSCT) recipients, is still one of the most common viral pathogens that affect these patients with a reported incidence ranging between 17\% and 50\% in the post transplantation period. Valganciclovir (V-GCV), a valine ester pro-drug of GCV orally administrable, has recently shown great activity against CMV infections, but there are no reports of its clinical efficacy against VZV. We here report a case history of a patient with positive serologic test for VZV, who underwent allogeneic HSCT and developed an atypical varicella-like illness. First-line therapy with foscarnet had to be discontinued due rapid development of renal impairment (creatinine: 2.60 mg/dL, urea: 130.6 mg/dL) and therefore was switched to V-GCV. The renal impairment and skin lesions of the patient fully recovered after few days of therapy, even though the patient had complete lymphocyte depletion. This is the first case of a patient with chickenpox-like illness treated successfully with V-GCV.

}, keywords = {Acute Kidney Injury, Adolescent, Bone Marrow Transplantation, Fatal Outcome, Female, Ganciclovir, Herpes Zoster, Herpesvirus 3, Human, Humans, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Viral Load}, issn = {1600-0463}, doi = {10.1111/apm.12303}, author = {Maximova, Natalia and Antonio, Pizzol and Marilena, Granzotto and Rovere, Francesca and Tamaro, Paolo} } @article {7705, title = {Does defibrotide induce a delay to polymorphonuclear neutrophil engraftment after hematopoietic stem cell transplantation? Observation in a pediatric population.}, journal = {Adv Ther}, volume = {32}, year = {2015}, month = {2015 Apr}, pages = {381-6}, abstract = {

INTRODUCTION: In recent years, defibrotide (DFT) has emerged as a promising therapy for veno-occlusive disease (VOD). The aim of this study was to investigate whether DFT prophylaxis affects neutrophil engraftment in patients undergoing hematopoietic stem cell transplantation (HSCT).

METHODS: A cohort of 44 consecutive pediatric patients who underwent HSCT was retrospectively analyzed to see the role of DFT on engraftment. Patients were assigned into two groups based on the use or non-use of prophylaxis with DFT.

RESULTS: The mean time to engraftment was statistically different between the two groups for both polymorphonuclear neutrophils (PMN) and white blood cells.

CONCLUSION: Our study supports the hypothesis that prophylaxis with DFT for VOD leads to a delay to the engraftment of PMN in pediatric patients that underwent HSCT.

}, issn = {1865-8652}, doi = {10.1007/s12325-015-0203-7}, author = {Maximova, Natalia and Pizzol, Antonio and Giurici, Nagua and Granzotto, Marilena} } @article {3599, title = {Does Teno Torque Virus Induce Autoimmunity After Hematopoietic Stem Cell Transplantation? A Case Report.}, journal = {J Pediatr Hematol Oncol}, volume = {37}, year = {2015}, month = {2015 Apr}, pages = {e194-7}, abstract = {

Teno Torque virus, member of the family of Anelloviridae, has been associated with many autoimmune diseases such as idiopathic hepatitis, systemic lupus erythematosus, and multiple sclerosis. Its viral load tends to be higher in the bone marrow and in tissues with high turnover rate. We report here a case of an 11-month-old infant affected by acute myeloid leukemia who underwent hematopoietic stem cell transplantation, and after 6 months had autoimmune hepatitis and atopic dermatitis. Extremely high-cytokine IP-10 and eotaxin levels were found in her sera, and serological tests and RT-PCR for viruses showed positive results exclusively for Teno Torque virus.

}, keywords = {Autoimmune Diseases, Autoimmunity, Dermatitis, Atopic, DNA Virus Infections, DNA, Viral, Female, Hematopoietic Stem Cell Transplantation, Hepatitis, Humans, Infant, Leukemia, Myeloid, Acute, Prognosis, Torque teno virus, Viral Load}, issn = {1536-3678}, doi = {10.1097/MPH.0000000000000194}, author = {Maximova, Natalia and Pizzol, Antonio and Ferrara, Giovanna and Maestro, Alessandra and Tamaro, Paolo} } @article {7706, title = {Metal accumulation in the renal cortex of a pediatric patient with sickle cell disease: a case report and review of the literature.}, journal = {J Pediatr Hematol Oncol}, volume = {37}, year = {2015}, month = {2015 May}, pages = {311-4}, abstract = {

BACKGROUND: Sickle cell disease (SCD) is a well-known multisystem illness characterized by vascular injury due to vasoocclusion and hemolysis, as well as infectious complications and iron overload, all of which contribute to high morbidity and mortality rates among children. In these patients, some authors have previously described iron cortical deposition in the kidney. We here report the first case in the literature of a girl affected by SCD showing an anomalous metal and rare element retention in the renal cortex.

CASE PRESENTATION: A 10-year-old white girl affected by SCD underwent a routine magnetic resonance imaging investigation that evidenced a reduced signal intensity in the renal cortex, compatible with hemosiderin precipitation. Histologic and elemental analyses of the hepatic and the renal biotic samples, performed with inductively coupled plasma mass spectrometry, revealed that concomitant with the high iron deposition, toxic and potentially carcinogenic elements such as nickel, magnesium, rubidium, and gadolinuim were anomalously retained particularly in the kidney.

CONCLUSIONS: The finding of rare and toxic elements in the kidney of SCD patients might be linked to the development of specific neoplastic transformations already described in this patient cohort. To be confirmed, our speculations need to be demonstrated in large sampling of patients.

}, keywords = {Anemia, Sickle Cell, Child, Female, Humans, Kidney Cortex, Metals, Spectrophotometry, Atomic}, issn = {1536-3678}, doi = {10.1097/MPH.0000000000000322}, author = {Maximova, Natalia and Zanon, Davide and Pascolo, Lorella and Zennaro, Floriana and Gregori, Massimo and Grosso, Daniele and Sonzogni, Aurelio} } @article {7743, title = {Pharmacokinetic/pharmacodynamic evaluation of linezolid in hospitalized paediatric patients: a step toward dose optimization by means of therapeutic drug monitoring and Monte Carlo simulation.}, journal = {J Antimicrob Chemother}, volume = {70}, year = {2015}, month = {2015 Jan}, pages = {198-206}, abstract = {

OBJECTIVES: To report on linezolid exposure in a paediatric population who routinely underwent therapeutic drug monitoring (TDM) for dosage optimization and to assess the factors affecting interpatient variability.

METHODS: We performed a retrospective study of patients whose plasma C(min) and Cmax levels were measured during linezolid treatment. Adequate exposure was defined as a C(min) of 2-7 mg/L and/or an estimated AUC24 of 160-300 mg {\textperiodcentered} h/L. Patients were divided into two subgroups (Group 1, 2-11 years; Group 2, 12-18 years). Monte Carlo simulation was performed to investigate whether or not the currently recommended dosages might enable a high probability of target attainment (PTA) of two thresholds for linezolid efficacy (AUC24/MIC >= 80 or >= 100). Data on demographic characteristics, disease, microbiology and haematochemical parameters and outcomes were collected.

RESULTS: A total of 23 patients were included. Standard dosages were suboptimal in 50.0\% and 44.4\% of patients in Group 1 and Group 2, respectively. Among those who underwent multiple instances of TDM, the dosages were increased in 33.3\% of cases in both groups, and decreased in 6.6\% and 9.5\% of cases in Group 1 and Group 2, respectively. Co-treatment with phenobarbital, proton pump inhibitors and amiodarone accounted for most of the variability in C(min) (adjusted R(2) of 0.692). Simulations showed a PTA of >= 90\% with the current dosing regimens in both groups only for pathogens with an MIC <= 1 mg/L.

CONCLUSIONS: Higher dosages of linezolid may be needed, especially in Group 1 when in the presence of pathogens with an MIC >1 mg/L. The role of TDM should be encouraged for optimization of linezolid exposure in the paediatric setting in the presence of infections caused by pathogens with borderline susceptibility and/or for patients co-treated with drugs that may alter linezolid exposure.

}, keywords = {Acetamides, Anti-Bacterial Agents, Area Under Curve, Child, Child, Preschool, Drug Monitoring, Female, Gram-Positive Bacterial Infections, Hospitalization, Humans, Infant, Inpatients, Linezolid, Male, Monte Carlo Method, Oxazolidinones, Plasma, Retrospective Studies, Tertiary Care Centers}, issn = {1460-2091}, doi = {10.1093/jac/dku337}, author = {Cojutti, Piergiorgio and Maximova, Natalia and Crichiutti, Giovanni and Isola, Miriam and Pea, Federico} } @article {7707, title = {Pharmacokinetics and pharmacodynamics of continuous-infusion meropenem in pediatric hematopoietic stem cell transplant patients.}, journal = {Antimicrob Agents Chemother}, volume = {59}, year = {2015}, month = {2015 Sep}, pages = {5535-41}, abstract = {

This study explored the pharmacokinetics and the pharmacodynamics of continuous-infusion meropenem in a population of pediatric hematopoietic stem cell transplant (HSCT) patients who underwent therapeutic drug monitoring. The relationship between meropenem clearance (CLM) and estimated creatinine clearance (CLCR) was assessed by nonlinear regression. A Monte Carlo simulation was performed to investigate the predictive performance of five dosing regimens (15 to 90 mg/kg of body weight/day) for the empirical treatment of severe Gram-negative-related infections in relation to four different categories of renal function. The optimal target was defined as a probability of target attainment (PTA) of >=90\% at steady-state concentration-to-MIC ratios (C SS/MIC) of >=1 and >=4 for MICs of up to 8 mg/liter. A total of 21 patients with 44 meropenem C SS were included. A good relationship between CLM and estimated CLCR was observed (r (2) = 0.733). Simulations showed that at an MIC of 2 mg/liter, the administration of continuous-infusion meropenem at doses of 15, 30, 45, and 60 mg/kg/day may achieve a PTA of >=90\% at a C SS/MIC ratio of >=4 in the CLCR categories of 40 to <80, 80 to <120, 120 to <200, and 200 to <300 ml/min/1.73 m(2), respectively. At an MIC of 8 mg/liter, doses of up to 90 mg/kg/day by continuous infusion may achieve optimal PTA only in the CLCR categories of 40 to <80 and 80 to <120 ml/min/1.73 m(2). Continuous-infusion meropenem at dosages up to 90 mg/kg/day might be effective for optimal treatment of severe Gram-negative-related infections in pediatric HSCT patients, even when caused by carbapenem-resistant pathogens with an MIC of up to 8 mg/liter.

}, issn = {1098-6596}, doi = {10.1128/AAC.00787-15}, author = {Cojutti, Piergiorgio and Maximova, Natalia and Pea, Federico} } @article {7704, title = {Polyclonal gammopathy after BKV infection in HSCT recipient: a novel trigger for plasma cells replication?}, journal = {Virol J}, volume = {12}, year = {2015}, month = {2015}, pages = {23}, abstract = {

BACKGROUND: BK polyomavirus infects most of the general population. However, its clinical manifestations are almost exclusively seen in immunocompromised patients, particularly in kidney and hematopoietic stem cell transplantation recipients.

CASE PRESENTATION: A 15-y-old female suffering from common B-cell acute lymphoblastic leukaemia underwent hematopoietic stem cell transplantation. The patient had reactivation of BKPyV infection and developed an haemorrhagic cystitis. Three months after transplant, BKPyV viremia and viruria increased and she developed a severe nephropathy associated to a polyclonal gammopathy with high levels of isolated IgM.

CONCLUSION: This case report describes a rare and unexpected polyclonal gammopathy developed during a polyomavirus-associated nephropathy confirmed by immunohistochemical and laboratory analyses.

}, issn = {1743-422X}, doi = {10.1186/s12985-015-0254-z}, author = {Maximova, Natalia and Pizzol, Antonio and Sonzogni, Aurelio and Gregori, Massimo and Granzotto, Marilena and Tamaro, Paolo} } @article {7703, title = {Romiplostim for secondary thrombocytopenia following allogeneic stem cell transplantation in children.}, journal = {Int J Hematol}, volume = {102}, year = {2015}, month = {2015 Nov}, pages = {626-32}, abstract = {

The outcome of romiplostim for secondary failure of platelet recovery (SFPR) was investigated in children who had undergone hematopoietic stem cell transplantation (HSCT). Seven transfusion-dependent pediatric patients (median age 11~years), with platelet counts below 10~{\texttimes}~10(9)/L, received four weekly doses of subcutaneous romiplostim to treat SFPR developed after HSCT. All patients, except one (patient 4), became platelet transfusion-independent in the second week from the beginning of treatment and no patient needed to discontinue drug treatment because of adverse events. Romiplostim could represent a beneficial first-line treatment, but further studies are required.

}, issn = {1865-3774}, doi = {10.1007/s12185-015-1821-1}, author = {Maximova, Natalia and Zanon, D and Rovere, F and Maestro, A and Schillani, G and Paparazzo, R} } @article {3558, title = {Hematopoietic stem cell transplantation effects on spinal cord compression in Hurler.}, journal = {Pediatr Transplant}, volume = {18}, year = {2014}, month = {2014 May}, pages = {E96-9}, abstract = {

Hurler syndrome type 1 (MPS-1) is an autosomal recessive lysosomal disorder due to the deficiency of the enzyme alpha-L-iduronidase which is necessary for the degradation of dermatan and heparan sulfate. It is characterized by deposit of glycosaminoglycans in tissues, progressive multisystem dysfunction, and early death. HSCT for children with MPS-I is effective, resulting in increased life expectancy and improvement of clinical parameters. The spinal MRI performed on a female 10 yr old undergoing HSCT at the age of 18 months and receiving ERT revealed a considerable decrease in soft tissue around the tip of odontoid causing a significant reduction in spinal cord compression. In light of this result, we suppose that combined ERT and HSCT are successful in Hurler I disease.

}, keywords = {Bone Marrow Transplantation, Child, Enzyme Replacement Therapy, Female, Glycosaminoglycans, Hematopoietic Stem Cell Transplantation, Humans, Iduronidase, Magnetic Resonance Imaging, Mucopolysaccharidosis I, Odontoid Process, Spinal Cord Compression, Treatment Outcome}, issn = {1399-3046}, doi = {10.1111/petr.12231}, author = {Ferrara, Giovanna and Maximova, Natalia and Zennaro, Floriana and Gregori, Massimo and Tamaro, Paolo} } @article {1834, title = {Glutamine-enriched nutrition does not reduce mucosal morbidity or complications after stem-cell transplantation for childhood malignancies: a prospective randomized study.}, journal = {Transplantation}, volume = {91}, year = {2011}, month = {2011 Jun 27}, pages = {1321-5}, abstract = {

BACKGROUND: Intravenous glutamine-enriched solution seems to be effective in posttransplant period in decreasing the severity and duration of mucositis. The aim of this randomized study was to determine the benefit of glutamine supplementation both on mucosal morbidity and in posttransplant associated complications.

METHODS: Children undergoing allogeneic hematopoietic stem-cell transplantation (HSCT) for malignant hematological diseases were randomly assigned to standard total parenteral nutrition (S-TPN) or glutamine-enriched (GE)-TPN solution consisting of 0.4 g/kg/day of l-alanine-glutamine dipeptide. This treatment started on the day of HSCT and ended when the patients could orally cover more than 50\% of their daily energy requirements. The severity and the rate of post-HSCT mucositis were based on World Health Organization criteria. All the analyses were conducted on intention-to-treat principle.

RESULTS: One hundred twenty consecutive patients (83 men; median age, 8.1 years) were enrolled. The mean duration of treatment was 23.5 and 23 days in the two treatment arms. The mean calorie intake was 1538 kcal/d in the S-TPN group and 1512 kcal/d in GE-TPN group. All patients were well nourished before and after HSCT. Mucositis occurred in 91.4\% and 91.7\% of patients in S-TPN and GE-TPN arm, respectively (P=0.98). Odds ratio adjusted by type of HSCT was 0.98 (95\% confidence interval, 0.26-2.63). Type and duration of analgesic treatment, clinical outcome (engraftment, graft versus host disease, early morbidity, and mortality, relapse rate up to 180 days post-HSCT) were not significantly different in the two treatment arms.

CONCLUSION: GE-TPN solution does not affect mucositis and outcome in well-nourished HSCT allogeneic patients.

}, keywords = {Adolescent, Analgesia, Child, Child, Preschool, Double-Blind Method, Female, Glutamine, Hematopoietic Stem Cell Transplantation, Humans, Infant, Male, Mucositis, Mucous Membrane, Neoplasms, Odds Ratio, Parenteral Nutrition, Prospective Studies, Recurrence, Stem Cells, Treatment Outcome}, issn = {1534-6080}, doi = {10.1097/TP.0b013e31821ab959}, author = {Uderzo, Cornelio and Rebora, Paola and Marrocco, Emanuela and Varotto, Stefania and Cichello, Francesca and Bonetti, Maurizio and Maximova, Natalia and Zanon, Davide and Fagioli, Franca and Nesi, Francesca and Masetti, Riccardo and Masetti, Roberto and Rovelli, Attilio and Rondelli, Roberto and Valsecchi, Maria Grazia and Cesaro, Simone} }