@article {3636, title = {Autoimmune hematological diseases after allogeneic hematopoietic stem cell transplantation in children: an Italian multicenter experience.}, journal = {Biol Blood Marrow Transplant}, volume = {20}, year = {2014}, month = {2014 Feb}, pages = {272-8}, abstract = {

Autoimmune hematological diseases (AHDs) may occur after allogeneic hematopoietic stem cell transplantation (HSCT), but reports on these complications in large cohorts of pediatric patients are lacking. Between 1998 and 2011, 1574 consecutive children underwent allogeneic HSCT in 9 Italian centers. Thirty-three children (2.1\%) developed AHDs: 15 autoimmune hemolytic anemia (45\%), 10 immune thrombocytopenia (30\%), 5 Evans{\textquoteright} syndrome (15\%), 2 pure red cell aplasia (6\%), and 1 immune neutropenia (3\%). The 10-year cumulative incidence of AHDs was 2.5\% (95\% confidence interval, 1.7 to 3.6). In a multivariate analysis, the use of alternative donor and nonmalignant disease was statistically associated with AHDs. Most patients with AHDs (64\%) did not respond to steroids. Sustained complete remission was achieved in 87\% of cases with the anti-CD20 monoclonal antibody (rituximab). Four patients (9\%) (1 autoimmune hemolytic anemia, 1 Evans{\textquoteright} syndrome, 2 immune thrombocytopenia) died at a median of 87~days after AHD diagnosis as a direct or indirect consequence of their disorder. Our data suggest that AHDs are a relatively rare complication occurring after HSCT that usually respond to treatment with rituximab.

}, keywords = {Child, Child, Preschool, Female, Hematologic Diseases, Hematopoietic Stem Cell Transplantation, Humans, Italy, Male, Remission Induction, Risk Factors, Transplantation Conditioning}, issn = {1523-6536}, doi = {10.1016/j.bbmt.2013.11.014}, author = {Faraci, Maura and Zecca, Marco and Pillon, Marta and Rovelli, Attilio and Menconi, Maria Cristina and Ripaldi, Mimmo and Fagioli, Franca and Rabusin, Marco and Ziino, Ottavio and Lanino, Edoardo and Locatelli, Franco and Daikeler, Thomas and Prete, Arcangelo} } @article {1795, title = {Allogeneic hematopoietic stem cell transplantation for Philadelphia-positive acute lymphoblastic leukemia in children and adolescents: a retrospective multicenter study of the Italian Association of Pediatric Hematology and Oncology (AIEOP).}, journal = {Biol Blood Marrow Transplant}, volume = {18}, year = {2012}, month = {2012 Jun}, pages = {852-60}, abstract = {

Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL) still represents a major challenge. We report the experience of the Italian Association of Pediatric Hematology and Oncology (AIEOP) with allogeneic hematopoietic stem cell transplantation (HSCT) in children with Ph+ ALL from 1990 to 2008. Sixty-nine patients received HSCT from either a related (37, 54\%) or an unrelated (32, 46\%) donor. Twenty-five patients (36\%) underwent transplantation before 2000 and 44 (64\%) after 2000. Twenty-three patients (33\%) received Imatinib mesylate treatment before HSCT and seven (10\%) after HSCT. After a median follow-up of 56 months, the overall survival (OS) probability was 51\% (95\% confidence interval [CI], 38-63), the leukemia-free survival (LFS) was 47\% (95\% CI, 34-59), transplantation-related mortality (TRM) was 17\% (95\% CI, 10-30), and relapse incidence (RI) was 36\% (95\% CI, 26-50). Transplantation in first complete remission, female gender, and lower WBC count at diagnosis were associated with a better LFS in both univariate and multivariate analyses. Patients with p210 transcript had a trend for a worse prognosis compared with those who had the p190 transcript. Our series confirms the role of HSCT in the eradication of Ph+ ALL. Early HSCT is recommended once morphologic remission is obtained.

}, keywords = {Adolescent, Antineoplastic Combined Chemotherapy Protocols, Benzamides, Child, Child, Preschool, Disease-Free Survival, Drug Administration Schedule, Female, Fusion Proteins, bcr-abl, Graft vs Host Disease, Hematopoietic Stem Cell Transplantation, Humans, Infant, Italy, Male, Philadelphia Chromosome, Piperazines, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Pyrimidines, Remission Induction, Retrospective Studies, Secondary Prevention, Transplantation, Homologous, Young Adult}, issn = {1523-6536}, doi = {10.1016/j.bbmt.2011.10.015}, author = {Fagioli, Franca and Zecca, Marco and Rognoni, Carla and Lanino, Edoardo and Balduzzi, Adriana and Berger, Massimo and Messina, Chiara and Favre, Claudio and Rabusin, Marco and Lo Nigro, Luca and Masetti, Riccardo and Prete, Arcangelo and Locatelli, Franco} } @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} }