@article {10809, title = {Long-Term Survival After Hematopoietic Stem Cell Transplantation for Complete STAT1 Deficiency.}, journal = {J Clin Immunol}, volume = {37}, year = {2017}, month = {2017 Oct}, pages = {701-706}, abstract = {

PURPOSE: Complete signal transducer and activator of transcription 1 (STAT1) deficiency is a rare autosomal recessive condition characterized by impairment of intracellular signaling from both type I and type II interferons (IFN). Affected patients are prone to early severe mycobacterial and viral infections, which usually result in death before 18~months of age. We previously reported a patient affected by complete STAT1 deficiency who underwent hematopoietic stem cell transplantation (HSCT). Here, we describe the transplantation procedures and long-term outcomes.

METHODS: The patient, who had suffered multiple life-threatening mycobacterial and viral infections in the first years of life, underwent HSCT at 4~years of age from a partially matched (HLA compatibility 8/10) unrelated donor after a myeloablative conditioning regimen consisting of busulfan, cyclophosphamide, and anti-thymocyte globulin.

RESULTS: Hematological reconstitution was detected at d+15, with full donor engraftment demonstrated by molecular analysis of leukocytes. Several complications occurred in the post-transplantation phase, including acute graft versus host disease, posterior reversible encephalopathy, thrombotic thrombocytopenic purpura, bilateral keratoconjunctivitis with complete loss of vision, and chronic lower limb lymphedema. Analysis of STAT1 in CD3 cells at 90 and 120~days after HSCT by flow cytometry showed normal STAT1 phosphorylation levels in response to IFN-α.

CONCLUSIONS: Notably, no severe infections occurred after discharge (day + 90) during a 9-year follow-up, suggesting that normal response to IFNs in hematopoietic cells is sufficient to provide protection in humans.

}, keywords = {Child, Preschool, Hematopoietic Stem Cell Transplantation, Humans, Immunologic Deficiency Syndromes, Male, STAT1 Transcription Factor, Treatment Outcome}, issn = {1573-2592}, doi = {10.1007/s10875-017-0430-6}, author = {Naviglio, Samuele and Soncini, Elena and Vairo, Donatella and Lanfranchi, Arnalda and Badolato, Raffaele and Porta, Fulvio} } @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} }