TY - JOUR T1 - Retrospective study on the incidence and outcome of proven and probable invasive fungal infections in high-risk pediatric onco-hematological patients. JF - Eur J Haematol Y1 - 2017 A1 - Cesaro, Simone A1 - Tridello, Gloria A1 - Castagnola, Elio A1 - Calore, Elisabetta A1 - Carraro, Francesca A1 - Mariotti, Ilaria A1 - Colombini, Antonella A1 - Perruccio, Katia A1 - Decembrino, Nunzia A1 - Russo, Giovanna A1 - Maximova, Natalia A1 - Baretta, Valentina A1 - Caselli, Désirée KW - Adolescent KW - Antifungal Agents KW - Antineoplastic Combined Chemotherapy Protocols KW - Child KW - Child, Preschool KW - Drug Therapy, Combination KW - Female KW - Hematologic Neoplasms KW - Hematopoietic Stem Cell Transplantation KW - Humans KW - Incidence KW - Male KW - Mycoses KW - Patient Outcome Assessment KW - Retrospective Studies KW - Survival Analysis KW - Treatment Outcome AB -

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.

VL - 99 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28556426?dopt=Abstract ER - TY - JOUR T1 - Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. On behalf of the coagulation defects working group and the supportive the JF - Ann Hematol Y1 - 2015 A1 - Giordano, Paola A1 - Saracco, Paola A1 - Grassi, Massimo A1 - Luciani, Matteo A1 - Banov, Laura A1 - Carraro, Francesca A1 - Crocoli, Alessandro A1 - Cesaro, Simone A1 - Zanazzo, Giulio Andrea A1 - Molinari, Angelo Claudio KW - Adult KW - Blood Coagulation Disorders KW - Catheter Obstruction KW - Catheterization, Central Venous KW - Central Venous Catheters KW - Child KW - Hematologic Neoplasms KW - Humans KW - Risk Factors KW - Thrombosis AB -

Central venous catheters (CVC), used for the management of children with hemato-oncological disorders, are burdened by a significant incidence of mechanical, infective, or thrombotic complications. These complications favor an increasing risk in prolongation of hospitalization, extra costs of care, and sometimes severe life-threatening events. No guidelines for the management of CVC-related occlusion and CVC-related thrombosis are available for children. To this aim, members of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP) reviewed the pediatric and adult literature to propose the first recommendations for the management of CVC-related occlusion and CVC-related thrombosis in children with hemato-oncological disorders.

VL - 94 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26300457?dopt=Abstract ER - TY - JOUR T1 - Single-day trimethoprim/sulfamethoxazole prophylaxis for Pneumocystis pneumonia in children with cancer. JF - J Pediatr Y1 - 2014 A1 - Caselli, Désirée A1 - Petris, Maria Grazia A1 - Rondelli, Roberto A1 - Carraro, Francesca A1 - Colombini, Antonella A1 - Muggeo, Paola A1 - Ziino, Ottavio A1 - Melchionda, Fraia A1 - Russo, Giovanna A1 - Pierani, Paolo A1 - Soncini, Elena A1 - DeSantis, Raffaella A1 - Zanazzo, Giulio A1 - Barone, Angelica A1 - Cesaro, Simone A1 - Cellini, Monica A1 - Mura, Rossella A1 - Milano, Giuseppe M A1 - Meazza, Cristina A1 - Cicalese, Maria P A1 - Tropia, Serena A1 - De Masi, Salvatore A1 - Castagnola, Elio A1 - Aricò, Maurizio KW - Anti-Infective Agents KW - Child KW - Dose-Response Relationship, Drug KW - Drug Administration Schedule KW - Follow-Up Studies KW - Hematologic Neoplasms KW - Humans KW - Incidence KW - Italy KW - Pneumocystis carinii KW - Pneumonia, Pneumocystis KW - Prospective Studies KW - Treatment Outcome KW - Trimethoprim, Sulfamethoxazole Drug Combination AB -

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.

VL - 164 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24252793?dopt=Abstract ER - TY - JOUR T1 - Morbidity of pandemic H1N1 influenza in children with cancer. JF - Pediatr Blood Cancer Y1 - 2010 A1 - Caselli, Désirée A1 - Carraro, Francesca A1 - Castagnola, Elio A1 - Ziino, Ottavio A1 - Frenos, Stefano A1 - Milano, Giuseppe Maria A1 - Livadiotti, Susanna A1 - Cesaro, Simone A1 - Marra, Nicoletta A1 - Zanazzo, Giulio A1 - Meazza, Cristina A1 - Cellini, Monica A1 - Aricò, Maurizio KW - Adolescent KW - Antineoplastic Agents KW - Cause of Death KW - Child KW - Child, Preschool KW - Data Collection KW - Disease Outbreaks KW - Humans KW - Influenza A Virus, H1N1 Subtype KW - Influenza, Human KW - Leukemia KW - Lymphoma, Non-Hodgkin KW - Morbidity KW - Neoplasms KW - Treatment Outcome KW - Young Adult AB -

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.

VL - 55 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20582951?dopt=Abstract ER -