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neutropenia paediatrics

Jonathan Spoor, Hamid Farajifard, Nima Rezaei
Neutropenia is a dangerous and potentially fatal condition that renders patients vulnerable to recurrent infections. Its severity is commensurate with the absolute count of neutrophil granulocytes in the circulation. In paediatric patients, neutropenia can have many different aetiologies. Primary causes make up but a small portion of the whole and are relatively unknown. In the past decades, a number of genes has been discovered that are responsible for congenital neutropenia. By perturbation of mitochondrial energy metabolism, vesicle trafficking or synthesis of functional proteins, these mutations cause a maturation arrest in myeloid precursor cells in the bone marrow...
January 2019: Critical Reviews in Oncology/hematology
Marc Leone, Lila Bouadma, Bélaïd Bouhemad, Olivier Brissaud, Stéphane Dauger, Sébastien Gibot, Sami Hraiech, Boris Jung, Eric Kipnis, Yoann Launey, Charles-Edouard Luyt, Dimitri Margetis, Fabrice Michel, Djamel Mokart, Philippe Montravers, Antoine Monsel, Saad Nseir, Jérôme Pugin, Antoine Roquilly, Lionel Velly, Jean-Ralph Zahar, Rémi Bruyère, Gérald Chanques
BACKGROUND: The French Society of Anaesthesia and Intensive Care Medicine and the French Society of Intensive Care edited guidelines focused on hospital-acquired pneumonia (HAP) in intensive care unit. The goal of 16 French-speaking experts was to produce a framework enabling an easier decision-making process for intensivists. RESULTS: The guidelines were related to 3 specific areas related to HAP (prevention, diagnosis and treatment) in 4 identified patient populations (COPD, neutropenia, post-operative and paediatric)...
November 3, 2018: Annals of Intensive Care
Franco Locatelli, Christine Mauz-Koerholz, Kathleen Neville, Anna Llort, Auke Beishuizen, Stephen Daw, Marta Pillon, Nathalie Aladjidi, Thomas Klingebiel, Judith Landman-Parker, Aurora Medina-Sanson, Keith August, Jessica Sachs, Kristen Hoffman, Judith Kinley, Sam Song, Gregory Song, Stephen Zhang, Ajit Suri, Lia Gore
BACKGROUND: Despite remarkable progress in the treatment of newly-diagnosed classical Hodgkin's lymphoma and systemic anaplastic large-cell lymphoma, treatment of relapsed or refractory disease remains challenging. The aims of this study were to assess the safety, tolerability, recommended phase 2 dose, and efficacy of brentuximab vedotin in paediatric patients with relapsed or refractory Hodgkin's lymphoma or systemic anaplastic large-cell lymphoma. METHODS: This open-label, dose-escalation phase 1/2 study was done at 12 centres across eight countries (France, Germany, Italy, Mexico, The Netherlands, Spain, UK, and USA)...
October 2018: Lancet Haematology
Peter D Cole, Kathleen M McCarten, Qinglin Pei, Menachem Spira, Monika L Metzger, Richard A Drachtman, Terzah M Horton, Rizvan Bush, Susan M Blaney, Brenda J Weigel, Kara M Kelly
BACKGROUND: Patients with primary refractory Hodgkin's lymphoma or early relapse have a poor prognosis. Although many salvage regimens have been developed, there is no standard of care. Brentuximab vedotin and gemcitabine have been shown to be active in patients with relapsed or refractory Hodgkin's lymphoma when used as monotherapy, and each has been successfully used in combination with other agents. Preclinical data suggest that brentuximab vedotin can sensitise lymphoma cells to gemcitabine, supporting the use of the combination...
September 2018: Lancet Oncology
Ricardo Vianna de Carvalho, Fernanda Ferreira da Silva Lima, Cíntia Silva Dos Santos, Mônica Cristina de Souza, Rondinele Santos da Silva, Ana Luiza de Mattos-Guaraldi
Bloodstream and venous catheter-related corynebacterial infections in paediatric patients with haematological cancer were investigated from January 2003 to December 2014 at the Brazilian National Cancer Institute in Rio de Janeiro, Brazil. We observed that during cancer treatment, invasive corynebacterial infections occurred independent of certain factors, such as age and gender, underlying diseases and neutropenia. These infections were ssscaused by Corynebacterium amycolatum and other non-diphtherial corynebacteria...
July 2018: Brazilian Journal of Infectious Diseases
Lucas Moreno, Michela Casanova, Julia C Chisholm, Pablo Berlanga, Pascal B Chastagner, Sylvain Baruchel, Loredana Amoroso, Soledad Gallego Melcón, Nicolas U Gerber, Gianni Bisogno, Franca Fagioli, Birgit Geoerger, Julia L Glade Bender, Isabelle Aerts, Christophe Bergeron, Pooja Hingorani, Ileana Elias, Mathew Simcock, Stefano Ferrara, Yvan Le Bruchec, Ruta Slepetis, Nianhang Chen, Gilles Vassal
BACKGROUND: nab-Paclitaxel has demonstrated efficacy in adults with solid tumours and preclinical activity in paediatric solid tumour models. Results from phase I of a phase I/II study in paediatric patients with recurrent/refractory solid tumours treated with nab-paclitaxel are reported. PATIENTS AND METHODS: Patients with recurrent/refractory extracranial solid tumours received nab-paclitaxel on days 1, 8 and 15 every 4 weeks at 120, 150, 180, 210, 240, or 270 mg/m2 (rolling-6 dose-escalation) to establish the maximum tolerated dose (MTD) and recommended phase II dose (RP2D)...
September 2018: European Journal of Cancer
Jose M Ramos, Agustin Clavijo, Luis Moral, Cesar Gavilan, Tatiana Salvador, Javier González de Dios
BACKGROUND: Visceral leishmaniasis (VL) is endemic to the Mediterranean basin. In children, VL often presents with non-specific symptoms and can be life-threatening without proper treatment. AIM: To describe the epidemiological and clinical features of pediatric VL in children in Alicante, Spain. METHODS: The study included all paediatric (<15 years) cases admitted to three hospitals in the province of Alicante from May 1992 to May 2015 with diagnosis of VL (detection was either by anti-Leishmania antibodies in serology or Leishmania in blood and/or bone marrow aspirates)...
August 2018: Paediatrics and International Child Health
Jessica E Morgan, Bob Phillips, Lesley A Stewart, Karl Atkin
OBJECTIVES: A systematic review of paediatric low-risk febrile neutropenia found that outpatient care is safe, with low rates of treatment failure. However, this review, and a subsequent meta-ethnography, suggested that early discharge of these patients may not be acceptable to key stakeholders. This study aimed to explore experiences and perceptions of patients, parents and healthcare professionals involved in paediatric febrile neutropenia care in the UK. SETTING: Three different centres within the UK, purposively selected from a national survey on the basis of differences in their service structure and febrile neutropenia management...
May 14, 2018: BMJ Open
Gertjan J L Kaspers, Denise Niewerth, Bram A J Wilhelm, Peggy Scholte-van Houtem, Marta Lopez-Yurda, Johannes Berkhof, Jacqueline Cloos, Valerie de Haas, Ron A Mathôt, Andishe Attarbaschi, André Baruchel, Eveline S de Bont, Franca Fagioli, Claudia Rössig, Thomas Klingebiel, Barbara De Moerloose, Brigitte Nelken, Giuseppe Palumbo, Dirk Reinhardt, Pierre-Simon Rohrlich, Pauline Simon, Arend von Stackelberg, Christian Michel Zwaan
This trial explored the efficacy of re-induction chemotherapy including bortezomib in paediatric relapsed/refractory acute lymphoblastic leukaemia. Patients were randomized 1:1 to bortezomib (1.3 mg/m2 /dose) administered early or late to a dexamethasone and vincristine backbone. Both groups did not differ regarding peripheral blast count on day 8, the primary endpoint. After cycle 1, 8 of 25 (32%) patients achieved complete remission with incomplete blood count recovery, 7 (28%) a partial remission and 10 had treatment failure...
May 2018: British Journal of Haematology
Pranatharthi Chandrasekar, Bhawna Sirohi, Nita L Seibel, Jack W Hsu, Nkechi Azie, Chunzhang Wu, Markus Ruhnke
Neutropenia is linked to the development of invasive candidiasis/candidaemia, for which micafungin has demonstrated efficacy, but evidence in patients with neutropenia is limited. The aim of this study was to evaluate the efficacy of micafungin for the treatment of invasive candidiasis/candidaemia in patients with neutropenia (<500 neutrophils/μL) and without neutropenia. This pooled, post hoc analysis of 2 Phase 3 trials compared micafungin 100 mg/d (adults) and 2 mg/kg/d (paediatrics) with L-AmB 3 mg/kg/d (NCT00106288) and micafungin 100 mg/d and 150 mg/d with caspofungin 70 mg/d followed by 50 mg/d (adults) (NCT00105144); treatment duration 2-4 weeks (≤8 weeks for chronic disseminated candidiasis)...
May 2018: Mycoses
Murad Melhem, Isabelle Delor, Juan Jose Pérez-Ruixo, John Harrold, Andrew Chow, Liviawati Wu, Philippe Jacqmin
AIM: The objective of the present study was to use pharmacokinetic-pharmacodynamic modelling to characterize the effects of chemotherapy on the granulopoietic system and to predict the absolute neutrophil counts (ANCs) for patients with chemotherapy-induced neutropenia treated with filgrastim and pegfilgrastim. METHODS: Data were extracted from 10 phase I-III studies conducted in 110 healthy adults, and 618 adult and 52 paediatric patients on chemotherapy following administration of filgrastim or pegfilgrastim...
May 2018: British Journal of Clinical Pharmacology
Jessica E Morgan, Jemma Cleminson, Lesley A Stewart, Robert S Phillips, Karl Atkin
PURPOSE (STATING THE MAIN PURPOSES AND RESEARCH QUESTION): Many children have no significant sequelae of febrile neutropenia. A systematic review of clinical studies demonstrated patients at low risk of septic complications can be safely treated as outpatients using oral antibiotics with low rates of treatment failure. Introducing earlier discharge may improve quality of life, reduce hospital acquired infection and reduce healthcare service pressures. However, the review raised concerns that this might not be acceptable to patients, families and healthcare professionals...
April 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Pauline Lancia, Beate Aurich, Phuong Ha, Anne Maisin, Véronique Baudouin, Evelyne Jacqz-Aigrain
BACKGROUND: Progress in immunosuppression has reduced acute rejection, graft loss and mortality after renal transplantation. Adverse drug reactions are well described in adults but few data are available in children. Our objectives were to analyse the adverse events reported in the first 3 years post-transplantation in children receiving tacrolimus or cyclosporine-based immunosuppression and compare them with the information of the Summary of Product Characteristics. METHODS: This retrospective study included all children who underwent a renal transplant at Hospital Robert Debré between 2002 and 2015...
February 2018: Clinical Drug Investigation
Lindy-Lee Green, Pierre Goussard, Anel van Zyl, Martin Kidd, Mariana Kruger
Purpose: To validate a clinical risk prediction score (Ammann score) to predict adverse events (AEs) in paediatric febrile neutropenia (FN). Patients and methods: Patients <16 years of age were enrolled. A risk prediction score (based on haemoglobin ≥ 9 g/dl, white cell count (WCC) < 0.3 G/l, platelet count <50 G/l and chemotherapy more intensive than acute lymphoblastic leukaemia maintenance therapy) was calculated and AEs were documented. Results: In total, 100 FN episodes occurred in 52 patients, male:female ratio was 1...
November 15, 2017: Journal of Tropical Pediatrics
Stefanie Hennig, Christine E Staatz, Daniel Natanek, Sabina Bialkowski, Carolina Consuelo Llanos Paez, Rachael Lawson, Julia Clark
OBJECTIVES: To evaluate the impact of an antimicrobial stewardship (AMS) intervention, involving introduction of new guidelines on the treatment of febrile neutropenia (FN), on improving the use of gentamicin in paediatric oncology patients. DESIGN AND INTERVENTION: Updated guidelines for gentamicin usage in paediatrics with FN were implemented at a tertiary children's teaching hospital, in Brisbane, Australia. Data on gentamicin usage before and after the guideline change were collected retrospectively from children with cancer admitted to hospital with FN between January 2012 and December 2013...
February 2018: Pediatric Blood & Cancer
Carl Gustaf Ljunggren, Lars Stenhammar, Leif Strömberg
No abstract text is available yet for this article.
July 2017: Acta Paediatrica
Victoria Hemming, Adam D Jakes, Geoff Shenton, Bob Phillips
BACKGROUND: Febrile neutropenia (FNP) causes significant morbidity and mortality in children undergoing treatment for cancer. The development of clinical decision rules to help stratify risks in paediatric FNP patients and the use of inflammatory biomarkers to identify high risk patients is an area of recent research. This study aimed to assess if procalcitonin (PCT) levels could be used to help diagnose or exclude severe infection in children with cancer who present with febrile neutropenia, both as a single measurement and in addition to previously developed clinical decision rules...
January 5, 2017: BMC Pediatrics
Zoi Dorothea Pana, Danila Seidel, Anna Skiada, Andreas H Groll, Georgios Petrikkos, Oliver A Cornely, Emmanuel Roilides
BACKGROUND: Mucormycosis has emerged as a rare but frequently fatal invasive fungal disease. Current knowledge on paediatric mucormycosis is based on case reports and small series reported over several decades. Contemporary data on a large cohort of patients is lacking. METHODS: Two large international registries ( and FungiScope™) were searched for mucormycosis cases in ≤19 year-old patients. Cases enrolled between 2005 and 2014 were extracted, and dual entries in the two databases merged...
November 10, 2016: BMC Infectious Diseases
Kenneth A Michelson, Richard G Bachur, Jason A Levy
OBJECTIVES: The presence of critically ill patients may impact care for other ED patients. We sought to evaluate whether the presence of a critically ill child was associated with the time to (1) receipt of the first medication among other patients, and (2) administration of diagnosis-specific medications. METHODS: We performed a retrospective cohort study of all paediatric ED visits over 3 years. Patients were exposed if they arrived during the first hour of a critically ill patient's care...
January 2017: Emergency Medicine Journal: EMJ
Neyssa M Marina, Sigbjørn Smeland, Stefan S Bielack, Mark Bernstein, Gordana Jovic, Mark D Krailo, Jane M Hook, Carola Arndt, Henk van den Berg, Bernadette Brennan, Bénédicte Brichard, Ken L B Brown, Trude Butterfass-Bahloul, Gabriele Calaminus, Heike E Daldrup-Link, Mikael Eriksson, Mark C Gebhardt, Hans Gelderblom, Joachim Gerss, Robert Goldsby, Allen Goorin, Richard Gorlick, Holcombe E Grier, Juliet P Hale, Kirsten Sundby Hall, Jendrik Hardes, Douglas S Hawkins, Knut Helmke, Pancras C W Hogendoorn, Michael S Isakoff, Katherine A Janeway, Heribert Jürgens, Leo Kager, Thomas Kühne, Ching C Lau, Patrick J Leavey, Stephen L Lessnick, Leo Mascarenhas, Paul A Meyers, Hubert Mottl, Michaela Nathrath, Zsuzsanna Papai, R Lor Randall, Peter Reichardt, Marleen Renard, Akmal Ahmed Safwat, Cindy L Schwartz, Michael C G Stevens, Sandra J Strauss, Lisa Teot, Mathias Werner, Matthew R Sydes, Jeremy S Whelan
BACKGROUND: We designed the EURAMOS-1 trial to investigate whether intensified postoperative chemotherapy for patients whose tumour showed a poor response to preoperative chemotherapy (≥10% viable tumour) improved event-free survival in patients with high-grade osteosarcoma. METHODS: EURAMOS-1 was an open-label, international, phase 3 randomised, controlled trial. Consenting patients with newly diagnosed, resectable, high-grade osteosarcoma aged 40 years or younger were eligible for randomisation...
October 2016: Lancet Oncology
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