False-positive galactomannan platelia Aspergillus test results for patients receiving piperacillin-tazobactam

At the bone marrow transplantation center of the San Martino Hospital ( Genoa), we observed an increase in the rate of patients with positive Platelia Aspergillus (PA; Bio-Rad) test results, from 10% ( 38 of 386 patients) in the period from January 1999 through January 2003 to 36% ( 21 of 59 patients) in the period from February 2003 through May 2003. Positivity was significantly (P < .001) associated with the administration of piperacillin-tazobactam (PT) (17 [74%] of 23 patients who received PT had positive results vs. 4 [11%] of 36 who did not receive PT). Multivariate analysis found administration of PT (&chi;2 = 34.7; P < .001) and underlying disease (chi(2) = 21.14; P < .001) to be associated with PA positivity. of 15 PT batches tested, 12 had positive PA test results.Natl Inst Canc Res, Infect Dis Unit, I-16132 Genoa, ItalyUniv Genoa, Genoa, ItalyNatl Inst Canc Res, Epidemiol Unit, I-16132 Genoa, ItalyOsped San Martino Genova, Dept Hematol, Genoa, ItalyUniversidade Federal de São Paulo, Infect Dis Unit, São Paulo, BrazilUniversidade Federal de São Paulo, Infect Dis Unit, São Paulo, BrazilWeb of Scienc

Early impact of the COVID-19 pandemic on paediatric cancer care in Latin America

Although previous studies have suggested that the complications and mortality rate related to COVID-19 are substantially lower in the paediatric population,1 it is reasonable to consider that children with underlying conditions such as cancer will be at increased risk of severe disease...Fil: Vasquez, Liliana. Universidad de San Martín de Porres; Perú. Organización Panamericana de la Salud; PerúFil: Sampor, Claudia. Fundacion Hospital de Pediatria Professor Dr. Juan P. Garrahan; ArgentinaFil: Villanueva, Gabriela. Fundacion Hospital de Pediatria Professor Dr. Juan P. Garrahan; ArgentinaFil: Maradiegue, Essy. Instituto Nacional de Enfermedades Neoplasicas; PerúFil: Garcia Lombardi, Mercedes. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Gomez García, Wendy. Hospital Infantil Dr. Robert Reid Cabral; República DominicanaFil: Moreno, Florencia. Ministerio de Salud. Instituto Nacional del Cáncer; ArgentinaFil: Diaz, Rosdali. Instituto Nacional de Enfermedades Neoplasicas; PerúFil: Cappellano, Andrea M.. Universidade Federal de Sao Paulo; BrasilFil: Portilla, Carlos Andres. Universidad del Valle; ColombiaFil: Salas, Beatriz. Hospital del Niño Manuel Ascencio Villarroel; BoliviaFil: Nava, Evelinda. Hospital de Niños Jesus Garcia Coello; VenezuelaFil: Brizuela, Silvia. Instituto de Previsión Social ; ParaguayFil: Jimenez, Soledad. Hospital Solca Núcleo de Loja; EcuadorFil: Espinoza, Ximena. Hospital de Niños Dr. Roberto del Río; ChileFil: Gassant, Pascale Yola. Hôpital Saint-Damien; HaitíFil: Quintero, Karina. Children's Hospital Dr Jose Renan Esquivel; PanamáFil: Fuentes Alabi, Soad. Hospital Nacional de Niños Benjamin Bloom; El SalvadorFil: Velasquez, Thelma. No especifíca;Fil: Fu, Ligia. Hospital Escuela de Tegucigalpa; HondurasFil: Gamboa, Yessika. National Children's Hospital; Costa RicaFil: Quintana, Juan. Clinica Las Condes; ChileFil: Castiglioni, Mariela. Hospital Pereira Rossell; UruguayFil: Nuñez, Cesar. Children's Cancer Hospital; Estados UnidosFil: Moreno, Arturo. Hospital Universitario de Puebla; MéxicoFil: Luna Fineman, Sandra. State University of Colorado at Boulder; Estados UnidosFil: Luciani, Silvana. Pan American Health Organization; Estados UnidosFil: Chantada, Guillermo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina. Hospital Sant Joan de Deu Barcelona; Españ

Ototoxicity evaluation in medulloblastoma patients treated with involved field boost using intensity-modulated radiation therapy (IMRT): a retrospective review

Abstract\ud \ud Background\ud Ototoxicity is a known side effect of combined radiation therapy and cisplatin chemotherapy for the treatment of medulloblastoma. The delivery of an involved field boost by intensity modulated radiation therapy (IMRT) may reduce the dose to the inner ear when compared with conventional radiotherapy. The dose of cisplatin may also affect the risk of ototoxicity. A retrospective study was performed to evaluate the impact of involved field boost using IMRT and cisplatin dose on the rate of ototoxicity.\ud \ud \ud Methods\ud Data from 41 medulloblastoma patients treated with IMRT were collected. Overall and disease-free survival rates were calculated by Kaplan-Meier method Hearing function was graded according to toxicity criteria of Pediatric Oncology Group (POG). Doses to inner ear and total cisplatin dose were correlated with hearing function by univariate and multivariate data analysis.\ud \ud \ud Results\ud After a mean follow-up of 44 months (range: 14 to 72 months), 37 patients remained alive, with two recurrences, both in spine with CSF involvement, resulting in a disease free-survival and overall survival of 85.2% and 90.2%, respectively.\ud Seven patients (17%) experienced POG Grade 3 or 4 toxicity. Cisplatin dose was a significant factor for hearing loss in univariate analysis (p < 0.03). In multivariate analysis, median dose to inner ear was significantly associated with hearing loss (p < 0.01). POG grade 3 and 4 toxicity were uncommon with median doses to the inner ear bellow 42 Gy (p < 0.05) and total cisplatin dose of less than 375 mg/m2 (p < 0.01).\ud \ud \ud Conclusions\ud IMRT leads to a low rate of severe ototoxicity. Median radiation dose to auditory apparatus should be kept below 42 Gy. Cisplatin doses should not exceed 375 mg/m2.This study was supported by Instituto Israelita de Responsabilidade Social\ud (IIRS) of Hospital Israelita Albert Einstein (HIAE)

Single agent vinorelbine in progressive unressectable low-grade glioma in children and adolescent

Introdução: O manejo dos gliomas de baixo grau não ressecáveis e/ou em progressão permanece controverso. As opções de tratamento incluem quimioterapia, geralmente precedido por um período de observação, na tentativa de adiar ou mesmo evitar a radioterapia e a ressecção cirúrgica extensa. Dentro deste contexto realizou-se um protocolo institucional no IOP/GRAACC/UNIFESP com vinorelbina, um alcaloide da vinca semissintético, com o objetivo de avaliar a resposta ao tratamento, a sobrevida e seu perfil de toxicidade. Pacientes e métodos: De julho de 2007 a maio de 2013, 41 pacientes com tratamento prévio (10) e recém-diagnosticados (31) foram tratados com vinorelbina na dose de 30 mg/m² nos dias 0, 8 e 22 por 18 ciclos. Os critérios de resposta incluíam as imagens de ressonância nuclear magnética e a avaliação física e oftalmológica, quando aplicável. Em relação às toxicidades, estas foram avaliadas segundo os critérios de terminologia comum para eventos adversos. Resultados: Com média de idade de 6,4 anos os locais primários dos tumores foram: 27 em vias ópticas/hipotálamo (1 disseminado), 7 em tronco cerebral, 3 em hemisfério cerebral, 2 em cerebelo, 1 intramedular e 1 gliomatose cerebral. Quatro pacientes apresentavam diagnóstico de neurofibromatose tipo 1 e três de síndrome diencefálica. Vinte e oito pacientes realizaram cirurgia, sendo glioma grau I em 21 casos e grau II em sete. Dezessete pacientes (42,5%) apresentaram resposta objetiva e em 23 doença estável. A toxicidade mais significativa foi hematológica, com neutropenia grau 3/4 em nove pacientes, ocorrendo apenas dois casos de neutropenia febril. Nenhuma toxicidade gastrointestinal grau 3/4 foi observada e apenas um caso de neurotoxicidade grau 3. Com seguimento médio de 56 meses, a sobrevida livre de progressão em 3 e 5 anos foi de 49,4% (I.C. a 95%: 33,2%; 65,4%) e 36,8% (I.C. a 95%: 20,7%; 52,9%), respectivamente e a global em 3 e 5 anos de 81,8%(I.C. a 95%: 69,6%; 94,0%). Conclusão: Os resultados sugerem ser o quimioterápico vinorelbina uma opção de tratamento para gliomas de baixo grau não ressecáveis e/ou em progressão demonstrando efetividade e baixa toxicidade.Background: The management of progressive unresectable low-grade gliomas remains controversial. Treatment options include chemotherapy, usually preceded by a period of observation, to delay or even avoid radiotherapy and extensive surgery in a proportion of children. Within this context an institutional protocol with vinorelbine, a semi-synthetic vinca alkaloid, was conducted at IOP/GRAACC/UNIFESP with the aim to evaluate the clinical and radiological response, as well as its toxicity profile. Patients and methods: From July 2007 to May 2013, 41 patients with recurrent (10) and newly diagnosed (31) progressive unresectable low-grade gliomas were treated with vinorelbine 30 mg/m² on days 0, 8 and 22 for 18 cycles. Response criteria used a combination of magnetic resonance imaging, physical and visual evaluation. Results: With the mean age of 6,4 years, the tumor sites were: 27 optic pathway, 7 brainstem, 3 hemispheric, 2 cerebellum, 1 intramedullary and 1 gliomatosis cerebri. Four patients had diagnosis of neurofibromatosis type 1 and 3 diencephalic syndrome. Twenty-eight patients had neurosurgical intervention, 21 grade I astrocytoma and 7 grade II. Of the 41 patients enrolled in the study, 40 were assessable for response. The best objective response was observed in 17 patients (42,5%) while 23 had stable disease. The most important documented toxicity was hematologic, with grade 3/4 neutropenia in 9 patients. None of the patients showed grade 3/4 gastrointestinal toxicity and only 1 grade 3 neurotoxicity. With a mean follow-up of 56 months the 40 available patients showed a progression-free survival in 3 years of 49.4% (I.C. a 95%: 33,2%; 65,4%) and in 5 years of 36.8% (I.C. a 95%: 20,7%; 52,9%) with an overall survival in 3 and 5 years of 81.8% (I.C a 95%: 69,6%; 94,0%). Conclusion: The results suggest that vinorelbine may be an option for progressive unresectable low-grade gliomas, showing activity with low toxicity and excellent quality of life

Epidemiology and risk factors for bloodstream infections after allogeneic hematopoietic stem cell transplantion

A total of 315 patients who underwent allogeneic Hematopoietic Stem Cell Transplantation (HSCT) during a 4year period were analysed with the aim of collecting information on bloodstream infections (BSI). Eighty-four patients (27%) developed 112 BSI, with a cumulative risk of 20.6% at 30 days and 27.7% at 180 days. Overall, 127 pathogens were isolated, 95 (75%) gram-positive cocci, 27 (21%) gram-negative rods and 5 (4%) fungi. Enterococcus sp. accounted for 46 of 127 (36%) isolates. In a multivariable analysis only including baseline factors, the type of transplant was the only factor significantly associated with the risk of BSI and the risk was higher for patients receiving transplant from mismatched or unrelated donors.In a case-control study aimed at evaluating the predictive role of additional factors during transplant, the risk appeared to be higher in patients with a positive CMV antigenemia (p=0.03; OR of 4.82; 95% CI, 1.21-19.17), long duration of severe granulocytopenia (p=0.015; OR 7.53; 95% CI, 1.92 - 29.58) and lower platelet count (p<0.001; OR 0.14; 95% CI, 0.05 - 0.40). By day 180 post-transplant, 87 (28%) out of 314 patients had died. The cumulative risk of death was significantly higher among patients with BSI than among other patients.Univ Genoa, Osped San Martino Genova, Div Infect Dis, I-16132 Genoa, ItalyUniv Fed Sao Paulo, Infect Dis Unit, Sao Paulo, BrazilUniv Fed Sao Paulo, Infect Dis Unit, Sao Paulo, BrazilWeb of Scienc

Recomendações no manejo das complicações infecciosas no transplante de células-tronco hematopoéticas Management of infectious complications after hematopoietic stem cell transplant

A infecção em receptores de transplante de células-tronco hematopoéticas (TCTH) está relacionada a altas taxas de morbidade e mortalidade. O tipo de transplante, a fonte de célula-tronco hematopoética, a utilização de doadores alternativos e outras medidas relacionadas ao procedimento influenciam diretamente no tipo e na intensidade da imunossupressão, modificando o risco de desenvolver uma infecção. Nesta seção são discutidas as estratégias para monitorização, diagnóstico e tratamento das infecções em receptores de TCTH em três fases: na fase pré-transplante, durante a fase de neutropenia, e na fase pós-pega do enxerto.<br>Infectious complications following stem cell transplantation are frequent and associated with high morbidity and mortality. Several factors related to the transplant procedure, such as type of transplant, the source of stem cells, the utilization of alternative donors are important determinants of the immune status of the host, and impact on the risk of infection. In this section we will discuss the different approaches for monitoring patients at risk and diagnosing and treating infectious complications in three time periods: before transplant, during neutropenia, and after engraftment