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

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

Diffuse Intrinsic Brainstem Tumor in an Infant: A Case of Therapeutic Efficacy With Vinorelbine

Brainstem gliomas constitute 10% to 20% of all pediatric tumors of the central nervous system, and diffusely infiltrative brainstem gliomas are the most common brainstem tumors associated with a poor prognosis. A small subset of these tumors is benign, showing low-grade features on histology. the role of chemotherapy in the management of these tumors is ill defined, especially in the neonates. There are anecdotal reports of spontaneous remission, but the natural history of these tumors does not support a wait-and-see approach. Thus, we report a successful experience of chemotherapy in a 4-month-old girl with a diffuse brainstem fibrillary astrocytoma, treated with vinorelbine (30 mg/m(2)/d on days 0, 8, and 22), a vinca alkaloid that has shown activity against glioma. Our experience suggests that vinorelbine may be effective in pediatric low-grade gliomas as this patient showed significant clinical improvement over a short period of time.Universidade Federal de São Paulo, GRAACC, IOP, Dept Pediat Oncol, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, GRAACC, IOP, Dept Neurol & Neurosurg, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, GRAACC, IOP, Dept Pathol, BR-04023062 São Paulo, BrazilHosp Sick Children, Div Hematol Oncol, Toronto, ON M5G 1X8, CanadaUniversidade Federal de São Paulo, GRAACC, IOP, Dept Pediat Oncol, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, GRAACC, IOP, Dept Neurol & Neurosurg, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, GRAACC, IOP, Dept Pathol, BR-04023062 São Paulo, BrazilWeb of Scienc