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1. Four Additional Doses of PEG-L-Asparaginase during the Consolidation Phase in the AIEOP-BFM ALL 2009 Protocol Do Not Improve Outcome and Increase Toxicity in High-Risk ALL: Results of a Randomized Study

Author

Conter, V, Valsecchi, M, Cario, G, Zimmermann, M, Attarbaschi, A, Stary, J, Niggli, F, Dalla Pozza, L, Elitzur, S, Silvestri, D, Locatelli, F, Moricke, A, Engstler, G, Smisek, P, Bodmer, N, Barbaric, D, Izraeli, S, Rizzari, C, Boos, J, Buldini, B, Zucchetti, M, Von Stackelberg, A, Matteo, C, Lehrnbecher, T, Lanvers-Kaminsky, C, Cazzaniga, G, Gruhn, B, Biondi, A, Schrappe, M, Conter V., Valsecchi M. G., Cario G., Zimmermann M., Attarbaschi A., Stary J., Niggli F., Dalla Pozza L., Elitzur S., Silvestri D., Locatelli F., Moricke A., Engstler G., Smisek P., Bodmer N., Barbaric D., Izraeli S., Rizzari C., Boos J., Buldini B., Zucchetti M., Von Stackelberg A., Matteo C., Lehrnbecher T., Lanvers-Kaminsky C., Cazzaniga G., Gruhn B., Biondi A., Schrappe M., Conter, V, Valsecchi, M, Cario, G, Zimmermann, M, Attarbaschi, A, Stary, J, Niggli, F, Dalla Pozza, L, Elitzur, S, Silvestri, D, Locatelli, F, Moricke, A, Engstler, G, Smisek, P, Bodmer, N, Barbaric, D, Izraeli, S, Rizzari, C, Boos, J, Buldini, B, Zucchetti, M, Von Stackelberg, A, Matteo, C, Lehrnbecher, T, Lanvers-Kaminsky, C, Cazzaniga, G, Gruhn, B, Biondi, A, Schrappe, M, Conter V., Valsecchi M. G., Cario G., Zimmermann M., Attarbaschi A., Stary J., Niggli F., Dalla Pozza L., Elitzur S., Silvestri D., Locatelli F., Moricke A., Engstler G., Smisek P., Bodmer N., Barbaric D., Izraeli S., Rizzari C., Boos J., Buldini B., Zucchetti M., Von Stackelberg A., Matteo C., Lehrnbecher T., Lanvers-Kaminsky C., Cazzaniga G., Gruhn B., Biondi A., and Schrappe M.

Abstract

PURPOSEThe AIEOP-BFM ALL 2009 protocol included, at the end of the induction phase, a randomized study of patients with high-risk (HR) ALL to investigate if an intensive exposure to pegylated L-asparaginase (PEG-ASNASE, 2,500 IU/sqm once a week × 4) on top of BFM consolidation phase IB allowed us to decrease minimal residual disease (MRD) and improve outcome.PATIENTS AND METHODSA total of 1,097 patients presented, from June 2010 to February 2017, with one or more of the following HR criteria: KMT2A::AFF1 rearrangement, hypodiploidy, prednisone poor response, poor bone marrow response at day 15 (Flow MRD ≥10%), or no complete remission (CR) at the end of induction. Of them, 809 (85.1%) were randomly assigned to receive (404) or not receive (405) four weekly doses of PEG-ASNASE.RESULTSBy intention to treat (ITT) analysis, there was no significant difference in the proportion of patients with polimerase chain reaction MRD ≥5 × 10-4 at the end of phase IB in the experimental versus control arm (13.9% v 17.0%, P =.25). The 5-year event-free survival (median follow-up 6.3 years) by ITT in the experimental and control arms was 70.4% (2.3) versus 75.0% (2.2; P =.18), and the 5-year overall survival was 81.5% (2.0) versus 84.0% (1.9; P =.25), respectively. The corresponding 5-year cumulative incidence of death in CR was 9.5% (1.5) versus 5.7% (1.2; P =.08), and that of relapse was 17.7% (1.9) versus 17.2% (1.9), respectively (P =.94). Adverse reactions in phase IB occurred in 22.2% and 8.9% of patients in the experimental and control arm, respectively (P <.001).CONCLUSIONAdditional PEG-ASNASE in phase IB did not translate into a benefit for decreasing relapse incidence but was associated with higher toxicity. Further improvements with conventional chemotherapy might be difficult in the context of intensive treatment protocols.

Published
2024

3. Infektionen

Author

Lehrnbecher, T., Simon, A., Laws, H.-J., Groll, A. H., Niemeyer, Charlotte, editor, and Eggert, Angelika, editor

Published
2018
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6. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline

Author

Ullmann, A.J., Aguado, J.M., Arikan-Akdagli, S., Denning, D.W., Groll, A.H., Lagrou, K., Lass-Flörl, C., Lewis, R.E., Munoz, P., Verweij, P.E., Warris, A., Ader, F., Akova, M., Arendrup, M.C., Barnes, R.A., Beigelman-Aubry, C., Blot, S., Bouza, E., Brüggemann, R.J.M., Buchheidt, D., Cadranel, J., Castagnola, E., Chakrabarti, A., Cuenca-Estrella, M., Dimopoulos, G., Fortun, J., Gangneux, J.-P., Garbino, J., Heinz, W.J., Herbrecht, R., Heussel, C.P., Kibbler, C.C., Klimko, N., Kullberg, B.J., Lange, C., Lehrnbecher, T., Löffler, J., Lortholary, O., Maertens, J., Marchetti, O., Meis, J.F., Pagano, L., Ribaud, P., Richardson, M., Roilides, E., Ruhnke, M., Sanguinetti, M., Sheppard, D.C., Sinkó, J., Skiada, A., Vehreschild, M.J.G.T., Viscoli, C., and Cornely, O.A.

Published
2018
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7. EBV-DRIVEN LYMPHOID NEOPLASMS ASSOCIATED WITH ALL MAINTENANCE THERAPY: AN INTERNATIONAL OBSERVATINAL STUDY

Author

Elitzur, S., primary, Vora, A., additional, Burkhardt, B., additional, Inaba, H., additional, Attarbaschi, A., additional, Baruchel, A., additional, Escherich, G., additional, Gibson, B., additional, Liu, H., additional, Loh, M., additional, Moorman, A., additional, Moricke, A., additional, Pieters, R., additional, Uyttebroeck, A., additional, Baird, S., additional, Bartram, J., additional, Ben-Harosh, M., additional, Bertrand, Y., additional, Buitenkamp, T., additional, Caldwell, K., additional, Drut, R., additional, Geerlinks, A., additional, Grainger, J., additional, Haouy, S., additional, Heaney, N., additional, Huang, M., additional, Ingham, D., additional, Krenova, Z., additional, Kuhlen, M., additional, Lehrnbecher, T., additional, Manabe, A., additional, Niggli, F., additional, Paris, C., additional, Revel-Vilk, S., additional, Rohrlich, P., additional, Sandeep, B., additional, Sinno, M., additional, Szczepanski, T., additional, Tamesberger, M., additional, Warrier, R., additional, Wolfl, M., additional, Nirel, R., additional, Izraeli, S., additional, Borkhardt, A., additional, and Schmiegelow, K., additional

Published
2022
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8. Supportive Care During Pediatric Hematopoietic Stem Cell Transplantation: Prevention of Infections. A Report From Workshops on Supportive Care of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT)

Author

Ifversen, M, Meisel, R, Sedlacek, P, Kalwak, K, Sisinni, L, Hutt, D, Lehrnbecher, T, Balduzzi, A, Diesch, T, Jarisch, A, Gungor, T, Stein, J, Yaniv, I, Bonig, H, Kuhlen, M, Ansari, M, Nava, T, Dalle, J, Diaz-de-Heredia, C, Trigoso, E, Falkenberg, U, Hartmann, M, Deiana, M, Canesi, M, Broggi, C, Bertaina, A, Gibson, B, Krivan, G, Vettenranta, K, Matic, T, Buechner, J, Lawitschka, A, Peters, C, Yesilipek, A, Yalcin, K, Lucchini, G, Bakhtiar, S, Turkiewicz, D, Niinimaki, R, Wachowiak, J, Cesaro, S, Dalissier, A, Corbacioglu, S, Willasch, A, Bader, P, Ifversen M., Meisel R., Sedlacek P., Kalwak K., Sisinni L., Hutt D., Lehrnbecher T., Balduzzi A., Diesch T., Jarisch A., Gungor T., Stein J., Yaniv I., Bonig H., Kuhlen M., Ansari M., Nava T., Dalle J. -H., Diaz-de-Heredia C., Trigoso E., Falkenberg U., Hartmann M., Deiana M., Canesi M., Broggi C., Bertaina A., Gibson B., Krivan G., Vettenranta K., Matic T., Buechner J., Lawitschka A., Peters C., Yesilipek A., Yalcin K., Lucchini G., Bakhtiar S., Turkiewicz D., Niinimaki R., Wachowiak J., Cesaro S., Dalissier A., Corbacioglu S., Willasch A. M., Bader P., Ifversen, M, Meisel, R, Sedlacek, P, Kalwak, K, Sisinni, L, Hutt, D, Lehrnbecher, T, Balduzzi, A, Diesch, T, Jarisch, A, Gungor, T, Stein, J, Yaniv, I, Bonig, H, Kuhlen, M, Ansari, M, Nava, T, Dalle, J, Diaz-de-Heredia, C, Trigoso, E, Falkenberg, U, Hartmann, M, Deiana, M, Canesi, M, Broggi, C, Bertaina, A, Gibson, B, Krivan, G, Vettenranta, K, Matic, T, Buechner, J, Lawitschka, A, Peters, C, Yesilipek, A, Yalcin, K, Lucchini, G, Bakhtiar, S, Turkiewicz, D, Niinimaki, R, Wachowiak, J, Cesaro, S, Dalissier, A, Corbacioglu, S, Willasch, A, Bader, P, Ifversen M., Meisel R., Sedlacek P., Kalwak K., Sisinni L., Hutt D., Lehrnbecher T., Balduzzi A., Diesch T., Jarisch A., Gungor T., Stein J., Yaniv I., Bonig H., Kuhlen M., Ansari M., Nava T., Dalle J. -H., Diaz-de-Heredia C., Trigoso E., Falkenberg U., Hartmann M., Deiana M., Canesi M., Broggi C., Bertaina A., Gibson B., Krivan G., Vettenranta K., Matic T., Buechner J., Lawitschka A., Peters C., Yesilipek A., Yalcin K., Lucchini G., Bakhtiar S., Turkiewicz D., Niinimaki R., Wachowiak J., Cesaro S., Dalissier A., Corbacioglu S., Willasch A. M., and Bader P.

Abstract

Specific protocols define eligibility, conditioning, donor selection, graft composition and prophylaxis of graft vs. host disease for children and young adults undergoing hematopoietic stem cell transplant (HSCT). However, international protocols rarely, if ever, detail supportive care, including pharmaceutical infection prophylaxis, physical protection with face masks and cohort isolation or food restrictions. Supportive care suffers from a lack of scientific evidence and implementation of practices in the transplant centers brings extensive restrictions to the child's and family's daily life after HSCT. Therefore, the Board of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) held a series of dedicated workshops since 2017 with the aim of initiating the production of a set of minimal recommendations. The present paper describes the consensus reached within the field of infection prophylaxis.

Published
2021

10. Correction: Supportive care during pediatric hematopoietic stem cell transplantation: beyond infectious diseases. A report from workshops on supportive care of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) (Bone Marrow Transplantation, (2020), 55, 6, (1126-1136), 10.1038/s41409-020-0818-4)

Author

Nava T., Nava, T, Ansari, M, Dalle, J, de Heredia, C, Gungor, T, Trigoso, E, Falkenberg, U, Bertaina, A, Gibson, B, Jarisch, A, Balduzzi, A, Boenig, H, Krivan, G, Vettenranta, K, Matic, T, Buechner, J, Kalwak, K, Lawitschka, A, Yesilipek, A, Lucchini, G, Peters, C, Turkiewicz, D, Niinimaki, R, Diesch, T, Lehrnbecher, T, Sedlacek, P, Hutt, D, Dalissier, A, Wachowiak, J, Yaniv, I, Stein, J, Yalcin, K, Sisinni, L, Deiana, M, Ifversen, M, Kuhlen, M, Meisel, R, Bakhtiar, S, Cesaro, S, Willasch, A, Corbacioglu, S, Bader, P, Nava T., Ansari M., Dalle J. -H., de Heredia C. D., Gungor T., Trigoso E., Falkenberg U., Bertaina A., Gibson B., Jarisch A., Balduzzi A., Boenig H., Krivan G., Vettenranta K., Matic T., Buechner J., Kalwak K., Lawitschka A., Yesilipek A., Lucchini G., Peters C., Turkiewicz D., Niinimaki R., Diesch T., Lehrnbecher T., Sedlacek P., Hutt D., Dalissier A., Wachowiak J., Yaniv I., Stein J., Yalcin K., Sisinni L., Deiana M., Ifversen M., Kuhlen M., Meisel R., Bakhtiar S., Cesaro S., Willasch A., Corbacioglu S., Bader P., Nava T., Nava, T, Ansari, M, Dalle, J, de Heredia, C, Gungor, T, Trigoso, E, Falkenberg, U, Bertaina, A, Gibson, B, Jarisch, A, Balduzzi, A, Boenig, H, Krivan, G, Vettenranta, K, Matic, T, Buechner, J, Kalwak, K, Lawitschka, A, Yesilipek, A, Lucchini, G, Peters, C, Turkiewicz, D, Niinimaki, R, Diesch, T, Lehrnbecher, T, Sedlacek, P, Hutt, D, Dalissier, A, Wachowiak, J, Yaniv, I, Stein, J, Yalcin, K, Sisinni, L, Deiana, M, Ifversen, M, Kuhlen, M, Meisel, R, Bakhtiar, S, Cesaro, S, Willasch, A, Corbacioglu, S, Bader, P, Nava T., Ansari M., Dalle J. -H., de Heredia C. D., Gungor T., Trigoso E., Falkenberg U., Bertaina A., Gibson B., Jarisch A., Balduzzi A., Boenig H., Krivan G., Vettenranta K., Matic T., Buechner J., Kalwak K., Lawitschka A., Yesilipek A., Lucchini G., Peters C., Turkiewicz D., Niinimaki R., Diesch T., Lehrnbecher T., Sedlacek P., Hutt D., Dalissier A., Wachowiak J., Yaniv I., Stein J., Yalcin K., Sisinni L., Deiana M., Ifversen M., Kuhlen M., Meisel R., Bakhtiar S., Cesaro S., Willasch A., Corbacioglu S., and Bader P.

Abstract

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Published
2020

11. Essential medicines for childhood cancer in Europe: a pan-European, systematic analysis by SIOPE

Author

Maria, O, Eva, B, Pamela R, K, Olga, K, Marko, O, Reineke A, S, Gilles, V, Achini, F, Balduzzi, A, Beck Popovic, M, Beishuizen, A, Bergamaschi, L, Biondi, A, Bourdeaut, F, Braicu, E, Brok, J, Brugières, L, Burke, A, Calaminus, G, Casanova, M, Choucair, M, Cleirec, M, Corbaciouglu, S, Genoveva Correa Llano, M, De Rojas, T, Domínguez Pinilla, N, Elmaraghi, C, Ferrari, A, Fossa, A, Gaspar, N, Herold, N, Karapiperi, K, Karu, M, Kjærsgaar, M, Knörr, F, Koenig, C, Kranjcec, I, Krawczyk, M, Lehmberg, K, Lehrnbecher, T, Lunesink, M, Massano, D, Matijasic, N, Merks, H, Metzler, M, Michalski, A, Minkov, M, Morland, B, Niktoreh, N, Oltenau, E, Orbach, D, Owens, C, Papachristidou, S, Pasqualini, C, Pavlovic, M, Perez Albert, P, Poyer, F, Radulovic, I, Reinhardt, D, Rebelo, J, Roser, E, Russo, I, Scheinemann, K, Schindera, C, Schrappe, M, Sehested, A, Sehouli, J, Spreafico, F, J Strauss, S, Stutterheim, J, Svojgr, K, Tzotzola, V, Van Ewijk, R, Verschuur, A, Vora, A, Woessmann, W, Zajac-Spychala, O, Zwaan, M, Otth, Maria, Brack, Eva, Kearns, Pamela R, Kozhaeva, Olga, Ocokoljic, Marko, Schoot, Reineke A, Vassal, Gilles, Federica Achini, Adriana Balduzzi, Maja Beck Popovic, Auke Beishuizen, Luca Bergamaschi, Andrea Biondi, Franck Bourdeaut, Elena Braicu, Jesper Brok, Laurence Brugières, Amos Burke, Gabriele Calaminus, Michela Casanova, Marie-Louise Choucair, Morgane Cleirec, Selim Corbaciouglu, Maria Genoveva Correa Llano, Teresa De Rojas, Nerea Domínguez Pinilla, Caroline Elmaraghi, Andrea Ferrari, Alexander Fossa, Nathalie Gaspar, Nikolas Herold, Kyriaki Karapiperi, Maarja Karu, Mimi Kjærsgaar, Fabian Knörr, Christa Koenig, Izabela Kranjcec, Malgorzata Krawczyk, Kai Lehmberg, Thomas Lehrnbecher, Maaike Lunesink, Davide Massano, Nuša Matijasic, Hans Merks, Markus Metzler, Anthony Michalski, Milen Minkov, Bruce Morland, Naghmeh Niktoreh, Elena Oltenau, Daniel Orbach, Cormac Owens, Smaragda Papachristidou, Claudia Pasqualini, Maja Pavlovic, Paula Perez Albert, Fiona Poyer, Ivana Radulovic, Dirk Reinhardt, Joana Rebelo, Eva Roser, Ida Russo, Katrin Scheinemann, Christina Schindera, Martin Schrappe, Astrid Sehested, Jalid Sehouli, Filippo Spreafico, Sandra J Strauss, Janine Stutterheim, Karel Svojgr, Vasiliki Tzotzola, Roelof Van Ewijk, Arnauld Verschuur, Ajay Vora, Willi Woessmann, Olga Zajac-Spychala, Michel Zwaan, Maria, O, Eva, B, Pamela R, K, Olga, K, Marko, O, Reineke A, S, Gilles, V, Achini, F, Balduzzi, A, Beck Popovic, M, Beishuizen, A, Bergamaschi, L, Biondi, A, Bourdeaut, F, Braicu, E, Brok, J, Brugières, L, Burke, A, Calaminus, G, Casanova, M, Choucair, M, Cleirec, M, Corbaciouglu, S, Genoveva Correa Llano, M, De Rojas, T, Domínguez Pinilla, N, Elmaraghi, C, Ferrari, A, Fossa, A, Gaspar, N, Herold, N, Karapiperi, K, Karu, M, Kjærsgaar, M, Knörr, F, Koenig, C, Kranjcec, I, Krawczyk, M, Lehmberg, K, Lehrnbecher, T, Lunesink, M, Massano, D, Matijasic, N, Merks, H, Metzler, M, Michalski, A, Minkov, M, Morland, B, Niktoreh, N, Oltenau, E, Orbach, D, Owens, C, Papachristidou, S, Pasqualini, C, Pavlovic, M, Perez Albert, P, Poyer, F, Radulovic, I, Reinhardt, D, Rebelo, J, Roser, E, Russo, I, Scheinemann, K, Schindera, C, Schrappe, M, Sehested, A, Sehouli, J, Spreafico, F, J Strauss, S, Stutterheim, J, Svojgr, K, Tzotzola, V, Van Ewijk, R, Verschuur, A, Vora, A, Woessmann, W, Zajac-Spychala, O, Zwaan, M, Otth, Maria, Brack, Eva, Kearns, Pamela R, Kozhaeva, Olga, Ocokoljic, Marko, Schoot, Reineke A, Vassal, Gilles, Federica Achini, Adriana Balduzzi, Maja Beck Popovic, Auke Beishuizen, Luca Bergamaschi, Andrea Biondi, Franck Bourdeaut, Elena Braicu, Jesper Brok, Laurence Brugières, Amos Burke, Gabriele Calaminus, Michela Casanova, Marie-Louise Choucair, Morgane Cleirec, Selim Corbaciouglu, Maria Genoveva Correa Llano, Teresa De Rojas, Nerea Domínguez Pinilla, Caroline Elmaraghi, Andrea Ferrari, Alexander Fossa, Nathalie Gaspar, Nikolas Herold, Kyriaki Karapiperi, Maarja Karu, Mimi Kjærsgaar, Fabian Knörr, Christa Koenig, Izabela Kranjcec, Malgorzata Krawczyk, Kai Lehmberg, Thomas Lehrnbecher, Maaike Lunesink, Davide Massano, Nuša Matijasic, Hans Merks, Markus Metzler, Anthony Michalski, Milen Minkov, Bruce Morland, Naghmeh Niktoreh, Elena Oltenau, Daniel Orbach, Cormac Owens, Smaragda Papachristidou, Claudia Pasqualini, Maja Pavlovic, Paula Perez Albert, Fiona Poyer, Ivana Radulovic, Dirk Reinhardt, Joana Rebelo, Eva Roser, Ida Russo, Katrin Scheinemann, Christina Schindera, Martin Schrappe, Astrid Sehested, Jalid Sehouli, Filippo Spreafico, Sandra J Strauss, Janine Stutterheim, Karel Svojgr, Vasiliki Tzotzola, Roelof Van Ewijk, Arnauld Verschuur, Ajay Vora, Willi Woessmann, Olga Zajac-Spychala, and Michel Zwaan

Abstract

Background: Shortages and unequal access to anticancer medicines for children and adolescents are a reality in Europe. The aim of the European Society for Paediatric Oncology (SIOPE) Essential Anticancer Medicines Project was to provide a list of anticancer medicines that are considered essential in the treatment of paediatric cancers to help ensure their continuous access to all children and adolescents with cancer across Europe. Methods: This pan-European project, done between Jan 20, 2020, and Feb 18, 2022, was designed to be a systematic collection and review of treatment protocols and strategies that are used to treat childhood cancer in Europe. We formed 16 working groups on the basis of paediatric cancer types, and which were based on the existing SIOPE Clinical Trial Groups. Workings groups consisted of representatives from the SIOPE Clinical Trial Groups, Young SIOPE members, and senior paediatric oncology experts. Each group collected existing treatment protocols that are used to treat the respective cancer types in Europe. Medicines from the standard group of each protocol were extracted. For medicines not on the WHO Essential Medicines List for children (EMLc) 2017, working groups did a literature search to determine whether the medicines should be defined as essential, promising, or neither essential nor promising. Each group provided an individual summary, and all medicines that were considered essential by at least one group were combined in a joint list. Findings: The working groups identified 73 treatment protocols used in Europe and defined 66 medicines as essential. For several newer medicines, such as kinase inhibitors or tisagenlecleucel, the supporting evidence was insufficient to consider them essential, so these medicines were defined as promising. 25 medicines were considered promising by at least one working group. 22 (33%) of the 66 essential and none of the promising medicines were included in the WHO EMLc 2017. The WHO EMLc 2021 included

Published
2022

18. Identification of invasive fungal diseases in immunocompromised patients by combining an Aspergillus specific PCR with a multifungal DNA-microarray from primary clinical samples

Author

Boch, T., Reinwald, M., Postina, P., Cornely, O. A., Vehreschild, J. J., Heuel, C. P., Heinz, W. J., Hoenigl, M., Eigl, S., Lehrnbecher, T., Hahn, J., Claus, B., Lauten, M., Egerer, G., Müller, M. C., Will, S., Merker, N., Hofmann, W.-K., Buchheidt, D., and Spiess, B.

Published
2015
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20. School and kindergarten attendance and home schooling of pediatric cancer patients before and during the SARS-CoV-2 pandemic: results of a survey of the German Society for Pediatric Oncology and Hematology

Author

Simon, A, Siebald, B, Stamm, W, Graf, N, Meier, S, Schrappe, M, Groll, AH, Laws, HJ, and Lehrnbecher, T

Subjects
Kindertagestätte, Schule, ddc: 610, SARS-CoV-2, children with cancer, school, day care center, Kinder mit Krebserkrankung, infection prevention, Hausunterricht, home schooling, Infektionsprävention
Abstract

In this multicenter survey (July 07 to August 08, 2020) in pediatric oncology centers (POCs) belonging to the German Society for Pediatric Oncology and Hematology (GPOH), 36 POCs participated (response rate 70.6%). Home schooling practice was judged as satisfying by 79% prior to and by 38% during the pandemic (P =0.0007). The individual risk of a SARS-CoV-2 infection and the risk of transmission to other patients/caregivers were arguments against attendance. Most POCs recommended regular social participation/school attendance after the end of intensive therapy. 81% stated that persisting restrictions result in serious negative psychosocial consequences for the patients and their families. In-hospital school education, home schooling and re-attendance of school and kindergarten among pediatric cancer patients have suffered a severe setback during the SARS-CoV-2 pandemic. Continuous communication and education concerning protective measures as well as an individual risk assessment are required to avoid the detrimental exclusion of pediatric oncology patients from kindergarten and school. An diesem multizentrischen Survey (7. Juli-8. August 2020) in pädiatrisch-onkologischen Zentren (POCs) der GPOH nahmen 36 POCs teil (Antwortrate 70,6%). Vor der Pandemie beurteilten 79%, während der Pandemie nur 38% den Hausunterricht als zufriedenstellend (P =.0007). Das individuelle Infektionsrisiko und das Risiko einer Übertragung auf andere Patienten oder medizinisches Personal waren die wichtigsten Argumente für soziale Distanzierung. Nach Ende der intensiven Therapie befürworten die meisten POCs einen regulären Schul- oder Kindergartenbesuch. 81% befürchten bei anhaltendem Ausschluss schwerwiegende psychosoziale Konsequenzen für die Patienten und ihre Familien. Die Auswirkungen der Pandemie auf die Edukation und soziale Teilhabe von Kindern mit Krebserkrankung sind gravierend. Kontinuierliche Information und Kommunikation über Präventionsmaßnahmen sowie eine individuelle Risikoanalyse sollten helfen, den Ausschluss während (Hausunterricht, Klinikschule) und nach (Kindergarten und Regelunterricht) einer Krebstherapie zu vermeiden.

Published
2021
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21. Global guideline for the diagnosis and management of rare mould infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and the American Society for Microbiology

Author

Hoenigl, M, Salmanton-Garcia, J, Walsh, TJ, Nucci, M, Neoh, CF, Jenks, JD, Lackner, M, Sprute, R, Al-Hatmi, AMS, Bassetti, M, Carlesse, F, Freiberger, T, Koehler, P, Lehrnbecher, T, Kumar, A, Prattes, J, Richardson, M, Revankar, S, Slavin, MA, Stemler, J, Spiess, B, Taj-Aldeen, SJ, Warris, A, Woo, PCY, Young, J-AH, Albus, K, Arenz, D, Arsic-Arsenijevic, V, Bouchara, J-P, Chinniah, TR, Chowdhary, A, de Hoog, GS, Dimopoulos, G, Duarte, RF, Hamal, P, Meis, JF, Mfinanga, S, Queiroz-Telles, F, Patterson, TF, Rahav, G, Rogers, TR, Rotstein, C, Wahyuningsih, R, Seidel, D, Cornely, OA, Hoenigl, M, Salmanton-Garcia, J, Walsh, TJ, Nucci, M, Neoh, CF, Jenks, JD, Lackner, M, Sprute, R, Al-Hatmi, AMS, Bassetti, M, Carlesse, F, Freiberger, T, Koehler, P, Lehrnbecher, T, Kumar, A, Prattes, J, Richardson, M, Revankar, S, Slavin, MA, Stemler, J, Spiess, B, Taj-Aldeen, SJ, Warris, A, Woo, PCY, Young, J-AH, Albus, K, Arenz, D, Arsic-Arsenijevic, V, Bouchara, J-P, Chinniah, TR, Chowdhary, A, de Hoog, GS, Dimopoulos, G, Duarte, RF, Hamal, P, Meis, JF, Mfinanga, S, Queiroz-Telles, F, Patterson, TF, Rahav, G, Rogers, TR, Rotstein, C, Wahyuningsih, R, Seidel, D, and Cornely, OA

Abstract

With increasing numbers of patients needing intensive care or who are immunosuppressed, infections caused by moulds other than Aspergillus spp or Mucorales are increasing. Although antifungal prophylaxis has shown effectiveness in preventing many invasive fungal infections, selective pressure has caused an increase of breakthrough infections caused by Fusarium, Lomentospora, and Scedosporium species, as well as by dematiaceous moulds, Rasamsonia, Schizophyllum, Scopulariopsis, Paecilomyces, Penicillium, Talaromyces and Purpureocillium species. Guidance on the complex multidisciplinary management of infections caused by these pathogens has the potential to improve prognosis. Management routes depend on the availability of diagnostic and therapeutic options. The present recommendations are part of the One World-One Guideline initiative to incorporate regional differences in the epidemiology and management of rare mould infections. Experts from 24 countries contributed their knowledge and analysed published evidence on the diagnosis and treatment of rare mould infections. This consensus document intends to provide practical guidance in clinical decision making by engaging physicians and scientists involved in various aspects of clinical management. Moreover, we identify areas of uncertainty and constraints in optimising this management.

Published
2021

22. Antibiotic Resistant Bloodstream Infections in Pediatric Patients Receiving Chemotherapy or Hematopoietic Stem Cell Transplant: Factors Associated with Development of Resistance, Intensive Care Admission and Mortality

Author

Castagnola, E, Bagnasco, F, Mesini, A, Agyeman, PKA, Ammann, RA, Carlesse, F, Santolaya de Pablo, ME, Groll, AH, Haeusler, GM, Lehrnbecher, T, Simon, A, D'Amico, MR, Duong, A, Idelevich, EA, Luckowitsch, M, Meli, M, Menna, G, Palmert, S, Russo, G, Sarno, M, Solopova, G, Tondo, A, Traubici, Y, Sung, L, Castagnola, E, Bagnasco, F, Mesini, A, Agyeman, PKA, Ammann, RA, Carlesse, F, Santolaya de Pablo, ME, Groll, AH, Haeusler, GM, Lehrnbecher, T, Simon, A, D'Amico, MR, Duong, A, Idelevich, EA, Luckowitsch, M, Meli, M, Menna, G, Palmert, S, Russo, G, Sarno, M, Solopova, G, Tondo, A, Traubici, Y, and Sung, L

Abstract

Bloodstream infections (BSI) are a severe complication of antineoplastic chemotherapy or hematopoietic stem cell transplantation (HSCT), especially in the presence of antibiotic resistance (AR). A multinational, multicenter retrospective study in patients aged ≤ 18 years, treated with chemotherapy or HSCT from 2015 to 2017 was implemented to analyze AR among non-common skin commensals BSI. Risk factors associated with AR, intensive care unit (ICU) admission and mortality were analyzed by multilevel mixed effects or standard logistic regressions. A total of 1291 BSIs with 1379 strains were reported in 1031 patients. Among Gram-negatives more than 20% were resistant to ceftazidime, cefepime, piperacillin-tazobactam and ciprofloxacin while 9% was resistant to meropenem. Methicillin-resistance was observed in 17% of S. aureus and vancomycin resistance in 40% of E. faecium. Previous exposure to antibiotics, especially to carbapenems, was significantly associated with resistant Gram-negative BSI while previous colonization with methicillin-resistant S. aureus was associated with BSI due to this pathogen. Hematological malignancies, neutropenia and Gram-negatives resistant to >3 antibiotics were significantly associated with higher risk of ICU admission. Underlying disease in relapse/progression, previous exposure to antibiotics, and need of ICU admission were significantly associated with mortality. Center-level variation showed a greater impact on AR, while patient-level variation had more effect on ICU admission and mortality. Previous exposure to antibiotics or colonization by resistant pathogens can be the cause of AR BSI. Resistant Gram-negatives are significantly associated with ICU admission and mortality, with a significant role for the treating center too. The significant evidence of center-level variations on AR, ICU admission and mortality, stress the need for careful local antibiotic stewardship and infection control programs.

Published
2021

23. Supportive care during pediatric hematopoietic stem cell transplantation: prevention of infections:a report from workshops on supportive care of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT)

Author

Ifversen, M. (Marianne), Meisel, R. (Roland), Sedlacek, P. (Petr), Kalwak, K. (Krzysztof), Sisinni, L. (Luisa), Hutt, D. (Daphna), Lehrnbecher, T. (Thomas), Balduzzi, A. (Adriana), Diesch, T. (Tamara), Jarisch, A. (Andrea), Güngör, T. (Tayfun), Stein, J. (Jerry), Yaniv, I. (Isaac), Bonig, H. (Halvard), Kuhlen, M. (Michaela), Ansari, M. (Marc), Nava, T. (Tiago), Dalle, J.-H. (Jean-Hugues), Diaz-de-Heredia, C. (Cristina), Trigoso, E. (Eugenia), Falkenberg, U. (Ulrike), Hartmann, M. (Mihaela), Deiana, M. (Marco), Canesi, M. (Marta), Broggi, C. (Chiara), Bertaina, A. (Alice), Gibson, B. (Brenda), Krivan, G. (Gergely), Vettenranta, K. (Kim), Matic, T. (Toni), Buechner, J. (Jochen), Lawitschka, A. (Anita), Peters, C. (Christina), Yesilipek, A. (Akif), Yalçin, K. (Koray), Lucchini, G. (Giovanna), Bakhtiar, S. (Shahrzad), Turkiewicz, D. (Dominik), Niinimäki, R. (Riitta), Wachowiak, J. (Jacek), Cesaro, S. (Simone), Dalissier, A. (Arnaud), Corbacioglu, S. (Selim), Willasch, A. M. (Andre Manfred), Bader, P. (Peter), Ifversen, M. (Marianne), Meisel, R. (Roland), Sedlacek, P. (Petr), Kalwak, K. (Krzysztof), Sisinni, L. (Luisa), Hutt, D. (Daphna), Lehrnbecher, T. (Thomas), Balduzzi, A. (Adriana), Diesch, T. (Tamara), Jarisch, A. (Andrea), Güngör, T. (Tayfun), Stein, J. (Jerry), Yaniv, I. (Isaac), Bonig, H. (Halvard), Kuhlen, M. (Michaela), Ansari, M. (Marc), Nava, T. (Tiago), Dalle, J.-H. (Jean-Hugues), Diaz-de-Heredia, C. (Cristina), Trigoso, E. (Eugenia), Falkenberg, U. (Ulrike), Hartmann, M. (Mihaela), Deiana, M. (Marco), Canesi, M. (Marta), Broggi, C. (Chiara), Bertaina, A. (Alice), Gibson, B. (Brenda), Krivan, G. (Gergely), Vettenranta, K. (Kim), Matic, T. (Toni), Buechner, J. (Jochen), Lawitschka, A. (Anita), Peters, C. (Christina), Yesilipek, A. (Akif), Yalçin, K. (Koray), Lucchini, G. (Giovanna), Bakhtiar, S. (Shahrzad), Turkiewicz, D. (Dominik), Niinimäki, R. (Riitta), Wachowiak, J. (Jacek), Cesaro, S. (Simone), Dalissier, A. (Arnaud), Corbacioglu, S. (Selim), Willasch, A. M. (Andre Manfred), and Bader, P. (Peter)

Abstract

Specific protocols define eligibility, conditioning, donor selection, graft composition and prophylaxis of graft vs. host disease for children and young adults undergoing hematopoietic stem cell transplant (HSCT). However, international protocols rarely, if ever, detail supportive care, including pharmaceutical infection prophylaxis, physical protection with face masks and cohort isolation or food restrictions. Supportive care suffers from a lack of scientific evidence and implementation of practices in the transplant centers brings extensive restrictions to the child’s and family’s daily life after HSCT. Therefore, the Board of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) held a series of dedicated workshops since 2017 with the aim of initiating the production of a set of minimal recommendations. The present paper describes the consensus reached within the field of infection prophylaxis.

Published
2021

34. Etiology and Outcome of Candidemia in Neonates and Children in Europe: An 11-year Multinational Retrospective Study

Author

Warris, A., Pana, Z.D., Oletto, A., Lundin, R., Castagnola, E., Lehrnbecher, T., Groll, A.H., Roilides, E., Andersen, C.T., Arendrup, M.C., Arsenijevic, V.A., Bianchini, S., Both, U. von, Chmelnik, M., Controzzi, T., Emonts, M., Esposito, S., Ferreras-Antolin, L., Henriet, S.S., Iosifidis, E., Irwin, A., Kopsidas, J., Lagrou, K., Lyall, H., Casteleiro, A.M., Mesini, A., Olbrich, P., Paulus, S., Lausch, K.R., Soler-Palacin, P., Spyridis, N., Strenger, V., Theodoraki, M., and Wolfs, T.

Subjects
Microbiology (medical), medicine.medical_specialty, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Candida parapsilosis, 03 medical and health sciences, [**EUROCANDY study group], 0302 clinical medicine, children, 030225 pediatrics, Internal medicine, Epidemiology, medicine, 030212 general & internal medicine, Candida albicans, Candida spp, biology, infants, business.industry, candidemia, Postmenstrual Age, Retrospective cohort study, Odds ratio, biology.organism_classification, neonates, Confidence interval, Infectious Diseases, EUROCANDY Study Group, Pediatrics, Perinatology and Child Health, Etiology, business
Abstract

BACKGROUND: Data on Candida bloodstream infections in pediatric patients in Europe are limited. We performed a retrospective multicenter European study of the epidemiology and outcome of neonatal and pediatric candidemia. MATERIAL AND METHODS: All first positive blood cultures from patients ≤ 18 years of age with candidemia were registered. Patients' demographic and clinical characteristics and causative Candida species were collected and analyzed. Regression analysis was used to identify factors independently associated with mortality. RESULTS: One thousand three hundred ninety-five episodes of candidemia (57.8% male) were reported from 23 hospitals in 10 European countries. Of the 1395 episodes, 36.4% occurred in neonates (≤ 44 weeks postmenstrual age), 13.8% in infants (> 44 weeks postmenstrual age to 1 year) and 49.8% in children and adolescents. Candida albicans (52.5%) and Candida parapsilosis (28%) were the predominant species. A higher proportion of candidemia caused by C. albicans was observed among neonatal patients (60.2%) with highest rates of C. parapsilosis seen among infants (42%). Children admitted to hematology-oncology wards presented the highest rates of non-albicans Candida species. Candidemia because of C. albicans was more frequent than non-albicans Candida in Northern versus Southern Europe (odds ratio, 2.3; 95% confidence interval, 1.8-2.9; P < 0.001). The all-cause mortality at 30 days was 14.4%. All-cause mortality was higher among patients admitted to the neonatal or pediatric intensive care units than other wards. Over time, no significant changes in species distribution were observed. CONCLUSIONS: This first multicenter European study shows unique characteristics of the epidemiology of pediatric candidemia. The insights obtained from this study will be useful to guide clinical management and antifungal stewardship. ispartof: Pediatr Infect Dis J vol:39 issue:2 pages:114-120 ispartof: location:United States status: published

Published
2020

35. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium

Author

Donnelly, J.P., Chen, S.C., Kauffman, C.A., Steinbach, W.J., Baddley, J.W., Verweij, P.E., Clancy, C.J., Wingard, J.R., Lockhart, S.R., Groll, A.H., Sorrell, T.C., Bassetti, M., Akan, H., Alexander, B.D., Andes, D., Azoulay, E., Bialek, R., Bradsher, R.W., Bretagne, S., Calandra, T., Caliendo, A.M., Castagnola, E., Cruciani, M., Cuenca-Estrella, M., Decker, C.F., Desai, S.R., Fisher, B., Harrison, T., Heussel, C.P., Jensen, H.E., Kibbler, C.C., Kontoyiannis, D.P., Kullberg, B.J., Lagrou, K., Lamoth, F., Lehrnbecher, T., Loeffler, J., Lortholary, O., Maertens, J., Marchetti, O., Marr, K.A., Masur, H., Meis, J.F.G.M., Morrisey, C.O., Nucci, M., Ostrosky-Zeichner, L., Pagano, L., Patterson, T.F., Perfect, J.R., Racil, Z., Roilides, E., Ruhnke, M., Schaefer-Prokop, C.M., Shoham, S., Slavin, M.A., Stevens, David A., Thompson, G.R., Vazquez, J.A., Viscoli, C., Walsh, T.J., Warris, A., Wheat, L.J., White, P.L., Zaoutis, T.E., Pappas, P.G., Donnelly, J.P., Chen, S.C., Kauffman, C.A., Steinbach, W.J., Baddley, J.W., Verweij, P.E., Clancy, C.J., Wingard, J.R., Lockhart, S.R., Groll, A.H., Sorrell, T.C., Bassetti, M., Akan, H., Alexander, B.D., Andes, D., Azoulay, E., Bialek, R., Bradsher, R.W., Bretagne, S., Calandra, T., Caliendo, A.M., Castagnola, E., Cruciani, M., Cuenca-Estrella, M., Decker, C.F., Desai, S.R., Fisher, B., Harrison, T., Heussel, C.P., Jensen, H.E., Kibbler, C.C., Kontoyiannis, D.P., Kullberg, B.J., Lagrou, K., Lamoth, F., Lehrnbecher, T., Loeffler, J., Lortholary, O., Maertens, J., Marchetti, O., Marr, K.A., Masur, H., Meis, J.F.G.M., Morrisey, C.O., Nucci, M., Ostrosky-Zeichner, L., Pagano, L., Patterson, T.F., Perfect, J.R., Racil, Z., Roilides, E., Ruhnke, M., Schaefer-Prokop, C.M., Shoham, S., Slavin, M.A., Stevens, David A., Thompson, G.R., Vazquez, J.A., Viscoli, C., Walsh, T.J., Warris, A., Wheat, L.J., White, P.L., Zaoutis, T.E., and Pappas, P.G.

Abstract

Contains fulltext : 225781.pdf (Publisher’s version ) (Open Access), BACKGROUND: Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. METHODS: To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups' findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. RESULTS: There is no change in the classifications of "proven," "probable," and "possible" IFD, although the definition of "probable" has been expanded and the scope of the category "possible" has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. CONCLUSIONS: These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.

Published
2020

36. Clinical Practice Guideline for Systemic Antifungal Prophylaxis in Pediatric Patients With Cancer and Hematopoietic Stem-Cell Transplantation Recipients

Author

Lehrnbecher, T, Fisher, BT, Phillips, B, Beauchemin, M, Carlesse, F, Castagnola, E, Duong, N, Dupuis, LL, Fioravantti, V, Groll, AH, Haeusler, GM, Roilides, E, Science, M, Steinbach, WJ, Tissing, W, Warris, A, Patel, P, Robinson, PD, Sung, L, Lehrnbecher, T, Fisher, BT, Phillips, B, Beauchemin, M, Carlesse, F, Castagnola, E, Duong, N, Dupuis, LL, Fioravantti, V, Groll, AH, Haeusler, GM, Roilides, E, Science, M, Steinbach, WJ, Tissing, W, Warris, A, Patel, P, Robinson, PD, and Sung, L

Abstract

PURPOSE: To develop a clinical practice guideline for systemic antifungal prophylaxis in pediatric patients with cancer and hematopoietic stem-cell transplantation (HSCT) recipients. METHODS: Recommendations were developed by an international multidisciplinary panel that included a patient advocate. We conducted a systematic review of systemic antifungal prophylaxis in children and adults with cancer and HSCT recipients. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to make strong or weak recommendations and to classify level of evidence as high, moderate, low, or very low. The panel considered directness of the data to pediatric patients. RESULTS: There were 68 randomized trials included in the systematic review, of which 6 (9%) were conducted in a solely pediatric population. Strong recommendations were made to administer systemic antifungal prophylaxis to children and adolescents receiving treatment of acute myeloid leukemia, to those undergoing allogeneic HSCT pre-engraftment, and to those receiving systemic immunosuppression for graft-versus-host disease treatment. A strong recommendation was made to administer a mold-active agent with an echinocandin or a mold-active azole when systemic antifungal prophylaxis is warranted. For children younger than 13 years of age, an echinocandin, voriconazole, or itraconazole is suggested. Posaconazole may also be used in those age 13 years or older. A strong recommendation against routine administration of amphotericin as systemic antifungal prophylaxis was made. CONCLUSION: We developed a clinical practice guideline for systemic antifungal prophylaxis administration in pediatric patients with cancer and HSCT recipients. Implementation and assessment of guideline-concordant rates and impacts are important future steps.

Published
2020

37. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium

Author

Donnelly, JP, Chen, SC, Kauffman, CA, Steinbach, WJ, Baddley, JW, Verweij, PE, Clancy, CJ, Wingard, JR, Lockhart, SR, Groll, AH, Sorrell, TC, Bassetti, M, Akan, H, Alexander, BD, Andes, D, Azoulay, E, Bialek, R, Bradsher, RW, Bretagne, S, Calandra, T, Caliendo, AM, Castagnola, E, Cruciani, M, Cuenca-Estrella, M, Decker, CF, Desai, SR, Fisher, B, Harrison, T, Heussel, CP, Jensen, HE, Kibbler, CC, Kontoyiannis, DP, Kullberg, B-J, Lagrou, K, Lamoth, F, Lehrnbecher, T, Loeffler, J, Lortholary, O, Maertens, J, Marchetti, O, Marr, KA, Masur, H, Meis, JF, Morrisey, CO, Nucci, M, Ostrosky-Zeichner, L, Pagano, L, Patterson, TF, Perfect, JR, Racil, Z, Roilides, E, Ruhnke, M, Prokop, CS, Shoham, S, Slavin, MA, Stevens, DA, Thompson, GR, Vazquez, JA, Viscoli, C, Walsh, TJ, Warris, A, Wheat, LJ, White, PL, Zaoutis, TE, Pappas, PG, Donnelly, JP, Chen, SC, Kauffman, CA, Steinbach, WJ, Baddley, JW, Verweij, PE, Clancy, CJ, Wingard, JR, Lockhart, SR, Groll, AH, Sorrell, TC, Bassetti, M, Akan, H, Alexander, BD, Andes, D, Azoulay, E, Bialek, R, Bradsher, RW, Bretagne, S, Calandra, T, Caliendo, AM, Castagnola, E, Cruciani, M, Cuenca-Estrella, M, Decker, CF, Desai, SR, Fisher, B, Harrison, T, Heussel, CP, Jensen, HE, Kibbler, CC, Kontoyiannis, DP, Kullberg, B-J, Lagrou, K, Lamoth, F, Lehrnbecher, T, Loeffler, J, Lortholary, O, Maertens, J, Marchetti, O, Marr, KA, Masur, H, Meis, JF, Morrisey, CO, Nucci, M, Ostrosky-Zeichner, L, Pagano, L, Patterson, TF, Perfect, JR, Racil, Z, Roilides, E, Ruhnke, M, Prokop, CS, Shoham, S, Slavin, MA, Stevens, DA, Thompson, GR, Vazquez, JA, Viscoli, C, Walsh, TJ, Warris, A, Wheat, LJ, White, PL, Zaoutis, TE, and Pappas, PG

Abstract

BACKGROUND: Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. METHODS: To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups' findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. RESULTS: There is no change in the classifications of "proven," "probable," and "possible" IFD, although the definition of "probable" has been expanded and the scope of the category "possible" has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. CONCLUSIONS: These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.

Published
2020

38. Guideline for Antibacterial Prophylaxis Administration in Pediatric Cancer and Hematopoietic Stem Cell Transplantation

Author

Lehrnbecher, T, Fisher, BT, Phillips, B, Alexander, S, Ammann, RA, Beauchemin, M, Carlesse, F, Castagnola, E, Davis, BL, Dupuis, LL, Egan, G, Groll, AH, Haeusler, GM, Santolaya, M, Steinbach, WJ, van de Wetering, M, Wolf, J, Cabral, S, Robinson, PD, Sung, L, Lehrnbecher, T, Fisher, BT, Phillips, B, Alexander, S, Ammann, RA, Beauchemin, M, Carlesse, F, Castagnola, E, Davis, BL, Dupuis, LL, Egan, G, Groll, AH, Haeusler, GM, Santolaya, M, Steinbach, WJ, van de Wetering, M, Wolf, J, Cabral, S, Robinson, PD, and Sung, L

Abstract

BACKGROUND: Bacteremia and other invasive bacterial infections are common among children with cancer receiving intensive chemotherapy and in pediatric recipients of hematopoietic stem cell transplantation (HSCT). Systemic antibacterial prophylaxis is one approach that can be used to reduce the risk of these infections. Our purpose was to develop a clinical practice guideline (CPG) for systemic antibacterial prophylaxis administration in pediatric patients with cancer and those undergoing HSCT. METHODS: An international and multidisciplinary panel was convened with representation from pediatric hematology/oncology and HSCT, pediatric infectious diseases (including antibiotic stewardship), nursing, pharmacy, a patient advocate, and a CPG methodologist. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to generate recommendations based on the results of a systematic review of the literature. RESULTS: The systematic review identified 114 eligible randomized trials of antibiotic prophylaxis. The panel made a weak recommendation for systemic antibacterial prophylaxis for children receiving intensive chemotherapy for acute myeloid leukemia and relapsed acute lymphoblastic leukemia (ALL). Weak recommendations against the routine use of systemic antibacterial prophylaxis were made for children undergoing induction chemotherapy for ALL, autologous HSCT and allogeneic HSCT. A strong recommendation against its routine use was made for children whose therapy is not expected to result in prolonged severe neutropenia. If used, prophylaxis with levofloxacin was recommended during severe neutropenia. CONCLUSIONS: We present a CPG for systemic antibacterial prophylaxis administration in pediatric cancer and HSCT patients. Future research should evaluate the long-term effectiveness and adverse effects of prophylaxis.

Published
2020

39. Supportive care during pediatric hematopoietic stem cell transplantation: beyond infectious diseases. A report from workshops on supportive care of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT)

Author

Nava, T, Ansari, M, Dalle, J, de Heredia, C, Güngör, T, Trigoso, E, Falkenberg, U, Bertaina, A, Gibson, B, Jarisch, A, Balduzzi, A, Boenig, H, Krivan, G, Vettenranta, K, Matic, T, Büchner, J, Kalwak, K, Lawitschka, A, Yesilipek, A, Lucchini, G, Peters, C, Turkiewicz, D, Niinimäki, R, Diesch, T, Lehrnbecher, T, Sedlacek, P, Hutt, D, Dalissier, A, Wachowiak, J, Yaniv, I, Stein, J, Yalçin, K, Sisinni, L, Deiana, M, Ifversen, M, Kuhlen, M, Miesel, R, Bakhtiar, S, Cesaro, S, Willasch, A, Corbacioglu, S, Bader, P, Nava, Tiago, Ansari, Marc, Dalle, Jean-Hugues, de Heredia, Christina Diaz, Güngör, Tayfun, Trigoso, Eugenia, Falkenberg, Ulrike, Bertaina, Alice, Gibson, Brenda, Jarisch, Andrea, Balduzzi, Adriana, Boenig, Halvard, Krivan, Gergely, Vettenranta, Kim, Matic, Toni, Büchner, Jochen, Kalwak, Krzysztof, Lawitschka, Anita, Yesilipek, Akif, Lucchini, Giovanna, Peters, Christina, Turkiewicz, Dominik, Niinimäki, Riitta, Diesch, Tamara, Lehrnbecher, Thomas, Sedlacek, Petr, Hutt, Daphna, Dalissier, Arnaud, Wachowiak, Jacek, Yaniv, Isaac, Stein, Jerry, Yalçin, Koray, Sisinni, Luisa, Deiana, Marco, Ifversen, Marianne, Kuhlen, Michaela, Miesel, Roland, Bakhtiar, Shahrzad, Cesaro, Simone, Willasch, Andre, Corbacioglu, Selim, Bader, Peter, Nava, T, Ansari, M, Dalle, J, de Heredia, C, Güngör, T, Trigoso, E, Falkenberg, U, Bertaina, A, Gibson, B, Jarisch, A, Balduzzi, A, Boenig, H, Krivan, G, Vettenranta, K, Matic, T, Büchner, J, Kalwak, K, Lawitschka, A, Yesilipek, A, Lucchini, G, Peters, C, Turkiewicz, D, Niinimäki, R, Diesch, T, Lehrnbecher, T, Sedlacek, P, Hutt, D, Dalissier, A, Wachowiak, J, Yaniv, I, Stein, J, Yalçin, K, Sisinni, L, Deiana, M, Ifversen, M, Kuhlen, M, Miesel, R, Bakhtiar, S, Cesaro, S, Willasch, A, Corbacioglu, S, Bader, P, Nava, Tiago, Ansari, Marc, Dalle, Jean-Hugues, de Heredia, Christina Diaz, Güngör, Tayfun, Trigoso, Eugenia, Falkenberg, Ulrike, Bertaina, Alice, Gibson, Brenda, Jarisch, Andrea, Balduzzi, Adriana, Boenig, Halvard, Krivan, Gergely, Vettenranta, Kim, Matic, Toni, Büchner, Jochen, Kalwak, Krzysztof, Lawitschka, Anita, Yesilipek, Akif, Lucchini, Giovanna, Peters, Christina, Turkiewicz, Dominik, Niinimäki, Riitta, Diesch, Tamara, Lehrnbecher, Thomas, Sedlacek, Petr, Hutt, Daphna, Dalissier, Arnaud, Wachowiak, Jacek, Yaniv, Isaac, Stein, Jerry, Yalçin, Koray, Sisinni, Luisa, Deiana, Marco, Ifversen, Marianne, Kuhlen, Michaela, Miesel, Roland, Bakhtiar, Shahrzad, Cesaro, Simone, Willasch, Andre, Corbacioglu, Selim, and Bader, Peter

Abstract

Hematopoietic stem cell transplantation (HSCT) is currently the standard of care for many malignant and nonmalignant blood diseases. As several treatment-emerging acute toxicities are expected, optimal supportive measurements critically affect HSCT outcomes. The paucity of good clinical studies in supportive practices gives rise to the establishment of heterogeneous guidelines across the different centers, which hampers direct clinical comparison in multicentric studies. Aiming to harmonize the supportive care provided during the pediatric HSCT in Europe, the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) promoted dedicated workshops during the years 2017 and 2018. The present paper describes the resulting consensus on the management of sinusoidal obstructive syndrome, mucositis, enteral and parenteral nutrition, iron overload, and emesis during HSCT.

Published
2020

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