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2. Invasive aspergillosis in relapsed/refractory acute myeloid leukaemia patients: Results from SEIFEM 2016-B survey

Author

Del Principe, M. I., Dragonetti, Giulia, Conti, A., Verga, L., Ballanti, S., Fanci, R., Candoni, A., Marchesi, F., Cattaneo, C., Lessi, F., Fracchiolla, N., Spolzino, A., Prezioso, L., Delia, M., Potenza, L., Decembrino, N., Castagnola, C., Nadali, G., Picardi, M., Zama, D., Orciulo, E., Veggia, B., Garzia, M., Dargenio, M., Melillo, L., Manetta, S., Russo, D., Mancini, V., Piedimonte, M., Tisi, M. C., Toschi, N., Busca, A., Pagano, Livio, Dragonetti G., Pagano L. (ORCID:0000-0001-8287-928X), Del Principe, M. I., Dragonetti, Giulia, Conti, A., Verga, L., Ballanti, S., Fanci, R., Candoni, A., Marchesi, F., Cattaneo, C., Lessi, F., Fracchiolla, N., Spolzino, A., Prezioso, L., Delia, M., Potenza, L., Decembrino, N., Castagnola, C., Nadali, G., Picardi, M., Zama, D., Orciulo, E., Veggia, B., Garzia, M., Dargenio, M., Melillo, L., Manetta, S., Russo, D., Mancini, V., Piedimonte, M., Tisi, M. C., Toschi, N., Busca, A., Pagano, Livio, Dragonetti G., and Pagano L. (ORCID:0000-0001-8287-928X)

Abstract

Background: In patients with relapsed/refractory acute myeloid leukaemia (R/R AML) who received salvage chemotherapy, limited and not updated studies explored the incidence of invasive aspergillosis (IA) and the role of antifungal prophylaxis (AP). The aims of this multicentre retrospective ‘SEIFEM 2016-B’ study were as follows: (1) to evaluate the current rate and the outcome of proven/probable IA and (2) to assess the efficacy of AP, in a large ‘real life’ series of patient with R/R AML submitted to salvage chemotherapy. Results: Of 2250 R/R AML patients, a total of 74 cases of IA (5.1%) were recorded as follows: 10 (0.7%) proven and 64 (4.3%) probable. Information about AP were available in 73/74 (99%) patients. Fifty-eight (79%) breakthrough infections occurred, mainly during AP with posaconazole [25 (43%)]. The patients who received AP during salvage chemotherapy showed a benefit from antifungal therapy (AT) than patients who did not received AP [43 (86%) vs 7 (14%); p <.033]. In a multivariate analysis, AP and absence of severe mucositis had a significant favourable effect on overall response rate. Conclusion: Our data demonstrated that the incidence of IA during the salvage chemotherapy is similar to the past. Nevertheless, the attributable mortality rate (AMR) appears to be lower than that previously reported in R/R AML. Further prospective studies should be performed to confirm our preliminary observation and understand and the why a decreased AMR is reported in this setting of high-risk patients.

Published
2022

3. Fungal infections of the central nervous system and paranasal sinuses in onco-haematologic patients. Epidemiological study reporting the diagnostic-therapeutic approach and outcome in 89 cases

Author

Candoni A, Klimko N, Busca A, Di Blasi R, Shadrivova O, Cesaro S, Zannier ME, Verga L, Forghieri F, Calore E, Nadali G, Simonetti E, Muggeo P, Quinto AM, Castagnola C, Cellini M, Del Principe MI, Fracchiolla N, Melillo L, Piedimonte M, Zama D, Farina F, Giusti D, Mosna F, Capelli D, Delia M, Picardi M, Decembrino N, Perruccio K, Vallero S, Aversa F, Fanin R, Pagano L, SEIFEM Group (Epidemiological Surveillance of Infections in Haematological Diseases), Candoni, A., Klimko, N., Busca, A., Di Blasi, R., Shadrivova, O., Cesaro, S., Zannier, M. E., Verga, L., Forghieri, F., Calore, Aldo, Nadali, G., Simonetti, E., Muggeo, P., Quinto, A. M., Castagnola, C., Cellini, M., Del Principe, M. I., Fracchiolla, N., Melillo, L., Piedimonte, M., Zama, D., Farina, F., Giusti, D., Mosna, F., Capelli, D., Delia, M., Picardi, M., Decembrino, N., Perruccio, K., Vallero, S., Aversa, F., Fanin, R., Pagano, L., Candoni A, Klimko N, Busca A, Di Blasi R, Shadrivova O, Cesaro S, Zannier ME, Verga L, Forghieri F, Calore E, Nadali G, Simonetti E, Muggeo P, Quinto AM, Castagnola C, Cellini M, Del Principe MI, Fracchiolla N, Melillo L, Piedimonte M, Zama D, Farina F, Giusti D, Mosna F, Capelli D, Delia M, Picardi M, Decembrino N, Perruccio K, Vallero S, Aversa F, Fanin R, Pagano L, and SEIFEM Group (Epidemiological Surveillance of Infections in Haematological Diseases)

Subjects
0301 basic medicine, Male, Antifungal Agents, haematological disease, Aspergillosis, fungal CNS infectious, haematological diseases, leukaemia, neurologic complications, Zygomicosis, 030207 dermatology & venereal diseases, 0302 clinical medicine, Central Nervous System Fungal Infections, Epidemiology, Paranasal Sinuses, Sinusitis, Child, Adolescent, Adult, Aged, Cerebrospinal Fluid, Child, Preschool, Epidemiologic Studies, Female, Fungi, Hematologic Neoplasms, Humans, Middle Aged, Survival Analysis, Treatment Outcome, Young Adult, Debridement, medicine.diagnostic_test, aspergillosis, fungal cns infectious, zygomicosis, neurologic complication, General Medicine, medicine.anatomical_structure, Infectious Diseases, Cohort, medicine.drug, medicine.medical_specialty, fungal CNS infectiou, Aspergillosi, 030106 microbiology, Dermatology, 03 medical and health sciences, Internal medicine, Biopsy, medicine, Preschool, Invasive fungal infection, central nervous system, onco-haematologic patients, Survival analysis, Voriconazole, business.industry, Zygomicosi, medicine.disease, Paranasal sinuses, 2708, business, Settore MED/15 - Malattie del Sangue
Abstract

Invasive fungal infections (IFI) of the Central Nervous System (IFI-CNS) and Paranasal Sinuses (IFI-PS) are rare, life-threatening infections in haematologic patients, and their management remains a challenge despite the availability of new diagnostic techniques and novel antifungal agents. In addition, analyses of large cohorts of patients focusing on these rare IFI are still lacking. Between January 2010 and December 2016, 89 consecutive cases of Proven (53) or Probable (36) IFI-CNS (71/89) and IFI-PS (18/89) were collected in 34 haematological centres. The median age was 40 years (range 5-79); acute leukaemia was the most common underlying disease (69%) and 29% of cases received a previous allogeneic stem cell transplant. Aspergillus spp. were the most common pathogens (69%), followed by mucormycetes (22%), Cryptococcus spp. (4%) and Fusarium spp. (2%). The lung was the primary focus of fungal infection (48% of cases). The nervous system biopsy was performed in 10% of IFI-CNS, and a sinus biopsy was performed in 56% of IFI-PS (P = 0.03). The Galactomannan test on cerebrospinal fluid has been performed in 42% of IFI-CNS (30/71), and it was positive in 67%. Eighty-four pts received a first-line antifungal therapy with Amphotericine B in 58% of cases, Voriconazole in 31% and both in 11%. Moreover, 58% of patients received 2 or more lines of therapy and 38% were treated with a combination of 2 or more antifungal drugs. The median duration of antifungal therapy was 60 days (range 5-835). A surgical intervention was performed in 26% of cases but only 10% of IFI-CNS underwent neurosurgical intervention. The overall response rate to antifungal therapy (complete or partial response) was 57%, and 1-year overall survival was 32% without significant differences between IFI-CNS and IFI-PS. The overall mortality was 69% but the IFI attributable mortality was 33%. Mortality of IFI-CNS/PS remains high but, compared to previous historical data, it seems to be reduced probably due to the availability of newer antifungal drugs. The results arising from this large contemporary cohort of cases may allow a more effective diagnostic and therapeutic management of these very rare IFI complications in haematologic patients.

Published
2018

6. Candidaemia in haematological malignancy patients from a SEIFEM study: Epidemiological patterns according to antifungal prophylaxis

Author

Posteraro, Brunella, De Carolis, Elena, Criscuolo, Marianna, Ballanti, S., De Angelis, Giulia, Del Principe, M. I., Delia, M., Fracchiolla, N., Marchesi, F., Nadali, G., Picardi, Stefano Maria, Piccioni, A. L., Verga, L., Candoni, A., Busca, A., Sanguinetti, Maurizio, Pagano, Livio, Muggeo, P., Stanzani, M., Cattaneo, C., Russo, D., Vacca, A., Fanci, R., De Paolis, M. R., Mancini, V., Lessi, F., Rossetti, E., Decembrino, N., Facchini, L., Dragonetti, Giulia, Ferrari, A., Vallero, S., Posteraro B. (ORCID:0000-0002-1663-7546), De Carolis E. (ORCID:0000-0003-4757-7256), Criscuolo M., De Angelis G. (ORCID:0000-0002-7087-7399), Picardi M., Sanguinetti M. (ORCID:0000-0002-9780-7059), Pagano L. (ORCID:0000-0001-8287-928X), Dragonetti G., Posteraro, Brunella, De Carolis, Elena, Criscuolo, Marianna, Ballanti, S., De Angelis, Giulia, Del Principe, M. I., Delia, M., Fracchiolla, N., Marchesi, F., Nadali, G., Picardi, Stefano Maria, Piccioni, A. L., Verga, L., Candoni, A., Busca, A., Sanguinetti, Maurizio, Pagano, Livio, Muggeo, P., Stanzani, M., Cattaneo, C., Russo, D., Vacca, A., Fanci, R., De Paolis, M. R., Mancini, V., Lessi, F., Rossetti, E., Decembrino, N., Facchini, L., Dragonetti, Giulia, Ferrari, A., Vallero, S., Posteraro B. (ORCID:0000-0002-1663-7546), De Carolis E. (ORCID:0000-0003-4757-7256), Criscuolo M., De Angelis G. (ORCID:0000-0002-7087-7399), Picardi M., Sanguinetti M. (ORCID:0000-0002-9780-7059), Pagano L. (ORCID:0000-0001-8287-928X), and Dragonetti G.

Abstract

Background: Candidaemia is an important infectious complication for haematological malignancy patients. Antifungal prophylaxis reduces the incidence of candidaemia but may be associated with breakthrough candidaemia. Objective: To analyse the Candida species’ distribution and relative antifungal susceptibility profiles of candidaemia episodes in relation to the use of antifungal prophylaxis among Italian SEIFEM haematology centres. Methodology: This multicentre retrospective observational SEIFEM study included 133 single-species candidaemia episodes of haematological malignancy patients for whom antifungal susceptibility testing results of blood Candida isolates were available between 2011 and 2015. Each participating centre provided both clinical and microbiological data. Results: Non-Candida albicans Candida (NCAC) species were the mostly isolated species (89, 66.9%), which accounted for C parapsilosis (35, 26.3%), C glabrata (16, 12.0%), C krusei (14, 10.5%), C tropicalis (13, 9.8%) and uncommon species (11, 8.3%). C albicans caused the remaining 44 (33.1%) episodes. Excluding 2 C albicans isolates, 23 of 25 fluconazole-resistant isolates were NCAC species (14 C krusei, 6 C glabrata, 2 C parapsilosis and 1 C tropicalis). Fifty-six (42.1%) of 133 patients developed breakthrough candidaemia. Systemic antifungal prophylaxis consisted of azoles, especially fluconazole and posaconazole, in 50 (89.3%) of 56 patients in whom a breakthrough candidaemia occurred. Interestingly, all these patients tended to develop a C krusei infection (10/56, P =.02) or a fluconazole-resistant isolate’s infection (14/50, P =.04) compared to patients (4/77 and 10/77, respectively) who did not have a breakthrough candidaemia. Conclusions: Optimisation of prophylactic strategies is necessary to limit the occurrence of breakthrough candidaemia and, importantly, the emergence of fluconazole-resistant NCAC isolates’ infections in

Published
2020

7. Fungaemia in haematological malignancies: SEIFEM-2015 survey

Author

Criscuolo, M., Marchesi, F., Candoni, A., Cattaneo, C., Nosari, A., Veggia, B., Verga, L., Fracchiolla, N., Vianelli, N., Del Principe, M. I., Picardi, M., Tumbarello, M., Aversa, F., Busca, A., Pagano, L., Dragonetti, G., Ballanti, S., Delia, M., Nadali, G., Sciume, M., Castagnola, C., Ferrari, A., Mancini, V., Decembrino, N., Spolzino, A., Iovino, L., Martino, B., Vacca, A., Calore, E., Fanci, R., Lessi, F., Vallero, S., Zama, D., Cesaro, S., De Paolis, M. R., Facchini, L., Muggeo, P., Offidani, M., Perruccio, K., Russo, D., Criscuolo M, Marchesi F, Candoni A, Cattaneo C, Nosari A, Veggia B, Verga L, Fracchiolla N, Vianelli N, Del Principe MI, Picardi M, Tumbarello M, Aversa F, Busca A, Pagano L, SEIFEM Group: Giulia Dragonetti, Stelvio Ballanti, Mario Delia, Gianpaolo Nadali, Sciumè M, Castagnola C, Ferrari A, Mancini V, Decembrino N, Spolzino A, Iovino L, Martino B, Vacca A, Calore E, Fanci R, Lessi F, Vallero S, Zama D, Cesaro S, De Paolis M, Facchini L, Muggeo P, Offidani M, Perruccio K, Russo D., Criscuolo, Marianna, Marchesi, Francesco, Candoni, Anna, Cattaneo, Chiara, Nosari, Annamaria, Veggia, Barbara, Verga, Luisa, Fracchiolla, Nicola, Vianelli, Nicola, Del Principe, Maria Ilaria, Picardi, Marco, Tumbarello, Mario, Aversa, Franco, Busca, Alessandro, and Pagano, Livio

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Clinical Biochemistry, Prevalence, 030204 cardiovascular system & hematology, Biochemistry, Young Adult, 03 medical and health sciences, acute leukaemias, candidemia, fungaemia, 0302 clinical medicine, Risk Factors, Yeasts, Internal medicine, acute leukemias, Epidemiology, Fungemia, Hematological malignancies, medicine, Aged, Candidemia, Child, Female, Fungemia, Hematologic Neoplasms, Humans, Italy, Middle Aged, Prognosis, Retrospective Studies, acute leukemia, 030212 general & internal medicine, Cause of death, Hematology, business.industry, Septic shock, Mortality rate, General Medicine, bacterial infections and mycoses, medicine.disease, Settore MED/15 - MALATTIE DEL SANGUE, fungemia, business, Central venous catheter
Abstract

BACKGROUND: Fungal infections are still a relevant challenge for clinicians involved in the cure of patients with cancer. We retrospectively reviewed charts of hospitalized patients with hematological malignancies (HMs), in which a documented fungemia was diagnosed between January 2011 and December 2015 at 28 adult and 6 pediatric Italian Hematology Departments. METHODS: During the study period we recorded 215 fungal blood stream infections (BSI). Microbiological analyses documented that BSI was due to molds in 17 patients (8%) and yeasts in 198 patients (92%), being Candida spp identified in 174 patients (81%). RESULTS: Mortality rates were 70% and 39% for mold and yeast infections, respectively. Infection was the main cause of death in 53% of the mold and 18% of the yeast groups. At the multivariate analysis, ECOG ≥2 and septic shock were significantly associated with increased mortality, and removal of CVC survival was found to be protective. When considering patients with candidemia only, ECOG >2 and removal of CVC were statistically associated with overall mortality. CONCLUSIONS: Although candidemia represents a group of BSI with a good prognosis, its risk factors largely overlap with those identified for all fungemias, even though the candidemia-related mortality is lower when compared to other fungal BSI. Management of fungal BSI is still a complex issue, in which both patients and disease characteristics should be focused to address a personalized approach. This article is protected by copyright. All rights reserved.

Published
2019
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8. 'Real-life' analysis of the role of antifungal prophylaxis in preventing invasive aspergillosis in AML patients undergoing consolidation therapy: Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM) 2016 study

Author

Del Principe MI, Dragonetti, G, Verga, L, Candoni, A, Marchesi, F, Cattaneo, C, Delia, M, Potenza, L, Farina, F, Ballanti, S, Decembrino, N, Castagnola, C, Nadali, G, Fanci, R, Orciulo, E, Veggia, B, Offidani, M, Melillo, L, Manetta, S, Tumbarello, M, Venditti, A, Busca, A, Aversa, F, and Pagano, L

Subjects
antifungal prophylaxis , consolidation therapy. AML
Published
2019

10. A Case Series and Literature Review of Isavuconazole Use in Pediatric Patients with Hemato-oncologic Diseases and Hematopoietic Stem Cell Transplantation

Author

Decembrino, N., primary, Perruccio, K., additional, Zecca, M., additional, Colombini, A., additional, Calore, E., additional, Muggeo, P., additional, Soncini, E., additional, Comelli, A., additional, Molinaro, M., additional, Goffredo, B. M., additional, De Gregori, S., additional, Giardini, I., additional, Scudeller, L., additional, and Cesaro, S., additional

Published
2020
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11. S1637 A BAL-DRIVEN ANTIMICROBIAL TREATMENT IMPROVES CLINICAL OUTCOME IN HEMATOLOGIC MALIGNANCIES PATIENTS WITH LUNG INFILTRATES DETECTION: A PROSPECTIVE MULTICENTER STUDY OF THE SEIFEM GROUP

Author

Marchesi, F., primary, Cattaneo, C., additional, Criscuolo, M., additional, Delia, M., additional, Dargenio, M., additional, Del Principe, M.I., additional, Spadea, A., additional, Fracchiolla, N. S., additional, Melillo, L., additional, Perruccio, K., additional, Alati, C., additional, Russo, D., additional, Garzia, M., additional, Zappasodi, P., additional, Cefalo, M.G., additional, Armiento, D., additional, Cesaro, S., additional, Decembrino, N., additional, Mengarelli, A., additional, Busca, A., additional, and Pagano, L., additional

Published
2019
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12. Early gut microbiota signature of aGvHD in children given allogeneic hematopoietic cell transplantation for hematological disorders

Author

Biagi, E., Zama, D., Rampelli, S., Turroni, S., Brigidi, P., Consolandi, C., Severgnini, M., Picotti, E., Gasperini, P., Merli, P., Decembrino, N., Zecca, M., Cesaro, S., Faraci, M., Prete, A., Locatelli, Franco, Pession, A., Candela, M., Masetti, R., Locatelli F. (ORCID:0000-0002-7976-3654), Biagi, E., Zama, D., Rampelli, S., Turroni, S., Brigidi, P., Consolandi, C., Severgnini, M., Picotti, E., Gasperini, P., Merli, P., Decembrino, N., Zecca, M., Cesaro, S., Faraci, M., Prete, A., Locatelli, Franco, Pession, A., Candela, M., Masetti, R., and Locatelli F. (ORCID:0000-0002-7976-3654)

Abstract

Background: The onset of acute Graft-versus-Host Disease (aGvHD) has been correlated with the gut microbiota (GM) composition, but experimental observations are still few, mainly involving cohorts of adult patients. In the current scenario where fecal microbiota transplantation has been used as a pioneer therapeutic approach to treat steroid-refractory aGvHD, there is an urgent need to expand existing observational studies of the GM dynamics in Hematopoietic Stem Cell Transplantation (HSCT). Aim of the present study is to explore the GM trajectory in 36 pediatric HSCT recipients in relation to aGvHD onset. Methods: Thirty-six pediatric patients, from four transplantation centers, undergoing HSCT were enrolled in the study. Stools were collected at three time points: before HSCT, at time of engraftment and > 30 days following HSCT. Changes in the GM phylogenetic structure were studied by 16S rRNA gene Illumina sequencing and phylogenetic assignation. Results: Children developing gut aGvHD had a dysbiotic GM layout before HSCT occurred. This putative aGvHD-predisposing ecosystem state was characterized by (i) reduced diversity, (ii) lower Blautia content, (iii) increase in Fusobacterium abundance. At time of engraftment, the GM structure underwent a deep rearrangement in all patients but, regardless of the occurrence of aGvHD and its treatment, it reacquired a eubiotic configuration from day 30. Conclusions: We found a specific GM signature before HSCT predictive of subsequent gut aGvHD occurrence. Our data may open the way to a GM-based stratification of the risk of developing aGvHD in children undergoing HSCT, potentially useful also to identify patients benefiting from prophylactic fecal transplantation.

Published
2019

13. A bronchoalveolar lavage-driven antimicrobial treatment improves survival in hematologic malignancy patients with detected lung infiltrates: A prospective multicenter study of the SEIFEM group

Author

Marchesi, F., Cattaneo, C., Criscuolo, Marianna, Delia, M., Dargenio, M., Del Principe, M. I., Spadea, A., Fracchiolla, N. S., Melillo, L., Perruccio, K., Alati, C., Russo, D., Garzia, M., Brociner, M., Cefalo, M., Armiento, D., Cesaro, S., Decembrino, N., Mengarelli, A., Tumbarello, Mario, Busca, A., Pagano, Livio, Criscuolo M., Tumbarello M. (ORCID:0000-0002-9519-8552), Pagano L. (ORCID:0000-0001-8287-928X), Marchesi, F., Cattaneo, C., Criscuolo, Marianna, Delia, M., Dargenio, M., Del Principe, M. I., Spadea, A., Fracchiolla, N. S., Melillo, L., Perruccio, K., Alati, C., Russo, D., Garzia, M., Brociner, M., Cefalo, M., Armiento, D., Cesaro, S., Decembrino, N., Mengarelli, A., Tumbarello, Mario, Busca, A., Pagano, Livio, Criscuolo M., Tumbarello M. (ORCID:0000-0002-9519-8552), and Pagano L. (ORCID:0000-0001-8287-928X)

Abstract

Bronchoalveolar lavage (BAL) is recommended for diagnosing lung infiltrates (LI) in patients with hematologic malignancy (HM). Prospective data on the impact of BAL on survival are still lacking. We conducted a prospective observational study on patients who performed BAL for LI among 3055 HM patients hospitalized from January to September 2018. The BAL was performed in 145 out of 434 patients who developed LI, at a median time of four days from LI detection. The median age was 60 (1-83). Most patients had an acute myeloid leukemia/myelodisplastic syndrome (81), followed by lymphoma (41), acute lymphoblastic leukemia (27), and other types of HM (36). A putative causal agent was detected in 111 cases (76%), and in 89 cases (61%) the BAL results provided guidance to antimicrobial treatment. We observed a significantly improved outcome of LI at day +30 in patients who could receive a BAL-driven antimicrobial treatment (improvement/resolution rate: 71% vs 55%; P = .04). Moreover, we observed a significantly improved outcome in 120-day overall survival (120d-OS) (78% vs 59%; P = .009) and 120-day attributable mortality (120d-AM) (11% vs 30%; P = 0.003) for patients who could receive a BAL-driven treatment. The multivariate analysis showed that BAL-driven antimicrobial treatment was significantly associated with better 120d-OS and lower 120d-AM. We did not observe any severe adverse events. In conclusion BAL allows detection of a putative agent of LI in about 75% of cases, it is feasible and well tolerated in most cases, demonstrating that a BAL-driven antimicrobial treatment allows improvement of clinical outcome and survival.

Published
2019

14. Fungal infections of the central nervous system and paranasal sinuses in onco-haematologic patients. Epidemiological study reporting the diagnostic-therapeutic approach and outcome in 89 cases

Author

Candoni, A., Klimko, N., Busca, A., Di Blasi, Roberta, Shadrivova, O., Cesaro, S., Zannier, M. E., Verga, L., Forghieri, F., Calore, E., Nadali, G., Simonetti, E., Muggeo, P., Quinto, A. M., Castagnola, C., Cellini, M., Del Principe, M. I., Fracchiolla, N., Melillo, L., Piedimonte, M., Zama, D., Farina, F., Giusti, D., Mosna, F., Capelli, D., Delia, M., Picardi, M., Decembrino, N., Perruccio, K., Vallero, S., Aversa, F., Fanin, R., Pagano, Livio, Di Blasi, R., Pagano, L. (ORCID:0000-0001-8287-928X), Candoni, A., Klimko, N., Busca, A., Di Blasi, Roberta, Shadrivova, O., Cesaro, S., Zannier, M. E., Verga, L., Forghieri, F., Calore, E., Nadali, G., Simonetti, E., Muggeo, P., Quinto, A. M., Castagnola, C., Cellini, M., Del Principe, M. I., Fracchiolla, N., Melillo, L., Piedimonte, M., Zama, D., Farina, F., Giusti, D., Mosna, F., Capelli, D., Delia, M., Picardi, M., Decembrino, N., Perruccio, K., Vallero, S., Aversa, F., Fanin, R., Pagano, Livio, Di Blasi, R., and Pagano, L. (ORCID:0000-0001-8287-928X)

Abstract

Invasive fungal infections (IFI) of the Central Nervous System (IFI-CNS) and Paranasal Sinuses (IFI-PS) are rare, life-threatening infections in haematologic patients, and their management remains a challenge despite the availability of new diagnostic techniques and novel antifungal agents. In addition, analyses of large cohorts of patients focusing on these rare IFI are still lacking. Between January 2010 and December 2016, 89 consecutive cases of Proven (53) or Probable (36) IFI-CNS (71/89) and IFI-PS (18/89) were collected in 34 haematological centres. The median age was 40 years (range 5-79); acute leukaemia was the most common underlying disease (69%) and 29% of cases received a previous allogeneic stem cell transplant. Aspergillus spp. were the most common pathogens (69%), followed by mucormycetes (22%), Cryptococcus spp. (4%) and Fusarium spp. (2%). The lung was the primary focus of fungal infection (48% of cases). The nervous system biopsy was performed in 10% of IFI-CNS, and a sinus biopsy was performed in 56% of IFI-PS (P = 0.03). The Galactomannan test on cerebrospinal fluid has been performed in 42% of IFI-CNS (30/71), and it was positive in 67%. Eighty-four pts received a first-line antifungal therapy with Amphotericine B in 58% of cases, Voriconazole in 31% and both in 11%. Moreover, 58% of patients received 2 or more lines of therapy and 38% were treated with a combination of 2 or more antifungal drugs. The median duration of antifungal therapy was 60 days (range 5-835). A surgical intervention was performed in 26% of cases but only 10% of IFI-CNS underwent neurosurgical intervention. The overall response rate to antifungal therapy (complete or partial response) was 57%, and 1-year overall survival was 32% without significant differences between IFI-CNS and IFI-PS. The overall mortality was 69% but the IFI attributable mortality was 33%. Mortality of IFI-CNS/PS remains high but, compared to previous historical data, it seems to be reduced probably due

Published
2019

16. ll microbiota intestinale come fattore di rischio dello sviluppo di aGVHD gastrointestinale in pazienti pediatrici sottoposti a trapianto allogenico di cellule staminali ematopoietiche

Author

Zama, D., Biagi, E., Rampelli, S., Turroni, S., Brigidi, P., Consolandi, C., Severgnini, M., Landi, E., Bossu, G., Carella, M., Merli, P., Decembrino, N., Zecca, M., Cesaro, S., Faraci, M., Prete, A., Locatelli, F., Pession, A., Candela, M., and R. Masetti. I.

Subjects
complicanze intestinali, microbiota, trapianto, microbiota, complicanze intestinali, trapianto
Published
2018

17. Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia After Allogeneic and Autologous Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey

Author

Girmenia, C, Bertaina, A, Piciocchi, A, Perruccio, K, Algarotti, A, Busca, A, Cattaneo, C, Raiola, Am, Guidi, S, Iori, Ap, Candoni, A, Irrera, G, Milone, G, Marcacci, G, Scimè, R, Musso, M, Cudillo, L, Sica, S, Castagna, L, Corradini, P, Marchesi, F, Pastore, D, Alessandrino, Ep, Annaloro, C, Ciceri, F, Santarone, S, Nassi, L, Farina, C, Viscoli, C, Rossolini, Gm, Bonifazi, F, Rambaldi, A, Capria, S, Mastronuzzi, A, Pagliara, D, Bernaschi, P, Amico, L, Carotti, A, Mencacci, A, Bruno, B, Costa, C, Passi, A, Ravizzola, G, Angelucci, E, Marchese, A, Pecile, P, Ventura, G, Fanin, R, Scarparo, C, Barbaro, A, Leotta, S, Marchese, Ae, Becchimanzi, C, Donnarumma, D, Tringali, S, Baldi, Mt, Scalone, R, Picardi, A, Arcese, W, Fontana, C, Giammarco, S, Spanu, T, Crocchiolo, R, Casari, E, Mussetti, A, Conte, E, Ensoli, F, Miragliotta, G, Marone, P, Arghittu, M, Greco, R, Forcina, A, Chichero, P, Di Bartolomeo, P, Fazii, P, Kroumova, V, Decembrino, N, Zecca, M, Pisapia, G, Palazzo, G, Lanino, E, Faraci, M, Castagnola, E, Bandettini, R, Pastano, R, Sammassimo, S, Passerini, R, Stefani, Pm, Gherlinzoni, F, Rigoli, R, Prezioso, L, Cambò, B, Calderaro, A, Carella, Am, Cascavilla, N, Labonia, Mt, Celeghini, I, Mordini, N, Piana, F, Vacca, A, Sanna, M, Podda, G, Corsetti, Mt, Rocchetti, A, Cilloni, D, De Gobbi, M, Bianco, O, Fagioli, F, Carraro, F, De Intinis, G, Severino, A, Proia, A, Parisi, G, Vallisa, D, Confalonieri, M, Russo, D, Malagola, M, Galieni, P, Falcioni, S, Travaglini, V, Raimondi, R, Borghero, C, Pavan, G, Prete, A, Belotti, T, Ambretti, S, Imola, M, Mianulli, Am, Pedna, Mf, Cesaro, S, Lo Cascio, G, Ferrari, A, Piedimonte, M, Santino, I, Calandrelli, M, Olivieri, A, Orecchioni, F, Mirabile, M, Centurioni, R, Gironacci, L, Caravelli, D, Gallo, S, De Filippi, M, Cupelli, L, Dentamaro, T, Falco, S, Eugenio, Os, Marotta, S, Risitano, A, Lula, D, Musto, P, Pietrantuono, G, Traficante, A, Cerchiara, E, Tirindelli, Mc, Dicuonzo, G, Chierichini, A, Anaclerico, B, and Placanica, P.

Published
2017

20. Infezioni Clinicamente rilevanti durante la terapia di induzione sono associate con un aumento del rischio di recidiva. Studio di 1999 pazienti arruolati nel protocollo AIEOP-LLA-2000

Author

Caselli, D., Colombini, A., Silvestri, D., Vinti, L., Parasole, R., Putti, M. C., Barisone, E., Lo Nigro, L., Santoro, N., Ziino, O., Decembrino, N., Castagnola, E., Cesaro, Simone, Aricò, M., and Conter, V. .

Subjects
leucemia linfoblastica acuta, chemioterapia, Infezioni, Infezioni, chemioterapia, leucemia linfoblastica acuta
Published
2016

21. Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia after Allogeneic and Autologous Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey

Author

Girmenia, C., Bertaina, A., Piciocchi, A., Perruccio, K., Algarotti, A., Busca, A., Cattaneo, C., Raiola, A. M., Guidi, S., Iori, A. P., Candoni, A., Irrera, G., Milone, G., Marcacci, G., Scime, R., Musso, M., Cudillo, L., Sica, Simona, Castagna, Luigi, Corradini, P., Marchesi, F., Pastore, D., Alessandrino, E. P., Annaloro, C., Ciceri, F., Santarone, S., Nassi, L., Farina, C., Viscoli, C., Rossolini, G. M., Bonifazi, F., Rambaldi, A., Capria, S., Mastronuzzi, A., Pagliara, D., Bernaschi, P., Amico, L., Carotti, A., Mencacci, A., Bruno, Brunella, Costa, C., Passi, A., Ravizzola, G., Angelucci, E., Marchese, Alessandra Maria, Pecile, P., Ventura, Giulio, Fanin, R., Scarparo, C., Barbaro, A., Leotta, Salvatore Nuccio, Marchese, A. E., Becchimanzi, C., Donnarumma, D., Tringali, S., Baldi, M. T., Scalone, R., Picardi, A., Arcese, W., Fontana, Cecilia Alejandra, Giammarco, S., Spanu, Teresa, Crocchiolo, R., Casari, E., Mussetti, A., Conte, Eliana, Ensoli, F., Miragliotta, G., Marone, P., Arghittu, M., Greco, R., Forcina, A., Chichero, P., Di Bartolomeo, P., Fazii, P., Kroumova, V., Decembrino, N., Zecca, M., Pisapia, Giovanni, Palazzo, G., Lanino, E., Faraci, M., Castagnola, E., Bandettini, R., Pastano, R., Sammassimo, S., Passerini, R., Stefani, P. M., Gherlinzoni, F., Rigoli, R., Prezioso, L., Cambo, B., Calderaro, A., Carella, A. M., Cascavilla, N., Labonia, M. T., Celeghini, I., Mordini, N., Piana, F., Vacca, A., Sanna, Maria Maddalena, Podda, G., Corsetti, M. T., Rocchetti, A., Cilloni, D., De Gobbi, M., Bianco, O., Fagioli, F., Carraro, F., De Intinis, G., Severino, A., Proia, Anna Silvia, Parisi, G., Vallisa, D., Confalonieri, Marco, Russo, D., Malagola, M., Galieni, P., Falcioni, S., Travaglini, V., Raimondi, Maria Rosa, Borghero, C., Pavan, Giuseppe, Prete, A., Belotti, T., Ambretti, S., Imola, M., Mianulli, A. M., Pedna, M. F., Cesaro, S., Lo Cascio, G., Ferrari, A., Piedimonte, M., Santino, I., Calandrelli, M., Olivieri, Alessandra, Orecchioni, F., Mirabile, M., Centurioni, R., Gironacci, L., Caravelli, D., Gallo, S., De Filippi, M., Cupelli, L., Dentamaro, T., Falco, S., Eugenio, O. S., Marotta, S., Risitano, A., Lula, D., Musto, P., Pietrantuono, G., Traficante, A., Cerchiara, E., Tirindelli, M. C., Dicuonzo, G., Chierichini, A., Anaclerico, B., Placanica, P., Sica S. (ORCID:0000-0003-2426-3465), Castagna L., Bruno B., Marchese A., Ventura G. (ORCID:0000-0002-0304-7264), Leotta S., Fontana C., Spanu T. (ORCID:0000-0003-1864-5184), Conte E., Pisapia G., Sanna M., Proia A., Confalonieri M. (ORCID:0000-0002-3708-379X), Raimondi R., Pavan G., Olivieri A., Girmenia, C., Bertaina, A., Piciocchi, A., Perruccio, K., Algarotti, A., Busca, A., Cattaneo, C., Raiola, A. M., Guidi, S., Iori, A. P., Candoni, A., Irrera, G., Milone, G., Marcacci, G., Scime, R., Musso, M., Cudillo, L., Sica, Simona, Castagna, Luigi, Corradini, P., Marchesi, F., Pastore, D., Alessandrino, E. P., Annaloro, C., Ciceri, F., Santarone, S., Nassi, L., Farina, C., Viscoli, C., Rossolini, G. M., Bonifazi, F., Rambaldi, A., Capria, S., Mastronuzzi, A., Pagliara, D., Bernaschi, P., Amico, L., Carotti, A., Mencacci, A., Bruno, Brunella, Costa, C., Passi, A., Ravizzola, G., Angelucci, E., Marchese, Alessandra Maria, Pecile, P., Ventura, Giulio, Fanin, R., Scarparo, C., Barbaro, A., Leotta, Salvatore Nuccio, Marchese, A. E., Becchimanzi, C., Donnarumma, D., Tringali, S., Baldi, M. T., Scalone, R., Picardi, A., Arcese, W., Fontana, Cecilia Alejandra, Giammarco, S., Spanu, Teresa, Crocchiolo, R., Casari, E., Mussetti, A., Conte, Eliana, Ensoli, F., Miragliotta, G., Marone, P., Arghittu, M., Greco, R., Forcina, A., Chichero, P., Di Bartolomeo, P., Fazii, P., Kroumova, V., Decembrino, N., Zecca, M., Pisapia, Giovanni, Palazzo, G., Lanino, E., Faraci, M., Castagnola, E., Bandettini, R., Pastano, R., Sammassimo, S., Passerini, R., Stefani, P. M., Gherlinzoni, F., Rigoli, R., Prezioso, L., Cambo, B., Calderaro, A., Carella, A. M., Cascavilla, N., Labonia, M. T., Celeghini, I., Mordini, N., Piana, F., Vacca, A., Sanna, Maria Maddalena, Podda, G., Corsetti, M. T., Rocchetti, A., Cilloni, D., De Gobbi, M., Bianco, O., Fagioli, F., Carraro, F., De Intinis, G., Severino, A., Proia, Anna Silvia, Parisi, G., Vallisa, D., Confalonieri, Marco, Russo, D., Malagola, M., Galieni, P., Falcioni, S., Travaglini, V., Raimondi, Maria Rosa, Borghero, C., Pavan, Giuseppe, Prete, A., Belotti, T., Ambretti, S., Imola, M., Mianulli, A. M., Pedna, M. F., Cesaro, S., Lo Cascio, G., Ferrari, A., Piedimonte, M., Santino, I., Calandrelli, M., Olivieri, Alessandra, Orecchioni, F., Mirabile, M., Centurioni, R., Gironacci, L., Caravelli, D., Gallo, S., De Filippi, M., Cupelli, L., Dentamaro, T., Falco, S., Eugenio, O. S., Marotta, S., Risitano, A., Lula, D., Musto, P., Pietrantuono, G., Traficante, A., Cerchiara, E., Tirindelli, M. C., Dicuonzo, G., Chierichini, A., Anaclerico, B., Placanica, P., Sica S. (ORCID:0000-0003-2426-3465), Castagna L., Bruno B., Marchese A., Ventura G. (ORCID:0000-0002-0304-7264), Leotta S., Fontana C., Spanu T. (ORCID:0000-0003-1864-5184), Conte E., Pisapia G., Sanna M., Proia A., Confalonieri M. (ORCID:0000-0002-3708-379X), Raimondi R., Pavan G., and Olivieri A.

Abstract

Background Gram-negative bacteremia (GNB) is a major cause of illness and death after hematopoietic stem cell transplantation (HSCT), and updated epidemiological investigation is advisable. Methods We prospectively evaluated the epidemiology of pre-engraftment GNB in 1118 allogeneic HSCTs (allo-HSCTs) and 1625 autologous HSCTs (auto-HSCTs) among 54 transplant centers during 2014 (SIGNB-GITMO-AMCLI study). Using logistic regression methods. we identified risk factors for GNB and evaluated the impact of GNB on the 4-month overall-survival after transplant. Results The cumulative incidence of pre-engraftment GNB was 17.3% in allo-HSCT and 9% in auto-HSCT. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most common isolates. By multivariate analysis, variables associated with GNB were a diagnosis of acute leukemia, a transplant from a HLA-mismatched donor and from cord blood, older age, and duration of severe neutropenia in allo-HSCT, and a diagnosis of lymphoma, older age, and no antibacterial prophylaxis in auto-HSCT. A pretransplant infection by a resistant pathogen was significantly associated with an increased risk of posttransplant infection by the same microorganism in allo-HSCT. Colonization by resistant gram-negative bacteria was significantly associated with an increased rate of infection by the same pathogen in both transplant procedures. GNB was independently associated with increased mortality at 4 months both in allo-HSCT (hazard ratio, 2.13; 95% confidence interval, 1.45-3.13; P <.001) and auto-HSCT (2.43; 1.22-4.84; P =.01). Conclusions Pre-engraftment GNB is an independent factor associated with increased mortality rate at 4 months after auto-HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNB. Clinical Trials registration NCT02088840.

Published
2017

34. Markers of neonatal sepsis

Author

Bonarrigo, A., Decembrino, N., Blandino, R., Gagliostro, G., Giorgianni, G., DE PASQUALE, G., and Barberi, Ignazio

Published
2006

41. SEIFEM 2016 STUDY: INCIDENCE OF PROBABLE AND PROVEN INVASIVE ASPERGILLOSIS IN PATIENTS WITH ACUTE MYELOID LEUKEMIA DURING CONSOLIDATION THERAPY

Author

Del Principe, M. I., Di Blasi, R., Verga, L., anna candoni, Potenza, L., Ballanti, S., Cattaneo, C., Delia, M., Decembrino, N., Melillo, L., Castagnola, C., Nadali, G., Fanci, R., Ferrari, A., Fracchiolla, N. S., Iovino, L., Lessi, F., Veggia, B., Offidani, M., Picardi, M., Prezioso, L., Rambaldi, B., Marchesi, F., Annibali, O., Zama, D., Mancini, V., Salutari, P., Garzia, M. G., Vacca, A., Cesaro, S., Paolis, M. R., Invernizzi, R., Perruccio, K., Mitra, M. E., Quinto, A. M., Venditti, A., Busca, A., Aversa, F., and Pagano, L.

Subjects
acute myeloid leukemia, aspergillosis, chemotherapy, aspergillosis, acute myeloid leukemia, chemotherapy

42. PRELIMINARY REPORT OF FUNGEMIA IN HEMATOLOGICAL MALIGNANCIES FROM SEIFEM-2015 SURVEY

Author

Criscuolo, M., Dragonetti, G., Fianchi, L., Verga, L., Del Principe, M. I., Picardi, M., Veggia, B., Ballanti, S., Marchesi, F., Delia, M., anna candoni, Nadali, G., Castagnola, C., Decembrino, N., Mancini, V., Ferrari, A., Busca, A., Vallero, S., Cattaneo, C., Giordano, A., Martino, B., Vacca, A., Iovino, L., Calore, E., Fanci, R., Lessi, F., Zama, D., Cesaro, S., Aversa, F., and Pagano, L.

43. SEIFEM 2016 STUDY: INCIDENCE AND MORTALITY OF PROBABLE AND PROVEN INVASIVE ASPERGILLOSIS DURING SALVAGE TREATMENT OF PATIENTS WITH RELAPSED OR REFRACTORY ACUTE MYELOID LEUKEMIA

Author

Del Principe, M. I., Dragonetti, G., Verga, L., Candoni, A., Potenza, L., Ballanti, S., Cattaneo, C., Delia, M., Decembrino, N., Valente, A., Castagnola, C., Nadali, G., Fanci, R., Piedimonte, M., Fracchiolla, N. S., Orciuolo, E., Lessi, F., Chierichini, A., Maracci, L., Della Pepa, R., Spolzino, A., Russo, D., Spadea, A., Sarlo, C., Zama, D., Mancini, V., Salutari, P., Garzia, M. G., Caria, R., Cesaro, S., Paolis, M. R., Invernizzi, R., Perruccio, K., Mitra, M. E., Quinto, A. M., Venditti, A., Busca, A., Aversa, F., and Livio PAGANO

45. SEIFEM 2015-B: INCIDENCE AND MORTALITY FOR CANDIDEMIA IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES

Author

Dragonetti, G., Cattaneo, C., Marchesi, F., Aversa, F., Busca, A., Candoni, A., Castagnola, C., Cesaro, S., Criscuolo, M., Del Principe, M. I., Decembrino, N., Delia, M., Fanci, R., Ferrari, A., Fracchiolla, N. S., Lessi, F., Mancini, V., Martino, B., Melillo, L., Nadali, G., Nosari, A., Perruccio, K., Picardi, M., Prezioso, L., Stanzani, M., Tumbarello, M., Veggia, B., and Livio PAGANO

46. Multicenter randomized, double-blind controlled trial to evaluate the efficacy of laser therapy for the treatment of severe oral mucositis induced by chemotherapy in children: laMPO RCT

Author

Maria Livia Mariuzzi, Alessandra Piras, Federico Verzegnassi, Elena Bardellini, Maria Grazia Petris, Patrizia Defabianis, Simone Bagattoni, Margherita Gobbo, Elisabetta Merigo, Fraia Melchionda, Davide Zanon, Matteo Biasotto, Alessandra Majorana, Giulio Andrea Zanazzo, Massimo Berger, Angelica Barone, Nunzia Decembrino, Giulia Ottaviani, Marina Consuelo Vitale, Luca Ronfani, Rosamaria Mura, Gobbo M., Verzegnassi F., Ronfani L., Zanon D., Melchionda F., Bagattoni S., Majorana A., Bardellini E., Mura R., Piras A., Petris M.G., Mariuzzi M.L., Barone A., Merigo E., Decembrino N., Vitale M.C., Berger M., Defabianis P., Biasotto M., Ottaviani G., Zanazzo G.A., Gobbo, M., Verzegnassi, F., Ronfani, L., Zanon, D., Melchionda, F., Bagattoni, S., Majorana, A., Bardellini, E., Mura, R., Piras, A., Petris, M. G., Mariuzzi, M. L., Barone, A., Merigo, E., Decembrino, N., Vitale, M. C., Berger, M., Defabianis, P., Biasotto, M., Ottaviani, G., and Zanazzo, G. A.

Subjects
Male, genetic structures, medicine.medical_treatment, Clinical trial, Laser, Mucositis, Pediatric hemato-oncology, Supportive care, Pediatrics, Perinatology and Child Health, Hematology, Oncology, Pediatrics, law.invention, Antineoplastic Agent, 0302 clinical medicine, Randomized controlled trial, law, Neoplasms, Child, Stomatitis, pediatric hemato-oncology, clinical trial, Perinatology and Child Health, Treatment Outcome, 030220 oncology & carcinogenesis, Female, Human, medicine.medical_specialty, Adolescent, Analgesic, chemical and pharmacologic phenomena, Antineoplastic Agents, macromolecular substances, Placebo, 03 medical and health sciences, Double-Blind Method, Internal medicine, medicine, Humans, Low-Level Light Therapy, Adverse effect, laser, mucositis, supportive care, Chemotherapy, business.industry, mucositi, fungi, 030206 dentistry, medicine.disease, Stomatiti, Neoplasm, business
Abstract

Objectives: To demonstrate the efficacy of laser photobiomodulation (PBM) compared to that of placebo on severe oral mucositis (OM) in pediatric oncology patients. The primary objective was the reduction of OM grade (World Health Organization [WHO] scale) 7 days after starting PBM. Secondary objectives were reduction of pain, analgesic consumption, and incidence of side effects. Methods: One hundred and one children with WHO grade>2 chemotherapy-induced OM were enrolled in eight Italian hospitals. Patients were randomized to either PBM or sham treatment for four consecutive days (days +1 to +4). On days +4, +7, and +11, OM grade, pain (following a 0–10 numeric pain rating scale, NRS) and need for analgesics were evaluated by an operator blinded to treatment. Results: Fifty-one patients were allocated to the PBM group, and 50 were allocated to the sham group. In total, 93.7% of PBM patients and 72% of sham patients had OM grade&nbsp

Published
2017

47. Consensus on COVID‐19 Vaccination in Pediatric Oncohematological Patients, on Behalf of Infectious Working Group of Italian Association of Pediatric Hematology Oncology

Author

Simone Cesaro, Paola Muggeo, Daniele Zama, Monica Cellini, Katia Perruccio, Antonella Colombini, Francesca Carraro, Maria Grazia Petris, Valeria Petroni, Maurizio Mascarin, Francesco Baccelli, Elena Soncini, Rosamaria Mura, Milena La Spina, Nunzia Decembrino, Roberta Burnelli, Stefano Frenos, Elio Castagnola, Maura Faraci, Cristina Meazza, Federica Barzaghi, Maria Rosaria D’Amico, Maria Capasso, Elisabetta Calore, Ottavio Ziino, Angelica Barone, Francesca Compagno, Laura Luti, Federica Galaverna, Raffaella De Santis, Letizia Brescia, Linda Meneghello, Angelamaria Petrone, Nagua Giurici, Daniela Onofrillo, Fabian Schumacher, Federico Mercolini, Cesaro S., Muggeo P., Zama D., Cellini M., Perruccio K., Colombini A., Carraro F., Petris M.G., Petroni V., Mascarin M., Baccelli F., Soncini E., Mura R., La Spina M., Decembrino N., Burnelli R., Frenos S., Castagnola E., Faraci M., Meazza C., Barzaghi F., D'amico M.R., Capasso M., Calore E., Ziino O., Barone A., Compagno F., Luti L., Galaverna F., De Santis R., Brescia L., Meneghello L., Petrone A., Giurici N., Onofrillo D., Schumacher F., and Mercolini F.

Subjects
Pandemic, COVID‐19, Vaccination, Hematological disease, pediatric malignancy, oncological diseases, hematological diseases, COVID-19, vaccination, pandemic, General Medicine, Oncological disease, Pediatric malignancy
Abstract

Vaccines represent the best tool to prevent the severity course and fatal consequences of the pandemic by the new Coronavirus 2019 infection (SARS-CoV-2). Considering the limited data on vaccination of pediatric oncohematological patients, we developed a Consensus document to support the Italian pediatric hematological oncological (AIEOP) centers in a scientifically correct communication with families and patients and to promote vaccination. The topics of the Consensus were: SARS-CoV-2 infection and disease (COVID-19) in the pediatric subjects; COVID-19 vaccines (type, schedule); who and when to vaccinate; contraindications and risk of serious adverse events; rare adverse events; third dose and vaccination after COVID-19; and other general prevention measures. Using the Delphi methodology for Consensus, 21 statements and their corresponding rationale were elaborated and discussed with the representatives of 31 centers, followed by voting. A high grade of Consensus was obtained on topics such as the potential risk of severe COVID-19 outcome in pediatric oncohematological patients, the need for vaccination as a preventative measure, the type, schedule and booster dose of vaccine, the eligibility of the patients for vaccination, and the timing, definition, and management of contraindications and serious adverse events, and other general prevention measures. All 21 of the statements were approved. This consensus document highlights that children and adolescents affected by hematological and oncological diseases are a fragile category. Vaccination plays an important role to prevent COVID-19, to permit the regular administration of chemotherapy or other treatments, to perform control visits and hospital admissions, and to prevent treatment delays.

Published
2022

48. Oral Lactoferrin Supplementation during Induction Chemotherapy Promotes Gut Microbiome Eubiosis in Pediatric Patients with Hematologic Malignancies

Author

Federica D’Amico, Nunzia Decembrino, Edoardo Muratore, Silvia Turroni, Paola Muggeo, Rosamaria Mura, Katia Perruccio, Virginia Vitale, Marco Zecca, Arcangelo Prete, Francesco Venturelli, Davide Leardini, Patrizia Brigidi, Riccardo Masetti, Simone Cesaro, Daniele Zama, D'Amico F., Decembrino N., Muratore E., Turroni S., Muggeo P., Mura R., Perruccio K., Vitale V., Zecca M., Prete A., Venturelli F., Leardini D., Brigidi P., Masetti R., Cesaro S., and Zama D.

Subjects
eubiosi, gut microbiota, pediatrics, Pharmaceutical Science, lactoferrin, chemotherapy, hematologic malignancies, oral supplementation, eubiosis, acute lymphoblastic leukemia, hematologic malignancie
Abstract

Induction chemotherapy is the first-line treatment for pediatric patients with hematologic malignancies. However, several complications may arise, mainly infections and febrile neutropenia, with a strong impact on patient morbidity and mortality. Such complications have been shown to be closely related to alterations of the gut microbiome (GM), making the design of strategies to foster its eubiosis of utmost clinical importance. Here, we evaluated the impact of oral supplementation of lactoferrin (LF), a glycoprotein endowed with anti-inflammatory, immunomodulatory and antimicrobial activities, on GM dynamics in pediatric oncohematologic patients during induction chemotherapy. Specifically, we conducted a double blind, placebo-controlled trial in which GM was profiled through 16S rRNA gene sequencing before and after two weeks of oral supplementation with LF or placebo. LF was safely administered with no adverse effects and promoted GM homeostasis by favoring the maintenance of diversity and preventing the bloom of pathobionts (e.g., Enterococcus). LF could, therefore, be a promising adjunct to current therapeutic strategies in these fragile individuals to reduce the risk of GM-related complications.

Published
2022

49. Parents in Neonatal Pain Management-An International Survey of Parent-Delivered Interventions and Parental Pain Assessment.

Author

Ullsten A, Beken S, Campbell-Yeo M, Cavallaro G, Decembrino N, Durrmeyer X, Garrido F, Kristjánsdóttir G, Amponsah AK, Lago P, Haslund-Thomsen H, Ojha S, Pölkki T, Gomez MR, Roue JM, Simons S, Slater R, Stenkjaer RL, Ünal S, Bosch GVD, Wielenga J, Eriksson M, On Behalf Of The Espr Special Interest Group For Neonatal Pain, and Pearl Research Group

Abstract

Background: While parent-delivered pain management has been demonstrated to effectively reduce neonatal procedural pain responses, little is known about to what extent it is utilized. Our aim was to explore the utilization of parents in neonatal pain management and investigate whether local guidelines promote parent-delivered interventions., Methods: A web-based survey was distributed to neonatal units worldwide., Results: The majority of the 303 responding neonatal intensive care units (NICUs) from 44 countries were situated in high-income countries from Europe and Central Asia. Of the responding units, 67% had local guidelines about neonatal pain management, and of these, 40% answered that parental involvement was recommended, 27% answered that the role of parents in pain management was mentioned as optional, and 32% responded that it was not mentioned in the guidelines. According to the free-text responses, parent-delivered interventions of skin-to-skin contact, breastfeeding, and parental live singing were the most frequently performed in the NICUs. Of the responding units, 65% answered that parents performed some form of pain management regularly or always., Conclusions: There appears to be some practice uptake of parent-delivered pain management to reduce neonatal pain in high-income countries. Additional incorporation of these interventions into NICU pain guidelines is needed, as well as a better understanding of the use of parent-delivered pain management in low- and middle-income countries.

Published
2024
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50. Ototoxic and nephrotoxic drugs in neonatal intensive care units: results of a Spanish and Italian survey.

Author

Arribas C, Decembrino N, Raffaeli G, Amodeo I, González-Caballero JL, Riaza M, Ortiz-Movilla R, Massenzi L, Gizzi C, Araimo G, Cattarelli D, Aversa S, Martinelli S, Frezza S, Orfeo L, Mosca F, Cavallaro G, and Garrido F

Subjects
Humans, Italy, Infant, Newborn, Cross-Sectional Studies, Prospective Studies, Spain, Drug Monitoring methods, Drug Monitoring statistics & numerical data, Ibuprofen adverse effects, Sodium Potassium Chloride Symporter Inhibitors adverse effects, Surveys and Questionnaires, Female, Kidney Diseases chemically induced, Kidney Diseases epidemiology, Infant, Premature, Male, Intensive Care Units, Neonatal statistics & numerical data, Aminoglycosides adverse effects, Ototoxicity etiology, Vancomycin adverse effects
Abstract

Neonates face heightened susceptibility to drug toxicity, often exposed to off-label medications with dosages extrapolated from adult or pediatric studies. Premature infants in Neonatal Intensive Care Units (NICUs) are particularly at risk due to underdeveloped pharmacokinetics and exposure to multiple drugs. The study aimed to survey commonly used medications with a higher risk of ototoxicity and nephrotoxicity in Spanish and Italian neonatal units. A prospective cross-sectional study was conducted in Italian and Spanish neonatal units using a web-based survey with 43 questions. A modified Delphi method involved experts refining the survey through online consensus. Ethical approval was obtained, and responses were collected from January to July 2023. The survey covered various aspects, including drug-related ototoxic and nephrotoxic management, hearing screening, and therapeutic drug monitoring. Responses from 131 participants (35.9% from Spain and 64.1% from Italy) revealed awareness of drug toxicity risks. Varied practices were observed in hearing screening protocols, and a high prevalence of ototoxic and nephrotoxic drug use, including aminoglycosides (100%), vancomycin (70.2%), loop diuretics (63.4%), and ibuprofen (62.6%). Discrepancies existed in guideline availability and adherence, with differences between Italy and Spain in therapeutic drug monitoring practices., Conclusions: The study underscores the need for clinical guidelines and uniform practices in managing ototoxic and nephrotoxic drugs in neonatal units. Awareness is high, but inconsistencies in practices indicate a necessity for standardization, including the implementation of therapeutic drug monitoring and the involvement of clinical pharmacologists. Addressing these issues is crucial for optimizing neonatal care in Southern Europe., What Is Known: • Neonates in intensive care face a high risk of nephrotoxicity and ototoxicity from drugs like aminoglycosides, vancomycin, loop diuretics, and ibuprofen. • Therapeutic drug monitoring is key for managing these risks, optimizing dosing for efficacy and minimizing side effects., What Is New: • NICUs in Spain and Italy show high drug toxicity awareness but differ in ototoxic/nephrotoxic drug management. • Urgent need for standard guidelines and practices to address nephrotoxic risks from aminoglycosides, vancomycin, loop diuretics, and ibuprofen., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2024
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