RESUMO
Therapy for post-transplant relapse of paediatric ALL is limited. Standardised curative approaches are not available. We hereby describe our local procedure in this life-threatening situation. A total of 101 ALL patients received their first allogeneic stem cell transplantation (SCT) in our institution. After relapse, our primary therapeutic goal was to cure the patient with high-dose chemotherapy or specific immunotherapy (HDCHT/SIT) followed by a second SCT from a haploidentical donor (transplant approach). If this was not feasible, low-dose chemotherapy and donor lymphocyte infusions (LDCHT+DLI) were offered (non-transplant approach). A total of 23 patients suffered a post-transplant relapse. Eight patients received HDCHT/SIT, followed by haploidentical SCT in 7/8. Ten received LDCHT+DLI. The eight patients treated with a second transplant and the ten treated with the non-transplant approach had a 4-year overall survival of 56% and 40%, respectively (P=0.232). Prerequisites for successful treatment of post-transplant relapse by either a second transplant or experimental non-transplant approaches are good clinical condition and the capacity to achieve haematological remission by the induction treatment element.
Assuntos
Imunoterapia , Transfusão de Linfócitos , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Transplante de Células-Tronco , Doadores de Tecidos , Adolescente , Aloenxertos , Criança , Pré-Escolar , Feminino , Alemanha , Humanos , Lactente , Masculino , Recidiva , Estudos RetrospectivosRESUMO
BACKGROUND: Preventive approaches (including those related to care of long term central venous catheters, CVADs) and the incidence of bloodstream infections (BSI) in 2 German university affiliated paediatric oncology units. PATIENTS AND METHODS: Non-interventional prospective observational study using the Oncoped surveillance module. Center A included 85 patients in 31 months and Center B 84 patients in 21 months. The populations did not differ in terms of age, gender, malignancy and disease status (first illness vs. relapse). Center A used ports (46 %) and 2 different Broviac catheters (54 %), in Center B nearly all patients with a CVAD had Broviacs (96 %). 30 BSI (24 patients) were diagnosed in Centre A and 28 BSI (22 patients) in Center B. Patients with relapsed malignancy experienced more BSI (51.4 % vs. 20.9 %; p = 0.001). Incidence rates were significantly lower in Center A (3.47 vs. 7.93 BSI/1000 CVAD days; p = 0.037). Poisson regression analysis revealed a significant lower incidence density (BSI/100 inpatient days) for all BSI in Center A (RR 0.47 CI95 0.27-0.81, p = 0.006). Overall, 52 % of all pathogens detected in blood cultures in Center A were Gram-positive (57 % in Center B) and 48 % Gram-negative (43 in Center B). One ALL patient without a CVAD died due to overwhelming sepsis caused by an ESBL-producing E. cloacae isolate. CONCLUSION: Paediatric cancer treatment centers differ substantially in regard to management of CVADs and in other preventive strategies. The most important use of local surveillance data is longitudinal internal assessment in close cooperation with microbiology and hospital hygiene experts.
Assuntos
Bacteriemia/mortalidade , Bacteriemia/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Neoplasias/imunologia , Infecções Oportunistas/prevenção & controle , Sepse/mortalidade , Sepse/prevenção & controle , Adolescente , Bacteriemia/imunologia , Institutos de Câncer , Cateterismo Venoso Central/instrumentação , Criança , Pré-Escolar , Comportamento Cooperativo , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Comunicação Interdisciplinar , Estudos Longitudinais , Masculino , Neoplasias/complicações , Infecções Oportunistas/imunologia , Infecções Oportunistas/mortalidade , Vigilância da População , Estudos Prospectivos , Fatores de Risco , Sepse/imunologiaRESUMO
A 10-year-old boy, who had received recurrent short-course treatments with steroids to control severe autoimmune thrombocytopaenia, developed Legionnaires' disease as community-acquired pneumonia. Legionella pneumophila pneumonia was complicated by an extended abscess of the right inferior lobe, leading to residual lung cavities. Legionellosis must be kept in mind as the differential diagnosis in the case of severe pneumonia and with lung abscesses in children receiving therapeutic steroids. Legionella-specific diagnostic tests (polymerase chain reaction [PCR] in respiratory samples or urine antigen assay) and, also, specific empirical antibiotic combination therapy are required for the early detection and treatment of L. pneumophila pneumonia in childhood.
Assuntos
Legionella pneumophila/isolamento & purificação , Doença dos Legionários/diagnóstico , Abscesso Pulmonar/diagnóstico , Pulmão/patologia , Pneumonia/diagnóstico , Esteroides/uso terapêutico , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Criança , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/patologia , Diagnóstico Diferencial , Alemanha , Humanos , Legionella pneumophila/efeitos dos fármacos , Doença dos Legionários/tratamento farmacológico , Doença dos Legionários/microbiologia , Doença dos Legionários/patologia , Pulmão/microbiologia , Abscesso Pulmonar/tratamento farmacológico , Abscesso Pulmonar/microbiologia , Abscesso Pulmonar/patologia , Masculino , Pneumonia/tratamento farmacológico , Pneumonia/microbiologia , Pneumonia/patologia , Reação em Cadeia da Polimerase , Trombocitopenia/tratamento farmacológicoAssuntos
Coriocarcinoma/secundário , Neoplasias Cutâneas/secundário , Neoplasias Testiculares/diagnóstico , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/sangue , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Coriocarcinoma/diagnóstico , Coriocarcinoma/tratamento farmacológico , Coriocarcinoma/patologia , Gonadotropina Coriônica Humana Subunidade beta/sangue , Seguimentos , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Masculino , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/secundário , Estadiamento de Neoplasias , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/secundário , Ombro , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/secundárioRESUMO
This prospective, clinical trial evaluated the effects of short-term propofol administration on triglyceride levels and serum pancreatic enzymes in children undergoing sedation for magnetic resonance imaging. Laboratory parameters of 40 children, mean age (SD; range) 67 (66; 4-178) months undergoing short-term sedation were assessed before and 4 h after having received propofol. Mean (SD) propofol loading dose was 2.2 (1.1) mg.kg(-1) followed by continuous propofol infusion of 6.9 (0.9) mg.kg(-1).h(-1). Serum lipase levels (p = 0.035) and serum triglyceride levels (p = 0.003) were raised significantly after propofol administration but remained within normal limits. No significant changes in serum pancreatic-amylase levels were seen (p = 0.127). In two (5%) children, pancreatic enzymes and in four (10%) children triglyceride levels were raised above normal limits; however, no child showed clinical symptoms of pancreatitis. We conclude that even short-term propofol administration with standard doses of propofol may have a significant effect on serum triglyceride and pancreatic enzyme levels in children.
Assuntos
Hipnóticos e Sedativos/farmacologia , Pâncreas/efeitos dos fármacos , Pâncreas/enzimologia , Propofol/farmacologia , Triglicerídeos/sangue , Adolescente , Amilases/sangue , Anestésicos Intravenosos/farmacologia , Peso Corporal , Criança , Pré-Escolar , Sedação Consciente/métodos , Esquema de Medicação , Feminino , Humanos , Lactente , Lipase/sangue , Imageamento por Ressonância Magnética , Masculino , Estudos ProspectivosRESUMO
BACKGROUND: Cholestasis following bone marrow transplantation is not rare, but should always be a warning signal. The main causes of cholestasis following bone marrow transplantation are hepatotoxic effects of drugs, venoocclusive disease (VOD), early graft-versus-host disease (GvHD), total parenteral nutrition, viral hepatitis, sepsis and opportunistic infections. Vanishing bile duct syndrome represents a very rare cause for cholestatic symptoms. CASE REPORT: We report on a 8-year-old boy suffering from myelodysplastic syndrome, who underwent allogeneic bone marrow transplantation and developed biliary ductopenia in terms of a vanishing bile duct syndrome. CONCLUSION: Differential diagnosis for cholestasis following bone marrow transplantation should include the vanishing bile duct syndrome.