Bone marrow transplantation for childhood hematological disorders: a global pediatric approach in a twelve year single center experience.

One hundred and 43 consecutive pediatric patients (June 1985-December 1996) with at least 18 months of follow-up, were considered: most of the patients (111/143, 77.6%) underwent allogeneic BMT. The median follow-up was 5.7 years. Overall survival and 5 years EFS were 48.6% and 46.9%, respectively. For patients who underwent allogeneic BMT from HLA-identical siblings, the 5 years EFS for ALL was 75% in 1st CR, 60.4% in 2nd CR, 22.3% in > 2nd CR and 86.7% for AML in 1st CR. The EFS for Allo-BMT in "good" and "poor" prognosis patients was 68.6% and 21.8%, respectively (p value = 0.001). Early mortality in Allo-BMT patients was 17.7% between 1985-1990 and 10.3% between 1991-1996. Early treatment-related organ complications occurred mostly in patients who underwent BMT from an unrelated or a mismatched family donor. Late toxicity was evaluated in 57 patients (median follow-up of 82 months): none of the patients complained of significant late cardiac or respiratory dysfunction. With regards to growth, 18/57 patients (31.6%) lost more than two height centile channels. Three cases of thyroid neoplasms were observed. Evaluation of psychosocial functioning, studied in 39 patients who had at least 2 years of follow-up in CR, did not reveal any evident quality of life impairment. The possibility of curing childhood hematological malignancies is based on a global pediatric and multidisciplinary approach. A continuous need to improve results in terms of EFS and quality of life suggests that further multicenter prospective studies should be carried out.

[Comparative study of 2 latex tests (rubalex and rubascan) with an immunoenzyme test (enzygnost-rubella) and a hemagglutination inhibition test for the study of anti-rubella antibodies]. / Studio comparativo di due tests al lattice (rubalex e rubascan) con un test immunoenzimatico (enzygnost-rubella) ed un test di inibizione dell' emoagglutinazione per la ricerca di anticorpi anti-rosolia.

Four different assays for detection of rubella IgG antibodies, two latex agglutination (Rubalex and Rubascan), one hemagglutination inhibition (HAI) and one enzyme-linked immunosorbent assay (ELISA IgG), were used to test 372 human serum samples. All samples were also tested with a rubella ELISA IgM test and all of them were found negative. The results obtained in 358 (96.2%) out of 372 samples tested were identical with all procedures. Inconclusive results were obtained in 14 (3.8%) specimens, in that there were positive and negative results for the different assays. These 14 specimens were sent to the Institute of Virology in Turku (Finland) and tested by using a hemolysis in gel and a non commercially-available ELISA IgG test. Results obtained with the two last tests were considered definitive. The two latex tests were found equal or better than HAI and ELISA IgG for sensitivity and specificity. Furthermore they were also cost effective and more simple to perform.

[IgM ISAGA test in the diagnosis of acute acquired Toxoplasma infections]. / Il test IgM ISAGA nella diagnosi di infezione toxoplasmica acuta acquista.

An immunoglobulin M immunosorbent agglutination assay (IgM ISAGA) was tested in 1804 outpatients' samples. The test was negative in all 1091 sera from individual negative in the total indirect immunofluorescence antibody (IFA tot) test and in the passive hemagglutination (HA) test and in 15 sera with inconclusive results in these two tests. The 698 sera positive in the IFA tot and HA tests were also tested with direct IgM enzyme-linked immunosorbent assay (IgM ELISA). The 74 sera positive in the IgM ISAGA and/or IgM ELISA were also tested in the IgM immunofluorescent (IgM IFA) test. These sera belong to 42 individuals, 26 of whom were followed for previous positive results in the IgM ELISA test. 51 samples (68.9%) were found positive in both IgM ISAGA and IgM ELISA tests. Only 13 (25.5%) of these 51 samples were found positive in the IgM IFA. 9 samples (12.2%) were positive only in the IgM ISAGA test. Conversely another 9 samples (12.2%) were positive only in the IgM ELISA test, performed on serum as well as on chromatographic IgM fraction. Finally five samples (6.7%) yielded false positive results in the IgM ELISA test, and three of them were found false positive also in the IgM IFA test. All these five samples in fact were found negative on IgM chromatographic fraction in both tests. In conclusion, IgM ISAGA appears to be more specific than direct IgM ELISA or IgM IFA test for the detection of Toxoplasma gondii IgM. Sensitivity of IgM ISAGA test seems to be as good as in the direct IgM ELISA and better than in the IgM IFA test for the diagnosis of acute acquired toxoplasma infection.

[The Sceptor system: relation of results from antibiograms in diffusion agar to MIC]. / Sistema Sceptor: confronto dei risultati degli antibiogrammi in agar diffusione rispetto alla MIC.

The Sceptor system and the susceptibility of Gram-positive cocci and Gram-negative rods to several antibiotics were presented. The accuracy of methicillin and gentamicin MIC of Staphylococcus aureus was determined. The MIC of methicillin-resistant strain was less than 8 mg/l. Finally the MIC accuracy to 29 Pseudomonas aeruginosa strains was compared with the results obtained by the standard disk diffusion method.

Incidence and outcome of pneumonia in patients with acute leukemia receiving first induction therapy with anthracycline-containing regimens.

BACKGROUND AND OBJECTIVES: Even though the risk of pneumonia is higher in patients with advanced disease, the potential risk of death is particularly relevant during induction therapy, when patients can be potentially cured of their hematologic disease: our study was aimed at evaluating the risk and outcome of pneumonia in these patients. DESIGN AND METHODS: We retrospectively studied all 458 patients affected by acute leukemia receiving an anthracycline-containing induction regimen in the years 1984-1989. RESULTS: Of the 458 patients, 109 (23.8%) developed pneumonia: 91 had acute myelogenous leukemia (AML) and 18 had acute lymphoblastic leukemia (ALL). At univariate analysis, advanced age, AML and total blast count significantly correlated with the risk of pneumonia. At multivariate analysis, only age (p< 0.0001) and total blast count (p=0.002) retained their prognostic significance. Pneumonia responded to treatment in 67 (61.5%) patients, while 42 (38.5%) patients died. Among patients with pneumonia, 51 (46.8%) patients achieved a complete remission: 9/18 ALL and 42/91 AML. At univariate analysis, the most significant determinant of a positive outcome was the achievement of complete remission; a higher absolute neutrophil count at the onset of pneumonia, the absence of rales, a single infiltrate and the absence of microbiological demonstration of infection were also related to a positive outcome. At multivariate analysis, the achievement of complete remission and, with borderline significance, a single infiltrate maintained their prognostic value. INTERPRETATION AND CONCLUSIONS: Pneumonia remains one of the most relevant risks of morbidity and mortality during induction therapy for acute leukemia. A fatal outcome is associated, in most cases, with a failure to achieve remission of leukemia.

Multiple types of Legionella pneumophila serogroup 6 in a hospital heated-water system associated with sporadic infections.

Five sporadic cases of nosocomial Legionnaires' disease were documented from 1989 to 1997 in a hospital in northern Italy. Two of them, which occurred in a 75-year-old man suffering from ischemic cardiopathy and in an 8-year-old girl suffering from acute leukemia, had fatal outcomes. Legionella pneumophila serogroup 6 was isolated from both patients and from hot-water samples taken at different sites in the hospital. These facts led us to consider the possibility that a single clone of L. pneumophila serogroup 6 had persisted in the hospital environment for 8 years and had caused sporadic infections. Comparison of clinical and environmental strains by monoclonal subtyping, macrorestriction analysis (MRA), and arbitrarily primed PCR (AP-PCR) showed that the strains were clustered into three different epidemiological types, of which only two types caused infection. An excellent correspondence between the MRA and AP-PCR results was observed, with both techniques having high discriminatory powers. However, it was not possible to differentiate the isolates by means of ribotyping and analysis of rrn operon polymorphism. Environmental strains that antigenically and chromosomally matched the infecting organism were present at the time of infection in hot-water samples taken from the ward where the patients had stayed. Interpretation of the temporal sequence of events on the basis of the typing results for clinical and environmental isolates enabled the identification of the ward where the patients became infected and the modes of transmission of Legionella infection. The long-term persistence in the hot-water system of different clones of L. pneumophila serogroup 6 indicates that repeated heat-based control measures were ineffective in eradicating the organism.

Febrile complications in the first 100 days after bone marrow transplantation in children: a single center's experience.

One hundred fifty-six episodes of fever occurred in 102 children during the first 100 days after bone marrow transplantation (BMT) performed at a single institution: fever of undetermined origin (FUO), 40.3%; septicemia, 7.1%; pneumonia, 19.2%; other infections, 33.4% of cases. The overall incidence of mortality was 22.6% and of mortality due to infections 17.4%. All FUO episodes resolved. Pneumonia was the major cause of death; 60% of recipients who developed pneumonia died, accounting for 90% of deaths attributable to febrile complications. Interstitial pneumonia, occurred rarely, in 3.9% of all febrile episodes. The Cox model showed that the presence of graft-versus-host disease (GVHD) was related to an approximately ninefold increase in the risk of a first episode of FUO (P value .03). The risk of developing pneumonia was fourfold greater in children who received a transplant from a matched unrelated donor or a mismatched family donor (P value .01). Developments in diagnostic tools are needed to diagnose febrile episodes earlier and more precisely with the aim of reducing early mortality after BMT.