Search Results (85)

Background: Acinetobacter, specifically A. baumannii, are becoming a great threat to hospitalized patients due to increasing antibiotic resistance. The aim of this study was to describe the epidemiology, clinical characteristics, antimicrobial susceptibility pattern and outcome of Acinetobacter infections in pediatric cancer patients and hematopoietic stem cell transplant (HSCT) recipients in Poland. Methods: A total of 125 episodes of Acinetobacter species infections were reported in patients <18 years treated in Polish pediatric hematology and oncology centers over a period from 2012 to 2023. Infections were subdivided into oncohematological disease (OHD) group (n = 106; 84.8%) and HSCT group (n = 19; 15.2%). Each episode represented a separate infection event; therefore, a patient who was infected more than once during the course of treatment was counted for each infection episode. Results: A. baumannii is the most common Acinetobacter species in all groups. The most common diagnoses in OHD group were acute lymphoblastic leukemia (ALL) (n = 32; 30.2%) and acute myeloid leukemia (AML) (n = 13; 12.3%). The most common underlying diseases that were indication for HSCT were hemophagocytic lymphohistiocytosis (n = 3; 15.8%) and neuroblastoma (n = 3; 15.8%). Mortality was significantly higher in the HSCT group compared to the OHD group. In the OHD group, deaths did not correlate with the type of antibiotic, with an exception for gentamicin, which correlated with higher mortality. In the HSCT group, deaths did not correlate with the type of antibiotic, except for levofloxacin that was correlated with a higher mortality rate. Conclusions: Acinetobacter infections are a great danger to immunocompromised patients. More research is needed in order to prevent and treat antibiotic-resistant bacteria. Full article

Background: Splenectomy remains necessary in selected oncologic and hematologic indications but is associated with significant postoperative morbidity and mortality. The data on outcomes in this high-risk population remain limited, particularly in mixed cohorts. Methods: We conducted a retrospective cohort study including all patients undergoing splenectomy for oncologic or hematologic causes between 2009 and 2022 at a cancer referral center. The primary outcomes were the occurrence of major complications at day 90 and the 1-year all-cause mortality. Multivariate logistic regression was used to identify independent predictors. Results: Among the 8503 ICU admissions from surgical wards, 204 splenectomies were performed; 179 patients were analyzed. The median age was 64 years, and 100 patients (55.9%) were female. Splenectomy was performed for hematologic malignancies in 76 cases (42.5%) and for oncologic causes in 103 cases (57.5%). Laparotomy was used in 154 cases (86.0%), and metastasectomy was performed in 54 patients (30.2%). At day 90, 86 patients (48.0%) developed a major complication: 12 deaths (6.7%), 44 surgical complications (24.6%), and 71 episodes of sepsis (39.7%). In a multivariate analysis, weight loss (OR 3.39, 95% CI [1.32–8.70], p = 0.011), laparotomy (OR 4.38 [1.09–17.60], p = 0.038), and a higher SAPS II score (OR 1.08 per point [1.03–1.13], p = 0.003) were associated with complications, while metastasectomy was protective (OR 0.23 [0.08–0.67], p = 0.007). At one year, the mortality reached 22.4%. Independent predictors of death were sepsis at one year (OR 5.04, 95% CI [1.30–25.96], p = 0.029), the Charlson Comorbidity Index (OR 1.30 per point, 95% CI [1.04–1.68], p = 0.030), invasive mechanical ventilation (OR 14.94, 95% CI [2.83–118.93], p = 0.003), and a performance status >1 (OR 7.84, 95% CI [2.38–27.75], p < 0.001). Encapsulated bacteria were not isolated; sepsis was mainly due to Gram-negative and enterococcal organisms. Conclusions: Splenectomy in onco-hematologic patients is associated with high rates of sepsis and mortality. In addition to surgical factors, frailty, immune status, and infection independently contribute to the patients’ outcomes. These results support risk-adapted perioperative strategies and long-term infectious surveillance in immunocompromised patients. Full article

Background: Sanger sequencing remains the gold standard for characterizing genetic variants in short DNA fragments (<700 bp). However, the increasing demand for short TATs and high sensitivities in variant detection, particularly in oncohematology, is driving the need for more efficient methods. Next-generation sequencing (NGS) has improved sensitivity and allows for the simultaneous analysis of multiple genes, but it is still costly and time-consuming. Consequently, Sanger sequencing continues to be widely used. In this study, we have compared Sanger sequencing with Oxford Nanopore technology (ONT), which offers enhanced sensitivity and faster sequencing, delivering diagnostic results within 24 h. Methods: This study involves 164 samples (for a total of 174 analyzed regions of interest) previously characterized using either Sanger sequencing or a next-generation sequencing (NGS) panel, categorized by their genetic alterations. Validation was conducted on 15 genes crucial for the diagnosis, prognosis, or identification of drug resistance in myeloproliferative neoplasms (MPN), myelodysplastic syndromes (MDS), acute myeloid leukemia (AML), and chronic myeloid leukemia (CML). The primary objective was to assess whether MinION could identify the same variants previously detected in these patients. Results and Conclusions: With a 99.43% concordance observed in our comparison, our results support the implementation of MinION technology in routine variant detection in MPN, MDS, AML, and CML cases due to its significant advantages over Sanger sequencing. Full article

Children with onco-hematological diseases require intensive medical treatments that can affect various aspects of their development. In addition to the disease itself, what influences the course of development most are the neurotoxic effects of therapies and frequent hospitalizations, especially if they occur in the first three years of the child’s life. Among these challenges there is the potential for language delay, a condition that can impact their communication abilities and overall development. Background/Objectives: The aim of this study is to examine communicative and linguistic development in a small group of young children diagnosed with different forms of leukemia, rhabdomyosarcoma, and CNS tumors, recruited through the Hematology–Oncology Clinic of the Department of Child and Woman Health (University of Padova). Methods: Child direct (Griffiths III, PinG, PCGO) and parent indirect assessments (PVB, ABAS-II, ASCB) were provided. Results: Griffiths communication subscale scores in children were mainly below average (55.6%), and 44.4% attested at the clinical level in ABAS-II, with the ability to understand being significantly higher than the production of words. However, the two levels of assertiveness–responsiveness obtained balance in 66.7% of cases, and using the Griffiths personal subscale, only 22.2% of children attested below average. Conclusions: Understanding and addressing children’s communication needs is crucial to improve the quality of life of these young patients and foster optimal communicative and linguistic development despite the obstacles they face in order to implement interventions designed specifically for this type of population and their respective families, if necessary. Full article

Background: Progress in the treatment of childhood oncological diseases has led to the prolonged survival of patients with this severe diagnosis. On the other hand, the prolonged chemotherapy courses that achieve this outcome also bring a number of complications, with acute kidney injury being one of them. Its occurrence in patients not only affects their quality of life but also prolongs and increases the cost of hospitalization, burdens the body with additional treatment, and impacts the ability to manage the underlying disease. Aim: The aim of this study is to determine the frequency of acute kidney injury among children hospitalized in the Pediatric Oncohematology Unit in Plovdiv during the period 2016–2020, as well as to identify the risk factors for its occurrence, its severity, and its dependence on tumor type, gender, and age. Patients and Methods: During the five-year period under review, a total of 213 newly diagnosed children with hematological diseases were admitted to our Pediatric Oncohematology Unit—122 boys and 91 girls. Results: Acute kidney injury was identified in 94 (44.1%) of the children—54 with solid tumors and 40 with malignant hemopathies. The main cause of acute kidney injury diagnosed was drug-induced nephrotoxicity, especially due to nephrotoxic chemotherapeutic agents. No statistically significant association was found between the type of tumor and the occurrence of acute kidney injury. Of the children with documented episodes of AKI, 11 were found to have CKD according to the KDIGO criteria. Conclusions: Acute kidney injury is a common complication that occurs during the medical treatment of children with malignant diseases. Full article

Background and Objectives: Platinum-resistant ovarian cancer (PROC) is associated with limited treatment options and poor outcomes, with median progression-free survival (PFS) and overall survival (OS) remaining suboptimal. Neutropenia, a common chemotherapy-related toxicity, has shown potential as a predictive biomarker for treatment efficacy in several malignancies, including ovarian cancer. However, its role as a prognostic marker, particularly baseline neutropenia, remains underexplored. This study aimed to evaluate the prognostic and predictive value of initial neutropenia and neutrophil dynamics in PROC patients undergoing chemotherapy. Materials and Methods: A retrospective cohort study was conducted on 250 PROC patients treated between 2018 and 2022 at the OncoHelp Medical Center, Timișoara, Romania. Patients were stratified into two groups based on baseline absolute neutrophil count (ANC), as those with initial neutropenia (ANC < 2000/mm³) and without initial neutropenia (ANC ≥ 2000/mm³). Clinical outcomes, including tumor response, PFS, and OS, were assessed using RECIST 1.1 criteria. Hematological toxicities and neutrophil dynamics across three chemotherapy cycles were analyzed. Results: Patients with baseline neutropenia demonstrated significantly higher tumor response rates (47.05% vs. 27.27%; p = 0.002), longer median PFS (8.2 vs. 6.3 months; p = 0.008), and extended median OS (14.5 vs. 11.2 months; p = 0.002). Hematological toxicities, including Grade ≥3 neutropenia and febrile neutropenia, were more frequent in the neutropenic group (p < 0.001). Baseline ANC thresholds effectively predicted clinical outcomes, with an AUC of 0.79 for OS. Conclusions: Baseline neutropenia is a significant prognostic marker in PROC, correlating with improved tumor response and survival outcomes despite increased hematological toxicities. These findings support incorporating baseline ANC into treatment personalization strategies for PROC. Full article

Background: Immunosuppressed patients still exhibit a high mortality rate due to SARS-CoV-2 infection, up to 21%. Persistent viral load replication and protracted viral symptoms result in a high risk of developing pneumonia, a potential risk of antiviral resistance, and a subsequent delay of onco-hematological treatments. Methods: Hematological patients and kidney transplant patients with SARS-CoV-2 infection, treated at GOM Niguarda Hospital (Milan) with combined antiviral therapy (remdesivir plus nirmatrelvir/ritonavir at standard doses) between November 2022 and March 2024, were retrospectively reviewed. Results: Thirty-four patients were analyzed. Twenty-four (71%) patients had pneumonia. The median duration of SARS-CoV-2 positivity before antiviral treatment was 40 (10–34) days. The median treatment duration was 11 (10–10) days. All patients went through clinical resolution. Thirteen patients were exposed to a new immune-chemotherapy cycle early after antiviral treatment (median 13, IQR 6–12 days), while five resumed a standard immunosuppressive regimen immediately after viral clearance. No relapse or recurrence of symptoms was reported for up to 226 (106–318) days of follow-up. Antiviral therapy was well tolerated, and no adverse events were observed. The 30-day overall survival was 94%, while the 90-day survival was 88%. No patient died of SARS-CoV-2 infection. Conclusions: The administration of nirmatrelvir/ritonavir and remdesivir lead to the complete resolution of SARS-CoV-2 pneumonia with no side effects in this cohort. The combination of these two antivirals may be a safe option in immunosuppressed population at risk of severe complications and prolonged SARS-CoV-2 infection in order to treat severe clinical presentation and to avoid viral recurrence after chemotherapy. Full article

Background: Bloodstream infections affect up to 20% of pediatric cancer patients receiving intensive care, contributing significantly to morbidity and mortality, with infection-related mortality rates reported to be as high as 16%. Methods: The identification of microorganisms directly from whole blood is difficult due to several factors, such as interference from host genomic material, low bacterial load, the endogenous components of whole blood and exogenous substances, which can interfere with the identification process. Nevertheless, rapid microbial diagnosis remains of paramount importance in these patients. Results and Conclusion: Here, we present the first case of bacterial pathogen identification directly from whole blood using MALDI-TOF mass spectrometry in an onco-hematological pediatric patient affected by sepsis and admitted to Bambino Gesù Children’s Hospital (IRCCS) in Rome, Italy. Full article

Background/Objectives: Platinum-resistant ovarian cancer (PROC) is a major therapeutic challenge, as it responds poorly to standard platinum-based treatment, has limited treatment options, and offers a generally unfavorable prognosis. Chemotherapeutic agents like pegylated liposomal doxorubicin (PLD), topotecan (TOPO), and gemcitabine (GEM) are used for this setting, but with varying efficacy and toxicity profiles, leading to an increasing need to understand the optimal balance between treatment effectiveness and tolerability for improving patient outcomes. This study evaluates the efficacy and side effects of PLD, TOPO, and GEM, focusing on progression-free survival (PFS), overall survival (OS), and safety profiles. Methods: We conducted a retrospective observational study that included 856 PROC patients treated with PLD (n = 383), TOPO (n = 352), or GEM (n = 121) at the OncoHelp Oncology Center from January 2018 to December 2023. Inclusion criteria encompass diagnosis, prior platinum therapy, and Eastern Cooperative Oncology Group (ECOG) status (0–2). Treatment protocols followed standard dosing, with adjustments for toxicity. Primary endpoints included PFS and OS, with safety assessed by incidence of grade 3 and 4 toxicities per CTCAE v5.0. Kaplan–Meier analysis and Cox regression were used to compare survival, and statistical significance was set at p < 0.05. Results: TOPO showed higher toxicity than PLD and GEM, including liver damage, hematological and non-hematological side effects, while PLD induced more skin toxicity. In terms of survival, minor differences were seen between the three chemotherapeutic agents, with a slight advantage for PLD for better disease control. Conclusions: Given the comparable results in OS across the regimens, treatment decisions should be based on other factors such as patient tolerance and quality of life. Full article

Introduction: Posaconazole is recommended for prophylaxis in pediatric immunocompromised patients. Due to its variability in bioavailability and drug-to-drug interactions, EBMT recommends regimens based on therapeutic drug monitoring (TDM). Materials and methods: In total, 171 oncohematological pediatric patients on posaconazole prophylaxis were included. Full pharmacokinetic posaconazole profiles were assessed in 51 children. The efficacy and safety of posaconazole was evaluated by measuring the drug concentration, with dose modification attempted in patients with suboptimal results. The influence of modifying factors on the posaconazole plasma concentration (PPC) was investigated. Results: An insufficient PPC was the main issue, but no significant increase in prophylaxis failure was reported. The modification of the dosage resulted in the optimization of PPC in 50% of patients. No significant correlation between age, gender, diagnosis or the posaconazole dosage and the PPC was found. HCT, total parenteral nutrition and diarrhea were associated with a lower PPC. Hypoalbuminemia was related to both higher and lower PPC. The concomitant administration of specified drugs significantly impacted the PPC. Conclusions: TDM allows the identification of patients receiving non-optimal treatment and offers an opportunity to improve the efficacy and safety of the therapy. However, further research involving larger patient groups and longer observation periods are needed to determine the optimal dosing and target PPC in pediatric patients. Full article

Multiple myeloma (MM) is a malignant disease characterized by the proliferation of plasma cells, primarily in the bone marrow. It accounts for approximately 1% of all cancers and 10% of hematologic malignancies. Clinical manifestations include hypercalcemia, anemia, renal failure, and bone lesions. The pathogenesis of MM involves complex interactions between myeloma cells and their microenvironment. Galectins, a family of β-galactoside-binding proteins, particularly galectin-1, -3, -4, -7, and -9, have been implicated in MM development. This study aimed to assess the plasma levels of these galectins in newly diagnosed MM patients and explore their correlation with clinical parameters. Peripheral blood samples were collected from patients at the Oncohematology Service of the Hospital de Câncer de Pernambuco, and galectin levels were measured using ELISA. Plasma levels of galectins-3, -7, and -9 were significantly higher in MM patients compared to the control group. Three clusters of MM patients were identified based on galectin plasma levels, with cluster 3, characterized by high levels of galectin-1, -4, and -7, being associated with a worse prognosis. A strong positive correlation was found between galectin-1, -4, and -7 levels and markers of kidney function (urea, creatinine, and β2-microglobulin), while negative correlations were observed with hematocrit and hemoglobin. Additionally, galectin-9 showed high accuracy in distinguishing MM patients from healthy controls (AUC = 0.931). Elevated galectin levels were indicative of disease aggressiveness and renal impairment in MM patients. Overall, our findings suggest that galectins-1, -4, -7, and -9 could serve as potential biomarkers for MM progression and severity, warranting further investigation into their utility in MM diagnosis and treatment. Full article

The clinical safety and efficacy of rituximab biosimilars compared to the reference rituximab (Mabthera) have been well established in randomized trials. However, concerns persist regarding the safety of changing from the reference product to biosimilars, and particularly between different biosimilars. This prospective multicenter observational study was conducted in 13 oncohematology units of eight Italian regions. The study included 800 patients with non-Hodgkin lymphoma (NHL) or chronic lymphocytic leukemia (CLL) who received rituximab between March 2018 and June 2022. To minimize survivorship bias, only newly diagnosed patients (i.e., those without prior rituximab treatment) were included in the analysis of adverse drug reactions (ADRs). Thus, this study focused on 505 incident cases (79.8% of the initial cohort) from 13 centers. A total of 3681 rituximab infusions were administered, and 16.8% of the patients experienced at least one ADR. These were observed most frequently during the first infusion (44 patients, 52%) and the second infusion (17 patients, 20%). The most frequent reactions were general disorders and administration site conditions (n. 50, 8% serious). These findings support the clinical safety of rituximab biosimilars and suggest that switching between biosimilars does not increase the risk of adverse events. This evidence may alleviate concerns about biosimilar use, potentially leading to broader acceptance and reduced healthcare costs. Full article

Background: JAK2 V617F is a somatic mutation associated with myeloproliferative neoplasms (MPNs) including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). In MPNs, this mutation is associated with the germline GGCC (46/1) haplotype. Several studies associated JAK2 haplotype GGCC_46/1 with some MPNs clinical parameters, but not one explore the link between JAK2 haplotype GGCC_46/1 and onco-drug resistance. Thus, we assessed for the JAK2 46/1 haplotype’s correlation with therapy response in JAK2 V617F-positive patients. Methods: Patients with MPN, selected by the Hematology Laboratory of “V. Fazzi” Hospital (LE), were analyzed with RLFP-PCR assay with rs10974944 SNP. Results: Results show how the majority of patients had PV (63%) or PMF (61%) and that 58% of patients who developed drug resistance had the C/G genotype, while only 11% had the G/G allele. While no direct correlation between JAK2 46/1 haplotype variants and drug resistance was found, the G/G allele was associated with disease progression to myelofibrosis and certain resistance-related clinical parameters (p = 0.002449, odds ratio = 3.701209). Conclusions: Although other analyses are required, due to the narrow cardinality of sample, our findings suggest how the G/G allele could be useful for MPNs diagnosis and for the prediction of the disease outcome. Full article

Objectives. Venous and arterial thromboembolism (VTE/ATE) often coexist with onco-hematologic diagnosis. This study aimed to assess the time relationship between the diagnosis of VTE/ATE and blood cancers. The second aim was to identify VTE/ATE risk factors related to the type of hematology disease and cardiac history. Methods. A total of 1283 patients underwent cardio-oncology evaluation at the Institute of Hematology and Transfusion Medicine in Warsaw from March 2021 through March 2023 (2 years), and 101 (7.8%) cases were identified with VTE/ATE. Results. ATE compared with VTE significantly occurred more often before the diagnosis and treatment of hematologic malignancy: 33/47 (70.2%) vs. 15/54 (27.8%), p < 0.0001. The risk of a VTE episode is exceptionally high in the first months after the diagnosis of an onco-hematological disease and the initiation of anticancer treatment. The higher frequency of VTE was associated with acute myeloid leukemia (17 cases/270 patients/6.30%/p = 0.055), acute lymphocytic leukemia (7 cases/76 patients/9.21%/p = 0.025), and chronic myeloproliferative disease (7 cases/48 patients/14.58%/p = 0.0003). Only the risk of VTE was significantly increased before (OR = 6.79; 95% CI: 1.85–24.95; p = 0.004) and after diagnosis of myeloproliferative disease (OR = 3.12; 95% CI: 1.06–9.16; p = 0.04). Conclusions. ATEs occur more often than VTE before a diagnosis of blood cancer. The risk of VTE is exceptionally high before and after diagnosis of chronic myeloproliferative disease. Full article

Background: Nowadays, Thoracic Surgery is technologically advanced; therefore, it also focuses its attention on nursing care. The aim of the study is to evaluate the effect of the assessment of a dedicated team of nurses (DTN) in all onco-hematological patients undergoing VATS lobectomy for lung cancer on the outcome of the patient, preventing pressure injuries, reducing perioperative stress, duration of operations, complications, and hospital stay times. Methods: We performed a single-center observational retrospective study, including 31 DTN and 760 onco-hematological patients who underwent thoracic surgery between 30 October 2018 and 30 June 2023 at “Vanvitelli” University of Naples. Results: DTN ensures good nursing care before, during, and after surgery. Operative time was reduced by approximately 20 min, decreasing hospital infections in the DNT period and reducing intraoperative complications such as bleeding and hospital costs (p < 0.05). Conclusions: Thoracic surgery nurses require more specialized training to adapt to the development of sophisticated. Full article