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1. National, longitudinal NASCITA birth cohort study: prevalence of overweight at 12 months of age in children born healthy

Author

Antonio Clavenna, Massimo Cartabia, Maurizio Bonati, Federico Marchetti, Giorgio Tamburlini, Antonio Addis, Michele Valente, Rita Campi, Stefania Manetti, Valeria Carraro, Sergio Conti Nibali, Renato Sansone, Patrizia Rogari, Annalisa Campomori, Luca De Fiore, Renata Bortolus, Sergio Cattani, Cristiana Piloni, Valeria Renzetti, Rosario Cavallo, Gherardo Rapisardi, Giacomo Toffol, Vicenza Briscioli, Carla Cafaro, Cristoforo Cocchiara, Isodiana Crupi, Patrizia Del Balzo, Laura Dell’edera, Chiara Di Francesco, Alberto Ferrando, Francesca Grassa, Chiara Guidoni, Claudio Mangialavori, Stefano Marinoni, Francesca Marongiu, Fausta Matera, Paolo Moretti, Laura Olimpi, Angela Pasinato, Ilaria Porro, Ippolita Roncoroni, Raffaella Schiro’, Patrizia Seppia, Federica Zanetto, Anna Aloisio, Elisabetta Anedda, Giuliana Apuzzo, Giovanna Argo, Anna Armenio, Emanuela Ballerini, Monica Benedetti, Daniela Bertoli, Stefano Bollettini, Chiara Bottalico, Aurora Bottiglieri, Vincenza Briscioli, Antonella Bruno, Laura Brusadin, Mariantonietta Caiazzo, Patrizia Calamita, Miriana Callegari, Rosaria Cambria, Maria Cristina Cantù, Domenico Capomolla, Anna Caracciolo, Maria Concetta Carbone, Gaetano Carrassi, Maria Laura Cartiglia, Sara Casagranda, Ornella Castiglione, Rosario Salvatore Cavallo, Teresa Cazzato, Maria Angela Cazzuffi, Jennifer Chiarolanza, Rosaria China, Nicoletta Cimadamore, Roberto Cionini, Cristina Ciuffo, Damiano Colazzo, Anna Maria Costantini, Claudio Cravidi, Marialuisa Criscione, Rita D’Agostino, Daniela Danieli, Luigi De Carlo, Marina De Sanctis, Giuseppina De Santes, Gian Piero Del Bono, Maria Elisabetta Di Pietro, Maria Chiara Dini, Paolo Fiammengo, Micaela Foco, Maria Teresa Fonte, Maria Frigeri, Andrea Galvagno, Matteo Gaudino, Stefania Genoni, Silvia Girotto, Gianluca Gornati, Marta Gozzi, Enrica Heritier, Antonella Lavagetto, Raffaele Limauro, Alessandra Magnelli, Maria Gabriella Maiolino, Monica Malventano, Silvia Marchi, Natale Maresca, Federico Marolla, Agata Martinelli, Chiara Martinez, Nicoletta Mascarello, Carla Matiotti, Elisabetta Mazzucchi, Donatella Moggia, Manuela Musetti, Paolo Nardini, Alberto Neri, Patrizia Neri, Flavia Nicoloso, Laura Maria Olimpi, Giancarlo Ottonello, Giacinta Padula, Paolo Maria Paganuzzi, Rosanna Palazzi, Alessandra Palmero, Maria Chiara Parisini, Giovannina Pastorelli, Marilena Pavoni, Lucia Peccarisi, Antonella Pellacani, Cristina Perrera, Michela Picciotti, Ivo Picotto, Tiziana Piunti, Francesca Preziosi, Giuseppe Primavera, Miriam Prodi, Maria Letizia Rabbone, Innocenza Rafele, Laura Reali, Franziska Stefanie Rempp, Ada Riundi, Paolo Rosas, Annarita Russo, Mariagrazia Saccà, Elisabetta Sala, Francesca Sala, Francesca Santus, Vittoria Sarno, Alessandra Savino, Raffaella Schirò, Giuseppa Scornavacca, Maria Francesca Siracusano, Adelisa Spalla, Gloria Sturaro, Maria Grazia Toma, Ettore Tomagra, Maria Tortorella, Fausta Trentadue, Marina Trevisan, Silvia Tulisso, Roberta Usella, Anna Valente, Mariangela Valera, Edda Vernile, Valeria Vicario, Lucia Vignutelli, Paolo Vinci, Lucia Vizziello, Rosette Zand, Marco Zanette, Graziano Zucchi, Maria Luisa Zuccolo, Eleonora Morabito, Chiara Liz Pandolfini, Chiara Segre’, Rossella Claudia Cannavo’, Melania Maria Cera, Emma Maria Giugnini, and Giovanni Giuliano Semprini

Subjects
Pediatrics, RJ1-570
Abstract

Objective To estimate the prevalence of overweight at 12 months in an Italian birth cohort and to identify factors related to an increased likelihood of being overweight.Methods The Italian NASCITA birth cohort was analysed. Infants were classified as underweight (

Published
2023
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2. Postpartum depression screening in mothers and fathers at well-child visits: a feasibility study within the NASCITA cohort

Author

Antonio Clavenna, Massimo Cartabia, Maurizio Bonati, Federico Marchetti, Giorgio Tamburlini, Antonio Addis, Michele Valente, Stefania Manetti, Valeria Carraro, Renato Sansone, Patrizia Rogari, Annalisa Campomori, Renata Bortolus, Sergio Cattani, Cristiana Piloni, Valeria Renzetti, Chiara Segré, Rosario Cavallo, Gherardo Rapisardi, Giacomo Toffol, Vicenza Briscioli, Carla Cafaro, Cristoforo Cocchiara, Isodiana Crupi, Laura Dell’edera, Alberto Ferrando, Francesca Grassa, Chiara Guidoni, Claudio Mangialavori, Stefano Marinoni, Francesca Marongiu, Fausta Matera, Paolo Moretti, Laura Olimpi, Angela Pasinato, Ilaria Porro, Ippolita Roncoroni, Raffaella Schiro’, Patrizia Seppia, Federica Zanetto, Anna Aloisio, Elisabetta Anedda, Giuliana Apuzzo, Giovanna Argo, Anna Armenio, Emanuela Ballerini, Monica Benedetti, Daniela Bertoli, Stefano Bollettini, Chiara Bottalico, Aurora Bottiglieri, Vincenza Briscioli, Antonella Bruno, Laura Brusadin, Mariantonietta Caiazzo, Patrizia Calamita, Miriana Callegari, Rosaria Cambria, Domenico Capomolla, Anna Caracciolo, Gaetano Carrassi, Sara Casagranda, Ornella Castiglione, Teresa Cazzato, Jennifer Chiarolanza, Rosaria China, Nicoletta Cimadamore, Roberto Cionini, Cristina Ciuffo, Damiano Colazzo, Claudio Cravidi, Marialuisa Criscione, Rita D’Agostino, Daniela Danieli, Paolo Fiammengo, Micaela Foco, Maria Frigeri, Andrea Galvagno, Matteo Gaudino, Stefania Genoni, Silvia Girotto, Gianluca Gornati, Marta Gozzi, Enrica Heritier, Antonella Lavagetto, Raffaele Limauro, Alessandra Magnelli, Monica Malventano, Silvia Marchi, Natale Maresca, Federico Marolla, Agata Martinelli, Chiara Martinez, Nicoletta Mascarello, Carla Matiotti, Elisabetta Mazzucchi, Donatella Moggia, Manuela Musetti, Paolo Nardini, Alberto Neri, Patrizia Neri, Flavia Nicoloso, Giancarlo Ottonello, Giacinta Padula, Rosanna Palazzi, Alessandra Palmero, Giovannina Pastorelli, Marilena Pavoni, Lucia Peccarisi, Antonella Pellacani, Cristina Perrera, Michela Picciotti, Ivo Picotto, Tiziana Piunti, Francesca Preziosi, Giuseppe Primavera, Miriam Prodi, Maria Letizia Rabbone, Innocenza Rafele, Laura Reali, Ada Riundi, Paolo Rosas, Annarita Russo, Mariagrazia Saccà, Elisabetta Sala, Francesca Sala, Francesca Santus, Vittoria Sarno, Alessandra Savino, Raffaella Schirò, Giuseppa Scornavacca, Giovanni GiulianoSemprini, Adelisa Spalla, Gloria Sturaro, Ettore Tomagra, Maria Tortorella, Fausta Trentadue, Marina Trevisan, Silvia Tulisso, Roberta Usella, Anna Valente, Mariangela Valera, Edda Vernile, Valeria Vicario, Lucia Vignutelli, Paolo Vinci, Lucia Vizziello, Rosette Zand, Marco Zanette, Graziano Zucchi, Giulia Segre, Luca DeFiore, Sergio ContiNibali, Patrizia DelBalzo, Chiara DiFrancesco, Rossella ClaudiaCannavò, Maria CristinaCantù, Maria ConcettaCarbone, Maria LauraCartiglia, Rosario SalvatoreCavallo, Maria AngelaCazzuffi, MelaniaMaria GiuseppinaCera, Anna MariaCostantini, Luigi DeCarlo, Marina DeSanctis, Giuseppina DeSantes, GianPiero DelBono, MariaElisabetta DiPietro, Maria ChiaraDini, Maria TeresaFonte, EmmaMaria LetiziaGiugnini, Maria GabriellaMaiolino, Laura MariaOlimpi, Paolo MariaPaganuzzi, Maria ChiaraParisini, Franziska StefanieRempp, Maria FrancescaSiracusano, Maria GraziaToma, and Maria LuisaZuccolo

Subjects
Medicine
Abstract

Objective To assess the feasibility of the family paediatrician’s (FP) role in identifying the signs of postpartum depression in parents in time to guarantee child well-being.Design, setting and participants Data for this observational prospective study were collected within the NASCITA (NAscere e creSCere in ITAlia) cohort. During the first visit, paediatricians collected sociodemographic data regarding the parents and information about their health status, the pregnancy and the delivery. Whooley questions were administered during the first and second visits (scheduled 60–90 days after childbirth). Moreover, on the third visit (5–7 months after childbirth) the FP was asked to answer ‘yes’ or ‘no’ to a question on the parental postpartum depression, based on his knowledge and on the acquired information.Results In 2203 couples who completed the assessment, 529 mothers (19.9%), 141 fathers (6.3%) and 110 (5%) couples reported any depressive symptomatology. Of these, 141 mothers (5.3% of the total sample) and 18 fathers (0.8% of the total sample) were classified as ‘likely depressed’. An association was found between maternal postnatal depressive symptoms and having a diagnosed psychiatric disorder during pregnancy (OR 9.49, 95% CI: 3.20 to 28.17), not exclusively breastfeeding at hospital discharge (OR 1.76, 95% CI: 1.19 to 2.61) and the presence of child sleeping disorders at 3 (OR 2.46, 95% CI: 1.41 to 4.28) and 6 months (OR 2.18, 95% CI: 1.37 to 3.47). Another significant predictor of postpartum depression was being primiparous (OR 1.99, 95% CI: 1.31 to 3.02). Concerning the fathers, a significant association was reported only between likely depressed fathers and child sleeping disorders at 3 months (OR 7.64, 95% CI: 2.92 to 19.97). Moreover, having a likely depressed partner was strongly associated with depressive symptoms in fathers (OR 85.53, 95% CI 26.83 to 272.69).Conclusions The findings of this study support the feasibility of an active screening programme for parental postnatal depression during well-child visits as an integral part of postpartum care.Trial registration number NCT03894566; Pre-results.

Published
2023
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3. National, longitudinal NASCITA birth cohort study to investigate the health of Italian children and potential influencing factors

Author

Antonio Clavenna, Massimo Cartabia, Maurizio Bonati, Federico Marchetti, Giorgio Tamburlini, Antonio Addis, Michele Valente, Rita Campi, Stefania Manetti, Valeria Carraro, Chiara Pandolfini, Sergio Conti Nibali, Renato Sansone, Patrizia Rogari, Annalisa Campomori, Luca De Fiore, Renata Bortolus, Sergio Cattani, Cristiana Piloni, Valeria Renzetti, Chiara Segré, Rosario Cavallo, Gherardo Rapisardi, Giacomo Toffol, Vicenza Briscioli, Carla Cafaro, Cristoforo Cocchiara, Isodiana Crupi, Patrizia Del Balzo, Laura Dell’edera, Chiara Di Francesco, Alberto Ferrando, Francesca Grassa, Chiara Guidoni, Claudio Mangialavori, Stefano Marinoni, Francesca Marongiu, Fausta Matera, Paolo Moretti, Laura Olimpi, Angela Pasinato, Ilaria Porro, Ippolita Roncoroni, Raffaella Schiro’, Patrizia Seppia, Federica Zanetto, Anna Aloisio, Elisabetta Anedda, Giuliana Apuzzo, Giovanna Argo, Anna Armenio, Emanuela Ballerini, Monica Benedetti, Daniela Bertoli, Stefano Bollettini, Chiara Bottalico, Aurora Bottiglieri, Vincenza Briscioli, Antonella Bruno, Laura Brusadin, Mariantonietta Caiazzo, Patrizia Calamita, Miriana Callegari, Rosaria Cambria, Rossella Claudia Cannavò, Maria Cristina Cantù, Domenico Capomolla, Anna Caracciolo, Maria Concetta Carbone, Gaetano Carrassi, Maria Laura Cartiglia, Sara Casagranda, Ornella Castiglione, Rosario Salvatore Cavallo, Teresa Cazzato, Maria Angela Cazzuffi, Melania MariaGiuseppina Cera, Jennifer Chiarolanza, Rosaria China, Nicoletta Cimadamore, Roberto Cionini, Cristina Ciuffo, Damiano Colazzo, Anna Maria Costantini, Claudio Cravidi, Marialuisa Criscione, Rita D’Agostino, Daniela Danieli, Luigi De Carlo, Marina De Sanctis, Giuseppina De Santes, Gian Piero Del Bono, Maria Elisabetta Di Pietro, Maria Chiara Dini, Paolo Fiammengo, Micaela Foco, Maria Teresa Fonte, Maria Frigeri, Andrea Galvagno, Matteo Gaudino, Stefania Genoni, Silvia Girotto, Emma MariaLetizia Giugnini, Gianluca Gornati, Marta Gozzi, Enrica Heritier, Antonella Lavagetto, Raffaele Limauro, Alessandra Magnelli, Maria Gabriella Maiolino, Monica Malventano, Silvia Marchi, Natale Maresca, Federico Marolla, Agata Martinelli, Chiara Martinez, Nicoletta Mascarello, Carla Matiotti, Elisabetta Mazzucchi, Donatella Moggia, Manuela Musetti, Paolo Nardini, Alberto Neri, Patrizia Neri, Flavia Nicoloso, Laura Maria Olimpi, Giancarlo Ottonello, Giacinta Padula, Paolo Maria Paganuzzi, Rosanna Palazzi, Alessandra Palmero, Maria Chiara Parisini, Giovannina Pastorelli, Marilena Pavoni, Lucia Peccarisi, Antonella Pellacani, Cristina Perrera, Michela Picciotti, Ivo Picotto, Tiziana Piunti, Francesca Preziosi, Giuseppe Primavera, Miriam Prodi, Maria Letizia Rabbone, Innocenza Rafele, Laura Reali, Franziska Stefanie Rempp, Ada Riundi, Paolo Rosas, Annarita Russo, Mariagrazia Saccà, Elisabetta Sala, Francesca Sala, Francesca Santus, Vittoria Sarno, Alessandra Savino, Raffaella Schirò, Giuseppa Scornavacca, Giovanni GiulianoSemprini, Maria Francesca Siracusano, Adelisa Spalla, Gloria Sturaro, Maria Grazia Toma, Ettore Tomagra, Maria Tortorella, Fausta Trentadue, Marina Trevisan, Silvia Tulisso, Roberta Usella, Anna Valente, Mariangela Valera, Edda Vernile, Valeria Vicario, Lucia Vignutelli, Paolo Vinci, Lucia Vizziello, Rosette Zand, Marco Zanette, Graziano Zucchi, and Maria Luisa Zuccolo

Subjects
Medicine
Abstract

Purpose The NASCITA Study, a national-level, population-based, prospective cohort study, was set up to better understand the early health status of Italian children, comprising their physical, cognitive and psychological development, and how it is affected by social and health determinants, including nurturing care. NASCITA will also assess geographical differences and disparities in healthcare.Participants Participating family paediatricians from throughout Italy enrolled infants born during the enrolment period (April 2019–July 2020). The 5054 newborns seen by the 139 paediatricians for at least two visits, including the first well-child visit, and for whom parental consent was given, make up the baseline population.Findings to date Mothers had a mean age at delivery of 33.0 years and tended to have a high or medium level of education (42.5% university and 41.7% high school degrees) and to be employed (69.7%). One-third (36.1%) took folic acid supplementation appropriately, and 6.5% smoked or consumed alcohol (10.0%) during pregnancy. One-third (31.7%) of deliveries were caesarean deliveries. Concerning the newborns, 5.8% had a low birth weight and 6.2% were born prematurely. The majority (87.7%) slept in the supine position, and 63.6% were exclusively breast fed at 1 month, with a decreasing north to south prevalence (χ2t 52; p

Published
2022
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4. Rationale for a pediatric-inspired approach in the adolescent and young adult population with acute lymphoblastic leukemia, with a focus on asparaginase treatment

Author

Carmelo Rizzari, Maria Caterina Putti, Antonella Colombini, Sara Casagranda, Giulia Maria Ferrari, Cristina Papayannidis, Ilaria Iacobucci, Maria Chiara Abbenante, Chiara Sartor, and Giovanni Martinelli

Subjects
asparaginase, acute lymphoblastic leukemia, adolescent, young adult, Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

In the last two decades great improvements have been made in the treatment of childhood acute lymphoblastic leukemia, with 5-year overall survival rates currently approaching almost 90%. In comparison, results reported in adolescents and young adults (AYAs) are relatively poor. In adults, results have improved, but are still lagging behind those obtained in children. Possible reasons for this different pattern of results include an increased incidence of unfavorable and a decreased incidence of favorable cytogenetic abnormalities in AYAs compared with children. Furthermore, in AYAs less intensive treatments (especially lower cumulative doses of drugs such as asparaginase, corticosteroids and methotrexate) and longer gaps between courses of chemotherapy are planned compared to those in children. However, although favorable results obtained in AYAs receiving pediatric protocols have been consistently reported in several international collaborative trials, physicians must also be aware of the specific toxicity pattern associated with increased success in AYAs, since an excess of toxicity may compromise overall treatment schedule intensity. Cooperative efforts between pediatric and adult hematologists in designing specific protocols for AYAs are warranted.

Published
2014
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5. Iron Overload Following Hematopoietic Stem Cell Transplantation: Prevalence, Severity, and Management in Children and Adolescents with Malignant and Nonmalignant Diseases

Author

Alessandro Cattoni, Giulia Capitoli, Sara Casagranda, Paola Corti, Marta Adavastro, Alessandro Molinaro, Filiberto Di Gennaro, Sonia Bonanomi, Andrea Biondi, Stefania Galimberti, Adriana Balduzzi, Cattoni, A, Capitoli, G, Casagranda, S, Corti, P, Adavastro, M, Molinaro, A, Gennaro, F, Bonanomi, S, Biondi, A, Galimberti, S, and Balduzzi, A

Subjects
Hemopoietic stem cell transplantation, Transplantation, Molecular Medicine, Immunology and Allergy, Iron overload, Cell Biology, Hematology, Long-term transplantation-related complication, Childhood
Abstract

Iron overload (IOL) is a frequently reported complication following hematopoietic stem cell transplantation (HSCT) that has been investigated extensively in the field of hemoglobinopathies but has not been thoroughly characterized after HSCT in pediatric malignancies. Our aim was to assess prevalence, severity, risk factors, and management of IOL, as defined using biochemical (serum ferritin) and radiologic tools (T2*-weighted magnetic resonance imaging [MRI]), in a cohort of pediatric patients who underwent HSCT for either malignant or benign diseases. This monocentric, retrospective, observational study included all the 163 patients alive and in continuous remission at 24 months post-HSCT out of the 219 consecutive children and adolescents who underwent HSCT at our institution between 2012 and 2018, were included in the study. IOL was classified into 4 categories: absent, mild, moderate, and severe. Among the 163 patients, 73% had some degree of IOL (mild in 37%, moderate in 29%, and severe in 7%). Moderate/severe IOL was more frequent among patients diagnosed with a malignant disease versus those with a benign disease (43% versus 19%; P =.0065). Trend lines for serum ferritin showed a “bell-shaped” distribution, with the highest levels recorded during the first 6 months post-HSCT, followed by a spontaneous reduction. Both pre-HSCT (1659 ng/mL versus 617 ng/mL; P

Published
2023

6. Acute myeloid leukemia in Baraitser-Winter cerebrofrontofacial syndrome

Author

Marco Spinelli, Paola Cianci, Grazia Fazio, Sara Casagranda, Carmelo Rizzari, Angelo Selicorni, Gianni Cazzaniga, Cianci, P, Fazio, G, Casagranda, S, Spinelli, M, Rizzari, C, Cazzaniga, G, and Selicorni, A

Subjects
0301 basic medicine, Lissencephaly, 030105 genetics & heredity, acute myeloid leukemia, Cutaneous lymphoma, Translocation, Genetic, Craniofacial Abnormalities, 03 medical and health sciences, Electrocardiography, Young Adult, Acute lymphocytic leukemia, Intellectual Disability, Antineoplastic Combined Chemotherapy Protocols, Genetics, Medicine, Missense mutation, craniofrontofacial syndrome, Humans, Abnormalities, Multiple, ACTG1 gene, Genetic Testing, ACTB gene, Genetics (clinical), Genetic testing, Comparative Genomic Hybridization, ACTG1, Epilepsy, medicine.diagnostic_test, craniofrontofacial syndromes, business.industry, Baraitser–Winter malformation syndrome, Myeloid leukemia, Fryns–Aftimos syndrome, Brain, Facies, Baraitser-Winter malformation syndrome, Bone Marrow Examination, medicine.disease, Magnetic Resonance Imaging, Bone marrow examination, Leukemia, Myeloid, Acute, Treatment Outcome, Fryns-Aftimos syndrome, Immunology, Mutation, Female, business
Abstract

Baraitser-Winter malformation syndrome (BWMS), Fryns-Aftimos syndrome (FA), and craniofrontofacial syndromes (CFFs) have all been recently proposed to be part of the same phenotypic spectrum of Baraitser-Winter cerebrofrontofacial syndrome (BWCFF), which is characterized by facial dysmorphism, ocular coloboma, brain malformations, and intellectual disabilities. In addition to that, the recent discovery of missense mutations in one of the two ubiquitously expressed cytoplasmic β- and γ-acting-encoding genes ACTB (7p22.1) and ACTG1 (17q25.3) in patients carrying a clinical diagnosis of BWSM, FA, or CCF has provided further evidence that these clinical conditions do indeed belong to the same entity at the molecular level. Two cases of BWCFF patients presenting with malignancies (i.e., acute lymphocytic leukemia and cutaneous lymphoma) have been published thus far. Here, we report a 21-year-old female with molecularly confirmed FA, who developed acute myeloid leukemia (AML). The present finding may indicate that actinopathies could be cancer-predisposing syndromes although small numbers and publication bias should be taken into account. © 2016 Wiley Periodicals, Inc.

Published
2016

7. Iron Overload after Hematopoietic Stem Cell Transplantation

Author

Attilio Rovelli, Corti Paola, Adriana Balduzzi, Stefania Galimberti, Fabio Pavan, Nicoletta Masera, Sara Casagranda, Maria Chiara Magri, and Sonia Bonanomi

Subjects
medicine.medical_specialty, Univariate analysis, Blood transfusion, medicine.diagnostic_test, biology, business.industry, Anemia, medicine.medical_treatment, Immunology, Deferasirox, Cell Biology, Hematology, Hematopoietic stem cell transplantation, medicine.disease, Biochemistry, Gastroenterology, Ferritin, Internal medicine, Liver biopsy, medicine, biology.protein, Complication, business, medicine.drug
Abstract

Introduction Iron overload (IOL) is a common complication after HSCT, mainly due to iterative red blood cell (RBC) transfusions with other mechanisms as ineffective erythropoiesis or dysregulation of hepcidin possibly contributing. IOL prevalence is estimated as 30-60% in adults transplanted for hematological malignancies, but few data are available in pediatric malignancies. Patients and Methods All patients (pts) undergoing allogenic HSCT between January 2012 and December 2016 in our institution, who were alive and in continuous complete remission at the last follow-up were included in the study and evaluated for post-HSCT IOL. Follow-up was updated as of 31 May 2018. 109 pts who fulfilled the inclusion criteria were included in the study. Pts characteristics are shown in Table 1. Overall pts affected with malignancies were 77 (71%) and with non malignancies were 32 (29%). IOL was initially assessed using serum ferritin pre and post HSCT, considered as maximum and minimum stable ferritin, defined respectively as the highest value of ferritin detected anytime after HSCT and the last ferritin value detected after HSCT and before starting IOL therapy in pts treated or the minimum ferritin value closer to 12 months after HSCT in pts never treated for IOL. In pts with a minimum stable ferritin >500 ng/mL, LIC was assessed by MRI-T2* or SQUID in younger pts who would have needed sedation to underwent MRI. Liver biopsy was performed in case of liver abnormalities. Imaging to detect IOL was not planned in pts with expected low compliance or when serum ferritin was lowest. These pts were classified according to their minimum stable ferritin values < or ≥ 1000 ng/mL. IOL was defined for all pts with a T2* value ≤3.8 msec or a LIC by SQUID >1000 μgFe/g liver ww or, in pts without imaging for IOL, with a minimum stable ferritin value ≥1000 ng/mL. For liver biopsy, IOL was assessed by Deugnier's score. A phlebotomy program was proposed to all pts with any grade of IOL. In pts with venous access difficulties, anemia or early severe IOL treatment with iron chelator (deferasirox or deferoxamine) was performed. Results Statistically significant differences between malignancies and non malignancies were found in terms of median number of pre-HSCT RBC transfusions (11 vs 7, p 0.002), median pre-HSCT ferritin (1490 vs 643 ng/mL, p Overall 71 pts have been investigated for IOL (65%) by MRI (64), SQUID (3) or liver biopsy (4). Prevalence of moderate-severe IOL was 37% (42% in malignancies and 25 % in non malignancies). Among the 38 pts who did not performed IOL assessment with instrumental evaluation, 25% of the malignancies group and 47% of the non malignancies group had a minimum stable ferritin The proportion of pts undergoing IOL assessment (by MRI, SQUID or liver biopsy) was significantly higher in pts with malignancies (72%) compared with non malignancies (47%, p 0.02). 81% of the pts with any grade of IOL have been treated. 51 pts (43 malignancies and 8 non malignancies) underwent phlebotomies, 10 (8 malignancies and 2 non malignancies) were treated with iron chelators and 5 (all malignancies) received both treatments after HSCT. Main side effects of phlebotomies were hypotension and difficult venous accesses. Few pts treated with iron chelator had drug-related side effects, mainly related with renal tubular function impairment, which was transient and rapidly reverted after drug discontinuation. Furthermore, factors significantly associated with IOL were: 1) in univariate analysis: age at HSCT> 10 years (odds ratio (OR) 3.63, 95% confidence intervaI (CI) 1.61-8.5, p 0.002), total number of RBC transfusion > 20 (OR 10.47, 95%CI 4.09-29.19, p10 compared with younger age (OR 4.02, 95% CI 1.49-11.8, p= 0.007) and RBC transfusion >20 (OR 10.83, 95% CI 4-32.7, p Conclusion IOL is a frequent complication post HSCT, even among children affected with malignancies. In our series the iron burden was worse for older pts and highly transfused. IOL is assessed by MRI-T2*. The minimum stable serum ferritin, approximately 1 year after HSCT and after, can be used to monitor IOL treatment. Phlebotomy is a well tolerated therapy but also pharmacological approaches could be safely used. Disclosures No relevant conflicts of interest to declare.

Published
2018
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8. Rationale for a Pediatric-Inspired Approach in the Adolescent and Young Adult Population with Acute Lymphoblastic Leukemia, with a Focus on Asparaginase Treatment

Author

Sara Casagranda, Ilaria Iacobucci, Maria Chiara Abbenante, Maria Caterina Putti, Chiara Sartor, Carmelo Rizzari, Giulia Maria Ferrari, Giovanni Martinelli, Cristina Papayannidis, Antonella Colombini, Rizzari, C, Putti, Mc, Colombini, A, Casagranda, S, Ferrari, Gm, Papayannidis, C, Iacobucci, I, Abbenante, Mc, Sartor, C, Martinelli, G, Putti, M, Ferrari, G, and Abbenante, M

Subjects
Pediatrics, medicine.medical_specialty, Asparaginase, medicine.medical_treatment, Lymphoblastic Leukemia, Population, Review, acute lymphoblastic leukemia, chemistry.chemical_compound, medicine, Young adult, education, Childhood Acute Lymphoblastic Leukemia, Chemotherapy, education.field_of_study, lcsh:RC633-647.5, business.industry, asparaginase, acute lymphoblastic leukemia, adolescent, young adult, Incidence (epidemiology), acute lymphoblastic leukemia, pediatric, asparaginase, lcsh:Diseases of the blood and blood-forming organs, Hematology, asparaginase, humanities, chemistry, adolescent, young adult, Methotrexate, business, medicine.drug
Abstract

In the last two decades great improvements have been made in the treatment of childhood acute lymphoblastic leukemia, with 5-year overall survival rates currently approaching almost 90%. In comparison, results reported in adolescents and young adults (AYAs) are relatively poor. In adults, results have improved, but are still lagging behind those obtained in children. Possible reasons for this different pattern of results include an increased incidence of unfavorable and a decreased incidence of favorable cytogenetic abnormalities in AYAs compared with children. Furthermore, in AYAs less intensive treatments (especially lower cumulative doses of drugs such as asparaginase, corticosteroids and methotrexate) and longer gaps between courses of chemotherapy are planned compared to those in children. However, although favorable results obtained in AYAs receiving pediatric protocols have been consistently reported in several international collaborative trials, physicians must also be aware of the specific toxicity pattern associated with increased success in AYAs, since an excess of toxicity may compromise overall treatment schedule intensity. Cooperative efforts between pediatric and adult hematologists in designing specific protocols for AYAs are warranted.

Published
2014
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