Publications by authors named "Giulia Prunotto"

12 Publications

  • Page 1 of 1

Correction: ABO incompatibile graft management in pediatric transplantation.

Bone Marrow Transplant 2021 Jan;56(1):297

Hospital for Children and Adolescents, Stammzelltransplantation und Immunologie, Klinik für Kinder- und Jugendmedizin, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany.

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http://dx.doi.org/10.1038/s41409-020-01012-zDOI Listing
January 2021

ABO incompatibile graft management in pediatric transplantation.

Bone Marrow Transplant 2021 Jan 27;56(1):84-90. Epub 2020 Jun 27.

Hospital for Children and Adolescents, Stammzelltransplantation und Immunologie, Klinik für Kinder- und Jugendmedizin, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany.

Up to 40% of donor-recipient pairs in SCT have some degree of ABO incompatibility, which may cause severe complications. The aim of this study was to describe available options and survey current practices by means of a questionnaire circulated within the EBMT Pediatric Diseases Working Party investigators. Major ABO incompatibility (donor's RBCs have antigens missing on the recipient's cell surface, towards which the recipient has circulating isohemagglutinins) requires most frequently an intervention in case of bone marrow grafts, as immediate or delayed hemolysis, delayed erythropoiesis and pure red cell aplasia may occur. RBC depletion from the graft (82%), recipient plasma-exchange (14%) were the most common practices, according to the survey. Graft manipulation is rarely needed in mobilized peripheral blood grafts. In case of minor incompatible grafts (donor has isohemagglutinins directed against recipient RBC antigens), isohemagglutinin depletion from the graft by plasma reduction/centrifugation may be considered, but acute tolerability of minor incompatible grafts is rarely an issue. According to the survey, minor ABO incompatibility was either managed by means of plasma removal from the graft, especially when isohemagglutinin titer was above a certain threshold, or led to no intervention at all (41%). Advantages and disadvantages of each method are discussed.
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http://dx.doi.org/10.1038/s41409-020-0981-7DOI Listing
January 2021

HSCT provides effective treatment for lymphoproliferative disorders in children with primary immunodeficiency.

J Allergy Clin Immunol 2020 08 1;146(2):447-450. Epub 2020 May 1.

BMT Department, Great Ormond Street Hospital NHS Trust, London, United Kingdom. Electronic address:

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http://dx.doi.org/10.1016/j.jaci.2020.03.043DOI Listing
August 2020

Hepatic focal nodular hyperplasia after pediatric hematopoietic stem cell transplantation: The impact of hormonal replacement therapy and iron overload.

Pediatr Blood Cancer 2020 04 30;67(4):e28137. Epub 2019 Dec 30.

Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy.

Background: The advent of techniques for the assessment of iron overload (liver T2*-MRI) has led to the awareness that focal nodular hyperplasia (FNH) represents a possible incidental finding after hematopoietic stem cell transplantation (HSCT), though its pathogenesis is still unclear.

Methods: We performed a retrospective analysis of the liver T2*-MRI scans performed between 2013 and 2018 in a single pediatric HSCT Unit and recorded the number of patients with FNH (group A). Patients incidentally diagnosed with FNH at imaging performed for different clinical indications were included in group B.

Results: Nine of 105 (8.6%) patients from group A were diagnosed with FNH. Group B included three patients. Overall, 12 patients were diagnosed 4.4 ± 3.1 years after HSCT. At univariate analysis, female gender (odds ratio [OR] 3.77, P = .03), moderate-to-severe iron overload (OR 6.97, P = .01), and hormone replacement therapy (HRT) administered for at least 6 months (OR 18.20, P = .0002) exposed patients to a higher risk of developing FNH. The detrimental effect of HRT was significant also at multivariate analysis (OR 7.93, P = .024). MRI-T2* values in affected patients were statistically lower than healthy controls (P < .001).

Conclusions: We confirm the high incidence of FNH among transplanted pediatric patients and demonstrate the potential pathogenic role of HRT and iron overload.
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http://dx.doi.org/10.1002/pbc.28137DOI Listing
April 2020

Should Posterior Reversible Encephalopathy Syndrome Be Mainly Considered an Epileptic Disorder? Results of a Sequential Neurophysiological Study in a Pediatric Cohort.

Neuropediatrics 2017 Apr 28;48(2):72-78. Epub 2017 Feb 28.

BMT Unit, Department of Pediatrics, MBBM Foundation, Monza, Italy.

Despite a wide number of studies trying to define clinical, physiopathological, and neuroradiological features of posterior reversible encephalopathy syndrome (PRES), the true nature of symptoms is still not fully understood. We studied a standard cohort of 24 pediatric patients, affected by hemato-oncological diseases, with a neuroradiological diagnosis consistent with PRES identified from 2006 to 2013. Ten of them developed PRES after hematopoietic stem cell transplantation. We analyzed the sequence of clinical, radiological, and electrophysiological data. In all the patients who were recorded at the onset of the first symptoms, electroencephalograms showed focal nonconvulsive seizures or status epilepticus (SE). We found a sensitivity of 100% for electroencephalogram (EEG) with a good correlation between clinical signs and the localization of seizures, whereas computed tomography scans showed a sensitivity of 50% only. Following prompt treatment, intensive care unit admission rate was only 8%. PRES is a multifactorial neurologic event with focal nonconvulsive seizures or SE as the main feature in pediatric patients. Clinical manifestations are epileptic in nature, and prompt EEG recording is useful for diagnosis and supports an earlier treatment, potentially preventing the appearance of complications such as generalized seizures or refractory SE.
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http://dx.doi.org/10.1055/s-0037-1598251DOI Listing
April 2017

Pentraxin 3 plasma levels at graft-versus-host disease onset predict disease severity and response to therapy in children given haematopoietic stem cell transplantation.

Oncotarget 2016 Dec;7(50):82123-82138

"M. Tettamanti" Research Center, Pediatric Department, University of Milano-Bicocca, Monza, Italy.

Acute Graft-versus-Host Disease (GvHD) remains a major complication of allogeneic haematopoietic stem cell transplantation, with a significant proportion of patients failing to respond to first-line systemic corticosteroids. Reliable biomarkers predicting disease severity and response to treatment are warranted to improve its management. Thus, we sought to determine whether pentraxin 3 (PTX3), an acute-phase protein produced locally at the site of inflammation, could represent a novel acute GvHD biomarker. Using a murine model of the disease, we found increased PTX3 plasma levels after irradiation and at GvHD onset. Similarly, plasma PTX3 was enhanced in 115 pediatric patients on day of transplantation, likely due to conditioning, and at GvHD onset in patients experiencing clinical symptoms of the disease. PTX3 was also found increased in skin and colon biopsies from patients with active disease. Furthermore, PTX3 plasma levels at GvHD onset were predictive of disease outcome since they resulted significantly higher in both severe and therapy-unresponsive patients. Multiple injections of rhPTX3 in the murine model of GvHD did not influence the disease course. Taken together, our results indicate that PTX3 constitutes a biomarker of GvHD severity and therapy response useful to tailor treatment intensity according to early risk-stratification of GvHD patients.
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http://dx.doi.org/10.18632/oncotarget.13488DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347680PMC
December 2016

The diagnosis of posterior reversible encephalopathy syndrome.

Lancet Neurol 2015 Nov;14(11):1073-4

BMT Unit, Pediatric Department, Milano-Bicocca University, MBBM Foundation, Monza, Italy.

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http://dx.doi.org/10.1016/S1474-4422(15)00254-9DOI Listing
November 2015

Two cases of hepatic adenomas in patients with Wolf-Hirschhorn syndrome: a new rare complication?

Am J Med Genet A 2013 Jul 21;161A(7):1759-62. Epub 2013 May 21.

Pediatric Genetic Unit, Pediatric Department of Monza Brianza per il Bambino e la sua Mamma (MBBM) Foundation, S.Gerardo Hospital, Monza, Italy.

Wolf-Hirschhorn syndrome (WHS) is a rare microdeletion syndrome associated with a characteristic facial appearance, failure to thrive, psychomotor delays, and various major malformations of internal organs; many medical complications have been described (feeding difficulties, epilepsy, hearing problems). Benign or malignant oncologic problems are not a typical feature of the natural history of these patients. We report on two patients with WHS patients in whom hepatic adenoma (HA) were diagnosed during adolescence. The clinical evolution of liver involvement was different between the two. We discuss the possibility of considering HA as a rare medical problem in the follow-up of WHS patients. © 2013 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ajmg.a.35966DOI Listing
July 2013

Impact of viral infections in children with community-acquired pneumonia: results of a study of 17 respiratory viruses.

Influenza Other Respir Viruses 2013 Jan 13;7(1):18-26. Epub 2012 Feb 13.

Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Background: Little is known about the prevalence of viral infections in children with community-acquired pneumonia (CAP).

Objectives: To describe the clinical and virological data collected from children with radiographically confirmed CAP in whom 17 respiratory viruses were sought in respiratory secretion samples during the acute phase of the disease.

Patients And Methods: The study involved 592 children with radiographically confirmed CAP whose respiratory secretion samples were tested using the Luminex xTAG Respiratory Virus Panel Fast assay, which simultaneously detects influenza A virus, influenza B virus, respiratory syncytial virus (RSV)-A and -B, parainfluenzavirus-1, -2, -3, and -4, adenovirus, human metapneumovirus, coronaviruses 229E, NL63, OC43, and HKU1, enterovirus/rhinovirus, and bocavirus. A real-time PCR assay was used to identify the rhinovirus in the enterovirus/rhinovirus-positive samples.

Results: A total of 435 children (73·5%) were positive for at least one virus: the most frequently detected was RSV, which was found in 188 (31·7%), followed by rhinovirus (n = 144, 24·3%), bocavirus (n = 60, 10·1%), influenza viruses (n = 57, 9·6), and hMPV (n = 49, 8·2%). Viral co-infections were found in 117 children (19·7% of the enrolled children; 26·9% of those with viral infections). Marginal differences were found between the infections owing to a single virus. Co-infections showed radiographic evidence of alveolar pneumonia significantly more frequently than single infections (OR 1·72, 95% CI 1·05-2·81).

Conclusions: The findings of this study highlight the importance of respiratory viruses (mainly RSV and rhinovirus) in children with CAP and show the characteristics of both the single infections and co-infections associated with the disease.
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http://dx.doi.org/10.1111/j.1750-2659.2012.00340.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5780730PMC
January 2013

Knowledge of malaria among women of Burundi and its impact on the incidence of the disease.

J Trop Pediatr 2012 Aug 11;58(4):258-62. Epub 2011 Oct 11.

Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

In order to investigate whether the persistently high incidence of malaria in Burundi is due to a lack of knowledge of the disease, mothers of children admitted to the hospital of Kiremba in Burundi were anonymously administered a semi-structured questionnaire about malaria. A total of 539 questionnaires were evaluated. About 75% of the women knew that malaria is transmitted by mosquitoes, and respectively 58.3 and 23.9% knew that it could lead to the death of a fetus or a low birth weight. Fewer than half of the women (44.7%) knew that malaria can be definitely diagnosed by means of a blood examination and only 39.7% indicates that artesunate-amodiaquine was the first-line therapy recommended by the Burundian health authorities. Long-lasting insecticidal or insecticide-treated nets were used by only 33.0%. Burundian women generally know little about malaria. Public awareness programmes should be conducted before any malaria control initiatives are planned.
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http://dx.doi.org/10.1093/tropej/fmr089DOI Listing
August 2012

Immunogenicity and safety of intradermal influenza vaccine in children.

Vaccine 2011 Oct 17;29(44):7606-10. Epub 2011 Aug 17.

Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy.

In order to compare the immunogenicity and safety of different doses of trivalent influenza vaccine (TIV) administered intradermallly (ID) with those evoked by a full dose of intramuscular (IM) virosomal-adjuvanted influenza vaccine (VA-TIV), 112 previously primed healthy children aged ≥ 3 years were randomised to receive 9 μg or 15 μg of each strain of ID-TIV, or a full IM dose (15 μg of each strain) of VA-TIV. The A/H1N1 and A/H3N2 seroconversion and seroprotection rates were ≥ 90% and geometric mean titres (GMTs) increased 3.2-14.9 times without any statistically significant between-group differences; however, the seroconversion and seroprotection rates against the B strain were significantly higher in the children receiving either ID-TIV dose (p<0.05) without any differences between them. GMT against B virus was significantly higher in the children receiving the highest dose (p<0.05). Local reactions were significantly more common among the children receiving either ID-TIV dose (p<0.05), but systemic reactions were relatively uncommon in all three groups. Our findings suggest that ID-TIV with 15 μg of each viral antigen can confer a significant better protection against influenza than that obtained with the same dose of IM TIV in already primed children aged ≥ 3 years with an acceptable safety profile. The lower dose of ID-TIV needs further evaluation to analyze persistence of protection.
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http://dx.doi.org/10.1016/j.vaccine.2011.08.021DOI Listing
October 2011

Pandemic influenza A/H1N1 vaccine administered sequentially or simultaneously with seasonal influenza vaccine to HIV-infected children and adolescents.

Vaccine 2011 Feb 1;29(8):1677-82. Epub 2011 Jan 1.

Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy.

In order to evaluate the immunogenicity, safety and tolerability of the 2009 A/H1N1 MF59-adjuvanted influenza vaccine administered sequentially or simultaneously with seasonal virosomal-adjuvanted influenza vaccine to HIV-infected children and adolescents, 36 HIV-infected children and adolescents, and 36 age- and gender-matched healthy controls were randomised 1:1 to receive the pandemic vaccine upon enrollment and the seasonal vaccine one month later, or to receive the pandemic and seasonal vaccines simultaneously upon enrollment. Seroconversion and seroprotection rates against the pandemic influenza A/H1N1 virus were 100% two months after vaccine administration in both groups, regardless of the sequence of administration. Geometric mean titres against pandemic and seasonal antigens were significantly higher when the seasonal and pandemic vaccines were administered simultaneously than when the seasonal vaccine was administered alone. Local and systemic reactions were mild and not increased by simultaneous administration. In conclusion, the 2009 pandemic influenza A/H1N1 MF59-adjuvanted vaccine is as immunogenic, safe and well tolerated in HIV-infected children and adolescents as in healthy controls. Its simultaneous administration with virosomal-adjuvanted seasonal antigens seems to increase immune response to both pandemic and seasonal viruses with the same safety profile as that of the pandemic vaccine alone. However, because this finding cannot be clearly explained by an immunological viewpoint, further studies are needed to clarify the reasons of its occurrence.
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http://dx.doi.org/10.1016/j.vaccine.2010.12.047DOI Listing
February 2011