Publications by authors named "Pernille Wendtland Edslev"

8 Publications

  • Page 1 of 1

A clinical prediction score for transient versus persistent childhood immune thrombocytopenia.

J Thromb Haemost 2021 01 27;19(1):121-130. Epub 2020 Nov 27.

Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands.

Essentials There is a need for improved tools to predict persistent and chronic immune thrombocytopenia (ITP). We developed and validated a clinical prediction model for recovery from newly diagnosed ITP. The Childhood ITP Recovery Score predicts transient vs. persistent ITP and response to intravenous immunoglobulins. The score may serve as a useful tool for clinicians to individualize patient care. ABSTRACT: Background Childhood immune thrombocytopenia (ITP) is an autoimmune bleeding disorder. The prognosis (transient, persistent, or chronic ITP) remains difficult to predict. The morbidity is most pronounced in children with persistent and chronic ITP. Clinical characteristics are associated with ITP outcomes, but there are no validated multivariate prediction models. Objective Development and external validatation of the Childhood ITP Recovery Score to predict transient versus persistent ITP in children with newly diagnosed ITP. Methods Patients with a diagnosis platelet count ≤ 20 × 10 /L and age below 16 years were included from two prospective multicenter studies (NOPHO ITP study, N = 377 [development cohort]; TIKI trial, N = 194 [external validation]). The primary outcome was transient ITP (complete recovery with platelets ≥100 × 10 /L 3 months after diagnosis) versus persistent ITP. Age, sex, mucosal bleeding, preceding infection/vaccination, insidious onset, and diagnosis platelet count were used as predictors. Results In external validation, the score predicted transient versus persistent ITP at 3 months follow-up with an area under the receiver operating characteristic curve of 0.71. In patients predicted to have a high chance of recovery, we observed 85%, 90%, and 95% recovered 3, 6, and 12 months after the diagnosis. For patients predicted to have a low chance of recovery, this was 32%, 46%, and 71%. The score also predicted cessation of bleeding symptoms and the response to intravenous immunoglobulins (IVIg). Conclusion The Childhood ITP Recovery Score predicts prognosis and may be useful to individualize clinical management. In future research, the additional predictive value of biomarkers can be compared to this score. A risk calculator is available (http://www.itprecoveryscore.org).
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http://dx.doi.org/10.1111/jth.15125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839442PMC
January 2021

Brentuximab vedotin monotherapy is an effective treatment in a frail pediatric patient with Down syndrome and classical Hodgkin lymphoma.

Pediatr Blood Cancer 2020 02 14;67(2):e28082. Epub 2019 Nov 14.

Department of Pediatric and Adolescent Health, Aarhus University Hospital, Aarhus, Denmark.

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http://dx.doi.org/10.1002/pbc.28082DOI Listing
February 2020

[Out of nowhere and into the clinical ethics committees].

Ugeskr Laeger 2015 10;177(42):V67470

Børneafdelingen, Afsnit for Hæmatologi og Onkologi, Aarhus Universitetshospital.

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October 2015

Acute Myeloid Leukemia in Adolescents and Young Adults Treated in Pediatric and Adult Departments in the Nordic Countries.

Pediatr Blood Cancer 2016 Jan 18;63(1):83-92. Epub 2015 Aug 18.

Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.

Background: Studies on adolescents and young adults with acute lymphoblastic leukemia suggest better results when using pediatric protocols for adult patients, while corresponding data for acute myeloid leukemia (AML) are limited.

Procedure: We investigated disease characteristics and outcome for de novo AML patients 10-30 years old treated in pediatric or adult departments. We included 166 patients 10-18 years of age with AML treated according to the pediatric NOPHO-protocols (1993-2009) compared with 253 patients aged 15-30 years treated in hematology departments (1996-2009) in the Nordic countries.

Results: The incidence of AML was 4.9/million/year for the age group 10-14 years, 6.5 for 15-18 years, and 6.9 for 19-30 years. Acute promyelocytic leukemia (APL) was more frequent in adults and in females of all ages. Pediatric patients with APL had similar overall survival as pediatric patients without APL. Overall survival at 5 years was 60% (52-68%) for pediatric patients compared to 65% (58-70%) for adult patients. Cytogenetics and presenting white blood cell count were the only independent prognostic factors for overall survival. Age was not an independent prognostic factor.

Conclusions: No difference was found in outcome for AML patients age 10-30 years treated according to pediatric as compared to adult protocols.
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http://dx.doi.org/10.1002/pbc.25713DOI Listing
January 2016

[Differences in the treatment of idiopathic thrombocytopenic purpura in children].

Ugeskr Laeger 2010 Nov;172(47):3249-54

Børneafdelingen, Århus Universitetshospital, Skejby, 8200 Århus N, Denmark.

Introduction: Idiopathic thrombocytopenic purpura (ITP) is a rare immune-mediated bleeding disorder that usually takes a self-limiting and benign course. Due to the risk of intracranial haemorrhage, treatment regimens tend to be active. We present treatment data from 17 paediatric departments in Denmark (1998-2000), focusing on regional differences in treatment strategy.

Material And Methods: As part of a prospective Nordic study, clinical findings and treatment were recorded for 109 children with newly diagnosed ITP. The course in the following six months was reported for 91 children. Results are compared for three geographical regions: East, North and South.

Results: Pharmacotherapy, almost exclusively intravenous immunoglobulin, was given within 14 days of diagnosis to 89%, 70%, and 48% in regions East, North, and South, respectively. A very low platelet count was the main indication. Platelet transfusion was given to 24%, 0% and 4%, respectively. There were no differences in remission rates or frequency of mucosal bleeding during follow-up, but treatment rates were 6.3, 4.7, and 3.0 per patient-year with severe thrombocytopenia. Chronic ITP lasting more than six months developed in 26%, 33%, and 18%, respectively.

Conclusion: We found obvious regional differences in treatment strategy which reflect differences in international clinical guidelines. The initial treatment approach had no influence on morbidity, time of remission or risk of chronic course.
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November 2010

Subcutaneous anti-D treatment of idiopathic thrombocytopenic purpura in children.

Pediatr Blood Cancer 2009 Dec;53(7):1315-7

Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark.

We investigated the effect of subcutaneous anti-D IgG as platelet enhancing therapy in children with idiopathic thrombocytopenic purpura (ITP). Twenty-three children were treated with subcutaneous anti-D 50 microg/kg. The median platelet count increased from 7 x 10(9) to 31 x 10(9)/L on day 3 (P < 0.01). The median decline in hemoglobin was 1.3 g/dl. Two children experienced minor fever and chills within 24 hr of treatment. Pain at the injection site was common but self-limiting with no effect on activity level. These results suggest subcutaneous anti-D IgG 50 microg/kg as an effective and well-tolerated treatment option in childhood ITP.
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http://dx.doi.org/10.1002/pbc.22248DOI Listing
December 2009

[Epidemiology, disease presentation and course of idiopathic thrombocytopenic purpura in Danish children from 1998-2000].

Ugeskr Laeger 2008 May;170(22):1922-6

Arhus Universitetshospital, Skejby, Børneafdelingen, Regionshospitalet Viborg, Børneafdelingen, Arhus N.

Introduction: Idopathic Thrombocytopenic Purpura (ITP) is a condition with isolated thrombocytopenia and bleeding symptoms in skin and mucous membranes. It is easy to establish the diagnosis, but treatment is controversial, possibly due to different estimates of the risk for serious bleeding. We present the epidemiology and clinical course of ITP during the first 6 months after diagnosis in Danish children diagnosed from 1998-2000.

Materials And Methods: The Nordic Society of Paediatric Haematology and Oncology conducted a prospective registration study of children with newly diagnosed ITP from 1998-2000. The study included children < 15 years of age with newly diagnosed, untreated ITP and platelet count (TBC) < 30 x 10(9) /l. Information about bleeding symptoms, TBC, treatment and ITP related episodes was recorded at diagnosis and during the first six months.

Results: Of 109 included children 81% had a short symptom history, 46% a preceding viral infection. At diagnosis 62% had TBC < 10 x 10(9) /l, 41% mucosal bleeding, and 72% received medical treatment. Follow-up was available for 91 children. Sixty seven children with acute ITP had TBC < 150 x 10(9) /l for 11 days (median). Twenty four children suffered chronic ITP, 8 of them had persistent TBC < 20 x 10(9) /l. Insidious onset had a 64% predictive value for chronic ITP. Of the 57 registered ITP-related episodes, 45 occurred in chronic cases, 23 of them in six of the children with persistent TBC < 20 x 10(9) /l.

Conclusion: It is likely that children with newly diagnosed ITP recover quickly, and the risk of serious bleeding is low. A small group of children with persistent severe thrombocytopenia experience significant morbidity.
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May 2008

A clinical score predicting a brief and uneventful course of newly diagnosed idiopathic thrombocytopenic purpura in children.

Br J Haematol 2007 Aug 29;138(4):513-6. Epub 2007 Jun 29.

Department of Paediatrics, Aalborg Hospital, Aalborg, Denmark.

The Nordic idiopathic thrombocytopenic purpura study data showed that morbidity occurred mainly in children with thrombocytopenia lasting >3 months, whereas, the risk period with platelet counts <20 x 10(9)/l was short and the number of bleeding events low in children with shorter disease duration. These brief, uneventful courses were predicted by developing a scoring system based on six clinical features: abrupt onset (weight 5), age <10 years (3), preceding infection (2), platelet count <5 x 10(9)/l, wet purpura (1) and male gender (1). The score was derived and validated in two different cohorts of children. High scores (10-14) clearly identified low-risk patients. The score provides valid prognostic information and may be useful in clinical decision-making.
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http://dx.doi.org/10.1111/j.1365-2141.2007.06682.xDOI Listing
August 2007