[CIS PIDD] [cis-pidd] therapeutic advise for severe Respiratory papillomatosis (RRP)

Mon Sep 29 17:46:41 EDT 2014

Dear all,
I am posting this on behalf of Dr O Neth and Dr D Falcon in order to share
their recent experience with you. Hope that helps.

Best,
Peter

Peter Olbrich
Seccion de Enfermedades Infecciosas e Inmunodeficiencia de Pediatria
Hospital Infantil Universitario Virgen del Rocio
Sevilla, Spain

> Dear all
>
> we have recently treated an ex preterm baby, currently 14 month old girl
> with recurrent laryngeal papillomatosis (HPV6). She initially presented
> aged 4 month and management consisted of repeated surgical interventions by
> ORL, however this did not at all control her symptoms. In contrary she
> developed more lesions, needed PICU admission for airway obstructions and
> tracheostomy. Basic immunology work-up including FBC, IgGAM, LSS and PHA
> stimulation were normal. We therefore decided to vaccine her (3 dosis
> quadrivalent (Types 6,11, 16, and 18; Gardasil) followed by interferon
> alpha (100.000U/kg/dose s.c daily for one week and then 3 times weekly).
> This resulted in a impressive clinical improvement over the last 3 months
> meaning no further surgical interventions were needed. Latest fibroscopy
> showing less lesions as well as being smaller in size. We are planning to
> continue INFa for 6-12 months and at this stage we are not considering
> adding cidofovir (inhaled and/or intralesional). Although long term outcome
> can be disappointing she is currently well controlled
>
Olaf
Olaf Neth
Seccion de Enfermedades Infecciosas e Inmunodeficiencia de Pediatria
Hospital Infantil Universitario Virgen del Rocio,
Av Manuel Siurot s/n
41013 Sevilla
(F) 0034955012991
(M) 0034622488740

2014-09-26 20:48 GMT-04:00 Laham, Federico R. <
Federico.Laham at orlandohealth.com>:

>  I am following a 5yo boy with Recalcitrant papillomatosis. He had some
> response to intralesional  cidofovir, but did not modified the disease
> course. gardasil x 3 doses (at the age of 2.5 years) did not objectively
> help. Immune studies normal except for decreased NK cytotoxicity that we
> are repeating.
>
>  Celebrex seems to be making a great difference, and now he goes to the
> OR every 7-8 weeks (used to go every 2-3 weeks due to severe stridor).
>
>  Parents have declined interferon. Cidofovir weekly x 4 weeks, then
> biweekly x 3 caused no improvement.
>
> Federico Laham, MD
> Pediatric Infectious Diseases
> Arnold Palmer Hospital for Children
> Orlando, FL
>
> On Sep 26, 2014, at 2:05 PM, Elie Haddad <elie.haddad at umontreal.ca> wrote:
>
>  Dear colleagues,
> We have a 13 yo patient with severe respiratory papillomatosis.
> Her lesions are progressing in the larynx and although a new surgery is
> scheduled, the ENT specialist is very worried and asked us for help.
> I know that some years ago, someone posted the feasibility of IFNa in
> aerosol for these patients, but I cannot find the post.
> Does anyone know how to do this (doses, frequency, solution) ?
> Do you think it is a good idea ?
> Do you think we should give systemic IFNa also (or only) ?
> Any anti-viral drug that could help ?
> Thanks
> Elie
>
>
>   Elie Haddad, MD, PhD,
> Professor of Pediatrics, University of Montreal,
> Head, Pediatric Immunology and Rheumatology Division,
> CHU Sainte-Justine, 3175 Cote Sainte-Catherine
> Montreal, QC, H3T 1C5, Canada
> Ph: 1 514 345 4713
> fax: 1 514 345 4897
> e-mail: elie.haddad at umontreal.ca
>
>
>
>
>
>  ---
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