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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="All Drug Records" href="/books/n/livertox/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" alt="Cover of LiverTox" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK605692_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK605692_dtls__"><div>Bethesda (MD): <a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&amp;targetsite=external&amp;targetcat=link&amp;targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>; 2012-.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/livertox/">Drug Records</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/livertox/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/livertox/Nateglinide/" title="Previous page in this title">&lt; Prev</a><a class="active page_link next" href="/books/n/livertox/Nebivolol/" title="Next page in this title">Next &gt;</a></div></div></div></div></div>
<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK605692_"><span class="title" itemprop="name">Naxitamab</span></h1><div class="subtitle">Short Chapter</div><p class="small">Last Update: <span itemprop="dateModified">July 12, 2024</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><p><i>[Preliminary review chapter based on the FDA Product Labeling and Integrated Review</i>
<i>only.]</i></p><div id="Naxitamab.OVERVIEW"><h2 id="_Naxitamab_OVERVIEW_">OVERVIEW</h2><div id="Naxitamab.Introduction"><h3>Introduction</h3><p>Naxitamab is a monoclonal antibody to GD2 that is used in combination with granulocyte-macrophage colony stimulating factor to treat children with relapsed or refractory high risk neuroblastoma of the bone or bone marrow. Naxitamab therapy is associated with transient serum aminotransferase elevations during therapy but has not been linked to instances of clinically apparent liver injury.</p></div><div id="Naxitamab.Background"><h3>Background</h3><p>Naxitamab (nax it&#x02019; a mab) is a humanized, cytolytic monoclonal antibody to glycolipid disialoganglioside (GD2), an adhesion molecule widely expressed on cell membranes of neuroectoderm derived tumors including neuroblastoma, the most common extra-cranial cancer of children. Naxitamab was found to be cytolytic to neuroblastoma cells in culture and resulted in objective responses in 34% to 45% of children and adults with refractory advanced neuroblastoma of bone and bone marrow. Naxitamab was granted accelerated approval in 2020 for treatment of children 1 year of age and older and adults with relapsed or refractory high risk neuroblastoma in the bone or more marrow. Naxitamab is available in solution in single dose vials of 40 mg in 10mL (4 mg/mL) under the brand name Danyelza. The recommended dose is 3 mg/kg/day (to a maximum of 150 mg/day) on days 1, 3, and 5 of 28-day cycles. Granulocyte-macrophage colony stimulatory factor (GM-CSF) should be given subcutaneously with each treatment cycle. In addition, premedication with acetaminophen, antihistamines, and corticosteroids is recommended to prevention serious infusion reactions. In prelicensure trials, adverse events were common and included infusion reactions, neurotoxicity, pain (abdominal, bone, neck, and extremity), neurologic toxicity to the eye (blurred vision, impaired vision, photophobia), tachycardia, hypertension, fatigue, nausea and vomiting, diarrhea, decreased appetite, rash, urticaria, fever, cough, peripheral edema, fatigue, irritability, and mental status changes. Serious adverse events associated with naxitamab therapy included severe neurotoxicity manifested by peripheral neuropathy, prolonged urinary retention, severe pain, transverse myelitis, and rare instances of reversible posterior leukoencephalopathy syndrome. Other potential severe adverse events included anaphylaxis, hypotension, bronchospasm, stridor, cardiac arrest, severe hypertension, myocarditis, and embryo-fetal toxicity. Obviously, naxitamab should only be administered by health care personnel with experience, expertise, and facilities capable of managing the complications of naxitamab therapy.</p></div><div id="Naxitamab.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Naxitamab was evaluated in small, prospective open label trials in children and adults with refractory neuroblastoma, a rare but often fatal cancer. Abnormal laboratory results were common during therapy including elevations in serum <a class="def" href="/books/n/livertox/glossary/def-item/glossary.alanine-aminotransferase-alt-/">ALT</a> levels in 55% of subjects which were 5 times ULN or greater than the upper limit of normal (ULN) in 9%. Nevertheless, there were no instances of serum aminotransferase elevations accompanied by jaundice, or suspected drug induced liver injury, and no subject discontinued therapy because of abnormal liver tests. Most of the abnormal liver test findings were not attributed to therapy. In assessing abnormal serum aminotransferases in children receiving cancer chemotherapy, it is worthwhile to review the premedications given, particularly of acetaminophen dose which should be limited to less than 75 mg per kilogram daily. Since its approval in 2020, there have been no published reports of clinically apparent liver injury attributable to naxitamab therapy, but clinical experience with its use has been limited.</p><p><a class="def" href="/books/n/livertox/glossary/def-item/glossary.likelihood-score/">Likelihood score</a>: E (unlikely cause of clinically apparent liver injury).</p></div><div id="Naxitamab.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>The causes of the frequent liver test abnormalities during naxitamab therapy are not known but may be due to the cytotoxic monoclonal antibody and low level expression of GD2 on hepatocytes. Some of the abnormalities are no doubt due to the underlying condition and other treatments administered. Naxitamab can cause hypersensitivity reactions including urticaria, rash, and anaphylaxis, and liver injury might be a part of a generalized immunoallergic reaction.</p></div><div id="Naxitamab.Outcome_and_Management"><h3>Outcome and Management</h3><p>The product label for naxitamab does not recommend monitoring of routine liver tests during therapy, and considerations of the severity of the underlying tumor and its poor prognosis generally outweigh concerns about serum aminotransferase elevations not accompanied by jaundice or symptoms of liver injury.</p><p>Drug Class: <a href="/books/n/livertox/AntineoplasticAgents/">Antineoplastic Agents</a>, <a href="/books/n/livertox/MonoclonalAntibodies/">Monoclonal Antibodies</a></p></div></div><div id="Naxitamab.PRODUCT_INFORMATION"><h2 id="_Naxitamab_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
<b>REPRESENTATIVE TRADE NAMES</b>
</p><p>Naxitamab &#x02013; Danyelza&#x000ae;</p><p>
<b>DRUG CLASS</b>
</p><p>Antineoplastic agents</p><p>
<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&#x00026;query=Naxitamab" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">COMPLETE LABELING</a>
</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div><div id="Naxitamab.CHEMICAL_FORMULA_AND_STRUCTURE"><h2 id="_Naxitamab_CHEMICAL_FORMULA_AND_STRUCTURE_">CHEMICAL FORMULA AND STRUCTURE</h2><div id="Naxitamab.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK605692/table/Naxitamab.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Naxitamab.Tc_lrgtbl__"><table><thead><tr><th id="hd_h_Naxitamab.Tc_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DRUG</th><th id="hd_h_Naxitamab.Tc_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CAS REGISTRY NUMBER</th><th id="hd_h_Naxitamab.Tc_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Naxitamab.Tc_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Naxitamab.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naxitamab</td><td headers="hd_h_Naxitamab.Tc_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
<a href="https://pubchem.ncbi.nlm.nih.gov/compound/Naxitamab" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">1879925-92-4</a>
</td><td headers="hd_h_Naxitamab.Tc_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Monoclonal Antibody</td><td headers="hd_h_Naxitamab.Tc_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not Available</td></tr></tbody></table></div></div></div><div id="Naxitamab.SELECTED_BIBLIOGRAPHY"><h2 id="_Naxitamab_SELECTED_BIBLIOGRAPHY_">SELECTED BIBLIOGRAPHY</h2><p>References updated: 12 July 2024</p><p>Abbreviations: ULN, upper limit of the normal range.</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Naxitamab.REF1">
<strong><em>[Short Chapter</em></strong>
<em>information is based largely on FDA Product Labeling and the FDA Integrated Review accessible from the FDA website</em>
<a href="https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm" ref="pagearea=cite-ref&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">
<i>https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm</i>
</a>
. <em>All other references have not been fully reviewed and annotated.]</em>
</div></li><li><div class="bk_ref" id="Naxitamab.REF2">FDA. Integrated Review. 2020. <a href="https://www.accessdata.fda.gov/drugsatfda_docs/nda/2020/761171Orig1s000MultidisciplineR.pdf" ref="pagearea=cite-ref&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">https://www<wbr style="display:inline-block"></wbr>.accessdata<wbr style="display:inline-block"></wbr>.fda.gov/drugsatfda_docs<wbr style="display:inline-block"></wbr>/nda/2020/761171Orig1s000MultidisciplineR.pdf</a><div><i>(FDA summary data on the safety and efficacy of naxitamab, submitted in support of the application for approval as therapy of neuroblastoma in children, mentions that no significant trends were observed across cycles for clinical chemistry parameters associated with liver function tests and there was no indication of drug induced liver injury).</i></div></div></li><li><div class="bk_ref" id="Naxitamab.REF.markham.2021.291">Markham
A.
Naxitamab: first approval.
Drugs.
2021;81:291-296.
[<a href="https://pubmed.ncbi.nlm.nih.gov/33616889" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 33616889</span></a>]</div></li><li><div class="bk_ref" id="Naxitamab.REF.mora.2021.e29121">Mora
J, Casta&#x000f1;eda
A, Gorostegui
M, Santa-Mar&#x000ed;a
V, Garraus
M, Mu&#x000f1;oz
JP, Varo
A, et al.
Naxitamab combined with granulocyte-macrophage colony- stimulating factor as consolidation for high-risk neuroblastoma patients in complete remission.
Pediatr Blood Cancer.
2021;68:e29121.
[<a href="https://pubmed.ncbi.nlm.nih.gov/34022112" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 34022112</span></a>]</div></li><li><div class="bk_ref" id="Naxitamab.REF.mora.2023.e1627">Mora
J, Chan
GC, Morgenstern
DA, Nysom
K, Bear
MK, Torn&#x000f8;e
K, Kushner
BH. Outpatient administration of naxitamab in combination with granulocyte-macrophage colony-stimulating factor in patients with refractory and/or relapsed high-risk neuroblastoma: management of adverse events.
Cancer Rep (Hoboken). 2023;6:e1627.
[<a href="/pmc/articles/PMC9875606/" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pmc">PMC free article<span class="bk_prnt">: PMC9875606</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35579862" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 35579862</span></a>]</div></li><li><div class="bk_ref" id="Naxitamab.REF.mora.2023.2535">Mora
J, Casta&#x000f1;eda
A, Gorostegui
M, Varo
A, Perez-Jaume
S, Simao
M, Mu&#x000f1;oz
JP, et al.
Naxitamab combined with granulocyte-macrophage colony-stimulating factor as consolidation for high-risk neuroblastoma patients in first complete remission under compassionate use-updated outcome report.
Cancers (Basel). 2023;15:2535.
[<a href="/pmc/articles/PMC10177429/" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pmc">PMC free article<span class="bk_prnt">: PMC10177429</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37174002" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 37174002</span></a>]</div></li><li><div class="bk_ref" id="Naxitamab.REF.trovillion.2024.e7045">Trovillion
EM, Michael
M, Jordan
CC, Brown
L, Phillips
K, Oesterheld
J, Saulnier-Sholler
G. Guidelines for outpatient administration of naxitamab: Experience from Atrium Health Levine Children's Hospital.
Cancer Med.
2024;13:e7045.
[<a href="/pmc/articles/PMC10891358/" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pmc">PMC free article<span class="bk_prnt">: PMC10891358</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/38396377" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 38396377</span></a>]</div></li></ul></div><div id="bk_toc_contnr"></div></div></div>
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class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>OTHER REFERENCE LINKS</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li>1. <a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&amp;db=pubmed&amp;pubmedfilters=true&amp;term=Naxitamab+AND+Human%5BMH%5D+AND+(drug+induced+liver+injury+OR+jaundice/CI+OR+bile+duct+diseases/CI+OR+liver/DE+OR+liver+diseases/CI)+AND+(%221900/1/1%22%5BEDat%5D:%222999/12/31%22%5BEDat%5D)" ref="pagearea=document-links&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">Recent References on Naxitamab: from PubMed.gov</a></li><li>2. <a href="https://clinicaltrials.gov/ct2/results?term=Naxitamab" ref="pagearea=document-links&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">Trials on Naxitamab: from ClinicalTrials.gov</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related information</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="discovery_db_links" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pmc&amp;DbFrom=books&amp;Cmd=Link&amp;LinkName=books_pmc_refs&amp;IdsFromResult=5650972" ref="log$=recordlinks">PMC</a><div class="brieflinkpop offscreen_noflow">PubMed Central citations</div></li><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pubmed&amp;DbFrom=books&amp;Cmd=Link&amp;LinkName=books_pubmed_refs&amp;IdsFromResult=5650972" ref="log$=recordlinks">PubMed</a><div class="brieflinkpop offscreen_noflow">Links to PubMed</div></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/35579862" ref="ordinalpos=1&amp;linkpos=1&amp;log$=relatedreviews&amp;logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Outpatient administration of naxitamab in combination with granulocyte-macrophage colony-stimulating factor in patients with refractory and/or relapsed high-risk neuroblastoma: Management of adverse events.</a><span class="source">[Cancer Rep (Hoboken). 2023]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Outpatient administration of naxitamab in combination with granulocyte-macrophage colony-stimulating factor in patients with refractory and/or relapsed high-risk neuroblastoma: Management of adverse events.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Mora J, Chan GC, Morgenstern DA, Nysom K, Bear MK, Tornøe K, Kushner BH. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Cancer Rep (Hoboken). 2023 Jan; 6(1):e1627. Epub 2022 May 17.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/34821881" ref="ordinalpos=1&amp;linkpos=2&amp;log$=relatedreviews&amp;logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Naxitamab: a humanized anti-glycolipid disialoganglioside (anti-GD2) monoclonal antibody for treatment of neuroblastoma.</a><span class="source">[Drugs Today (Barc). 2021]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Naxitamab: a humanized anti-glycolipid disialoganglioside (anti-GD2) monoclonal antibody for treatment of neuroblastoma.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Slatnick LR, Jimeno A, Gore L, Macy ME. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Drugs Today (Barc). 2021 Nov; 57(11):677-688. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/35397431" ref="ordinalpos=1&amp;linkpos=3&amp;log$=relatedreviews&amp;logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> How we approach the treatment of patients with high-risk neuroblastoma with naxitamab: experience from the Hospital Sant Joan de Déu in Barcelona, Spain.</a><span class="source">[ESMO Open. 2022]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> How we approach the treatment of patients with high-risk neuroblastoma with naxitamab: experience from the Hospital Sant Joan de Déu in Barcelona, Spain.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Castañeda A, Gorostegui M, Miralles SL, Chamizo A, Patiño SC, Flores MA, Garraus M, Lazaro JJ, Santa-Maria V, Varo A, et al. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">ESMO Open. 2022 Apr; 7(2):100462. Epub 2022 Apr 6.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/34022112" ref="ordinalpos=1&amp;linkpos=4&amp;log$=relatedarticles&amp;logdbfrom=pubmed">Naxitamab combined with granulocyte-macrophage colony-stimulating factor as consolidation for high-risk neuroblastoma patients in complete remission.</a><span class="source">[Pediatr Blood Cancer. 2021]</span><div class="brieflinkpop offscreen_noflow">Naxitamab combined with granulocyte-macrophage colony-stimulating factor as consolidation for high-risk neuroblastoma patients in complete remission.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Mora J, Castañeda A, Gorostegui M, Santa-María V, Garraus M, Muñoz JP, Varo A, Perez-Jaume S, Mañe S. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Pediatr Blood Cancer. 2021 Oct; 68(10):e29121. 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