A Ferster

Hôpital Universitaire des Enfants Reine Fabiola, Bruxelles, Brussels Capital, Belgium

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Publications (168)780.92 Total impact

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    ABSTRACT: Ovarian insufficiency is a major long-term adverse event, following the administration of a myeloablative conditioning regimen, and occurring in >80% of children and adolescents receiving such treatment for malignant or non-malignant disease. Cryopreservation of ovarian tissue is currently offered to preserve the fertility of these young patients. At least 35 live births have been reported after transplantation of cryopreserved ovarian tissue in adult patients, but the procedure remains unproven for ovarian tissue harvested at a prepubertal or pubertal age. We report here the first live birth after autograft of cryopreserved ovarian tissue in a woman with primary ovarian failure after a myeloablative conditioning regimen as part of a hematopoietic stem cell transplantation performed for homozygous sickle-cell anemia at age 14 years. This first report of successful fertility restoration after the graft of ovarian tissue cryopreserved before menarche offers reassuring evidence for the feasibility of the procedure when performed during childhood. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    Human Reproduction 06/2015; DOI:10.1093/humrep/dev128 · 4.59 Impact Factor
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    ABSTRACT: The added value of IKZF1 gene deletion (IKZF1(del)) as a stratifying criterion in B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is still debated. We performed a comprehensive analysis of the impact of IKZF1(del) in a large cohort of children (N=1223) with BCR-ABL1-negative BCP-ALL treated in the EORTC-CLG trial 58951. Patients with IKZF1(del) had a lower eight-year event-free survival (EFS 67.7 vsersus 86.5%; HR 2.41; 95% CI 1.75-3.32; P<0.001). Importantly, despite association with high-risk features such as high minimal residual disease, IKZF1(del) remained significantly predictive in multivariate analyses. Analysis by genetic subtype showed that IKZF1(del) increased risk only in the high hyperdiploid ALLs (HR 2.57; 95% CI 1.19-5.55; P=0.013) and in "B-other" ALLs, i.e. lacking classifying genetic lesions (HR 2.22; 95% CI 1.45-3.39; P<0.001), the latter having then a dramatically low 8-year EFS (56.4%; 95% CI 44.6-66.7). Among IKZF1(del)-positive patients randomized for vincristine-steroid pulses during maintenance, those receiving pulses had a significantly higher 8-year EFS (93.3%; 95% CI 61.3-99.0 vs 42.1%; 95% CI, 20.4-62.5). Thus, IKZF1(del) retains independent prognostic significance in the context of current risk-adapted protocols, and is associated with a dismal outcome in 'B-other' ALL. Addition of vincristine-steroid pulses during maintenance may specifically benefit to IKZF1(del) patients in preventing relapses.Leukemia accepted article preview online, 08 June 2015. doi:10.1038/leu.2015.134.
    Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K 06/2015; DOI:10.1038/leu.2015.134 · 9.38 Impact Factor
  • Leukemia and Lymphoma 12/2014; DOI:10.3109/10428194.2014.1003058 · 2.61 Impact Factor
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    ABSTRACT: Background For centuries, writers have recorded their observations on pica. Our attention was drawn to pica by a casual remark passed by the mother of a sickle cell boy. The association of pica and sickle cell disease (SCD) was poorly documented. Methods Children and caregivers attending the outpatient clinic completed questionnaires assessing symptoms of pica. Results Out of 55 sickle cell children, 31(56.4%) reported practicing pica regularly. Substances ingested by patients covered a broad spectrum. Compared with the non-pica group, subjects who reported pica were younger and had lower hemoglobin (8.3 g/dl (7.6-9.7) vs. 9.1 g/dl (7.9-10.5): P < 0.01). The level of ferritin, zinc, copper, and lead was similar between the pica and non-pica groups (P > 0.05). Discussion In this series, there are many substances consumed by SCD children and adolescents, and we did not find an occurrence of similar substances among this select group. The main categories associated with pica in our cohort were anemic patients and children. Conclusion The preliminary literature on the subject of pica in SCD is briefly reported. This study suggests that pica remains an unknown and underreporting clinical problem in children with SCD. The next step of this project will need to clarify causal mechanisms for pica and its association with sickle cell disease in a large population.
    Hematology (Amsterdam, Netherlands) 12/2014; DOI:10.1179/1607845414Y.0000000219 · 1.19 Impact Factor
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    ABSTRACT: Background The 6-minute walk test (6MWT) is used in adults and children affected by a wide range of chronic diseases to evaluate their sub-maximal exercise capacity. It reflects the global response of various physiological systems in a situation simulating a daily life activity. Methods We analyzed factors affecting the 6MWT in 46 Sickle Cell Disease children. Forty-two were treated with hydroxyurea (HU). Patients with normal test (>80% of the age-standardized predicted value) were compared to patients with abnormal test (≤80%). Baseline hematological values, clinical events, cerebrovascular disease, cardio-pulmonary parameters and disease-modifying treatment were compared according to the performance of the test. Results Among the 46 patients, 14 had an abnormal 6MWT. In univariate analysis, both groups were similar for biological and clinical data. Six of the 14 patients with an abnormal 6MWT had silent infarct (SI) compared to 6/32 with a normal test (P = 0.09). When excluding chronically transfused patients, 4 of the 11 patients with an abnormal 6MWT had SI compared to 1/26 (P = 0.02). Baseline pulse oximetry was normal in both groups but slightly lower in patients with abnormal 6MWT (P = 0.02). No patient presented exercise-induced desaturation. In multivariate analysis, the only factor associated with abnormal 6MWT was the presence of SI (P = 0.045). Conclusions In our cohort of 46 patients characterized by high exposure rate to HU and by the absence of severe cardiopulmonary disease, the sole factor independently associated with 6MWT was the presence of SI. The lower exercise capacity of children with SI may reflect some subclinical neurological impairment as they do not differ by hemoglobin level or cardiopulmonary parameters.
    PLoS ONE 10/2014; 9(10):e108922. DOI:10.1371/journal.pone.0108922 · 3.53 Impact Factor
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    ABSTRACT: Objective Red cell exchange transfusion is frequently used in the management of patients with sickle cell disease (SCD) either electively or chronically to maintain hemoglobin S (HbS) <30%. The purpose of this retrospective study was to evaluate the results of manual chronic partial exchange transfusion (MCPET) on level of Hb and HbS, on iron load and on the need for chelation, on risk of immunization, monitoring transfusion-transmitted viral infection, and clinical outcome. Methods We reviewed the long-term effect of MCPET in 10 children (six men and four women) with SCD and evaluated the iron balance during a median follow-up of 20 months (range: 6-36) in which 248 exchanges were performed. Results The pre-exchange median Hb value was 9.5 g/dl (range: 7.7-10.9 g/dl) and the median post-exchange value was 9.4 g/dl (range: 8.4-11.1 g/dl).The majority of patients reached an HbS of <50% with a median HbS value of 40.04% (range: 30-54). At start of the MCPET program, the median ferritin was 439 ng/ml (range: 80-1704 ng/ml). In the final evaluation, the median value of ferritin was 531 ng/ml (range: 84-3840 ng/ml). The annual calculated iron balance was 0. 28 ± 0.08 mg/kg/day. MCPET was well tolerated, and adverse effects were limited. Discussion MCPET in children with SCD is safe to prevent iron overload, and is effective and easy to use in our cohort. Conclusion Indication for chronic exchange blood transfusion is essential for patients with SCD with recurrent and frequent crises who do not respond to hydroxyurea. However, there is no consensual study for the period at which chronic transfusion can safely be stopped and further research in large population of patients with SCD will need to clarify this question.
    Hematology (Amsterdam, Netherlands) 08/2014; 20(5). DOI:10.1179/1607845414Y.0000000191 · 1.19 Impact Factor
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    ABSTRACT: Do the benefits of ovarian tissue cryopreservation outweigh the risks for patients seeking to preserve fertility before gonadotoxic treatment in various indications?
    Human Reproduction 06/2014; 29(9). DOI:10.1093/humrep/deu158 · 4.59 Impact Factor
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    ABSTRACT: Viral infections are important causes of morbidity and mortality in patients after hematopoietic stem cell transplantation. The monitoring by PCR of Herpesviridae loads in blood samples has become a critical part of post-transplant follow-up representing mounting costs for the laboratory. In this study, we assessed the clinical performances of the multiplex PCR DNA microarray Clart® Entherpex kit for detection of CMV, EBV and HHV-6 as screening test for virological follow-up. 255 blood samples from 16 transplanted patients, prospectively tested by routine PCR assays, were analyzed by microarray. Routine PCR detected single or multiple viruses in 42% and 10 % of the samples respectively. Microarray detected single or multiple viruses in 34% and 18% of the samples. Microarray results correlated well with CMV and EBV detections by routine PCR (Kappa tests = 0.79 and 0.78 respectively), whereas a weak correlation was observed with HHV-6 (0.43). HHV-7 was also detected in 48 samples by microarray. In conclusion, the microarray is a reliable screening assay for a post-transplant virological follow-up to detect CMV and EBV infections in blood. However, positive samples must be subsequently confirmed and viral loads quantified by PCR assays. Limitations were identified regarding HHV-6 detection. Although promising, easy to use as first-line test and allowing a reduction in the cost of analysis without undue delay in the reporting of the final quantitative result to the clinician, some characteristics of this microarray should be improved, particularly regarding quality control and targeted virus panel such that it could then be used as a routine test.
    Journal of clinical microbiology 05/2014; 52(7). DOI:10.1128/JCM.00061-14 · 4.23 Impact Factor
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    ABSTRACT: Pregnancy in women with inherited thrombocytopenias is a major matter of concern as both the mothers and the newborns are potentially at risk of bleeding. However, medical management of this condition cannot be based on evidence because of the lack of consistent information in the literature. To advance knowledge on this matter, we performed a multicentric, retrospective study evaluating 339 pregnancies in 181 women with 13 different forms of inherited thrombocytopenia. Neither the degree of thrombocytopenia nor the severity of bleeding tendency worsened during pregnancy, and the course of pregnancy was not different from that of healthy subjects in terms of miscarriages, fetal bleeding and preterm births. The degree of thrombocytopenia in the babies was similar to that in the mother. Only 7 of 156 affected newborns had delivery-related bleeding, but two of them died of cerebral hemorrhage. The frequency of delivery-related maternal bleeding ranged from 6.8 to 14.2% depending on the definition of abnormal blood loss, suggesting that the risk of risk of abnormal blood loss was increased with respect to the general population. However, no mother died or received hysterectomy to arrest bleeding. The search for parameters predicting delivery-related bleeding in the mother suggested that hemorrhages requiring blood transfusion were more frequent in women with history of severe bleedings before pregnancy and with platelet count at delivery lower than 50 x 10(9)/L.
    Haematologica 04/2014; DOI:10.3324/haematol.2014.105924 · 5.87 Impact Factor
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    ABSTRACT: Dexamethasone could be more effective than prednisolone at similar anti-inflammatory doses in the treatment of childhood acute lymphoblastic leukemia. In order to check if this superiority of dexamethasone might be dose-dependent, we conducted a randomized phase III trial comparing dexamethasone (6 mg/m2/day) to prednisolone (60 mg/m2/day) in induction therapy. All newly diagnosed children and adolescents with acute lymphoblastic leukemia in 58951 EORTC trial were randomized either on prephase day 1 or day 8. The main endpoint was event-free survival; secondary endpoints were overall survival and toxicity. A total of 1947 acute lymphoblastic leukemia patients were randomized. At a median follow up of 6.9 years, the 8-year event-free survival rate was 81.5% in the dexamethasone arm and 81.2% in the prednisolone arm; the 8-year overall survival rates were 87.2% and 89.0% respectively. The 8-year central nervous system isolated or combined relapse incidence was 2.9% (dexamethasone) v 4.5% (prednisolone). The incidence of grade 3-4 toxicities during induction and the frequency of osteonecrosis were similar in the two arms. In conclusion, dexamethasone and prednisolone, used respectively at the doses of 6 and 60 mg/m2/day during induction, were equally effective and had a similar toxicity profile. Dexamethasone decreased the 8-year central nervous system relapse incidence by 1.6%. This trial was registered at www.clinicaltrials.gov as #NCT00003728.
    Haematologica 04/2014; 99(7). DOI:10.3324/haematol.2014.103507 · 5.87 Impact Factor
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    ABSTRACT: Despite improvements in medical management, sickle cell disease (SCD) remains associated with severe morbidity and decreased survival. Allogeneic haematopoietic stem cell transplantation (HSCT) remains the only curative approach. We report the outcome of 50 consecutive children with severe SCD that received HSCT in our unit between November 1988 and April 2013. The stem cell source was bone marrow (n = 39), cord blood (n = 3), bone marrow and cord blood (n = 7) and peripheral blood stem cells (n = 1). All patients had ≥1 severe manifestation: 37 presented with recurrent vaso-occlusive crises/acute chest syndrome, 27 cerebral vasculopathy and 1 nephropathy. The conditioning regimen consisted of busulfan + cyclophosphamide (BuCy) before November 1991 and BuCy + rabbit antithymocyte globulin after that date. Since 1995, all patients have been treated with hydroxycarbamide (HC) prior to transplantation for a median duration of 2·7 years. Median age at transplantation and median follow-up was 8·3 and 7·7 years, respectively. Acute graft-versus-host disease (GVHD) and chronic GVHD were observed in 11 and 10 patients, respectively. An excellent outcome was achieved, with 8-year overall survival and event-free survival (EFS) rates of 94·1% and 85·6%, respectively. Since HC introduction, no graft failure occurred and EFS reached 97·4%. Prior treatment with HC may have contributed to successful engraftment.
    British Journal of Haematology 01/2014; 165(3). DOI:10.1111/bjh.12737 · 4.96 Impact Factor
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    ABSTRACT: OBJECTIVES:Clinical data are lacking on optimal levels of specific antipneumococcal antibodies (PnPsAbs) in patients with primary immunodeficiency (PID) receiving intravenous immunoglobulin (IVIG) replacement. Objectives were to conduct a prospective multicenter study providing data on total immunoglobulin G (IgG) and peak/trough levels of PnPsAbs specifically targeting the 16 most prevalent pneumococcal serotypes in IVIG-treated children with PID; to compare trough PnPsAb levels with those measured in healthy adults and the IVIG product; and to evaluate PnPsAb protection correlates with thresholds based on World Health Organization.METHODS:Patients received 7 consecutive IVIG infusions. Total IgG and PnPsAb levels were determined on plasma samples obtained before and after infusion.RESULTS:Twenty-two children with PID were treated with IVIG (mean weekly dose: 0.10 g/kg). The mean trough and peak levels of total IgG were 7.77 and 13.93 g/L, respectively. Trough and peak geometric mean concentrations and distribution curves differed between serotypes and showed wide dispersion (0.17-7.96 µg/mL). In patients (89%-100%), antibodies against most serotypes reached trough levels ≥0.2 µg/mL, a threshold considered protective against invasive pneumococcal infection. For several serotypes, trough levels reached ≥1.0 to 1.3 µg/mL, the level found in adults. Trough geometric mean concentrations correlated well with the PnPsAb contents of the IVIG product.CONCLUSIONS:In IVIG-treated children with PID, protective PnPsAb levels for most pathogenic serotypes were obtained. A correlation was observed between PnPsAb levels in patients and in the IVIG product. This offers the potential to improve infection prevention by adapting the IVIG product and dose according to epidemiology.
    PEDIATRICS 12/2013; 133(1). DOI:10.1542/peds.2013-1155 · 5.30 Impact Factor
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    ABSTRACT: Transient neonatal leukemia occurs almost exclusively in Down syndrome babies. We report here the unusual case of a newborn without Down syndrome who presented neonatal transient leukemia and who achieved spontaneously complete remission. Trisomy 21 and GATA1 mutation were both present in leukemic cells. While close follow-up is advised since true leukemia may develop later, the patient is still in remission for 2.5 years. We performed a literature review of 15 other similar cases. Conclusion: Our case of transient leukemia without Down syndrome and the literature review highlight the important role of trisomy 21 and GATA1 mutation in the development of transient neonatal leukemia.
    European Journal of Pediatrics 11/2013; 173(12). DOI:10.1007/s00431-013-2163-8 · 1.98 Impact Factor
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    ABSTRACT: Oncogenic subtypes in childhood B-cell precursor acute lymphoblastic leukemia (BCP-ALL) are used for risk-stratification. However, a significant number of BCP-ALL patients are still genetically unassigned. Using array-CGH in a selected BCP-ALL cohort, we characterized a recurrent V(D)J-mediated intragenic deletion of the ERG gene (ERG(del)). A breakpoint-specific PCR assay was designed and used to screen an independent non-selected cohort of 897 children aged 1-17 years treated for BCP-ALL in the EORTC-CLG 58951 trial. ERG(del) was found in 29/897 patients (3.2%) and was mutually exclusive of known classifying genetic lesions, suggesting that it characterized a distinct leukemia entity. ERG(del) was associated with higher age (median 7.0 years vs 4.0 years, P=0.004), aberrant CD2 expression (43.5% vs 3.7%, P<0.001) and frequent IKZF1 Δ4-7 deletions (37.9% vs 5.3%, P<0.001). However, ERG(del) patients had a very good outcome, with an 8-year event-free survival (8-y EFS) and overall survival (8-y OS) of 86.4% and 95.6%, respectively, suggesting that the IKZF1 deletion had no impact on prognosis in this genetic subtype. Accordingly, within patients with an IKZF1 Δ4-7 deletion, those with ERG(del) had a better outcome (8-y EFS, 85.7% vs 51.3%, HR: 0.16, 95% CI: 0.02-1.20, P=0.04). These findings have implications for further stratification including IKZF1 status.Leukemia accepted article preview online, 25 September 2013. doi:10.1038/leu.2013.277.
    Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K 09/2013; 28(1). DOI:10.1038/leu.2013.277 · 9.38 Impact Factor
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    ABSTRACT: INTRODUCTION: Increased thrombin generation (TG) was described in sickle cell (SCD) children. The aim of this study was to characterize TG at the individual level and assess its relationship with age, hemolysis transcranial Doppler velocity (TCD) and hydroxyurea treatment. PATIENTS AND METHODS: TG was triggered in the platelet-poor plasma using tissue factor and phospholipids with addition of thrombomodulin in 97 SCD at steady-state and 80 control children. Patients and controls were aged from 2 to 20 years and they were distributed in 4 categories of age: [2-5], [6-10], [11-15] and [16-20] years. For each subject, ratio of endogenous thrombin potential (rETP) and peak height (rPeak) was calculated as subject's value divided by the mean value of controls of the same age range. rETP and rPeak of patients were considered abnormal when > mean +2SD of controls. LDH, total hemoglobin and reticulocyte count were measured as markers of hemolysis. Data on hydroxyurea treatment and TCD were collected from medical records. RESULTS: Overall 38.1% and 44.3% of patients showed elevated rETP and rPeak respectively. rETP and rPeak decreased significantly with increasing age. In SS patients, TCD velocities and all markers of hemolysis correlated significantly with both rETp and rPeak. Negative correlations were observed between these ratios and the duration of hydroxyurea treatment. CONCLUSION: Elevated TG in SCD children is mainly related to younger age and to the intensity of hemolysis. There is a link between TG and cerebral vasculopathy in these patients. Hydroxyurea may have a beneficial effect which could be related to the duration of treatment. © 2013 John Wiley & Sons A/S.
    European Journal Of Haematology 03/2013; 91(1). DOI:10.1111/ejh.12113 · 2.41 Impact Factor
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    ABSTRACT: Immunodeficiency with centromeric instability and facial anomalies (ICF) syndrome is a primary immunodeficiency, predominantly characterized by agammaglobulinemia or hypoimmunoglobulinemia, centromere instability and facial anomalies. Mutations in two genes have been discovered to cause ICF syndrome: DNMT3B and ZBTB24. To characterize the clinical features of this syndrome, as well as genotype-phenotype correlations, we compared clinical and genetic data of 44 ICF patients. Of them, 23 had mutations in DNMT3B (ICF1), 13 patients had mutations in ZBTB24 (ICF2), whereas for 8 patients, the gene defect has not yet been identified (ICFX). While at first sight these patients share the same immunological, morphological and epigenetic hallmarks of the disease, systematic evaluation of all reported informative cases shows that: (1) the humoral immunodeficiency is generally more pronounced in ICF1 patients, (2) B- and T-cell compartments are both involved in ICF1 and ICF2, (3) ICF2 patients have a significantly higher incidence of intellectual disability and (4) congenital malformations can be observed in some ICF1 and ICF2 cases. It is expected that these observations on prevalence and clinical presentation will facilitate mutation-screening strategies and help in diagnostic counseling.European Journal of Human Genetics advance online publication, 13 March 2013; doi:10.1038/ejhg.2013.40.
    European journal of human genetics: EJHG 03/2013; DOI:10.1038/ejhg.2013.40 · 4.23 Impact Factor
  • Douleurs Evaluation - Diagnostic - Traitement 11/2012; 13:A53-A54. DOI:10.1016/j.douler.2012.08.141
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    ABSTRACT: Hydroxycarbamide, well known in clinical settings as hydroxyurea (HU), is an antineoplastic agent inhibiting the ribonucleotide reductase enzyme, and thus, the conversion of ribonucleotides into deoxyribonucleotides. A concern about long term side effects of HU treatment in sickle cell disease patients, particularly genotoxicity, has often been evoked. The present study assessed two suitable methods to evaluate oxidative DNA damage associated with HU: the comet assay on blood lymphocytes and the quantification of urinary excretion of 8-oxodeoxyguanosine (8-oxodG). Both methods were applied in a preliminary study including seven sickle cell disease patients treated with HU, seven untreated sickle cell disease patients and five healthy volunteers. Concerning DNA damage, the comet assay and the 8-oxodG assay did not reveal any significant differences among the three groups. Methodologies used in this pilot study could be suitable to carry out further research in this area including a larger size sample setting.
    Hemoglobin 10/2012; 36(6). DOI:10.3109/03630269.2012.725688 · 0.96 Impact Factor
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    ABSTRACT: Changes in several components of the clotting system are well documented in sickle cell disease (SCD) patients. However, whether the global hemostatic potential of these patients is altered is still unclear. Calibrated automated thrombogram® method of thrombin generation (TG) was used to characterize the hemostatic potential of 83 SCD children (75 SS, 6 SC, and 2 Sβ (thal) ) at steady-state as compared with 50 controls of the same range of age. TG was triggered using 1 pM tissue factor and 4 μM phospholipids with and without thrombomodulin. Thirteen SCD children were also evaluated during vaso-occlusive crisis. Protein C activity, free protein S and D-dimers levels were measured in parallel. SCD patients showed higher rates of thrombin formation, higher thrombin peak height (with and without thrombomodulin), and higher endogenous thrombin potential (ETP) than controls in the presence of thrombomodulin. Reduction of ETP (RETP) in the presence of thrombomodulin was lower in SCD group compared with controls and correlated both with protein C and protein S levels. ETP, RETP, peak height, and velocity index of TG correlated with D-dimers. Compound heterozygous patients showed an intermediate hemostatic phenotype at steady-state. No significant difference was observed when comparing TG parameters during vaso-occlusive crisis to those obtained at steady-state in the same patients. The global hemostatic potential is increased and reflects the hypercoagulable state of SCD patients even at steady-state. The relevance of this finding with respect to the risk of thrombotic complications of the disease needs further investigation. Am. J. Hematol. 2011. © 2011 Wiley-Liss, Inc.
    American Journal of Hematology 02/2012; 87(2). DOI:10.1002/ajh.22206 · 3.48 Impact Factor

Publication Stats

3k Citations
780.92 Total Impact Points

Institutions

  • 1988–2015
    • Hôpital Universitaire des Enfants Reine Fabiola
      • • Department of Hemato-Oncology
      • • Department of Pediatrics
      Bruxelles, Brussels Capital, Belgium
  • 2014
    • Universitair Ziekenhuis Leuven
      • Department of Pedriatrics
      Louvain, Flemish, Belgium
  • 2013
    • University Hospital Brussels
      Bruxelles, Brussels Capital, Belgium
  • 1990–2013
    • Université Libre de Bruxelles
      • Department of Hematology
      Bruxelles, Brussels Capital Region, Belgium
  • 2008
    • Ministère de la Santé du Burkina Faso
      Wagadugu, Centre, Burkina Faso
  • 1997–2001
    • Université de Poitiers
      Poitiers, Poitou-Charentes, France
  • 1999
    • Catholic University of Louvain
      Лувен-ла-Нев, Walloon, Belgium
  • 1986–1999
    • Vrije Universiteit Brussel
      • Department of Pediatrics
      Bruxelles, Brussels Capital, Belgium
  • 1996–1997
    • Centre Hospitalier Universitaire Saint-Pierre
      Bruxelles, Brussels Capital, Belgium
  • 1994
    • European Organisation for Research and Treatment of Cancer
      Bruxelles, Brussels Capital Region, Belgium
  • 1993
    • Cliniques Universitaires Saint-Luc
      • Division of Hematology and Pediatric Oncology
      Brussels, BRU, Belgium