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Hayek S, Dichtiar R, Shohat T, Silverman B, Ifrah A, Boker LK. Risk of second primary neoplasm and mortality in childhood cancer survivors based on a national registry database. Cancer Epidemiol 2018; 57:127-133. [PMID: 30399484 DOI: 10.1016/j.canep.2018.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/13/2018] [Accepted: 10/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although overall childhood cancer survival has improved, survivors may still have an elevated risk for second primary neoplasm (SPN) and excess mortality. The aim of the current study was to estimate the risks for SPN and mortality in childhood cancer survivors in Israel as compared to the general population. METHODS All children aged 0-19 diagnosed with primary neoplasm between 1980-2007 who survived at least 5 years following diagnosis were included in the study. Follow-up continued until December 31st, 2013, or diagnosis of SPN, or death due to any cause (the earliest of these events). Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were calculated. Cox proportional hazards regression was employed to assess predictors of SPN and mortality. RESULTS The cohort consisted of 6637 childhood cancer survivors. A total of 244 all-site SPN cases were observed. Compared to the general population, the risks for SPN and for mortality were significantly increased (SIR = 5.48; 95%CI: 4.82-6.22 and SMR = 13.99; 95%CI = 12.54-15.56, respectively). Factors predicting SPN were sex (female), older age at first diagnosis, and initial cancer diagnosis (lymphomas). Factors predicting mortality were older age at first diagnosis, initial cancer diagnosis (myeloproliferative diseases) and earlier years, according to calendar period of initial diagnosis. CONCLUSIONS Although 5-year childhood cancer survival is high, survivors are at elevated risk for SPN and mortality, and the risks are associated with baseline characteristics of the patients. The increased risks should be considered when planning treatment, follow-up and surveillance of the survivors.
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Affiliation(s)
- Samah Hayek
- Israel Center for Disease Control, Israel Ministry of Health, Israel.
| | - Rita Dichtiar
- Israel Center for Disease Control, Israel Ministry of Health, Israel
| | - Tamy Shohat
- Israel Center for Disease Control, Israel Ministry of Health, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Barbara Silverman
- Israel Center for Disease Control, Israel Ministry of Health, Israel
| | - Anneke Ifrah
- Israel Center for Disease Control, Israel Ministry of Health, Israel
| | - Lital Keinan Boker
- Israel Center for Disease Control, Israel Ministry of Health, Israel; School of Public Health, University of Haifa, Israel
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Physcion 8-O-β-glucopyranoside exhibits anti-leukemic activity through targeting sphingolipid rheostat. Pharmacol Rep 2018; 70:853-862. [DOI: 10.1016/j.pharep.2018.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 03/03/2018] [Accepted: 03/14/2018] [Indexed: 12/25/2022]
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Mueller BA, Doody DR, Weiss NS, Chow EJ. Hospitalization and mortality among pediatric cancer survivors: a population-based study. Cancer Causes Control 2018; 29:1047-1057. [PMID: 30187228 DOI: 10.1007/s10552-018-1078-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/29/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE We examined serious long-term outcomes among childhood cancer survivors using population-based data. METHODS We used 1982-2014 Washington State data to compare hospitalization and/or death (including cause-specific) during up to 27 years follow-up among all 5+ year childhood cancer survivors < 20 years at diagnosis (n = 3,152) and a sample of comparison children within birth cohorts, with assessment by cancer type and child/family characteristics. RESULTS During follow-up (9 years median), 12% of survivors had hospitalizations; 4% died. Greatest absolute risks/1,000 person-years were for hospitalization/deaths due to cancers (8.1), infection (6.2), injuries (6.0), and endocrine/metabolic disorders (5.8). Hazard ratios (HR) and 95% confidence intervals (CI) for hospitalization (2.7, 95% CI 2.4-3.0) and any-cause death (14.7, 95% CI 11.3-19.1) were increased, and for all cause-specific outcomes examined, most notably cancer- (35.1, 95% CI 23.7-51.9), hematological- (6.7, 95% CI 5.3-8.5), nervous system- (6.4, 95% CI 5.2-7.8), and circulatory- (5.2, 95% CI 4.1-6.5) related outcomes. Hospitalizations occurred more often among females and those receiving radiation, with modest differences by urban/rural birth residence and race/ethnicity. Cause-specific outcomes varied by cancer type. CONCLUSIONS This study suggests increased risks for the rarely-studied outcomes of long-term fracture and injury, and confirms increased risks of selected other conditions among survivors. Multi-state pooling of population-based data would increase the ability to evaluate outcomes for uncommon cancer types and by racial/ethnic groups under-represented in many studies.
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Affiliation(s)
- Beth A Mueller
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center (FHCRC), PO 19024, Mailstop M4-C308, Seattle, WA, USA. .,Department of Epidemiology, University of Washington (UW), Seattle, WA, USA.
| | - David R Doody
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center (FHCRC), PO 19024, Mailstop M4-C308, Seattle, WA, USA
| | - Noel S Weiss
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center (FHCRC), PO 19024, Mailstop M4-C308, Seattle, WA, USA.,Department of Epidemiology, University of Washington (UW), Seattle, WA, USA
| | - Eric J Chow
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center (FHCRC), PO 19024, Mailstop M4-C308, Seattle, WA, USA.,Clinical Research Division, FHCRC, Seattle, WA, USA.,Department of Pediatrics, Seattle Children's Hospital, UW, Seattle, WA, USA
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54
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Schulte F, Brinkman TM, Li C, Fay-McClymont T, Srivastava DK, Ness KK, Howell RM, Mueller S, Wells E, Strother D, Lafay-Cousin L, Leisenring W, Robison LL, Armstrong GT, Krull KR. Social adjustment in adolescent survivors of pediatric central nervous system tumors: A report from the Childhood Cancer Survivor Study. Cancer 2018; 124:3596-3608. [PMID: 30067866 DOI: 10.1002/cncr.31593] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/25/2018] [Accepted: 05/10/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to examine the prevalence and predictors of social difficulties in adolescent survivors of central nervous system (CNS) tumors. METHODS Six hundred sixty-five survivors of CNS tumors (53.8% male and 51.7% treated with cranial radiation therapy [CRT]), who had a current median age of 15.0 years (range, 2.0-17.0 years) and were a median of 12.1 years (range, 8.0-17.7 years) from their diagnosis, were compared with 1376 survivors of solid tumors (50.4% male), who had a median age of 15.0 years (range, 12.0-17.0 years) and were a median of 13.2 years (range, 8.3-17.9 years) from their diagnosis, and 726 siblings (52.2% male), who had a median age of 15.0 years (range, 12.0-17.0 years). Social adjustment was measured with parent-proxy responses to the Behavior Problems Index. Latent profile analysis defined social classes. Multinomial logistic regression, adjusted for age, sex, and age at diagnosis, identified predictors of class membership. Path analyses tested mediating effects of physical limitations, sensory loss, and cognitive impairment on social outcomes. RESULTS Caregivers reported that survivors of CNS tumors were more likely to have 0 friends (15.3%) and to interact with friends less than once per week (41.0%) in comparison with survivors of solid tumors (2.9% and 13.6%, respectively) and siblings (2.3% and 8.7%, respectively). Latent profile analysis identified 3 social classes for survivors of CNS tumors: well-adjusted (53.4%), social deficits (16.2%), and poor peer relationships (30.4%). However, 2 classes were identified for survivors of solid tumors and siblings: well-adjusted (86.2% and 91.1%, respectively) and social deficits (13.8% and 8.9%, respectively). CRT predicted class membership for CNS survivors (odds ratio [OR] for poor peer relationships, 1.16/10 Gy; 95% confidence interval [CI], 1.08-1.25; OR for social deficits 1.14/10 Gy; 95% CI, 1.04-1.25; reference, well-adjusted). Cognitive impairment mediated the association between all social outcomes and CRT (P values < .001). CONCLUSION Almost 50% of survivors of CNS tumors experience social difficulties; the pattern is unique in comparison with solid tumor and sibling groups. Cognitive impairment is associated with increased risk, and this highlights the need for multitargeted interventions.
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Affiliation(s)
- Fiona Schulte
- University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | - Chenghong Li
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Taryn Fay-McClymont
- University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | - Kirsten K Ness
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rebecca M Howell
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sabine Mueller
- University of California San Francisco, San Francisco, California
| | - Elizabeth Wells
- Children's National Medical Center, Washington, District of Columbia
| | - Douglas Strother
- University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Lucie Lafay-Cousin
- University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | | | | | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, Tennessee
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Dracham CB, Shankar A, Madan R. Radiation induced secondary malignancies: a review article. Radiat Oncol J 2018; 36:85-94. [PMID: 29983028 PMCID: PMC6074073 DOI: 10.3857/roj.2018.00290] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 12/31/2022] Open
Abstract
Radiation-induced second malignancies (RISM) is one of the important late side effects of radiation therapy and has an impact on optimal treatment decision-making. Many factors contribute to the development of RISM such as age at radiation, dose and volume of irradiated area, type of irradiated organ and tissue, radiation technique and individual and family history of cancer. Exact mechanism of RISM is unknown. But nowadays, it is a growing concern in oncology because of the increased number of cancer survivors and efforts are being made to prevent or decrease the incidence of RISM. The primary search for articles was carried via Google Scholar and PubMed with keywords included 'radiation induced malignancies, second malignancies, and chemotherapy induced malignancies'. Additional papers were found through references from relevant articles. In this review article, we have discussed about the pathogenesis, factors contributing to RISM, screening and prevention strategies of RISM.
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Affiliation(s)
| | - Abhash Shankar
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
| | - Renu Madan
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
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56
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Myrdal OH, Kanellopoulos A, Christensen JR, Ruud E, Edvardsen E, Kongerud J, Sikkeland LI, Lund MB. Risk factors for impaired pulmonary function and cardiorespiratory fitness in very long-term adult survivors of childhood acute lymphoblastic leukemia after treatment with chemotherapy only . Acta Oncol 2018; 57:658-664. [PMID: 29303026 DOI: 10.1080/0284186x.2017.1423177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk of late treatment-related side-effects. Data regarding prevalence and risk factors for impairments in pulmonary function and cardiorespiratory fitness are limited, and reported findings are inconsistent and inconclusive. MATERIAL AND METHODS In a cross-sectional study, 116 ALL survivors (median 5 years at diagnosis, 29 years at follow-up, 53% females) were examined, median 23 years after treatment with chemotherapy only. Individual cumulative doses of cytostatic agents were calculated. Methods included blood tests, echocardiography, pulmonary function tests and cardiorespiratory exercise test. RESULTS Females had lower % predicted gas diffusing capacity (DLCO) than males (mean [SD] 84 [13] versus 97 [14], p < .001). Impairment in DLCO was found in 34% females versus 7% males, p < .001. In a multiple linear regression model, female gender, body mass index (BMI) and smoking were risk factors for reduced % predicted DLCO, with a borderline significant effect of left ventricular ejection fraction (LVEF). Impaired cardiorespiratory fitness was found in 42% of the survivors, with a borderline increased risk in females, p = .06. Smoking and BMI were risk factors for reduced % predicted VO2peak. Subjects exposed to anthracyclines had lower LVEF% and % predicted VO2peak than those not exposed, (mean [SD] 56.2 [4.3] versus 59.2 [5.2], p = .01 and 86.9 [18.4] versus 92.8 [18.4], p = .03, respectively). CONCLUSIONS Impairments in pulmonary function and cardiorespiratory fitness are common in very long-term survivors of childhood ALL. Risk factors are female gender, BMI and smoking. In order to preserve pulmonary function and cardiorespiratory fitness, we suggest increased attention and targeted advice on modifiable lifestyle factors such as smoking, inactivity and overweight.
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Affiliation(s)
- Ole Henrik Myrdal
- Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Adriani Kanellopoulos
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Dept of Pediatric Oncology and Haematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jon R. Christensen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ellen Ruud
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Dept of Pediatric Oncology and Haematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Elisabeth Edvardsen
- The Norwegian School of Sport Sciences, Oslo, Norway
- Department of Pulmonary Medicine, Oslo University Hospital, Ullevål, Norway
| | - Johny Kongerud
- Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Ingunn Sikkeland
- Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - May B. Lund
- Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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57
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Dixon SB, Bjornard KL, Alberts NM, Armstrong GT, Brinkman TM, Chemaitilly W, Ehrhardt MJ, Fernandez-Pineda I, Force LM, Gibson TM, Green DM, Howell CR, Kaste SC, Kirchhoff A, Klosky JL, Krull KR, Lucas JT, Mulrooney DA, Ness KK, Wilson CL, Yasui Y, Robison LL, Hudson MM. Factors influencing risk-based care of the childhood cancer survivor in the 21st century. CA Cancer J Clin 2018; 68:133-152. [PMID: 29377070 PMCID: PMC8893118 DOI: 10.3322/caac.21445] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 12/30/2022] Open
Abstract
The population of adult survivors of childhood cancer continues to grow as survival rates improve. Although it is well established that these survivors experience various complications and comorbidities related to their malignancy and treatment, this risk is modified by many factors that are not directly linked to their cancer history. Research evaluating the influence of patient-specific demographic and genetic factors, premorbid and comorbid conditions, health behaviors, and aging has identified additional risk factors that influence cancer treatment-related toxicity and possible targets for intervention in this population. Furthermore, although current long-term follow-up guidelines comprehensively address specific therapy-related risks and provide screening recommendations, the risk profile of the population continues to evolve with ongoing modification of treatment strategies and the emergence of novel therapeutics. To address the multifactorial modifiers of cancer treatment-related health risk and evolving treatment approaches, a patient-centered and risk-adapted approach to care that often requires a multidisciplinary team approach, including medical and behavioral providers, is necessary for this population. CA Cancer J Clin 2018;68:133-152. © 2018 American Cancer Society.
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Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kari L Bjornard
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Nicole M Alberts
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Tara M Brinkman
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Wassim Chemaitilly
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pediatric Medicine – Division of Endocrinology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew J Ehrhardt
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Lisa M Force
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel M Green
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sue C Kaste
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN
| | - Anne Kirchhoff
- Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - James L Klosky
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kevin R Krull
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - John T Lucas
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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58
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Ultimo S, Martelli AM, Zauli G, Vitale M, Calin GA, Neri LM. Roles and clinical implications of microRNAs in acute lymphoblastic leukemia. J Cell Physiol 2018; 233:5642-5654. [DOI: 10.1002/jcp.26290] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/14/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Simona Ultimo
- Department of Morphology, Surgery and Experimental MedicineUniversity of FerraraFerraraItaly
| | - Alberto M. Martelli
- Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
| | - Giorgio Zauli
- Department of Morphology, Surgery and Experimental MedicineUniversity of FerraraFerraraItaly
| | - Marco Vitale
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM)University of ParmaParmaItaly
- CoreLabHospital‐University of ParmaParmaItaly
| | - George A. Calin
- Departments of Experimental Therapeutics and LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexas
- Center for RNA Interference and Non‐Coding RNAsThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Luca M. Neri
- Department of Morphology, Surgery and Experimental MedicineUniversity of FerraraFerraraItaly
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Sharafeldin N, Bosworth A, Patel SK, Chen Y, Morse E, Mather M, Sun C, Francisco L, Forman SJ, Wong FL, Bhatia S. Cognitive Functioning After Hematopoietic Cell Transplantation for Hematologic Malignancy: Results From a Prospective Longitudinal Study. J Clin Oncol 2018; 36:463-475. [DOI: 10.1200/jco.2017.74.2270] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Cognitive impairment is well-recognized after myeloablative allogeneic hematopoietic cell transplantation (HCT). However, cognitive functioning after reduced-intensity allogeneic or autologous HCT remains unclear. Methods A total of 477 HCT recipients (236 autologous, 128 reduced-intensity allogeneic, 113 myeloablative allogeneic) underwent standardized neuropsychologic testing before HCT and at 6 months and 1, 2, and 3 years after HCT. Ninety-nine frequency-matched healthy controls underwent testing at commensurate time points. Primary outcomes of the study were practice effect–adjusted domain-specific T scores and global deficit scores. Piecewise generalized estimating equation models were used to compare groups and to identify associated variables and post-HCT trends of cognitive impairment. Results Median age was 52 years (range, 18 to 74 years) for HCT recipients and 55 years (range, 19 to 73 years) for controls. Post-HCT scores were comparable between controls and autologous and reduced-intensity HCT recipients. Myeloablative HCT recipients had significantly lower ( P < .001) post-HCT scores than controls for executive function, verbal speed, processing speed, auditory memory, and fine motor dexterity. Pre-HCT to 6 months post-HCT scores did not change after reduced-intensity HCT but declined significantly for fine motor dexterity ( P < .001) after myeloablative HCT. However, pre-HCT to 3 years post-HCT scores declined significantly ( P < .003) in reduced-intensity HCT recipients for executive function, verbal fluency, and working memory. Older age, male sex, and lower education, income, and cognitive reserve were associated with post-HCT cognitive impairment. At 3 years post-HCT, global cognitive impairment was present in 18.7% of autologous and 35.7% of allogeneic HCT recipients. Conclusion Myeloablative allogeneic HCT recipients showed significant cognitive decline compared with healthy controls. Reduced-intensity allogeneic HCT recipients showed evidence of delayed decline. Cognitive functioning in autologous HCT recipients generally was spared. The study identified vulnerable subpopulations that could benefit from targeted interventions.
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Affiliation(s)
- Noha Sharafeldin
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Alysia Bosworth
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Sunita K. Patel
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Yanjun Chen
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Emily Morse
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Molly Mather
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Canlan Sun
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Liton Francisco
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Stephen J. Forman
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - F. Lennie Wong
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Smita Bhatia
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
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Uppal S, Al-Kindi SG, Oliveira GH. Cardiovascular mortality among 76 864 survivors of childhood cancers in the United States. J Cardiovasc Med (Hagerstown) 2018; 19:38-41. [DOI: 10.2459/jcm.0000000000000585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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61
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Oktem O, Kim SS, Selek U, Schatmann G, Urman B. Ovarian and Uterine Functions in Female Survivors of Childhood Cancers. Oncologist 2017; 23:214-224. [PMID: 29158370 DOI: 10.1634/theoncologist.2017-0201] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/21/2017] [Indexed: 01/27/2023] Open
Abstract
Adult survivors of childhood cancers are more prone to developing poor reproductive and obstetrical outcomes than their siblings and the general population as a result of previous exposure to chemotherapy and radiation during childhood. Chemotherapy drugs exert cytotoxic effects systemically and therefore can damage the ovaries, leading to infertility, premature ovarian failure, and, to a lesser extent, spontaneous abortions. They have very limited or no deleterious effects on the uterus that can be recognized clinically. By contrast, radiation is detrimental to both the ovaries and the uterus, thereby causing a greater magnitude of adverse effects on the female reproductive function. These include infertility, premature ovarian failure, miscarriage, fetal growth restrictions, perinatal deaths, preterm births, delivery of small-for-gestational-age infants, preeclampsia, and abnormal placentation. Regrettably, the majority of these adverse outcomes arise from radiation-induced uterine injury and are reported at higher incidence in the adult survivors of childhood cancers who were exposed to uterine radiation during childhood in the form of pelvic, spinal, or total-body irradiation. Recent findings of long-term follow-up studies evaluating reproductive performance of female survivors provided some reassurance to female cancer survivors by documenting that pregnancy and live birth rates were not significantly compromised in survivors, including those who had been treated with alkylating agents and had not received pelvic, cranial, and total-body irradiation. We aimed in this narrative review article to provide an update on the impact of chemotherapy and radiation on the ovarian and uterine function in female survivors of childhood cancer. IMPLICATIONS FOR PRACTICE Adult survivors of childhood cancers are more prone to developing a number of poor reproductive and obstetrical outcomes than their siblings and the general population as a result of previous exposure to chemotherapy and radiation during childhood. The impact of radiation therapy on the female genital system is greater than chemotherapy regimens because radiation is detrimental to both the uterus and the ovaries, whereas toxic effects of chemotherapy drugs are confined to the ovaries. Therefore, radiation-induced uterine damage accounts for most poor obstetrical outcomes in the survivors. These include infertility, miscarriages, stillbirths, fetal growth restrictions, preeclampsia, and preterm deliveries.
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Affiliation(s)
- Ozgur Oktem
- Department of Obstetrics and Gynecology, School of Medicine, Koc University, Istanbul, Turkey
- Assisted Reproduction Unit, Fertility Preservation Program, American Hospital Women's Health Center, Istanbul, Turkey
| | - Samuel S Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kansas University, Kansas City, Kansas, USA
| | - Ugur Selek
- Department of Radiation Oncology, Koc University School of Medicine and MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, Comprehensive Cancer Care Program, American Hospital, Istanbul, Turkey
| | - Glenn Schatmann
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Medical College of Cornell University, New York, New York, USA
| | - Bulent Urman
- Department of Obstetrics and Gynecology, School of Medicine, Koc University, Istanbul, Turkey
- Assisted Reproduction Unit, Fertility Preservation Program, American Hospital Women's Health Center, Istanbul, Turkey
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62
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Gupta P, Jalali R. Long-term Survivors of Childhood Brain Tumors: Impact on General Health and Quality of Life. Curr Neurol Neurosci Rep 2017; 17:99. [PMID: 29119343 DOI: 10.1007/s11910-017-0808-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW We review and summarize the key issues affecting general health and quality of life (QOL) of pediatric long-term survivors of brain tumors. RECENT FINDINGS Long-term survivors of brain tumors are at risk of considerable late morbidity and mortality. Lengthening survival in brain tumors has highlighted the deep impact of tumor and its treatment on the physical, psychological, functional, and social health and QOL of these survivors. Evolution in tumor therapy including surgery, radiotherapy, and systemic therapies, etc., has the potential to mitigate this impact to some extent. Sensitization of health staff, policy makers, and the primary designers of clinical trials towards integration of QOL end points while measuring survival in brain tumor patients is the need of the hour. New developments in tumor therapeutics must not only provide quantitative gain but also improve the quality of survival in these long-term survivors. While majority of the issues presented pertain to survivorship in pediatric brain tumor population, similar challenges are likely to exist in young adults surviving brain tumors as well.
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Affiliation(s)
- Priyamvada Gupta
- Neuro Oncology Group, Tata Memorial Centre, Tata Memorial Hospital, Dr Ernest Borges Road, Parel, Mumbai, 400 012, India
| | - Rakesh Jalali
- Neuro Oncology Group, Tata Memorial Centre, Tata Memorial Hospital, Dr Ernest Borges Road, Parel, Mumbai, 400 012, India.
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63
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Gao F, Liu W, Guo Q, Bai Y, Yang H, Chen H. Physcion blocks cell cycle and induces apoptosis in human B cell precursor acute lymphoblastic leukemia cells by downregulating HOXA5. Biomed Pharmacother 2017; 94:850-857. [PMID: 28810515 DOI: 10.1016/j.biopha.2017.07.149] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/17/2017] [Accepted: 07/30/2017] [Indexed: 01/01/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) presents the most common type of malignancy in children and ranks the third most common cancer in adults. This study is aimed to investigate the anti-leukemia activity of physcion in ALL. Our results have showed that physcion could significantly suppress cell growth, induce apoptosis and blocked cell cycle progression in vitro. Mechanistically, we found that physcion downregulated the expression of HOXA5, which is responsible for the anti-leukemia activity of physcion. To verify this finding, siRNA targeting HOXA5 and overexpressing plasmid were used to repress HOXA5 expression and introduce ectopic overexpression of HOXA5 in ALL cell lines, respectively. Our results showed that overexpression of HOXA5 significantly abrogated the inducing effect of physcion on apoptosis and cell cycle blockasde. In contrast, knockdown of HOXA5 by siRNA enhanced the anti-tumor effect of physcion on ALL cell lines. Our results provided experimental base for the use of physcion in the treatment of ALL.
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Affiliation(s)
- Fei Gao
- Department of Pediatrics, Affliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Wenjun Liu
- Department of Pediatrics, Affliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China.
| | - Qulian Guo
- Department of Pediatrics, Affliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Yongqi Bai
- Department of Pediatrics, Affliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Hong Yang
- Department of Pediatrics, Affliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Hongying Chen
- Department of Pediatrics, Affliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
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64
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Cheung YT, Brinkman TM, Mulrooney DA, Mzayek Y, Liu W, Banerjee P, Panoskaltsis-Mortari A, Srivastava D, Pui CH, Robison LL, Hudson MM, Krull KR. Impact of sleep, fatigue, and systemic inflammation on neurocognitive and behavioral outcomes in long-term survivors of childhood acute lymphoblastic leukemia. Cancer 2017; 123:3410-3419. [PMID: 28452142 DOI: 10.1002/cncr.30742] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Long-term survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for neurocognitive impairment, which may be associated with fatigue, sleep problems, systemic inflammation, and oxidative stress. We examined these associations among survivors of childhood ALL treated with chemotherapy only. METHODS Survivors of childhood ALL (male, n = 35 and female, n = 35; mean age, 14.3 years [standard deviation, 4.7 years] and mean years from diagnosis, 7.4 years [standard deviation, 1.9 years]) completed neurocognitive testing, behavioral ratings, and reported sleep quality and fatigue symptoms 5 years after diagnosis. Serum was collected concurrently and assayed for interleukin (IL)-1β and IL-6, tumor necrosis factor α (TNF-α), high-sensitivity C-reactive protein (hsCRP), malondialdehyde, myeloperoxidase, and oxidized low-density lipoprotein. General linear modeling was used to assess associations among biomarkers and functional outcomes, adjusting for age and stratified by sex. RESULTS Survivors performed worse than population norms on executive function and processing speed and reported more behavioral problems (P < .05 adjusted for multiple comparison). In female survivors, fatigue was associated with poor executive function (r = 0.41; P = .02), processing speed (r = 0.56; P < .001), and attention (r = 0.36-0.55; P < .05). Female survivors with frequent nighttime awakening displayed more inattention (P = .01), hyperactivity (P = .03), and aggression (P = .01). Worse executive function, processing speed, and behavioral symptoms were observed in female survivors with higher levels of IL-6, IL-1β, and hsCRP (P < .05). Male survivors with high levels of TNF-α demonstrated worse organization (P = .03), but no significant associations between neurocognitive outcomes and sleep/fatigue measures were observed. CONCLUSION Neurocognitive function in female survivors of childhood ALL appears more susceptible to the effects of sleep disturbance and fatigue. Systemic inflammation may play a role in neurocognitive impairment and behavioral symptoms. Cancer 2017;123:3410-9. © 2017 American Cancer Society.
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Affiliation(s)
- Yin Ting Cheung
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yasmin Mzayek
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wei Liu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Pia Banerjee
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Angela Panoskaltsis-Mortari
- Division of Pediatric Blood and Bone Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.,Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Deokumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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65
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Cheung YT, Chemaitilly W, Mulrooney DA, Brinkman TM, Liu W, Banerjee P, Srivastava D, Pui CH, Robison LL, Hudson MM, Krull KR. Association between dehydroepiandrosterone-sulfate and attention in long-term survivors of childhood acute lymphoblastic leukemia treated with only chemotherapy. Psychoneuroendocrinology 2017; 76:114-118. [PMID: 27907849 PMCID: PMC5272831 DOI: 10.1016/j.psyneuen.2016.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/09/2016] [Indexed: 12/24/2022]
Abstract
Long-term survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for neurocognitive impairment, as well as compromised hypothalamic-pituitary-adrenal (HPA) function. Dehydroepiandrosterone-sulfate (DHEAS) is an adrenal androgen commonly used as a marker of HPA function. In the general population, a low level of DHEAS has been associated with poorer cognition. At ≥2years post-treatment, we examined the association of DHEAS with attention outcomes in 35 male and 34 female long-term survivors of childhood ALL (mean[standard deviation] age at evaluation 14.5[4.7] years; 7.5[1.9] years post-diagnosis) who were treated with only chemotherapy and without prophylactic cranial irradiation. Male survivors with low-normal levels of DHEAS had worse performance than male survivors with high levels of DHEAS on multiple measures of attention (all P's<0.05). However, association between DHEAS and attention measures were not found in female survivors. Our results suggest that survivors of ALL who suffer from partial but persistent adrenal insufficiency may be at risk for neurocognitive deficits. This finding should be validated in a larger prospective study, with attention to sex differences in the potential impact of adrenal insufficiency on neurocognitive outcomes.
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Affiliation(s)
- Yin Ting Cheung
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, USA
| | - Wassim Chemaitilly
- Department of Endocrinology, St Jude Children's Research Hospital, Memphis, USA
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, USA; Department of Psychology, St Jude Children's Research Hospital, Memphis, USA
| | - Wei Liu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, USA
| | - Pia Banerjee
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, USA
| | - Deokumar Srivastava
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, USA
| | - Ching-Hon Pui
- Department of Oncology, St Jude Children's Research Hospital, Memphis, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, USA; Department of Psychology, St Jude Children's Research Hospital, Memphis, USA.
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66
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Leukoencephalopathy and long-term neurobehavioural, neurocognitive, and brain imaging outcomes in survivors of childhood acute lymphoblastic leukaemia treated with chemotherapy: a longitudinal analysis. LANCET HAEMATOLOGY 2016; 3:e456-e466. [PMID: 27658980 DOI: 10.1016/s2352-3026(16)30110-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 07/22/2016] [Accepted: 08/01/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Leukoencephalopathy is observed in some children undergoing chemotherapy for acute lymphoblastic leukaemia, although its effects on long-term outcomes is unknown. This study examines the associations between acute leukoencephalopathy and neurobehavioural, neurocognitive, and brain white matter imaging outcomes in long-term survivors of childhood acute lymphoblastic leukaemia treated with chemotherapy without cranial radiation. METHODS In this longitudinal analysis, we used data of children with acute lymphoblastic leukaemia at St Jude Children's Research Hospital (Memphis, TN, USA) who had been treated between June 1, 2000, and Oct 31, 2010. Eligible patients were diagnosed with non-B-cell acute lymphoblastic leukaemia, aged at least 8 years, and survivors with at least 5 years since their initial diagnosis. Brain MRIs obtained during active therapy were systematically coded for leukoencephalopathy using Common Terminology Criteria for Adverse Event version 4. At least 5 years after their diagnosis, survivors completed neurocognitive testing, another brain MRI, and their parents completed neurobehavioural ratings of their child (Behavior Rating Inventory of Executive Function [BRIEF]). Follow-up MRI included diffusion tensor imaging to assess white matter integrity, with indices of fractional anisotropy, axial diffusivity, and radial diffusivity from frontal lobes, parietal lobes, and in the frontostriatal tract. The neuroradiologist, who assessed abnormal MRIs, was masked to both group assignment of survivors and the neurobehavioural and neurocognitive outcomes. The primary outcomes were neurobehavioural function, assessed from completed BRIEF, and neurocognitive performance, measured by direct neurocognitive tests (Delis-Kaplan Executive Function System, Wechsler Intelligence Scale for Children-IV/Wechsler Adult Intelligence Scale-III, Rey-Osterrieth Complex Figure Test, and Lafayette Grooved Pegboard Test). This study had completed enrolment in October, 2014, and is registered as an observational study at ClinicalTrials.gov, number NCT01014195. FINDINGS Between Feb 18, 2010, and Oct 22, 2014, 210 (70%) of 301 eligible survivors participated in our study of whom 190 were evaluable, 162 had an MRI. 56 participants had quantitative brain imaging data and were included in evaluable population analyses. 51 (27%) of the 190 evaluable participants had acute leukoencephalopathy. Compared with population norms, survivors were reported to have more neurobehavioural problems with working memory, organisation, initiation, and planning (p<0·001 for all). Survivors had worse scores than the general population on direct measures of memory span, processing speed, and executive function (p<0·05 for all). Survivors with a history of acute leukoencephalopathy had more neurobehavioural problems than survivors with no history of leukoencephalopathy on organisation (adjusted T-score 56·2 [95% CI 53·3-59·1] vs 52·2 [50·4-53·9], p=0·020) and initiation (55·5 [52·7-58·3] vs 52·1 [50·4-53·8], p=0·045). Survivors with acute leukoencephalopathy also had reduced white matter integrity in the frontostriatal tract at follow-up: lower fractional anisotropy (p=0·069), higher axial diffusivity (p=0·020), and higher radial diffusivity (p=0·0077). A one-unit change in the radial diffusivity index corresponded with a 15·0 increase in raw score points on initiation, 30·3 on planning, and 28·0 on working memory (p<0·05 for all). INTERPRETATION Acute leukoencephalopathy during chemotherapy treatment, without cranial radiation, for childhood acute lymphoblastic leukaemia predicted higher risk for long-term neurobehavioural problems and reduced white matter integrity in frontal brain regions. Survivors of childhood acute lymphoblastic leukaemia might benefit from preventive cognitive or behavioural interventions, particularly those who develop acute leukoencephalopathy. FUNDING National Institute of Mental Health, National Cancer Institute, American Lebanese Syrian Associated Charities.
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67
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Pépin AJ, Cloutier-Bergeron A, Malboeuf-Hurtubise C, Achille M, Krajinovic M, Laverdière C, Lippé S, Marcoux S, Sinnett D, Sultan S. Adverse neuropsychological effects associated with cumulative doses of corticosteroids to treat childhood acute lymphoblastic leukemia: A literature review. Crit Rev Oncol Hematol 2016; 107:138-148. [PMID: 27823641 DOI: 10.1016/j.critrevonc.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/11/2016] [Accepted: 09/06/2016] [Indexed: 01/07/2023] Open
Abstract
Corticosteroids (CS) are an essential component of childhood acute lymphoblastic leukemia treatments (cALL). Although there is evidence that daily doses of CS can have neuropsychological effects, few studies have investigated the role of cumulative doses of CS in short- and long-term neuropsychological effects in cALL. The aims of this review were to identify the measures used for documenting adverse neuropsychological effects (ANEs) of CS treatment and to study the association between cumulative doses of CS and the presence of ANEs. Twenty-two articles met the inclusion criteria. A variety of measures were used to evaluate outcomes in the domains of emotion, behaviour, neurocognition, and fatigue/sleep. The results suggest that we cannot conclude in favour of an association between the cumulative dosage of CS and ANEs. Yet, several factors including the heterogeneity of measures used to evaluate outcomes and reporting biases may limit the scope of the results. We offer several recommendations that could help improve the future published evidence on ANEs in relation to CS treatment in cALL.
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Affiliation(s)
- A J Pépin
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada.
| | | | | | | | - M Krajinovic
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - C Laverdière
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - S Lippé
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - S Marcoux
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - D Sinnett
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - S Sultan
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada.
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68
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Krawczuk-Rybak M, Tomczuk-Ostapczuk M, Panasiuk A, Goscik E. Carotid intima-media thickness in young survivors of childhood cancer. J Med Imaging Radiat Oncol 2016; 61:85-92. [DOI: 10.1111/1754-9485.12510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/23/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology; Medical University of Bialystok; Bialystok Poland
| | - Monika Tomczuk-Ostapczuk
- Department of Pediatric Radiology; Medical University of Bialystok; Children's Clinical Hospital of L. Zamenhof; Bialystok Poland
| | - Anna Panasiuk
- Department of Pediatric Oncology and Hematology; Medical University of Bialystok; Bialystok Poland
| | - Elzbieta Goscik
- Department of Pediatric Radiology; Medical University of Bialystok; Children's Clinical Hospital of L. Zamenhof; Bialystok Poland
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69
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Ye W, Jiang Z, Lu X, Ren X, Deng M, Lin S, Xiao Y, Lin S, Wang S, Li B, Zheng Y, Lai P, Weng J, Wu D, Ma Y, Chen X, Wen Z, Chen Y, Feng X, Li Y, Liu P, Du X, Pei D, Yao Y, Xu B, Ding K, Li P. GZD824 suppresses the growth of human B cell precursor acute lymphoblastic leukemia cells by inhibiting the SRC kinase and PI3K/AKT pathways. Oncotarget 2016; 8:87002-87015. [PMID: 29152059 PMCID: PMC5675611 DOI: 10.18632/oncotarget.10881] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/09/2016] [Indexed: 01/13/2023] Open
Abstract
Available therapeutic options for advanced B cell precursor acute lymphoblastic leukemia (pre-B ALL) are limited. Many lead to neutropenia, leaving patients at risk of life-threatening infections and result in bad outcomes. New treatment options are needed to improve overall survival. We previously showed that GZD824, a novel BCR-ABL tyrosine kinase inhibitor, has anti-tumor activity in Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia cells and tumor models. Here, we show that GZD824 decreases cell viability, induces cell-cycle arrest, and causes apoptosis in pre-B ALL cells. Furthermore, Ph– pre-B ALL cells were more sensitive to GZD824 than Ph+ pre-B ALL cells. GZD824 consistently reduced tumor loads in Ph– pre-B ALL xenografts but failed to suppress Ph+ pre-B ALL xenografts. GZD824 decreased phosphorylation of SRC kinase, STAT3, RB and C-myc. It also downregulated the expression of BCL-XL, CCND1 and CDK4 and upregulated expression of CCKN1A. Expression of IRS1 was decreased in GZD824-treated pre-B ALL cells, blocking the PI3K/AKT pathway. These data demonstrate that GZD824 suppresses pre-B ALL cells through inhibition of the SRC kinase and PI3K/AKT pathways and may be a potential therapeutic agent for the management of pre-B ALL.
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Affiliation(s)
- Wei Ye
- School of Life Science, University of Science and Technology of China, Anhui, China.,State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Zhiwu Jiang
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Xiaoyun Lu
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Xiaomei Ren
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Manman Deng
- Department of Hematology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Shouheng Lin
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Yiren Xiao
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Simiao Lin
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Suna Wang
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Baiheng Li
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Yi Zheng
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Peilong Lai
- Department of Hematology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Jianyu Weng
- Department of Hematology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Donghai Wu
- Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Yuguo Ma
- Yikang Tailai Technology Co. Ltd, Guangzhou, China
| | - Xudong Chen
- Department of Interventional Radiology, Shenzhen People's Hospital, Shenzhen, China
| | - Zhesheng Wen
- Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yaoyu Chen
- First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Xiaoyan Feng
- Chongqing HiChuang Biomedical Corp., Chongqing, China
| | - Yangqiu Li
- Department of Hematology, Medical College, Jinan University, Guangzhou, China.,Key Laboratory for Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
| | - Pentao Liu
- Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1HH, England, UK
| | - Xin Du
- Department of Hematology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Duanqing Pei
- Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Yao Yao
- Drug Discovery Pipeline, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Bing Xu
- Department of Hematology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Ke Ding
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Peng Li
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
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Wilson CL, Chemaitilly W, Jones KE, Kaste SC, Srivastava DK, Ojha RP, Yasui Y, Pui CH, Robison LL, Hudson MM, Ness KK. Modifiable Factors Associated With Aging Phenotypes Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia. J Clin Oncol 2016; 34:2509-15. [PMID: 27001572 PMCID: PMC4962734 DOI: 10.1200/jco.2015.64.9525] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for low bone mineral density (BMD) and frail health, outcomes potentially modifiable by altering health behaviors and/or treating endocrine abnormalities. We evaluated associations between lifestyle and hormonal deficits with risk of low BMD and frailty among survivors of ALL. PATIENTS AND METHODS Participants included 862 survivors of ALL (median age, 31.3 years [range, 18.4 to 59.7 years]) enrolled in the St Jude Lifetime Cohort study. Bone density was measured using quantitative computed tomography of L1 through L2 vertebrae; low BMD was defined as an age- and sex-standardized z score < -1. The presence of frailty or prefrailty was defined as having at least two of the following: low muscle mass, self-reported exhaustion, low energy expenditure, slow walking speed, and weakness. Hormonal deficiencies were determined according to medical history, medications, and laboratory findings (insulin-like growth factor 1, follicle-stimulating hormone, luteinizing hormone, and testosterone levels). Logistic regression was used to examine associations between lifestyle (smoking, alcohol consumption, and activity levels) and deficiencies in growth hormone (GHD) and/or sex steroids with low BMD and frailty. RESULTS Thirty percent of survivors met criteria for low BMD, and 18.6% for frailty/prefrailty. After adjusting for body mass index, low BMD was associated with GHD (odds ratio [OR], 1.59; 95% CI, 1.02 to 2.13) and current smoking (OR, 1.71; 95% CI, 1.02 to 2.85) among men; and GHD (OR, 2.18; 95% CI, 1.26 to 3.78) and moderate alcohol consumption (OR, 2.09; 95% CI, 1.14 to 3.83) among women. After adjusting for current age, the odds of frailty/prefrailty were increased among men with GHD (OR, 2.97; 95% CI, 1.56 to 5.67) and those who smoked (OR, 3.26; 95% CI, 1.65 to 6.43); there were no significant associations among women. CONCLUSION The findings suggest that survivors of ALL should receive counseling regarding lifestyle and undergo screening for hormonal deficits to minimize the risk of low BMD and frailty.
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Affiliation(s)
- Carmen L Wilson
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN.
| | - Wassim Chemaitilly
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Kendra E Jones
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Sue C Kaste
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Deo Kumar Srivastava
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Rohit P Ojha
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Yutaka Yasui
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Ching-Hon Pui
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Leslie L Robison
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Melissa M Hudson
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
| | - Kirsten K Ness
- Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN
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High Hospitalization Rates in Survivors of Childhood Cancer: A Longitudinal Follow-Up Study Using Medical Record Linkage. PLoS One 2016; 11:e0159518. [PMID: 27433937 PMCID: PMC4951023 DOI: 10.1371/journal.pone.0159518] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 07/05/2016] [Indexed: 11/21/2022] Open
Abstract
Hospitalization rates over time of childhood cancer survivors (CCS) provide insight into the burden of unfavorable health conditions on CCS and health care resources. The objective of our study was to examine trends in hospitalizations of CCS and risk factors in comparison with the general population. We performed a medical record linkage study of a cohort of 1564 ≥five-year CCS with national registers. We obtained a random sample of the general population matched on year of birth, gender and calendar year per CCS retrieved. We quantified and compared hospitalization rates of CCS and reference persons from 1995 until 2005, and we analyzed risk factors for hospitalization within the CCS cohort with multivariable Poisson models. We retrieved hospitalization information from 1382 CCS and 25583 reference persons. The overall relative hospitalization rate (RHR) was 2.2 (95%CI:1.9–2.5) for CCS compared to reference persons. CCS with central nervous system and solid tumors had highest RHRs. Hospitalization rates in CCS were increased compared to reference persons up to at least 30 years after primary diagnosis, with highest rates 5–10 and 20–30 years after primary cancer. RHRs were highest for hospitalizations due to neoplasms (10.7; 95%CI:7.1–16.3) and endocrine/nutritional/metabolic disorders (7.3; 95%CI:4.6–11.7). Female gender (P<0.001), radiotherapy to head and/or neck (P<0.001) or thorax and/or abdomen (P = 0.03) and surgery (P = 0.01) were associated with higher hospitalization rates in CCS. In conclusion, CCS have increased hospitalization rates compared to the general population, up to at least 30 years after primary cancer treatment. These findings imply a high and long-term burden of unfavorable health conditions after childhood cancer on survivors and health care resources.
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Philpot RM, Ficken M, Wecker L. Doxorubicin and cyclophosphamide lead to long-lasting impairment of spatial memory in female, but not male mice. Behav Brain Res 2016; 307:165-75. [DOI: 10.1016/j.bbr.2016.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/08/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
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Incidence and severity of crucial late effects after allogeneic HSCT for malignancy under the age of 3 years: TBI is what really matters. Bone Marrow Transplant 2016; 51:1482-1489. [PMID: 27348540 DOI: 10.1038/bmt.2016.139] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/21/2016] [Accepted: 04/10/2016] [Indexed: 01/26/2023]
Abstract
Younger children are considered to be more vulnerable to late effects (LE), which prompted us to study LE in patients after haematopoietic stem cell transplantation (HSCT) for a haematological malignancy before the age of 3. In this multicentre EBMT study, cumulative incidence (CI) and severity of endocrine LE, central nervous system complications and secondary malignancies at 5, 10, 15 and 20 years of follow-up were assessed. Risk factors (RF) like gender, diagnosis, age at and year of HSCT, TBI- or chemo-conditioning and GVHD were analysed. CI of any LE was 0.30, 0.52, 0.66 and 0.72 at 5, 10, 15 and 20 years after HSCT, respectively. In 25% of the patients, LE were severe at a median follow-up of 10.4 years. In multivariate analysis, only TBI was a RF for having any LE and for thyroid dysfunction and growth disturbance. Female gender was a RF for delayed pubertal development. Some more insight could be gained by descriptive analysis regarding the role of TBI and GVHD on the severity of LE. Although only five selected LE have been studied and median follow-up is relatively short, the incidence and severity of these LE are considerable but not different from what has been found in older children and TBI is the main RF.
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74
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Higby C, Khafaga Y, Al-Shabanah M, Mousa A, Ilyas M, Nazer G, Khalil EM. Volumetric-modulated arc therapy (VMAT) versus 3D-conformal radiation therapy in supra-diaphragmatic Hodgkin's Lymphoma with mediastinal involvement: A dosimetric comparison. J Egypt Natl Canc Inst 2016; 28:163-8. [PMID: 27245145 DOI: 10.1016/j.jnci.2016.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To compare volumetric-modulated arc therapy (VMAT) with 3D-conformal radiation therapy (3D-CRT) mediastinal irradiation for stage I-II supra-diaphragmatic Hodgkin's Lymphoma (HL). PATIENTS AND METHODS Eleven patients were planned for RT after 4-6 cycles of ABVD chemotherapy: conventional 3D-CRT (AP/PA) and VMAT plans were conformed to the same PTV. Objective was to choose the best PTV coverage plan with the least OAR dose. The 2 plans were compared for: PTV coverage, mean dose and V5,V20lung, mean dose and V30heart, V5, V10, V15breast (female patients), and the integral body dose. RESULTS Both techniques achieved adequate PTV coverage. Mean lung and heart dose was consistently lower in VMAT plans. The lung V20 dose was acceptable for VMAT, but exceeded the tolerance threshold in 6 cases with 3DCRT plans. A mean difference of 15.9% for both lungs V20 favored VMAT plans; average MLD difference was 2.3Gy less for VMAT plans. Similarly, lower maximum and mean heart doses with a 3.3Gy dose reduction and a 9.4% difference in V30 favored VMAT plans. Mean V5lung/female breast and integral dose were invariably higher in VMAT plans because of the low-dose spread. CONCLUSIONS VMAT is a valuable technique for treatment of large mediastinal HL. VMAT spares the lung and heart compared to 3DCRT using ISRT in select HL cases. VMAT allows dose escalation for post-chemotherapy residual disease with minimal dose to OARs. VMAT low radiation dose (V5) to the normal tissues, and the increased integral dose should be considered.
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Affiliation(s)
- Christine Higby
- Biomedical Physics Department, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, KSA.
| | - Yasser Khafaga
- Section of Radiation Oncology, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, KSA; Radiation Oncology and Nuclear Medicine Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.
| | - Mohammad Al-Shabanah
- Section of Radiation Oncology, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, KSA.
| | - Amr Mousa
- Section of Radiation Oncology, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, KSA; Radiation Oncology and Nuclear Medicine Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.
| | - Mohamed Ilyas
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, KSA
| | - Ghadeer Nazer
- Biomedical Physics Department, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, KSA.
| | - Ehab M Khalil
- Section of Radiation Oncology, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, KSA; Radiation Oncology and Nuclear Medicine Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.
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75
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Subclinical Cardiovascular Disease in Lymphoma Survivors by Sex. J Obstet Gynecol Neonatal Nurs 2016; 45:438-53. [DOI: 10.1016/j.jogn.2015.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 12/29/2022] Open
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Meeske KA, Ji L, Freyer DR, Gaynon P, Ruccione K, Butturini A, Avramis VI, Siegel S, Matloub Y, Seibel NL, Sposto R. Comparative Toxicity by Sex Among Children Treated for Acute Lymphoblastic Leukemia: A Report From the Children's Oncology Group. Pediatr Blood Cancer 2015; 62:2140-9. [PMID: 26173904 PMCID: PMC4624005 DOI: 10.1002/pbc.25628] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/19/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Epidemiologic studies find sex-based differences in incidence, survival, and long-term outcomes for children with cancer. The purpose of this study was to determine whether male and female patients differ with regard to acute treatment-related toxicities. PROCEDURES We reviewed data collected on the Children's cancer group (CCG) high-risk acute lymphoblastic leukemia (ALL-HR) study (CCG-1961), and compared male and female patients' toxicity incidence and related variables in the first four phases of treatment. Similar analyses were performed with standard-risk ALL (ALL-SR) patients enrolled in CCG-1991. RESULTS Among ALL-HR patients, females had significantly more hospital days, delays in therapy, grade 3 or 4 toxicities (e.g., gastrointestinal, liver), and supportive care interventions (e.g., transfusions, intravenous antibiotics) than males. Females were significantly more likely to have died of treatment-related causes than males (Hazard ratio = 2.8, 95%CI = 1.5-5.3, P = 0.002). Five months after beginning the treatment, the cumulative incidence of treatment-related deaths was 2.6% for females and 1.2% for males. Similar disparities were found among ALL-SR patients, with females experiencing significantly more hospital days and treatment-related toxicities than males. CONCLUSIONS This study complements cancer survivorship studies that also report an increase in treatment-related late effects among females. Risk profiles appear to be different for male and female patients, with females having greater risk of developing both acute and long-term treatment-related toxicities. The underlying biological mechanisms for these sex differences are poorly understood and warrant further study in order to determine how sex-based outcome disparities can be addressed in future clinical trials and practice.
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Affiliation(s)
- Kathleen A. Meeske
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lingyun Ji
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David R. Freyer
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Paul Gaynon
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kathleen Ruccione
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Vassilios I. Avramis
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Stuart Siegel
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Yousif Matloub
- Division of Hematology-Oncology, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland OH
| | - Nita L. Seibel
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - Richard Sposto
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Wong J, Welschinger R, Hewson J, Bradstock KF, Bendall LJ. Efficacy of dual PI-3K and mTOR inhibitors in vitro and in vivo in acute lymphoblastic leukemia. Oncotarget 2015; 5:10460-72. [PMID: 25361005 PMCID: PMC4279386 DOI: 10.18632/oncotarget.2260] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/25/2014] [Indexed: 12/21/2022] Open
Abstract
The major regulators of human acute lymphoblastic leukemia (ALL) cell growth and survival mediate their effects through the phosphoinositide 3-kinase (PI-3K)/mammalian target of rapamycin (mTOR) pathway. We have shown that the mTOR inhibitor everolimus extended survival in a non-obese diabetic/severe combined immune-deficient (NOD/SCID) mouse xenograft model of human ALL. Since PI-3K has mTOR dependent and independent functions we examined the effect of the dual PI-3K/mTOR inhibitors BEZ235 and BGT226. These agents inhibited the proliferation of ALL cell lines with a three log greater potency than everolimus. However, the induction of cell death differed, with BGT226 being cytotoxic in the low micromolar range while a two log higher concentration of BEZ235 was required to produce the same effect. While all three agents extended the survival of NOD/SCID mice engrafted with human ALL, the responses of individual xenografts varied. Although differential phosphorylation of AKT on Ser473 and Thr308 in response to everolimus exposure was observed, this did not entirely explain the different in vivo responses to the drugs. Our data suggests that while dual PI-3K/mTOR inhibitors may improve therapeutic outcomes for a subset of ALL patients, patient selection will be important, with some patients likely to respond better to single mTOR inhibition.
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Affiliation(s)
- Jacky Wong
- Centre for Cancer Research, Westmead Millennium Institute, University of Sydney, Westmead, Australia
| | - Robert Welschinger
- Centre for Cancer Research, Westmead Millennium Institute, University of Sydney, Westmead, Australia
| | - John Hewson
- Centre for Cancer Research, Westmead Millennium Institute, University of Sydney, Westmead, Australia
| | | | - Linda J Bendall
- Centre for Cancer Research, Westmead Millennium Institute, University of Sydney, Westmead, Australia
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Pole JD, Gu LY, Kirsh V, Greenberg ML, Nathan PC. Subsequent Malignant Neoplasms in a Population-Based Cohort of Pediatric Cancer Patients: A Focus on the First 5 Years. Cancer Epidemiol Biomarkers Prev 2015; 24:1585-92. [DOI: 10.1158/1055-9965.epi-15-0360] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/27/2015] [Indexed: 11/16/2022] Open
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Olson K, Sands SA. Cognitive training programs for childhood cancer patients and survivors: A critical review and future directions. Child Neuropsychol 2015; 22:509-36. [PMID: 26070928 DOI: 10.1080/09297049.2015.1049941] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A robust literature has developed documenting neurocognitive late effects in survivors of leukemia and central nervous system (CNS) tumors, the most frequent cancer diagnoses of childhood. Patterns of late effects include deficits in attention and concentration, working memory, processing speed, and executive function, as well as other domains. As childhood cancer survivors are living longer, ameliorating deficits both in broad and specific neurocognitive domains has been increasingly recognized as an endeavor of paramount importance. Interventions to improve cognitive functioning were first applied to the field of pediatric oncology in the 1990s, based on strategies used effectively with adults who had sustained a traumatic brain injury (TBI). Compilation and modification of these techniques has led to the development of structured cognitive training programs, with the effectiveness and feasibility of such interventions currently an active area of research. Consequently, the purpose of this critical review is to: (1) review cognitive training programs intended to remediate or prevent neurocognitive deficits in pediatric cancer patients and survivors, (2) critically analyze training program strengths and weaknesses to inform practice, and (3) provide recommendations for future directions of clinical care and research.
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Affiliation(s)
- Katie Olson
- a Children's National Medical Center , Divisions of Hematology and Oncology , Washington , DC , USA
| | - Stephen A Sands
- b Columbia University Medical Center, Herbert Irving Division of Child & Adolescent Oncology , New York , NY , USA
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Increased Body Mass Index during Therapy for Childhood Acute Lymphoblastic Leukemia: A Significant and Underestimated Complication. Int J Pediatr 2015; 2015:386413. [PMID: 26101530 PMCID: PMC4458559 DOI: 10.1155/2015/386413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/22/2015] [Accepted: 05/04/2015] [Indexed: 01/09/2023] Open
Abstract
Objective & Design. We undertook a retrospective review of children diagnosed with acute lymphoblastic leukemia (ALL) and treated with modern COG protocols (n = 80) to determine longitudinal changes in body mass index (BMI) and the prevalence of obesity compared with a healthy reference population. Results. At diagnosis, the majority of patients (77.5%) were in the healthy weight category. During treatment, increases in BMI z-scores were greater for females than males; the prevalence of obesity increased from 10.3% to 44.8% (P < 0.004) for females but remained relatively unchanged for males (9.8% to 13.7%, P = 0.7). Longitudinal analysis using linear mixed-effects identified associations between BMI z-scores and time-dependent interactions with sex (P = 0.0005), disease risk (P < 0.0001), age (P = 0.0001), and BMI z-score (P < 0.0001) at diagnosis and total dose of steroid during maintenance (P = 0.01). Predicted mean BMI z-scores at the end of therapy were greater for females with standard risk ALL irrespective of age at diagnosis and for males younger than 4 years of age at diagnosis with standard risk ALL. Conclusion. Females treated on standard risk protocols and younger males may be at greatest risk of becoming obese during treatment for ALL. These subgroups may benefit from intervention strategies to manage BMI during treatment for ALL.
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81
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Armenian SH, Landier W, Francisco L, Herrera C, Mills G, Siyahian A, Supab N, Wilson K, Wolfson JA, Horak D, Bhatia S. Long-term pulmonary function in survivors of childhood cancer. J Clin Oncol 2015; 33:1592-600. [PMID: 25847925 PMCID: PMC4417729 DOI: 10.1200/jco.2014.59.8318] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE This study was undertaken to determine the magnitude of pulmonary dysfunction in childhood cancer survivors when compared with healthy controls and the extent (and predictors) of decline over time. PATIENTS AND METHODS Survivors underwent baseline (t1) pulmonary function tests, followed by a second comprehensive evaluation (t2) after a median of 5 years (range, 1.0 to 10.3 years). Survivors were also compared with age- and sex-matched healthy controls at t2. RESULTS Median age at cancer diagnosis was 16.5 years (range, 0.2 to 21.9 years), and time from diagnosis to t2 was 17.1 years (range, 6.3 to 40.1 years). Compared with odds for healthy controls, the odds of restrictive defects were increased 6.5-fold (odds ratio [OR], 6.5; 95% CI, 1.5 to 28.4; P < .01), and the odds of diffusion abnormalities were increased 5.2-fold (OR, 5.2; 95% CI, 1.8 to 15.5; P < .01). Among survivors, age younger than 16 years at diagnosis (OR, 3.0; 95% CI, 1.2 to 7.8; P = .02) and exposure to more than 20 Gy chest radiation (OR, 5.6; 95% CI, 1.5 to 21.0; P = .02, referent, no chest radiation) were associated with restrictive defects. Female sex (OR, 3.9; 95% CI, 1.7 to 9.5; P < .01) and chest radiation dose (referent: no chest radiation; ≤ 20 Gy: OR, 6.4; 95% CI, 1.7 to 24.4; P < .01; > 20 Gy: OR, 11.3; 95% CI, 2.6 to 49.5; P < .01) were associated with diffusion abnormalities. Among survivors with normal pulmonary function tests at t1, females and survivors treated with more than 20 Gy chest radiation demonstrated decline in diffusion function over time. CONCLUSION Childhood cancer survivors exposed to pulmonary-toxic therapy are significantly more likely to have restrictive and diffusion defects when compared with healthy controls. Diffusion capacity declines with time after exposure to pulmonary-toxic therapy, particularly among females and survivors treated with high-dose chest radiation. These individuals could benefit from subsequent monitoring.
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Affiliation(s)
- Saro H Armenian
- Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
| | - Wendy Landier
- Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Liton Francisco
- Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Claudia Herrera
- Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - George Mills
- Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Aida Siyahian
- Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Natt Supab
- Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Karla Wilson
- Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Julie A Wolfson
- Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - David Horak
- Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Smita Bhatia
- Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
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Hudson MM, Oeffinger KC, Jones K, Brinkman TM, Krull KR, Mulrooney DA, Mertens A, Castellino SM, Casillas J, Gurney JG, Nathan PC, Leisenring W, Robison LL, Ness KK. Age-dependent changes in health status in the Childhood Cancer Survivor cohort. J Clin Oncol 2014; 33:479-91. [PMID: 25547510 DOI: 10.1200/jco.2014.57.4863] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To compare age-dependent changes in health status among childhood cancer survivors and a sibling cohort. METHODS Adult survivors of childhood cancer and siblings, all participants of the Childhood Cancer Survivor Study, completed three surveys assessing health status. At each of three time points, participants were classified as having poor outcomes in general health, mental health, function, or daily activities if they indicated moderate to extreme impairment. Generalized linear mixed models were used to compare survivors with siblings for each outcome as a function of age and to identify host- and treatment-related factors associated with age-dependent worsening health status. RESULTS Adverse health status outcomes were more frequent among survivors than siblings, with evidence of a steeper trajectory of age-dependent change among female survivors with impairment in at least one health status domain (P = .01). In adjusted models, survivors were more likely than siblings to report poor general health (prevalence ratio [PR], 2.37; 95% CI, 2.09 to 2.68), adverse mental health (PR, 1.66; 95% CI, 1.52 to 1.80), functional impairment (PR, 4.53; 95% CI, 3.91 to 5.24), activity limitations (PR, 2.38; 95% CI, 2.12 to 2.67), and an adverse health status outcome in any domain (PR, 2.10; 95% CI, 1.97 to 2.23). Cancer treatment and health behaviors influence the magnitude of differences by age groups. Chronic conditions were associated with adverse health status outcomes across organ systems. CONCLUSION The prevalence of poor health status is higher among survivors than siblings, increases rapidly with age, particularly among female participants, and is related to an increasing burden of chronic health conditions.
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Affiliation(s)
- Melissa M Hudson
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada.
| | - Kevin C Oeffinger
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kendra Jones
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Tara M Brinkman
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kevin R Krull
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Daniel A Mulrooney
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ann Mertens
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Sharon M Castellino
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Jacqueline Casillas
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - James G Gurney
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paul C Nathan
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Wendy Leisenring
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Leslie L Robison
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kirsten K Ness
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
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Tonning Olsson I, Perrin S, Lundgren J, Hjorth L, Johanson A. Long-term cognitive sequelae after pediatric brain tumor related to medical risk factors, age, and sex. Pediatr Neurol 2014; 51:515-21. [PMID: 25266614 DOI: 10.1016/j.pediatrneurol.2014.06.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/16/2014] [Accepted: 06/18/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Young age at diagnosis and treatment with cranial radiation therapy are well studied risk factors for cognitive impairment in pediatric brain tumor survivors. Other risk factors are hydrocephalus, surgery complications, and treatment with intrathecal chemotherapy. Female gender vulnerability to cognitive sequelae after cancer treatment has been evident in some studies, but no earlier studies have related this to tumor size. The purpose of our study was to find factors correlated with lowered IQ in a nationally representative sample of pediatric brain tumor patients referred for neuropsychologic evaluation. METHODS Sixty-nine pediatric brain tumor patients, diagnosed 1988-2005 and tested 1995-2006, were included in the study. In a series of stepwise multiple regressions, the relationship of IQ to disease, treatment, and individual variables (sex and syndromes) were evaluated. A subanalysis was made of the covariation between sex and tumor size. RESULTS The patients had generally suppressed IQ and impairments in executive function, memory, and attention. Lowered IQ was associated with young age at diagnosis, being male, tumor size, and treatment with whole-brain radiation therapy. A sex difference was evident for patients with increased intracranial pressure at diagnosis with males having larger tumors. Tumor size was found to be a better predictor of cognitive sequelae than sex. CONCLUSIONS Whole-brain radiation therapy, large tumors, young age at diagnosis, and male gender are risk factors for late cognitive sequelae after pediatric brain tumors. When examining sex differences, tumor size at diagnosis needs to be taken into account.
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Affiliation(s)
- Ingrid Tonning Olsson
- Department of Psychology, Lund University, Lund, Sweden; Department of Pediatrics, Skåne University Hospital, Lund, Sweden.
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden; Department of Psychology, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Johan Lundgren
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lars Hjorth
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Aki Johanson
- Department of Psychology, Lund University, Lund, Sweden; Department of Psychiatry, Lund University, Lund, Sweden
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84
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Castellino SM, Ullrich NJ, Whelen MJ, Lange BJ. Developing interventions for cancer-related cognitive dysfunction in childhood cancer survivors. J Natl Cancer Inst 2014; 106:dju186. [PMID: 25080574 DOI: 10.1093/jnci/dju186] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Survivors of childhood cancer frequently experience cancer-related cognitive dysfunction, commonly months to years after treatment for pediatric brain tumors, acute lymphoblastic leukemia (ALL), or tumors involving the head and neck. Risk factors for cancer-related cognitive dysfunction include young age at diagnosis, treatment with cranial irradiation, use of parenteral or intrathecal methotrexate, female sex, and pre-existing comorbidities. Limiting use and reducing doses and volume of cranial irradiation while intensifying chemotherapy have improved survival and reduced the severity of cognitive dysfunction, especially in leukemia. Nonetheless, problems in core functional domains of attention, processing speed, working memory and visual-motor integration continue to compromise quality of life and performance. We review the epidemiology, pathophysiology and assessment of cancer-related cognitive dysfunction, the impact of treatment changes for prevention, and the broad strategies for educational and pharmacological interventions to remediate established cognitive dysfunction following childhood cancer. The increased years of life saved after childhood cancer warrants continued study toward the prevention and remediation of cancer-related cognitive dysfunction, using uniform assessments anchored in functional outcomes.
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Affiliation(s)
- Sharon M Castellino
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL).
| | - Nicole J Ullrich
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Megan J Whelen
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Beverly J Lange
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
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85
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Pérez-Campdepadrós M, Castellano-Tejedor C, Sábado-Álvarez C, Gros-Subías L, Capdevila L, Blasco-Blasco T. Type of tumour, gender and time since diagnosis affect differently health-related quality of life in adolescent survivors. Eur J Cancer Care (Engl) 2014; 24:635-41. [DOI: 10.1111/ecc.12215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Pérez-Campdepadrós
- Department of Pediatric Oncology and Hematology; Hospital Universitari Vall d'Hebron; Barcelona Spain
- Department of Basic Psychology; Universitat Autònoma de Barcelona; Bellaterra Spain
| | - C. Castellano-Tejedor
- Department of Basic Psychology; Universitat Autònoma de Barcelona; Bellaterra Spain
- Departament of Psychiatry; Hospital Universitari Vall d'Hebron-Fundació Institut de Recerca; Barcelona Spain
| | - C. Sábado-Álvarez
- Department of Pediatric Oncology and Hematology; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - L. Gros-Subías
- Department of Pediatric Oncology and Hematology; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - L. Capdevila
- Department of Basic Psychology; Universitat Autònoma de Barcelona; Bellaterra Spain
| | - T. Blasco-Blasco
- Department of Basic Psychology; Universitat Autònoma de Barcelona; Bellaterra Spain
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86
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Whitaker MCO, Nascimento LC, Bousso RS, Lima RAGD. [Life after childhood cancer: experiences of the survivors]. Rev Bras Enferm 2014; 66:873-8. [PMID: 24488459 DOI: 10.1590/s0034-71672013000600010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 10/17/2013] [Indexed: 11/22/2022] Open
Abstract
Late effects of cancer treatment in children, adolescents and young adults may be physical, social, and emotional, with effects on their quality of life. Through an ethnographic study, we sought to identify the impact on survivors' quality of life caused by late effects of treatment of childhood cancer. Twenty-one survivors participated in the study with aged between 10 and 29 years. Data were collected through interviews, observation, and clinical data from the medical charts. The data were analyzed around two themes: the experience of living with the late effects and life satisfaction. The experience revealed by children, adolescents and young adults, survivors of cancer, showed that they feel the impact of late effects in their lives. The intensity of these effects varied according to age groups, socio-cultural context, support health service and their families.
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87
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Feasibility and initial effectiveness of home exercise during maintenance therapy for childhood acute lymphoblastic leukemia. Pediatr Phys Ther 2014; 26:301-7. [PMID: 24979081 PMCID: PMC4211618 DOI: 10.1097/pep.0000000000000053] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Children with acute lymphoblastic leukemia (ALL) are at increased risk of obesity and deconditioning from cancer therapy. This pilot study assessed feasibility/initial efficacy of an exercise intervention for patients with ALL undergoing maintenance therapy. METHODS Participants were aged 5 to 10 years, receiving maintenance therapy, in first remission. A 6-month home-based intervention, with written and video instruction, was supervised with weekly calls from an exercise coach. Pre- and poststudy testing addressed strength, flexibility, fitness, and motor function. RESULTS Seventeen patients enrolled (participation 63%). Twelve (71%) finished the intervention, completing 81.7 ± 7.2% of prescribed sessions. Improvements of 5% or more occurred in 67% for knee and 75% for grip strength, 58% for hamstring/low-back and 83% for ankle flexibility, 75% for the 6-Minute Walk Test, and 33% for performance on the Bruininks-Oseretsky Test of Motor Proficiency Version 2. CONCLUSIONS This pilot study demonstrated that exercise intervention during ALL therapy is feasible and has promise for efficacy.
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Lotrionte M, Biondi-Zoccai G, Abbate A, Lanzetta G, D'Ascenzo F, Malavasi V, Peruzzi M, Frati G, Palazzoni G. Review and meta-analysis of incidence and clinical predictors of anthracycline cardiotoxicity. Am J Cardiol 2013; 112:1980-4. [PMID: 24075281 DOI: 10.1016/j.amjcard.2013.08.026] [Citation(s) in RCA: 236] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 02/08/2023]
Abstract
The management of individual patients requiring anthracyclines remains challenging because uncertainty persists on predictors of cardiotoxicity. We aimed to perform a systematic review and meta-analysis on incidence and predictors of anthracycline chemotherapy in patients with cancer. Databases were searched for pertinent studies. Meta-analytic pooling with random-effects methods was performed for incidence estimates, while relying on descriptive statistics for prevalence and strength of association of predictors. From 16,054 retrieved citations, 18 studies reporting on 49,017 patients with cancer were included, with 22,815 treated with anthracyclines. After a median follow-up of 9 years, clinically overt cardiotoxicity occurred in 6% (95% confidence interval 3% to 9%), whereas subclinical cardiotoxicity developed in 18% (95% confidence interval 12% to 24%). Appraisal of independent risk factors of cardiotoxicity showed that cumulative anthracycline dose was most consistently reported as an accurate and robust predictor of cardiotoxicity, with an acceptable prognostic role also for chest radiotherapy, African-American ethnicity, very young or very old age, diabetes, hypertension, very high or very low body weight, or severe co-morbidities. In conclusion, despite ongoing refinements in chemotherapy regimens, anthracyclines still pose a significant risk of cardiotoxicity, especially in those requiring a high cumulative dose or chest radiotherapy.
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89
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Dynlacht JR. The role of age, sex and steroid sex hormones in radiation cataractogenesis. Radiat Res 2013; 180:559-66. [PMID: 24261552 DOI: 10.1667/rr13549.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
It is critical to identify and gain a better understanding of the factors that enhance or reduce the risk of cataractogenesis, to minimize the possibility of occurrence after deliberate (e.g., radiation therapy, interplanetary travel) or unintentional exposure to ionizing radiation. Both gender and age at the time of exposure have been established as key determinants of cataractogenesis induced by sparsely ionizing (low-LET) and densely ionizing (high-LET) radiation. However, animal data from several older studies are often conflicting and somewhat difficult to interpret, in that the experiments suffered from small group sizes, limited dose ranges or short periods of observation, and human data are sparse or statistical significance is sometimes limited. Steroid sex hormones (SSH) may underlie age and gender-based differences in the progression and prevalence of cataracts that otherwise occur spontaneously in humans and animal models, and may also underlie age and sex-related differences in radiation cataractogenesis. Here, we review data that have aided in our understanding of the role of age, sex and steroid sex hormones in radiation cataractogenesis.
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Affiliation(s)
- Joseph R Dynlacht
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202
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90
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Zhang Y, Lorenzi MF, Goddard K, Spinelli JJ, Gotay C, McBride ML. Late morbidity leading to hospitalization among 5-year survivors of young adult cancer: a report of the childhood, adolescent and young adult cancer survivors research program. Int J Cancer 2013; 134:1174-82. [PMID: 24037993 DOI: 10.1002/ijc.28453] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/12/2013] [Accepted: 08/07/2013] [Indexed: 11/10/2022]
Abstract
To estimate the risk of late morbidity leading to hospitalization among young adult cancer 5-year survivors compared to the general population and to examine the long-term effects of demographic and disease-related factors on late morbidity, a retrospective cohort of 902 five-year survivors of young adult cancer diagnosed between 1981 and 1999 was identified from British Columbia (BC) Cancer Registry. A matched comparison group (N = 9020) was randomly selected from the provincial health insurance plan. All hospitalizations until the end of 2006 were determined from the BC health insurance plan hospitalization records. The Poisson regression model was used to estimate the rate ratios for late morbidity leading to hospitalization except pregnancy after adjusting for sociodemographic and clinical risk factors. Overall, 455 (50.4%) survivors and 3,419 (37.9%) individuals in the comparison group had at least one type of late morbidity leading to hospitalization. The adjusted risk of this morbidity for survivors was 1.4 times higher than for the comparison group (95% CI = 1.22-1.54). The highest risks were found for hospitalization due to blood disease (RR = 4.2; 95% CI = 1.98-8.78) and neoplasm (RR = 4.3; 95% CI = 3.41-5.33). Survivors with three treatment modalities had three-fold higher risk of having any type of late morbidity (RR = 3.22; 95% CI = 2.09-4.94) than the comparators. These findings emphasize that young adult cancer survivors still have high risks of a wide range of late morbidities.
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Affiliation(s)
- Yang Zhang
- Cancer Control Research Program, British Columbia Cancer Research Centre, British Columbia Cancer Agency, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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91
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Braunstein S, Nakamura JL. Radiotherapy-induced malignancies: review of clinical features, pathobiology, and evolving approaches for mitigating risk. Front Oncol 2013; 3:73. [PMID: 23565507 PMCID: PMC3615242 DOI: 10.3389/fonc.2013.00073] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 03/21/2013] [Indexed: 12/24/2022] Open
Abstract
One of the most significant effects of radiation therapy on normal tissues is mutagenesis, which is the basis for radiation-induced malignancies. Radiation-induced malignancies are late complications arising after radiotherapy, increasing in frequency among survivors of both pediatric and adult cancers. Genetic backgrounds harboring germline mutations in tumor suppressor genes are recognized risk factors. Some success has been found with using genome wide association studies to identify germline polymorphisms associated with susceptibility. The insights generated by genetics, epidemiology, and the development of experimental models are defining potential strategies to offer to individuals at risk for radiation-induced malignancies. Concurrent technological efforts are developing novel radiotherapy delivery to reduce irradiation of normal tissues, and thereby, to mitigate the risk of radiation-induced malignancies. The goal of this review is to discuss epidemiologic, modeling, and radiotherapy delivery data, where these lines of research intersect and their potential impact on patient care.
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Affiliation(s)
- Steve Braunstein
- Department of Radiation Oncology, University of California San FranciscoSan Francisco, CA, USA
| | - Jean L. Nakamura
- Department of Radiation Oncology, University of California San FranciscoSan Francisco, CA, USA
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92
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Carroll C, Watson P, Spoudeas HA, Hawkins MM, Walker DA, Clare ICH, Holland AJ, Ring HA. Prevalence, associations, and predictors of apathy in adult survivors of infantile (<5 years of age) posterior fossa brain tumors. Neuro Oncol 2013; 15:497-505. [PMID: 23502428 DOI: 10.1093/neuonc/nos320] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Apathy is associated with pervasive and disadvantageous effects on daily functioning. It has been observed transiently in some children after surgery for posterior fossa tumors. In this study, our objective was to examine prevalence, associations, and predictors of apathy in adult survivors of an infantile posterior fossa brain tumor (PFT). METHODS One hundred seventeen adult survivors of a childhood PFT diagnosed before age 5 years and 60 of their siblings were assessed in a cross-sectional study a mean of 32 years (range, 18-53 years) after survivors' initial tumor diagnoses, using the Marin Apathy Evaluation Scale (AES), the Weschler Abbreviated Scale of Intelligence and the Composite International Diagnostic Interview for psychiatric disorders. RESULTS Marin Apathy Evaluation Scale, the Weschler Abbreviated Scale of Intelligence reached or exceeded a criterion score for clinically significant apathy in 35% of survivors, compared with 18% in a sibling comparison group. In both siblings and survivors, apathy was associated with lower verbal and full-scale IQ and, among survivors, with having undergone partial rather than total tumor resection (independent of irradiation status). Apathy was not related to presence of concurrent International Classification of Diseases, 10(th) Revision, depression. Female sex was associated with late apathy after a PFT, with increased likelihood of women reaching the apathy criterion relative to men if they were survivors. CONCLUSIONS Clinically significant and potentially treatable apathy occurs relatively commonly in adult survivors of an infantile childhood PFT, particularly women. Clinicians, including those managing posterior fossa pathology in very young children, should be aware of this association, and future research should clarify whether specific treatment-related variables are implicated in increasing this risk of apathy.
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Affiliation(s)
- Cliodhna Carroll
- Cambridge Intellectual and Developmental Disability Research Group, University of Cambridge. Douglas House, 18b Trumpington Rd., Cambridge, CB2 8AH, UK
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93
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Cantrell MA, Conte T, Hudson M, Shad A, Ruble K, Herth K, Canino A, Kemmy S. Recruitment and retention of older adolescent and young adult female survivors of childhood cancer in longitudinal research. Oncol Nurs Forum 2013; 39:483-90. [PMID: 22940512 DOI: 10.1188/12.onf.483-490] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE/OBJECTIVES To describe the challenges encountered in the recruitment and retention of a sample of older adolescent and young adult female survivors of childhood cancer for a longitudinal study testing a targeted psychosocial intervention aimed at enhancing hope. DATA SOURCES Published literature on constructing longitudinal intervention studies and strategies in the recruitment and retention of childhood cancer survivors in research was used to develop the protocol of this study. DATA SYNTHESIS Using empirical literature to construct the study's design resulted in achieving certain goals for the design, but not in the recruitment and retention of study participants. Using online technology to deliver the intervention and collect data was efficient and effective. Traditional approaches to recruitment and retention of those survivors, however, were not effective. Use of more novel approaches to enroll study participants demonstrated only modest success. CONCLUSIONS Additional research is needed on strategies to successfully recruit and retain older adolescents and young adult female survivors of childhood cancer in longitudinal intervention studies. IMPLICATIONS FOR NURSING The improvement in the psychological well-being of female survivors of childhood cancer remains an important outcome in ongoing care. The need to continue to identify creative and effective ways to recruit and retain those survivors is warranted.
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94
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Kumar S. Second malignant neoplasms following radiotherapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:4744-59. [PMID: 23249860 PMCID: PMC3546788 DOI: 10.3390/ijerph9124744] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/06/2012] [Accepted: 12/06/2012] [Indexed: 12/15/2022]
Abstract
More than half of all cancer patients receive radiotherapy as a part of their treatment. With the increasing number of long-term cancer survivors, there is a growing concern about the risk of radiation induced second malignant neoplasm [SMN]. This risk appears to be highest for survivors of childhood cancers. The exact mechanism and dose-response relationship for radiation induced malignancy is not well understood, however, there have been growing efforts to develop strategies for the prevention and mitigation of radiation induced cancers. This review article focuses on the incidence, etiology, and risk factors for SMN in various organs after radiotherapy.
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Affiliation(s)
- Sanath Kumar
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI 48202, USA.
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95
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Inaba H, Yang J, Kaste SC, Hartford CM, Motosue MS, Chemaitilly W, Triplett BM, Shook DR, Pui CH, Leung W. Longitudinal changes in body mass and composition in survivors of childhood hematologic malignancies after allogeneic hematopoietic stem-cell transplantation. J Clin Oncol 2012; 30:3991-7. [PMID: 23032628 DOI: 10.1200/jco.2011.40.0457] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To measure longitudinal changes in body mass and composition in survivors of childhood hematologic malignancies after allogeneic hematopoietic stem-cell transplantation (HSCT). PATIENTS AND METHODS Body mass index (BMI) was analyzed in 179 survivors by category (underweight, healthy-weight, overweight, and obese) and by z score. Fat and lean body mass measured by dual-energy x-ray absorptiometry was analyzed as z scores. RESULTS Over a median 6.6 years of follow-up, BMI z scores diminished significantly (0.32 pre-HSCT v -0.60 at 10 years post-HSCT; P < .001). Mean z scores for fat mass stayed within population norms, but those for lean mass remained below normal levels and diminished significantly over time (P = .018). Pre-HSCT BMI category and/or z score were strongly predictive of post-HSCT BMI (P < .001) and of fat and lean mass z scores (both P < .001). Survivors with extensive chronic graft-versus-host disease were more likely than others to have low BMI (P = .004) and low lean mass (P < .001) post-HSCT. Older age at HSCT (P = .015) and T-cell-depleted graft (P = .018) were predictive of lower post-HSCT BMI. Female patients had higher body fat (P = .002) and lower lean mass (P = .013) z scores than male patients, and black patients had higher fat mass z scores than white patients (P = .026). CONCLUSION BMI declines significantly after allogeneic HSCT for childhood hematologic malignancies, reflecting primarily a substantial decrease in lean mass but not fat mass. Monitoring and preservation of BMI and lean mass are vital, especially in those with the identified risk factors.
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Affiliation(s)
- Hiroto Inaba
- Department of Bone Marrow Transplantation and Cellular Therapy, MS 1130, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA
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96
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Cardiac failure 30 years after treatment containing anthracycline for childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2012; 34:395-7. [PMID: 22584777 PMCID: PMC3380184 DOI: 10.1097/mph.0b013e3182532078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In 1977, a 5-year-old girl diagnosed with acute lymphoblastic leukemia was treated on Dana-Farber Cancer Institute Childhood Acute Lymphoblastic Leukemia Protocol 77-01, receiving a cumulative doxorubicin dose of 465 mg/m(2), cranial radiation, and other drugs. After being in continuous complete remission for 34 months, she developed heart failure and was treated with digoxin and furosemide. At 16 years of age, she was diagnosed and treated for dilated cardiomyopathy. Over the years, she continued to have bouts of heart failure, which became less responsive to treatment. At 36 years of age, she received a heart transplant. Six months later, she stopped taking her medications and suffered a sudden cardiac death.
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97
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Marcoux S, Robaey P, Krajinovic M, Moghrabi A, Laverdière C. Predictive factors of internalized and externalized behavioral problems in children treated for acute lymphoblastic leukemia. Pediatr Blood Cancer 2012; 58:971-7. [PMID: 22287274 DOI: 10.1002/pbc.24079] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 12/22/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pediatric cancer survivors are at increased risk of various neurological and psychological problems. The prevalence of behavioral problems was assessed in a longitudinal study in pediatric patients with an acute lymphoblastic leukemia (ALL). Multilevel modeling was used to identify associated predictive factors. PROCEDURE ALL patients and their parents (n = 138) took part to this study. Patients were treated according to the Dana-Farber Cancer Institute (DFCI) consortium protocols 91-01 or 95-01. Mothers filled out questionnaires providing a measure of behavioral problems for their child at diagnosis and during the subsequent 4 years, and of their perceived familial stress at diagnosis and post-induction. RESULTS Prevalence of internalized behavioral problems at diagnosis was increased [42% above 1 standard deviation (SD); P < 0.001], but it normalized over time. Internalized problems resolved more slowly in the presence of medical variables associated with increased stress related to the disease (hospitalization duration, P < 0.001; relapse risk at diagnosis, P < 0.001). Externalized behavioral problems were within the expected normal range, but more sustained over time with the 95-01 than with the 91-01 treatment protocols (P < 0.05), likely due to the type of corticosteroid (CS) used (dexamethasone vs. prednisone). CONCLUSIONS Assessment of both internalized and externalized problems is required in this population. The impact of pharmacological variables on externalized behavioral problems is likely related to CS use.
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Affiliation(s)
- Sophie Marcoux
- Department of Psychiatry, Sainte-Justine Hospital Research Center, Montréal University, Montréal, Québec, Canada
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98
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Sands SA, Zhou T, O'Neil SH, Patel SK, Allen J, McGuire Cullen P, Kaleita TA, Noll R, Sklar C, Finlay JL. Long-term follow-up of children treated for high-grade gliomas: children's oncology group L991 final study report. J Clin Oncol 2012; 30:943-9. [PMID: 22355055 PMCID: PMC3341107 DOI: 10.1200/jco.2011.35.7533] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE High-grade gliomas of the CNS are characterized by poor treatment response and prognosis for long-term survival. The Children's Oncology Group (COG) L991 study investigated the neuropsychological, behavioral, and quality of life (QoL) outcomes after treatment on the Children's Cancer Group (CCG) trial for high-grade gliomas (CCG-945). PATIENTS AND METHODS Fifty-four patients (29 males, 25 females) with a median age of 8.8 years at diagnosis (range, 0.2 to 19.5 years) were enrolled at 25 institutions in North America, representing 81% of available survivors; median length of follow-up was 15.1 years (range, 9.5 to 19.2 years), and median age at study evaluation was 23.6 years (range, 11.3 to 36 years). Standardized tests of neuropsychological functioning and QoL were performed. Descriptive statistics summarized principal findings, and one-way analysis of variance identified potential predictors of outcomes. RESULTS With an average follow-up time of 15 years, survivors demonstrated intellectual functioning within the low-average range. Executive functioning and verbal memory were between the low-average and borderline ranges. In contrast, visual memory and psychomotor processing speed were between the borderline and impaired ranges, respectively. Approximately 75% of patient reported overall QoL within or above normal limits for both physical and psychosocial domains. Nonhemispheric tumor location (midline or cerebellum), female sex, and younger age at treatment emerged as independent risk factors. CONCLUSION These results serve as a benchmark for comparison with future pediatric high-grade glioma studies, in addition to identifying at-risk cohorts that warrant further research and proactive interventions to minimize late effects while striving to ensure survival.
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Affiliation(s)
- Stephen Alan Sands
- Columbia University College of Physicians and Surgeons, New York, NY, USA.
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99
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Barrera M, Teall T, Barr R, Silva M, Greenberg M. Health related quality of life in adolescent and young adult survivors of lower extremity bone tumors. Pediatr Blood Cancer 2012; 58:265-73. [PMID: 21319288 DOI: 10.1002/pbc.23017] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 12/14/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND Dramatic increases in survival rates have led to increased interest regarding the health related quality of life (HRQOL) of adolescent and young adult survivors of bone tumors. This study investigated HRQOL and physical disability in adolescent and young adult survivors of lower extremity bone tumors as a function of type of surgical intervention, gender, and age at assessment. PROCEDURE Twenty-eight participants (age range 18-32 years) completed three generic and one disease-specific measures of HRQOL and a measure of physical disability. For analysis, surgical intervention was grouped into limb sparing surgeries (LS; allograft fusion and endoprosthesis) and ablative surgeries (AMP; amputation or Van Nes rotationplasty). Age at study was grouped into ≤ 25 years of age and ≥ 26 years of age. The MOS-SF-36, HUI2, HUI3, and EORTC-QLQ-C30 were used to measure HRQOL and the TESS was used to assess physical disability. RESULTS Survivors reported HRQOL equivalent to the general population, with the exception of physical functioning. LS reported poorer HRQOL than AMP participants for emotional functioning and fatigue. Males reported better HRQOL compared with females for overall HRQOL, general health, physical functioning, and social functioning. Finally, younger participants generally reported better HRQOL than older participants for overall HRQOL and physical functioning. CONCLUSIONS This study identifies LS surgical intervention, female gender and older age as risk factors for reduced HRQOL in adolescent and young adult survivors of lower extremity bone tumors. This study also provides information about what instrument may be most useful in identifying these specific difficulties and subgroups.
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Affiliation(s)
- Maru Barrera
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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100
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Eshelman-Kent D, Kinahan KE, Hobbie W, Landier W, Teal S, Friedman D, Nagarajan R, Freyer DR. Cancer survivorship practices, services, and delivery: a report from the Children's Oncology Group (COG) nursing discipline, adolescent/young adult, and late effects committees. J Cancer Surviv 2011; 5:345-57. [PMID: 21894490 PMCID: PMC4528909 DOI: 10.1007/s11764-011-0192-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 08/09/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe survivorship services provided by the Children's Oncology Group (COG), an assessment of services was undertaken. Our overall aims were (1) to describe survivorship services, including the extent of services provided, resources (personnel, philanthropy, and research funding), billing practices, and barriers to care and 2) to describe models of care that are in use for childhood cancer survivors and adult survivors of childhood cancer. METHODS One hundred seventy-nine of 220 COG institutions (81%) completed an Internet survey in 2007. RESULTS One hundred fifty-five (87%) reported providing survivorship care. Fifty-nine percent of institutions provide care for their pediatric population in specialized late effects programs. For adult survivors, 47% of institutions chose models of care, which included transitioning to adult providers for risk-based health care, while 44% of institutions keep survivors indefinitely at the treating institution (Cancer Center Based Model without Community Referral). Sixty-eight percent provide survivors with a copy of their survivorship care plan. Only 31% of institutions provide a detailed summary of results after each clinic visit, and 41% have a database to track survivor health outcomes. Minimal time required for initial and annual survivorship visits is estimated to be approximately 120 and 90 min, respectively. The most prevalent barriers to care were the lack of dedicated time for program development and a perceived insufficient knowledge on the part of the clinician receiving the transition referral. CONCLUSIONS Not all COG institutions provide dedicated survivorship care, care plans, or have databases for tracking outcomes. Transitioning to adult providers is occurring within the COG. Survivorship care is time intensive.
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Affiliation(s)
- Debra Eshelman-Kent
- Division of Hematology-Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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