151
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Ferrari A, Trama A, De Paoli A, Bergeron C, Merks JHM, Jenney M, Orbach D, Chisholm JC, Gallego S, Glosli H, De Salvo GL, Botta L, Gatta G, Bisogno G. Access to clinical trials for adolescents with soft tissue sarcomas: Enrollment in European pediatric Soft tissue sarcoma Study Group (EpSSG) protocols. Pediatr Blood Cancer 2017; 64. [PMID: 27882658 DOI: 10.1002/pbc.26348] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/28/2016] [Accepted: 10/12/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adolescents with cancer are enrolled in clinical trials at far lower rates than children. This report compares the number of adolescents (15-19-year-olds) and children (0-14-year-olds) enrolled in the protocols of the European pediatric Soft tissue sarcoma Study Group (EpSSG) with the number of cases expected to occur. METHODS The observed-to-expected (O/E) ratio was detected in the EpSSG countries contributing most of the cases, that is, Italy, France, Spain, the Netherlands, United Kingdom, and Ireland. The observed cases included patients enrolled in any of the EpSSG protocols from October 2008 to October 2015, when all EpSSG protocols were open in these countries. The number of expected cases was calculated from the incidence rates estimated throughout the RARECAREnet database in the countries' population-based cancer registries. RESULTS In the countries considered, 2,118 cases aged 0-19 years were enrolled in the EpSSG trials from 2008 to 2015: 82.8% were children and 17.2% were adolescents. The O/E ratio was 0.30 among patients 15-19 years old, as opposed to 0.64 for those 0-14 years old. The O/E ratio differed for the different subtypes: in adolescents, it was 0.64 and 0.18 for rhabdomyosarcoma (RMS) and non-rhabdomyosarcoma soft tissue sarcomas (NRSTS), respectively; in children, it was 0.77 and 0.50, respectively. The O/E ratios differed across the countries considered. CONCLUSIONS Adolescents were less well represented than children on the EpSSG protocols, with better enrolment for RMS than for NRSTS for all age groups.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Annalisa Trama
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Angela De Paoli
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Christophe Bergeron
- Department of Pediatric Oncology, Institut d'Hematologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Johannes H M Merks
- Department of Pediatric Oncology, Emma Children's Hospital-Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Meriel Jenney
- Department of Pediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, United Kingdom
| | - Daniel Orbach
- Department of Pediatric, Adolescent and Young Adult Oncology, Institut Curie, Paris, France
| | - Julia C Chisholm
- Department of Paediatric Oncology, Royal Marsden Hospital, London, United Kingdom
| | - Soledad Gallego
- Department of Paediatric Oncology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Heidi Glosli
- Department of Pediatrics, University Hospital Oslo, Rikshospitalet, Oslo, Norway
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Laura Botta
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Gemma Gatta
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Gianni Bisogno
- Pediatric Hematology and Oncology Division, Padova University, Padova, Italy
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152
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Thorsteinsson T, Larsen HB, Schmiegelow K, Thing LF, Krustrup P, Pedersen MT, Christensen KB, Mogensen PR, Helms AS, Andersen LB. Cardiorespiratory fitness and physical function in children with cancer from diagnosis throughout treatment. BMJ Open Sport Exerc Med 2017; 3:e000179. [PMID: 28761697 PMCID: PMC5530132 DOI: 10.1136/bmjsem-2016-000179] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2016] [Indexed: 01/13/2023] Open
Abstract
Background Children with cancer experience severe reductions in physical fitness and functionality during and following intensive treatment. This may negatively impact their quality of life. Purpose To describe the physical capacity and functionality of children with cancer during and after treatment as well as the feasibility of physical activity intervention in the Rehabilitation including Social and Physical activity and Education in Children and Teenagers with Cancer study. Patients and methods The study included children diagnosed from January 2013 to April 2016 with paediatric cancer or Langerhans cell histiocytosis, all treated with chemotherapy. Seventy-five of 78 consecutively eligible children (96.2%) were included. Median age was 11 years (range 6‒18). The physical capacity and function were assessed based on testing of physical strength, balance and cardiorespiratory fitness. Children were tested at diagnosis, 3 and 6 months after diagnosis and 1 year after cessation of treatment. The feasibility evaluation was inspired by the criteria for reporting the development and evaluation of complex interventions in healthcare. Results All children participated in the physical intervention programme with no dropouts. Strenuous physical exercise and physiological testing during paediatric cancer treatment was safe and feasible, with only five minor adverse events during the intervention. Cardiorespiratory fitness was significantly lower in children with cancer than norms for healthy age-matched children at diagnosis (difference 19.1 mL/kg/min, 95% CI 15.4 to 22.7; p <0.0001), during treatment 3 and 6 months from diagnosis (difference 21.0 mL/kg/min, 95% CI 17.4 to 24.6; p <0.0001 and difference 21.6 mL/kg/min, 95% CI 17.3 to 25.8; p <0.0001, respectively) and 1 year after cessation of treatment (difference 6.9 mL/kg/min, 95% CI 1.1 to 12.7; p <0.0072). Furthermore, children with cancer experienced a pronounced decline in physical function. Conclusion This study shows that it is safe and feasible to perform strenuous physical exercise and testing during paediatric cancer treatment and that children with cancer have significantly lower physical capacity and functionality than healthy age-matched norms. Trial registration number ClinicalTrials.gov: NCT01772862.
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Affiliation(s)
- Troels Thorsteinsson
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hanne Baekgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lone Friis Thing
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Peter Krustrup
- Department of Sport and Health Sciences, University of Exeter, College of Life and Environmental Sciences, Exeter, UK.,Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense, Denmark
| | | | | | - Pernille Rudebeck Mogensen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Diabetes and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anne Sofie Helms
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lars Bo Andersen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Department of Teacher Education and Sport, Western Norway University of Applied Sciences, Røyrgata, Norway
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153
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Marr KC, Connors JM, Savage KJ, Goddard KJ, Deyell RJ. ABVD chemotherapy with reduced radiation therapy rates in children, adolescents and young adults with all stages of Hodgkin lymphoma. Ann Oncol 2017; 28:849-854. [PMID: 28327925 DOI: 10.1093/annonc/mdx005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background We adopted ABVD chemotherapy with risk-adapted radiation therapy (RT) as first-line therapy for children, adolescents and young adults with Hodgkin lymphoma (HL) in British Columbia in 2004. Patients and methods Patients ≤ 25 years diagnosed from 2004 to 2013 with all stages of HL who received ABVD as initial therapy were included. Results Among 55 children (age < 18 year) and 154 young adults (18-25 year), there were no significant differences among age groups for sex, histologic subtype, tumour bulk, B symptoms, prognostic risk groups or treatment received. The rates of complete response, partial response and progressive disease were 84%, 7% and 10% for children and 95%, 4% and 1% for young adults (P=0.01), respectively. Treatment failures in children all occurred within one year of completion, while 8/21 (38%) relapses in young adults occurred later (P=0.04). With a median follow-up of 66 months the 5-year progression-free (PFS) and overall survival (OS) were 85 ± 3% and 97 ± 1%, respectively. For limited stage disease, PFS was 90 ± 7% for children and 93 ± 3% for young adults (P=0.65); OS was 100% for both. For advanced stage patients, PFS and OS were also similar for the children and young adults (77 ± 7% versus 81 ± 4%; P=0.38 and OS 90 ± 6% versus 97 ± 2%; P=0.17). The rate of consolidative RT was low (21%) and did not differ between age groups. Conclusion ABVD is an effective treatment in children, adolescents and young adults with HL. Children were less likely to achieve complete response and demonstrated earlier relapses compared to young adults. RT may be omitted for the majority of patients while maintaining excellent 5-year OS.
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Affiliation(s)
- K C Marr
- Division of Paediatric Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital
| | - J M Connors
- British Columbia Cancer Agency, Centre for Lymphoid Cancer
| | - K J Savage
- British Columbia Cancer Agency, Centre for Lymphoid Cancer
| | - K J Goddard
- British Columbia Cancer Agency, Department of Radiation Oncology, University of British Columbia, Vancouver, Canada
| | - R J Deyell
- Division of Paediatric Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital
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154
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Rueegg CS, Gianinazzi ME, Michel G, Zwahlen M, von der Weid NX, Kuehni CE. No evidence of response bias in a population-based childhood cancer survivor questionnaire survey - Results from the Swiss Childhood Cancer Survivor Study. PLoS One 2017; 12:e0176442. [PMID: 28463966 PMCID: PMC5413049 DOI: 10.1371/journal.pone.0176442] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/10/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose This is the first study to quantify potential nonresponse bias in a childhood cancer survivor questionnaire survey. We describe early and late responders and nonresponders, and estimate nonresponse bias in a nationwide questionnaire survey of survivors. Methods In the Swiss Childhood Cancer Survivor Study, we compared characteristics of early responders (who answered an initial questionnaire), late responders (who answered after ≥1 reminder) and nonresponders. Sociodemographic and cancer-related information was available for the whole population from the Swiss Childhood Cancer Registry. We compared observed prevalence of typical outcomes in responders to the expected prevalence in a complete (100% response) representative population we constructed in order to estimate the effect of nonresponse bias. We constructed the complete population using inverse probability of participation weights. Results Of 2328 survivors, 930 returned the initial questionnaire (40%); 671 returned the questionnaire after ≥1reminder (29%). Compared to early and late responders, we found that the 727 nonresponders (31%) were more likely male, aged <20 years, French or Italian speaking, of foreign nationality, diagnosed with lymphoma or a CNS or germ cell tumor, and treated only with surgery. But observed prevalence of typical estimates (somatic health, medical care, mental health, health behaviors) was similar among the sample of early responders (40%), all responders (69%), and the complete representative population (100%). In this survey, nonresponse bias did not seem to influence observed prevalence estimates. Conclusion Nonresponse bias may play only a minor role in childhood cancer survivor studies, suggesting that results can be generalized to the whole population of such cancer survivors and applied in clinical practice.
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Affiliation(s)
- Corina S. Rueegg
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- * E-mail:
| | - Micòl E. Gianinazzi
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Gisela Michel
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Marcel Zwahlen
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nicolas X. von der Weid
- Paediatric Hematology/Oncology Unit, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Claudia E. Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Epidemiology, Children’s University Hospital of Bern, University of Bern, Bern, Switzerland
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155
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Font-Gonzalez A, Feijen ELAM, Geskus RB, Dijkgraaf MGW, van der Pal HJH, Heinen RC, Jaspers MW, van Leeuwen FE, Reitsma JBJ, Caron HN, Sieswerda E, Kremer LC. Risk and associated risk factors of hospitalization for specific health problems over time in childhood cancer survivors: a medical record linkage study. Cancer Med 2017; 6:1123-1134. [PMID: 28378525 PMCID: PMC5430098 DOI: 10.1002/cam4.1057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/10/2017] [Accepted: 02/14/2017] [Indexed: 12/13/2022] Open
Abstract
Childhood cancer survivors (CCS) experience higher hospitalization rates compared to the general population for neoplasms, circulatory diseases, endocrine/nutritional/metabolic diseases and eye disorders. We studied trends in hospitalization rates and associated patient and treatment‐specific risk factors for diagnosis subgroups among these four diseases. We performed medical record linkage of a ≥5‐year CCS cohort with national registers, and obtained a random reference sample matched on age, gender and calendar year per CCS. For each diagnosis subgroup we compared hospitalization rates and trends over time in CCS and the reference population. Further, we analyzed risk factors for hospitalizations within the four CCS diagnosis groups. We used multivariate Poisson regression for all models. We retrieved hospitalization data from 1382 CCS and 26,583 reference persons. CCS had increased hospitalization rates for almost all diagnosis subgroups examined. Hospitalization rates for endocrine/nutritional/metabolic diseases appeared to increase with longer time since primary cancer diagnosis up to 30 years after primary cancer diagnosis. Survivors initially treated with radiotherapy had increased hospitalization rates for neoplasms (P < 0.001), those initially treated with anthracyclines (2.5 [1.1–5.5]) and radiotherapy to thorax and/or abdomen (9.3 [2.4–36.6]) had increased hospitalization rates for diseases of the circulatory system, and those initially treated with radiotherapy to head and/or neck had increased hospitalization rates for endocrine/nutritional/metabolic diseases (6.7 [3.5–12.7]) and diseases of the eye (3.6 [1.5–8.9]). Our study highlights that long‐term health problems resulting in hospitalizations are still clinically relevant later in life of CCS. The identified treatment‐related risk factors associated with hospitalizations support targeted follow‐up care for these risk groups of CCS.
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Affiliation(s)
- Anna Font-Gonzalez
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands
| | - Elizabeth Lieke A M Feijen
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands
| | - Ronald B Geskus
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Helena J H van der Pal
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.,Department of Medical Oncology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Richard C Heinen
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands
| | - Monique W Jaspers
- Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology (HITlab), Academic Medical Center, Amsterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, National Cancer Institute, Amsterdam, The Netherlands
| | - J B Johannes Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
| | - Hubert N Caron
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands
| | - Elske Sieswerda
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands
| | - Leontien C Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands
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156
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Amani O, Mazaheri MA, Nejati V, Shamsian BS. Effect of Cognitive Rehabilitation on Executive Functions in Adolescent Survivors of Leukemia: A Randomized and Controlled Clinical Trial. JOURNAL OF REHABILITATION 2017. [DOI: 10.21859/jrehab-180173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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157
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Marcos-Gragera R, Galceran J, Martos C, de Munain AL, Vicente-Raneda M, Navarro C, Quirós-Garcia JR, Sánchez MJ, Ardanaz E, Ramos M, Mateos A, Salmerón D, Felipe S, Peris-Bonet R. Incidence and survival time trends for Spanish children and adolescents with leukaemia from 1983 to 2007. Clin Transl Oncol 2017; 19:301-316. [PMID: 27447899 DOI: 10.1007/s12094-016-1531-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/12/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We have analysed incidence and survival trends of children and adolescents with leukaemia registered in Spanish population-based cancer registries during the period 1983-2007. METHODS Childhood and adolescent leukaemia cases were drawn from the 11 Spanish population-based cancer registries. For survival, registries with data for the period 1991-2005 and follow-up until 31-12-2010 were included. Overall incidence trends were evaluated using joinpoint analysis. Observed survival rates were estimated using Kaplan-Meier, and trends were tested using the log-rank test. RESULTS Based on 2606 cases (2274 children and 332 adolescents), the overall age-adjusted incidence rate (ASRw) of leukaemia was 47.9 cases per million child-years in children and 23.8 in adolescents. The ASRw of leukaemia increased with an annual percentage change of 9.6 % (95 % CI: 2.2-17.6) until 1990 followed by a stabilisation of rates. In adolescents, incidence did not increase. Five-year survival increased from 66 % in 1991-1995 to 76 % in 2001-2005. By age, survival was dramatically lower in infants (0) and adolescents (15-19) than in the other age groups and no improvement was observed. In both children and adolescents, differences in 5-year survival rates among major subgroups of leukaemias were significant. CONCLUSIONS The increasing incidence trends observed in childhood leukaemias during the study period were confined to the beginning of the period. Remarkable improvements in survival have been observed in Spanish children with leukaemias. However, this improvement was not observed in infants and adolescents.
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Affiliation(s)
- R Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry (UERCG), Oncology Coordination Plan (PDO), Department of Health, Autonomous Government of Catalonia, Girona, Spain.
- Descriptive Epidemiology, Genetics and Cancer Prevention Group [Girona Biomedical Research Institute] IDIBGI, Catalan Institute of Oncology-Girona (ICO), Girona, Spain.
- Nursing Department, University of Girona (UdG), Girona, Spain.
| | - J Galceran
- Tarragona Cancer Registry, Foundation Society for Cancer Research and Prevention (FUNCA), Reus, Spain
- Pere Virgili Health Research Institute, Reus, Spain
- Rovira i Virgili University (URV), Reus, Spain
| | - C Martos
- Zaragoza Cancer Registry, Aragon Government, Saragossa, Spain
- Centre of Public Health Research-FISABIO, Valencia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública CIBERESP), Madrid, Spain
| | - A L de Munain
- Basque Country Cancer Registry, Basque Government, Vitoria-Gasteiz, Spain
| | - M Vicente-Raneda
- Community Valenciana Childhood Cancer Registry, Public Health Directorate, Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, Valencia, Spain
| | - C Navarro
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública CIBERESP), Madrid, Spain
| | | | - M-J Sánchez
- Granada Cancer Registry, Andalusian School of Public Health, Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública CIBERESP), Madrid, Spain
| | - E Ardanaz
- Navarre Cancer Registry, Navarre Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública CIBERESP), Madrid, Spain
| | - M Ramos
- Mallorca Cancer Registry, Epidemiology Department, Directorate-General of Public Health and Participation, Palma de Mallorca, Spain
| | - A Mateos
- Albacete Cancer Registry, Health and Social Welfare Authority, Albacete, Spain
| | - D Salmerón
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública CIBERESP), Madrid, Spain
| | - S Felipe
- Spanish Childhood Cancer Registry (RETI-SEHOP), Spanish Society of Paediatric Haematology and Oncology, University of Valencia, Valencia, Spain
| | - R Peris-Bonet
- Spanish Childhood Cancer Registry (RETI-SEHOP), Spanish Society of Paediatric Haematology and Oncology, University of Valencia, Valencia, Spain
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158
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Zhao Q, Cao D, Yu M, Yang J, Liu Y, Xiang Y, Wu M, Pan L, Lang J, Xu K, Han J, Shen K. Safety and efficacy of bleomycin/pingyangmycin-containing chemotherapy regimens for malignant germ cell tumor patients in the female genital system. Oncotarget 2017; 8:15952-15960. [PMID: 28160575 PMCID: PMC5362537 DOI: 10.18632/oncotarget.15021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/09/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To comprehensively evaluate the safety and effectiveness of bleomycin/pingyangmycin-containing chemotherapy for female patients with malignant germ cell tumors in their genital system; to assess the diagnostic value of pulmonary function tests for bleomycin-induced pulmonary toxicity. METHODS Data from a cohort of 120 patients, collected across 25 years, was reviewed. Chemotherapy-related adverse events were routinely monitored. Pulmonary toxicity was diagnosed and graded according to serial pulmonary function testing results, and potential impact factors were explored. Short-term remission probability and long-term prognosis were evaluated. RESULTS Overall, 49.2% of the patients had pulmonary dysfunction, and the majority manifested as diffusion function impairment. A moderate reduction of carbon monoxide diffusion capacity was detected in 45.0% of all patients, and was severe in 3 patients. Thrombocytopenia, renal dysfunction, and accumulating dose of bleomycin/pingyangmycin significantly increased the risk of lung injury (P<0.05). Thorough surgical removal of tumors enhanced both remission and survival rate. Full-dose delivery of bleomycin/pingyangmycin and patients' sensitivity to chemotherapy also improved long-term survival (P<0.05). CONCLUSIONS BPT could be sensitively detected and elaborately graded by PFTs, but the appropriate cut-off value for diagnosis needs further investigations. Timely recognition and control of renal dysfunction and thrombocytopenia could avail the patients of the opportunity to complete curative antineopalstic treatment. Prescriptive bleomycin/pingyangmycin-containing chemotherapy after optimal surgical resection could benefit MGCT patients maximally by improving both remission and survival rate.
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Affiliation(s)
- Qianying Zhao
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dongyan Cao
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mei Yu
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiaxin Yang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yongjian Liu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Xiang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ming Wu
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lingya Pan
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinghe Lang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kaifeng Xu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiangna Han
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Keng Shen
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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159
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Pini SA, Gibson F, Fern LA, Morgan SJ, Phillips RS, Stark DP. Multi-Professional Perspectives on Adolescent and Young Adult Oncology Across Europe: An e-Delphi Survey. J Adolesc Young Adult Oncol 2017; 6:178-185. [PMID: 28080182 DOI: 10.1089/jayao.2016.0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aims of this article are to describe the ongoing development of adolescent and young adult (AYA) cancer services within the European Union (EU), and to develop consensus on key areas within the field. This survey used an e-Delphi design. An initial survey was distributed via email to professionals working in Europe. A snowball sampling technique was used to promote distribution. Consensus was sought over three rounds from October 2012 to April 2015. Consensus was defined as >80% agreement ("agree" or "strongly agree"). Sixty professionals participated in round 1, 106 in round 2, and 61 in round 3. Twenty-six countries were represented across all rounds. Consensus was achieved for: the need for national policy guidance, the importance of patient choice, the validity of the International Charter of Rights for Young People, and some aspects of multi-disciplinary working. There was 75% agreement on a single definition of the patient age range within AYA cancer care. European professionals with expertise in AYA cancer care reached consensus on key elements of care for this group. The optimal AYA age range remained an elusive topic on which to agree. The broad engagement and interest in AYA cancer across the EU through the European Network for Cancer in Children and Adolescents (ENCCA) network was also demonstrated.
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Affiliation(s)
| | - Faith Gibson
- 2 Great Ormond Street Hospital for Children, NHS Foundation Trust and University of Surrey , London, United Kingdom
| | - Lorna A Fern
- 3 University College London Hospitals NHS Foundation Trust , London, United Kingdom
| | | | | | - Dan P Stark
- 1 St. James's Hospital , Leeds, United Kingdom
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Vermeulen M, Poels J, de Michele F, des Rieux A, Wyns C. Restoring Fertility with Cryopreserved Prepubertal Testicular Tissue: Perspectives with Hydrogel Encapsulation, Nanotechnology, and Bioengineered Scaffolds. Ann Biomed Eng 2017; 45:1770-1781. [PMID: 28070774 DOI: 10.1007/s10439-017-1789-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
New and improved oncological therapies are now able to cure more than 80% of cancer-affected children in Europe. However, such treatments are gonadotoxic and result in fertility issues, especially in boys who are not able to provide a sperm sample before starting chemo/radiotherapy because of their prepubertal state. For these boys, cryopreservation of immature testicular tissue (ITT) is the only available option, aiming to preserve spermatogonial stem cells (SSCs). Both slow-freezing and vitrification have been investigated to this end and are now applied in a clinical setting for SSC cryopreservation. Research now has to focus on methods that will allow fertility restoration. This review discusses different studies that have been conducted on ITT transplantation, including those using growth factor supplementation like free molecules, or tissue encapsulation with or without nanoparticles, as well as the possibility of developing a bioartificial testis that can be used for in vitro gamete production or in vivo transplantation.
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Affiliation(s)
- Maxime Vermeulen
- Gynecology-Andrology Research Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - Jonathan Poels
- Gynecology-Andrology Research Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200, Brussels, Belgium.,Department of Gynecology-Andrology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Francesca de Michele
- Gynecology-Andrology Research Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200, Brussels, Belgium.,Department of Gynecology-Andrology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Anne des Rieux
- Advanced Drug Delivery and Biomaterials Unit, Louvain Drug Research Institute, Université Catholique de Louvain, 1200, Brussels, Belgium.,Institute of Condensed Matter and Nanosciences, Université Catholique de Louvain, 1348, Louvain-la-Neuve, Belgium
| | - Christine Wyns
- Gynecology-Andrology Research Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200, Brussels, Belgium. .,Department of Gynecology-Andrology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
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Moxon-Emre I, Taylor MD, Bouffet E, Hardy K, Campen CJ, Malkin D, Hawkins C, Laperriere N, Ramaswamy V, Bartels U, Scantlebury N, Janzen L, Law N, Walsh KS, Mabbott DJ. Intellectual Outcome in Molecular Subgroups of Medulloblastoma. J Clin Oncol 2016; 34:4161-4170. [DOI: 10.1200/jco.2016.66.9077] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate intellectual functioning and the implications of limiting radiation exposure in the four biologically distinct subgroups of medulloblastoma: wingless (WNT), sonic hedgehog (SHH), Group 3, and Group 4. Patients and Methods A total of 121 patients with medulloblastoma (n = 51, Group 4; n = 25, Group 3; n = 28, SHH; and n = 17, WNT), who were treated between 1991 and 2013 at the Hospital for Sick Children (Toronto, Ontario, Canada), Children’s National Health System (Washington, DC), or the Lucile Packard Children’s Hospital (Palo Alto, CA), had intellectual assessments. First, we compared intellectual trajectories between subgroups. Next, we evaluated the effect of treatment with reduced-dose craniospinal irradiation (CSI) plus a tumor bed boost versus treatments that deliver higher CSI doses and/or larger boost volumes to the brain (all other treatments) within subgroups. Linear mixed modeling was used to determine the stability or change in intelligence scores over time. Results Intellectual outcomes declined comparably in each subgroup except for processing speed; SHH declined less than Group 3 ( P = .04). SHH had the lowest incidence of cerebellar mutism and motor deficits. Treatment with reduced-dose CSI plus a tumor bed boost was associated with preserved intellectual functioning in WNT and Group 4 patients considered together (ie, subgroups containing patients who are candidates for therapy de-escalation), and not in Group 3 or SHH. Across all subgroups, patients in the all other treatments group declined over time (all P < .05). Conclusion SHH patients appear to have the most distinct functional (ie, motor deficits and mutism) outcomes and a unique processing speed trajectory. Only WNT and Group 4 patients seem to benefit from limiting radiation exposure. Our findings highlight the value of conducting subgroup-specific analyses, and can be used to inform novel biologically based treatment protocols for patients with medulloblastoma.
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Affiliation(s)
- Iska Moxon-Emre
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - Michael D. Taylor
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - Eric Bouffet
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - Kristina Hardy
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - Cynthia J. Campen
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - David Malkin
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - Cynthia Hawkins
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - Normand Laperriere
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - Vijay Ramaswamy
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - Ute Bartels
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - Nadia Scantlebury
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - Laura Janzen
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - Nicole Law
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - Karin S. Walsh
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
| | - Donald J. Mabbott
- Iska Moxon-Emre, Michael D. Taylor, Eric Bouffet, David Malkin, Cynthia Hawkins, Normand Laperriere, Vijay Ramaswamy, Ute Bartels, Nadia Scantlebury, Laura Janzen, Nicole Law, and Donald J. Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, David Malkin, Cynthia Hawkins, Normand Laperriere, Laura Janzen, Nicole Law, and Donald J. Mabbott, University of Toronto; Iska Moxon-Emre and David Malkin, Pediatric Oncology Group of Ontario; Normand Laperriere, Princess Margaret Hospital,
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Roesler C, Pautre I, Thirry D, Flores S, Chabbert C, Savre N, Pibarot M, Seveau MA, Dugas K, Rollin Z, Dumont S, Gaspar N. [What specific socialisation, social, educational and professional for teenagers and young adults with cancer?]. Bull Cancer 2016; 103:979-989. [PMID: 27863725 DOI: 10.1016/j.bulcan.2016.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/13/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
Socialisation, education, first jobs and autonomy are key steps to teenagers and young adults (TYA) integration into the society. The occurrence of a cancer in this population increases the difficulties. Although, suffering of cancer do affect TYA life journey at social, scholar and professional levels, from diagnosis to the after-cancer live and sometime forever, few studies exist in France. A national study on TYA with cancer (TYAC) social, scholar and professional pathways is on-going (ESPOIR-AJA). A national survey of the existing TYAC insertion support in 2013 by the "Insertion group" of groupe onco-hématologie adolescents et jeunes adultes (GO-AJA) revealed structured and ancient support at scholar level based on national governmental or associative structures, but insufficient and non-specific scholar help in secondary school and professional help. Specific initiatives have emerged since 2012 with the "Plan cancer 2". All these helps remain unequal across the country. A referential on TYAC social, scholar and professional insertion has been prepared by GO-AJA in collaboration with the association francophone des soins oncologiques de support (AFSOS). The impact of the action 9 of the nation "plan cancer 3" is awaited.
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Affiliation(s)
| | - Isabelle Pautre
- Académie de Paris, Gustave Roussy, département de cancérologie de l'enfant et l'adolescent, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | | | - Soccoro Flores
- Institut Curie, département DPO AJA, 26, rue D'Ulm, 75006 Paris, France
| | - Catherine Chabbert
- Association École à l'hôpital, Gustave-Roussy, 94805 Villejuif cedex, France
| | - Nikita Savre
- Association Juris Santé, 101crs Gambeta, 69003 Lyon, France
| | - Michèle Pibarot
- Hôpitaux Sud, réseau régional de cancérologie Oncopaca-Corse, groupe AFSOS, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | | | - Karyn Dugas
- Observatoire de la ré-insertion scolaire des élèves/étudiants atteints de cancer (ORSECa), maison aquitaine ressources pour les adolescents et jeunes adultes atteints de cancer (maison Maradja), CHU de Bordeaux, place Amélie-Raba-Léon, 33073 Bordeaux cedex, France
| | - Zoé Rollin
- Université Paris 13, 1, rue de Chablis, 93000 Bobigny, France; Laboratoire IRIS, 190-198, avenue de France, 75013 Paris, France
| | - Sarah Dumont
- Gustave Roussy, département de médecine oncologique, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - Nathalie Gaspar
- Académie de Paris, Gustave Roussy, département de cancérologie de l'enfant et l'adolescent, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.
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Carceller F, Bautista FJ, Jiménez I, Hladun-Álvaro R, Giraud C, Bergamaschi L, Dandapani M, Aerts I, Doz F, Frappaz D, Casanova M, Morland B, Hargrave DR, Marshall LV, Vassal G, Pearson AD, Geoerger B, Moreno L. Prognostic factors of overall survival in children and adolescents enrolled in dose-finding trials in Europe: An Innovative Therapies for Children with Cancer study. Eur J Cancer 2016; 67:130-140. [DOI: 10.1016/j.ejca.2016.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/29/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
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Jaime-Pérez JC, López-Razo ON, García-Arellano G, Pinzón-Uresti MA, Jiménez-Castillo RA, González-Llano O, Gómez-Almaguer D. Results of Treating Childhood Acute Lymphoblastic Leukemia in a Low-middle Income Country: 10 Year Experience in Northeast Mexico. Arch Med Res 2016; 47:668-676. [DOI: 10.1016/j.arcmed.2017.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/13/2017] [Indexed: 10/19/2022]
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Schrøder H, Rechnitzer C, Wehner PS, Rosthøj S, Møller JK, Lausen B, Petersen G, Nørgaard M. Danish Childhood Cancer Registry. Clin Epidemiol 2016; 8:461-464. [PMID: 27822085 PMCID: PMC5094529 DOI: 10.2147/clep.s99508] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim of database The overall aim is to monitor the quality of childhood cancer care in Denmark; to register late effects of treatment; to analyze complications of permanent central venous catheters (CVCs); to study blood stream infections in children with cancer; and to study acute toxicity of high-dose methotrexate infusions in children with leukemia. Study population All children below 15 years of age at diagnosis living in Denmark diagnosed after January 1, 1985 according to the International Classification of Diseases 10, including diagnoses DC00–DD48. Main variables Cancer type, extent of disease, treatment, participation in international studies, recurrence of malignant disease, survival, yearly follow-up status, causes of death, and development of secondary malignancies. Type of CVC, causes for removal of the CVC, type of blood stream infection, pathogens isolated, antimicrobial sensitivity, and outcome of antimicrobial chemotherapy. Descriptive data Since 1985, 4,944 children below 15 years of age have been registered in the database. There has been no significant change in the incidence of childhood cancer in Denmark since 1985. The 5-year survival has increased significantly since 1985 and is now 86%. The median number of days from diagnosis to initiation of therapy is 7 days and in 80% of the children less than 14 days. Clinical data of 95% of the patients are reported to open international studies. Conclusion The survival of Danish children with cancer since 2003 compares favorably with other international population-based studies. The annual reports support the collaboration within pediatric oncology in Denmark.
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Affiliation(s)
- Henrik Schrøder
- Department of Pediatrics, Aarhus University Hospital, Aarhus
| | - Catherine Rechnitzer
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen
| | - Peder Skov Wehner
- Department of Pediatric Hematology and Oncology, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense
| | - Steen Rosthøj
- Department of Pediatrics, Aalborg University Hospital, Aalborg
| | | | - Birgitte Lausen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen
| | - Gitte Petersen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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El Issaoui M, Giorgione V, Mamsen LS, Rechnitzer C, Birkebæk N, Clausen N, Kelsey TW, Andersen CY. Effect of first line cancer treatment on the ovarian reserve and follicular density in girls under the age of 18 years. Fertil Steril 2016; 106:1757-1762.e1. [PMID: 27717554 DOI: 10.1016/j.fertnstert.2016.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/24/2016] [Accepted: 09/02/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To study the impact of first-line antineoplastic treatment on ovarian reserve in young girls returning for ovarian tissue cryopreservation (OTC) in connection with a relapse. DESIGN Retrospective case-control study. SETTING University hospitals. PATIENT(S) Sixty-three girls under the age of 18 years who underwent OTC before (group 1: 31 patients) and after (group 2: 32 patients) their initial cancer treatment. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Follicular densities (follicles/mm3) measured from an ovarian cortical biopsy before OTC. The ovarian volume (mL) of entire ovaries excised for OTC was also monitored. RESULT(S) There was no statistically significant difference in the mean age or follicular density between groups 1 and 2 (334 ± 476/mm3 vs. 327 ± 756/mm3). In contrast, the ovarian volume and total number of ovarian cortex chips cryopreserved were statistically significantly lower in patients who received gonadotoxic treatment before OTC (mean ± standard deviation [SD]: ovarian volume, 5.3 ± 3.1 mL vs. 2.9 ± 2.1 mL, respectively; number of cortex chips: 21.3 ± 8.1 vs. 15.2 ± 7.1, respectively). The reduction in the estimated ovarian reserve ranged from 10% to 20% in children to around 30% in adolescent girls (>10 years). CONCLUSION(S) Girls under the age of 10 tolerate a gonadotoxic insult better than adolescents, who may experience up to a 30% reduction in the ovarian reserve via first-line gonadotoxic treatment, which at present is considered to have little effect on the follicle pool. This information will improve counseling of young female cancer patients in deciding whether to undergo fertility preservation treatment.
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Affiliation(s)
- Meryam El Issaoui
- Laboratory of Reproductive Biology, Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Veronica Giorgione
- Laboratory of Reproductive Biology, Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Linn S Mamsen
- Laboratory of Reproductive Biology, Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Catherine Rechnitzer
- Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Birkebæk
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Clausen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas W Kelsey
- School of Computer Science, University of St. Andrews, St. Andrews, United Kingdom
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Dumont L, Oblette A, Rondanino C, Jumeau F, Bironneau A, Liot D, Duchesne V, Wils J, Rives N. Vitamin A prevents round spermatid nuclear damage and promotes the production of motile sperm during in vitro maturation of vitrified pre-pubertal mouse testicular tissue. Mol Hum Reprod 2016; 22:819-832. [PMID: 27671755 DOI: 10.1093/molehr/gaw063] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 08/06/2016] [Accepted: 08/31/2016] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does vitamin A (retinol, Rol) prevent round spermatid nuclear damage and increase the production of motile sperm during in vitro maturation of vitrified pre-pubertal mouse testicular tissue? SUMMARY ANSWER The supplementation of an in vitro culture of ~0.75 mm3 testicular explants from pre-pubertal mice with Rol enhances spermatogenesis progression during the first spermatogenic wave. WHAT IS KNOWN ALREADY The production of functional spermatozoa in vitro has only been achieved in the mouse model and remains a rare event. Establishing an efficient culture medium for vitrified pre-pubertal testicular tissue is now a crucial step to improve the spermatic yield obtained in vitro. The role of Rol in promoting the differentiation of spermatogonia and their entry into meiosis is well established; however, it has been postulated that Rol is also required to support their full development into elongated spermatids. STUDY DESIGN, SIZE, DURATION A total of 60 testes from 6.5 days post-partum (dpp) mice were vitrified/warmed, cut into fragments and cultured for 30 days: 20 testes were used for light microscopy and histological analyses, 20 testes for DNA fragmentation assessment in round spermatids and 20 testes for induced sperm motility assessment. Overall, 16 testes of 6.5 dpp were used as in vitro fresh tissue controls and 12 testes of 36.5 dpp mice as in vivo controls. Testes were vitrified with the optimal solid surface vitrification procedure and cultured with an in vitro organ culture system until Day 30 (D30). Histological analysis, cell death, degenerating round spermatids, DNA fragmentation in round spermatids and induced sperm motility were assessed. Testosterone levels were measured in media throughout the culture by radioimmunoassay. MAIN RESULTS AND THE ROLE OF CHANCE At D30, better tissue development together with higher differentiation of spermatogonial stem cells, and higher global cell division ability were observed for vitrified/warmed testicular fragments of ~0.75 mm3 with a culture medium supplemented with Rol compared to controls. During in vitro culture of vitrified pre-pubertal testicular tissue, Rol enhanced and maintained the entry of spermatogonia into meiosis and promoted a higher spermatic yield. Furthermore, decreased round spermatid nuclear alterations and DNA damage combined with induced sperm motility comparable to in vivo highlight the crucial role of Rol in the progression of spermatogenesis during the first wave. LIMITATIONS, REASONS FOR CAUTION Despite our promising results, the culture media will have to be further improved and adapted within the context of a human application. WIDER IMPLICATIONS OF THE FINDINGS The results have potential implications for the handling of human pre-pubertal testicular tissues cryopreserved for fertility preservation. However, because some alterations in round spermatids persist after in vitro culture with Rol, the procedure needs to be optimized before human application, bearing in mind that the murine and human spermatogenic processes differ in many respects. LARGE SCALE DATA None. STUDY FUNDING AND COMPETING INTERESTS This study was supported by a Ph.D. grant from the Normandy University and a financial support from 'la Ligue nationale contre le cancer' (both awarded to L.D.), funding from Rouen University Hospital, Institute for Research and Innovation in Biomedicine (IRIB) and Agence de la Biomédecine. The authors declare that there is no conflict of interest.
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Affiliation(s)
- L Dumont
- EA 4308 'Gametogenesis and Gamete Quality', Reproductive Biology Laboratory-CECOS, Rouen University Hospital, Institute for Biomedical Research, Pavillon Derocque, Hôpital Charles Nicolle, 1 Rue de Germont, 76031 Rouen Cedex, France.,Normandy University, Ed 497 Normande de Biologie Intégrative, Santé et Environnement (EdNBISE), Bâtiment Principal UFR Sciences, Place Emilie Blondel, 76821 Mont-Saint-Aignan Cedex, France.,Institute for Research and Innovation in Biomedicine (IRIB) , IRIB Normandy, 22 Boulevard Gambetta, 76183 Rouen Cedex, France
| | - A Oblette
- EA 4308 'Gametogenesis and Gamete Quality', Reproductive Biology Laboratory-CECOS, Rouen University Hospital, Institute for Biomedical Research, Pavillon Derocque, Hôpital Charles Nicolle, 1 Rue de Germont, 76031 Rouen Cedex, France.,Normandy University, Ed 497 Normande de Biologie Intégrative, Santé et Environnement (EdNBISE), Bâtiment Principal UFR Sciences, Place Emilie Blondel, 76821 Mont-Saint-Aignan Cedex, France.,Institute for Research and Innovation in Biomedicine (IRIB) , IRIB Normandy, 22 Boulevard Gambetta, 76183 Rouen Cedex, France
| | - C Rondanino
- EA 4308 'Gametogenesis and Gamete Quality', Reproductive Biology Laboratory-CECOS, Rouen University Hospital, Institute for Biomedical Research, Pavillon Derocque, Hôpital Charles Nicolle, 1 Rue de Germont, 76031 Rouen Cedex, France.,Institute for Research and Innovation in Biomedicine (IRIB) , IRIB Normandy, 22 Boulevard Gambetta, 76183 Rouen Cedex, France
| | - F Jumeau
- EA 4308 'Gametogenesis and Gamete Quality', Reproductive Biology Laboratory-CECOS, Rouen University Hospital, Institute for Biomedical Research, Pavillon Derocque, Hôpital Charles Nicolle, 1 Rue de Germont, 76031 Rouen Cedex, France.,Institute for Research and Innovation in Biomedicine (IRIB) , IRIB Normandy, 22 Boulevard Gambetta, 76183 Rouen Cedex, France
| | - A Bironneau
- EA 4308 'Gametogenesis and Gamete Quality', Reproductive Biology Laboratory-CECOS, Rouen University Hospital, Institute for Biomedical Research, Pavillon Derocque, Hôpital Charles Nicolle, 1 Rue de Germont, 76031 Rouen Cedex, France
| | - D Liot
- EA 4308 'Gametogenesis and Gamete Quality', Reproductive Biology Laboratory-CECOS, Rouen University Hospital, Institute for Biomedical Research, Pavillon Derocque, Hôpital Charles Nicolle, 1 Rue de Germont, 76031 Rouen Cedex, France
| | - V Duchesne
- EA 4308 'Gametogenesis and Gamete Quality', Reproductive Biology Laboratory-CECOS, Rouen University Hospital, Institute for Biomedical Research, Pavillon Derocque, Hôpital Charles Nicolle, 1 Rue de Germont, 76031 Rouen Cedex, France
| | - J Wils
- Biochemistry Laboratory, Rouen University Hospital, Institute for Biomedical Research , Pavillon Derocque, Hôpital Charles Nicolle, 1 Rue de Germont, 76031 Rouen Cedex, France
| | - N Rives
- EA 4308 'Gametogenesis and Gamete Quality', Reproductive Biology Laboratory-CECOS, Rouen University Hospital, Institute for Biomedical Research, Pavillon Derocque, Hôpital Charles Nicolle, 1 Rue de Germont, 76031 Rouen Cedex, France .,Institute for Research and Innovation in Biomedicine (IRIB) , IRIB Normandy, 22 Boulevard Gambetta, 76183 Rouen Cedex, France
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169
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Indolfi P, Picazio S, Perrotta S, Rossi F, Pession A, Di Martino M, Pota E, Di Pinto D, Indolfi C, Rondelli R, Vetrano F, Casale F. Time trends of cancer incidence in childhood in Campania region: 25 years of observation. Ital J Pediatr 2016; 42:82. [PMID: 27599999 PMCID: PMC5013613 DOI: 10.1186/s13052-016-0287-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood cancer is relatively uncommon and the European age-standardized rate was 164 new case per million per year among children 0 to 14 years of age (95 % CI 158-170). Aims of our study are to evaluate the cases of these malignant diseases observed between 0 and 15 years of age in the Campania region between 1990 and 2014, the ration between observed and expected cases by disease and province of residence. Also we studied the percentage of extra-regional migration over the time by disease and province of residence. METHODS In this study we reported the patients with malignant disease observed in 25 years (1990-2014) based on the specialized registry, the Mod. 1.01 of the AIEOP (Association Italian Pediatric Hematology-Oncology). The size of the monitored population also allowed us to systematically examine five time trends: 1990-94: 1995-99; 2000-04; 2005-09; and 2010-14. RESULTS Between 1990 and 2014 a total of 3655 malignant neoplasms were reported: Napoli province (2059 cases), Salerno province (625), Caserta province (589), Avellino province (229), and Benevento province (153). Epidemiological data suggested that about 4100 cases could be expected in Campania region during the same period. The overall ratio between observed (O) and expected (E) numbers of cases in the five periods considered rose gradually from 0.69 in the first period to 0.76, then 0.82, 0.91, and 0.94, in the other periods considered. The extra-regional migration involved 1029 cases (28.1 %), showing a reduction from 33.7 % of the first period to 20.3 % of the last period considered. Considering single province of residence we observed the lowest rate of migration in Napoli and Caserta province, whereas higher levels were observed in the other provinces. For all provinces, except Salerno, the extra-regional migration declined significantly over time. CONCLUSIONS The present findings showed an increase over time of O/E ratio, probably due to improvement in the organization of centers and greater trust of families in local centers. It is possible to further improve the efficiency of healthcare system of Campania region and migration can be reduced with a more rational use of hospitals throughout region.
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Affiliation(s)
- Paolo Indolfi
- Servizio di Oncologia Pediatrica, Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica- Seconda Università degli Studi di Napoli, Naples, Italy. .,AIL Sezione "Valentina Picazio", Caserta, Italy.
| | | | - Silverio Perrotta
- Servizio di Oncologia Pediatrica, Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica- Seconda Università degli Studi di Napoli, Naples, Italy
| | - Francesca Rossi
- Servizio di Oncologia Pediatrica, Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica- Seconda Università degli Studi di Napoli, Naples, Italy
| | - Andrea Pession
- Unità di Oncologia ed Ematologia Pediatrica "Lalla Seràgnoli", Università di Bologna, Bologna, Italy
| | - Martina Di Martino
- Servizio di Oncologia Pediatrica, Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica- Seconda Università degli Studi di Napoli, Naples, Italy
| | - Elvira Pota
- Servizio di Oncologia Pediatrica, Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica- Seconda Università degli Studi di Napoli, Naples, Italy
| | - Daniela Di Pinto
- Servizio di Oncologia Pediatrica, Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica- Seconda Università degli Studi di Napoli, Naples, Italy
| | - Cristiana Indolfi
- Servizio di Oncologia Pediatrica, Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica- Seconda Università degli Studi di Napoli, Naples, Italy
| | - Roberto Rondelli
- Unità di Oncologia ed Ematologia Pediatrica "Lalla Seràgnoli", Università di Bologna, Bologna, Italy
| | - Francesco Vetrano
- Responsabile Registro Tumori Infantili Regione Campania, Naples, Italy
| | - Fiorina Casale
- Servizio di Oncologia Pediatrica, Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica- Seconda Università degli Studi di Napoli, Naples, Italy
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170
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Galán S, de la Vega R, Miró J. Needs of adolescents and young adults after cancer treatment: a systematic review. Eur J Cancer Care (Engl) 2016; 27:e12558. [DOI: 10.1111/ecc.12558] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 01/08/2023]
Affiliation(s)
- S. Galán
- Unit for the Study and Treatment of Pain - ALGOS; Tarragona, Catalonia Spain
- Department of Psychology; Research Center for Behavior Assessment (CRAMC); Tarragona, Catalonia Spain
- Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili; Tarragona, Catalonia Spain
| | - R. de la Vega
- Unit for the Study and Treatment of Pain - ALGOS; Tarragona, Catalonia Spain
- Department of Psychology; Research Center for Behavior Assessment (CRAMC); Tarragona, Catalonia Spain
- Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili; Tarragona, Catalonia Spain
| | - J. Miró
- Unit for the Study and Treatment of Pain - ALGOS; Tarragona, Catalonia Spain
- Department of Psychology; Research Center for Behavior Assessment (CRAMC); Tarragona, Catalonia Spain
- Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili; Tarragona, Catalonia Spain
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171
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Ben-Aharon I, Abir R, Perl G, Stein J, Gilad G, Toledano H, Elitzur S, Avrahami G, Ben-Haroush A, Oron G, Freud E, Kravarusic D, Ben-Arush M, Herzel G, Yaniv I, Stemmer SM, Fisch B, Ash S. Optimizing the process of fertility preservation in pediatric female cancer patients - a multidisciplinary program. BMC Cancer 2016; 16:620. [PMID: 27506811 PMCID: PMC4979150 DOI: 10.1186/s12885-016-2584-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 07/19/2016] [Indexed: 12/02/2022] Open
Abstract
Background Current evidence indicates sub-optimal incidence of fertility preservation (FP) in eligible patients. We present herein our designated multidisciplinary program for FP in pediatric and adolescent population and present our data on FP in female patients. Methods Pediatric patients (age 0–18) who were candidate for highly gonadotoxic treatments were referred to FP program for a multidisciplinary discussion and gonadal risk-assessment followed by either oocyte cryopreservation or ovarian cryopreservation (OCP) for female patients, and sperm banking for male patients. The OCP protocol consists of aspiration of oocytes from small antral follicles and in-vitro maturation followed by cryopreservation, as well as ovarian tissue cryopreservation. Results The establishment of a designated FP program resulted in a significant increase in referral and subsequent FP procedures of all eligible patients. Sixty-two female patients were referred for FP discussion during a period of 36 months; 41 underwent OCP; 11 underwent oocyte cryopreservation and six were declined due to parental decision. The median age was 13.2y (range 18 months-18y). Thirty-two (51.6 %) were chemotherapy-naïve. Seventeen patients (27 %) had sarcoma, 16 patients (26 %) had acute leukemia. The mean number of mature oocytes that were eventually vitrified was significantly higher in chemotherapy-naïve patients compared with chemotherapy-exposed patients (mean 12 oocytes (1–42) versus 2 (0–7)). Conclusion Multidisciplinary programs that encompass experts of all relevant fields, skilled laboratory resources and a facilitated path appear to maximize the yield. We observed a considerable higher referral rates following launching a designated program and earlier OCP in chemo-naïve patients that culminated in a better fertility preservation procedure.
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Affiliation(s)
- Irit Ben-Aharon
- Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - R Abir
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Perl
- Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Stein
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Gilad
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Toledano
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Elitzur
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Avrahami
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Ben-Haroush
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Oron
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Freud
- Department of Pediatric Surgery, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Kravarusic
- Department of Pediatric Surgery, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Ben-Arush
- Division of Pediatric Hematology Oncology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - G Herzel
- Department of Pediatric Hematology Oncology, Ha'Emek Hospital, Afula, Israel
| | - I Yaniv
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S M Stemmer
- Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Fisch
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Ash
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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van Dorp W, Mulder RL, Kremer LCM, Hudson MM, van den Heuvel-Eibrink MM, van den Berg MH, Levine JM, van Dulmen-den Broeder E, di Iorgi N, Albanese A, Armenian SH, Bhatia S, Constine LS, Corrias A, Deans R, Dirksen U, Gracia CR, Hjorth L, Kroon L, Lambalk CB, Landier W, Levitt G, Leiper A, Meacham L, Mussa A, Neggers SJ, Oeffinger KC, Revelli A, van Santen HM, Skinner R, Toogood A, Wallace WH, Haupt R. Recommendations for Premature Ovarian Insufficiency Surveillance for Female Survivors of Childhood, Adolescent, and Young Adult Cancer: A Report From the International Late Effects of Childhood Cancer Guideline Harmonization Group in Collaboration With the PanCareSurFup Consortium. J Clin Oncol 2016; 34:3440-50. [PMID: 27458300 DOI: 10.1200/jco.2015.64.3288] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were treated with alkylating agents and/or radiation, with potential exposure of the ovaries, have an increased risk of premature ovarian insufficiency (POI). Clinical practice guidelines can facilitate these survivors' access to optimal treatment of late effects that may improve health and quality of survival; however, surveillance recommendations vary among the existing long-term follow-up guidelines, which impedes the implementation of screening. PATIENTS AND METHODS The present guideline was developed by using an evidence-based approach and summarizes harmonized POI surveillance recommendations for female survivors of CAYA cancer who were diagnosed at age < 25 years. The recommendations were formulated by an international multidisciplinary panel and graded according to the strength of the evidence and the potential benefit gained from early detection and intervention. The harmonized POI surveillance recommendations were developed by using a transparent process and are intended to facilitate care for survivors of CAYA cancer. RESULTS AND CONCLUSION The harmonized set of POI surveillance recommendations is intended to be scientifically rigorous, to positively influence health outcomes, and to facilitate the care for female survivors of CAYA cancer.
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Affiliation(s)
- Wendy van Dorp
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Renée L Mulder
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Leontien C M Kremer
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Melissa M Hudson
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Marry M van den Heuvel-Eibrink
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Marleen H van den Berg
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Jennifer M Levine
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Eline van Dulmen-den Broeder
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Natascia di Iorgi
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Assunta Albanese
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Saro H Armenian
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Smita Bhatia
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Louis S Constine
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Andreas Corrias
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Rebecca Deans
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Uta Dirksen
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Clarisa R Gracia
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Lars Hjorth
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Leah Kroon
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Cornelis B Lambalk
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Wendy Landier
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Gill Levitt
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Alison Leiper
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Lillian Meacham
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Alesandro Mussa
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Sebastian J Neggers
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Kevin C Oeffinger
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Alberto Revelli
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Hanneke M van Santen
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Roderick Skinner
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Andrew Toogood
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - William H Wallace
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
| | - Riccardo Haupt
- Wendy van Dorp and Sebastian J. Neggers, Erasmus University Medical Centre; Wendy van Dorp, Sophia Children's Hospital, Rotterdam; Renée L. Mulder and Leontien C.M. Kremer, Emma Children's Hospital and Academic Medical Centre; Marleen H. van den Berg, Eline van Dulmen-den Broeder, and Cornelis B. Lambalk, Vrije Universiteit Medical Center, Amsterdam; Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology; Hanneke M. van Santen, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; Jennifer M. Levine, Columbia University Medical Center; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Natascia di Iorgi, University of Genoa; Riccardo Haupt, Istituto Giannina Gaslini, Genoa; Andreas Corrias and Alesandro Mussa, University of Turin, Turin; Alberto Revelli, S. Anna Hospital and University of Torino, Torino, Italy; Assunta Albanese, St George's University Hospitals NHS Foundation Trust; Gill Levitt and Alison Leiper, Great Ormond St Hospital for Children NHS Foundation Trust, London; Roderick Skinner, Great North Children's Hospital and Newcastle University, Newcastle upon Tyne; Andrew Toogood, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham; William H. Wallace, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Saro H. Armenian, City of Hope, Duarte, CA; Smita Bhatia and Wendy Landier, University of Alabama at Birmingham, Birmingham, AL; Rebecca Deans, University of New South Wales, Sydney, New South Wales, Australia; Uta Dirksen, Westfalian Wilhelms University Muenster, University Hospital Muenster, Germany; Clarisa R. Gracia, University of Pennsylvania, Philadelphia, PA; Lars Hjorth, Skåne University Hospital and Lund University, Lund, Sweden; Leah Kroon, Seattle Children's Hospital, Seat
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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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Poels J, Abou-Ghannam G, Decamps A, Leyman M, Rieux AD, Wyns C. Transplantation of testicular tissue in alginate hydrogel loaded with VEGF nanoparticles improves spermatogonial recovery. J Control Release 2016; 234:79-89. [DOI: 10.1016/j.jconrel.2016.05.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/10/2016] [Accepted: 05/13/2016] [Indexed: 12/24/2022]
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Incidence and survival of children and young people with central nervous system embryonal tumours in the North of England, 1990–2013. Eur J Cancer 2016; 61:36-43. [DOI: 10.1016/j.ejca.2016.03.083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/24/2016] [Accepted: 03/28/2016] [Indexed: 11/19/2022]
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Seppänen VI, Artama MS, Malila NK, Pitkäniemi JM, Rantanen ME, Ritvanen AK, Madanat-Harjuoja LM. Risk for congenital anomalies in offspring of childhood, adolescent and young adult cancer survivors. Int J Cancer 2016; 139:1721-30. [PMID: 27280956 DOI: 10.1002/ijc.30226] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/11/2016] [Accepted: 05/27/2016] [Indexed: 11/06/2022]
Abstract
Offspring of cancer survivors (CS) may be at risk for congenital anomalies due to the mutagenic therapies received by their parents. Our population-based cohort study aimed to investigate the risk for congenital anomalies in offspring of CS compared to offspring of their siblings. Using the Finnish Cancer Registry, Central Population Register, and Hospital Discharge Register, we identified hospital contacts due to congenital anomalies in 6,862 offspring of CS (early-onset cancer between 1953 and 2004) and 35,690 offspring of siblings. Associations between congenital anomalies and cancer were evaluated using generalized linear regression modelling. The ratio of congenital anomalies in offspring of CS (3.2%) was slightly, but non-significantly, elevated compared to that in offspring of siblings (2.7%) [prevalence ratio (PR) 1.07, 95% confidence interval (CI) 0.91-1.25]. When offspring of childhood and adolescent survivors (0-19 years at cancer diagnosis) were compared to siblings' offspring, the risk for congenital anomalies was non-significantly increased (PR 1.17, 95% CI 0.92-1.49). No such increase existed for offspring of young adult survivors (20-34 years at cancer diagnosis) (PR 1.01, 95% CI 0.83-1.23). The risks for congenital anomalies were elevated among offspring of CS diagnosed with cancer in the earlier decades (1955-1964: PR 2.77, 95% C I 1.26-6.11; and 1965-1974: PR 1.55, 95% C I 0.94-2.56). In our study, we did not detect an overall elevated risk for congenital anomalies in offspring of survivors diagnosed in young adulthood. An association between cancer exposure of the parent and congenital anomalies in the offspring appeared only for those CS who were diagnosed in the earlier decades.
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Affiliation(s)
- Viivi I Seppänen
- University of Helsinki, Helsinki, Finland.,Finnish Cancer Registry, Helsinki, Finland
| | | | - Nea K Malila
- Finnish Cancer Registry, Helsinki, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland
| | | | | | - Annukka K Ritvanen
- Finnish Register of Congenital Malformations, THL National Institute for Health and Welfare, Helsinki, Finland
| | - Laura-Maria Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland.,Department of Pediatrics, Jorvi Hospital and University of Helsinki, Helsinki, Finland
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177
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Zavras N, Siristatidis C, Siatelis A, Koumarianou A. Fertility Risk Assessment and Preservation in Male and Female Prepubertal and Adolescent Cancer Patients. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2016; 10:49-57. [PMID: 27398041 PMCID: PMC4927042 DOI: 10.4137/cmo.s32811] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/22/2016] [Accepted: 05/26/2016] [Indexed: 12/15/2022]
Abstract
Cancer represents the second cause of death in prepubertal children and adolescents, although it is currently associated with an overall survival rate of 80%–85%. The annual incidence rate is 186.6 per 1 million children and adolescents aged up to 19 years. Both disease and treatment options are associated with life-altering, long-term effects that require monitoring. Infertility is a common issue, and as such, fertility preservation represents an essential part in the management of young patients with cancer who are at risk of premature gonadal failure. This review deals with the up-to-date available data on fertility risk assessment and preservation strategies that should be addressed prior to antineoplastic therapy in this vulnerable subgroup of cancer patients.
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Affiliation(s)
- Nikolaos Zavras
- Unit of Pediatric and Adolescent Surgery, Third Department of Surgery, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalampos Siristatidis
- Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyris Siatelis
- Urology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Koumarianou
- Consultant in Medical Oncology, Hematology-Oncology Unit, Fourth Department of Internal Medicine, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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178
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Massimino M, Biassoni V, Gandola L, Garrè ML, Gatta G, Giangaspero F, Poggi G, Rutkowski S. Childhood medulloblastoma. Crit Rev Oncol Hematol 2016; 105:35-51. [PMID: 27375228 DOI: 10.1016/j.critrevonc.2016.05.012] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 04/05/2016] [Accepted: 05/25/2016] [Indexed: 01/06/2023] Open
Abstract
Medulloblastoma accounts for 15-20% of childhood nervous system tumours. The risk of dying was reduced by 30% in the last twenty years. Patients are divided in risk strata according to post-surgical disease, dissemination, histology and some molecular features such as WNT subgroup and MYC status. Sixty to 70% of patients older than 3 years are assigned to the average-risk group. High-risk patients include those with disseminated and/or residual disease, large cell and/or anaplastic histotypes, MYC genes amplification. Current and currently planned clinical trials will: (1) evaluate the feasibility of reducing both the dose of craniospinal irradiation and the volume of the posterior fossa radiotherapy (RT) for those patients at low biologic risk, commonly identified as those having a medulloblastoma of the WNT subgroup; (2) determine whether intensification of chemotherapy (CT) or irradiation can improve outcome in patients with high-risk disease; (3) find target therapies allowing tailored therapies especially for relapsing patients and those with higher biological risk.
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Affiliation(s)
- Maura Massimino
- Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan Italy.
| | | | - Lorenza Gandola
- Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan Italy.
| | | | - Gemma Gatta
- Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan Italy.
| | | | | | - Stefan Rutkowski
- University Medical Center Hamburg-Eppendorf, Department of Pediatric Hematology and Oncology, Hamburg, Germany.
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179
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Vos R, Verleden GM, Dupont LJ. Long-term survival after lung transplantation among cystic fibrosis patients: Moving away from mere palliation. J Heart Lung Transplant 2016; 35:837-40. [DOI: 10.1016/j.healun.2016.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/10/2016] [Indexed: 01/07/2023] Open
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180
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Ferrari A, Rondelli R, Pession A, Mascarin M, Buzzoni C, Mosso ML, Maule M, Barisone E, Bertolotti M, Clerici CA, Jankovic M, Fagioli F, Biondi A. Adolescents with Cancer in Italy: Improving Access to National Cooperative Pediatric Oncology Group (AIEOP) Centers. Pediatr Blood Cancer 2016; 63:1116-9. [PMID: 26914476 DOI: 10.1002/pbc.25954] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
This analysis compared the numbers of patients treated at Italian pediatric oncology group (Associazione Italiana Ematologia Oncologia Pediatrica [AIEOP]) centers with the numbers of cases predicted according to the population-based registry. It considered 32,431 patients registered in the AIEOP database (1989-2012). The ratio of observed (O) to expected (E) cases was 0.79 for children (0-14 years old) and 0.15 for adolescents (15-19 years old). The proportion of adolescents increased significantly over the years, however, from 0.05 in the earliest period to 0.10, 0.18, and then 0.28 in the latest period of observation, suggesting a greater efficacy of local/national programs dedicated to adolescents.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Roberto Rondelli
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli,", University of Bologna, Bologna, Italy
| | - Andrea Pession
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli,", University of Bologna, Bologna, Italy
| | - Maurizio Mascarin
- Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Carlotta Buzzoni
- Clinical and Descriptive Epidemiology and Registries Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy
| | - Maria Luisa Mosso
- Childhood Cancer Registry of Piedmont, Department of Medical Sciences, University of Turin, Italy
| | - Milena Maule
- Childhood Cancer Registry of Piedmont, Department of Medical Sciences, University of Turin, Italy
| | - Elena Barisone
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
| | - Marina Bertolotti
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
| | - Carlo Alfredo Clerici
- Department of Biomolecular Sciences and Biotechnology, Psychology Section, Faculty of Medicine, University of Milan, Milano, Italy
| | - Momcilo Jankovic
- Pediatric Hematology-Oncology Department and "Tettamanti" Research Centre, Milano-Bicocca University, "Fondazione MBBM," San Gerardo Hospital, Monza, Italy
| | - Franca Fagioli
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
| | - Andrea Biondi
- Pediatric Hematology-Oncology Department and "Tettamanti" Research Centre, Milano-Bicocca University, "Fondazione MBBM," San Gerardo Hospital, Monza, Italy
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181
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Trama A, Botta L, Foschi R, Ferrari A, Stiller C, Desandes E, Maule MM, Merletti F, Gatta G. Survival of European adolescents and young adults diagnosed with cancer in 2000-07: population-based data from EUROCARE-5. Lancet Oncol 2016; 17:896-906. [PMID: 27237614 DOI: 10.1016/s1470-2045(16)00162-5] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/03/2016] [Accepted: 03/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Data from EUROCARE have consistently shown lower survival for adolescents and young adults (AYAs; aged 15-24 years) than for children (0-14 years) for most cancers that affect both groups, and modest survival improvements up to 2000-02. AYAs have longer survival than that of adults for most cancers. We used the latest definition of AYAs (aged 15-39 years) and provided estimates of 5-year relative survival for European AYAs with cancer diagnosed in 2000-07, compared with children and adults (40-69 years) with cancer, and assessed survival improvements over time. METHODS We analysed data from population-based cancer registries of 27 European countries participating in EUROCARE-5. We used the so-called complete method to estimate 5-year, population-weighted relative survival for 19 cancers affecting AYAs and children, and for 27 cancers affecting AYAs and adults. We assessed relative-survival differences between children versus AYAs, and between AYAs versus adults, using the Z test. We used the period approach to estimate 5-year relative survival over time for children and AYAs, and used a generalised linear model to model survival time trends (1999-2007) and to assess the significance of changes over time. FINDINGS We analysed 56 505 cancer diagnoses in children, 312 483 in AYAs, and 3 567 383 in adults. For all cancers combined, survival improved over time for AYAs (from 79% [95% CI 78·1-80·5] in 1999-2002 to 82% [81·1-83·3] in 2005-07; p<0·0001) and children (from 76% [74·7-77·1] to 79% [77·2-79·4]; p<0·0001). Survival improved significantly in children and AYAs for acute lymphoid leukaemia (p<0·0001) and non-Hodgkin lymphoma (p<0·0001 in AYAs and p=0·023 in children). Survival improved significantly in AYAs only for CNS tumours (p=0·0046), astrocytomas (p=0·040), and malignant melanomas (p<0·0001). Survival remained significantly worse in AYAs than in children for eight important cancers: acute lymphoid leukaemias, acute myeloid leukaemias, Hodgkin's lymphomas, non-Hodgkin lymphomas, astrocytomas, Ewing's sarcomas, and rhabdomyosarcomas (p<0·0001 in all cases), and osteosarcomas (p=0·011). INTERPRETATION Notwithstanding the encouraging results for some cancers, and overall, we showed poorer survival in AYAs than in children for the eight important cancers. Recent European initiatives to improve outcomes in AYAs might reduce the survival gap between children and AYAs, but this reduction can only be verified by future population-based studies. FUNDING Italian Ministry of Health, European Commission.
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Affiliation(s)
- Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - Laura Botta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Roberto Foschi
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Ferrari
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Charles Stiller
- Childhood Cancer Research Group, University of Oxford, Oxford, UK
| | - Emmanuel Desandes
- CHU Nancy, Registre National des Tumeurs Solides de l'Enfant, Vandoeuvre-lès-Nancy, France; Université Paris-Sorbonne, CRESS équipe 7, INSERM UMRS-1153, Paris, France
| | - Milena Maria Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Abstract
Introduction Little is known about the impact of childhood cancer on the personal income of survivors. We compared income between survivors and siblings, and determined factors associated with income. Methods As part of the Swiss Childhood Cancer Survivor Study (SCCSS), a questionnaire was sent to survivors, aged ≥18 years, registered in the Swiss Childhood Cancer Registry (SCCR), diagnosed at age <21 years, who had survived ≥5 years after diagnosis of the primary tumor. Siblings were used as a comparison group. We asked questions about education, profession and income and retrieved clinical data from the SCCR. We used multivariable logistic regression to identify characteristics associated with income. Results We analyzed data from 1’506 survivors and 598 siblings. Survivors were less likely than siblings to have a high monthly income (>4’500 CHF), even after we adjusted for socio-demographic and educational factors (OR = 0.46, p<0.001). Older age, male sex, personal and parental education, and number of working hours were associated with high income. Survivors of leukemia (OR = 0.40, p<0.001), lymphoma (OR = 0.63, p = 0.040), CNS tumors (OR = 0.22, p<0.001), bone tumors (OR = 0.24, p = 0.003) had a lower income than siblings. Survivors who had cranial irradiation, had a lower income than survivors who had no cranial irradiation (OR = 0.48, p = 0.006). Discussion Even after adjusting for socio-demographic characteristics, education and working hours, survivors of various diagnostic groups have lower incomes than siblings. Further research needs to identify the underlying causes.
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183
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Gunn HM, Rinne I, Emilsson H, Gabriel M, Maguire AM, Steinbeck KS. Primary Gonadal Insufficiency in Male and Female Childhood Cancer Survivors in a Long-Term Follow-Up Clinic. J Adolesc Young Adult Oncol 2016; 5:344-350. [PMID: 27195593 DOI: 10.1089/jayao.2016.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Childhood cancer survivors (CCS) are at increased risk of primary gonadal insufficiency (PGI). This study evaluated the prevalence and clinical characteristics of PGI in CCS. METHODS In this single-center, retrospective, observational, longitudinal study, we characterized CCS with PGI attending the oncology Long-Term Follow-Up (LTFU) Clinic at an Australian university hospital (January 2012-August 2014). From a cohort of 276 CCS, 54 (32 males) met criteria for PGI: elevated gonadotropins plus low estradiol/amenorrhoea (females) or low testosterone/small testicles for age (males). RESULTS Median age at primary diagnosis was 4.8 years (inter-quartile range [IQR] 3.0-9.7 years) and at LTFU, it was 22.3 years (IQR 18.2-25.7 years). Fifty-three participants (98.1%) were treated with known highly gonadotoxic therapies: alkylating chemotherapy (96.3%), radiotherapy (70.3%), total body irradiation (29.6%), bone marrow transplantation (51.9%), or multimodal protocols (68.5%). At primary diagnosis, 86.7% participants were Tanner stage I and at LTFU, 89.1% participants were Tanner stage V. More females (95.5%; n = 21) than males (40.6%; n = 13) were treated with hormone development therapy (HDT) (p < 0.01). Of these, more than half (n = 18; 7 males) required pubertal induction. There was no significant difference in serum luteinizing hormone/follicle stimulating hormone (LH/FSH), testosterone/estradiol between those untreated and those treated with HDT. Among those on HDT, 60.7% had persistently elevated FSH±LH and 33.3% had low testosterone or estradiol. Six males had semen analysis (five azoospermic, one oligospermic). Psychological assessment was documented in 61.1% of participants, and two-thirds reported fertility concerns. CONCLUSION PGI is an evolving phenotype that is common in CCS. Suboptimal treatment and non-adherence occur frequently. Ongoing assessment is essential to ensure prompt diagnosis, adequate intervention and to promote HDT adherence.
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Affiliation(s)
- Harriet M Gunn
- 1 Academic Department of Adolescent Medicine, The Children's Hospital at Westmead , Sydney, New South Wales, Australia .,2 Discipline of Child and Adolescent Health, The University of Sydney , Sydney, New South Wales, Australia
| | - Ida Rinne
- 3 The Faculty of Medicine and Health Sciences, Linköping University , Linköping, Sweden
| | - Hanna Emilsson
- 3 The Faculty of Medicine and Health Sciences, Linköping University , Linköping, Sweden
| | - Melissa Gabriel
- 4 Long Term Follow Up Clinic, Department of Oncology, The Children's Hospital at Westmead , Sydney, New South Wales, Australia
| | - Ann M Maguire
- 2 Discipline of Child and Adolescent Health, The University of Sydney , Sydney, New South Wales, Australia .,5 Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead , Sydney, New South Wales, Australia
| | - Katharine S Steinbeck
- 1 Academic Department of Adolescent Medicine, The Children's Hospital at Westmead , Sydney, New South Wales, Australia .,2 Discipline of Child and Adolescent Health, The University of Sydney , Sydney, New South Wales, Australia
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184
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Font-Gonzalez A, Mulder RL, Loeffen EAH, Byrne J, van Dulmen-den Broeder E, van den Heuvel-Eibrink MM, Hudson MM, Kenney LB, Levine JM, Tissing WJE, van de Wetering MD, Kremer LCM. Fertility preservation in children, adolescents, and young adults with cancer: Quality of clinical practice guidelines and variations in recommendations. Cancer 2016; 122:2216-23. [PMID: 27175973 DOI: 10.1002/cncr.30047] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/24/2016] [Accepted: 03/17/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fertility preservation care for children, adolescents, and young adults (CAYAs) with cancer is not uniform among practitioners. To ensure high-quality care, evidence-based clinical practice guidelines (CPGs) are essential. The authors identified existing CPGs for fertility preservation in CAYAs with cancer, evaluated their quality, and explored differences in recommendations. METHODS A systematic search in PubMed (January 2000-October 2014); guideline databases; and Web sites of oncology, pediatric, and fertility organizations was performed. Two reviewers evaluated the quality of the identified CPGs using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II). From high-quality CPGs, the authors evaluated concordant and discordant areas among the recommendations. RESULTS A total of 25 CPGs regarding fertility preservation were identified. The average AGREE II domain scores (scale of 0%-100%) varied from 15% on applicability to 100% on clarity of presentation. The authors considered 8 CPGs (32%) to be of high quality, which was defined as scores ≥60% in any 4 domains. Large variations in the recommendations of the high-quality CPGs were observed, with 87.2% and 88.6%, respectively, of discordant guideline areas among the fertility preservation recommendations for female and male patients with cancer. CONCLUSIONS Only approximately one-third of the identified CPGs were found to be of sufficient quality. Of these CPGs, the fertility preservation recommendations varied substantially, which can be a reflection of inadequate evidence for specific recommendations, thereby hindering the ability of providers to deliver high-quality care. CPGs including a transparent decision process for fertility preservation can help health care providers to deliver optimal and uniform care, thus improving the quality of life of CAYAs with cancer and cancer survivors. Cancer 2016;122:2216-23. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
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Affiliation(s)
- Anna Font-Gonzalez
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Renée L Mulder
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Erik A H Loeffen
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | | - Melissa M Hudson
- Department of Pediatric Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Lisa B Kenney
- Department of Pediatric Oncology, Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jennifer M Levine
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, New York
| | - Wim J E Tissing
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marianne D van de Wetering
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
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185
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Sridharan V, Thomas CJ, Cao M, Melnyk SB, Pavliv O, Joseph J, Singh SP, Sharma S, Moros EG, Boerma M. Effects of local irradiation combined with sunitinib on early remodeling, mitochondria, and oxidative stress in the rat heart. Radiother Oncol 2016; 119:259-64. [PMID: 27072940 PMCID: PMC4909572 DOI: 10.1016/j.radonc.2016.03.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/23/2016] [Accepted: 03/28/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Thoracic (chemo)radiation therapy is increasingly administered with tyrosine kinase inhibitors (TKI). While TKI have adverse effects on the heart, it is unknown whether combination with other cancer therapies causes enhanced toxicity. We used an animal model to investigate whether radiation and sunitinib interact in their effects on the heart. MATERIAL AND METHODS Male Sprague-Dawley rats received local heart irradiation (9Gy per day, 5days). Oral sunitinib (8 or 15mg/kg bodyweight per day) started on day 1 of irradiation and continued for 2weeks. Cardiac function was examined with echocardiography. Cardiac remodeling, cell death, left ventricular (LV) oxidative stress markers, mitochondrial morphology and mitochondrial permeability transition pore (mPTP) opening were assessed. RESULTS Cardiac diameter, stroke volume, and LV volume, mass and anterior wall thickness increased in time, but only in the vehicle group. Sunitinib reduced LV inner diameter and volume in systole, which were counteracted by radiation. Sunitinib and radiation showed enhanced effects on mitochondrial morphology and mPTP opening, but not on cardiac troponin I, mast cell numbers or markers of oxidative stress. CONCLUSIONS This study found no early enhanced effects of radiation and sunitinib on cardiac function or structure. Long-term effects remain to be determined.
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Affiliation(s)
- Vijayalakshmi Sridharan
- University of Arkansas for Medical Sciences, Department of Pharmaceutical Sciences, Division of Radiation Health, Little Rock, United States
| | | | - Maohua Cao
- University of Arkansas for Medical Sciences, Department of Pharmaceutical Sciences, Division of Radiation Health, Little Rock, United States
| | - Stepan B Melnyk
- University of Arkansas for Medical Sciences, Department of Pediatrics, Little Rock, United States
| | - Oleksandra Pavliv
- University of Arkansas for Medical Sciences, Department of Pediatrics, Little Rock, United States
| | - Jacob Joseph
- Veterans Affairs Boston Healthcare System, Department of Medicine, United States; Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, United States
| | - Sharda P Singh
- University of Arkansas for Medical Sciences, Department of Pharmacology and Toxicology, Little Rock, United States
| | - Sunil Sharma
- University of Arkansas for Medical Sciences, Department of Radiation Oncology, Little Rock, United States
| | - Eduardo G Moros
- Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, United States
| | - Marjan Boerma
- University of Arkansas for Medical Sciences, Department of Pharmaceutical Sciences, Division of Radiation Health, Little Rock, United States.
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186
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Jin SL, Hahn SM, Kim HS, Shin YJ, Kim SH, Lee YS, Lyu CJ, Han JW. Symptom Interval and Patient Delay Affect Survival Outcomes in Adolescent Cancer Patients. Yonsei Med J 2016; 57:572-9. [PMID: 26996554 PMCID: PMC4800344 DOI: 10.3349/ymj.2016.57.3.572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/29/2015] [Accepted: 09/07/2015] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Unique features of adolescent cancer patients include cancer types, developmental stages, and psychosocial issues. In this study, we evaluated the relationship between diagnostic delay and survival to improve adolescent cancer care. MATERIALS AND METHODS A total of 592 patients aged 0-18 years with eight common cancers were grouped according to age (adolescents, ≥10 years; children, <10 years). We retrospectively reviewed their symptom intervals (SIs, between first symptom/sign of disease and diagnosis), patient delay (PD, between first symptom/sign of disease and first contact with a physician), patient delay proportion (PDP), and overall survival (OS). RESULTS Mean SI was significantly longer in adolescents than in children (66.4 days vs. 28.4 days; p<0.001), and OS rates were higher in patients with longer SIs (p=0.001). In children with long SIs, OS did not differ according to PDP (p=0.753). In adolescents with long SIs, OS was worse when PDP was ≥0.6 (67.2%) than <0.6 (95.5%, p=0.007). In a multivariate analysis, adolescents in the long SI/PDP ≥0.6 group tended to have a higher hazard ratio (HR, 6.483; p=0.069) than those in the long SI/PDP <0.6 group (HR=1, reference). CONCLUSION Adolescents with a long SI/PDP ≥0.6 had lower survival rates than those with a short SI/all PDP or a long SI/PDP <0.6. They should be encouraged to seek prompt medical assistance by a physician or oncologist to lessen PDs.
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Affiliation(s)
- Song Lee Jin
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Seung Min Hahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Hyo Sun Kim
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoon Jung Shin
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Sun Hee Kim
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoon Sun Lee
- Department of Pharmacy, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.
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187
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Use of endocrinological and neurological medication among 5-year survivors of young onset brain tumors. J Neurooncol 2016; 128:473-9. [PMID: 27115743 DOI: 10.1007/s11060-016-2134-9] [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: 02/16/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
The burden of late-effects for young onset brain tumor (BT) survivors needs more careful evaluation. Our aim was to assess the need for endocrinological and neurological medication among this specific group. We identified 5-year survivors diagnosed at the age of 0-24 years between 1988 and 2004 from the Finnish Cancer Registry (N = 602). Data on endocrinological and neurological drug purchases were collected from the Social Insurance Institution of Finland. Five years after diagnosis the most commonly purchased drugs had been: antiepileptics (44.8 %), systemic hydrocortisone (18.3 %), female sex hormones (17.6 %), thyroid hormones (11.2 %), and growth hormone (10.0 %). The survivors showed an increased hazard ratio (HR) for a need for new types of drugs still 5 years after diagnosis. Thyroid hormones (HR 10.6, 95 % CI 5.1-21.4), estrogens (HR 8.0, 95 % CI 2.1-25.7), and antiepileptics (HR 6.3, 95 % CI 3.4-11.2) were bought with high frequencies. Irradiation increased the hazard for drug-purchases other than antiepileptics. Cumulative incidence of purchases of estrogens or androgens increased still 15 years after diagnosis. The cumulative incidence of purchasing thyroid hormones and antiepileptics showed continuous increase for the youngest group, whereas survivors diagnosed at 15-24 years of age reached stable level before 15 years from diagnosis. The need for new medication continued more than a decade after BT diagnosis. Especially the need for new thyroid or sex hormone medication among childhood BT survivors may emerge long after diagnosis.
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188
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van Dijk IWEM, van der Pal HJH, van Os RM, Roos YBWEM, Sieswerda E, van Dalen EC, Ronckers CM, Oldenburger F, van Leeuwen FE, Caron HN, Koning CCE, Kremer LCM. Risk of Symptomatic Stroke After Radiation Therapy for Childhood Cancer: A Long-Term Follow-Up Cohort Analysis. Int J Radiat Oncol Biol Phys 2016; 96:597-605. [PMID: 27325477 DOI: 10.1016/j.ijrobp.2016.03.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/29/2016] [Accepted: 03/24/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Long-term childhood cancer survivors are at high risk of late adverse effects, including stroke. We aimed to determine the cumulative incidence of clinically validated symptomatic stroke (transient ischemic attack [TIA], cerebral infarction, and intracerebral hemorrhage [ICH]) and to quantify dose-effect relationships for cranial radiation therapy (CRT) and supradiaphragmatic radiation therapy (SDRT). METHODS AND MATERIALS Our single-center study cohort included 1362 survivors of childhood cancer that were diagnosed between 1966 and 1996. Prescribed CRT and SDRT doses were converted into the equivalent dose in 2-Gy fractions (EQD2). Multivariate Cox regression models were used to analyze the relationship between the EQD2 and stroke. RESULTS After a median latency time of 24.9 years and at a median age of 31.2 years, 28 survivors had experienced a first stroke: TIA (n=5), infarction (n=13), and ICH (n=10). At an attained age of 45 years, the estimated cumulative incidences, with death as competing risk, among survivors treated with CRT only, SDRT only, both CRT and SDRT, and neither CRT nor SDRT were, respectively, 10.0% (95% confidence interval [CI], 2.5%-17.0%), 5.4% (95% CI, 0%-17.0%), 12.5% (95% CI, 5.5%-18.9%), and 0.1% (95% CI, 0%-0.4%). Radiation at both locations significantly increased the risk of stroke in a dose-dependent manner (hazard ratios: HRCRT 1.02 Gy(-1); 95% CI, 1.01-1.03, and HRSDRT 1.04 Gy(-1); 95% CI, 1.02-1.05). CONCLUSIONS Childhood cancer survivors treated with CRT, SDRT, or both have a high stroke risk. One in 8 survivors treated at both locations will have experienced a symptomatic stroke at an attained age of 45 years. Further research on the pathophysiologic processes involved in stroke in this specific group of patients is needed to enable the development of tailored secondary prevention strategies.
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Affiliation(s)
- Irma W E M van Dijk
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Helena J H van der Pal
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Rob M van Os
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Elske Sieswerda
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Elvira C van Dalen
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Cécile M Ronckers
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Foppe Oldenburger
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Huib N Caron
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Caro C E Koning
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
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189
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Yamini N, Pourmand G, Amidi F, Salehnia M, Ataei Nejad N, Mougahi SM. Developmental Potential of Vitrified Mouse Testicular Tissue after Ectopic Transplantation. CELL JOURNAL 2016; 18:74-82. [PMID: 27054121 PMCID: PMC4819389 DOI: 10.22074/cellj.2016.3989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/16/2015] [Indexed: 11/23/2022]
Abstract
Objective Cryopreservation of immature testicular tissue should be considered as an
important factor for fertility preservation in young boys with cancer. The objective of this
study is to investigate whether immature testicular tissue of mice can be successfully
cryopreserved using a simple vitrification procedure to maintain testicular cell viability,
proliferation, and differentiation capacity.
Materials and Methods In this experimental study, immature mice testicular tissue fragments (0.5-1 mm²) were vitrified-warmed in order to assess the effect of vitrification on
testicular tissue cell viability. Trypan blue staining was used to evaluate developmental
capacity. Vitrified tissue (n=42) and fresh (control, n=42) were ectopically transplanted
into the same strain of mature mice (n=14) with normal immunity. After 4 weeks, the graft
recovery rate was determined. Hematoxylin and eosin (H&E) staining was used to evaluate germ cell differentiation, immunohistochemistry staining by proliferating cell nuclear
antigen (PCNA) antibody, and terminal deoxynucleotidyl transferase (TdT) dUTP Nick-
End Labeling (TUNEL) assay for proliferation and apoptosis frequency.
Results Vitrification did not affect the percentage of cell viability. Vascular anastomoses
was seen at the graft site. The recovery rate of the vitrified graft did not significantly differ
with the fresh graft. In the vitrified graft, germ cell differentiation developed up to the secondary spermatocyte, which was similar to fresh tissue. Proliferation and apoptosis in the
vitrified tissue was comparable to the fresh graft.
Conclusion Vitrification resulted in a success rates similar to fresh tissue (control) in
maintaining testicular cell viability and tissue function. These data provided further evidence that vitrification could be considered an alternative for cryopreservation of immature
testicular tissue.
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Affiliation(s)
- Nazila Yamini
- Department of Anatomy, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Pourmand
- Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fardin Amidi
- Department of Anatomy, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojdeh Salehnia
- Department of Anatomy, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran
| | - Nahid Ataei Nejad
- Department of Anatomy, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Mougahi
- Department of Histology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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190
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Preferences for the organization of long-term follow-up in adolescent and young adult cancer survivors. Support Care Cancer 2016; 24:3425-36. [PMID: 26988228 DOI: 10.1007/s00520-016-3157-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE As survival rates of adolescent and young adult (AYA) cancer patients increase, a growing number of AYA cancer survivors need follow-up care. However, there is little research on their preferences for follow-up care. We aimed to (1) describe AYA cancer survivors' preferences for the organization and content of follow-up care, (2) describe their preferences for different models of follow-up, and (3) investigate clinical and sociodemographic characteristics associated with preferences for the different models. METHODS AYA cancer survivors (diagnosed with cancer at age 16-25 years; ≥5 years after diagnosis) were identified through the Cancer Registry Zurich and Zug. Survivors completed a questionnaire on follow-up attendance, preferences for organizational aspects of follow-up care (what is important during follow-up, what should be included during appointments, what specialists should be involved, location), models of follow-up (telephone/questionnaire, general practitioner (GP), pediatric oncologist, medical oncologist, multidisciplinary team), and sociodemographic characteristics. Information on tumor and treatment was available through the Cancer Registry Zurich and Zug. RESULTS Of 389 contacted survivors, 160 (41.1 %) participated and 92 (57.5 %) reported still attending follow-up. Medical aspects of follow-up care were more important than general aspects (p < 0.001). Among different organizational models, follow-up by a medical oncologist was rated higher than all other models (p = 0.002). Non-attenders of follow-up rated GP-led follow-up significantly higher than attenders (p = 0.001). CONCLUSION Swiss AYA cancer survivors valued medical content of follow-up and showed a preference for medical oncologist-led follow-up. Implementation of different models of follow-up care might improve accessibility and attendance among AYA cancer survivors.
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191
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Sleeper LA, Towbin JA, Colan SD, Hsu D, Orav EJ, Lemler MS, Clunie S, Messere J, Fountain D, Miller TL, Wilkinson JD, Lipshultz SE. Health-Related Quality of Life and Functional Status Are Associated with Cardiac Status and Clinical Outcome in Children with Cardiomyopathy. J Pediatr 2016; 170:173-80.e1-4. [PMID: 26725459 PMCID: PMC4790092 DOI: 10.1016/j.jpeds.2015.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/04/2015] [Accepted: 10/01/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To measure the health-related quality of life (HRQOL) and functional status of children with cardiomyopathy and to determine whether they are correlated with sociodemographics, cardiac status, and clinical outcomes. STUDY DESIGN Parents of children in the Pediatric Cardiomyopathy Registry completed the Child Health Questionnaire (CHQ; age ≥ 5 years) and Functional Status II (Revised) (age ≤ 18 years) instruments. Linear and Cox regressions were used to examine hypothesized associations with HRQOL. RESULTS The 355 children evaluated at ≥ 5 years (median 8.6 years) had lower functioning (CHQ Physical and Psychosocial Summary Scores 41.7 ± 14.4 and 47.8 ± 10.7) than that of healthy historical controls. The most extreme CHQ domain score, Parental Impact-Emotional, was one SD below normal. Younger age at diagnosis and smaller left ventricular end-diastolic dimension z score were associated independently with better physical functioning in children with dilated cardiomyopathy. Greater income/education correlated with better psychosocial functioning in children with hypertrophic and mixed/other types of cardiomyopathy. In the age ≥ 5 year cohort, lower scores on both instruments predicted earlier death/transplant and listing for transplant in children with dilated and mixed/other types of cardiomyopathy (P < .001). Across all ages (n = 565), the Functional Status II (Revised) total score was 87.1 ± 16.4, and a lower score was associated with earlier death/transplant for all cardiomyopathies. CONCLUSIONS HRQOL and functional status in children with cardiomyopathy is on average impaired relative to healthy children. These impairments are associated with older age at diagnosis, lower socioeconomic status, left ventricular size, and increased risk for death and transplant. Identification of families at risk for functional impairment allows for provision of specialized services early in the course of disease. TRIAL REGISTRATION ClinicalTrials.gov: NCT00005391.
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Affiliation(s)
| | - Jeffrey A Towbin
- University of Tennessee Health Science Center, St. Jude Children's Research Hospital and Le Bonheur Children's Hospital, Memphis, TN
| | | | - Daphne Hsu
- The Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY
| | - Endel J Orav
- Department of Medicine, Harvard Medical School, Boston, MA
| | | | | | | | - Darlene Fountain
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN
| | | | - James D Wilkinson
- Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI
| | - Steven E Lipshultz
- Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI
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192
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Ferrari A, Lo Vullo S, Giardiello D, Veneroni L, Magni C, Clerici CA, Chiaravalli S, Casanova M, Luksch R, Terenziani M, Spreafico F, Meazza C, Catania S, Schiavello E, Biassoni V, Podda M, Bergamaschi L, Puma N, Massimino M, Mariani L. The Sooner the Better? How Symptom Interval Correlates With Outcome in Children and Adolescents With Solid Tumors: Regression Tree Analysis of the Findings of a Prospective Study. Pediatr Blood Cancer 2016; 63:479-85. [PMID: 26797893 DOI: 10.1002/pbc.25833] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/09/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND The potential impact of diagnostic delays on patients' outcomes is a debated issue in pediatric oncology and discordant results have been published so far. We attempted to tackle this issue by analyzing a prospective series of 351 consecutive children and adolescents with solid malignancies using innovative statistical tools. METHODS To address the nonlinear complexity of the association between symptom interval and overall survival (OS), a regression tree algorithm was constructed with sequential binary splitting rules and used to identify homogeneous patient groups vis-à-vis functional relationship between diagnostic delay and OS. RESULTS Three different groups were identified: group A, with localized disease and good prognosis (5-year OS 85.4%); group B, with locally or regionally advanced, or metastatic disease and intermediate prognosis (5-year OS 72.9%), including neuroblastoma, Wilms tumor, non-rhabdomyosarcoma soft tissue sarcoma, and germ cell tumor; and group C, with locally or regionally advanced, or metastatic disease and poor prognosis (5-year OS 45%), including brain tumors, rhabdomyosarcoma, and bone sarcoma. The functional relationship between symptom interval and mortality risk differed between the three subgroups, there being no association in group A (hazard ratio [HR]: 0.96), a positive linear association in group B (HR: 1.48), and a negative linear association in group C (HR: 0.61). CONCLUSIONS Our analysis suggests that at least a subset of patients can benefit from an earlier diagnosis in terms of survival. For others, intrinsic aggressiveness may mask the potential effect of diagnostic delays. Based on these findings, early diagnosis should remain a goal for pediatric cancer patients.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Daniele Giardiello
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Laura Veneroni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Chiara Magni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Carlo Alfredo Clerici
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Section of Psychology, Department of Biomolecular Sciences and Biotechnology, Faculty of School of Medicine, University of Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Serena Catania
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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193
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Michel G, Vetsch J. Screening for psychological late effects in childhood, adolescent and young adult cancer survivors: a systematic review. Curr Opin Oncol 2016; 27:297-305. [PMID: 26049268 DOI: 10.1097/cco.0000000000000196] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In the past years, increasing evidence showed that many childhood cancer survivors suffer from psychological distress long after treatment ended. However, psychosocial issues are often neglected during follow-up care. Including screening for psychological distress before follow-up appointments might help addressing the topic in survivors who need support. Our aim was to systematically review the available evidence on screening for psychological distress in childhood cancer survivors. RECENT FINDINGS We found eight studies that investigated different screening tools for their utility in detecting psychological distress in childhood cancer survivors. The Brief Symptom Inventory-18 with an adapted cutoff score for childhood cancer survivors, and the newly developed short form of the Beck Depression Index were both shown to be of a potential benefit as brief screening tools in follow-up care. SUMMARY We identified promising screening tools to be used to detect psychological distress in childhood cancer survivors. However, there is still a lack of studies addressing applicability and effectiveness when screening is routinely implemented into follow-up care. To improve quality of follow-up care, and identify and treat survivors with psychological distress, screening tools should now be implemented and their adequacy further tested in day-to-day clinic life.
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Affiliation(s)
- Gisela Michel
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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194
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Lindgren LH, Schmiegelow K, Helms AS, Thorsteinsson T, Larsen HB. In sickness and in health: classmates are highly motivated to provide in-hospital support during childhood cancer therapy. Psychooncology 2016; 26:37-43. [PMID: 26872002 DOI: 10.1002/pon.4094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/16/2015] [Accepted: 01/15/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Extended hospitalization for school-aged cancer patients increases their risk of social marginalization. School-aged children mature through peer-interaction, but healthcare providers fail to incorporate this in rehabilitation efforts. The RESPECT study offers classmates to cancer patients to become ambassadors during hospital stays. This study explores classmate decision-making patterns about ambassadorship. METHODS An open-ended question was prospectively and consecutively provided to classmates (N = 221) (and parents) of 10 children diagnosed with cancer in 2014 and enrolled in the RESPECT study. Statements were analysed using thematic content analysis. RESULTS Of 221 classmates, 140 responded (63%). Of these, 81 applied for ambassadorship (median 8/patient), 58 declined, one was undecided. Nine forms were incomplete; leaving 131 in total that revealed 303 statements for analysis. Five major themes emerged: existing friendship (132/303 statements), personal resources (academic, emotional and social) (107/303), attitudes towards the ambassadorship (34/303), hospital environment (18/303) and logistics (12/303). Of the classmates with pre-existing friendships, 77% applied for ambassadorship and 80% with a surplus of personal resources applied. These were predominant predictors for ambassadorship application. Classmate motives were condensed into four archetypes: pre-existing friendship with a surplus of resources (100% applied), non-friend classmates with a surplus of resources (63% applied), pre-existing friendship with limited resources (22% applied) and non-friend classmates with limited resources (0% applied). CONCLUSION Classmates are highly motivated to support patients during serious illness, irrespective of pre-existing friendships. Ambassadors offer a novel in-hospital approach to promote rehabilitation in children with severe/chronic diseases. Results need validation in other settings. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lea H Lindgren
- Department of Paediatrics and Adolescent Medicine, The University Hospital (Rigshospitalet), Copenhagen, Denmark.,Institute of Clinical Medicine, The Faculty of Medicine, University of Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, The University Hospital (Rigshospitalet), Copenhagen, Denmark.,Institute of Clinical Medicine, The Faculty of Medicine, University of Copenhagen, Denmark.,Division of Pediatric Hematology/Oncology, Perlmutter Cancer Center and the Langone Medical Center, New York University, New York, NY, USA
| | - Anne Sofie Helms
- Department of Paediatrics and Adolescent Medicine, The University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Troels Thorsteinsson
- Department of Paediatrics and Adolescent Medicine, The University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Hanne B Larsen
- Department of Paediatrics and Adolescent Medicine, The University Hospital (Rigshospitalet), Copenhagen, Denmark
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195
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Lupatsch JE, Wengenroth L, Rueegg CS, Teuffel O, Gumy-Pause F, Kuehni CE, Michel G. Follow-up care of adolescent survivors of childhood cancer: The role of health beliefs. Pediatr Blood Cancer 2016; 63:318-25. [PMID: 26398593 DOI: 10.1002/pbc.25755] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/20/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about follow-up care attendance of adolescent survivors of childhood cancer, and which factors foster or hinder attendance. Attending follow-up care is especially important for adolescent survivors to allow for a successful transition into adult care. We aimed to (i) describe the proportion of adolescent survivors attending follow-up care; (ii) describe adolescents' health beliefs; and (iii) identify the association of health beliefs, demographic, and medical factors with follow-up care attendance. PROCEDURE Of 696 contacted adolescent survivors diagnosed with cancer at ≤ 16 years of age, ≥ 5 years after diagnosis, and aged 16-21 years at study, 465 (66.8%) completed the Swiss Childhood Cancer Survivor Study questionnaire. We assessed follow-up care attendance and health beliefs, and extracted demographic and medical information from the Swiss Childhood Cancer Registry. Cross-sectional data were analyzed using descriptive statistics and logistic regression models. RESULTS Overall, 56% of survivors reported attending follow-up care. Most survivors (80%) rated their susceptibility for late effects as low and believed that follow-up care may detect and prevent late effects (92%). Few (13%) believed that follow-up care is not necessary. Two health beliefs were associated with follow-up care attendance (perceived benefits: odds ratio [OR]: 1.56; 95% confidence interval [CI]: 1.07-2.27; perceived barriers: OR: 0.70; 95%CI: 0.50-1.00). CONCLUSIONS We show that health beliefs are associated with actual follow-up care attendance of adolescent survivors of childhood cancer. A successful model of health promotion in adolescent survivors should, therefore, highlight the benefits and address the barriers to keep adolescent survivors in follow-up care.
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Affiliation(s)
- Judith E Lupatsch
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Laura Wengenroth
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Corina S Rueegg
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Oliver Teuffel
- Departement of Pediatric Hematology-Oncology, Bern University Hospital, Bern, Switzerland
| | - Fabienne Gumy-Pause
- Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Gisela Michel
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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196
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Wang G, Chen L, Yu B, Zellmer L, Xu N, Liao DJ. Learning about the Importance of Mutation Prevention from Curable Cancers and Benign Tumors. J Cancer 2016; 7:436-45. [PMID: 26918057 PMCID: PMC4749364 DOI: 10.7150/jca.13832] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/03/2015] [Indexed: 01/08/2023] Open
Abstract
Some cancers can be cured by chemotherapy or radiotherapy, presumably because they are derived from those cell types that not only can die easily but also have already been equipped with mobility and adaptability, which would later allow the cancers to metastasize without the acquisition of additional mutations. From a viewpoint of biological dispersal, invasive and metastatic cells may, among other possibilities, have been initial losers in the competition for resources with other cancer cells in the same primary tumor and thus have had to look for new habitats in order to survive. If this is really the case, manipulation of their ecosystems, such as by slightly ameliorating their hardship, may prevent metastasis. Since new mutations may occur, especially during and after therapy, to drive progression of cancer cells to metastasis and therapy-resistance, preventing new mutations from occurring should be a key principle for the development of new anticancer drugs. Such new drugs should be able to kill cancer cells very quickly without leaving the surviving cells enough time to develop new mutations and select resistant or metastatic clones. This principle questions the traditional use and the future development of genotoxic drugs for cancer therapy.
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Affiliation(s)
- Gangshi Wang
- 1. Department of Geriatric Gastroenterology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Lichan Chen
- 2. Hormel Institute, University of Minnesota, Austin, MN 55912, USA
| | - Baofa Yu
- 3. Beijing Baofa Cancer Hospital, Shahe Wangzhuang Gong Ye Yuan, Chang Pin Qu, Beijing 102206, P.R. China
| | - Lucas Zellmer
- 2. Hormel Institute, University of Minnesota, Austin, MN 55912, USA
| | - Ningzhi Xu
- 4. Laboratory of Cell and Molecular Biology, Cancer Institute, Chinese Academy of Medical Science, Beijing 100021, P.R. China
| | - D Joshua Liao
- 5. D. Joshua Liao, Clinical Research Center, Guizhou Medical University Hospital, Guizhou, Guiyang 550004, P.R. China
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197
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Wang C, Yuan XJ, Jiang MW, Wang LF. Clinical characteristics and abandonment and outcome of treatment in 67 Chinese children with medulloblastoma. J Neurosurg Pediatr 2016; 17:49-56. [PMID: 26451721 DOI: 10.3171/2015.5.peds1573] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECT The purpose of this study was to explore the clinical features and outcome of medulloblastoma in Chinese children. The authors analyze the reasons that treatment is abandoned and attempt to provide evidence-based recommendations for improving the prognosis of medulloblastoma in this population. METHODS A total of 67 pediatric cases of newly diagnosed medulloblastoma were included in this study. All of the children were treated at Xinhua Hospital between January 2007 and June 2013. The authors retrospectively analyzed the clinical data, treatment modalities, and outcome. The male-to-female ratio was 2:1, and the patients' median age at diagnosis was 51.96 months (range 3.96-168.24 months). The median duration of follow-up was 32 months (range 3-70 months). RESULTS At the most recent follow-up date, 31 patients (46%) were alive, 30 (45%) had died, and 6 (9%) had been lost to follow-up. The estimated 3-year overall survival and progression-free survival, based on Kaplan-Meier analysis, were 55.1% ± 6.4% and 45.6% ± 6.7%, respectively. Univariate analysis showed that standard-risk group (p = 0.009), postoperative radiotherapy (RT) combined with chemotherapy (p < 0.001), older age (≥ 3 years) at diagnosis (p = 0.010), gross-total resection (p = 0.012), annual family income higher than $3000 (p = 0.033), and living in urban areas (p = 0.008) were favorable prognostic factors. Multivariate analysis revealed that postoperative RT combined with chemotherapy was an independent prognostic factor (p < 0.001). The treatment abandonment rate in this cohort was 31% (21 of 67 cases). CONCLUSIONS There was a large gap between the outcome of medulloblastoma in Chinese children and the outcome in Western children. Based on our data, treatment abandonment was the major cause of therapeutic failure. Parents' misunderstanding of medulloblastoma played a major role in abandonment, followed by financial and transportation difficulties. Establishment of multidisciplinary treatment teams could improve the prognosis of medulloblastoma in Chinese children.
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Affiliation(s)
- Chen Wang
- Departments of 1 Pediatric Hematology/Oncology
| | | | | | - Li-Feng Wang
- Pathology, Xin Hua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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198
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Einberg EL, Nygren JM, Svedberg P, Enskär K. 'Through my eyes': health-promoting factors described by photographs taken by children with experience of cancer treatment. Child Care Health Dev 2016; 42:76-86. [PMID: 26303054 DOI: 10.1111/cch.12285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/15/2015] [Accepted: 07/21/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Health promotion for children with cancer should be based on the children's own needs and desires. Because there is a lack of knowledge in this area, the aim of this study was to explore what promotes health from the perspective of children with experience of cancer treatment. METHODS Fifteen children between 8 and 12 years of age participated in focus groups with three children in each group. The children were given a camera and instructions to photograph subjects that promote their health. Focus group discussions were based on the photographs and the children's own description of those photographs. The analysis of focus group discussions and photographs was conducted using inductive content analysis. RESULTS According to the children, health-promoting factors are defined as meaningful relationships, recreational activities and a trustful environment. Meaningful relationships include togetherness within the family, affection for pets and friendship with peers. Recreational activities include engagement in play and leisure, withdrawal for relaxation and feeling enjoyment. Trustful environment includes confidence in significant others and feeling safe. CONCLUSIONS Knowledge from this study can contribute to health promotion interventions and quality improvements in the health care of children with experience of cancer treatment. Children's experiences with what promotes health in their everyday lives provide a better understanding of the type of support children prefer when promoting their own health.
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Affiliation(s)
- E-L Einberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.,School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - J M Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - P Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - K Enskär
- School of Health Sciences, Jönköping University, Jönköping, Sweden
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199
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Panagiotopoulou N, Ghuman N, Sandher R, Herbert M, Stewart J. Barriers and facilitators towards fertility preservation care for cancer patients: a meta-synthesis. Eur J Cancer Care (Engl) 2015; 27. [DOI: 10.1111/ecc.12428] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 12/14/2022]
Affiliation(s)
- N. Panagiotopoulou
- Newcastle Fertility Centre; International Centre for Life; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | - N. Ghuman
- Obstetrics and Gynaecology Department; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | - R. Sandher
- Institute of Human Genetics, International Centre for Life; Newcastle University; Newcastle upon Tyne UK
| | - M. Herbert
- Institute of Human Genetics, International Centre for Life; Newcastle University; Newcastle upon Tyne UK
| | - J.A. Stewart
- Newcastle Fertility Centre; International Centre for Life; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
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200
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Hayama M, Izumo T, Chavez C, Matsumoto Y, Tsuchida T, Sasada S. Additional transbronchial needle aspiration through a guide sheath for peripheral pulmonary lesions that cannot be detected by radial EBUS. CLINICAL RESPIRATORY JOURNAL 2015; 11:757-764. [PMID: 26605754 DOI: 10.1111/crj.12413] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 09/24/2015] [Accepted: 11/13/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endobronchial ultrasound with a guide sheath (EBUS-GS) has resulted to better diagnostic outcome for peripheral pulmonary lesions (PPLs), although the yield is not satisfactory for lesions that cannot be located by EBUS. We aimed to evaluate whether the addition of a new technique, transbronchial needle aspiration through a guide sheath (GS-TBNA), can increase the yield for these cases. METHODS This was a retrospective review of cases that were not located by EBUS during EBUS-GS for PPL diagnosis. From September 2012 to August 2014, 67 PPLs had 'invisible' EBUS-GS location prior to transbronchial sampling. The patients were divided into two groups according to the use of additional GS-TBNA: GS-TBNA group (n=22) and non-GS-TBNA group (n=45). Diagnostic yields were compared and multivariate analysis was performed to determine the factors associated with increased diagnostic yield. RESULTS The diagnostic yield was significantly higher in the GS-TBNA group than in the non-GS-TBNA group (54.5% vs 17.8%, P<0.01). The complication rate was not significantly different between the GS-TBNA group and the non-GS-TBNA group (0% vs 4.4%, P=1.0). Multivariate analysis showed that only performing GS-TBNA was significantly associated with increased diagnostic yield (odds ratio 3.99, P=0.03). CONCLUSION GS-TBNA is a safe technique for PPL diagnosis and may be useful when the EBUS probe cannot reach the lesion.
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Affiliation(s)
- Manabu Hayama
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takehiro Izumo
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Christine Chavez
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shinji Sasada
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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