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Mai B, Friscia M, Wahed A, Nguyen A, Chen L. The novel coexistence of SERPINA1 and JAK2 V617F mutations in alpha-1 antitrypsin deficiency. Pathology 2020; 52:382-385. [PMID: 32115143 DOI: 10.1016/j.pathol.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/25/2019] [Accepted: 12/01/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Brenda Mai
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center, Houston, TX, USA
| | - Michaelangelo Friscia
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center, Houston, TX, USA
| | - Amer Wahed
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center, Houston, TX, USA
| | - Andy Nguyen
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center, Houston, TX, USA
| | - Lei Chen
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center, Houston, TX, USA.
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2
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Choi YB, Lee NH, Yi ES, Kim YJ, Koo HH. Changes in hepatitis B antibody status after chemotherapy in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2019; 66:e27904. [PMID: 31448550 DOI: 10.1002/pbc.27904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Children with cancer may be at an increased risk of infection with hepatitis B virus (HBV) when levels of hepatitis B antibodies are reduced owing to chemotherapy-induced immunosuppression. This study evaluated the changes in HBV antibody status and HBV infections after chemotherapy in children with acute lymphoblastic leukemia (ALL). PROCEDURE The data of patients with ALL diagnosed between April 2007 and March 2013 were retrospectively collected. Hepatitis B surface antibody (HBsAb) titers were defined as negative at levels <10 IU/L. The HBsAb titers were individually compared before and after chemotherapy. RESULTS A total of 88 patients were included in this study. At the time of diagnosis, 32 (36.4%) and 56 (63.6%) patients were HBsAb negative and HBsAb positive, respectively. The 56 HBsAb-positive patients were categorized into two groups, namely, group A with 44 patients (78.6%, 44/56) who became HBsAb negative after chemotherapy, and group B with 12 patients (21.4%) who remained HBsAb positive. On multivariate analysis, lower initial levels of HBsAb titers were associated with HBsAb negativity after chemotherapy (relative risk: 1.003, 95% confidence interval: 1.001-1.006; P = .009). CONCLUSION This study demonstrated that patients with a low level of prechemotherapy HBsAb titers were likely to become HBsAb negative after chemotherapy. Therefore, evaluation of HBsAb status may be necessary after the completion of chemotherapy in children with ALL.
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Affiliation(s)
- Young Bae Choi
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, South Korea
| | - Na Hee Lee
- Department of Pediatrics, Cha Bundang Medical Center, Cha University, Seongnam, South Korea
| | - Eun Sang Yi
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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3
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Lin HC, Yang YS, Teng CLJ, Shen CH, Jan YG, Cheng SB, Wu CC, Lin YL, Huang CC, P'eng FK. Liver resection for hepatocellular carcinoma in patients with hematological malignancies. World J Surg Oncol 2017; 15:194. [PMID: 29096656 PMCID: PMC5667519 DOI: 10.1186/s12957-017-1260-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/15/2017] [Indexed: 01/03/2023] Open
Abstract
Background Improvements in antimetabolite drugs have prolonged the survival of patient with hematological malignancies. However, these drugs may have hepatotoxic side effects and may induce acute liver failure, chronic liver fibrosis, cirrhosis, or even hepatocellular carcinoma (HCC). Although liver resection remains a curative option for HCC, its role in HCC with hematological malignancies has never been fully explored. Methods A retrospective review of 1725 patients who underwent curative liver resection for newly diagnosed HCC between 1994 and 2016 was conducted. Among these patients, 16 had a history of hematological malignancies (HM group). Their hematological malignancies were well-controlled at the time of liver resection. The clinicopathological characteristics of the HM group, along with their short- and long-term outcomes after liver resection, were compared with those of the other 1709 patients without hematological malignancy (non-HM group). Results All HM group patients were seropositive for hepatitis marker surface for hepatitis B and C. No significant differences were observed in any background characteristics between the two groups. The postoperative complication rate and 90-day mortality in the HM and non-HM groups were 25 and 20.4%, P = 0.754, and 0 and 0.6%, P = 1.000, respectively. The 5-year disease-free and overall survival rates for the HM and non-HM groups were 42.3 and 35.1%, P = 0.552, and 69.5 and 56.9%, P = 0.192, respectively. Conclusions Hepatitis markers should be examined during chemotherapy for hematological malignancies. Regular liver imaging studies are recommended for seropositive cases. When HCC occurs secondary to a well-controlled hematological malignancy, liver resection is suggested in selected patients.
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Affiliation(s)
- Hui-Chen Lin
- Department of Surgery, Taichung Veterans General Hospital, Section, 4, No. 1650, Taiwan Boulevard, Taichung, Taiwan
| | - Yang-Shen Yang
- Department of Hematology, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ching-Hui Shen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yee-Gee Jan
- Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shao-Bin Cheng
- Department of Surgery, Taichung Veterans General Hospital, Section, 4, No. 1650, Taiwan Boulevard, Taichung, Taiwan.,Department of Surgery, Chung-Shan Medical University, Taichung, Taiwan
| | - Cheng-Chung Wu
- Department of Surgery, Taichung Veterans General Hospital, Section, 4, No. 1650, Taiwan Boulevard, Taichung, Taiwan. .,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Surgery, Taipei Medical University, Taipei, Taiwan. .,Department of Surgery, Chung-Shan Medical University, Taichung, Taiwan.
| | - Yi-Ling Lin
- Department of Surgery, Taichung Veterans General Hospital, Section, 4, No. 1650, Taiwan Boulevard, Taichung, Taiwan
| | - Chu-Chun Huang
- Department of Surgery, Taichung Veterans General Hospital, Section, 4, No. 1650, Taiwan Boulevard, Taichung, Taiwan
| | - Fang-Ku P'eng
- Department of Surgery, Taichung Veterans General Hospital, Section, 4, No. 1650, Taiwan Boulevard, Taichung, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Grigorian A, O'Brien CB. Hepatotoxicity Secondary to Chemotherapy. J Clin Transl Hepatol 2014; 2:95-102. [PMID: 26357620 PMCID: PMC4521265 DOI: 10.14218/jcth.2014.00011] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/06/2014] [Accepted: 05/22/2014] [Indexed: 12/20/2022] Open
Abstract
The difficult problem faced by multiple generation of practicing physicians is determining the cause of abnormal liver function tests in cancer patients on chemotherapy. Hepatotoxicity from chemotherapy occurs frequently from an unpredictable or idiosyncratic reaction. Despite remarkable advances in our understanding of the mechanisms of action, pharmacodynamics, and interrelationships between the liver and chemotherapy, the underlying etiology of hepatic toxicity for various agents remains unexplained. Here, we present a concise review of the broad differential diagnosis for abnormal liver function tests (LFTs) in oncology patients.
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Affiliation(s)
- Alla Grigorian
- Divisions of Liver and GI Transplantation, University of Miami School of Medicine, Miami, FL, USA
| | - Christopher B O'Brien
- Divisions of Liver and GI Transplantation, University of Miami School of Medicine, Miami, FL, USA
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Das M, Datir SR, Singh RP, Jain S. Augmented anticancer activity of a targeted, intracellularly activatable, theranostic nanomedicine based on fluorescent and radiolabeled, methotrexate-folic Acid-multiwalled carbon nanotube conjugate. Mol Pharm 2013; 10:2543-57. [PMID: 23683251 DOI: 10.1021/mp300701e] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The present study reports the design, synthesis, and biological evaluation of a novel, intravenously injectable, theranostic prodrug based on multiwalled carbon nanotubes (MWCNTs) concomitantly decorated with a fluorochrome (Alexa-fluor, AF488/647), radionucleide (Technitium-99m), tumor-targeting module (folic acid, FA), and anticancer agent (methotrexate, MTX). Specifically, MTX was conjugated to MWCNTs via a serum-stable yet intracellularly hydrolyzable ester linkage to ensure minimum drug loss in circulation. Cell uptake studies corroborated the selective internalization of AF-FA-MTX-MWCNTs (1) by folate receptor (FR) positive human lung (A549) and breast (MCF 7) cancer cells through FR mediated endocytosis. Lysosomal trafficking of 1 enabled the conjugate to exert higher anticancer activity as compared to its nontargeted counterpart that was mainly restricted to cytoplasm. Tumor-specific accumulation of 1 in Ehlrich Ascites Tumor (EAT) xenografted mice was almost 19 and 8.6 times higher than free MTX and FA-deprived MWCNTs. Subsequently, the conjugate 1 was shown to arrest tumor growth more effectively in chemically breast tumor induced rats, when compared to either free MTX or nontargeted controls. Interestingly, the anticancer activities of the ester-linked CNT-MTX conjugates (including the one deprived of FA) were significantly higher than their amide-linked counterpart, suggesting that cleavability of linkers between drug and multifunctional nanotubes critically influence their therapeutic performance. The results were also supported by in silico docking and ligand similarity analysis. Toxicity studies in mice confirmed that all CNT-MTX conjugates were devoid of any perceivable hepatotoxicity, cardiotoxicity, and nephrotoxicity. Overall, the delivery property of MWCNTs, high tumor binding avidity of FA, optical detectability of AF fluorochromes, and radio-traceability of (99m)Tc could be successfully integrated and partitioned on a single CNT-platform to augment the therapeutic efficacy of MTX against FR overexpressing cancer cells while allowing a real-time monitoring of treatment response through multimodal imaging.
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Affiliation(s)
- Manasmita Das
- Centre for Pharmaceutical Nanotechnology, Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER) , Sector 67, SAS Nagar (Mohali) Punjab, India 160062
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Takeishi K, Shirabe K, Muto J, Toshima T, Taketomi A, Maehara Y. Clinicopathological features and outcomes of young patients with hepatocellular carcinoma after hepatectomy. World J Surg 2011; 35:1063-71. [PMID: 21380583 DOI: 10.1007/s00268-011-1017-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND There are few reports about hepatectomy for young patients with hepatocellular carcinoma (HCC), and the significance of resection for young patients remains unknown. The present study aimed to investigate retrospectively the clinicopathological features and outcomes after hepatectomy of young HCC patients. METHODS Among 610 patients who underwent curative hepatectomy for HCC between January 1987 and December 2007, 13 patients younger than 40 years of age were defined as the young group. Because none of the young group had hepatitis C virus antibodies (HCVAb), 246 patients aged above 40 years without HCVAb were defined as the older group. The clinicopathological findings and outcomes after hepatectomy were compared between the two groups. RESULTS In the young group, 7 patients had hepatitis B surface antigen and 3 other patients had hepatitis B core antibodies. The young group had better liver function but more advanced HCC, with a large tumor size and a high incidence of portal vein invasion compared with the older group. Major hepatectomy was more frequently chosen in the young group than in the older group. There was no significant difference in the incidences of postoperative complications. The overall survival tended to be better in the young group than in the older group (p=0.057). CONCLUSIONS Hepatitis B virus-related HCC was common in the younger group of patients reported here. Although the young patients had advanced HCC, there were no significant differences in the complication rate and the overall survival rate of the young and older groups. Aggressive hepatic resection for young patients would contribute to improved survival and should be recommended.
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Affiliation(s)
- Kazuki Takeishi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Mathew J, Igbokwe UO, Morley N, Burt AD. Tempting liver fibrosis? Long-term psoriatic methotrexate therapy and heterozygous alpha1-antitrypsin deficiency. Dermatology 2006; 213:147-9. [PMID: 16902293 DOI: 10.1159/000093855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 02/02/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dermatologists, or pathologists, occasionally need to decide whether or not to continue methotrexate therapy in a patient with an identifiable risk factor for liver fibrosis, in this instance heterozygous alpha(1)-antitrypsin deficiency. CASE PRESENTATION We relate our experience with an elderly male patient, diagnosed as having alpha(1)-antitrypsin deficiency on a liver biopsy, genotypically confirmed as PiMZ. He had been receiving methotrexate for psoriasis for 17 years with a cumulative dose of 7,200 mg. He was monitored by biochemical profiling and interval (10) liver biopsies. Non-specific changes were seen on liver histology although grade 1 liver fibrosis was seen in his last 2 biopsies. CONCLUSION We suggest that methotrexate therapy is relatively safe in patients with heterozygous alpha(1)-antitrypsin deficiency, with no other risk factor. We however advise that the risk of fibrosis should be monitored and that the patient receives appropriate counselling.
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Affiliation(s)
- Joseph Mathew
- Department of Histopathology, Royal Cornwall Hospital, Truro, UK.
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Abstract
The selection of an antineoplastic regimen for an oncology patient is based first on the availability of effective drugs and then on a balancing of potential treatment-related toxicities with the patient's clinical condition and associated comorbidities. Liver function abnormalities are commonly observed in this patient population and identifying their etiology is often difficult. Immunosuppression, paraneoplastic phenomena, infectious diseases, metastases, and poly-pharmacy may cloud the picture. While criteria for standardizing liver injury have been established, dose modifications often rely on empiric clinical judgment. Therefore, a comprehensive understanding of hepatotoxic manifestations for the most common chemotherapeutic agents is essential. We herein review the hepatotoxicity of commonly used antineoplastic agents and regimens.
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Affiliation(s)
- Justin Floyd
- Division of Hematology and Medical Oncology, Department of Internal Medicine, University of Missouri-Columbia/Ellis Fischel Cancer Center, Columbia, MO 65203, USA
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9
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Abstract
Treatment of children with rheumatic diseases has advanced with novel therapeutics and the use of early aggressive treatment to achieve better long-term functional outcome. Many of the current treatments in pediatric rheumatology are based on studies in adults on medications without U.S. Food and Drug Administration labeling for pediatric use. This is not ideal because the pharmacokinetics (absorption, distribution, metabolism, and elimination) of many medications when used in children vary according to age, somatic growth, sexual maturity, and ontogeny of drug-metabolizing enzymes. Special dosing, administration considerations, and toxicity screening are reviewed for the more commonly used medications. Vaccinations for children on antirheumatic drugs are also discussed. Continued study of the long-term impact of medications and biologic treatments on children is necessary, but given the paucity of children with rheumatic diseases, this will require multicentered trials and collaborations. Lastly, this article reviews recent regulatory and legislative action on pediatric drug testing. Passage of the Pediatric Research Equity Act of 2003, which requires testing of pharmaceuticals in children, will facilitate more rational use of drugs in pediatric rheumatic diseases in the future.
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Affiliation(s)
- Esi M DeWitt
- Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine, 3615 Civic Center Boulevard, Philadelphia, PA 19104-4318, USA
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Mabed M, Aref S, Aladle DA. Hepatocellular carcinoma of a short malignant transformation time in a patient with acute myeloblastic leukemia. Ann Hematol 2003; 82:318-20. [PMID: 12709828 DOI: 10.1007/s00277-003-0653-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2003] [Accepted: 04/01/2003] [Indexed: 11/30/2022]
Abstract
Few cases of hepatocellular carcinoma (HCC) have been described during the course of acute leukemia. The chemotherapy given may be responsible for the development of HCC in such cases. Associated hepatitis may also be responsible. Usually, cancer is a multistep process in which multiple genetic alterations must occur to have a cumulative effect on the control of cell differentiation, cell division, and growth control. This usually takes place over the span of years. Here, we present a case of a patient with acute myeloblastic leukemia who developed HCC of a short malignant transformation time, which does not seem to be related to associated hepatitis or to the chemotherapy given. This may draw attention to the possible contributory role of certain products secreted by the myeloid leukemic cells such as the hepatocyte growth factor (HGF) in increasing the risk of developing HCC.
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Affiliation(s)
- M Mabed
- Hematology and Medical Oncology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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11
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Abstract
The selection of a chemotherapeutic regimen for the oncology patient is based on a thorough assessment of potential hazards relating to the patient's clinical condition and the toxicities of chemotherapy. Liver function abnormalities are commonly seen in this patient population and deducing their aetiology may be difficult. Immunosuppression, paraneoplastic phenomena, infectious disease, metastases and polypharmacy may all confound the clinical picture. While criteria for standardising liver injury have been established, dose modifications often rely on empirical clinical judgement. Therefore, a comprehensive understanding of hepatotoxic manifestations for the most common chemotherapeutic agents is essential. This article reviews the hepatotoxicity of commonly utilised antineoplastic agents.
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Affiliation(s)
- Bradley Sachs
- Department of Internal Medicine, University of Missouri-Columbia, Columbia, MO 65203, USA
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12
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Su LK, Abdalla EK, Law CH, Kohlmann W, Rashid A, Vauthey JN. Biallelic inactivation of the APC gene is associated with hepatocellular carcinoma in familial adenomatous polyposis coli. Cancer 2001; 92:332-9. [PMID: 11466687 DOI: 10.1002/1097-0142(20010715)92:2<332::aid-cncr1327>3.0.co;2-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Certain primary hepatic tumors have been associated with familial adenomatous polyposis (FAP), a condition caused by germline mutations of the adenomatous polyposis coli (APC) gene. However, a genetic association between FAP and hepatocellular carcinoma (HCC) has not been shown. This study tested the hypothesis that biallelic inactivation of the APC gene contributed to the development of HCC in a patient with FAP and a known germline mutation of the APC gene at codon 208, but no other risk factors for HCC. METHODS Total RNA and genomic DNA were isolated from the tumor, and in vitro synthesized protein assay and DNA sequencing analysis were used to screen for a somatic mutation in the APC gene. RESULTS A somatic one-base pair deletion at codon 568 was identified in the wild-type allele of the APC gene. CONCLUSIONS To the authors' knowledge, this study provides the first evidence that biallelic inactivation of the APC gene may contribute to the development of HCC in patients with FAP.
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Affiliation(s)
- L K Su
- Department of Molecular and Cellular Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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13
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Abstract
After assessment of tumor histology, the next important factor to consider in the selection of a chemotherapy regime is organ function. Patients who are to receive chemotherapy require careful assessment of liver function prior to treatment to determine which drugs may not be appropriate, and which drug doses should be modified. Following therapy abnormalities of liver function tests may be due to the therapy rather than to progressive disease, and this distinction is of critical importance. Furthermore, not all abnormalities in liver function are due to the tumor or its treatment, and other processes, such as hepatitis, must be kept in mind. This article reviews the hepatic toxicity of chemotherapeutic agents, and suggests dose modifications based upon liver function abnormalities. Emphasis is placed on agents known to be hepatotoxic, and those agents with hepatic metabolism.
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Affiliation(s)
- P D King
- Gastroenterology and Hepatology, Department of Internal Medicine, University of Missouri-Columbia, Columbia, MO 65203, USA
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Kumari TP, Shanvas A, Mathews A, Kusumakumary P. Hepatocellular carcinoma: a rare late event in childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2000; 22:289-90. [PMID: 10864067 DOI: 10.1097/00043426-200005000-00021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Most patients do not exhibit overt signs of immunosuppression. Studies cited in this article support a modest increase in the rate of bacterial respiratory and skin infections. Opportunistic infections occur rarely, however, and may be life threatening. The case for MTX carcinogenicity is less clear. The risk for malignancy other than lymphoproliferative disorders does not seem to be elevated, although multiple sporadic malignancies have been reported in treated patients. MTX is a superb agent for the therapy of a large group of immune-mediated diseases. Although an increased risk for infection and possible malignancy exists, the risk is small compared with the potential clinical benefit.
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Affiliation(s)
- K S Kanik
- Department of Medicine, University of South Florida School of Medicine, Tampa, USA
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Antillon F, Kaste SC, Jenkins JJ, Shurtleff SA, Merchant TE, Downing JR, Pappo AS. Primitive neuroectodermal tumor of bone as a second malignant neoplasm in a child previously treated for acute lymphoblastic leukemia. J Pediatr Hematol Oncol 1997; 19:473-6. [PMID: 9329474 DOI: 10.1097/00043426-199709000-00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Although rare, second malignant neoplasms (SMNs) are a devastating consequence of successful treatment of childhood cancer. The 15-year estimated risk of developing a second malignant neoplasm after treatment of childhood acute lymphoblastic leukemia (ALL) is 2.5%. Most of these neoplasms are central nervous system tumors. The risk of secondary acute myeloid leukemia has been negligible in most treatment regimens. Here, we report the first case of a primitive neuroectodermal tumor (PNET) in a patient treated for ALL. PATIENTS AND METHODS A 15.7-year-old girl developed pain in her left leg 7 years after diagnosis of low-risk ALL. Imaging studies revealed lytic lesions in her left proximal tibia and several vertebra as well as metastatic nodules in both lungs. RESULTS Immunocytochemical and molecular analyses led to the diagnosis of PNET. The treatment of this SMN was composed of combination chemotherapy with hematopoietic growth factor support and radiotherapy to the primary lesion and affected spine. The tumor recurred 5 months after the completion of treatment, and the patient is now undergoing salvage therapy composed of chemotherapy and radiotherapy. CONCLUSIONS To our knowledge, this is the first report of PNET as an SMN after successful treatment of ALL.
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Affiliation(s)
- F Antillon
- Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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17
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Affiliation(s)
- W S Robinson
- Standard University School of Medicine, Stanford, California
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18
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Neglia JP, Meadows AT, Robison LL, Kim TH, Newton WA, Ruymann FB, Sather HN, Hammond GD. Second neoplasms after acute lymphoblastic leukemia in childhood. N Engl J Med 1991; 325:1330-6. [PMID: 1922234 DOI: 10.1056/nejm199111073251902] [Citation(s) in RCA: 418] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Effective forms of treatment for acute lymphoblastic leukemia (ALL) in childhood now result in survival rates above 70 percent at five years, but the treatments are potentially carcinogenic. To determine the magnitude of this risk and identify possible risk factors for the development of second neoplasms, we studied a large cohort of children treated for ALL. METHODS AND RESULTS. We undertook a retrospective cohort study of 9720 children who had been given a diagnosis of ALL between June 1972 and August 1988 and had been treated according to the therapeutic protocols of the Children's Cancer Study Group. The median follow-up was 4.7 years (range, 2 months to 16 years). We found that 43 second neoplasms occurred among the children in the cohort, including 24 neoplasms of the central nervous system, 10 new leukemias and lymphomas, and 9 other neoplasms. This represented a 7-fold excess of all cancers and a 22-fold excess of neoplasms of the central nervous system. The estimated cumulative proportion of children in whom a second neoplasm developed was 2.53 percent 15 years after diagnosis (95 percent confidence limits, 1.74 percent and 3.38 percent). An even higher risk, particularly of central nervous system tumors, was evident in children five years of age or less at the time of the diagnosis of ALL (P = 0.012). All central nervous system neoplasms developed in children who had previously undergone irradiation. There was no association with exposure to cyclophosphamide or anthracyclines. CONCLUSIONS There is a substantial excess of second neoplasms, especially of the central nervous system, among children treated for ALL. Children five years old or younger and those receiving radiation are at higher risk, especially for second tumors arising in the central nervous system.
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Affiliation(s)
- J P Neglia
- Children's Cancer Study Group, Arcadia, CA 91066-6012
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