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Pio L, Abib S, Guerin F, Chardot C, Blanc T, Sarrai N, Martelli H, De Souza FKM, Fanelli MCA, Tamisier D, Guilhen JCS, Le Bret E, Belli E, Fadel E, Cypriano MDS, Minard V, Pasqualini C, Schleiermacher G, Lemelle L, Rod J, Irtan S, Pistorio A, Gauthier F, Branchereau S, Sarnacki S. Surgical Management of Wilms Tumors with Intravenous Extension: A Multicenter Analysis of Clinical Management with Technical Insights. Ann Surg Oncol 2024; 31:4713-4723. [PMID: 38578552 DOI: 10.1245/s10434-024-15232-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/12/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND About 5% of Wilms tumors present with vascular extension, which sometimes extends to the right atrium. Vascular extension does not affect the prognosis, but impacts the surgical strategy, which is complex and not fully standardized. Our goal is to identify elements of successful surgical management of Wilms tumors with vascular extensions. PATIENTS AND METHODS A retrospective study of pediatric Wilms tumors treated at three sites (January 1999-June 2019) was conducted. The inclusion criterion was the presence of a renal vein and vena cava thrombus at diagnosis. Tumor stage, pre and postoperative treatment, preoperative imaging, operative report, pathology, operative complications, and follow-up data were reviewed. RESULTS Of the 696 pediatric patients with Wilms tumors, 69 (9.9%) met the inclusion criterion. In total, 24 patients (37.5%) had a right atrial extension and two presented with Budd-Chiari syndrome at diagnosis. Two died at diagnosis owing to pulmonary embolism. All patients received neoadjuvant chemotherapy and thrombus regressed in 35.6% of cases. Overall, 14 patients had persistent intra-atrial thrombus extension (58%) and underwent cardiopulmonary bypass. Most thrombi (72%) were removed intact with nephrectomy. Massive intraoperative bleeding occurred during three procedures. Postoperative renal insufficiency was identified as a risk factor for patient survival (p = 0.01). With a median follow-up of 9 years (range: 0.5-20 years), overall survival was 89% and event-free survival was 78%. CONCLUSIONS Neoadjuvant chemotherapy with proper surgical strategy resulted in a survival rate comparable to that of children with Wilms tumors without intravascular extension. Clinicians should be aware that postoperative renal insufficiency is associated with worse survival outcomes.
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Affiliation(s)
- Luca Pio
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France.
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Paris Kids Cancer, Paris, France.
| | - Simone Abib
- Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Pediatric Oncology Institute-GRAACC-Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Florent Guerin
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
- Paris Kids Cancer, Paris, France
| | - Christophe Chardot
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
- Paris Kids Cancer, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
- Paris Kids Cancer, Paris, France
| | - Nadia Sarrai
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | - Helene Martelli
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | - Fernanda K M De Souza
- Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Pediatric Oncology Institute-GRAACC-Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Mayara C A Fanelli
- Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Pediatric Oncology Institute-GRAACC-Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Daniel Tamisier
- Department of Cardiovascular Surgery, Hôpital Universitaire Necker Enfants Malades-Université de Paris Cité, Paris, France
| | - José Cícero S Guilhen
- Department of Cardiovascular Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Emmanuel Le Bret
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue-Groupe Hospitalier Paris-Saclay, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Emré Belli
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue-Groupe Hospitalier Paris-Saclay, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Elie Fadel
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue-Groupe Hospitalier Paris-Saclay, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Monica D S Cypriano
- Pediatric Oncology, Pediatric Oncology Institute-GRAACC-Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Véronique Minard
- Pediatric Oncology Unit, Institut Gustave Roussy, Paris, France
- Paris Kids Cancer, Paris, France
| | - Claudia Pasqualini
- Pediatric Oncology Unit, Institut Gustave Roussy, Paris, France
- Paris Kids Cancer, Paris, France
| | - Gudrun Schleiermacher
- Pediatric Oncology Unit, Institut Curie, Paris, France
- Paris Kids Cancer, Paris, France
| | - Lauriane Lemelle
- Pediatric Oncology Unit, Institut Curie, Paris, France
- Paris Kids Cancer, Paris, France
| | - Julien Rod
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
| | - Sabine Irtan
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
- Paris Kids Cancer, Paris, France
| | - Angela Pistorio
- Epidemiology, and Biostatistics Unit, Instituto Giannina Gaslini, Genoa, Italy
| | - Frederic Gauthier
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | - Sophie Branchereau
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
- Paris Kids Cancer, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
- Paris Kids Cancer, Paris, France
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Sakashita K, Komori K, Morokawa H, Kurata T. Screening and interventional strategies for the late effects and toxicities of hematological malignancy treatments in pediatric survivors. Expert Rev Hematol 2024; 17:313-327. [PMID: 38899398 DOI: 10.1080/17474086.2024.2370559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 06/17/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Advancements in pediatric cancer treatment have increased patient survival rates; however, childhood cancer survivors may face long-term health challenges due to treatment-related effects on organs. Regular post-treatment surveillance and early intervention are crucial for improving the survivors' quality of life and long-term health outcomes. The present paper highlights the significance of late effects in childhood cancer survivors, particularly those with hematologic malignancies, stressing the importance of a vigilant follow-up approach to ensure better overall well-being. AREAS COVERED This article provides an overview of the treatment history of childhood leukemia and lymphoma as well as outlines the emerging late effects of treatments. We discuss the various types of these complications and their corresponding risk factors. EXPERT OPINION Standardizing survivorship care in pediatric cancer aims to improve patient well-being by optimizing their health outcomes and quality of life. This involves early identification and intervention of late effects, requiring collaboration among specialists, nurses, and advocates, and emphasizing data sharing and international cooperation.
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Affiliation(s)
- Kazuo Sakashita
- Department of Hematology and Oncology, Nagano Children's Hospital, Azumino, Japan
| | - Kazutoshi Komori
- Department of Hematology and Oncology, Nagano Children's Hospital, Azumino, Japan
| | - Hirokazu Morokawa
- Department of Hematology and Oncology, Nagano Children's Hospital, Azumino, Japan
| | - Takashi Kurata
- Department of Hematology and Oncology, Nagano Children's Hospital, Azumino, Japan
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Li S, Wang J, Li M, Zhang Z, Mi T, Wu X, Wang Z, Jin L, He D. Efficacy and late kidney effects of nephron-sparing surgery in the management of unilateral Wilms tumor: a systematic review and meta-analysis. Pediatr Surg Int 2023; 40:29. [PMID: 38150145 DOI: 10.1007/s00383-023-05611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/28/2023]
Abstract
To evaluate the efficiency and long-term renal function of nephron sparing surgery (NSS) in unilateral WT patients compared with radical nephrectomy (RN). The review was performed following Cochrane Handbook guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched five databases (Pubmed, Embase, Scopus, Web of Science and Cochrane) for studies reporting the efficiency and late renal function of NSS and/or RN on February 10, 2023. Comparative studies were evaluated by Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) and RoB 2.0. Assessed outcomes included survival rate, relapse rate, eGFR, renal dysfunction and hypertension. 26 studies involving 10322 unilateral WT cases underwent RN and 657 unilateral WT cases underwent NSS were enrolled. Overall effect estimates demonstrated that NSS significantly increased eGFR at follow-up (SMD, 0.38; 95% CI 0.05-0.72; p = 0.025) compared to that at diagnosis, and RN did not significantly decrease eGFR at follow-up (SMD, - 0.33; 95% CI - 0.77-0.11; p = 0.142) compared to that at diagnosis. Moreover, no significant difference was found in outcomes of survivability (OR, 1.38; 95% CI 0.82-2.32; p = 0.226), recurrence (OR, 0.62; 95% CI 0.34-1.12; p = 0.114), eGFR at follow-up (SMD, 0.16; 95% CI - 0.36-0.69; p = 0.538), renal dysfunction (OR, 0.36; 95% CI 0.07-1.73; p = 0.200) and hypertension (OR, 0.17; 95% CI 0.03-1.10; p = 0.063). Current evidence suggests that NSS is safe and effective for unilateral WT patients, because it causes better renal function and similar oncological outcomes compared with RN. Future efforts to conduct more high-quality studies and explore sources of heterogeneity is recommended.
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Affiliation(s)
- Shan Li
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Jinkui Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Mujie Li
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Zhaoxia Zhang
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Tao Mi
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Xin Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Zhang Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Liming Jin
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Dawei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China.
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China.
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
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Cisplatin-induced nephrotoxicity in childhood cancer: comparison between two countries. Pediatr Nephrol 2023; 38:593-604. [PMID: 35748941 DOI: 10.1007/s00467-022-05632-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Various definitions used to describe cisplatin nephrotoxicity potentially lead to differences in determination of risk factors. This study evaluated incidence of kidney injury according to commonly used and alternative definitions in two cohorts of children who received cisplatin. METHODS This retrospective cohort study included children from Vancouver, Canada (one center), and Mexico City, Mexico (two centers), treated with cisplatin for a variety of solid tumors. Serum creatinine-based definitions (KDIGO and Pediatric RIFLE (pRIFLE)), electrolyte abnormalities consisted of hypokalemia, hypophosphatemia and hypomagnesemia (based on NCI-CTCAE v5), and an alternative definition (Alt-AKI) were used to describe nephrotoxicity. Incidence with different definitions, definitional overlap, and inter-definition reliability was analyzed. RESULTS In total, 173 children (100 from Vancouver, 73 from Mexico) were included. In the combined cohort, Alt-AKI criteria detected more patients with cisplatin nephrotoxicity compared to pRIFLE and KDIGO criteria (82.7 vs. 63.6 vs. 44.5%, respectively). Nephrotoxicity and all electrolyte abnormalities were significantly more common in Vancouver cohort than in Mexico City cohort except when using KDIGO definition. The most common electrolyte abnormalities were hypomagnesemia (88.9%, Vancouver) and hypophosphatemia (24.2%, Mexico City). The KDIGO definition provided highest overlap of cases in Vancouver (100%), Mexico (98.6%), and the combined cohort (99.4%). Moderate overall agreement was found among Alt-AKI, KDIGO, and pRIFLE definitions (κ = 0.18, 95% CI 0.1-0.27) in which KDIGO and pRIFLE showed moderate agreement (κ = 0.48, 95% CI 0.36-0.60). CONCLUSIONS Compared to pRIFLE and KDIGO criteria, Alt-AKI criteria detected more patients with cisplatin nephrotoxicity. pRIFLE is more sensitive to detect not only actual kidney injury but also patients at risk of cisplatin nephrotoxicity, while KDIGO seems more useful to detect clinically significant kidney injury. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Khondker A, Groff M, Nunes S, Sun C, Jawa N, Lee J, Cockovski V, Hejri-Rad Y, Chanchlani R, Fleming A, Garg A, Jeyakumar N, Kitchlu A, Lebel A, McArthur E, Mertens L, Nathan P, Parekh R, Patel S, Pole J, Ramphal R, Schechter T, Silva M, Silver S, Sung L, Wald R, Gibson P, Pearl R, Wheaton L, Wong P, Kim K, Zappitelli M. KIdney aNd blooD prESsure ouTcomes in Childhood Cancer Survivors: Description of Clinical Research Protocol of the KINDEST-CCS Study. Can J Kidney Health Dis 2022; 9:20543581221130156. [PMID: 36325265 PMCID: PMC9618744 DOI: 10.1177/20543581221130156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Approximately 30% of childhood cancer survivors (CCSs) will develop chronic kidney disease (CKD) or hypertension 15 to 20 years after treatment ends. The incidence of CKD and hypertension in the 5-year window after cancer therapy is unknown. Moreover, extent of monitoring of CCS with CKD and associated complications in current practice is underexplored. To inform the development of new and existing care guidelines for CCS, the epidemiology and monitoring of CKD and hypertension in the early period following cancer therapy warrants further investigation. Objective To describe the design and methods of the KIdney aNd blooD prESsure ouTcomes in Childhood Cancer Survivors study, which aims to evaluate the burden of late kidney and blood pressure outcomes in the first ~10 years after cancer therapy, the extent of appropriate screening and complications monitoring for CKD and hypertension, and whether patient, disease/treatment, or system factors are associated with these outcomes. Design Two distinct, but related studies; a prospective cohort study and a retrospective cohort study. Setting Five Ontario pediatric oncology centers. Patients The prospective study will involve 500 CCS at high risk for these late effects due to cancer therapy, and the retrospective study involves 5,000 CCS ≤ 18 years old treated for cancer between January 2008 and December 2020. Measurements Chronic kidney disease is defined as Estimated glomerular filtration rate <90 mL/min/1.73 m2 or albumin-to-creatinine ratio ≥ 3mg/mmol. Hypertension is defined by 2017 American Academy of Pediatrics guidelines. Methods Prospective study: we aim to investigate CKD and hypertension prevalence and the extent to which they persist at 3- and 5-year follow-up in CCS after cancer therapy. We will collect detailed biologic and clinical data, calculate CKD and hypertension prevalence, and progression at 3- and 5-years post-therapy. Retrospective study: we aim to investigate CKD and hypertension monitoring using administrative and health record data. We will also investigate the validity of CKD and hypertension administrative definitions in this population and the incidence of CKD and hypertension in the first ~10 years post-cancer therapy. We will investigate whether patient-, disease/treatment-, or system-specific factors modify these associations in both studies. Limitations Results from the prospective study may not be generalizable to non-high-risk CCS. The retrospective study is susceptible to surveillance bias. Conclusions Our team and knowledge translation plan is engaging patient partners, researchers, knowledge users, and policy group representatives. Our work will address international priorities to improve CCS health, provide the evidence of new disease burden and practice gaps to improve CCS guidelines, implement and test revised guidelines, plan trials to reduce CKD and hypertension, and improve long-term CCS health.
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Affiliation(s)
- Adree Khondker
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Michael Groff
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Sophia Nunes
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Carolyn Sun
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Natasha Jawa
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jasmine Lee
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vedran Cockovski
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yasmine Hejri-Rad
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rahul Chanchlani
- Department of Pediatrics, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Adam Fleming
- Department of Pediatric Hematology/Oncology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Amit Garg
- Department of Medicine, London Health Sciences Centre Research Inc., London, ON, Canada
| | | | - Abhijat Kitchlu
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada
| | - Asaf Lebel
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Luc Mertens
- Division of Cardiology, The Labatt Family Heart Center, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Nathan
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rulan Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Serina Patel
- Department of Pediatric Hematology/Oncology, Children’s Hospital of Western Ontario, London, Canada
| | - Jason Pole
- Pediatric Oncology Group of Ontario, Toronto, Canada
| | - Raveena Ramphal
- Department of Pediatrics, Children’s Hospital of Eastern Ontario–Ottawa Children’s Treatment Centre, Canada
| | - Tal Schechter
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mariana Silva
- Department of Pediatrics, Kingston Health Sciences Centre, ON, Canada
| | - Samuel Silver
- Division of Nephrology, Department of Medicine, Queen’s University, Kingston, ON, Canada
| | - Lillian Sung
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ron Wald
- Unity Health Toronto, ON, Canada
| | - Paul Gibson
- Pediatric Oncology Group of Ontario, Toronto, Canada
| | - Rachel Pearl
- William Osler Health System, Brampton, ON, Canada
| | - Laura Wheaton
- Department of Pediatrics, Kingston Health Sciences Centre, ON, Canada
| | - Peter Wong
- William Osler Health System, Brampton, ON, Canada
| | - Kirby Kim
- Patient Partner, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Zappitelli
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada,Michael Zappitelli, Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Room 11.9722, 11th Floor, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
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Bélanger V, Napartuk M, Bouchard I, Meloche C, Curnier D, Sultan S, Laverdière C, Sinnett D, Marcil V. Cardiometabolic Health After Pediatric Cancer Treatment: Adolescents Are More Affected than Children. Nutr Cancer 2022; 74:3236-3252. [PMID: 35533005 DOI: 10.1080/01635581.2022.2072908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This cross-sectional study aimed at comparing the cardiometabolic (CM) health of children and adolescents and identifying factors associated with CM complications shortly after cancer treatment. Cancer-related characteristics, blood pressure (BP), anthropometry, and biochemical parameters were collected in 80 patients (56.3% female, mean age: 11.8 years; range: 4.5 - 21.0) a mean of 1.4 years following therapy completion. Compared to children, adolescents had higher mean z-score of insulin (-0.47 vs. 0.20; P = 0.01), HOMA-IR (-0.40 vs. 0.25; P = 0.02), waist-to-height ratio (0.36 vs. 0.84; P = 0.01), subscapular skinfold thickness (-0.19 vs. 0.47; P = 0.02), total body fat (-1.43 vs. 0.26; P < 0.01), and lower mean z-score of HDL-C (0.07 vs. -0.53; P < 0.01). Adolescents were more likely to have high BP (42% vs. 15%; P < 0.01), dyslipidemia (64% vs. 15%; P < 0.001), and cumulating ≥ 2 CM complications (42% vs. 2%; P < 0.001) than children. Adiposity indices (z-scores) were associated with high BP [odds ratio (OR) ranging from 2.11 to 4.09] and dyslipidemia (OR ranging from 2.06 to 4.34). These results suggest that adolescents have a worse CM profile than children shortly after therapy and that adiposity parameters are associated with CM complications, highliting the importance to develop intervention strategies targeting this population.
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Affiliation(s)
- Véronique Bélanger
- Research Centre, CHU Sainte-Justine University Health Centre, Montreal, Quebec, Canada.,Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Mélanie Napartuk
- Research Centre, CHU Sainte-Justine University Health Centre, Montreal, Quebec, Canada.,Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Bouchard
- Research Centre, CHU Sainte-Justine University Health Centre, Montreal, Quebec, Canada
| | - Caroline Meloche
- Research Centre, CHU Sainte-Justine University Health Centre, Montreal, Quebec, Canada
| | - Daniel Curnier
- Research Centre, CHU Sainte-Justine University Health Centre, Montreal, Quebec, Canada.,School of Kinesiology and Physical Activity Sciences, University de Montréal, Montreal, Quebec, Canada
| | - Serge Sultan
- Research Centre, CHU Sainte-Justine University Health Centre, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Caroline Laverdière
- Research Centre, CHU Sainte-Justine University Health Centre, Montreal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Daniel Sinnett
- Research Centre, CHU Sainte-Justine University Health Centre, Montreal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Valérie Marcil
- Research Centre, CHU Sainte-Justine University Health Centre, Montreal, Quebec, Canada.,Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
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Evaluation of kidney dysfunction in childhood cancer survivors. Pediatr Res 2022; 92:1689-1694. [PMID: 35338352 PMCID: PMC9771802 DOI: 10.1038/s41390-022-02015-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The major increase in the survival rate among children with cancer is due to improvement in the diagnosis and treatment. Despite this increase, childhood cancer survivors (CCS) are at high risk of developing late complications such as nephrotoxicity due to chemotherapy. So, we aimed to detect early subclinical kidney dysfunction among CCS. METHODS This cross-sectional study was implemented on 52 survivors of childhood cancer recruited from Pediatric Oncology Unit, Menoufia University. Laboratory evaluations for each participant, including complete blood count, serum urea, creatinine, urinary protein, urinary calcium, uric acid, and serum cystatin C and urinary Neutrophil Gelatinase Associated Lipocalin (UrNGAL) by ELISA were obtained. RESULTS Estimated GFR was decreased in 23.1% of cases, with elevated serum cystatin C, UrNGAL and UrNGAL/Cr. There was a significant increase of Uprotein/Cr, UCa/Cr, UACR (p = 0.02), UrNGAL and UrNGAL/Cr (P < 0.001) in patients with tubular dysfunction compared without tubular dysfunction. There was a significant difference between two groups regarding cisplatin (P = 0.03) and high-dose methotrexate chemotherapy (p = 0.04). The AUCs for detecting kidney tubular dysfunction by UrNGAL and UrNGAL/Cr were 0.807 and 0.747. CONCLUSION A significant tubular dysfunction among childhood cancer survivors receiving chemotherapy as cisplatin and high-dose methotrexate. IMPACT Detection of kidney dysfunction mainly tubular in childhood cancer survivors after finishing chemotherapy. Urinary NGAL is a good predictor for detection of tubular dysfunction in childhood cancer survivors after finishing chemotherapy.
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Ahmad A, Shi J, Ansari S, Afaghani J, Molina J, Pollack A, Merscher S, Zeidan YH, Fornoni A, Marples B. Noninvasive assessment of radiation-induced renal injury in mice. Int J Radiat Biol 2021; 97:664-674. [PMID: 33464992 PMCID: PMC8352084 DOI: 10.1080/09553002.2021.1876950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/11/2020] [Accepted: 01/06/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE The kidney is a radiosensitive late-responding normal tissue. Injury is characterized by radiation nephropathy and decline of glomerular filtration rate (GFR). The current study aimed to compare two rapid and cost-effective methodologies of assessing GFR against more conventional biomarker measurements. METHODS C57BL/6 mice were treated with bilateral focal X-irradiation (1x14Gy or 5x6Gy). Functional measurements of kidney injury were assessed 20 weeks post-treatment. GFR was estimated using a transcutaneous measurement of fluorescein-isothiocyanate conjugated (FITC)-sinistrin renal excretion and also dynamic contrast-enhanced CT imaging with a contrast agent (ISOVUE-300 Iopamidol). RESULTS Hematoxylin and eosin (H&E) and Periodic acid-Schiff staining identified comparable radiation-induced glomerular atrophy and mesangial matrix accumulation after both radiation schedules, respectively, although the fractionated regimen resulted in less diffuse tubulointerstitial fibrosis. Albumin-to-creatinine ratios (ACR) increased after irradiation (1x14Gy: 100.4 ± 12.2 µg/mg; 6x5Gy: 80.4 ± 3.02 µg/mg) and were double that of nontreated controls (44.9 ± 3.64 µg/mg). GFR defined by both techniques was negatively correlated with BUN, mesangial expansion score, and serum creatinine. The FITC-sinistrin transcutaneous method was more rapid and can be used to assess GFR in conscious animals, dynamic contrast-enhanced CT imaging technique was equally safe and effective. CONCLUSION This study demonstrated that GFR measured by dynamic contrast-enhanced CT imaging is safe and effective compared to transcutaneous methodology to estimate kidney function.
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Affiliation(s)
- Anis Ahmad
- Department of Radiation Oncology, University of Miami, Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Junwei Shi
- Department of Radiation Oncology, University of Miami, Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Saba Ansari
- Department of Radiation Oncology, University of Miami, Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Jumana Afaghani
- Department of Radiation Oncology, University of Miami, Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Judith Molina
- Peggy and Harold Katz Family Drug Discovery Center and Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami, Miami, FL, USA
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami, Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Sandra Merscher
- Peggy and Harold Katz Family Drug Discovery Center and Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami, Miami, FL, USA
| | - Youssef H. Zeidan
- Department of Radiation Oncology, Anatomy, Cell Biology, and Physiology, American University of Beirut School of Medicine, Beirut, Lebanon
| | - Alessia Fornoni
- Peggy and Harold Katz Family Drug Discovery Center and Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami, Miami, FL, USA
| | - Brian Marples
- Department of Radiation Oncology, University of Miami, Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
- Department of Radiation Oncology, University of Rochester, Rochester, NY 14642
- Peggy and Harold Katz Family Drug Discovery Center and Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami, Miami, FL, USA
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Dietz AC, Seidel K, Leisenring WM, Mulrooney DA, Tersak JM, Glick RD, Burnweit CA, Green DM, Diller LR, Smith SA, Howell RM, Stovall M, Armstrong GT, Oeffinger KC, Robison LL, Termuhlen AM. Solid organ transplantation after treatment for childhood cancer: a retrospective cohort analysis from the Childhood Cancer Survivor Study. Lancet Oncol 2019; 20:1420-1431. [PMID: 31471158 PMCID: PMC6871649 DOI: 10.1016/s1470-2045(19)30418-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/24/2019] [Accepted: 06/04/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Serious chronic medical conditions occur in childhood cancer survivors. We aimed to investigate incidence of and risk factors for end-organ damage resulting in registration on a waiting list for or receiving a solid organ transplantation and 5-year survival following these procedures. METHODS The Childhood Cancer Survivor Study (CCSS) is a retrospective cohort of individuals who survived at least 5 years after childhood cancer diagnosed at younger than 21 years of age, between Jan 1, 1970, and Dec 31, 1986, at one of 25 institutions in the USA. We linked data from CCSS participants treated in the USA diagnosed between Jan 1, 1970, and Dec 31, 1986 (without solid organ transplantation before cohort entry) to the Organ Procurement and Transplantation Network-a database of all US organ transplants. Eligible participants had been diagnosed with leukaemia, lymphoma, malignant CNS tumours, neuroblastoma, Wilms' tumours, and bone and soft tissue sarcomas. The two primary endpoints for each type of organ transplant were date of first registration of a transplant candidate on the waiting list for an organ and the date of the first transplant received. We also calculated the cumulative incidence of being placed on a waiting list or receiving a solid organ transplantation, hazard ratios (HRs) for identified risk factors, and 5-year survival following transplantation. FINDINGS Of 13 318 eligible survivors, 100 had 103 solid organ transplantations (50 kidney, 37 heart, nine liver, seven lung) and 67 were registered on a waiting list without receiving a transplant (21 kidney, 25 heart, 15 liver, six lung). At 35 years after cancer diagnosis, the cumulative incidence of transplantation or being on a waiting list was 0·54% (95% CI 0·40-0·67) for kidney transplantation, 0·49% (0·36-0·62) for heart, 0·19% (0·10-0·27) for liver, and 0·10% (0·04-0·16) for lung. Risk factors for kidney transplantation were unilateral nephrectomy (HR 4·2, 95% CI 2·3-7·7), ifosfamide (24·9, 7·4-83·5), total body irradiation (6·9, 2·3-21·1), and mean kidney radiation of greater than 15 Gy (>15-20 Gy, 3·6 [1·5-8·5]; >20 Gy 4·6 [1·1-19·6]); for heart transplantation, anthracycline and mean heart radiation of greater than 20 Gy (dose-dependent, both p<0·0001); for liver transplantation, dactinomycin (3·8, 1·3-11·3) and methotrexate (3·3, 1·0-10·2); for lung transplantation, carmustine (12·3, 3·1-48·9) and mean lung radiation of greater than 10 Gy (15·6, 2·6-92·7). 5-year overall survival after solid organ transplantation was 93·5% (95% CI 81·0-97·9) for kidney transplantation, 80·6% (63·6-90·3) for heart, 27·8% (4·4-59·1) for liver, and 34·3% (4·8-68·6) for lung. INTERPRETATION Solid organ transplantation is uncommon in ageing childhood cancer survivors. Organ-specific exposures were associated with increased solid organ transplantation incidence. Survival outcomes showed that solid organ transplantation should be considered for 5-year childhood cancer survivors with severe end-organ failure. FUNDING US National Institute of Health, American Lebanese Syrian Associated Charities, US Health Resources and Services Administration.
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Affiliation(s)
- Andrew C Dietz
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA; bluebird bio, Cambridge, MA, USA
| | - Kristy Seidel
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Jean M Tersak
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Richard D Glick
- Cohen Children's Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
| | | | | | - Lisa R Diller
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Susan A Smith
- The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca M Howell
- The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Marilyn Stovall
- The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | | | - Kevin C Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Amanda M Termuhlen
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.
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Urinary Neutrophil Gelatinase Associated Lipocalin (NGAL) in Predicting Cisplatin-Induced Acute Kidney Injury. Nephrourol Mon 2019. [DOI: 10.5812/numonthly.87523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Kooijmans ECM, Bökenkamp A, Tjahjadi NS, Tettero JM, van Dulmen‐den Broeder E, van der Pal HJH, Veening MA. Early and late adverse renal effects after potentially nephrotoxic treatment for childhood cancer. Cochrane Database Syst Rev 2019; 3:CD008944. [PMID: 30855726 PMCID: PMC6410614 DOI: 10.1002/14651858.cd008944.pub3] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Improvements in diagnostics and treatment for paediatric malignancies resulted in a major increase in survival. However, childhood cancer survivors (CCS) are at risk of developing adverse effects caused by multimodal treatment for their malignancy. Nephrotoxicity is a known side effect of several treatments, including cisplatin, carboplatin, ifosfamide, radiotherapy and nephrectomy, and can cause glomerular filtration rate (GFR) impairment, proteinuria, tubulopathy, and hypertension. Evidence about the long-term effects of these treatments on renal function remains inconclusive. It is important to know the risk of, and risk factors for, early and late adverse renal effects, so that ultimately treatment and screening protocols can be adjusted. This review is an update of a previously published Cochrane Review. OBJECTIVES To evaluate existing evidence on the effects of potentially nephrotoxic treatment modalities on the prevalence of renal dysfunction in survivors treated for childhood cancer with a median or mean survival of at least one year after cessation of treatment, where possible in comparison with the general population or CCS treated without potentially nephrotoxic treatment. In addition, to evaluate evidence on associated risk factors, such as follow-up duration, age at time of diagnosis and treatment combinations, as well as the effect of doses. SEARCH METHODS On 31 March 2017 we searched the following electronic databases: CENTRAL, MEDLINE and Embase. In addition, we screened reference lists of relevant studies and we searched the congress proceedings of the International Society of Pediatric Oncology (SIOP) and The American Society of Pediatric Hematology/Oncology (ASPHO) from 2010 to 2016/2017. SELECTION CRITERIA Except for case reports, case series and studies including fewer than 20 participants, we included studies with all study designs that reported on renal function (one year or longer after cessation of treatment), in CCS treated before the age of 21 years with cisplatin, carboplatin, ifosfamide, radiation involving the kidney region, a nephrectomy, or a combination of two or more of these treatments. When not all treatment modalities were described or the study group of interest was unclear, a study was not eligible for the evaluation of prevalence. We still included it for the assessment of risk factors if it had performed a multivariable analysis. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction using standardised data collection forms. We performed analyses according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS Apart from the remaining 37 studies included from the original review, the search resulted in the inclusion of 24 new studies. In total, we included 61 studies; 46 for prevalence, six for both prevalence and risk factors, and nine not meeting the inclusion criteria, but assessing risk factors. The 52 studies evaluating the prevalence of renal dysfunction included 13,327 participants of interest, of whom at least 4499 underwent renal function testing. The prevalence of adverse renal effects ranged from 0% to 84%. This variation may be due to diversity of included malignancies, received treatments, reported outcome measures, follow-up duration and the methodological quality of available evidence.Seven out of 52 studies, including 244 participants, reported the prevalence of chronic kidney disease, which ranged from 2.4% to 32%.Of these 52 studies, 36 studied a decreased (estimated) GFR, including at least 432 CCS, and found it was present in 0% to 73.7% of participants. One eligible study reported an increased risk of glomerular dysfunction after concomitant treatment with aminoglycosides and vancomycin in CCS receiving total body irradiation (TBI). Four non-eligible studies assessing a total cohort of CCS, found nephrectomy and (high-dose (HD)) ifosfamide as risk factors for decreased GFR. The majority also reported cisplatin as a risk factor. In addition, two non-eligible studies showed an association of a longer follow-up period with glomerular dysfunction.Twenty-two out of 52 studies, including 851 participants, studied proteinuria, which was present in 3.5% to 84% of participants. Risk factors, analysed by three non-eligible studies, included HD cisplatin, (HD) ifosfamide, TBI, and a combination of nephrectomy and abdominal radiotherapy. However, studies were contradictory and incomparable.Eleven out of 52 studies assessed hypophosphataemia or tubular phosphate reabsorption (TPR), or both. Prevalence ranged between 0% and 36.8% for hypophosphataemia in 287 participants, and from 0% to 62.5% for impaired TPR in 246 participants. One non-eligible study investigated risk factors for hypophosphataemia, but could not find any association.Four out of 52 studies, including 128 CCS, assessed the prevalence of hypomagnesaemia, which ranged between 13.2% and 28.6%. Both non-eligible studies investigating risk factors identified cisplatin as a risk factor. Carboplatin, nephrectomy and follow-up time were other reported risk factors.The prevalence of hypertension ranged from 0% to 50% in 2464 participants (30/52 studies). Risk factors reported by one eligible study were older age at screening and abdominal radiotherapy. A non-eligible study also found long follow-up time as risk factor. Three non-eligible studies showed that a higher body mass index increased the risk of hypertension. Treatment-related risk factors were abdominal radiotherapy and TBI, but studies were inconsistent.Because of the profound heterogeneity of the studies, it was not possible to perform meta-analyses. Risk of bias was present in all studies. AUTHORS' CONCLUSIONS The prevalence of adverse renal effects after treatment with cisplatin, carboplatin, ifosfamide, radiation therapy involving the kidney region, nephrectomy, or any combination of these, ranged from 0% to 84% depending on the study population, received treatment combination, reported outcome measure, follow-up duration and methodological quality. With currently available evidence, it was not possible to draw solid conclusions regarding the prevalence of, and treatment-related risk factors for, specific adverse renal effects. Future studies should focus on adequate study designs and reporting, including large prospective cohort studies with adequate control groups when possible. In addition, these studies should deploy multivariable risk factor analyses to correct for possible confounding. Next to research concerning known nephrotoxic therapies, exploring nephrotoxicity after new therapeutic agents is advised for future studies. Until more evidence becomes available, CCS should preferably be enrolled into long-term follow-up programmes to monitor their renal function and blood pressure.
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Affiliation(s)
- Esmee CM Kooijmans
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Arend Bökenkamp
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatric NephrologyPO Box 7057AmsterdamNetherlands1007 MB
| | - Nic S Tjahjadi
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Jesse M Tettero
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Eline van Dulmen‐den Broeder
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Helena JH van der Pal
- Princess Maxima Center for Pediatric Oncology, KE.01.129.2PO Box 85090UtrechtNetherlands3508 AB
| | - Margreet A Veening
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
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Barton CD, Pizer B, Jones C, Oni L, Pirmohamed M, Hawcutt DB. Identifying cisplatin-induced kidney damage in paediatric oncology patients. Pediatr Nephrol 2018; 33:1467-1474. [PMID: 28821959 PMCID: PMC6061670 DOI: 10.1007/s00467-017-3765-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 11/06/2022]
Abstract
Cisplatin is one chemotherapeutic agent used to treat childhood cancer in numerous treatment protocols, including as a single agent. It is likely to remain in clinical use over the long term. However, cisplatin-related toxicities, including neurotoxicity and nephrotoxicity, are common, affecting treatment, day-to-day life and survival of such children. With one in 700 young adults having survived childhood cancer, patients who have completed chemotherapy that includes cisplatin can experience long-term morbidity due to treatment-related adverse reactions. A better understanding of these toxicities is essential to facilitate prevention, surveillance and management. This review article discusses the effect of cisplatin-induced nephrotoxicity (Cis-N) in children and considers the underlying mechanisms. We focus on clinical features and identification of Cis-N (e.g. investigations and biomarkers) and the importance of magnesium homeostasis and supplementation.
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Affiliation(s)
- Chris D Barton
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Paediatric Oncology, Alder Hey Children's Hospital, Liverpool, UK
| | - Barry Pizer
- Department of Paediatric Oncology, Alder Hey Children's Hospital, Liverpool, UK
| | - Caroline Jones
- Department of Paediatric Nephrology, Alder Hey Children's Hospital, Liverpool, UK
| | - Louise Oni
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Paediatric Nephrology, Alder Hey Children's Hospital, Liverpool, UK
| | - Munir Pirmohamed
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Daniel B Hawcutt
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
- NIHR Alder Hey Clinical Research Facility, University of Liverpool, Liverpool, UK.
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Tibúrcio FR, Rodrigues KEDS, Belisário AR, Simões-e-Silva AC. Glomerular hyperfiltration and β-2 microglobulin as biomarkers of incipient renal dysfunction in cancer survivors. Future Sci OA 2018; 4:FSO333. [PMID: 30271618 PMCID: PMC6153459 DOI: 10.4155/fsoa-2018-0045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/26/2018] [Indexed: 11/17/2022] Open
Abstract
Herein, we aimed to evaluate the occurrence of impaired renal function after cancer treatment with potentially nephrotoxic chemotherapy in children. A cross-sectional study was performed in 41 cancer survivors after chemotherapy with potentially nephrotoxic drugs. 26 (63.4%) children were detected with glomerular hyperfiltration, and urinary levels of β-2 microglobulin (B2MG) were higher than reference range in all patients. Levels of B2MG were positively correlated with plasma creatinine and negatively correlated with glomerular filtration rate. Plasma creatinine, systolic blood pressure and cholesterol were independently associated with B2MG values. The final multivariate model for glomerular hyperfiltration risk included plasma levels of urea and of magnesium. Urinary levels of B2MG and glomerular hyperfiltration may emerge as potential biomarkers of early renal dysfunction in childhood cancer survivors.
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Affiliation(s)
- Fernanda R Tibúrcio
- Department of Pediatrics, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Pediatric Nephrology Unity, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Karla E de S Rodrigues
- Department of Pediatrics, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Pediatric Nephrology Unity, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - André R Belisário
- Department of Pediatrics, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Pediatric Nephrology Unity, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana Cristina Simões-e-Silva
- Department of Pediatrics, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Pediatric Nephrology Unity, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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Late Effects and Survivorship Issues in Patients with Neuroblastoma. CHILDREN-BASEL 2018; 5:children5080107. [PMID: 30082653 PMCID: PMC6111874 DOI: 10.3390/children5080107] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 12/19/2022]
Abstract
Over the past two decades, marked progress has been made in understanding the biology of neuroblastoma; this has led to refined risk stratification and treatment modifications with resultant increasing 5-year survival rates for children with neuroblastoma. Survivors, however, remain at risk for a wide variety of potential treatment-related complications, or "late effects", which may lead to excess morbidity and premature mortality in this cohort. This review summarizes the existing survivorship literature on long-term health outcomes for survivors of neuroblastoma, focusing specifically on potential injury to the endocrine, sensory, cardiovascular, pulmonary, and renal systems, as well as survivors' treatment-related risk for subsequent neoplasms and impaired quality of life. Additional work is needed to assess the potential late effects of newer multimodality therapies with the aim of optimizing long-term medical and psychosocial outcomes for all survivors of neuroblastoma.
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Fernandez CV, Mullen EA, Chi YY, Ehrlich PF, Perlman EJ, Kalapurakal JA, Khanna G, Paulino AC, Hamilton TE, Gow KW, Tochner Z, Hoffer FA, Withycombe JS, Shamberger RC, Kim Y, Geller JI, Anderson JR, Grundy PE, Dome JS. Outcome and Prognostic Factors in Stage III Favorable-Histology Wilms Tumor: A Report From the Children's Oncology Group Study AREN0532. J Clin Oncol 2017; 36:254-261. [PMID: 29211618 DOI: 10.1200/jco.2017.73.7999] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background The National Wilms Tumor Study (NWTS) approach to treating stage III favorable-histology Wilms tumor (FHWT) is Regimen DD4A (vincristine, dactinomycin, and doxorubicin) and radiation therapy. Further risk stratification is required to improve outcomes and reduce late effects. We evaluated clinical and biologic variables for patients with stage III FHWT without combined loss of heterozygosity (LOH) at chromosomes 1p and 16q treated in the Children's Oncology Group protocol AREN0532. Methods From October 2006 to August 2013, 588 prospectively treated, centrally reviewed patients with stage III FHWT were treated with Regimen DD4A and radiation therapy. Tumor LOH at 1p and 16q was determined by microsatellite analysis. Ineligible patients (n = 5) and those with combined LOH 1p/16q (n = 40) were excluded. Results A total of 535 patients with stage III disease were studied. Median follow-up was 5.2 years (range, 0.2 to 9.5). Four-year event-free survival (EFS) and overall survival estimates were 88% (95% CI, 85% to 91%) and 97% (95% CI, 95% to 99%), respectively. A total of 58 of 66 relapses occurred in the first 2 years, predominantly pulmonary (n = 36). Eighteen patients died, 14 secondary to disease. A better EFS was associated with negative lymph node status ( P < .01) and absence of LOH 1p or 16q ( P < .01), but not with gross residual disease or peritoneal implants. In contrast, the 4-year EFS was only 74% in patients with combined positive lymph node status and LOH 1p or 16q. A total of 123 patients (23%) had delayed nephrectomy. Submitted delayed nephrectomy histology showed anaplasia (n = 8; excluded from survival analysis); low risk/completely necrotic (n = 7; zero relapses), intermediate risk (n = 63; six relapses), and high-risk/blastemal type (n=7; five relapses). Conclusion Most patients with stage III FHWT had good EFS/overall survival with DD4A and radiation therapy. Combined lymph node and LOH status was highly predictive of EFS and should be considered as a potential prognostic marker for future trials.
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Affiliation(s)
- Conrad V Fernandez
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Elizabeth A Mullen
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Yueh-Yun Chi
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Peter F Ehrlich
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Elizabeth J Perlman
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - John A Kalapurakal
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Geetika Khanna
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Arnold C Paulino
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Thomas E Hamilton
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Kenneth W Gow
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Zelig Tochner
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Fredric A Hoffer
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Janice S Withycombe
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Robert C Shamberger
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Yeonil Kim
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - James I Geller
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - James R Anderson
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Paul E Grundy
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Jeffrey S Dome
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
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Ruggiero A, Ferrara P, Attinà G, Rizzo D, Riccardi R. Renal toxicity and chemotherapy in children with cancer. Br J Clin Pharmacol 2017; 83:2605-2614. [PMID: 28758697 PMCID: PMC5698594 DOI: 10.1111/bcp.13388] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 06/30/2017] [Accepted: 07/25/2017] [Indexed: 12/26/2022] Open
Abstract
The clinical use of antineoplastic drugs can be limited by different drug-induced toxicities. Of these, renal dysfunction may be one of the most troublesome in that it can be cumulative and in general is only partially reversible with the discontinuation of the treatment. Renal toxicity may be manifested as a reduction of the glomerular filtration rate, electrolyte imbalances, or acute renal failure. Careful assessment of renal function has to be performed taking into account that the impairment of renal function is initially silent and only later may be clinically dramatic. When clinically indicated, the reduction or, in cases of severe nephrotoxicity, the suspension of chemotherapy should be considered to avoid the progressive deterioration of the compromised glomerular and/or tubular function.
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Affiliation(s)
- Antonio Ruggiero
- Division of Paediatric OncologyCatholic University of RomeRomeItaly
| | - Pietro Ferrara
- Division of Paediatric OncologyCatholic University of RomeRomeItaly
- Institute of PaediatricsCatholic University of RomeRomeItaly
| | - Giorgio Attinà
- Division of Paediatric OncologyCatholic University of RomeRomeItaly
| | - Daniela Rizzo
- Division of Paediatric OncologyCatholic University of RomeRomeItaly
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Sterling M, Al-Ismaili Z, McMahon KR, Piccioni M, Pizzi M, Mottes T, Lands LC, Abish S, Fleming AJ, Bennett MR, Palijan A, Devarajan P, Goldstein SL, O’Brien MM, Zappitelli M. Urine biomarkers of acute kidney injury in noncritically ill, hospitalized children treated with chemotherapy. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26538. [PMID: 28417544 PMCID: PMC7287509 DOI: 10.1002/pbc.26538] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/07/2017] [Accepted: 02/16/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cisplatin (Cis), carboplatin (Carb), and ifosfamide (Ifos) are common nephrotoxic chemotherapies. Biomarkers of tubular injury may allow for early acute kidney injury (AKI) diagnosis. PROCEDURE We performed a two-center (Canada, United States) pilot study to prospectively measure serum creatinine (SCr), urine neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-18 (IL-18) in children receiving Cis/Carb (27 episodes), Ifos (30 episodes), and in 15 hospitalized, nonchemotherapy patients. We defined AKI using the Kidney Disease Improving Global Outcomes (KDIGO) definition. We compared postchemotherapy infusion NGAL and IL-18 concentrations (immediate postdose to 3 days later) to pre-infusion concentrations. We calculated area under the receiver operating characteristic curve (AUC) for postinfusion biomarkers to discriminate for AKI. RESULTS Prechemotherapy infusion NGAL and IL-18 concentrations were not higher than nonchemotherapy control concentrations. Increasing chemotherapy dose was associated with increasing postinfusion (0-4 hr after infusion) NGAL (P < 0.05). Post-Ifos, immediate postdose, and daily postdose NGAL and IL-18 were significantly higher than pre-infusion biomarker concentrations (P < 0.05), during AKI episodes. NGAL and IL-18 did not rise significantly after Cis-Carb infusion, relative to predose concentrations (P > 0.05). NGAL and IL-18 measured immediately after Ifos infusion discriminated for AKI with AUCs is 0.80 (standard error = 0.13) and 0.73 (standard error = 0.16), respectively. NGAL and IL-18 were not diagnostic of Cis-Carb-associated AKI. When AUCs were adjusted for age, all biomarker AUCs (Cis-Carb and Ifos) improved. CONCLUSION Urine NGAL and IL-18 show promise as early AKI diagnostic tests in children treated with ifosfamide and may have a potential role in drug toxicity monitoring.
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Affiliation(s)
- Maya Sterling
- Division of Nephrology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Zubaida Al-Ismaili
- Division of Nephrology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kelly R. McMahon
- Division of Nephrology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Melissa Piccioni
- Division of Nephrology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Pizzi
- Division of Nephrology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Theresa Mottes
- Department of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Larry C. Lands
- Division of Respirology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sharon Abish
- Division of Hematology-Oncology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Adam J. Fleming
- Division of Hematology-Oncology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Michael R. Bennett
- Department of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ana Palijan
- Division of Nephrology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Prasad Devarajan
- Department of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Stuart L. Goldstein
- Department of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Maureen M. O’Brien
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Michael Zappitelli
- Division of Nephrology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Chemaitilly W, Li Z, Krasin MJ, Brooke RJ, Wilson CL, Green DM, Klosky JL, Barnes N, Clark KL, Farr JB, Fernandez-Pineda I, Bishop MW, Metzger M, Pui CH, Kaste SC, Ness KK, Srivastava DK, Robison LL, Hudson MM, Yasui Y, Sklar CA. Premature Ovarian Insufficiency in Childhood Cancer Survivors: A Report From the St. Jude Lifetime Cohort. J Clin Endocrinol Metab 2017; 102:2242-2250. [PMID: 28368472 PMCID: PMC5505200 DOI: 10.1210/jc.2016-3723] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/20/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Long-term follow-up data on premature ovarian insufficiency (POI) in childhood cancer survivors are limited. OBJECTIVE To describe the prevalence of POI, its risk factors, and associated long-term adverse health outcomes. DESIGN Cross-sectional. SETTING The St. Jude Lifetime Cohort Study, an established cohort in a tertiary care center. PATIENTS Nine hundred twenty-one participants (median age, 31.7 years) were evaluated at a median of 24.0 years after cancer diagnosis. MAIN OUTCOME MEASURE POI was defined by persistent amenorrhea combined with a follicle-stimulating hormone level >30 IU/L before age 40. Multivariable Cox regression was used to study associations between demographic or treatment-related risk factors and POI. Multivariable logistic regression was used to study associations between POI and markers for cardiovascular disease, bone mineral density (BMD), and frailty. Exposure to alkylating agents was quantified using the validated cyclophosphamide equivalent dose (CED). RESULTS The prevalence of POI was 10.9%. Independent risk factors for POI included ovarian radiotherapy at any dose and CED ≥8000 mg/m2. Patients with a body mass index ≥30 kg/m2 at the time of the St. Jude Lifetime Cohort assessment were less likely to have a diagnosis of POI. Low BMD and frailty were independently associated with POI. CONCLUSION High-dose alkylating agents and ovarian radiotherapy at any dose are associated with POI. Patients at the highest risk should be offered fertility preservation whenever feasible. POI contributes to poor general health outcomes in childhood cancer survivors; further studies are needed to investigate the role of sex hormone replacement in improving such outcomes.
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Affiliation(s)
- Wassim Chemaitilly
- Department of Pediatric Medicine–Endocrinology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Zhenghong Li
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Matthew J. Krasin
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Russell J. Brooke
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Daniel M. Green
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - James L. Klosky
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Nicole Barnes
- Department of Pediatric Medicine–Endocrinology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Karen L. Clark
- Department of Pediatric Medicine–Endocrinology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Jonathan B. Farr
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | | | - Michael W. Bishop
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Monika Metzger
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Sue C. Kaste
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
- Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee 38163
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | | | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105
| | - Charles A. Sklar
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065
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Boonstra A, van Dulmen‐den Broeder E, Rovers MM, Blijlevens N, Knoop H, Loonen J. Severe fatigue in childhood cancer survivors. Cochrane Database Syst Rev 2017; 2017:CD012681. [PMCID: PMC6481861 DOI: 10.1002/14651858.cd012681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The main objective is to estimate the prevalence of severe fatigue, as part of the cancer‐related fatigue (CRF) definition, in childhood cancer survivors (CCS). The second objective is to describe the course of severe fatigue following cancer treatment and examine risk factors for, or factors associated with, severe fatigue (e.g. demographic, life‐style, cancer and cancer treatment‐related factors and co‐morbidity). We will not include studies that assess the genetic basis of severe fatigue.
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Affiliation(s)
- Amilie Boonstra
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein‐Zuid 10NijmegenNetherlands6525 GA
| | - Eline van Dulmen‐den Broeder
- VU University Medical CenterDepartment of Pediatrics, Division of Oncology/HematologyPO Box 7057AmsterdamNetherlands1007 MB
| | - Maroeska M Rovers
- Radboud University Nijmegen Medical CentreDepartment of Operating RoomsHp 630, route 631PO Box 9101NijmegenNetherlands6500 HB
| | - Nicole Blijlevens
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein‐Zuid 10NijmegenNetherlands6525 GA
| | - Hans Knoop
- Academic Medical Centre, University of AmsterdamDepartment of Medical PsychologyMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Jacqueline Loonen
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein‐Zuid 10NijmegenNetherlands6525 GA
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21
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Beckham TH, Casey DL, LaQuaglia MP, Kushner BH, Modak S, Wolden SL. Renal Function Outcomes of High-risk Neuroblastoma Patients Undergoing Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 99:486-493. [PMID: 28872000 DOI: 10.1016/j.ijrobp.2017.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/04/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To analyze the renal function outcomes in patients undergoing radiation therapy for neuroblastoma. METHODS AND MATERIALS The clinical metrics of renal function were analyzed in patients undergoing radiation therapy for high-risk neuroblastoma from 2000 to 2015. The blood urea nitrogen (BUN) and creatinine values before radiation therapy were compared with last available follow-up values and analyzed with the clinical circumstances, including follow-up length, age at primary irradiation, nephrectomy, and radiation technique. The creatinine clearance was estimated using the Shull method. RESULTS With a median follow-up period of 3.5 years, none of the 266 patients studied developed a chronic renal insufficiency. For all patients, the creatinine level increased from 0.44 to 0.51 mg/dL and the BUN increased from 10.53 to 15.52 mg/dL. Three patients required antihypertensive medication. The patients who underwent intensity modulated radiation therapy did not experience increased creatinine levels during the follow-up period; however, they had a reduced median follow-up length compared with patients treated with anteroposterior/posteroanterior beams (4.7 vs 3.3 years). A longer follow-up length was associated with an increased creatinine level. The preradiation therapy creatinine level increased with patient age, similar to that of the last follow-up creatinine level, suggesting that the changes in creatinine could likely be explained by physiologic increases associated with aging rather than radiation-induced renal damage. The creatinine clearance did not decrease in any circumstance. CONCLUSIONS The present cohort had excellent renal outcomes after radiation therapy for neuroblastoma. No patient developed chronic renal insufficiency, and the small increases in BUN and creatinine we observed correlated, as expected, with increases in patient age. The results of the present study revealed a possible advantage for intensity modulated radiation therapy in preserving renal function; however, the follow-up length is a recognized confounding variable. The kidneys are vital structures to consider when planning radiation therapy for neuroblastoma patients, and we have found encouraging evidence that modern techniques to spare them in the setting of multiple treatment-related insults have been successful.
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Affiliation(s)
- Thomas H Beckham
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dana L Casey
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael P LaQuaglia
- Department of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brian H Kushner
- Department of Pediatric Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shakeel Modak
- Department of Pediatric Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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22
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Cisplatin nephrotoxicity: a review of the literature. J Nephrol 2017; 31:15-25. [DOI: 10.1007/s40620-017-0392-z] [Citation(s) in RCA: 307] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/11/2017] [Indexed: 12/22/2022]
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23
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McMahon KR, Rod Rassekh S, Schultz KR, Pinsk M, Blydt-Hansen T, Mammen C, Tsuyuki RT, Devarajan P, Cuvelier GDE, Mitchell LG, Baruchel S, Palijan A, Carleton BC, Ross CJD, Zappitelli M. Design and Methods of the Pan-Canadian Applying Biomarkers to Minimize Long-Term Effects of Childhood/Adolescent Cancer Treatment (ABLE) Nephrotoxicity Study: A Prospective Observational Cohort Study. Can J Kidney Health Dis 2017; 4:2054358117690338. [PMID: 28270931 PMCID: PMC5317038 DOI: 10.1177/2054358117690338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/14/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Childhood cancer survivors experience adverse drug events leading to lifelong health issues. The Applying Biomarkers to Minimize Long-Term Effects of Childhood/Adolescent Cancer Treatment (ABLE) team was established to validate and apply biomarkers of cancer treatment effects, with a goal of identifying children at high risk of developing cancer treatment complications associated with thrombosis, graft-versus-host disease, hearing loss, and kidney damage. Cisplatin is a chemotherapy well known to cause acute and chronic nephrotoxicity. Data on biomarkers of acute kidney injury (AKI) and late renal outcomes in children treated with cisplatin are limited. OBJECTIVE To describe the design and methods of the pan-Canadian ABLE Nephrotoxicity study, which aims to evaluate urine biomarkers (neutrophil gelatinase-associated lipocalin [NGAL] and kidney injury molecule-1 [KIM-1]) for AKI diagnosis, and determine whether they predict risk of long-term renal outcomes (chronic kidney disease [CKD], hypertension). DESIGN This is a 3-year observational prospective cohort study. SETTING The study includes 12 Canadian pediatric oncology centers. PATIENTS The target recruitment goal is 150 patients aged less than 18 years receiving cisplatin. Exclusion criteria: Patients with an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 or a pre-existing renal transplantation at baseline. MEASUREMENTS Serum creatinine (SCr), urine NGAL, and KIM-1 are measured during cisplatin infusion episodes (pre-infusion, immediate post-infusion, discharge sampling). At follow-up visits, eGFR, microalbuminuria, and blood pressure are measured and outcomes are collected. METHODS Outcomes: AKI is defined as per SCr criteria of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. CKD is defined as eGFR <90 mL/min/1.73m2 or albumin-to-creatinine ratio≥3mg/mmol. Hypertension is defined as per guidelines. Procedure: Patients are recruited before their first or second cisplatin cycle. Participants are evaluated during 2 cisplatin infusion episodes (AKI biomarker validation) and at 3, 12, and 36 months post-cisplatin treatment (late outcomes). LIMITATIONS The study has a relatively moderate sample size and short follow-up duration. There is potential for variability in data collection since multiple sites are involved. CONCLUSIONS ABLE will provide a national platform to study biomarkers of late cancer treatment complications. The Nephrotoxicity study is a novel study of AKI biomarkers in children treated with cisplatin that will greatly inform on late cisplatin renal outcomes and follow-up needs.
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Affiliation(s)
- Kelly R. McMahon
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Canada
| | - Shahrad Rod Rassekh
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Kirk R. Schultz
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Maury Pinsk
- Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | - Tom Blydt-Hansen
- Department of Pediatrics, Division of Pediatric Nephrology, British Columbia Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Cherry Mammen
- Department of Pediatrics, Division of Pediatric Nephrology, British Columbia Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Ross T. Tsuyuki
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Prasad Devarajan
- Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, OH, USA
| | - Geoff D. E. Cuvelier
- Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | - Lesley G. Mitchell
- Department of Pediatrics, Division of Hematology/Oncology, Stollery Children’s Hospital, University of Alberta, Edmonton, Canada
| | - Sylvain Baruchel
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Ana Palijan
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Canada
| | - Bruce C. Carleton
- Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Colin J. D. Ross
- Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Canada
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Abstract
The majority of medications in children are administered in an unlicensed or off-label manner. Paediatricians are obliged to prescribe using the limited evidence available. The 2007 EU regulation on the use of paediatric drugs means pharmaceutical companies are now obliged to (and receive incentives for) contributing to paediatric drug data and carrying out paediatric clinical trials. This is important, as the efficacy and adverse effect profiles of medicines vary across childhood. Additionally, there are significant age-related changes in the pharmacodynamic and pharmacokinetic activity of many drugs. This may be related to physiological (differential expressions of cytochrome P450 enzymes or variable glomerular filtration rates at different ages for example) and psychological (increasing autonomy and risk perception in teenage years) changes. Increasing numbers of children are surviving life-threatening childhood conditions due to medical advances. This means there is an increasing population who are at risk of the consequences of the long-term, early exposure to nephrotoxic agents. The kidney is an organ that is particularly vulnerable to damage as a consequence of drugs. Drug-induced acute kidney injury (AKI) episodes in children and babies are principally due to non-steroidal anti-inflammatory drugs, antibiotics or chemotherapeutic agents. The renal tubules are vulnerable to injury because of their concentrating ability and high-energy hypoxic environment. This review focuses on drug-induced AKI and the methods to minimise its effect, including general management plus the role of child-specific pharmacokinetic data, the use of pharmacogenomics and early detection of AKI using urinary biomarkers and electronic triggers.
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25
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Saban JA, Pizzi M, Caldwell J, Palijan A, Zappitelli M. Previous aminoglycoside use and acute kidney injury risk in non-critically ill children. Pediatr Nephrol 2017; 32:173-179. [PMID: 27718084 DOI: 10.1007/s00467-016-3471-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 07/18/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Aminoglycosides (AG) are a group of bactericidal antibiotics with nephrotoxic effects that are commonly used in the treatment of hospitialized children. We have examined previous AG treatment as a risk factor for acute kidney injury (AKI) during current AG treatment. STUDY DESIGN We performed a retrospective cohort study of children ranging in age from 1 month to 18 years who were treated with AG between October 2008 and April 2012 at Montreal's Children's Hospital. Children for whom no serum creatinine data (SCr) were available and those with baseline renal disease were excluded from the analysis. Main exposures were prior AG use (number and hours of prior treatments) and time since last AG treatment. The main outcome was AKI, defined on the basis of the Kidney Disease: Improving Global Outcomes guidelines. Logistic regression was used to examine exposure-outcome associations. RESULTS AG treatments episodes with Stage 1, 2, and 3 AKI, respectively, were associated with a median of 98 [interquartile range (IQR) 339], 231 (IQR 688), and 111 (IQR 505) h of prior AG treatment, respectively, versus non-AKI (median 0, IQR 54 h) (p < 0.0001). AKI episodes were associated with a mean (± standard deviation) of 1.5 ± 1.8 AG treatments in the previous 6 months, versus 0.9 ± 1.6 AG treatments for non-AKI. The number of AG-treatment days during the preceding 6 months [adjusted odds ratio (adjOR) 1.04, 95 % confidence interval (CI) 1.03-1.06; p < 0.001], younger age (adjOR 0.96, 95 % CI 0.93-0.99; p = 0.009), admission to hematology-oncology department (adjOR 3.88, 95 % CI 2.17-6.96; p < 0.001), and tobramycin use (adjOR 1.77, 95 % CI 1.04-3.02; p = 0.04) were independently associated with AKI. Episodes with Stage 1 and 2 AKI were associated with fewer days since last treatment compared to non-AKI treatment (p < 0.02 and p < 0.005, respectively; Mann-Whitney test). CONCLUSIONS Based on these results, prior AG treatment is a risk factor for AKI and should be considered when dosing and monitoring hospitalized children being treated with AG.
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Affiliation(s)
- Jeremy Andrew Saban
- Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, Quebec, Canada
| | - Michael Pizzi
- Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, Quebec, Canada
| | - Jillian Caldwell
- Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, Quebec, Canada
| | - Ana Palijan
- Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, Quebec, Canada
| | - Michael Zappitelli
- Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, Quebec, Canada.
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26
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Beck A, Eberherr C, Hagemann M, Cairo S, Häberle B, Vokuhl C, von Schweinitz D, Kappler R. Connectivity map identifies HDAC inhibition as a treatment option of high-risk hepatoblastoma. Cancer Biol Ther 2016; 17:1168-1176. [PMID: 27635950 DOI: 10.1080/15384047.2016.1235664] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Hepatoblastoma (HB) is the most common liver tumor of childhood, usually occurring in children under the age of 3 y. The prognosis of patients presenting with distant metastasis, vascular invasion and advanced tumor stages remains poor and children that do survive often face severe late effects from the aggressive chemotherapy regimen. To identify potential new therapeutics for high risk HB we used a 1,000-gene expression signature as input for a Connectivity Map (CMap) analysis, which predicted histone deacetylase (HDAC) inhibitors as a promising therapy option. Subsequent expression analysis of primary HB and HB cell lines revealed a general overexpression of HDAC1 and HDAC2, which has been suggested to be predictive for the efficacy of HDAC inhibition. Accordingly, treatment of HB cells with the HDAC inhibitors SAHA and MC1568 resulted in a potent reduction of cell viability, induction of apoptosis, reactivation of epigenetically suppressed tumor suppressor genes, and the reversion of the 16-gene HB classifier toward the more favorable expression signature. Most importantly, the combination of HDAC inhibitors and cisplatin - a major chemotherapeutic agent of HB treatment - revealed a strong synergistic effect, even at significantly reduced doses of cisplatin. Our findings suggest that HDAC inhibitors skew HB cells toward a more favorable prognostic phenotype through changes in gene expression, thus indicating a targeted molecular mechanism that seems to enhance the anti-proliferative effects of conventional chemotherapy. Thus, adding HDAC inhibitors to the treatment regimen of high risk HB could potentially improve outcomes and reduce severe late effects.
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Affiliation(s)
- Alexander Beck
- a Department of Pediatric Surgery, Dr. von Hauner Children's Hospital , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Corinna Eberherr
- a Department of Pediatric Surgery, Dr. von Hauner Children's Hospital , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Michaela Hagemann
- a Department of Pediatric Surgery, Dr. von Hauner Children's Hospital , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Stefano Cairo
- b XenTech , 4 rue Pierre Fontaine , Evry , France.,c University of Ferrara, LTTA Center, Department of Morphology , Surgery and Experimental Medicine, Via Fossato di Mortara , Ferrara , Italy
| | - Beate Häberle
- a Department of Pediatric Surgery, Dr. von Hauner Children's Hospital , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Christian Vokuhl
- d Institute of Paidopathology, Pediatric Tumor Registry, Christian-Albrechts-University Kiel , Kiel , Germany
| | - Dietrich von Schweinitz
- a Department of Pediatric Surgery, Dr. von Hauner Children's Hospital , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Roland Kappler
- a Department of Pediatric Surgery, Dr. von Hauner Children's Hospital , Ludwig-Maximilians-University Munich , Munich , Germany
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Tarín JJ, García-Pérez MA, Cano A. Obstetric and offspring risks of women's morbid conditions linked to prior anticancer treatments. Reprod Biol Endocrinol 2016; 14:37. [PMID: 27386839 PMCID: PMC4936115 DOI: 10.1186/s12958-016-0169-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 06/16/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Literature shows the effects of type of cancer and/or anticancer treatment on live birth percentages and/or pregnancy and neonatal complications in female cancer survivors. However, studies analyzing the obstetric and offspring risks of the morbid conditions associated with previous anti-cancer treatments are missing. The present review aims to uncover these risks. METHODS A literature search based on publications up to March 2016 identified by PubMed and references cited in relevant articles. RESULTS The morbid conditions associated with prior anticancer treatments including chemotherapy, radiotherapy, surgery, and/or hematopoietic stem-cell transplant may induce not only obstetric and neonatal complications but also long-term effects on offspring. Whereas some risks are predominantly evidenced in untreated women others are observed in both treated and untreated women. These risks may be superimposed on those induced by the current women's trend in Western societies to postpone maternity. CONCLUSIONS Medical professionals should be aware and inform female cancer survivors wishing to have a child not only of the short- and long-term risks to themselves and their prospective offspring of previous anticancer treatments, fertility-preservation technologies, and pregnancy itself, but also of those risks linked to the morbid conditions induced by prior anticancer treatments. Once female cancer survivors wishing to have a child have been properly informed about the risks of reproduction, they will be best placed to make decisions of whether or not to have a biological or donor-conceived child. In addition, when medical professionals be aware of these risks, they will be also best placed to provide appropriate treatments before/during pregnancy in order to prevent or alleviate the impact of these morbid conditions on maternal and offspring health.
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Affiliation(s)
- Juan J. Tarín
- Department of Cellular Biology, Functional Biology and Physical Anthropology, Faculty of Biological Sciences, University of Valencia, Burjassot, Valencia, 46100 Spain
| | - Miguel A. García-Pérez
- Department of Genetics, Faculty of Biological Sciences, University of Valencia, Burjassot, Valencia, 46100 Spain
- Research Unit-INCLIVA, Hospital Clínico de Valencia, Valencia, 46010 Spain
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Valencia, Valencia, 46010 Spain
- Service of Obstetrics and Gynecology, University Clinic Hospital, Valencia, 46010 Spain
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Skrypnyk NI, Siskind LJ, Faubel S, de Caestecker MP. Bridging translation for acute kidney injury with better preclinical modeling of human disease. Am J Physiol Renal Physiol 2016; 310:F972-84. [PMID: 26962107 PMCID: PMC4889323 DOI: 10.1152/ajprenal.00552.2015] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/04/2016] [Indexed: 12/14/2022] Open
Abstract
The current lack of effective therapeutics for patients with acute kidney injury (AKI) represents an important and unmet medical need. Given the importance of the clinical problem, it is time for us to take a few steps back and reexamine current practices. The focus of this review is to explore the extent to which failure of therapeutic translation from animal studies to human studies stems from deficiencies in the preclinical models of AKI. We will evaluate whether the preclinical models of AKI that are commonly used recapitulate the known pathophysiologies of AKI that are being modeled in humans, focusing on four common scenarios that are studied in clinical therapeutic intervention trials: cardiac surgery-induced AKI; contrast-induced AKI; cisplatin-induced AKI; and sepsis associated AKI. Based on our observations, we have identified a number of common limitations in current preclinical modeling of AKI that could be addressed. In the long term, we suggest that progress in developing better preclinical models of AKI will depend on developing a better understanding of human AKI. To this this end, we suggest that there is a need to develop greater in-depth molecular analyses of kidney biopsy tissues coupled with improved clinical and molecular classification of patients with AKI.
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Affiliation(s)
- Nataliya I Skrypnyk
- Division of Nephology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Leah J Siskind
- Department of Pharmacology and Toxicology, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky; and
| | - Sarah Faubel
- Renal Division, University of Colorado Denver and Denver Veterans Affairs Medical Center, Aurora, Colorado
| | - Mark P de Caestecker
- Division of Nephology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee;
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29
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ter Haar E, Labarque V, Tousseyn T, Mekahli D. Severe acute kidney injury as presentation of Burkitt's lymphoma. BMJ Case Rep 2016; 2016:bcr-2016-214780. [PMID: 27118748 DOI: 10.1136/bcr-2016-214780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We discuss a case of acute kidney injury (AKI) at a very young age caused by primary lymphomatous renal infiltration due to Burkitt's lymphoma and analyse the literature on this rare condition. At presentation, clinical examination showed impressive bilateral nephromegaly and hypertension. Blood analysis indicated severe AKI, mild anaemia and normal serum electrolytes. There were no signs of tumour lysis syndrome. Urine sediment was normal, with neither haematuria nor proteinuria. Abdominal ultrasound demonstrated bilateral renal enlargement (+12 SD), with increased corticomedullar differentiation. MRI demonstrated the presence of a homogenous renal enlargement with features of an infiltrative lesion. Ultimately, microscopic and immunohistochemical analysis of the renal biopsy confirmed the diagnosis of Burkitt's lymphoma. Early and aggressive therapy is the key to ensure a good outcome.
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Affiliation(s)
- Eva ter Haar
- Department of Pediatric Hemato-oncology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Veerle Labarque
- Department of Pediatric Hemato-oncology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Thomas Tousseyn
- Department of Pathology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Djalila Mekahli
- Department of Pediatric Nephrology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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30
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Lanvers-Kaminsky C, Sprowl JA, Malath I, Deuster D, Eveslage M, Schlatter E, Mathijssen RH, Boos J, Jürgens H, Am Zehnhoff-Dinnesen AG, Sparreboom A, Ciarimboli G. Human OCT2 variant c.808G>T confers protection effect against cisplatin-induced ototoxicity. Pharmacogenomics 2016; 16:323-32. [PMID: 25823781 DOI: 10.2217/pgs.14.182] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
AIM Assuming that genetic variants of the SLC22A2 and SLC31A1 transporter affect patients' susceptibility to cisplatin-induced ototoxicity, we compared the distribution of 11 SLC22A2 variants and the SLC31A1 variant rs10981694 between patients with and without cisplatin-induced ototoxicity. PATIENTS & METHODS Genotyping was performed in 64 pediatric patients and significant findings were re-evaluated in 66 adults. RESULTS The SLC22A2 polymorphism rs316019 (c.808G>T; Ser270Ala) was significantly associated with protection from cisplatin-induced ototoxicity in the pediatric (p = 0.022) and the adult cohort (p = 0.048; both: Fisher's exact test). This result was confirmed by multiple logistic regression analysis accounting for age which was identified as a relevant factor for ototoxicity as well (rs316019: OR [G/T vs G/G] = 0.12, p = 0.009; age: OR [per year]: 0.84, p = 0.02). CONCLUSION These results identified rs316019 as potential pharmacogenomic marker for cisplatin-induced ototoxicity and point to a critical role of SLC22A2 for cisplatin transport in humans and its contribution to the organ specific side effects of this drug. Original submitted 17 September 2014; Revision submitted 19 December 2014.
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Affiliation(s)
- Claudia Lanvers-Kaminsky
- Department of Pediatric Hematology & Oncology, University Children's Hospital of Muenster, Muenster, Germany
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31
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Rodieux F, Wilbaux M, van den Anker JN, Pfister M. Effect of Kidney Function on Drug Kinetics and Dosing in Neonates, Infants, and Children. Clin Pharmacokinet 2015; 54:1183-204. [PMID: 26138291 PMCID: PMC4661214 DOI: 10.1007/s40262-015-0298-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neonates, infants, and children differ from adults in many aspects, not just in age, weight, and body composition. Growth, maturation and environmental factors affect drug kinetics, response and dosing in pediatric patients. Almost 80% of drugs have not been studied in children, and dosing of these drugs is derived from adult doses by adjusting for body weight/size. As developmental and maturational changes are complex processes, such simplified methods may result in subtherapeutic effects or adverse events. Kidney function is impaired during the first 2 years of life as a result of normal growth and development. Reduced kidney function during childhood has an impact not only on renal clearance but also on absorption, distribution, metabolism and nonrenal clearance of drugs. 'Omics'-based technologies, such as proteomics and metabolomics, can be leveraged to uncover novel markers for kidney function during normal development, acute kidney injury, and chronic diseases. Pharmacometric modeling and simulation can be applied to simplify the design of pediatric investigations, characterize the effects of kidney function on drug exposure and response, and fine-tune dosing in pediatric patients, especially in those with impaired kidney function. One case study of amikacin dosing in neonates with reduced kidney function is presented. Collaborative efforts between clinicians and scientists in academia, industry, and regulatory agencies are required to evaluate new renal biomarkers, collect and share prospective pharmacokinetic, genetic and clinical data, build integrated pharmacometric models for key drugs, optimize and standardize dosing strategies, develop bedside decision tools, and enhance labels of drugs utilized in neonates, infants, and children.
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Affiliation(s)
- Frederique Rodieux
- Department of Pediatric Clinical Pharmacology, Pediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital (UKBB), University of Basel, Spitalstrasse 33, CH-4056, Basel, Switzerland.
| | - Melanie Wilbaux
- Department of Pediatric Clinical Pharmacology, Pediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital (UKBB), University of Basel, Spitalstrasse 33, CH-4056, Basel, Switzerland
| | - Johannes N van den Anker
- Department of Pediatric Clinical Pharmacology, Pediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital (UKBB), University of Basel, Spitalstrasse 33, CH-4056, Basel, Switzerland.
- Division of Pediatric Clinical Pharmacology, Children's National Health System, Washington, DC, USA.
- Intensive Care, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Marc Pfister
- Department of Pediatric Clinical Pharmacology, Pediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital (UKBB), University of Basel, Spitalstrasse 33, CH-4056, Basel, Switzerland
- Quantitative Solutions LP, Menlo Park, CA, USA
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32
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Mulder RL, Paulides M, Langer T, Kremer LCM, van Dalen EC. Cyclophosphamide versus ifosfamide for paediatric and young adult bone and soft tissue sarcoma patients. Cochrane Database Syst Rev 2015; 2015:CD006300. [PMID: 26421585 PMCID: PMC7389335 DOI: 10.1002/14651858.cd006300.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Alkylating agents, such as cyclophosphamide and ifosfamide, play a major role in the improved survival of children and young adults with bone and soft tissue sarcoma. However, there is still controversy as to their comparative anti-tumour efficacy and possible adverse effects. This is the second update of the first systematic review evaluating the state of evidence on the effectiveness of cyclophosphamide as compared to ifosfamide for paediatric and young adult patients with sarcoma. OBJECTIVES The primary obective was to compare the effectiveness, that is response rate, event-free survival and overall survival, of cyclophosphamide with that of ifosfamide for paediatric and young adult patients with sarcoma. Secondary objectives were to determine effects of these agents on toxicities (including late effects) and quality of life. SEARCH METHODS We searched CENTRAL (The Cochrane Library 2015, issue 2), MEDLINE/PubMed (from 1966 to March 2015) and EMBASE/Ovid (from 1980 to March 2015) with prespecified terms. In addition, we searched reference lists of relevant articles, conference proceedings and ongoing trial databases (www.controlled-trials.com; searched June 2015). SELECTION CRITERIA Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) comparing cyclophosphamide and ifosfamide for the treatment of different types of sarcoma in paediatric and young adult patients (aged less than 30 years at diagnosis). Chemotherapy other than either cyclophosphamide or ifosfamide should have been the same in both treatment groups. DATA COLLECTION AND ANALYSIS Two authors independently performed the study selection. MAIN RESULTS No studies meeting the inclusion criteria of the review were identified. AUTHORS' CONCLUSIONS No RCTs or CCTs comparing the effectiveness of cyclophosphamide and ifosfamide in the treatment of bone and soft tissue sarcoma in children and young adults were identified. Therefore no definitive conclusions can be made about the effects of cyclophosphamide and ifosfamide in these patients. Based on the currently available evidence, we are not able to give recommendations for clinical practice. More high-quality research is needed.
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Affiliation(s)
- Renée L Mulder
- Emma Children's Hospital/Academic Medical CenterDepartment of Paediatric OncologyP.O. Box 22660AmsterdamNetherlands1100 DD
| | - Marios Paulides
- Drug Commission of the German Medical AssociationHerbert‐Lewin‐Platz 1BerlinGermany10623
| | - Thorsten Langer
- University Hospital for Children and AdolescentsPediatric Oncology HematologyRatzeburger Allee 160LübeckGermany23538
| | - Leontien CM Kremer
- Emma Children's Hospital/Academic Medical CenterDepartment of Paediatric OncologyP.O. Box 22660AmsterdamNetherlands1100 DD
| | - Elvira C van Dalen
- Emma Children's Hospital/Academic Medical CenterDepartment of Paediatric OncologyP.O. Box 22660AmsterdamNetherlands1100 DD
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Romao RLP, Lorenzo AJ. Renal function in patients with Wilms tumor. Urol Oncol 2015; 34:33-41. [PMID: 26278364 DOI: 10.1016/j.urolonc.2015.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 12/18/2022]
Abstract
Survival in patients with Wilms tumor (WT) is excellent compared with other pediatric malignancies and adult renal tumors. Treatment-related long-term morbidity and mortality in WT survivors is an area of increasing concern. Renal dysfunction is an example of one of the most feared long-term issues observed in these survivors. Direct toxicity from chemotherapy and radiation as well as direct nephron ablation from surgical treatment (nephrectomy) renders the kidney susceptible to a multitude of problems over time in patients with WT. In this article, we review the existing literature pertaining to renal function in these patients. Incidence rates, causes, and methods to mitigate renal dysfunction are presented in 3 distinct clinical situations: sporadic unilateral WT, syndromic unilateral WT, and bilateral WT. We also offer a critical lens on the current role of nephron-sparing surgery as a means to preserve renal function in these patients. Finally, we discuss potential avenues for refining renal function preservation in patients with WT in the future. We conclude that: (1) renal function in pediatric cancer survivors must be carefully ascertained prospectively using methods that allow diagnosis of mild cases (rather than focus solely on extreme cases represented by the development of end-stage renal disease), (2) every effort should be made to recognize subtle features of predisposition syndromes to avoid syndromic cases from being misclassified and treated as sporadic, (3) molecular stratification for disease aggressiveness as well as multifocality and renal dysfunction will be very important to tailor treatment and balance survival with preservation of renal function, and (4) the role and potential benefits of nephron-sparing surgery deserves careful exploration under well-designed protocols.
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Affiliation(s)
- Rodrigo L P Romao
- Division of Urology, Division of Pediatric General Surgery, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Armando J Lorenzo
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Sudour-Bonnange H, Vanrenterghem A, Nobili F, Guigonis V, Boudailliez B. [Renal late effects in patients treated for cancer in childhood]. Bull Cancer 2015; 102:627-35. [PMID: 25935232 DOI: 10.1016/j.bulcan.2015.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/31/2015] [Indexed: 11/24/2022]
Abstract
Impaired renal function may occur following multimodal treatment of cancer in childhood. Renal late effects caused by chemotherapy, renal surgery and/or radiotherapy are now well described; but little is known about their prevalence and time of development. Herein, we provide a synthesis of the different renal complications that may occur with their physiopathology in relation with specific treatment exposures. This review summarized the literature that supported the recommendations issued by the long-term follow-up group of the "Société française des cancers de l'enfant (SFCE)" for childhood cancer survivors at risk for nephrotoxicity (www.sfce.org ; www.soc-nephrologie.org/SNP/index.htm). We developed these monitoring elements and the lifestyle recommendations for all asymptomatic survivors.
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Affiliation(s)
- Hélène Sudour-Bonnange
- Centre Oscar-Lambret, unité d'oncologie pédiatrique, 3, rue Frederic-Combemale, 59000 Lille, France.
| | | | - François Nobili
- CHU de Besançon, service de pédiatrie, réanimation-néphrologie infantile, 25000 Besançon, France
| | - Vincent Guigonis
- Hôpital de la Mère et de l'Enfant, Département de pédiatrie, 87000 Limoges, France
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35
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Holtzman AL, Hoppe BS, Li Z, Su Z, Slayton WB, Ozdemir S, Joyce M, Sandler E, Mendenhall NP, Flampouri S. Advancing the Therapeutic Index in Stage III/IV Pediatric Hodgkin Lymphoma with Proton Therapy. Int J Part Ther 2014. [DOI: 10.14338/ijpt.14.00001.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Barnes N, Chemaitilly W. Endocrinopathies in survivors of childhood neoplasia. Front Pediatr 2014; 2:101. [PMID: 25295241 PMCID: PMC4172013 DOI: 10.3389/fped.2014.00101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/06/2014] [Indexed: 01/26/2023] Open
Abstract
Advancements in cancer treatments have increased the number of survivors of childhood cancers. Endocrinopathies are common complications following cancer therapy and may occur decades later. The objective of the current review is to address the main endocrine abnormalities detected in childhood cancer survivors including disorders of the hypothalamic-pituitary axis, thyroid, puberty, gonads, bone, body composition, and glucose metabolism.
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Affiliation(s)
- Nicole Barnes
- Division of Pediatric Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, TN , USA
| | - Wassim Chemaitilly
- Division of Pediatric Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, TN , USA ; Epidemiology and Cancer Control, St. Jude Children's Research Hospital , Memphis, TN , USA
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