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Ali N, Selim M, Salah Z, El Nabarawy NM, Hussein H, Sidhom I. Cardiovascular and Thyroid Late Effects in Pediatric Patients With Hodgkin Lymphoma Treated With ABVD Protocol. J Pediatr Hematol Oncol 2023; 45:e455-e463. [PMID: 36898022 DOI: 10.1097/mph.0000000000002638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/10/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Hodgkin lymphoma (HL) survivors are at risk of developing a range of therapy-related complications. The goal of this study is to investigate therapy-related late-effects in HL survivors. MATERIALS AND METHODS We performed a cross-sectional study on 208 HL survivors who were treated at the National Cancer Institute or at the Children Cancer Hospital Egypt with doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy. RESULTS Age at diagnosis ranged from 2.5 to 17.5 with a median of 8.7 years. The cumulative incidence of cardiac toxicity at 5 and 9 years were 18.7%±2.7% and 43.3%±4.4%, respectively. Preexisting cardiac abnormalities, cumulative anthracycline dose, and end of treatment cardiac status are strong predictors of late cardiotoxicity. Hypertension was observed in ~31% of patients. Young age and obesity at the time of treatment are important risk factors for hypertension. Thyroid abnormalities developed with a 5-year cumulative incidence of 2%±1%, whereas at 9 years the cumulative incidence was 27.9%±4.5%. Thyroid dysfunction was observed in 21.2% and thyroid tumors in 1.6% of cases. Subclinical hypothyroidism was the most common thyroid abnormality. CONCLUSIONS Cardiotoxicity, hypertension, and thyroid dysfunction are frequent late effects after doxorubicin, bleomycin, vinblastine, and dacarbazine regimen, especially if combined with radiation therapy.
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Affiliation(s)
- Nesreen Ali
- Department of Pediatric Oncology, National Cancer Institute
| | - Mustafa Selim
- Department of Pediatric Oncology, National Cancer Institute
| | - Zeinab Salah
- Department of Pediatric Cardiology, Faculty of Medicine, Cairo University and Children Cancer Hospital
| | | | - Hany Hussein
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Egypt
| | - Iman Sidhom
- Department of Pediatric Oncology, National Cancer Institute
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Katano A, Minamitani M, Yamashita H, Nakagawa K. Delayed Onset of Pleural Effusion After Thoracic Radiation Therapy for Hodgkin Lymphoma: A Case Report With Over 30-Year Follow-Up. Cureus 2022; 14:e27138. [PMID: 36017284 PMCID: PMC9392964 DOI: 10.7759/cureus.27138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/05/2022] Open
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Zahnreich S, Schmidberger H. Childhood Cancer: Occurrence, Treatment and Risk of Second Primary Malignancies. Cancers (Basel) 2021; 13:cancers13112607. [PMID: 34073340 PMCID: PMC8198981 DOI: 10.3390/cancers13112607] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/14/2022] Open
Abstract
Cancer represents the leading cause of disease-related death and treatment-associated morbidity in children with an increasing trend in recent decades worldwide. Nevertheless, the 5-year survival of childhood cancer patients has been raised impressively to more than 80% during the past decades, primarily attributed to improved diagnostic technologies and multiagent cytotoxic regimens. This strong benefit of more efficient tumor control and prolonged survival is compromised by an increased risk of adverse and fatal late sequelae. Long-term survivors of pediatric tumors are at the utmost risk for non-carcinogenic late effects such as cardiomyopathies, neurotoxicity, or pneumopathies, as well as the development of secondary primary malignancies as the most detrimental consequence of genotoxic chemo- and radiotherapy. Promising approaches to reducing the risk of adverse late effects in childhood cancer survivors include high precision irradiation techniques like proton radiotherapy or non-genotoxic targeted therapies and immune-based treatments. However, to date, these therapies are rarely used to treat pediatric cancer patients and survival rates, as well as incidences of late effects, have changed little over the past two decades in this population. Here we provide an overview of the epidemiology and etiology of childhood cancers, current developments for their treatment, and therapy-related adverse late health consequences with a special focus on second primary malignancies.
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Rascon J, Smailytė G. Improvement in childhood cancer survival in Lithuania over three decades. Acta Med Litu 2020; 27:1-9. [PMID: 32577090 DOI: 10.6001/actamedica.v27i1.4260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Population-based EUROCARE-5 studies demonstrated that childhood cancer survival rates in Lithuania were 10-20% lower than the European mean. We aimed to analyse the change in the outcome of treatment of paediatric malignancies in Lithuania over 30 years. Methods A single-centre retrospective analysis of children below 18 years of age treated for cancer at Vilnius University Hospital Santaros Klinikos between 1982 and 2011 was carried out. The minimal requirement of 5-year follow-up after diagnosis was specified for survival estimation. The vital status was assessed using data from the population-based Lithuanian Cancer Registry. To evaluate changes over time, the entire cohort was split into three groups according to the time of diagnosis: 1982-1991, 1992-2001, and 2002-2011. Results A total of 1268 children met the inclusion criteria. The shortest median follow-up was 8.9 (IQR 6.4-11.5) years for patients treated in the third decade. The 5-year overall survival of the entire cohort increased from 37.3% (95% CI 30.2-44.3) in 1982-1991 to 70.7% (95% CI 66.4-74.1) in 2002-2011 (p < 0.0001). The same trend was evident when calculated separately for leukaemia (p < 0.0001), lymphoma (p < 0.0005), and solid tumours (p < 0.004). The percentage of cure rose from zero in the early years of the period analysed to 80% in 2010 and 2011. The improvement in the treatment outcome was attributable to the reduction of treatment-related mortality from 45.8% in 1982-1991 to 12.4% in 2002-2011 and disease recurrence from 30.4% to 19.6% for the same periods, respectively. Conclusions Significant progress in the cure rate of children treated for cancer at our institution was observed over 30 years. Collaborative national and international clinical and research efforts are crucial to ensure further advances in care and cure.
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Affiliation(s)
- Jelena Rascon
- Centre for Paediatric Oncology and Haematology, Vilnius University, Vilnius, Lithuania
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Šalaševičius L, Vaitkevičienė GE, Pasaulienė R, Kiudelienė R, Ivanauskaitė-Didžiokienė E, Vajauskas D, Jurkienė N, Rascon J. Early Radiation-Induced Sarcoma in an Adolescent Treated for Relapsed Hodgkin Lymphoma with Nivolumab. MEDICINA-LITHUANIA 2020; 56:medicina56040155. [PMID: 32244416 PMCID: PMC7230437 DOI: 10.3390/medicina56040155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/04/2020] [Accepted: 03/25/2020] [Indexed: 11/17/2022]
Abstract
Radiation-induced sarcoma (RIS) has been reported as a late secondary malignancy following radiotherapy for various types of cancer with a median latency of 10 years. We describe an early RIS that developed in an adolescent within three years of treatment (including PD-L1 check-point inhibitor Nivolumab) of a relapsed classic Hodgkin lymphoma (HL) and was diagnosed post-mortem. The patient died of the progressive RIS that was misleadingly assumed to be a resistant HL based on the positive PET/CT scan. Repetitive tumor biopsies are warranted in cases of aggressive and multi-drug resistant HL to validate imaging findings, ensure correct diagnosis and avoid overtreatment.
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Affiliation(s)
- Lukas Šalaševičius
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.Š.); (G.E.V.)
| | - Goda Elizabeta Vaitkevičienė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.Š.); (G.E.V.)
- Center for Pediatric Oncology and Hematology, Vilnius University, 08406 Vilnius, Lithuania;
| | - Ramunė Pasaulienė
- Center for Pediatric Oncology and Hematology, Vilnius University, 08406 Vilnius, Lithuania;
| | - Rosita Kiudelienė
- Center of Pediatric Oncology and Hematology at Pediatric Department and Hospital of Kauno Klinikos, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | | | - Donatas Vajauskas
- Institute of Biomedical Sciences, Department of Radiology, Nuclear Medicine and Medical Physics, Vilnius University, 03101 Vilnius, Lithuanian;
- Radiology and Nuclear Medicine Center, Department of Nuclear Medicine, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Nemira Jurkienė
- Radiology Clinic, Nuclear Medicine Department of Kauno Klinikos, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Jelena Rascon
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.Š.); (G.E.V.)
- Center for Pediatric Oncology and Hematology, Vilnius University, 08406 Vilnius, Lithuania;
- Correspondence:
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Voss SD, Cairo MS. Surveillance imaging in pediatric lymphoma. Pediatr Radiol 2019; 49:1565-1573. [PMID: 31620855 DOI: 10.1007/s00247-019-04511-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/03/2019] [Accepted: 08/12/2019] [Indexed: 11/29/2022]
Abstract
Current therapies used in treating children with Hodgkin lymphoma and many histological subtypes of non-Hodgkin lymphoma have resulted in overall survival rates exceeding 90% in many instances. With increasing concerns related to the cost of radiologic imaging, exposure to ionizing radiation, and potential false-positive results, the role of routine off-therapy surveillance imaging has been called into question. Although radiologic imaging plays an important role in diagnosing and assessing treatment response, in these children - the majority of whom have an excellent outcome following completion of therapy - there is an opportunity to dramatically reduce the number of off-therapy imaging evaluations. This review summarizes several recent studies in both Hodgkin and non-Hodgkin lymphoma providing evidence to support these efforts. In addition, we propose a surveillance imaging strategy that uses a novel risk-adapted and response-based approach to determine which children would most benefit from off-therapy imaging surveillance.
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Affiliation(s)
- Stephan D Voss
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Mitchell S Cairo
- Department of Pediatric Hematology,Oncology, and Stem Cell Transplantation, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Mauz-Körholz C, Ströter N, Baumann J, Botzen A, Körholz K, Körholz D. Pharmacotherapeutic Management of Pediatric Lymphoma. Paediatr Drugs 2018; 20:43-57. [PMID: 29127674 DOI: 10.1007/s40272-017-0265-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) comprise approximately 15% of all childhood malignancies. Cure rates for both lymphoma entities have evolved tremendously during the last couple of decades, raising the 5-year survival rates to almost 100% for HL and to 85% for NHL. The mainstay therapy for both malignancies is still chemotherapy-with different regimens recommended for different types of disease. In HL, combined modality treatment, i.e., chemotherapy followed by radiotherapy, has long been the standard regimen. In order to reduce long-term side effects, such as second malignancies, most major pediatric HL consortia have studied response-based radiotherapy reduction strategies over the last 3 decades. For recurrent disease, high-dose chemotherapy followed by an autologous or an allogeneic hematopoietic stem-cell transplant is an option. No targeted agents have yet gained regulatory approval for use in pediatric patients with lymphoma. For adult lymphoma patients, the CD20 antibody rituximab and the CD30 antibody-drug conjugate brentuximab vedotin are targeted agents used regularly in first- and second-line treatment regimens. More recently, immune checkpoint inhibitors, phosphatidyl-inositol-3-kinase inhibitors, and Bruton's tyrosine kinase inhibitors appear to be very promising new treatment options in adult lymphoma. Here, we discuss the current experience with these types of agents in pediatric lymphoma patients.
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Affiliation(s)
- Christine Mauz-Körholz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany. .,Medical Faculty of the Martin-Luther-University of Halle-Wittenberg, Halle, Germany.
| | - Natascha Ströter
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany
| | - Julia Baumann
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany
| | - Ante Botzen
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany
| | - Katharina Körholz
- Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research center (DKFZ), Heidelberg, Germany
| | - Dieter Körholz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany
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Derman YE. Clinical Practice Recommendations Based on an Updated Review of Breast Cancer Risk Among Women Treated for Childhood Cancer. J Pediatr Oncol Nurs 2017; 35:65-78. [PMID: 28863725 DOI: 10.1177/1043454217727515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Breast cancer is the most common secondary malignancy among women treated for childhood cancer. This review highlights interacting etiologies contributing to development of secondary breast cancer to complement guidelines for surveillance and survivorship care and make recommendations for clinical practice. Treatment exposures determine Children's Oncology Group breast cancer surveillance guidelines; those treated with cumulative doses ≥20 Gy chest irradiation should undergo annual magnetic resonance imaging and mammography after age 25 years or 8 years after exposure, whichever comes last. Recent investigations suggest that those treated with cumulative doses ≥10 Gy in fields affecting breast tissue, specifically whole lung, should be counseled for similar surveillance. Childhood sarcoma and leukemia survivors treated with anthracyclines and/or alkylating agents without radiation have increased risk for breast cancer and may require enhanced surveillance. Multigene testing and/or genomic evaluation for predisposition among certain childhood cancer subtypes may prove to be beneficial in identifying those at greatest risk. Pediatric oncology nurses who incorporate this information into survivorship care planning discussions/documents and clinical research endeavors may help reduce breast cancer-related morbidity/mortality for this at-risk population.
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Affiliation(s)
- Yael E Derman
- 1 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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