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Poyer F, Dieckmann K, Dworzak M, Tamesberger M, Haas O, Jones N, Nebral K, Köhrer S, Moser R, Kropshofer G, Peters C, Urban C, Mann G, Pötschger U, Attarbaschi A. Second malignant neoplasms after treatment of 1487 children and adolescents with acute lymphoblastic leukemia-A population-based analysis of the Austrian ALL-BFM Study Group. EJHAEM 2022; 3:940-948. [PMID: 36051012 PMCID: PMC9421960 DOI: 10.1002/jha2.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/07/2022]
Abstract
Second malignant neoplasms (SMN) after primary childhood acute lymphoblastic leukemia (ALL) are rare. Among 1487 ALL patients diagnosed between 1981 and 2010 in Austria, the 10-year cumulative incidence of an SMN was 1.1% ± 0.3%. There was no difference in the 10-year incidence of SMNs with regard to diagnostic-, response- and therapy-related ALL characteristics except for a significantly higher incidence in patients with leukocytes ≥50.0 G/L at ALL diagnosis (2.1% ± 1.0% vs. 0% for 20.0-50.0 G/L, and 1.0% ± 0.3% for < 20.0 G/L; p = 0.033). Notably, there was no significant difference in the incidence of SMNs between patients with or without cranial radiotherapy (1.2% ± 0.5% vs. 0.8% ± 0.3%; p = 0.295). Future strategies must decrease the incidence of SMNs, as this event still leads to death in one-third (7/19) of the patients.
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Affiliation(s)
- Fiona Poyer
- Department of Pediatric Hematology and Oncology, St. Anna Children's HospitalMedical University of ViennaViennaAustria
| | - Karin Dieckmann
- Department of RadiotherapyMedical University of ViennaViennaAustria
| | - Michael Dworzak
- Department of Pediatric Hematology and Oncology, St. Anna Children's HospitalMedical University of ViennaViennaAustria
- St. Anna Children's Cancer Research Institute (CCRI)ViennaAustria
| | - Melanie Tamesberger
- Department of Pediatrics and Adolescent MedicineKepler University Hospital LinzLinzAustria
| | - Oskar Haas
- St. Anna Children's Cancer Research Institute (CCRI)ViennaAustria
- Labdia DiagnosticsViennaAustria
| | - Neil Jones
- Department of Pediatrics and Adolescent MedicineUniversity Clinics SalzburgSalzburgAustria
| | | | - Stefan Köhrer
- Department of Pediatric Hematology and Oncology, St. Anna Children's HospitalMedical University of ViennaViennaAustria
- Labdia DiagnosticsViennaAustria
| | - Reinhard Moser
- Department of Pediatrics and Adolescent MedicineState Hospital LeobenLeobenAustria
| | - Gabriele Kropshofer
- Division of Pediatric Hematology and Oncology and Stem Cell Transplantation, Department of Pediatrics and Adolescent MedicineMedical University of InnsbruckInnsbruckAustria
| | - Christina Peters
- Department of Pediatric Hematology and Oncology, St. Anna Children's HospitalMedical University of ViennaViennaAustria
| | - Christian Urban
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent MedicineMedical University of GrazGrazAustria
| | - Georg Mann
- Department of Pediatric Hematology and Oncology, St. Anna Children's HospitalMedical University of ViennaViennaAustria
- St. Anna Children's Cancer Research Institute (CCRI)ViennaAustria
| | - Ulrike Pötschger
- St. Anna Children's Cancer Research Institute (CCRI)ViennaAustria
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's HospitalMedical University of ViennaViennaAustria
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2
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Prasad PK, Mahajan P, Hawkins DS, Mostoufi-Moab S, Venkatramani R. Management of pediatric differentiated thyroid cancer: An overview for the pediatric oncologist. Pediatr Blood Cancer 2020; 67:e28141. [PMID: 32275118 DOI: 10.1002/pbc.28141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/11/2019] [Accepted: 12/09/2019] [Indexed: 02/03/2023]
Abstract
Differentiated thyroid cancer (DTC) is the most common childhood thyroid malignancy. The standard of care for pediatric DTC is total thyroidectomy followed by radioactive iodine (RAI) treatment when indicated. Molecular changes and potential therapeutic targets have been recently described in pediatric thyroid cancer. Pediatric oncologists are increasingly involved in the evaluation of thyroid nodules in childhood cancer survivors and in the management of advanced thyroid cancer. In 2015, the American Thyroid Association published management guidelines for children with DTC. We provide an overview of the current standard of care and highlight available targeted therapies for progressive or RAI refractory DTC.
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Affiliation(s)
- Pinki K Prasad
- Louisiana State University Health Sciences Center, Children's Hospital of New Orleans, New Orleans, Louisiana
| | - Priya Mahajan
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Douglas S Hawkins
- Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Sogol Mostoufi-Moab
- Divisions of Endocrinology and Hematology/Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rajkumar Venkatramani
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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3
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Lorenz E, Scholz-Kreisel P, Baaken D, Pokora R, Blettner M. Radiotherapy for childhood cancer and subsequent thyroid cancer risk: a systematic review. Eur J Epidemiol 2018; 33:1139-1162. [PMID: 30511135 DOI: 10.1007/s10654-018-0467-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022]
Abstract
Most of the pooled analyses and reviews reported an association between radiotherapy for childhood cancer and an increased thyroid cancer risk. Up to now this article presents the first systematic literature review on this association combined with a critical assessment of the methodological quality of the included articles. PubMed and Web of Science databases were searched for relevant articles until May 2016. We included peer-reviewed cohort and case-control studies that investigated an association between radiotherapy for childhood cancer and the occurrence of subsequent thyroid cancer. A systematic overview is presented for the included studies. We identified 17 retrospective cohort studies, and four nested case-control studies, representing 100,818 subjects. The age range at first cancer diagnosis was 0-25.2 years. Considerable variability was found regarding study sizes, study design, treatment strategies, dose information, and follow-up periods. 20 of the 21 identified studies showed increased thyroid cancer risks associated with childhood radiation exposure. The large majority showed an increased relative risk or odds ratio confirming the association between radiotherapy and thyroid cancer although the variation in results was large. Additionally to a pooled analysis that has been published recently, we systematically included 17 further studies, which allowed us to cover information from countries that were not covered by large-scale childhood cancer survivor studies. The methodological limitations of existing studies and inconsistencies in findings across studies yielded a large study heterogeneity, which made a detailed comparison of study results difficult. There is a need to strengthen standardisation for reporting.
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Affiliation(s)
- Eva Lorenz
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, 55101, Mainz, Germany. .,Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Straße 74, 20359, Hamburg, Germany.
| | - Peter Scholz-Kreisel
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, 55101, Mainz, Germany
| | - Dan Baaken
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, 55101, Mainz, Germany
| | - Roman Pokora
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, 55101, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, 55101, Mainz, Germany
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4
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Abu-Ouf NM, Jan MM. Metabolic syndrome in the survivors of childhood acute lymphoblastic leukaemia. Obes Res Clin Pract 2015; 9:114-24. [DOI: 10.1016/j.orcp.2014.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/21/2014] [Accepted: 06/26/2014] [Indexed: 12/28/2022]
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5
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A child with concurrent acute lymphoblastic leukemia and a brain tumor: diagnostic and therapeutic implications. J Pediatr Hematol Oncol 2014; 36:659-60. [PMID: 23588327 DOI: 10.1097/mph.0b013e318286d518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Ishida Y, Maeda M, Urayama KY, Kiyotani C, Aoki Y, Kato Y, Goto S, Sakaguchi S, Sugita K, Tokuyama M, Nakadate N, Ishii E, Tsuchida M, Ohara A. Secondary cancers among children with acute lymphoblastic leukaemia treated by the Tokyo Children's Cancer Study Group protocols: a retrospective cohort study. Br J Haematol 2013; 164:101-12. [DOI: 10.1111/bjh.12602] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 09/06/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Yasushi Ishida
- Department of Paediatrics; St. Luke's International Hospital; Tokyo Japan
- Centre of Clinical Epidemiology; St. Luke's Life Science Institute; Tokyo Japan
| | - Miho Maeda
- Department of Paediatrics; Nippon Medical School; Tokyo Japan
| | - Kevin Y. Urayama
- Centre of Clinical Epidemiology; St. Luke's Life Science Institute; Tokyo Japan
- School of Public Health; University of California; Berkeley CA USA
| | - Chikako Kiyotani
- Division of Oncology; National Centre for Child Health and Development; Tokyo Japan
| | - Yuki Aoki
- Department of Paediatrics and Developmental Biology; Tokyo Medical and Dental University; Tokyo Japan
| | - Yoko Kato
- Department of Paediatrics; Jikei University School of Medicine; Tokyo Japan
| | - Shoko Goto
- Department of Paediatrics; Yokohama City University School of Medicine; Yokohama Japan
| | - Sachi Sakaguchi
- Department of Paediatrics and Adolescent Medicine; Juntendo University School of Medicine; Tokyo Japan
| | - Kenichi Sugita
- Department of Paediatrics; Dokkyo Medical University; Tochigi Japan
| | - Mika Tokuyama
- Department of Paediatrics; Yachimata Hospital; Chiba Japan
| | - Naoya Nakadate
- Department of General Paediatrics; National Centre for Child Health and Development; Tokyo Japan
| | - Eizaburo Ishii
- Department of Paediatrics; Nagano Prefectural Suzaka Hospital; Nagano Japan
| | | | - Akira Ohara
- First Department of Paediatrics; Toho University; Tokyo Japan
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7
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Dang ND, Teh BS, Paulino AC. Rhabdomyosarcoma arising in a previously irradiated field: an analysis of 43 patients. Int J Radiat Oncol Biol Phys 2012; 85:598-603. [PMID: 22836049 DOI: 10.1016/j.ijrobp.2012.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/04/2012] [Accepted: 06/06/2012] [Indexed: 01/08/2023]
Abstract
Patients with soft tissue sarcomas that arise from previously irradiated fields have traditionally been reported to have a poor prognosis. In this report, we examined the characteristics and outcomes of patients who developed a rhabdomyosarcoma in a previously irradiated field (RMS-RIF); we hypothesize that these patients should have a better outcome compared to other postradiation soft tissue sarcomas as these tumors are chemosensitive and radiosensitive. A PubMed search of the literature from 1961-2010 yielded 33 studies with data for patients with RMS-RIF. The study included 43 patients with a median age of 6.5 years at the time of radiation therapy (RT) for the initial tumor. The median RT dose was 48 Gy. The median latency period, the time from RT to development of RMS-RIF, was 8 years. The 3-year overall survival for RMS-RIF was 42%. The 3-year overall survival was 66% for patients receiving chemotherapy and local treatment (surgery and/or RT) compared to 29% for those who had systemic treatment only or local treatment only (P=.049). Other factors associated with increased 3-year overall survival included retinoblastoma initial diagnosis (P<.001), age ≤ 18 years at diagnosis of RMS-RIF (P=.003), favorable site (P=.008), and stage 1 disease (P=.002). Age at time of RMS-RIF, retinoblastoma initial tumor, favorable site, stage 1 disease, and use of both systemic and local treatment were found to be favorable prognostic factors for 3-year overall survival.
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Affiliation(s)
- Nguyen D Dang
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
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Hosni-Ahmed A, Barnes JD, Wan J, Jones TS. Thiopurine methyltransferase predicts the extent of cytotoxicty and DNA damage in astroglial cells after thioguanine exposure. PLoS One 2011; 6:e29163. [PMID: 22216194 PMCID: PMC3244435 DOI: 10.1371/journal.pone.0029163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 11/22/2011] [Indexed: 01/11/2023] Open
Abstract
Thiopurine methyltransferase (Tpmt) is the primary enzyme responsible for deactivating thiopurine drugs. Thiopurine drugs (i.e., thioguanine [TG], mercaptopurine, azathioprine) are commonly used for the treatment of cancer, organ transplant, and autoimmune disorders. Chronic thiopurine therapy has been linked to the development of brain cancer (most commonly astrocytomas), and Tpmt status has been associated with this risk. Therefore, we investigated whether the level of Tpmt protein activity could predict TG-associated cytotoxicity and DNA damage in astrocytic cells. We found that TG induced cytotoxicity in a dose-dependent manner in Tpmt+/+, Tpmt+/− and Tpmt−/− primary mouse astrocytes and that a low Tpmt phenotype predicted significantly higher sensitivity to TG than did a high Tpmt phenotype. We also found that TG exposure induced significantly more DNA damage in the form of single strand breaks (SSBs) and double strand breaks (DSBs) in primary astrocytes with low Tpmt versus high Tpmt. More interestingly, we found that Tpmt+/− astrocytes had the highest degree of cytotoxicity and genotoxicity (i.e., IC50, SSBs and DSBs) after TG exposure. We then used human glioma cell lines as model astroglial cells to represent high (T98) and low (A172) Tpmt expressers and found that A172 had the highest degree of cytoxicity and SSBs after TG exposure. When we over-expressed Tpmt in the A172 cell line, we found that TG IC50 was significantly higher and SSB's were significantly lower as compared to mock transfected cells. This study shows that low Tpmt can lead to greater sensitivity to thiopurine therapy in astroglial cells. When Tpmt deactivation at the germ-line is considered, this study also suggests that heterozygosity may be subject to the greatest genotoxic effects of thiopurine therapy.
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Affiliation(s)
- Amira Hosni-Ahmed
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Department of Chemistry, College of Science, Fayoum University, Fayoum, Egypt
| | - Joseph D. Barnes
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Jim Wan
- Division of Biostatistics and Epidemiology, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Terreia S. Jones
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- * E-mail:
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9
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Risk of thyroid cancer, brain cancer, and non-Hodgkin lymphoma after adult leukemia: a nationwide study. Blood 2011; 118:4062-9. [DOI: 10.1182/blood-2011-02-337170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
Patients with childhood leukemia surviving into adulthood have elevated risk of developing thyroid cancer, brain cancer, and non-Hodgkin lymphoma (NHL); these risks cannot automatically be extrapolated to patients surviving adult leukemia. We tested whether survivors of adult leukemia are at increased risk of developing thyroid cancer, brain cancer, and NHL. We included the entire adult Danish population (14 years of age or older), in a 28-year follow-up period from 1980 through 2007, composed of 6 542 639 persons; during this period, 18 834 developed adult leukemia, 4561 developed thyroid cancer, 13 362 developed brain cancer, and 15 967 developed NHL. In nested studies using Cox regression models on individual participant data, we found that, after adult leukemia, the multivariate adjusted hazard ratios were 4.9 (95% confidence interval [CI], 2.8-8.5) for thyroid cancer, 1.9 (95% CI, 1.2-3.1) for brain cancer, and 3.3 (95% CI, 2.5-4.4) for NHL. Corresponding hazard ratios after childhood leukemia were 10.4 (95% CI, 0.4-223) for thyroid cancer, 7.2 (95% CI, 2.0-26) for brain cancer, and 6.5 (95% CI, 0.4-110) for NHL. Patients with adult leukemia have excess risk of thyroid cancer, brain cancer, and NHL, similar to patients with childhood leukemia.
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10
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Bertorello N, Manicone R, Galletto C, Barisone E, Fagioli F. Physical activity and late effects in childhood acute lymphoblastic leukemia long-term survivors. Pediatr Hematol Oncol 2011; 28:354-63. [PMID: 21413831 DOI: 10.3109/08880018.2010.550987] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In the present study the authors evaluated therapy-related long-term adverse effects and physical activity in a cohort of long-term survivors of childhood acute lymphoblastic leukemia (ALL), diagnosed in their center between March 1991 and August 2000, treated according to the AIEOP (Associazione Italiana di Ematologia e Oncologia Pediatrica) ALL 91 or 95 study protocol and regularly seen in the authors' long-term follow-up unit. The authors analyzed the long-term sequelae of major body systems in this cohort of subjects and administered an "ad hoc" questionnaire concerning sport. The authors found that 70 patients out of 102 (68.5%) showed no late effects, 10% presented only instrumental or neuropsychological test abnormalities, and 21.5% had 1 or more clinical late sequelae. None of the evidenced late effects represented a contraindication to do physical activity. Sixty-one percent of survivors do physical activity, most of them regularly. Sixty-one percent of males and 18.5% of females (P < .005) do competitive sport (sports rates are similar to those of the general age-matched population). Nearly all subjects spontaneously choose to do sport and think physical exercise is an important and useful resource for their health. The authors conclude that the more recent therapy regimens for leukemia treatment, excluding bone marrow transplantation, do not seem to cause such late effects as to prevent survivors from doing sport. Therefore, in the care of ALL survivors, physical activity is not only not contraindicated, but should also be promoted as much as possible. The development of specific educational programs is warranted as part of the care of cancer survivors.
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Affiliation(s)
- N Bertorello
- Division of Pediatric Onco-Hematology and Cell Stem Transplantation, Regina Margherita Children's Hospital, Turin, Italy.
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Renard M, Suciu S, Bertrand Y, Uyttebroeck A, Ferster A, van der Werff Ten Bosch J, Mazingue F, Plouvier E, Robert A, Boutard P, Millot F, Munzer M, Mechinaud F, Lescoeur B, Baila L, Vandecruys E, Benoit Y, Philippet P. Second neoplasm in children treated in EORTC 58881 trial for acute lymphoblastic malignancies: low incidence of CNS tumours. Pediatr Blood Cancer 2011; 57:119-25. [PMID: 21412967 DOI: 10.1002/pbc.23083] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 01/20/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND Intensive chemotherapy has markedly improved the survival of children with acute lymphoblastic leukaemia (ALL) or lymphoblastic lymphoma (LL). Evaluation of late effects and analysis of factors contributing to their occurrence has become of major importance. Second neoplasm (SN) belongs to the most severe late events. PROCEDURE We report the incidence of SN which occurred in patients recruited in EORTC trial 58881 for children with ALL or LL. The front-line treatment regimen was adapted from the BFM protocol, but did not include cranial radiotherapy, even in patients with initial involvement of the central nervous system. A total of 2,216 patients were recruited, of whom 2,136 achieved complete remission (CR). RESULTS At a median follow-up of 7.5 years, 22 (1%) patients developed a SN: 20 during or after completion of front-line therapy and 2 in second CR, after relapse treatment including haematopoietic stem cell transplantation (HSCT). Ten patients developed acute myeloblastic leukaemia. Only one SN, a glioblastoma, was a brain tumour. Other SN were: two Hodgkin lymphomas, one non-Hodgkin lymphoma, two thyroid cancers, one osteosarcoma, two soft tissue sarcomas, one Ewing sarcoma, one cutaneous histiocytosis and one peritoneal carcinomatosis. The cumulative incidences of SN at 5, 8 and 13 years after registration were 0.8% (SE 0.2%), 1.0% (SE 0.2%) and 3.0% (SE 1.9%), respectively. CONCLUSION The overall incidence rate of SN is comparable to that reported previously. In spite of short follow-up time, the low incidence of brain tumours might be related to the omission of cranial radiotherapy.
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12
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Brent RL, Christian MS, Diener RM. Evaluation of the reproductive and developmental risks of caffeine. BIRTH DEFECTS RESEARCH. PART B, DEVELOPMENTAL AND REPRODUCTIVE TOXICOLOGY 2011; 92:152-87. [PMID: 21370398 PMCID: PMC3121964 DOI: 10.1002/bdrb.20288] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 01/18/2011] [Accepted: 01/23/2011] [Indexed: 11/12/2022]
Abstract
A risk analysis of in utero caffeine exposure is presented utilizing epidemiological studies and animal studies dealing with congenital malformation, pregnancy loss, and weight reduction. These effects are of interest to teratologists, because animal studies are useful in their evaluation. Many of the epidemiology studies did not evaluate the impact of the "pregnancy signal," which identifies healthy pregnancies and permits investigators to identify subjects with low pregnancy risks. The spontaneous abortion epidemiology studies were inconsistent and the majority did not consider the confounding introduced by not considering the pregnancy signal. The animal studies do not support the concept that caffeine is an abortafacient for the wide range of human caffeine exposures. Almost all the congenital malformation epidemiology studies were negative. Animal pharmacokinetic studies indicate that the teratogenic plasma level of caffeine has to reach or exceed 60 µg/ml, which is not attainable from ingesting large amounts of caffeine in foods and beverages. No epidemiological study described the "caffeine teratogenic syndrome." Six of the 17 recent epidemiology studies dealing with the risk of caffeine and fetal weight reduction were negative. Seven of the positive studies had growth reductions that were clinically insignificant and none of the studies cited the animal literature. Analysis of caffeine's reproductive toxicity considers reproducibility and plausibility of clinical, epidemiological, and animal data. Moderate or even high amounts of beverages and foods containing caffeine do not increase the risks of congenital malformations, miscarriage or growth retardation. Pharmacokinetic studies markedly improve the ability to perform the risk analyses.
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Affiliation(s)
- Robert L Brent
- Thomas Jefferson University, Alfred I. duPont Hospital for Children, Wilmington, Delaware 19899, USA.
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Radiotherapy-induced supratentorial primitive neuroectodermal tumour in a 17-year-old female: a case report and review of the literature. Acta Neurochir (Wien) 2011; 153:413-7. [PMID: 21125410 DOI: 10.1007/s00701-010-0890-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
Abstract
We report a case of a 17-year-old female who presented with a CNS primitive neuroectodermal tumour 12 years after cranial radiotherapy for relapsed childhood acute lymphoblastic leukaemia. In this article, we discuss the association of these rare tumours with previous craniospinal irradiation and review the pertinent literature.
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Abstract
The treatment of acute leukemia is usually similar in women and men. The outcome is also generally the same. However, diagnosis in women poses additional challenges in clinical practice such as leukemia following breast or ovarian cancers, prevention of abnormal uterine bleeding in premenopausal females, treatment during pregnancy related-problems in long-term survivors. All these special issues are addressed in this review of the literature.
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Hines RN, Sargent D, Autrup H, Birnbaum LS, Brent RL, Doerrer NG, Cohen Hubal EA, Juberg DR, Laurent C, Luebke R, Olejniczak K, Portier CJ, Slikker W. Approaches for assessing risks to sensitive populations: lessons learned from evaluating risks in the pediatric population. Toxicol Sci 2009; 113:4-26. [PMID: 19770482 DOI: 10.1093/toxsci/kfp217] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Assessing the risk profiles of potentially sensitive populations requires a "tool chest" of methodological approaches to adequately characterize and evaluate these populations. At present, there is an extensive body of literature on methodologies that apply to the evaluation of the pediatric population. The Health and Environmental Sciences Institute Subcommittee on Risk Assessment of Sensitive Populations evaluated key references in the area of pediatric risk to identify a spectrum of methodological approaches. These approaches are considered in this article for their potential to be extrapolated for the identification and assessment of other sensitive populations. Recommendations as to future research needs and/or alternate methodological considerations are also made.
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Affiliation(s)
- Ronald N Hines
- Medical College of Wisconsin, Department of Pediatrics, Children's Research Institute, Children's Hospital and Health Systems, Milwaukee, Wisconsin 53226-4801, USA
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Staykov D, Radespiel‐Tröger M, Meyer M, Petsch S, Schwab S, Handschu R. Birth Month and Risk of Glioma in Adults: A Registry‐Based Study in Bavaria. Chronobiol Int 2009; 26:282-92. [DOI: 10.1080/07420520902761778] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Schmiegelow K, Al-Modhwahi I, Andersen MK, Behrendtz M, Forestier E, Hasle H, Heyman M, Kristinsson J, Nersting J, Nygaard R, Svendsen AL, Vettenranta K, Weinshilboum R. Methotrexate/6-mercaptopurine maintenance therapy influences the risk of a second malignant neoplasm after childhood acute lymphoblastic leukemia: results from the NOPHO ALL-92 study. Blood 2009; 113:6077-84. [PMID: 19224761 PMCID: PMC2699230 DOI: 10.1182/blood-2008-11-187880] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 01/22/2009] [Indexed: 02/08/2023] Open
Abstract
Among 1614 children with acute lymphoblastic leukemia (ALL) treated with the Nordic Society for Paediatric Haematology and Oncology (NOPHO) ALL-92 protocol, 20 patients developed a second malignant neoplasm (SMN) with a cumulative risk of 1.6% at 12 years from the diagnosis of ALL. Nine of the 16 acute myeloid leukemias or myelodysplastic syndromes had monosomy 7 (n = 7) or 7q deletions (n = 2). In Cox multivariate analysis, longer duration of oral 6-mercaptopurine (6MP)/methotrexate (MTX) maintenance therapy (P = .02; longest for standard-risk patients) and presence of high hyperdiploidy (P = .07) were related to increased risk of SMN. Thiopurine methyltransferase (TPMT) methylates 6MP and its metabolites, and thus reduces cellular levels of cytotoxic 6-thioguanine nucleotides. Of 524 patients who had erythrocyte TPMT activity measured, the median TPMT activity in 9 patients developing an SMN was significantly lower than in the 515 that did not develop an SMN (median, 12.1 vs 18.1 IU/mL; P = .02). Among 427 TPMT wild-type patients for whom the 6MP dose was registered, those who developed SMN received higher average 6MP doses than the remaining patients (69.7 vs 60.4 mg/m2; P = .03). This study indicates that the duration and intensity of 6MP/MTX maintenance therapy of childhood ALL may influence the risk of SMNs in childhood ALL.
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Affiliation(s)
- Kjeld Schmiegelow
- Faculty of Medicine, Institute of Gynecology, Obstetrics, and Pediatrics, University of Copenhagen, Copenhagen, Denmark.
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18
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Banerjee J, Pääkkö E, Harila M, Herva R, Tuominen J, Koivula A, Lanning M, Harila-Saari A. Radiation-induced meningiomas: a shadow in the success story of childhood leukemia. Neuro Oncol 2009; 11:543-9. [PMID: 19179425 DOI: 10.1215/15228517-2008-122] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
While the prognosis of acute childhood leukemia has improved, long-term survivors are increasingly experiencing late effects of the treatment. Cranially irradiated survivors are predisposed to the development of CNS tumors. Our aim was to describe the incidence of secondary brain tumors and to define the significance of treatment-related risk factors and host characteristics in a cohort of childhood leukemia survivors. Our cohort consisted of 60 consecutive cranially irradiated adult survivors of childhood leukemia treated in Oulu University Hospital (Oulu, Finland); MRI of the brain was performed on 49. The sites of the tumors, their histology, and details of the leukemia treatment were determined. Of the 49 patients, 11 (22%) 1-8 years of age at the time of diagnosis developed meningioma later in life, while no other brain tumors were seen. In this cohort, the development of meningioma seemed to show undisputable linkage with long latency periods (mean, 25 years; range, 14-34 years) and an increasing incidence 20 years after the treatment (47%). Three patients had multiple meningiomas, two had recurrent disease, and one had an atypical meningioma. Age at the time of irradiation, gender, or cumulative doses of chemotherapeutic agents showed no significant association with the development of meningiomas. The high incidence of meningiomas in this study was associated with long follow-up periods. Although the cohort is small, it seems probable that the increasing incidence of meningioma will shadow the future of cranially irradiated leukemia survivors. Systematic brain imaging after the treatment is therefore justifiable.
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Affiliation(s)
- Joanna Banerjee
- Department of Pediatric, University Hospital of Oulu, Oulu, Finland
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19
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Abstract
Gliomas account for more than 70% of all brain tumors, and of these, glioblastoma is the most frequent and malignant histologic type (World Health Organization [WHO] grade IV). There is a tendency toward a higher incidence of gliomas in highly developed, industrialized countries. Some reports indicate that Caucasians have a higher incidence than African or Asian populations. With the exception of pilocytic astrocytomas (WHO grade I), the prognosis of glioma patients is still poor. Fewer than 3% of glioblastoma patients are still alive at 5 years after diagnosis, older age being the most significant and consistent prognostic factor of poorer outcome. Gliomas are components of several inherited tumor syndromes, but the prevalence of these syndromes is very low. Many environmental and lifestyle factors including several occupations, environmental carcinogens, and diet have been reported to be associated with an elevated glioma risk, but the only factor unequivocally associated with an increased risk is therapeutic X-irradiation. In particular, children treated with X-irradiation for acute lymphoblastic leukemia show a significantly elevated risk of developing gliomas and primitive neuroectodermal tumors, often within 10 years after therapy. Significant correlation between G:C --> A:T transitions in the TP53 gene and promoter methylation of the O6 -methylguanine-DNA methyltransferase (MGMT) gene in glio-mas have been reported in several studies, suggesting the possible involvement of O6-methylguanine DNA adducts, which may be produced by exogenous or endogenous alkylating agents in the development of gliomas.
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Affiliation(s)
- Hiroko Ohgaki
- Pathology Group, International Agency for Research on Cancer, Lyon, France
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20
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Okada A, Hatori M, Hosaka M, Watanuki M, Itoi E. Secondary osteosarcoma arising after treatment for childhood hematologic malignancies. Ups J Med Sci 2009; 114:249-55. [PMID: 19961270 PMCID: PMC2852780 DOI: 10.3109/03009730903177340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Secondary osteosarcoma arising after the treatment of hematologic malignancies other than Hodgkin's lymphoma is rare. We report two cases of secondary osteosarcoma arising after treatment for childhood hematologic malignancies (non-Hodgkin's lymphoma and lymphoblastic leukemia). A 10-year-old boy, at the age of 3, was diagnosed with non-Hodgkin's lymphoma. He received chemotherapy, radiation, and bone-marrow transplantation and then was in complete remission. At 6 years, he complained of increasing pain of the right thigh and was diagnosed with osteoblastic osteosarcoma. A 26-year-old man, at the age of 6, was diagnosed as having acute lymphoblastic leukemia (ALL). He received chemotherapy, radiation, and peripheral blood stem cell transplantation (PBSCT). At 11 years after PBSCT, he visited with the complaint of left lumbar swelling. He was diagnosed with chondroblastic osteosarcoma. In both cases alkaline phosphatase (ALP) had already increased prior to the onset of the symptom. We should rule out secondary osteosarcoma at the abnormal elevation of ALP during clinical follow-up of patients after treatment of childhood hematologic malignancies.
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Affiliation(s)
| | - Masahito Hatori
- Department of Orthopaedic Surgery, Tohoku University School of MedicineJapan
| | - Masami Hosaka
- Department of Orthopaedic Surgery, Tohoku University School of MedicineJapan
| | - Munenori Watanuki
- Department of Orthopaedic Surgery, Tohoku University School of MedicineJapan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of MedicineJapan
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21
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Weinstein JL, Ayyanar K, Watral MA. Secondary neoplasms following treatment for brain tumors. Cancer Treat Res 2009; 150:239-273. [PMID: 19834673 DOI: 10.1007/b109924_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Joanna L Weinstein
- Division of Hematology, Oncology and Stem Cell Transplantation, Children's Memorial Hospital, Chicago, IL, USA.
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22
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Affiliation(s)
- Abigail Walton
- Palliative Care Hope Healthcare, Greenwich Hospital, Sydney, New South Wales, Australia
| | - Andrew L. Broadbent
- Palliative Care Hope Healthcare, Greenwich Hospital, Sydney, New South Wales, Australia
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23
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Moftakhar P, Fan X, Hurvitz CH, Black KL, Danielpour M. Long-term survival in a child with a central nervous system medulloepithelioma. J Neurosurg Pediatr 2008; 2:339-45. [PMID: 18976104 DOI: 10.3171/ped.2008.2.11.349] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Central nervous system medulloepitheliomas are extremely rare and malignant (World Health Organization Grade IV) primitive neuroectodermal tumors (PNETs) that arise in childhood. Unlike other PNETs, medulloepitheliomas have a dismal prognosis, with only 2 reported cases in the literature in which the patient survived beyond 5 years after treatment. The authors report on the third known case of a child who survived longer than 5 years. A review of all the published cases of medulloepithelioma is also presented, and alternative treatment strategies for PNET tumors, including high-dose chemotherapy with stem-cell rescue, are discussed.
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Affiliation(s)
- Parham Moftakhar
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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24
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Anaplastic oligodendroglioma after childhood acute lymphoblastic leukemia: chemotherapy and autologous peripheral blood stem cell transplantation. J Pediatr Hematol Oncol 2008; 30:764-7. [PMID: 19011476 DOI: 10.1097/mph.0b013e31817e4a55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Secondary brain tumors after cranial irradiation occur in survivors of childhood acute lymphoblastic leukemia (ALL). We report a case of anaplastic oligodendroglioma with recurrence occurring in a 15-year-old girl, 8 years after the diagnosis of ALL. She was treated with cisplatin, vincristine, etoposide, and ifosfamide followed by cranial irradiation with good response. However, as new lesions appeared out of the radiation field and then multiple lesions after she stopped the chemotherapy, she was treated with procarbazine, CCNU, and vincristine followed by autologous peripheral blood stem cell transplantation with preconditioning of carboplatin, thiotepa, and etoposide. She showed no evidence of disease for 3 years after last recurrence. High-dose chemotherapy with stem cell rescue seems to be potentially effective for multiple recurrent anaplastic oligodendroglioma occurring after childhood ALL.
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25
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Mody R, Li S, Dover DC, Sallan S, Leisenring W, Oeffinger KC, Yasui Y, Robison LL, Neglia JP. Twenty-five-year follow-up among survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study. Blood 2008; 111:5515-23. [PMID: 18334672 PMCID: PMC2424150 DOI: 10.1182/blood-2007-10-117150] [Citation(s) in RCA: 283] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Accepted: 02/25/2008] [Indexed: 11/20/2022] Open
Abstract
Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for late effects of cancer therapy. Five-year ALL survivors (< 21 years at diagnosis; n = 5760 eligible, 4151 participants), diagnosed from 1970 to 1986 were compared with the general population and a sibling cohort (n = 3899). Cumulative mortality of 5760 5-year survivors was 13% at 25 years from diagnosis. Recurrent ALL (n = 483) and second neoplasms (SNs; n = 89) were the major causes of death. Among 185 survivors, 199 SNs occurred, 53% in the CNS. Survivors reported more multiple chronic medical conditions (CMCs; odds ratio [OR], 2.8; 95% CI, 2.4-3.2) and severe or life-threatening CMCs (OR, 3.6; 95% CI, 3.0-4.5) than siblings. Cumulative incidence of severe CMCs, including death, 25 years from diagnosis was 21.3% (95% CI, 18.2-24.4; 23.3% [95% CI, 19.4-27.2] and 13.4% [95% CI, 8.4-18.4] for irradiated and nonirradiated survivors, respectively). Survivors reported more adverse general and mental health, functional impairment, and activity limitations compared with siblings (P < .001). Rates of marriage, college graduation, employment, and health insurance were all lower compared with sibling controls (P < .001). Long-term survivors of childhood ALL exhibit excess mortality and morbidity. Survivors who received radiation therapy as part of their treatment or had a leukemia relapse are at greatest risk for adverse outcomes.
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Affiliation(s)
- Rajen Mody
- Department of Pediatrics, University of Michigan, Ann Arbor, USA
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26
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Borgmann A, Zinn C, Hartmann R, Herold R, Kaatsch P, Escherich G, Möricke A, Henze G, von Stackelberg A. Secondary malignant neoplasms after intensive treatment of relapsed acute lymphoblastic leukaemia in childhood. Eur J Cancer 2008; 44:257-68. [DOI: 10.1016/j.ejca.2007.09.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 09/24/2007] [Indexed: 11/15/2022]
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27
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Leung GKK, Lee WCK, Nicholls JM. Radiation-induced rhabdomyosarcomatous transformation of a recurrent meningeal haemangiopericytoma. Acta Neurochir (Wien) 2007; 149:1163-7; discussion 1167. [PMID: 17906967 DOI: 10.1007/s00701-007-1289-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2007] [Accepted: 06/12/2007] [Indexed: 11/26/2022]
Abstract
A 53-year-old woman presented in 1979 with a posterior fossa meningeal haemangiopericytoma (HPC) for which she underwent surgical resection and post-operative radiotherapy. Repeated tumour recurrences occurred 18 years afterwards which were treated with resections and stereotactic radiotherapy. Surgery for tumour recurrence in 2005 revealed features of rhabdomyosarcomatous transformation. To our knowledge, this is the first reported case of rhabdomyosarcomatous transformation within a HPC which was likely to be radiation-induced, and was associated with relentless disease progression more than 20 years after the initial presentation.
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Affiliation(s)
- G Ka Kit Leung
- Division of Neurosurgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, China.
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28
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Tavernier E, Le QH, de Botton S, Dhédin N, Bulabois CE, Reman O, Vey N, Lhéritier V, Dombret H, Thomas X. Secondary or concomitant neoplasms among adults diagnosed with acute lymphoblastic leukemia and treated according to the LALA-87 and LALA-94 trials. Cancer 2007; 110:2747-55. [DOI: 10.1002/cncr.23097] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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29
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Maule M, Scélo G, Pastore G, Brennan P, Hemminki K, Tracey E, Sankila R, Weiderpass E, Olsen JH, McBride ML, Brewster DH, Pompe-Kirn V, Kliewer EV, Chia KS, Tonita JM, Martos C, Jonasson JG, Merletti F, Boffetta P. Risk of Second Malignant Neoplasms After Childhood Leukemia and Lymphoma: An International Study. J Natl Cancer Inst 2007; 99:790-800. [PMID: 17505074 DOI: 10.1093/jnci/djk180] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Survivors of childhood leukemia and lymphoma experience high risks of second malignant neoplasms. We quantified such risk using a large dataset from 13 population-based cancer registries. METHODS The registries provided individual data on cases of leukemia, Hodgkin lymphoma, and non-Hodgkin lymphoma occurring in children aged 0-14 years and on subsequent second malignant neoplasms for different time periods from 1943 to 2000. Risks of second malignant neoplasms were assessed through standardized incidence ratios (SIRs) and corresponding 95% confidence intervals (CIs), using the incidence rates in the general populations covered by the registries as a reference. Cumulative absolute risks were also calculated. RESULTS A total of 133 second malignant neoplasms were observed in 16,540 patients (12,731 leukemias, 1246 Hodgkin lymphomas, and 2563 non-Hodgkin lymphomas) after an average follow-up of 6.5 years. The most frequent second malignancies after leukemia were brain cancer (19 cases, SIR = 8.52, 95% CI = 5.13 to 13.3), non-Hodgkin lymphoma (nine cases, SIR = 9.41, 95% CI = 4.30 to 17.9), and thyroid cancer (nine cases, SIR = 18.8, 95% CI = 8.60 to 35.7); the most frequent after Hodgkin lymphoma were thyroid cancer (nine cases, SIR = 52.5, 95% CI = 24.0 to 99.6), breast cancer (six cases, SIR = 20.9, 95% CI = 7.66 to 45.4), and neoplasms of skin (non-melanoma) (six cases, SIR = 34.0, 95% CI = 12.5 to 74.0); and the most frequent after non-Hodgkin lymphoma were thyroid cancer (six cases, SIR = 40.4, 95% CI = 14.8 to 88.0) and brain cancer (four cases, SIR = 6.97, 95% CI = 1.90 to 17.9). Cumulative incidence of any second malignant neoplasm was 2.43% (95% CI = 1.09 to 3.78), 12.7% (95% CI = 8.29 to 17.2), and 2.50% (95% CI = 1.04 to 3.96) within 30 years from diagnosis of leukemia, Hodgkin lymphoma, and non-Hodgkin lymphoma, respectively. CONCLUSIONS This population-based study provides, to our knowledge, the most precise and up-to-date estimates for relative and absolute risks of second malignant neoplasms after childhood leukemia and lymphoma.
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Affiliation(s)
- Milena Maule
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, CPO Piemonte, CeRMS, University of Turin, Via Santena 7, 10126, Turin, Italy.
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30
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Mazonakis M, Tzedakis A, Damilakis J, Varveris H, Kachris S, Gourtsoyiannis N. Scattered dose to thyroid from prophylactic cranial irradiation during childhood: a Monte Carlo study. Phys Med Biol 2006; 51:N139-45. [PMID: 16585835 DOI: 10.1088/0031-9155/51/8/n01] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to estimate the scattered dose to thyroid from prophylactic cranial irradiation during childhood. The MCNP transport code and mathematical phantoms representing the average individual at ages 3, 5, 10, 15 and 18 years old were employed to simulate cranial radiotherapy using two lateral opposed fields. The mean radiation dose received by the thyroid gland was calculated. A 10 cm thick lead block placed on the patient's couch to shield the thyroid was simulated by MCNP code. The Monte Carlo model was validated by measuring the scattered dose to the unshielded and shielded thyroid using three different humanoid phantoms and thermoluminescense dosimetry. For a cranial dose of 18 Gy, the thyroid dose obtained by Monte Carlo calculations varied from 47 to 79 cGy depending upon the age of the child. Appropriate placement of the couch block resulted in a thyroid dose reduction by 39 to 54%. Thyroid dose values at all possible positions of the radiosensitive gland with respect to the inferior field edge at five different patient ages were found. The mean difference between Monte Carlo results and thyroid dose measurements was 9.6%.
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Affiliation(s)
- Michalis Mazonakis
- Department of Medical Physics, University Hospital of Iraklion, 71110 Iraklion, Crete, Greece.
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31
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FitzGerald TJ, Aronowitz J, Giulia Cicchetti M, Fisher G, Kadish S, Lo YC, Mayo C, McCauley S, Meyer J, Pieters R, Sherman A. The Effect of Radiation Therapy on Normal Tissue Function. Hematol Oncol Clin North Am 2006; 20:141-63. [PMID: 16580561 DOI: 10.1016/j.hoc.2006.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
As more patients are treated for their primary malignancy with cure or increased disease-free intervals, injury to normal tissues will become more detectable and an important endpoint for study. Future protocols will probably be modified based on toxicity endpoints. In Hodgkin's disease, current protocols use response-based treatment strategies to limit therapy. The objective is to provide the same level of tumor control and follow normal tissue endpoints for outcome analysis. DVH analysis has improved the ability to analyze endpoint data for normal tissues. These image-guided platforms will provide the infrastructure needed to continue efforts in improving the delivery of radiation therapy.
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Affiliation(s)
- T J FitzGerald
- Department of Radiation Oncology and the Cancer Center, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01625, USA.
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32
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Hammal DM, Bell CL, Craft AW, Parker L. Second primary tumors in children and young adults in the North of England (1968-99). Pediatr Blood Cancer 2005; 45:155-61. [PMID: 15880357 DOI: 10.1002/pbc.20448] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study describes the risk of second malignancy in patients diagnosed with cancer under the age of 25 years, registered on the Northern Region Young Person's Malignant Disease Registry. PROCEDURE Incidence rates were calculated to describe the occurrence of second malignancies, rate ratios were estimated to compare rates between subgroups. Standardized incidence ratios (SIRs) were calculated for comparison with a reference population. RESULTS There were 4,072 children and young adults diagnosed with a first malignancy from 1968 to 1999, of whom 68 had a second malignancy (including basal cell carcinomas and meningiomas). The incidence rate of second malignancy is 1.7 per 1,000 survivor person-years (95% CI: 1.4, 2.2), reflecting a four-fold increased risk of malignancy compared with the general population. The rate of second malignancy was non-significantly higher for those diagnosed during young adulthood rather than childhood (RR = 1.2, 95% CI: 0.7, 2.0), significantly higher in females than males (RR = 1.8, 95% CI: 1.1, 3.0) and significantly lower for those diagnosed in more recent years (RR = 0.4, 95% CI: 0.2, 0.8). In contrast, the SIRs indicated that children were at substantial increased risk; whilst males and females, and those diagnosed in earlier and later time periods, were at equivalent risks. CONCLUSIONS There is evidence of a sustained increased risk of second malignancy in those treated for primary cancer, especially those diagnosed in childhood; with no evidence that this risk is reducing.
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Affiliation(s)
- Donna M Hammal
- School of Clinical Medical Sciences (Child Health), University of Newcastle Upon Tyne, United Kingdom.
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33
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Edick MJ, Cheng C, Yang W, Cheok M, Wilkinson MR, Pei D, Evans WE, Kun LE, Pui CH, Relling MV. Lymphoid gene expression as a predictor of risk of secondary brain tumors. Genes Chromosomes Cancer 2005; 42:107-16. [PMID: 15543619 DOI: 10.1002/gcc.20121] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Gene expression profiles are tissue-specific but may also reflect germ-line-driven expression patterns across tissue types. Previously, using a targeted pharmacologic approach, we identified germ-line polymorphisms in a single gene (thiopurine methyltransferase) associated with the risk of irradiation- and chemotherapy-induced secondary brain tumors in children with acute lymphoblastic leukemia (ALL). To identify additional candidate genetic risk factors, in identically treated patients, we compared the gene expression profiles of diagnostic ALL blasts of those who did develop irradiation-associated brain tumors (n = 9) with the profiles from those who did not (n = 33). Weighted rank regression was used to identify 33 probe sets associated with the time-dependent development of brain tumors; k-means clustering (k = 2) identified 2 groups that differed significantly in cumulative incidence of brain tumors (P = 0.012). Permutation analysis was used to estimate the probability (P = 0.18) of obtaining 2 such clusters by chance. Linear discriminant analysis (time-independent categorization of outcome) was used to identify 70 probe sets whose expression differentiated between the 2 groups of patients. Permutation analyses (n = 1,000) was used to estimate the probability of selecting these probe sets by chance (P = 0.055). Five probe sets were in common between the time-independent and time-dependent methods. The distinguishing genes are involved in neural growth (FGFR1) and in nuclear trafficking (HNRPL, KPNB1). These data suggest that gene expression profiling from accessible tissues may identify targets involved in therapy-related malignancies in unrelated tissues.
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Affiliation(s)
- Mathew J Edick
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, University of Tennessee, Memphis, Tennessee, USA
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34
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Kim GE, Beach B, Gastier-Foster JM, Murata-Collins JL, Rowland JM, O'Donnell RJ, Goldsby RE. Ewing sarcoma as a second malignant neoplasm after acute lymphoblastic leukemia. Pediatr Blood Cancer 2005; 45:57-9. [PMID: 15700259 DOI: 10.1002/pbc.20238] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Second malignant neoplasms (SMNs) are being increasingly recognized. This report describes a case of a 7-year-old girl with a history of acute lymphoblastic leukemia (ALL) who presented with a mass in her humerus that was diagnosed as Ewing sarcoma. Second malignant neoplasms are relatively rare in survivors of ALL treated without radiation. Even more unusual is the development of Ewing sarcoma as the SMN.
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Affiliation(s)
- Grace E Kim
- UCSF Children's Hospital, San Francisco, California 94143-0106, USA
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35
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Ohgaki H, Kleihues P. Epidemiology and etiology of gliomas. Acta Neuropathol 2005; 109:93-108. [PMID: 15685439 DOI: 10.1007/s00401-005-0991-y] [Citation(s) in RCA: 859] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Accepted: 11/01/2004] [Indexed: 02/01/2023]
Abstract
Gliomas of astrocytic, oligodendroglial and ependymal origin account for more than 70% of all brain tumors. The most frequent (65%) and most malignant histological type is the glioblastoma. Since the introduction of computerized tomography and magnetic resonance imaging, the incidence rates of brain tumors have been rather stable, with a tendency of higher rates in highly developed, industrialized countries. Some reports indicate that Caucasians have higher incidence than black or Asian populations, but to some extent, this may reflect socio-economic differences and under-ascertainment in some regions, rather than a significant difference in genetic susceptibility. With the exception of pilocytic astrocytomas, the prognosis of glioma patients is still poor. Less than 3% of glioblastoma patients are still alive at 5 years after diagnosis, higher age being the most significant predictor of poor outcome. Brain tumors are a component of several inherited tumor syndromes, but the prevalence of these syndromes is very low. Several occupations, environmental carcinogens, and diet (N-nitroso compounds) have been reported to be associated with an elevated glioma risk, but the only environmental factor unequivocally associated with an increased risk of brain tumors, including gliomas, is therapeutic X-irradiation. In particular, children treated with X-irradiation for acute lymphoblastic leukemia show a significantly elevated risk of developing gliomas and primitive neuroectodermal tumor (PNET), often within 10 years after therapy. TP53 mutations are frequent in low-grade gliomas and secondary glioblastomas derived therefrom. Approximately 60% of mutations are located in the hot spot codons 248 and 273, and the majority of these are G:C-->A:T transitions at CpG sites. TP53 mutations are significantly more frequent in low-grade astrocytomas with promoter methylation of the O(6)-methylguanine-DNA methyltransferase repair gene, suggesting that, in addition to deamination of 5-methylcytosine, exogenous or endogenous alkylation in the O(6) position of guanine may contribute to the formation of these mutations.
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Affiliation(s)
- Hiroko Ohgaki
- International Agency for Research on Cancer, Lyon, France.
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Suarez CR, Bertolone SJ, Raj AB, Coventry S. Second malignant neoplasms in childhood acute lymphoblastic leukemia: primitive neuroectodermal tumor of the chest wall with germline p53 mutation as a second malignant neoplasm. Am J Hematol 2004; 76:52-6. [PMID: 15114597 DOI: 10.1002/ajh.20012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
About 80% of children treated for acute lymphoblastic leukemia (ALL) will be long-term survivors. Second malignant neoplasm (SMNs) are a devastating sequelae observed on these children, with an estimated cumulative risk of 2-3.3% fifteen years after diagnosis. Primitive neuroectodermal tumor of bone (PNET) is rarely observed as a SMN following treatment of childhood ALL. The authors described the occurrence of a chest wall PNET of the bone at the site of a central line placement associated with both germ-line and tumor cell p53 mutation in a 8-year-old boy 1 year after completing therapy for standard risk ALL. A review of the literature of 25,051 children treated for ALL discovered 230 SMNs (0.99%), and only one case of PNET of the bone was noted among this group. The occurrence of a SMN in children treated for ALL is a rare event. Such an occurrence, in particular the development of an unusual SMN, should be evaluated for a germline p53 mutation.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child, Preschool
- Combined Modality Therapy
- Humans
- Male
- Mutation
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/therapy
- Neuroectodermal Tumors, Primitive, Peripheral/genetics
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Thoracic Wall/metabolism
- Thoracic Wall/pathology
- Treatment Outcome
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- Carlos R Suarez
- Department of Pediatrics, Section of Hematology/Oncology, University of Louisville School of Medicine, Louisville, Kentucky, USA.
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Mora J, Filippa DA, Qin J, Wollner N. Lymphoblastic lymphoma of childhood and the LSA2-L2 protocol: the 30-year experience at Memorial-Sloan-Kettering Cancer Center. Cancer 2003; 98:1283-91. [PMID: 12973853 DOI: 10.1002/cncr.11615] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Until the 1970s, diffuse lymphoblastic lymphoma (DLBL) was considered incurable. With intensive multidrug regimens, the majority of patients can now be cured. In the current study, the authors present what to their knowledge is the longest follow-up presented to date (median, 20 years for survivors) of the largest group of DLBL patients treated with a single protocol at a single institution. METHODS Between 1971-1990, a total of 95 consecutive patients (age < 21 years) with DLBL were treated with the LSA(2)-L(2) protocol at the Memorial Sloan-Kettering Cancer Center (MSKCC). Patients with Stage I-II disease were treated for 2 years. In 1980, the protocol was modified and patients with Stage III and IV disease were treated for 3 years. In addition, before the modification, patients with Stage IV disease received a cumulative dose of 15,600 mg/m(2) of cyclophosphamide for 3 years; after 1980, these patients received the same dosage as the other patients (i.e., 8400 mg/m(2) for 2 years). Radiation therapy initially was administered to all patients with bulky disease in the primary tumor site. Until 1977, the dose of radiation was 20-55 grays (Gy); from 1977 to 1989, the dose was 20 Gy. After the fifth year of completion of treatment, all patients were evaluated comprehensively every 2 years. RESULTS The overall survival (OS) of the patients was 79% with a median follow-up of 20 years. The overall event-free survival (EFS) was 75% (71 of 95 patients). Seventeen patients developed a disease recurrence and 15 died of disease. The OS and EFS rates for patients with Stages I-II disease (n = 8) were 87% and 87%, respectively, and the OS and EFS rates for patients with Stage III disease (n = 41) were 90% and 85%, respectively. The OS and EFS for patients with Stage IVA disease (with bone marrow [BM] involvement of < 25%) (n = 19) were 79% and 73%, respectively, whereas the OS and EFS for patients with Stage IVB disease (BM involvement of > 25%) (n = 27) were 74% and 70%. Of the 29 patients with Stage IV disease who were treated with the original protocol, 7 died of disease (1 of 8 patients with Stage IVA disease and 6 of 21 patients with Stage IVB disease). Of the 17 patients with Stage IV disease who were treated with the modified protocol, 3 died of disease (2 of 11 patients with Stage IVA disease and 1 of 6 patients with Stage IVB disease). Six patients developed secondary malignancies, four of whom died. CONCLUSIONS Long-term EFS can be achieved in the majority of patients with widely disseminated pediatric DLBL. Chemotherapy alone appears to be sufficient prophylaxis against disease recurrence in the central nervous system. No disease-related or treatment-related deaths were reported to occur > 4.5 years after diagnosis in the current study.
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Affiliation(s)
- Jaume Mora
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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38
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Pui CH, Cheng C, Leung W, Rai SN, Rivera GK, Sandlund JT, Ribeiro RC, Relling MV, Kun LE, Evans WE, Hudson MM. Extended follow-up of long-term survivors of childhood acute lymphoblastic leukemia. N Engl J Med 2003; 349:640-9. [PMID: 12917300 DOI: 10.1056/nejmoa035091] [Citation(s) in RCA: 291] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children who survive acute lymphoblastic leukemia are at risk for leukemia-related or treatment-related complications, which can adversely affect survival and socioeconomic status. We determined the long-term survival and the rates of health insurance coverage, marriage, and employment among patients who had attained at least 10 years of event-free survival. METHODS A total of 856 eligible patients were treated between 1962 and 1992 in 13 consecutive clinical trials. Survival rates, the cumulative risk of a second neoplasm, and selected indicators of socioeconomic status were analyzed for the entire group and for patients who did or did not receive cranial or craniospinal radiation therapy during initial treatment. RESULTS Fifty-six patients had major adverse events, including 8 deaths during remission, 4 relapses, and 44 second neoplasms (41 of them radiation-related); most of the second neoplasms were benign or of a low grade of malignant potential. The risk of a second neoplasm was significantly higher in the 597 patients who received radiation therapy (irradiated group) than in the 259 patients who did not receive radiation therapy (nonirradiated group) (P=0.04; estimated cumulative risk [+/-SE] at 20 years, 20.9+/-3.9 percent vs. 0.95+/-0.9 percent). The death rate for the irradiated group slightly exceeded the expected rate in the general U.S. population (standardized mortality ratio, 1.90; 95 percent confidence interval, 1.12 to 3.00), whereas that for the nonirradiated group did not differ from the population norm (standardized mortality ratio, 1.75; 95 percent confidence interval, 0.34 to 5.00). The rates of health insurance coverage, marriage, and employment in the nonirradiated group were similar to the age- and sex-adjusted national averages. Despite having health insurance rates similar to those in the general population, men and women in the irradiated group had higher-than-average unemployment rates (15.1 percent vs. 5.4 percent and 35.4 percent vs. 5.2 percent, respectively), and women in the irradiated group were less likely to be married (35.2 percent vs. 48.8 percent). CONCLUSIONS Children with acute lymphoblastic leukemia who did not receive radiation therapy and who have attained 10 or more years of event-free survival can expect a normal long-term survival. Irradiation is associated with the development of second neoplasms, a slight excess in mortality, and an increased unemployment rate.
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Affiliation(s)
- Ching-Hon Pui
- Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Schiavetti A, Clerico A, De Pasquale MD, Bernardini L, Moleti ML. Medulloblastoma as a secondary malignancy after radiotherapy-free treatment for acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2003; 25:562-4. [PMID: 12847325 DOI: 10.1097/00043426-200307000-00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malignant brain tumors have been reported to occur in survivors of childhood acute lymphoblastic leukemia (ALL) more frequently than in the noncancer control population. The strongest risk factor seems to be cranial radiotherapy, used as central nervous system (CNS) prophylaxis. We report the case of a 9-year-old girl affected with metastatic medulloblastoma that developed 6 years after a diagnosis of acute lymphoblastic leukemia. CNS prophylaxis for ALL consisted of intrathecal methotrexate plus cytarabine (20 administrations) and 4 courses of high-dose methotrexate (5g/m2). No prophylactic cranial radiotherapy was administered. The child, in first complete remission, was well until the occurrence of a second tumor. She was treated for medulloblastoma with craniospinal radiotherapy and chemotherapy. At present, she is alive but with disease. As the unusual association of these 2 malignancies in this patient, the p53 status was investigated using FISH analysis by specific DNA probe; no p53 mutation was detected.
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Affiliation(s)
- Amalia Schiavetti
- Pediatric Department, University of Rome La Sapienza, Viale Regina Elena 324, 00161 Rome, Italy.
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Abstract
Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, accounting for one-third of all cancers occurring in childhood and adolescents. Over the last 3 decades there has been a marked improvement in survival, with 5-year survival rates approaching 80%. With this improvement in survival, increasing attention is now being focused on issues relating to long-term morbidity and mortality associated with the treatments responsible for that increased survival. Because of the young age of these cancer survivors, and thus the potential longevity, the delayed consequences of therapy may have a significant impact on their lives. Long-term sequelae of treatment, such as impaired intellectual and psychomotor functioning, neuroendocrine abnormalities, impaired reproductive capacity, cardiotoxicity, and second malignant neoplasms, are now being reported with increasing frequency in this growing cohort of survivors and knowledge of the late -effects associated with cancer in children and adolescents continues to increase through ongoing research efforts. However, much of the available information relates to outcomes within the first decade following treatment, although information about the longer term outcomes that may occur later in adulthood is emerging as a result of well-conducted, large cohort studies. Through a multi-disciplinary approach to the diagnosis, treatment, and long-term follow-up of pediatric leukemia patients, we can achieve the goal of cure while minimizing the occurrence of long-term adverse outcomes. This review summarizes some of the well-described long-term consequences of therapy among children and adolescents treated for ALL.
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Affiliation(s)
- Smita Bhatia
- Division of Pediatrics, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91019, USA.
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41
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Affiliation(s)
- Daniel M Green
- Department of Pediatrics, Roswell Park Cancer Center, Buffalo, New York, USA
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42
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Bielack SS, Rerin JS, Dickerhoff R, Dilloo D, Kremens B, von Stackelberg A, Vormoor J, Jürgens H. Osteosarcoma after allogeneic bone marrow transplantation. A report of four cases from the Cooperative Osteosarcoma Study Group (COSS). Bone Marrow Transplant 2003; 31:353-9. [PMID: 12634726 DOI: 10.1038/sj.bmt.1703864] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Osteosarcoma, one of the most frequent secondary malignancies after the treatment of young patients with cancer, has only very rarely been observed in association with hematopoietic stem cell transplantation (HSCT). We report four patients who were identified by searching the database of the Cooperative Osteosarcoma Study Group (COSS) for patients whose osteosarcoma arose following HSCT. Transplant indications had been acute lymphoblastic leukemia (3). and sickle cell disease (1). and the stem cell source was bone marrow in all cases (three allogeneic, one syngeneic). All four had received chemotherapy with alkylators as part of their conditioning regimen and/or first line therapy. The conditioning regimen included total body irradiation in three patients. The osteosarcomas arose at the age (adolescence) and sites (around the knee) typical for the disease. All four patients received chemotherapy as part of multimodal osteosarcoma treatment, and all four are currently alive, three in continuous remission at 5 7/12, 2 11/12, and 0 6/12 years and one with relapsed osteosarcoma at 4 1/12 years. One of the osteosarcoma-free survivors suffered a third malignancy, myelodysplastic syndrome. Osteosarcoma should be included among the secondary malignancies that can arise following HSCT. Multi-modal therapy according to guidelines for de novo osteosarcoma can lead to long-term survival in selected patients.
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Affiliation(s)
- S S Bielack
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster, Germany
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Bhatia S, Sather HN, Pabustan OB, Trigg ME, Gaynon PS, Robison LL. Low incidence of second neoplasms among children diagnosed with acute lymphoblastic leukemia after 1983. Blood 2002; 99:4257-64. [PMID: 12036851 DOI: 10.1182/blood.v99.12.4257] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Second malignant neoplasms are a serious complication after successful treatment of childhood acute lymphoblastic leukemia (ALL). With improvement in survival, it is important to assess the impact of contemporary risk-based therapies on second neoplasms in ALL survivors. A cohort of 8831 children diagnosed with ALL and enrolled on Children's Cancer Group therapeutic protocols between 1983 and 1995 were observed to determine the incidence of second neoplasms and associated risk factors. The median age at diagnosis of ALL was 4.7 years. The cohort had accrued 54 883 person-years of follow-up. Sixty-three patients developed second neoplasms, including solid, nonhematopoietic tumors (n = 39: brain tumors n = 19, other solid tumors n = 20), myeloid leukemia or myelodysplasia (n = 16), and lymphoma (n = 8). The cumulative incidence of any second neoplasm was 1.18% at 10 years (95% confidence interval, 0.8%-1.5%), representing a 7.2-fold increased risk compared with the general population. The risk was increased significantly for acute myeloid leukemia (standardized incidence ratio [SIR] 52.3), non-Hodgkin lymphoma (SIR 8.3), parotid gland tumors (SIR 33.4), thyroid cancer (SIR 13.3), brain tumors (SIR 10.1), and soft tissue sarcoma (SIR 9.1). Multivariate analysis revealed female sex (relative risk [RR] 1.8), radiation to the craniospinal axis (RR 1.6), and relapse of primary disease (RR 3.5) to be independently associated with increased risk of all second neoplasms. Risk of second neoplasms increased with radiation dose (1800 cGy RR 1.5; 2400 cGy RR 3.9). Actuarial survival at 10 years from diagnosis of second neoplasms was 39%. Follow-up of this large cohort that was treated with contemporary risk-based therapy showed that the incidence of second neoplasms remains low after diagnosis of childhood ALL.
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Affiliation(s)
- Smita Bhatia
- City of Hope National Medical Center, Duarte, CA, USA. smason@childrensoncology group.org
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44
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Kowalczyk JR, Nurzyńska J, Armata J, Bogusławska-Jaworska J, Rokicka-Milewska R, Sońta-Jakimczyk D, Balwierz W, Chybicka A, Kaczmarek-Kanold M, Kołecki P, Matysiak M, Pawelec K. International note: second malignant neoplasms in children: a multicenter study of the Polish Pediatric Leukemia/Lymphoma Group. MEDICAL AND PEDIATRIC ONCOLOGY 2002; 38:421-3. [PMID: 11984804 DOI: 10.1002/mpo.1356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- J R Kowalczyk
- Department of Pediatric Hematology/Oncology, University Children's Hospital, Lublin, Poland.
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Yeh DJ, Hessler RB, Lee MR. Leiomyosarcomatous transformation of unknown pediatric primary brainstem lesion following radiotherapy. Neurosurg Focus 2002; 12:ecp2. [PMID: 15926790 DOI: 10.3171/foc.2002.12.6.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary leiomyosarcoma of the central nervous system is rare and has been described both de novo and following temporally remote radiotherapy for a different unrelated malignancy. The authors report the case of a 42-year-old man in whom 60Co radiation treatment had been performed for an unknown primary mass in the brainstem 25 years previously. He presented with progressive neurological deterioration after undergoing many years of conservative therapy. A stereotactic biopsy sampling procedure was performed, and examination of the left cerebral pedunculopontine lesion revealed a spindle cell neoplasm. Histopathological and immunohistochemical examination of the tumor obtained from definitive resection suggested leiomyosarcomatous transformation of ganglioglioma.
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Affiliation(s)
- David John Yeh
- Department of Neurosurgery, Medical College of Georgia, Augusta, Georgia, USA.
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Hölttä P, Alaluusua S, Saarinen-Pihkala UM, Wolf J, Nyström M, Hovi L. Long-term adverse effects on dentition in children with poor-risk neuroblastoma treated with high-dose chemotherapy and autologous stem cell transplantation with or without total body irradiation. Bone Marrow Transplant 2002; 29:121-7. [PMID: 11850706 DOI: 10.1038/sj.bmt.1703330] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2001] [Accepted: 10/08/2001] [Indexed: 11/09/2022]
Abstract
Chemo- and radiotherapy may have injurious effects on developing teeth. In this long-term follow-up study among poor-risk neuroblastoma (NBL) survivors our aims were: (1) to assess both the type and extent of the side-effects of the anticancer treatment on tooth development; and (2) to develop an index for expressing total damage to the permanent dentition. We studied the dental development from panoramic radiographs (PRG) of 18 long-term survivors treated under the age of 6 years with high-dose (HD) chemotherapy and autologous stem cell transplantation (ASCT) for poor-risk NBL. The myeloablative therapy was either HD chemotherapy and fractionated total body irradiation (TBI) of 10-12 Gy (TBI group, n = 10) or HD chemotherapy only (non-TBI group, n = 8). A defect index (DeI) was developed to describe the damage to the permanent dentition. The DeI was also tested in 18 healthy adolescents. All NBL patients had disturbances in dental development including short roots, arrested root development, microdontia and tooth aplasia. After TBI, 9/10 patients had very severe root defects, in contrast to none in the non-TBI group. All children in the TBI group had 2-12 (mean 6.6) missing permanent teeth, while 2/5 in the non-TBI group (3/8 excluded due to young age) had two and four missing permanent teeth, respectively. Microdontia was found at equal frequency in both groups. The mean value of the DeI was 70.0 (range 28-117) in the TBI group, 15.2 (range 4-34) in the non-TBI group (P<0.001, Mann-Whitney U test) and 1.8 (range 0-15) in healthy adolescents. Disturbances in dental development may compromise occlusal function in poor-risk NBL patients after ASCT, especially when TBI is included in the conditioning regimen. Long-term dental follow-up and rehabilitation is required.
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Affiliation(s)
- P Hölttä
- Department of Pedodontics and Orthodontics, Institute of Dentistry, University of Helsinki, Helsinki, Finland
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47
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Leung W, Ribeiro RC, Hudson M, Tong X, Srivastava DK, Rubnitz JE, Sandlund JT, Razzouk BI, Evans WE, Pui CH. Second malignancy after treatment of childhood acute myeloid leukemia. Leukemia 2001; 15:41-5. [PMID: 11243397 DOI: 10.1038/sj.leu.2401948] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To investigate the cumulative incidence of second malignancy and the competing risk of death due to any other cause in patients who were treated for childhood acute myeloid leukemia (AML), we analyzed the outcomes in a cohort of 501 patients who were treated at St Jude Children's Research Hospital between 1970 and 1996. Five patients developed a second cancer (two carcinomas of the parotid gland, one non-Hodgkin's lymphoma, one supratentorial primitive neuroectodermal tumor, one acute lymphoblastic leukemia) as compared with 0.47 expected in the general population (standardized incidence ratio, 10.64; 95% confidence interval, 3.28 to 22.34). A third neoplasm (meningioma) developed in one patient. At 15 years after the diagnosis of AML, the estimated cumulative incidence of second malignancy was 1.34% +/- 0.61%, whereas the cumulative incidence of death due to any other cause was 72.96% +/- 2.14%. We concluded that although a more than 10-fold increased risk of development of cancer was found in survivors of childhood AML as compared to the general population, the risk of this late complication is small when compared to the much larger risk of death because of the primary leukemia or the early complications of its treatment. Future studies should focus on improving treatments for primary AML while preventing second malignancies.
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Affiliation(s)
- W Leung
- Department of Hematology-Oncology, St Jude Children's Research Hospital, and University of Tennessee, College of Medicine, Memphis, USA
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Kim AL, Fernandez CV, Greer WL, Hogg D, Lassam NJ, Resch L. Concurrent acute lymphoblastic leukemia and juvenile pilocytic astrocytoma in a pediatric patient. J Pediatr Hematol Oncol 2000; 22:451-3. [PMID: 11037859 DOI: 10.1097/00043426-200009000-00013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The concurrence of acute lymphoblastic leukemia (ALL) and an asymptomatic juvenile pilocytic astrocytoma is described. A 6-year-old boy without clinical evidence of neurofibromatosis had a juvenile pilocytic astrocytoma diagnosed on radiologic examination and before treatment of acute pre-B cell lymphoblastic leukemia. The patient has had a partial resection of the astrocytoma and is 9 months into treatment of his ALL, which is in complete remission. p53 gene mutation was not identified in this patient. The concurrent diagnosis before treatment of ALL and juvenile pilocytic astrocytoma, the latter normally an indolent tumor, suggests that some cases of astrocytoma previously ascribed to radiotherapy or other treatment may in fact be caused by other factors.
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Affiliation(s)
- A L Kim
- QEII Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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49
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Secondary neoplasms subsequent to Berlin-Frankfurt-Münster therapy of acute lymphoblastic leukemia in childhood: significantly lower risk without cranial radiotherapy. Blood 2000. [DOI: 10.1182/blood.v95.9.2770.009k16_2770_2775] [Citation(s) in RCA: 203] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Secondary neoplasms (SNs) represent serious late complications after successful treatment of malignant diseases. To evaluate the rate and type of SNs after Berlin-Frankfurt-Münster (BFM) treatment in children with acute lymphoblastic leukemia (ALL), we analyzed the data from the BFM database and the German Childhood Cancer Registry (GCCR). Between April 1979 and April 1995, 5006 children with B-precursor or T-ALL were enrolled in 5 ALL-BFM multicenter trials. The median follow-up time from diagnosis was 5.7 years (range 1.5-18 years). By December 1997, 52 SNs were documented, including 16 acute myeloid leukemias (AMLs), 13 neoplasms of the central nervous system (CNS), and 23 other neoplasms. Compared with the expected numbers estimated from incidence rates derived from the GCCR, this represented a 14-fold increase for all cancers and a 19-fold increase for CNS tumors. SNs developed 0.9 to 15 years (median: 6 years) after the diagnosis of ALL; 46 patients were in first complete remission (CR). The overall cumulative risk of SNs at 15 years was 3.3% (95% confidence interval [CI]: 1.6%-5.1%) and 2.9% (95% CI: 1.6%-4.2%) in first CR. The risk was 3.5% (95% CI: 1.5%-5.5%) after treatment, including cranial irradiation and significantly lower in nonirradiated patients: 1.2% (95% CI: 0.2%-2.3%;P = .048). The development of secondary AML was not associated with the use of any specific cytotoxic agent. Considering the high-survival rate of this large unselected ALL cohort, the risk of SN is relatively low, though higher, especially after cranial irradiation, than in the general population. Long-term follow-up is mandatory, and further SNs with longer latency periods are to be expected.
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