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Uemura S, Hasegawa D, Kishimoto K, Fujikawa T, Nakamura S, Kozaki A, Saito A, Ishida T, Mori T, Ozaki K, Kosaka Y. Association between conditioning intensity and height growth after allogeneic hematopoietic stem cell transplantation in children. Cancer Med 2023; 12:17018-17027. [PMID: 37434385 PMCID: PMC10501226 DOI: 10.1002/cam4.6336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/15/2023] [Accepted: 07/02/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND The present study aimed to examine the association between the conditioning intensity and height growth in pediatric patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS We reviewed the clinical records of 89 children with malignant diseases who underwent initial allo-HSCT between 2003 and 2021. Height measurements were standardized using standard height charts prepared by the Japanese Society for Pediatric Endocrinology to calculate standard deviation score (SDS). We defined short stature as a height SDS less than -2.0 in that reference. Myeloablative conditioning (MAC) comprised total-body irradiation at more than 8 Gy and busulfan administration at more than 8 mg/kg (more than 280 mg/m2 ). Other conditioning regimens were defined as reduced intensity conditioning (RIC). RESULTS A total of 58 patients underwent allo-HSCT with MAC, and 31 patients received allo-HSCT with RIC. There were significant differences in the height SDS at 2 and 3 years after allo-HSCT between MAC and RIC group (-1.33 ± 1.20 vs. -0.76 ± 1.12, p = 0.047, -1.55 ± 1.28 vs. -0.75 ± 1.11, p = 0.022, respectively). Multivariate logistic regression analysis with the adjustments for potential confounding factors of patients less than 10 years of age at allo-HSCT and chronic graft-versus host disease demonstrated that MAC regimen was associated with a markedly increased risk of a short stature at 3 years after allo-HSCT (adjusted odds ratio, 5.61; 95% confidence interval, 1.07-29.4; p = 0.041). CONCLUSION The intensity of conditioning regimen may be associated with short statures after allo-HSCT.
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Affiliation(s)
- Suguru Uemura
- Department of Hematology and OncologyKobe Children's HospitalKobeJapan
| | | | - Kenji Kishimoto
- Department of Hematology and OncologyKobe Children's HospitalKobeJapan
| | - Tomoko Fujikawa
- Department of Hematology and OncologyKobe Children's HospitalKobeJapan
| | - Sayaka Nakamura
- Department of Hematology and OncologyKobe Children's HospitalKobeJapan
| | - Aiko Kozaki
- Department of Hematology and OncologyKobe Children's HospitalKobeJapan
| | - Atsuro Saito
- Department of Hematology and OncologyKobe Children's HospitalKobeJapan
| | - Toshiaki Ishida
- Department of Hematology and OncologyKobe Children's HospitalKobeJapan
| | - Takeshi Mori
- Department of Hematology and OncologyKobe Children's HospitalKobeJapan
| | - Kayo Ozaki
- Department of Endocrinology and MetabolismKobe Children's HospitalKobeJapan
| | - Yoshiyuki Kosaka
- Department of Hematology and OncologyKobe Children's HospitalKobeJapan
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Tapio S, Little MP, Kaiser JC, Impens N, Hamada N, Georgakilas AG, Simar D, Salomaa S. Ionizing radiation-induced circulatory and metabolic diseases. ENVIRONMENT INTERNATIONAL 2021; 146:106235. [PMID: 33157375 PMCID: PMC10686049 DOI: 10.1016/j.envint.2020.106235] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/09/2020] [Accepted: 10/08/2020] [Indexed: 05/23/2023]
Abstract
Risks to health are the prime consideration in all human situations of ionizing radiation exposure and therefore of relevance to radiation protection in all occupational, medical, and public exposure situations. Over the past few decades, advances in therapeutic strategies have led to significant improvements in cancer survival rates. However, a wide range of long-term complications have been reported in cancer survivors, in particular circulatory diseases and their major risk factors, metabolic diseases. However, at lower levels of exposure, the evidence is less clear. Under real-life exposure scenarios, including radiotherapy, radiation effects in the whole organism will be determined mainly by the response of normal tissues receiving relatively low doses, and will be mediated and moderated by systemic effects. Therefore, there is an urgent need for further research on the impact of low-dose radiation. In this article, we review radiation-associated risks of circulatory and metabolic diseases in clinical, occupational or environmental exposure situations, addressing epidemiological, biological, risk modelling, and systems biology aspects, highlight the gaps in knowledge and discuss future directions to address these gaps.
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Affiliation(s)
- Soile Tapio
- Institute of Radiation Biology, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health GmbH, Neuherberg, Germany.
| | - Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute (NCI), National Institutes of Health (NIH), MD, USA
| | - Jan Christian Kaiser
- Institute of Radiation Medicine, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health GmbH, Neuherberg, Germany
| | - Nathalie Impens
- Institute of Environment, Health and Safety, Biosphere Impact Studies, SCK•CEN, Mol, Belgium
| | - Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan
| | - Alexandros G Georgakilas
- DNA Damage Laboratory, Department of Physics, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Athens, Greece
| | - David Simar
- Mechanisms of Disease and Translational Research, School of Medical Sciences, UNSW Sydney, Sydney, Australia
| | - Sisko Salomaa
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
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Bruzzi P, Bigi E, Predieri B, Bonvicini F, Cenciarelli V, Felici F, Iughetti L. Long-term effects on growth, development, and metabolism of ALL treatment in childhood. Expert Rev Endocrinol Metab 2019; 14:49-61. [PMID: 30596296 DOI: 10.1080/17446651.2019.1561271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 12/17/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION One aim of the long-term care in survivors from acute lymphoblastic leukemia (ALL) during childhood is to avoid or limit complications caused by aggressive therapeutic strategies. AREAS COVERED ALL survivors are a heterogeneous group according to therapeutic protocols. In the last decades, cranial radiotherapy (cRT) has been largely replaced by intrathecal chemotherapy (CT) with a reduction of endocrine sequelae. Published studies are generally difficult to be interpreted because patients were treated according to different risk-adapted protocols and results are conflicting. We perform this review on endocrine long-term effects in childhood ALL survivors focusing on studies published in the last decades. Articles were selected using the following terms (Mesh terms): 'acute lymphoblastic leukemia' AND 'survivors' AND 'childhood' AND 'growth/puberty/fertility/obesity/metabolic syndrome/bone'. EXPERT COMMENTARY Most childhood ALL survivors treated with CT alone attain normal height and have adequate pubertal development. Despite recent protocols improvements, ALL survivors still develop long-term metabolic complications (overweight, obesity, and cardiovascular disease) especially the female gender and patients with an increased body mass index (BMI) at diagnosis. The aim of this review is to describe the state of the art on these topics. We should be able to anticipate, prevent, and treat endocrine long-term morbidities through a well-established follow-up strategy.
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Affiliation(s)
- Patrizia Bruzzi
- a Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Elena Bigi
- b Oncology and Hematology Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Barbara Predieri
- a Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Federico Bonvicini
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Valentina Cenciarelli
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Francesca Felici
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Lorenzo Iughetti
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
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Zucchetti G, Bellini S, Bertolotti M, Bona F, Biasin E, Bertorello N, Tirtei E, Fagioli F. Body Image Discomfort of Adolescent and Young Adult Hematologic Cancer Survivors. J Adolesc Young Adult Oncol 2017; 6:377-380. [DOI: 10.1089/jayao.2016.0067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giulia Zucchetti
- Psycho-Oncology Service, Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Simona Bellini
- Psycho-Oncology Service, Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Marina Bertolotti
- Psycho-Oncology Service, Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Francesca Bona
- Psycho-Oncology Service, Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Eleonora Biasin
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Nicoletta Bertorello
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Elisa Tirtei
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Franca Fagioli
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
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González-Llano O, González-López EE, Ramírez-Cázares AC, Marcos-Ramírez ER, Ruiz-Argüelles GJ, Gómez-Almaguer D. Haploidentical peripheral blood stem cell transplantation with posttransplant cyclophosphamide in children and adolescents with hematological malignancies. Pediatr Blood Cancer 2016; 63:2033-7. [PMID: 27394055 DOI: 10.1002/pbc.26131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) using posttransplant cyclophosphamide (Cy) for graft versus host disease (GVHD) prophylaxis has emerged as an alternative transplant strategy for patients without related donors, especially in the setting of limited resources in which T-cell ex vivo depletion is not affordable. Experience with this transplant modality in children and adolescents is limited. PROCEDURE We report a retrospective analysis of 25 consecutive outpatients under 21 years of age with high-risk hematological malignancies, who received a haplo-HSCT using posttransplant Cy as GVHD prophylaxis. RESULTS Twenty-three (92%) of the 25 patients engrafted, and 20 (95%) of 21 evaluable subjects achieved full donor chimerism by day +30. One-year estimated overall survival and event-free survival were 50% and 33%, respectively. The cumulative incidence rate of severe acute GVHD was 19%, and 15% of patients developed chronic GVHD. CONCLUSIONS Haplo-HSCT with posttransplant Cy is a feasible therapeutic option for children and adolescents with high-risk hematological malignancies in a limited resource setting.
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Affiliation(s)
- Oscar González-Llano
- Hematology Service, Hospital Universitario "Dr. Jose E. Gonzalez," Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Elías Eugenio González-López
- Hematology Service, Hospital Universitario "Dr. Jose E. Gonzalez," Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Ana Carolina Ramírez-Cázares
- Hematology Service, Hospital Universitario "Dr. Jose E. Gonzalez," Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Edson René Marcos-Ramírez
- Hematology Service, Hospital Universitario "Dr. Jose E. Gonzalez," Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | | | - David Gómez-Almaguer
- Hematology Service, Hospital Universitario "Dr. Jose E. Gonzalez," Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
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