1
|
Giertz M, Aarnivala H, Wilk Michelsen S, Björklund C, Englund A, Grönroos M, Hjalgrim LL, Huttunen P, Niinimäki T, Penno E, Pöyhönen T, Raittinen P, Ranta S, Svahn JE, Törnudd L, Niinimäki R, Harila A. Symptomatic osteonecrosis in children treated for Hodgkin lymphoma: A population-based study in Sweden, Finland, and Denmark. Pediatr Blood Cancer 2024:e31250. [PMID: 39140964 DOI: 10.1002/pbc.31250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Osteonecrosis (ON) is a potentially disabling skeletal complication of cancer treatment. Although symptomatic osteonecrosis (sON) is well-known in acute lymphoblastic leukemia (ALL), with an incidence around 6%, studies on sON in pediatric Hodgkin lymphoma (HL) are scarce. The aim of this study was to examine the incidence, risk factors, and outcome of sON in children treated for HL. PROCEDURE A total of 490 children under 18, diagnosed with HL between 2005 and 2019 in Sweden, Finland, and Denmark were eligible for the study. Data on patient characteristics, HL treatment, and development of sON were collected from patients' medical records. Magnetic resonance imaging scans were used to establish ON diagnosis and grade ON according to the Niinimäki grading system. RESULTS Cumulative 2-year incidence of sON among the 489 included patients was 5.5% (n = 30). The risk for developing sON was higher for those with older age (odds ratio [OR] 1.25, 95% confidence interval [CI]: 1.05-1.49, p < .010), female sex (OR 4.45, CI 1.87-10.58, p < .001), high total cumulative glucocorticoid (GC) doses (OR 1.76, 95% CI: 1.21-2.56, p = 0.003), and advanced HL (OR 2.19, 95% CI: 1.03-4.65, p = .042). Four (13.3%) patients underwent major surgical procedures and 13 (43.3%) had persistent symptoms due to ON at follow-up. CONCLUSIONS This study shows that sON is as common in pediatric HL as in pediatric ALL, with risk factors such as older age, female sex, high cumulative GC doses, and advanced HL. Future HL protocol development should aim to reduce the burden of ON by modifying GC treatment.
Collapse
Affiliation(s)
- Mia Giertz
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Pediatric Oncology and Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Henri Aarnivala
- Department of Paediatrics, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Sascha Wilk Michelsen
- Department of Pediatric Hematology and Oncology, Department of Pediatric and Adolescence Medicine, Juliane Marie Centret, University Hospital Copenhagen, Copenhagen, Denmark
| | - Caroline Björklund
- Department of Pediatric Hematology and Oncology, Umeå University Hospital, Umeå, Sweden
| | - Annika Englund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Pediatric Oncology and Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Marika Grönroos
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Lisa Lyngsie Hjalgrim
- Department of Pediatric Hematology and Oncology, Department of Pediatric and Adolescence Medicine, Juliane Marie Centret, University Hospital Copenhagen, Copenhagen, Denmark
| | - Pasi Huttunen
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Tuukka Niinimäki
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Eva Penno
- Department of Surgical Sciences, Unit of Radiology, Uppsala University, Uppsala, Sweden
| | - Tuuli Pöyhönen
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Päivi Raittinen
- Centre for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Susanna Ranta
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Johan E Svahn
- Department of Paediatric Oncology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lisa Törnudd
- Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Pediatrics, H.R.H Crown Princess Victoria's Children's and Youth Hospital, Linköping, Sweden
| | - Riitta Niinimäki
- Department of Paediatrics, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Arja Harila
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Pediatric Oncology and Hematology, Uppsala University Hospital, Uppsala, Sweden
| |
Collapse
|
3
|
Cihoric N, Tsikkinis A, Minniti G, Lagerwaard FJ, Herrlinger U, Mathier E, Soldatovic I, Jeremic B, Ghadjar P, Elicin O, Lössl K, Aebersold DM, Belka C, Herrmann E, Niyazi M. Current status and perspectives of interventional clinical trials for glioblastoma - analysis of ClinicalTrials.gov. Radiat Oncol 2017; 12:1. [PMID: 28049492 PMCID: PMC5210306 DOI: 10.1186/s13014-016-0740-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/08/2016] [Indexed: 01/09/2023] Open
Abstract
The records of 208.777 (100%) clinical trials registered at ClinicalTrials.gov were downloaded on the 19th of February 2016. Phase II and III trials including patients with glioblastoma were selected for further classification and analysis. Based on the disease settings, trials were classified into three groups: newly diagnosed glioblastoma, recurrent disease and trials with no differentiation according to disease setting. Furthermore, we categorized trials according to the experimental interventions, the primary sponsor, the source of financial support and trial design elements. Trends were evaluated using the autoregressive integrated moving average model. Two hundred sixteen (0.1%) trials were selected for further analysis. Academic centers (investigator initiated trials) were recorded as primary sponsors in 56.9% of trials, followed by industry 25.9%. Industry was the leading source of monetary support for the selected trials in 44.4%, followed by 25% of trials with primarily academic financial support. The number of newly initiated trials between 2005 and 2015 shows a positive trend, mainly through an increase in phase II trials, whereas phase III trials show a negative trend. The vast majority of trials evaluate forms of different systemic treatments (91.2%). In total, one hundred different molecular entities or biologicals were identified. Of those, 60% were involving drugs specifically designed for central nervous system malignancies. Trials that specifically address radiotherapy, surgery, imaging and other therapeutic or diagnostic methods appear to be rare. Current research in glioblastoma is mainly driven or sponsored by industry, academic medical oncologists and neuro-oncologists, with the majority of trials evaluating forms of systemic therapies. Few trials reach phase III. Imaging, radiation therapy and surgical procedures are underrepresented in current trials portfolios. Optimization in research portfolio for glioblastoma is needed.
Collapse
Affiliation(s)
- Nikola Cihoric
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Alexandros Tsikkinis
- Department of Genitourinary Oncology, David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Giuseppe Minniti
- Unit of Radiation Oncology, Sant' Andrea Hospital, University Sapienza, and IRCCS Neuromed, Pozzilli (IS), Italy
| | - Frank J Lagerwaard
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ulrich Herrlinger
- Department of Neurology, Division of Clinical Neurooncology, University of Bonn Medical Center, Bonn, Germany
| | - Etienne Mathier
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Ivan Soldatovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branislav Jeremic
- Institute of Lung Diseases, Sremska Kamenica, Serbia and BioIRC Center for Biomedical Research, Kragujevac, Serbia
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Kristina Lössl
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Claus Belka
- Department of Radiation Oncology, LMU Munich, München, Germany.,German Cancer Consortium (DKTK) & German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Evelyn Herrmann
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Maximilian Niyazi
- Department of Radiation Oncology, LMU Munich, München, Germany.,German Cancer Consortium (DKTK) & German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
5
|
Englund A, Molin D, Enblad G, Karlén J, Glimelius I, Ljungman G, Amini R. The role of tumour‐infiltrating eosinophils, mast cells and macrophages in Classical and Nodular Lymphocyte Predominant Hodgkin Lymphoma in children. Eur J Haematol 2016; 97:430-438. [DOI: 10.1111/ejh.12747] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Annika Englund
- Department of Women's and Children′s Health, Paediatric Oncology Uppsala University Uppsala Sweden
| | - Daniel Molin
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology Uppsala University Uppsala Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology Uppsala University Uppsala Sweden
| | - Jonas Karlén
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology Uppsala University Uppsala Sweden
| | - Gustaf Ljungman
- Department of Women's and Children′s Health, Paediatric Oncology Uppsala University Uppsala Sweden
| | - Rose‐Marie Amini
- Department of Immunology, Genetics and Pathology Unit of Pathology Uppsala University Uppsala Sweden
| |
Collapse
|