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Lemmen J, Njuguna F, Verhulst S, Vik TA, Ket JCF, Kaspers G, Mostert S. Late Effects of Childhood Cancer Survivors in Africa: a Scoping Review. Crit Rev Oncol Hematol 2023; 185:103981. [PMID: 37003444 DOI: 10.1016/j.critrevonc.2023.103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION The number of children surviving cancer in Africa is increasing. Knowledge about late effects of survivors is lacking. Our study maps literature regarding late effects of childhood cancer survivors in Africa. METHODS Scoping review was performed following JBI-guidelines. Systematic literature search was conducted in: Medline, Embase, African Index Medicus, Web of Science, Scopus, Psycinfo. Titles and abstracts were screened by two reviewers, followed by full-text analysis by the lead reviewer. RESULTS Sixty-eight studies were included for content analysis. Studies originated from 10 of 54 African countries. Most studies had retrospective study design, 2-5 years follow-up, solely chemotherapy as treatment modality, Egypt as country of origin. Fifty-three studies described physical, and seventeen studies described psychosocial late effects. CONCLUSION Literature concerning late effects is available from a limited number of African countries. Psychosocial domain lacks attention compared to the physical domain. More countries should report on this topic to prevent, identify and monitor late effects.
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Affiliation(s)
- Jesse Lemmen
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, the Netherlands; Princess Máxima Center for Pediatric oncology, Utrecht, the Netherlands.
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | - Sanne Verhulst
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, the Netherlands
| | - Terry A Vik
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, United States of America
| | | | - Gertjan Kaspers
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, the Netherlands; Princess Máxima Center for Pediatric oncology, Utrecht, the Netherlands
| | - Saskia Mostert
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, the Netherlands; Princess Máxima Center for Pediatric oncology, Utrecht, the Netherlands
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Zhang Y, Ning H, Zheng W, Liu J, Li F, Chen J. Lung microbiome in children with hematological malignancies and lower respiratory tract infections. Front Oncol 2022; 12:932709. [PMID: 36212487 PMCID: PMC9533145 DOI: 10.3389/fonc.2022.932709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022] Open
Abstract
Background Respiratory infectious complications remain a major cause of morbidity and mortality in children with hematological malignancies. Knowledge regarding the lung microbiome in aforementioned children is limited. Methods A prospective cohort was conducted, enrolling 16 children with hematological malignancies complicated with moderate-to-severe lower respiratory tract infections (LRTIs) versus 21 LRTI children with age, gender, weight, and infection severity matched, with no underlying malignancies, to evaluate the lung microbiome from bronchoalveolar lavage fluid samples in different groups. Results The lung microbiome from children with hematological malignancies and LRTIs showed obviously decreased α and β diversity; increased microbial function in infectious disease:bacteria/parasite; drug resistance:antimicrobial and human pathogenesis than the control group; a significantly reduced proportion of Firmicutes, Bacteroidota, Actinobacteriota; increased Proteobacteria at the phylum level; and distinctly elevated Parabacteroides, Klebsiella, Grimontia, Escherichia_Shigella, unclassified_Enterobacteriaceae at the genus level than the control group. Furthermore, it was revealed that α diversity (Shannon), β diversity (Bray-Curtis dissimilarity), Proteobacteria at the phylum level, and unclassified_Enterobacteriaceae and Escherichia_Shigella at the genus level were significantly negatively associated with hospitalization course whereas Firmicutes at the phylum level was established positively correlated with the hospitalization course. Conclusions Children with hematological malignancies and LRTIs showed obviously decreased α and β diversity, significantly increased function in infectious disease pathogenesis, antimicrobial drug resistance, and unfavorable environment tolerance. Moreover, α diversity (Shannon), β diversity (Bray-Curtis dissimilarity), and Proteobacteria may be used as negative correlated predictors for hospitalization course in these children whereas Firmicutes may be utilized as a positive correlated predictor.
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Affiliation(s)
- Yun Zhang
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Haonan Ning
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Wenyu Zheng
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Jing Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fuhai Li
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Junfei Chen
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China
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3
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Zheng K, Bassal M, Mitsakakis N, Cepalo T, Hamid JS, Momoli F, Reisman J, Nair V, Radhakrishnan D. A longitudinal analysis of early lung function trajectory in survivors of childhood Hodgkin lymphoma. Cancer Rep (Hoboken) 2022; 6:e1661. [PMID: 35760768 PMCID: PMC9875613 DOI: 10.1002/cnr2.1661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Childhood Hodgkin lymphoma survivors suffer from long-term effects decades after treatment completion with a prevalence of pulmonary dysfunction of up to 65.2%. AIMS This study explored the early trajectory of pulmonary function in pediatric cancer patients with Hodgkin lymphoma who received pulmonary toxic therapy. METHODS AND RESULTS In this single-center, 20-year retrospective cohort study, we included patients who were <18 years old at diagnosis of Hodgkin lymphoma between January 1994 and December 2014, and received bleomycin or thoracic radiation. We measured pulmonary function and reported on percent predicted values for forced expiratory volume in 1 s, total lung capacity, and diffusing capacity of the lungs. We used linear mixed models to identify the association of clinical factors with longitudinal changes in lung function at time points before and after treatment completion. Of 80 children who met inclusion criteria, all were treated with bleomycin, and 83.8% received thoracic radiation. More than half (51.2%) of patients had any abnormalities in lung function measures during the study observation period which averaged 24.2 months (±31.1SD). Females, younger age at diagnosis and treatment with radiation were associated with lower lung function measurements at various time points. While the majority of children experienced a recovery of their lung function within 1-2 years after treatment completion, some children with these risk factors did not. CONCLUSION Pulmonary function abnormalities begin early in children treated for Hodgkin lymphoma. While the majority of children demonstrate a slow and continuous improvement in lung function back to baseline over time, we recommend routine asymptomatic screening of pulmonary function in certain childhood cancer survivors, particularly females, those diagnosed young and patients who received radiation therapy.
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Affiliation(s)
- Katina Zheng
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Mylène Bassal
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,Department of Pediatrics, Division of Hematology/OncologyChildren's Hospital of Eastern OntarioOttawaOntarioCanada,Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada
| | - Nicholas Mitsakakis
- Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada
| | | | - Jemila Seid Hamid
- Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada
| | - Franco Momoli
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada,Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Joseph Reisman
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada,Department of Pediatrics, Division of RespirologyChildren's Hospital of Eastern OntarioOttawaOntarioCanada
| | - Vimoj Nair
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada,Ottawa Hospital Research InstituteOttawaOntarioCanada,Division of Radiation OncologyUniversity of OttawaOttawaOntarioCanada
| | - Dhenuka Radhakrishnan
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada,Department of Pediatrics, Division of RespirologyChildren's Hospital of Eastern OntarioOttawaOntarioCanada,ICES uOttawaOttawaOntarioCanada
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Pulmonary Dysfunction after Treatment for Childhood Cancer. Comparing Multiple-Breath Washout with Spirometry. Ann Am Thorac Soc 2021; 18:281-289. [PMID: 32877212 DOI: 10.1513/annalsats.202003-211oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Rationale: Childhood cancer survivors are at risk of long-term pulmonary dysfunction, but we lack sensitive outcome measures to detect early pulmonary damage.Objectives: To assess the ability of nitrogen multiple-breath washout (N2MBW) for detecting pulmonary dysfunction compared with spirometry in long-term survivors of childhood cancer.Methods: We analyzed cross-sectional data from long-term (≥5-yr) survivors of childhood cancer, aged ≤16 years at cancer diagnosis, ≥16 years at study (assessment period 2015-2019). We categorized survivors by risk: high risk for those having had pulmotoxic chemotherapy, chest radiation, thoracic surgery, and/or hematopoietic stem cell transplantation, and standard risk for other cancer therapies. Primary outcomes were the global lung clearance index (LCI) and acinar ventilation inhomogeneity index (SACIN) from N2MBW, and forced expiratory volume in 1 second (FEV1) and functional vital capacity (FVC) from spirometry. We calculated z-scores for N2MBW and spirometry parameters and compared pulmonary dysfunction between risk groups. Pulmonary dysfunction was defined as z-score +1.64 for N2MBW and -1.64 for spirometry.Results: We studied 46 survivors, median age at diagnosis 10 years (interquartile range, 4-14), median age at study 30 years (interquartile range, 25-40). Thirty-seven percent were at high risk and 63% at standard risk for pulmonary dysfunction. LCI and SACIN were higher in the high-risk group compared with the standard-risk group (mean LCI z-scores 2.09, standard deviation [SD] 2.39 vs. 0.95, SD 2.81; mean SACIN z-scores 2.45, SD 3.29 vs. 0.65, SD 2.79). FEV1 and FVC were lower in the high-risk compared with the standard-risk group (mean FEV1 z-scores -0.94, SD 1.39 vs. -0.10, SD 1.07; mean FVC z-scores -1.14, SD 1.23 vs. 0.15, SD 1.61). Overall, LCI, SACIN, FEV1, and FVC were abnormal in 60%, 53%, 33%, and 33% of high-risk patients compared with 23%, 21%, 0%, and 4% of standard-risk patients.Conclusions: N2MBW identified more cases of pulmonary dysfunction in long-term survivors of childhood cancer than spirometry, even in patients who had cancer therapy not specifically known as being pulmotoxic. N2MBW could be a complementary screening tool for early pulmonary damage after treatment for childhood cancer.Clinical trial registered with www.clinicaltrials.gov (NCT02730767).
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Exploring pulmonary function and physical function in childhood cancer: A systematic review. Crit Rev Oncol Hematol 2021; 160:103279. [PMID: 33716200 DOI: 10.1016/j.critrevonc.2021.103279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/28/2021] [Accepted: 02/27/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Children with cancer experience pulmonary and physical function side effects from the cancer itself and the medical interventions. This systematic review examines the known relationship between pulmonary function and physical function in childhood cancer and identifies gaps in the literature. METHODS A search of Ovid Medline, CINAHL (EbscoHost) and Embase to identify literature from 2009 to March 2020. RESULTS Fifty-seven studies met inclusion criteria. Thirty-seven studies reported impaired pulmonary function. Incidence of pulmonary dysfunction ranged from 45.5 % to 84.1 %. Eighteen studies reported impaired physical function. Three studies investigated the relationship between pulmonary function and physical function. No studies explored inspiratory muscle strength. CONCLUSION Pulmonary function and physical function are related and frequently impaired in children during and after cancer treatment. A literature gap was found in diaphragm function and its relationship with physical function. Future studies should focus on interventions that target the pulmonary mechanisms impacting physical function.
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Lin B, Kennedy B, McBride J, Dalla‐Pozza L, Trahair T, McCowage G, Coward E, Plush L, Robinson PD, Hardaker K, Widger J, Ng A, Jaffe A, Selvadurai H. Long-term morbidity of respiratory viral infections during chemotherapy in children with leukaemia. Pediatr Pulmonol 2019; 54:1821-1829. [PMID: 31393087 PMCID: PMC7167615 DOI: 10.1002/ppul.24456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/06/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Respiratory viruses are a common cause of infection in immunosuppressed children undergoing cancer therapy. Pulmonary sequelae have been documented following respiratory viral infections (RVIs) in hematopoietic stem cell transplant (HSCT) recipients; however potential late effects in children undergoing nonmyeloablative chemotherapy have not been investigated. AIM To evaluate the long-term pulmonary morbidity of respiratory viral infections during chemotherapy in children with acute lymphoblastic leukemia (ALL). METHODS Childhood ALL survivors, aged 7 to 18 years, greater than 6 months posttreatment were recruited. Exclusion criteria included HSCT or proven bacterial/fungal respiratory infection during treatment. Subjects were classified into "viral" or "control" groups according to retrospective medical records that documented the presence of laboratory-proven RVIs during chemotherapy. Symptom questionnaires (Liverpool, ISAAC) and lung function testing (spirometry, plethysmography, diffusing capacity, forced oscillation technique to ATS/ERS standards) were then performed cross-sectionally at the time of recruitment. RESULTS Fifty-four patients (31 viral, 23 control) were recruited: median (range) age 11.2 (7.2-18.1) years, and at 4.9 (0.5-13) years posttherapy. Abnormalities were detected in 17 (31%) individuals (8 viral, 9 control), with the most common being DLCO impairment (3 viral, 4 control) and reduced respiratory reactance at 5 Hz (5 viral, 6 control). Children with RVIs during chemotherapy reported more current respiratory symptoms, particularly wheeze (odds ratio [OR], 3.0; 95% confidence interval [CI]: 0.9-10.0; P = .09) and cough (OR, 2.7; 95% CI: 0.8-9.5; P = .11). No differences in lung function tests were observed between the two groups. CONCLUSIONS Our study found children with RVIs during chemotherapy developed more long-term respiratory symptoms than controls; however, differences did not reach statistical significance. No differences in static lung function were found between the two groups. Overall, pulmonary abnormalities and/or significant ongoing respiratory symptoms were detected in nearly a third of ALL survivors treated without HSCT. Larger, prospective studies are warranted to evaluate the etiology and clinical significance of these findings.
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Affiliation(s)
- Beryl Lin
- Faculty of MedicineUniversity of New South WalesSydneyAustralia
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyAustralia
| | - Brendan Kennedy
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyAustralia
| | - Jamie McBride
- Department of Respiratory MedicineSydney Children's HospitalSydneyAustralia
| | - Luciano Dalla‐Pozza
- Cancer Centre for ChildrenThe Children's Hospital at WestmeadSydneyAustralia
| | - Toby Trahair
- Faculty of MedicineUniversity of New South WalesSydneyAustralia
- Kids Cancer CentreSydney Children's HospitalRandwickAustralia
| | - Geoffrey McCowage
- Cancer Centre for ChildrenThe Children's Hospital at WestmeadSydneyAustralia
| | - Emma Coward
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyAustralia
| | - Leanne Plush
- Department of Respiratory MedicineSydney Children's HospitalSydneyAustralia
| | - Paul D. Robinson
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyAustralia
- Discipline of Paediatrics and Child HealthUniversity of SydneySydneyAustralia
| | - Kate Hardaker
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyAustralia
- Discipline of Paediatrics and Child HealthUniversity of SydneySydneyAustralia
| | - John Widger
- Faculty of MedicineUniversity of New South WalesSydneyAustralia
- Department of Respiratory MedicineSydney Children's HospitalSydneyAustralia
| | - Anthea Ng
- Cancer Centre for ChildrenThe Children's Hospital at WestmeadSydneyAustralia
| | - Adam Jaffe
- Department of Respiratory MedicineSydney Children's HospitalSydneyAustralia
| | - Hiran Selvadurai
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyAustralia
- Discipline of Paediatrics and Child HealthUniversity of SydneySydneyAustralia
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Impairment of lung diffusion capacity-a new consequence in the long-term childhood leukaemia survivors. Ann Hematol 2019; 98:2103-2110. [PMID: 31267177 PMCID: PMC6700051 DOI: 10.1007/s00277-019-03745-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/15/2019] [Indexed: 01/20/2023]
Abstract
Childhood leukaemia survivors (CLS) are known to have developed long-term impairment of lung function. The reasons for that complication are only partially known. The aims of this study were to assess pulmonary function in CLS and identify (1) risk factors and (2) clinical manifestations for the impairment of airflow and lung diffusion. The study group included 74 CLS: 46 treated with chemotherapy alone (HSCT−), 28 with chemotherapy and haematopoietic stem cell transplantation (HSCT+), and 84 healthy subjects (control group (CG)). Spirometry and diffusion limit of carbon monoxide (DLCO) tests were performed in all subjects. Ten (14%) survivors had restrictive, five (7%) had obstructive pattern, and 47 (66%) had reduced DLCO. The age at diagnosis, type of transplant, and type of conditioning regimen did not significantly affect the pulmonary function tests. The DLCO%pv were lower in CLS than in CG (p < 0.03) and in the HSCT+ than in the HSCT− survivors (p < 0.05). The pulmonary infection increased the risk of diffusion impairment (OR 5.1, CI 1.16–22.9, p = 0.019). DLCO was reduced in survivors who experienced CMV lung infection (p < 0.001). The main symptom of impaired lung diffusion was poor tolerance of exercise (p < 0.005). The lower lung diffusion capacity is the most frequent abnormality in CLS. HSCT and pulmonary infection, in particular with CMV infection, are strong risk factors for impairment of lung diffusion capacity in CLS. Clinical manifestation of DLCO impairment is poor exercise tolerance. A screening for respiratory abnormalities in CLS seems to be of significant importance.
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Pulmonary Complications of Malignancies and Blood and Marrow Transplantation. PULMONARY COMPLICATIONS OF NON-PULMONARY PEDIATRIC DISORDERS 2018. [PMCID: PMC7120544 DOI: 10.1007/978-3-319-69620-1_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Shelmerdine SC, Chavhan GB, Babyn PS, Nathan PC, Kaste SC. Imaging of late complications of cancer therapy in children. Pediatr Radiol 2017; 47:254-266. [PMID: 27904916 DOI: 10.1007/s00247-016-3708-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/25/2016] [Accepted: 09/13/2016] [Indexed: 12/26/2022]
Abstract
Long-term survival after childhood cancer has improved dramatically over recent decades but survivors face lifelong risks of adverse health effects. Many of these chronic conditions are a direct result of previous therapeutic exposures. Compared to their siblings, survivors face a greater than 8-fold increase in relative risk of severe or life-threatening medical conditions; the most significant of these include second malignancies and cardiovascular and pulmonary diseases. Imaging can play a key role in identifying and characterizing such complications, which can be reasonably predicted with knowledge of the child's treatment. This article highlights the varied radiologic presentations and features seen in late cancer-therapy-related conditions.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
| | - Paul S Babyn
- Department of Medical Imaging, Royal University Hospital, Saskatoon, SK, Canada
| | - Paul C Nathan
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Sue C Kaste
- Department of Diagnostic Imaging and Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Radiology, University of Tennessee School of Health Sciences, Memphis, Memphis, TN, USA
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Bechtel A, Joyce M, Dudek CJ, Sarandria JJ, Shah C, Saad AG. Multiple unusual lung etiologies in a child with acute lymphocytic leukemia. Pediatr Blood Cancer 2017; 64. [PMID: 27616461 DOI: 10.1002/pbc.26247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/09/2016] [Accepted: 08/15/2016] [Indexed: 11/12/2022]
Abstract
Granulomatous lung disease is a rare and perplexing differential in pediatrics. Pulmonary Cryptococcus falls into the differential but is not high on the list, particularly in a non-AIDS patient. Methotrexate (MTX) is a commonly used agent for chemotherapy in oncology and has been documented to cause lung injury in both patients with rheumatologic and oncologic diseases. Our patient had chronic cough and then developed an opportunistic infection resulting in respiratory failure. Lung biopsy showed two underlying unusual diagnoses: MTX lung injury and cryptococcal pneumonia. His case is presented with particular attention to his prolonged road to diagnosis.
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Affiliation(s)
- Allison Bechtel
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida.,Division of Pediatric Hematology and Oncology, Department of Pediatrics, Nemours Jacksonville, Jacksonville, Florida
| | - Michael Joyce
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Nemours Jacksonville, Jacksonville, Florida
| | - Christopher J Dudek
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
| | - John J Sarandria
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
| | - Chetan Shah
- Division of Pediatric Radiology, Department of Pediatrics, Nemours Jacksonville, Jacksonville, Florida
| | - Ali G Saad
- Baptist Health/MD Anderson Cancer Center and Wolfson Children's Hospital, Jacksonville, Florida.,Department of Pathology, University of Mississippi, Jackson, Mississippi
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Record E, Williamson R, Wasilewski-Masker K, Mertens AC, Meacham LR, Popler J. Analysis of Risk Factors for Abnormal Pulmonary Function in Pediatric Cancer Survivors. Pediatr Blood Cancer 2016; 63:1264-71. [PMID: 27002916 DOI: 10.1002/pbc.25969] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Childhood cancer survivors are at increased risk for pulmonary-related morbidity and mortality. The Children's Oncology Group Long-Term Follow-Up (COG-LTFU) guidelines recommend pulmonary function testing after treatment with bleomycin, busulfan, carmustine, lomustine, thoracic radiation, bone marrow transplant, or pulmonary surgery. The aim of this analysis was to determine the prevalence of pulmonary function abnormalities in a pediatric survivor cohort. PROCEDURE Patients ≥5 years old seen in our survivor clinic with at least one exposure outlined by COG-LFTU Guidelines were included. Original pulmonary function test (PFT) results were obtained and blindly reinterpreted by a single reviewer. Demographic, diagnosis, treatment factors, and clinical and/or patient-reported symptoms of cough, wheeze, and/or dyspnea were abstracted from their medical record. RESULTS Overall, 143 (63.3%) survivors had PFT results available; 55.2% were male, 49.7% were white, and the mean age was 14.1 ± 4.8 years. Abnormal PFTs were found in 65.0% (n = 93) with 21.0% having multiple abnormalities. Specifically, 41.3% had hyperinflation, 25.9% had obstructive, and 13.3% had restrictive disease. Patients diagnosed at <5 years were more likely to have a pulmonary abnormality (P = 0.04); a majority of those diagnosed <5 years underwent pulmonary surgery or thoracic radiation. Regardless of the presence of a PFT abnormality, more than 80% of survivors were asymptomatic (82.9% vs.81.5%; P-value = 0.54). CONCLUSIONS Almost two-thirds of survivors screened per the COG-LTFU Guidelines had an abnormal PFT but a majority reported no clinical symptoms. Hyperinflation was the most prevalent abnormality.
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Affiliation(s)
- Elizabeth Record
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Rebecca Williamson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Ann C Mertens
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Lillian R Meacham
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Emory University, Atlanta, Georgia
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de Macêdo TMF, Campos TF, Mendes REDF, França DC, Chaves GSDS, de Mendonça KMPP. [Pulmonary function of children with acute leukemia in maintenance phase of chemotherapy]. REVISTA PAULISTA DE PEDIATRIA 2014; 32:320-5. [PMID: 25510995 PMCID: PMC4311785 DOI: 10.1016/j.rpped.2014.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/29/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE: The aim of this study was to assess the pulmonary function of children with acute
leukemia. METHODS: Cross-sectional observational analytical study that enrolled 34 children divided
into groups A (17 with acute leukemia in the maintenance phase of chemotherapy)
and B (17 healthy children). The groups were matched for sex, age and height.
Spirometry was measured using a spirometer Microloop Viasys(r) in
accordance with American Thoracic Society and European Respiratory Society
guidelines. Maximal respiratory pressures were measured with an MVD300 digital
manometer (Globalmed(r)). Maximal inspiratory pressures and maximal
expiratory pressures were measured from residual volume and total lung capacity,
respectively. RESULTS: Group A showed a significant decrease in maximal inspiratory pressures when
compared to group B. No significant difference was found between the spirometric
values of the two groups, nor was there any difference between maximal inspiratory
pressure and maximal expiratory pressure values in group A compared to the lower
limit values proposed as reference. CONCLUSION: Children with acute leukemia, myeloid or lymphoid, during the maintenance phase
of chemotherapy exhibited unchanged spirometric variables and maximal expiratory
pressure; However, there was a decrease in inspiratory muscle strength.
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13
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Macêdo TMFD, Campos TF, Mendes REDF, França DC, Chaves GSDS, Mendonça KMPPD. Pulmonary function of children with acute leukemia in maintenance phase of chemotherapy. REVISTA PAULISTA DE PEDIATRIA 2014. [DOI: 10.1590/s0103-05822014000400007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: The aim of this study was to assess the pulmonary function of children with acute leukemia.METHODS: Cross-sectional observational analytical study that enrolled 34 children divided into groups A (17 with acute leukemia in the maintenance phase of chemotherapy) and B (17 healthy children). The groups were matched for sex, age and height. Spirometry was measured using a spirometer Microloop Viasys(r) in accordance with American Thoracic Society and European Respiratory Society guidelines. Maximal respiratory pressures were measured with an MVD300 digital manometer (Globalmed(r)). Maximal inspiratory pressures and maximal expiratory pressures were measured from residual volume and total lung capacity, respectively.RESULTS: Group A showed a significant decrease in maximal inspiratory pressures when compared to group B. No significant difference was found between the spirometric values of the two groups, nor was there any difference between maximal inspiratory pressure and maximal expiratory pressure values in group A compared to the lower limit values proposed as reference.CONCLUSION: Children with acute leukemia, myeloid or lymphoid, during the maintenance phase of chemotherapy exhibited unchanged spirometric variables and maximal expiratory pressure; However, there was a decrease in inspiratory muscle strength.
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Madanat-Harjuoja LM, Valjento S, Vettenranta K, Kajosaari M, Dyba T, Taskinen M. Pulmonary function following allogeneic stem cell transplantation in childhood: a retrospective cohort study of 51 patients. Pediatr Transplant 2014; 18:617-24. [PMID: 25041660 DOI: 10.1111/petr.12313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 11/27/2022]
Abstract
HSCT is associated with a high risk of late morbidity. The aim of this study was to evaluate the frequency, time frame, risk factors, and possible etiology of pulmonary dysfunction following allogeneic HSCT in childhood. We evaluated the pulmonary function of 51 HSCT patients (>6 yr), by including FVC and FEV1 values prior to (baseline) and annually up to five yr after HSCT. A Cox proportional hazards model was used to analyze the risk factors for a pulmonary event. Over half (59%) of the patients developed pulmonary dysfunction, mainly consisting of restrictive abnormalities. Acute GvHD (HR 4.31, 95% CI 1.47-12.63), chronic GvHD (HR 10.20, 95% CI 2.42-43.03), and an abnormal baseline pulmonary function (HR 4.82, 95% CI 1.02-22.84) were associated with post-transplant dysfunction. FEV1 (p < 0.001) and FVC (p < 0.001) declined significantly by 12 months after HSCT and both remained below the pre-HSCT level at up to four yr post-transplantation. HSCT in childhood is associated with early and persistent restrictive impairment of pulmonary function. Patients with extensive chronic GvHD are particularly vulnerable to severe pulmonary dysfunction. Scheduled pulmonary function testing is warranted as part of the follow-up of survivors of HSCT in childhood.
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Jordán Z, Tokodi Z, Németh A, Müller J, Csóka M, Mohl A, Erdélyi D, Kovács G. [Examination of late pulmonary toxicity in children treated for malignancies]. Orv Hetil 2013; 154:345-50. [PMID: 23434884 DOI: 10.1556/oh.2013.29549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The present investigation was based on a survey in 2005, in which the authors found pulmonary function abnormalities in survivors of childhood cancer, who were treated with anticancer therapy. AIM The purpose of the present study was to follow-up childhood cancer survivors and detect late pulmonary toxicity. PATIENTS AND METHODS Lung function test was performed with spirometry in 26 survivors participated in this study (10 females and 16 males; mean age, 19.4 years at the time of the second follow-up evaluation). The average time periods from treatment until the first and second follow-up evaluation were 4.5 and 10 years, respectively. RESULTS The authors found 14 patients with pathological pulmonary function tests results at the time of the first follow-up evaluation, from which 7 patients had obstructive, 5 patients had mixed and 2 patients had restrictive abnormalities. However, there were only 6 patients who had abnormal pulmonary function at the time of the second follow-up evaluation (2 patients with obstructive and 4 patients with restrictive pulmonary function tests (p<0.05). CONCLUSION Restrictive pulmonary disorder was detected in only small part of the treated patients. The obstructive pulmonary abnormalities caused by the treatment showed an improving tendency over time.
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Affiliation(s)
- Zsófia Jordán
- Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
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