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Benetou DR, Stergianos E, Geropeppa M, Ntinopoulou E, Tzanni M, Pourtsidis A, Petropoulos AC, Georgakis MK, Tousoulis D, Petridou ET. Late-onset cardiomyopathy among survivors of childhood lymphoma treated with anthracyclines: a systematic review. Hellenic J Cardiol 2018; 60:152-164. [PMID: 30273645 DOI: 10.1016/j.hjc.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/13/2018] [Accepted: 09/24/2018] [Indexed: 02/01/2023] Open
Abstract
Medical advances in pediatric oncology have led to increases in survival but the long-term adverse effects of treatment in childhood cancer survivors have not yet been examined in depth. In this systematic review, we aimed to study the prevalence and risk factors of late-onset cardiomyopathy (LOCM) among survivors of childhood lymphoma treated with anthracyclines. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines we searched Pubmed/Medline, abstracted data and rated studies on quality regarding late-onset (>1 year following treatment) cardiotoxicity of anthracyclines in survivors of childhood lymphoma. Across 22 identified studies, the prevalence of anthracycline-induced LOCM among survivors of childhood lymphoma ranges from 0 to 40%. Anthracycline dose, administration and dose of mediastinal radiation, patient's age and era of diagnosis and evaluation, follow-up duration as well as disease relapse have been reported as risk factors for LOCM, whereas administration of dexrazoxane seems to act protectively. There was significant between-study heterogeneity with regards to lymphoma subtypes, follow-up duration, definition of outcomes, and anthracycline-based treatment protocols. The rates of anthracycline-induced LOCM among survivors of childhood lymphoma are high and dependent on study design. Future studies should explore whether modifying risk factors and suggested supportive care could decrease its prevalence among childhood lymphoma survivors. Until then, lifelong follow-up of these patients aiming to determinate the earliest signs of cardiac dysfunction is the most important measure towards primordial prevention of LOCM.
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Affiliation(s)
- Despoina-Rafailia Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Evangelos Stergianos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Geropeppa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Erato Ntinopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina Tzanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Apostolos Pourtsidis
- Department of Pediatric Hematology-Oncology, "Pan. &Agl. Kyriakou" Children's Hospital, Athens, Greece
| | - Andreas C Petropoulos
- Department of Pediatric Cardiology, XMSK & Merkezi Hospital, National Medical University and the "Aziz Aliyev" National Postgraduate and CME Medical Training Center, Baku, Azerbaijan
| | - Marios K Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- 1(st) Department of Cardiology, Athens University Medical School, "Hippokration" Hospital, Athens, Greece
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Unit of Clinical Epidemiology, Medical School, Karolinska Institute, Stockholm, Sweden
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Geel JA, Chirwa TC, Rowe B, Eyal KC, Omar F, Stones DK, Goga Y, Stefan DC, van Zyl A, Van Emmenes B, Wedi O, Vaithilingum M, Hendricks MG. Treatment outcomes of children with Hodgkin lymphoma between 2000 and 2010: First report by the South African Children's Cancer Study Group. Pediatr Blood Cancer 2017; 64. [PMID: 28383768 DOI: 10.1002/pbc.26536] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/11/2017] [Accepted: 02/16/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children with Hodgkin lymphoma (HL) have excellent survival rates in high-income countries, but there are minimal outcome data in South African patients. Differing approaches to treatment are used in centres across South Africa, and the South African Children's Cancer Study Group (SACCSG) embarked on a programme to audit outcomes to improve survival rates. PATIENTS AND METHODS A multicentre study was conducted to analyse outcomes and prognostic factors of children with HL in South Africa. Ten dedicated South African paediatric oncology units participated in a retrospective data review. All patients with HL treated consecutively between January 2000 and December 2010 were included. Kaplan-Meier curves and Cox regression model were employed to determine survival rates and prognostic factors. RESULTS Two hundred and ninety-four patients were eligible for inclusion. The median age at presentation was 9.6 years (range 2.9-18.8); 55.4% of the patients presented with Stage III and IV disease and 9.9% were human immunodeficiency virus (HIV) positive. First-line therapy consisted of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) in 158 patients, vincristine, procarbazine/etoposide, prednisone and doxorubicin in 97 and adriamycin, bleomycin, vincristine and dacarbazine-chlorambucil, vinblastine, prednisone and procarbazine in 23 patients. The 5-year overall survival (OS) was 79% (95% confidence interval 73-84%). Multivariate analysis demonstrated that HIV infection (P = 0.018) and Ann Arbor Stage III and IV disease (P = 0.006) conferred a poor prognosis, while treatment with ABVD was associated with higher survival rates (P = 0.028). CONCLUSION OS rates are encouraging for a middle-income country, although economic disparities continue to impact negatively on outcomes. Study results will form the basis for the development of national protocol and continued advocacy to rectify disparities.
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Affiliation(s)
- Jennifer A Geel
- Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Tobias C Chirwa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Biance Rowe
- Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Katherine C Eyal
- Faculty of Economics, University of Cape Town, Cape Town, South Africa
| | - Fareed Omar
- Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - David K Stones
- Faculty of Health Sciences, University of the Free State, Universitas Hospital, Bloemfontein, South Africa
| | - Yasmin Goga
- Faculty of Health Sciences, University of Kwazulu-Natal, Inkosi Albert Luthuli Hospital, Durban, South Africa
| | | | - Anel van Zyl
- Faculty of Health Sciences, University of Stellenbosch, Tygerberg Hospital, Tygerberg, South Africa
| | - Barry Van Emmenes
- Divison of Paediatric Haemetology and Oncology, Frere Hospital, East London, South Africa
| | - Oloko Wedi
- Divison of Paediatric Haemetology and Oncology, Polokwane-Mankweng Hospital Complex, Polokwane, South Africa
| | | | - Marc G Hendricks
- Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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Mihăilă RG. Liver Involvement in Hodgkin's Lymphoma: Types of Injuries and Therapeutic Implications. ACTA ACUST UNITED AC 2017. [DOI: 10.18052/www.scipress.com/ijppe.8.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The hepatocytolysis raises questions on following therapeutic conduct when it occurs during chemotherapy for Hodgkin's lymphoma, expression of its liver toxicity. But the onset of primary liver Hodgkin's lymphoma, including the form manifested by acute liver failure, poses even greater problems, as in the case of occurrence of vanishing bile duct syndrome - expression of a paraneoplastic syndrome, hemophagocytic lymphohistiocytosis, peliosis hepatis or association of lymphoma with infection with hepatitis viruses or human immunodeficiency virus or different autoimmune diseases. This review summarizes the clinical experience acquired on the relationship between Hodgkin's lymphoma and liver, from the point of view of clinical manifestations, used treatments and clinical evolution. Suggestions on the course of treatment in patients with Hodgkin's lymphoma and liver damage have been formulated starting from the metabolism and elimination of chemotherapy drugs and taking into account the clinical experience of published clinical trials and cases. This review is a synthesis of knowledge obtained in this field, during the time, of therapeutic possibilities and limits, and formulates potential future milestones for research.
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Abstract
Hodgkin lymphoma (HL) was described for the first time in 1832 by Sir Thomas Hodgkin, who is considered the father of the disease. This lymphoma occupies a special place among childhood malignancies, due to its high rate of cure. HL is described as one of the most common haematological malignancies in African children. Despite high rates of survival achieved in resource rich countries, the outcome in Africa is not as rewarding as many challenges are encountered. This paper reviews published African studies on childhood HL in order to delineate the amplitude of this health problem and its African specifics, in the quest for effective ways to improve the outcome of the children diagnosed with this disease.
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Affiliation(s)
- Daniela C Stefan
- Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, PO Box 19063, Tygerberg, Cape Town 7505, South Africa.
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