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Saglio F, Pagliara D, Zecca M, Balduzzi A, Cattoni A, Prete A, Tambaro FP, Faraci M, Calore E, Locatelli F, Fagioli F. Long-Term Complications after Allogeneic Hematopoietic Stem Cell Transplantation with Treosulfan- or Busulfan-Based Conditioning in Pediatric Patients with Acute Leukemia or Myelodysplastic Syndrome: Results of an Associazione Italiana Ematologia Oncologia Pediatrica Retrospective Study. Transplant Cell Ther 2024; 30:433.e1-433.e10. [PMID: 38176654 DOI: 10.1016/j.jtct.2023.12.671] [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: 11/01/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
Patients undergoing hematopoietic stem cell transplantation (HSCT) for hematologic malignancies during childhood have an increased risk of developing long-term sequelae that are in part attributable to the conditioning regimen. The present study aimed to assess the occurrence of long-term toxicities in a population of children who underwent HSCT for hematologic malignancies using either treosulfan or busulfan in the conditioning regimen. The cumulative incidences of growth impairment, altered gonadal function, altered thyroid function, cataracts, secondary malignant neoplasia, and altered pulmonary function were evaluated retrospectively by univariable and multivariable analyses in a population of 521 pediatric patients with acute leukemias or myelodysplastic syndromes treated in 20 Italian transplant centers affiliated with the Associazione Italiana Ematologia ed Oncologia Pediatrica (AIEOP). The median duration of follow-up for the entire study population was 7.1 years (range, 1 to 16 years). Overall, a larger proportion of patients given busulfan developed long-term toxicities compared to patients treated with treosulfan (34% versus 20%; P = .01). In univariable analysis, gonadal toxicity developed in 10% of patients who received treosulfan (95% confidence interval [CI], 3% to 15%), compared with 38% (95% CI, 24% to 39%) of busulfan-treated patients (P = .02), and this finding was confirmed by multivariable analysis (relative risk, .51; 95% CI, .34 to .76; P = .0009). We did not find any statistically significant associations between the occurrence of other long-term toxicities and the use of either busulfan or treosulfan. This study provides evidence that the use of treosulfan is correlated with a reduced incidence of gonadal toxicity in children undergoing HSCT for hematologic malignancies.
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Affiliation(s)
- Francesco Saglio
- Paediatric Onco-Haematology Division, Regina Margherita Children's Hospital AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Daria Pagliara
- Department of Hematology/Oncology, Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Adriana Balduzzi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; School of Medicine and Surgery, University of di Milano-Bicocca, Monza, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; School of Medicine and Surgery, University of di Milano-Bicocca, Monza, Italy
| | - Arcangelo Prete
- Pediatric Oncology and Hematology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Maura Faraci
- Hematopoietic stem cell Transplant Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Elisabetta Calore
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, University Hospital of Padua, Padua, Italy
| | - Franco Locatelli
- Department of Hematology/Oncology, Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Franca Fagioli
- Paediatric Onco-Haematology Division, Regina Margherita Children's Hospital AOU Città della Salute e della Scienza di Torino, Turin, Italy; Università degli Studi di Torino, Turin, Italy.
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Yoshida T, Delaney A. Impact of Childhood Cancer on Growth. J Clin Endocrinol Metab 2024; 109:e892-e900. [PMID: 37539847 DOI: 10.1210/clinem/dgad457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 08/05/2023]
Abstract
Along with improvements in cancer treatment over time, the number of childhood cancer survivors has been growing. Survivors are at risk for serious medical complications, and growth impairment is among the most common. There are multiple factors that may cause impaired growth among survivors. In this article, we review the impact of cancer on growth in children and adolescents. We first provide an overview of growth disturbance among childhood cancer patients and survivors due to nonhormonal causes, including a recent understanding of the effect of targeted cancer therapies (eg, tyrosine kinase inhibitors and immune checkpoint inhibitors) on growth. Then we describe the hormonal causes of growth impairment among survivors, focusing on growth hormone deficiency, including the prevalence, risk factors, and treatment. Lastly, we briefly summarize overgrowth and tall stature in childhood cancer. It is critical to assess the linear growth of children and adolescents, especially in cancer survivors who are at risk for growth disturbance, since growth is an important measure of their health.
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Affiliation(s)
- Tomoko Yoshida
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Angela Delaney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
- Division of Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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[Chinese expert consensus on the management of long-term complications after hematopoietic stem cell transplantation (2023)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:717-722. [PMID: 38049314 PMCID: PMC10630577 DOI: 10.3760/cma.j.issn.0253-2727.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Indexed: 12/06/2023]
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Jin HY, Lee JA, Park M, Lee DE, Park HJ. Characteristics and clinical course of thyroid abnormalities arisen in long term survivors of childhood cancer. BMC Pediatr 2023; 23:124. [PMID: 36932342 PMCID: PMC10024379 DOI: 10.1186/s12887-023-03900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/08/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Thyroid abnormality is a common late effect seen in childhood cancer survivors (CCSs). We analyzed the prevalence and risk factors of thyroid abnormalities based on diagnoses and treatment modalities in CCSs. METHODS The medical records of 257 CCSs who were diagnosed with cancer less than 20 year of age were retrospectively reviewed. The median age was 11.8 years (0.1-19.8). The median follow-up period after completion of therapy was 9.6 years (5.0-19.5). RESULTS Of 257 subjects, thyroid abnormalities were identified in 107 (41.6%). Sixty-five out of 257 (25.3%) had subclinical hypothyroidism, and 16 (6.2%) developed central hypothyroidism. Five CCSs (1.9%) had primary overt hypothyroidism. Five (1.9%) and 6 (2.3%) CCSs were diagnosed with autoimmune thyroiditis and thyroid cancer, respectively. Among the different diagnostic groups, thyroid abnormalities were frequent in the brain tumor or Hodgkin disease or nasopharyngeal cancer groups. CCSs who received irradiation directly or near hypothalamus-pituitary-thyroid (HPT) axis had more thyroid abnormalities compared to the rest CCSs (P < 0.0001). CCSs who were treated with SCT had an increased prevalence of thyroid abnormalities (60.5%) compared to the other CCSs (37.9%) (P = 0.0069). Forty-five (42%) of 107 subjects with thyroid abnormalities had normalized thyroid hormone levels at the last follow-up. Irradiation directly or near HPT axis were thought to be a predicting factor of persistent subclinical hypothyroidism. CONCLUSIONS Subclinical hypothyroidism was common in CCSs. CCSs with irradiation directly or near HPT axis were at risk for persistent thyroid dysfunction.
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Affiliation(s)
- Hye Young Jin
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Jun Ah Lee
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Meerim Park
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Dong-Eun Lee
- Biostatistics Collaboration Team, Research Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Hyeon Jin Park
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
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Maa van Roessel I, Bakker B, van Santen HM, Chemaitilly W. Hormone replacement in survivors of childhood cancer and brain tumors: safety and controversies. Endocr Connect 2023; 12:e220382. [PMID: 36347051 PMCID: PMC9782441 DOI: 10.1530/ec-22-0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/09/2022]
Abstract
Childhood cancer survivors are at risk for developing endocrine disorders, including deficits in growth hormone, thyroid hormone and sex hormones. The influence these hormones have on cell growth and metabolism has raised concerns regarding the safety of their use as treatments in survivors of childhood cancer and brain tumors. This article offers a summary of current knowledge, controversies and areas for future research pertaining to this area.
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Affiliation(s)
- Ichelle Maa van Roessel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, AB Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, AB Utrecht, The Netherlands
| | - Boudewijn Bakker
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, AB Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, AB Utrecht, The Netherlands
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, AB Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, AB Utrecht, The Netherlands
| | - Wassim Chemaitilly
- Division of Pediatric Endocrinology, UPMC Children’s Hospitalof Pittsburgh, Pittsburgh, Pennsylvania, USA
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Hoekx CA, Bresters D, le Cessie S, Oostdijk W, Hannema SE. Improved growth with growth hormone treatment in children after hematopoietic stem cell transplantation. Clin Endocrinol (Oxf) 2022; 97:596-603. [PMID: 35606687 PMCID: PMC9796667 DOI: 10.1111/cen.14782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Hematopoietic stem cell transplantation (HSCT) can be a curative treatment for malignant and nonmalignant diseases in children but is associated with significant late effects including growth failure. Growth hormone treatment (GHRx) is offered to improve growth, but limited data are available on its effect on adult height (AH). We aim to evaluate the effectiveness of GHRx. DESIGN Single-center retrospective study. PATIENTS Thirty-four patients who had received GHRx for ≥1 year were matched with two controls each, without GHRx, based on sex, indication for HSCT (malignancy, benign haematological disease or immunodeficiency), age at HSCT and conditioning with/without total body irradiation (TBI). All had reached AH. MEASUREMENTS The primary outcome measure was the difference between AH and predicted AH (PAH) at start of GHRx or the equivalent age in controls (AH-PAH), calculated according to Bailey and Pinneau. RESULTS GHRx was started at age 12.0 ± 2.6 years; median treatment duration was 3.8 years (range 1.7-9.2). AH-PAH standard deviation score (SDS) was significantly higher in growth hormone (GH) treated boys (-0.5 ± 0.7 SDS) than in controls (-1.5 ± 1.0 SDS, p < .001). Girls also had a higher AH-PAH after GHRx (+0.5 ± 0.6 SDS) compared to controls (-0.2 SDS ±0.7, p < .01). AH remained approximately 2 SDS below target height (TH) in treated and untreated individuals. Among GH-treated children, AH-PAH was higher in those who had received busulfan-based compared to TBI-based conditioning. CONCLUSION GHRx had a significant positive effect on AH compared to PAH, although AH remained far below TH. Higher AH-PAH was observed in girls and in those conditioned without TBI.
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Affiliation(s)
- Carlijn A. Hoekx
- Department of PediatricsLeiden University Medical CentreLeidenthe Netherlands
| | - Dorine Bresters
- Department of PediatricsLeiden University Medical CentreLeidenthe Netherlands
- Princess Máxima Center for Pediatric OncologyUtrechtthe Netherlands
| | - Saskia le Cessie
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Wilma Oostdijk
- Department of PediatricsLeiden University Medical CentreLeidenthe Netherlands
| | - Sabine E. Hannema
- Department of PediatricsLeiden University Medical CentreLeidenthe Netherlands
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MPSI Manifestations and Treatment Outcome: Skeletal Focus. Int J Mol Sci 2022; 23:ijms231911168. [PMID: 36232472 PMCID: PMC9569890 DOI: 10.3390/ijms231911168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/23/2022] Open
Abstract
Mucopolysaccharidosis type I (MPSI) (OMIM #252800) is an autosomal recessive disorder caused by pathogenic variants in the IDUA gene encoding for the lysosomal alpha-L-iduronidase enzyme. The deficiency of this enzyme causes systemic accumulation of glycosaminoglycans (GAGs). Although disease manifestations are typically not apparent at birth, they can present early in life, are progressive, and include a wide spectrum of phenotypic findings. Among these, the storage of GAGs within the lysosomes disrupts cell function and metabolism in the cartilage, thus impairing normal bone development and ossification. Skeletal manifestations of MPSI are often refractory to treatment and severely affect patients’ quality of life. This review discusses the pathological and molecular processes leading to impaired endochondral ossification in MPSI patients and the limitations of current therapeutic approaches. Understanding the underlying mechanisms responsible for the skeletal phenotype in MPSI patients is crucial, as it could lead to the development of new therapeutic strategies targeting the skeletal abnormalities of MPSI in the early stages of the disease.
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Late endocrine effects after hematopoietic stem cell transplantation in children with nonmalignant diseases. Bone Marrow Transplant 2022; 57:1564-1572. [PMID: 35840745 DOI: 10.1038/s41409-022-01755-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/23/2022] [Accepted: 06/30/2022] [Indexed: 11/08/2022]
Abstract
The number of children undergoing hematopoietic stem cell transplantation (HSCT) for nonmalignant diseases has increased in recent years. Endocrine complications are common after HSCT for malignant diseases, while little is known about long-term prevalence and risk factors in children transplanted for nonmalignant diseases. We retrospectively evaluated gonadal function, near adult height and thyroid function in 197 survivors of pediatric HSCT for hemoglobinopathies (n = 66), inborn errors of immunity/metabolism (n = 74) and bone marrow failure disorders (n = 57); median follow-up was 6.2 years (range 3.0-10.5). Gonadal dysfunction occurred in 55% of (post)pubertal females, was still present at last assessment in 43% and was more common after busulfan- than treosulfan-based conditioning (HR 10.6, CI 2.2-52.7; adjusted for HSCT indication). Gonadal dysfunction occurred in 39% of (post)pubertal males, was still present at last assessment in 32% and was less common in those who were prepubertal compared to (post)pubertal at HSCT (HR 0.11; CI 0.05-0.21). Near adult height was more than 2 SDS below mean parental height in 21% of males and 8% of females. Hypothyroidism occurred in 16% of patients; 4% received thyroxin treatment. In conclusion, endocrine complications, especially gonadal dysfunction, are common after pediatric HSCT for nonmalignant conditions. In females, treosulfan seems less gonadotoxic than busulfan. Careful long-term endocrine follow-up is indicated.
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Maier S, Zivicnjak M, Grigull L, Hennermann JB, Aries C, Maecker‐Kolhoff B, Sauer M, Das AM, Beier R. Predictors of growth patterns in children with mucopolysaccharidosis I after haematopoietic stem cell transplantation. JIMD Rep 2022; 63:371-378. [PMID: 35822096 PMCID: PMC9259397 DOI: 10.1002/jmd2.12291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 12/15/2022] Open
Abstract
Mucopolysaccharidosis type I (MPS I) is an autosomal‐recessive metabolic disorder caused by an enzyme deficiency of lysosomal alpha‐l‐iduronidase (IDUA). Haematopoietic stem cell transplantation (HSCT) is the therapeutic option of choice in MPS I patients younger than 2.5 years, which has a positive impact on neurocognitive development. However, impaired growth remains a problem. In this monocentric study, 14 patients with MPS I (mean age 1.72 years, range 0.81–3.08) were monitored according to a standardised follow‐up program after successful allogeneic HSCT. A detailed anthropometric program was carried out to identify growth patterns and to determine predictors of growth in these children. All patients are alive and in outpatient care (mean follow‐up 8.1 years, range 0.1–16.0). Progressively lower standard deviation scores (SDS) were observed for body length (mean SDS −1.61; −4.58 – 3.29), weight (−0.56; −3.19 – 2.95), sitting height (−3.28; −7.37 – 0.26), leg length (−1.64; −3.88 – 1.49) and head circumference (0.91; −2.52 – 6.09). Already at the age of 24 months, significant disproportions were detected being associated with increasing deterioration in growth for age. Younger age at HSCT, lower counts for haemoglobin and platelets, lower potassium, higher donor‐derived chimerism, higher counts for leukocytes and recruitment of a matched unrelated donor (MUD) positively correlated with body length (p ≤ 0.05). In conclusion, this study characterised predictors and aspects of growth patterns in children with MPS I after HSCT, underlining that early HSCT of MUD is essential for slowing body disproportion.
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Affiliation(s)
- Stefanie Maier
- Department of Paediatric Haematology and Oncology Hannover Medical School Hannover Germany
| | - Miroslav Zivicnjak
- Department of Paediatric Kidney Liver and Metabolic Diseases at Hannover Medical School Hannover Germany
| | - Lorenz Grigull
- Rare Disease Centre, Bonn University Medical Centre Bonn Germany
| | - Julia B. Hennermann
- Villa Metabolica, Department of Paediatric and Adolescent Medicine University Medical Centre Mainz Germany
| | - Charlotte Aries
- Department of Paediatrics Hamburg‐Eppendorf University Medical Centre Hamburg Germany
| | - Britta Maecker‐Kolhoff
- Department of Paediatric Haematology and Oncology Hannover Medical School Hannover Germany
| | - Martin Sauer
- Department of Paediatric Haematology and Oncology Hannover Medical School Hannover Germany
| | - Anibh M. Das
- Department of Paediatric Kidney Liver and Metabolic Diseases at Hannover Medical School Hannover Germany
| | - Rita Beier
- Department of Paediatric Haematology and Oncology Hannover Medical School Hannover Germany
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van Roessel IMAA, van Schaik J, Meeteren AYNSV, Boot AM, der Grinten HLCV, Clement SC, van Iersel L, Han KS, van Trotsenburg ASP, Vandertop WP, Kremer LCM, van Santen HM. Body mass index at diagnosis of a childhood brain tumor; a reflection of hypothalamic-pituitary dysfunction or lifestyle? Support Care Cancer 2022; 30:6093-6102. [PMID: 35416504 PMCID: PMC9135856 DOI: 10.1007/s00520-022-07031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Childhood brain tumor survivors (CBTS) are at risk of becoming overweight, which has been shown to be associated with hypothalamic-pituitary (HP) dysfunction during follow-up. Body mass index (BMI) at diagnosis is related to BMI at follow-up. It is uncertain, however, whether aberrant BMI at brain tumor diagnosis reflects early hypothalamic dysfunction or rather reflects genetic and sociodemographic characteristics. We aimed to examine whether BMI at childhood brain tumor diagnosis is associated with HP dysfunction at diagnosis or its development during follow-up. METHODS The association of BMI at diagnosis of a childhood brain tumor to HP dysfunction at diagnosis or during follow-up was examined in a Dutch cohort of 685 CBTS, excluding children with craniopharyngioma or a pituitary tumor. Individual patient data were retrospectively extracted from patient charts. RESULTS Of 685 CTBS, 4.7% were underweight, 14.2% were overweight, and 3.8% were obese at diagnosis. Being overweight or obese at diagnosis was not associated with anterior pituitary deficiency or diabetes insipidus at diagnosis or during follow-up. In children with suprasellar tumors, being obese at diagnosis was associated with central precocious puberty. CONCLUSION Overweight or obesity at diagnosis of a childhood brain tumor seems not to be associated with pituitary deficiencies. These results suggest that genetics and lifestyle may be more important etiologic factors for higher BMI at diagnosis in these children than hypothalamic dysfunction. To improve the long-term outcome of CBTS with regards to overweight and obesity, more attention should be given to lifestyle already at the time of brain tumor treatment.
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Affiliation(s)
- I M A A van Roessel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - J van Schaik
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - A Y N Schouten-van Meeteren
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A M Boot
- Department of Pediatric Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H L Claahsen-van der Grinten
- Department of Pediatric Endocrinology, Amalia Children's Hospital, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - S C Clement
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - L van Iersel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K S Han
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A S P van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - W P Vandertop
- Amsterdam University Medical Centers, University of Amsterdam, and VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - H M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. .,Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.
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11
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Wanaguru AL, Cohn RJ, Johnston KA, Gabriel MA, Maguire AM, Neville KA. Growth and Nutritional Outcomes in Children Post-Haematopoietic Stem Cell Transplant without Exposure to Total Body Irradiation. Clin Oncol (R Coll Radiol) 2022; 34:e345-e352. [PMID: 35410818 DOI: 10.1016/j.clon.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/11/2022] [Accepted: 03/03/2022] [Indexed: 12/01/2022]
Abstract
AIMS Poor growth in childhood cancer survivors who undergo haematopoietic stem cell transplant (HSCT) without exposure to radiation is reported anecdotally, although literature to support this is limited. The aims of this study were to assess the change in height standard deviation score (SDS) and the final adult height (FAH) in children who underwent chemotherapy-only conditioned HSCT and to identify predictors of poor growth. MATERIALS AND METHODS We conducted a retrospective hospital medical record review (1984-2010) of children (1-10 years) who underwent chemotherapy-only conditioned HSCT, noting anthropology measurements at cancer diagnosis, HSCT, 10 years old and FAH. RESULTS The median age at HSCT of the 53 patients was 4.5 years, 75% had a haematological malignancy and 25% a solid tumour. Half of the cohort underwent allogenic HSCT and most (89%) conditioned with busulphan. The mean change in height SDS from primary cancer diagnosis to FAH was -1.21 (±1.18 SD), equivalent to 7-8.5 cm loss, with a mean FAH of -0.91 SDS (±1.10 SD). The greatest height loss occurred between diagnosis and HSCT (-0.77 SDS, 95% confidence interval -1.42, -0.12, P = 0.01), with no catch-up growth seen by FAH. Patients with solid tumours had the greatest height loss. Overall body mass index SDS did not change significantly over time, or by cancer type. CONCLUSIONS Chemotherapy-only conditioned HSCT during childhood can impact FAH, with the greatest height loss occurring prior to HSCT and no catch-up growth after treatment finishes. Children transplanted for a solid tumour malignancy seem to be more at risk, possibly due to intensive treatment regimens, both pre-transplant and during conditioning.
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Affiliation(s)
- A L Wanaguru
- Endocrinology Department, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia.
| | - R J Cohn
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - K A Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - M A Gabriel
- Oncology Department, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - A M Maguire
- Oncology Department, The Children's Hospital at Westmead, Westmead, NSW, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia; University of Sydney Medical School, Sydney, NSW, Australia
| | - K A Neville
- Endocrinology Department, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia
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12
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Wang YM, Howell JC, Grimley MS, Lane A, Davies SM, Myers KC. Incidence of thyroid dysfunction in children after HSCT with reduced intensity conditioning (RIC) or myeloablative conditioning (MAC). Pediatr Transplant 2021; 25:e13983. [PMID: 33548104 DOI: 10.1111/petr.13983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/10/2021] [Accepted: 01/20/2021] [Indexed: 11/28/2022]
Abstract
We have previously demonstrated a 11% incidence of post-transplant de novo thyroid disease, even with a radiation-free RIC regimen. Following the enactment of a universal late effects screening program at our institution, we compared the outcomes of 108 pediatric hematopoietic stem cell transplant recipients after a RIC regimen (n = 33) to those after a MAC regimen (n = 75) during the same time period. Overall, 10% of subjects developed thyroid dysfunction after HSCT, with a median follow-up of 669 days. Seven subjects had primary hypothyroidism prior to HSCT. Of the thirty-one subjects who received RIC, one (3.2%) developed a new thyroid disorder, compared to the nine of sixty-nine (13.0%) subjects who received MAC (p = .167). No significant associations were seen with donor type, graft-vs.-host disease, or total body irradiation. Nine of the 10 subjects who developed thyroid disease after transplant were asymptomatic. Continued follow-up of this contemporary cohort will further delineate risk factors for post-transplant-associated thyroid dysfunction and better inform discussions of transplant-associated sequelae.
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Affiliation(s)
- YunZu M Wang
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jonathan C Howell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael S Grimley
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Adam Lane
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stella M Davies
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kasiani C Myers
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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13
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Guner Ozenen G, Aksoylar S, Goksen D, Gozmen S, Darcan S, Ozek G, Kansoy S. Metabolic syndrome and risk factors after hematopoietic stem cell transplantation in children and adolescents. J Pediatr Endocrinol Metab 2021; 34:485-493. [PMID: 33639046 DOI: 10.1515/jpem-2020-0584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The early and late complications after hematopoietic stem cell transplantation (HSCT) determine the patients' prognosis and life quality. We aim to determine the metabolic syndrome development frequency after HSCT in children to find out the risk factors and compare them with healthy adolescents. METHODS Thirty-six children who underwent HSCT at least two years ago were analyzed prospectively and cross-sectionally. Our study included 18 healthy children between the ages of 11 and 17 as a control group. All of the cases were assessed in terms of metabolic syndrome (MS) through the use of Modified WHO Criteria. RESULTS The patients' median age was 10.6 (5.1-17) years, the median time of follow-up after HCST was 4.1 (2-13.5) years and 70% were male. Two cases were diagnosed with MS (5.6%). When considered in terms of the sub-components of MS, 2 cases (5.6%) were found to have obesity, 17 cases (47%) abnormal glucose tolerance, 11 cases (30.7%) dyslipidemia, and 3 cases (8.6%) hypertension. The MS rate was not different when compared with the 11-17 year-old healthy control group (0 vs. 11%, p=0.48). Myeloablative conditioning regimen (65 vs. 20%) and the increased age at which HSCT was performed were considered to be risk factors in terms of insulin resistance (p=0.025 and 0.002). CONCLUSIONS Age and conditioning regimens were found to be the risk factors for insulin resistance development. The long-term follow-up of the cases who had undergone HSCT in childhood in terms of MS and its sub-components is important in order to increase life quality.
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Affiliation(s)
- Gizem Guner Ozenen
- Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Serap Aksoylar
- Department of Pediatric Hematology & Oncology and Bone Marrow Transplantation, Medical School of Ege University, Izmir, Turkey
| | - Damla Goksen
- Department of Pediatric Endocrinology and Diabetes, Medical School of Ege University, Izmir, Turkey
| | - Salih Gozmen
- Department of Pediatric Hematology & Oncology and Bone Marrow Transplantation, Medical School of Ege University, Izmir, Turkey
| | - Sukran Darcan
- Department of Pediatric Endocrinology and Diabetes, Medical School of Ege University, Izmir, Turkey
| | - Gulcihan Ozek
- Department of Pediatric Hematology & Oncology and Bone Marrow Transplantation, Medical School of Ege University, Izmir, Turkey
| | - Savas Kansoy
- Department of Pediatric Hematology & Oncology and Bone Marrow Transplantation, Medical School of Ege University, Izmir, Turkey
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14
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Erickson D, Donegan D. Diagnosis and Management of Neuroendocrine Disorders of Survivors of Brain Tumors. Am Soc Clin Oncol Educ Book 2021; 41:1-9. [PMID: 33793312 DOI: 10.1200/edbk_321059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Advances in the treatment of brain tumors have led to an increase in the number of survivors of this disease. Consequently, the long-term complications associated with past and current treatments are becoming more apparent. Of relevance to patients who receive treatment of brain tumors are the potential neuroendocrine complications that develop either acutely or several years following treatment. Presentation may differ between adults and children (e.g., short stature or adult growth hormone deficiency) but in both settings can complicate treatment and impact quality of life. The risk for the development of these complications depends on the location of the tumor (proximity to the pituitary/hypothalamus) and/or the treatment delivered (chemotherapy/surgery/radiation). Given the potential overlap in symptoms attributable to the underlying brain tumor and neuroendocrine dysfunction, a high level of suspicion, appropriate investigation, and administration of treatment may reduce morbidity and mortality for patients with brain tumors experiencing neuroendocrine dysfunction.
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Affiliation(s)
- Dana Erickson
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Diane Donegan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.,Department of Endocrinology, Diabetes and Metabolism, Indiana University, Indianapolis, IN
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15
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Weinhard S, Wiedemann A, Leheup B, Dalle JH, Lebon Labich B, Pochon C. Pubertal outcomes of children transplanted with allogeneic stem cells after myeloablative total body irradiation or busulfan: Influence of age and sex is confirmed, while a role of chronic graft-versus-host disease in delayed puberty onset is revealed. Pediatr Transplant 2020; 24:e13773. [PMID: 32701220 DOI: 10.1111/petr.13773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/25/2020] [Accepted: 05/22/2020] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Myeloablative conditioning before allogeneic HSCT during childhood exposes to serious long-term complications, especially gonadal dysfunction. Pubertal issues are less described than other post-HSCT sequelae in childhood. METHODS Pubertal development and biological gonadal parameters were assessed in a retrospective monocentric cohort of prepubertal patients who underwent HSCT after myeloablative conditioning with TBI or busulfan between 1981 and 2017. RESULTS Seventy-four patients (28 girls and 46 boys) were included. No spontaneous pubertal development was found in 50% of girls and 10% of boys (P < .001), and delayed puberty or no spontaneous pubertal development was found in 57% of girls and 24% of boys (P = .009). HRT was used in 82% of girls and 24% of boys (P < .001). In univariate analysis, TBI conditioning (P = .05), female sex (P < .001), acute GVHD (P = .05), extensive chronic GVHD (P = .021), steroid treatment >6 months (P = .016), and malignant diseases (P = .016) were associated with no spontaneous pubertal development, whereas TBI conditioning (P = .003) and extensive chronic GVHD (P = .005) were associated with delayed puberty. In multivariate analysis, factors independently associated with no spontaneous puberty onset were female sex (P = .001) and age >10 years (P = .033). Factors independently associated with delayed puberty were extensive chronic GVHD (P = .041) and age >10 years (P = .031). CONCLUSION This study highlighted the toxicity of MAC in prepubescent children: TBI did worse, but this was especially true for the most susceptible patients (girls, leukemic patients, and patients older than 10 years). It suggests a possible role of GVHD in delayed puberty.
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Affiliation(s)
- Sara Weinhard
- Département d'Onco-Hématologie Pédiatrique, CHRU de Nancy, Nancy, France
| | - Arnaud Wiedemann
- Département de Réanimation pédiatrique, CHRU de Nancy, Nancy, France
| | - Bruno Leheup
- Département de Médecine Infantile, CHRU de Nancy, Nancy, France
| | - Jean-Hugues Dalle
- Département d'Immuno-Hématologie Pédiatrique, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Robert Debré, Paris, France
| | | | - Cécile Pochon
- Département d'Onco-Hématologie Pédiatrique, CHRU de Nancy, Nancy, France
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16
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Cattoni A, Motta S, Masera N, Gasperini S, Rovelli A, Parini R. The use of recombinant human growth hormone in patients with Mucopolysaccharidoses and growth hormone deficiency: a case series. Ital J Pediatr 2019; 45:93. [PMID: 31370860 PMCID: PMC6676577 DOI: 10.1186/s13052-019-0691-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The treatment with recombinant human growth hormone in patients affected by Mucopolysaccharidoses (MPS) is considered whenever a concurrent diagnosis of growth hormone deficiency is demonstrated. The short- and long-term effects of recombinant human growth hormone in this selected cohort is still debated, given the natural progression of disease-related skeletal malformations and the paucity of treated patients reported in literature. The presented case series provides detailed information about the response to recombinant growth hormone in MPS patients diagnosed with growth hormone deficiency. CASES PRESENTATION The growth patterns of 4 MPS female patients (current age: 11.7-14.3 years) treated with recombinant human growth hormone due to growth hormone deficiency have been retrospectively analyzed. Two patients, diagnosed with MPS IH, had undergone haematopoietic stem cell transplantation at an early age; the remaining two patients were affected by MPS IV and VI and were treated with enzyme replacement therapy. 4/4 patients presented with a progressive growth deceleration before the diagnosis of growth hormone deficiency was confirmed. This trend was initially reverted by a remarkable increase in height velocity after the start of recombinant growth hormone. We recorded an average increase in height velocity z-score of + 4.23 ± 2.9 and + 4.55 ± 0.96 respectively after 6 and 12 months of treatment. After the first 12-24 months, growth showed a deceleration in all the patients. While in a girl with MPS IH recombinant human growth hormone was discontinued due to a lack in clinical efficacy, 3/4 patients grew at a stable pace, tracking the height centile achieved after the cited initial increase in height velocity. Furthermore, mineral bone density assessed via bone densitometry, showed a remarkable increase in the two patients who were tested before and after starting treatment. CONCLUSIONS Recombinant human growth hormone appears to have effectively reverted the growth deceleration experienced by MPS patients diagnosed with growth hormone deficiency, at least during the first 12-24 months of treatment.
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Affiliation(s)
- A Cattoni
- Paediatric Department, Azienda Ospedaliera San Gerardo - Fondazione Monza e Brianza per il Bambino e la sua Mamma, Via Pergolesi 33, 20900, Monza, MB, Italy.
| | - S Motta
- Paediatric Department, Azienda Ospedaliera San Gerardo - Fondazione Monza e Brianza per il Bambino e la sua Mamma, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - N Masera
- Paediatric Department, Azienda Ospedaliera San Gerardo - Fondazione Monza e Brianza per il Bambino e la sua Mamma, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - S Gasperini
- Paediatric Department, Azienda Ospedaliera San Gerardo - Fondazione Monza e Brianza per il Bambino e la sua Mamma, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - A Rovelli
- Paediatric Department, Azienda Ospedaliera San Gerardo - Fondazione Monza e Brianza per il Bambino e la sua Mamma, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - R Parini
- Paediatric Department, Azienda Ospedaliera San Gerardo - Fondazione Monza e Brianza per il Bambino e la sua Mamma, Via Pergolesi 33, 20900, Monza, MB, Italy.,TIGET Institute, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Segrate, MI, Italy
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17
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Gebauer J, Higham C, Langer T, Denzer C, Brabant G. Long-Term Endocrine and Metabolic Consequences of Cancer Treatment: A Systematic Review. Endocr Rev 2019; 40:711-767. [PMID: 30476004 DOI: 10.1210/er.2018-00092] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/21/2018] [Indexed: 02/08/2023]
Abstract
The number of patients surviving ≥5 years after initial cancer diagnosis has significantly increased during the last decades due to considerable improvements in the treatment of many cancer entities. A negative consequence of this is that the emergence of long-term sequelae and endocrine disorders account for a high proportion of these. These late effects can occur decades after cancer treatment and affect up to 50% of childhood cancer survivors. Multiple predisposing factors for endocrine late effects have been identified, including radiation, sex, and age at the time of diagnosis. A systematic literature search has been conducted using the PubMed database to offer a detailed overview of the spectrum of late endocrine disorders following oncological treatment. Most data are based on late effects of treatment in former childhood cancer patients for whom specific guidelines and recommendations already exist, whereas current knowledge concerning late effects in adult-onset cancer survivors is much less clear. Endocrine sequelae of cancer therapy include functional alterations in hypothalamic-pituitary, thyroid, parathyroid, adrenal, and gonadal regulation as well as bone and metabolic complications. Surgery, radiotherapy, chemotherapy, and immunotherapy all contribute to these sequelae. Following irradiation, endocrine organs such as the thyroid are also at risk for subsequent malignancies. Although diagnosis and management of functional and neoplastic long-term consequences of cancer therapy are comparable to other causes of endocrine disorders, cancer survivors need individually structured follow-up care in specialized surveillance centers to improve care for this rapidly growing group of patients.
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Affiliation(s)
- Judith Gebauer
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom.,Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Thorsten Langer
- Division of Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christian Denzer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Ulm University Medical Center, Ulm, Germany
| | - Georg Brabant
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
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18
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Faraci M, Diesch T, Labopin M, Dalissier A, Lankester A, Gennery A, Sundin M, Uckan-Cetinkaya D, Bierings M, Peters AMJ, Garwer M, Schulz A, Michel G, Giorgiani G, Gruhn B, Locatelli F, Giardino S, Uyttebroeck A, Rialland F, Itäla-Remes M, Dreger P, Shaw PJ, Bordon V, Schlegel PG, Mellgren K, Moraleda JM, Patrick K, Schneider P, Jubert C, Lawitschka A, Salooja N, Basak GW, Corbacioglu S, Duarte R, Bader P. Gonadal Function after Busulfan Compared with Treosulfan in Children and Adolescents Undergoing Allogeneic Hematopoietic Stem Cell Transplant. Biol Blood Marrow Transplant 2019; 25:1786-1791. [PMID: 31082473 DOI: 10.1016/j.bbmt.2019.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/27/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022]
Abstract
Gonadal impairment is an important late effect with a significant impact on quality of life of transplanted patients. The aim of this study was to compare gonadal function after busulfan (Bu) or treosulfan (Treo) conditioning regimens in pre- and postpubertal children. This retrospective, multicenter study included children transplanted in pediatric European Society for Blood and Marrow Transplantation (EBMT) centers between 1992 and 2012 who did not receive gonadotoxic chemoradiotherapy before the transplant. We evaluated 137 patients transplanted in 25 pediatric EBMT centers. Median age at transplant was 11.04 years (range, 5 to 18); 89 patients were boys and 48 girls. Eighty-nine patients were prepubertal at transplant and 48 postpubertal. One hundred eighteen children received Bu and 19 Treo. A higher proportion of girls treated with Treo in the prepubertal stage reached spontaneous puberty compared with those treated with Bu (P = .02). Spontaneous menarche was more frequent after Treo than after Bu (P < .001). Postpubertal boys and girls treated with Treo had significantly lower luteinizing hormone levels (P = .03 and P = .04, respectively) compared with the Bu group. Frequency of gonadal damage associated with Treo was significantly lower than that observed after Bu. These results need to be confirmed in a larger population.
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Affiliation(s)
- Maura Faraci
- Istituto G. Gaslini, Hematopoietic Stem Cell Transplantation Unit- Hematology-Oncology, Genova, Italy.
| | - Tamara Diesch
- University Children's Hospital Basel, Division of Pediatric Oncology/Hematology, Basel, Switzerland
| | - Myriam Labopin
- Hȏpital Saint-Antoine, Department of Hematology and Cell Therapy, Paris, France
| | - Arnaud Dalissier
- EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, Department of Hematology, Paris, France
| | - Arian Lankester
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Department of Pediatric Stem Cell Transplantation, Leiden, Netherlands
| | - Andrew Gennery
- Children's Hospital Newcastle upon Tyne, Pediatric Team Children's BMT Unit, Newcastle upon Tyne, United Kingdom
| | - Mikael Sundin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Hematology/Immunology Section, Stockholm, Sweden
| | - Duygu Uckan-Cetinkaya
- Hacettepe University Faculty of Medicine, Bone Marrow Transplantation Unit, Department of Pediatrics, Ankara, Turkey
| | - Marc Bierings
- Princess Maxima Centre for Pediatric Oncology and University Children's Hospital, Utrecht, Netherlands
| | - Anke M J Peters
- Medical Center, University of Freiburg, Center for Pediatrics, Department of Pediatric Hematology and Oncology, Freiburg, Germany
| | - Martina Garwer
- University Hamburg-Eppendorf, Pediatric Hematology Clinic and Policlinic of Oncology, Hamburg-Eppendorf, Germany
| | - Ansgar Schulz
- University Medical Center Ulm, Department of Pediatrics, Ulm, Germany
| | - Gerard Michel
- Hopital d'Enfants de la Timone Marseille, Marseille, France
| | - Giovanna Giorgiani
- Fondazione IRCCS Policlinico San Matteo, Pediatric Hematology-Oncology, Pavia, Italy
| | - Bernd Gruhn
- Jena University Hospital, Department of Pediatrics, Jena, Germany
| | - Franco Locatelli
- IRCSS Ospedale Pediatrico Bambino Gesù, University La Sapienza, Department of Pediatric Hematology/Oncology, Rome, Italy
| | - Stefano Giardino
- Istituto G. Gaslini, Hematopoietic Stem Cell Transplantation Unit- Hematology-Oncology, Genova, Italy
| | - Anne Uyttebroeck
- University Hospitals Leuven, Department of Pediatric Hematology-Oncology, Leuven, Belgium
| | | | | | | | - Peter J Shaw
- The Children's Hospital at Westmead, Division of Blood and Marrow Transplantation, Sydney, Australia
| | - Victoria Bordon
- Ghent University Hospital, Department of Pediatric Hematology, Oncology and SCT, Ghen, Belgium
| | - Paul G Schlegel
- University Children's Hospital Würzburg, Department of Pediatric Oncology, Würzburg, Germany
| | - Karin Mellgren
- The Queen Silvia's Hospital for Children and Adolescents, University of Göteborg, Pediatric Hematology and Oncology, Göteborg, Sweden
| | - Jose M Moraleda
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB, University of Murcia, Barcelona, Spain
| | - Katharine Patrick
- Sheffield Children's Hospital, Department of Hematology and Oncology, Sheffield, United Kingdom
| | - Pascale Schneider
- Pediatric Hemato-Oncology Department, University Hospital, Rouen, Rouen, France
| | - Charlotte Jubert
- Bordeaux University Hospital, Pediatric BMT Unit, Bordeaux, France
| | - Anita Lawitschka
- St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Nina Salooja
- Imperial College London, Department of Medicine, London, United Kingdom
| | - Grzegorz W Basak
- Medical University of Warsaw, Department of Hematology, Oncology and Internal Medicine, Warsaw, Poland
| | - Selim Corbacioglu
- University of Regensburg, Department of Pediatric Hematology, Oncology & Stem Cell Transplantation, Regensburg, Germany
| | - Rafael Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Peter Bader
- Goethe-Universität, Universitätsklinikum Frankfurt, Frankfurt, Germany
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19
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Kenney LB, Antal Z, Ginsberg JP, Hoppe BS, Bober SL, Yu RN, Constine LS, van Santen HM, Skinner R, Green DM. Improving Male Reproductive Health After Childhood, Adolescent, and Young Adult Cancer: Progress and Future Directions for Survivorship Research. J Clin Oncol 2018; 36:2160-2168. [PMID: 29874140 DOI: 10.1200/jco.2017.76.3839] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Reproductive health is a common concern and often a source of distress for male childhood, adolescent, and young adult cancer survivors. Clinical and epidemiologic research in survivor populations has identified alkylating agent chemotherapy, testicular radiation, and surgery or radiation to the genitourinary organs, lower spine, or the hypothalamic-pituitary region as risk factors for adverse reproductive outcomes, including impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction. Much of the research on male survivors has focused on the outcome of fertility, using spermatogenesis, serum gonadotropins, and paternity as the measures. However, these studies often fail to account for the clinically relevant but difficult-to-quantify aspects of fertility such as sexual function, cancer-related delayed psychosocial development, medical comorbidities, and socioeconomic concerns. Clinical and basic science research has made significant contributions to improving reproductive outcomes for survivors, with recent advancements in the areas of fertility preservation, clinical assessment of reproductive function, and treatment of adverse reproductive outcomes. Furthermore, there is an emerging qualitative literature addressing the psychosexual aspects of male reproductive health, the clinical application of which will improve quality of life for survivors. This review summarizes the current survivorship literature on reproductive health outcomes for male survivors, including the epidemiology of impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction; clinical and laboratory assessment of reproductive function; and established and investigational interventions to preserve reproductive function for patients newly diagnosed and survivors. Although survivorship research has made significant contributions to improving reproductive outcomes, additional scientific progress is needed in the areas of fertility preservation, risk assessment, and psychosexual support with the aim of optimizing reproductive health for current and future survivors.
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Affiliation(s)
- Lisa B Kenney
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Zoltan Antal
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Jill P Ginsberg
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Bradford S Hoppe
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Sharon L Bober
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Richard N Yu
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Louis S Constine
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Hanneke M van Santen
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Roderick Skinner
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Daniel M Green
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
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20
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Chemaitilly W, Cohen LE, Mostoufi-Moab S, Patterson BC, Simmons JH, Meacham LR, van Santen HM, Sklar CA. Endocrine Late Effects in Childhood Cancer Survivors. J Clin Oncol 2018; 36:2153-2159. [PMID: 29874130 DOI: 10.1200/jco.2017.76.3268] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Endocrine complications are highly prevalent in childhood cancer survivors. Approximately 50% of survivors will experience at least one hormonal disorder over the course of their lives. Endocrine complications often are observed in survivors previously treated with radiation to the head, neck, or pelvis. We provide an overview the most common endocrine late effects seen in survivors, including hypothalamic-pituitary dysfunction, primary thyroid dysfunction, obesity, diabetes mellitus, metabolic syndrome, and decreased bone mineral density. Primary gonadal injury is discussed elsewhere in this series. Given a variable latency interval, a systematic approach where individuals are periodically screened on the basis of their risk factors can help to improve health outcomes by prompt diagnosis and treatment of evolving endocrinopathies. These recommendations must be revised in the future given changes and improvements in cancer treatment over time.
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Affiliation(s)
- Wassim Chemaitilly
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Laurie E Cohen
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sogol Mostoufi-Moab
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Briana C Patterson
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jill H Simmons
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lillian R Meacham
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hanneke M van Santen
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charles A Sklar
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
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21
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Kim H, Kim H, Ku SY. Fertility preservation in pediatric and young adult female cancer patients. Ann Pediatr Endocrinol Metab 2018; 23:70-74. [PMID: 29969877 PMCID: PMC6057020 DOI: 10.6065/apem.2018.23.2.70] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 01/08/2023] Open
Abstract
As the 5-year survival rate increases up to 80% in pediatric cancer patients, the number of women patients with reduced gonadal function by chemotherapy and radiotherapy increases. The gonadal toxicity of pediatric patients varies highly according to the chemotherapeutic agent and the type of radiotherapy. Although American Society of Clinical Oncology published the guideline for fertility preservation, additional scientific and ethical concerns should be considered for clinical practice. In addition, only the experimental method can be applied for the prepubertal patients in contrast to the postpubertal patients. In this review, we will discuss some options for preserving fertility among women's quality of life issues.
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Affiliation(s)
| | | | - Seung-Yup Ku
- Address for correspondence: Seung-Yup Ku, MD, PhD Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-2387 Fax: +82-2-762-3599 E-mail:
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22
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Treosulfan induces distinctive gonadal toxicity compared with busulfan. Oncotarget 2018; 9:19317-19327. [PMID: 29721205 PMCID: PMC5922399 DOI: 10.18632/oncotarget.25029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/19/2018] [Indexed: 01/03/2023] Open
Abstract
Treosulfan (L-treitol-1,4-bis-methanesulfonate) has been increasingly incorporated as a main conditioning protocol for hematopoietic stem cell transplantation in pediatric malignant and non-malignant diseases. Treosulfan presents lower toxicity profile than other conventional alkylating agents containing myeloablative and immunosuppressive traits such as busulfan. Yet, whereas busulfan is considered highly gonadotoxic, the gonadal toxicity profile of treosulfan remains to be elucidated. To study the gonadotoxicity of treosulfan, pubertal and prepubertal male and female mice were injected with treosulfan or busulfan and sacrificed one week, one month or six months later. Testicular function was assessed by measurements of sperm properties, testes and epididymides weights as well as markers for testicular reserve, proliferation and apoptosis. Ovarian function was assessed by measurements of ovary weight and markers for ovarian reserve, proliferation and apoptosis. Treosulfan testicular toxicity was milder than that of busulfan toxicity; possibly by sparing the stem spermatogonia in the testicular sanctuary. By contrast, ovarian toxicity of both treosulfan and busulfan was severe and permanent and displayed irreversible reduction of reserve primordial follicles in the ovaries. Our data indicate that treosulfan exerts a different gonadal toxicity profile from busulfan, manifested by mild testicular toxicity and severe ovarian toxicity.
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23
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Chemaitilly W, Cohen LE. DIAGNOSIS OF ENDOCRINE DISEASE: Endocrine late-effects of childhood cancer and its treatments. Eur J Endocrinol 2017; 176:R183-R203. [PMID: 28153840 DOI: 10.1530/eje-17-0054] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 02/01/2017] [Indexed: 12/12/2022]
Abstract
Endocrine complications are frequently observed in childhood cancer survivors (CCS). One of two CCS will experience at least one endocrine complication during the course of his/her lifespan, most commonly as a late-effect of cancer treatments, especially radiotherapy and alkylating agent chemotherapy. Endocrine late-effects include impairments of the hypothalamus/pituitary, thyroid and gonads, as well as decreased bone mineral density and metabolic derangements leading to obesity and/or diabetes mellitus. A systematic approach where CCS are screened for endocrine late-effects based on their cancer history and treatment exposures may improve health outcomes by allowing the early diagnosis and treatment of these complications.
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Affiliation(s)
- Wassim Chemaitilly
- Departments of Pediatric Medicine-Division of Endocrinology
- Departments of Epidemiology and Cancer ControlSt Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Laurie E Cohen
- Departments of Epidemiology and Cancer ControlSt Jude Children's Research Hospital, Memphis, Tennessee, USA
- Division of EndocrinologyBoston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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24
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Friedman DN, Hilden P, Moskowitz CS, Suzuki M, Boulad F, Kernan NA, Wolden SL, Oeffinger KC, Sklar CA. Cardiovascular Risk Factors in Survivors of Childhood Hematopoietic Cell Transplantation Treated with Total Body Irradiation: A Longitudinal Analysis. Biol Blood Marrow Transplant 2016; 23:475-482. [PMID: 28040534 DOI: 10.1016/j.bbmt.2016.12.623] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/10/2016] [Indexed: 12/18/2022]
Abstract
Hematopoietic cell transplantation (HCT) survivors treated with total body irradiation (TBI) are known to be at increased risk for the development of cardiovascular risk factors (CVRFs). We sought to characterize the incidence of CVRFs in a TBI-exposed survivor cohort and to describe prognostic indicators of their development through a retrospective analysis of CVRFs in 1-year survivors of leukemia or lymphoma treated with TBI at Memorial Sloan Kettering between April 1987 and May 2011. Eligible participants were age ≤21 years at the time of TBI and were not receiving glucocorticoid therapy at the time of entry to long-term follow-up. Survivors were assessed for obesity (body mass index ≥95th percentile for age ≤ 20 years and ≥30 kg/m2 for age >20 years), elevated blood pressure, dyslipidemia (elevated triglycerides [TG], low high-density lipoprotein [HDL]), and glucose intolerance (fasting glucose ≥100 mg/dL); those with ≥3 risk factors were deemed to have a CVRF cluster, a surrogate for metabolic syndrome. Cox regression models were used to estimate hazard ratios (HRs) for factors associated with each CVRF. To compare the prevalence of CVRFs in HCT survivors and the general population, survivors were compared with age-, sex-, and race-matched controls from the National Health and Nutrition Examination Survey. A total of 123 survivors were evaluated (62.6% males). The median age at TBI was 11.8 years (range, 1.6 to 21.9 years). The median duration of follow-up was 8.0 years (range, 1.01 to 24.6 years), and the median age at last follow-up was 20.1 years (range, 4.0 to 41.3 years). The 5-year cumulative incidence was 14.7% for elevated blood pressure, 10.5% for elevated glucose, 26.8% for low HDL, 39.2% for hypertriglyceridemia, and 16.0% for obesity, and corresponding 10-year cumulative incidences of 28.8%, 33.1%, 52.0%, 65.0%, and 18.6%. The median cumulative incidence of a CVRF cluster rose from 10.6% (range, 5.6% to 17.5%) at 5 years to 28.4% (range, 18.8% to 38.7%) at 10 years. In multivariate analysis, growth hormone (GH) deficiency (hazard ratio [HR], 8.6; 95% confidence interval [CI], 2.1 to 34.4; P = .002), history of cranial radiation (HR, 4.0; 95% CI, 1.7 to 9.6; P = .002), and grade II-IV acute graft-versus-host disease GVHD (HR, 4.2; 95% CI, 1.5 to 12.2; P = .008) were associated with the risk of developing a CVRF cluster. Compared with a random sample of matched population controls, HCT survivors had an increased prevalence of hypertriglyceridemia and low HDL, but not of glucose intolerance, elevated blood pressure, or CVRF cluster. Given the young age of this HCT survivor cohort, these data highlight the importance of routine screening for CVRF starting in childhood in individuals exposed to TBI.
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Affiliation(s)
| | - Patrick Hilden
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chaya S Moskowitz
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maya Suzuki
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Farid Boulad
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy A Kernan
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kevin C Oeffinger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charles A Sklar
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
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Abstract
Recent years have witnessed marked improvement in cytotoxic treatments with a parallel increase in patient survival. Despite efforts done to minimize long-term side effects of these treatment regimens, it is estimated that 40% of survivors of pediatric cancer will suffer from those. Some will be mild whereas others such as impaired fertility will be a heavy load on parents׳ expectations and patient׳s quality of life. Gonadal damage and severe loss of function is not a rare condition among children cured for cancer. Despite the young age of those patients, methods exist to try to reduce gonadal insult or to preserve gonadal function. Some of them are well studied and controlled; others are more experimental with encouraging results so far. This article aims to summarize all the procedures that can be offered to young patients treated for cancer in order to protect, as possible, their fertility potential.
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Affiliation(s)
- Raffoul Lara
- Department of Pediatric Surgery, APHP, Necker Enfants Malades Hospital, Paris, France
| | - Capito Carmen
- Department of Pediatric Surgery, APHP, Necker Enfants Malades Hospital, Paris, France
| | - Sarnacki Sabine
- Department of Pediatric Surgery, APHP, Necker Enfants Malades Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
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26
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Gunn HM, Rinne I, Emilsson H, Gabriel M, Maguire AM, Steinbeck KS. Primary Gonadal Insufficiency in Male and Female Childhood Cancer Survivors in a Long-Term Follow-Up Clinic. J Adolesc Young Adult Oncol 2016; 5:344-350. [PMID: 27195593 DOI: 10.1089/jayao.2016.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Childhood cancer survivors (CCS) are at increased risk of primary gonadal insufficiency (PGI). This study evaluated the prevalence and clinical characteristics of PGI in CCS. METHODS In this single-center, retrospective, observational, longitudinal study, we characterized CCS with PGI attending the oncology Long-Term Follow-Up (LTFU) Clinic at an Australian university hospital (January 2012-August 2014). From a cohort of 276 CCS, 54 (32 males) met criteria for PGI: elevated gonadotropins plus low estradiol/amenorrhoea (females) or low testosterone/small testicles for age (males). RESULTS Median age at primary diagnosis was 4.8 years (inter-quartile range [IQR] 3.0-9.7 years) and at LTFU, it was 22.3 years (IQR 18.2-25.7 years). Fifty-three participants (98.1%) were treated with known highly gonadotoxic therapies: alkylating chemotherapy (96.3%), radiotherapy (70.3%), total body irradiation (29.6%), bone marrow transplantation (51.9%), or multimodal protocols (68.5%). At primary diagnosis, 86.7% participants were Tanner stage I and at LTFU, 89.1% participants were Tanner stage V. More females (95.5%; n = 21) than males (40.6%; n = 13) were treated with hormone development therapy (HDT) (p < 0.01). Of these, more than half (n = 18; 7 males) required pubertal induction. There was no significant difference in serum luteinizing hormone/follicle stimulating hormone (LH/FSH), testosterone/estradiol between those untreated and those treated with HDT. Among those on HDT, 60.7% had persistently elevated FSH±LH and 33.3% had low testosterone or estradiol. Six males had semen analysis (five azoospermic, one oligospermic). Psychological assessment was documented in 61.1% of participants, and two-thirds reported fertility concerns. CONCLUSION PGI is an evolving phenotype that is common in CCS. Suboptimal treatment and non-adherence occur frequently. Ongoing assessment is essential to ensure prompt diagnosis, adequate intervention and to promote HDT adherence.
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Affiliation(s)
- Harriet M Gunn
- 1 Academic Department of Adolescent Medicine, The Children's Hospital at Westmead , Sydney, New South Wales, Australia .,2 Discipline of Child and Adolescent Health, The University of Sydney , Sydney, New South Wales, Australia
| | - Ida Rinne
- 3 The Faculty of Medicine and Health Sciences, Linköping University , Linköping, Sweden
| | - Hanna Emilsson
- 3 The Faculty of Medicine and Health Sciences, Linköping University , Linköping, Sweden
| | - Melissa Gabriel
- 4 Long Term Follow Up Clinic, Department of Oncology, The Children's Hospital at Westmead , Sydney, New South Wales, Australia
| | - Ann M Maguire
- 2 Discipline of Child and Adolescent Health, The University of Sydney , Sydney, New South Wales, Australia .,5 Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead , Sydney, New South Wales, Australia
| | - Katharine S Steinbeck
- 1 Academic Department of Adolescent Medicine, The Children's Hospital at Westmead , Sydney, New South Wales, Australia .,2 Discipline of Child and Adolescent Health, The University of Sydney , Sydney, New South Wales, Australia
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27
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Hill G, Meikle D. The role of total body irradiation (TBI) as a conditioning regime for paediatric acute lymphoblastic leukaemia: A discussion of the evidence. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2015.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Tonorezos ES, Hudson MM, Edgar AB, Kremer LC, Sklar CA, Wallace WHB, Oeffinger KC. Screening and management of adverse endocrine outcomes in adult survivors of childhood and adolescent cancer. Lancet Diabetes Endocrinol 2015; 3:545-55. [PMID: 25873569 PMCID: PMC4490990 DOI: 10.1016/s2213-8587(15)00038-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
5 year survival for childhood and adolescent cancer in developed countries is now in excess of 80% and the number of survivors of cancer continues to increase worldwide. After completion of therapy, many of these survivors will face a lifelong risk of endocrine late effects. We summarise the available evidence related to the prevalence and risk factors for endocrine late effects among adult survivors of childhood and adolescent cancer. Present screening, surveillance, and treatment recommendations differ by country and region, so we also highlight the continued effort to harmonise the international guidelines for this population.
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Affiliation(s)
- Emily S Tonorezos
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa M Hudson
- Departments of Oncology, Epidemiology and Cancer Control, and Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Angela B Edgar
- Department of hematology and Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Leontien C Kremer
- Department of Paediatric Oncology, Emma Children's Hospital and Academic Medical Centre, Amsterdam, Netherlands
| | - Charles A Sklar
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - W Hamish B Wallace
- Department of hematology and Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Kevin C Oeffinger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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29
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Panasiuk A, Nussey S, Veys P, Amrolia P, Rao K, Krawczuk-Rybak M, Leiper A. Gonadal function and fertility after stem cell transplantation in childhood: comparison of a reduced intensity conditioning regimen containing melphalan with a myeloablative regimen containing busulfan. Br J Haematol 2015; 170:719-26. [DOI: 10.1111/bjh.13497] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/24/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Panasiuk
- Department of Pediatric Oncology and Haematology; Medical University of Bialystok; Białystok Poland
| | - Stephen Nussey
- Department of Endocrinology; St George's Hospital Medical School; London UK
| | - Paul Veys
- Department of Blood and Marrow Transplantation; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
- Infection, Immunity, Inflammation and Physiological Medicine; Molecular and Cellular Section; UCL Institute of Child Health; London UK
| | - Persis Amrolia
- Department of Blood and Marrow Transplantation; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
- Infection, Immunity, Inflammation and Physiological Medicine; Molecular and Cellular Section; UCL Institute of Child Health; London UK
| | - Kanchan Rao
- Department of Blood and Marrow Transplantation; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Haematology; Medical University of Bialystok; Białystok Poland
| | - Alison Leiper
- Department of Haematology; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
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Williams KM, Dietzen D, Hassoun AA, Fennoy I, Bhatia M. Autoimmune thyroid disease following alemtuzumab therapy and hematopoietic cell transplantation in pediatric patients with sickle cell disease. Pediatr Blood Cancer 2014; 61:2307-9. [PMID: 24938636 PMCID: PMC4440678 DOI: 10.1002/pbc.25102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/25/2014] [Indexed: 11/06/2022]
Abstract
Allogenic hematopoietic cell transplantation (alloHCT) is currently the only curative treatment option for patients with sickle cell disease. Alemtuzumab is a monoclonal antibody directed against CD52 positive cells used in myeloablative conditioning regimens for alloHCT. Its use has been associated with development of autoimmune disease in adult patients with rheumatologic conditions. We report on three cases of new onset autoimmune thyroid disease after alloHCT treatment with alemtuzumab in pediatric patients with sickle cell disease.
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Affiliation(s)
| | - Danielle Dietzen
- Department of Pediatrics; Columbia University Medical Center; New York NY
| | - Abeer A. Hassoun
- Department of Pediatrics; Columbia University Medical Center; New York NY
| | - Ilene Fennoy
- Department of Pediatrics; Columbia University Medical Center; New York NY
| | - Monica Bhatia
- Department of Pediatrics; Columbia University Medical Center; New York NY
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31
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Bresters D, Emons JAM, Nuri N, Ball LM, Kollen WJW, Hannema SE, Bakker-Steeneveld JDJ, van der Bom JG, Oostdijk W. Ovarian insufficiency and pubertal development after hematopoietic stem cell transplantation in childhood. Pediatr Blood Cancer 2014; 61:2048-53. [PMID: 25111958 DOI: 10.1002/pbc.25162] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/03/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Ovarian insufficiency (OI) and infertility are common and devastating late effects of cancer treatment and hematopoietic stem cell transplantation (HSCT). In children, gonadal insufficiency may subsequently lead to abnormal pubertal development. The aim of this study was to assess the cumulative incidence of OI and the need for hormonal induction of pubertal development after HSCT in childhood. We additionally assessed HSCT-related risk factors for OI. PROCEDURES A single center cohort study was undertaken of female patients transplanted during childhood, surviving at least 2 years post-HSCT and who were at least 10 years old at initiation of the study. Of 141 eligible patients, 109 were included and hormone levels and clinical data of these patients during follow-up were collected. Risk factors for OI were analyzed by multivariate Cox regression analysis. RESULTS Cumulative incidence of OI was 56% at a median follow-up of 7.2 years. Eight patients, initially diagnosed with OI, showed recovery of ovarian function over time. Hormonal induction of puberty was necessary in 44% of females who were pre-pubertal or pubertal at HSCT. In multivariate analysis, more advanced pubertal stage at HSCT was associated with OI. We found a trend for an association of busulfan with OI in patients conditioned with chemotherapy only. CONCLUSIONS The incidence of OI after HSCT was high and associated with more advanced pubertal stage at HSCT. Almost half of the females who were pre-pubertal or pubertal at HSCT required hormonal induction of pubertal development.
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Affiliation(s)
- Dorine Bresters
- Leiden University Medical Center (LUMC), Willem-Alexander Children's Hospital, Leiden, The Netherlands
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Personalized busulfan and treosulfan conditioning for pediatric stem cell transplantation: the role of pharmacogenetics and pharmacokinetics. Drug Discov Today 2014; 19:1572-86. [DOI: 10.1016/j.drudis.2014.04.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/01/2014] [Accepted: 04/08/2014] [Indexed: 01/22/2023]
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Tewari P, Franklin AR, Tarek N, Askins MA, Mofield S, Kebriaei P. Hematopoietic stem cell transplantation in adolescents and young adults. Acta Haematol 2014; 132:313-25. [PMID: 25228557 DOI: 10.1159/000360211] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) are a very unique subset of our population journeying through a dynamic stage of their lives. This age group often remains understudied as a separate entity because they are commonly lumped into either pediatric or adult subgroups. METHODS Here we review acute and chronic issues surrounding hematopoietic stem cell transplantation (HSCT) with a focus on the AYA age group. RESULTS HSCT is a commonly used treatment modality for patients with certain types of cancers. AYA patients undergoing HSCT present a very unique perspective, circumstances, medical, psychological and social issues requiring a diligent workup, care and follow-up. CONCLUSION The medical care of these patients should be approached in a multidisciplinary method involving the patient, caregivers, physicians, psychologists and social workers.
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Pfitzer C, Orawa H, Balcerek M, Langer T, Dirksen U, Keslova P, Zubarovskaya N, Schuster FR, Jarisch A, Strauss G, Borgmann-Staudt A. Dynamics of fertility impairment and recovery after allogeneic haematopoietic stem cell transplantation in childhood and adolescence: results from a longitudinal study. J Cancer Res Clin Oncol 2014; 141:135-42. [DOI: 10.1007/s00432-014-1781-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
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Polgreen LE, Thomas W, Orchard PJ, Whitley CB, Miller BS. Effect of recombinant human growth hormone on changes in height, bone mineral density, and body composition over 1-2 years in children with Hurler or Hunter syndrome. Mol Genet Metab 2014; 111:101-6. [PMID: 24368158 PMCID: PMC4018305 DOI: 10.1016/j.ymgme.2013.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 11/28/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
Patients with Hurler or Hunter syndrome typically have moderate to severe growth deficiencies despite therapy with allogeneic hematopoietic stem cell transplantation and/or enzyme replacement therapy. It is unknown whether treatment with recombinant human growth hormone (hGH) can improve growth in these children. The objectives of this study were to determine the effects of hGH on growth, bone mineral density (BMD), and body composition in children with Hurler or Hunter syndrome enrolled in a longitudinal observational study. The difference in annual change in outcomes between hGH treated and untreated subjects was estimated by longitudinal regression models that adjusted for age, Tanner stage, and sex where appropriate. We report on 23 participants who completed at least 2 annual study visits (10 [43%] treated with hGH): Hurler syndrome (n=13) average age of 9.8 ± 3.1 years (range 5.3-13.6 years; 54% female) and Hunter syndrome (n=10) average age of 12.0 ± 2.7 years (range 7.0-17.0 years; 0% female). As a group, children with Hurler or Hunter syndrome treated with hGH had no difference in annual change in height (growth velocity) compared to those untreated with hGH. Growth velocity in hGH treated individuals ranged from -0.4 to 8.1cm/year and from 0.3 to 6.6 cm/year in the untreated individuals. Among children with Hunter syndrome, 100% (N=4) of those treated but only 50% of those untreated with hGH had an annual increase in height standard deviation score (SDS). Of the individuals treated with hGH, those with GHD had a trend towards higher annualized growth velocity compared to those without GHD (6.5 ± 1.9 cm/year vs. 3.5 ± 2.1cm/year; p=.050). Children treated with hGH had greater annual gains in BMD and lean body mass. In conclusion, although as a group we found no significant difference in growth between individuals treated versus not treated with hGH, individual response was highly variable and we are unable to predict who will respond to treatment. Thus, a trial of hGH may be appropriate in children with Hurler or Hunter syndrome, severe short stature, and growth failure. However, efficacy of hGH therapy should be evaluated after 1 year and discontinued if there is no increase in growth velocity or height SDS. Finally, the long-term benefits of changes in body composition with hGH treatment in this population are unknown.
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Affiliation(s)
- Lynda E Polgreen
- University of Minnesota, Department of Pediatrics, Minneapolis, MN, USA.
| | - William Thomas
- University of Minnesota, School of Public Health, Division of Biostatistics, Minneapolis, MN, USA.
| | - Paul J Orchard
- University of Minnesota, Department of Pediatrics, Minneapolis, MN, USA.
| | - Chester B Whitley
- University of Minnesota, Department of Pediatrics, Minneapolis, MN, USA.
| | - Bradley S Miller
- University of Minnesota, Department of Pediatrics, Minneapolis, MN, USA.
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Barnes N, Chemaitilly W. Endocrinopathies in survivors of childhood neoplasia. Front Pediatr 2014; 2:101. [PMID: 25295241 PMCID: PMC4172013 DOI: 10.3389/fped.2014.00101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/06/2014] [Indexed: 01/26/2023] Open
Abstract
Advancements in cancer treatments have increased the number of survivors of childhood cancers. Endocrinopathies are common complications following cancer therapy and may occur decades later. The objective of the current review is to address the main endocrine abnormalities detected in childhood cancer survivors including disorders of the hypothalamic-pituitary axis, thyroid, puberty, gonads, bone, body composition, and glucose metabolism.
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Affiliation(s)
- Nicole Barnes
- Division of Pediatric Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, TN , USA
| | - Wassim Chemaitilly
- Division of Pediatric Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, TN , USA ; Epidemiology and Cancer Control, St. Jude Children's Research Hospital , Memphis, TN , USA
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Irtan S, Orbach D, Helfre S, Sarnacki S. Ovarian transposition in prepubescent and adolescent girls with cancer. Lancet Oncol 2013; 14:e601-8. [DOI: 10.1016/s1470-2045(13)70288-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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SCID patients with ARTEMIS vs RAG deficiencies following HCT: increased risk of late toxicity in ARTEMIS-deficient SCID. Blood 2013; 123:281-9. [PMID: 24144642 DOI: 10.1182/blood-2013-01-476432] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A subgroup of severe combined immunodeficiencies (SCID) is characterized by lack of T and B cells and is caused by defects in genes required for T- and B-cell receptor gene rearrangement. Several of these genes are also involved in nonhomologous end joining of DNA double-strand break repair, the largest subgroup consisting of patients with T(-)B(-)NK(+)SCID due to DCLRE1C/ARTEMIS defects. We postulated that in patients with ARTEMIS deficiency, early and late complications following hematopoietic cell transplantation might be more prominent compared with patients with T(-)B(-)NK(+)SCID caused by recombination activating gene 1/2 (RAG1/2) deficiencies. We analyzed 69 patients with ARTEMIS and 76 patients with RAG1/2 deficiencies who received transplants from either HLA-identical donors without conditioning or from HLA-nonidentical donors without or with conditioning. There was no difference in survival or in the incidence or severity of acute graft-versus-host disease regardless of exposure to alkylating agents. Secondary malignancies were not observed. Immune reconstitution was comparable in both groups, however, ARTEMIS-deficient patients had a significantly higher occurrence of infections in long-term follow-up. There is a highly significant association between poor growth in ARTEMIS deficiency and use of alkylating agents. Furthermore, abnormalities in dental development and endocrine late effects were associated with alkylation therapy in ARTEMIS deficiency.
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Gundgurthi A, Garg MK, Nair V, Pakhetra R, Das S, Sharma S, Dutta MK, Kharb S, Kapoor R. Endocrine complications after busulphan and cyclophosphamide based hematopoietic stem cell transplant: A single tertiary care centre experience. Indian J Endocrinol Metab 2013; 17:855-863. [PMID: 24083167 PMCID: PMC3784869 DOI: 10.4103/2230-8210.117248] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Endocrine complications are common after hematopoietic stem cell transplant (HSCT). Although HSCT is performed at various centers in India, no study is available for endocrine dysfunctions among them. This study was carried out with the objective to evaluate endocrine dysfunction among patients undergone HSCT in the past. MATERIALS AND METHODS We carried out a cross-sectional study in a 50 post-HSCT recipients (39 allogenic, 11 autologous). All relevant data were collected from patient's records. Samples for hormonal estimation were collected and stimulation tests for cortisol and growth hormone were interpreted based on peak values achieved during insulin tolerance test. RESULTS The mean age of patients was 26.3 ± 16.9 years (range 4-74). Adrenal insufficiency (AI) was present in 60%, hypergonadotropic hypogonadism (HH) in 60%, growth hormone deficiency (GHD) in 54%, hypothyroidism in 4%, hyperprolactinemia in 4%, new onset diabetes after transplant in 4%, and impaired fasting glucose in 6%. Multiple endocrine complications were common. GHD was present in 77% of children (n = 22) although height standard deviation score was not statistically different compared to those who didn't have GHD. HH was present in 36% of children. In adults (n = 28), 36% had GHD, all females had HH, and 89% of males had HH. Germ cell dysfunction with compensated Leydig cell dysfunction was the most common pattern of HH in males. Fifteen patients had graft versus host disease (GVHD). GVHD had no bearing on development of endocrine deficiencies. AI was related to duration after and type of transplant, but was unrelated to steroid intake. CONCLUSIONS Endocrine manifestations are common after HSCT; they can occur as early or late complications. All HSCT recipients should have endocrine evaluation as per prevailing guidelines.
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Affiliation(s)
- Abhay Gundgurthi
- Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
| | - M. K. Garg
- Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
| | - Velu Nair
- Department of Haematology, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
| | - Rajeev Pakhetra
- Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
| | - Satyanarayan Das
- Department of Haematology, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
| | - Sanjeevan Sharma
- Department of Haematology, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
| | - Manoj K. Dutta
- Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
| | - Sandeep Kharb
- Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
| | - Rajan Kapoor
- Department of Haematology, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
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Siklar Z, Berberoglu M. Pediatric hormonal disturbances after hematopoietic stem cell transplantation. Expert Rev Endocrinol Metab 2013; 8:81-90. [PMID: 30731655 DOI: 10.1586/eem.12.71] [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] [Indexed: 11/08/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is the treatment of choice for various malignant and nonmalignant diseases. Improvement of HSCT in children has resulted in many long-term survivors with substantial long-term morbidities. Endocrine complications are most frequently observed as late effects in HSCT recipients. Growth failure, pubertal disorders, thyroid dysfunctions, obesity, metabolic syndrome and bone loss are usually encountered after HSCT in children, while infertility is an important problem in adulthood. Patient age at HSCT, characteristics of primary diseases, intervention duration, preparative conditioning regimens, dose of irradiation and specificity of chemotherapeutic agents affect the prevalence of endocrine late effects. Awareness of endocrine late effects of HSCT and close follow-up of patients would help to increase the quality of health of patients.
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Affiliation(s)
- Zeynep Siklar
- b Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey.
| | - Merih Berberoglu
- a Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
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Chow EJ, Liu W, Srivastava K, Leisenring WM, Hayashi RJ, Sklar CA, Stovall M, Robison LL, Baker KS. Differential effects of radiotherapy on growth and endocrine function among acute leukemia survivors: a childhood cancer survivor study report. Pediatr Blood Cancer 2013; 60:110-5. [PMID: 22628201 PMCID: PMC3436954 DOI: 10.1002/pbc.24198] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 04/20/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND The differential effects of cranial radiotherapy (CRT), spinal radiotherapy (SRT), and total body irradiation (TBI) on growth and endocrine outcomes have rarely been examined in combination among childhood acute leukemia survivors. PROCEDURE Self-reported height/weight, hypothyroidism, and pregnancy/live birth were determined among acute lymphoblastic and myeloid leukemia survivors (n = 3,467) participating in the Childhood Cancer Survivor Study, an ongoing cohort study of 5-year survivors of pediatric cancers diagnosed from 1970 to 1986. RESULTS Compared with no radiotherapy, risk estimates were consistent across outcomes (adult short stature, hypothyroidism, absence of pregnancy/live birth) with CRT treatment associated with 2-3-fold increased risks, TBI associated with 5-10 fold increased risks, and CRT + TBI associated with >10 fold increased risks. Exposure to any SRT further increased risk of these outcomes 2-3-fold. Changes in body composition were more nuanced as CRT only was associated with an increased risk of being overweight/obese (OR 1.6, 95% CI 1.3-1.9) whereas TBI only was associated with an increased risk of being underweight (OR 6.0, 95% CI 2.4-14.9). CONCLUSIONS Although patients treated with CRT + TBI were at greatest risk for short stature, hypothyroidism, and a reduced likelihood of pregnancy/live birth, those treated with either modality alone had significantly increased risks as well, including altered body composition. Any SRT exposure further increased risk in an independent fashion.
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Affiliation(s)
- Eric J. Chow
- Dept. Pediatrics, Seattle Children’s Hospital & University of Washington, Seattle, WA,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA,Corresponding author: Eric Chow, MD, MPH, Fred Hutchinson Cancer Research Center, PO Box 19024, Mailstop M4-C308, Seattle, WA 98109-1024, USA, 206-667-7724 phone, 206-667-5948 fax,
| | - Wei Liu
- Dept. Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kumar Srivastava
- Dept. Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Wendy M. Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Robert J. Hayashi
- Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, MO
| | - Charles A. Sklar
- Dept. of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Marilyn Stovall
- Dept. of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Leslie L. Robison
- Dept. Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - K. Scott Baker
- Dept. Pediatrics, Seattle Children’s Hospital & University of Washington, Seattle, WA,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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Chung SJ, Park SW, Kim MK, Kang MJ, Lee YA, Lee SY, Shin CH, Yang SW, Kang HJ, Park KD, Shin HY, Ahn HS. Growth after hematopoietic stem cell transplantation in children with acute myeloid leukemia. J Korean Med Sci 2013; 28:106-13. [PMID: 23341720 PMCID: PMC3546088 DOI: 10.3346/jkms.2013.28.1.106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 10/26/2012] [Indexed: 11/20/2022] Open
Abstract
Previous studies have shown that hematopoietic stem cell transplantation (HSCT) may result in growth impairment. The purpose of this study was to evaluate the growth during 5 yr after HSCT and to determine factors that influence final adult height (FAH). We retrospectively reviewed the medical records of acute myeloid leukemia (AML) patients who received HSCT. Among a total of 37 eligible patients, we selected 24 patients who began puberty at 5 yr after HSCT (Group 1) and 19 patients who reached FAH without relapse (Group 2). In Group 1, with younger age at HSCT, sex, steroid treatment, hypogonadism and hypothyroidism were not significantly associated with growth impairment 5 yr after HSCT. History of radiotherapy (RT) significantly impaired the 5 yr growth after HSCT. Chronic graft-versus-host disease (cGVHD) only temporarily impaired growth after HSCT. In Group 2, with younger age at HSCT, steroid treatment and hypogonadism did not significantly reduce FAH. History of RT significantly reduced FAH. Growth impairment after HSCT may occur in AML patients, but in patients without a history of RT, growth impairment seemed to be temporary and was mitigated by catch-up growth.
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Affiliation(s)
- Seung Joon Chung
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Seung Wan Park
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Min Kyoung Kim
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Min Jae Kang
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Young Ah Lee
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Seong Yong Lee
- Department of Pediatrics, Seoul National University Boramae Hospital, Seoul, Korea
| | - Choong Ho Shin
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Sei Won Yang
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Duk Park
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Young Shin
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Seop Ahn
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Khalil A, Zaidman I, Elhasid R, Peretz-Nahum M, Futerman B, Ben-Arush M. Factors influencing outcome and incidence of late complications in children who underwent allogeneic hematopoietic stem cell transplantation for hemoglobinopathy. Pediatr Hematol Oncol 2012; 29:694-703. [PMID: 23020512 DOI: 10.3109/08880018.2012.725198] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) remains the only potentially curative treatment for severe hemoglobinopathy (HGP). Late complications (LCs) are all events occurring beyond two years post-HSCT. We retrospectively analyzed prevalence, factors influencing occurrence, and prognosis of LCs post-HSCT for HGP. PATIENTS AND METHODS Between 2000 and 2011, 47 patients (21 males, 26 females; 43 with beta thalassemia major, four with sickle cell disease) who had survived more than two years post-HSCT for HGP were retrospectively reviewed. Mean age at HSCT was 7.7 years (1.1-32 years); mean follow-up was 7.1 years (2-11.6 years); 11 patients were splenectomized; mean ferritin level was 3022 ng/mL (350-10900); and seven patients underwent a second HSCT. RESULTS Endocrinological complications were observed with primary gonadal failure in 16/20 mature females and 4/11 mature males, in five patients with primary hypothyroidism and in four with insulin-dependent diabetes mellitus (DM). Skeletal complications were observed in 10 with secondary osteoporosis; 22 patients had elevated transaminase levels; two had hepatitis B reactivation. Neurological, cardiac and ocular manifestations were relatively rare. A higher incidence of LCs was observed in splenectomized than in nonsplenectomized patients: cGVHD -64% versus 13% (P = .003); endocrine abnormalities -91% versus 30.5%, (P = .001); elevated transaminase levels -73% versus 33% (P = .043); mortality -18% versus 2.7% (NS). CONCLUSIONS LCs post-HSCT for HGP are common and heterogeneous. Etiology is multifactorial with iron overload (IO), class, splenectomy, age, chronic GVHD, and corticosteroid (CS) treatment. Our data may help build follow-up guidelines to limit, detect, and treat any LCs and improve quality of life.
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Affiliation(s)
- Abdalla Khalil
- Department of Pediatric Hematology Oncology, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel
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Sathyapalan T, Dixit S. Radiotherapy-induced hypopituitarism: a review. Expert Rev Anticancer Ther 2012; 12:669-83. [PMID: 22594901 DOI: 10.1586/era.12.27] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hypopituitarism is a disorder caused by impaired hormonal secretions from the hypothalamic-pituitary axis. Radiotherapy is the most common cause of iatrogenic hypopituitarism. The hypothalamic-pituitary axis inadvertently gets irradiated in patients receiving prophylactic cranial radiotherapy for leukemia, total body irradiation and radiotherapy for intracranial, base skull, sinonasal and nasopharyngeal tumors. Radiation-induced hypopituitarism (RIH) is insidious, progressive and largely nonreversible. Mostly, RIH involves one hypothalamic-pituitary axis; however, multiple hormonal axes deficiency starts developing at higher doses. Although the clinical effects of the hypopituitarism are more profound in children and young adults, its implications in older adults are being increasingly recognized. The risk continues to persist or increase up to 10 years following radiation exposure. The clinical management of hypopituitarism is challenging both for the patients and healthcare providers. Here we have reviewed the scale of the problem, the risk factors and the management of RIH.
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Affiliation(s)
- Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Hull, UK
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45
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Binart N, Sauvat F. [Cryopreserved ovaries: models of experimental grafting]. Biol Aujourdhui 2012; 205:235-43. [PMID: 22251858 DOI: 10.1051/jbio/2011019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Indexed: 01/16/2023]
Abstract
Childhood cancers account for 1% of malignant tumors. As a result of advances in treatment, almost 80% of children and adolescents who currently receive a diagnosis of cancer become long-term survivors. Assessment of potential for fertility preservation should thus be a systematic element of care for children treated for a malignant tumor (high-dose chemotherapy with alkylizing agents, radiation therapy including the gonads) or those receiving hematopoietic stem cell grafts for malignant or benign disease (sickle-cell anemia, immune deficit). Potential adverse consequences of treatment include impaired puberty and fertility due to gonadal removal, genital tract injury or damage to germ cells from adjuvant therapy. Advances in assisted reproductive technologies have led to new possibilities for the prevention and treatment of infertility. Among them, cryopreservation of ovarian tissue appears to be the most promising, or perhaps the only one available before puberty with encouraging results. Nevertheless the uncertainties, or even risks, related to these treatments, should not be neglected. We review experimental data in mouse and sheep animal models. The results demonstrate that immature ovarian grafting can restore spontaneous puberty and fertility in both models. This study addresses the very important issue of epigenetics, and provides valuable information for the study of ovarian transplantation, suggesting that these procedures do not perturb normal epigenetic marks. These results are highly relevant to the question of immature cortex reimplantation.
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46
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25-Hydroxy Vitamin D Deficiency Following Pediatric Hematopoietic Stem Cell Transplant. Biol Blood Marrow Transplant 2011; 17:749-53. [DOI: 10.1016/j.bbmt.2010.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 10/09/2010] [Indexed: 12/13/2022]
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47
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Gardner CJ, Robinson N, Meadows T, Wynn R, Will A, Mercer J, Church HJ, Tylee K, Wraith JE, Clayton PE. Growth, final height and endocrine sequelae in a UK population of patients with Hurler syndrome (MPS1H). J Inherit Metab Dis 2011; 34:489-97. [PMID: 21253827 DOI: 10.1007/s10545-010-9262-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 11/24/2010] [Accepted: 12/06/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Hurler Syndrome, (MPSIH) is an inborn error of glycosaminoglycan metabolism. Haematopoietic stem cell transplantation (HSCT) has transformed the prognosis for these children. Prior to transplant patients receive chemotherapy or chemo-radiotherapy. Regular screening for the development of endocrine sequelae is therefore essential. We present for the first time data on final adult height and endocrine complications in children with MPSIH post HSCT. DESIGN Retrospective case note study and a prospective programme of growth and endocrine assessment. PATIENTS 22 patients were included, mean age at last assessment 12.2 (Range 6.3-21.6) years. Mean age at HSCT was 1.3 (SD 0.6) years. Conditioning included mostly busulphan and cyclophosphamide, with 5 patients receiving total body irradiation prior to second transplant. RESULTS Height SDS decreased over time. Final height (FH) was attained in seven patients with male FH SDS -4.3 (Range -3.8, -5.1) and female FH SDS -3.4 (Range -2.9, -5.6). Eight of 13 patients tested had evidence of high growth hormone (GH) levels, while one had GH deficiency. Adrenal and thyroid function was normal in all. 11 patients were pubertal or post pubertal. Two females had pubertal failure requiring intervention. All male patients had spontaneous, complete puberty; however three patients have reduced testicular volumes. Five out of 13 patients tested had an abnormal oral glucose tolerance test. CONCLUSION Growth is impaired, primarily related to skeletal dysplasia, but also associated with GH resistance. Pubertal development may be compromised and abnormalities of glucose metabolism are common. We recommend a structured endocrine surveillance programme for these patients.
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Successful reduced-intensity SCT from unrelated cord blood in three patients with X-linked SCID. Bone Marrow Transplant 2011; 46:1526-31. [PMID: 21258424 PMCID: PMC3234418 DOI: 10.1038/bmt.2010.338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We describe three males with X-linked SCID (X-SCID) who were successfully treated by reduced-intensity SCT from unrelated cord blood (CB). Mean age at transplant was 5.7 months (range, 3–9 months). Pre-transplant conditioning for all patients consisted of fludarabine (FLU) (30 mg/m2 per day) from day −7 to day −2 (total dose 180 mg/m2) and BU 4 mg/kg per day from day −3 to day −2 (total dose 8 mg/kg). All CB units were serologically matched at HLA-A, B and DR loci. Although two patients had suffered from fungal or bacterial pneumonia before transplantation, there were no other infectious complications during transplantation. All patients engrafted and achieved 100% donor chimerism. We also confirmed full donor chimerism of both T and B cells. Only one patient developed acute GVHD grade III, which was resolved by increasing the dose of oral corticosteroid. None of the patients has developed chronic GVHD during follow up for 21–77 months. None of the patient received i.v. Ig replacement post transplant, or showed delay in psychomotor development. Reduced-intensity conditioning consisting of FLU and BU and transplantation from unrelated CB was an effective and safe treatment for these patients with X-SCID.
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Savas-Erdeve S, Berberoglu M, Siklar Z, Hacihamdioglu B, Ocal G, Ertem M, Ileri T, Ince EU, Uysal Z. Primary adrenal insufficiency in a child after busulfan and cyclophosphamide-based conditioning for hematopoietic stem cell transplantation. J Pediatr Endocrinol Metab 2011; 24:853-5. [PMID: 22145493 DOI: 10.1515/jpem.2011.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
High rates of skeletal complications, growth disturbances, thyroid and gonadal dysfunction have been described in children undergoing stem cell transplantation. Although secondary adrenal insufficiency has been diagnosed, no primary adrenal insufficiency has been reported after busulfan and cyclophosphamide (Bu/Cy)-based conditioning regimens for stem cell transplantation in children. A 9-year-old girl with myelodysplastic syndrome was treated with stem cell transplantation of allogeneic origin. She received myeloablative conditioning chemotherapy, Bu and Cy. Her serum cortisol level was normal before stem cell transplantation. Then, 17 months after stem cell transplantation, chronic graft-versus-host disease developed and was treated with methyl prednisolone for 3 months. The control endocrinological investigation revealed low serum cortisol and high serum adrenocorticotropin (ACTH) levels 6 months after completion of methyl prednisolone treatment. The ACTH stimulation test demonstrated primary adrenal insufficiency, and the other etiologies of primary adrenal insufficiency were excluded. The patient received oral prednisolone replacement therapy. She was followed-up for 44 months and required increases in steroid doses during stress periods. Primary adrenal insufficiency which was observed in our patient after Bu/Cy-based conditioning regimen for stem cell transplantation has not been reported in children and adrenal function should be closely monitored in these patients both before stem cell transplantation and after stem cell transplantation.
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Affiliation(s)
- Senay Savas-Erdeve
- Division of Pediatric Endocrinology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
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McClune BL, Polgreen LE, Burmeister LA, Blaes AH, Mulrooney DA, Burns LJ, Majhail NS. Screening, prevention and management of osteoporosis and bone loss in adult and pediatric hematopoietic cell transplant recipients. Bone Marrow Transplant 2010; 46:1-9. [PMID: 20729922 DOI: 10.1038/bmt.2010.198] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Long-term survivors of hematopoietic cell transplantation (HCT) are at risk for loss of bone mineral density (BMD) and subsequent osteoporosis. There is a lack of clear guidelines for the screening, prevention and treatment of bone loss after HCT. We reviewed the prevailing literature and provide guidelines developed by our center for the screening and management of this complication. Bone loss occurs predominantly within the first 6-12 months after autologous and allogeneic HCT. Recovery first occurs in the lumbar spine and is followed by a slower recovery of BMD in the femoral neck. BMD may not return to baseline levels in patients with continuing exposure to corticosteroids and calcineurin inhibitors. All HCT recipients should be advised general interventions to reduce fracture risk including adequate intake of calcium and vitamin D. We recommend screening all adult allogeneic and autologous HCT recipients with dual-energy X-ray absorptiometry 1 year after transplantation. Patients at high risk for bone loss (for example, patients receiving ≥ 5 mg of prednisone equivalent daily for > 3 months) can be screened earlier (for example, 3-6 months after HCT). Where indicated, bisphosphonates or other anti-resorptive agents (for example, calcitonin) can be used for prevention or treatment of osteoporosis in adult HCT recipients. Pediatric HCT recipients should be referred to a pediatric endocrinologist for evaluation and treatment of bone loss. There remain several areas of uncertainty that need further research in adult and pediatric HCT recipients, such as the optimal timing and frequency of screening for loss of bone mineral density, relationship of bone loss with risk of fractures, selection of appropriate patients for pharmacologic therapy, and optimal dosing schedule and duration of therapy with anti-resorptive agents.
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Affiliation(s)
- B L McClune
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
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