Bone marrow suppression in pediatric patients with differentiated thyroid cancer following empirical radioiodine therapy

Effect of radioactive iodine therapy on hematological parameters in patients with thyroid cancer: systematic review and meta-analysis

Background

Patients with thyroid cancer (TC) are commonly treated with radioactive iodine therapy (RIA) to prevent neoplastic transformation and the re-emergence of cancer cells. However, it has major side effects on blood cells. However, the degree of change in hematological parameters reported varies across studies. Therefore, the aim of this review was to assesses the mean differences in hematological parameters after RAI therapy.

Methods

The relevant articles for this review were identified through extensive searches of databases and the Google search engine. The identified articles were subsequently selected using predetermined eligibility criteria. All relevant information from the screened articles was extracted. The pooled standardized mean differences (SMDs) of the parameters were assessed via a random effects model. The heterogeneity was determined by I2 statistics test. Funnel plots and Egger's test were utilized to assess publication bias.

Results

A total of 17 studies including 4,112 and 3,766 study participants before and after RAI therapy, respectively, were included. The pooled SMDs of the total leucocyte count (TLC) (*109/L) at one, three, six and 12 months and the last follow-up period were 2.39, 2.46, 5.84, 3.19, and 0.53, respectively. Changes in the TLC after one, three and six months of therapy were statistically significant. In terms of the absolute neutrophil count (ANC; *109/L) and absolute lymphocyte count (ALC; *109/L), the pooled SMDs at the last follow-up period were 6.32 and 7.37, respectively. In addition, statistically significant changes in the platelet count (PLT; *109/L) were observed at one, three, six and 12 months and at the last follow-up, with pooled SMDs of 7.01, 0.22, 2.63, 6.61, and 8.76, respectively. Furthermore, statistically significant changes in red blood cells (RBCs; *1012/L) and hemoglobin (Hgb; g/dl) were detected after three and six months of therapy, with pooled SMDs of -1.088 and 2.4, respectively.

Conclusion

According to the current systematic review and meta-analysis, radioiodine therapy had a significant effect on hematological parameters. Thus, early screening and correction of hematological toxicity may be helpful for improving quality of life in thyroid cancer patients receiving radioiodine therapy.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024586449.

The effect of radioiodine therapy on blood cell count in patients with differentiated thyroid cancer

PURPOSE

This study aimed to investigate the long-term effects of radioiodine treatment (RAI) on blood cell counts in patients with differentiated thyroid cancer (DTC) and to describe the characteristics of patients at high risk for blood cell count abnormalities.

METHODS

The study included patients with DTC who underwent RAI treatment between 2007 and 2017. Patients with regular complete blood counts for at least 5 years were included, while those with diseases or treatments that could influence blood count parameters were excluded. Blood cell count abnormalities were defined according to the Common Terminology Criteria for Adverse Events version 5.0, and factors influencing these abnormalities were examined.

RESULTS

A total of 225 patients were analyzed. The mean age at diagnosis was 45.8 ± 13.9 years, and 76.5% of patients were female. In the first year after RAI, leukocyte, neutrophil, and lymphocyte counts were significantly reduced compared with baseline values. The leukocyte and neutrophil counts returned to baseline values by the third year, while the decrease in lymphocytes continued until the fifth year. Blood cell count abnormalities developed in 16 patients (7.1%) within the first year after RAI. Risk factors for blood cell count abnormalities within the first year after RAI included male sex, older age, T4, N1, and M1 disease, as well as higher RAI doses. In logistic regression analysis, only RAI dose remained independently associated with blood cell count abnormalities.

CONCLUSION

These results suggest an association between RAI dose and blood cell count abnormalities, characterized by mild lymphopenia, and indicate that the risk of mild lymphopenia persists over time. Careful consideration should be given when planning high-dose RAI for patients at a high risk of blood cell count abnormalities, such as males with metastatic disease and of advanced age.

Side effects of theragnostic agents currently employed in clinical practice

Nuclear medicine plays an increasingly important role in several neoplasms management through a theragnostic approach by which targeted molecular imaging and radiotherapy are obtained with the use of radionuclide pairs with similar characteristics. In some cases, nuclear theragnostic use a pair of agents with identical chemical and biological characteristics while in others are employed theragnostic molecules which are not chemically or biologically identical but show similar biodistribution (so-called "twins in spirit" radiopharmaceuticals). This strategy was developed for the first time over 75 years ago, when iodine-131 was used for diagnostic imaging, confirmation of target expression and radionuclide therapy of thyroid cancer. Other theragnostic approaches were subsequently introduced with significant clinical results and some of them are currently considered standard treatment for different cancers. However, as any other therapy, also nuclear theragnostic treatment carries the potential risk of early deterministic and late stochastic off-target adverse effects, generally minimal and easily managed. This article reviews the reported side effects and risks of the main radiopharmaceuticals used for nuclear theragnostic in oncology for the treatment of thyroid cancer, neuroendocrine neoplasms, adrenergic tumors, metastatic prostate cancer, and liver tumors. Selecting appropriate patients using a multidisciplinary approach, meticulous pretreatment planning and knowledge of methods permit to decrease the incidence of these potential side effects.

Transcriptome analysis reveals possible antitumor mechanism of Chlorella exopolysaccharide

Microalgae, one of the most important classes of biomass producers, can produce exopolysaccharides similar to bacteria. The exopolysaccharide from Chlorella (CEPS) displays remarkable anticancer activity the mechanism of which remains to be elucidated. In this study, we analyzed the inhibitory effect of CEPS on the growth of HeLa cells. The results showed that CEPS inhibited the proliferation, decreased the viability, and changed the morphology of HeLa cells. Transcriptome analysis showed that 1894 genes were differentially expressed in the CEPS-treated group compared with the control group, including 1076 genes that were upregulated and 818 genes that were downregulated. The results of gene function enrichment analysis showed that the differentially expressed genes (DEGs) were significantly enriched in apoptosis and tumor-related biological processes and participated in several cancer and apoptosisrelated signaling pathways, including the MAPK signaling pathway, TNF signaling pathway, and the PI3K-Akt signaling pathway. The protein-protein interaction network identified 13 DEGs including PTPN11, RSAD2, ISG15, IFIT1, MX2, IFIT2, OASL, OAS1, JUN, OAS2, XAF1, ISG20, and IRF9 as hub genes. Our results suggest that CEPS is a promising therapeutic drug for the follow-up interventional therapy of cancer.

Low- and high-dose radioiodine ablation for low-/intermediate-risk differentiated thyroid cancer in China: Large randomized clinical trial

BACKGROUND

To determine whether 1.1 GBq radioiodine therapy is as effective as 3.7 GBq for ablation in Chinese patients with differentiated thyroid cancer (DTC).

METHODS

In this single-center randomized study, we compared the successful radioiodine ablation rates of 1.1 GBq and 3.7 GBq for patients with DTC.

RESULTS

At 6-8 months after radioiodine ablation, there were 95 (39%) patients in the 1.1 GBq group and 79 (32%) patients in the 3.7 GBq group with thyroid hormone withdrawal (THW), and ablation success rates were 84% versus 80%, respectively; and 149 (61%) patients in the 1.1 GBq group and 169 (68%) patients in the 3.7 GBq group without THW, and ablation success rates were 89% versus 90%, respectively. In total, the ablation was successful in 412 (87%) of the 474 patients, and it was similar between the two groups.

CONCLUSIONS

Low-dose radioiodine ablation was as effective as high dose in Chinese DTC patients.