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Hao Y, Zhang X, Cui G, Qi X, Jiang Z, Yu L. Clinicopathological features, prognostic factor analysis, and survival nomogram of patients with double primary cancers involving lung cancer. Cancer Med 2024; 13:e7296. [PMID: 38770671 PMCID: PMC11106682 DOI: 10.1002/cam4.7296] [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: 01/21/2024] [Revised: 03/17/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Although the incidence of double primary cancers (DPCs) involving lung cancer is rising, they have not been studied sufficiently. This study retrospectively analyzed the clinicopathological and prognostic characteristics of DPC patients with lung cancer and developed a survival nomogram to predict the individual OS rates. METHODS We included 103 DPC patients with lung cancer from Shengjing Hospital between 2016 and 2021. Based on the 6-month cancer occurrence interval, the cases were categorized as synchronous DPCs (sDPCs) or metachronous DPCs (mDPCs). Furthermore, the mDPCs were subdivided based on whether the lung cancer occurred first (LCF cohort) or the other cancer occurred first (OCF cohort). RESULTS Among the patients, 35 (33.98%) and 68 (66.02%) had sDPCs and mDPCs, respectively. In the mDPCs cohort, 18 (26.47%) belonged to the LCF cohort and 50 (73.53%) to the OCF cohort. The most frequent primary cancer sites were the breast (27.18%), colorectum (22.33%), and urinary system (18.45%). Independent risk factors for progression-free survival were Stage IV lung cancer (p = 0.008) and failure to undergo radical lung cancer surgery (p = 0.028). The risk factors for OS included squamous carcinoma (p = 0.048), Stage IV lung cancer (p = 0.001), single cancer resection plus drug therapy (p < 0.001), drug therapy alone (p = 0.002), failure to undergo radical lung cancer surgery (p = 0.014), and chemotherapy (p = 0.042). The median OS was 37 months, with 3- and 5-year rates of 50.9% and 35.9%, respectively. CONCLUSION DPCs involving lung cancer account for 1.11% of cases. The breast, colorectum, and urinary system were the most common extra-pulmonary sites, and mDPCs were more frequent than sDPCs. Radical lung cancer surgery significantly affects prognosis, and drug therapy alone may be preferable when only one tumor is operable. The developed nomogram can accurately predict individual 3-year and 5-year OS rates.
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Affiliation(s)
- Yuxuan Hao
- Department of OncologyShengjing Hospital of China Medical UniversityShenyangChina
- Hematology LaboratoryShengjing Hospital of China Medical UniversityShenyangChina
| | - Xiaoye Zhang
- Department of OncologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Guoyuan Cui
- Department of OncologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Xiaoying Qi
- Department of OncologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Zhongxiu Jiang
- Department of OncologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Li Yu
- Department of OncologyShengjing Hospital of China Medical UniversityShenyangChina
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Mak LS, Li X, Chan WYK, Leung AWK, Cheuk DKL, Yuen LYP, So JCC, Ha SY, Liu APY. Case report: Therapy-related myeloid neoplasms in three pediatric cases with medulloblastoma. Front Oncol 2024; 14:1364199. [PMID: 38595820 PMCID: PMC11002154 DOI: 10.3389/fonc.2024.1364199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/13/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Medulloblastoma is the most common malignant brain tumor in children, often requiring intensive multimodal therapy, including chemotherapy with alkylating agents. However, therapy-related complications, such as therapy-related myeloid neoplasms (t-MNs), can arise, particularly in patients with genetic predisposition syndromes. This case report presents three pediatric cases of medulloblastoma with subsequent development of t-MNs, highlighting the potential role of genetic predisposition and the importance of surveillance for hematological abnormalities in long-term survivors. Case presentation We describe three cases of pediatric medulloblastoma who developed t-MNs after receiving chemotherapy, including alkylating agents. Two of the patients had underlying genetic predisposition syndromes (TP53 pathologic variants). The latency period between initial diagnosis of medulloblastoma and the development of secondary cancer varied among the cases, ranging from 17 to 65 months. The three cases eventually succumbed from secondary malignancy, therapy-related complications and progression of primary disease, respectively. Conclusions This report highlights the potential association between genetic predisposition syndromes and the development of therapy-related myeloid neoplasms in pediatric medulloblastoma survivors. It underscores the importance of surveillance for hematological abnormalities among such patients.
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Affiliation(s)
- Li Shun Mak
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, Hong Kong SAR, China
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, China
| | - Xiuling Li
- Department of Pathology, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, China
| | - Wilson Y. K. Chan
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, China
| | - Alex W. K. Leung
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, China
| | - Daniel K. L. Cheuk
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, China
| | - Liz Y. P. Yuen
- Department of Pathology, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, China
| | - Jason C. C. So
- Department of Pathology, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, China
| | - Shau Yin Ha
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, China
| | - Anthony P. Y. Liu
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Sookai S, Akerman MP, Munro OQ. Chiral Au(III) chelates exhibit unique NCI-60 cytotoxicity profiles and interactions with human serum albumin. Dalton Trans 2024; 53:5089-5104. [PMID: 38375922 DOI: 10.1039/d3dt04024k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Au(III) bis(pyrrolide-imine) chelates are emerging as a class of versatile, efficacious metallodrug candidates. Here, we synthesised two enantiopure chiral ligands H2L1 and H2L2 (tetradentate cyclohexane-1,2-diamine-bridged bis(pyrrole-imine) derivatives). Metallation of the ligands with Au(III) afforded the chiral cationic complexes AuL1 and AuL2. The in vitro cytotoxicities of AuL1 and AuL2 determined in the NCI-60 single-dose drug screen were 56.5% and 89.1%, respectively. AuL1 was subsequently selected for a five-dose NCI-60 screen, attaining GI50, IC50, and LC50 values of 4.7, 9.3 and 39.8 μM, respectively. Hierarchical cluster analysis of the NCI-60 data indicated that the profile for AuL1 was similar to that of vinblastine sulfate, a microtubule-targeting vinca alkaloid. Reactions of AuL1 with glutathione (GSH) in vitro confirmed its susceptibility to reduction, Au(III) → Au(I), by intracellular thiols. Because human serum albumin (HSA) is responsible for transporting clinically deployed and investigational drugs, we studied the uptake of AuL1 and AuL2 by HSA to delineate how chirality impacts their protein-binding affinity. Steady-state fluorescence quenching data acquired on the native protein and data from site-specific probes showed that the compounds bind at sites close enough to Trp-214 (subdomain IIA) of HSA to quench the fluorophore. The bimolecular quenching rate constants, Kq, were ca. 102 times higher than the maximum diffusion-controlled collision constant of a biomolecule in water (1010 M-1 s-1), confirming that static fluorescence quenching was the dominant mechanism. The Stern-Volmer constants, KSV, were ∼104 M-1 at 37 °C, while the affinity constants, Ka (37 °C), measured ∼2.1 × 104 M-1 (AuL1) and ∼1.2 × 104 M-1 (AuL2) for enthalpy-driven ligand uptake targeting Sudlow's site I. Although far- and near-UV CD spectroscopy indicated that both complexes minimally perturb the secondary and tertiary structure of HSA, substantial shifts in the CD spectra were recorded for both protein-bound ligands. This study highlights the role of chirality in determining the cytotoxicity profiles and protein binding behaviour of enantiomeric Au(III) chelates.
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Affiliation(s)
- Sheldon Sookai
- Molecular Sciences Institute, School of Chemistry, University of the Witwatersrand, PO WITS 2050, Johannesburg, South Africa.
| | - Matthew P Akerman
- School of Chemistry and Physics, University of KwaZulu-Natal, Pietermaritzburg, 3201, South Africa
| | - Orde Q Munro
- Molecular Sciences Institute, School of Chemistry, University of the Witwatersrand, PO WITS 2050, Johannesburg, South Africa.
- School of Chemistry, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
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Trobaugh-Lotrario A, Watanabe K, O'Neill AF, Dembowska-Bagińska B, Häberle B, Murphy A, Hiyama E, Czauderna P, Meyers RL, Langham M, Feusner J. Second Malignant Neoplasms Following Treatment for Hepatoblastoma: An International Report and Review of the Literature. J Pediatr Hematol Oncol 2024; 46:80-87. [PMID: 38316145 DOI: 10.1097/mph.0000000000002824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
Treatment intensification has improved survival in patients with hepatoblastoma (HB); however, these treatments are associated with an increased risk of late effects, including second malignant neoplasms (SMNs). Data is limited regarding SMNs following HB treatment. Cases of SMNs following treatment for HB reported in the literature and from personal communication were analyzed to further assess this late effect. Thirty-eight patients were identified. The median age at diagnosis of HB was 16 months (range: 3 to 168 mo). All patients had received a platinum agent, and almost all had anthracycline exposure. The SMNs reported were hematopoietic malignancies (n=19), solid tumors (n=12), and post-transplant lymphoproliferative disorder (n=7). Of the 36 patients with outcome data, 19 survived. SMNs following HB treatment were primarily seen in patients with chemotherapy exposure, a history of liver transplantation, hereditary tumor predisposition syndromes, and/or a history of radiation treatment. Hematopoietic malignancies were the most common SMN reported in this cohort and were diagnosed earlier than other SMNs. Prospective collection of data through a companion late effects study or international registry could be used to further evaluate the rates and risks of SMNs as well as tumor predisposition syndromes in patients treated for HB.
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Affiliation(s)
| | | | - Allison F O'Neill
- Dana-Farber Cancer Institute, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | - Max Langham
- University of Tennessee Health Science Center, Memphis, TN
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Lim W, Moon S, Lee NR, Shin HG, Yu SY, Lee JE, Kim I, Ko KP, Park SK. Group I pharmaceuticals of IARC and associated cancer risks: systematic review and meta-analysis. Sci Rep 2024; 14:413. [PMID: 38172159 PMCID: PMC10764325 DOI: 10.1038/s41598-023-50602-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
We aimed to summarize the cancer risk among patients with indication of group I pharmaceuticals as stated in monographs presented by the International Agency for Research on Cancer working groups. Following the PRISMA guidelines, a comprehensive literature search was conducted using the PubMed database. Pharmaceuticals with few studies on cancer risk were identified in systematic reviews; those with two or more studies were subjected to meta-analysis. For the meta-analysis, a random-effects model was used to calculate the summary relative risks (SRRs) and 95% confidence intervals (95% CIs). Heterogeneity across studies was presented using the Higgins I square value from Cochran's Q test. Among the 12 group I pharmaceuticals selected, three involved a single study [etoposide, thiotepa, and mustargen + oncovin + procarbazine + prednisone (MOPP)], seven had two or more studies [busulfan, cyclosporine, azathioprine, cyclophosphamide, methoxsalen + ultraviolet (UV) radiation therapy, melphalan, and chlorambucil], and two did not have any studies [etoposide + bleomycin + cisplatin and treosulfan]. Cyclosporine and azathioprine reported increased skin cancer risk (SRR = 1.32, 95% CI 1.07-1.62; SRR = 1.56, 95% CI 1.25-1.93) compared to non-use. Cyclophosphamide increased bladder and hematologic cancer risk (SRR = 2.87, 95% CI 1.32-6.23; SRR = 2.43, 95% CI 1.65-3.58). Busulfan increased hematologic cancer risk (SRR = 6.71, 95% CI 2.49-18.08); melphalan was associated with hematologic cancer (SRR = 4.43, 95% CI 1.30-15.15). In the systematic review, methoxsalen + UV and MOPP were associated with an increased risk of skin and lung cancer, respectively. Our results can enhance persistent surveillance of group I pharmaceutical use, establish novel clinical strategies for patients with indications, and provide evidence for re-categorizing current group I pharmaceuticals into other groups.
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Affiliation(s)
- Woojin Lim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, 03080, Republic of Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, 03080, Republic of Korea
| | - Sungji Moon
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, 03080, Republic of Korea
- Interdisciplinary Program in Cancer Biology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Na Rae Lee
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, 04933, Republic of Korea
| | - Ho Gyun Shin
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, 04933, Republic of Korea
| | - Su-Yeon Yu
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, 04933, Republic of Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, Seoul National University College of Human Ecology, Seoul, 08826, Republic of Korea
| | - Inah Kim
- Department of Occupational and Environmental Medicine, Hanyang University College of Medicine, Seoul, 04763, Republic of Korea
| | - Kwang-Pil Ko
- Clinical Preventive Medicine Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
- Cancer Research Institute, Seoul National University, Seoul, 03080, Republic of Korea.
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
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Scholz-Kreisel P, Becker C, Kaiser M, Mahmoudpour SH, Voigt M, Ressing M, Blettner M, Calaminus G, Baust K, Scholtes C, Zimmermann M, Zeissig SR, Schmidberger H, Karle H, Meyer-Oldenburg S, Kaatsch P, Spix C. Subsequent primary neoplasms after childhood cancer therapy - design and description of the German nested case-control study STATT-SCAR. Cancer Causes Control 2024; 35:33-41. [PMID: 37530985 PMCID: PMC10764383 DOI: 10.1007/s10552-023-01760-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Subsequent primary neoplasms (SPN) are among the most severe late effects and the second most frequent cause of death in childhood cancer patients. In this paper we introduce method and properties of the STATT-SCAR study (Second Tumor After Tumor Therapy, Second Cancer After Radiotherapy), which is a joint nested matched case-control study to evaluate the impact of chemotherapy (STATT) as well as radiotherapy (SCAR) on the risk of developing a SPN. METHODS Based on the cohort of the German childhood cancer registry (GCCR), we selected patients diagnosed with a first neoplasm before age 15 or younger between 1980 and 2014. We selected those with a SPN at least half a year after the first neoplasm, and matched up to four controls to each case. Therapy data were acquired from various sources, including clinical study centers and treating hospitals. To analyze the impact of radiotherapy, organ doses were estimated by using reconstructed treatment plans. The effect of chemotherapy was analyzed using substance groups summarized after isotoxic dose conversion. RESULTS 1244 cases with a SPN were identified and matched with 4976 controls. Treatment data were acquired for 83% of all match groups (one case and at least one control). Based on preliminary analyses, 98% of all patients received chemotherapy and 54% of all patients were treated with radiotherapy. CONCLUSIONS Based on our data, detailed analyses of dose response relationships and treatment element combinations are possible, leading to a deeper insight into SPN risks after cancer treatments. TRIAL REGISTRATION The study is registered at the German clinical trial register (DRKS) under number DRKS00017847 [45].
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Affiliation(s)
- Peter Scholz-Kreisel
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
- Federal Offices for Radiation Protection, Neuherberg, Germany.
| | - Cornelia Becker
- German Childhood Cancer Registry (GCCR) Division of Childhood Cancer Epidemiology at the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry (GCCR) Division of Childhood Cancer Epidemiology at the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Seyed Hamidreza Mahmoudpour
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Mathias Voigt
- German Childhood Cancer Registry (GCCR) Division of Childhood Cancer Epidemiology at the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Meike Ressing
- German Childhood Cancer Registry (GCCR) Division of Childhood Cancer Epidemiology at the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Cathy Scholtes
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Martin Zimmermann
- Department for Pediatric Hematology and Oncology, Children's Hospital, Medical School Hannover, Hannover, Germany
| | - Sylke Ruth Zeissig
- Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
- Regional Centre Würzburg, Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Würzburg, Germany
| | - Heinz Schmidberger
- Department for Radiation Oncology and Radiotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Heiko Karle
- Department for Radiation Oncology and Radiotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sarah Meyer-Oldenburg
- Department for Radiation Oncology and Radiotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR) Division of Childhood Cancer Epidemiology at the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Claudia Spix
- German Childhood Cancer Registry (GCCR) Division of Childhood Cancer Epidemiology at the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Ressing M, Becker C, Müller C, Mahmoudpour SH, Calaminus G, Langer T, Erdmann F, Voigt M, Kaiser M, Kaatsch P, Blettner M, Spix C. Equivalent doses for anticancer agents used in pediatric oncology: A literature review and evaluation of a novel approach for conversion factors. Cancer Rep (Hoboken) 2023; 6:e1811. [PMID: 36975206 PMCID: PMC10172172 DOI: 10.1002/cnr2.1811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/27/2023] [Accepted: 02/24/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Epidemiological research on late effects of therapy shows the necessity to aggregate chemotherapy agents to substance classes. This requires using conversion factors by substance classes. AIMS The aim of this study was to identify previously used conversion factors from the literature, to present a novel approach for additional factors, and to compare these approaches. METHODS AND RESULTS A literature review was performed, which identified two main principles of deriving conversion factors: effect-equivalence and equimolar. Thirty-five articles presenting effect equivalence-based factors in the widest sense were found in the literature. Ten articles presented the equimolar approach which can be applied to almost all chemotherapy substances. Based on a comprehensive list of treatment protocols used in German pediatric oncology, we derived alternative conversion factors from typical doses. We compared the conversion factors using Pearson correlation coefficients and linear regression. At least two types of conversion factor were available for each of the 49 substances included. The equivalent effect-based and the typical dose-based factors were highly correlated with a regression coefficient close to 1. The equimolar factors are independent. CONCLUSIONS For substances for which no conversion factor based on some type of effect equivalence has been published so far, a factor based on a typical doses-approach may be used in epidemiological late effects research. Doses aggregated based on the equimolar approach may not be compatible with doses aggregated based on equivalent effects.
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Affiliation(s)
- Meike Ressing
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Cornelia Becker
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | | | - Seyed Hamidreza Mahmoudpour
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Gabriele Calaminus
- Department of Pediatric Hematology and OncologyUniversity Hospital BonnBonnGermany
| | - Thorsten Langer
- Pediatric Oncology and HematologyUniversity Hospital for Children and AdolescentsLübeckGermany
| | - Friederike Erdmann
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Mathias Voigt
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Melanie Kaiser
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Claudia Spix
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
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Management of Optic Pathway Glioma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14194781. [PMID: 36230704 PMCID: PMC9563939 DOI: 10.3390/cancers14194781] [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: 09/01/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: OPG accounts for 3−5% of childhood central nervous system (CNS) tumors and about 2% of pediatric glial lesions. Methods: Article selection was performed by searching PubMed, Web of Science, and Cochrane databases. Results: The pooled mortality rate was 0.12 (95%CI 0.09−0.14). Due to the unrepresentative data, improved and not changed outcomes were classified as favorable outcomes and worsened as unfavorable. Meta-analyses were performed to determine the rate of clinical and radiological favorable outcomes. In terms of visual assessment, the pooled rate of a favorable outcome in chemotherapy, radiotherapy, and surgery was 0.74, 0.81, and 0.65, respectively, and the overall pooled rate of the favorable outcome was 0.75 (95%CI 0.70−0.80). In terms of radiological assessment, the rate of a favorable outcome following chemotherapy, radiotherapy, and surgery was 0.71, 0.74, and 0.67, respectively, and the overall pooled rate of the favorable outcome is 0.71 (95%CI 0.65−0.77). The subgroup analysis revealed no significant difference in the rate of clinical and radiological favorable outcomes between the different treatment modalities (p > 0.05). Conclusion: Our analyses showed that each therapeutic modality represents viable treatment options to achieve remission for these patients.
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Dynamic characterization of breast cancer response to neoadjuvant therapy using biophysical metrics of spatial proliferation. Sci Rep 2022; 12:11718. [PMID: 35810187 PMCID: PMC9271064 DOI: 10.1038/s41598-022-15801-7] [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: 03/07/2022] [Accepted: 06/29/2022] [Indexed: 11/08/2022] Open
Abstract
Current tools to assess breast cancer response to neoadjuvant chemotherapy cannot reliably predict disease eradication, which if possible, could allow early cessation of therapy. In this work, we assessed the ability of an image data-driven mathematical modeling approach for dynamic characterization of breast cancer response to neoadjuvant therapy. We retrospectively analyzed patients enrolled in the I-SPY 2 TRIAL at the Atrium Health Wake Forest Baptist Comprehensive Cancer Center. Patients enrolled on the study received four MR imaging examinations during neoadjuvant therapy with acquisitions at baseline (T0), 3-weeks/early-treatment (T1), 12-weeks/mid-treatment (T2), and completion of therapy prior to surgery (T3). We use a biophysical mathematical model of tumor growth to generate spatial estimates of tumor proliferation to characterize the dynamics of treatment response. Using histogram summary metrics to quantify estimated tumor proliferation maps, we found strong correlation of mathematical model-estimated tumor proliferation with residual cancer burden, with Pearson correlation coefficients ranging from 0.88 and 0.97 between T0 and T2, representing a significant improvement from conventional assessment methods of change in mean apparent diffusion coefficient and functional tumor volume. This data shows the significant promise of imaging-based biophysical mathematical modeling methods for dynamic characterization of patient-specific response to neoadjuvant therapy with correlation to residual disease outcomes.
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Watson C, Gadikota H, Barlev A, Beckerman R. A review of the risks of long-term consequences associated with components of the CHOP chemotherapy regimen. J Drug Assess 2022; 11:1-11. [PMID: 35693477 PMCID: PMC9176678 DOI: 10.1080/21556660.2022.2073101] [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] [Indexed: 12/14/2022] Open
Abstract
A common chemotherapy regimen in post-transplant lymphoproliferative disease (PTLD) following solid organ transplants (SOT) is cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). This study reviews the quantitative evidence for long-term consequences associated with components of CHOP identified from the Children's Oncology Group Long-Term Follow-Up Guidelines. Cited references were screened using prespecified criteria (English, systematic review, randomized controlled trial n > 100, observation study n > 100, case series n > 20). Relevant data were extracted and synthesized. Of 61 studies, 66% were retrospective cohort studies, 28% were in the US, and 95% enrolled pediatric patients. No study focused specifically on the CHOP regimen. Long-term consequences for CHOP components observed in >3 studies included cardiac toxicity (n = 14), hormone deficiencies/infertility (n = 14), secondary leukemia (n = 7), osteonecrosis (n = 6), and bladder cancer (n = 4). These effects are significant, impact a high percentage of patients, and occur as early as one year after treatment. Although none of the studies focused specifically on the CHOP regimen, 30%, 23%, and 15% evaluated alkylating agents (e.g. cyclophosphamide), anthracyclines (e.g. doxorubicin), and corticosteroids (e.g. prednisone), respectively. All three product classes had a dose-dependent risk of long-term consequences with up to 13.2-fold, 27-fold, 16-fold, 14.5-fold, and 6.2-fold increase in risk of heart failure, early menopause, secondary leukemia, bladder cancer, and osteonecrosis, respectively. Lymphoma patients had significantly elevated risks of cardiac toxicity (up to 12.2-fold), ovarian failure (up to 3.8-fold), and osteonecrosis (up to 6.7-fold). No studies were found in PTLD or SOT. Safe and effective PTLD treatments that potentially avoid these long-term consequences are urgently needed.
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Affiliation(s)
- Crystal Watson
- Atara Biotherapeutics Inc., South San Francisco, CA, USA
| | | | - Arie Barlev
- Atara Biotherapeutics Inc., South San Francisco, CA, USA
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11
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Tringale KR, Casey DL, Niyazov G, Lavery JA, Moskowitz C, Friedman DN, Wolden SL. Second cancer risk in childhood cancer survivors treated with intensity-modulated radiation therapy: An updated analysis of more than 10 years of follow-up. Pediatr Blood Cancer 2022; 69:e29600. [PMID: 35234340 PMCID: PMC9476885 DOI: 10.1002/pbc.29600] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is unclear how intensity-modulated radiation therapy (IMRT) impacts long-term risk of second malignant neoplasms (SMNs) in childhood cancer patients. PROCEDURE Patients aged ≤21 years treated with IMRT between 1998 and 2009 and who survived ≥5 years after IMRT were included. SMN site in relation to isodose level (IDL) of IMRT was evaluated. Standardized incidence ratios (SIR) and excess absolute risks (EAR) were calculated. Cumulative incidences were estimated with death as a competing risk. RESULTS Three-hundred twenty-five patients were included with median follow-up of 11.2 years from IMRT (interquartile range: 9.4-14.0) among patients alive at the end of follow-up. Two hundred (62%) patients had ≥10 years of follow-up and 284 (87%) patients were alive at the time of analysis. Fifteen patients developed SMNs (11 solid, four hematologic). Median time from IMRT to solid SMN was 11.0 years (range: 6.8-19.2) with 10- and 15-year cumulative incidences 1.8% (95% CI: 0.7-3.9) and 3.5% (95% CI: 1.4-7.5), respectively; SIR was 13.7 (95% CI: 6.9-24.6) and EAR was 2.8 per 1000 person-years (95% CI: 1.0-4.6). Eight solid SMNs developed within the IMRT field (100% IDL [n = 5], 80% IDL [n = 1], 50% IDL [n = 1], 40% IDL [n = 1]), one within the 70%-80% IDL of a conventional field, one was out-of-field, and one could not be determined. CONCLUSIONS With median follow-up of >10 years, many solid SMNs after IMRT in childhood cancer survivors develop in the high-dose region. These data serve as a foundation for comparison with other modalities of radiation treatment (e.g., proton therapy).
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Affiliation(s)
| | - Dana L. Casey
- Department of Radiation Oncology, University of North Carolina
| | - Gregory Niyazov
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center
| | - Jessica A. Lavery
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Chaya Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | | | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center
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12
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Liao M, Yu J. Secondary Leukemia in a Patient With EBV-HLH Carrying Heterozygous STXBP2 Variant. J Pediatr Hematol Oncol 2022; 44:e526-e528. [PMID: 33661178 DOI: 10.1097/mph.0000000000002141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/09/2021] [Indexed: 11/25/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a symptom with severe systemic hyperinflammation. A 26-month-old male presented with Epstein-Barr virus associated HLH with a heterozygous variant of syntaxin-binding protein-2 (STXBP2). Complete remission was achieved with the HLH-2004 protocol, but the disease soon relapsed. Four weeks after re-installing HLH-2004 protocol, HLH was resolved. The cumulative dosage of etoposide was 2100 mg/m2. He developed acute promyelocytic leukemia 17 months later. The patient underwent standard chemotherapy and since remained in complete remission. In conclusion, a regular screening of malignance might be in necessity for the patients harboring gene variants associated with familial HLH.
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Affiliation(s)
- Meiling Liao
- Department of Hematology and Oncology, Chongqing Medical University Affiliated Children's Hospital, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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13
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Out-of-field organ doses and associated risk of cancer development following radiation therapy with photons. Phys Med 2021; 90:73-82. [PMID: 34563834 DOI: 10.1016/j.ejmp.2021.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022] Open
Abstract
Innovations in cancer treatment have contributed to the improved survival rate of these patients. Radiotherapy is one of the main options for cancer management nowadays. High doses of ionizing radiation are usually delivered to the tumor site with high energy photon beams. However, the therapeutic radiation exposure may lead to second cancer induction. Moreover, the introduction of intensity-modulated radiation therapy over the last decades has increased the radiation dose to out-of-field organs compared to that from conventional irradiation. The increased organ doses might result in elevated probabilities for developing secondary malignancies to critical organs outside the treatment volume. The organ-specific dosimetry is considered necessary for the theoretical second cancer risk assessment and the proper analysis of data derived from epidemiological reports. This study reviews the methods employed for the measurement and calculation of out-of-field organ doses from exposure to photons and/or neutrons. The strengths and weaknesses of these dosimetric approaches are described in detail. This is followed by a review of the epidemiological data associated with out-of-field cancer risks. Previously published theoretical cancer risk estimates for adult and pediatric patients undergoing radiotherapy with conventional and advanced techniques are presented. The methodology for the theoretical prediction of the probability of carcinogenesis to out-of-field sites and the limitations of this approach are discussed. The article also focuses on the factors affecting the magnitude of the probability for developing radiotherapy-induced malignancies. The restriction of out-of-field doses and risks through the use of different types of shielding equipment is presented.
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14
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Imgruet MK, Lutze J, An N, Hu B, Khan S, Kurkewich J, Martinez TC, Wolfgeher D, Gurbuxani SK, Kron SJ, McNerney ME. Loss of a 7q gene, CUX1, disrupts epigenetically driven DNA repair and drives therapy-related myeloid neoplasms. Blood 2021; 138:790-805. [PMID: 34473231 PMCID: PMC8414261 DOI: 10.1182/blood.2020009195] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
Therapy-related myeloid neoplasms (t-MNs) are high-risk late effects with poorly understood pathogenesis in cancer survivors. It has been postulated that, in some cases, hematopoietic stem and progenitor cells (HSPCs) harboring mutations are selected for by cytotoxic exposures and transform. Here, we evaluate this model in the context of deficiency of CUX1, a transcription factor encoded on chromosome 7q and deleted in half of t-MN cases. We report that CUX1 has a critical early role in the DNA repair process in HSPCs. Mechanistically, CUX1 recruits the histone methyltransferase EHMT2 to DNA breaks to promote downstream H3K9 and H3K27 methylation, phosphorylated ATM retention, subsequent γH2AX focus formation and propagation, and, ultimately, 53BP1 recruitment. Despite significant unrepaired DNA damage sustained in CUX1-deficient murine HSPCs after cytotoxic exposures, they continue to proliferate and expand, mimicking clonal hematopoiesis in patients postchemotherapy. As a consequence, preexisting CUX1 deficiency predisposes mice to highly penetrant and rapidly fatal therapy-related erythroleukemias. These findings establish the importance of epigenetic regulation of HSPC DNA repair and position CUX1 as a gatekeeper in myeloid transformation.
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MESH Headings
- Animals
- Chromosomes, Mammalian/genetics
- Chromosomes, Mammalian/metabolism
- Clonal Hematopoiesis
- DNA Repair
- Epigenesis, Genetic
- Gene Expression Regulation, Leukemic
- Homeodomain Proteins/genetics
- Homeodomain Proteins/metabolism
- Leukemia, Erythroblastic, Acute/genetics
- Leukemia, Erythroblastic, Acute/metabolism
- Mice
- Mice, Transgenic
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/metabolism
- Nuclear Proteins/genetics
- Nuclear Proteins/metabolism
- Repressor Proteins/genetics
- Repressor Proteins/metabolism
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Affiliation(s)
| | - Julian Lutze
- Department of Molecular Genetics and Cell Biology
- Committee on Cancer Biology
| | | | | | | | | | | | | | - Sandeep K Gurbuxani
- Department of Pathology
- The University of Chicago Medicine Comprehensive Cancer Center, and
| | - Stephen J Kron
- Department of Molecular Genetics and Cell Biology
- Committee on Cancer Biology
- The University of Chicago Medicine Comprehensive Cancer Center, and
| | - Megan E McNerney
- Department of Pathology
- Committee on Cancer Biology
- The University of Chicago Medicine Comprehensive Cancer Center, and
- Section of Pediatric Hematology/Oncology and Stem Cell Transplantation, Department of Pediatrics, The University of Chicago, Chicago, IL
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15
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Balis F, Green DM, Anderson C, Cook S, Dhillon J, Gow K, Hiniker S, Jasty-Rao R, Lin C, Lovvorn H, MacEwan I, Martinez-Agosto J, Mullen E, Murphy ES, Ranalli M, Rhee D, Rokitka D, Tracy EL, Vern-Gross T, Walsh MF, Walz A, Wickiser J, Zapala M, Berardi RA, Hughes M. Wilms Tumor (Nephroblastoma), Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:945-977. [PMID: 34416707 DOI: 10.6004/jnccn.2021.0037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Wilms Tumor focus on the screening, diagnosis, staging, treatment, and management of Wilms tumor (WT, also known as nephroblastoma). WT is the most common primary renal tumor in children. Five-year survival is more than 90% for children with all stages of favorable histology WT who receive appropriate treatment. All patients with WT should be managed by a multidisciplinary team with experience in managing renal tumors; consulting a pediatric oncologist is strongly encouraged. Treatment of WT includes surgery, neoadjuvant or adjuvant chemotherapy, and radiation therapy (RT) if needed. Careful use of available therapies is necessary to maximize cure and minimize long-term toxicities. This article discusses the NCCN Guidelines recommendations for favorable histology WT.
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Affiliation(s)
- Frank Balis
- Abramson Cancer Center at the University of Pennsylvania
| | - Daniel M Green
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Shelly Cook
- University of Wisconsin Carbone Cancer Center
| | | | - Kenneth Gow
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Chi Lin
- Fred & Pamela Buffett Cancer Center
| | | | | | | | | | - Erin S Murphy
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Mark Ranalli
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Daniel Rhee
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Amy Walz
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Matthew Zapala
- UCSF Helen Diller Family Comprehensive Cancer Center; and
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16
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Abstract
Pediatric myelodysplastic syndromes (MDS) comprise less than 5% of childhood malignancies. Approximately 30% to 45% of pediatric MDS cases are associated with an underlying genetic predisposition syndrome. A subset of patients present with MDS/acute myeloid leukemia (AML) following intensive chemotherapy for an unrelated malignancy. A definitive diagnosis of MDS can often only be rendered pending a comprehensive clinical and laboratory-based evaluation, which frequently includes ancillary testing in a reference laboratory. Clinical subtypes, the current diagnostic schema, and the results of more recently performed next-generation sequencing studies in pediatric MDS are discussed here.
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Affiliation(s)
- Sanjay S Patel
- Division of Hematopathology, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 525 East 68th Street, Starr 711A, New York, NY 10065, USA.
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17
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Abstract
Acute leukemias are the most common pediatric cancer. With a cure rate of about 80%, their treatment is based on a combination of cytotoxic chemotherapies whose intensity is adapted to prognostic factors. Sometimes, allogeneic hematopoietic stem cell transplantation is indicated. New therapeutic options are being developed, such as CAR T-cells.
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18
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Abstract
The current 5-year survival rate for cancer in infants is greater than 75% in developed countries. However, survivors of neonatal malignancies have an increased risk of late effects from their tumor or its treatment, which may lead to long-term morbidity and/or early mortality. This article reviews surgical approaches and chemotherapeutic agents commonly used in neonatal malignancies and their associated late effects. It also reviews the increased risk for late effects associated with radiation at a young age and hematopoietic stem cell transplantation at a young age.. It highlights the importance of survivor-specific multidisciplinary care in the long-term management of neonatal cancer survivors.
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Affiliation(s)
- Sanyukta K. Janardan
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, 2015 Uppergate Drive, 4th Floor, Atlanta, GA 30322, USA
| | - Karen E. Effinger
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, 2015 Uppergate Drive, 4th Floor, Atlanta, GA 30322, USA,Corresponding author. Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, 2015 Uppergate Drive, Fourth Floor, Atlanta, GA 30322.
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19
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Hawkins M, Bhatia S, Henderson TO, Nathan PC, Yan A, Teepen JC, Morton LM. Subsequent Primary Neoplasms: Risks, Risk Factors, Surveillance, and Future Research. Pediatr Clin North Am 2020; 67:1135-1154. [PMID: 33131538 DOI: 10.1016/j.pcl.2020.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The authors' objective is to provide a brief update on recent advances in knowledge relating to subsequent primary neoplasms developing in survivors of childhood cancer. This includes a summary of established large-scale cohorts, risks reported, and contrasts with results from recently established large-scale cohorts of survivors of adolescent and young adult cancer. Recent evidence is summarized concerning the role of radiotherapy and chemotherapy for childhood cancer and survivor genomics in determining the risk of subsequent primary neoplasms. Progress with surveillance, screening, and clinical follow-up guidelines is addressed. Finally, priorities for future research are outlined.
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Affiliation(s)
- Michael Hawkins
- Epidemiology & Director of Centre, Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Robert Aitken Building, Birmingham B15 2TY, UK.
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Adam Yan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Jop C Teepen
- Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, USA
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20
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Allodji RS, Tucker MA, Hawkins MM, Le Deley MC, Veres C, Weathers R, Howell R, Winter D, Haddy N, Rubino C, Diallo I, Little MP, Morton LM, de Vathaire F. Role of radiotherapy and chemotherapy in the risk of leukemia after childhood cancer: An international pooled analysis. Int J Cancer 2020; 148:2079-2089. [PMID: 33105035 DOI: 10.1002/ijc.33361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022]
Abstract
Childhood cancer survivors are at increased risk for second primary leukemia (SPL), but there is little consensus on the magnitude of some risk factors because of the small size of previous studies. We performed a pooled analysis of all published studies with detailed treatment data, including estimated active bone marrow (ABM) dose received during radiation therapy and doses of specific chemotherapeutic agents for childhood cancer diagnosed from 1930 through 2000, in order to more thoroughly investigate treatment-related risks of SPL. A total of 147 SPL cases (of which 69% were acute myeloid leukemia [AML]) were individually matched to 522 controls, all from four case-control studies including patients from six countries (France, United Kingdom, United States, Canada, Italy and Netherlands). Odds ratios (OR) and corresponding 95% confidence intervals (CIs) were calculated using conditional logistic regression, and the excess OR per Gray (EOR/Gy) was also calculated. After accounting for the other therapies received, topoisomerase II inhibitor was associated with an increased SPL risk (highest tertile vs none: OR = 10.0, 95% CI: 3.7-27.3). Radiation dose to the ABM was also associated with increased SPL risk among those not receiving chemotherapy (EOR/Gy = 1.6, 95% CI: 0.1-14.3), but not among those who received chemotherapy (CT). SPL were most likely to occur in the first decade following cancer treatment. Results were similar when analyses were restricted to AML. The evidence of interaction between radiation and CT has implications for leukemogenic mechanism. The results for topoisomerase II inhibitors are particularly important given their increasing use to treat childhood cancer.
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Affiliation(s)
- Rodrigue S Allodji
- Radiation Epidemiology Group, Unit 1018 INSERM-CESP, Villejuif, France.,Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Villejuif, France.,Polytechnic School of Abomey-Calavi (EPAC), University of Abomey-Calavi, 01, Cotonou, Benin
| | - Margaret A Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, University of Birmingham, Public Health Bldg, Edgbaston, Birmingham, UK
| | | | - Cristina Veres
- Radiation Epidemiology Group, Unit 1018 INSERM-CESP, Villejuif, France.,Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Villejuif, France
| | - Rita Weathers
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rebecca Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,The University of Texas Graduate School of Biomedical Sciences (GSBS), Houston, Texas, USA
| | - Dave Winter
- Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, University of Birmingham, Public Health Bldg, Edgbaston, Birmingham, UK
| | - Nadia Haddy
- Radiation Epidemiology Group, Unit 1018 INSERM-CESP, Villejuif, France.,Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Villejuif, France
| | - Carole Rubino
- Radiation Epidemiology Group, Unit 1018 INSERM-CESP, Villejuif, France.,Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Villejuif, France
| | - Ibrahima Diallo
- Radiation Epidemiology Group, Unit 1018 INSERM-CESP, Villejuif, France.,Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Villejuif, France
| | - Mark P Little
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Florent de Vathaire
- Radiation Epidemiology Group, Unit 1018 INSERM-CESP, Villejuif, France.,Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Villejuif, France
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21
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Alblooshi R, Kanfar S, Lord B, Atenafu EG, Michelis FV, Pasic I, Gerbitz A, Al-Shaibani Z, Viswabandya A, Kim DDH, Lam W, Law A, Mattsson J, Kumar R, Lipton JH. Clinical prevalence and outcome of cardiovascular events in the first 100 days postallogeneic hematopoietic stem cell transplant. Eur J Haematol 2020; 106:32-39. [PMID: 32599663 DOI: 10.1111/ejh.13482] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Recent advances in allogeneic hematopoietic stem cell transplant (HSCT) have allowed us to offer HSCT to older, advanced disease patients with more co-morbidities. Cardiovascular toxicity post-transplant is a major concern due to the increased risk of mortality. Few studies have examined the prevalence of CV events including CAD (MI, angina, PCI, CABG, CHF, arrhythmias), HTN, stroke/TIA, and death in the first 100 days post-transplant. PATIENTS We assessed the impact of pretransplant MUGA results in predicting postallogeneic HSCT CV events and overall survival in the first 100 days, and whether or not transient anthracycline-induced cardiomyopathy or cumulative anthracycline dose affected overall survival. This retrospective, cohort study included 665 patients with a median age of 52 years who underwent HSCT from 2009 to 2015. RESULTS The most frequent CV event in the first 100 days post-HSCT was arrhythmia seen in 2.9% of patients followed up by CHF (12.3%), MI (9%), and angina (8%). Two patients had PCI, and both survived the first 100 days. Cardiovascular risk factors predict for a poor MUGA scan but not survival. Higher dose anthracycline pretransplant predicted for a poor outcome. CONCLUSION A history of CV disease, MI, or CAD was the most important predictive of CV events, P-value = .00002. 88.6% survived the first 100 days. Patients with an EF < 50% had a significant likelihood of having a CV event compared to patients with an EF > 60% (OR = 5.3, 95% CI [1.6-18.1], P = .0219). Cumulative anthracycline dose did not have a significant impact on overall survival.
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Affiliation(s)
- Rehab Alblooshi
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Solaf Kanfar
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Bridgette Lord
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Fotios V Michelis
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ivan Pasic
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Armin Gerbitz
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zeyad Al-Shaibani
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Auro Viswabandya
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Dennis Dong Hwan Kim
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wilson Lam
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Arjun Law
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jonas Mattsson
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rajat Kumar
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jeffrey H Lipton
- Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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22
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van der Zanden SY, Qiao X, Neefjes J. New insights into the activities and toxicities of the old anticancer drug doxorubicin. FEBS J 2020; 288:6095-6111. [PMID: 33022843 PMCID: PMC8597086 DOI: 10.1111/febs.15583] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/10/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022]
Abstract
The anthracycline drug doxorubicin is among the most used—and useful—chemotherapeutics. While doxorubicin is highly effective in the treatment of various hematopoietic malignancies and solid tumours, its application is limited by severe adverse effects, including irreversible cardiotoxicity, therapy‐related malignancies and gonadotoxicity. This continues to motivate investigation into the mechanisms of anthracycline activities and toxicities, with the aim to overcome the latter without sacrificing the former. It has long been appreciated that doxorubicin causes DNA double‐strand breaks due to poisoning topoisomerase II. More recently, it became clear that doxorubicin also leads to chromatin damage achieved through eviction of histones from select sites in the genome. Evaluation of these activities in various anthracycline analogues has revealed that chromatin damage makes a major contribution to the efficacy of anthracycline drugs. Furthermore, the DNA‐damaging effect conspires with chromatin damage to cause a number of adverse effects. Structure–activity relationships within the anthracycline family offer opportunities for chemical separation of these activities towards development of effective analogues with limited adverse effects. In this review, we elaborate on our current understanding of the different activities of doxorubicin and their contributions to drug efficacy and side effects. We then offer our perspective on how the activities of this old anticancer drug can be amended in new ways to benefit cancer patients, by providing effective treatment with improved quality of life.
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Affiliation(s)
- Sabina Y van der Zanden
- Department of Cell and Chemical Biology, ONCODE Institute, Leiden University Medical Centre LUMC, The Netherlands
| | - Xiaohang Qiao
- Division of Tumour Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jacques Neefjes
- Department of Cell and Chemical Biology, ONCODE Institute, Leiden University Medical Centre LUMC, The Netherlands
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Shu Y, Weng S, Zheng S. Metronomic chemotherapy in non-small cell lung cancer. Oncol Lett 2020; 20:307. [PMID: 33093916 DOI: 10.3892/ol.2020.12170] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 07/15/2020] [Indexed: 12/17/2022] Open
Abstract
Metronomic chemotherapy (MCT) is defined as the rhythmic chemotherapy of low-dose cytotoxic drugs with short or no drug-free breaks over prolonged periods. MCT affects tumor cells and the tumor microenvironment. Particularly, the low-dose schedule impairs the repair process of endothelial cells, resulting in an anti-angiogenesis effect. By stimulating the immune system to eliminate tumor cells, MCT induces immunological activation. Furthermore, combined with targeted therapy, anti-angiogenic drugs enhance the efficacy of MCT. The present review is an overview of phase I, II and III clinical trials focusing on the efficacy, toxicity and mechanism of MCT in patients with non-small cell lung cancer (NSCLC). Furthermore, the prospects of MCT in NSCLC have been discussed. The present review indicated that MCT is an efficacious treatment for selected patients with NSCLC, with acceptable systemic side effects and economic viability for public health.
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Affiliation(s)
- Yefei Shu
- Department of Medical Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang 310002, P.R. China
| | - Shanshan Weng
- Department of Medical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Song Zheng
- Department of Medical Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang 310002, P.R. China.,Department of Medical Oncology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
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Ruggiero A, Ariano A, Triarico S, Capozza MA, Romano A, Maurizi P, Mastrangelo S, Attinà G. Temozolomide and oral etoposide in children with recurrent malignant brain tumors. Drugs Context 2020; 9:dic-2020-3-1. [PMID: 32547627 PMCID: PMC7271709 DOI: 10.7573/dic.2020-3-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 11/26/2022] Open
Abstract
Despite advances in the treatment of brain tumors, the prognosis of children with recurrent malignant brain tumors remains poor. Etoposide (VP-16), an inhibitor of nuclear enzyme deoxyribonucleic acid (DNA)-topoisomerase II, has shown activity in brain tumors. Its efficacy appears schedule dependent but, to date, the most effective schedule of administration has not been well defined. Temozolomide (TMZ), like VP-16, penetrates the blood–brain barrier and has activity against malignant brain tumors. This novel alkylating agent is rapidly absorbed and is highly bioavailable after oral administration. The antitumor activity of TMZ has been shown to be schedule dependent. Based on the evidence of different mechanisms of cytotoxicity, TMZ and VP-16 have been utilized in combination in patients with malignant brain tumors. This review evaluates the results derived from the combination use of TMZ and oral VP-16. The reported data suggest potential activity of oral VP-16 and TMZ alone or in combination. Further clinical trials are needed to explore and confirm their promising activity in relapsed brain neoplasms.
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Affiliation(s)
- Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Anna Ariano
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Silvia Triarico
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Michele Antonio Capozza
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alberto Romano
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Palma Maurizi
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Stefano Mastrangelo
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Giorgio Attinà
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
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25
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Streefkerk N, Tissing WJE, Korevaar JC, van Dulmen-den Broeder E, Bresters D, van der Heiden-van der Loo M, van de Heuvel-Eibrink MM, Van Leeuwen FE, Loonen J, van der Pal HHJ, Ronckers CM, Versluys AB, de Vries ACH, Feijen EAM, Kremer LCM. A detailed insight in the high risks of hospitalizations in long-term childhood cancer survivors-A Dutch LATER linkage study. PLoS One 2020; 15:e0232708. [PMID: 32427994 PMCID: PMC7236987 DOI: 10.1371/journal.pone.0232708] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background Insight in hospitalizations in long-term childhood cancer survivors (CCS) is useful to understand the impact of long-term morbidity. We aimed to investigate hospitalization rates and underlying types of diagnoses in CCS compared to matched controls, and to investigate the determinants. Methods We linked 5,650 five-year CCS from the Dutch nationwide Dutch LATER cohort and 109,605 age- and sex-matched controls to the Dutch Hospital Discharge register, which contained detailed information on inpatient hospitalizations from 1995–2016. Relative hospitalization rates (RHRs) were calculated using a Poisson regression model. Adjusting for multiple hospitalizations per person via a Poisson model for generalized estimated equations, we investigated determinants for hospitalizations for all types of underlying diagnoses among CCS. Results CCS were twice as likely to be hospitalized as reference persons (hospitalization rate 178 and 78 per 1,000 person-years respectively; RHR 2.0, 95% confidence interval (CI) 1.9–2.2). Although CCS had more hospitalizations for 17 types of underlying diagnoses, they were especially more likely to be hospitalized for endocrine conditions (RHR: 6.0, 95% CI 4.6–7.7), subsequent neoplasms (RHR: 5.6, 95% CI 4.6–6.7) and symptoms without underlying diagnoses (RHR: 5.2, 95% CI 4.6–5.8). For those types of underlying diagnoses, female sex and radiotherapy were determinants. Conclusion This study provides new insights in the high risk of hospitalizations for many types of underlying diagnoses in CCS and treatment related determinants. CCS are especially at high risk for hospitalizations for endocrine conditions, subsequent neoplasms and symptoms without an underlying diagnosis. This new knowledge is important for survivorship care and to identify possible preventable hospitalizations among CCS.
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Affiliation(s)
- Nina Streefkerk
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Beatrix Children’s Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Joke C. Korevaar
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Marry M. van de Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Sophia Children’s Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - Flora E. Van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Cecile M. Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A. Brigitta Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology and Hematology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrica C. H. de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Sophia Children’s Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - Elizabeth A. M. Feijen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Leontine C. M. Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Longhi A, Cesari M, Serra M, Mariani E. Long-Term Follow-up of a Randomized Study of Oral Etoposide versus Viscum album Fermentatum Pini as Maintenance Therapy in Osteosarcoma Patients in Complete Surgical Remission after Second Relapse. Sarcoma 2020; 2020:8260730. [PMID: 32398946 PMCID: PMC7201820 DOI: 10.1155/2020/8260730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/20/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In relapsed osteosarcoma, the 5-yr postrelapse disease-free survival (PRDFS) rate after the second relapse is <20%. In June 2007, a randomized study was started comparing oral etoposide vs Viscum album fermentatum Pini (an extract derived from the parasitic plant Viscum album L., European mistletoe) as maintenance therapy in patients with metastatic osteosarcoma in complete surgical remission after the second relapse. The primary endpoint was the PRDFS rate at 12 months (compared to the historical control rate). This is a long-term updated result. Patients and Methods. 10 patients received oral etoposide 50 mg/m2 daily for 21 days every 28 days for 6 months, and 9 patients received Viscum album fermentatum Pini 3 times/wk subcutaneously for 1 year. The study closed early in July 2011 due to insufficient recruitment. Lymphocyte subpopulations were analyzed at T0, T3, T6, T9, and T12 months. RESULTS On 30 June 2019, at a median follow-up ITT of 83 months (range 3-144 ms), a median PRDFS of 106 ms (2-144) was observed in the Viscum arm with 5/9 patients who never relapse vs a PRDFS of 7 months (3-134) in the etoposide arm (all patients in the Etoposide arm relapsed) (hazard ratio HR = 0.287, 95% CI: 0.076-0.884, p=0.03). Model forecast 10-yr overall survival rates as 64% in the Viscum arm and 33% in the etoposide arm. Lymphocyte subpopulation counts (CD3, CD4, and CD56) showed an increase in the Viscum arm while a decrease was observed in the etoposide arm during treatment. CONCLUSIONS After 12 years from the start of the trial, the patients in the Viscum arm continue to show a considerably longer PRDFS compared to oral etoposide, and a trend for an advantage in OS is evident even if the number of treated patients is too small to draw conclusions. Viscum as maintenance treatment after complete surgical remission in relapsed osteosarcoma should be further investigated and compared with other drugs.
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Affiliation(s)
- Alessandra Longhi
- Chemotherapy Division, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marilena Cesari
- Chemotherapy Division, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimo Serra
- Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erminia Mariani
- Immunoreumathology and Tissue Regeneration Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Linschoten M, Kamphuis JAM, van Rhenen A, Bosman LP, Cramer MJ, Doevendans PA, Teske AJ, Asselbergs FW. Cardiovascular adverse events in patients with non-Hodgkin lymphoma treated with first-line cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP with rituximab (R-CHOP): a systematic review and meta-analysis. LANCET HAEMATOLOGY 2020; 7:e295-e308. [PMID: 32135128 DOI: 10.1016/s2352-3026(20)30031-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients treated for non-Hodgkin lymphoma are at risk of cardiovascular adverse events, with the risk of heart failure being particularly high. A regimen of cyclophosphamide, doxorubicin, vincristine, and prednisone, with (R-CHOP) or without (CHOP) rituximab is the standard first-line treatment for aggressive non-Hodgkin lymphoma, and doxorubicin and cyclophosphamide are both associated with left ventricular dysfunction. The aim of this systematic review and meta-analysis was to evaluate the cardiovascular toxicity of this regimen. METHODS We systematically searched PubMed, EMBASE, and the Cochrane Library from database inception to June 3, 2019, for clinical trials and observational studies in adult patients with non-Hodgkin lymphoma (diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, peripheral T-cell lymphoma, and non-Hodgkin lymphoma not otherwise specified) that received first-line treatment with R-CHOP or CHOP. Studies reporting on cardiovascular adverse events and treatment-related cardiovascular mortality were included. Abstracts and articles not written in English were excluded. The main outcomes were the proportion of patients with grade 3-4 cardiovascular adverse events and heart failure. Meta-analyses of one-sample proportions were done in all patients receiving CHOP or R-CHOP. Subgroup analyses on summary estimates were done to determine the effect of number of CHOP or R-CHOP cycles, cycle interval, age, and sex. FINDINGS Of 2314 identified entries, 137 studies (21 211 patients) published between April, 1984, and June, 2019 were eligible (9541 patients treated with CHOP, 11 293 patients treated with R-CHOP, 377 both regimens used in the study; median follow-up 39·0 months [IQR 25·5-52·8]). From the included studies, 85 subgroups were treated with CHOP, 76 with R-CHOP, and in four studies both CHOP and R-CHOP were used without a subdivision in separate groups. The pooled proportion for grade 3-4 cardiovascular adverse events, based on 77 studies (n=14 351 patients), was 2·35% (95% CI 1·81-2·93; heterogeneity test Q=326·21; τ2=0·0042; I2=71·40%; p<0·0001). For heart failure, the pooled proportion, based on 38 studies (n=5936 patients), was 4·62% (2·25-7·65; heterogeneity test Q=527·33; τ2=0·0384; I2=95·05%; p<0·0001), with a significant increase in reported heart failure from 1·64% (95% CI 0·82-2·65) to 11·72% (3·00-24·53) when cardiac function was evaluated post-chemotherapy (p=0·017). 53 (39%) of 137 studies were rated as having high risk of bias for incomplete outcome data and 54 (39%) for selective reporting. INTERPRETATION The considerable increase of reported heart failures with cardiac monitoring, indicates that this complication often remains undiagnosed in patients with non-Hodgkin lymphoma who received first-line R-CHOP or CHOP. Our findings are of importance to raise awareness of this complication among clinicians treating patients with non-Hodgkin lymphoma and stresses the need for cardiac monitoring during and after chemotherapy. Prompt initiation of treatment for heart failure in the presymptomatic phase can mitigate the progression to more advanced heart failure stages. FUNDING None.
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Affiliation(s)
- Marijke Linschoten
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands.
| | - Janine A M Kamphuis
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Anna van Rhenen
- Department of Haematology, Cancer Centre, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Laurens P Bosman
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Maarten J Cramer
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands; Netherlands Heart Institute, Utrecht, Netherlands; Central Military Hospital, Utrecht, Netherlands
| | - Arco J Teske
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands; Netherlands Heart Institute, Utrecht, Netherlands; Health Data Research UK, Institute of Health Informatics and Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
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Dix DB, Fernandez CV, Chi YY, Mullen EA, Geller JI, Gratias EJ, Khanna G, Kalapurakal JA, Perlman EJ, Seibel NL, Ehrlich PF, Malogolowkin M, Anderson J, Gastier-Foster J, Shamberger RC, Kim Y, Grundy PE, Dome JS. Augmentation of Therapy for Combined Loss of Heterozygosity 1p and 16q in Favorable Histology Wilms Tumor: A Children's Oncology Group AREN0532 and AREN0533 Study Report. J Clin Oncol 2019; 37:2769-2777. [PMID: 31449468 DOI: 10.1200/jco.18.01972] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE In National Wilms Tumor Study 5 (NWTS-5), tumor-specific combined loss of heterozygosity of chromosomes 1p and 16q (LOH1p/16q) was associated with adverse outcomes in patients with favorable histology Wilms tumor. The AREN0533/AREN0532 studies assessed whether augmenting therapy improved event-free survival (EFS) for these patients. Patients with stage I/II disease received regimen DD4A (vincristine, dactinomycin and doxorubicin) but no radiation therapy. Patients with stage III/IV disease received regimen M (vincristine, dactinomycin, and doxorubicin alternating with cyclophosphamide and etoposide) and radiation therapy. METHODS Patients were enrolled through the AREN03B2 Biology study between October 2006 and October 2013; all underwent central review of pathology, surgical reports, and imaging. Tumors were evaluated for LOH1p/16q by microsatellite testing. EFS and overall survival were compared using the log-rank test between NWTS-5 and current studies. RESULTS LOH1p/16q was detected in 49 of 1,147 evaluable patients with stage I/II disease (4.27%) enrolled in AREN03B2; 32 enrolled in AREN0532. LOH1p/16q was detected in 82 of 1,364 evaluable patients with stage III/IV disease (6.01%) in AREN03B2; 51 enrolled in AREN0533. Median follow-up for 83 eligible patients enrolled in AREN0532/0533 was 5.73 years (range, 2.84 to 9.63 years). The 4-year EFS for patients with stage I/II and stage III/IV disease with LOH1p/16 was 87.3% (95% CI, 75.1% to 99.5%) and 90.2% (95% CI, 81.8% to 98.6%), respectively. These results are improved compared with the NWTS-5 updated 4-year EFS of 68.8% for patients with stage I/II disease (P = .042), and 61.3% for patients with stage III/IV disease (P = .001), with trends toward improved 4-year overall survival. The most common grade 3 or higher nonhematologic toxicities with regimen M were febrile neutropenia (39.2%) and infections (21.6%). CONCLUSION Augmentation of therapy improved EFS for patients with favorable histology Wilms tumor and LOH1p/16q compared with the historical NWTS-5 comparison group, with an expected toxicity profile.
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Affiliation(s)
- David B Dix
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Elizabeth A Mullen
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | - James I Geller
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Eric J Gratias
- University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | | | - John A Kalapurakal
- Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | | | | | - Marcio Malogolowkin
- University of California at Davis Comprehensive Cancer Center, Sacramento, CA
| | | | - Julie Gastier-Foster
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
| | | | | | - Paul E Grundy
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey S Dome
- Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
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Allodji RS, Hawkins MM, Bright CJ, Fidler-Benaoudia MM, Winter DL, Alessi D, Fresneau B, Journy N, Morsellino V, Bárdi E, Bautz A, Byrne J, Feijen ELA, Teepen JC, Vu-Bezin G, Rubino C, Garwicz S, Grabow D, Gudmundsdottir T, Guha J, Hau EM, Jankovic M, Kaatsch P, Kaiser M, Linge H, Muraca M, Llanas D, Veres C, Øfstaas H, Diallo I, Mansouri I, Ronckers CM, Skinner R, Terenziani M, Wesenberg F, Wiebe T, Sacerdote C, Jakab Z, Haupt R, Lähteenmäki P, Zaletel LZ, Kuehni CE, Winther JF, Michel G, Kremer LCM, Hjorth L, Haddy N, de Vathaire F, Reulen RC. Risk of subsequent primary leukaemias among 69,460 five-year survivors of childhood cancer diagnosed from 1940 to 2008 in Europe: A cohort study within PanCareSurFup. Eur J Cancer 2019; 117:71-83. [PMID: 31260818 DOI: 10.1016/j.ejca.2019.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Survivors of childhood cancers are at risk of developing subsequent primary leukaemias (SPLs), but the long-term risks beyond 20 years of treatment are still unclear. We investigated the risk of SPLs in five-year childhood cancer survivors using a large-scale pan-European (PanCareSurFup) cohort and evaluated variations in the risk by cancer and demographic factors. METHODS This largest-ever assembled cohort comprises 69,460 five-year childhood cancer survivors from 12 European countries. Standardised incidence ratios (SIRs) and absolute excess risks (AERs) were calculated. RESULTS One hundred fifteen survivors developed an SPL including 86 myeloid leukaemias (subsequent primary myeloid leukaemias [SPMLs]), 17 lymphoid leukaemias and 12 other types of leukaemias; of these SPLs, 31 (27%) occurred beyond 20 years from the first childhood cancer diagnosis. Compared with the general population, childhood cancer survivors had a fourfold increased risk (SIR = 3.7, 95% confidence interval [CI]: 3.1 to 4.5) of developing leukaemia, and eight leukaemias per 100,000 person-years (AER = 7.5, 95% CI: 6.0 to 9.2) occurred in excess of that expected. The risks remained significantly elevated beyond 20 years from the first primary malignancy (SIR = 2.4, 95% CI: 1.6 to 3.4). Overall, the risk ratio for SPML (SIR = 5.8, 95% CI: 4.6 to 7.1) was higher than that for other SPLs. CONCLUSIONS We demonstrate that beyond 20 years after childhood cancer diagnosis, survivors experience an increased risk for SPLs compared with that expected from the general population. Our findings highlight the need for awareness by survivors and their healthcare providers for potential risk related to SPL.
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Affiliation(s)
- Rodrigue S Allodji
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK; Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France; Polytechnic School of Abomey-Calavi (EPAC), University of Abomey-Calavi, 01 P.O. Box 2009, Cotonou, Benin.
| | - Mike M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Miranda M Fidler-Benaoudia
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città Della Salute e Della Scienza di Torino, Italy
| | - Brice Fresneau
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France; Department of Pediatric Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Neige Journy
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Vera Morsellino
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Edit Bárdi
- St Anna Kinderspital Wien, Austria; Department of Paediatrics and Adolescent Medicine, Kepler University Hospital, Linz, Austria
| | - Andrea Bautz
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
| | | | - Elizabeth Lieke Am Feijen
- Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jop C Teepen
- Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Giao Vu-Bezin
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Carole Rubino
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Stanislaw Garwicz
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Thorgerdur Gudmundsdottir
- Department of Paediatrics and Adolescent Medicine, Kepler University Hospital, Linz, Austria; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Joyeeta Guha
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Eva-Maria Hau
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland; Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Switzerland
| | - Momcilo Jankovic
- Foundation MBBM, Hemato-Oncology Center, University of Milano-Bicocca, Via Cadore 38, 20900 Monza, MB, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Helena Linge
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Monica Muraca
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Damien Llanas
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Cristina Veres
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Hilde Øfstaas
- Norwegian National Advisory Unit on Solid Tumors in Children, Norway
| | - Ibrahima Diallo
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Imene Mansouri
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Cecile M Ronckers
- Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, And Northern Institute of Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Finn Wesenberg
- Norwegian Cancer Registry and Dept. of Pediatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Thomas Wiebe
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città Della Salute e Della Scienza di Torino, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Päivi Lähteenmäki
- Turku University and Turku University Hospital, Department of Pediatric and Adolescent Medicine, Turku, Finland
| | | | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland; Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Switzerland
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Gisela Michel
- Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Nadia Haddy
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK; Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Florent de Vathaire
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
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Feijen EAM, Leisenring WM, Stratton KL, Ness KK, van der Pal HJH, van Dalen EC, Armstrong GT, Aune GJ, Green DM, Hudson MM, Loonen J, Oeffinger KC, Robison LL, Yasui Y, Kremer LCM, Chow EJ. Derivation of Anthracycline and Anthraquinone Equivalence Ratios to Doxorubicin for Late-Onset Cardiotoxicity. JAMA Oncol 2019; 5:864-871. [PMID: 30703192 PMCID: PMC6490232 DOI: 10.1001/jamaoncol.2018.6634] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Anthracyclines are part of many effective pediatric cancer treatment protocols. Most pediatric oncology treatment groups assume that the hematologic toxicity of anthracycline agents is equivalent to their cardiotoxicity; for example, Children's Oncology Group substitution rules consider daunorubicin and epirubicin isoequivalent to doxorubicin, whereas mitoxantrone and idarubicin are considered 4 to 5 times as toxic as doxorubicin. OBJECTIVE To determine optimal dose equivalence ratios for late-onset cardiomyopathy between doxorubicin and other anthracyclines or the anthraquinone mitoxantrone. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study of childhood cancer survivors who survived 5 or more years analyzed data pooled from 20 367 participants in the Childhood Cancer Survivor Study treated from 1970 to 1999, 5741 participants in the Dutch Childhood Oncology Group LATER study diagnosed between 1963 and 2001, and 2315 participants in the St Jude Lifetime study treated from 1962 to 2005. EXPOSURES Cumulative doses of each agent (the anthracyclines doxorubicin, daunorubicin, epirubicin, and idarubicin; and the anthraquinone mitoxantrone) along with chest radiotherapy exposure were abstracted from medical records. MAIN OUTCOMES AND MEASURES Cardiomyopathy (severe, life-threatening, or fatal) by 40 years of age. Agent-specific Cox proportional hazards models evaluated cardiomyopathy risk, adjusting for chest radiotherapy, age at cancer diagnosis, sex, and exposure to anthracyclines or to an anthraquinone. An agent-specific cardiomyopathy equivalence ratio (relative to doxorubicin) was estimated for each dose category as a ratio of the hazard ratios, and then a weighted mean determined the overall agent-specific equivalence ratio across all dose categories. RESULTS Of 28 423 survivors (46.4% female; median age at cancer diagnosis 6.1 years [range, 0.0-22.7 years]), 9330 patients received doxorubicin, 4433 received daunorubicin, 342 received epirubicin, 241 received idarubicin, and 265 received mitoxantrone. After a median follow-up of 20.0 years (range, 5.0-40.0 years) following receipt of a cancer diagnosis, 399 cardiomyopathy cases were observed. Relative to doxorubicin, the equivalence ratios were 0.6 (95% CI, 0.4-1.0) for daunorubicin, 0.8 (95% CI, 0.5-2.8) for epirubicin, and 10.5 (95% CI, 6.2-19.1) for mitoxantrone. Outcomes were too rare to generate idarubicin-specific estimates. Ratios based on a continuous linear dose-response relationship were similar for daunorubicin (0.5 [95% CI, 0.4-0.7]) and epirubicin (0.8 [95% CI, 0.3-1.4]). The relationship between mitoxantrone and doxorubicin appeared better characterized by a linear exponential model. CONCLUSIONS AND RELEVANCE In a large data set assembled to examine long-term cardiomyopathy risk in childhood cancer survivors, daunorubicin was associated with decreased cardiomyopathy risk vs doxorubicin, whereas epirubicin was approximately isoequivalent. By contrast, the current hematologic-based doxorubicin dose equivalency of mitoxantrone (4:1) appeared to significantly underestimate the association of mitoxantrone with long-term cardiomyopathy risk.
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Affiliation(s)
- Elizabeth A. M. Feijen
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Wendy M. Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kayla L. Stratton
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Elvira C. van Dalen
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gregory J. Aune
- Department of Pediatrics, Greehey Children’s Cancer Research Institute, The University of Texas Health Science Center at San Antonio
| | - Daniel M. Green
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kevin C. Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Leontien C. M. Kremer
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Eric J. Chow
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle
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Abstract
PURPOSE OF REVIEW Myelodysplastic syndromes (MDSs) are rare disorders in children, showing peculiar clinical manifestations and biological features. This review will summarize biological, genetic and clinical features of childhood MDS and will provide an update of the algorithm of treatment of the different disease variants. RECENT FINDINGS The most recent classification of MDS includes refractory cytopenia of childhood (RCC), advanced and therapy-related MDS. Importantly, in children, these clonal hematopoietic disorders may be often associated with inherited bone marrow failure syndromes, this representing a challenge for diagnostic work-up and treatment. Moreover, germline syndromes predisposing to develop MDS/acute myeloid leukemia have been recently identified, such as those caused by mutations in GATA2, ETV6, SRP72 and SAMD9/SAMD9-L. SUMMARY Treatment of childhood MDS varies according to specific disease features; allogeneic hematopoietic stem cell transplantation (HSCT) using a Human Leukocyte antigen (HLA)-identical donor, whenever available, represents the treatment of choice for most of these children. HSCT is indicated in MDS with excess of blasts, or in therapy-related MDS. For RCC patients, HSCT is recommended for RCC associated with monosomy 7, or complex karyotype and for patients showing severe neutropenia or transfusion dependence. Novel approaches of HSCT from an HLA-haploidentical relative after selective graft manipulation allow reducing transplant-related complications.
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Perez-Somarriba M, Andión M, López-Pino MA, Lavarino C, Madero L, Lassaletta A. Old drugs still work! Oral etoposide in a relapsed medulloblastoma. Childs Nerv Syst 2019; 35:865-869. [PMID: 30707305 DOI: 10.1007/s00381-019-04072-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/21/2019] [Indexed: 01/03/2023]
Abstract
Medulloblastoma is the most common malignant brain tumor in children. Approximately 30% of children with medulloblastoma will progress or relapse despite being treated. New therapies have been proposed in recent years, including high-dose chemotherapy, immunotherapy, and targeted therapy. However, the best treatment for these patients remains unclear, and in this situation prognosis is poor. Oral etoposide has been used as a single agent or in combination for treating relapsed brain tumors since the 1990s. We report an 8-year-old patient with recurrent metastatic medulloblastoma who had an excellent response after treatment with oral etoposide, maintaining a great quality of life. As clinicians, we must always try to include our patients in clinical trials; however, when this is not possible, we should not forget that "old drugs" such as oral etoposide may work in some patients, with a good response of the tumor, and what is most important, providing the patient with a good quality of life.
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Affiliation(s)
- Marta Perez-Somarriba
- Department of Pediatric Oncology, Hospital Universitario Niño Jesús, Avenida Menendez Pelayo, 65, 28009, Madrid, Spain
| | - Maitane Andión
- Department of Pediatric Oncology, Hospital Universitario Niño Jesús, Avenida Menendez Pelayo, 65, 28009, Madrid, Spain
| | | | - Cinzia Lavarino
- Developmental Tumor Biology Laboratory, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Luis Madero
- Department of Pediatric Oncology, Hospital Universitario Niño Jesús, Avenida Menendez Pelayo, 65, 28009, Madrid, Spain
| | - Alvaro Lassaletta
- Department of Pediatric Oncology, Hospital Universitario Niño Jesús, Avenida Menendez Pelayo, 65, 28009, Madrid, Spain.
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Ding C, Huang Y, Shi M, Nie B, Li Y, Wu K, Yang J, Zeng Y. CD20-negative primary middle ear diffuse large B-cell lymphoma coexpressing MYC and BCL-2 secondary to acute lymphoblastic leukemia: A case report. Medicine (Baltimore) 2019; 98:e15204. [PMID: 30985716 PMCID: PMC6485888 DOI: 10.1097/md.0000000000015204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Second diffuse large B-cell lymphoma (DLBCL) after treatment of acute lymphoblastic leukemia (ALL) is uncommon. To our knowledge, primary middle ear DLBCL which presents CD20-negative and coexpression of MYC and BCL-2 has not been reported yet. PATIENT CONCERNS A 20-year-old Chinese man complained fever and weakness for 2 months. Subsequently bone marrow morphology and flow cytometry immunophenotype suggested ALL. Administrated with 9 cycles of multiagent combined chemotherapy, he felt right ear progressive hearing loss, otalgia, aural fullness. Otoendoscopic examination revealed a pitchy mass obstructing the right external auditory canal. Then the mass resection was performed for biopsy and immunohistochemistry examination. DIAGNOSIS The mass was diagnosed as DLBCL which was negative for CD20 and double expression of MYC and BCL-2. INTERVENTIONS Chemotherapy. OUTCOMES The patient eventually gave up and died of severe infection. LESSONS Although intensive chemotherapy has markedly improved the survival of ALL, more and more secondary cancers have been reported. In addition, primary middle ear lymphoma is much rare; hence, it is easy to be misdiagnosed. Furthermore, DLBCL with negative CD20 and double expression of MYC and BCL-2 is aggressive, which is characterized by chemotherapy resistance and inferior survival rates. We discuss this case aiming at raising awareness of tumors secondary to ALL and exploring the appropriate treatment options for the rare DLBCL.
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MESH Headings
- Antigens, CD20/analysis
- Biomarkers, Tumor/analysis
- Diagnosis, Differential
- Ear Neoplasms/chemistry
- Ear Neoplasms/diagnosis
- Ear Neoplasms/drug therapy
- Ear Neoplasms/pathology
- Ear, Middle
- Fatal Outcome
- Humans
- Lymphoma, Large B-Cell, Diffuse/chemistry
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Neoplasms, Second Primary/diagnosis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Proto-Oncogene Proteins c-bcl-2/analysis
- Proto-Oncogene Proteins c-myc/analysis
- Young Adult
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34
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Demoor-Goldschmidt C, de Vathaire F. Review of risk factors of secondary cancers among cancer survivors. Br J Radiol 2018; 92:20180390. [PMID: 30102558 DOI: 10.1259/bjr.20180390] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Improvements in cancer survival have made the long-term risks from treatments more important, in particular among the children, adolescents and young adults who are more at risk particularly due to a longer life expectancy and a higher sensitivity to treatments. Subsequent malignancies in cancer survivors now constitute 15 to 20% of all cancer diagnoses in the cancer registries. Lots of studies are published to determine risk factors, with some controversial findings. Just data from large cohorts with detailed information on individual treatments and verification of what is called "secondary cancers" can add some knowledge, because their main difficulty is that the number of events for most second cancer sites are low, which impact the statistical results. In this review of the literature, we distinguish second and secondary cancers and discuss the factors contributing to this increased risk of secondary cancers. The article concludes with a summary of current surveillance and screening recommendations.
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Affiliation(s)
- Charlotte Demoor-Goldschmidt
- CESP University, Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,Cancer and Radiation Team, Gustave Roussy, Villejuif, France.,Pediatric Oncology, Hematology, Immunology, CHU d'Angers, Angers, France
| | - Florent de Vathaire
- CESP University, Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,Cancer and Radiation Team, Gustave Roussy, Villejuif, France
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Turcotte LM, Neglia JP, Reulen RC, Ronckers CM, van Leeuwen FE, Morton LM, Hodgson DC, Yasui Y, Oeffinger KC, Henderson TO. Risk, Risk Factors, and Surveillance of Subsequent Malignant Neoplasms in Survivors of Childhood Cancer: A Review. J Clin Oncol 2018; 36:2145-2152. [PMID: 29874133 DOI: 10.1200/jco.2017.76.7764] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Subsequent malignant neoplasms (SMNs) in childhood cancer survivors cause substantial morbidity and mortality. This review summarizes recent literature on SMN epidemiology, risk factors, surveillance, and interventions. Survivors of childhood cancer experience long-term increased SMN risk compared with the general population, with a greater than twofold increased solid tumor risk extending beyond age 40 years. There is a dose-dependent increased risk for solid tumors after radiotherapy, with the highest risks for tumors occurring in or near the treatment field (eg, greater than fivefold increased risk for breast, brain, thyroid, skin, bone, and soft tissue malignancies). Alkylating and anthracycline chemotherapies increase the risk for development of several solid malignancies in addition to acute leukemia/myelodysplasia, and these risks may be modified by other patient characteristics, such as age at exposure and, potentially, inherited genetic susceptibility. Strategies for identifying survivors at risk and initiating long-term surveillance have improved and interventions are underway to improve knowledge about late-treatment effects among survivors and caregivers. Better understanding of treatment-related risk factors and genetic susceptibility holds promise for refining surveillance strategies and, ultimately, upfront cancer therapies.
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Affiliation(s)
- Lucie M Turcotte
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children's Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children's Hospital, Chicago, IL
| | - Joseph P Neglia
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children's Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children's Hospital, Chicago, IL
| | - Raoul C Reulen
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children's Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children's Hospital, Chicago, IL
| | - Cecile M Ronckers
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children's Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children's Hospital, Chicago, IL
| | - Flora E van Leeuwen
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children's Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children's Hospital, Chicago, IL
| | - Lindsay M Morton
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children's Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children's Hospital, Chicago, IL
| | - David C Hodgson
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children's Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children's Hospital, Chicago, IL
| | - Yutaka Yasui
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children's Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children's Hospital, Chicago, IL
| | - Kevin C Oeffinger
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children's Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children's Hospital, Chicago, IL
| | - Tara O Henderson
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children's Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children's Hospital, Chicago, IL
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36
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Dix DB, Seibel NL, Chi YY, Khanna G, Gratias E, Anderson JR, Mullen EA, Geller JI, Kalapurakal JA, Paulino AC, Perlman EJ, Ehrlich PF, Malogolowkin M, Gastier-Foster JM, Wagner E, Grundy PE, Fernandez CV, Dome JS. Treatment of Stage IV Favorable Histology Wilms Tumor With Lung Metastases: A Report From the Children's Oncology Group AREN0533 Study. J Clin Oncol 2018; 36:1564-1570. [PMID: 29659330 DOI: 10.1200/jco.2017.77.1931] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose The National Wilms Tumor Study (NWTS) treatment of favorable histology Wilms tumor with lung metastases was vincristine/dactinomycin/doxorubicin (DD4A) and lung radiation therapy (RT). The AREN0533 study applied a new risk stratification and treatment strategy to improve event-free survival (EFS) while reducing exposure to lung RT. Methods Patients with favorable histology Wilms tumor and isolated lung metastases showing complete lung nodule response (CR) after 6 weeks of DD4A continued receiving chemotherapy without lung RT. Patients with incomplete response (IR) or loss of heterozygosity at chromosomes 1p/16q received lung RT and four cycles of cyclophosphamide/etoposide in addition to DD4A drugs (Regimen M). AREN0533 was designed to preserve a 4-year EFS of 85% for lung nodule CR and improve 4-year EFS from 75% to 85% for lung nodule IR. Results Among 292 assessable patients, 133 had CR and 159 had IR. For patients with CR, 4-year EFS and overall survival (OS) estimates were 79.5% (95% CI, 71.2% to 87.8%) and 96.1% (95% CI, 92.1% to 100%), respectively. Expected versus observed event rates were 15% and 20.2% ( P = .052), respectively. For patients with IR, 4-year EFS and OS estimates were 88.5% (95% CI, 81.8% to 95.3%) and 95.4% (95% CI, 90.9% to 99.8%), respectively. Expected versus observed event rates were 25% and 12.2% ( P < .001), respectively. Overall, 4-year EFS and OS were 85.4% (95% CI, 80.5% to 90.2%) and 95.6% (95% CI, 92.8% to 98.4%) compared with 72.5% (95% CI, 66.9% to 78.1%; P < .001) and 84.0% (95% CI, 79.4% to 88.6%; P < .001), respectively, in the predecessor NWTS-5 study. Conclusion Excellent OS was achieved after omission of primary lung RT in patients with lung nodule CR, although there were more events than expected. EFS was significantly improved, with excellent OS, in patients with lung nodule IR using four cycles of cyclophosphamide/etoposide in addition to DD4A drugs. The overall AREN0533 treatment strategy yielded EFS and OS estimates that were superior to previous studies.
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Affiliation(s)
- David B Dix
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Nita L Seibel
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Yueh-Yun Chi
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Geetika Khanna
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Eric Gratias
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - James R Anderson
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth A Mullen
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - James I Geller
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - John A Kalapurakal
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Arnold C Paulino
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth J Perlman
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Peter F Ehrlich
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Marcio Malogolowkin
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Julie M Gastier-Foster
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth Wagner
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Paul E Grundy
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Conrad V Fernandez
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Jeffrey S Dome
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
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Fresneau B, Orbach D, Faure-Conter C, Sudour-Bonnange H, Vérité C, Gandemer V, Pasquet M, Fasola S, Rome A, Raimbault S, Martelli H, Frappaz D, Le Teuff G, Patte C. Is alpha-fetoprotein decline a prognostic factor of childhood non-seminomatous germ cell tumours? Results of the French TGM95 study. Eur J Cancer 2018; 95:11-19. [PMID: 29604495 DOI: 10.1016/j.ejca.2018.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/01/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE In adults' non-seminomatous germ cell tumours (NS-GCT), alpha-fetoprotein (AFP) decline was identified as an important prognostic factor. We investigated its prognostic value in the French TGM95 study for childhood NS-GCT. PATIENTS AND METHODS Three risk groups were defined: low risk (LR: localised and completely resected pS1, AFP<15000 ng/ml), with a 'wait-and-see' strategy; intermediate-risk (IR: localised incompletely resected, AFP<15000 ng/ml) with 3-5 vinblastine-bleomycine-cisplatin courses; high risk (HiR: AFP≥15000 ng/ml and/or metastatic) with 4-6 etoposide-ifosfamide-cisplatin courses. The multivariable prognostic analysis for progression-free survival (PFS) included age (±10 years), primary tumour site (1-testis, 2-ovary, 3-extragonadal), extent of disease (1-pS1, 2-loco-regional dissemination, 3-metastasis) and AFP (±10,000 ng/ml). AFP decline prognostic value was investigated in IR + HiR groups using predicted time to normalisation (TTN), AFP change, and difference between observed and expected (based on AFP half-life) area under the curve (O-E AUC). RESULTS From January 1995 to December 2005, 239 patients (median age = 3years, 60 LR, 65 IR, 114 HiR) were included. Main sites were testis (n = 66), ovary (n = 77) and sacrococcygeal (n = 57). Five-year PFS and OS were 85% (95% confidence interval [CI] = 80-89%) and 93% (89-95%), respectively. Age ≥ 10 years (hazard ratio [HR] = 4.6, 95% CI = 2.1-10.1, p = 0.0001) and extragonadal primary (HR = 6.3, 95% CI = 2.0-19.9, p = 0.005) were significant prognostic factors. In AFP decline analysis (n = 151, 17 events), TTN (p = 0.61) and AFP change (p = 0.10) were not prognostic, whereas we showed a significant effect of O-E AUC (HR = 2.1, 95% CI = 1.0-4.2, p = 0.05). CONCLUSION Age ≥ 10 years and extragonadal tumours remain as poor prognostic factors. Contrary to adults, TTN is not reliable in paediatric NS-GCT. The prognostic value of O-E AUC should be investigated in larger studies.
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Affiliation(s)
- B Fresneau
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric Oncology, Villejuif, F-94805, France; Paris-Saclay University, Paris-Sud University, CESP, INSERM, Villejuif, France.
| | - D Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France
| | - C Faure-Conter
- Institut D'Hemato-oncologie Pediatrique, Department of Pediatric Oncology, Lyon, France
| | - H Sudour-Bonnange
- Centre Oscar Lambret, Department of Pediatric Oncology, Lille, France
| | - C Vérité
- Centre Hospitalier Universitaire, Department of Pediatric Onco-hematology, Bordeaux, France
| | - V Gandemer
- Centre Hospitalier Universitaire, Department of Pediatric Onco-hematology, Rennes, France
| | - M Pasquet
- Centre Hospitalier Universitaire, Department of Pediatric Onco-hematology, Toulouse, France
| | - S Fasola
- Centre Hospitalier Universitaire, Department of Pediatric Onco-hematology, Hôpital Trousseau, AP-HP, France
| | - A Rome
- Centre Hospitalier Universitaire, Department of Pediatric Oncology, Marseille, France
| | - S Raimbault
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric Oncology, Villejuif, F-94805, France
| | - H Martelli
- Centre Hospitalier Universitaire, Department of Pediatric Surgery, Le Kremlin-Bicêtre, France
| | - D Frappaz
- Institut D'Hemato-oncologie Pediatrique, Department of Pediatric Oncology, Lyon, France
| | - G Le Teuff
- Paris-Saclay University, Paris-Sud University, CESP, INSERM, Villejuif, France; Gustave Roussy, Department of Biostatistics, F94805 Villejuif, France
| | - C Patte
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric Oncology, Villejuif, F-94805, France
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How I treat myelodysplastic syndromes of childhood. Blood 2018; 131:1406-1414. [PMID: 29438960 DOI: 10.1182/blood-2017-09-765214] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/27/2018] [Indexed: 02/06/2023] Open
Abstract
Pediatric myelodysplastic syndromes (MDSs) are a heterogeneous group of clonal disorders with an annual incidence of 1 to 4 cases per million, accounting for less than 5% of childhood hematologic malignancies. MDSs in children often occur in the context of inherited bone marrow failure syndromes, which represent a peculiarity of myelodysplasia diagnosed in pediatric patients. Moreover, germ line syndromes predisposing individuals to develop MDS or acute myeloid leukemia have recently been identified, such as those caused by mutations in GATA2, ETV6, SRP72, and SAMD9/SAMD9-L Refractory cytopenia of childhood (RCC) is the most frequent pediatric MDS variant, and it has specific histopathologic features. Allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment of choice for many children with MDSs and is routinely offered to all patients with MDS with excess of blasts, to those with MDS secondary to previously administered chemoradiotherapy, and to those with RCC associated with monosomy 7, complex karyotype, severe neutropenia, or transfusion dependence. Immune-suppressive therapy may be a treatment option for RCC patients with hypocellular bone marrow and the absence of monosomy 7 or a complex karyotype, although the response rate is lower than that observed in severe aplastic anemia, and a relevant proportion of these patients will subsequently need HSCT for either nonresponse or relapse.
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Danylesko I, Shimoni A. Second Malignancies after Hematopoietic Stem Cell Transplantation. Curr Treat Options Oncol 2018; 19:9. [PMID: 29423555 DOI: 10.1007/s11864-018-0528-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OPINION STATEMENT Second malignancies are a rare but well-defined late complication after autologous and allogeneic hematopoietic stem-cell transplantation (SCT). Solid malignancies occur in up to 15% of patients 15 years after SCT with myeloablative conditioning, with no plateau in the incidence rates. They are responsible for 5-10% of late deaths after SCT. The incidence is increased with advanced age at SCT. The major risk factors are the use of total body irradiation, which is associated with adenocarcinomas and with chronic graft-versus-host disease which is associated with squamous cell cancers. There is less data on the incidence of second malignancies after reduced-intensity conditioning, but it may not be lower. The types of solid tumors reported in excess include melanoma and other skin cancers; cancers of the oral cavity and head and neck, brain, liver, uterine cervix, thyroid, breast, lung; and possibly gastrointestinal cancers. Therapy-related myeloid neoplasms (t-MN) are more common after autologous SCT and may be related mostly to pre-transplant therapies. Post-transplant lymphoproliferative disease is donor-cell-derived lymphoma that is more common after allogeneic SCT with T-cell depletion or intensive immune-suppression state. Second malignancies are most often treated similarly to the standard therapy for similar malignancies. Lifelong cancer screening and prevention interventions are required for all transplantation survivors.
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Affiliation(s)
- Ivetta Danylesko
- The Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sacker school of medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avichai Shimoni
- The Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel. .,Sacker school of medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Vyas C, Jain S, Kapoor G. Therapy Related AML/MDS Following Treatment for Childhood Cancer: Experience from a Tertiary Care Centre in North India. Indian J Hematol Blood Transfus 2018; 34:78-82. [PMID: 29398803 DOI: 10.1007/s12288-017-0840-x] [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] [Received: 03/29/2017] [Accepted: 06/15/2017] [Indexed: 01/03/2023] Open
Abstract
Therapy-related acute myeloid leukemia/myelodysplastic syndrome (t-AML/MDS) is a devastating late effect of cancer treatment. There is limited data on incidence of t-AML/MDS from India. We retrospectively studied pediatric t AML/MDS at our institute between January 1996 and December 2015. Among 1285 children, 8 patients developed t-AML with a median age of 15.5 years. Overall incidence of t-AML/MDS was 0.62% [0.99% (4/402) in solid tumours and 0.45% (4/883) in leukemia/lymphoma, P = 0.26] with 6390 patient years of follow up. Primary malignancy included sarcoma [bone (2), soft tissue (2)], B-non-Hodgkin lymphoma (2) and acute lymphoblastic leukemia (2). The median cumulative equivalent doses of cyclophosphamide, doxorubicin and etoposide were 6.8, 270 and 2.5 gm/m2 respectively. Two patients received radiotherapy [rhabdomyosarcoma (50 Gy), synovial sarcoma (45 Gy)]. The median latency period to develop t-AML/MDS was 24 months (range 16.5-62 months). Most common FAB morphology was M4/M5 (7/8) and cytogenetic abnormality was MLL rearrangement (4/8). Five patients opted for treatment, 4 achieved remission out of which 2 patients are alive and disease free. Short latency periods, absence of pre-leukemic phase and 11q23 translocations were characteristic in the patients with t-AML/MDS. In view of poor outcome with conventional therapy, novel strategies and prevention need to be considered.
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Affiliation(s)
- Chintan Vyas
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085 India
| | - Sandeep Jain
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085 India
| | - Gauri Kapoor
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085 India
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Therapy-related Acute Myeloid Leukemia After the Treatment of Primary Solid Cancer in Children: A Single-center Experience. J Pediatr Hematol Oncol 2018; 40:e23-e28. [PMID: 29200163 DOI: 10.1097/mph.0000000000001019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Therapy-related acute myeloid leukemia (t-AML) has a dismal prognosis and is one of the most frequent second malignant neoplasms which could be encountered by pediatric oncologists. Between October 2000 and September 2016, 16 patients who had primary solid tumors were diagnosed with t-AML at the Seoul National University Children's Hospital. The median patient age at the time of diagnosis of their primary solid tumors was 9.6 years (range, 0.1 to 15.4 y), and that of t-AML was 14.0 years (range, 4.7 to 23.9 y). The median latency period from the end of the primary tumor treatment to the initial diagnosis of t-AML was 29 months (range, 6 to 130 mo). Twelve patients achieved complete remission. Of them, only 7 patients underwent hematopoietic stem cell transplantation (HSCT). The 3-year overall survival (OS) rates and event-free survival rates were 33.7±12.2% and 26.9±11.5% respectively. The patients who underwent HSCT showed favorable 5-year OS rates (57.1±18.7%), whereas the 5-year OS rates of those who did not undergo HSCT was 0%. This study demonstrates that an achievement of complete remission and a subsequent HSCT can be the optimal solution for the treatment of t-AML, and this strategy showed acceptable outcomes.
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Results of methotrexate-etoposide-ifosfamide based regimen (M-EI) in osteosarcoma patients included in the French OS2006/sarcome-09 study. Eur J Cancer 2017; 88:57-66. [PMID: 29190507 DOI: 10.1016/j.ejca.2017.09.036] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/19/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In most countries, reference chemotherapy for osteosarcoma is MAP regimen (M = high-dose methotrexate, AP = doxorubicin-cisplatinum). In France, the standard preoperative chemotherapy for children/adolescents combines M and etoposide-ifosfamide (EI), based on the OS94-trial. We report the safety and efficacy results of patients ≤25 years treated with preoperative M-EI regimen enroled in the French OS2006-study, between 2007 and 2014. METHODS Treatment comprised preoperative chemotherapy with the 7 M-courses and 2 EI-courses, then surgery and postoperative chemotherapy assigned by risk's groups: standard-risk (good histological response without metastases) received 12 M-courses, 3 EI-courses; high-risk (poor histologic response, initial metastases or unresectable primary) received 5 M-courses alternated with 5 AP-courses. 253 patients were randomised to receive (n = 128) or not (n = 125) zoledronate. RESULTS 409/522 patients enroled in the OS2006 study who received preoperative M-EI were analysed. Median age was 14.3 years (4.7-24.5), with 55 patients aged 18-25 years. Primary tumour location was limb in 383 patients (94%) and 85 (21%) presented metastases. Median chemotherapy duration was 37.4 weeks. 381 (96%) patients underwent surgery, 258 patients (65%) had a good histologic response. 187/324 patients (58%) with localised disease did not receive doxorubicin nor cisplatinum. Toxicity was evaluated in the randomised study: most patients experienced ≥1 severe toxicity (grade IV haematological or grade III/IV extra-haematological). Median follow-up was 4.8 years, and 168 patients had events. Five-year event-free survival was 56% (95% CI, 51-62%) and overall survival 71% (66-76%). CONCLUSION M-EI regimen/strategy was feasible for patient aged ≤25 years with survival rates are comparable to those obtained with MAP regimen.
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43
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Epigenetic Combination Therapy for Children With Secondary Myelodysplastic Syndrome (MDS)/Acute Myeloid Leukemia (AML) and Concurrent Solid Tumor Relapse. J Pediatr Hematol Oncol 2017; 39:560-564. [PMID: 28562519 PMCID: PMC5708164 DOI: 10.1097/mph.0000000000000868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Secondary myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) is a rare but devastating complication of solid tumor treatment involving high-dose topoisomerase II inhibitor and alkylator chemotherapy. For relapsed or elderly MDS and AML patients ineligible for hematopoietic stem cell transplantation, epigenetic therapies, including DNA methyltransferase inhibitors and histone deacetylase inhibitors, have been utilized as palliative therapy, offering a well-tolerated approach to disease stabilization, prolonged survival, and quality of life. Literature on the use of epigenetic therapies for both primary and relapsed disease is scarce in the pediatric population. Here, we report 2 pediatric patients with secondary AML and MDS, respectively, due to prior therapy for metastatic solid tumors. Both patients were ineligible for hematopoietic stem cell transplantation due to concurrent solid tumor relapse, but were treated with the epigenetic combination therapy, decitabine and vorinostat, and achieved stabilization of marrow disease, outpatient palliation, and family-reported reasonable quality of life.
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44
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Zong X, Pole JD, Grundy PE, Mahmud SM, Parker L, Hung RJ. Second malignant neoplasms after childhood non-central nervous system embryonal tumours in North America: A population-based study. Eur J Cancer 2017; 84:173-183. [PMID: 28822326 DOI: 10.1016/j.ejca.2017.06.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/23/2017] [Accepted: 06/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few studies in North America have quantified the risks of second malignant neoplasms (SMNs) among survivors of childhood non-central nervous system (non-CNS) embryonal tumours due to their rarity. We aimed to investigate these risks by combining population-based data from the United States of America and Canada. METHODS We evaluated patients with childhood non-CNS embryonal tumours reported to the Surveillance Epidemiology and End Results program and eight Canadian cancer registries from 1969 to 2010. Standardised incidence ratio (SIR) and cumulative incidence of SMNs were calculated. Subgroup analyses were conducted by the type of first primary cancer, age at first primary diagnosis and follow-up duration. FINDINGS Of the 13,107 survivors, 190 SMNs were reported over 134,548 person-years of follow-up. The SIR for all SMNs combined was 6.4 (95% confidence interval [CI]: 5.5-7.4). Most site-specific SIRs were significantly increased, ranging from 36 (95% CI: 26-49) for bone and joint cancer to 3.1 (95% CI: 1.5-5.2) for brain tumour. The risk for second malignancies declined as the time elapsed from the first primary diagnosis and was less prominent for patients first diagnosed at age 1-4 years. Notably, rhabdomyosarcoma survivors had a higher risk for SMNs than those with other first primaries. The overall cumulative incidence of SMNs was 1.0% at 10 years, increasing to 2.2% at 20 years and 4.1% at 30 years. INTERPRETATION Survivors with childhood non-CNS embryonal tumours faced an increased risk for SMNs compared to the general population. The risk variations observed in different patient categories may help target prevention strategies in high-risk subgroups.
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Affiliation(s)
- Xuchen Zong
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, M5T 3L9, Canada
| | - Jason D Pole
- Pediatric Oncology Group of Ontario (POGO), Toronto, ON, M5G 1V2, Canada
| | - Paul E Grundy
- University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada
| | | | - Rayjean J Hung
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, M5T 3L9, Canada.
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Friedman DL, Krailo M, Villaluna D, Gombos D, Langholz B, Jubran R, Shields C, Murphree L, O’Brien J, Kessel S, Rodriguez-Galindo C, Chintagumpala M, Meadows AT. Systemic neoadjuvant chemotherapy for Group B intraocular retinoblastoma (ARET0331): A report from the Children's Oncology Group. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26394. [PMID: 28019092 PMCID: PMC5651987 DOI: 10.1002/pbc.26394] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 11/12/2022]
Abstract
PURPOSE To evaluate a chemoreduction regimen using systemic vincristine and carboplatin (VC) and local ophthalmic therapies to avoid external-beam radiotherapy (EBRT) or enucleation in patients with Group B intraocular retinoblastoma. PATIENTS AND METHODS Twenty-one patients (25 eyes) were treated with six cycles of VC, accompanied by local ophthalmic therapies after cycle 1. The primary study objective was to determine the 2-year event-free survival (EFS) where an event was defined as the use of systemic chemotherapy in addition to vincristine or carboplatin, EBRT, and/or enucleation. RESULTS All patients had tumor regression after the first cycle of VC and only two patients had progression during therapy. There were seven treatment failures within 2 years of study enrollment, resulting in 2-year EFS of 65% and early study closure in accordance with the statistical design. The 2-year cumulative incidence of enucleation was 15%; for external beam radiation therapy, it was 10%; and for chemotherapy to control progressive disease, it was 10%. All patients sustaining a treatment failure were salvaged with additional therapy. CONCLUSIONS For the majority of patients with Group B intraocular retinoblastoma, chemoreduction with VC, without etoposide, in conjunction with local therapy provides excellent opportunity for ocular salvage. Local therapy given with every chemotherapy cycle and incorporation of etoposide may provide improved ocular salvage rates. Central review of group at diagnosis is critical in assigning appropriate therapies.
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Affiliation(s)
- Debra L. Friedman
- Vanderbilt University School of Medicine, Nashville, TN,Vanderbilt-Ingram Cancer Center, Nashville TN
| | - Mark Krailo
- University of Southern California, Los Angeles, CA,Children’s Oncology Group, Monrovia, CA
| | | | | | - Bryan Langholz
- University of Southern California, Los Angeles, CA,Children’s Oncology Group, Monrovia, CA
| | - Rima Jubran
- Children’s Hospital of Los Angeles, Los Angeles, CA
| | | | - Linn Murphree
- University of Southern California, Los Angeles, CA,MD Anderson Cancer Center, Houston TX
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Mulrooney DA, Soliman EZ, Ehrhardt MJ, Lu L, Duprez DA, Luepker RV, Armstrong GT, Joshi VM, Green DM, Srivastava D, Krasin MJ, Morris GS, Robison LL, Hudson MM, Ness KK. Electrocardiographic abnormalities and mortality in aging survivors of childhood cancer: A report from the St Jude Lifetime Cohort Study. Am Heart J 2017. [PMID: 28625376 DOI: 10.1016/j.ahj.2017.03.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Electrocardiography (ECG), predictive of adverse outcomes in the general population, has not been studied in cancer survivors. We evaluated the prevalence of ECG abnormalities and associations with mortality among childhood cancer survivors. METHODS Major and minor abnormalities were coded per the Minnesota Classification system for participants in the St Jude Lifetime Cohort Study (n = 2,715) and community controls (n = 268). Odds ratios (ORs) and 95% CIs were calculated using multivariable logistic regression; and hazard ratios, using Cox proportional hazards regression. RESULTS Survivors were a median age of 31.3 (range 18.4-63.8) years at evaluation and 7.4 (range 0-24.8) years at diagnosis. Prior therapies included cardiac-directed radiation (29.5%), anthracycline (57.9%), and alkylating (60%) chemotherapies. The prevalence of minor ECG abnormalities was similar among survivors and controls (65.2% vs 67.5%, P = .6). Major ECG abnormalities were identified in 10.7% of survivors and 4.9% of controls (P < .001). Among survivors, the most common major abnormalities were isolated ST/T wave abnormalities (7.2%), evidence of myocardial infarction (3.7%), and left ventricular hypertrophy with strain pattern (2.8%). Anthracyclines ≥300 mg/m2 (OR 1.7 95% CI 1.1-2.5) and cardiac radiation (OR 2.1 95% CI 1.5-2.9 [1-1,999 cGy], 2.6 95% CI 1.6-3.9 [2,000-2,999 cGy], 10.5 95% CI 6.5-16.9 [≥3,000 cGy]) were associated with major abnormalities. Thirteen participants had a cardiac-related death. Major abnormalities were predictive of all-cause mortality (hazard ratio 4.0 95% CI 2.1-7.8). CONCLUSIONS Major ECG abnormalities are common among childhood cancer survivors, associated with increasing doses of anthracyclines and cardiac radiation, and predictive of both cardiac and all-cause mortality.
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Teepen JC, van Leeuwen FE, Tissing WJ, van Dulmen-den Broeder E, van den Heuvel-Eibrink MM, van der Pal HJ, Loonen JJ, Bresters D, Versluys B, Neggers SJCMM, Jaspers MWM, Hauptmann M, van der Heiden-van der Loo M, Visser O, Kremer LCM, Ronckers CM. Long-Term Risk of Subsequent Malignant Neoplasms After Treatment of Childhood Cancer in the DCOG LATER Study Cohort: Role of Chemotherapy. J Clin Oncol 2017; 35:2288-2298. [PMID: 28530852 DOI: 10.1200/jco.2016.71.6902] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Childhood cancer survivors (CCSs) are at increased risk for subsequent malignant neoplasms (SMNs). We evaluated the long-term risk of SMNs in a well-characterized cohort of 5-year CCSs, with a particular focus on individual chemotherapeutic agents and solid cancer risk. Methods The Dutch Childhood Cancer Oncology Group-Long-Term Effects After Childhood Cancer cohort includes 6,165 5-year CCSs diagnosed between 1963 and 2001 in the Netherlands. SMNs were identified by linkages with the Netherlands Cancer Registry, the Dutch Pathology Registry, and medical chart review. We calculated standardized incidence ratios, excess absolute risks, and cumulative incidences. Multivariable Cox proportional hazard regression analyses were used to evaluate treatment-associated risks for breast cancer, sarcoma, and all solid cancers. Results After a median follow-up of 20.7 years (range, 5.0 to 49.8 years) since first diagnosis, 291 SMNs were ascertained in 261 CCSs (standardized incidence ratio, 5.2; 95% CI, 4.6 to 5.8; excess absolute risk, 20.3/10,000 person-years). Cumulative SMN incidence at 25 years after first diagnosis was 3.9% (95% CI, 3.4% to 4.6%) and did not change noticeably among CCSs treated in the 1990s compared with those treated earlier. We found dose-dependent doxorubicin-related increased risks of all solid cancers ( Ptrend < .001) and breast cancer ( Ptrend < .001). The doxorubicin-breast cancer dose response was stronger in survivors of Li-Fraumeni syndrome-associated childhood cancers (leukemia, CNS, and non-Ewing sarcoma) versus survivors of other cancers ( Pdifference = .008). In addition, cyclophosphamide was found to increase sarcoma risk in a dose-dependent manner ( Ptrend = .01). Conclusion The results strongly suggest that doxorubicin exposure in CCSs increases the risk of subsequent solid cancers and breast cancer, whereas cyclophosphamide exposure increases the risk of subsequent sarcomas. These results may inform future childhood cancer treatment protocols and SMN surveillance guidelines for CCSs.
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Affiliation(s)
- Jop C Teepen
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Flora E van Leeuwen
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Wim J Tissing
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Eline van Dulmen-den Broeder
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Marry M van den Heuvel-Eibrink
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Helena J van der Pal
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Jacqueline J Loonen
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Dorine Bresters
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Birgitta Versluys
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Sebastian J C M M Neggers
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Monique W M Jaspers
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Michael Hauptmann
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Margriet van der Heiden-van der Loo
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Otto Visser
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Leontien C M Kremer
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
| | - Cécile M Ronckers
- Jop C. Teepen, Leontien C.M. Kremer, and Cécile M. Ronckers, Emma Children's Hospital/Academic Medical Center; Flora E. van Leeuwen and Michael Hauptmann, Netherlands Cancer Institute; Eline van Dulmen-den Broeder, VU University Medical Center; Helena J. van der Pal and Monique W.M. Jaspers, Academic Medical Center, Amsterdam; Wim J. Tissing, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam; Princess Maxima Center for Pediatric Oncology; Jacqueline J. Loonen, Radboud University Medical Center, Nijmegen; Dorine Bresters, Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden; Birgitta Versluys, Wilhelmina Children's Hospital/University Medical Center Utrecht; Otto Visser, Netherlands Comprehensive Cancer Organisation, Utrecht; Sebastian J.C.M.M. Neggers, Erasmus Medical Center, Rotterdam; and Margriet van der Heiden-van der Loo, Dutch Childhood Oncology Group, The Hague, the Netherlands
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48
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Kutanzi KR, Lumen A, Koturbash I, Miousse IR. Pediatric Exposures to Ionizing Radiation: Carcinogenic Considerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111057. [PMID: 27801855 PMCID: PMC5129267 DOI: 10.3390/ijerph13111057] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 12/13/2022]
Abstract
Children are at a greater risk than adults of developing cancer after being exposed to ionizing radiation. Because of their developing bodies and long life expectancy post-exposure, children require specific attention in the aftermath of nuclear accidents and when radiation is used for diagnosis or treatment purposes. In this review, we discuss the carcinogenic potential of pediatric exposures to ionizing radiation from accidental, diagnostic, and therapeutic modalities. Particular emphasis is given to leukemia and thyroid cancers as consequences of accidental exposures. We further discuss the evidence of cancers that arise as a result of radiotherapy and conclude the review with a summary on the available literature on the links between computer tomography (CT) and carcinogenesis. Appropriate actions taken to mitigate or minimize the negative health effects of pediatric exposures to ionizing radiation and future considerations are discussed.
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Affiliation(s)
- Kristy R Kutanzi
- Department of Environmental and Occupational Health, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Annie Lumen
- Division of Biochemical Toxicology, National Center for Toxicological Research, Jefferson, AR 72079, USA.
| | - Igor Koturbash
- Department of Environmental and Occupational Health, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Isabelle R Miousse
- Department of Environmental and Occupational Health, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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49
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Casagranda L, Oriol M, Freycon F, Frappaz D, Bertrand Y, Bergeron C, Plantaz D, Stephan JL, Freycon C, Gomez F, Berger C, Trombert-Paviot B. Second malignant neoplasm following childhood cancer: A nested case-control study of a recent cohort (1987-2004) from the Childhood Cancer Registry of the Rhône-Alpes region in France. Pediatr Hematol Oncol 2016; 33:371-382. [PMID: 27687523 DOI: 10.1080/08880018.2016.1214653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
From a population-based cohort of cases of first cancers diagnosed between 1987 and 2004, before the patient's age of 15 years, the authors conducted a nested case-control study, matching 64 patients who experienced a second malignant neoplasm (SMN) with 190 controls. SMNs comprised 10 leukemia or myelodysplastic syndromes, 5 lymphomas induced by Epstein-Barr virus after allograft, and 49 solid tumors, including mainly 25 carcinomas (17 of the thyroid), 9 bone sarcomas, and 7 central nervous system (CNS) tumors. The median latency occurrence was 6.5 years, and that of thyroid carcinomas induced by 12 Gy fractioned total body irradiation (TBI) was 7.6 years. The relative risk (RR) of an SMN was increased by genetic and family factors and increased 17 to 69 times according to the dose of radiotherapy administered in the region for the first cancer. Age younger than 4 years at the time of radiotherapy increased the risk of SMN. Chemotherapy adjusted according to the dose of radiotherapy administered in the field yielded a greater RR of an SMN only for cumulative doses exceeding 2 g/m2 of epipodophyllotoxin but not for alkylating agents or platinum compounds. The RR of secondary leukemia increased 10-fold following high doses of epipodophyllotoxin >2 g/m2 but was not affected by alkylating agents or anthracyclines. The crude RR of a solid SMN developing after radiotherapy was very high at 18 and reached 90.7 for thyroid carcinoma after TBI, whereas the authors observed no increased risk associated with chemotherapy. These results confirm the risk of secondary leukemia after epipodophyllotoxin and of solid tumor after radiotherapy.
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Affiliation(s)
- L Casagranda
- a Pediatric Hematology and Oncology Unit, University Hospital of Saint-Etienne , Saint-Etienne , France.,b Laboratory EA4607 SNA-EPIS (Autonomic Nervous System, Epidemiology, Physiology, Exercise, and Health) , Jean Monnet University of Saint-Étienne , COMUE (Education and Research Cluster) Lyon , Saint-Étienne , France.,c Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France
| | - M Oriol
- d Department of Public Health and Medical Informatics , University Hospital of Saint-Étienne , Saint-Étienne , France
| | - F Freycon
- c Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France
| | - D Frappaz
- e Institute of Pediatric Hematology and Oncology , Lyon , France
| | - Y Bertrand
- e Institute of Pediatric Hematology and Oncology , Lyon , France
| | - C Bergeron
- e Institute of Pediatric Hematology and Oncology , Lyon , France
| | - D Plantaz
- f Pediatric Hematology and Oncology Unit, University Hospital of Grenoble , Grenoble , France
| | - J L Stephan
- a Pediatric Hematology and Oncology Unit, University Hospital of Saint-Etienne , Saint-Etienne , France
| | - C Freycon
- f Pediatric Hematology and Oncology Unit, University Hospital of Grenoble , Grenoble , France
| | - F Gomez
- g Centre Léon Bérard , Lyon , France
| | - C Berger
- a Pediatric Hematology and Oncology Unit, University Hospital of Saint-Etienne , Saint-Etienne , France.,b Laboratory EA4607 SNA-EPIS (Autonomic Nervous System, Epidemiology, Physiology, Exercise, and Health) , Jean Monnet University of Saint-Étienne , COMUE (Education and Research Cluster) Lyon , Saint-Étienne , France.,c Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France
| | - B Trombert-Paviot
- b Laboratory EA4607 SNA-EPIS (Autonomic Nervous System, Epidemiology, Physiology, Exercise, and Health) , Jean Monnet University of Saint-Étienne , COMUE (Education and Research Cluster) Lyon , Saint-Étienne , France.,c Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France.,d Department of Public Health and Medical Informatics , University Hospital of Saint-Étienne , Saint-Étienne , France
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50
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Huibregtse KE, Vo KT, DuBois SG, Fetzko S, Neuhaus J, Batra V, Maris JM, Weiss B, Marachelian A, Yanik GA, Matthay KK. Incidence and risk factors for secondary malignancy in patients with neuroblastoma after treatment with (131)I-metaiodobenzylguanidine. Eur J Cancer 2016; 66:144-52. [PMID: 27573428 DOI: 10.1016/j.ejca.2016.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/19/2016] [Accepted: 07/15/2016] [Indexed: 01/22/2023]
Abstract
Several reports of second malignant neoplasm (SMN) in patients with relapsed neuroblastoma after treatment with (131)I-MIBG suggest the possibility of increased risk. Incidence of and risk factors for SMN after (131)I-MIBG have not been defined. This is a multi-institutional retrospective review of patients with neuroblastoma treated with (131)I-MIBG therapy. A competing risk approach was used to calculate the cumulative incidence of SMN from time of first exposure to (131)I-MIBG. A competing risk regression was used to identify potential risk factors for SMN. The analytical cohort included 644 patients treated with (131)I-MIBG. The cumulative incidence of SMN was 7.6% (95% confidence interval [CI], 4.4-13.0%) and 14.3% (95% CI, 8.3-23.9%) at 5 and 10 years from first (131)I-MIBG, respectively. No increase in SMN risk was found with increased number of (131)I-MIBG treatments or higher cumulative activity per kilogram of (131)I-MIBG received (p = 0.72 and p = 0.84, respectively). Thirteen of the 19 reported SMN were haematologic. In a multivariate analysis controlling for variables with p < 0.1 (stage, age at first (131)I-MIBG, bone disease, disease status at time of first (131)I-MIBG), patients with relapsed/progressive disease had significantly lower risk of SMN (subdistribution hazard ratio 0.3, 95% CI, 0.1-0.8, p = 0.023) compared to patients with persistent/refractory neuroblastoma. The cumulative risk of SMN after (131)I-MIBG therapy for patients with relapsed or refractory neuroblastoma is similar to the greatest published incidence for high-risk neuroblastoma after myeloablative therapy, with no dose-dependent increase. As the number of patients treated and length of follow-up time increase, it will be important to reassess this risk.
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Affiliation(s)
- Kelly E Huibregtse
- University of California San Francisco Benioff Children's Hospital, USA.
| | - Kieuhoa T Vo
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, USA.
| | - Steven G DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, USA.
| | - Stephanie Fetzko
- Department of Pediatrics, Baylor University Medical Center, USA.
| | - John Neuhaus
- University of California San Francisco Benioff Children's Hospital, Department of Biostatistics, USA.
| | - Vandana Batra
- Children's Hospital of Philadelphia, Department of Pediatric Oncology, USA.
| | - John M Maris
- Children's Hospital of Philadelphia, Department of Pediatric Oncology, USA.
| | - Brian Weiss
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Oncology, USA.
| | - Araz Marachelian
- Children's Hospital of Los Angeles, New Approaches to Neuroblastoma Research, USA.
| | - Greg A Yanik
- Department of Pediatrics, University of Michigan Medical Center, USA.
| | - Katherine K Matthay
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, USA.
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