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Seremidi K, Mitsea A, Papaioannou W, Petroleka K, Gizani S. Assessing quality and quantity of cortical bone in childhood cancer survivors using anthropometric indices. Oral Radiol 2023; 39:811-820. [PMID: 37474688 DOI: 10.1007/s11282-023-00700-y] [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: 04/06/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES Evaluate mandibular cortical bone in childhood cancer survivors (CCS) and correlate findings with disease and treatment characteristics. METHODS Dental panoramic radiographs of 60 CCS and of 120 age and gender-matched healthy individuals were assessed by two independent observers. Bone was categorized as normal, moderately or severely eroded and its width was calculated at four sites bilaterally. Significant differences were tested using Chi-square and Pearson correlation co-efficient. Possible risk factors were detected by multivariate regression analysis. RESULTS Forty five percent of CCS had moderately eroded bone, while 67% of healthy individuals normal bone. Mean width was 3.9 mm in CCS (1.9 mm-6.4 mm) and 2.7 mm in healthy controls (1.4 mm-6 mm). None of the above differences were significant. Survivors diagnosed at a younger age had a five times greater probability of presenting mildly eroded bone. CONCLUSIONS No direct effect of antineoplastic treatment on cortical bone could be demonstrated in the current study, underlying the need for more well-designed studies.
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Affiliation(s)
- Kyriaki Seremidi
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Street, 11527, Athens, Greece.
| | - Anastasia Mitsea
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - William Papaioannou
- Department of Preventive and Community Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Petroleka
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Street, 11527, Athens, Greece
| | - Sotiria Gizani
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Street, 11527, Athens, Greece
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van Atteveld JE, Mulder RL, van den Heuvel-Eibrink MM, Hudson MM, Kremer LCM, Skinner R, Wallace WH, Constine LS, Higham CE, Kaste SC, Niinimäki R, Mostoufi-Moab S, Alos N, Fintini D, Templeton KJ, Ward LM, Frey E, Franceschi R, Pavasovic V, Karol SE, Amin NL, Vrooman LM, Harila-Saari A, Demoor-Goldschmidt C, Murray RD, Bardi E, Lequin MH, Faienza MF, Zaikova O, Berger C, Mora S, Ness KK, Neggers SJCMM, Pluijm SMF, Simmons JH, Di Iorgi N. Bone mineral density surveillance for childhood, adolescent, and young adult cancer survivors: evidence-based recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Diabetes Endocrinol 2021; 9:622-637. [PMID: 34339631 PMCID: PMC8744935 DOI: 10.1016/s2213-8587(21)00173-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 02/01/2023]
Abstract
Childhood, adolescent, and young adult cancer survivors are at increased risk of reduced bone mineral density. Clinical practice surveillance guidelines are important for timely diagnosis and treatment of these survivors, which could improve bone mineral density parameters and prevent fragility fractures. Discordances across current late effects guidelines necessitated international harmonisation of recommendations for bone mineral density surveillance. The International Late Effects of Childhood Cancer Guideline Harmonization Group therefore established a panel of 36 experts from ten countries, representing a range of relevant medical specialties. The evidence of risk factors for very low and low bone mineral density and fractures, surveillance modality, timing of bone mineral density surveillance, and treatment of very low and low bone mineral density were evaluated and critically appraised, and harmonised recommendations for childhood, adolescent, and young adult cancer survivors were formulated. We graded the recommendations based on the quality of evidence and balance between potential benefits and harms. Bone mineral density surveillance is recommended for survivors treated with cranial or craniospinal radiotherapy and is reasonable for survivors treated with total body irradiation. Due to insufficient evidence, no recommendation can be formulated for or against bone mineral density surveillance for survivors treated with corticosteroids. This surveillance decision should be made by the survivor and health-care provider together, after careful consideration of the potential harms and benefits and additional risk factors. We recommend to carry out bone mineral density surveillance using dual-energy x-ray absorptiometry at entry into long-term follow-up, and if normal (Z-score > -1), repeat when the survivor is aged 25 years. Between these measurements and thereafter, surveillance should be done as clinically indicated. These recommendations facilitate evidence-based care for childhood, adolescent, and young adult cancer survivors internationally.
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Affiliation(s)
| | - Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - W Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Claire E Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Sue C Kaste
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Riitta Niinimäki
- Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Sogol Mostoufi-Moab
- Department of Pediatrics, The Children's Hospital of Philadelphia, and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nathalie Alos
- Department of Pediatrics, Endocrinology Division, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Danilo Fintini
- Endocrinology Unit, University-Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Kimberly J Templeton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Leanne M Ward
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Eva Frey
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Vienna, Austria
| | | | - Vesna Pavasovic
- Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Seth E Karol
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Nadia L Amin
- Department of Paediatric Haematology, Leeds Children's Hospital, Leeds, UK
| | - Lynda M Vrooman
- Dana-Farber Cancer Institute, and Boston Children's Hospital, Boston, MA, USA
| | - Arja Harila-Saari
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Charlotte Demoor-Goldschmidt
- INSERM U1018, Paris-Sud XI University, Paris-Saclay University, Centre for Research in Epidemiology and Population Health, Cancer & Radiations Group, Gustave Roussy Cancer Campus, Villejuif, France; Department of Pediatric Onco-hematology, CHU Angers, Angers, France; Department of Radiotherapy, François Baclesse Center, Caen, France
| | - Robert D Murray
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Edit Bardi
- St Anna Children's Hospital, Vienna, Austria; Department of Pediatrics and Adolescent Medicine, Kepler Universitätsklinikum, Linz, Austria
| | - Maarten H Lequin
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, Pediatric Unit, University A Moro, Bari, Italy
| | - Olga Zaikova
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Claire Berger
- Department for Pediatric Hematology and Oncology CHU Nord, University Hospital Saint-Etienne, Saint-Priest en Jarez, France; 28U1059 Sainbiose, University Jean Monnet, Saint-Etienne, France
| | - Stefano Mora
- Laboratory of Pediatric Endocrinology and Pediatric Bone Density Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jill H Simmons
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natascia Di Iorgi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Italy and Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Bone Mineral Density Evolution and Its Determinants in Long-term Survivors of Childhood Acute Leukemia: A Leucémies Enfants Adolescents Study. Hemasphere 2021; 5:e518. [PMID: 33458594 PMCID: PMC7806242 DOI: 10.1097/hs9.0000000000000518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022] Open
Abstract
This prospective study aimed to analyze determinants that can influence bone mineral density evolution in childhood acute leukemia survivors. Patients included were selected from the long-term follow-up LEA cohort and had dual energy radiograph absorptiometry scan between 10 and 18 years and after the age of 18. All scans were centrally reviewed. Bone mineral density was measured at the lumbar spine, femoral neck, total hip, and whole body, and expressed as z-score. Eighty-nine patients (female 39, lymphoblastic leukemia 68, relapse 25, hematopoietic stem cell transplantation 44, and mean age 15.4 and 20.1 years at the first and second scans, respectively) were studied. The first and second scan z-scores were significantly correlated (P < 10−3). Mean femoral neck and total hip z-scores improved significantly between the first and second scans, whereas no significant evolution occurred at the lumbar spine and whole-body level. On the second evaluation, 14.6% of patients had z-score <−2 at the lumbar spine and 4.3% at the femoral neck level. Gender, type of leukemia, transplantation, relapse, cumulative corticosteroid doses, or growth hormone deficiency did not have any significant impact on z-score variation. Younger age at diagnosis (≤8.5 years) proved an unfavorable risk factor for z-score evolution at the lumbar spine (P = 0.041); the trend did not reach statistical significance for metabolic syndrome (P = 0.054). At the femoral neck, both were associated with unfavorable z-score evolution (P = 0.003 and 0.025, respectively). Patients treated at a younger age and those with metabolic syndrome seem to be at higher risk of bone mineral density decline and should benefit from specific interventions.
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Late Effects in Childhood Cancer Survivors: Early Studies, Survivor Cohorts, and Significant Contributions to the Field of Late Effects. Pediatr Clin North Am 2020; 67:1033-1049. [PMID: 33131533 PMCID: PMC8393933 DOI: 10.1016/j.pcl.2020.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
With improvement in cure of childhood cancer came the responsibility to investigate the long-term morbidity and mortality associated with the treatments accountable for this increase in survival. Several large cohorts of childhood cancer survivors have been established throughout Europe and North America to facilitate research on long-term complications of cancer treatment. The cohorts have made significant contributions to the understanding of early mortality, somatic late complications, and psychosocial outcomes among childhood cancer survivors, which has been translated into the design of new treatment protocols for pediatric cancers, with the goal to reduce the potential risk and severity of late effects.
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5
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Jin HY, Lee JA. Low bone mineral density in children and adolescents with cancer. Ann Pediatr Endocrinol Metab 2020; 25:137-144. [PMID: 33017885 PMCID: PMC7538298 DOI: 10.6065/apem.2040060.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/10/2020] [Indexed: 12/18/2022] Open
Abstract
Maximizing accumulation of bone mass during childhood and adolescence is essential to attaining optimal peak bone mass. Childhood cancer survivors (CCS) have lower bone mineral density (BMD) than the general population. Chemotherapeutic agents including steroids and radiotherapy can affect BMD. Cancer itself, hormonal insufficiency, a poor nutritional state, and a deficit of physical activities during or after treatment also influence BMD in CCS, resulting in failure to achieve appropriate peak bone mass. Low BMD in childhood and adolescence can lead to osteoporosis in adult life and complications such as bone pain, bone deformity, and fractures. Thus, BMD in CCS should be monitored with appropriate intervention. Adequate intake of calcium and vitamin D and an increase in physical activity are recommended. Timely supplements of hormones are needed in some cases. Some publications have reported that bisphosphonate therapies using pamidronate or alendronate were well tolerated in CCS and helped increase BMD.
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Affiliation(s)
- Hye Young Jin
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, Goyang, Korea
| | - Jun Ah Lee
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, Goyang, Korea,Address for correspondence: Jun Ah Lee, MD, PhD Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea Tel: +82-31-920-1604 Fax: +82-31-920-1244 E-mail:
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Bloomhardt HM, Sint K, Ross WL, Rotatori J, Ness K, Robinson C, Carpenter TO, Chow EJ, Kadan-Lottick NS. Severity of reduced bone mineral density and risk of fractures in long-term survivors of childhood leukemia and lymphoma undergoing guideline-recommended surveillance for bone health. Cancer 2019; 126:202-210. [PMID: 31536650 DOI: 10.1002/cncr.32512] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/30/2019] [Accepted: 08/18/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Survivors of childhood leukemia/lymphoma are at increased risk for reduced bone mineral density (BMD). The authors sought to determine the frequency of reduced BMD detected by off-therapy surveillance, factors associated with reduced BMD, and the association of reduced BMD with fractures. METHODS This cross-sectional study included childhood leukemia/lymphoma survivors attending 2 survivorship clinics who received guideline-recommended BMD surveillance ≥2 years post-therapy with dual-energy x-ray absorptiometry (from January 1, 2004 to August 31, 2016). Lumbar spine BMD z-scores were height-for-age-adjusted. Low and very low BMD were >1 SD and >2 SDs below norms, respectively. Treatment, chronic conditions, and fractures were abstracted from medical records. Logistic regression was used to examine the association of low BMD with patient/treatment factors and fractures. RESULTS In total, 542 patients (51.5% female) with a mean age of 15.5 years (range, 4.4-52.2 years) who were 6 years post-therapy (range, 2.0-35.1 years) were evaluated, including 116 who reported post-therapy fractures. Lumbar spine low BMD was identified in 17.2% of survivors, and very low BMD was identified in 3.5% of survivors, but frequencies varied considerably between subgroups; 10.8% of survivors aged 15 to 19 years at diagnosis had very low BMD. In multivariable analyses, older age at diagnosis, white race, and being underweight were significantly associated with low BMD. Survivors with low BMD had greater odds of nondigit fractures (odds ratio, 2.2; 95% CI, 1.3-3.7) and specifically long-bone fractures (odds ratio, 2.7; 95% CI, 1.5-4.7). CONCLUSIONS In this study of childhood leukemia/lymphoma survivors undergoing guideline-recommended dual-energy x-ray absorptiometry surveillance, patients who were older at diagnosis, white, and underweight were at the highest risk for lumbar spine low BMD. Low BMD was associated with a greater risk of fractures, emphasizing the clinical importance of surveillance.
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Affiliation(s)
- Hadley M Bloomhardt
- Department of Pediatrics (Hematology-Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Kyaw Sint
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Wilhelmenia L Ross
- Department of Pediatrics (Hematology-Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Jaime Rotatori
- Department of Pediatrics (Hematology-Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Kathryn Ness
- Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Cemre Robinson
- Department of Pediatrics (Endocrinology), Yale School of Medicine, New Haven, Connecticut
| | - Thomas O Carpenter
- Department of Pediatrics (Endocrinology), Yale School of Medicine, New Haven, Connecticut
| | - Eric J Chow
- Seattle Children's Hospital, University of Washington, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nina S Kadan-Lottick
- Department of Pediatrics (Hematology-Oncology), Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
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Lim Y, Baek KH, Kim HJ, Lee S, Lee JW, Kang MI. Changes in trabecular bone score and bone mineral density following allogeneic hematopoietic stem cell transplantation. Bone 2019; 124:40-46. [PMID: 30959188 DOI: 10.1016/j.bone.2019.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/17/2019] [Accepted: 04/04/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE It has been demonstrated that bone mineral density (BMD) loss is substantial within the first 12 months after allogeneic hematopoietic stem cell transplantation (alloHSCT). Declines in BMD showed a disproportionate cortical bone loss even though trabecular bone is metabolically more active than cortical bone. This finding suggests a unique mechanism. However, the structural bone deficits after alloHSCT have not been well characterized. The trabecular bone score (TBS) has emerged as a method to assess bone microarchitecture. The aim of this study was to evaluate the changes in BMD and TBS in patients who received alloHSCT with follow-up of two years. METHODS All patients 18 years and older who received alloHSCT between 2009 and 2015 at Seoul St. Mary's Hospital, Korea were included. They were segregated into a first group (A, n = 24) that was evaluated for BMD at the time of alloHSCT and 12 months posttransplant and a second group (B, n = 44) that was evaluated for BMD at 12 and 24 months following alloHSCT. RESULTS Subjects in group A experienced a decrease in BMD at the femoral neck and total hip between the time of transplantation and 12 months posttransplantation: 0.056 ± 0.057 (5.48%) and 0.072 ± 0.063 (6.84%), respectively. Subjects in group B experienced an increase in BMD at the lumbar spine and total hip between 12 and 24 months post-alloHSCT: 0.047 ± 0.064 (4.90%) and 0.017 ± 0.045 (2.16%), respectively. In group A, TBS at 12 months post-alloHSCT decreased 0.028 ± 0.067 (1.92%) from the baseline (p = 0.086). In group B, TBS at 24 months post-alloHSCT increased 0.010 ± 0.049 (0.78%) from the 12 months post-alloHSCT evaluation (p = 0.149). TBS change was positively associated with BMD changes at all measured sites. The cumulative dose of glucocorticoid therapy was associated with loss of BMD at all measured sites and TBS. In addition, the dose of total body irradiation (TBI) was negatively associated with TBS. CONCLUSIONS In summary, this study delineated longitudinal microarchitectural changes in bone structure occurring in the context of alloHSCT. TBS change per 12 months was insignificant during the two years following alloHSCT. Therefore, our data represented disproportionate cortical bone loss in the context of the microarchitecture.
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Affiliation(s)
- Yejee Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Ki Hyun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul 07345, Republic of Korea
| | - Hee-Je Kim
- Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Seok Lee
- Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jong Wook Lee
- Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Moo-Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea.
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Donmez AD, Isik P, Cetinkaya S, Yarali N. Bone Loss in Pediatric Survivors of Acute Lymphoblastic Leukemia. Eurasian J Med 2019; 51:38-41. [PMID: 30911254 DOI: 10.5152/eurasianjmed.2018.18196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/01/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Bone mineral density (BMD) in children may be negatively affected by acute lymphoblastic leukemia (ALL) or its treatment protocol. The aim of our study was to evaluate bone health by measuring BMD after ALL treatment. Materials and Methods The age, anthropometric measurements, and lumbar spine BMDs were recorded in 39 pediatric survivors of ALL, with no history of relapse, secondary malignancy, or transplantation. The lumbar spine BMD was measured by dual energy x-ray absorptiometry. The BMD risk factors, pubertal status, age at diagnosis, risk category, the time interval from the completion of the chemotherapy, and cranial radiotherapy were investigated. Serum calcium, phosphate, alkaline phosphates, magnesium, parathormone, and 25-hydroxy vitamin D levels were determined. Results The mean BMD value was calculated as 0.668±0.176 g/cm2. Osteopenia and osteoporosis were detected in nine patients (23.1%) and three patients (7.7%), respectively, according to previously published data of healthy age- and sex-related Turkish children's BMD values. The mean age at diagnosis of patients with ALL, having the Z-score above -1 was lower than in patients having bone defect (Z score <-1). Conclusion Early detection and intervention strategies to optimize bone health are essential in pediatric patients with ALL.
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Affiliation(s)
| | - Pamir Isik
- Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
| | - Semra Cetinkaya
- Department of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Nese Yarali
- Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
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9
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Freycon F, Casagranda L, Trombert-Paviot B. The impact of severe late-effects after 12 Gy fractionated total body irradiation and allogeneic stem cell transplantation for childhood leukemia (1988-2010). Pediatr Hematol Oncol 2019; 36:86-102. [PMID: 30978121 DOI: 10.1080/08880018.2019.1591549] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study consists of a retrospective study including 71 childhood leukemia survivors (36 females) treated with allo-HSCT 12 Gy fractionated total body irradiation (fTBI) conditioning, with a median age of 25.0 y at time of follow-up and a median delay of 14.8 y since the graft. The recovery ratio was 90%. The number of severe late-effects was specified for each patient: 21 with growth deficiency (final height <162.5 cm for 12/35 men and <152.0 cm for 9/36 women - Growth deficiency was correlated to young age at the time of the allograft); 5 with sclerodermic chronic graft vs. host disease; 9 with osteonecrosis; risk of impaired fertility for 25 women and 28 men (only 2 women had a child); 8 with diabetes; 5 with pulmonary late-effects including 1 death; 5 with chronic renal insufficiency including 1 death; 2 with cardiac late-effects; 2 with arterial high blood pressure; 11 (8 women) declared 14 subsequent cancers (7 with thyroid carcinomas, 3 with multiple squamous cell carcinomas, 2 with epidermoïdis carcinomas of the tongue or the lip, 1 with bone sarcoma, and 1 with carcinoma of the breast); 6 with chelating treatments of hemochromatosis; 14 with important educational underachievement; 11 with depression at adult age; 1 with hepatitis B virus infection; 4 with other severe late-effects, including 2 with blindness. The average number of severe late-effects was 2.3 with a positive correlation according to delay from fTBI (p < 0.0002). Two-thirds had at least 2 late-effects. These results emphasize the urgent abandonment of conditioning by TBI in children.
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Affiliation(s)
- Fernand Freycon
- a Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France
| | - Léonie Casagranda
- a Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France.,b Department of Pediatric Hematology and Oncology Unit , University Hospital of Saint-Etienne , Saint-Etienne , France.,c Host Research Team EA4607 SNA-EPIS, PRES Lyon, Jean Monnet University, University Hospital , Saint-Etienne , France
| | - Béatrice Trombert-Paviot
- c Host Research Team EA4607 SNA-EPIS, PRES Lyon, Jean Monnet University, University Hospital , Saint-Etienne , France.,d Department of Public Health and Medical Informatics , University of Saint-Etienne , Saint-Etienne , France
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10
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Frascino AV, Costa C, de Andrade Salgado DMR, Coracin FL, Fava M, Odone-Filho V. Mandibular radiomorphometric assessment of bone mineral density in survivors of pediatric hematopoietic stem-cell transplantation. Clinics (Sao Paulo) 2019; 74:e929. [PMID: 31166472 PMCID: PMC6530437 DOI: 10.6061/clinics/2019/e929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 02/27/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Hematopoietic stem-cell transplantation (HSCT) childhood survivors of hematologic malignancies are prone to develop late osteopenia and osteoporosis. The purpose of this retrospective study was to quantitatively and qualitatively assess bone mineral density (BMD) in HSCT childhood survivors and to compare the effectiveness of both qualitative and quantitative assessment methods. METHODS DESIGN BMD assessment using panoramic radiographs of childhood HSCT survivors aged 3.69-18.88 years using two radiomorphometric indexes. Case-control double-blinded comparison of panoramic radiographic images from childhood HSCT survivors and age- and sex-matched healthy controls. Quantitative assessment was performed by measuring the cortical bone width bilaterally at the mental foramen level. Qualitative assessment was performed using the mandibular cortical index bilaterally on all panoramic images. RESULTS Radiographs were taken 6.59-83.95 months after bone marrow transplantation [median±SD=25.92±24.9 months]. Fifty-two panoramic radiographic images were analyzed: 21 from HSCT survivors and 31 from healthy controls aged 3.69-25.1 years [mean±SD=11.89±5.28 years]. The mandibular cortical bone width was 17% smaller in childhood HSCT survivors than in healthy controls (case group: 2.420, control group: 3.307; p=0.00617). Qualitative analysis revealed an increased frequency of severe mandibular cortical erosion in childhood HSCT survivors, although no significant difference was observed (case group: 1.540, control group: 1.490; p=0.32). The interobserver agreement was 85% (Kappa index). CONCLUSIONS HSCT childhood survivors exhibit quantitative and qualitative mandibular bone impairments. Further studies are needed to establish an association between mandibular cortical bone impairment and osteoporosis.
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Affiliation(s)
- Alexandre Viana Frascino
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, BR
- Corresponding author. E-mail:
| | - Claudio Costa
- Departamento de Estomatologia, Faculdade de Odontologia, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Fabio Luiz Coracin
- Departamento de Saude, Faculdade de Odontologia, Universidade Nove de Julho, Sao Paulo, SP, BR
| | - Marcelo Fava
- Odontologia Pediatrica, Faculdade de Odontologia, Universidade Estadual Paulista (UNESP), Sao Jose dos Campos, SP, BR
| | - Vicente Odone-Filho
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, BR
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11
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Kendler DL, Body JJ, Brandi ML, Broady R, Cannata-Andia J, Cannata-Ortiz MJ, El Maghraoui A, Guglielmi G, Hadji P, Pierroz DD, de Villiers TJ, Rizzoli R, Ebeling PR. Bone management in hematologic stem cell transplant recipients. Osteoporos Int 2018; 29:2597-2610. [PMID: 30178158 DOI: 10.1007/s00198-018-4669-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 08/13/2018] [Indexed: 12/13/2022]
Abstract
Autologous and allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment of choice for patients with some malignant and non-malignant hematological diseases. Advances in transplantation techniques and supportive care measures have substantially increased the number of long-term HSCT survivors. This has led to an increasing patient population suffering from the late effects of HSCT, of which, bone loss and its consequent fragility fractures lead to substantial morbidity. Altered bone health, with consequent fragility fractures, and chronic graft-versus-host disease (GVHD) are factors affecting long-term quality of life after HSCT. Hypogonadism, HSCT preparative regimens, nutritional factors, and glucocorticoids all contribute to accelerated bone loss and increased fracture risk. Management strategies should include bone mineral density examination, evaluation of clinical risk factors, and general dietary and physical activity measures. Evidence has accumulated permitting recommendations for more attentiveness to evaluation and monitoring of bone health, with appropriate application of osteoporosis pharmacotherapies to patients at increased risk of bone loss and fracture.
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Affiliation(s)
- D L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, 150 - 943 W. Broadway, Vancouver, V5Z 4E1, Canada.
| | - J J Body
- CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M L Brandi
- Mineral and Bone Metabolic Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - R Broady
- Department of Medicine, Division of Hematology, University of British Columbia, Vancouver, Canada
| | - J Cannata-Andia
- Servicio de Metabolismo Óseo y Mineral, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - M J Cannata-Ortiz
- Haematology Department, IIS Princesa, Hospital de la Princesa, Madrid, Spain
| | - A El Maghraoui
- Rheumatology Department, Military Hospital Mohammed V, Mohammed V-Souissi University, Rabat, Morocco
| | - G Guglielmi
- Department of Radiology, University of Foggia, Foggia, Italy
| | - P Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Nord West Hospital, Frankfurt, Germany
| | - D D Pierroz
- International Osteoporosis Foundation (IOF), Nyon, Switzerland
| | - T J de Villiers
- Department of Gynaecology, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Mediclinic Panorama, Cape Town, South Africa
| | - R Rizzoli
- Division of Bone Diseases, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland
| | - P R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
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12
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Wei C, Candler T, Davis N, Elson R, Crabtree N, Stevens M, Crowne E. Bone Mineral Density Corrected for Size in Childhood Leukaemia Survivors Treated with Haematopoietic Stem Cell Transplantation and Total Body Irradiation. Horm Res Paediatr 2018; 89:246-254. [PMID: 29804121 DOI: 10.1159/000487996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Childhood leukaemia survivors treated with haematopoietic stem cell transplantation and total body irradiation (HSCT-TBI) have multiple risk factors for reduced bone mineral density (BMD) and growth failure; hence, BMD assessment must take body size into consideration. This study aimed to evaluate size-corrected BMD in leukaemia survivors treated with and without HSCT-TBI. METHODS Childhood leukaemia survivors treated with HSCT-TBI (n = 35), aged 17.3 (10.5-20.9) years, were compared with those treated with chemotherapy only, (n = 16) aged 18.5 (16.1-20.9) years, and population references. Outcome measures included anthropometric measurements and BMD by dual-energy X-ray absorptiometry. BMD was corrected for size as bone mineral apparent density (BMAD). Statistical analysis was performed by 1- and 2-sample t tests as well as regression analysis (5% significance). RESULTS HSCT-TBI survivors were lighter and shorter with reduced spinal heights compared with chemotherapy-only subjects and population references. Compared with population references, HSCT-TBI survivors showed lower BMD standard deviation scores (SDS) (p = 0.008), but no difference in BMAD-SDS, and chemotherapy-only survivors showed no differences in neither BMD-SDS nor BMAD-SDS. All HSCT-TBI participants with BMD-SDS <-2 had BMAD-SDS >-2. BMAD-SDS was negatively associated with age (r = -0.38, p = 0.029) in HSCT-TBI survivors. CONCLUSIONS Size-corrected BMD are normal in HSCT-TBI survivors in young adulthood, but may reduce overtime. BMD measurements should be corrected for size in these patients to be clinically meaningful.
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Affiliation(s)
- Christina Wei
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.,University of Bristol, Bristol, United Kingdom.,St George's University, NHS Foundation Trust, Bristol, United Kingdom
| | - Toby Candler
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.,University of Bristol, Bristol, United Kingdom
| | - Nikki Davis
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.,University of Bristol, Bristol, United Kingdom.,University Hospital Southampton, NHS Foundation Trust, Southampton, United Kingdom
| | - Ruth Elson
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Nicola Crabtree
- Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | | | - Elizabeth Crowne
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.,University of Bristol, Bristol, United Kingdom
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13
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Long-term Effects of Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Patients with Acute Lymphoblastic Leukemia. Curr Oncol Rep 2018; 20:74. [DOI: 10.1007/s11912-018-0719-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Buxbaum NP, Robinson C, Sinaii N, Ling A, Curtis LM, Pavletic SZ, Baird K, Lodish MB. Impaired Bone Mineral Density in Pediatric Patients with Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant 2018; 24:1415-1423. [PMID: 29496562 PMCID: PMC6045967 DOI: 10.1016/j.bbmt.2018.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/15/2018] [Indexed: 11/18/2022]
Abstract
Pediatric allogeneic hematopoietic stem cell transplantation (AHSCT) recipients with chronic graft-versus-host disease (cGVHD) are at high risk for endocrinopathies, particularly impaired bone mineral density (BMD). However, rates of BMD impairment in pediatric AHSCT recipients with cGVHD have not been well documented. We report 33 patients with cGVHD who were referred to the National Institutes of Health (NIH) for the Natural History of Clinical and Biological Factors Determining Outcomes in Chronic Graft-versus-Host Disease Study (NCT 0092235) and underwent formal BMD assessment via dual-energy X-ray absorptiometry (DEXA). Not surprisingly, we found much higher rates of BMD impairment than previously reported for pediatric AHSCT recipients who were not stratified by the presence or absence of cGVHD. Most of these patients (73%) had a z-score ≤-2 in at least 1 anatomic site. Although we expected the rate to be higher than that observed for pediatric AHSCT recipients in studies that did not analyze patients with cGVHD separately, this rate is nonetheless extremely high. Furthermore, the overall rate of occult vertebral compression fractures (VCFs) in our cohort was 17%, and the rate was 23% in patients with at least 1 z-score of ≤-2. The rates of BMD impairment and VCF in our pediatric cohort were significantly higher than those seen in the adult AHSCT recipients who were concurrently enrolled on the same study at the NIH and had similar cGVHD severity. We found that older age at cGVHD diagnosis and a greater number of systemic therapies were associated with occult VCF. Moreover, the intensity of current immunosuppression negatively impacted lumbar spine and total hip BMD in this cohort. Our study, although limited by small patient numbers and lack of a control AHSCT recipient group without cGVHD, indicates that children with cGVHD are at a greater risk for BMD impairment than previously appreciated. Given the rising incidence of cGVHD in AHSCT recipients and our findings, we recommend that pre-AHSCT DEXA be incorporated into routine pediatric pretransplantation screening studies. A baseline DEXA study could facilitate longitudinal monitoring of BMD in children, who may be more susceptible than adults to the negative effects of AHSCT on BMD. In addition, given the high risk of BMD impairment in pediatric AHSCT recipients with cGVHD, such patients should undergo BMD evaluation upon developing cGVHD, with continued monitoring thereafter to allow intervention before progression of the BMD impairment to its severe manifestation, VCF.
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Affiliation(s)
- Nataliya P Buxbaum
- Experimental Transplantation and Immunology Branch, National Cancer Institute Center for Cancer Research, National Institutes of Health, Bethesda, Maryland.
| | - Cemre Robinson
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Ninet Sinaii
- Biostatistics and Clinical Epidemiology Service, Warren Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Alexander Ling
- Diagnostic Radiology Department, Warren Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Lauren M Curtis
- Experimental Transplantation and Immunology Branch, National Cancer Institute Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Kristin Baird
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland; Division of Clinical Evaluation, Pharmacology and Toxicology, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Maya B Lodish
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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15
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Chow EJ, Anderson L, Baker KS, Bhatia S, Guilcher GMT, Huang JT, Pelletier W, Perkins JL, Rivard LS, Schechter T, Shah AJ, Wilson KD, Wong K, Grewal SS, Armenian SH, Meacham LR, Mulrooney DA, Castellino SM. Late Effects Surveillance Recommendations among Survivors of Childhood Hematopoietic Cell Transplantation: A Children's Oncology Group Report. Biol Blood Marrow Transplant 2016; 22:782-95. [PMID: 26802323 PMCID: PMC4826622 DOI: 10.1016/j.bbmt.2016.01.023] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/12/2016] [Indexed: 12/12/2022]
Abstract
Hematopoietic cell transplantation (HCT) is an important curative treatment for children with high-risk hematologic malignancies, solid tumors, and, increasingly, nonmalignant diseases. Given improvements in care, there are a growing number of long-term survivors of pediatric HCT. Compared with childhood cancer survivors who did not undergo transplantation, HCT survivors have a substantially increased burden of serious chronic conditions and impairments involving virtually every organ system and overall quality of life. This likely reflects the joint contributions of pretransplantation treatment exposures and organ dysfunction, the transplantation conditioning regimen, and any post-transplantation graft-versus-host disease (GVHD). In response, the Children's Oncology Group (COG) has created long-term follow-up guidelines (www.survivorshipguidelines.org) for survivors of childhood, adolescent, and young adult cancer, including those who were treated with HCT. Guideline task forces, consisting of HCT specialists, other pediatric oncologists, radiation oncologists, organ-specific subspecialists, nurses, social workers, other health care professionals, and patient advocates systematically reviewed the literature with regards to late effects after childhood cancer and HCT since 2002, with the most recent review completed in 2013. For the most recent review cycle, over 800 articles from the medical literature relevant to childhood cancer and HCT survivorship were reviewed, including 586 original research articles. Provided herein is an organ system-based overview that emphasizes the most relevant COG recommendations (with accompanying evidence grade) for the long-term follow-up care of childhood HCT survivors (regardless of current age) based on a rigorous review of the available evidence. These recommendations cover both autologous and allogeneic HCT survivors, those who underwent transplantation for nonmalignant diseases, and those with a history of chronic GVHD.
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Affiliation(s)
- Eric J Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, Washington.
| | - Lynnette Anderson
- Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - K Scott Baker
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregory M T Guilcher
- Departments of Oncology and Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer T Huang
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wendy Pelletier
- Departments of Oncology and Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Joanna L Perkins
- Department of Cancer and Blood Disorders, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota
| | - Linda S Rivard
- Department of Pediatric Hematology Oncology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Tal Schechter
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ami J Shah
- Division of Stem Cell Transplant and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford University, Stanford, California
| | - Karla D Wilson
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Kenneth Wong
- Department of Radiation Oncology, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, California
| | - Satkiran S Grewal
- Department of Pediatrics, Baystate Children's Hospital, Tufts University School of Medicine, Springfield, Massachusetts
| | - Saro H Armenian
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Lillian R Meacham
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sharon M Castellino
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
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16
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Cupit MC, Duncan C, Savani BN, Hashmi SK. Childhood to adult transition and long-term follow-up after blood and marrow transplantation. Bone Marrow Transplant 2015; 51:176-81. [DOI: 10.1038/bmt.2015.228] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 07/21/2015] [Accepted: 08/20/2015] [Indexed: 12/24/2022]
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17
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Han JW, Kim HS, Hahn SM, Jin SL, Shin YJ, Kim SH, Lee YS, Lee J, Lyu CJ. Poor bone health at the end of puberty in childhood cancer survivors. Pediatr Blood Cancer 2015; 62:1838-43. [PMID: 25970742 DOI: 10.1002/pbc.25581] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/06/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although the survival rate following childhood cancer is >80%, late effects are a major concern. We aimed to determine the clinical factors affecting bone health after puberty in childhood cancer survivors at risk for low bone mineral density (BMD). PROCEDURES We performed dual-energy X-ray absorptiometry at the lumbar spine, femoral neck, and total hip regions for survivors with the following bone densitometry indications (BDIXs): brain or nasopharyngeal cancer, head or neck area radiotherapy, or corticosteroid treatment (N = 92). Additionally, we evaluated 16 survivors without these BDIXs but with other clinical factors that could affect bone health. We assessed the effects of these factors on BMD using univariate and logistic regression analyses. Moderate BMD deficit was defined as a Z-score of <-1.0 and ≥-2.0, and severe BMD deficit was defined as <-2.0. RESULTS Severe BMD deficits were found in 18 survivors (16.7%) and moderate BMD deficits were in 39 (36.1%) in at least one bone region. BMD deficits tended to increase as the number of BDIXs increased (P < 0.010). There were no severe BMD deficits in survivors without BDIXs. The duration since cancer treatment completion was correlated with higher BMD (P < 0.05). Endocrine dysfunction was a significant risk factor for decreased BMD in univariate and multivariate analyses (P < 0.05 for both). CONCLUSIONS Decreased BMD was prevalent in our study cohort. Endocrine dysfunction was found to be a significant risk factor, and it should be managed in survivors to ensure future bone health.
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Affiliation(s)
- Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.,Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Hyo Sun Kim
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.,Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Seung Min Hahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.,Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Song Lee Jin
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.,Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Yoon Jung Shin
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.,Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Sun Hee Kim
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.,Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Yoon Sun Lee
- Department of Pharmacy, Yonsei University Health System, Seoul, Korea
| | - Jin Lee
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.,Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.,Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
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18
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Vitanza NA, Hogan LE, Zhang G, Parker RI. The Progression of Bone Mineral Density Abnormalities After Chemotherapy for Childhood Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2015; 37:356-61. [PMID: 25222061 DOI: 10.1097/mph.0000000000000263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although reduced bone mineral density in survivors of childhood acute lymphoblastic leukemia (ALL) is well documented, the degree of demineralization and relation to age are not well described. This is a retrospective chart analysis of 58 patients consecutively treated for ALL without relapse, cranial irradiation, or transplantation. Bone mineral densities were measured by dual-energy x-ray absorptiometry and patients were divided by sex and age (≤5, 6 to 10, and >10 y) at diagnosis. Serial scans for 6 years after therapy were analyzed as Z-scores. Over 6 years after therapy, 93.1% of patients exhibited a decreased Z-score in at least 1 anatomic site. The difference in Z-score among the age cohorts was significant at both the lumbar spine and femoral neck. Patients older than 10 years at diagnosis had the lowest Z-scores: -2.78 and -2.87 for boys and -2.39 and -2.91 for girls at the lumbar spine and femoral neck, respectively. Children after ALL therapy exhibit a significant bone mineral deficit shortly after completion of therapy that persists for at least 6 years. The degree of bone demineralization can be followed up by a dual-energy x-ray absorptiometry scan and is most severe in patients older than 10 years at the initiation of therapy.
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Affiliation(s)
- Nicholas A Vitanza
- *Department of Pediatrics, Division of Pediatric Hematology/Oncology, Stony Brook Long Island Children's Hospital †Department of Preventative Medicine, Stony Brook University, Stony Brook, NY
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19
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de Berranger E, Jubert C, Michel G. [Post-hematopietic stem cell transplant complications]. Bull Cancer 2015; 102:648-55. [PMID: 25962541 DOI: 10.1016/j.bulcan.2015.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/09/2015] [Indexed: 12/28/2022]
Abstract
Under the long-term monitoring of patients treated in childhood or adolescence for cancer, we present in this article the long-term monitoring and therefore possible effects of patients who underwent allergenic hematopoietic stem cell transplantation. This article is based on a collaborative effort organized by the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC), which took place during the 4th day of allograft harmonization practices. Patients affected are children and young adults (0-25 years). We defined the monitoring effects beyond 1 year post-transplant. Our recommendations are based on a literature review, in line with the Leucémie Enfant Adulte (LEA) study cohort of long-term monitoring of patients treated for hematological malignancies in childhood, grafted or not. It became important to determine the nature of problems, their risk factors, frequency and monitoring necessary to implement for their detection. We will not address the therapeutic management of sequelae.
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Affiliation(s)
- Eva de Berranger
- Hôpital Jeanne-de-Flandre, unité d'hématologie pédiatrique, avenue Eugène-Avinée, 59037 Lille cedex, France.
| | - Charlotte Jubert
- Groupe hospitalier Pellegrin, hôpital des enfants, unité d'oncohématologie pédiatrique, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - Gérard Michel
- AP-HM, hôpital d'enfant de la Timone, service d'hématologie et oncologie pédiatrique, boulevard Jean-Moulin, 13385 Marseille cedex 05, France; AP-HM, Aix-Marseille université, département d'épidémiologie et économie de la santé publique et des maladies chroniques et de la qualité de l'unité de recherche sur la vie (EA3279), SPMC EA3279, 13385 Marseille cedex 05, France
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20
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Winther JF, Kenborg L, Byrne J, Hjorth L, Kaatsch P, Kremer LCM, Kuehni CE, Auquier P, Michel G, de Vathaire F, Haupt R, Skinner R, Madanat-Harjuoja LM, Tryggvadottir L, Wesenberg F, Reulen RC, Grabow D, Ronckers CM, van Dulmen-den Broeder E, van den Heuvel-Eibrink MM, Schindler M, Berbis J, Holmqvist AS, Gudmundsdottir T, de Fine Licht S, Bonnesen TG, Asdahl PH, Bautz A, Kristoffersen AK, Himmerslev L, Hasle H, Olsen JH, Hawkins MM. Childhood cancer survivor cohorts in Europe. Acta Oncol 2015; 54:655-68. [PMID: 25813473 DOI: 10.3109/0284186x.2015.1008648] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
With the advent of multimodality therapy, the overall five-year survival rate from childhood cancer has improved considerably now exceeding 80% in developed European countries. This growing cohort of survivors, with many years of life ahead of them, has raised the necessity for knowledge concerning the risks of adverse long-term sequelae of the life-saving treatments in order to provide optimal screening and care and to identify and provide adequate interventions. Childhood cancer survivor cohorts in Europe. Considerable advantages exist to study late effects in individuals treated for childhood cancer in a European context, including the complementary advantages of large population-based cancer registries and the unrivalled opportunities to study lifetime risks, together with rich and detailed hospital-based cohorts which fill many of the gaps left by the large-scale population-based studies, such as sparse treatment information. Several large national cohorts have been established within Europe to study late effects in individuals treated for childhood cancer including the Nordic Adult Life after Childhood Cancer in Scandinavia study (ALiCCS), the British Childhood Cancer Survivor Study (BCCSS), the Dutch Childhood Oncology Group (DCOG) LATER study, and the Swiss Childhood Cancer Survivor Study (SCCSS). Furthermore, there are other large cohorts, which may eventually become national in scope including the French Childhood Cancer Survivor Study (FCCSS), the French Childhood Cancer Survivor Study for Leukaemia (LEA), and the Italian Study on off-therapy Childhood Cancer Survivors (OTR). In recent years significant steps have been taken to extend these national studies into a larger pan-European context through the establishment of two large consortia - PanCareSurFup and PanCareLIFE. The purpose of this paper is to present an overview of the current large, national and pan-European studies of late effects after childhood cancer. This overview will highlight the strong cooperation across Europe, in particular the EU-funded collaborative research projects PanCareSurFup and PanCareLIFE. Overall goal. The overall goal of these large cohort studies is to provide every European childhood cancer survivor with better care and better long-term health so that they reach their full potential, and to the degree possible, enjoy the same quality of life and opportunities as their peers.
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21
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Bechard LJ, Gordon C, Feldman HA, Venick R, Gura K, Guinan EC, Duggan C. Bone loss and vitamin D deficiency in children undergoing hematopoietic cell transplantation. Pediatr Blood Cancer 2015; 62:687-92. [PMID: 25630874 PMCID: PMC4743025 DOI: 10.1002/pbc.25370] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 11/03/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hematopoietic cell transplantation (HCT) may be detrimental to bone health and vitamin D status in children. PROCEDURE We conducted a prospective, multicenter cohort study to identify changes in bone health markers during the first 100 days after allogeneic HCT in 26 children. Bone mineral density (BMD), bone mineral content (BMC), and serum 25-hydroxyvitamin D (25OHD) concentrations were measured at baseline, 30 days, and 100 days after HCT. RESULTS Mean (SD) BMD and BMC Z-scores (-0.48 ± 1.09 and -0.98 ± 1.26, respectively) were normal at baseline. Repeated-measures analysis revealed significant declines in BMD and BMC Z-scores over the 100 day study period, when adjusted for age, sex, Tanner stage, lean mass, fat mass, resting energy expenditure, total energy intake, insulin sensitivity, serum phosphorus, and inpatient steroid intake. Adjusted mean (SE) 25OHD concentrations declined from 29.2 (3.1) ng/ml at baseline, to 17.7 (1.8) ng/ml at 100 days after HCT. Vitamin D deficiency (25OHD <20 ng/ml) was present in 50% of patients 100 days after HCT. CONCLUSIONS Significant bone loss and vitamin D deficiency occur in children in the first 100 days following allogeneic HCT. Strategies to diminish acute bone loss during HCT in children are needed.
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Affiliation(s)
- Lori J. Bechard
- Center for Nutrition, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA
,Dana-Farber Cancer Institute, Boston, MA
,Correspondence to: Center for Nutrition, Boston Children’s Hospital, 333 Longwood Avenue, Boston, MA 02115.
| | | | - Henry A. Feldman
- Center for Nutrition, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA
| | | | - Kathleen Gura
- Center for Nutrition, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA
| | | | - Christopher Duggan
- Center for Nutrition, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA
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Hashmi S, Carpenter P, Khera N, Tichelli A, Savani BN. Lost in Transition: The Essential Need for Long-Term Follow-Up Clinic for Blood and Marrow Transplantation Survivors. Biol Blood Marrow Transplant 2015; 21:225-32. [DOI: 10.1016/j.bbmt.2014.06.035] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/30/2014] [Indexed: 12/28/2022]
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den Hoed MAH, Klap BC, te Winkel ML, Pieters R, van Waas M, Neggers SJCMM, Boot AM, Blijdorp K, van Dorp W, Pluijm SMF, van den Heuvel-Eibrink MM. Bone mineral density after childhood cancer in 346 long-term adult survivors of childhood cancer. Osteoporos Int 2015; 26:521-9. [PMID: 25209410 DOI: 10.1007/s00198-014-2878-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 08/27/2014] [Indexed: 12/12/2022]
Abstract
SUMMARY More than 45 % of long-term childhood cancer survivors (CCS) were diagnosed with osteopenia. Our data suggest that greater awareness for osteopenia is warranted in long-term CCS, especially in survivors who are older than 30 years, male, and underweight and were treated with cranial-spinal radiotherapy and/or steroids. INTRODUCTION Osteopenia is a potential complication of childhood cancer treatment, but the magnitude of this problem in survivors is unknown. We examined (determinants of) bone mineral density (BMD) status in long-term survivors of adult childhood cancer. METHODS This retrospective single-centre cohort study included 346 subjects with the most common types of childhood cancer. Subjects had a median age at diagnosis of 7.0 years (range 0.1-16.8 years), a median age at follow-up of 24.5 years (range 18.0-47.6 years) and a median follow-up time of 16.7 years (range 5.6-39.9 years). Total body BMD (BMDTB) and BMD of the lumbar spine (BMDLS) were measured by dual X-ray absorptiometry. Osteopenia was defined as BMD standardized deviation score (SDS) below -1. RESULTS Survivors had a lower BMDTB and BMDLS (mean SDS -0.55; p<0.001 and -0.30; p<0.001, respectively) as compared to healthy peers. Osteopenia (BMDTB and/or BMDLS) was present in 45% of the survivors. Multivariate logistic regression analyses identified age at diagnosis<12 years, age>30 years at follow-up, male gender, underweight at follow-up and treatment with cranial-spinal radiotherapy or prednisone as independent prognostic factors for osteopenia. CONCLUSIONS This large cohort of childhood cancer survivors identified osteopenia in 45% of CCS. This indicates that greater awareness is warranted, especially in survivors who are older than 30 years, male, have underweight and were treated with cranial-spinal radiotherapy and/or steroids.
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Affiliation(s)
- M A H den Hoed
- Department of Paediatric Oncology/Haematology, Erasmus University Medical Center (Erasmus MC)-Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
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Vantyghem MC, Cornillon J, Decanter C, Defrance F, Karrouz W, Leroy C, Le Mapihan K, Couturier MA, De Berranger E, Hermet E, Maillard N, Marcais A, Francois S, Tabrizi R, Yakoub-Agha I. Management of endocrino-metabolic dysfunctions after allogeneic hematopoietic stem cell transplantation. Orphanet J Rare Dis 2014; 9:162. [PMID: 25496809 PMCID: PMC4243320 DOI: 10.1186/s13023-014-0162-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/09/2014] [Indexed: 12/31/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation is mainly indicated in bone marrow dysfunction related to blood diseases, but also in some rare diseases (adrenoleucodystrophy, mitochondrial neurogastrointestinal encephalomyopathy or MNGIE…). After decades, this treatment has proven to be efficient at the cost of numerous early and delayed side effects such as infection, graft-versus-host disease, cardiovascular complications and secondary malignancies. These complications are mainly related to the conditioning, which requires a powerful chemotherapy associated to total body irradiation (myelo-ablation) or immunosuppression (non myelo-ablation). Among side effects, the endocrine complications may be classified as 1) hormonal endocrine deficiencies (particularly gonado- and somatotropic) related to delayed consequences of chemo- and above all radiotherapy, with their consequences on growth, puberty, bone and fertility); 2) auto-immune diseases, particularly dysthyroidism; 3) secondary tumors involving either endocrine glands (thyroid carcinoma) or dependent on hormonal status (breast cancer, meningioma), favored by immune dysregulation and radiotherapy; 4) metabolic complications, especially steroid-induced diabetes and dyslipidemia with their increased cardio-vascular risk. These complications are intricate. Moreover, hormone replacement therapy can modulate the cardio-vascular or the tumoral risk of patients, already increased by radiotherapy and chemotherapy, especially steroids and anthracyclins… Therefore, patients and families should be informed of these side effects and of the importance of a long-term follow-up requiring a multidisciplinary approach.
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Bone mineral density, thyroid function, and gonadal status in young adult survivors of childhood cancer. Contemp Oncol (Pozn) 2014; 19:142-7. [PMID: 26034393 PMCID: PMC4444441 DOI: 10.5114/wo.2014.44123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/24/2014] [Accepted: 06/04/2014] [Indexed: 11/21/2022] Open
Abstract
Introduction During the last years, changes in the diagnosis and treatment have caused a significant increase of the number of young adults who experienced cancer in childhood. This enlarging population is affected by many health problems, including multiple hormone deficiencies and bone mineral deficits. This is the first polish study assessing bone mineral density and endocrine status in young adult cancer survivors. Material and methods A total of 76 long-term survivors treated for pediatric cancer were identified. The mean age at the time of study was 24.1 ±3.5 years. Bone mineral density and TSH, fT3, fT4, FSH, LH, estradiol and testosterone level were assessed for each patient. Results Nine subjects were diagnosed with subclinical hypothyroidism. We found higher level of TSH in the study group, in comparison with control group (p = 0.015). Eighteen patients had increased level of FSH. In the study group higher number of patients with high FSH level was found in comparison with the control group (p = 0.049). A low BMD was observed in 7 patients whereas mild BMD deficits were found in 19 participants. Conclusions In conclusion, our data show that young adult cancer survivors might experienced various hormonal problems including low bone mass, thyroid impairment and gonadal dysfunction. Some of the patients required treatment, but they were not diagnosed before this study. There is the lack of proper clinical assessment among adult childhood cancer survivors in Poland. Therefore, we demonstrated the need for a comprehensive plan for longitudinal follow-up for late effects in these population.
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Ness KK, Kaste SC, Zhu L, Pui CH, Jeha S, Nathan PC, Inaba H, Wasilewski-Masker K, Shah D, Wells RJ, Karlage RE, Robison LL, Cox CL. Skeletal, neuromuscular and fitness impairments among children with newly diagnosed acute lymphoblastic leukemia. Leuk Lymphoma 2014; 56:1004-11. [PMID: 25030039 DOI: 10.3109/10428194.2014.944519] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study describes skeletal, neuromuscular and fitness impairments among 109 children (median age 10 [range 4-18] years, 65.1% male, 63.3% white) with acute lymphoblastic leukemia (ALL). Outcomes were measured 7-10 days after diagnosis and compared to age- and sex-specific expected values. Associations between function and health-related quality of life (HRQL) were evaluated with logistic regression. Children with ALL had sub-optimal bone mineral density (BMD) Z-score/height (mean ± standard error: - 0.53 ± 0.16 vs. 0.00 ± 0.14, p < 0.01), body mass index percentile (57.6 ± 3.15 vs. 50.0 ± 3.27%, p = 0.02), quadriceps strength (201.9 ± 8.3 vs. 236.1 ± 5.4 N, p < 0.01), 6 min walk distance (385.0 ± 13.1 vs. 628.2 ± 7.1 m, p < 0.001) and Bruininks-Oseretsky Test of Motor Proficiency scores (23 ± 2.5 vs. 50 ± 3.4%, p < 0.01). Quadriceps weakness was associated with a 20.9-fold (95% confidence interval 2.5-173.3) increase in poor physical HRQL. Children with newly diagnosed ALL have weakness and poor endurance and may benefit from early rehabilitation that includes strengthening and aerobic conditioning.
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Affiliation(s)
- Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital , Memphis, TN , USA
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de Berranger E, Michel G, Fahd M, Gandemer V, Jubert C, Marie-Cardine A, Pochon C, Rohrlich PS, Sirvent A, Cartigny M, Deschildre A, Yakoub-Agha I. [Managing late-effects after allogeneic stem cell transplantation in children: recommendations from the SFGM-TC]. ACTA ACUST UNITED AC 2014; 62:212-7. [PMID: 24973860 DOI: 10.1016/j.patbio.2014.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 05/14/2014] [Indexed: 02/05/2023]
Abstract
In this report, we address the issue of late-effects after allogeneic stem cell transplantation in children. In an effort to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the fourth annual series of workshops which brought together practitioners from all member centers and took place in September 2013 in Lille.
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Affiliation(s)
- E de Berranger
- Service d'hématologie pédiatrique, hôpital Jeanne-de-Flandre, CHRU, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - G Michel
- Service d'hématologie pédiatrique, hôpital d'Enfants de la Timone, boulevard Jean-Moulin, 13385 Marseille cedex 05, France
| | - M Fahd
- Unité d'hématologie-immunologie, hôpital Robert-Debré, 48, boulevard Serrurier, 75019 Paris, France
| | - V Gandemer
- Service d'hémato-oncologie pédiatrique, hôpital Sud, 16, boulevard de Bulgarie, BP 56129, 35056 Rennes cedex, France
| | - C Jubert
- Unité d'onco-hématologique pédiatrique, hôpital des Enfants, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - A Marie-Cardine
- Service d'immuno-hémato-oncologie pédiatrique, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - C Pochon
- Hématologie, unité de transplantation médullaire allogénique, CHU de Nancy, avenue de la Forêt-de-Haye, 54500 Vandœuvre-Lès-Nancy, France
| | - P S Rohrlich
- Médecine interne-hématologie, clinique hôpital de l'Archet, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice cedex 03, France
| | - A Sirvent
- Hématologie et d'oncologie médicale, hôpital Lapeyronie, CHU, avenue du Doyen-Giraud, 34275 Montpellier cedex, France
| | - M Cartigny
- Service d'endocrinologie pédiatrique, pôle Enfant, hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - A Deschildre
- Service de pneumologie pédiatrique, pôle Enfant, hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - I Yakoub-Agha
- Maladies du sang, CHRU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France.
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Fin de chimiothérapie dans les hémopathies malignes, et après ? Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Berbis J, Michel G, Baruchel A, Bertrand Y, Chastagner P, Demeocq F, Kanold J, Leverger G, Plantaz D, Poirée M, Stephan JL, Auquier P, Contet A, Dalle JH, Ducassou S, Gandemer V, Lutz P, Sirvent N, Tabone MD, Thouvenin-Doulet S. Cohort Profile: the French childhood cancer survivor study for leukaemia (LEA Cohort). Int J Epidemiol 2014; 44:49-57. [PMID: 24639445 DOI: 10.1093/ije/dyu031] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The main aim of the Leucémies de l'Enfant et l'Adolescent (LEA) project (Childhood and Adolescent Leukaemia) is to study the determinants (medical, socioeconomic, behavioural and environmental) of medium- and long-term outcomes of patients treated for childhood acute leukaemia (AL). The LEA study began in 2004 and is based on a French multicentric prospective cohort. Included are children treated for AL since January 1980 (incident and prevalent cases), surviving at month 24 for myeloblastic AL and lymphoblastic AL grafted in first complete remission or at month 48 for lymphoblastic AL not grafted in first complete remission. Information is collected during specific medical visits and notably includes the following data: socioeconomic data, AL history, physical late effects (such as fertility, cardiac function and metabolic syndrome) and quality of life. Data are collected every 2 years until the patient is 20 years old and has had a 10-year follow-up duration from diagnosis or last relapse. Thereafter, assessments are planned every 4 years. In active centres in 2013, eligible patients number more than 3000. The cohort has already included 2385 survivors, with rate of exhaustiveness of almost 80%. Data access can be requested from principal coordinators and must be approved by the steering committee.
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Affiliation(s)
- Julie Berbis
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Gérard Michel
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - André Baruchel
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric
| | - Yves Bertrand
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pascal Chastagner
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - François Demeocq
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Justyna Kanold
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Guy Leverger
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Dominique Plantaz
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Marilyne Poirée
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Louis Stephan
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pascal Auquier
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Audrey Contet
- Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France
| | - Jean-Hugues Dalle
- Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France
| | - Stéphane Ducassou
- Department of Paediatric Onco-haematology, University Hospital of Bordeaux, Bordeaux, France
| | - Virginie Gandemer
- Department of Paediatric Onco-haematology, University Hospital of Rennes, Rennes, France
| | - Patrick Lutz
- Department of Paediatric Onco-haematology, University Hospital of Strasbourg, Strasbourg, France
| | - Nicolas Sirvent
- Department of Paediatric Onco-haematology, University Hospital of Montpellier, Montpellier, France
| | - Marie-Dominique Tabone
- Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France
| | - Sandrine Thouvenin-Doulet
- Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
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Bernard F, Auquier P, Herrmann I, Contet A, Poiree M, Demeocq F, Plantaz D, Galambrun C, Barlogis V, Berbis J, Garnier F, Sirvent N, Kanold J, Chastagner P, Chambost H, Michel G. Health status of childhood leukemia survivors who received hematopoietic cell transplantation after BU or TBI: an LEA study. Bone Marrow Transplant 2014; 49:709-16. [PMID: 24535128 DOI: 10.1038/bmt.2014.3] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 12/15/2013] [Accepted: 12/20/2013] [Indexed: 01/03/2023]
Abstract
The purpose of this multicenter study was to compare the long-term impact of a preparative regimen with either BUBU or TBI on health status and quality of life (QoL) in childhood acute leukemia survivors treated with hematopoietic SCT (HSCT). Two-hundred and forty patients were included. Sixty-six had received BU, while 174 had received TBI. Median follow-up from HSCT was 10.1 years. Multivariate analyses were performed to assess the occurrence of late effects according to treatment. QoL was assessed in 130 adults using SF-36 questionnaires. Patients developed fewer late complications after BU (2.35 vs 3.01, P=0.03) while the risk to present with at least one complication was equivalent in both groups (87.9% after BU and 93.1% after TBI, P=0.66). Detailed multivariate analyses revealed a lower risk of height growth failure (OR=0.2), cataract (OR=0.1) and iron overload (OR=0.2) after BU, and an increased risk of overweight (OR=3.9) and alopecia (OR=11.2). SF-36 mental and physical composite scores were similar in both treatment groups and proved significantly lower than French norms. Late effects induced by BU might differ from those experienced after TBI. Although less frequent, they are still of considerable importance and may affect patients' QoL.
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Affiliation(s)
- F Bernard
- Department of Pediatric Hematology-Oncology, La Timone Children's Hospital, Marseille, France
| | - P Auquier
- Department of Public Health -EA 3279 Research Unit, University Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - I Herrmann
- Department of Pediatric Hematology-Oncology, La Timone Children's Hospital, Marseille, France
| | - A Contet
- Department of Pediatric Hematology-Oncology, Brabois Children's Hospital, Vandoeuvre-Les-Nancy, France
| | - M Poiree
- Department of Pediatric Hematology-Oncology, L'Archet II Hospital, Nice, France
| | - F Demeocq
- Department of Pediatric Hematology-Oncology, CIC Inserm 501, University Hospital of Clermont Ferrand, Clermont-Ferrand, France
| | - D Plantaz
- Department of Pediatric Hematology-Oncology, University Hospital of Grenoble, Grenoble, France
| | - C Galambrun
- Department of Pediatric Hematology-Oncology, La Timone Children's Hospital, Marseille, France
| | - V Barlogis
- Department of Pediatric Hematology-Oncology, La Timone Children's Hospital, Marseille, France
| | - J Berbis
- Department of Public Health -EA 3279 Research Unit, University Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - F Garnier
- Department of Public Health -EA 3279 Research Unit, University Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - N Sirvent
- Department of Pediatric Hematology-Oncology, Arnaud de Villeneuve Hospital, Montpellier, France
| | - J Kanold
- Department of Pediatric Hematology-Oncology, CIC Inserm 501, University Hospital of Clermont Ferrand, Clermont-Ferrand, France
| | - P Chastagner
- Department of Pediatric Hematology-Oncology, Brabois Children's Hospital, Vandoeuvre-Les-Nancy, France
| | - H Chambost
- Department of Pediatric Hematology-Oncology, La Timone Children's Hospital, Marseille, France
| | - G Michel
- 1] Department of Pediatric Hematology-Oncology, La Timone Children's Hospital, Marseille, France [2] Department of Public Health -EA 3279 Research Unit, University Hospital of Marseille, Aix-Marseille University, Marseille, France
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31
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Alloin AL, Barlogis V, Auquier P, Contet A, Poiree M, Demeocq F, Herrmann I, Villes V, Bertrand Y, Plantaz D, Kanold J, Chastagner P, Chambost H, Sirvent N, Michel G. Prevalence and risk factors of cataract after chemotherapy with or without central nervous system irradiation for childhood acute lymphoblastic leukaemia: an LEA study. Br J Haematol 2013; 164:94-100. [DOI: 10.1111/bjh.12598] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/03/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Anne-Lise Alloin
- Department of Paediatric Haematology-Oncology; APHM; La Timone Hospital; Aix-Marseille University; Marseille France
| | - Vincent Barlogis
- Department of Paediatric Haematology-Oncology; APHM; La Timone Hospital; Aix-Marseille University; Marseille France
| | - Pascal Auquier
- Department of Public Health -EA 3279 Research Unit; University Hospital Marseille; Aix-Marseille University; Marseille France
| | - Audrey Contet
- Department of Paediatric Haematology-Oncology; University Hospital of Nancy; Nancy France
| | - Maryline Poiree
- Department of Paediatric Haematology-Oncology; University Hospital of Nice; Nice France
| | - François Demeocq
- Department of Paediatric Haematology-Oncology; CIC Inserm 501; University Hospital of Clermont Ferrand; Clermont Ferrand France
| | - Iris Herrmann
- Department of Paediatric Haematology-Oncology; APHM; La Timone Hospital; Aix-Marseille University; Marseille France
| | - Virginie Villes
- Department of Public Health -EA 3279 Research Unit; University Hospital Marseille; Aix-Marseille University; Marseille France
| | - Yves Bertrand
- Department of Paediatric Haematology-Oncology; University Hospital of Lyon; Lyon France
| | - Dominique Plantaz
- Department of Paediatric Haematology-Oncology; University Hospital of Grenoble; Grenoble France
| | - Justyna Kanold
- Department of Paediatric Haematology-Oncology; CIC Inserm 501; University Hospital of Clermont Ferrand; Clermont Ferrand France
| | - Pascal Chastagner
- Department of Paediatric Haematology-Oncology; University Hospital of Nancy; Nancy France
| | - Hervé Chambost
- Department of Paediatric Haematology-Oncology; APHM; La Timone Hospital; Aix-Marseille University; Marseille France
| | - Nicolas Sirvent
- Department of Paediatric Haematology-Oncology; University Hospital of Montpellier; Montpellier France
| | - Gérard Michel
- Department of Paediatric Haematology-Oncology; APHM; La Timone Hospital; Aix-Marseille University; Marseille France
- Department of Public Health -EA 3279 Research Unit; University Hospital Marseille; Aix-Marseille University; Marseille France
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33
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Endocrine sequelae and metabolic syndrome in adult long-term survivors of childhood acute myeloid leukemia. Leuk Res 2013; 37:367-71. [DOI: 10.1016/j.leukres.2012.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/13/2012] [Accepted: 12/16/2012] [Indexed: 11/22/2022]
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34
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Brignardello E, Felicetti F, Castiglione A, Chiabotto P, Corrias A, Fagioli F, Ciccone G, Boccuzzi G. Endocrine health conditions in adult survivors of childhood cancer: the need for specialized adult-focused follow-up clinics. Eur J Endocrinol 2013; 168:465-72. [PMID: 23258270 DOI: 10.1530/eje-12-1043] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Survival rates among childhood cancer survivors (CCS) have enormously increased in the last 40 years. However, this improvement has been achieved at the expense of serious late effects that frequently involve the endocrine system. AIM To evaluate the cumulative incidence of endocrine diseases in a cohort of long-term CCS. MATERIALS AND METHODS We analyzed the clinical data of 310 adults, followed for a median time of 16.0 years after the first cancer diagnosis. The monitoring protocols applied to each patient were personalized on the basis of cancer diagnosis and previous treatments, according to the Children's Oncology Group guidelines. RESULTS The cumulative incidence of endocrine late effects steadily increased over time. At the last follow-up visit available, 48.46% of females and 62.78% of males were affected by at least one endocrine disease. The most common disorders were gonadal dysfunction, primary hypothyroidism, and GH deficiency (GHD). The main risk factors for endocrine disease were male sex (hazard ratio (HR)=1.45, 95% confidence interval (95% CI) 1.05-1.99), radiotherapy (HR=1.91, 95% CI 1.28-2.84), hematopoietic stem cells transplantation (HR=3.11, 95% CI 2.23-4.34), and older age at cancer diagnosis (HR=1.89, 95% CI 1.25-2.85). Male sex was associated with a higher risk of gonadal disorders, whereas radiotherapy specifically increased the risk of GHD and thyroid dysfunction. CONCLUSIONS Endocrine disorders among CCS have a high prevalence and increase over time. Thus, endocrinologists need to cope with an increasing demand for health care in a field that is still little developed and that, in perspective, could also be extended to some selected types of adult cancer survivors.
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Affiliation(s)
- E Brignardello
- Transition Unit for Childhood Cancer Survivors, San Giovanni Battista Hospital, Via Cherasco 15, 10126 Turin, Italy.
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Kang MJ, Lim JS. Bone mineral density deficits in childhood cancer survivors: Pathophysiology, prevalence, screening, and management. KOREAN JOURNAL OF PEDIATRICS 2013; 56:60-7. [PMID: 23482662 PMCID: PMC3589592 DOI: 10.3345/kjp.2013.56.2.60] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/09/2012] [Indexed: 11/29/2022]
Abstract
As chemotherapy and other sophisticated treatment strategies evolve and the number of survivors of long-term childhood cancer grows, the long-term complications of treatment and the cancer itself are becoming ever more important. One of the most important but often neglected complications is osteoporosis and increased risk of fracture during and after cancer treatment. Acquisition of optimal peak bone mass and strength during childhood and adolescence is critical to preventing osteoporosis later in life. However, most childhood cancer patients have multiple risk factors for bone mineral loss. Cancer itself, malnutrition, decreased physical activity during treatment, chemotherapeutic agents such as steroids, and radiotherapy cause bone mineral deficit. Furthermore, complications such as growth hormone deficiency and musculoskeletal deformity have negative effects on bone metabolism. Low bone mineral density is associated with fractures, skeletal deformity, pain, and substantial financial burden not only for childhood cancer survivors but also for public health care systems. Thus, it is important to monitor bone health in these patients and minimize their risk of developing osteoporosis and fragility fractures later in life.
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Affiliation(s)
- Min Jae Kang
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
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Mäkitie O, Heikkinen R, Toiviainen-Salo S, Henriksson M, Puukko-Viertomies LR, Jahnukainen K. Long-term skeletal consequences of childhood acute lymphoblastic leukemia in adult males: a cohort study. Eur J Endocrinol 2013. [PMID: 23197573 DOI: 10.1530/eje-12-0702] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Long-term health sequelae of childhood-onset acute lymphoblastic leukemia (ALL) remain largely unknown. Low bone mineral content (BMC) and bone mineral density (BMD) are recognized complications, but it is unknown whether these persist until adulthood. We evaluated skeletal characteristics and their association with ALL therapy in long-term male ALL survivors. DESIGN This cross-sectional cohort study included 49 long-term male ALL survivors and 55 age-matched healthy males. METHODS BMD and compression fractures were assessed by dual-energy X-ray absorptiometry; blood biochemistry was obtained for parameters of calcium homeostasis. RESULTS The ALL survivors (median age 29 years, range 25-38 years), assessed 10-38 years after ALL diagnosis, had lower lumbar spine (P<0.001), femoral neck (P<0.001), and whole-body (P=0.017) BMD than expected based on normative values. When compared with the controls (median age 30 years, range 24-36 years), the ALL survivors had lower lumbar spine BMC (P=0.014), lower whole-body BMC (P<0.001), and lower whole-body BMD (P<0.001), but the differences were partly explained by differences in height. Altogether, 20% of the ALL survivors had spinal compression fractures, but these were equally prevalent in the controls. Males diagnosed with ALL before age 5 years had significantly lower BMD values. Other recognized risk factors included untreated hypogonadism, vitamin D deficiency, hypophosphatemia, low IGF-binding protein-3, and low physical activity. CONCLUSIONS At young adulthood, long-term male ALL survivors have significantly reduced BMC and BMD and a high prevalence of spinal compression fractures. Careful follow-up and active treatment of the recognized risk factors are warranted.
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Affiliation(s)
- O Mäkitie
- Division of Pediatric Endocrinology and Metabolic Bone Diseases, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, PO Box 281, FIN-00029 Helsinki, Finland.
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