1
|
Kemps PG, Kester L, Scheijde-Vermeulen MA, van Noesel CJM, Verdijk RM, Diepstra A, van Marion AMW, Dors N, van den Bos C, Bruggink AH, Hogendoorn PCW, van Halteren AGS. Demographics and additional haematologic cancers of patients with histiocytic/dendritic cell neoplasms. Histopathology 2024; 84:837-846. [PMID: 38213281 DOI: 10.1111/his.15127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024]
Abstract
AIMS The discovery of somatic genetic alterations established many histiocytic disorders as haematologic neoplasms. We aimed to investigate the demographic characteristics and additional haematologic cancers of patients diagnosed with histiocytic disorders in The Netherlands. METHODS AND RESULTS We retrieved data on histiocytosis patients from the Dutch Nationwide Pathology Databank (Palga). During 1993 to 2022, more than 4000 patients with a pathologist-assigned diagnosis of a histiocytic disorder were registered in Palga. Xanthogranulomas were the most common subtype, challenging the prevailing assumption that Langerhans cell histiocytosis (LCH) is the most common histiocytic disorder. LCH and juvenile xanthogranuloma (JXG) had a peak incidence in the first years of life; males were overrepresented among all histiocytosis subgroups. 118 patients had a histiocytic disorder and an additional haematologic malignancy, including 107 (91%) adults at the time of histiocytosis diagnosis. In 16/118 patients, both entities had been analysed for the same genetic alteration(s). In 11 of these 16 patients, identical genetic alterations had been detected in both haematologic neoplasms. This included two patients with PAX5 p.P80R mutated B cell acute lymphoblastic leukaemia and secondary histiocytic sarcoma, further supporting that PAX5 alterations may predispose (precursor) B cells to differentiate into the myeloid lineage. All 4/11 patients with myeloid neoplasms as their additional haematologic malignancy had shared N/KRAS mutations. CONCLUSIONS This population-based study highlights the frequency of xanthogranulomas. Furthermore, our data add to the growing evidence supporting clonal relationships between histiocytic/dendritic cell neoplasms and additional myeloid or lymphoid malignancies. Particularly adult histiocytosis patients should be carefully evaluated for the development of these associated haematologic cancers.
Collapse
Affiliation(s)
- Paul G Kemps
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lennart Kester
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Carel J M van Noesel
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Robert M Verdijk
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Arjan Diepstra
- Department of Pathology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Natasja Dors
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Cor van den Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | - Astrid G S van Halteren
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Internal Medicine, Section Clinical Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
2
|
Schwartz ER, Rensen N, Steur LMH, Gemke R, van Eijkelenburg NKA, van der Sluis IM, Dors N, van den Bos C, Tissing WJE, Grootenhuis MA, Kaspers GJL, Van Litsenburg RRL. Health-related quality of life and its determinants during and after treatment for paediatric acute lymphoblastic leukaemia: a national, prospective, longitudinal study in the Netherlands. BMJ Open 2023; 13:e070804. [PMID: 37899146 PMCID: PMC10619055 DOI: 10.1136/bmjopen-2022-070804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/20/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES Health-related quality of life (HRQoL) is impaired in paediatric patients with acute lymphoblastic leukaemia (ALL). Over the past decades, ALL treatment has successfully been adjusted to the risk of relapse, which is now reflected by the stratification of patients into three risk groups who receive treatment of differing intensities. This study is the first to evaluate the longitudinal course of HRQoL in light of these adjustments and identify determinants of HRQoL. DESIGN Two prospective, national cohort studies (add-on studies within the two most recent treatment protocols for children with ALL (ALL-10 and ALL-11)). SETTING Dutch paediatric oncology hospitals between October 2006 and October 2009 (ALL-10) and between August 2013 and July 2017 (ALL-11). PARTICIPANTS Patients with ALL (2-18 years) are treated according to the ALL-10 or ALL-11 treatment protocol. Patients treated according to the ALL-10 protocol only completed a cancer-specific QoL measure and patients treated according to the ALL-11 protocol completed both a cancer-specific and generic QoL measure (see below). OUTCOME MEASURES HRQoL, assessed with parent-proxy questionnaires (PedsQL Generic and Cancer module) within the first 5 months (T0), at 1 year (T1), 2 years (T2) and 3 years (T3) after diagnosis. The proportion of patients with clinically relevant generic HRQoL impairment was compared with healthy norm values. Multivariable mixed model analyses were used to evaluate the development of HRQoL over time and its medical and sociodemographic determinants (collected on enrolment). RESULTS Of the ALL-10 cohort, 132 families participated and of the ALL-11 cohort, 136 families participated (268 total). Thus, cancer-specific HRQoL assessments were available for 268 patients (median age 5.3 years (IQR 6.15), 56.0% boys, 69.0% medium-risk ALL), and generic HRQoL assessments for 136 patients (median age 4.8 years (IQR 6.13), 60.3% boys, 75.0% medium-risk ALL). Generic HRQoL improved between timepoints T0 and T3 (total score B 16.1, 95% CI 12.2 to 20.1, p<0.001), but did not restore to normal 1 year after the end of treatment: 28.0% of children remained impaired compared with 16% in the general population (p=0.003). Cancer-specific HRQoL generally improved from T0 to T2 (Pain B 11.3, 95% CI 7.1 to 15.5; Nausea B 11.7, 8.4 to 15.1; Procedural Anxiety B 19.1, 14.8 to 23.4; Treatment Anxiety B 12.8, 9.5 to 16.0; Worry B 3.5, 0.6 to 6.3; Communication B 8.5, 5.0 to 11.9; all p<0.001 except for Worry (p=0.02)), while Physical Appearance and Cognitive Functioning remained stable. Higher treatment intensity and experiencing pain or simultaneous chronic illness were associated with lower HRQoL over time for multiple subscales. CONCLUSIONS HRQoL impairment is prevalent during and after ALL treatment. Patients with standard-risk ALL and reduced treatment intensity have better HRQoL than patients in higher risk groups. Systematic monitoring of HRQoL is of utmost importance in order to provide timely psychosocial interventions and supportive care.
Collapse
Affiliation(s)
- Emily R Schwartz
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | - Niki Rensen
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Lindsay M H Steur
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | - Reinoud Gemke
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | | | - Inge M van der Sluis
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
| | - Natasja Dors
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Cor van den Bos
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wim J E Tissing
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Martha A Grootenhuis
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Raphaele R L Van Litsenburg
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| |
Collapse
|
3
|
van Gorp M, Irestorm E, Twisk JWR, Dors N, Mavinkurve-Groothuis A, Meeteren AYNSV, de Bont J, van den Bergh EMM, van der Meer WVDP, Beek LR, Aarsen FK, Streefkerk N, van Litsenburg RRL, Grootenhuis MA. The course of health-related quality of life after the diagnosis of childhood cancer: a national cohort study. BMC Cancer 2023; 23:855. [PMID: 37697253 PMCID: PMC10496372 DOI: 10.1186/s12885-023-11379-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Comprehensive insight in the longitudinal development of health-related quality of life (HRQOL) after childhood cancer diagnosis could improve quality of care. Thus, we aimed to study the course and biopsychosocial determinants of HRQOL in a unique national cohort of children with cancer. METHODS HRQOL of 2154 children with cancer was longitudinally reported (median: 3 reports) between diagnosis and 5 years after, using the pediatric quality of life inventory generic core scales (PedsQL). HRQOL was modelled over time since diagnosis using mixed model analysis for children 2-7 years (caregiver-reports) and ≥ 8 years (self-reports). Differences in the course between hematological, solid and central nervous system malignancies were studied. Additional associations of demographics, disease characteristics (age at diagnosis, relapse, diagnosis after the national centralization of childhood cancer care and treatment components) and caregiver distress (Distress thermometer) were studied. RESULTS Overall, HRQOL improved with time since diagnosis, mostly in the first years. The course of HRQOL differed between diagnostic groups. In children aged 2-7 years, children with a solid tumor had most favorable HRQOL. In children aged ≥ 8 years, those with a hematological malignancy had lower HRQOL around diagnosis, but stronger improvement over time than the other diagnostic groups. In both age-groups, the course of HRQOL of children with a CNS tumor showed little or no improvement. Small to moderate associations (β: 0.18 to 0.67, p < 0.05) with disease characteristics were found. Centralized care related to better HRQOL (β: 0.25 to 0.44, p < 0.05). Caregiver distress was most consistently associated with worse HRQOL (β: - 0.13 to - 0.48, p < 0.01). CONCLUSIONS The HRQOL course presented can aid in identifying children who have not fully recovered their HRQOL following cancer diagnosis, enabling early recognition of the issue. Future research should focus on ways to support children, especially those with a CNS tumor, for example by decreasing distress in their caregivers.
Collapse
Affiliation(s)
- Marloes van Gorp
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | - Elin Irestorm
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
- Faculty of Medicine, Department of Paediatrics, Lund University, Lund, Sweden
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Natasja Dors
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Judith de Bont
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Laura R Beek
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | - Femke K Aarsen
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | - Nienke Streefkerk
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | | | | |
Collapse
|
4
|
Pieters R, de Groot-Kruseman H, Fiocco M, Verwer F, Van Overveld M, Sonneveld E, van der Velden V, Beverloo HB, Bierings M, Dors N, de Haas V, Hoogerbrugge P, Van der Sluis I, Tissing W, Veening M, Boer J, Den Boer M. Improved Outcome for ALL by Prolonging Therapy for IKZF1 Deletion and Decreasing Therapy for Other Risk Groups. J Clin Oncol 2023; 41:4130-4142. [PMID: 37459571 DOI: 10.1200/jco.22.02705] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/30/2023] [Accepted: 05/12/2023] [Indexed: 07/20/2023] Open
Abstract
PURPOSE The ALL10 protocol improved outcomes for children with ALL by stratifying and adapting therapy into three minimal residual disease-defined risk groups: standard risk, medium risk (MR), and high risk. IKZF1-deleted (IKZF1del) ALL in the largest MR group still showed poor outcome, in line with protocols worldwide, accounting for a high number of overall relapses. ALL10 showed high toxicity in Down syndrome (DS) and excellent outcome in ETV6::RUNX1 ALL. Poor prednisone responders (PPRs) were treated as high risk in ALL10. In ALL11, we prolonged therapy for IKZF1del from 2 to 3 years. We reduced therapy for DS by omitting anthracyclines completely, for ETV6::RUNX1 in intensification, and for PPR by treatment as MR. METHODS Eight hundred nineteen patients with ALL (age, 1-18 years) were enrolled on ALL11 and stratified as in ALL10. Results were compared with those in ALL10. RESULTS The five-year overall survival (OS), event-free survival (EFS), cumulative risk of relapse (CIR), and death in complete remission on ALL11 were 94.2% (SE, 0.9%), 89.0% (1.2), 8.2% (1.1), and 2.3% (0.6), respectively. Prolonged maintenance for IKZF1del MR improved 5-year CIR by 2.2-fold (10.8% v 23.4%; P = .035) and EFS (87.1% v 72.3%; P = .019). Landmark analysis at 2 years from diagnosis showed a 2.9-fold reduction of CIR (25.6%-8.8%; P = .008) and EFS improvement (74.4%-91.2%; P = .007). Reduced therapy did not abrogate 5-year outcome for ETV6::RUNX1 (EFS, 98.3%; OS, 99.4%), DS (EFS, 87.0%; OS, 87.0%), and PPR (EFS, 81.1%; OS, 94.9%). CONCLUSION Children with IKZF1del ALL seem to benefit from prolonged maintenance therapy. Chemotherapy was successfully reduced for patients with ETV6::RUNX1, DS, and PPR ALL. It has to be noted that these results were obtained in a nonrandomized study using a historical control group.
Collapse
Affiliation(s)
- Rob Pieters
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Dutch Childhood Oncology Group (DCOG), Utrecht, the Netherlands
| | - Hester de Groot-Kruseman
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Dutch Childhood Oncology Group (DCOG), Utrecht, the Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Dutch Childhood Oncology Group (DCOG), Utrecht, the Netherlands
- Department of Biomedical Data Science, Section Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
- Mathematical Institute, Leiden University, Leiden, the Netherlands
| | - Femke Verwer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Dutch Childhood Oncology Group (DCOG), Utrecht, the Netherlands
| | | | - Edwin Sonneveld
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Dutch Childhood Oncology Group (DCOG), Utrecht, the Netherlands
| | | | - H Berna Beverloo
- Department of Clinical Genetics, Erasmus MC, Rotterdam, the Netherlands
| | - Marc Bierings
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Dutch Childhood Oncology Group (DCOG), Utrecht, the Netherlands
| | - Natasja Dors
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Valérie de Haas
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Dutch Childhood Oncology Group (DCOG), Utrecht, the Netherlands
| | | | | | - Wim Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Margreet Veening
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Judith Boer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Monique Den Boer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| |
Collapse
|
5
|
Steur LMH, Kaspers GJL, Van Someren EJW, Van Eijkelenburg NKA, Van der Sluis IM, Dors N, Van den Bos C, Tissing WJE, Grootenhuis MA, Van Litsenburg RRL. Sleep-wake rhythm disruption is associated with cancer-related fatigue in pediatric acute lymphoblastic leukemia. Sleep 2021; 43:5691200. [PMID: 31889198 PMCID: PMC7294409 DOI: 10.1093/sleep/zsz320] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/28/2019] [Indexed: 12/16/2022] Open
Abstract
Study Objectives To compare sleep–wake rhythms, melatonin, and cancer-related fatigue in pediatric patients with acute lymphoblastic leukemia (ALL) to healthy children and to assess the association between sleep–wake outcomes and cancer-related fatigue. Methods A national cohort of ALL patients (2–18 years) was included. Sleep–wake rhythms were measured using actigraphy and generated the following variables: Interdaily stability (IS): higher IS reflects higher stability; intradaily variability (IV): lower IV indicates less fragmentation; L5 and M10 counts: activity counts during the five least and 10 most active hours, respectively; and relative amplitude (RA): the ratio of L5 and M10 counts (higher RA reflects a more robust rhythm). The melatonin metabolite, 6-sulfatoxymelatonin (aMT6s), was assessed in urine. Cancer-related fatigue was assessed with the PedsQL Multidimensional Fatigue Scale. Using regression models sleep–wake rhythms, aMT6s, and cancer-related fatigue were compared to healthy children and associations between sleep–wake outcomes and cancer-related fatigue were assessed in ALL patients. Results In total, 126 patients participated (response rate: 67%). IS, RA, and M10 counts were lower in patients compared to healthy children (p < 0.001). aMT6s levels were comparable to healthy children (p = 0.425). Patients with ALL were more fatigued compared to healthy children (p < 0.001). Lower IS, RA and M10 counts and higher IV were significantly associated with more parent-reported cancer-related fatigue. Associations between sleep–wake rhythms and self-reported cancer-related fatigue were not statistically significant. Conclusions Sleep–wake rhythm impairment is associated with more cancer-related fatigue in pediatric ALL patients. Interventions aimed to improve sleep hygiene and encourage physical activity may reduce cancer-related fatigue.
Collapse
Affiliation(s)
- Lindsay M H Steur
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Gertjan J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Dutch Childhood Oncology Group, Utrecht, the Netherlands
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (An Institute of the Royal Netherlands Academy of Arts and Sciences), Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Amsterdam Neuroscience, Center for Neurogenomics and Cognitive Research (CNCR), VU University Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Inge M Van der Sluis
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Natasja Dors
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cor Van den Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Raphaële R L Van Litsenburg
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| |
Collapse
|
6
|
Smits BM, van Montfrans J, Merrill SA, van de Corput L, van Gijn M, de Vries A, van den Bos C, Abbink F, van der Molen RG, Dors N, Lindemans C, Boelens JJ, Nierkens S. A Minimal Parameter Set Facilitating Early Decision-making in the Diagnosis of Hemophagocytic Lymphohistiocytosis. J Clin Immunol 2021; 41:1219-1228. [PMID: 33779897 PMCID: PMC8310853 DOI: 10.1007/s10875-021-01005-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 02/23/2021] [Indexed: 12/11/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening immune dysregulation syndrome characterized by uncontrolled immune cell activation. Timely diagnosis is important, since early treatment can improve survival rates. However, completing all assessments needed to reach ≥5 positive criteria out of the 8 HLH-2004 criteria can be time consuming and may delay timely initiation of treatment. Hence, we applied a data-driven approach to identify a minimal parameter set for early decision-making towards the initiation of HLH-specific treatment. We retrospectively evaluated 165 patients from five Dutch tertiary hospitals with suspected HLH. Sixteen pHLH (median age 0.5 years) and 70 sHLH patients (median age 8.7 years) were identified using the HLH-2004 criteria. Clustering analysis and multi-receiver operator characteristics were used to identify parameters distinctive of HLH. The presence of either increased ferritin, cytopenia in ≥2 lineages, or splenomegaly distinguished HLH from non-HLH cases with a negative predictive value of 100%. A minimal parameter set consisting of 2 major criteria (phagocytosis and splenomegaly) and 3 minor criteria (cytopenia, increased ferritin, and increased triglycerides/low fibrinogen) predicted HLH with 95% (88-99) sensitivity and 94% (86-98) specificity. This finding was replicated in an independent retrospective validation cohort of 109 US patients (n = 109). By dividing a subset of the HLH-2004 criteria into major and minor criteria, this strategy uses the evaluation of less than 5 criteria to quickly identify patients with HLH. When confirmed in a prospective setting, this approach could be of value for timely diagnosis and treatment of HLH.
Collapse
Affiliation(s)
- Bas M Smits
- Center of Translational Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.,Department of Pediatric Immunology and Infectious Diseases, UMC Utrecht, Utrecht, The Netherlands
| | - Joris van Montfrans
- Department of Pediatric Immunology and Infectious Diseases, UMC Utrecht, Utrecht, The Netherlands
| | - Samuel A Merrill
- Division of Hematology/Oncology, West Virginia University, Morgantown, WV, USA
| | - Lisette van de Corput
- Center of Translational Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Mariëlle van Gijn
- Center of Translational Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.,Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrica de Vries
- Department of Pediatric Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Cor van den Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Floor Abbink
- Department of Pediatric Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Renate G van der Molen
- Department of Laboratory Medicine, Laboratory for Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Natasja Dors
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jaap J Boelens
- Center of Translational Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Stem Cell Transplantation and Cellular Therapies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stefan Nierkens
- Center of Translational Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands. .,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| |
Collapse
|
7
|
Rensen N, Steur LMH, Grootenhuis MA, van Eijkelenburg NKA, van der Sluis IM, Dors N, van den Bos C, Tissing WJE, Kaspers GJL, van Litsenburg RRL. Parental functioning during maintenance treatment for childhood acute lymphoblastic leukemia: Effects of treatment intensity and dexamethasone pulses. Pediatr Blood Cancer 2020; 67:e28697. [PMID: 32909677 DOI: 10.1002/pbc.28697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND During maintenance treatment, Dutch pediatric patients with medium-risk (MR) acute lymphoblastic leukemia (ALL) receive intravenous chemotherapy and cyclic dexamethasone. Dexamethasone affects child's sleep and behavior. Standard-risk (SR) patients only receive oral chemotherapy, without dexamethasone. Effects of stratified therapy on parents are not well known. This study compares parental sleep, distress and quality of life (QoL) with the general population, between MR and SR groups, and on- and off-dexamethasone (MR group). PROCEDURE One year after diagnosis, parents of MR patients completed the Medical Outcomes Study (MOS) sleep, distress thermometer for parents and Short Form-12 (SF-12) twice; once on-dexamethasone and once off-dexamethasone. SR parents completed one measurement. Sleep problems, distress and QoL scores (off-dexamethasone) were compared to reference values and between MR and SR. Score differences on- and off-dexamethasone were assessed by multilevel regression analysis. RESULTS Parents (80% mothers) of 121 patients (57% males; 75% MR, 25% SR) completed 191 measurements. Compared to reference values, parents reported more sleep disturbances, higher distress, and lower mental QoL. Additionally, MR parents reported clinical distress (score ≥ 4), whereas SR parents (on average) did not (mean 4.8 ± 2.4 vs 3.5 ± 2.4, P = .02). Within the MR group, outcomes did not significantly differ on- and off-dexamethasone. CONCLUSIONS Parents of ALL patients report sleep problems, high distress, and QoL impairment. Within the MR group, parental functioning did not differ on- and off-dexamethasone. However, MR parents reported clinical distress more often than SR parents, possibly reflecting differences in prognostic estimates and treatment burden. This perhaps includes the overall strain of cyclic dexamethasone. This study highlights the need for psychosocial support throughout treatment, regardless of risk stratification.
Collapse
Affiliation(s)
- Niki Rensen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Lindsay M H Steur
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | | | | | - Inge M van der Sluis
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Sophia Children's Hospital, Erasmus Medical Center, Pediatric Oncology, Rotterdam, Netherlands
| | - Natasja Dors
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Amalia Children's Hospital, Radboud University Medical Center, Pediatric Oncology, Nijmegen, Netherlands
| | - Cor van den Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Emma Children's Hospital, Amsterdam UMC, Academic Medical Center, Pediatric Oncology, Amsterdam, Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,University of Groningen, University Medical Center Groningen, Pediatric Oncology, Groningen, Netherlands
| | - Gertjan J L Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands.,Dutch Childhood Oncology Group, Utrecht, Netherlands
| | - Raphaële R L van Litsenburg
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
8
|
Zijtregtop EAM, Dors N, Bakker H, Klasen LD, Oegema S, Beishuizen A. [A young lady with shortness of breath during the coronavirus crisis]. Ned Tijdschr Geneeskd 2020; 164:D5090. [PMID: 33201643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 16-year-old girl repeatedly visited a general practitioner during the coronavirus pandemic for progressive shortness of breath. Progressive orthopnoea was found as well. Her neck was swollen for two weeks and there was generalised itching for months. Given the nature of her symptoms, she was assessed at the coronavirus station. A diagnosis of coronavirus disease 2019 (COVID-19) was assumed. Due to limited testing capacity, the diagnosis was not confirmed. She was treated with supportive treatment that had no effect on her dyspnoea. Tunnel vision ensured that the symptoms that did not fit COVID-19, were not recognised. Moreover, a scheduled ultrasound of her neck was cancelled because of the coronavirus restrictions, which did not help matters. She was eventually admitted to the paediatric intensive care unit with respiratory failure associated with cervical and mediastinal Hodgkin lymphoma.
Collapse
Affiliation(s)
- E A M Zijtregtop
- Erasmus MC-Sophia Kinderziekenhuis, afd. Kinderoncologie, Rotterdam
- Contact: E.A.M. Zijtregtop
| | - N Dors
- Prinses Máxima Centrum voor kinderoncologie, afd. Hemato-oncologie, Utrecht
| | - H Bakker
- Erasmus MC-Sophia Kinderziekenhuis, afd. Intensive Care Kinderen, Rotterdam
| | - L D Klasen
- Gezondheidscentrum Haagse Hout, Den Haag
| | - S Oegema
- HagaZiekenhuis, locatie Juliana Kinderziekenhuis, afd. Kindergeneeskunde, Den Haag
| | - A Beishuizen
- Prinses Máxima Centrum voor kinderoncologie, afd. Hemato-oncologie, Utrecht
| |
Collapse
|
9
|
Steur LMH, Kaspers GJL, van Someren EJW, van Eijkelenburg NKA, van der Sluis IM, Dors N, van den Bos C, Tissing WJE, Grootenhuis MA, van Litsenburg RRL. The impact of maintenance therapy on sleep-wake rhythms and cancer-related fatigue in pediatric acute lymphoblastic leukemia. Support Care Cancer 2020; 28:5983-5993. [PMID: 32285260 PMCID: PMC7686190 DOI: 10.1007/s00520-020-05444-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
Abstract
Purpose To assess the impact of maintenance therapy and the additional impact of dexamethasone treatment on cancer-related fatigue and sleep-wake rhythms in pediatric acute lymphoblastic leukemia (ALL) patients and to determine the association between these outcomes. Methods A national cohort of pediatric ALL patients (≥ 2 years) was included (± 1 year post-diagnosis). Patients receiving dexamethasone were assessed twice (assessment with and without dexamethasone). Actigraphy assessments were used to calculate sleep-wake outcomes with nonparametric methods. Cancer-related fatigue was assessed with the PedsQL Multidimensional Fatigue Scale. Sleep-wake rhythms and cancer-related fatigue were compared between patients participating in the assessment without dexamethasone and healthy children (linear regression) and between assessments with and without dexamethasone (mixed models). Using linear regression, associations between sleep-wake outcomes and cancer-related fatigue were determined during assessments with and without dexamethasone. Results Responses were collected for 125 patients (113 assessments with and 81 without dexamethasone). The sleep-wake rhythm was less stable (p = 0.03) and less robust (p = 0.01), with lower physical activity levels (p < 0.001) and higher cancer-related fatigue levels (p < 0.001) in ALL patients compared to healthy children. Physical activity was lower (p = 0.001) and cancer-related fatigue more severe (p ≤ 0.001) during assessments with dexamethasone compared to without dexamethasone. Sleep-wake outcomes were significantly associated with cancer-related fatigue during periods without dexamethasone, but not during periods with dexamethasone. Conclusion Sleep-wake rhythms are disturbed, physical activity levels lower, and cancer-related fatigue levels higher during maintenance therapy. Interventions aimed to enhance sleep-wake rhythms during maintenance therapy could improve cancer-related fatigue. Families should be supported in coping with the additional burden of dexamethasone treatment to improve well-being of ALL patients. Electronic supplementary material The online version of this article (10.1007/s00520-020-05444-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- L M H Steur
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, ZH 8D12, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - G J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, ZH 8D12, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Dutch Childhood Oncology Group, Utrecht, The Netherlands
| | - E J W van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (an institute of the Royal Netherlands Academy of Arts and Sciences), Amsterdam, The Netherlands
- Department of Integrative Neurophysiology, Amsterdam Neuroscience, Center for Neurogenomics and Cognitive Research (CNCR), VU University Amsterdam, Amsterdam, The Netherlands
- Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - N K A van Eijkelenburg
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - I M van der Sluis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - N Dors
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatric Oncology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C van den Bos
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of pediatric oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M A Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - R R L van Litsenburg
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, ZH 8D12, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
| |
Collapse
|
10
|
Klein K, van Litsenburg RRL, de Haas V, Dors N, van den Heuvel-Eibrink MM, Knops RRG, Tissing WJE, Versluys BA, Zwaan CM, Kaspers GJL. Causes of early death and treatment-related death in newly diagnosed pediatric acute myeloid leukemia: Recent experiences of the Dutch Childhood Oncology Group. Pediatr Blood Cancer 2020; 67:e28099. [PMID: 31872548 DOI: 10.1002/pbc.28099] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/02/2019] [Accepted: 11/05/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND With the current more effective treatment regimens for pediatric acute myeloid leukemia (AML), research on early death (ED), treatment-related mortality (TRM), and toxicity becomes increasingly important. The aim of this study was to give an overview of the frequency, clinical features, and risk factors associated with ED and TRM in first complete remission (CR1) during the last three consecutive treatment protocols of the Dutch Childhood Oncology Group (DCOG) between 1998 and 2014. METHODS Incidence and risk factors associated with ED and TRM in CR1 were retrospectively studied in 245 patients treated according to the Dutch ANLL-97/AML-12 (n = 118), AML-15 (n = 60), or DB AML-01 (n = 67) protocols. RESULTS The incidence of ED was, respectively, 5.1%, 6.7%, and 3.0% excluding deaths before treatment (P = NS), and 7.4%, 11.1%, and 4.4% including deaths before the onset of treatment. Severe underweight at initial diagnosis was significantly associated with more frequent ED. When relapse was included as a competing risk, cumulative incidence of death in CR1 were 5.9%, 5.0%, and 4.6% for ANLL97, AML15, and DB01, respectively (P = NS). The most important cause of TRM included infectious and SCT-related complications. CONCLUSION We report relatively stable rates of ED and TRM in CR1 in the latest completed DCOG protocols for newly diagnosed AML patients. The most important causes of TRM were SCT- or infection-related, warranting further evaluation and awareness.
Collapse
Affiliation(s)
- Kim Klein
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Raphaële R L van Litsenburg
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Valérie de Haas
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Dutch Childhood Oncology Group, The Hague, The Netherlands
| | - Natasja Dors
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Rutger R G Knops
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Birgitta A Versluys
- University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Dutch Childhood Oncology Group, The Hague, The Netherlands.,Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gertjan J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Dutch Childhood Oncology Group, The Hague, The Netherlands
| |
Collapse
|
11
|
Steur LMH, Grootenhuis MA, Van Someren EJW, Van Eijkelenburg NKA, Van der Sluis IM, Dors N, Van den Bos C, Tissing WJE, Kaspers GJL, Van Litsenburg RRL. High prevalence of parent-reported sleep problems in pediatric patients with acute lymphoblastic leukemia after induction therapy. Pediatr Blood Cancer 2020; 67:e28165. [PMID: 31944548 DOI: 10.1002/pbc.28165] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess sleep problems (prevalence and predictors) in pediatric patients with acute lymphoblastic leukemia (ALL) after the most intensive phase of therapy (induction). METHODS Patients (≥2 years) treated according to the Dutch ALL-11 protocol were included. Sleep was measured using parent-reports and self-reports (Children's Sleep Habits Questionnaire; CSHQ) and actigraphy. Parental sleep (Medical Outcome Study Sleep Scale) and distress and parenting problems (Distress Thermometer for Parents) were assessed with questionnaires. Z-scores were calculated for total CSHQ scores using age-appropriate scores of healthy Dutch children. The prevalence of sleep problems (defined as a Z-score > 1) in patients with ALL was compared to healthy children (chi-square tests). Actigraphic sleep estimates were collected in healthy Dutch children (n = 86, 2-18 years) for comparison with patients (linear regression). Determinants of parent-reported child sleep (total CSHQ Z-score) were identified with regression models. RESULTS Responses were collected for 124 patients (response rate 67%), comprising 123 parent-reports, 34 self-reports, and 69 actigraphy assessments. Parents reported sleep problems in 38.0% of the patients compared to 15.2% in healthy children (P < .001). Patients reported fewer sleep problems themselves: 12.1% compared to 15.8% in healthy children (P = .33). Total time in bed (B (95% CI): 22.89 (9.55-36.22)) and total sleep time (B (95% CI):16.30 (1.40-31.19)), as derived from actigraphy, were significantly longer in patients. More parent-reported child sleep problems were predicted by parenting problems, more parental sleep problems, bedroom sharing, and child's sleep medication use (explained variance: 27.4%). CONCLUSIONS Systematic monitoring of child and parental sleep and implementation of effective interventions may be a gateway to improve quality of survival in pediatric ALL.
Collapse
Affiliation(s)
- Lindsay M H Steur
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (An institute of the Royal Netherlands Academy of Arts and Sciences), Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Amsterdam Neuroscience, Center for Neurogenomics and Cognitive Research (CNCR), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Inge M Van der Sluis
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Natasja Dors
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cor Van den Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gertjan J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Dutch Childhood Oncology Group, Utrecht, The Netherlands
| | - Raphaële R L Van Litsenburg
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| |
Collapse
|
12
|
van Munster HE, Steur A, Hagleitner MM, Dors N. [Throat and abdominal symptoms in malignant lymphoma; recognize the alarm signals in children]. Ned Tijdschr Geneeskd 2020; 164:D4074. [PMID: 32267635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In children, a malignant lymphoma can present with life-threatening complications arising from progressive tumour growth, warranting swift diagnosis and treatment. Early recognition can be challenging if a child with paediatric lymphoma presents with abdominal and throat symptoms because of the frequency, and frequently benign nature, of these symptoms in the general paediatric population. In these cases, it is essential for the physician to recognize the alarm signals for suspicion of malignant lymphoma, to allow timely diagnosis and treatment. We present two cases (children age 8 and 16 years) demonstrating the symptoms of malignant lymphoma that should raise alarm in children presenting with unilateral tonsil enlargement or intussusception, and illustrating the importance of timely recognition of these alarm signals, to prevent life-threatening complications due to tumour progression. In patients presenting with unilateral tonsil enlargement, malignant lymphoma should be considered if atypical macroscopic tonsil morphology, cervical lymphadenopathy, dysphagia, snoring, fever or weight loss is present. The presence of a lead point as the cause of intussusception should be considered in children aged > 2 years of age, in a child with an ileo-iliac intussusception and in patients with longstanding abdominal symptoms. In patients presenting with simultaneous symptoms and alarm signals for malignant lymphoma, the relationship between the presenting symptoms should be recognized. Interdisciplinary and intradisciplinary consultation with colleagues can help in the search for an overarching diagnosis, and it is crucial that this should happen without delay to prevent acute life-threatening situations.
Collapse
Affiliation(s)
- H E van Munster
- Radboudumc, Amalia kinderziekenhuis, afd. Kindergeneeskunde, Nijmegen
- Contact: H.E. van Munster
| | - A Steur
- Prinses Máxima Centrum voor kinderoncologie, afd. Hemato-oncologie, Utrecht
| | - M M Hagleitner
- Prinses Máxima Centrum voor kinderoncologie, afd. Hemato-oncologie, Utrecht
| | - N Dors
- Prinses Máxima Centrum voor kinderoncologie, afd. Hemato-oncologie, Utrecht
| |
Collapse
|
13
|
Bertrums EJM, Buijs A, van Grotel M, Dors N, de Rooij JDE, de Haas V, Hopman S, Jongmans MCJ, Zwaan CM, van den Heuvel-Eibrink MM. A neonate with a unique non-Down syndrome transient proliferative megakaryoblastic disease. Pediatr Blood Cancer 2017; 64. [PMID: 27667142 DOI: 10.1002/pbc.26230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/08/2022]
Abstract
Transient myeloproliferative disorder (TMD) is a leukemia type that occurs typically in newborns. In Down syndrome, TMD is referred to as transient abnormal myelopoiesis (TAM).32 Recently, transientness has also been reported in acute myeloid leukemia patients with germline trisomy 21 mosaicism, and even in cases with somatic trisomy 21, with or without GATA1 mutations. TMD cases without trisomy 21 are rare, and recurrent genetic aberrations that aid in clinical decision-making are scarcely described. We describe here a TMD patient without trisomy 21 or GATA1 mutation in whom single-nucleotide polymorphism analysis of leukemic blasts revealed a novel combined submicroscopic deletion (5q31.1-5q31.3 and 8q23.2q24).
Collapse
Affiliation(s)
- Eline J M Bertrums
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,University of Utrecht, Utrecht, The Netherlands
| | - Arjan Buijs
- Department of Genetics, University Medical Center, Utrecht, The Netherlands
| | | | - Natasja Dors
- Department of Pediatrics, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Valerie de Haas
- Dutch Childhood Oncology Group (SKION), The Hague, The Netherlands
| | - Sanne Hopman
- Department of Genetics, University Medical Center, Utrecht, The Netherlands
| | | | - C M Zwaan
- Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatrics, Catharina Hospital, Eindhoven, The Netherlands.,University of Utrecht, Utrecht, The Netherlands
| |
Collapse
|
14
|
Loomans JI, van Velzen AS, Eckhardt CL, Peters M, Mäkipernaa A, Holmstrom M, Brons PP, Dors N, Haya S, Voorberg J, van der Bom JG, Fijnvandraat K. Variation in baseline factor VIII concentration in a retrospective cohort of mild/moderate hemophilia A patients carrying identical F8 mutations. J Thromb Haemost 2017; 15:246-254. [PMID: 27943580 DOI: 10.1111/jth.13581] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/14/2016] [Indexed: 02/05/2023]
Abstract
Essentials Factor VIII levels vary in mild and moderate hemophilia A (MHA) patients with the same mutation. We aimed to estimate the variation and determinants of factor VIII levels among MHA patients. Age and genotype explain 59% of the observed inter-individual variation in factor VIII levels. Intra-individual variation accounted for 45% of the variation in the three largest mutation groups. SUMMARY Background The bleeding phenotype in patients with mild/moderate hemophilia A (MHA) is inversely associated with the residual plasma concentration of factor VIII (FVIII:C). Within a group of patients with the same F8 missense mutation, baseline FVIII:C may vary, because, in healthy individuals, von Willebrand factor (VWF) levels, ABO blood group and age are also known to influence baseline FVIII:C. Our understanding of the pathophysiologic process of the causative genetic event leading to reduced baseline FVIII:C in MHA patients is still limited. Objectives To estimate the variation and determinants of baseline FVIII:C among MHA patients with the same F8 missense mutation. Methods Three hundred and forty-six patients carrying mutations that were present in at least 10 patients in the cohort were selected from the INSIGHT and the RISE studies, which are cohort studies including data of 3534 MHA patients from Europe, Canada, and Australia. Baseline FVIII:C was measured with a one-stage clotting assay. We used Levene's test, univariate and multivariate linear regression, and mixed-model analyses. Results For 59% of patients, the observed variation in baseline FVIII:C was explained by age and genotype. Compared to FVIII:C in patients with Arg612Cys, FVIII:C was significantly different in patients with eight other F8 missense mutations. Intra-individual variation explained 45% of the observed variance in baseline FVIII:C among patients with the same mutation. Conclusion Our results indicate that baseline FVIII:C levels are not exclusively determined by F8 genotype in MHA patients. Insights into other factors may provide potential novel targets for the treatment of MHA.
Collapse
Affiliation(s)
- J I Loomans
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam, the Netherlands
| | - A S van Velzen
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam, the Netherlands
| | - C L Eckhardt
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam, the Netherlands
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - M Peters
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam, the Netherlands
| | - A Mäkipernaa
- Children's Hospital and Hematology, Comprehensive Cancer Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - M Holmstrom
- Coagulation Unit, Hematology Center, Karolinska University Hospital and Department of Medicine Karolinska Inisitutet, Stockholm, Sweden
| | - P P Brons
- Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - N Dors
- Catharina Hospital, Eindhoven, the Netherlands
| | - S Haya
- University Hospital la Fe, Valencia, Spain
| | - J Voorberg
- Department of Plasma Proteins, Sanquin-AMC Landsteiner Laboratory, Amsterdam, the Netherlands
| | - J G van der Bom
- Leiden University Hospital, Leiden, the Netherlands
- Sanquin Research, Leiden, the Netherlands
| | - K Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam, the Netherlands
- Department of Plasma Proteins, Sanquin-AMC Landsteiner Laboratory, Amsterdam, the Netherlands
| |
Collapse
|
15
|
Abstract
A 17-month-old girl with no medical history presented at our emergency room with abnormal vaginal bleeding and vaginal tissue loss with a "grape bunch" appearance. Physical examination showed no abnormalities, but gynaecological examination showed abnormal vaginal tissue protruding through the vagina introitus. Given the typical clinical presentation, the age of the girl and the location and aspect of the lesion, there was a high suspicion of the botryoid variant of embryonal rhabdomyosarcoma of the vagina. Histology of a biopsy of the lesion was consistent with embryonal rhabdomyosarcoma. As no metastases were detected, the girl received chemotherapy. This case report describes the importance of early recognition of the typical clinical symptoms of sarcoma botryoides, since a rapid diagnosis followed by treatment is necessary to prevent death.
Collapse
Affiliation(s)
- S J van Sambeeck
- Department of Paediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - U Flucke
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N Dors
- Department of Paediatrics, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| |
Collapse
|
16
|
Suijker MH, Roovers EAL, Fijnvandraat CJK, Dors N, Rodrigues Pereira R, Giordano PC, Verkerk PH, Peters M. [Haemoglobinopathy in the 21st century: incidence, diagnosis and heel prick screening]. Ned Tijdschr Geneeskd 2014; 158:A7365. [PMID: 25052352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the incidence of severe haemoglobinopathy, to evaluate the effect of heel prick screening, and to identify those children who do not benefit from this early diagnosis. DESIGN Prospective descriptive study. METHOD Registration of all symptomatic and asymptomatic children who between 2003-2009 were newly diagnosed with the a severe form of a hereditary disorder concerning the formation of the alpha haemoglobin chain (HbH disease), or the beta haemoglobin chain (sickle cell disease or beta thalassaemia major) in the Netherlands. Registration was done by collecting anonymised reports from the Dutch Paediatric Surveillance Unit and TNO, and by additional questionnaires. RESULTS During the study period, 48 children (range: 36-76) per year were diagnosed with severe haemoglobinopathy. The overall incidence was 2.5 per 10,000 live births. The incidence of sickle cell disease diagnosed by heel prick screening was 2.1 per 10,000 live births and of thalassaemia major 0.6 per 10,000 live births. In 7% of the children with sickle cell disease who were diagnosed without any form of screening, the diagnosis was made on (a life threatening) infection. Twenty-two percent of the children with a severe form of haemoglobinopathy were not born in the Netherlands. The parents of almost half of the children with sickle cell disease originally came from West- or Central Africa. The parents of children with thalassaemia major were mainly from Morocco or various Asiatic countries. CONCLUSION The number of children with severe haemoglobinopathy in the Netherlands has trebled since 1992. In order for all children to benefit from early diagnosis and preventive treatment, it is advisable that children who originate from risk areas should be tested for haemoglobinopathy when they first arrive in the Netherlands.
Collapse
|
17
|
Kuijper PHM, Schellings MWM, van de Kerkhof D, Nicolaes GAF, Reitsma P, Halbertsma F, Dors N. Two novel mutations in the prothrombin gene identified in a patient with compound heterozygous type 1/2 prothrombin deficiency. Haemophilia 2013; 19:e304-6. [PMID: 23711336 DOI: 10.1111/hae.12180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2013] [Indexed: 11/29/2022]
|
18
|
Kuijpers TW, Baars PA, aan de Kerk DJ, Jansen MH, Dors N, van Lier RA, Pals ST. Common variable immunodeficiency and hemophagocytic features associated with a FAS gene mutation. J Allergy Clin Immunol 2011; 127:1411-4.e2. [DOI: 10.1016/j.jaci.2011.01.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 01/19/2011] [Accepted: 01/21/2011] [Indexed: 10/18/2022]
|
19
|
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a rare disease, especially in childhood, and has a high mortality rate in the absence of appropriate treatment. It is characterised by microangiopathic haemolytic anaemia and consumptive thrombocytopenia. TTP may be difficult to distinguish from haemolytic uraemic syndrome (HUS) because of similar clinical manifestations and laboratory findings. In the past, TTP and HUS have often been considered to represent variable expressions of a single entity. Our increased understanding of the pathogenesis of TTP has in turn resulted in significant improvements in its treatment and outcomes. Several immunomodulating agents are currently being used with variable outcomes.
Collapse
Affiliation(s)
- Maria C Bouw
- Department of Paediatrics, Meander Medical Centre, Amersfoort, The Netherlands
| | | | | | | |
Collapse
|
20
|
Dors N, Rodrigues Pereira R, van Zwieten R, Fijnvandraat K, Peters M. [Glucose-6-phosphate dehydrogenase deficiency: clinical presentation and eliciting factors]. Ned Tijdschr Geneeskd 2008; 152:1029-1033. [PMID: 18547022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency, a hereditary X-linked disorder, is the most common enzymatic disorder of red blood cells in humans, affecting more than 200 million people worldwide. The prevalence is increasing in the Netherlands due to immigration of people from the Middle East and Africa. We present three different clinical manifestations of G6PD deficiency: neonatal jaundice, haemolysis provoked by infection and haemolysis caused by fava beans. The pathophysiology and treatment are discussed. Furthermore a recent update of chemicals which should be avoided in G6PD deficiency is provided.
Collapse
Affiliation(s)
- N Dors
- Emma Kinderziekenhuis AMC, Amsterdam.
| | | | | | | | | |
Collapse
|
21
|
Wilsterman MEF, Dors N, Sprij AJ, Wit JM. [Clinical characteristics and management of adolescents admitted to the emergency ward for alcohol intoxication in the region of The Hague during the period 1999-2001]. Ned Tijdschr Geneeskd 2004; 148:1496-500. [PMID: 15481574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To analyse the findings in adolescents between the ages of 12 and 17 who were admitted to the emergency ward as a result of excessive alcohol consumption. DESIGN Retrospective. METHOD The clinical characteristics, laboratory findings and treatment policy were studied in adolescents between the ages of 12 and 17 who were admitted for alcohol intoxication (> or = 1/1000) to the emergency wards of Leiden University Medical Centre, Juliana Children's Hospital, Haaglanden Medical Centre (Westeinde location) or the Leyenburg Hospital (all hospitals in the area of The Hague, The Netherlands) during the period 1999-2001. RESULTS In the three successive years, the number of patients was 19, 18 and 51, respectively; there were a total of 58 boys and 30 girls. Laboratory determinations and other investigations were carried out and/or recorded in varying numbers of patients. The cause of the intoxication was usually the consumption of spirits together with friends; 60% of the patients had a Glasgow coma score < 15 and 30% were admitted to hospital. In 25% the visit to the emergency ward was preceded by an accident in which alcohol played a part. Little attention seems to have been paid to aftercare in the form of a follow-up visit.
Collapse
Affiliation(s)
- M E F Wilsterman
- Leids Universitair Medisch Centrum, afd. Kindergeneeskunde, Leiden.
| | | | | | | |
Collapse
|