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Foster KL, Lee DJ, Witchel SF, Gordon CM. Ovarian Insufficiency and Fertility Preservation During and After Childhood Cancer Treatment. J Adolesc Young Adult Oncol 2024. [PMID: 38265460 DOI: 10.1089/jayao.2023.0111] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Premature ovarian insufficiency (POI) is one of many potential long-term consequences of childhood cancer treatment in females. Causes of POI in this patient population can include chemotherapy, especially alkylating agents, and radiation therapy. Rarely, ovarian tumors lead to ovarian dysfunction. POI can manifest as delayed pubertal development, irregular menses or amenorrhea, and infertility. This diagnosis often negatively impacts emotional health due to the implications of impaired ovarian function after already enduring treatment for a primary malignancy. The emerging adult may be challenged by the impact on energy level, quality of life, and fertility potential. POI can also lead to low bone density and compromised skeletal strength. This review discusses the health consequences of POI in childhood cancer survivors (CCS). We also explore the role of fertility preservation for CCS, including ovarian tissue cryopreservation and other available options. Lastly, knowledge gaps are identified that will drive a future research agenda.
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Affiliation(s)
- Kayla L Foster
- Texas Children's Cancer and Hematology Center, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Danielle J Lee
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Selma F Witchel
- Division of Pediatric Endocrinology, Department of Pediatrics, UPMC Children's Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Catherine M Gordon
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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He CY, Lee DJ, Foster KL, Gordon CM. Impact of ovarian insufficiency on bone health in childhood cancer survivors: Two cases. Bone 2024; 178:116930. [PMID: 37844715 DOI: 10.1016/j.bone.2023.116930] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/14/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE To investigate the skeletal phenotype of adolescent girls with premature ovarian insufficiency (POI). METHODS Data are presented from two adolescent girls who participated in a clinical research protocol to evaluate axial bone mineral density (BMD) (via dual-energy x-ray absorptiometry, DXA) and appendicular bone density, microarchitecture, and strength (via high-resolution peripheral quantitative computed tomography, HRpQCT). Anthropometric data were also obtained, and pubertal staging was performed by a clinician. RESULTS Both cases presented with an undetectable estradiol concentration and an elevated follicle stimulating hormone (FSH), meeting the criteria for POI. Each also received alkylating agents as part of their chemotherapy and radiotherapy, but in different locations as one presented with stage IV neuroblastoma and the other, metastatic medulloblastoma. Both had a low BMD of the axial and appendicular skeleton, as well as microarchitectural changes of the latter. The low BMD Z-score (<-2.0) seen when interpreting their DXA measurements for chronological age improved when adjusted for short stature, but it was not normalized. Lastly, most variables obtained by HRpQCT were abnormal for each participant, indicating that appendicular bone structure and strength were compromised. CONCLUSIONS Chemotherapy and radiation affect growth, puberty, and bone accrual deleteriously. However, as these cases show, POI in an adolescent is not always classic primary ovarian insufficiency. Adolescents with brain cancer can present with signs of estrogen deficiency but may not be able to secrete FSH to the extent of elevation typically seen in long-term cancer survivors. Estrogen deficiency is almost universally present in either clinical setting and prompt recognition facilitates early provision of hormone replacement therapy that may then allow for a resumption of bone accrual as an adolescent approaches her peak bone mass.
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Affiliation(s)
- Cara Y He
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States of America.
| | - Danielle J Lee
- USDA/ARS Children's Nutrition Research Center, 1100 Bates Avenue, Houston, TX 77030, United States of America.
| | - Kayla L Foster
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States of America; Section of Hematology/Oncology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, United States of America.
| | - Catherine M Gordon
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States of America; USDA/ARS Children's Nutrition Research Center, 1100 Bates Avenue, Houston, TX 77030, United States of America.
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Foster KL, Salehabadi SM, Green DM, Xing M, Ness KK, Krull KR, Brinkman TM, Ehrhardt MJ, Chemaitilly W, Dixon SB, Bhakta N, Brennan RC, Krasin MJ, Davidoff AM, Robison LL, Hudson MM, Mulrooney DA. Clinical Assessment of Late Health Outcomes in Survivors of Wilms Tumor. Pediatrics 2022; 150:e2022056918. [PMID: 36300342 PMCID: PMC9812640 DOI: 10.1542/peds.2022-056918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We aimed to clinically characterize the health, neurocognitive, and physical function outcomes of curative treatment of Wilms tumor. METHODS Survivors of Wilms tumor (n = 280) participating in the St. Jude Lifetime Cohort, a retrospective study with prospective follow-up of individuals treated for childhood cancer at St. Jude Children's Research Hospital, were clinically evaluated and compared to age and sex-matched controls (n = 625). Health conditions were graded per a modified version of the National Cancer Institute's Common Terminology Criteria for Adverse Events. Standardized neurocognitive testing was graded by using age-adjusted z-scores. Impaired physical function was defined by age- and sex-matched z-scores >1.5 SD below controls. Modified Poisson regression was used to compare the prevalence of conditions and multivariable logistic regression to examine treatment associations. RESULTS Median age at evaluation was similar between survivors and controls (30.5 years [9.0-58.0] and 31.0 [12.0-70.0]). Therapies included nephrectomy (100%), vincristine (99.3%), dactinomycin (97.9%), doxorubicin (66.8%), and abdominal (59.3%) and/or chest radiation (25.0%). By age 40 years, survivors averaged 12.7 (95% confidence interval [CI] 11.7-13.8) grade 1-4 and 7.5 (CI: 6.7-8.2) grade 2 to 4 health conditions, compared to 4.2 (CI: 3.9-4.6) and 2.3 (CI: 2.1-2.5), respectively, among controls. Grade 2 to 4 endocrine (53.9%), cardiovascular (26.4%), pulmonary (18.2%), neurologic (8.6%), neoplastic (7.9%), and kidney (7.2%) conditions were most prevalent. Survivors exhibited neurocognitive and physical performance impairments. CONCLUSIONS Wilms tumor survivors experience a threefold higher burden of chronic health conditions compared to controls and late neurocognitive and physical function deficits. Individualized clinical management, counseling, and surveillance may improve long-term health maintenance.
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Affiliation(s)
- Kayla L. Foster
- Department of Pediatrics, Texas Children’s Hospital, Section of Hematology-Oncology Baylor College of Medicine, Houston, Texas
| | | | - Daniel M. Green
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Mengqi Xing
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Matthew J. Ehrhardt
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Wassim Chemaitilly
- Division of Pediatric Endocrinology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephanie B. Dixon
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Nickhill Bhakta
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Rachel C. Brennan
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
| | - Matthew J. Krasin
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Daniel A. Mulrooney
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
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Foster KL, Green DM, Mirzaei Salehabadi S, Xing M, Ness KK, Krull KR, Brinkman TM, Ehrhardt MJ, Chemaitilly W, Dixon SB, Bhakta N, Brennan RC, Krasin MJ, Davidoff AM, Robison LL, Hudson MM, Mulrooney DA. Late health outcomes in survivors of Wilms tumor: A report from the St. Jude Lifetime (SJLIFE) cohort study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10038 Background: We aimed to characterize late health, neurocognitive, and physical performance outcomes among survivors of Wilms tumor. Methods: Wilms tumor survivors (n = 280), ≥ 5 years from diagnosis, participating in SJLIFE were clinically assessed along with a community control sample (n = 625). Health outcomes were graded per a modified Common Terminology Criteria for Adverse Events (grade 1 [mild] to grade 4 [life threatening]). Standardized neurocognitive testing was graded using age-adjusted z-scores. Aerobic function (six-minute walk), mobility (timed up and go) and flexibility (sit and reach) were assessed. Associations between treatment exposures and prevalent conditions were examined by multivariable logistic regression, adjusted for current age, sex and race. Results: Survivors (59% female, 73% white), median age 3 years (range 0-15) at diagnosis and 31 years (9-58) at evaluation, were comprehensively evaluated on the St. Jude campus. Two-thirds (67%) were treated with doxorubicin (median dose 175 mg/m2 range 52-490), 167 (60%) received abdominal radiation (median dose 12 Gy range 8.8-61.2) and 25% received chest radiation (12 Gy range 9-44). By age 40 years, survivors averaged 12.7 (95% confidence interval [CI] 11.7-13.8) grade 1-4 and 7.5 (CI 6.7-8.2) grade 2-4 conditions, compared to 4.2 (CI 3.9-4.6) and 2.3 (CI 2.1-2.5), respectively, among controls. The most prevalent medical conditions (grade ≥ 2) are reported in the table. Abnormal glucose metabolism was associated with abdominal radiation (relative risk [RR] 5.1 CI 1.4-19.0); restrictive pulmonary defects with chest radiation (RR 24.0 CI 3.2-180); and cardiomyopathy (RR 15.6 CI 1.9-128), pulmonary diffusion (RR 4.5 CI 1.3-15.1), and chronic kidney disease (RR 4.5 CI 1.3-16.1) with doxorubicin exposure. Survivors had a three-fold higher risk (standardized incidence ratio 3.5, CI 2.2-6.6) for subsequent neoplasms. Impairments (grade ≥ 2) in executive function (20% vs. 12%), attention (17% vs. 9%), memory (21% vs. 10%), and processing speed (20% vs. 8%) were more frequent in survivors than controls (p < 0.05). Impairments in aerobic function (13.6%), mobility (13.6%), and flexibility (11.1%) were higher than expected (p < 0.01). Significant associations were not identified between treatment exposures and neurocognitive or physical performance outcomes. Conclusions: Systematic clinical assessment identified a significant burden of chronic health conditions and previously unrecognized neurocognitive and physical performance limitations in survivors of Wilms tumor.[Table: see text]
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Affiliation(s)
| | | | | | - Mengqi Xing
- St Jude Children's Research Hospital, Memphis, TN
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Oluyomi A, Aldrich KD, Foster KL, Badr H, Kamdar KY, Scheurer ME, Lupo PJ, Brown AL. Neighborhood deprivation index is associated with weight status among long-term survivors of childhood acute lymphoblastic leukemia. J Cancer Surviv 2020; 15:767-775. [PMID: 33226568 DOI: 10.1007/s11764-020-00968-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, has been linked to metabolic outcomes in the general population but has received limited attention in survivors of childhood acute lymphoblastic leukemia (ALL), a population with high rates of overweight and obesity. METHODS We retrospectively reviewed heights and weights of ≥ 5 year survivors of pediatric ALL (diagnosed 1990-2013). Residential addresses were geocoded using ArcGIS to assign quartiles of ADI, a composite of 17 measures of poverty, housing, employment, and education, with higher quartiles reflecting greater deprivation. Odds ratios (OR) and 95% confidence intervals (CI) for the association between ADI quartiles and overweight/obesity or obesity alone were calculated with logistic regression. RESULTS On average, participants (n = 454, 50.4% male, 45.2% Hispanic) were age 5.5 years at diagnosis and 17.4 years at follow-up. At follow-up, 26.4% were overweight and 24.4% obese. Compared to the lowest ADI quartile, survivors in the highest quartile were more likely to be overweight/obese at follow-up (OR = 2.33, 95% CI: 1.23-4.44) after adjusting for race/ethnicity, sex, age at diagnosis, and age at follow-up. The highest ADI quartile remained significantly associated with obesity (OR = 5.28, 95% CI: 1.79-15.54) after accounting for weight status at diagnosis. CONCLUSIONS This study provides novel insights into possible social determinants of health inequalities among survivors of childhood ALL by reporting a significant association between neighborhood deprivation and overweight/obesity. IMPLICATIONS FOR CANCER SURVIVORS Survivors of childhood ALL residing in neighborhood with greater socioeconomic disadvantage may be at increased risk of overweight and obesity and candidates for targeted interventions.
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Affiliation(s)
- Abiodun Oluyomi
- Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS BCM307, Houston, TX, 77030, USA.
| | - K Danielle Aldrich
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS BCM622, Houston, TX, 77030, USA
| | - Kayla L Foster
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hoda Badr
- Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS BCM307, Houston, TX, 77030, USA
| | - Kala Y Kamdar
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS BCM622, Houston, TX, 77030, USA
| | - Michael E Scheurer
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS BCM622, Houston, TX, 77030, USA
| | - Philip J Lupo
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS BCM622, Houston, TX, 77030, USA
| | - Austin L Brown
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS BCM622, Houston, TX, 77030, USA.
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Richard MA, Brown AL, Belmont JW, Scheurer ME, Arroyo VM, Foster KL, Kern KD, Hudson MM, Leisenring WM, Okcu MF, Sapkota Y, Yasui Y, Morton LM, Chanock SJ, Robison LL, Armstrong GT, Bhatia S, Oeffinger KC, Lupo PJ, Kamdar KY. Genetic variation in the body mass index of adult survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study and the St. Jude Lifetime Cohort. Cancer 2020; 127:310-318. [PMID: 33048379 DOI: 10.1002/cncr.33258] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/06/2020] [Accepted: 08/13/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treatment characteristics such as cranial radiation therapy (CRT) do not fully explain adiposity risk in childhood acute lymphoblastic leukemia (ALL) survivors. This study was aimed at characterizing genetic variation related to adult body mass index (BMI) among survivors of childhood ALL. METHODS Genetic associations of BMI among 1458 adult survivors of childhood ALL (median time from diagnosis, 20 years) were analyzed by multiple approaches. A 2-stage genome-wide association study in the Childhood Cancer Survivor Study (CCSS) and the St. Jude Lifetime Cohort Study (SJLIFE) was performed. BMI was a highly polygenic trait in the general population. Within the known loci, the BMI percent variance explained was estimated, and additive interactions (chi-square test) with CRT in the CCSS were evaluated. The role of DNA methylation in CRT interaction was further evaluated in a subsample of ALL survivors. RESULTS In a meta-analysis of the CCSS and SJLIFE, 2 novel loci associated with adult BMI among survivors of childhood ALL (LINC00856 rs575792008 and EMR1 rs62123082; PMeta < 5E-8) were identified. It was estimated that the more than 700 known loci explained 6.2% of the variation in adult BMI in childhood ALL survivors. Within the known loci, significant main effects for 23 loci and statistical interactions with CRT at 9 loci (P < 7.0E-5) were further identified. At 2 CRT-interacting loci, DNA methylation patterns may have differed by age. CONCLUSIONS Adult survivors of childhood ALL have genetic heritability for BMI similar to that observed in the general population. This study provides evidence that treatment with CRT can modify the effect of genetic variants on adult BMI in childhood ALL survivors.
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Affiliation(s)
- Melissa A Richard
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center and Baylor College of Medicine, Houston, Texas
| | - Austin L Brown
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center and Baylor College of Medicine, Houston, Texas
| | - John W Belmont
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Michael E Scheurer
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center and Baylor College of Medicine, Houston, Texas
| | - Vidal M Arroyo
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center and Baylor College of Medicine, Houston, Texas
| | - Kayla L Foster
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center and Baylor College of Medicine, Houston, Texas
| | - Kathleen D Kern
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center and Baylor College of Medicine, Houston, Texas
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wendy M Leisenring
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - M Fatih Okcu
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center and Baylor College of Medicine, Houston, Texas
| | - Yadav Sapkota
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kevin C Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Philip J Lupo
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center and Baylor College of Medicine, Houston, Texas
| | - Kala Y Kamdar
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center and Baylor College of Medicine, Houston, Texas
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Foster KL, Kern KD, Chambers TM, Lupo PJ, Kamdar KY, Scheurer ME, Brown AL. Weight trends in a multiethnic cohort of pediatric acute lymphoblastic leukemia survivors: A longitudinal analysis. PLoS One 2019; 14:e0217932. [PMID: 31150521 PMCID: PMC6544325 DOI: 10.1371/journal.pone.0217932] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/21/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As survival rates for childhood acute lymphoblastic leukemia (ALL) continue to improve, there is growing concern over the chronic health conditions that survivors face. Given that survivors of childhood ALL are at increased risk of cardiovascular complications and obesity, we sought to characterize BMI trends from diagnosis through early survivorship in a multi-ethnic, contemporary cohort of childhood ALL patients and determine if early weight change was predictive of long-term weight status. METHODS The study population consisted of ALL patients aged 2-15 years at diagnosis who were treated with chemotherapy alone at Texas Children's Hospital. Each patient had BMI z-scores collected at diagnosis, 30-days post-diagnosis, and annually for five years. Linear regression models were estimated to evaluate the association between: 1) BMI z-score change in the first 30 days and BMI z-scores at five-years post-diagnosis; and 2) BMI z-score change in the first year post-diagnosis and BMI z-scores at five-years post-diagnosis. RESULTS This retrospective cohort study included longitudinal data from 121 eligible patients. The mean BMI z-scores for the population increased significantly (p-value<0.001) from baseline (mean = 0.25) to 30 days post-diagnosis (mean = 1.17) before plateauing after one year post-diagnosis (mean = 0.99). Baseline BMI z-scores were statistically significant predictors to five year BMI z-scores (p <0.001). Independent of baseline BMI z-score and other clinical factors, the BMI z-score at one year post-diagnosis was significantly associated with BMI z-score at five-years post-diagnosis (β = 0.63, p <0.001), while BMI z-score at 30 days post-diagnosis was not (β = 0.10, p = 0.23). CONCLUSION Our results suggest that weight gain within the first year after diagnosis is more strongly associated with long-term BMI than early weight gain (within 30 days). If confirmed, this information may help identify a window of time during therapy when ALL patients would benefit most from weight management directed interventions.
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Affiliation(s)
- Kayla L. Foster
- St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Kathleen D. Kern
- Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
| | - Tiffany M. Chambers
- Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
| | - Philip J. Lupo
- Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
| | - Kala Y. Kamdar
- Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
| | - Michael E. Scheurer
- Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
| | - Austin L. Brown
- Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
- * E-mail:
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Brown AL, Foster KL, Lupo PJ, Peckham-Gregory EC, Murray JC, Okcu MF, Lau CC, Rednam SP, Chintagumpala M, Scheurer ME. DNA methylation of a novel PAK4 locus influences ototoxicity susceptibility following cisplatin and radiation therapy for pediatric embryonal tumors. Neuro Oncol 2018; 19:1372-1379. [PMID: 28444219 DOI: 10.1093/neuonc/nox076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Ototoxicity is a common adverse side effect of platinum chemotherapy and cranial radiation therapy; however, individual susceptibility is highly variable. Therefore, our objective was to conduct an epigenome-wide association study to identify differentially methylated cytosine-phosphate-guanine (CpG) sites associated with ototoxicity susceptibility among cisplatin-treated pediatric patients with embryonal tumors. Methods Samples were collected for a discovery cohort (n = 62) and a replication cohort (n = 18) of medulloblastoma and primitive neuroectodermal tumor patients. Posttreatment audiograms were evaluated using the International Society of Paediatric Oncology (SIOP) Boston Ototoxicity Scale. Genome-wide associations between CpG methylation and ototoxicity were examined using multiple linear regression, controlling for demographic and treatment factors. Results The mean cumulative dose of cisplatin was 330 mg/m2 and the mean time from end of therapy to the last available audiogram was 6.9 years. In the discovery analysis of 435233 CpG sites, 6 sites were associated with ototoxicity grade (P < 5 × 10-5) after adjusting for confounders. Differential methylation at the top CpG site identified in the discovery cohort (cg14010619, PAK4 gene) was replicated (P = 0.029) and reached genome-wide significance (P = 2.73 × 10-8) in a combined analysis. These findings were robust to a sensitivity analysis evaluating other potential confounders. Conclusions We identified and replicated a novel CpG methylation loci (cg14010619) associated with ototoxicity severity. Methylation at cg14010619 may modify PAK4 activity, which has been implicated in cisplatin resistance in malignant cell lines.
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Affiliation(s)
- Austin L Brown
- Department of Pediatrics Hematology-Oncology Section, Baylor College of Medicine, Houston, Texas; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas; Department of Hematology & Oncology, Cook Children's Medical Center, Fort Worth, Texas
| | - Kayla L Foster
- Department of Pediatrics Hematology-Oncology Section, Baylor College of Medicine, Houston, Texas; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas; Department of Hematology & Oncology, Cook Children's Medical Center, Fort Worth, Texas
| | - Philip J Lupo
- Department of Pediatrics Hematology-Oncology Section, Baylor College of Medicine, Houston, Texas; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas; Department of Hematology & Oncology, Cook Children's Medical Center, Fort Worth, Texas
| | - Erin C Peckham-Gregory
- Department of Pediatrics Hematology-Oncology Section, Baylor College of Medicine, Houston, Texas; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas; Department of Hematology & Oncology, Cook Children's Medical Center, Fort Worth, Texas
| | - Jeffrey C Murray
- Department of Pediatrics Hematology-Oncology Section, Baylor College of Medicine, Houston, Texas; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas; Department of Hematology & Oncology, Cook Children's Medical Center, Fort Worth, Texas
| | - M Fatih Okcu
- Department of Pediatrics Hematology-Oncology Section, Baylor College of Medicine, Houston, Texas; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas; Department of Hematology & Oncology, Cook Children's Medical Center, Fort Worth, Texas
| | - Ching C Lau
- Department of Pediatrics Hematology-Oncology Section, Baylor College of Medicine, Houston, Texas; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas; Department of Hematology & Oncology, Cook Children's Medical Center, Fort Worth, Texas
| | - Surya P Rednam
- Department of Pediatrics Hematology-Oncology Section, Baylor College of Medicine, Houston, Texas; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas; Department of Hematology & Oncology, Cook Children's Medical Center, Fort Worth, Texas
| | - Murali Chintagumpala
- Department of Pediatrics Hematology-Oncology Section, Baylor College of Medicine, Houston, Texas; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas; Department of Hematology & Oncology, Cook Children's Medical Center, Fort Worth, Texas
| | - Michael E Scheurer
- Department of Pediatrics Hematology-Oncology Section, Baylor College of Medicine, Houston, Texas; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas; Department of Hematology & Oncology, Cook Children's Medical Center, Fort Worth, Texas
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June HL, Harvey SC, Foster KL, McKay PF, Cummings R, Garcia M, Mason D, Grey C, McCane S, Williams LS, Johnson TB, He X, Rock S, Cook JM. GABA(A) receptors containing (alpha)5 subunits in the CA1 and CA3 hippocampal fields regulate ethanol-motivated behaviors: an extended ethanol reward circuitry. J Neurosci 2001; 21:2166-77. [PMID: 11245701 PMCID: PMC6762602] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
GABA receptors within the mesolimbic circuitry have been proposed to play a role in regulating alcohol-seeking behaviors in the alcohol-preferring (P) rat. However, the precise GABA(A) receptor subunit(s) mediating the reinforcing properties of EtOH remains unknown. We examined the capacity of intrahippocampal infusions of an alpha5 subunit-selective ( approximately 75-fold) benzodiazepine (BDZ) inverse agonist [i.e., RY 023 (RY) (tert-butyl 8-(trimethylsilyl) acetylene-5,6-dihydro-5-methyl-6-oxo-4H-imidazo [1,5a] [1,4] benzodiazepine-3-carboxylate)] to alter lever pressing maintained by concurrent presentation of EtOH (10% v/v) and a saccharin solution (0.05% w/v). Bilateral (1.5-20 microgram) and unilateral (0.01-40 microgram) RY dose-dependently reduced EtOH-maintained responding, with saccharin-maintained responding being reduced only with the highest doses (e.g., 20 and 40 microgram). The competitive BDZ antagonist ZK 93426 (ZK) (7 microgram) reversed the RY-induced suppression on EtOH-maintained responding, confirming that the effect was mediated via the BDZ site on the GABA(A) receptor complex. Intrahippocampal modulation of the EtOH-maintained responding was site-specific; no antagonism by RY after intra-accumbens [nucleus accumbens (NACC)] and intraventral tegmental [ventral tegmental area (VTA)] infusions was observed. Because the VTA and NACC contain very high densities of alpha1 and alpha2 subunits, respectively, we determined whether RY exhibited a "negative" or "neutral" pharmacological profile at recombinant alpha1beta3gamma2, alpha2beta3gamma2, and alpha5beta3gamma2 receptors expressed in Xenopus oocytes. RY produced "classic" inverse agonism at all alpha receptor subtypes; thus, a neutral efficacy was not sufficient to explain the failure of RY to alter EtOH responding in the NACC or VTA. The results provide the first demonstration that the alpha5-containing GABA(A) receptors in the hippocampus play an important role in regulating EtOH-seeking behaviors.
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Affiliation(s)
- H L June
- Psychobiology Program, Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana 46202, USA.
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10
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Foster KL, Plastridge RA, Bottenheim JW, Shepson PB, Finlayson-Pitts BJ, Spicer CW. The role of Br2 and BrCl in surface ozone destruction at polar sunrise. Science 2001; 291:471-4. [PMID: 11161198 DOI: 10.1126/science.291.5503.471] [Citation(s) in RCA: 302] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Bromine atoms are believed to play a central role in the depletion of surface-level ozone in the Arctic at polar sunrise. Br2, BrCl, and HOBr have been hypothesized as bromine atom precursors, and there is evidence for chlorine atom precursors as well, but these species have not been measured directly. We report here measurements of Br2, BrCl, and Cl2 made using atmospheric pressure chemical ionization-mass spectrometry at Alert, Nunavut, Canada. In addition to Br2 at mixing ratios up to approximately 25 parts per trillion, BrCl was found at levels as high as approximately 35 parts per trillion. Molecular chlorine was not observed, implying that BrCl is the dominant source of chlorine atoms during polar sunrise, consistent with recent modeling studies. Similar formation of bromine compounds and tropospheric ozone destruction may also occur at mid-latitudes but may not be as apparent owing to more efficient mixing in the boundary layer.
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Affiliation(s)
- K L Foster
- Department of Chemistry, University of California, Irvine, CA 92697-2025, USA
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11
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Abstract
Experiments were performed using probe-word recognition methodology in which participants read sentences that were presented 1 word at a time and were then shown a probe word and had to make a speeded response indicating whether the word had occurred in the sentence. One experiment showed that response times to probe words increased with the size of the set of candidate probes. The other experiments showed that the effects caused by name repetition in circumstances in which the repeated name was co-referential also occurred when the repeated name was not co-referential and when the order of words in a sentence was scrambled. The results suggest that responses in the task can be based on probe-list memory, a mental representation created to keep track of those words that the participant believes are likely to be probed, and that the use of the task to make inferences about language comprehension should be accompanied by controls ruling out such strategies.
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Affiliation(s)
- P C Gordon
- Department of Psychology, University of North Carolina at Chapel Hill, 27599-3270, USA.
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12
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Knipping EM, Lakin MJ, Foster KL, Jungwirth P, Tobias DJ, Gerber RB, Dabdub D, Finlayson-Pitts BJ. Experiments and simulations of ion-enhanced interfacial chemistry on aqueous NaCl aerosols. Science 2000; 288:301-6. [PMID: 10764637 DOI: 10.1126/science.288.5464.301] [Citation(s) in RCA: 410] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
A combination of experimental, molecular dynamics, and kinetics modeling studies is applied to a system of concentrated aqueous sodium chloride particles suspended in air at room temperature with ozone, irradiated at 254 nanometers to generate hydroxyl radicals. Measurements of the observed gaseous molecular chlorine product are explainable only if reactions at the air-water interface are dominant. Molecular dynamics simulations show the availability of substantial amounts of chloride ions for reaction at the interface, and quantum chemical calculations predict that in the gas phase chloride ions will strongly attract hydroxl radicals. Model extrapolation to the marine boundary layer yields daytime chlorine atom concentrations that are in good agreement with estimates based on field measurements of the decay of selected organics over the Southern Ocean and the North Atlantic. Thus, ion-enhanced interactions with gases at aqueous interfaces may play a more generalized and important role in the chemistry of concentrated inorganic salt solutions than was previously recognized.
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Affiliation(s)
- EM Knipping
- Department of Mechanical and Aerospace Engineering, Department of Chemistry, University of California, Irvine, Irvine, CA 92697, USA. J. Heyrovsky Institute of Physical Chemistry, Academy of Sciences of the Czech Republic, Dolejskova 3, 18223, Pragu
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