RESUMEN
BACKGROUND: Children with central nervous system (CNS) toxicity during therapy for acute lymphoblastic leukaemia (ALL) are at risk for treatment modifications, long-term sequelae and even higher mortality. A better understanding of CNS symptoms and their complications improves the potential to prevent and treat them. METHODS: Patient files from 649 children treated with Nordic Society of Pediatric Hematology and Oncology ALL92 and ALL2000 protocols in Finland were reviewed retrospectively for any acute CNS symptom. Detailed data on symptoms, examinations and treatment of the underlying CNS complications were collected from the medical records. Disease-related and outcome data were retrieved from the Nordic leukaemia registry. RESULTS: Altogether, 13% (86) of patients with ALL had acute CNS symptoms. Most symptoms (64%) occurred during the first 2 months of therapy. Posterior reversible encephalopathy syndrome was the most frequent complication (4.5%). Cerebrovascular events were diagnosed in 10 cases (1.6%), while methotrexate-related stroke-like syndrome (SLS) was observed in only one patient (0.2%). CNS symptoms due to systemic or unclear conditions, especially sepsis, were important for differential diagnosis. CNS leukaemia was associated with CNS symptoms (hazard ratio [HR] = 4.03; P = .003), and epilepsy was a common sequel of CNS complications (19%). CONCLUSIONS: Acute CNS symptoms are common during ALL therapy, occurring mainly during the first 2 months of treatment. Patients with CNS leukaemia at diagnosis are at a higher risk for CNS toxicity. Despite intensive CNS-directed methotrexate treatment, SLS was diagnosed extremely rarely in our series.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Enfermedades del Sistema Nervioso Central/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Enfermedades del Sistema Nervioso Central/inducido químicamente , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Posterior reversible encephalopathy syndrome (PRES) in children with acute lymphoblastic leukemia has been increasingly recognized as a clinicoradiological entity. Our aim was to describe the incidence of PRES in pediatric patients with ALL, identify its risk factors, and examine its prognostic importance. For this research, we conducted a systematic, retrospective review of the patient records in a population-based series of children with acute lymphoblastic leukemia (n=643) treated in Finland from 1992 to 2008. Of the patients with ALL, 4.5% (n=29) developed radiologically confirmed PRES, of which 28 cases occurred during induction. Hypertension (P=0.006; odds ratio [OR], 4.10, confidence interval [CI], 1.50-11.25), constipation (P=0.001; OR, 5.60; CI, 2.02-15.52), and >14 days of alkalinization (P=0.017; OR, 3.27; CI, 1.23-8.68) were significant independent risk factors for PRES. One-third of the patients developed epilepsy. Relapses occurred significantly more often in those patients with PRES (P=0.001), which was associated with worse overall survival (P=0.040; 5-year survival=75.9% [60.3%-91.4%] vs. 88.4% [85.8%-90.9%]). Using NOPHO-ALL 92/2000 protocols, PRES is a significant early complication of therapy in ALL, and was associated with a poorer prognosis and significant neurological morbidity.
Asunto(s)
Síndrome de Leucoencefalopatía Posterior/inducido químicamente , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Adolescente , Niño , Preescolar , Epilepsia/etiología , Femenino , Finlandia/epidemiología , Humanos , Hipertensión/etiología , Incidencia , Quimioterapia de Inducción/efectos adversos , Lactante , Masculino , Síndrome de Leucoencefalopatía Posterior/epidemiología , Síndrome de Leucoencefalopatía Posterior/etiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Convulsiones/etiología , Análisis de SupervivenciaRESUMEN
BACKGROUND: Reports on the quality of life (QOL) of childhood brain tumor (BT) survivors have been inconsistent. As cognitive limitations may restrict their participation in questionnaire-based studies, our aim was to evaluate in depth the QOL with a mixed-method analysis. METHODS: The 5-year survivors of childhood BTs born in 1975-2000 and alive in 2010 were identified via the Finnish Cancer Registry and treating clinics. Twenty-one survivors (32%) participated in a mixed-method analysis including 15D (a general health-related QOL questionnaire), the Beck Depression Inventory, and a qualitative semi-structured interview. RESULTS: Based on the 15D-questionnaire, the BT survivors had an impaired health-related QOL in several dimensions such as speech and usual activities. On the other hand, no difference was found in other dimensions such as distress or vitality. A majority (95%) of the survivors showed no increased risk for depression. The qualitative interview revealed that the most important aspects affecting the QOL of the survivors were positive mental growth, negative conceptions concerning illness, living one day at a time, age at diagnosis, time since diagnosis, social relationships, learning disabilities and limitations in vocational opportunities, limitations in independent life, and changed understanding of the term 'health'. CONCLUSIONS: Childhood BT survivors have heterogeneous attitudes on QOL. The survivors assess social aspects to be more important than functionality for their QOL. Social concerns should actively be brought up to offer support for those with significant social difficulties. Interventions for social difficulties should be more actively developed. Copyright © 2015 John Wiley & Sons, Ltd.
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Neoplasias Encefálicas/psicología , Salud Mental , Calidad de Vida/psicología , Sobrevivientes/psicología , Adulto , Neoplasias Encefálicas/terapia , Niño , Depresión/psicología , Femenino , Humanos , Masculino , Pronóstico , Encuestas y CuestionariosRESUMEN
AIM: Our aims were to establish the 10-year overall and event-free survival rates among children and adolescents with bone sarcomas in Finland, estimate their respective incidences, evaluate the treatment given and describe the key prognostic factors. METHODS: We included 88 patients of <18 years of age diagnosed with a bone sarcoma during 1991-2005 in this retrospective, nationwide and population-based study. Median follow-up time was 12.2 years (range 5.8-20.3 years) for surviving patients. RESULTS: The overall incidence among children and adolescents was 5.1 per million: 3.6 for osteosarcoma, 1.2 for Ewing's sarcoma and 0.3 for chondrosarcoma. The 10-year event-free and overall survival of those with a localised disease at diagnosis was 69% and 82%, respectively. The overall 10-year survival of those with a metastatic disease at diagnosis was 47%. Prognostic factors for localised disease included an axial versus peripheral primary tumour site in Ewing's sarcoma (p = 0.022) and age at diagnosis in osteosarcoma (p = 0.027). CONCLUSION: The 10-year overall survival of children and adolescents diagnosed with a bone sarcoma in Finland during 1991 to 2005 was very good, at 82% if the disease was localised at diagnosis and 47% if it was metastatic at diagnosis.
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Neoplasias Óseas/epidemiología , Neoplasias Óseas/terapia , Sarcoma/epidemiología , Sarcoma/terapia , Adolescente , Factores de Edad , Neoplasias Óseas/diagnóstico , Niño , Preescolar , Terapia Combinada , Femenino , Finlandia/epidemiología , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Pronóstico , Estudios Retrospectivos , Sarcoma/diagnóstico , Tasa de SupervivenciaRESUMEN
BACKGROUND: Despite major treatment attempts, the prognosis for pediatric diffuse intrinsic pontine gliomas (DIPGs) remains dismal. Gliomas are highly vascularized tumors, suggesting that the prevention of vessel formation by anti-angiogenic treatment might be effective. PROCEDURE: Forty-one pediatric patients with DIPG were treated according to the Angiocomb protocol, starting with radiotherapy combined with topotecan and followed by anti-angiogenic triple medication consisting of thalidomide, etoposide, and celecoxib. Overall survival, radiological response, quality of life, requirement of corticosteroids, and adverse effects were monitored. Eight patients treated with only radiotherapy were used as controls. RESULTS: For study patients, the 12 and 24 months overall survival was 61% and 17%, respectively. The median overall survival was 12 months (range 4-60 months). Four radiological complete responses were seen, of which two were transient. Radiologically, 56% of the tumors reduced in size and 78% in signal intensity. Study patients were able to visit school or daycare and walk for a significantly longer time compared to controls (Log Rank 0.036 and 0.008, respectively). Adverse effects were generally minor. CONCLUSIONS: The Angiocomb protocol created a noticeable share of long-term survivors and was well tolerated, suggesting that anti-angiogenic therapy for patients with DIPG should be studied more in the future.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Tronco Encefálico/terapia , Quimioradioterapia , Glioma/terapia , Calidad de Vida , Adolescente , Neoplasias del Tronco Encefálico/mortalidad , Neoplasias del Tronco Encefálico/patología , Estudios de Casos y Controles , Celecoxib , Quimioterapia Adyuvante , Niño , Preescolar , Etopósido/administración & dosificación , Femenino , Estudios de Seguimiento , Glioma/mortalidad , Glioma/patología , Humanos , Lactante , Masculino , Clasificación del Tumor , Pronóstico , Pirazoles/administración & dosificación , Inducción de Remisión , Sulfonamidas/administración & dosificación , Tasa de Supervivencia , Talidomida/administración & dosificación , Topotecan/administración & dosificaciónRESUMEN
BACKGROUND: Ewing's sarcoma family of tumors (ESFTs) are rare bone and soft tissue tumors characterized by specific genetic alterations. Our aim was to carry out a nationwide analysis of ESFT, to survey the treatments used and to report the five-year disease specific and event-free survival rates (EFS and DSS). MATERIAL AND METHODS: The study data was gathered from the Finnish National Cancer Registry and all five University Hospitals and consisted of 76 bone and soft tissue ESFT patients diagnosed during 1990-2009. Their medical records were reviewed and data on their disease, treatments, complications and outcome were analyzed. RESULTS: The five-year EFS and DSS of patients with localized disease at diagnosis (n = 57) were 70% and 60%, respectively. Factors contributing to DSS and EFS were the axial vs. peripheral site of primary tumor and adequate surgical resection of the primary tumor. DSS was also affected by patient's age at diagnosis and the treatment employed. The five-year DSS of patients with metastatic disease at diagnosis (n = 19) was 33% and both preoperative and high dose chemotherapy were associated with improved survival. CONCLUSION: Population-based studies including both bone and soft tissue ESFTs are few. In this nationwide, population-based study on Finnish bone and soft tissue ESFT patients, we find their treatment successful and results comparable to those previously published. Absence of metastases, young age at diagnosis and a peripheral primary tumor site were associated with a better prognosis. It seems that surgical resection of the primary tumor should be performed whenever adequate resection margins can be achieved. The role of high dose chemotherapy merits further studies in this setting.
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Neoplasias Óseas/epidemiología , Sarcoma de Ewing/epidemiología , Adolescente , Neoplasias Óseas/mortalidad , Neoplasias Óseas/patología , Neoplasias Óseas/terapia , Terapia Combinada , Femenino , Finlandia/epidemiología , Humanos , Masculino , Metástasis de la Neoplasia , Sistema de Registros/estadística & datos numéricos , Sarcoma de Ewing/mortalidad , Sarcoma de Ewing/patología , Sarcoma de Ewing/terapia , Análisis de Supervivencia , Adulto JovenRESUMEN
[This corrects the article DOI: 10.1371/journal.pone.0274274.].
RESUMEN
The mobilization of stem cells using the standard approach, chemotherapy and G-CSF, may not be successful in all cases heavily pretreated. Plerixafor (AMD3100) has emerged as a viable option in attempts to mobilize stem cells among these patients. The use of plerixafor in the adult setting has been established, but data on pediatric use is scarce. We report on the use of plerixafor in eight pediatric cases either as add-on to chemotherapy plus G-CSF or in remobilization.
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Separación Celular/instrumentación , Movilización de Célula Madre Hematopoyética/métodos , Trasplante de Células Madre de Sangre Periférica , Adolescente , Adulto , Separación Celular/métodos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Neoplasias/terapia , Trasplante AutólogoRESUMEN
Despite improved treatment results of childhood acute lymphoblastic leukemia (ALL), 20% to 30% have a relapse, and then the outcome is very poor. We studied 40 children with ALL marrow relapse piloting an ALL relapse protocol with well-known drugs and drug combinations by using a concept of response-guided design. We also measured response in logarithmic fashion. Our primary end points were achievement of M1 marrow status, minimal residual disease status below 10, and second remission. The remission induction rate was 90% with 10% induction mortality. After the A blocks (dexamethasone, vincristine, idarubicin and pegylated L-asparaginase), 85% had M1 status, 39% had minimal residual disease ≤1×10, and 66% had 2 to 3 log response. After B1 block (cyclo, VP-16) the figures were 92%, 58%, and 83%, respectively. Twenty-five of 40 patients received allogeneic stem cell transplantation. Three-year event-free survival of the whole cohort was 37%, and the relapse rate was 38%. Three-year event-free survival by risk group was 53% for late, 34% for early, and 21% for very early relapses. An ALL marrow relapse nonresponsive to steroids, vincristine, asparaginase, anthracyclines, and alkylating agents is uncommon, and these classic drugs can still be advocated for induction of ALL relapse. The problems lie in creating a consolidation capable of preventing particularly posttransplant relapses.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Médula Ósea , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidad , Leucemia-Linfoma Linfoblástico de Células Precursoras/prevención & control , Trasplante de Células Madre , Adolescente , Ácido Aspártico/administración & dosificación , Niño , Preescolar , Dexametasona/administración & dosificación , Supervivencia sin Enfermedad , Femenino , Humanos , Idarrubicina/administración & dosificación , Lactante , Masculino , Proyectos Piloto , Recurrencia , Inducción de Remisión , Tasa de Supervivencia , Trasplante Homólogo , Vincristina/administración & dosificaciónRESUMEN
PURPOSE: Growth failure is common in radiotherapy-treated long-term survivors of pediatric brain tumors, but studies on longitudinal growth in this patient group are lacking. Here, the aim was to assess the changes in growth patterns before and after brain tumor diagnosis, the adult height, and the risk factors for compromised growth. The incidence and treatment practices of growth hormone deficiency were analyzed. METHODS: A cohort of 73 survivors of childhood brain tumor (median age 27.2 years, range 16.2 to 43.8 years) was studied after a median follow-up period of 20.4 years from diagnosis (IQR 14.9 to 22.9 years). Patients were treated in five university hospitals in Finland between 1970 and 2008. Growth curves, final height, and patient- and disease-related risk factors for compromised growth during different growth periods were analyzed. Laboratory analyses for IGF-1 and IGFBP-3 were performed at the follow-up. RESULTS: Growth failure was evident at diagnosis, with a mean height decline of -0.6 SDS (standard deviation score) from birth (95% CI -1.15 to -0.05). Mean height SDS decline after the diagnosis was -1.09 SDS (95%CI -1.51 to -0.66). At follow-up, 37% of the study subjects (27/73) had true short stature (height < -2 SDS). The mean height deficit corrected for target height was -1.9 SDS (95% CI -1.45 to -2.40). Growth failure was associated with the age at diagnosis, corticosteroid dose, radiotherapy modality and mean dose of irradiation in the thalamic area. Low IGF-1 level (below -2.0 SDS) was found in 32% (23/72), and untreated growth hormone deficiency in 40% (29/72) of the subjects. CONCLUSION: Longitudinal growth impairment was common in radiotherapy-treated survivors of childhood brain tumor, resulting in compromised adult height. Loss of growth potential was evident already at diagnosis and further accelerated by the treatments. At young adulthood, unrecognized growth hormone deficiency was common.
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Neoplasias Encefálicas , Hormona de Crecimiento Humana , Adolescente , Adulto , Estatura , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/radioterapia , Niño , Insuficiencia de Crecimiento/tratamiento farmacológico , Hormona del Crecimiento , Humanos , Factor I del Crecimiento Similar a la Insulina/análisis , Sobrevivientes , Adulto JovenRESUMEN
Acute lymphoblastic leukemia (ALL) is a rare disease in infants. Asparaginase is an essential part of the treatment, and there Acute is a need to evaluate the efficiency and safety of this drug in this age group. We evaluated the pharmacokinetics of intramuscularly administered native E. coli asparaginase (Asparaginase Medac®) and PEG-asparaginase (Oncaspar®) as well as hypersensitivity reactions during treatment in Interfant-06 ( www.clinicaltrials.gov : NCT01025804). All patients without hypersensitivity had sufficiently high enzyme activity levels during treatment with both preparations. Patients with hypersensitivity reactions during treatment, characterized by the presence of either or not of clinical symptoms and no measurable enzyme activity, received ineffective therapy. For optimization of the bad prognosis in infant ALL, therapeutic drug monitoring should be performed for identification of patients who should be switched to a different asparaginase preparation because of inactivation of the drug.
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Antineoplásicos/efectos adversos , Antineoplásicos/farmacocinética , Asparaginasa/efectos adversos , Asparaginasa/farmacocinética , Hipersensibilidad a las Drogas/etiología , Polietilenglicoles/efectos adversos , Polietilenglicoles/farmacocinética , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Antineoplásicos/uso terapéutico , Asparaginasa/uso terapéutico , Hipersensibilidad a las Drogas/diagnóstico , Monitoreo de Drogas , Femenino , Estudios de Seguimiento , Humanos , Quimioterapia de Inducción , Lactante , Recién Nacido , Masculino , Polietilenglicoles/uso terapéutico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Resultado del TratamientoRESUMEN
Commonly used indicators of sepsis are nonspecific and insufficient for predicting the course of febrile neutropenia (FN) in hematological patients. We analyzed data from 91 adult FN patients who received intensive chemotherapy for acute myeloid leukemia or autologous stem cell transplantation. Compared to patients with non-severe sepsis, patients with severe sepsis had significantly higher serum levels of tissue inhibitor of metalloproteinases-1 on the day of first occurrence of fever (day 0: 172 vs. 112 µg/L, p= .002) and for the two following days (day 1: 219 vs. 128 µg/L, p< .001; day 2: 443 vs. 128 µg/L, p= .001), and significantly higher serum levels of matrix metalloproteinase-10 on day 1 (1975 vs. 876 ng/L, p= .001) and day 2 (2020 vs. 841 ng/L, p< .001). We conclude that the measurement of these biomarkers may be useful in predicting the severity of sepsis in FN patients.
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Biomarcadores , Enfermedades Hematológicas/complicaciones , Metaloproteinasa 10 de la Matriz/sangre , Sepsis/sangre , Sepsis/etiología , Inhibidor Tisular de Metaloproteinasa-1/sangre , Anciano , Neutropenia Febril/etiología , Femenino , Enfermedades Hematológicas/diagnóstico , Enfermedades Hematológicas/terapia , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Masculino , Persona de Mediana Edad , Sepsis/diagnóstico , Factores de Tiempo , Trasplante AutólogoRESUMEN
BACKGROUND: Respiratory viruses occur frequently in the community and are a common cause of fever in children. Data on respiratory viral infections in children with cancer are limited. METHODS: A long-term, prospective, multicenter study was carried out in Finland searching for respiratory viruses in febrile children with leukemia. For this purpose, 138 febrile episodes in 51 children with leukemia were analyzed. Twelve types of respiratory viruses were searched for by viral culture, antigen detection, and polymerase chain reaction tests. RESULTS: Evidence of a respiratory viral infection was found in 61 of 138 febrile episodes (44%), accounting for an incidence of 0.8 (range, 0-2.4) per person year at risk during the treatment of leukemia. The most common viruses detected were rhinovirus (22%), respiratory syncytial virus (11%), human bocavirus (5%), and influenza A virus (4%). Dual viral infections were detected in 12 cases (9%). Half of the children had respiratory symptoms with cough being the most common symptom. Two children developed pneumonia. The mean duration of fever was 2.6 (SD 1.7) days in children with respiratory viral infection and 2.1 (SD 1.3) days in children without evidence of viral infection (P = 0.44). CONCLUSIONS: Respiratory viruses are found commonly during febrile episodes in children with leukemia. The detection of viruses permits the use of available antiviral agents, may explain a poor response to antimicrobial agents, and minimizes the proportion of febrile episodes without possible etiologic agents in children with leukemia.
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Leucemia Mieloide Aguda/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Infecciones del Sistema Respiratorio/virología , Virosis/virología , Adolescente , Bocavirus/aislamiento & purificación , Niño , Preescolar , Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/virología , Infección Hospitalaria/complicaciones , Infección Hospitalaria/virología , Femenino , Fiebre/etiología , Humanos , Lactante , Virus de la Influenza A/aislamiento & purificación , Leucemia Mieloide Aguda/virología , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/virología , Virus Sincitiales Respiratorios/aislamiento & purificación , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/diagnóstico , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Rhinovirus/aislamiento & purificación , Virosis/complicaciones , Virosis/diagnósticoRESUMEN
BACKGROUND: Interest has recently been paid to adolescents and young adults with acute lymphoblastic leukemia, particularly because all reports so far published indicate that these patients have a better outcome when treated with pediatric rather than adult therapeutic protocols. There are different biological subtypes of acute lymphoblastic leukemia with distinct features and prognoses; the distribution of these subtypes is not well known among adolescents. We, therefore, studied acute lymphoblastic leukemia in adolescents and young adults aged 10 to 25 years in Finland. DESIGN AND METHODS: This population-based study included 225 consecutive patients aged 10-25 years diagnosed with acute lymphoblastic leukemia during 1990-2004. One hundred and twenty-eight patients (10-16 years) were treated with pediatric Nordic (NOPHO) protocols, and 97 patients (17-25 years) with Finnish Leukemia Group National protocols. We characterized the biological subtypes, clinical features and outcome of these patients. RESULTS: For the whole cohort, the remission rate was 96%, 5-year event-free survival 62% and overall survival 72%. The 5-year event-free survival was 67% for the pediatric treatment group and 60% for the adult treatment group (p=n.s.). Patients with inferior outcome were those with a white blood cell count >or= 100 x 10(9)/L, the Philadelphia chromosome and MLL. Good prognostic features were TEL-AML1, hyperdiploidy, and pediatric intermediate risk stratification. CONCLUSIONS: Unlike all previous studies, we found that the outcome of adolescents and young adults with acute lymphoblastic leukemia treated with pediatric or adult therapeutic protocols was comparable. The success of the adult acute lymphoblastic leukemia therapy emphasizes the benefit of central referral of patients to academic centers and adherence to research protocols.
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Antineoplásicos/uso terapéutico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Adolescente , Adulto , Crisis Blástica , Niño , Supervivencia sin Enfermedad , Femenino , Finlandia , Humanos , Leucemia-Linfoma de Células T del Adulto/tratamiento farmacológico , Leucemia-Linfoma de Células T del Adulto/genética , Leucemia-Linfoma de Células T del Adulto/mortalidad , Leucemia-Linfoma de Células T del Adulto/patología , Recuento de Leucocitos , Masculino , Fenotipo , Cromosoma Filadelfia , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidad , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , Análisis de SupervivenciaRESUMEN
PURPOSE: The purpose of this study was to find out the incidence of and clinical risk factors for magnetic resonance imaging (MRI)-detected osteonecrosis (ON) in children treated for lymphoma or solid tumors. PATIENTS AND METHODS: The development of ON was studied in 32 childhood cancer patients who underwent MRI scanning of the lower extremities at the end of their treatment. The underlying malignancy was Wilms tumor in 8 patients, non-Hodgkin lymphoma (NHL) in 8, Hodgkin disease (HD) in 7, rhabdomyosarcoma in 6, and other occasional solid tumors in 3 patients. RESULTS: Six of the 32 patients (19%) had ON. The mean age of the patients with ON at diagnosis was 12.7 years compared with 5.8 years for the patients without ON (P<0.001). All the patients with ON had either HD (4 patients) or NHL (2 patients). Two (33%) of the patients with ON were symptomatic. CONCLUSIONS: ON in MRI was found to be a common complication in children after treatment for HD or NHL. The risk for ON seems to be very low in patients with other solid tumors even when they receive high cumulative doses of dexamethasone.
Asunto(s)
Enfermedad de Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Neoplasias/tratamiento farmacológico , Osteonecrosis/inducido químicamente , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Niño , Preescolar , Dexametasona/uso terapéutico , Femenino , Enfermedad de Hodgkin/patología , Humanos , Incidencia , Linfoma no Hodgkin/patología , Imagen por Resonancia Magnética , Masculino , Neoplasias/patología , Osteonecrosis/diagnóstico , Factores de RiesgoRESUMEN
PURPOSE: Long-term side effects of the treatments are common in survivors of irradiated pediatric brain tumors. Ionizing radiation in combination with surgery and chemotherapy during childhood may reduce vertebral height and bone mineral density (BMD), and cause growth failure. The aim of this study was to evaluate the late consequences of tumor treatments on vertebrae in survivors of childhood brain tumors. METHODS: 72 adult survivors (mean age 27.8 years, standard deviation 6.7) of irradiated childhood brain tumor were studied by spinal magnetic resonance imaging (MRI) for vertebral abnormalities from the national cohort of Finland. Patients were treated in five university hospitals in Finland between the years 1970 and 2008. Subject height and weight were measured and body mass index (BMI) was calculated. The morphology and height/depth ratio of the vertebrae in the middle of the kyphotic thoracic curvature (Th8) and lumbar lordosis (L3) were examined. Vertebrae were analyzed by Genant's semiquantative (SQ) method and spinal deformity index (SDI) was calculated. BMD was measured by using dual X-ray absorptiometry. RESULTS: 4.2% (3/72) of the patients had undiagnosed asymptomatic vertebral fracture and 5.6% (4/72) of patients had radiation-induced decreased vertebral body height. Male patients had flatter vertebrae compared with females. Patient age at the time of irradiation, BMI and irradiation area correlated to vertebral morphology differentially in males and females. BMD had no association with the vertebral shape. Patients who had received craniospinal irradiation were shorter than the general population. CONCLUSION: Childhood brain tumor survivors had a high number of vertebral abnormalities in young adulthood. Irradiation was associated with abnormal vertebral morphology and compromised final height. Male gender may predispose vertebrae to the side effects of irradiation.
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Neoplasias Encefálicas/radioterapia , Traumatismos por Radiación/diagnóstico por imagen , Radioterapia/efectos adversos , Enfermedades de la Columna Vertebral/etiología , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/efectos de la radiación , Absorciometría de Fotón , Adulto , Densidad Ósea/efectos de la radiación , Supervivientes de Cáncer , Estudios de Cohortes , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Traumatismos por Radiación/etiología , Factores de Riesgo , Factores Sexuales , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Traumatismos Vertebrales/diagnóstico por imagen , Traumatismos Vertebrales/etiología , Factores de TiempoRESUMEN
BACKGROUND: Febrile infections in children with leukemia are common. The occurrence of possible mixed bacterial-viral infections is unknown. METHODS: We searched for viruses in leukemic children with blood culture-positive bacterial infections. The prospective multicenter survey included 156 febrile episodes in 51 children with acute leukemia. The mean follow-up time was 1.5 years per patient (27,743 patient-days at risk). Sixteen viruses were searched for from nasal swab and stool samples using virus culture, virus antigen detection, and polymerase chain reaction tests. RESULTS: Bacterial blood cultures were positive in 19 (11%) febrile episodes among 17 children. In half of the septic episodes (11 of 19), a virus was also found. Rhinovirus and respiratory syncytial virus were the most common viruses detected. CONCLUSIONS: Our findings suggest that invasive bacterial infections are commonly associated with viral infections in children with leukemia.
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Bacteriemia/complicaciones , Leucemia/complicaciones , Virosis/complicaciones , Adolescente , Bacteriemia/epidemiología , Bacteriemia/microbiología , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Sangre/microbiología , Niño , Preescolar , Heces/virología , Fiebre/etiología , Humanos , Incidencia , Lactante , Leucemia/epidemiología , Cavidad Nasal/virología , Virus Sincitial Respiratorio Humano/clasificación , Virus Sincitial Respiratorio Humano/genética , Virus Sincitial Respiratorio Humano/aislamiento & purificación , Rhinovirus/clasificación , Rhinovirus/genética , Rhinovirus/aislamiento & purificación , Virosis/epidemiología , Virosis/virología , Virus/clasificación , Virus/genética , Virus/aislamiento & purificaciónRESUMEN
Central neurocytomas are intraventricular tumors composed of round uniform cells. These tumors have usually favorable prognosis. Leukemic infiltrates are occasionally seen as a complication of acute lymphatic leukemia. This report describes a 7-year-old boy who was treated because of diagnosed lymphatic leukemia with central nervous system involvement and concomitant neurocytic tumor located in the fourth ventricle. These two entities might be problematic to differentiate from each other without proper histopathological examination.
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Neoplasias Encefálicas/patología , Cuarto Ventrículo/patología , Infiltración Leucémica/patología , Neoplasias Primarias Secundarias , Neurocitoma/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , Biomarcadores de Tumor/análisis , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/terapia , Niño , Terapia Combinada , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Masculino , Neurocitoma/diagnóstico por imagen , Neurocitoma/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico por imagen , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Tronco Encefálico/radioterapia , Glioma/radioterapia , Fármacos Sensibilizantes a Radiaciones/uso terapéutico , Topotecan/uso terapéutico , Adolescente , Inhibidores de la Angiogénesis/administración & dosificación , Neoplasias del Tronco Encefálico/patología , Celecoxib , Niño , Preescolar , Progresión de la Enfermedad , Etopósido/administración & dosificación , Glioma/patología , Humanos , Proyectos Piloto , Pirazoles/administración & dosificación , Calidad de Vida , Sulfonamidas/administración & dosificación , Análisis de Supervivencia , Talidomida/administración & dosificación , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate cardiac function by means of conventional and three-dimensional echocardiography (3DE) and measurement of natriuretic peptides in children and adolescents previously treated for childhood malignancy using individual follow-up data and matched control children as reference criteria. PATIENTS AND METHODS: Thirty-nine survivors of childhood malignancy were examined in 1994 and 1998. The mean time from the diagnosis was 8.6 (3.9 to 16.8) years and between cardiac evaluations was 4.1 (3.3 to 5.1) years. Patients were divided into two groups according to therapies given (group I (n = 30): no cardiac irradiation, median cumulative anthracycline dose 210 mg/m2; group II (n = 9): irradiation in the cardiac region, median cumulative anthracycline dose 180 mg/m2). RESULTS: Fractional shortening (FS) in 1994 was higher than in 1998 (32.5 +/- 4.3 vs. 30.3% +/- 3.3%, P =.009). 33% of patients in group I and 56% in group II in 1994 and 30% of patients in group I and 67% in group II in 1998 had N-terminal of the propeptide-atrial natriuretic peptide (NT-proANP) levels exceeding the 90th percentile of controls. In 1998, both groups (I and II) had lower ejection fraction (EF) measured by 3DE than their matched controls (52.9 +/- 5.2 vs. 58.8% +/- 3.1%, P <.001 and 50.0 +/- 6.6 vs. 60.8% +/- 3.2%, P =.024, respectively). Left atrial maximum volumes/body surface area were smaller in the patients than in controls. B-Type natriuretic peptide values did not differ significantly in either group. CONCLUSION: Left ventricular contractility decreases slowly even years after cardiotoxic cancer therapy in children. 3DE and NT-proANP measurements are effective methods to evaluate the cardiac function in these patients.