Late Effects After Treatment of Hodgkin Lymphoma in Childhood and Adolescence

AbstractObjectiveTo define the prevalence of neuromuscular, musculoskeletal, pain, visceral, oncologic and other late effects impacting function and quality of life in Hodgkin lymphoma(HL) survivors presenting to an outpatient cancer rehabilitation clinic.DesignA retrospective cohort analysis.SettingOutpatient cancer rehabilitation clinic.ParticipantsOne hundred consecutive HL survivors.InterventionsNone.Main Outcome MeasuresThe prevalence of neuromuscular, musculoskeletal, pain, visceral, oncologic and other late effects contributing to functional impairment and disability in HL survivors.ResultsAmong the 100 HL survivors, 43% received chemotherapy, 94% radiation therapy, and 38% a combination of chemotherapy and radiation for initial treatment. Nearly all HL survivors were diagnosed with myelopathy (83%), radiculo-plexopathy (93%), mononeuropathy (95%) and localized myopathy (93%). Musculoskeletal sequelae were extremely common and included dropped head syndrome (83%), cervicalgia (79%), shoulder girdle dysfunction (73%), and dysphagia (42%). Visceral disorders were also common and included cardiovascular (70%), pulmonary (44%), endocrine (63%), gastrointestinal (29%), and genitourinary (11%) dysfunction. Lymphedema affected 21% of survivors and 30% had a history of a secondary malignancy. Pain (71%), fatigue (45%), and dyspnea (43%) were major function-limiting impairments. Nearly all (95%) of survivors were referred to at least one therapy discipline including physical therapy, occupational therapy, speech and language pathology and/or lymphedema therapy.ConclusionNeuromuscular, musculoskeletal, pain, visceral, oncologic and other late effectsare extremely common in HL survivors seeking physiatric evaluation. Multiple function-limiting disorders can co-exist in HL survivors with the potential to severely compromise function and quality of life. Safe and effective rehabilitation may depend on the physiatrist’s ability to identify, evaluate and manage the multitude of complex and often interrelated functional late effects seen in HL survivors.

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Evaluation of the Risk of Therapy-Associated Complications in Survivors of Hodgkin Lymphoma

Hematology ◽

10.1182/asheducation-2007.1.192 ◽

2007 ◽

Vol 2007 (1) ◽

pp. 192-196 ◽

Cited By ~ 4

Author(s):

Lois B. Travis

Keyword(s):

Hodgkin Lymphoma ◽

Health Care Providers ◽

Late Effects ◽

Disease Risk ◽

Risk Measures ◽

Epidemiologic Study ◽

Incidence Rates ◽

Care Providers ◽

Large Numbers ◽

Study Designs

Abstract Given the improvements in survival of patients with Hodgkin lymphoma (HL) in the last three decades, quantification of the late effects of successful treatment has become critical. Since the highest incidence rates of HL occur at ages 20 to 34 years, large numbers of patients remain at lifelong risk for the late effects of treatment. Deaths due to second cancers are now the most common cause of mortality among long-term survivors of HL, followed by cardiac disease. Risk measures of these and other late sequelae, however, can vary markedly between investigations, depending on the types of treatment, the rigor with which epidemiologic study designs are applied, ascertainment of events of interest, the duration and completeness of follow-up, and consideration of competing risks. Further, numerous influences apart from therapy can affect late effects, including patient age, sex, race, lifestyle factors (tobacco, alcohol, diet), comorbidities, and the underlying cancer process. In the future, it will become increasingly important for health-care providers to be able to critically evaluate the risk of late effects in HL survivors, which will include a working knowledge of various epidemiologic study designs and risk measures and an ability to judiciously review the medical literature. In this article, the methods, significance and caveats in calculating and reporting risks of complications of treatment for HL are reviewed.

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Linfoma di Burkitt in età pediatrica

Medico e Bambino pagine elettr ◽

10.53126/mebxxiv175 ◽

2021 ◽

Vol 24 (6) ◽

pp. 175-184

Author(s):

Fabio Timeus ◽

Matilde Piglione ◽

Franca Fagioli ◽

Aldo Ravaglia

Keyword(s):

Late Effects ◽

Well Being ◽

Developed Countries ◽

Primary Care Doctor ◽

High Dose ◽

Childhood And Adolescence ◽

Myc Oncogene ◽

Alternating Chemotherapy ◽

Short Courses ◽

Chemotherapy Agents

Sporadic Burkitt lymphoma (BL) accounts for about 80% of non-Hodgkin lymphomas in childhood and adolescence, with an incidence of 3-5 cases per million in developed countries. The hallmark of LB is the deregulation of MYC oncogene, usually caused by the [t(8;14)(q24;q32)] translocation, involving the gene of immunoglobulin heavy chain. BL is a very aggressive neoplasm, with a doubling time of 12-24 hours and its diagnosis and therapy are a true haematologic emergency. Abdomen, head and neck are the most frequent sites of presentation and the involvement of ileo-caecal area can cause an intussusception as first manifestation of the disease. <br> BL and mature B-cell acute leukaemia (the leukaemic manifestation of BL) share the same therapeutic approach, intensive short courses with multiple alternating chemotherapy agents, the use of high dose-methotrexate and intrathecal CNS prophylaxis. The outcomes are satisfactory: in Italy during the period 1997-2014 the children with BL were treated according to the AIEOP LNH-97 protocol, achieving more than 90% of 5 year-survival. <br> In the last decades, the prognosis for children and adolescents with cancer has dramatically improved and the increasing number of long-term survivors has focused the attention of clinicians on the late effects of cancer and its therapy. A multidisciplinary follow up and a correct transition from the paediatrician to the primary care doctor plays a central role not only in the early detection and therapy of late effects of cancer but also in supporting the patient to realize their physical, mental and social well-being as much as possible.

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The risk of late effects following pediatric and adult radiotherapy regimens in Hodgkin lymphoma

Strahlentherapie und Onkologie ◽

10.1007/s00066-020-01721-w ◽

2020 ◽

Author(s):

Anni Young Lundgaard ◽

Lisa Lyngsie Hjalgrim ◽

Laura Ann Rechner ◽

Michael Lundemann ◽

N. Patrik Brodin ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Late Effects

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Quality of life in long-term survivors of CNS tumors of childhood and adolescence.

Journal of Clinical Oncology ◽

10.1200/jco.1991.9.4.592 ◽

1991 ◽

Vol 9 (4) ◽

pp. 592-599 ◽

Cited By ~ 137

Author(s):

E N Mostow ◽

J Byrne ◽

R R Connelly ◽

J J Mulvihill

Keyword(s):

Quality Of Life ◽

Late Effects ◽

Pediatric Brain Tumor ◽

Adverse Outcomes ◽

Cns Tumors ◽

Childhood And Adolescence ◽

Long Term Survivors

Clinical reports of small numbers of pediatric brain tumor patients observed for brief periods suggest that long-term survivors continue to have major handicaps into adulthood. To quantify these late effects we interviewed 342 adults (or their proxies) who had CNS tumors diagnosed before the age of 20 between 1945 and 1974, survived at least 5 years, and reached 21 years of age. Survivors were 32 years old on average at follow-up. When compared with 479 matched siblings as controls. CNS tumor survivors were more likely to have died or to have become mentally incompetent sometime during the follow-up period. They were more likely to be at risk for such adverse outcomes as unemployment (odds ratio [OR], 10.8; 95% confidence interval [CI], 4.6 to 25.7], to have a health condition that affected their ability to work (OR, 5.9; CI, 3.7 to 9.4), to be unable to drive (OR, 28.8; CI, 6.9 to 119.9), or to describe their current health as poor (OR, 7.8; CI, 1.7 to 35.7). Unfavorable outcomes were more frequent in male survivors than in females, in those with supratentorial tumors compared with infratentorial ones, and in those who received radiation therapy. As clinicians consider improving therapies, they should anticipate late effects, such as those we observed, and attempt to target subgroups for interventions that may improve subsequent quality of life.

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