Trends in body mass index (BMI) during and after treatment for standard risk (SR) acute lymphoblastic leukemia (ALL): A report from the Children’s Oncology Group (COG).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9546-9546
Author(s):  
Susan Joy Lindemulder ◽  
Linda C. Stork ◽  
Bruce C. Bostrom ◽  
Xiaomin Lu ◽  
Meenakshi Devidas ◽  
...  
Keyword(s):  
Lymphoblastic Leukemia ◽  
Temporal Trends ◽  
Limited Data ◽  
And Gender ◽  
One Year ◽  
Long Term Survivors ◽  
Standard Risk ◽  
Post Therapy

9546 Background: Obesity is a potential complication in children treated for ALL. Limited data exist regarding timing of BMI changes and risk in long-term survivors of ALL treated without cranial radiation (CRT). This study describes temporal trends in BMI during and after therapy for SR-ALL and identifies associated factors. Methods: We conducted a retrospective cohort study of children with SR-ALL enrolled on two sequential clinical trials between 1993 and 2000 and on the COG ALTE02C2 follow-up study. Therapy included prednisone or dexamethasone during induction, the same steroid in maintenance phases, and no CRT. Standing height and weight was ascertained at diagnosis (dx), start of consolidation, start of maintenance, start of the last cycle of maintenance, and at least one year off therapy. Age and gender-specific BMI percentiles (BMI%) were calculated using 2000 CDC growth charts for patients 2-20 years. Results: The 269 subjects were a median of 3.5 years at dx, 46.7% female, 82.3% white, and a median of 9.1 years since dx at the last timepoint. The BMI% was associated with elapsed time since dx: BMI% increased between dx and consolidation (50.9%-68.3%, p < 0.0001), remained stably elevated until the end of maintenance, and then decreased somewhat from the end of maintenance to the last timepoint (74.1%-70.6%, p = 0.03). After therapy, 18.1% of survivors were overweight (BMI% 85-95) and 20.9% were obese (BMI% ≥ 95). By unadjusted linear regression, higher dx BMI% was positively associated with BMI% post-therapy (p < 0.0001). There was an interaction with steroid and dx BMI% such that the association between dx BMI% and post therapy BMI% was significantly greater for the dexamethasone group than the prednisone group (p = 0.01). There was no association with age at dx, gender, or race. Conclusions: In this retrospective study of SR-ALL survivors treated without CRT, we found that BMI% increased significantly in the month after dx and remained substantially elevated even several years after the end of therapy. Dx BMI% was highly associated with off-therapy BMI%, particularly in patients who had received dexamethasone rather than prednisone.

High Prevalence of Chronic Fatigue in Long Term Survivors of Childhood Acute Lymphoblastic Leukemia and Lymphoma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4225-4225
Author(s):  
Hanne Hamre ◽  
Bernward Zeller ◽  
Adriani Kanellopoulos ◽  
Sophie Dorothea Fosså ◽  
Jon Håvar Loge ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
General Population ◽  
Lymphoblastic Leukemia ◽  
Chronic Fatigue ◽  
Diffusion Capacity ◽  
And Gender ◽  
Long Term Survivors ◽  
And Diffusion

Abstract Abstract 4225 Introduction: Chronic fatigue is a frequent and distressing late effect after successful cancer treatment. However, few studies have included survivors of childhood cancers. Aims: The primary aim of the study was to assess the prevalence of fatigue in long-term survivors of childhood acute lymphoblastic leukemia (ALL), non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL), and to compare with the Norwegian general population. A secondary aim was to explore the association between cardiac or pulmonary late effects and fatigue in long-term survivors after NHL and HL. Material and method: This population-based cross-sectional study included tumor-free adult survivors of childhood ALL, NHL and HL diagnosed between 1970 and 2002 at an age of <19 years with at least 5 years follow-up time. The enrolled patients underwent extensive biochemical and clinical investigation including echocardiography and estimation of lung volumes and diffusion capacity. Clinical information was retrieved from the patient records. Chalder′s fatigue questionnaire (FQ) was used to assess fatigue. Chronic fatigue (CF) was defined as a substantially increased level of fatigue with duration of more than 6 months. 1423 age and gender matched individuals from the general Norwegian population served as controls. Results: A total of 290 patients completed the questionnaire (ALL 151, NHL 47, HL 92). Median age (range) at assessment was 29.9 (18.3–54.5) years. Median follow-up time from diagnosis was 21.3 (6.9–39.2) years. The overall prevalence of CF was 27% (ALL 23%, NHL 30%, HL 34%), as compared to 8.4% among the controls (p>0.001). There was a tendency towards a higher prevalence of CF by increasing age (32% among subjects aged ≥30 years at follow-up vs. 22% in subjects aged<30 years, p=0.063). This was most pronounced among the ALL survivors (36% among subjects aged ≥30 years years at follow-up vs. 13% among subjects aged <30 years, p=0.001). In ALL survivors, older age at diagnosis was associated with higher prevalence of CF (15% among subjects aged <6 years at diagnosis vs. 32% among subjects aged ≥6 years, p= 0.012). Indeed, among all survivors ≥6 years at diagnosis, the ALL group had a similar prevalence of CF as the two other diagnostic groups; 32%. No association was found between CF and gender, time from diagnosis, radiotherapy, cumulative anthracycline dose, body mass index, proBNP or hypothyreosis. Among the lymphoma survivors the presence of B-symptoms at diagnosis tended to be associated with CF (Presence: CF 48% vs. Absence: CF 29%, p=0.058). In long-term survivors of NHL and HL, no association was found between CF and aortic valve disease, total lung capacity and diffusion capacity. Conclusions: Compared to the general population the prevalence of CF is 3-fold increased in long-term survivors of childhood leukemia and lymphoma. The prevalence is highest in HL (34%), but, rather surprisingly, even ALL survivors have a high occurrence of CF (23%). The lack of association between CF and somatic co-morbidity or dysfunction warrants future studies exploring the etiology of CF in long-term survivors. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Role of methyleprednisolone succinate in the management of acute spinal cord injury

1970 ◽  
Vol 9 (3) ◽  
pp. 168-172
Author(s):  
NK Karn ◽  
BP Shrestha ◽  
GP Khanal ◽  
R Rijal ◽  
P Chaudhary ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neurological Status ◽  
Acute Spinal Cord Injury ◽  
Cord Injury ◽  
And Gender ◽  
One Year

Objective: To see the role of methyleprednisolone succinate in the management of acute spinal cord injury. Methods: A randomized control trial was done including the patients with acute spinal cord injury. They were divided into age and gender matched two groups. Patients with presence of active infection, associated open fracture, those on long term steroid and those who did not give consent to participate in the trial were excluded. One group received methyleprednisolone succinate within 8 hours of injury and another group did not receive the drug. Both the groups were managed nonoperatively. The neurological status of the patients was assessed at presentation, once spinal shock was over, at 6th week and 6th month and after one year according to ASIA scoring. Frankel grading was also assessed in every follow up. Conclusion: Methylprednisolone succinct prevents secondary cord injury to a great extent and hence its administration within 8 hours of injury results in a better functional (motor and sensory) outcome. Keywords: acute spinal cord injury; methyleprednisolone succinate DOI: http://dx.doi.org/10.3126/hren.v9i3.5585   HR 2011; 9(3): 168-172

Chronic Progressive Cardiac Dysfunction Years After Doxorubicin Therapy for Childhood Acute Lymphoblastic Leukemia

2005 ◽  
Vol 23 (12) ◽  
pp. 2629-2636 ◽  
Author(s):  
Steven E. Lipshultz ◽  
Stuart R. Lipsitz ◽  
Stephen E. Sallan ◽  
Virginia M. Dalton ◽  
Suzanne M. Mone ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Left Ventricular ◽  
Childhood Acute Lymphoblastic Leukemia ◽  
Cardiac Abnormalities ◽  
Z Scores ◽  
Long Term Survivors ◽  
Fractional Shortening

Purpose Cross-sectional studies show that cardiac abnormalities are common in long-term survivors of doxorubicin-treated childhood malignancies. Longitudinal data, however, are rare. Methods Serial echocardiograms (N = 499) were obtained from 115 doxorubicin-treated long-term survivors of childhood acute lymphoblastic leukemia (median age at diagnosis, 4.8 years; median follow-up after completion of doxorubicin, 11.8 years). Results were expressed as z scores to indicate the number of standard deviations (SDs) above (+) or below (−) the normal predicted value. Median individual and cumulative doxorubicin doses were 30 mg/m2 per dose and 352 mg/m2, respectively. Results Left ventricular fractional shortening was significantly reduced after doxorubicin therapy, and the reduction was related to cumulative dose. z scores for fractional shortening transiently improved before falling to −2.76 more than 12 years after diagnosis. Reduced fractional shortening was related to impaired contractility and increasing afterload, consequences of a progressive reduction of ventricular mass, and wall thickness relative to body-surface area. Left ventricular contractility fell significantly over time and was depressed at last follow-up in patients receiving more than 300 mg/m2 of doxorubicin. Systolic and diastolic blood pressures were below normal more than 9 years after diagnosis. Even patients receiving lower cumulative doxorubicin doses experienced reduced mass and dimension. Fractional shortening and dimension at the end of therapy predicted these parameters 11.8 years later. Conclusion Cardiac abnormalities were persistent and progressive after doxorubicin therapy. Inadequate ventricular mass with chronic afterload excess was associated with progressive contractile deficit and possibly reduced cardiac output and restrictive cardiomyopathy. The deficits were worst after highest cumulative doses of doxorubicin, but appeared even after low doses.

scholarly journals Chemotherapy Pharmacodynamics and Neuroimaging and Neurocognitive Outcomes in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia

2016 ◽  
Vol 34 (22) ◽  
pp. 2644-2653 ◽  
Author(s):  
Kevin R. Krull ◽  
Yin Ting Cheung ◽  
Wei Liu ◽  
Slim Fellah ◽  
Wilburn E. Reddick ◽  
...  
Keyword(s):  
Executive Function ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Executive Dysfunction ◽  
Brain Regions ◽  
Childhood Acute Lymphoblastic Leukemia ◽  
Long Term Follow Up ◽  
Long Term Survivors

Purpose To examine associations among methotrexate pharmacodynamics, neuroimaging, and neurocognitive outcomes in long-term survivors of childhood acute lymphoblastic leukemia treated on a contemporary chemotherapy-only protocol. Patients and Methods This longitudinal study linked pharmacokinetic assays collected during therapy to neurocognitive and brain imaging outcomes during long-term follow-up. A total of 218 (72.2%) of 302 eligible long-term survivors were recruited for outcome studies when they were more than 5 years post-diagnosis and older than 8 years of age. At long-term follow-up, survivors were an average of 13.8 years old and 7.7 years from diagnosis, and 51% were male. Neurocognitive testing, functional magnetic resonance imaging (MRI) during an executive function task, and structural MRI with diffusion tensor imaging were conducted. Generalized linear models were developed to identify predictors, and models were adjusted for age at diagnosis, sex, and parent education. Results Intelligence was within normal limits (mean, 98; standard deviation, 14) compared with population expectations (mean, 100; standard deviation, 15), though measures of executive function, processing speed, and memory were less than population means (all P < .02 after correction for false discovery rates). Higher plasma concentration of methotrexate was associated with a poorer executive function score (P < .02). Higher plasma methotrexate was also associated with higher functional MRI activity, with thicker cortices in dorsolateral prefrontal brain regions, and with white matter microstructure in the frontostriatal tact. Neurocognitive impairment was associated with these imaging findings as well. Associations did not change after adjustment for age or dose of leucovorin rescue. Conclusion Survivors of childhood acute lymphoblastic leukemia treated on contemporary chemotherapy-only protocols demonstrate executive dysfunction. A higher plasma concentration of methotrexate was associated with executive dysfunction as well as with a thicker cortex and higher activity in frontal brain regions, regions often associated with executive function.

Extended Follow-up of Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia

2003 ◽  
Vol 349 (7) ◽  
pp. 640-649 ◽  
Author(s):  
Ching-Hon Pui ◽  
Cheng Cheng ◽  
Wing Leung ◽  
Shesh N. Rai ◽  
Gaston K. Rivera ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Childhood Acute Lymphoblastic Leukemia ◽  
Long Term Survivors

Incidence of non-breast cancer neoplasms (non-BCN) diagnosed prior and subsequent to breast cancer (BC): Single institution experience.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13689-e13689
Author(s):  
Zorica Tomasevic ◽  
Zoran Tomasevic ◽  
Danica Grujicic ◽  
Marina Nikitovic ◽  
Zorka Milovanovic
Keyword(s):  
Breast Cancer ◽  
Medical Records ◽  
Genetic Factors ◽  
Subsequent Development ◽  
Limited Data ◽  
Single Institution ◽  
Long Term Survivors ◽  
Similar Incidence

e13689 Background: The risk for developing subsequent non-BCN in BC patients is recognized as growing problem hence more patients are long term survivors. Limited data are available for non-BCN developed prior to BC. Better defining of types and frequency of non-BCN might be important for recognition of cancer predisposing factors. We aim to evaluate incidence, type, and time of development for all non-BCN in BC patients at the Institute for Oncology and Radiology of Serbia (IORS). Methods: During 2019, 2384 BC patients were seen at the IORS for treatment or follow up, all medical records have been evaluated for potential non-BCN diagnosis. Results: 230 (9.7%) patients also had variety of histologically confirmed non-BCN: in 78 (34%) as prior to BC, median 5 years (1-42); as synchronous with BC in 12 (5%) median 4 months (0 < 12 months) and in 140 (61%) as subsequent to BC, median 8 years (≥1-33). Six most frequent non-BCNs are presented in table. Conclusions: Amongst 230 BC patients 34 different non-BCN were identified. All non-BCNs were more frequently developed subsequently to BC, representing 61% of all non-BCN cases, with expected exception of HL hence 12/13 (92%) occurred prior to BC. EC,TC, OC, CRC and LC, represents 54 % of all non-BCN and were diagnosed more frequently as subsequent to BC while TC had similar incidence as prior and subsequent to BC. Subsequent development might be related solely to genetic factors, but at least in some cases, influence of BC treatment (tamoxifen, cyclophosphamide, radiotherapy) cannot be excluded.[Table: see text]

scholarly journals Thrombotic Microangiopathy Increases the Risk of Chronic Kidney Disease but Not Overall Mortality in Long-Term Survivors

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 47-48
Author(s):  
Ang Li ◽  
Hanqing Shang ◽  
Rohit Gupta ◽  
Chris Davis ◽  
Stephanie J. Lee ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Research Funding ◽  
Post Transplant ◽  
Long Term Follow Up ◽  
History Of ◽  
One Year ◽  
Long Term Survivors ◽  
Over Time

Introduction: Thrombotic microangiopathy (TMA) is a known complication of allogeneic hematopoietic cell transplantation (HCT). Post-transplant TMA has been associated with acute kidney injury (AKI) and early mortality. However, the long-term kidney outcomes and survival in patients who recover from the disease have not been well characterized. Methods: We performed a retrospective cohort study of adult allogeneic HCT recipients transplanted during 2006-2015 who survived to one-year (index date) and had follow-up at the Long-Term Follow-Up (LTFU) clinic at the Fred Hutchinson Cancer Research Center (FHCRC). Patients were classified as TMA or non-TMA based on whether a diagnosis was made within one-year post-transplant (BBMT 2019;25:570). Outpatient creatinine values obtained during LTFU visits were assessed over time and averaged at the distinct years post-transplant. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula. Chronic kidney disease (CKD) was defined as eGFR &lt;60 mL/min/1.73m2. Potential confounders included pre-HCT eGFR, prior autologous HCT, older age, female sex, black race, myeloablative conditioning (including high-dose total body irradiation), calcineurin/mTOR inhibitor exposure, development of AKI within 6 months, acute graft versus host disease (GVHD) within 6 months, and chronic GVHD within 12 months post-transplant. Pre-transplant hypertension and diabetes were not considered as confounders because they had no known association with TMA development. To assess the association between history of TMA and CKD over time among post-transplant survivors, generalized estimating equation (GEE) was used with exchangeable correlation, binomial family, and logit link, after adjustment for pre-index variables. GEE was chosen to model the longitudinal creatinine outcomes at discrete intervals and to help account for interval missingness. The adjusted odds ratio (OR), 95% confidence interval (CI), robust standard error (SE), and P-values were presented. Unadjusted Kaplan Meier (KM) analysis with landmark at 1 year was used to compare long-term overall survival. Results: Among 2091 patients that underwent first allogeneic HCT, we identified 1151 patients who had survived at least one-year and had available long-term follow-up data (Figure 1). Fifty-seven patients were survivors who had a history of TMA within one-year post-transplant and 1094 did not. Outpatient creatinine data were available in decreasing number of patients each year for the first 5 years post-transplant. The median eGFR over time for the two groups was shown in Figure 2. At one-year post-transplant, 52% of TMA survivors had CKD versus 27% of non-TMA survivors. After adjusting for other potential confounders, a history of TMA was associated with an odds ratio of 2.62 (95% CI 1.25-5.52) for CKD at one-year post-transplant (Table 1). There was no appreciable change in CKD status over time (non-significant interaction for TMA x year). The adjusted covariates had the expected magnitude and significance of association with CKD development, whereas age, pre-transplant eGFR, acute GVHD, and early AKI had the strongest association. While TMA was significantly associated with short-term mortality, there was no association between history of TMA and long-term overall survival in KM analysis landmarked beyond year one, where the conditional 5-year survival was 71% in the TMA survivors and 74% in the non-TMA survivors (log rank P= 0.113). Conclusions: In this study of 1151 post-transplant long-term survivors, we found that TMA survivors had higher risk of CKD post-transplant despite adjusting for key potential confounders. The overall eGFR had the largest decrease between pre-transplant and year-one post-transplant, with non-appreciable variation in subsequent years. While TMA patients were more likely to die early, in those who survived to one-year, their long-term mortality was similar to non-TMA patients. Limitations in the study include the lack of uniform follow-up for all transplant survivors and potentially unobserved confounders. Overall, our data suggest that TMA appears to be a time-limited systemic insult; although its damage to the kidney requires continued monitoring and management. Disclosures Lee: Amgen: Research Funding; Novartis: Research Funding; AstraZeneca: Research Funding; Kadmon: Research Funding; Incyte: Consultancy, Research Funding; Syndax: Research Funding; Pfizer: Consultancy, Research Funding; Takeda: Research Funding.

Outcome of 609 adults after relapse of acute lymphoblastic leukemia (ALL); an MRC UKALL12/ECOG 2993 study

Blood ◽  
2006 ◽  
Vol 109 (3) ◽  
pp. 944-950 ◽  
Author(s):  
Adele K. Fielding ◽  
Susan M. Richards ◽  
Rajesh Chopra ◽  
Hillard M. Lazarus ◽  
Mark R. Litzow ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Term Survival ◽  
First Remission ◽  
Previously Treated ◽  
Long Term Survivors ◽  
To Receive ◽  
Prevention Of Recurrence

Abstract Most adults with acute lymphoblastic leukemia (ALL) who achieve complete remission (CR) will relapse. We examined the outcome of 609 adults with recurring ALL, all of whom were previously treated on the Medical Research Council (MRC) UKALL12/ECOG2993 study, where the overall survival (OS) of newly diagnosed patients is 38% (95% confidence interval [CI] = 36%-41%) at 5 years. By contrast, OS at 5 years after relapse was 7% (95% CI = 4%-9%). Factors predicting a good outcome after salvage therapy were young age (OS of 12% in patients younger than 20 years vs OS of 3% in patients older than 50 years; 2P < .001) and short duration of first remission (CR1) (OS of 11% in those with a CR1 of more than 2 years versus OS of 5% in those with a CR1 of less than 2 years; 2P < .001). Treatment received in CR1 did not influence outcome after relapse. In a very highly selected subgroup of patients who were able to receive HSCT after relapse, some were long-term survivors. We conclude from a large, unselected series with mature follow-up that most adults with recurring ALL, whatever their prior treatment, cannot be rescued using currently available therapies. Prevention of recurrence is the best strategy for long-term survival in this disease.

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