scholarly journals Blood coagulation in venous thrombosis, complicating treatment of children, adolescents and young adults with lymphomas

2019 ◽  
Vol 13 (4) ◽  
pp. 37-45
Author(s):  
V. V. Dmitriev ◽  
A. S. Fedorova ◽  
N. V. Lipay ◽  
I. V. Begun ◽  
I. A. Dunaev ◽  
...  
Keyword(s):  
Young Adults ◽  
Venous Thrombosis ◽  
Hodgkin Lymphoma ◽  
Blood Coagulation ◽  
Anticoagulant Therapy ◽  
Blood Clotting ◽  
Adolescents And Young Adults ◽  
Control Group ◽  
Homozygous Mutation ◽  
Healthy Children

Objective of the study was to compare blood clotting parameters in lymphoma patients with or without venous thrombosis (VT), as well as to analyze the duration and outcome of anticoagulant therapy in children, adolescents and young adults with lymphoma, whose program treatment was complicated by VT.Materials and methods . The analysis included 28 patients with lymphoma (Hodgkin lymphoma – 5, non-Hodgkin lymphoma – 23), aged from 2 to 25 years (median – 16.0 years), whose program treatment in 2005–2017 was complicated by VT. The case-control study was carried out to compare the parameters of blood coagulation. The control group consisted of 22 patients, aged from 2 to 20 years (median – 15.5 years) with the same diagnosis, age, therapy protocol and phase of treatment who had no thrombotic complications. The comparison group consisted of 35 healthy children aged from 3 to 18 years (median – 14.0 years).Results . There was no difference in majority of blood clotting parameters in lymphoma patients with or without VT. Hyperfibrinogenemia and an increased D-dimers level distinguished patients with lymphoma, regardless of the presence or absence of thrombosis, from healthy children of the same age (р<0.05). Anticoagulant therapy up to 3 months received 10 patients, for 4–6 months – 4, for 7–12 months – 12, up to 18 months – 2. One adult patient with a homozygous mutation 20210G>A gene of the factor II takes warfarin continuously for a long time after relapse of VT. Complete recanalization of the thrombosed vessel occurred within the first 3 months in 9 patients, within 4–6 months – in 1, within 7–12 months ‒ in 4. Partial recanalization within 3–12 months was confirmed in 8 patients. Vein obliteration, mainly the internal jugular vein, as the outcome of VT occurred in 6 patients within 4–12 months.Conclusion . Detection of routine blood clotting parameters does not allow identifying patients with thrombosis among children, adolescents and young adults with lymphoma. Fibrinogen and D-dimers levels were significantly higher in lymphoma patients, than in healthy children. Anticoagulant therapy for 3–12 months led to the complete or partial recanalization of VT in 79 % of patients. To detect blood clotting parameters by thrombosis development, as well as to reveal and monitor transient and permanent risk factors are necessary to specify the cause of VT and to determine the appropriate anticoagulant therapy.

Cerebral Venous Thrombosis in Adolescents and Young Adults with Classical Hodgkin Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4784-4784
Author(s):  
Poornima Kumar ◽  
Rebekah Ahmed ◽  
Renu Riat ◽  
Kirit M Ardeshna ◽  
Stephen Daw
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Venous Thrombosis ◽  
Hodgkin Lymphoma ◽  
Cerebral Venous Thrombosis ◽  
Central Venous Catheters ◽  
Adolescents And Young Adults ◽  
Classical Hodgkin Lymphoma ◽  
Central Venous ◽  
Life Threatening

Abstract Abstract 4784 Background Patients with classical Hodgkin Lymphoma (cHL) have a relatively high risk of venous thrombo-embolism (VTE); reported incidence 4.6–7% in adults and up to 11.5% in children and adolescents. Most VTE episodes are peripheral or related to central venous catheters, with very limited data on central or life-threatening thromboses in adolescents. There is only 1 reported case series on cerebral venous thrombosis (CVT) in adolescents. We report 4 cases of CVT from our centre, all treated with chemo-radiotherapy. Chemotherapy comprised OEPA (vincristine, prednisolone, doxorubicin, etoposide) and COPP/COPDAC (cyclophosphamide, vincristine, prednisolone, procarbazine/dacarbazine respectively). Results All patients received involved field radiotherapy (IFRT) 19.8 – 30Gy on completing chemotherapy. All were female, aged 12–23. All received norethisterone contraception. All had indwelling central venous catheters (PICC). Patient 4 alone had a raised body mass index. All were exposed to steroids; Patient 4 completed steroid therapy several weeks before developing CVT symptoms. Patients 2 and 4 received treatment dose low molecular weight heparin (LMWH) for 6 weeks after diagnosis of PICC-associated thrombosis, and were not on anticoagulation or thromboprophylaxis when CVT was diagnosed. Regarding other risk factors, 3/4 had no documented prothrombotic tendency. Patient 4 was found to have a moderately positive IgM anti beta 2 glycoprotein antibody present 12 weeks apart, consistent with antiphospholipid syndrome. All patients were therapeutically anticoagulated for 6 months to 1 year. LMWH of choice at our centre was dalteparin. Patient 1 was switched to warfarin upon completion of chemo-radiotherapy, and Patient 4 was commenced on warfarin with dalteparin cover at diagnosis of CVT as she had completed treatment. Patients 1 and 2 had raised intracranial pressure on lumbar puncture, and required therapeutic lumbar punctures and acetazolamide. Patients 2 and 3 both required anticonvulsant therapy for 1 year. Patient 2 was initially treated with phenytoin, and switched to carbamazepine. Patient 3 was also initially managed with phenytoin, and switched to levetiracetam. Neither patient had any subsequent seizures. All 4 patients have recovered completely from CVT with no residual neurological deficits or further thromboses. Conclusion CVT is a rare and potentially life threatening complication in adolescents and young adults with cHL with paucity of data. The risk factors are unclear however all patients in our series were female, received steroids and were on norethisterone. Only 1 patient had a prothrombotic tendency detected on thrombophila screening. CVT is treatable, and complete resolution of signs and symptoms can be expected. More studies are required to elucidate risk factors which may help develop thromboprophylaxis guidance in this group of patients. Disclosures: No relevant conflicts of interest to declare.

Second Neoplasms in Adolescents and Young Adults with Hodgkin Lymphoma

2014 ◽  
Vol 226 (02) ◽  
Author(s):  
M Santos ◽  
R Guilherme ◽  
M Gomes ◽  
J Paulo ◽  
E Magalhães ◽  
...  
Keyword(s):  
Young Adults ◽  
Hodgkin Lymphoma ◽  
Adolescents And Young Adults ◽  
Second Neoplasms

Risk of Depression in Adolescents and Young Adults with Rheumatic Diseases

2020 ◽  
Vol 62 (1) ◽  
pp. 38-42
Author(s):  
Anna Kostiukow ◽  
Wojciech Strzelecki ◽  
Mateusz W. Romanowski ◽  
Marta Rosołek ◽  
Ewa Mojs ◽  
...  
Keyword(s):  
Young Adults ◽  
Young People ◽  
Rheumatic Diseases ◽  
Disease Risk ◽  
Statistical Significance ◽  
Energy Levels ◽  
Young Patients ◽  
Depression Scale ◽  
Adolescents And Young Adults ◽  
Control Group

Introduction: The study is aimed at drawing the attention of the medical environment to the mental health aspects of young patients as a factor that significantly influences the efficiency of their rheumatic disease treatment. Aim: This paper is to check the risk of depression among a group of adolescents and young adults with rheumatic diseases. Material and Methods: The study was conducted among a group of 68 late adolescents and young adults (18-22 years old) with rheumatic diseases. The control group consisted of 102 young people (18-22 years old) without a diagnosed chronic disease. Risk of depression was measured using a screening tool – the Kutcher Adolescent Depression Scale (KADS). Results: The analysis showed that the probability of depression in the study group was 35.3%. In the control group, this rate was 19.6%. The results were statistical significance (p=0.028). Conclusions: The results of this study prove that the risk of depression among adolescents and young adults with rheumatic diseases is significantly higher than in healthy young people. The highest risk of depression is related to feeling tired, fatigue, low energy levels and lack of motivation as well as feeling worried, nervous, panicky, tense, keyed-up and anxious.

Germline EGFR variants are over-represented in adolescents and young adults (AYA) with adrenocortical carcinoma

2020 ◽  
Author(s):  
Sara Akhavanfard ◽  
Lamis Yehia ◽  
Roshan Padmanabhan ◽  
Jordan P Reynolds ◽  
Ying Ni ◽  
...  
Keyword(s):  
Young Adults ◽  
Adrenocortical Carcinoma ◽  
Kinase Inhibitor ◽  
Mapk Pathway ◽  
Adolescents And Young Adults ◽  
Control Group ◽  
Precision Oncology ◽  
Sequencing Data ◽  
Germline Variants ◽  
Mutant Cells

Abstract Adrenocortical Carcinoma (ACC) is a rare endocrine tumor with poor overall prognosis and 1.5-fold overrepresentation in females. In children, ACC is associated with inherited cancer syndromes with 50–80% of childhood-ACC associated with TP53 germline variants. ACC in adolescents and young adults (AYA) is rarely due to germline TP53, IGF2, PRKAR1A and MEN1 variants. We analyzed exome sequencing data from 21 children (&lt;15y), 32 AYA (15-39y), and 60 adults (&gt;39y) with ACC, and retained all pathogenic, likely pathogenic, and highly prioritized variants of uncertain significance. We engineered a stable lentiviral-mutant ACC cell line, harboring an EGFR variant (p.Asp1080Asn) from a 21-year-old female without germline-TP53-variant and with aggressive ACC. We found that 4.8% of the children (P = 0.004) and 6.2% of AYA (P &lt; 0.0001), all-female participants, harbored germline EGFR variants, compared to only 0.3% of the control group. Expanding our analysis to the RTK-RAS-MAPK pathway, we found that the RTK genes have the highest number of highly prioritized germline variants in these individuals amongst all three arms of this pathway. We showed EGFR mutant cells migrate faster and are characterized by a stem-like phenotype compared to wild type cells. While EGFR inhibitors did not affect the stemness of mutant cells, Sunitinib, a multireceptor tyrosine kinase inhibitor, significantly reduced their stem-like behavior. Our data suggest that EGFR could be a novel underlying germline predisposition factor for ACC, especially in the Childhood-AYA (C-AYA) population. Further clinical validation can improve precision oncology management of this disease, which is known to have limited therapeutic options.

scholarly journals Factors Associated with Non-Attendance at Dental Preventive Care in Slovak High School Students

2021 ◽  
Vol 18 (3) ◽  
pp. 1295
Author(s):  
Martin Samohyl ◽  
Jana Babjakova ◽  
Diana Vondrova ◽  
Jana Jurkovicova ◽  
Juraj Stofko ◽  
...  
Keyword(s):  
High School ◽  
Young Adults ◽  
High School Students ◽  
Preventive Care ◽  
Parental Influence ◽  
Adolescents And Young Adults ◽  
Control Group ◽  
School Students ◽  
Factors Associated ◽  
Older Adolescents

This study aimed to determine the factors associated with the avoidance of dental preventive care in high school students and their parents in the framework of The Youth and Parents Risk Factor Behavior Survey in Slovakia, the ongoing cross-sectional school-based survey of students and their parents or legal representatives. The data were collected using two separate standardized questionnaires: (i) the questionnaire for students (n = 515) and (ii) the questionnaire for parents (n = 681). The study group included 57 high school students (54.4% males) who did not visit the dentist for preventive care in the previous year. The control group included 458 students (35.8% males) who visited a dentist for preventive care at least once in the previous year. A significantly higher number of males (54.4%), older adolescents, and young adults (21.8%; 20.0%) were not visiting dental preventive care regularly. Incomplete family (56.1%), stressful situations at home (17.5%), and feeling unwell were the factors contributing to the avoidance of dental preventive care. More than 34.5% of adolescents and young adults were not visiting either dental preventive care or pediatric preventive care (adjusted odds ratio (AOR) = 5.14; 95% confidence interval (CI) = 2.40, 10.99). Children of divorced mothers and mothers with household income lower than EUR 900 had significantly higher dental care avoidance in bivariate analysis. A significantly higher percentage of fathers from the exposed group were not visiting dental preventive care regularly (47.8%, p < 0.05). The results of the study can be used as an educational intervention step focusing on the parental influence on adolescent and young adults’ behavior and as a challenge for the improvement of dental preventive care in older adolescents and young adults.

scholarly journals The management of Hodgkin lymphoma in adolescents and young adults: burden of disease or burden of choice?

Blood ◽  
2018 ◽  
Vol 132 (4) ◽  
pp. 376-384 ◽  
Author(s):  
Jamie E. Flerlage ◽  
Monika L. Metzger ◽  
Nickhill Bhakta
Keyword(s):  
Overall Survival ◽  
Clinical Trials ◽  
Young Adults ◽  
Hodgkin Lymphoma ◽  
Burden Of Disease ◽  
Health Care Services ◽  
Survival Rates ◽  
Adolescents And Young Adults ◽  
Adult Health ◽  
Treatment Regimens

Abstract Adolescents and young adults (AYAs) comprise the largest age group affected by Hodgkin lymphoma (HL). Despite excellent overall survival of AYA patients with HL due to advances in treatment regimens, therapy-associated late effects continue to be a concern in HL survivors, especially for younger patients who have decades of life remaining. Since the first clinical trial for HL with chemotherapy in 1964, subsequent protocols have attempted to reduce chemotherapy-induced toxicities and yet maintain high overall survival rates. Today, new analytic methods applied to data from survivorship cohorts, such as the recently described cumulative burden of disease metric, can be used to inform changes for future protocols. Although pediatric and adult trial consortia have followed this process, the AYA population, an age cohort split between pediatric and adult health care services, faces many barriers to care and is the least likely to be enrolled in clinical trials. AYA patients with HL theoretically have a choice to be treated in pediatric or adult protocols when presented with these options. Recent efforts by the National Clinical Trials Network, the Children’s Oncology Group, and others have been made to ensure that the burden of choice for the AYA population is not greater than the burden of disease.

scholarly journals 3245 Comparison of Health Outcomes in Adolescent and Young Adult (AYA) Oncology Patients Treated at a Pediatric versus Adult Institute

2019 ◽  
Vol 3 (s1) ◽  
pp. 141-142
Author(s):  
Amy Moskop ◽  
Julie Panepinto ◽  
Sadie Dobrozsi
Keyword(s):  
Young Adults ◽  
Supportive Care ◽  
Health Outcomes ◽  
Hodgkin Lymphoma ◽  
Pediatric Cancer ◽  
Germ Cell Tumors ◽  
Adolescents And Young Adults ◽  
Adolescent And Young Adult ◽  
Cancer Center ◽  
Study Population

OBJECTIVES/SPECIFIC AIMS: Objectives: To examine the differences in health outcomes of adolescents and young adults treated for malignancy at a pediatric cancer center compared to an adult cancer center. To determine the differences in receipt of supportive care for adolescents and young adults with malignancy who are treated at a pediatric cancer center compared to an adult cancer center. METHODS/STUDY POPULATION: Methods: This will be a retrospective cohort study of patients from the ages of 15 to 39 years who are diagnosed with a malignancy common between adult and pediatric facilities within 2013-2017. Data will be abstracted from an existing database at MCW containing patient information at the adult and pediatric centers. Study population: Patients ages 15-39 years of age who are categorized as young adolescent and adult patients (AYAs). Patients are eligible for the cohort if they have a diagnosis that is common between adult and pediatric oncology centers and that is made within the years 2013-2017. These diagnoses will include ALL, AML, Hodgkin Lymphoma, Non-Hodgkin Lymphoma, Germ cell tumors, Osteosarcoma, Ewing Sarcoma, other sarcomas, and CNS tumors. RESULTS/ANTICIPATED RESULTS: There will be a difference in health care utilization, clinical trial enrollment and toxicity of therapy in AYAs with malignancies treated at an adult facility than AYAs treated for similar malignancy at pediatric facility. DISCUSSION/SIGNIFICANCE OF IMPACT: There will be a difference in receipt of supportive care referrals, including psychology, social work, sperm banking, initiation of palliative care, in AYAs treated at a pediatric facility compared to AYAs treated at adult facility.

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