scholarly journals Parto cesárea como fator de risco de leucemia infantil / C section as a risk fator for leucemias

2019 ◽  
Vol 64 (2) ◽  
pp. 84
Author(s):  
Milena Martello Cristófalo ◽  
Carina Pita Lottenberg ◽  
Rômulo Negrini
Keyword(s):  
Cesarean Delivery ◽  
Myeloid Leukemia ◽  
Childhood Leukemia ◽  
Lymphoblastic Leukemia ◽  
High Rate ◽  
Pregnancy And Childbirth ◽  
Caesarean Birth ◽  
National Rate ◽  
Leucemia Mieloide Crónica

Introdução: As condições de nascimento, em especial o parto cesáreo, impactam a curto e longo prazo a saúde infantil. Nesse estudo, tivemos como objetivo: Associar o parto cesárea a incidência de leucemias em crianças. Métodos: Trata-se de estudo observacional com pacientes dos Ambulatórios da Pediatria Oncológica, entre 0 a 14 anos, nascidos a termo, em tratamento ou acompanhamento por Leucemia Mieloblástica Aguda, Leucemia Linfoblástica Aguda, ou Leucemia Mielóide Crônica. A investigação sobre gestação e parto foi feita por meio de questionário, que aborda, após identificação do paciente, dados do diagnóstico e das condições de nascimento e parto das crianças. A incidência de parto cesarianas na amostragem foi comparada com as taxas brasileiras, segundo o DATASUS. Resultados: A taxa brasileira de cesarianas foi de 55,5% em 2016, enquanto nos pacientes estudados, 41,9% (IC 31,9-51,9) nasceram por cesarianas. Portanto, a incidência de cesáreas na população em questão é inferior à brasileira. Conclusão: A população estudada neste trabalho, crianças com diagnóstico de leucemia, não apresenta taxa de nascimentos por cesarianas superior à taxa nacional. Assim, a hipótese de que a taxa de cesarianas seria maior em uma população com diagnóstico de leucemia não foi confirmada. Portanto, apesar do que já fora proposto em estudos prévios não foi possível confirmar a associação entre parto cesariana com maior incidência de leucemia infantil. Novos trabalhos ainda são necessários para melhor entendimento da associação entre via de parto e diagnóstico de malignidades, especialmente populações com alta taxa de cesarianas.Descritores: Cesárea, Trabalho de parto, Fatores de risco, Leucemia, Neoplasias, CriançaABSTRACTAim: Birth conditions, in particular caesarean delivery, can impact on child health. In this study, our objective was: associate the cesarean delivery with incidence of leukemias in children. Methods: This is an observational study with outpatients from Pediatric Oncology Clinic, between 0 and 14 years old, born at term, undergoing treatment or having follow-up care due to acute myeloblastic leukemia, acute lymphoblastic leukemia, or chronic myeloid leukemia. The research of pregnancy and childbirth was done using a questionnaire, which addresses, after identification of the patient, data from the diagnosis and birth conditions. The sample’s cesarean delivery incidence was compared with the Brazilian rates, according to DATASUS. Results: The Brazilian cesarean rate was 55.5% in 2016, while in our sample, 41.9% (CI 31.9-51.9). Therefore, our incidence of Caesarean section is inferior compared to the Brazilian. Conclusion: The population studied, children diagnosed with leukemia, does not present a higher rate of caesarean birth than the national rate. Thus, the hypothesis that the cesarean rate would be higher in a population diagnosed with leukemia was not confirmed. Therefore, despite what has already been proposed in previous studies it was not possible to corroborate with the association between cesarean delivery and higher incidence of childhood leukemia. New studies are required to better understand the relation between delivery and diagnosis of malignancies, especially including populations with a high rate of caesarean sections.Keywords: Cesarian section; Labor, obstetric; Risk factors;  Leukemia; Neoplasms; Child

scholarly journals Cesarean delivery on maternal request and its influencing factors in Chongqing, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ruibin Deng ◽  
Xian Tang ◽  
Jiaxiu Liu ◽  
Yuwen Gao ◽  
Xiaoni Zhong
Keyword(s):  
Logistic Regression ◽  
Pregnant Women ◽  
Cesarean Delivery ◽  
High Rate ◽  
Primiparous Woman ◽  
Personal Factors ◽  
Maternal Request ◽  
Primary Indication ◽  
Vaginal Deliveries

Abstract Background A high rate of cesarean delivery has become a cause of global concern. Although the rate of cesarean delivery has declined over recent years, it remains at a high level largely because of cesarean delivery on maternal request (CDMR). Unnecessary cesarean delivery has limited significance in benefiting maternal and infant physical health; in some ways, it might pose potential risks instead. With the implementation of the “Two-child Policy” in China, an increasing number of women plan to have a second child. Accordingly, how to handle the CDMR rate in China remains an important issue. Methods Data were collected from a longitudinal follow-up study conducted in Chongqing, China, from 2018 to 2019. A structured questionnaire was administered to subjects for data collection. Basic information, including demographic characteristics, living habits, medical history, and follow-up data of pregnant women, as well as their families and society, was collected. Additionally, delivery outcomes were recorded. Logistic regression was performed to analyze the factors influencing CDMR. Results The rate of cesarean delivery in Chongqing, China was 36.01 %, and the CDMR rate was 8.42 %. Maternal request (23.38 %), fetal distress (22.73 %), and pregnancy complications (9.96 %) were the top three indications for cesarean delivery. Logistic regression analysis showed that older age (OR = 4.292, 95 % CI: 1.984–9.283) and being a primiparous woman (OR = 6.792, 95 % CI: 3.230-14.281) were risk factors for CDMR. In addition, CDMR was also associated with factors such as the tendency to choose cesarean delivery during late pregnancy (OR = 5.525, 95 % CI: 2.116–14.431), frequent contact with mothers who had undergone vaginal deliveries (OR = 0.547, 95 % CI: 0.311–0.961), and the recommendation of cesarean delivery by doctors (OR = 4.071, 95 % CI: 1.007–16.455). Conclusions “Maternal request” has become the primary indication for cesarean delivery. The occurrence of CDMR is related to both the personal factors of women during pregnancy and others. Medical institutions and obstetricians should continue popularizing delivery knowledge among pregnant women, enhancing their own professional knowledge about delivery, adhering to the standard indications for cesarean delivery, and providing pregnant women with adequate opportunities for attempting vaginal delivery.

Unrelated Cord Blood Transplants in Children/Adolescents in Multi-Racial Singapore.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5089-5089
Author(s):  
Poh-Lin Tan ◽  
Ah-Moy Tan ◽  
Mei-Yoke Chan ◽  
Mariflor Villegas ◽  
Allen Yeoh ◽  
...  
Keyword(s):  
Cord Blood ◽  
Myeloid Leukemia ◽  
Lymphoblastic Leukemia ◽  
Chronic Gvhd ◽  
Severe Combined Immunodeficiency ◽  
Hla Antigen ◽  
Cell Dose ◽  
Malignant Group ◽  
Unrelated Cord Blood

Abstract Alternative donor choices are limited in multi-racial, multi-ethnic societies with small families such as Singapore. Unrelated cord blood transplant (UCBT) provides a feasible alternative to patients lacking adult stem cell donors. We reviewed the Singapore experience in UCBT for 29 children/adolescents with malignant (N = 19) and non-malignant diseases (N = 10) from 1998 – 2006. A significant 25% of patients were of varied South-East Asian (SEA) descent with majority being SEA-Chinese. The median age at UCBT was 6.7 (0.5 – 17.7) years with younger patients in the non-malignant compared to the malignant group (4.7 versus 8.8 years). Malignant indications for UCBT included acute lymphoblastic leukemia (ALL, N = 12), acute myeloid leukemia (N = 4), chronic myeloid leukemia (N = 2) and hemophagolymphohistiocytosis (N = 1); and non-malignant indications severe combined immunodeficiency disease (N = 3), CD40 ligand deficiency (N = 2), chronic granulomatous disease (N = 1), leukocyte adhesion disease (N = 1), thalassaemia (N = 2) and Fanconi anemia (N = 1). Seventeen patients received myeloablative conditioning (MAC), 12 received reduced intensity conditioning (RIC). Of the 12 RIC patients, 8 received dual UCBT with a median total nucleated cell dose (TNC) of 7.2 (3.4 – 12.2) x 10(7)/kg, CD34 cell dose of 1.7 (0.7 – 3.7) x 10(5)/kg compared to a median 6.2 (2.4 – 21.8) x 10(7)/kg, CD34 of 3.1 (0.2 – 297.6) x 10(5)/kg in MAC patients who received single UCBT.All except 3 patients received 1 – 2 HLA antigen mismatched cords. Sixteen of 19 and 6 of 10 patients in the malignant and non-maligant groups engrafted at a median of 19.5 (2 – 21) days and 20 (14 – 41) days, respectively. Nine and 2 of 17 malignant patients and none of non-malignant patients developed grade 1- III aGVHD and chronic GVHD, respectively. Thirteen of 19 patients and 8 of 10 patients in the malignant and non-malignant groups are alive at a median follow-up of 23 (9 – 48) months and 31 (14 – 73) months, respectively. The main cause of death was disease relapse in the malignant group (5 of 6 patients). In the malignant group, a select group of ALL patients (ALL-RIC, N = 6) was given dual UCBT after RIC with the aim to reduce transplant-related morbidity/mortality while preserving chances of engraftment, graft-versus-leukemia effects and long-term neuro-endocrine outcome. These patients received a median total nucleated cells (TNC) dose of 7.2 (3.4 – 12.2) x 10(7)/kg and CD34 cell dose of 2.0 (0.8 – 3.7) x 10(5)/kg recipient BW and were discharged at a median of 17 (12 – 16) days. Compared to another 6 ALL patients who received single UCBT after MAC (ALL-MAC), these received a median TNC of 5.4 (2.6 – 8.1) x 10(7)/kg and CD34 of 2.8 (0.6 – 297.6) x 10(5)/kg recipient BW and were discharged at a median of 59 (31 – 118) days. ALL-RIC and ALL-MAC patients engrafted at a median of 6 (2 – 28) days and 21 (14 – 37) days, respectively, with one primary graft failure in the ALL-MAC group. There were 4 relapses, 2 in each group at a median follow-up of 23 (12 – 30) months and 16 (3.5 – 48) months, respectively. More patients in ALL-RIC group developed acute GVHD compared to the ALL-MAC (83% versus 33%). All patients except 1 from each group are alive as of last follow-up, with death occurring from a road-traffic accident while in complete remission and one from relapse in the ALL-RIC and ALL-MAC groups, respectively. UCBT successes in children/adolescent is high in multi-racial Singapore using conventional and novel approaches.

Proptosis as Initial Presentation of Acute Lymphoblastic Leukemia in a Child with no associated symptoms: A Case Report

2020 ◽  
Author(s):  
Kourosh Goudarzipour ◽  
Ahmad Mohammadi ◽  
Reza Taherian ◽  
Mehran Arab Ahmadi ◽  
Behdad Behnam ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Myeloid Leukemia ◽  
Acute Lymphocytic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Rapid Diagnosis ◽  
Lymphocytic Leukemia ◽  
Initial Presentation ◽  
Associated Symptoms ◽  
Blast Cells

Acute lymphocytic leukemia (ALL) is one of the frequent malignancies in pediatrics and involves bone marrow and extramedullary sites. Proptosis as extramedullary involvement of leukemia usually present in acute and chronic myeloid leukemia. It is extremely rare for ALL to present initially as proptosis.Here, a-21-month-old boy was presented with proptosis without any associated symptoms except lymphadenopathy. He was referred with the impression of malignancy from an ophthalmologist. After bone marrow biopsy which showed 33% blast cells, all positive for CD10, CD19, and CD79, the diagnosis of pre-B cell ALL was finally made. His symptoms were improved completely 16 days after starting standard protocol for ALL.Afterone-year follow-up, he was free of any symptoms.According to this initial presentation of ALL and no typical associated symptoms, it is important to make rapid diagnosis and start the treatment in the childhood.

scholarly journals Genetic variation in the folate metabolic pathway and risk of childhood leukemia

Blood ◽  
2010 ◽  
Vol 115 (19) ◽  
pp. 3923-3929 ◽  
Author(s):  
Tracy J. Lightfoot ◽  
W. Thomas Johnston ◽  
Dan Painter ◽  
Jill Simpson ◽  
Eve Roman ◽  
...  
Keyword(s):  
Genetic Variation ◽  
Myeloid Leukemia ◽  
Childhood Leukemia ◽  
Lymphoblastic Leukemia ◽  
Folate Metabolism ◽  
The United Kingdom ◽  
Etiologic Role ◽  
Increased Risk ◽  
Metabolism Enzymes

Abstract Studies of childhood leukemia and the potential etiologic role of genetic variation in folate metabolism have produced conflicting findings and have often been based on small numbers. We investigated the association between polymorphisms in key folate metabolism enzymes (MTHFR 677 C>T, MTHFR 1298 A>C, SHMT1 1420 C>T, MTR 2756 A>G, TS 1494del6, and TS 28bp repeat) in 939 cases of childhood acute lymphoblastic leukemia (ALL) and 89 cases of acute myeloid leukemia (AML) recruited into the United Kingdom Childhood Cancer Study. We also examined the maternal genotypes of 752 of these cases. Data from 824 noncancer controls recruited were used for comparison. No evidence of an association with MTHFR 677 was observed for ALL or AML, either in children or their mothers. However, in children an increased risk of ALL (odds ratio [OR] = 1.88; 95% confidence interval [CI], 1.16-3.07; P = .010) and AML (OR = 2.74; 95% CI, 1.07-7.01; P = .036) was observed with the MTR 2756 GG genotype; the association was most pronounced for cases with the MLL translocation (OR = 4.90; 95% CI, 1.30-18.45; P = .019). These data suggest that genetic variation in methionine synthase could mediate risk of childhood leukemia, either via effects on DNA methylation or via effects on fetal growth and development.

Low incidence of second neoplasms among children diagnosed with acute lymphoblastic leukemia after 1983

Blood ◽  
2002 ◽  
Vol 99 (12) ◽  
pp. 4257-4264 ◽  
Author(s):  
Smita Bhatia ◽  
Harland N. Sather ◽  
Olga B. Pabustan ◽  
Michael E. Trigg ◽  
Paul S. Gaynon ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Brain Tumors ◽  
Myeloid Leukemia ◽  
Lymphoblastic Leukemia ◽  
Malignant Neoplasms ◽  
Childhood All ◽  
Second Neoplasms ◽  
Increased Risk ◽  
The Impact

Second malignant neoplasms are a serious complication after successful treatment of childhood acute lymphoblastic leukemia (ALL). With improvement in survival, it is important to assess the impact of contemporary risk-based therapies on second neoplasms in ALL survivors. A cohort of 8831 children diagnosed with ALL and enrolled on Children's Cancer Group therapeutic protocols between 1983 and 1995 were observed to determine the incidence of second neoplasms and associated risk factors. The median age at diagnosis of ALL was 4.7 years. The cohort had accrued 54 883 person-years of follow-up. Sixty-three patients developed second neoplasms, including solid, nonhematopoietic tumors (n = 39: brain tumors n = 19, other solid tumors n = 20), myeloid leukemia or myelodysplasia (n = 16), and lymphoma (n = 8). The cumulative incidence of any second neoplasm was 1.18% at 10 years (95% confidence interval, 0.8%-1.5%), representing a 7.2-fold increased risk compared with the general population. The risk was increased significantly for acute myeloid leukemia (standardized incidence ratio [SIR] 52.3), non-Hodgkin lymphoma (SIR 8.3), parotid gland tumors (SIR 33.4), thyroid cancer (SIR 13.3), brain tumors (SIR 10.1), and soft tissue sarcoma (SIR 9.1). Multivariate analysis revealed female sex (relative risk [RR] 1.8), radiation to the craniospinal axis (RR 1.6), and relapse of primary disease (RR 3.5) to be independently associated with increased risk of all second neoplasms. Risk of second neoplasms increased with radiation dose (1800 cGy RR 1.5; 2400 cGy RR 3.9). Actuarial survival at 10 years from diagnosis of second neoplasms was 39%. Follow-up of this large cohort that was treated with contemporary risk-based therapy showed that the incidence of second neoplasms remains low after diagnosis of childhood ALL.

Role of Folylpolyglutamate Synthetase and Folylpolyglutamate Hydrolase in Methotrexate Accumulation and Polyglutamylation in Childhood Leukemia

Blood ◽  
1999 ◽  
Vol 93 (5) ◽  
pp. 1677-1683 ◽  
Author(s):  
Marianne G. Rots ◽  
Rob Pieters ◽  
Godefridus J. Peters ◽  
Paul Noordhuis ◽  
Christina H. van Zantwijk ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Multivariate Analysis ◽  
Myeloid Leukemia ◽  
Childhood Leukemia ◽  
Lymphoblastic Leukemia ◽  
Folylpolyglutamate Synthetase ◽  
Additional Role ◽  
Acute Myeloid

Abstract Inefficient polyglutamylation is a mechanism of resistance to methotrexate (MTX) in childhood T-lineage acute lymphoblastic leukemia (T-ALL) and in acute myeloid leukemia (AML) in comparison with childhood c/preB-ALL. We analyzed the profile of MTX polyglutamylation in childhood c/preB-ALL, T-ALL, and AML (n = 45, 15, and 14, respectively), the activity of the MTX-polyglutamate synthesizing enzyme folylpolyglutamate synthetase (FPGS) (n = 39, 11, and 19, respectively) and of the MTX-polyglutamate breakdown enzyme folylpolyglutamate hydrolase (FPGH) (n = 98, 25, and 34, respectively). MTX-Glu4-6 accumulation after 24 hours exposure to 1 μmol/L [3H]-MTX in vitro was lower in T-ALL (threefold) and AML (fourfold) compared with c/preB-ALL (P ≤ .001). The FPGS activity was twofold lower in T-ALL and AML than in c/preB-ALL samples (P < .01). FPGH activity was not different between c/preB-ALL and T-ALL, but threefold higher in AML (P < .001). FPGS, FPGH, and the ratio FPGS/FPGH were correlated with MTX-Glu4-6 accumulation (r = .49, r = −.34 and r = .61, respectively). Multivariate analysis showed that FPGS, but not FPGH, was an independent contributor for MTX-Glu1-6 accumulation, but not for MTX-Glu4-6 accumulation. In conclusion, low FPGS activity is associated with low accumulation of MTX-Glu4-6 in T-ALL and AML. For the group of AML as compared with the group of ALL, a high FPGH activity can play an additional role.

What Happens to Children with Leukemia and Lymphoma after Diagnosis in Developing World?.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5519-5519
Author(s):  
Satya Prakash Yadav ◽  
Sunil Dutt Sharma ◽  
Ruchira Misra ◽  
Anupam Sachdeva
Keyword(s):  
Myeloid Leukemia ◽  
Developing World ◽  
Lymphoblastic Leukemia ◽  
Developed Countries ◽  
Single Centre ◽  
Indian Children ◽  
Access To Treatment ◽  
Cancer Centre ◽  
Lost To Follow Up

Abstract Cure rates in children with leukemia and lymphoma have improved dramatically in the last four decades. In developed countries almost all patient opt for and receive proper treatment and survival rates are close to 80 %. In developing world even after proper diagnosis many patients are lost to follow up. India is a developing country with a population of more than a billion and cancer is emerging as a major cause of childhood death as a result of reduced mortality from preventable infectious diseases. In 1960, the rate of death among infants in India was 150 per 1000 live births. By 2001, the rate had decreased to 58 per 1000. As the population of Indian children nears 350 million, a conservative projection of 50,000 new cases of pediatric cancer each year can be made. We analyzed the outcome of the children diagnosed with leukemia and lymphoma at a single centre in Delhi, India. Study included all children aged less than 16 years diagnosed with leukemia (Acute lymphoblastic leukemia ALL, Acute myeloid leukemia AML and Chronic myeloid leukemia CML) and lymphoma (Hodgkin Disease HD and Non Hodgkin Lymphoma NHL) at Sir Ganga Ram hospital from January 2005 to July 2006. Follow up survey was done by contacting parents by telephone and/or letter in all patients lost to follow up and reasons asked for the same. 146 children with cancer were diagnosed during the study period. 82 children (56 males and 26 females) had hematological malignancies (ALL 58, AML 4, HD 8, NHL 7, CML 5). 47 children (Male: Female = 3:1) remained in our follow up out of which 11 have died. 36 (43%) are alive in follow up. A total of 35 children (Male: Female = 1.3:1) were lost to follow up (ALL 27, AML 1, HD 3, NHL 1, CML 3). Average duration of follow up of these patients was 1 week (range 1–4 weeks). None of the patients were lost to follow up if they finished first one month of chemotherapy. Parents of only 32/35 children could be contacted. 19/32 children have died (ALL 18, AML 1). 8 opted for no treatment out of which 6 have died. 7 opted for alternative therapy mostly ayurvedic treatment (longest follow up was AML patient who lived for 12 months and remained transfusion free for 8 months) out of which 5 have died. 17 opted for chemotherapy at other hospital (4 opted for a cancer centre in another city and 2 died, 13 opted for treatment in other cancer centres in the same city-11 in public hospital out of which 5 died and 2 in private hospital with 1 death). Average annual income of parents of children in follow up was US $ 8000 and those lost to follow up was US $ 2500. Reasons for not following up were cost of treatment in 21 (66%), lack of faith in our cancer centre 10 (31 %), ignorance & fear of chemotherapy 14 (43%), girl child 9 (28%). Patients living more than 100 km away from our centre were 16/47 (34%) in follow up and 18/35 (51%) in those lost to follow up. Our experience is a reflection of status of children who are diagnosed with leukemia/ and lymphoma in a single centre with just 43% alive and left in follow up. Almost 60% of children who were lost to follow up have died. What, if anything, can be done to bring the benefits of modern cancer treatment to more children? The most immediate and substantial results will probably come from expanded access to treatment, the elimination of reasons for abandoning treatment, and better control of complications of infections. It has been said that if we are to preserve civilization, we must make certain its benefits are available to the many, not reserved for the few.

Response at Three Months Is a Good Predictive Factor for Newly Diagnosed Chronic Myeloid Leukemia Patients Treated by Recombinant Interferon-

Blood ◽  
1998 ◽  
Vol 92 (11) ◽  
pp. 4059-4065 ◽  
Author(s):  
F.X. Mahon ◽  
C. Fabères ◽  
S. Pueyo ◽  
P. Cony-Makhoul ◽  
R. Salmi ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Predictive Factor ◽  
Myeloid Leukemia ◽  
Proportional Hazards ◽  
Cytogenetic Response ◽  
High Rate ◽  
Newly Diagnosed ◽  
Recombinant Interferon ◽  
Sokal Score

Abstract In a single institution, we have used recombinant interferon- (IFN-) to treat 116 newly diagnosed Philadelphia-positive (Ph+) chronic myeloid leukemia (CML) patients and analyzed the predictive factors for response and survival. The patients whose median age was 50.3 years (range, 9 to 70) were administered IFN- (5 million units/m2/d) subcutaneously. The IFN- dose was subsequently adjusted to maintain the white blood cell and platelet counts between 1.5 and 5 × 109/L, 50 and 100 × 109/L, respectively. At diagnosis, the Sokal score was used to classify the patients into three groups: low (n = 57), intermediate (n = 42), and high risk (n = 16). A complete hematological response (CHR) was achieved in 93 cases (80.2%). Of the 116 patients, 113 were available for cytogenetic evaluation. Fifty patients (43%) achieved a major cytogenetic response (MCR) (=65% marrow Ph− cells), 37 of them having a complete cytogenetic response (CCR). The estimated 5-year survival of the 116 patients was 68% ± 11% (95% confidence interval [CI]) with a median follow-up of 42 months (range, 3 to 114) and 85% ± 11% (95% CI) with a median follow-up of 30.9 (range, 3 to 111) when patients were censored at the time of transplantation. Event-free survival at 5 years (adding death and transplant as event) was 46% ± 11% (95% CI). Using proportional hazards regression to study time-dependent variables, we confirmed that the most significant factor associated with survival was the cytogenetic response (MCR or CCR) (P < .0001). This factor was independent compared with the Sokal score and baseline variables used to calculate the Sokal score. Moreover, using either univariate or multivariate analysis, the achievement of CHR within 3 months was strongly correlated with MCR (P < .0001). Minimum cytogenetic response (mCR, ie, at least 5% of Ph− metaphases) at 3 months was also a significant predictive factor for MCR (P < .0001). These results show that IFN- can induce a high rate of hematological and cytogenetic response when administered in doses leading to myelosuppression. Factors such as the achievement of CHR and mCR within 3 months could be useful to identify early those patients who will not respond to IFN- and who need alternative treatments such as stem cell transplantation.

Patient Stratification Based on Prednisolone-Vincristine-Asparaginase Resistance Profiles in Children With Acute Lymphoblastic Leukemia

2003 ◽  
Vol 21 (17) ◽  
pp. 3262-3268 ◽  
Author(s):  
M.L. Den Boer ◽  
D.O. Harms ◽  
R. Pieters ◽  
K.M. Kazemier ◽  
U. Göbel ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Acute Lymphoblastic Leukemia ◽  
Childhood Leukemia ◽  
Lymphoblastic Leukemia ◽  
Disease Free Survival ◽  
Late Relapse ◽  
Early Event ◽  
Study Group ◽  
Increased Risk

Purpose: To confirm the prognostic value of a drug resistance profile combining prednisolone, vincristine, and l-asparaginase (PVA) cytotoxicity in an independent group of children with acute lymphoblastic leukemia (ALL) treated with a different protocol and analyzed at longer follow-up compared with our previous study of patients treated according to the Dutch Childhood Leukemia Study Group (DCLSG) ALL VII/VIII protocol. Patients and Methods: Drug resistance profiles were determined in 202 children (aged 1 to 18 years) with newly diagnosed ALL who were treated according to the German Cooperative Study Group for Childhood Acute Lymphoblastic Leukemia (COALL)-92 protocol. Results: At a median follow-up of 6.2 years (range, 4.1 to 9.3 years), the 5-year disease-free survival probability (pDFS) rate ± SE was 69% ± 7.0%, 83% ± 4.4%, and 84% ± 6.8% for patients with resistant (PVA score 7 to 9), intermediate-sensitive (PVA score 5 to 6), and sensitive (SPVA score 3 to 4) profiles, respectively (sensitive and intermediate-sensitive v resistant, P ≤ .05). Resistant patients were at increased risk of an early event (nonresponse or relapse within 2.5 years of diagnosis) compared with sensitive and intermediate-sensitive patients (P = .03). The profile did not identify patients at higher risk of late relapse, which was also observed for DCLSG ALL-VII/VIII patients now analyzed at a median of 7.5 years of follow-up (range, 4.4 to 10.8 years). Despite being nondiscriminative for late relapses, the resistant profile was still the strongest prognostic factor for COALL-92 patients in a multivariate analysis including known risk factors (P = .07). Conclusion: Drug resistance profiles identify patients at higher risk of early treatment failures and may, therefore, be used to improve risk-group stratification of children with ALL.

scholarly journals Long-Term Risk of Hospitalization Among Five-Year Survivors of Childhood Leukemia in the Nordic Countries

2019 ◽  
Vol 111 (9) ◽  
pp. 943-951 ◽  
Author(s):  
Gitte Vrelits Sørensen ◽  
Jeanette Falck Winther ◽  
Sofie de Fine Licht ◽  
Klaus Kaa Andersen ◽  
Anna Sällfors Holmqvist ◽  
...  
Keyword(s):  
Myeloid Leukemia ◽  
Childhood Leukemia ◽  
Comprehensive Evaluation ◽  
Statistical Tests ◽  
Lymphoblastic Leukemia ◽  
Healthcare Providers ◽  
Adult Life ◽  
Hospitalization Rate ◽  
Population Comparisons ◽  
Leukemia Treatment

Abstract Background Adverse effects from childhood leukemia treatment may persist or present years after cure from cancer. We provide a comprehensive evaluation of subsequent hospitalization in five-year survivors of childhood acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and chronic myeloid leukemia (CML). Methods In the Adult Life after Childhood Cancer in Scandinavia Study, we identified 4003 five-year survivors diagnosed with childhood leukemia 1970–2008 in Denmark, Sweden, Iceland, and Finland. Survivors and 129 828 population comparisons were followed for first-time nonpsychiatric hospitalizations for 120 disease categories in the hospital registries. Standardized hospitalization rate ratios and absolute excess rates were calculated. All statistical tests were two-sided. Results Survivors of ALL (n = 3391), AML (n = 389), and CML (n = 92) had an increased overall hospitalization rate compared with population comparisons. The rate ratio for any hospitalization was 1.95 (95% confidence interval [CI] = 1.83 to 2.07) in ALL, 3.09 (95% CI = 2.53 to 3.65) in AML, and 4.51 (95% CI = 3.03 to 6.00) in CML survivors and remained increased even 20 years from leukemia diagnosis. Corresponding absolute excess rates per 1000 person-years were 28.48 (95% CI = 24.96 to 32.00), 62.75 (95% CI = 46.00 to 79.50), and 105.31 (95% CI = 60.90 to 149.72). Conclusion Leukemia survivors have an increased rate of hospitalization for medical conditions. We provide novel insight into the relative and absolute rate of hospitalization for 120 disease categories in survivors of ALL, AML, and CML, which are likely to be informative for both survivors and healthcare providers.

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