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Efficacy of immunization against hepatitis B virus infection in children with cancer

BACKGROUND The purpose of this study was to evaluate the impact of hepatitis B prophylaxis in preventing hepatitis B infection in children with malignancy. PROCEDURE Between May, 1993, and September, 1998, a total of 151 children (95 boys, 56 girls), 29 (19%) with lymphoma, 58 (39%) with leukemia, and 64 (42%) with solid tumor, were screened for hepatitis B virus (HBV). The mean age was 7. 5 +/- 2.5 years. Children with negative serology received active and/or passive immunization. HBsAg and anti-HBs were positive prior to vaccination in 16 (10%) and 17 (11%) children, respectively. One hundred eighteen children (78%) of one hundred fifty-one with negative serology were included in the vaccination program. The vaccine dose was 40 microg. Children with solid tumor and lymphoma received recombinant hepatitis B vaccine at diagnosis, repeated at months 1, 2, and 12. Hyperimmunglobulin was administered monthly in children with leukemia during the intensive chemotherapy period. They were then vaccinated following the third month of maintenance therapy with the schedule described above. Anti-HBs titers were measured every 3 months, and titers above 10 mlU/ml were accepted as protective. RESULTS Anti-HBs positivity after the first three doses was 77% in solid tumors, 88% in acute leukemia, and 48% in lymphomas. Anti-HBs positivity with respect to diagnosis in children completing the vaccination schedule was 94% in solid tumor, 90% in leukemia, and 74% in lymphoma (P > 0.05). Thirty-three percent of children have not received the fourth dose as yet. In total 78% of the children developed protective antibody titers with or without the fourth dose, and none was infected with HBV during 3 years of follow-up. Ten (39%) of twenty-six children who remained unresponsive to immunization were infected with HBV. CONCLUSIONS These data reveal that HBV prophylaxis is necessary and that our vaccination schedule is effective in preventing HBV infection in these children.

Disturbed dental development of permanent teeth in children with solid tumors and lymphomas

Deficient dental root development has been reported after conventional pediatric anticancer therapy but less information is available on children with solid tumors and lymphomas.

Catheter-associated bloodstream infections in pediatric hematology-oncology patients.

Catheter-associated bloodstream infections (CABSIs) are common complications encountered with cancer treatment. The aims of this study were to analyze the factors associated with recurrent infection and catheter removal in pediatric hematology-oncology patients. All cases of CABSIs in patients attending the Department of Pediatric Hematology-Oncology between January 2008 and December 2010 were reviewed. A total of 44 episodes of CABSIs, including multiple episodes involving the same catheter, were identified in 31 children with cancer. The overall CABSIs rate was 7.4 infections per 1000 central venous catheter (CVC) days. The most frequent organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in nine (20.4%) episodes. We found that hypotension, persistent bacteremia, Candida infection, exit-side infection, neutropenia, and prolonged duration of neutropenia were the factors for catheter removal. There were 23 (52.2%) episodes of recurrence or reinfection. Mortality rate was found to be 9.6% in children with CABSIs. In this study, we found that CABSIs rate was 7.4 infections per 1000 catheter-days. CABSIs rates in our hematology-oncology patients are comparable to prior reports. Because CONS is the most common isolated microorganism in CABSIs, vancomycin can be considered part of the initial empirical regimen.

Use of complementary and alternative medicine in children with cancer: effect on survival.

The objective of the present study was to determine the type, frequency, the reason why complementary and alternative medicine (CAM) treatments are used, the factors related with their use, and the effects of CAM usage on long-term survival. Families of a total of 120 children with cancer between 0–18 years of age, including 50 (41.7%) girls and 70 (58.3%) boys, participated in our study. The authors found that 88 patients (73.3%) used at least one CAM method, the most common (95.5%) of which was biologically based therapies. Most frequently used biologically based therapies were dietary supplements and herbal products. The most commonly used dietary supplement or herbal product was honey (43.2%) or stinging nettle (43.2%), respectively. We found that patients used such CAM methods as complementary to, but not instead of, conventional therapy. Sixty-nine out of 88 patient families (78.4%) shared the CAM method they used with their physicians. No statistically significant relation was found between socioeconomic, sociodemographic, or other factors or items and CAM use. The mean follow-up period of the CAM users and nonusers groups was 79.4 ± 36.7 (21.3–217.9) and 90.9 ± 50.3 (27.4–193.7) months, respectively. Five-year survival rates for CAM users and nonusers were found as 81.5% and 86.5%, respectively (P > .05). In conclusion, families of children with cancer use complementary and alternative treatment frequently. They do not attempt to replace conventional treatment with CAM. Higher rates of CAM use was found in families with higher educational level. CAM usage did not affect the long-term survival.

Lymphoma of the Cavernous Sinus Mimicking Tolosa-Hunt Syndrome in a Child

Some children with malignancies initially present with neurologic signs. Cavernous sinus syndrome is a rare manifestation of lymphomas, more commonly reported in adults. A patient presenting with third and fourth cranial nerve palsies was initially thought to manifest Tolosa-Hunt syndrome, but during follow-up a diagnosis of lymphoma without systemic involvement was established. This patient is the youngest, to our knowledge, to be diagnosed with primary cavernous sinus lymphoma. He remains in remission 5 years after chemotherapy. Malignancies (especially non-Hodgkins lymphoma) should be considered in young children with cavernous sinus syndrome, even without systemic involvement.

A Rare Cause of Precocious Puberty: Hepatoblastoma

Hepatoblastoma, an embryonal tumor, is one of the most common primary liver tumors in childhood. It secretes human chorionic gonadotropin (hCG), which can cause precocious puberty (PP). Herein, we present a case with PP who had enlarged penile size noticed during a diagnosis of hepatoblastoma. Laboratory examination revealed increased testosterone, alpha-fetoprotein (AFP), and hCG levels. Serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were within prepubertal ranges. The diagnosis of hepatoblastoma was made by liver biopsy. Chemotherapy was administered, and the patient was referred to surgery. Ten months later, testis volumes were below 4 ml bilaterally, and penile length was 5.5 cm. Serum testosterone, AFP, and hCG levels decreased. Resection of the tumor and chemotherapy are essential for the treatment of hepatoblastoma and they can eliminate the symptoms of PP. Conflict of interest:None declared.

Recombinant Human Erythropoietin β: The Effect of Weekly Dosing on Anemia, Quality of Life, and Long-Term Outcomes in Pediatric Cancer Patients

Anemia, which is a common problem in cancer patients, has a negative effect on survival by decreasing the efficacy of chemotherapy and particularly of radiotherapy, as well as impairing the quality of life (QoL) of patients. Recombinant human erythropoietin (rHuEPO) decreases a patients need for transfusions and increases their QoL. The aim of this study was to evaluate the effect of weekly single-dose EPO treatment on transfusion rates, QoL, and hemoglobin (Hb) levels. In addition, patients were followed up for a long period to assess the impact of EPO treatment on survival. The study was conducted from December 2001 to December 2002 in patients with newly diagnosed lymphoma or solid tumors using a prospective and controlled design. EPO-β was given as a single dose of 450 U/kg once a week for 12 weeks. The study and control groups included 16 patients each. Hb levels measured in the study group at the 4th, 8th, and 12th weeks were significantly higher than the values recorded before the start of chemotherapy. In the control group, Hb levels post chemotherapy were significantly lower than values recorded prior to treatment. The increased Hb levels in the study group were significant at the 8th and 12th weeks of treatment compared to levels measured prior to treatment. In the control group, Hb levels at the 4th and 8th weeks were significantly lower than pretreatment levels. When the percent increase of Hb levels of the study and control groups with respect to treatment week was compared, the difference was statistically significant at the 4th, 8th, and 12th weeks. Although the increase on the performance scale within each group during treatment was significant in both the study and control groups, the increase was more marked in the study group. The percent increase on the performance scale with respect to week of treatment was higher in the study group than in the control group. In EPO treatment group, side effects were seen in 38% of patients, with 19% being local pain in the injection area, 13% local hyperemia, and 6% headache. The mean follow-up period of the study and control group was 7.03 ± 0.41 (6.0–7.41) and 7.46 ± 0.45 (6.58–7.83) years, respectively; no statistically significant difference existed between these figures. Overall survival at the end of 7 years of follow-up was 68.8% and 81.3% for the study and control groups, respectively. The use of EPO-β in lymphoma and solid tumor patients on a once-weekly regimen (450 U/kg) was determined to be effective in increasing Hb levels, decreasing transfusion rates, and improving QoL. This regimen was safe, did not cause serious side effects, and can be recommended because of its high patient compliance and tolerability. An effect of EPO on prognosis was not evident. We could not have an explanation on the effect of EPO treatment on prognosis, as there were low number of patients and advanced-staged patients died earlier. Therefore, a larger number of patients are needed to clarify the effect of EPO treatment on prognosis.

Thyroid Functions in Long-Term Survivors of Pediatric Hodgkin’s Lymphoma Treated with Chemotherapy and Radiotherapy

Objective: Post-treatment endocrine disturbances are common in cancer patients who have received radiotherapy or chemotherapy. The objective of this study was to evaluate the thyroid functions of long-term survivors of pediatric Hodgkin’s lymphoma treated with chemotherapy and radiotherapy. Methods: Thyroid functions of 55 Hodgkin’s lymphoma patients (M/F:2.05/1) in complete remission were evaluated retrospectively. Results: The mean age of the patients at diagnosis was 10.35±4.09 (range: 2.83-17) years and the mean follow-up period was 5.54±3.68 (range: 0.92-13.92) years. All patients received chemotherapy; a total of 50 patients (90.9%) underwent radiotherapy, 42 (76.4%) of whom received neck/mantle radiotherapy. Thyroid function tests were abnormal in 14 (24.5%) patients and normal - in the remaining 41 (74.5%). A diagnosis of subclinical and overt hypothyroidism was made in 11 (78.6%) and 3 (21.4%) patients with abnormal thyroid function tests, respectively. Nearly one-fourth (21.4%) of all thyroid function disorders were detected in the first year of follow-up. A statistically significant correlation was found between the dose of mantle radiotherapy and thyroid function disorder (p=0.002). In addition, statistically significant correlations were established between thyroid examination or thyroid ultrasonography findings and thyroid functions (p <0.001 or p=0.006, respectively). Conclusions: Radiation-induced thyroid disorders may develop in pediatric Hodgkin’s lymphoma patients in complete remission starting as early as the first year after treatment and are dose-dependent. Patients, particularly those who have been exposed to radiotherapy of the neck, must be followed up closely for occurrence of thyroid dysfunctions. Conflict of interest:None declared.

Transitional cell carcinoma of the bladder presenting after blunt abdominal trauma: A very rare occurrence in childhood

Abstract  Tumors of the urinary bladder are rare in children and nearly all of them are of mesodermal in origin. Herein we report a case of transitional cell carcinoma of the urinary bladder in a 13‐year‐old boy who presented after blunt abdominal trauma. It should be remembered that hematuria could develop after blunt abdominal trauma in children, for reasons other than the trauma itself (e.g. tumors of the urinary tract).

DENTAL HEALTH INDICES OF LONG-TERM CHILDHOOD CANCER SURVIVORS WHO HAD ORAL SUPERVISION DURING TREATMENT: A Case–Control Study

The aim of this case–control study was to compare the dental health of a group of long-term survivors of childhood cancer with that of age- and gender-matched healthy controls. All children who had been progress- and/or disease-free for at least 5 years were selected. Caries indices for permanent dentition (DMF/T) and primary dentition (dmf/t) were calculated. Past data were collected from medical and dental records and read separately by one of the authors. The mean age of the subjects at the initial diagnosis of the disease was 4.3 ± 0.3 yr (range 0.5–14 yr). The mean time lapse from the cessation of the therapy to the present dental examination was 5.0 ± 0.7 yr. The study group had significantly (p <. 001) more carious lesions in their primary teeth than the control group. The mean dmf/t value was 5.8 ± 0.6 in the long-term survivors compared to 3.4 ± 0.2 in the controls. The difference in DMF/T value of those children was statistically insignificant (p >. 05) compared to healthy subjects (2.1 ± 0.6 and 1.6 ± 0.2, respectively). There was a significant positive correlation between the presence of head and neck radiotherapy (r = 0.427, p <. 05), the number of months the child had been on chemotherapy (r = 0.413, p <. 01), the number of fluoride gel treatments (r =. 361, p <. 05), and dmf/t values, separately. Based on the results of this study, our Unit now considers a through semiannual dental examination for every child who will be or has been treated at Pediatric Oncology Department to be mandatory. The focus should be on caries prevention and include dietary counseling, oral hygiene, and fluoride applications if necessary.