Donatella Fraschini

Self-image of adolescent survivors of long-term childhood leukemia.

The purpose of our research was to evaluate the attitude to face the life cycle and the impact that the experience of childhood leukemia may have had in a group of adolescents who had the disease cured. A questionnaire was administered at the Pediatric Hematology Center, San Gerardo Hospital, Monza, Italy, to all former patients age 12 to 20 years and off therapy from leukemia for at least 2 years (total of 116 adolescents) during 1997; 70 patients responded to the mailing and a comparison group of 70 secondary-school students was investigated. The two groups were matched as closely as possible on key characteristics (age, gender, socio-economic level of families, education and occupation of the parents, and geographic area of residence). The Offer Self-Image Questionnaire was the instrument used in this study. Overall, the teenagers in whom leukemia was cured showed a more positive and mature self-image (psychologic, social, attitude toward family, and coping) compared with the student group (statistical evidence, P < 0.05). An effective psychosocial support for patients and their families during their treatment, in addition to medical therapy, is strongly recommended. The majority of survivors of childhood cancer grow successfully without serious psychologic sequelae.

Low anthracyclines doses-induced cardiotoxicity in acute lymphoblastic leukemia long-term female survivors†

High dosage anthracyclines in pediatric patients with acute lymphoblastic leukemia (ALL) is associated with cardiotoxicity. However, data on the cardiac effects of lower cumulative doses of these drugs are not conclusive. The aim of this study was to assess the cardiac effects of low cumulative anthracycline doses in long‐term survivors of ALL.

Audiotaping communication of the diagnosis of childhood leukemia: Parents' evaluation

Purpose To evaluate how parents viewed the authors practice of audiotaping the initial communication of the leukemia diagnosis and of the complete program of care, including the prognosis. Methods From January 1997 through December 1998, at the end of the formal communication interview, parents were asked to evaluate the audiotaping by filling out a questionnaire concerning the procedure. Results Sixty-three parents of children with leukemia participated. Conclusions The authors use of audiotapes was strongly supported by the parents as a supplementary intervention and has become a routine procedure.

Outcome after cessation of therapy in childhood acute lymphoblastic leukaemia

A total of 2192 children with acute lymphoblastic leukaemia who had reached cessation of therapy in complete remission were followed for a median time of 52 months after treatment suspension. Of the 485 relapses observed, 62.3% occurred in the first year off therapy and 68.9% involved the bone marrow. Eight relapses were reported more than 5 years (62-143 months) after treatment withdrawal. Males fared worse than females consistently, experiencing 1.5 times more relapses (P < 0.0001). Thirteen patients died in continuous complete remission, 5 because of non-neoplastic central nervous system complications. There were 11 second solid malignancies, 8 of them in the central nervous system; 9 subjects presented an haematopoietic malignancy after ALL. The projected event-free survival at 8 years is 73%. Twenty-two of the 171 young adults (age > 20 years) were married and 16 have had 21 healthy children. Twenty-four per cent of patients experienced an unfavourable event. Relapses accounted for 93% of failures. Central nervous system late effects and second malignancies were the major causes of non-leukaemic morbidity and mortality.

Evidence Against the Role of Hepatitis C Virus in Severe Liver Damage Occurring Early in the Course of Acute Leukemia in Children

Severe liver damage revealed by a sharp transaminase elevation may be seen in patients with leukemia. This may be due to several possible causes, including viral hepatitis, chemotherapy-induced hepatotoxicity and leukemic infiltration. HCV infection may be suspected to play a relevant role as these patients are often heavily transfused after the onset of their hematologic disorder. We have therefore examined the role of HCV in 15 children with leukemia who developed severe liver damage shortly after the diagnosis of leukemia. All patients were tested for HCV-RNA by the polymerase chain reaction at the time of peak SGPT elevation and for anti-HCV on serial serum samples taken thereafter. Only one patient (6.6%) showed hepatitis C viremia and none developed confirmed anti-HCV positivity during follow-up, suggesting that HCV had not played a major role in causing these severe episodes of liver necrosis. This is in agreement with observations made in non-immunocompromised patients in whom fulminant hepatitis is only exceptionally due to HCV.

The Psychosocial Program for Childhood Leukemia in Monza, Italy

Since the early 197Os, a cure for childhood leukemia has become a reality: Over 60% of cases are now cured. Yet, despite the relatively high cure rate, the diagnosis of leukemia continues to place a heavy burden on family functioning. The parents must walk the narrow line between focusing too much on the child’s disease and treatment and maintaining a normal family life. Because cure is such a real possibility, the children must be prepared for a full and active participation in adult life, just like their peers. Proper discipline must be maintained within as normal a family life as possible. The child’s continued attendance at school and participation in normal childhood activities is imperative in the child’s preparation for adulthood. For all these reasons, psychosocial intervention has become a necessity in the treatment of the child, even for those children who eventually will die from the disease. Although there is little disagreement that the ultimate goal of treatment for childhood leukemia is the total cure of the child-medical, educational, psychological, and social-the issue is how best to achieve this end.I2 The literature is filled with research-based conclusions on which type of psychosocial intervention is best? including when and how one should communicate with the child about the diagnosis,45 how to help the parents maintain some sense of normality in their family life>-* how to help the child return to school? how to keep the siblings informed,’0-” how to start parent groups,’2 how to involve parents in medical decision-making,’2

Natural course of HCV infection in childhood cancer survivors

Goals of workTo describe the course of hepatitis C in a cohort of 105 survivors after childhood cancer.Patients and methodsData on chemo/radiotherapy, clinical status, serial alanine aminotransferase (ALT) evaluation, and virological parameters after the end of treatment were collected for each patient. Liver biopsies, when performed, were centrally evaluated by a pathologist.Main resultsAll patients were alive at the end of follow-up and did not show hepatic insufficiency. ALT evaluation along the entire follow-up showed a moderate (87%) or a remarkable (13%) cytolytic pattern. Young age at diagnosis, hematopoietic stem cell transplantation, and duration of infection significantly correlate with a worse hepatic activity. Type of tumor and chemo and/or radiotherapy regimens did not influence the pattern of hepatic cytolysis. Liver biopsy, centrally reviewed in 30% of the cohort, showed one case of cirrhosis and mild fibrosis in 71% of the group. Higher degrees of fibrosis did not seem to be related to any exposition to chemo/radiotherapy but correlated significantly with the more remarkable cytolytic course.ConclusionsThe outcome of hepatitis C in our patients is comparable to the one described in European cohorts of adult cancer survivors and perinatally infected subjects. Nevertheless, progression to high degrees of hepatic damage has to be monitored by a careful follow-up.

Precocious puberty and empty sella syndrome in a girl cured of acute lymphoblastic leukemia

Abstract We describe a case of precocious puberty in a girl treated with chemoradiotherapy according to the Italian Association of Pediatric Hematology and Oncology ALL 9503 protocol for acute lymphoblastic leukemia (ALL) from the age of 15 months until the age of 3 years and 4 months. The patient was treated with chemotherapy and cranial irradiation (18 Gy in 12 fractions). At 7 years of age, during topical estrogenic treatment for congenital adhesions of the labia minora, she showed bilateral breast development that evolved into precocious puberty. A magnetic resonance imaging of the brain showed an “empty sella” (ES); the etiology of the ES, and the consequent precocious puberty, being presumably iatrogenic. Children treated with cranial radiotherapy should be carefully checked for signs of precocious puberty and the exogenous administration of estrogens should be avoided, as far as possible, because these could act as a trigger factor in a population at higher risk of precocious puberty.