Late-occurring stroke among long-term survivors of childhood leukemia and brain tumors: A report from the Childhood Cancer Survivor Study
ABSTRACT This report examines the incidence of and risk factors for strokes that occur in > or = 5-year survivors of childhood leukemia and brain tumors.
The rate of first occurrence of self-reported late-occurring strokes was determined for leukemia survivors (n = 4,828), brain tumor survivors (n = 1,871), and a comparison group of a random sample of cancer survivor siblings (n = 3,846). Relative risks (RRs) and 95% confidence intervals (CIs) of stroke by treatment exposures were examined by multivariate analyses.
Thirty-seven leukemia survivors and 63 brain tumor survivors reported a late-occurring stroke. The rate of late-occurring stroke for leukemia survivors was 57.9 per 100,000 person-years (95% CI, 41.2 to 78.7). The RR of stroke for leukemia survivors compared with the sibling comparison group was 6.4 (95% CI, 3.0 to 13.8; P < .0001). The rate of late-occurring stroke for brain tumor survivors was 267.6 per 100,000 person-years (95% CI, 206.8 to 339.2). The RR of stroke for brain tumor survivors compared with the sibling comparison group was 29.0 (95% CI, 13.8 to 60.6; P < .0001). Mean cranial radiation therapy (CRT) dose of > or = 30 Gy was associated with an increased risk in both leukemia and brain tumor survivors in a dose-dependent fashion, with the highest risk after doses of > or = 50 Gy CRT.
Survivors of childhood leukemia and brain tumors, particularly those with brain tumors treated with CRT at doses of greater than 30 Gy, are at an increased risk of stroke.
- SourceAvailable from: Walentyna Balwierz
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- "Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy and adult survivors of childhood-onset ALL account for about 28% of the Childhood Cancer Survival Study cohort . Among survivors of childhood leukemia (ALL in about 90%), the relative hazard of congestive heart failure, myocardial infarction and late-occurring stroke was increased 4.2-fold, 3.3-fold and 6.4-fold, respectively, with the reference to the sibling control groups  . Additionally, in ALL survivors standardized CV mortality ratio was elevated 4.2-fold compared with the age-, sex-and year-matched US population . "
ABSTRACT: Adult survivors of childhood malignancy are predisposed to late cardiovascular (CV) complications. Our aim was to estimate plasma levels of the endogenous nitric oxide formation inhibitor asymmetric dimethylarginine (ADMA), in long-term survivors of childhood acute lymphoblastic leukemia (ALL) treated with only chemotherapy. ADMA and its isomer symmetric dimethylarginine (SDMA) were measured in 25 former ALL patients (aged 18-28 years) who had survived without recurrent disease ≥ 5 years from completing chemotherapy without cranial irradiation, and in 20 healthy controls (aged 20-31 years). Characteristics of the both groups were similar, except for lower high-density lipoproteins-cholesterol (HDL-C) in ALL survivors. Compared to controls, the former ALL patients exhibited significant, albeit small, rises in levels of ADMA (0.63 ± 0.09 [SD] vs. 0.57 ± 0.07 μmol/L; p=0.016), but not SDMA, with a consequently increased ADMA to SDMA ratio (1.08 ± 0.22 vs. 0.91 ± 0.16; p=0.004). The effect of former ALL on ADMA was attenuated (intergroup p=0.10 [ANCOVA]) upon adjustment for HDL-C (ADMA vs. HDL-C regression coefficient: -0.065 ± 0.030 [SEM]; p=0.03). ADMA is elevated in adult childhood ALL survivors, which can reflect late detrimental chemotherapy effects, partially related to minor lipid profile changes. Whether these subtle ADMA elevations might herald future CV morbidity, remains to be elucidated.Disease markers 07/2012; 33(2):69-76. DOI:10.3233/DMA-2012-0906 · 2.17 Impact Factor
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- "Although strokes and blood clots have been reported to be rare outcomes in SCNST, a large cohort study of SCNST reports at least a 3-fold higher risk of these adverse events in survivors who had received chemotherapy , radiation, and surgery than in those who had received surgery and radiation without chemotherapy (Gurney et al., 2003). Late-occurring stroke has been reported in survivors who received cranial radiation doses of greater than 30 Gy, with the highest risk for lateoccurring stroke in survivors who received greater than 50 Gy(Bowers et al., 2006). In another study of over 1600 survivors of brain tumors, 18% reported one or more cardiovascular conditions, including stroke, blood clots, or angina-like symptoms (Gurney et al., 2003). "
ABSTRACT: Survivors of central nervous system tumors (SCNST) are a growing group of cancer survivors who require risk-based, long-term health care due to the chemotherapy, surgery, and radiation they have received.Although treatment strategies are being developed to reduce morbidity and mortality, ultimately this subgroup of pediatric cancer survivors often faces moderate to severe late effects of their treatment.As a result, they will need lifelong health care that includes risk-based health care due to cancer treatment exposures as well as primary adult health care, including primary and secondary preventative care. The best way to accomplish lifelong health care for SCNST as they enter adulthood is not clearly defined. In this article, the authors plan to (1) present an overview of the complexities of health care problems that make transition challenging for SCNST; (2) review the evolving transition literature; (3) explore the barriers to successful transition; (4) discuss methods to facilitate transition; (5) describe approaches, strategies, and models for survivorship care in SCNST; (6) present issues for consideration when transitioning SCNST; and (7) provide information on transition-related resources.Journal of Pediatric Oncology Nursing 10/2009; 26(5):280-94. DOI:10.1177/1043454209343209 · 0.87 Impact Factor
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ABSTRACT: Ischemic stroke in childhood is a rare but serious disorder, which is associated with significant morbidity and mortality. The lack of causal homogeneity in the aetiology of this disorder presents problems for predicting and preventing it, making the ischemic stroke in childhood a real dilemma for the clinician. Although a variety of potential inherited and acquired causes have been now identified, including cardiac pathologies, infections, prothrombotic, metabolic and vascular disorders, the aetiology of ischemic stroke in the young remains still unknown in more than one third of the patients. Presently, an appropriate evaluation of some hypercoagulable conditions seems justified in adults with stroke. However, the etiologic contribution of several thrombophilic conditions to initial and recurrent stroke in affected children has not been definitely clarified, since more powerful and influential non-thrombophilic risk factors are usually present, making the thrombophilia screening in such circumstance a matter of debate. In particular, the diagnostic yield of the screening is reportedly lower in children, the role of several prothrombotic abnormalities is uncertain, especially in recurrent stroke, and there is no evidence-based guidance to stroke prevention and therapy in children carrying a hypercoagulable state. Additional studies are needed to quantify the risk for a cerebrovascular event in children with a prothrombotic disorder and to determine which combination of endogenous and exogenous risk factors leads to greater rates of initial and recurrent stroke.Journal of Thrombosis and Thrombolysis 02/2009; 27(2):239-248. DOI:10.1007/s11239-008-0202-5 · 2.17 Impact Factor