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Annual Meeting Proceedings Part 1 - American Society of Clinical ...

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612s Pediatric Oncology<br />

9524 Poster Discussion Session (Board #4), Sun, 8:00 AM-12:00 PM and<br />

11:30 AM-12:30 PM<br />

Treatment <strong>of</strong> pediatric stage IA lymphocyte-predominant Hodgkin lymphoma<br />

with surgical resection alone: A report from the Children’s Oncology<br />

Group. Presenting Author: Burton Appel, Hackensack University Medical<br />

Center, Hackensack, NJ<br />

Background: Lymphocyte-predominant Hodgkin lymphoma (LPHL) is an<br />

uncommon histologic subtype comprising up to 10% <strong>of</strong> cases in pediatric<br />

series. Patients with LPHL typically present with low stage disease and are<br />

responsive to regimens used for classical HL. Recurrence is uncommon;<br />

secondary malignant neoplasms or evolution to non-Hodgkin lymphoma are<br />

more common events. Small retrospective studies have suggested that<br />

some patients with stage I LPHL can be cured with surgery alone. We report<br />

the results <strong>of</strong> a large prospective study using a treatment algorithm in which<br />

a selected subset <strong>of</strong> patients received surgery alone. Methods: Patients ages<br />

0-21 years with newly-diagnosed, low risk LPHL were eligible for<br />

AHOD03P1. Low risk was defined as clinical Stage IA and IIA in the<br />

absence <strong>of</strong> bulk disease (a mediastinal mass � 1/3 <strong>of</strong> the thoracic diameter<br />

or a nodal aggregate � 6 cm). Central pathology review was performed to<br />

confirm LPHL histology. Baseline evaluations included CT and FDG-PET.<br />

Patients with Stage IA disease in a single node that was completely<br />

resected were observed without further therapy. Total resection (TR) was<br />

confirmed by rapid central review <strong>of</strong> CT and FDG-PET. In some cases the<br />

extent <strong>of</strong> resection was equivocal; repeat imaging 6-7 weeks after initial<br />

evaluation was used to allocate such patients to either observation or<br />

chemotherapy. Patients who recurred were assigned to treatment with 3<br />

cycles <strong>of</strong> AV-PC (doxorubicin/vincristine/prednisone/cyclophosphamide).<br />

Results: Between January 2006 and November 2010, 52 patients with<br />

Stage IA, single node LPHL were enrolled with a confirmed TR. Nine<br />

patients have experienced a relapse; 8 were Stage I and 1 was Stage II at<br />

relapse. The median time to relapse was 10 (range 1-17) months. The<br />

median follow up among the 43 remaining patients is 26 (range 4-60)<br />

months. The current 2 year EFS estimate among these patients is 80.3%<br />

(95% CI: 65.3% -89.3%). Overall survival for the 52 patients is 100%.<br />

Conclusions: With this strategy <strong>of</strong> surgical resection followed by observation<br />

in a highly select cohort <strong>of</strong> pediatric LPHL, up to 80% <strong>of</strong> patients may be<br />

spared chemotherapy. Follow up is limited but overall survival to date is<br />

excellent.<br />

9526 Poster Discussion Session (Board #6), Sun, 8:00 AM-12:00 PM and<br />

11:30 AM-12:30 PM<br />

Dietary intake and metabolic syndrome in adult survivors <strong>of</strong> childhood<br />

cancer. Presenting Author: Webb A. Smith, St. Jude Children’s Research<br />

Hospital, Memphis, TN<br />

Background: Childhood cancer survivors (CCS) are at increased risk for<br />

metabolic syndrome (MetSyn) and increased morbidity and mortality from<br />

cardiovascular disease. Following a heart healthy diet may decrease this<br />

risk. The purpose <strong>of</strong> this investigation was to characterize dietary patterns<br />

and to evaluate the association between diet and MetSyn among CCS.<br />

Methods: CCS who were 10� year survivors <strong>of</strong> childhood cancer, who were<br />

older than 18 years <strong>of</strong> age, and participating in the St. Jude Lifetime Cohort<br />

Study (SJLIFE). They completed a medical assessment based on Children’s<br />

Oncology Group screening guidelines, and a food frequency questionnaire<br />

(FFQ). Laboratory and physical measures were obtained to determine<br />

MetSyn status using the NCEP-ATPIII criteria. <strong>Part</strong>icipants were classified<br />

as having MetSyn if they met the criteria for �3 components <strong>of</strong> MetSyn.<br />

Data from the FFQ were used to score dietary patterns according to<br />

WCRF/AICR recommendations. Those who met �4 <strong>of</strong> the 7 recommendations<br />

were classified as following a “healthy diet.” A stratified analysis by<br />

sex using log-binomial regression models was undertaken to evaluate<br />

associations between diet and MetSyn, adjusted for age, age at diagnosis,<br />

cranial radiation, education, household income, and smoking status.<br />

Results: Among 1421 participating CCS (49.3% male, median age 33.0<br />

years, range, 18.9-60.0 years), 31.5% met the criteria for MetSyn and<br />

25.8 % followed a healthy diet according to the WCRF/AICR recommendations.<br />

In multiple regression models stratified by sex, females who followed<br />

a “healthy diet” were 2.1 (95% CI 1.5-2.9) times less likely and males who<br />

followed a “healthy diet” were 2.2 (95% CI 1.5-3.1) times less likely to<br />

have MetSyn than those who reported following a “healthy diet”. Conclusions:<br />

Heart healthy diets in CCS are associated with decreased risk for MetSyn.<br />

Dietary interventions may be warranted in CCS with MetSyn.<br />

9525 Poster Discussion Session (Board #5), Sun, 8:00 AM-12:00 PM and<br />

11:30 AM-12:30 PM<br />

Family history <strong>of</strong> cancer and clinical outcome in pediatric oncology.<br />

Presenting Author: Joshua David Schiffman, Huntsman Cancer Institute,<br />

University <strong>of</strong> Utah, Salt Lake City, UT<br />

Background: We previously reported in a small study (n�363) that children<br />

diagnosed with cancer who have a family history <strong>of</strong> cancer (FHC) may have<br />

worse prognosis than those without FHC, specifically children diagnosed<br />

with Hodgkin Disease (HD) and acute lymphoblastic leukemia (ALL)<br />

(Eichstadt et al., ASCO 2009). The Utah Population Database (UPDB), a<br />

unique resource, includes a Surveillance Epidemiology and End Results<br />

(SEER) registry (the Utah Cancer Registry) record-linked to extensive<br />

genealogies for 6.5 million people in which most Utah families are<br />

represented. A majority <strong>of</strong> pedigrees include �3 generations and several<br />

span 7� generations. The UPDB provides an accurate, objective assessment<br />

<strong>of</strong> FHC. We expanded our original study by examining cancer<br />

mortality <strong>of</strong> 4,482 pediatric cases (age �18) diagnosed from 1966-2009<br />

with adequate follow-up (median 9.5 years) and family information.<br />

Methods: We compared survival from cancer-caused mortality for pediatric<br />

cases diagnosed from 1966-2009 with FHC <strong>of</strong> any cancer diagnosed �80<br />

yo in 1st-degree, 2nd-degree, or 3rd-degree relatives to pediatric cases<br />

without FHC. Nonparametric estimates <strong>of</strong> survivor function were determined<br />

by the life-table method and a log-rank test <strong>of</strong> homogeneity was used<br />

to test for differences between pediatric probands with FHC compared to no<br />

FHC. Results: Overall survival was significantly lower in children with<br />

positive FHC (n�1,128) than in children with no FHC (n�3,354) independent<br />

<strong>of</strong> stage (p�0.0001; 10yr survival, 69% with FHC vs.78% with no<br />

FHC). We observed lower survival in children with any leukemia and FHC<br />

(n�279) compared to children with leukemia and no FHC (n�871;<br />

p�0.0001). In particular, cases with ALL and FHC had lower survival<br />

(p�0.0001; 10yr survival, 61% vs. 75%). Pediatric lymphoma cases had<br />

lower survival when positive for FHC (n�150) vs. no FHC (n�428;<br />

p�0.0001), specifically for an HD diagnosis (p�0.0004; 10yr survival,<br />

83% vs. 94%). Conclusions: Pediatric cancer cases with FHC <strong>of</strong> any cancer<br />

(children or adults) have decreased survival compared to cases with no<br />

FHC, specifically in children diagnosed with ALL or HD, thus validating our<br />

earlier findings. Familial factors likely contribute to increased pediatric<br />

cancer mortality.<br />

9527 Poster Discussion Session (Board #7), Sun, 8:00 AM-12:00 PM and<br />

11:30 AM-12:30 PM<br />

Association <strong>of</strong> bone mineral density with incidental renal stone in long-term<br />

survivors <strong>of</strong> childhood acute lymphoblastic leukemia. Presenting Author:<br />

Prasad Laxman Gewade, St. Jude Children’s Research Hospital, Memphis,<br />

TN<br />

Background: With 5-year survival <strong>of</strong> childhood acute lymphoblastic leukemia<br />

(ALL) now exceeding 90%, long term morbidities are <strong>of</strong> growing<br />

concern. Both low bone mineral density (BMD) and renal dysfunction have<br />

been reported in ALL survivors. Our objective was to evaluate the association<br />

between low BMD and incidental renal stones, a known predictor <strong>of</strong><br />

renal dysfunction. Methods: Adult participants who were 10� year survivors<br />

<strong>of</strong> childhood ALL and members <strong>of</strong> St. Jude Lifetime Cohort study were<br />

recruited between 12/2007 and 3/2011. During their risk-based medical<br />

evaluations they underwent quantitative computed tomography (QCT) to<br />

evaluate BMD. Incidental renal stones were identified by radiologists’<br />

review <strong>of</strong> axial QCT source images. Demographic information was abstracted<br />

from responses to health surveys and dietary intake from a Block<br />

food frequency questionnaire. Association between BMD and renal stones<br />

was evaluated in a multivariable logistic regression model. Confounding<br />

variables were selected using directed acyclic graphs and change in effect<br />

estimates strategy. Results: At a median <strong>of</strong> 26.1 years from diagnosis, BMD<br />

Z score <strong>of</strong> � 1 standard deviation (SD) was detected in 77/662 (11.6%)<br />

and renal stones in 73/662 (11%) participants. In a multivariable model<br />

adjusted for age, dietary vitamin D and renal radiation, when compared to<br />

BMD Z score � 1 SD, the risk <strong>of</strong> renal stones increased with a decrease in<br />

BMD Z-score; 1 to 0 SD (Odds Ratio (OR), 1.93; 95% confidence interval<br />

(CI), 0.69 to 5.41), 0 to -1 SD (OR, 1.46; 95% CI, 0.52 to 4.05), -1 to -2<br />

SD (OR, 2.72; 95% CI, 0.81 to 6.41), and � -2 SD (OR, 4.96; 95% CI,<br />

1.43 to 17.13). Older age (45-54 vs.18-24 y; OR, 3.66; 95% CI, 1.10 to<br />

12.15), renal radiation (OR, 1.97; 95% CI, 0.59 to 6.50) and � 141.5 IU<br />

intake <strong>of</strong> vitamin D (OR, 1.65; 95% CI, 0.98 to 2.77) were also associated<br />

with renal stone formation. Conclusions: Our results not only help us<br />

recognize survivors at risk, but also informs radiologists to be vigilant <strong>of</strong><br />

incidental renal stones among older ALL survivors with low BMD.<br />

Visit abstract.asco.org and search by abstract for the full list <strong>of</strong> abstract authors and their disclosure information.

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