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

612s Pediatric Oncology
9524 Poster Discussion Session (Board #4), Sun, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Treatment of pediatric stage IA lymphocyte-predominant Hodgkin lymphoma
with surgical resection alone: A report from the Children’s Oncology
Group. Presenting Author: Burton Appel, Hackensack University Medical
Center, Hackensack, NJ
Background: Lymphocyte-predominant Hodgkin lymphoma (LPHL) is an
uncommon histologic subtype comprising up to 10% of cases in pediatric
series. Patients with LPHL typically present with low stage disease and are
responsive to regimens used for classical HL. Recurrence is uncommon;
secondary malignant neoplasms or evolution to non-Hodgkin lymphoma are
more common events. Small retrospective studies have suggested that
some patients with stage I LPHL can be cured with surgery alone. We report
the results of a large prospective study using a treatment algorithm in which
a selected subset of patients received surgery alone. Methods: Patients ages
0-21 years with newly-diagnosed, low risk LPHL were eligible for
AHOD03P1. Low risk was defined as clinical Stage IA and IIA in the
absence of bulk disease (a mediastinal mass � 1/3 of the thoracic diameter
or a nodal aggregate � 6 cm). Central pathology review was performed to
confirm LPHL histology. Baseline evaluations included CT and FDG-PET.
Patients with Stage IA disease in a single node that was completely
resected were observed without further therapy. Total resection (TR) was
confirmed by rapid central review of CT and FDG-PET. In some cases the
extent of resection was equivocal; repeat imaging 6-7 weeks after initial
evaluation was used to allocate such patients to either observation or
chemotherapy. Patients who recurred were assigned to treatment with 3
cycles of AV-PC (doxorubicin/vincristine/prednisone/cyclophosphamide).
Results: Between January 2006 and November 2010, 52 patients with
Stage IA, single node LPHL were enrolled with a confirmed TR. Nine
patients have experienced a relapse; 8 were Stage I and 1 was Stage II at
relapse. The median time to relapse was 10 (range 1-17) months. The
median follow up among the 43 remaining patients is 26 (range 4-60)
months. The current 2 year EFS estimate among these patients is 80.3%
(95% CI: 65.3% -89.3%). Overall survival for the 52 patients is 100%.
Conclusions: With this strategy of surgical resection followed by observation
in a highly select cohort of pediatric LPHL, up to 80% of patients may be
spared chemotherapy. Follow up is limited but overall survival to date is
excellent.
9526 Poster Discussion Session (Board #6), Sun, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Dietary intake and metabolic syndrome in adult survivors of childhood
cancer. Presenting Author: Webb A. Smith, St. Jude Children’s Research
Hospital, Memphis, TN
Background: Childhood cancer survivors (CCS) are at increased risk for
metabolic syndrome (MetSyn) and increased morbidity and mortality from
cardiovascular disease. Following a heart healthy diet may decrease this
risk. The purpose of this investigation was to characterize dietary patterns
and to evaluate the association between diet and MetSyn among CCS.
Methods: CCS who were 10� year survivors of childhood cancer, who were
older than 18 years of age, and participating in the St. Jude Lifetime Cohort
Study (SJLIFE). They completed a medical assessment based on Children’s
Oncology Group screening guidelines, and a food frequency questionnaire
(FFQ). Laboratory and physical measures were obtained to determine
MetSyn status using the NCEP-ATPIII criteria. Participants were classified
as having MetSyn if they met the criteria for �3 components of MetSyn.
Data from the FFQ were used to score dietary patterns according to
WCRF/AICR recommendations. Those who met �4 of the 7 recommendations
were classified as following a “healthy diet.” A stratified analysis by
sex using log-binomial regression models was undertaken to evaluate
associations between diet and MetSyn, adjusted for age, age at diagnosis,
cranial radiation, education, household income, and smoking status.
Results: Among 1421 participating CCS (49.3% male, median age 33.0
years, range, 18.9-60.0 years), 31.5% met the criteria for MetSyn and
25.8 % followed a healthy diet according to the WCRF/AICR recommendations.
In multiple regression models stratified by sex, females who followed
a “healthy diet” were 2.1 (95% CI 1.5-2.9) times less likely and males who
followed a “healthy diet” were 2.2 (95% CI 1.5-3.1) times less likely to
have MetSyn than those who reported following a “healthy diet”. Conclusions:
Heart healthy diets in CCS are associated with decreased risk for MetSyn.
Dietary interventions may be warranted in CCS with MetSyn.
9525 Poster Discussion Session (Board #5), Sun, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Family history of cancer and clinical outcome in pediatric oncology.
Presenting Author: Joshua David Schiffman, Huntsman Cancer Institute,
University of Utah, Salt Lake City, UT
Background: We previously reported in a small study (n�363) that children
diagnosed with cancer who have a family history of cancer (FHC) may have
worse prognosis than those without FHC, specifically children diagnosed
with Hodgkin Disease (HD) and acute lymphoblastic leukemia (ALL)
(Eichstadt et al., ASCO 2009). The Utah Population Database (UPDB), a
unique resource, includes a Surveillance Epidemiology and End Results
(SEER) registry (the Utah Cancer Registry) record-linked to extensive
genealogies for 6.5 million people in which most Utah families are
represented. A majority of pedigrees include �3 generations and several
span 7� generations. The UPDB provides an accurate, objective assessment
of FHC. We expanded our original study by examining cancer
mortality of 4,482 pediatric cases (age �18) diagnosed from 1966-2009
with adequate follow-up (median 9.5 years) and family information.
Methods: We compared survival from cancer-caused mortality for pediatric
cases diagnosed from 1966-2009 with FHC of any cancer diagnosed �80
yo in 1st-degree, 2nd-degree, or 3rd-degree relatives to pediatric cases
without FHC. Nonparametric estimates of survivor function were determined
by the life-table method and a log-rank test of homogeneity was used
to test for differences between pediatric probands with FHC compared to no
FHC. Results: Overall survival was significantly lower in children with
positive FHC (n�1,128) than in children with no FHC (n�3,354) independent
of stage (p�0.0001; 10yr survival, 69% with FHC vs.78% with no
FHC). We observed lower survival in children with any leukemia and FHC
(n�279) compared to children with leukemia and no FHC (n�871;
p�0.0001). In particular, cases with ALL and FHC had lower survival
(p�0.0001; 10yr survival, 61% vs. 75%). Pediatric lymphoma cases had
lower survival when positive for FHC (n�150) vs. no FHC (n�428;
p�0.0001), specifically for an HD diagnosis (p�0.0004; 10yr survival,
83% vs. 94%). Conclusions: Pediatric cancer cases with FHC of any cancer
(children or adults) have decreased survival compared to cases with no
FHC, specifically in children diagnosed with ALL or HD, thus validating our
earlier findings. Familial factors likely contribute to increased pediatric
cancer mortality.
9527 Poster Discussion Session (Board #7), Sun, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Association of bone mineral density with incidental renal stone in long-term
survivors of childhood acute lymphoblastic leukemia. Presenting Author:
Prasad Laxman Gewade, St. Jude Children’s Research Hospital, Memphis,
TN
Background: With 5-year survival of childhood acute lymphoblastic leukemia
(ALL) now exceeding 90%, long term morbidities are of growing
concern. Both low bone mineral density (BMD) and renal dysfunction have
been reported in ALL survivors. Our objective was to evaluate the association
between low BMD and incidental renal stones, a known predictor of
renal dysfunction. Methods: Adult participants who were 10� year survivors
of childhood ALL and members of St. Jude Lifetime Cohort study were
recruited between 12/2007 and 3/2011. During their risk-based medical
evaluations they underwent quantitative computed tomography (QCT) to
evaluate BMD. Incidental renal stones were identified by radiologists’
review of axial QCT source images. Demographic information was abstracted
from responses to health surveys and dietary intake from a Block
food frequency questionnaire. Association between BMD and renal stones
was evaluated in a multivariable logistic regression model. Confounding
variables were selected using directed acyclic graphs and change in effect
estimates strategy. Results: At a median of 26.1 years from diagnosis, BMD
Z score of � 1 standard deviation (SD) was detected in 77/662 (11.6%)
and renal stones in 73/662 (11%) participants. In a multivariable model
adjusted for age, dietary vitamin D and renal radiation, when compared to
BMD Z score � 1 SD, the risk of renal stones increased with a decrease in
BMD Z-score; 1 to 0 SD (Odds Ratio (OR), 1.93; 95% confidence interval
(CI), 0.69 to 5.41), 0 to -1 SD (OR, 1.46; 95% CI, 0.52 to 4.05), -1 to -2
SD (OR, 2.72; 95% CI, 0.81 to 6.41), and � -2 SD (OR, 4.96; 95% CI,
1.43 to 17.13). Older age (45-54 vs.18-24 y; OR, 3.66; 95% CI, 1.10 to
12.15), renal radiation (OR, 1.97; 95% CI, 0.59 to 6.50) and � 141.5 IU
intake of vitamin D (OR, 1.65; 95% CI, 0.98 to 2.77) were also associated
with renal stone formation. Conclusions: Our results not only help us
recognize survivors at risk, but also informs radiologists to be vigilant of
incidental renal stones among older ALL survivors with low BMD.
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