Showing papers by "Otto Visser published in 2019"

Radiation Exposure From Pediatric CT Scans and Subsequent Cancer Risk in the Netherlands

Abstract: Background: Computed tomography (CT), a strong diagnostic tool, delivers higher radiation doses than most imaging modalities. As CT use has increased rapidly, radiation protection is important, particularly among children. We evaluate leukemia and brain tumor risk following exposure to low-dose ionizing radiation from CT scans in childhood. Methods: For a nationwide retrospective cohort of 168 394 children who received one or more CT scans in a Dutch hospital between 1979 and 2012 who were younger than age 18 years, we obtained cancer incidence, vital status, and confounder information by record linkage with external registries. Standardized incidence ratios were calculated using cancer incidence rates from the general Dutch population. Excess relative risks (ERRs) per 100 mGy organ dose were calculated with Poisson regression. All statistical tests were two-sided. Results: Standardized incidence ratios were elevated for all cancer sites. Mean cumulative bone marrow doses were 9.5 mGy at the end of follow-up, and leukemia risk (excluding myelodysplastic syndrome) was not associated with cumulative bone marrow dose (44 cases). Cumulative brain dose was on average 38.5 mGy and was statistically significantly associated with risk for malignant and nonmalignant brain tumors combined (ERR/100 mGy: 0.86, 95% confidence interval = 0.20 to 2.22, P = .002, 84 cases). Excluding tuberous sclerosis complex patients did not substantially change the risk. Conclusions: We found evidence that CT-related radiation exposure increases brain tumor risk. No association was observed for leukemia. Compared with the general population, incidence of brain tumors was higher in the cohort of children with CT scans, requiring cautious interpretation of the findings.

Treatment of patients with MYC rearrangement positive large B-cell lymphoma with R-CHOP plus lenalidomide: results of a multicenter HOVON phase II trial.

Abstract: Patients with MYC-rearrangement positive large B-cell lymphoma (MYC+ LBCL) have an inferior prognosis following standard first-line therapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) as compared to patients without MYC rearrangement. Although intensive chemotherapy regimens yield higher remission rates, toxicity remains a concern. Lenalidomide is an oral immunomodulatory drug which downregulates MYC and its target genes thereby providing support using lenalidomide as additional therapeutic option for MYC+ LBCL. A phase II trial was conducted evaluating the efficacy of lenalidomide (15 mg day 1-14) in combination with R-CHOP (R2CHOP) in newly diagnosed MYC+ LBCL patients identified through a nationwide MYC-FISH screening program. The primary endpoint was complete metabolic response (CMR) on centrally reviewed 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)-computer tomography (CT)-scan at end-of-treatment. Secondary endpoints were overall survival (OS), disease-free survival (DFS) and event-free survival (EFS). Eighty-two patients with stage II-IV MYC+ LBCL were treated with 6 cycles of R2CHOP. At EOT, 67% (confidence interval (CI) 58-75%) of the patients reached CMR. With a median follow-up of 25.4 months, 2-year estimates (95% CI) for OS, DFS, EFS were 73% (62-82%), 75% (63-84%) and 63% (52-73%) respectively. In this prospective trial for newly diagnosed MYC+ LBCL patients, we found that administering R2CHOP was safe, and yields comparable CMR and survival rates as in studies applying more intensive chemotherapy regimens. Hence, these findings offer new prospects for MYC+ LBCL patients and warrant comparison in prospective randomized clinical trials. This trial was registered at www.clinicaltrialsregister.eu (#2014-002654-39).

Improvement of Care in Patients With Colorectal Cancer: Influence of the Introduction of Standardized Structured Reporting for Pathology.

Abstract: PURPOSEThe use of standardized structured reporting (SSR) can improve communication between cancer specialists, which might improve clinical care; however, there are no reliable data on whether the...

Incidence of acute promyelocytic leukemia across Europe: results of RARECAREnet—a population-based study

Abstract: The scarcity of studies performed over the past decades in Central and South America provided clues that the prevalence of acute promyelocytic leukemia (APL)-a rare and distinct subtype of acute myeloid leukemia-might be higher among descendants of Spaniards, as compared to other ethnic groups. Currently, a comprehensive apprehension on APL incidence across Europe has yet been established. Therefore, we conducted a population-based study to assess the incidence of APL across Europe. We selected all patients diagnosed with APL in Europe from the RARECAREnet database that holds data from 94 cancer registries across 27 European countries on rare malignancies diagnosed during 2000-2007. Age-standardized incidence rates (ASRs) with 95% confidence intervals (CIs) were calculated for the European pool per 100,000 person-years. Also, crude incidence rates with 95% CIs were calculated per 100,000 person-years by country. Overall, 1,876 patients with APL (48% male and 24% aged ≥65 years) were included in our analytic cohort. The overall ASR of APL was 0.112 (95% CI, 0.107-0.117) in Europe. The incidence of APL varied considerably across Europe, with the highest incidence in Spain (0.257; 95% CI, 0.205-0.317), as compared to the European average. Altogether, these finding adds additional support to the hypothesis that APL might be more prevalent among individuals with Spanish ancestry. Future research is warranted to specifically explore etiologic factors of APL across different genetic and environmental backgrounds.

Quality of Care Indicators for Head and Neck Cancers: The Experience of the European Project RARECAREnet.

Abstract: Background: Monitoring and improving quality of cancer care has become pivotal today. This is especially relevant for head and neck cancers since the disease is complex, it needs multi therapy, patients tend to be older, they tend to have comorbidities and limited social support. However, information on quality of care for head and neck cancers is scarce. In the context of the project "Information Network on Rare Cancers" we aimed to identify indicators of quality of care specific for the head and neck cancers management and to measure the quality of care for head and neck cancers in different EU Member States. Methods: We defined indicators of quality of care for head and neck cancers based on a multidisciplinary and expert-based consensus process at a European level. To test the proposed indicators, we performed an observational population-based retrospective study in four countries (Ireland, Italy, Netherlands, and Slovenia) in the years 2009-2011. Results: The main quality indicators identified are: availability of formalized multidisciplinary team, participation in clinical and translational research; timeliness of care, high quality of surgery and radiotherapy, and of pathological reporting. For head and neck cancers, the quality of care did not reach the optimal standards in most of the countries analyzed. A high proportion of patients was diagnosed at an advanced disease stage, showed delays in starting treatment (especially for radiotherapy), and there was only a very limited use of multi therapy. Conclusions: According to the achieved consensus, indicators of quality of care for head and neck cancers have to cover the patient journey (i.e., diagnosis and treatment). Our results, showed suboptimal quality of care across countries and call for solutions for ensuring good quality of care for head and neck cancer patients in all EU countries. One possible option might be to refer head and neck cancer patients to specialized centers or to networks including specialized centers.

Overrepresentation of patients from HTLV-1 endemic countries among T cell Non-Hodgkin lymphomas in the Netherlands: an indication of under-diagnosis of Adult T cell leukaemia/lymphoma.

Abstract: Agrawal, A.K. & Feusner, J.H. (2011) Management of tumour lysis syndrome in children: what is the evidence for prophylactic rasburicase in non-hyperleucocytic leukaemia? British Journal of Haematology, 153, 275–277. Bertrand, Y., Mechinaud, F., Brethon, B., Mialou, V., Auvrignon, A., Nelken, B., Notz-Carrer, A., Plantaz, D., Patte, C., Urbieta, M., Baruchel, A. & Leverger, G. (2008) SFCE (Societe Francaise du Lutte contre les Cancers et Leucemies de l’Enfant et de l’Adolescent) recommendations for the management of tumor lysis syndrome (TLS) with rasburicase: an observational survey. Journal of Pediatric Hematology/Oncology, 30, 267–271. Cairo, M.S., Coiffier, B., Reiter, A. & Younes, A. (2010) Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. British Journal of Haematology, 149, 578–586. Citrin, R., Horowitz, J.P., Reilly, A.F., Li, Y., Huang, Y.S., Getz, K.D., Seif, A.E., Fisher, B.T. & Aplenc, R. (2017) Creation of a pediatric mature B-cell non-Hodgkin lymphoma cohort within the Pediatric Health Information System Database. PLoS ONE, 12, e0186960. Fisher, B.T., Gerber, J.S., Leckerman, K.H., Seif, A.E., Huang, Y.S., Li, Y., Harris, T., Torp, K., Douglas, R., Shah, A., Walker, D. & Aplenc, R. (2013) Variation in hospital antibiotic prescribing practices for children with acute lymphoblastic leukemia. Leukaemia & Lymphoma, 54, 1633–1639. Fisher, B.T., Harris, T., Torp, K., Seif, A.E., Shah, A., Huang, Y.V., Bailey, L.C., Kersun, L.S., Reilly, A.F., Rheingold, S.R., Walker, D., Li, Y. & Aplenc, R. (2014) Establishment of an 11-year cohort of 8733 pediatric patients hospitalized at United States free-standing Children’s Hospitals with de novo acute lymphoblastic leukemia from heath care administrative data. Medical Care, 52, e1–e6. Flerlage, J. & Engorn, B. (eds.);Children’s Medical and Surgical Center (2015) The Harriet Lane Handbook: A Manual for Pediatric House Officers/the Harriet Lane Service, Children’s Medical and Surgical Center of the Johns Hopkins Hospital, 20th edn. Saunders, Philadelphia. Howard, S.C., Jones, D.P. & Pui, C. (2011) The tumor lysis syndrome. New England Journal of Medicine, 364, 1844–1854. Maude, S.L., Fitzgerald, J.C., Fisher, B.T., Li, Y., Huang, Y.S., Torp, K., Seif, A.E., Kavcic, M., Walker, D.M., Leckerman, K.H., Kilbaugh, T.J., Rheingold, S.R., Sung, L., Zaoutis, T.E., Berg, R.A., Nadkarni, V.M., Thomas, N.J. & Aplenc, R. (2014) Outcome of pediatric acute myeloid leukemia patients receiving intensive care in the United States. Pediatric Critical Care Medicine, 15, 112–120. Walker, D.M., Fisher, B.T., Seif, A.E., Huang, Y.S., Torp, K., Li, Y. & Aplenc, R. (2013) Dexrazoxane use in pediatric patients with acute lymphoblastic or myeloid leukemia from 1999 and 2009: analysis of a national cohort of patients in the Pediatric Health Information Systems database. Pediatric Blood & Cancer, 60, 616–620.

Survival of early posthematopoietic stem cell transplantation relapse of myeloid malignancies

Abstract: Objective: Relapse of AML after allogeneic hematopoietic stem cell transplantation (HSCT) has a poor prognosis, and standard of care therapy is lacking. Early ( 50% of the survivors had a relapse <6 months. Conclusion: We confirmed the dismal prognosis of postallogeneic HSCT relapse. Importantly, our data demonstrate that patients fit enough to receive high-dose chemotherapy, even when relapse occurred <6 months, had the best chance to obtain durable remissions, in particular when immunologic consolidation was performed after reaching CR.

Clinical characteristics and survival patterns of subsequent sarcoma, breast cancer, and melanoma after childhood cancer in the DCOG-LATER cohort

Abstract: Purpose: Childhood cancer survivors are at increased risk of developing subsequent malignant neoplasms (SMNs) We compared survival and clinical characteristics of survivors with SMNs (sarcoma, breast cancer, or melanoma) and a population-based sample of similar first malignant neoplasm (FMN) patients Methods: We assembled three case series of solid SMNs observed in a cohort of 5-year Dutch childhood cancer survivors diagnosed 1963–2001 and followed until 2014: sarcoma (n = 45), female breast cancer (n = 41), and melanoma (n = 17) Each SMN patient was sex-, age-, and calendar year-matched to 10 FMN patients in the population-based Netherlands Cancer Registry We compared clinical and histopathological characteristics by Fisher’s exact tests and survival by multivariable Cox regression and competing risk regression analyses Results: Among sarcoma-SMN patients, overall survival [hazard ratio (HR) 188, 95% confidence interval (CI) 123–287] and sarcoma-specific mortality (HR 191, 95% CI 116–313) were significantly worse compared to sarcoma-FMN patients (foremost for soft-tissue sarcoma), with 15-year survival rates of 308% and 616%, respectively Overall survival did not significantly differ for breast-SMN versus breast-FMN patients (HR 114, 95% CI 054–237), nor for melanoma-SMN versus melanoma-FMN patients (HR 071, 95% CI 010–500) No significant differences in tumor characteristics were observed between breast-SMN and breast-FMN patients Breast-SMN patients were treated more often with mastectomy without radiotherapy/chemotherapy compared to breast-FMN patients (171% vs 56%) Conclusions: Survival of sarcoma-SMN patients is worse than sarcoma-FMN patients Although survival and tumor characteristics appear similar for breast-SMN and breast-FMN patients, treatment differs; breast-SMN patients less often receive breast-conserving therapy Larger studies are necessary to substantiate these exploratory findings

Overall and disease-specific survival of Hodgkin lymphoma survivors who subsequently developed gastrointestinal cancer

Abstract: Background: Hodgkin lymphoma (HL) survivors have an increased risk of gastrointestinal (GI) cancer. This study aims to evaluate whether survival of patients who survived HL and developed GI cancer differs from survival of first primary GI cancer patients. Methods: Overall and cause‐specific survival of GI cancer patients in a HL survivor cohort (GI‐HL, N = 104, including esophageal, gastric, small intestinal, and colorectal cancer) was compared with survival of a first primary GI cancer patient cohort (GI‐1, N = 1025, generated by case matching based on tumor site, gender, age, and year of diagnosis). Cox proportional hazards regression was used for survival analyses. Multivariable analyses were adjusted for GI cancer stage, grade of differentiation, surgery, radiotherapy, and chemotherapy. Results: GI‐HL cancers were diagnosed at a median age of 54 years (interquartile range 45‐60). No differences in tumor stage or frequency of surgery were found. GI‐HL patients less often received radiotherapy (8% vs 23% in GI‐1 patients, P < 0.001) and chemotherapy (28% vs 41%, P = 0.01) for their GI tumor. Compared with GI‐1 patients, overall and disease‐specific survival of GI‐HL patients was worse (univariable hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.03‐1.65, P = 0.03; and HR 1.29, 95% CI 1.00‐1.67, P = 0.049, respectively; multivariable HR 1.33, 95% CI 1.05‐1.68, P = 0.02; and HR 1.33, 95% CI 1.03‐1.72, P = 0.03, respectively). Conclusions: Long‐term overall and disease‐specific survival of GI cancer in HL survivors is worse compared with first primary GI cancer patients. Differences in tumor stage, grade of differentiation, or treatment could not explain this worse survival.

[Fight against cancer in the Netherlands: current state of affairs].

Abstract: Objective To give insight into the fight against cancer in the Netherlands. Design Nationwide observational cohort study. Method Data from the Netherlands Cancer Registry on standardized incidence rates and relative survival were analysed. Mortality data was obtained from Statistics Netherlands. Results Between 1989 and 2017 the number of newly-diagnosed cancers doubled to 111,582. The standardized incidence (ESR) increased from 377 per 100,000 inhabitants in 1989 to 481 in 2011, and stabilized thereafter (459 in 2017). In 2018 the five most common types of cancer were skin cancer (excl. basal cell carcinoma, n = 21,000), breast cancer (n = 15,000), colorectal cancer (n = 14,000), lung cancer (n = 13,000) and prostate cancer (n = 13,000). The incidence of skin cancer rose the fastest (melanoma from 11 to 32 per 100,000; squamous cell carcinoma from 14 to 49 per 100,000). The largest shift to local disease (T1-T2 according to the TNM) was seen in breast cancer (from 50% to 75%). The 5-year survival improved from 50% in patients diagnosed with cancer in 1991-1996 to 65% in 2011-2016. Of the most common cancer types, survival of acute myeloid leukaemia increased the most (from 10% to 25%). The absolute number of deaths increased (from 35,000 in 1989 to 45,000 in 2017), but after standardization this decreased from 234 to 169. Conclusion The incidence of cancer in absolute numbers is still increasing due to the ageing population. However, taking population demographics into account, the standardized incidence has not increased since 2011. This is related to the decrease in smoking-related cancers, amongst other things. The increase in survival is related to early detection and improved treatment. The decrease in mortality is mainly related to the decrease in lung cancer mortality in men.

[Immunotherapy for cancer: from medical breakthrough to application in daily practice].

Abstract: Immunotherapy induces a response against cancer by activating the immune system. Examples are therapies with checkpoint inhibitors, oncolytic viruses and chimeric antigen receptor T-cells (CAR T-cells). These therapies have, due to their rapid development, found their way to daily practice. For some patients with metastatic disease immunotherapy has led to significant long-term survival. Currently, there is a shift in the treatment with checkpoint inhibitors towards the (neo)adjuvant setting. Treatments with CAR T-cells seem particularly effective in haematological malignancies. Oncolytic viruses are used in the treatment for melanoma, but presently only on a limited scale. Only a limited number of patients benefit from immunotherapy. There remain many challenges for the future, most importantly the optimal use of treatment, recognition and treatment of side effects, determining the optimal duration of treatment and the increasing healthcare costs.