Showing papers by "Sue C. Kaste published in 2019"

Prediction of Low and Very Low Bone Mineral Density Among Adult Survivors of Childhood Cancer.

Abstract: PURPOSETo develop and validate prediction models for low and very low bone mineral density (BMD) on the basis of clinical and treatment characteristics that identify adult survivors of childhood ca...

Bloodstream infections exacerbate incidence and severity of symptomatic glucocorticoid-induced osteonecrosis.

Abstract: Background Osteonecrosis is a common toxicity associated with glucocorticoid (e.g., dexamethasone and prednisone) treatment of children with acute lymphoblastic leukemia (ALL), but risk factors are incompletely defined. Infections are also a common complication of ALL therapy. Lipopolysaccharide (LPS) is used experimentally to mimic infection-related systemic effects. To our knowledge, the contribution of systemic infections to the risk of glucocorticoid-induced osteonecrosis has not been investigated. Procedure Patients with ALL on St. Jude Total Therapy XV (n = 365) were assessed for documented bacteremia prior to development of osteonecrosis, which was confirmed by MRI, and graded using the National Cancer Institute's Common Terminology for Adverse Events (version 3.0). In a preclinical model, Balb/cJ mice treated with dexamethasone plus or minus LPS were assessed for frequency and severity of osteonecrosis and arteriopathy. Results We found that patients with ALL who experienced bacteremia had a higher frequency of symptomatic osteonecrosis (≥grade 2) than those who did not (OR: 1.88; 95% CI, 1.03-3.41, P = 0.038). LPS exacerbated experimental dexamethasone-induced osteonecrosis. Mice treated with dexamethasone plus LPS had a higher incidence of osteonecrosis (P = 0.00086) and arteriopathy (P = 0.0047) than did those treated with dexamethasone alone, and the severity of osteonecrosis (P = 0.00045) and arteriopathy (P = 0.0048) was also more pronounced with the addition of LPS treatment. The increase in osteonecrosis was not explained by any alteration of dexamethasone pharmacokinetics by LPS. Conclusions These data identify systemic infection during ALL therapy as a novel risk factor in the development of glucocorticoid-induced osteonecrosis.

Brentuximab vedotin as consolidation after hematopoietic cell transplant for relapsed Hodgkin lymphoma in pediatric patients.

Abstract: To the Editor: Pediatric Hodgkin lymphoma (HL) affects approximately 1100 children and adolescents <20 years of age in the United States each year with anestimated5-year overall survival of>90%.1 However, theoverall survival falls to 70% for a small percentage of patients who relapse, and down to 50% for those requiring hematopoietic cell transplant (HCT).2 A trial conducted in adult patients, AETHERA, assessed theuse of brentuximab vedotin (Bv) as consolidation therapy after autologous HCT in patientswithHL at risk of relapse or progression.3 Bv is an antibody-drug conjugate containing an anti-CD30murine/human chimeric monoclonal antibody (cAC10; brentuximab) linked to monomethyl auristatin E (MMAE). After binding to CD30, a transmembrane receptor highly expressed on the malignant Hodgkin Reed-Sternberg cells, Bv is internalized andMMAE is released. Like vincristine,MMAEexerts antineoplastic effect by inhibiting tubulin polymerization, leading to M-phase arrest and apoptosis.

Imaging of pediatric cutaneous melanoma

Abstract: Melanoma accounts for 7% of all cancers in adolescents ages 15–19 years but is an unexpected malignancy in younger children. The prevalence of malignant melanoma is very rare in children ages 1–4 years, but certain non-modifiable risk factors such as xeroderma pigmentosum, congenital melanocytic nevus syndrome and other inherited traits increase the risk for its development in these young children. Recent genomic studies have identified characteristics of pediatric melanoma that differ from conventional melanoma seen in adults. In this review the authors inform on the types of melanoma seen in children and adolescents, discuss similarities and differences in melanoma between children and adults, and discuss the role of imaging in the care of these children.

Non-neurologic Late Effects of Therapy

Abstract: With the overall 5-year survival of patients diagnosed with cancer during childhood and adolescence now exceeding 80%, these survivors represent a rapidly growing population who may be burdened with adverse late toxicities and chronic disease. The chapter is organized by organ systems involved and addresses many of the more common adverse non-neurologic treatment-related late effects. The mechanisms of and risk factors for their development and imaging methods for their detection are discussed.