1. Late thyroid complications in survivors of childhood acute leukemia. An LEA study
- Author
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Gérard Michel, Marie-Dominique Tabone, Jean-Hugues Dalle, Dominique Plantaz, P Chastagner, Vincent Barlogis, Patrick Lutz, Pascal Auquier, Julie Berbis, Claire Oudin, Maryline Poiree, André Baruchel, Sandrine Thouvenin, Justyna Kanold, Yves Bertrand, Stéphane Ducassou, Virginie Villes, Guy Leverger, Anne Sirvent, Virginie Gandemer, Service d'hématologie pédiatrique, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Santé Publique et maladies Chroniques : Qualité de vie Concepts, Usages et Limites, Déterminants (SPMC), Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), Hématologie et immunologie pédiatrique, Hospices Civils de Lyon (HCL)-CHU Lyon-Institut d'hématologie et d'oncologie pédiatrique [CHU - HCL] (IHOPe), Hospices Civils de Lyon (HCL)-Hôpital Femme-Mère-Enfant (HFME), CHU Clermont-Ferrand-CIC Inserm 501, Service de Pédiatrie, Unité d'Oncologie et Hématologie Pédiatrique, Centre Hospitalier Universitaire de Nice (CHU Nice), Hôpital Pellegrin Tripode, Service Hématologie Infantile, CHU Grenoble, Service d'hématologie-immunologie-oncologie pédiatrique [CHU Trousseau], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Hôpital Robert Debré Paris, Hôpital Robert Debré, Institut de Génétique et Développement de Rennes (IGDR), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), CHU Pontchaillou [Rennes], Service de pédiatrie, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Pédiatrie et oncologie pédiatrique [Hôpital de la Timone - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Service d'hématologie et immunologie pédiatrique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7), Hôpital Trousseau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), French National Clinical Research Program, French National Cancer Institute (InCA), French National Research Agency (ANR), Canceropole PACA, Regional Council PACA, Herault Departmental Comity of the Ligue Contre le Cancer, French Institute for Public Health Research (IRESP), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Trousseau [APHP], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Paris Diderot - Paris 7 (UPD7)-Hôpital Robert Debré-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
- Subjects
Male ,MESH: Therapy/adverse effects ,[SHS.PSY]Humanities and Social Sciences/Psychology ,Gastroenterology ,0302 clinical medicine ,Risk Factors ,MESH: Risk Factors ,MESH: Child ,Prevalence ,Cumulative incidence ,Survivors ,MESH: Incidence ,Child ,Thyroid cancer ,MESH: Combined Modality ,MESH: Survivors ,Acute leukemia ,Leukemia ,MESH: Thyroid Diseases/diagnosis ,MESH: France/epidemiology ,Incidence ,Thyroid ,Hematology ,MESH: Follow-Up Studies ,Total body irradiation ,[SHS.ECO]Humanities and Social Sciences/Economics and Finance ,Combined Modality Therapy ,MESH: Leukemia/complications ,3. Good health ,medicine.anatomical_structure ,Child, Preschool ,030220 oncology & carcinogenesis ,Acute Disease ,MESH: Acute Disease ,Female ,France ,Thyroid function ,medicine.medical_specialty ,MESH: Leukemia/epidemiology ,MESH: Combined Modality Therapy/methods ,MESH: Leukemia/therapy ,MESH: Thyroid Diseases/epidemiology ,Article ,MESH: Multivariate Analysis ,03 medical and health sciences ,Internal medicine ,MESH: Thyroid Diseases/etiology ,medicine ,Humans ,MESH: Prevalence ,MESH: Humans ,business.industry ,MESH: Child, Preschool ,medicine.disease ,Thyroid Diseases ,MESH: Male ,Surgery ,Transplantation ,[SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health ,Multivariate Analysis ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Prophylactic cranial irradiation ,business ,MESH: Female ,Follow-Up Studies ,030215 immunology - Abstract
International audience; Thyroid complications are known side effects of irradiation. However, the risk of such complications in childhood acute leukemia survivors who received either central nervous system irradiation or hematopoietic stem cell transplantation is less described. We prospectively evaluated the incidence and risk factors for thyroid dysfunction and tumors in survivors of childhood acute myeloid or lymphoid leukemia. A total of 588 patients were evaluated for thyroid function, and 502 individuals were assessed for thyroid tumors (median follow-up duration: 12.6 and 12.5 years, respectively). The cumulative incidence of hypothyroidism was 17.3% (95% CI: 14.1-21.1) and 24.6% (95% CI: 20.4-29.6) at 10 and 20 years from leukemia diagnosis, respectively. Patients who received total body irradiation (with or without prior central nervous system irradiation) were at higher risk of hypothyroidism (adjusted HR: 2.87; P=0.04 and 2.79, P=0.01, respectively) as compared with transplanted patients who never received any irradiation. Patients transplanted without total body irradiation who received central nervous system irradiation were also at higher risk (adjusted HR: 3.39; P=0.02). Patients irradiated or transplanted at older than 10 years of age had a lower risk (adjusted HR: 0.61; P=0.02). Thyroid malignancy was found in 26 patients (5.2%). Among them, two patients had never received any type of irradiation: alkylating agents could also promote thyroid cancer. The cumulative incidence of thyroid malignancy was 9.6% (95% CI: 6.0-15.0) at 20 years. Women were at higher risk than men (adjusted HR: 4.74; P=0.002). In conclusion, thyroid complications are frequent among patients who undergo transplantation after total body irradiation and those who received prior central nervous system irradiation. Close monitoring is thus warranted for these patients. Clinicaltrials.gov identifier: NCT 01756599.
- Published
- 2016
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