ABSTRACT
Children who receive head, neck, or chest radiotherapy for various primary malignancies have increased risk for secondary thyroid malignancy. Thyroid nodules are difficult to identify by physical examination and/or laboratory tests. Thyroid ultrasound can detect non-palpable nodules without adverse side effects. We performed a retrospective chart review of 36 patients who received radiotherapy and underwent thyroid ultrasound. Forty-seven percent (n = 17) had ≥1 nodule(s) detected. Seven patients underwent thyroidectomy; four of whom were diagnosed with thyroid malignancy. Our study suggests routine use of thyroid ultrasound in high-risk patients detects subclinical thyroid nodules and potential thyroid malignancy post-radiotherapy.
Subject(s)
Cranial Irradiation/adverse effects , Neck/radiation effects , Neoplasms, Second Primary/diagnostic imaging , Thorax/radiation effects , Thyroid Gland/diagnostic imaging , Thyroid Neoplasms/diagnostic imaging , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Neoplasms, Second Primary/etiology , Retrospective Studies , Thyroid Neoplasms/etiology , Thyroid Nodule/diagnostic imaging , Thyroid Nodule/etiology , UltrasonographyABSTRACT
We report a case of a child with precursor-B acute lymphoblastic leukemia (ALL) who experienced refractory thrombocytopenia and massive splenomegaly during standard induction chemotherapy. He was diagnosed with hemophatocytic lymphohistiocytosis (HLH) during induction. Clinical and laboratory evaluation showed no evidence of infectious cause to HLH. Pancytopenia and HLH persisted after consolidation therapy even with remission from leukemia. After failure to control HLH with ALL-directed therapy and HLH-directed therapy, the patient underwent unrelated donor hematopoietic stem cell transplantation 8 months after diagnosis. He is 34 months post-transplant and in remission from leukemia and HLH.
Subject(s)
Lymphohistiocytosis, Hemophagocytic/complications , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/complications , Child , Humans , Lymphohistiocytosis, Hemophagocytic/drug therapy , Male , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/drug therapyABSTRACT
BACKGROUND: During initial treatments, pediatric cancer patients are frequently hospitalized for fever, which may be due to neutropenia or a manifestation of the somnolence syndrome (SS) after cranial radiation therapy (CRT). This was a retrospective chart review of patients who received CRT for central nervous system prophylaxis or treatment in acute lymphoblastic leukemia or lymphoma. OBSERVATIONS: Of 21 patients, 15 (71%) developed SS; 10 were hospitalized for fever. Comparing somnolent and nonsomnolent patients, there was no statistically significant difference in the admission absolute neutrophil count; radiation dose, fraction, or duration; and time between completion of CRT and first hospitalization. CONCLUSIONS: In postradiation phase, patients with SS are more likely to get fever leading to hospital admission regardless of ANC.
Subject(s)
Cranial Irradiation/adverse effects , Disorders of Excessive Somnolence/etiology , Fever/etiology , Adolescent , Central Nervous System Neoplasms , Child , Child, Preschool , Hospitalization , Humans , Infant , Infant, Newborn , Lymphoma , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Retrospective Studies , Young AdultABSTRACT
We present the case of a 3-year-old girl with acute lymphoblastic leukemia who developed isolated central nervous system relapse while receiving chemotherapy 10 months after diagnosis. The child achieved a second remission on retreatment with systemic and intrathecal chemotherapy. She then underwent myeloablative chemotherapy and radiation therapy followed by infusion of her own umbilical cord blood, which the parents had saved after her delivery. She is now doing well and is in complete remission 20 months after cord blood transplantation. In this first report of autologous cord blood transplantation for treatment of childhood leukemia, we discuss the safety and feasibility of this procedure as well as some of the uncertainties surrounding autologous cord blood collection and usage.