| 11. |
- Dreisig, Karin, et al.
(författare)
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TPMT polymorphisms and minimal residual disease after 6-mercaptopurine post-remission consolidation therapy of childhood acute lymphoblastic leukaemia
- 2021
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Ingår i: Pediatric Hematology and Oncology. - : Informa UK Limited. - 0888-0018 .- 1521-0669. ; 38:3, s. 227-238
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Tidskriftsartikel (refereegranskat)abstract
- © 2020 Taylor & Francis Group, LLC. Bone marrow minimal residual disease (MRD) is the strongest predictor of relapse in children with acute lymphoblastic leukemia (ALL). 6-mercaptopurine (6MP) in ALL therapy has wide inter-individual variation in disposition and is strongly influenced by polymorphisms in the thiopurine methyltransferase (TPMT) gene. In 952 patients treated according to the NOPHO ALL2008 protocol, we explored the association between thiopurine disposition, TPMT genotypes and MRD levels after consolidation therapy with 6MP, high-dose methotrexate (HD-MTX), asparaginase, and vincristine. The levels of the cytotoxic DNA-incorporated thioguanine were significantly higher on day 70-79 in G460A/A719G TPMT heterozygous (TPMT HZ) compared to TPMT wild type (TPMT WT) patients (mean: 230.7 vs. 149.7 fmol/µg DNA, p = 0.002). In contrast, TPMT genotype did not associate with the end of consolidation MRD levels irrespective of randomization of the patients to fixed dose (25 mg/m2/day) or 6MP escalation (up to 50 or 75 mg/m2/day) during consolidation therapy.
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| 12. |
- Egnell, Christina, et al.
(författare)
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Obesity as a predictor of treatment-related toxicity in children with acute lymphoblastic leukaemia
- 2022
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Ingår i: British Journal of Haematology. - : John Wiley & Sons. - 0007-1048 .- 1365-2141. ; 196:5, s. 1239-1247
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Tidskriftsartikel (refereegranskat)abstract
- Obesity is associated with poor outcomes in childhood acute lymphoblastic leukaemia (ALL). We explored whether severe treatment-related toxicity and treatment delays could explain this observation. This study included 1 443 children aged 2 center dot 0-17 center dot 9 years with ALL treated with the Nordic Society of Pediatric Haematology and Oncology (NOPHO) ALL2008 non-high-risk protocol. Prospective treatment-related toxicities registered every three-month interval were used. Patients were classified according to sex- and age-adjusted international childhood cut-off values, corresponding to adult body mass index: underweight, <17 kg/m(2); healthy weight, 17 to <25 kg/m(2); overweight, 25 to <30 kg/m(2); and obese, >= 30 kg/m(2). Obese children had a higher incidence rate ratio (IRR) for severe toxic events {IRR: 1 center dot 55 [95% confidence interval (CI) 1 center dot 07-2 center dot 50]}, liver and kidney failures, bleeding, abdominal complication, suspected unexpected severe adverse reactions and hyperlipidaemia compared with healthy-weight children. Obese children aged >= 10 years had increased IRRs for asparaginase-related toxicities compared with healthy-weight older children: thromboses [IRR 2 center dot 87 (95% CI 1 center dot 00-8 center dot 21)] and anaphylactic reactions [IRR 7 center dot 95 (95% CI 2 center dot 15-29 center dot 37)] as well as higher risk for truncation of asparaginase [IRR 3 center dot 54 (95% CI 1 center dot 67-7 center dot 50)]. The high prevalence of toxicity and a higher risk of truncation of asparaginase may play a role in the poor prognosis of obese children aged >= 10 years with ALL.
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| 13. |
- Hafsteinsdottir, Solveig, et al.
(författare)
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Suspected infections in children treated for ALL
- 2009
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 98:7, s. 1149-1155
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Tidskriftsartikel (refereegranskat)abstract
- The aim of our study was to get epidemiological information on bacterial infections in children treated for ALL and to analyse which patients have an enhanced infection risk. Episodes of suspected or confirmed infections were evaluated during the first 12 months of treatment for childhood acute lymphoblastic leukaemia (ALL). The number of patients was 73 (43 boys). The median age was 4.6 years. A total of 179 episodes occurred, varying from none in six patients to eight in one. Bacteria were cultured in 57 episodes (31.8%), the most common being coagulase-negative staphylococci. The number of episodes fell significantly with increasing age for suspected and confirmed infections (p < 0.001 and p = 0.03). The proportion of confirmed infections was significantly higher (p < 0.001) in the first episodes. The average number of suspected infections was higher in girls than in boys (p = 0.03), but confirmed infections were not. Most of the serious infections occur early in the treatment and the number of suspected and confirmed infections falls with age. Suspicion of infection is more likely in girls, but the number of confirmed infections is equal in both sexes. Coagulase-negative staphylococcus was most commonly isolated, highlighting the importance of careful handling of central venous devices.
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| 14. |
- Hansen, Violeta, 1979, et al.
(författare)
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Naturally occurring radionuclides assessment in the Arctic
- 2023
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Ingår i: The XIX conference of the Nordic Society for Radiation Protection, held at Malmö Live, Malmö, Sweden, June 5-9, 2023. - https://nsfs.org/?lang=en : The Nordic Society for Radiation Protection (NSFS).
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Naturally occurring radionuclides (NORs), primarily 210Po, accumulates in seafood, marine, and terrestrial mammals, which are an important part of the traditional Arctic diet. Arctic seafood plays an important role in the worldwide seafood industry. NORs were measured in glaciers from Svalbard, the Arctic Ocean, surface seawater and sediments from Norwegian marine areas, seabirds from Greenland, seafood and marine mammals from the Nordic region, Faroe Islands, Greenland, and Canada, terrestrial mammals from Greenland, and lake sediments in northernmost Finland. Outdoor 222Rn was measured in Finland, Canada, and Norway and atmospheric 210Pb, 212Pb, and 7Be were measured in Norway, Sweden, Finland, Iceland, and Canada. Deposited 210Pb and 7Be were measured in Sweden and Finland. Glaciers and marine sediment results show oil and gas, coal combustion, and ore mining as anthropogenic sources. NORs are long-range transported via atmospheric and oceanic currents in the Arctic. 210Pb has a long atmospheric residence time, especially in winter. 228Ra activities in the Transpolar Drift approximately doubled between 2007 and 2015, indicating that climate-driven changes may be increasing the release of shelf-derived elements to the open Arctic Ocean. Results showed no effect of climate change on 210Pb deposition in sediments in Lake Kevojarvi in northernmost Finland. 210Po is the major contributor to the annual effective dose via seafood and marine and terrestrial mammal consumption in the Arctic population, far exceeding dose contributions from 137Cs, 226Ra, 228Ra, and 210Pb. 210Po absorbed dose rates to studied biota are several orders of magnitude lower than the recommended dose rate screening value of 10 µGy h-1. NORs atmospheric results follow an annual cycle, which is mainly driven by seasonal weather and climate changes. Understanding the sources and associated doses from NORs is necessary to assess risks and public perception of risks, support science-based decision-making, and policy development engaging public and Indigenous peoples.
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| 15. |
- Hasle, Henrik, et al.
(författare)
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Gemtuzumab ozogamicin as postconsolidation therapy does not prevent relapse in children with AML : results from NOPHO-AML 2004
- 2012
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Ingår i: Blood. - : American Society of Hematology. - 0006-4971 .- 1528-0020. ; 120:5, s. 978-984
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Tidskriftsartikel (refereegranskat)abstract
- There are no data on the role of postconsolidation therapy with gemtuzumab ozogamicin (GO; Mylotarg) in children with acute myeloid leukemia (AML). The NOPHO-AML 2004 protocol studied postconsolidation randomization to GO or no further therapy. GO was administered at 5 mg/m(2) and repeated after 3 weeks. We randomized 120 patients; 59 to receive GO. Survival was analyzed on an intention-to-treat basis. The median follow-up for patients who were alive was 4.2 years. Children who received GO showed modest elevation of transaminase and bilirubin without signs of venoocclusive disease. Severe neutropenia followed 95% and febrile neutropenia 40% of the GO courses. Only a moderate decline in platelet count and a minor decrease in hemoglobin occurred. Relapse occurred in 24 and 25 of those randomized to GO or no further therapy. The median time to relapse was 16 months versus 10 months (nonsignificant). The 5-year event-free survival and overall survival was 55% versus 51% and 74% versus 80% in those randomized to receive GO or no further therapy, respectively. Results were similar in all subgroups. In conclusion, GO therapy postconsolidation as given in this trial was well tolerated, showed a nonsignificant delay in time to relapse, but did not change the rate of relapse or survival (clinicaltrials.gov identifier NCT00476541).
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| 16. |
- Helenius, Marianne, et al.
(författare)
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Characteristics of white blood cell count in acute lymphoblastic leukemia : A COST LEGEND phenotype-genotype study
- 2022
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Ingår i: Pediatric Blood & Cancer. - : John Wiley & Sons. - 1545-5009 .- 1545-5017. ; 69:6
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Tidskriftsartikel (refereegranskat)abstract
- Background White blood cell count (WBC) as a measure of extramedullary leukemic cell survival is a well-known prognostic factor in acute lymphoblastic leukemia (ALL), but its biology, including impact of host genome variants, is poorly understood.Methods We included patients treated with the Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL-2008 protocol (N = 2347, 72% were genotyped by Illumina Omni2.5exome-8-Bead chip) aged 1-45 years, diagnosed with B-cell precursor (BCP-) or T-cell ALL (T-ALL) to investigate the variation in WBC. Spline functions of WBC were fitted correcting for association with age across ALL subgroups of immunophenotypes and karyotypes. The residuals between spline WBC and actual WBC were used to identify WBC-associated germline genetic variants in a genome-wide association study (GWAS) while adjusting for age and ALL subtype associations.Results We observed an overall inverse correlation between age and WBC, which was stronger for the selected patient subgroups of immunophenotype and karyotypes (rho(BCP-ALL )= -.17, rho(T-ALL )= -.19; p < 3 x 10(-4)). Spline functions fitted to age, immunophenotype, and karyotype explained WBC variation better than age alone (rho = .43, p << 2 x 10(-6)). However, when the spline-adjusted WBC residuals were used as phenotype, no GWAS significant associations were found. Based on available annotation, the top 50 genetic variants suggested effects on signal transduction, translation initiation, cell development, and proliferation.Conclusion These results indicate that host genome variants do not strongly influence WBC across ALL subsets, and future studies of why some patients are more prone to hyperleukocytosis should be performed within specific ALL subsets that apply more complex analyses to capture potential germline variant interactions and impact on WBC.
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| 17. |
- Helenius, Marianne, et al.
(författare)
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Characteristics of white blood cell count in acute lymphoblastic leukemia: A COST LEGEND phenotype-genotype study.
- 2022
-
Ingår i: Pediatric blood & cancer. - : Wiley. - 1545-5017 .- 1545-5009. ; 69:6
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Tidskriftsartikel (refereegranskat)abstract
- White blood cell count (WBC) as a measure of extramedullary leukemic cell survival is a well-known prognostic factor in acute lymphoblastic leukemia (ALL), but its biology, including impact of host genome variants, is poorly understood.We included patients treated with the Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL-2008 protocol (N = 2347, 72% were genotyped by Illumina Omni2.5exome-8-Bead chip) aged 1-45 years, diagnosed with B-cell precursor (BCP-) or T-cell ALL (T-ALL) to investigate the variation in WBC. Spline functions of WBC were fitted correcting for association with age across ALL subgroups of immunophenotypes and karyotypes. The residuals between spline WBC and actual WBC were used to identify WBC-associated germline genetic variants in a genome-wide association study (GWAS) while adjusting for age and ALL subtype associations.We observed an overall inverse correlation between age and WBC, which was stronger for the selected patient subgroups of immunophenotype and karyotypes (ρBCP-ALL = -.17, ρT-ALL = -.19; p < 3 × 10-4 ). Spline functions fitted to age, immunophenotype, and karyotype explained WBC variation better than age alone (ρ = .43, p << 2 × 10-6 ). However, when the spline-adjusted WBC residuals were used as phenotype, no GWAS significant associations were found. Based on available annotation, the top 50 genetic variants suggested effects on signal transduction, translation initiation, cell development, and proliferation.These results indicate that host genome variants do not strongly influence WBC across ALL subsets, and future studies of why some patients are more prone to hyperleukocytosis should be performed within specific ALL subsets that apply more complex analyses to capture potential germline variant interactions and impact on WBC.
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| 18. |
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| 19. |
- Iosjpe, Mikhail, et al.
(författare)
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Evaluation of the bioaccumulation processes for a wide set of radionuclides under accidental releases by biota
- 2022
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- It was shown that it is impossible to use two approaches for the bioaccumulation process at the same time: (i) bioaccumulation based on the concentration rate approach and (ii) kinetic modelling of the bioaccumulation process. Simultaneous use of these two approaches provides a wrong description of the bioaccumulation process and concentration of radionuclides in biota, especially during the first period of exposure. In this connection, the evaluation of the kinetic parameters for bioaccumulation process for a wide set of radionuclides and biota has been provided. Preliminary evaluation of the kinetic parameters has been provided based on literature review and the extraction from existing databases. The selected kinetic parameters have been further improved based on mathematical experiments, including the successive simulations of bioaccumulation processes during increasing trophic levels. The sub-model with the modified kinetic parameters for bioaccumulation process has been used based on simulations from the compartmental model, which uses the non-instantaneous dispersion of radioactivity in the marine environment. The selected release scenario corresponds to a potential accident with nuclear submarine reactor in the Gulf of Finland. Concentrations of radionuclides in biota, doses to humans and dose rates to the marine organisms have been evaluated. The results of the present study can be used to improve the ability to evaluate the consequences to humans and biota after a radioactive release into marine environment. It was shown that the methodology, which was used in the present study allows to find a suitable set of kinetic parameters.
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| 20. |
- Jensen, Karen Schow, et al.
(författare)
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Temporal changes in incidence of relapse and outcome after relapse of childhood acute lymphoblastic leukemia over three decades : a Nordic population-based cohort study
- 2022
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Ingår i: Leukemia. - : Springer Nature. - 0887-6924 .- 1476-5551. ; 36, s. 1274-1282
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Tidskriftsartikel (refereegranskat)abstract
- Relapse remains the main obstacle to curing childhood acute lymphoblastic leukemia (ALL). The aims of this study were to compare incidence of relapse, prognostic factors, and survival after relapse between three consecutive Nordic Society of Pediatric Hematology and Oncology trials. Relapse occurred as a primary event in 638 of 4 458 children (1.0–14.9 years) diagnosed with Ph-negative ALL between 1992 and 2018. The 5-year cumulative incidence of relapse was 17.3% (95% CI 15.4–19.2%) and 16.5% (95% CI 14.3–18.8%) for patients in the ALL1992 and ALL2000 trials, respectively, but decreased to 8.4% (95% CI 7.0–10.1%) for patients in the ALL2008 trial. No changes in duration of first complete remission and site of relapse were observed over time; however, high hyperdiploidy, and t(12;21) decreased in the ALL2008 trial. The 4-year overall survival after relapse was 56.6% (95% CI 52.5–60.5%) and no statistically significant temporal improvements were observed. Age ≥10 years, T-cell immunophenotype, bone-marrow involvement, early and very early relapse, hypodiploidy, and Down syndrome all independently predicted worse outcome after relapse. Improvements in the primary treatment of childhood ALL has resulted in fewer relapses. However, failure to improve outcome of remaining relapses suggests a selection of harder-to-cure relapses and calls for new therapeutic strategies.
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