Late infection-related mortality in asplenic survivors of childhood cancer: A report from the Childhood Cancer Survivor Study Journal Article


Authors: Weil, B. R.; Madenci, A. L.; Liu, Q.; Howell, R. M.; Gibson, T. M.; Yasui, Y.; Neglia, J. P.; Leisenring, W. M.; Smith, S. A.; Tonorezos, E. S.; Friedman, D. N.; Constine, L. S.; Tinkle, C. L.; Diller, L. R.; Armstrong, G. T.; Oeffinger, K. C.; Weldon, C. B.
Article Title: Late infection-related mortality in asplenic survivors of childhood cancer: A report from the Childhood Cancer Survivor Study
Abstract: Purpose Infection-related outcomes associated with asplenia or impaired splenic function in survivors of childhood cancer remains understudied. Methods Late infection-related mortality was evaluated in 20, 026 5-year survivors of childhood cancer (diagnosed < 21 years of age from 1970 to 1999; median age at diagnosis, 7.0 years [range, 0 to 20 years]; median follow-up, 26 years [range, 5 to 44 years]) using cumulative incidence and piecewise-exponential regression models to estimate adjusted relative rates (RRs). Splenic radiation was approximated using average dose (direct and/or indirect) to the left upper quadrant of the abdomen (hereafter, referred to as splenic radiation). Results Within 5 years of diagnosis, 1, 354 survivors (6.8%) had a splenectomy and 9, 442 (46%) had splenic radiation without splenectomy. With 62 deaths, the cumulative incidence of infection-related late mortality was 1.5% (95% CI, 0.7% to 2.2%) at 35 years after splenectomy and 0.6% (95% CI, 0.4% to 0.8%) after splenic radiation. Splenectomy (RR, 7.7; 95% CI, 3.1 to 19.1) was independently associated with late infection-related mortality. Splenic radiation was associated with increasing risk for late infection-related mortality in a dose-response relationship (0.1 to 9.9 Gy: RR, 2.0; 95% CI, 0.9 to 4.5; 10 to 19.9 Gy: RR, 5.5; 95% CI, 1.9 to 15.4; ≥ 20 Gy: RR, 6.0; 95% CI, 1.8 to 20.2). High-dose alkylator chemotherapy exposure was also independently associated with an increased risk of infection-related mortality (RR, 1.9; 95% CI, 1.1 to 3.4). Conclusion Splenectomy and splenic radiation significantly increase risk for late infection-related mortality. Even low-to intermediate-dose radiation exposure confers increased risk, suggesting that the spleen is highly radiosensitive. These findings should inform long-term follow-up guidelines for survivors of childhood cancer and should lead clinicians to avoid or reduce radiation exposure involving the spleen whenever possible. © 2018 by American Society of Clinical Oncology.
Journal Title: Journal of Clinical Oncology
Volume: 36
Issue: 16
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2018-06-01
Start Page: 1571
End Page: 1578
Language: English
DOI: 10.1200/jco.2017.76.1643
PROVIDER: scopus
PMCID: PMC5978467
PUBMED: 29664715
DOI/URL:
Notes: Conference Paper -- Export Date: 4 September 2018 -- Source: Scopus
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