Lifetime follow-up care after childhood cancer.

Cancers that occur during childhood and adolescence (ages 0 to 19 years) are very responsive to treatment, with a current overall cure rate of better than 80%. However, approximately 75% of childhood cancer survivors develop late effects, including problems with growth and development, vital organ function, reproduction, and psychological health, as well as serious complications of secondary neoplasms and recurrence. The primary physician should continue some level of involvement during all phases of patient care and pay special attention to possible late effects during the follow-up phase.

Late effects in long-term survivors after treatment for childhood acute leukemia.

Background: This is a report of late effects in childhood cancer survivors seen in the follow-up clinic of a single institution.

Materials And Methods: There were 324 acute leukemia survivors in the database of the Long Term Follow Up Clinic of Children's National Medical Center from January 1, 1997, through June 30, 2005.

Results: Of the 324 acute leukemia survivors, 228 were white, 48 black, 20 Hispanic, and 12 other.

Cousin Lizzie's tuberculosis tent.

Before the discovery of antibiotics as a cure for tuberculosis in the 1940s, open-air therapy was the standard treatment for the disease. This article describes how families and health care institutions used tents, shacks, balconies, and verandas to expose loved ones and patients to the cold, pure air that was believed to help them fight tubercle bacillus.

Hypertension and prehypertension in long-term survivors of childhood and adolescent cancer.

Background: Hypertension as a late effect following childhood and adolescent cancer has received little attention. Since obesity, a known risk factor for hypertension, is increased following some childhood cancers, it seems likely that significant numbers of survivors would have hypertension.

Procedures: The records of patients seen in the Long Term Follow Up Clinic of Children's National Medical Center were examined for a single institution, retrospective study of blood pressure in survivors of childhood and adolescent cancer.

Growth hormone deficiency after chemotherapy for acute lymphoblastic leukemia in children who have not received cranial radiation.

Chemotherapy-related growth failure is a significant problem in children with acute lymphoblastic leukemia (ALL) and other childhood cancers. Growth impairment after cranial radiation (CR) can result in diminished adult height, but growth failure following chemotherapy without CR is usually followed by catch-up growth and normal adult height.1 A retrospective review of 347 ALL survivors registered in our Long Term Follow Up (LTFU) Clinic, since 1997 revealed that 109 had received CR; 3, total body irradiation (TBI); and 235, neither CR nor TBI.

Philip S. Hench, M.D., Sc.D. (1896-1965): a glimpse at the early clinical years.

Philip S. Hench, M.D.

Second neoplasms in survivors of childhood and adolescent cancer are often treatable.

Purpose: To estimate the incidence and types of second neoplasms in survivors of childhood and adolescent cancer, as well as the characteristics of those who developed second neoplasms.

Methods: Survivors who were under age 21 years at initial diagnosis, off therapy, and in remission for 2 years are referred to the Long Term Survivors' Clinic (LTSC) at Children's National Medical Center (CNMC). This review includes patients entered in the clinic database from January 1, 1997 to August 30, 2002.

Osteoporosis in survivors of acute lymphoblastic leukemia.

Osteoporosis is currently receiving increasing attention as an important late effect in survivors of childhood cancer and its treatment because of their quality of life and its negative effect on the survivors' ability to perform developmentally appropriate activities. Survivors of childhood cancer are especially vulnerable because they are affected during childhood and adolescence, a time when peak bone mass should be achieved. This paper reviews decreased bone density in acute lymphoblastic leukemia (ALL), which is the most common childhood cancer and has a cure rate approaching 80%.

Benign ethnic neutropenia: what is a normal absolute neutrophil count?

Approximately 25% to 50% of persons of African descent and some ethnic groups in the Middle East have benign ethnic neutropenia, with low leukocyte and neutrophil counts. It is important to recognize the existence of this condition, the most common form of neutropenia throughout the world, and thus avoid both under-and overevaluation. Although there is no scientific basis for an absolute neutrophil count of 1.

Late effects in long-term survivors of high-grade non-Hodgkin's lymphomas.

Purpose: To evaluate long-term survivors of high-grade non-Hodgkin's lymphomas (NHLs) for late effects and to attempt to assess the relative contributions of the primary treatment modalities to these late effects.

Patients And Methods: Of 103 young survivors followed up for 1 to 20 years, 74 patients were interviewed and underwent various investigations, and an additional 12 patients were interviewed only. Of the 86 patients, 65 had previously suffered from small non-cleaved-cell lymphoma, 16 from lymphoblastic lymphoma, and five from large-cell lymphoma.

Treatment of patients with high grade non-Hodgkin's lymphomas and central nervous system involvement: is radiation an essential component of therapy?

We have retrospectively examined the outcome of 41 patients with high grade non-Hodgkin's lymphomas (NHL) and central nervous system (CNS) involvement who were treated with and without radiation at a single institution. Group I consisted of 25 patients with CNS involvement at presentation and Group II, of 16 with CNS involvement at first relapse. All 41 had systemic disease at diagnosis and received systemic and intrathecal chemotherapy.

Leukocyte response to administration of corticosteroid in healthy black children with neutropenia.

After a challenge with corticosteroid, increments in the absolute neutrophil count were > 50% in eight healthy black children with neutropenia, and > 2.0 x 10(9)/L (> 2000/mm3) in all but one child. Decrements in the absolute lymphocyte count mirrored the increments.

Cancer knowledge and attitudes of African-American and white adolescents: a comparison of two secondary schools.

A cancer knowledge and attitude survey was administered to 385 students 12 to 18 years of age. Half attended a predominantly African-American academic high school and the other half, a predominantly white college preparatory school. Both schools were in Washington, DC.

CNS involvement in small noncleaved-cell lymphoma: is CNS disease per se a poor prognostic sign?

Of 120 patients with small noncleaved-cell lymphoma who were entered sequentially on four National Cancer Institute (NCI) protocols, 29 (24%) had CNS involvement at some time in their clinical course. Seventeen had initial CNS involvement, and 12 developed CNS involvement at the time of first relapse. All 29 patients had extensive disease at presentation.

Minerals in hair, serum, and urine of healthy and anemic black children.

Hair mineral analysis can be used as a reliable screening test for heavy metals, but it is not an established method for defining nutritional and disease states. Wide variation in test results is a major problem in utilizing the technique for clinical purposes. Better reference values are needed, especially for children, as well as information about how hair mineral values correlate with body fluid values.

High frequency of benign mediastinal uptake of gallium-67 after completion of chemotherapy in children with high-grade non-Hodgkin's lymphoma.

We observed increased gallium-67 uptake in the mediastinum after completion of chemotherapy in 10 of 62 patients with non-Hodgkin's lymphoma. All 10 were under 15 years of age, yielding a frequency of 43% in this age group. The interval between cessation of chemotherapy and the development of increased gallium-67 uptake ranged from 1 to 8 months, and the abnormality persisted for 2 to 59 months.

Bone marrow involvement in young patients with non-Hodgkin's lymphoma: the importance of multiple bone marrow samples for accurate staging.

Of 95 young patients with non-Hodgkin's lymphoma treated at the National Cancer Institute on Pediatric Branch Protocol 7704, 18 (18.9%) had bone marrow involvement prior to treatment. Their mean age was 20.

Bone involvement in young patients with non-Hodgkin's lymphoma: efficacy of chemotherapy without local radiotherapy.

Of 95 young non-Hodgkin's lymphoma patients entered consecutively on the National Cancer Institute (NCI) Protocol 7704, 26 (27.4%) had involvement of one or more bones. The mean age of these 26 patients was 16.

Testicular involvement in young patients with non-Hodgkin's lymphoma.

Because of its rarity, there is a paucity of information in the medical literature about testicular lymphoma in young people. In our series of 99 patients with non-Hodgkin's lymphoma, 12% percent of the male patients had one or both testes involved at the time of diagnosis. Of the nine patients with testicular disease, six had Burkitt's, one undifferentiated non-Burkitt's, one diffuse large cell, and one lymphoblastic lymphoma.

Hereditary hemochromatosis in children, adolescents, and young adults.

Hereditary hemochromatosis is the most common cause of iron overload in adults and is probably the second most common cause of iron overload in children in the United States next to transfusional overload. Serious morbidity from this disorder of iron absorption can occur in early as well as in middle and advanced age, iron overload having been reported in children with hereditary hemochromatosis as early as 2 years of age. Younger persons differ from older persons in that the risk for iron loading in females appears to be equal to the risk for males, in contrast to a preponderance of males among older patients.