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The purpose was to describe the incidence and risk factors of congestive heart failure (CHF) among children with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). We included 2053 children (≤18 years) with first primary ALL and AML diagnosed 1992-2010 and registered in the Pediatric Oncology Group of Ontario Networked Information System. We identified CHF events through linked administrative databases. At 10 years, the cumulative incidence of CHF was 1.7% in ALL and 7.5% in AML. Factors associated with CHF in ALL were female gender, age <1 year at cancer diagnosis, irradiation and cumulative anthracycline dose ≥250 mg/m2. Irradiation was the only risk factor in AML patients. Of the 23 patients with CHF during active therapy, one developed CHF following treatment completion. Incidence of CHF were 1.7% in ALL and 7.5% in AML. Most with CHF during active therapy did not develop CHF after treatment completion. [ABSTRACT FROM AUTHOR]

Between 1977 and 1991, the Children's Cancer Group and the National Cancer Institute conducted three trials of very high-dose methotrexate (33.6 g/m2; VHD-MTX) in place of cranial radiation (CRT) as central nervous system (CNS) preventive therapy, and assessed efficacy, acute toxicity and long-term neurocognitive outcome. CCG-191P compared VHD-MTX to CRT plus intrathecal methotrexate (IT-MTX) in 181 patients and demonstrated equivalent survival. However, patients treated with CRT had poorer performance on neurocognitive testing over time. CCG-134P evaluated the addition of intensified systemic and intrathecal therapy to VHD-MTX in 128 patients with high-risk acute lymphoblastic leukemia (ALL) and demonstrated reduced CNS relapse compared to the CCG-191P trial, but equivalent survival. CCG-144P compared VHD-MTX to IT-MTX alone in 175 patients with average-risk ALL and demonstrated equivalent survival. VHD-MTX was associated with significant toxicities, particularly neutropenia, transient hepatic dysfunction and sepsis. VHD-MTX achieved similar survival to other CNS-directed therapies without the long-term impact on intelligence, but with substantial acute toxicities. [ABSTRACT FROM AUTHOR]

Little is known about infections occurring after childhood cancer treatment. We assessed the risk of severe infection postcancer therapy in survivors of leukemia compared to other cancer types. We performed a population-based cohort study of children <15 years of age diagnosed with cancer (2001–2016), alive and relapse-free 30 days after treatment completion. The risk of severe infection in both groups was estimated using subdistribution proportional hazard regression. We identified 6148 survivors (1960 with leukemia). The cumulative incidence (95% confidence interval) of severe infections at 3 years was 0.70% (0.40–1.2%) in leukemia and 0.51% (0.32–0.79%) in other cancers. The risk of severe infection was not statistically different in leukemia survivors compared to other cancer types in univariate and multivariate analysis (adjusted hazard ratio: 1.40, 95% CI: 0.69–2.85). No significant association was found between a history of leukemia and an increased risk of severe infection after treatment, compared to other cancer types. [ABSTRACT FROM AUTHOR]

Infections are a common complication of treatment for pediatric acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML). Less is known about infections occurring after treatment. We performed a systematic review of the literature to assess the incidence of infections after therapy completion in children and young adults with ALL or AML. Twenty-eight studies, with 4138 patients, were included. Four studies reported infections in patients who did not undergo hematopoietic stem cell transplant (HSCT). Respiratory tract and urinary tract infections affected 9.9–72.5% and 2.9–19.8% of patients, respectively. Twelve studies reported infections in patients treated with HSCT. Late bacterial, viral and fungal infections affected 3.9–38.5%, 16.1–66.7%, and 0.2–41.7% of patients, respectively. Viral hepatitis affected 0.8–75.4% of patients from 12 studies. Our review suggests that infections are a frequent complication after treatment for leukemia in children, especially after HSCT and identifies several knowledge gaps in the current literature. [ABSTRACT FROM AUTHOR]

This study describes skeletal, neuromuscular and fitness impairments among 109 children (median age 10 [range 4-18] years, 65.1% male, 63.3% white) with acute lymphoblastic leukemia (ALL). Outcomes were measured 7-10 days after diagnosisand compared to age-and sex-specific expected values. Associations between function and health-related quality of life (HRQL) were evaluated with logistic regression. Children with ALL had sub-optimal bone mineral density (BMD) Z-score/height (mean ± standard error: - 0.53 ± 0.16 vs. 0.00 ± 0.14, p < 0.01), body mass index percentile (57.6 + 3.15 vs. 50.0 ±3.27%, p = 0.02), quadriceps strength (201.9 ± 8.3 vs. 236.1 ±5.4 N, p<0.01), 6 min walk distance (385.0 ±13.1 vs. 628.2 ±7.1 m, p< 0.001) and Bruininks-Oseretsky Test of Motor Proficiency scores (23 ± 2.5 vs. 50 ± 3.4%, p < 0.01). Quadriceps weakness was associated with a 20.9-fold (95% confidence interval 2.5-173.3) increase in poor physical HRQL. Children with newly diagnosed ALL have weakness and poor endurance and may benefit from early rehabilitation that includes strengthening and aerobic conditioning. [ABSTRACT FROM AUTHOR]