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Indianapolis, IN, United States

Lenz A.M.,University of South Florida | Shulman D.,University of South Florida | Eugster E.A.,Indiana University | Rahhal S.,Peyton Manning Childrens Hospital at St. Vincent | And 3 more authors.
Pediatrics | Year: 2010

Testotoxicosis, a form of gonadotropin-independent precocious puberty, results from an activating mutation of the luteinizing hormone receptor expressed in testicular Leydig cells. Affected males experience early testosterone secretion, virilization, advancing bone age, and resultant short stature. Recently, the use of combination therapy with a potent antiandrogen agent (bicalutamide) and a third-generation aromatase inhibitor (anastrozole or letrozole) was reported to yield encouraging short-term results. We present here the results of longer-term treatment (4.5 and 5 years) with this combination therapy in 2 boys who demonstrated that it is well tolerated, slows bone-age advancement in the face of continued linear growth, and prevents progression of virilization. Copyright © 2010 by the American Academy of Pediatrics. Source


Ullrich C.K.,Dana-Farber Cancer Institute | Dussel V.,Dana-Farber Cancer Institute | Hilden J.M.,Peyton Manning Childrens Hospital at St. Vincent | Sheaffer J.W.,Childrens Hospitals and Clinics of Minnesota | And 2 more authors.
Blood | Year: 2010

The end-of-life (EOL) experience of children who undergo stem cell transplantation (SCT) may differ from that of other children with cancer. To evaluate perspectives and patterns of EOL care after SCT, we surveyed 141 parents of children who died of cancer (response rate, 64%) and their physicians. Chart review provided additional information. Children for whom SCT was the last cancer therapy (n = 31) were compared with those for whom it was not (n = 110). SCT parents and physicians recognized no realistic chance for cure later than non-SCT peers (both P < .001) and were more likely to have a primary goal of cure at death (parents, P < .001; physicians, P = .02). SCT children were more likely to suffer highly from their last cancer therapy and die in the intensive care unit (both P < .001), with less opportunity for EOL preparation. SCT parents who recognized no realistic chance for cure more than 7 days before death along with the physician were more likely to prepare for EOL, and if their primary goal was to reduce suffering, to achieve this (P < .001). SCT is associated with significant suffering and less opportunity to prepare for EOL. Children and families undergoing SCT may benefit from ongoing discussions regarding prognosis, goals, and opportunities to maximize quality of life. © 2010 by The American Society of Hematology. Source


Slater M.E.,University of Minnesota | Linabery A.M.,University of Minnesota | Spector L.G.,University of Minnesota | Johnson K.J.,University of Minnesota | And 4 more authors.
Cancer Causes and Control | Year: 2011

Objective: Utilizing data from the largest study to date, we examined associations between maternal preconception/prenatal exposure to household chemicals and infant acute leukemia. Methods: We present data from a Children's Oncology Group case-control study of 443 infants (\1 year of age) diagnosed with acute leukemia [including acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML)] between 1996 and 2006 and 324 population controls. Mothers recalled household chemical use 1 month before and throughout pregnancy. We used unconditional logistic regression adjusted for birth year, maternal age, and race/ethnicity to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results: We did not find evidence for an association between infant leukemia and eight of nine chemical categories. However, exposure to petroleum products during pregnancy was associated with AML (OR = 2.54; 95% CI:1.40-4.62) and leukemia without mixed lineage leukemia (MLL) gene rearrangements (''MLL-'') (OR = 2.69; 95% CI: 1.47-4.93). No associations were observed for exposure in the month before pregnancy. Conclusions: Gestational exposure to petroleum products was associated with infant leukemia, particularly AML, and MLL- cases. Benzene is implicated as a potential carcinogen within this exposure category, but a clear biological mechanism has yet to be elucidated. © 2011 Springer Science+Business Media B.V. Source


Ullrich C.K.,Dana-Farber Cancer Institute | Dussel V.,Dana-Farber Cancer Institute | Hilden J.M.,Peyton Manning Childrens Hospital at St. Vincent | Sheaffer J.W.,Childrens Hospitals and Clinics of Minnesota | And 3 more authors.
Journal of Pain and Symptom Management | Year: 2010

Context: Fatigue is a prevalent source of suffering in children with advanced cancer; yet, little is known about it. Objectives: This study aimed to describe fatigue experienced by children with advanced cancer and to identify the factors associated with suffering from fatigue and its treatment. Methods: A retrospective cross-sectional study of 141 parents of children who died of cancer (response rate: 64%) was conducted in two tertiary-level U.S. pediatric hospitals. Results: By parent report, 96% of children experienced fatigue in the last month of life. Nearly 50% experienced significant suffering from fatigue; this was associated with suffering from pain, dyspnea, anorexia, nausea/vomiting, diarrhea, anxiety, sadness, or fear (P < 0.05), and with side effects from pain or dyspnea treatment (P < 0.05). In multivariate analysis of symptom-related factors, suffering from nausea/vomiting (odds ratio [OR] = 3.93, 95% confidence interval [CI] = 1.23-12.61, P = 0.02); anorexia (OR = 7.52, 95% CI = 1.87-30.25, P = 0.005); and fear (OR = 5.13, 95% CI = 2.03-12.96, P ≤ 0.001) remained independently associated with fatigue. Children suffering from fatigue had primary oncologists with fewer years' experience than children who did not suffer from fatigue (mean = 7.7 years, standard deviation [SD] = 4.9 vs. mean of 9.9 years, SD = 6.0, P = 0.02). Among children with fatigue, 17 of 129 (13%) received fatigue-directed treatment, which was successful in 3 of 12 (25%). Children experiencing side effects from dyspnea or pain treatment were more likely to be treated for fatigue (relative risk = 1.25, 95% CI = 1.06-1.47, P = 0.009). Conclusion: Fatigue is a common source of suffering in children with cancer at the end of life. Palliation of this symptom is rarely successful. Increased attention to factors associated with fatigue and effective interventions to ameliorate fatigue are needed. © 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved. Source


Johnson K.J.,University of Minnesota | Roesler M.A.,University of Minnesota | Linabery A.M.,University of Minnesota | Hilden J.M.,Peyton Manning Childrens Hospital at St. Vincent | And 2 more authors.
Pediatric Blood and Cancer | Year: 2010

Background. Leukemia in infants is rare and has not been well studied apart from leukemia in older children. Differences in survival and the molecular characteristics of leukemia in infants versus older children suggest a distinct etiology, likely involving prenatal factors. Procedure. We examined the association between eight categories of maternally reported congenital abnormalities (CAs) (cleft lip or palate, spina bifida or other spinal defect, large or multiple birthmarks, other chromosomal abnormalities, small head or microcephaly, rib abnormalities, urogenital abnormalities, and other) and infant leukemia in a case-control study. The study included 443 cases diagnosed at <1 year of age at a Children's Oncology Group Institution in the United States or Canada from 1996 to 2006 and 324 controls. Controls were recruited from the cases' geographic area either by random digit dialing (1999-2002) or through birth certificates (2003-2008) and were frequency-matched to cases on birth year. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by unconditional logistic regression after adjustment for birth year and a measure of follow-up time to account for differences in the CA observation period. Results. No statistically significant associations were observed between infant leukemia and any CA (OR=1.2; 95% CI: 0.8-1.9), birthmarks (OR=1.4; 95% CI: 0.7-2.5), urogenital abnormalities (OR=0.7; 95% CI: 0.2-2.0), or other CA (OR=1.4; 95% CI: 0.7-2.8). Results were similar for acute lymphoblastic and myeloid leukemia cases. Fewer than five subjects were in the remaining CA categories precluding analysis. Conclusions. Overall, we did not find evidence to support an association between CAs and infant leukemia. © 2010 Wiley-Liss, Inc. Source

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