RESUMO
OBJECTIVES: To determine whether children born in Texas regions with higher vaccination coverage had reduced risk of childhood cancer. STUDY DESIGN: The Texas Cancer Registry identified 2800 cases diagnosed from 1995 to 2006 who were (1) born in Texas and (2) diagnosed at ages 2 to 17 years. The state birth certificate data were used to identify 11 200 age- and sex-matched control subjects. A multilevel mixed-effects regression model compared vaccination rates among cases and control subjects at the public health region and county level. RESULTS: Children born in counties with higher hepatitis B vaccine coverage had lower odds of all cancers combined (OR = 0.81, 95% CI: 0.67 to 0.98) and acute lymphoblastic leukemia (ALL) specifically (OR = 0.63, 95% CI: 0.46 to 0.88). A decreased odds for ALL also was associated at the county level with higher rates of the inactivated poliovirus vaccine (OR = 0.67, 95% CI: 0.49 to 0.92) and 4-3-1-3-3 vaccination series (OR = 0.62, 95% CI: 0.44 to 0.87). Children born in public health regions with higher coverage levels of the Haemophilus influenzae type b-conjugate vaccine had lower odds of ALL (OR: 0.58; 95% CI: 0.42 to 0.82). CONCLUSIONS: Some common childhood vaccines appear to be protective against ALL at the population level.
Assuntos
Oncologia/métodos , Neoplasias/epidemiologia , Neoplasias/prevenção & controle , Pediatria/métodos , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Vacinas Anti-Haemophilus/uso terapêutico , Vacinas contra Hepatite B/uso terapêutico , Humanos , Lactente , Masculino , Razão de Chances , Vacinas contra Poliovirus/uso terapêutico , Leucemia-Linfoma Linfoblástico de Células Precursoras/prevenção & controle , Análise de Regressão , Texas , Vacinas/efeitos adversosRESUMO
OBJECTIVES: To investigate whether children with acute lymphocytic leukemia (ALL) who have development of hyperglycemia during induction may have worse relapse-free (RFS) and overall survival (OS) rates. STUDY DESIGN: A review of 167 children diagnosed with ALL between 1999 to 2002 at Texas Children's Hospital was performed. Blood glucose concentrations during induction therapy were reviewed; patients were assigned to 3 groups: euglycemia (blood glucose < 140 mg/dL), mild hyperglycemia (blood glucose between 140-200 mg/dL), and overt hyperglycemia (blood glucose > 200 mg/dL). RFS and OS among groups were compared by use of Kaplan-Meier and Cox-proportional hazard analyses, adjusting for potential confounding variables. RESULTS: The median follow-up in survivors was 6 years; there were 18 deaths and 36 relapses. Overt hyperglycemia was seen in 56 (34%) patients. Patients with overt hyperglycemia had poorer RFS (68% +/- [SE] 6.7 vs 85% +/- 3.6, P = .025) and OS (74% +/- 6.1 vs 96% +/- 1.9, P < .0001) at 5 years than their counterparts. Patients with overt hyperglycemia had 6.2 times (95% CI 1.6-24.7, P = .01) greater risk for death, independent of risk group and type of steroid. CONCLUSIONS: Overt hyperglycemia may be an independent predictor of survival in children with ALL.
Assuntos
Hiperglicemia/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Índice de Gravidade de Doença , Antineoplásicos/uso terapêutico , Asparaginase/uso terapêutico , Glicemia/análise , Criança , Pré-Escolar , Daunorrubicina/uso terapêutico , Dexametasona/uso terapêutico , Escherichia coli/enzimologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Recidiva Local de Neoplasia/epidemiologia , Prednisona/uso terapêutico , Vincristina/uso terapêuticoRESUMO
OBJECTIVE: To test the hypothesis that 5,10-methylenetetrahydroreductase (MTHFR) polymorphisms can partially explain the individual variation in developing attention-deficit/hyperactivity disorder (ADHD) after acute lymphoblastic leukemia (ALL) therapy. STUDY DESIGN: Parents of 48 survivors of childhood ALL completed a clinical diagnostic process to identify subtypes of ADHD. Genotyping was performed with peripheral blood DNA for MTHFR (C677T and A1298C) polymorphisms. RESULTS: Eleven of the 48 patients (22.9%) had scores consistent with the inattentive symptoms of ADHD. Patients with genotypes related to lower folate levels (11 out of 39; 39.2%) were more likely to have ADHD. The A1298C genotype appeared to be the predominant linkage to the inattentive symptoms, leading to a 7.4-fold increase in diagnosis, compared with a 1.3-fold increase for the C677T genotype. Age at diagnosis and sex were not associated with inattentiveness. CONCLUSIONS: Preliminary data imply a strong relationship between MTHFR polymorphisms and the inattentive symptoms of ADHD in survivors of childhood ALL.