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De novo malignancy after paediatric renal replacement therapy
H M Coutinho1, J W Groothoff, M Offringa
1Department of Paediatric Nephrology, Department of Paediatrics, Emma Children's Hospital AMC, University of Amsterdam, 1100 DE Amsterdam, Netherlands.
Archives of Disease in Childhood
|November 24, 2001
Summary
Children undergoing renal replacement therapy face a significantly higher risk of developing malignancies, particularly skin cancer and non-Hodgkin lymphoma. Awareness of this increased cancer risk is crucial, especially following cyclophosphamide treatment.
Area of Science:
- Pediatric Nephrology
- Oncology
- Epidemiology
Background:
- Children with end-stage renal failure (ESRF) undergoing chronic renal replacement therapy (RRT) may have altered risks for developing malignancies.
- Long-term outcomes regarding cancer incidence and mortality in this vulnerable pediatric population require thorough investigation.
Purpose of the Study:
- To determine the frequency, types, risk factors, and outcomes of malignancies in children with ESRF.
- To compare cancer incidence in pediatric RRT patients to the general population.
Main Methods:
- Retrospective study of Dutch pediatric patients (<15 years) who initiated chronic RRT between 1972 and 1992.
- Minimum follow-up of 18 years, with mean follow-up of 15.5 years post-RRT.
Main Results:
- Twenty-two malignancies were identified in 21 of 249 patients (8.4%).
- Skin cancer (59%) and non-Hodgkin lymphoma (23%) were the most common malignancies.
- At 25 years post-RRT, malignancy probability was 17%; overall cancer incidence was tenfold higher than the general population.
- Standardized risks for non-melanoma skin cancer and non-Hodgkin lymphoma were 222 and 46, respectively.
- Cyclophosphamide use (>20 mg/kg) was associated with increased malignancy risk.
- Malignancies caused 9.5% of deaths, with non-Hodgkin lymphoma being fatal in 4 out of 5 cases.
Conclusions:
- Children treated with RRT have a significantly elevated long-term risk for specific malignancies.
- Increased awareness of cancer risk is essential for pediatric RRT patients, particularly those treated with cyclophosphamide.
- Malignancies represent a significant cause of mortality in this cohort, necessitating vigilant monitoring and management strategies.