Long-Term Neurodevelopmental Outcome of Children after in Utero Exposure to Chemotherapy

Korakiti, Anna-Maria; Zografos, Εleni; Gerwen, Mathilde van; Amant, Frédéric; Dimopoulos, Meletios Α.; Zagouri, Flora

doi:10.3390/cancers12123623

Cited by 14 publications

(11 citation statements)

References 41 publications

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“…In 2020, a comprehensive literature review on long-term neurodevelopmental outcome was published (Korakiti et al, 2020). Based on 17 cohort studies, no major cognitive abnormalities were reported; however, it was concluded that more thorough follow-up of the children is required.…”

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confidence: 99%

Long-term neurodevelopmental outcome after prenatal exposure to maternal hematological malignancies with or without cytotoxic treatment

Gerwen

Veld

Grotel

et al. 2021

Child Neuropsychology

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Data on the long-term neurodevelopmental outcomes of children exposed to hematological maternal cancer with or without treatment during pregnancy are lacking. A total of 57 children, of whom 33 males and 24 females, prenatally exposed to hematological malignancies and its treatment, were invited for neuropsychological and physical examinations at 18 months, 36 months, 6, 9, 12, 15 and 18 years of age. Oncological, obstetrical, neonatal and follow-up data of these children were collected. Parents were asked to complete questionnaires on their child's general health, school performances, social situation, behavioral development, executive functioning, and if their child receives supportive care. Non-Hodgkin lymphoma was diagnosed in 35.1%, Hodgkin lymphoma in 28.1%, acute myeloid leukemia in 15.8%, chronic myeloid leukemia in 12.3%, and acute lymphoblastic leukemia in 8.8%. Cognitive development at a median age of 10.7 years was within the normal range. In subgroup analyses of children in early childhood, the gestational age at birth was correlated with the cognitive outcome at a median age of 1.7 years. Scores for language development, intelligence, attention, memory and behavior, as well as clinical neurological and general pediatric examinations were within normal ranges. In subgroup analyses, the need for supportive care in the child was associated with the loss of the mother. Prenatal exposure to hematological maternal malignancies with or without treatment did ARTICLE HISTORY

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confidence: 99%

Long-term neurodevelopmental outcome after prenatal exposure to maternal hematological malignancies with or without cytotoxic treatment

Gerwen

Veld

Grotel

et al. 2021

Child Neuropsychology

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“…Another point that should be mentioned is the need to follow-up with the child in the future since cyclophosphamide has been reported to cause secondary neoplasms later in life following exposure in utero 21 . In our case report, the child has not yet presented any complications, despite that the 17-month follow-up period may be considered insufficient for a definitive conclusion.…”

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confidence: 99%

Successful pregnancy after cyclophosphamide therapy for systemic lupus erythematosus: a case report

Drie,

Alsamman,

Tarcha

et al. 2024

Annals of Medicine &Amp; Surgery

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Introduction and Importance: The use of cyclophosphamide in women of childbearing age with severe systemic lupus erythematosus is normally indicated. However, cyclophosphamide is generally avoided during pregnancy due to the risk of teratogenicity, especially since its effect on fetal survival is poorly understood. This is a case report of a lupus patient exposed to cyclophosphamide during pregnancy. Case Presentation: A 35-year-old woman with a history of lupus presented to our outpatient clinic in the 12th week of pregnancy for her 6th routine cyclophosphamide bolus. The fetal echocardiogram result with gynecology consultation was normal with the recommendation for a medical termination of pregnancy, which has been refused by the patient. Shared decision-making with the patient included a discussion of maternal risks of continuation of pregnancy in the setting of worsening systemic function and the fetal risks of definitive treatment with cyclophosphamide for a lupus flare and the patient decided to proceed with the pregnancy. Treatment with immunosuppressants, including azathioprine was initiated replacing cyclophosphamide with close monitoring of her and the fetus every month. Clinical Discussion: The first trimester of pregnancy seems to be particularly susceptible to fetal malformations, although CPA effects on fetuses in later stages of pregnancy are also reported occasionally. Nonetheless, its repercussions on fetal survival remain poorly comprehended. Conclusion: In conclusion, exposing pregnancy to cyclophosphamide could end with pregnancy loss. Based on our experience, the survival of the fetus is strongly in doubt when cyclophosphamide is required to treat lupus in the mother. However, in rare cases, it could be without complications.

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“…Lastly, the use of multi-gene panel testing for hereditary breast cancer risk, not limited to BRCA1/2 pathogenic mutations, is essential to increase the likelihood of detecting an underlying germline genetic component and achieve better PABC patient outcomes. Unfortunately, as already mentioned the incidence of pregnancy-associated breast cancer is expected to increase considerably in the years to come while the introduction of non-invasive prenatal testing has led to higher cancer detection rates in pregnant women [ 38 ]; therefore, further research in a larger cohort of patients is deemed necessary.…”

Section: Discussionmentioning

confidence: 99%

Germline mutations in a clinic-based series of pregnancy associated breast cancer patients

et al. 2021

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Background Pregnancy-associated breast cancer (PABC) defined as breast cancer diagnosed during gestation, lactation or within 1 year after delivery, represents a truly challenging situation with significantly increasing incidence rate. The genomic background of PABC has only recently been addressed while the underlying mechanisms of the disease still remain unknown. This analysis aims to further elucidate the frequency of PABC cases attributable to genetic predisposition and identify specific cancer susceptibility genes characterizing PABC. Methods A comprehensive 94-cancer gene panel was implemented in a cohort of 20 PABC patients treated in our clinic and descriptive correlation was performed among the results and the patients’ clinicopathological data. Results In the present study, 35% of PABC patients tested carried pathogenic mutations in two known cancer predisposition genes (BRCA1 and CHEK2). In total, 30% of the patients carried BRCA1 pathogenic variants. An additional 5% carried pathogenic variants in the CHEK2 gene. Variants of unknown/uncertain significance (VUS) in breast cancer susceptibility genes BRCA2, CHEK2 and BRIP1 were also identified in three different PABC patients (15%). Not all patients carrying germline mutations reported known family history of cancer. Conclusions Genetic testing should be considered as an option for PABC patients since the disease is highly associated with genetic susceptibility among other predisposing factors. Germline mutation identification may further modify PABC management approach and improve the prognostic outcome.

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Long-Term Neurodevelopmental Outcome of Children after in Utero Exposure to Chemotherapy

Cited by 14 publications

References 41 publications

Long-term neurodevelopmental outcome after prenatal exposure to maternal hematological malignancies with or without cytotoxic treatment

Long-term neurodevelopmental outcome after prenatal exposure to maternal hematological malignancies with or without cytotoxic treatment

Successful pregnancy after cyclophosphamide therapy for systemic lupus erythematosus: a case report

Germline mutations in a clinic-based series of pregnancy associated breast cancer patients

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