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Spleen/Immunology QuickFact

Childhood cancer survivors can be at risk for developing the following splenic and immunologic late effects:

  • Chronic Hepatitis B
  • Chronic Hepatitis C
  • HIV Infection
  • Functional Asplenia
  • Immunologic Complications
    • Secretory IgA Deficiency
    • Hypogammaglobulinemia
    • Decreased B Cells
    • T cell Dysfunction
    • Chronic Infections

If your patient does not have a Survivor Health Plan (SHP), please refer him/her to the appropriate survivor clinic. 

 

Important factors in determining risk for splenic and immunologic late effects:

 

  • Total dose of radiation
  • Exposure to blood/serum products prior to 1972: Hepatitis B
  • Exposure to blood/serum products prior to 1993: Hepatitis C
  • Exposure to blood/serum products between 1977-1985: HIV
  • Ongoing immunosuppression
  • Hypogammaglobulinemia
  • HPV infection
  • Practices that predispose to sexual or blood transmission of Hepatitis or HIV

 

Time of Treatment

Chronic Hepatitis B

Chronic Hepatitis C

HIV Infection

Diagnoses Prior to 1972

X

 

 

Diagnosed Prior to 1993

 

X

 

Diagnosed between 1977 and 1985

 

 

X

Chemotherapy

Table 1

 

Functional Asplenia

Immunologic Complications

Alkylating Agents

Carmustine

   BCNU

Busulfan

Lomustine

   CCNU

Chlorambucil Cyclophosphamide

   Cytoxan

Ifosphamide

Mechlorethamine

Melphalan

Procarbazine

Thiotepa

 

Dacarbazine

    DTIC

Temozolomide

 

 

Heavy Metals

Carboplatin

Cisplatin

 

 

 

Antimetabolites Cytarabine

   Ara-C

Mercaptopurine

   6MP

Thioguanine

   6TG

Methotrexate

 

 

 

Anthracycline antibiotics

Daunorubicin

Doxorubicin

   Adriamycin

Epirubicin

Idarubicin

Mitoxantrone

 

 

 

Chemotherapy

Table 2

Functional Asplenia

Immunologic Complications

Anti-tumor antibiotics                

Bleomycin

Dactinomycin

 

 

Corticosteroids

Dexamethasone

   Decadron

Prednisone

 

 

 

Enzymes

Asparaginase

 

 

 

Plant alkaloids

Vincristine

Vinblastine

 

 

 

Epipodophyllotoxins

Etoposide

   VP16

Teniposide

   VM26

 

 

 

 

Radiation

Functional Asplenia

Immunologic Complications

All Radiation                             

 

 

TBI

 

 

Head/Brain

 

 

Neck

 

 

Thorax

 

 

Abdomen

> 40 Gy

 

Include TBI in

total dose

calculation

 

Pelvis

 

 

Extremity

 

 

 

Hematopoetic Stem Cell Transplant  

Functional Asplenia

Immunologic Complications

Hematopoeitic Stem Cell

Transplant with ANY

history of

chronic Graft vs. Host Disease

(GVHD)           

 

X

Hematopoeitic Stem Cell

Transplant currently active

chronic GVHD

X

 

Surgery

Functional Asplenia

Immunologic Complications

Splenectomy                         

X

 

For recommendations on how to screen for all potential late effects, please refer to The

Children's Oncology Group Long-term Follow-up Guidelines.

Health Links-Teaching Handouts from The Children's Oncology Group        

Visit http://www.survivorshipguidelines.org/ to find many of the Health Links translated into other languages.

Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and related Health Links Version 4.0. October, 2013. www.survivorshipguidelines.org.

Source: Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta
Last Updated: 2/10/2015 8:59:23 PM
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