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
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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:
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Total dose of radiation
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Exposure to blood/serum products prior to 1972: Hepatitis B
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Exposure to blood/serum products prior to 1993: Hepatitis C
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Exposure to blood/serum products between 1977-1985: HIV
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Ongoing immunosuppression
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Hypogammaglobulinemia
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HPV infection
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Practices that predispose to sexual or blood transmission of Hepatitis or HIV
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Time of Treatment
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Chronic Hepatitis B
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Chronic Hepatitis C
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HIV Infection
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Diagnoses Prior to 1972
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X
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Diagnosed Prior to 1993
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X
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Diagnosed between 1977 and 1985
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X
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Chemotherapy
Table 1
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Functional Asplenia
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Immunologic Complications
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Alkylating Agents
Carmustine
BCNU
Busulfan
Lomustine
CCNU
Chlorambucil Cyclophosphamide
Cytoxan
Ifosphamide
Mechlorethamine
Melphalan
Procarbazine
Thiotepa
Dacarbazine
DTIC
Temozolomide
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Heavy Metals
Carboplatin
Cisplatin
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Antimetabolites
Cytarabine
Ara-C
Mercaptopurine
6MP
Thioguanine
6TG
Methotrexate
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Anthracycline antibiotics
Daunorubicin
Doxorubicin
Adriamycin
Epirubicin
Idarubicin
Mitoxantrone
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Chemotherapy
Table 2
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Functional Asplenia
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Immunologic Complications
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Anti-tumor antibiotics
Bleomycin
Dactinomycin
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Corticosteroids
Dexamethasone
Decadron
Prednisone
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Enzymes
Asparaginase
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Plant alkaloids
Vincristine
Vinblastine
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Epipodophyllotoxins
Etoposide
VP16
Teniposide
VM26
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Radiation
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Functional Asplenia
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Immunologic Complications
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All Radiation
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TBI
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Head/Brain
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Neck
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Thorax
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Abdomen
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>
40 Gy
Include TBI in
total dose
calculation
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Pelvis
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Extremity
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Hematopoetic Stem Cell Transplant
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Functional Asplenia
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Immunologic Complications
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Hematopoeitic Stem Cell
Transplant with ANY
history of
chronic Graft vs. Host Disease
(GVHD)
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X
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Hematopoeitic Stem Cell
Transplant currently active
chronic GVHD
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X
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Surgery
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Functional Asplenia
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Immunologic Complications
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Splenectomy
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X
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