Iron Overload in Pediatric Oncology Patients

Long term survivors of childhood cancer, are a distinct group requiring specific follow-up in
order to enhance their quality of life. Studies have shown that many of these patients will
go on to develop chronic issues within different organ systems. Because of the iron burden of
the frequent transfusions required to care for these patients, iron overload may indeed be
one of the problems these survivors potentially face. Research primarily in thalassemia and
bone marrow transplant patients who were extensively transfused has shown that iron overload
can have a significant impact on their overall health. Complications from increased iron
burden can include growth retardation, gonadal dysfunction, hypothyroidism, impaired glucose
metabolism, cardiac arrhythmias and failure, hepatic fibrosis and cirrhosis, and increased
susceptibility to infections. However all of these conditions related to iron overload can be
prevented with the use of either phlebotomy or chelation therapy. Based on this knowledge,
our objective is to determine if pediatric oncology and transplant patients heavily supported
with transfusions develop consequential biochemical and clinical evidence of iron overload.

Inclusion Criteria:

- Patients six and a half to twenty five years of age with a history of acute
myelogenous leukemia, rhabdomyosarcoma, Ewing sarcoma, osteosarcoma, and neuroblastoma
who have completed their treatment or received their last packed red blood cell
transfusion at least one year prior to enrollment (which ever occurred later) and are
one to ten years post-treatment.

- Patients six and a half to twenty five years of age who have undergone hematopoietic
stem cell transplant for any malignancy and are at least one year from their last
transfusion or transplant date prior to enrollment (which ever occurred later) and are
one to ten years post-transplant.

- Patients who were treated at Schneider Children's Hospital or at Children's Hospital
of Philadelphia.

Exclusion Criteria:

- Patients who have clinical evidence of chronic graft vs. host disease of skin, liver
or gastrointestinal tract.

- Patients with a chronic infection (viral hepatitis), liver disease (fibrosis,
cirrhosis), or a history of radiation to the liver.

- Patients who cannot have an MRI due to metallic implants (i.e. pacemakers, prosthetic
valves, etc.)

- Patients who are pregnant.