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Arvidson, Johan
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Publications (10 of 42) Show all publications
Ifversen, M., Turkiewicz, D., Marquart, H. V., Winiarski, J., Buechner, J., Mellgren, K., . . . Vettenranta, K. (2019). Low burden of minimal residual disease prior to transplantation in children with very high risk acute lymphoblastic leukaemia: The NOPHO ALL2008 experience. British Journal of Haematology, 184(6), 982-993
Open this publication in new window or tab >>Low burden of minimal residual disease prior to transplantation in children with very high risk acute lymphoblastic leukaemia: The NOPHO ALL2008 experience
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2019 (English)In: British Journal of Haematology, ISSN 0007-1048, E-ISSN 1365-2141, Vol. 184, no 6, p. 982-993Article in journal (Refereed) Published
Abstract [en]

The population-based Nordic/Baltic acute lymphoblastic leukaemia (ALL) Nordic Society for Paediatric Haematology and Oncology (NOPHO) ALL2008 protocol combined minimal residual disease (MRD)-driven treatment stratification with very intense first line chemotherapy for patients with high risk ALL. Patients with MRD >= 5% at end of induction or >= 10(-3) at end of consolidation or following two high risk blocks were eligible for haematopoietic cell transplantation (HCT) in first remission. After at least three high risk blocks a total of 71 children received HCT, of which 46 had MRD >= 5% at end of induction. Ten patients stratified to HCT were not transplanted; 12 received HCT without protocol indication. Among 69 patients with evaluable pre-HCT MRD results, 22 were MRD-positive, one with MRD >= 10(-3). After a median follow-up of 5 center dot 5 years, the cumulative incidence of relapse was 23 center dot 5% (95% confidence interval [CI]: 10 center dot 5-47 center dot 7) for MRD-positive versus 5 center dot 1% (95% CI: 1 center dot 3-19 center dot 2), P = 0 center dot 02) for MRD-negative patients. MRD was the only variable significantly associated with relapse (hazard ratio 9 center dot 1, 95% CI: 1 center dot 6-51 center dot 0, P = 0 center dot 012). Non-relapse mortality did not differ between the two groups, resulting in disease-free survival of 85 center dot 6% (95% CI: 75 center dot 4-97 center dot 2) and 67 center dot 4% (95% CI: 50 center dot 2-90 center dot 5), respectively. In conclusion, NOPHO block treatment efficiently reduced residual leukaemia which, combined with modern transplant procedures, provided high survival rates, also among pre-HCT MRD-positive patients.

Keywords
acute lymphoblastic leukaemia, haematopoietic stem cell transplantation, minimal residual disease, children
National Category
Hematology Pediatrics
Identifiers
urn:nbn:se:uu:diva-379930 (URN)10.1111/bjh.15761 (DOI)000460183700012 ()30680711 (PubMedID)
Available from: 2019-03-28 Created: 2019-03-28 Last updated: 2019-03-28Bibliographically approved
Mårtensson, T., Szakos, A., Mellgren, K., Toporski, J., Arvidson, J., Casswall, T. H. & Gustafsson, B. (2018). Choice of Endoscopic Procedure in Children With Clinically Suspected Gastrointestinal Graft-Versus-Host Disease.. Journal of Pediatric Gastroenterology and Nutrition - JPGN, 66(5), 744-750
Open this publication in new window or tab >>Choice of Endoscopic Procedure in Children With Clinically Suspected Gastrointestinal Graft-Versus-Host Disease.
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2018 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 66, no 5, p. 744-750Article in journal (Refereed) Published
Abstract [en]

Objectives: Gastrointestinal graft-versus-host disease (GI-GVHD) is a potentially life-threatening complication after hematopoietic stem cell transplantation. Symptoms indicating GI-GVHD motivates endoscopy with biopsy sampling and histopathological confirmation. Optimal extent of endoscopy in children is, however, presently unknown. Therefore, we aimed to evaluate whether biopsies from the rectosigmoid area versus the rest of the colon/ileocolon with or without biopsies from simultaneous upper endoscopy, were equally reliable for detection of GI-GVHD and relevant differential diagnoses.

Methods: Retrospective multicenter study based on histopathological re-evaluation of biopsies and hospital record data, collected from children with suspected GI-GVHD.

Results: Forty-four children with 51 endoscopic occasions (81 procedures) were included. Thirty-nine of 51 (76.5%) were diagnosed as GI-GVHD, 14 (27.4%) received a differential diagnosis and 7 (13.7%) had normal histology findings. Comorbidity, that is, simultaneous detection of a differential diagnosis and GI-GVHD, was observed in 9 (23.1%) cases. Cytomegalovirus infection was the most frequent differential diagnosis, 6 of 7 were detected in biopsies from rectosigmoid and esophagogastroduodenal areas. Sensitivity for detection of GI-GVHD in biopsies collected from rectosigmoid-ileocolonic-, rectosigmoid-, or esophagogastroduodenal areas were 97.4%, 84.6%, 83.3%, respectively, and 97.4% when the latter 2 were merged. The difference, nondetected GI-GVHD in the rectosigmoid area versus detected elsewhere in the GI tract, was statistically significant (P = 0.03).

Conclusions: Biopsies collected from the rectosigmoid area solely were not optimal for detection of pediatric GI-GVHD. When biopsy sampling from rectosigmoid and upper GI tract areas was combined, the sensitivity for GI-GVHD was, however, equally high as for ileocolonoscopy or full upper and lower endoscopy.

Keywords
children, cytomegalovirus, endoscopy, gastrointestinal tract, graft-versus-host disease, hematopoietic stem cell transplantation
National Category
Pediatrics Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-347042 (URN)10.1097/MPG.0000000000001776 (DOI)000431516400015 ()29045348 (PubMedID)
Funder
Swedish Childhood Cancer FoundationStockholm County CouncilSwedish Research Council
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2018-07-13Bibliographically approved
Kinch, A., Hallböök, H., Arvidson, J., Sällström, K., Bondeson, K. & Pauksen, K. (2018). Long-term outcome of Epstein-Barr virus DNAemia and PTLD with the use of preemptive rituximab following allogeneic HSCT. Leukemia and Lymphoma, 59(5), 1172-1179
Open this publication in new window or tab >>Long-term outcome of Epstein-Barr virus DNAemia and PTLD with the use of preemptive rituximab following allogeneic HSCT
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2018 (English)In: Leukemia and Lymphoma, ISSN 1042-8194, E-ISSN 1029-2403, Vol. 59, no 5, p. 1172-1179Article in journal (Refereed) Published
Abstract [en]

We studied retrospectively the outcome of Epstein-Barr virus (EBV)-related disease with EBV monitoring and preemptive rituximab to prevent post-transplant lymphoproliferative disorder (PTLD) in 319 consecutive allogeneic stem cell transplantations 2004-2012. Patients who received anti-thymocyte globulin (ATG) or alemtuzumab were regarded as high-risk for PTLD (n = 214). EBV DNAemia ≥1000 copies/mL plasma was observed in 50 (23%) of the high-risk patients. Thirty-three of the high-risk (15%) and one of the low-risk (1%) patients received rituximab, in combination with reduction of immunosuppression (n = 24) or chemotherapy (n = 4). Although rituximab was initiated only 5 d after first EBV load ≥1000 copies/mL, 85% of the rituximab-treated patients developed symptoms (lymphadenopathy 50%, fever 76%, and encephalitis/meningitis 12%). Response-rate to EBV treatment was 88%. Overall survival at 1- and 5-year was 71 and 52% for rituximab-treated patients, which was not inferior to all other patients post-transplant. In conclusion, rituximab therapy for EBV DNAemia does not affect long-term survival negatively.

Keywords
EBV, PTLD, allogeneic HSCT, rituximab, survival
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-343169 (URN)10.1080/10428194.2017.1365860 (DOI)000426933700017 ()28831836 (PubMedID)
Available from: 2018-02-26 Created: 2018-02-26 Last updated: 2018-05-16Bibliographically approved
Oskarsson, T., Soderhäll, S., Arvidson, J., Forestier, E., Frandsen, T. L., Hellebostad, M., . . . Heyman, M. (2018). Treatment-related mortality in relapsed childhood acute lymphoblastic leukemia. Pediatric Blood & Cancer, 65(4), Article ID e26909.
Open this publication in new window or tab >>Treatment-related mortality in relapsed childhood acute lymphoblastic leukemia
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2018 (English)In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 65, no 4, article id e26909Article in journal (Refereed) Published
Abstract [en]

Background: Treatment of relapsed childhood acute lymphoblastic leukemia (ALL) is particularly challenging due to the high treatment intensity needed to induce and sustain a second remission. To improve results, it is important to understand how treatment-related toxicity impacts survival.

Procedure: In this retrospective population-based study, we described the causes of death and estimated the risk for treatment-related mortality in patients with first relapse of childhood ALL in the Nordic Society of Paediatric Haematology and Oncology ALL-92 and ALL-2000 trials.

Results: Among the 483 patients who received relapse treatment with curative intent, we identified 52 patients (10.8%) who died of treatment-related causes. Twelve of these died before achieving second remission and 40 died in second remission. Infections were the cause of death in 38 patients (73.1%), predominantly bacterial infections during the chemotherapy phases of the relapse treatment. Viral infections were more common following hematopoietic stem cell transplantation (HSCT) in second remission. Independent risk factors for treatment-related mortality were as follows: high-risk stratification at relapse (hazard ratio [HR] 2.2; 95% confidence interval [CI] 1.3-3.9; P < 0.01), unfavorable cytogenetic aberrations (HR 3.4; 95% CI 1.3-9.2; P = 0.01), and HSCT (HR 4.64; 95% CI 2.17-9.92; P < 0.001). In contrast to previous findings, we did not observe any statistically significant sex or age differences. Interestingly, none of the 17 patients with Down syndrome died of treatment-related causes.

Conclusions: Fatal treatment complications contribute significantly to the poor overall survival after relapse. Implementation of novel therapies with reduced toxicity and aggressive supportive care management are important to improve survival in relapsed childhood ALL.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
acute lymphoblastic leukemia, hematopoietic stem cell transplantation, infection, pediatric, relapse, treatment-related mortality
National Category
Hematology Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-350742 (URN)10.1002/pbc.26909 (DOI)000425642100015 ()
Available from: 2018-05-16 Created: 2018-05-16 Last updated: 2018-05-16Bibliographically approved
Kinch, A., Hallböök, H., Arvidson, J., Sällström, K., Bondeson, K. & Pauksen, K. (2017). Epstein-Barr virus-related disease after allogeneic HSCT and use of pre-emptive rituximab: Clinical Features And Outcome. Paper presented at 43rd Annual Meeting of the European-Society-for-Blood-and-Marrow-Transplantation (EBMT), MAR 26-29, 2017, Marseille, FRANCE. Bone Marrow Transplantation, 52(Supplement: 1), S88-S88
Open this publication in new window or tab >>Epstein-Barr virus-related disease after allogeneic HSCT and use of pre-emptive rituximab: Clinical Features And Outcome
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2017 (English)In: Bone Marrow Transplantation, ISSN 0268-3369, E-ISSN 1476-5365, Vol. 52, no Supplement: 1, p. S88-S88Article in journal, Meeting abstract (Other academic) Published
National Category
Hematology
Identifiers
urn:nbn:se:uu:diva-351609 (URN)10.1038/bmt.2017.132 (DOI)000424355300109 ()
Conference
43rd Annual Meeting of the European-Society-for-Blood-and-Marrow-Transplantation (EBMT), MAR 26-29, 2017, Marseille, FRANCE
Note

In: Abstracts From The 43RD Annual Meeting Of The Europeansociety For Blood And Marrow Transplantation: Physicians—Oral Sessions (O011–O179).

Meeting Abstract: O132

Available from: 2018-06-08 Created: 2018-06-08 Last updated: 2018-06-08Bibliographically approved
Kamsvåg-Magnusson, T., von Essen, L., Arvidson, J., Svanberg, A., Mellgren, K., Garming-Legert, K., . . . Ljungman, G. (2017). Oral Cryotherapy to Reduce the Incidence of Severe Oral Mucositis in Children Undergoing Hematopoietic Stem Cell Transplantation: Results of a Randomized Clinical Trial. Pediatric Blood & Cancer, 64(S3), S360-S361
Open this publication in new window or tab >>Oral Cryotherapy to Reduce the Incidence of Severe Oral Mucositis in Children Undergoing Hematopoietic Stem Cell Transplantation: Results of a Randomized Clinical Trial
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2017 (English)In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 64, no S3, p. S360-S361Article in journal, Meeting abstract (Other academic) Published
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-346781 (URN)000408978203227 ()
Available from: 2018-03-22 Created: 2018-03-22 Last updated: 2018-03-22Bibliographically approved
Armuand, G. M., Nilsson, J., Rodriguez-Wallberg, K. A., Malmros, J., Arvidson, J., Lampic, C. & Wettergren, L. (2017). Physicians' self-reported practice behaviour regarding fertility-related discussions in paediatric oncology in Sweden. Psycho-Oncology, 26(10), 1684-1690
Open this publication in new window or tab >>Physicians' self-reported practice behaviour regarding fertility-related discussions in paediatric oncology in Sweden
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2017 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 26, no 10, p. 1684-1690Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to investigate practice behaviours of Swedish physicians with regard to discussing the impact of cancer treatment on fertility with paediatric oncology patients and their parents, and to identify factors associated with such discussions.

Methods: A cross-sectional survey study was conducted targeting all physicians in Sweden working in paediatric oncology care settings. Participants responded to a questionnaire measuring practice behaviour, attitudes, barriers, and confidence in knowledge. Multivariable logistic regression was used to determine factors associated with seldom discussing fertility.

Results: More than half of the physicians routinely talked with their patients/parents about the treatment's potential impact on fertility (male patients: 62%; female patients: 57%; P = 0.570). Factors associated with less frequently discussing fertility with patients/parents were working at a non-university hospital (male patients: OR 11.49, CI 1.98-66.67; female patients: OR 33.18, CI 4.06-271.07), concerns that the topic would cause worry (male patients: OR 8.23, CI 1.48-45.89; female patients: OR 12.38, CI 1.90-80.70), and perceiving the parents as anxious (male patients: OR 7.18, CI 1.20-42.85; female patients: OR 11.65, CI 1.32-103.17).

Conclusions: Based on our findings, we recommend structured training in how to communicate about fertility issues in stressful situations, which in turn might increase fertility-related discussions in paediatric oncology.

Keywords
Cancer, Communication, Fertility, Fertility preservation, Oncology, Pediatric oncology, Physician, Survey study
National Category
Cancer and Oncology Obstetrics, Gynecology and Reproductive Medicine Pediatrics
Identifiers
urn:nbn:se:uu:diva-345272 (URN)10.1002/pon.4507 (DOI)000417434300036 ()28734133 (PubMedID)
Funder
Swedish Cancer Society, 2010/877Swedish Childhood Cancer Foundation, TJ2014-0050The Cancer Research Funds of Radiumhemmet, 121242Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2018-03-09 Created: 2018-03-09 Last updated: 2018-03-09Bibliographically approved
Oskarsson, T., Söderhäll, S., Arvidson, J., Forestier, E., Montgomery, S., Bottai, M., . . . Heyman, M. (2016). Relapsed childhood acute lymphoblastic leukemia in the Nordic countries: prognostic factors, treatment and outcome.. Haematologica, 101(1), 68-76
Open this publication in new window or tab >>Relapsed childhood acute lymphoblastic leukemia in the Nordic countries: prognostic factors, treatment and outcome.
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2016 (English)In: Haematologica, ISSN 0390-6078, E-ISSN 1592-8721, Vol. 101, no 1, p. 68-76Article in journal (Refereed) Published
Abstract [en]

Relapse is the main reason for treatment failure in childhood acute lymphoblastic leukemia. Despite improvements in the up-front therapy, survival after relapse is still relatively poor, especially for high-risk relapses. The aims of this study were to assess outcomes following acute lymphoblastic leukemia relapse after common initial Nordic Society of Paediatric Haematology and Oncology protocol treatment; to validate currently used risk stratifications, and identify additional prognostic factors for overall survival. Altogether, 516 of 2735 patients (18.9%) relapsed between 1992 and 2011 and were included in the study. There were no statistically significant differences in outcome between the up-front protocols or between the relapse protocols used, but an improvement over time was observed. The 5-year overall survival for patients relapsing in the period 2002-2011 was 57.5±3.4%, but 44.7±3.2% (P<0.001) if relapse occurred in the period 1992-2001. Factors independently predicting mortality after relapse included short duration of first remission, bone marrow involvement, age ten years or over, unfavorable cytogenetics, and Down syndrome. T-cell immunophenotype was not an independent prognostic factor unless in combination with hyperleukocytosis at diagnosis. The outcome for early combined pre-B relapses was unexpectedly poor (5-year overall survival 38.0±10.6%), which supports the notion that these patients need further risk adjustment. Although survival outcomes have improved over time, the development of novel approaches is urgently needed to increase survival in relapsed childhood acute lymphoblastic leukemia.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-271360 (URN)10.3324/haematol.2015.131680 (DOI)000371220700021 ()26494838 (PubMedID)
Funder
Swedish Childhood Cancer Foundation
Available from: 2016-01-07 Created: 2016-01-07 Last updated: 2017-12-01Bibliographically approved
Mellgren, K., Arvidson, J., Toporski, J. & Winiarski, J. (2015). Chimerism analysis in clinical practice and its relevance for the detection of graft rejection and malignant relapse in pediatric hematopoietic stem cell transplant patients. Pediatric Transplantation, 19(7), 758-766
Open this publication in new window or tab >>Chimerism analysis in clinical practice and its relevance for the detection of graft rejection and malignant relapse in pediatric hematopoietic stem cell transplant patients
2015 (English)In: Pediatric Transplantation, ISSN 1397-3142, E-ISSN 1399-3046, Vol. 19, no 7, p. 758-766Article in journal (Refereed) Published
Abstract [en]

Chimerism and clinical outcome data from 244 hematopoietic stem cell transplants in 218 children were retrospectively analyzed to assess their relevance for the detection of graft rejection and malignant relapse. Patients transplanted for a non-malignant disease had significantly higher proportions of residual recipient T cells in peripheral blood at one, three, and sixmonths compared with patients transplanted for malignant disease. Recipient T-cell levels were below 50% at onemonth after transplantation in most patients (129 of 152 transplants). Graft rejection occurred more frequently in the group of patients with high levels of recipient cells at onemonth (10 graft rejections in the 23 patients with recipient T cells >50% at onemonth as compared to seven graft rejections occurred in 129 patients with recipient T cells <50% (p<0.001). Multilineage chimerism data in 87 children with leukemia at one, three, and sixmonths after transplantation were not correlated with subsequent relapse of malignant disease. In conclusion, early analysis of lineage-specific chimerism in peripheral blood can be used to identify patients who are at high risk of graft rejection. However, the efficacy of early chimerism analysis for predicting leukemia relapse was limited.

Keywords
chimerism analysis, stem cell transplantation, pediatric patients
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-265805 (URN)10.1111/petr.12580 (DOI)000362580100022 ()26290161 (PubMedID)
Funder
Swedish Childhood Cancer Foundation
Available from: 2015-11-03 Created: 2015-11-03 Last updated: 2017-12-01Bibliographically approved
Kamsvåg-Magnusson, T., Thorsell-Cederberg, J., Svanberg, A., von Essen, L., Arvidson, J., Mellgren, K., . . . Ljungman, G. (2014). Parents and children's perceptions of distress related to oral mucositis during haematopoietic stem cell transplantation. Acta Paediatrica, 103(6), 630-636
Open this publication in new window or tab >>Parents and children's perceptions of distress related to oral mucositis during haematopoietic stem cell transplantation
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2014 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 6, p. 630-636Article in journal (Refereed) Published
Abstract [en]

AimOral mucositis is a common and debilitating side effect of haematopoietic stem cell transplantation. Our study investigated parents' and children's experiences of oral mucositis treatment and whether the parents' perceptions accurately reflected the children's views. MethodsWe analysed 71 questionnaires completed by the parents of children who had undergone haematopoietic stem cell transplantation, together with 38 questionnaires completed by children who were 7 years of age or over. ResultsThe parent proxy and child self-reports showed good to excellent agreement. For example, 86% of the parents and 83% of the children reported oral pain and 44% of the parents and 47% of the children reported difficulty swallowing often or very often. The majority of the parents (61%) were satisfied with the pain treatment that had been given to their child. However, the treatment provided for oral mucositis was not altogether consistent. ConclusionOral mucositis affected the majority of the children undergoing haematopoietic stem cell transplantation, causing considerable pain and discomfort. The parent proxy reports proved to be reliable and are an important supplement to child self-reports on symptoms related to oral mucositis. But there is a clear need to establish more evidence-based care for children suffering from oral mucositis.

Keywords
Haematopoietic stem cell transplantation, Oral mucositis, Pain, Parent proxy, Questionnaire
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-227698 (URN)10.1111/apa.12627 (DOI)000335754700020 ()
Available from: 2014-07-01 Created: 2014-06-30 Last updated: 2017-12-05Bibliographically approved
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