Infection related late mortality in survivors of childhood cancer with asplenia or radiation-induced hyposplenism: A report from the Childhood Cancer Survivor Study.
Bibliographic record
Abstract
10563 Background: Asplenia or hyposplenism can develop in survivors of childhood cancer following splenectomy or radiotherapy exposure to the left upper quadrant of the abdomen (LUQ). Knowledge regarding long-term infection related outcomes for these survivors is limited. Methods: Infection related late mortality (sepsis, meningitis or pneumonia) was evaluated in 20,805 5-year survivors (diagnosed <21 years of age from 1970-1999, median follow-up 26 years, range 5-44) using cumulative incidence and Poisson regression models to calculate adjusted relative risk (RR) and 95% confidence intervals (CI). Average LUQ radiation was calculated as a surrogate for splenic radiation. Results: Treatment included splenectomy for 1328 survivors (6%). An additional 10,295 (49%) were exposed to LUQ radiotherapy without splenectomy. The cumulative incidence of infection related late mortality was 1.4% (95%CI: 0.7%-2.2%) at 35 years after splenectomy and 0.6% (95%CI: 0.4%-0.8%) after LUQ radiotherapy, with a total of 78 deaths attributable to infectious causes (25 sepsis, 1 meningitis, 52 pneumonia). Splenectomy (RR=8.4, p<0.001) and increasing LUQ radiotherapy dose (p<0.001) were independently associated with infection related late mortality (Table). Conclusions: Splenectomy and LUQ radiotherapy increased risk for infection related late mortality. While infectious mortality increased with increasing LUQ radiation dose, even lower dose exposure (<10Gy) increased risk substantially. Accordingly, cancer survivors exposed to LUQ radiotherapy should be considered at risk for functional asplenia and managed similarly to asplenic individuals with respect to vaccinations and febrile illnesses. [Table: see text]
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".