Chromosomal translocation resulting in abnormal expressionThus the expression is not confined to malignant B cells but

Late cardiac complications after radiotherapy for breast cancer was studied in 197 patients examined before, 6 months after, and 10 years after treatment. The 10-year follow-up was done by survey of the files of patients who had died and re-examination of patients who were alive and free of cancer. Among 95 patients who died, 3 died of cardiopulmonary diseases. Autopsy in 32 patients showed serious cardiac abnormalities in 3. Of 102 patients alive at follow-up, 3 reported heart symptoms. Sixty-nine patients participated in the re-examination. Electrocardiogram (ECG) abnormalities were found in 19% of these patients before treatment; in 45% at 6 months, essentially due to T-wave changes in patients who had received left-sided irradiation; and in 45% at 10 years, with fewer T-wave abnormalities but more ST depression and ectopic beats. Average working capacity was 83 W before, 81 W at 6 months, and 84 W at ten years. Average heart volume was 680 ml before, 689 ml at 6 months, and 718 ml (P < 0.01) 10 years after treatment. In conclusion, there was a high incidence of ECG T-wave changes, but they were reversible, and the perimyoeardil damage indicated was functionally insignificant. The incidence of serious cardiac complications was low.Cancer 57:929-934,1986EVERAL CASE REPORTS on late cardiovascular com-S plications after radiotherapy for various thoracic tumors have been published. Pericardial effusion, constrictive pericarditis, and myocardial fibrosis are most often encountered,' but coronary heart disease has also been reported.2 Reviews of the subject have been p~blished.~" However, there are few reports as to the incidence of longterm cardiac complications in prospective studies of patients given irradiation for breast cancer. Changes in the electrocardiogram (ECG) appearing in connection with radiotherapy for thoracic tumors also have been repeatedlyIn a major series treated for breast cancer, the incidence of T-wave changes was 4% with right-sided and 70% with left-sided treatment.' The prognostic significance of this sign of perimyocardial damage has been studied in small patient groups only, and only for fairly short follow-up periods.'oJ'Radiotherapy reduces the rate of local recurrence in breast cancer,'* and its application is increasing in combination with local excision of small t~m o r s . '~

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Background Epstein-Barr virus (EBV) infections can induce post-transplant lymphoproliferative disorder (PTLD). A chronic high load (CHL), as indicated by long-term high EBV DNA levels after transplantation, has been associated with an enhanced risk of PTLD. We aimed to evaluate incidence, time of occurrence, risk factors, and outcome of EBV CHL carrier state after pediatric renal transplantation. Methods A retrospective study of 58 children aged 1-17 years (median 10), who underwent renal transplantation between January 2004 and June 2017 at a single medical center. EBV IgG antibodies in serum were analyzed before and yearly after transplantation. EBV DNA in whole blood were analyzed weekly for the first 3 months post-transplant, monthly up to 1 year and then at least once yearly. CHL was defined as EBV DNA ≥ 4.2 log 10 Geq/ml in > 50% of the samples during ≥ 6 months. Results At transplantation, 31 (53%) patients lacked EBV IgG and 25 (81%) of them developed primary EBV infection posttransplant. Of the 27 seropositive patients, 20 (74%) experienced reactivation of EBV. Altogether, 14 (24%) children developed CHL, starting at a median of 69 days post-transplant and lasting for a median time of 2.3 years (range 0.5-6.5), despite reduction of immunosuppression. Patients with CHL were younger and 11/14 were EBV seronegative at transplantation. No child developed PTLD during median clinical follow-up of 7.8 years (range 0.7-13). Conclusions CHL was frequent, long lasting, and occurred mainly in young transplant recipients. The absence of PTLD suggests that monitoring of EBV DNA to guide immunosuppression was effective.

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AimRenal transplant patients are particularly susceptible to highly contagious diseases due to their reduced immunity. We studied transplant recipients to gauge their varicella zoster virus (VZV) serology status over time and the outcome of any VZV infections.MethodThis retrospective study comprised 85 children who underwent renal transplants in Gothenburg, Sweden, from 1986 to 2014, at a mean age of eight (1–18) years. The children's medical records were reviewed and 47 had the VZV infection pre‐transplant and 38 had been vaccinated pre‐transplant. Clinical outcomes were available for 85 children and serology results for 72.ResultsAt transplantation, the VZV seropositivity rate was 50% in the vaccination group and 94% in the infection group and the antibody titres were significantly lower in the vaccination group (p = 0.031). During the median follow‐up period of five years post‐transplant, 28% of the vaccinated children and 97% of the infection group remained seropositive and the varicella infection affected eight children: one in the infection group and seven in the vaccination group. The herpes zoster was observed in two children in the infection group.ConclusionThis study demonstrated that VZV vaccination protected from symptomatic infections to a lesser extent than natural infection, but provided effective protection from life‐threatening disease.

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