الفهرس 
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Abstract
Fortunately, we are witnessing a great improvement in the management of patients suffering from childhood cancer, including early diagnosis, multimodal therapy and hospital supportive care. Vascular disorders as atherosclerosis and cardiovascular disease are one of the leading causes of morbidity and mortality among long-term cancer survivors. So it is very important to regularly follow up survivors for early detection and management of such conditions.
Early detection of atherosclerosis, dyslipidemia, cardiac dysfunction, CBC abnormalities and APO E variation plays a crucial role in the management of the condition before developing a life threatening health issue. Therefore, it is becoming a priority for oncologists to develop new modalities and techniques directed for early detection of subclinical disorders.
The aim of this work was to investigate premature atherosclerosis in survivors of childhood malignancy together with studying Apolipoprotein E polymorphism and its relation to premature atherosclerosis in survivors of childhood malignancy.
Our study was carried out on 36 pediatric patients who finished
their chemotherapy treatment in the Hematology and Oncology Unit of
the Pediatric department at Menoufia University Hospitals during their
follow up visits. All the patients were treated by chemotherapy according
to the approved protocol of the unit. Also, the study included 37 healthy
children with matched age and sex as a control group.
Pediatric Childhood Cancer survivors (CCS) who received chemotherapy as anthracycline in the form of Doxorubicin as part of their treatment protocol at least 6 months after finishing chemotherpy were subjected to the following after taking informed consent:
1. Detailed history taking
2. Full clinical examination
3. Laboratory investigation
4. Imaging studies: including conventional Echocardiography, CIMT measurements by Ultrasound.
5. Genetic study: genotyping of the ApoE gene polymorphism by PCR- RFLP method for the survivors and control groups. The genotyping was carried out at our Biochemistry and Molecular Biology department, Menoufia University Hospital
Results showed that:
• There was a high significant difference between the survivors and control groups regarding Hb%, Platelets count and WBCs.
• Mean serum ferritin was significantly higher in the survivors than the control group.
• The mean serum cholesterol and LDL were significantly higher in survivors than the control group, but triglycerides and HDL did not show statistical significance between the two groups.
• The results showed a significant increase of Apo E4E4 genotype (p = 0.05) and E4 allele (P=0.009) in survivors than controls.
• Significant statistical difference was present between Apolipoprotein E groups (p= 0.02) as regards to the type of malignancy among survivors.
• A significant difference between Apo E groups as regards cholesterol , LDL (p ≤ 0.001) and HDL (p ≤0.001) was found.
• The mean ejection fraction and fractional shortening were not significant among survivors and controls (p=0.27 and 0.15) respectively. Moreover, the results of our research did not support the association between APO E genotypes and EF and/or FS.
• The mean CIMT measurements were not significant between survivors and controls. No significant difference was observed between APO E genotypes and carotid intima media thickness in survivors.