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Isaac EI, Meisman AR, Drucker K, Violante S, Behrhorst KL, Floyd A, Rohan JM. The Relationship between Health Disparities, Psychosocial Functioning and Health Outcomes in Pediatric Hematology-Oncology and Stem Cell Transplant Populations: Recommendations for Clinical Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2218. [PMID: 32224963 PMCID: PMC7178256 DOI: 10.3390/ijerph17072218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 01/09/2023]
Abstract
Not only do racial and ethnic minority children and adolescents with chronic illness experience disparities in health status and health outcomes, they also experience significant healthcare disparities, including differences in healthcare coverage, access to care, and quality of care. It is well known that the interaction between psychosocial functioning, health behaviors and ethnic and racial disparities, ultimately leads to worse health and psychosocial outcomes in pediatric and AYA chronic illness patient populations, including increased rates of morbidity and mortality. Investigating the impact of racial and ethnic factors on health outcomes, and strategies for reducing these disparities, is of the utmost importance, specifically in life-threatening conditions like cancer and sickle cell disease. This commentary underscores the relative importance of identifying factors that could reduce disparities between minority and non-minority populations. This present paper will focus on the dynamic relationships between health disparities, psychosocial factors and health outcomes within pediatric cancer, sickle cell disease and bone marrow transplant populations, and will offer recommendations for healthcare professionals working with these vulnerable patient populations. The primary goal of this commentary is to provide recommendations for enhancing cultural competency and humility for those working with highly vulnerable patient populations.
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Affiliation(s)
- Evrosina I. Isaac
- Virginia Commonwealth University School of Medicine, 1201 E. Marshall St #4-100, Richmond, VA 23298, USA; (K.D.); (J.M.R.)
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA; (S.V.); (K.L.B.); (A.F.)
| | - Andrea R. Meisman
- Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
| | - Kirstin Drucker
- Virginia Commonwealth University School of Medicine, 1201 E. Marshall St #4-100, Richmond, VA 23298, USA; (K.D.); (J.M.R.)
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA; (S.V.); (K.L.B.); (A.F.)
| | - Stephanie Violante
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA; (S.V.); (K.L.B.); (A.F.)
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Kathryn L. Behrhorst
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA; (S.V.); (K.L.B.); (A.F.)
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Alfonso Floyd
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA; (S.V.); (K.L.B.); (A.F.)
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Jennifer M. Rohan
- Virginia Commonwealth University School of Medicine, 1201 E. Marshall St #4-100, Richmond, VA 23298, USA; (K.D.); (J.M.R.)
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
- Massey Cancer Center Virginia Commonwealth University, Richmond, VA 23298, USA
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Hooke MC, Hatch D, Hockenberry MJ, Whitman S, Moore I, Montgomery D, Marano K, Mitby P, Scheurer ME, Taylor O, Pan W. The Longitudinal Parallel Process Analysis of Biomarkers of Oxidative Stress, Symptom Clusters, and Cognitive Function in Children With Leukemia. J Pediatr Oncol Nurs 2020; 37:244-254. [PMID: 32141369 DOI: 10.1177/1043454220909785] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: During treatment for acute lymphoblastic leukemia (ALL), children report co-occurring symptoms of fatigue, sleep disturbance, pain, nausea, and depression as a symptom cluster. Central nervous system-directed ALL therapies also put children at risk for cognitive impairments. Cancer therapies can cause an increase in oxidative stress, which may contribute to treatment-related symptoms. This study examined the longitudinal relationships between biomarkers of oxidative stress in the cerebrospinal fluid, the Childhood Cancer Symptom Cluster-Leukemia (CCSC-L), and cognition, in children over the first year of ALL treatment. Methods: Glutathione (GSH) biomarkers of oxidative stress were measured in cerebrospinal fluid collected during treatment lumbar punctures. GSH biomarkers, symptoms, and cognitive function of 132 children aged 3 to 18 years were evaluated at four time points during the first year of leukemia treatment. Participants, 7 years and older, completed self-report measures, and parents reported for younger children. Cognitive function measurements for all participants were completed by parents. A longitudinal parallel-process model was used to explore the influence of the initial measurement and the subsequent change over four time points of the GSH biomarkers on the CCSC-L and cognition. Results: GSH biomarkers increased over the four time points indicating decreasing oxidative stress. When GSH biomarkers were higher (less oxidative stress) at the initial measurement, the CCSC-L severity was lower, cognition was better, and cognition improved over the four measurements. Screening children for high levels of oxidative stress would be a foundation for future intervention studies to address symptom distress and cognitive impairments.
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Affiliation(s)
- Mary C Hooke
- University of Minnesota, Minneapolis, MN, USA
- Children's Minnesota Cancer and Blood Disorders Program, Minneapolis, MN, USA
| | | | - Marilyn J Hockenberry
- Children's Minnesota Cancer and Blood Disorders Program, Minneapolis, MN, USA
- Texas Children's Cancer and Hematology Centers/Baylor College of Medicine, Houston, TX, USA
| | | | - Ida Moore
- University of Arizona, Tucson, AZ, USA
| | | | | | - Pauline Mitby
- Children's Minnesota Cancer and Blood Disorders Program, Minneapolis, MN, USA
| | - Michael E Scheurer
- Texas Children's Cancer and Hematology Centers/Baylor College of Medicine, Houston, TX, USA
| | - Olga Taylor
- Texas Children's Cancer and Hematology Centers/Baylor College of Medicine, Houston, TX, USA
| | - Wei Pan
- Duke University, Durham, NC, USA
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Park KJ, Kim IS, Yang EJ, Lim YT, Cho SH. Mutation analysis in Korean patients with T-cell acute lymphoblastic leukemia. Pediatr Hematol Oncol 2020; 37:129-139. [PMID: 31852326 DOI: 10.1080/08880018.2019.1701160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Genomic studies have illuminated the alterations in pathways underlying T-cell acute lymphoblastic leukemia (T-ALL) pathogenesis, but detailed mutation data by next-generation sequencing have not been reported in Korean patients. We aimed to investigate mutation frequency, spectrum, and pattern in the Korean patients with T-ALL. We designed a multigene panel targeting 101 genes and validated it using 10 reference materials. The mutation analysis was done in a total of 10 patients with T-ALL. Clinical data and laboratory tests including immunophenotyping, cytogenetics, and molecular genetic tests were also investigated. All of the 10 patients harbored at least one mutation (range 1-6 per patient). A total of 34 clinically significant mutations including 15 novel mutations were identified in 23 genes. The median of variant allelic frequencies (VAFs) and blasts were counted upto 33% (range 5-91%) and 79% (range 38-90%), respectively. Recurrent mutations were involved in epigenetic regulators (60%), NOTCH1 signaling (40%), PI3K-AKT (40%), JAK-STAT (30%), and transcription factors (30%). We found that both NOTCH signaling and JAK-STAT signaling were positively associated with epigenetic regulators, while showed mutually exclusive patterns with PI3K-AKT pathway. This study showed that the frequency of mutations in epigenetic regulators in Korean patients was significantly higher than expected. Distribution of VAF as well as mutation spectrum is considerably heterogeneous in Korean patients with T-ALL. Although from a limited number of patients, this study provides the first detailed mutational portrait of T-ALL of Korean patients, and gives additional insight into molecular pathogenesis of the disease.
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Affiliation(s)
- Kyoung-Jin Park
- Department of Laboratory Medicine, Myongji Hospital, Goyang, Republic of Korea
| | - In-Suk Kim
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Eu Jeen Yang
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Young Tak Lim
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Su-Hee Cho
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
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Elhasid R, Nirel R, Avigad S, Avrahami G, Abramov A, Attias D, Arad N, Ballin A, Ben-Arush M, Bielorai B, Burstein Y, Elitzur S, Gabriel H, Hameiri-Grossman M, Kapelushnik J, Sthoeger D, Toren A, Wientraub M, Yaniv I, Izraeli S, Stark B. Poorer outcome of childhood acute lymphoblastic leukemia in the Bedouin population: A report from the Berlin-Frankfurt-Muenster-based Israeli national protocols. Pediatr Blood Cancer 2020; 67:e28024. [PMID: 31595664 DOI: 10.1002/pbc.28024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/10/2019] [Accepted: 09/04/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Therapy outcomes for childhood acute lymphoblastic leukemia (ALL) had substantially improved in the last decades, but variability across racial and ethnic groups was identified in some clinical studies. In this study, we aimed to investigate whether such a difference in outcome is found in the diverse ethnicities in Israel as well. METHODS A retrospective study was conducted among 1154 patients (855 Jews, 195 Muslims, 52 Bedouins, 26 Druze, and 26 others) aged 1 to 21 years, who were diagnosed with ALL between 1989 and 2011 and were treated according to the same Berlin-Frankfurt-Muenster-based Israel National Study protocols. RESULTS Bedouins had a higher incidence of t(1;19) (16% vs 3% for non-Bedouins) and a lower incidence of high-hyperdiploidy (10% vs 25% for non-Bedouins) (P = 0.01). Five-year event-free survival (EFS) and overall survival (OS) were poorer for the Bedouins (60.3% ± 7.2% and 63.1% ± 7.2%, respectively) compared with the Jews, Muslims, and Druze (80.4% ± 1.4%, 77.3% ± 3.2%, and 84% ± 7.3%, respectively, for EFS [P = 0.02], and 86.3% ± 1.2%, 82.3% ± 2.9%, and 88.3% ± 6.4%, respectively, for OS [P = 0.002]). Adherence to intensive chemotherapy was similar between the Muslims and the Bedouins. CONCLUSIONS Our findings suggest that the Bedouins, a highly inbred ethnic Arab people, may be considered a higher risk group that may need more intensive chemotherapy and/or supportive care in order to improve their outcome.
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Affiliation(s)
- Ronit Elhasid
- Department of Pediatric Hemato-Oncology, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Nirel
- Department of Statistics, Hebrew University, Jerusalem, Israel
| | - Smadar Avigad
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gali Avrahami
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aya Abramov
- Department of Pediatric Hematology/Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Dina Attias
- Department of Pediatric Hematology/Oncology, Bnei-Zion Medical Center and Faculty of Medicine, Technion, Haifa, Israel
| | - Nira Arad
- Department of Pediatric Hematology/Oncology, Rambam Medical Center, and The Bruce Rappaport Faculty of Medicine, Technion-Israel, Institute of Technology, Haifa, Israel
| | - Ami Ballin
- Department of Pediatric Hematology/Oncology, Edith Wolfson Medical Center, Holon, Israel
| | - Myriam Ben-Arush
- Department of Pediatric Hematology/Oncology, Rambam Medical Center, and The Bruce Rappaport Faculty of Medicine, Technion-Israel, Institute of Technology, Haifa, Israel
| | - Bella Bielorai
- Department of Pediatric Hematology/Oncology Chaim Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Burstein
- Department of Pediatric Hemato-Oncology, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarah Elitzur
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Herzel Gabriel
- Department of Pediatric Hematology/Oncology, Ha-Emek Medical Center, Afula, Israel
| | - Michal Hameiri-Grossman
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Kapelushnik
- Department of Pediatric Hematology/Oncology, Soroka Medical Center, Beer Sheva, Israel
| | - Dalia Sthoeger
- Department of Pediatric Hematology/Oncology, Kaplan Medical Center, Rehovot, Israel
| | - Amos Toren
- Department of Pediatric Hematology/Oncology Chaim Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Wientraub
- Department of Pediatric Hematology/Oncology, Hadassah University Hospital, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Isaac Yaniv
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Izraeli
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Batia Stark
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Grinspon RP, Arozarena M, Prada S, Bargman G, Sanzone M, Morales Bazurto M, Gutiérrez M, Bedecarrás P, Kannemann A, Elena GO, Gottlieb S, Berenstein AJ, Ropelato MG, Bergadá I, Aversa LA, Rey RA. Safety of standardised treatments for haematologic malignancies as regards to testicular endocrine function in children and teenagers. Hum Reprod 2019; 34:2480-2494. [PMID: 31768530 DOI: 10.1093/humrep/dez216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/02/2019] [Indexed: 12/23/2022] Open
Abstract
STUDY QUESTION Does standardised treatments used in children and adolescents with haematologic malignancies, including acute lymphoblastic (ALL) or myeloid leukaemia (AML) and non-Hodgkin lymphoma (NHL), affect endocrine function of the developing testes? SUMMARY ANSWER Therapy of haematologic malignancies do not provoke an overt damage of Sertoli and Leydig cell populations, as revealed by normal levels of anti-Müllerian hormone (AMH) and testosterone, but a mild primary testicular dysfunction may be observed, compensated by moderate gonadotropin elevation, during pubertal development. WHAT IS KNOWN ALREADY Evidence exists on the deleterious effect that chemotherapy and radiotherapy have on germ cells, and some attention has been given to the effects on Leydig and Sertoli cells of the adult gonads, but information is virtually non-existent on the effects of oncologic treatment on testicular somatic cell components during childhood and adolescence. STUDY DESIGN, SIZE, DURATION A retrospective, analytical, observational study included 97 boys with haematological malignancies followed at two tertiary paediatric public hospitals in Buenos Aires, Argentina, between 2002 and 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS Clinical records of males aged 1-18 years, referred with the diagnoses of ALL, AML or NHL for the assessment of gonadal function, were eligible. We assessed serum levels of AMH and FSH as biomarkers of Sertoli cell endocrine function and testosterone and LH as biomarkers of Leydig cell function. MAIN RESULTS AND THE ROLE OF CHANCE All hormone levels were normal in the large majority of patients until early pubertal development. From Tanner stage G3 onwards, while serum AMH and testosterone kept within the normal ranges, gonadotropins reached mildly to moderately elevated values in up to 35.9% of the cases, indicating a compensated Sertoli and/or Leydig cell dysfunction, which generally did not require hormone replacement therapy. LIMITATIONS, REASONS FOR CAUTION Serum inhibin B determination and semen analysis were not available for most patients; therefore, we could not conclude on potential fertility impairment or identify whether primary Sertoli cell dysfunction resulted in secondary depleted spermatogenesis or whether primary germ cell damage impacted Sertoli cell function. WIDER IMPLICATIONS OF THE FINDINGS The regimens used in the treatment of boys and adolescents with ALL, AML or NHL in the past two decades seem relatively safe for endocrine testicular function; nonetheless, a mild primary testicular endocrine dysfunction may be observed, usually compensated by slightly elevated gonadotropin secretion by the pituitary in adolescents, and not requiring hormone replacement therapy. No clinically relevant risk factor, such as severity of the disease or treatment protocol, could be identified in association with the compensated endocrine dysfunction. STUDY FUNDING/COMPETING INTEREST(S) This work was partially funded by grants PIP 11220130100687 of Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) and PICT 2016-0993 of Fondo para la Investigación Científica y Tecnológica (FONCYT), Argentina. R.A.R., R.P.G. and P.B. have received honoraria from CONICET (Argentina) for technology services using the AMH ELISA. L.A.A. is part-time employee of CSL Behring Argentina. The other authors have no conflicts of interest to disclose.
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Affiliation(s)
- Romina P Grinspon
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - María Arozarena
- Unidad de Hematología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Silvina Prada
- Unidad de Hematología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Graciela Bargman
- División de Endocrinología, Hospital de Niños Pedro de Elizalde, C1270AAN Buenos Aires, Argentina
| | - María Sanzone
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Marjorie Morales Bazurto
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Marcela Gutiérrez
- Unidad de Hematología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Patricia Bedecarrás
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Ana Kannemann
- Unidad de Hematología, Hospital Pedro de Elizalde, C1270AAN Buenos Aires, Argentina
| | - Graciela O Elena
- Unidad de Hematología, Hospital Pedro de Elizalde, C1270AAN Buenos Aires, Argentina
| | - Silvia Gottlieb
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Ariel J Berenstein
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET-GCBA, Laboratorio de Biología Molecular, División Patología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - María Gabriela Ropelato
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Ignacio Bergadá
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Luis A Aversa
- Unidad de Hematología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Rodolfo A Rey
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
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Mueske NM, Mittelman SD, Wren TAL, Gilsanz V, Orgel E. Myosteatosis in adolescents and young adults treated for acute lymphoblastic leukemia. Leuk Lymphoma 2019; 60:3146-3153. [PMID: 31264493 PMCID: PMC6923569 DOI: 10.1080/10428194.2019.1623889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/19/2019] [Indexed: 02/06/2023]
Abstract
Myosteatosis refers to fat deposition within muscle and is linked to risk of cardiovascular disease and metabolic disorders. Though these comorbidities are common during and after therapy for acute lymphoblastic leukemia (ALL), little is known about tissue distribution, including myosteatosis, in this population. Using quantitative computed tomography, we assessed the impact of ALL therapy on bone, muscle, subcutaneous, and muscle-associated (MA) fat in 12 adolescents and young adults (AYA) treated for ALL as compared to a healthy control group without ALL (n = 116). AYA had a marked loss of muscle with a gain in MA fat between ALL diagnosis and end of induction. These changes persisted throughout intensive therapy. Lower bone and muscle and higher MA fat were also observed during and after treatment in comparison to controls. Altered lower extremity tissue distribution, specifically myosteatosis and sarcopenia, may contribute to functional declines and increased risk of metabolic disorders and cardiovascular diseases.
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Affiliation(s)
- Nicole M Mueske
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Steven D Mittelman
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Center for Endocrinology, Diabetes & Metabolism, Children's Hospital Los Angeles, CA, USA
| | - Tishya A L Wren
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Vicente Gilsanz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Imaging Research Program, Children's Hospital, Los Angeles, CA, USA
| | - Etan Orgel
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA
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57
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Totadri S, Trehan A, Kaur A, Bansal D. Effect of socio-economic status & proximity of patient residence to hospital on survival in childhood acute lymphoblastic leukaemia. Indian J Med Res 2019; 149:26-33. [PMID: 31115371 PMCID: PMC6507537 DOI: 10.4103/ijmr.ijmr_579_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background & objectives: Survival in paediatric acute lymphoblastic leukaemia (ALL) in lower/middle income countries continues to lag behind outcomes seen in high-income countries. Socio-economic factors and distance of their residence from the hospital may contribute to this disparity. This study was aimed at identifying the impact of these factors on outcome in childhood ALL. Methods: In this retrospective study, file review of children with ALL was performed. Patients were treated with the modified United Kingdom (UK) ALL-2003 protocol. Details of socio-economic/demographic factors were noted from a web-based patients’ database. Modified Kuppuswamy scale was used to classify socio-economic status. Results: A total of 308 patients with a median age of five years (range: 1-13 yr) were studied. Patients belonging to upper, middle and lower SE strata numbered 85 (28%), 68 (22%) and 155 (50%). Nearly one-third of the patients were underweight. There was no treatment abandonment among children whose mothers were graduates. Neutropenic deaths during maintenance therapy were lower in mothers who had passed high school. In patients who survived induction therapy, the five year event-free survival (EFS) of upper SE stratum was significantly better 78.7±4.9 vs. 59±7.2 and 58.1±4.6 per cent in middle and lower strata (P=0.026). Five year overall survival was higher in the higher SE group; being 91.2±3.5, 78.3±5.6 and 78.8±3.9 per cent (P=0.055) in the three strata. Survival was unaffected by a distance of residence from treating centre or rural/urban residence. High-risk and undernourished children had a greater hazard of mortality [1.80 (P=0.015); 1.98 (P=0.027)]. Interpretation & conclusions: Our findings showed that higher socio-economic status contributed to superior EFS in children with ALL who achieved remission. Undernutrition increased the risk of mortality.
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Affiliation(s)
- Sidharth Totadri
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Appinderjit Kaur
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Khullar K, Rivera-Núñez Z, Jhawar SR, Drachtman R, Cole PD, Hoppe BS, Parikh RR. Pediatric hodgkin lymphoma: disparities in survival by race. Leuk Lymphoma 2019; 61:546-556. [DOI: 10.1080/10428194.2019.1680841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Karishma Khullar
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Zorimar Rivera-Núñez
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Sachin R. Jhawar
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Richard Drachtman
- Section of Pediatric Hematology and Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Peter D. Cole
- Section of Pediatric Hematology and Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Rahul R. Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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59
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Lupo PJ. Quantifying survival disparities among children diagnosed with cancer on a global scale. Lancet Oncol 2019; 20:894-896. [DOI: 10.1016/s1470-2045(19)30315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 11/26/2022]
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60
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Precision medicine and health disparities: The case of pediatric acute lymphoblastic leukemia. Nurs Outlook 2019; 67:331-336. [PMID: 31279488 DOI: 10.1016/j.outlook.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/07/2019] [Accepted: 05/12/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Precision medicine has uncertain potential to address population health disparities. PURPOSE Case study of disparities in pediatric acute lymphoblastic leukemia (ALL). METHOD Literature-based evaluation of ALL in African American (AA) and European American (EA) children. FINDINGS AA children have a lower incidence of ALL than EA children, experience higher relapse rates, and are more likely to be diagnosed with poor prognostic indicators. Environmental risk exposures for ALL have small effect sizes; data are insufficient to determine their contribution to differences in incidence and prognosis. Differences in prevalence of gene variants associated with treatment response contribute to higher relapse rates in AA children. However, higher relapse rates were not seen in a care setting that eliminated out of pocket costs, used risk-directed therapy, and included rigorous case management. DISCUSSION Unequal access to effective treatment contributes to ALL disparities. Precision medicine can help to define effective treatment for diverse patient populations.
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Alvarez EM, Malogolowkin M, Li Q, Brunson A, Pollock BH, Muffly L, Wun T, Keegan THM. Decreased Early Mortality in Young Adult Patients With Acute Lymphoblastic Leukemia Treated at Specialized Cancer Centers in California. J Oncol Pract 2019; 15:e316-e327. [PMID: 30849003 DOI: 10.1200/jop.18.00264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Studies suggest that patients with acute lymphoblastic leukemia (ALL) have superior survival when treated at specialized cancer centers (SCCs). However, the association of early mortality (< 60 days) with location of initial care, sociodemographic factors, and complications has not been evaluated in pediatric and young adult (YA) patients with ALL. METHODS Using the California Cancer Registry linked to hospitalization data, we identified pediatric and YA patients with ALL who received inpatient leukemia treatment between 1991 and 2014. Patients were classified as receiving all or part/none of their care at an SCC (Children's Oncology Group- or National Cancer Institute-designated cancer center). Propensity scores were created for treatment at an SCC in each age group. Multivariable, inverse probability-weighted Cox proportional hazards regression models identified factors associated with early mortality. Results are presented as hazard ratios (HRs) and 95% CIs. RESULTS Among 6,531 newly diagnosed pediatric (≤ 18 years) and YA (19 to 39 years of age) patients with ALL, 1.6% of children and 5.4% of YAs died within 60 days of diagnosis. Most children received all of their care at an SCC (n = 4,752; 85.7%) compared with 35.5% of YAs (n = 1,779). Early mortality rates were lower in pediatric patients and those receiving all care at an SCC (pediatric: all, 1.5%, v part/none, 2.4%; P = .049; YAs: all, 3.2%, v part/none, 6.6%; P = .001). However, in adjusted models, receiving all care at an SCC was associated with significantly lower early mortality in YAs (HR, 0.51; 95% CI, 0.32 to 0.81), but not in pediatric patients (HR, 0.77; 95% CI, 0.47 to 1.25). CONCLUSION YAs with ALL experience significant reductions in early mortality after treatment at SCCs.
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Affiliation(s)
| | | | - Qian Li
- 1 University of California, Davis, CA
| | | | | | | | - Ted Wun
- 1 University of California, Davis, CA
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Jastaniah W, Elimam N, Abdalla K, AlAzmi AA, Elgaml AM, Alkassar A, Daghistani M, Felimban S. Early vs. late MRD response- and risk-based treatment intensification of childhood acute lymphoblastic leukemia: a prospective pilot study from Saudi Arabia. Exp Hematol Oncol 2018; 7:29. [PMID: 30479872 PMCID: PMC6245521 DOI: 10.1186/s40164-018-0121-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 11/14/2018] [Indexed: 12/20/2022] Open
Abstract
Background Refinement of risk-based treatment stratification by minimal residual disease (MRD) at different time points has improved outcomes of childhood acute lymphoblastic leukemia (ALL). In this prospective study we evaluated effects of such stratification, including intensification of therapy based on response assessment at day-15 and MRD at day-29 of induction to test if treatment intensification would improve outcomes. Methods 241 patients, 1-14 years old, newly diagnosed with ALL, were recruited and stratified by risk and MRD response into three treatment Arms (A, B, or C). Arm A was modified from COG AALL0331, B from AALL0232, and C from AALL0232 and AALL0434. Assignments were according to NCI risk, phenotype, rapid vs. slow early response (SER), steroid pretreatment, MLL rearrangement (MLLR), CNS3, and testicular involvement. Patients on Arm A had treatment intensified early based on day-15 marrow results or late based on end-of-induction MRD. Results 5-year OS, EFS, and CIR were 89.5% ± 4.0%, 87.6% ± 4.3%, and 7.1% ± 3.5%. No significant difference was found by B- vs. T cell phenotype. 5-year OS, EFS, and CIR for B-cell ALL were 90.5% ± 2.4%, 88.7% ± 2.6%, and 6.4% ± 2.0%. Outcomes for patients with t(1;19)/TCF3-PBX1 and MLLR were significantly (p ≤ 0.05) worse than for other patients. MRD level at end-of-induction associated with outcomes, but association with a specific MRD value at end-of-induction varied significantly by NCI-risk group. Late treatment intensification based on end-of-induction MRD significantly improved survival outcomes for NCI-SR patients, however, patients with NCI-HR and positive MRD at end-of-induction had significantly inferior outcomes despite intensification. MRD transitions between day-15 and day-29 of induction associated with differences for OS and EFS. Conclusions Arm switching to a more intensive protocol had mixed results. Assigning patients by end-of-induction MRD-risk alone did not reflect response kinetics of the different NCI-risk groups. Although late treatment intensification improved outcomes of NCI-SR patients with positive MRD at end-of-induction, further refinement is needed to improve outcomes of NCI-HR with SER. Integration of NCI-risk group with specific MRD value and time point allows more refined treatment stratification.Trial Registration Protocols were approved by King Abdullah International Medical Research Center and Ethics Review Committee RC08053J.
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Affiliation(s)
- Wasil Jastaniah
- 1Department of Pediatrics, Faculty of Medicine, Umm AlQura University, Makkah, Saudi Arabia.,Princess Noorah Oncology Center, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Naglla Elimam
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Khalid Abdalla
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Aeshah A AlAzmi
- Department of Pharmaceutical Care, Clinical Pharmacy, Pediatric Hematology/Oncology, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Aml M Elgaml
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Ahmad Alkassar
- 4Department of Pathology and Laboratory Medicine, Flow Cytometry Unit, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Mustafa Daghistani
- 5Department of Pathology and Laboratory Medicine, Cytogenetics and Molecular Cytogenetics Unit, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Sami Felimban
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
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Miller KD, Goding Sauer A, Ortiz AP, Fedewa SA, Pinheiro PS, Tortolero-Luna G, Martinez-Tyson D, Jemal A, Siegel RL. Cancer Statistics for Hispanics/Latinos, 2018. CA Cancer J Clin 2018; 68:425-445. [PMID: 30285281 DOI: 10.3322/caac.21494] [Citation(s) in RCA: 282] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
Cancer is the leading cause of death among Hispanics/Latinos, who represent the largest racial/ethnic minority group in the United States, accounting for 17.8% (57.5 million) of the total population in the continental United States and Hawaii in 2016. In addition, more than 3 million Hispanic Americans live in the US territory of Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanics in the United States based on data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the Centers for Disease Control and Prevention. For the first time, contemporary incidence and mortality rates for Puerto Rico, which has a 99% Hispanic population, are also presented. An estimated 149,100 new cancer cases and 42,700 cancer deaths will occur among Hispanics in the continental United States and Hawaii in 2018. For all cancers combined, Hispanics have 25% lower incidence and 30% lower mortality compared with non-Hispanic whites, although rates of infection-related cancers, such as liver, are up to twice as high in Hispanics. However, these aggregated data mask substantial heterogeneity within the Hispanic population because of variable cancer risk, as exemplified by the substantial differences in the cancer burden between island Puerto Ricans and other US Hispanics. For example, during 2011 to 2015, prostate cancer incidence rates in Puerto Rico (146.6 per 100,000) were 60% higher than those in other US Hispanics combined (91.6 per 100,000) and 44% higher than those in non-Hispanic whites (101.7 per 100,000). Prostate cancer is also the leading cause of cancer death among men in Puerto Rico, accounting for nearly 1 in 6 cancer deaths during 2011-2015, whereas lung cancer is the leading cause of cancer death among other US Hispanic men combined. Variations in cancer risk are driven by differences in exposure to cancer-causing infectious agents and behavioral risk factors as well as the prevalence of screening. Strategies for reducing cancer risk in Hispanic populations include targeted, culturally appropriate interventions for increasing the uptake of preventive services and reducing cancer risk factor prevalence, as well as additional funding for Puerto Rico-specific and subgroup-specific cancer research and surveillance.
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Affiliation(s)
- Kimberly D Miller
- Senior Associate Scientist, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Ann Goding Sauer
- Senior Associate Scientist, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Ana P Ortiz
- Professor, Epidemiology and Biostatistics, University of Puerto Rico School of Public Health, San Juan, PR
| | - Stacey A Fedewa
- Senior Principal Scientist, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Paulo S Pinheiro
- Research Associate Professor, Miller School of Medicine, University of Miami, Miami, FL
| | | | | | - Ahmedin Jemal
- Scientific Vice President, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Scientific Director, Surveillance Research, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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Colton MD, Hawkins M, Goulding D, Cockburn M, Green AL. Socioeconomics, race, and ethnicity in childhood cancer survival: Accessing and addressing root causes of disparities. Cancer 2018; 124:3975-3978. [PMID: 30125347 DOI: 10.1002/cncr.31558] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/13/2018] [Accepted: 05/02/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Meryl D Colton
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Makenzie Hawkins
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - DeLayna Goulding
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Myles Cockburn
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.,University of Colorado Cancer Center, Aurora, Colorado
| | - Adam L Green
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,University of Colorado Cancer Center, Aurora, Colorado.,Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colorado
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Abstract
New Caledonia (NC) is a small French territory in the Pacific Ocean with a relatively young (32% under 20) and multiethnic population. It is divided into 3 districts: Loyalty Island, the North, and the South, each with specific population characteristics. The aim of this study was to describe childhood cancer age-standardized incidence rate (ASR) in NC, compare it with the estimated one in France , and to determine whether residence and ethnicity may have an influence on intrapopulation ASR. All incident cancer cases diagnosed between 1994 and 2012 in children (0 to 14 y) resident in NC for more than 6 months were included. With 162 registered cases, the ASR for all cancers combined was 142.2 (range, 104.9 to 193.3) cases per million children per year and was not different from what was estimated in France (156.6). However, incidence varies according to the place of residence, with a higher ASR in the Loyalty Island district for several types of neoplasms, but not according to the ethnicity. The small migratory flux between this district and the rest of the territory may have led to these results, but, because of the small number of cases, no conclusion can be drawn.
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González-Quezada BA, Flores-Aguilar H, Olaya-Vargas A, Salazar-Rosales H, Pérez-García M, Valero-Saldaña LM, Acosta-Maldonado BL, Ovilla-Martínez R, Gorodezky C. IFNG +874 A/T is associated with acute lymphoblastic leukemia in Mexican Mestizos. Cytokine 2018; 111:265-271. [PMID: 30212785 DOI: 10.1016/j.cyto.2018.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 01/02/2023]
Abstract
Acute lymphoblastic leukemia (ALL), the most common type of cancer in children worldwide, has one of the highest incidence rates in Mexico. It is a multifactorial disease and different cytokine single nucleotide polymorphisms (SNP), have been associated with ALL expression. Few studies have been published analyzing IFNG +874 T/A and IL2 -330 G/T in this type of leukemia. These SNPs are involved in high or low expression, and are central to cellular immunity, influencing greatly tumor growth. The purpose of this work was to explore the association of IFNG +874 A/T (rs2430561) and IL2 -330 G/T (rs2069762) SNPs with ALL susceptibility and/or protection in 488 Mexican Mestizos patients, as compared to 950 Mexican Mestizo healthy controls. The results demonstrated that IFNG +874 T allele (pc = 0.00004, OR = 0.673) and the TT genotype (pc = 0.00015, OR = 0.349), protect against ALL expression with no specific gender association; however, the TT homozygote genotype (vs. TA+AA) seems more protective in males (pc = 0.00683). IL2 -330 G/T does not contribute to the development of ALL. In healthy Mexicans, the most common genotypes for IL2 and IFNG, are the low cytokine producers, suggesting that the genetic background in this ethnic group, may be partly responsible for the high incidence of ALL. These results show for the first time in Mexicans, the relevant role that IFNG SNP has in the genetic etiology of ALL. Thus, a large group of patients belonging to different ethnicities will be very helpful to study in order to demonstrate if these SNPs contribute to the genetic etiology of ALL, as shown here in Mexican Mestizos.
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Affiliation(s)
- Betsy Annel González-Quezada
- Department of Immunology and Immunogenetics, InDRE, Secretary of Health, Francisco P. Miranda #177, col. Lomas de Plateros, Del. Álvaro Obregón, CP 01480 Mexico City, Mexico; Fundación Comparte Vida, A.C. Galileo #92, col. Polanco, Del. Miguel Hidalgo, CP 11550 Mexico City, Mexico.
| | - Hilario Flores-Aguilar
- Department of Immunology and Immunogenetics, InDRE, Secretary of Health, Francisco P. Miranda #177, col. Lomas de Plateros, Del. Álvaro Obregón, CP 01480 Mexico City, Mexico; Fundación Comparte Vida, A.C. Galileo #92, col. Polanco, Del. Miguel Hidalgo, CP 11550 Mexico City, Mexico.
| | - Alberto Olaya-Vargas
- Instituto Nacional de Pediatría, Secretary of Health, Insurgentes Sur #3700, Letra C, Delegación Coyoacán, CP. 04530 Mexico City, Mexico
| | - Haydee Salazar-Rosales
- Instituto Nacional de Pediatría, Secretary of Health, Insurgentes Sur #3700, Letra C, Delegación Coyoacán, CP. 04530 Mexico City, Mexico
| | - Martín Pérez-García
- Instituto Nacional de Pediatría, Secretary of Health, Insurgentes Sur #3700, Letra C, Delegación Coyoacán, CP. 04530 Mexico City, Mexico
| | - Luis Manuel Valero-Saldaña
- Instituto Nacional de Cancerología, Secretary of Health, Av. San Fernando #22, Col. Sección 16, C.P. 14080 Mexico City, Mexico
| | - Brenda Lizeth Acosta-Maldonado
- Instituto Nacional de Cancerología, Secretary of Health, Av. San Fernando #22, Col. Sección 16, C.P. 14080 Mexico City, Mexico
| | - Roberto Ovilla-Martínez
- Hospital Ángeles Lomas, Hacienda de las Palmas, Col. Valle de las Palmas, CP 52763 State of Mexico, Mexico
| | - Clara Gorodezky
- Department of Immunology and Immunogenetics, InDRE, Secretary of Health, Francisco P. Miranda #177, col. Lomas de Plateros, Del. Álvaro Obregón, CP 01480 Mexico City, Mexico; Fundación Comparte Vida, A.C. Galileo #92, col. Polanco, Del. Miguel Hidalgo, CP 11550 Mexico City, Mexico.
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Genetic Mutations in B-Acute Lymphoblastic Leukemia Among African American and European American Children. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e501-e508. [PMID: 30181103 DOI: 10.1016/j.clml.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The survival of patients with B-acute lymphoblastic leukemia (B-ALL) is significantly lower in African American (AA) children compared with European American children (EA). Here, we present a whole exome sequencing (WES) study showing race-specific genetic variations that may play a role on the disparate outcomes among AA and EA children with B-ALL. PATIENTS AND METHODS Five AA and 15 EA patients ranging in age from 1 to 18 years were enrolled. The median blast percentage was 94.8% (range, 64.5%-99.9%). Frozen bone marrow aspirate was used to extract DNA, and WES was performed, focusing on race and B-ALL-specific germline mutations. RESULTS Most genetic variants (n = 339) were shared between AA and EA children. Some genetic aberrations were only uniquely identified in AA (n = 58) and others in EA (n = 52) In AA, the genetic aberrations clustered in canonical pathways related to telomerase signaling and cancer signaling. In EA, the unique genetic aberration clustered in pathways related to stem cell pluripotency and hereditary cancer. CONCLUSIONS Our study revealed aberrant genetic aberrations in signaling networks that may contribute to race-specific aspects of leukemogenesis. Our results suggest the value of WES as a tool for development of individual gene signatures and gene scores for AA and EA children afflicted by B-ALL. These findings may ultimately impact disease management and contribute to the elimination of disparate outcomes in AA children with B-ALL.
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Revisiting the complete blood count and clinical findings at diagnosis of childhood acute lymphoblastic leukemia: 10-year experience at a single center. Hematol Transfus Cell Ther 2018; 41:57-61. [PMID: 30793106 PMCID: PMC6371227 DOI: 10.1016/j.htct.2018.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/21/2018] [Indexed: 12/21/2022] Open
Abstract
Background Heterogeneity regarding clinical and laboratory findings at diagnosis of acute lymphoblastic leukemia exists. The frequency of complete blood count abnormalities and its combinations, symptoms and physical findings were investigated in Hispanic children from an open population at the diagnosis of acute lymphoblastic leukemia. Methods The patient charts and electronic records of under 16-year-old children diagnosed with acute lymphoblastic leukemia over 10 years at a regional hematology center of a university hospital were analyzed to retrieve data concerning the complete blood count at first evaluation. Type and distribution of abnormal data, frequency of symptoms and physical findings at presentation were documented. Results The records of 203 children aged 0–15 years diagnosed with acute lymphoblastic leukemia from 2006 to 2016 were revisited. The results of the blood workup showed a median white blood cell count of 7120 × 109/L (range: 450–600,000 × 109/L), and a median hemoglobin concentration of 7.5 g/dL (range: 2.4–15.3 g/dL), whereas the median platelet count was 47,400 × 109/L (range: 4000–544,000 × 109/L). Leukocytosis and leukopenia were present in 36.6% and 36.1% of cases, respectively; anemia was diagnosed in 82.9% children. The order of frequency for major clinical symptoms was fatigue 62%, fever 60%, bone and joint pain 39%, hyporexia 33% and weight loss 21%, while main physical findings were hepatomegaly 78%, splenomegaly 63%, lymphadenopathy 57%, pallor 48%, and purpura 30%. Conclusion Data differing from those classically expected at diagnosis of acute lymphoblastic leukemia in children were documented in a cohort of Hispanic children over one decade with a wide spectrum of complete blood count abnormalities, forms of presentation and frequency of physical findings.
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Amankwah EK, Hale GA. Hispanic Ethnicity and the Risk of Pediatric Leukemia Relapse. Clin Pediatr (Phila) 2018; 57:656-659. [PMID: 28929798 DOI: 10.1177/0009922817732147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Limited knowledge currently exists on the disparity in pediatric leukemia relapse. This study compared the risk of pediatric leukemia relapse between Hispanic and non-Hispanic Whites. Study participants were children (<20 years) diagnosed with leukemia from January 2006 to December 2014 at the Johns Hopkins All Children's Hospital, St. Petersburg, Florida. Hazard ratios and 95% confidence intervals for relapse-free survival were calculated using adjusted Cox regression. The study included 35 Hispanic and 94 non-Hispanic Whites. Among patients <10 years old, there was a significantly higher risk of relapse in Hispanic compared to non-Hispanic Whites (hazard ratio = 6.19, 95% confidence interval = 1.15-33.27). No association was observed for patients aged ≥10 years nor all participants combined. Although the finding of this study may suggest that ethnic disparity in pediatric leukemia relapse may exist in younger children, our finding is limited by the small sample size from a single institution. Therefore, future larger multiinstitutional studies are warranted.
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Affiliation(s)
- Ernest K Amankwah
- 1 Cancer and Blood Disorders Institute Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Greg A Hale
- 1 Cancer and Blood Disorders Institute Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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Kahn JM, Cole PD, Blonquist TM, Stevenson K, Jin Z, Barrera S, Davila R, Roberts E, Neuberg DS, Athale UH, Clavell LA, Laverdiere C, Leclerc JM, Michon B, Schorin MA, Welch JJ, Sallan SE, Silverman LB, Kelly KM. An investigation of toxicities and survival in Hispanic children and adolescents with ALL: Results from the Dana-Farber Cancer Institute ALL Consortium protocol 05-001. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26871. [PMID: 29090520 PMCID: PMC5766393 DOI: 10.1002/pbc.26871] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/26/2017] [Accepted: 09/29/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE This study compared the relative incidence of treatment-related toxicities and the event-free and overall survival between Hispanic and non-Hispanic children undergoing therapy for acute lymphoblastic leukemia (ALL) on Dana-Farber Cancer Institute ALL Consortium protocol 05-001. PATIENTS AND METHODS Secondary analysis of prospectively collected data from a phase III multicenter study in children and adolescents of 1-18 years with previously untreated ALL. RESULTS Between 2005 and 2011, 794 eligible patients enrolled on DFCI 05-001, 730 of whom were included in this analysis (19% [N = 150] Hispanic, 73% [N = 580] non-Hispanic). Hispanic patients were more likely to be ≥10 years of age (32% vs. 24%, P = 0.045) at diagnosis. Toxicity analyses revealed that Hispanic patients had significantly lower cumulative incidence of bone fracture (P < 0.001) and osteonecrosis (ON; P = 0.047). In multivariable risk regression, the risk of ON was significantly lower in Hispanic patients ≥10 years (HR 0.23; P = 0.006). Hispanic patients had significantly lower 5-year event-free survival (EFS) (79.4%; 95% CI: 71.6-85.2) and overall survival (OS) (89.2%; 95% CI: 82.7-93.4) than non-Hispanic patients (EFS: 87.5%; 95% CI: 84.5-90.0, P = 0.004; OS: 92.7%; 95% CI: 90.2-94.6, P = 0.006). Exploratory analyses revealed differences between Hispanic and non-Hispanic patients in the frequency of common variants in genes related to toxicity or ALL outcome. CONCLUSION Hispanic children treated for ALL on DFCI 05-001 had fewer bone-related toxicities and inferior survival than non-Hispanic patients. While disease biology is one explanatory variable for outcome disparities, these findings suggest that biologic and non-biologic mechanisms affecting drug delivery and exposure in this population may be important contributing factors as well.
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Affiliation(s)
- Justine M. Kahn
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Peter D. Cole
- Division of Pediatric Hematology/Oncology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Traci M. Blonquist
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Kristen Stevenson
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University Medical Center, New York, New York, USA
| | - Sergio Barrera
- Department of Economics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Randy Davila
- Department of Psychology, University of California, Davis, Davis, California, USA
| | - Emily Roberts
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Donna S. Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Uma H. Athale
- Division of Pediatric Hematology/Oncology, McMaster University, Hamilton, ON, Canada
| | - Luis A. Clavell
- Division of Pediatric Oncology, San Jorge Children’s Hospital, San Juan, Puerto Rico
| | - Caroline Laverdiere
- Division of Hematology and Oncology, Hospital Sainte-Justine, University of Montreal, Montreal, Canada
| | - Jean-Marie Leclerc
- Division of Hematology and Oncology, Hospital Sainte-Justine, University of Montreal, Montreal, Canada
| | - Bruno Michon
- Division of Hematology-Oncology, Centre Hospitalier de l’Université Laval, Quebec City, Canada
| | | | - Jennifer J.G. Welch
- Division of Pediatric Hematology-Oncology, Hasbro Children’s Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Stephen E. Sallan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Division of Hematology/Oncology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Lewis B. Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Division of Hematology/Oncology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kara M. Kelly
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA,Roswell Park Cancer Institute and Women and Children’s Hospital, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Lv H, Hu SY, Du ZZ, Zhai Z, Cao L, Sun YN, Lu J, Li J, He HL, Chai YH, Wang Y. Gene polymorphisms in the folate metabolic pathway and risk of pediatric acute lymphoblastic leukemia: a case-control study in a Chinese population. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:1724-1731. [PMID: 31938276 PMCID: PMC6958122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/29/2017] [Indexed: 06/10/2023]
Abstract
Polymorphisms in folate pathway genes may influence susceptibility to pediatric acute lymphoblastic leukemia (ALL). This case-control study was undertaken to analyze the association of genetic polymorphisms (677C>T and 1298A>C) of methylenetetrahydrofolate reductase (MTHFR) and reduced folate carrier (RFC1) (80G>A) with the risk of pediatric ALL in China. A total of 176 pediatric ALL patients and 170 matched healthy subjects (as controls) were included and DNA was extracted from the peripheral blood. SNaPshot single nucleotide polymorphism typing was used to determine the genotypes of MTHFR 677C>T, MTHFR 1298A>C, and RFC1 80G>A. All statistical analyses were conducted with SAS software (version 9.2; SAS Institute). There were no significant differences in the genotype and allele frequencies of MTHFR 677C>T, MTHFR 1298A>C, or RFC1 80G>A between patients and controls. No significant correlation was found between the combined genotypes of these polymorphisms and the risk of developing ALL in this study. Furthermore, no significant differences were observed for 677C>T and 1298A>C frequencies between the control and case groups. There was no association between MTHFR 677C>T, MTHFR 1298A>C, or RFC1 80G>A gene polymorphisms and risk of pediatric ALL in the Han Chinese population.
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Affiliation(s)
- Hui Lv
- Department of Hematology and Oncology, Children's Hospital of Soochow University Suzhou 215123, Jiangsu Province, China
| | - Shao-Yan Hu
- Department of Hematology and Oncology, Children's Hospital of Soochow University Suzhou 215123, Jiangsu Province, China
| | - Zhi-Zuo Du
- Department of Hematology and Oncology, Children's Hospital of Soochow University Suzhou 215123, Jiangsu Province, China
| | - Zong Zhai
- Department of Hematology and Oncology, Children's Hospital of Soochow University Suzhou 215123, Jiangsu Province, China
| | - Lan Cao
- Department of Hematology and Oncology, Children's Hospital of Soochow University Suzhou 215123, Jiangsu Province, China
| | - Yi-Na Sun
- Department of Hematology and Oncology, Children's Hospital of Soochow University Suzhou 215123, Jiangsu Province, China
| | - Jun Lu
- Department of Hematology and Oncology, Children's Hospital of Soochow University Suzhou 215123, Jiangsu Province, China
| | - Jie Li
- Department of Hematology and Oncology, Children's Hospital of Soochow University Suzhou 215123, Jiangsu Province, China
| | - Hai-Long He
- Department of Hematology and Oncology, Children's Hospital of Soochow University Suzhou 215123, Jiangsu Province, China
| | - Yi-Huan Chai
- Department of Hematology and Oncology, Children's Hospital of Soochow University Suzhou 215123, Jiangsu Province, China
| | - Yi Wang
- Department of Hematology and Oncology, Children's Hospital of Soochow University Suzhou 215123, Jiangsu Province, China
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Esteban RE, Christianne B, Alvaro A, Demichelis-Gómez R. Prognostic Effect of CD20 Expression in Adult B-cell Acute Lymphoblastic Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:361-367. [PMID: 29544762 DOI: 10.1016/j.clml.2018.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 02/21/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The expression of the CD20 on adult B-cell acute lymphoblastic leukemia (ALL-B) has generally been associated with a poor prognosis, and several studies have explored the incorporation of rituximab into the therapeutic regimen for adult ALL-B patients, with a positive effect on event-free survival (EFS). PATIENTS AND METHODS We analyzed the prognostic value of CD20 expression and the effect of rituximab for the treatment of Hispanic adult ALL-B patients. We performed a retrospective study of 152 ALL-B patients treated from 2009 to 2016. The patient characteristics and treatment outcomes were analyzed according to CD20 expression (CD20+ vs. CD20-), age group, and treatment with rituximab. RESULTS CD20 expression was positive for 47.7% of patients (n = 72). Excluding the patients who had received rituximab, the overall survival (OS) was greater for the CD20- patient subgroup than for the CD20+ subgroup (11.2 vs. 6.9 months; 95% confidence interval [CI], 7.43-14.9; P = .008). In the CD20+ subgroup, 10 patients (7.2%) received treatment with rituximab, with 100% reaching complete remission (CR) 4 weeks after treatment. In the 18- to 39-year age group, CD20+ patients treated with rituximab had EFS and OS that was not reached. In addition, for CD20+ patients who received with chemotherapy, EFS was 3.9 months (95% CI, 0.6-7.2 months; P = .025) and OS was 7.2 months (95% CI, 3.37-11.0; P = .013). Multivariate analysis showed that the use of rituximab was independently associated with OS and CR at 4 weeks after induction. CONCLUSION CD20 expression in adult ALL-B is associated with decreased OS. Treatment with rituximab can increase OS, EFS, and CR in the 18- to 39-year age group.
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Affiliation(s)
- Reibán-Espinoza Esteban
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Bourlon Christianne
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Aguayo Alvaro
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Roberta Demichelis-Gómez
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
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73
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Tobin J, Miller KA, Baezconde-Garbanati L, Unger JB, Hamilton AS, Milam JE. Acculturation, Mental Health, and Quality of Life among Hispanic Childhood Cancer Survivors: A Latent Class Analysis. Ethn Dis 2018; 28:55-60. [PMID: 29467567 DOI: 10.18865/ed.28.1.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Acculturation appears to be an important aspect of the association between ethnicity and disease, but it has not been explored in depth among childhood cancer survivors (CCS). The purpose of our study was to identify distinct acculturative profiles among Hispanic CCS and to assess differences in quality of life and depressive symptoms. Design Latent class analysis was used to identify distinct acculturative profiles using 9 indicator items reflecting Hispanic and Anglo cultural orientation. Multinomial logistic regression was performed to explore differences in depressive symptoms and quality of life between acculturation classes. Setting and Participants Participants were diagnosed in Los Angeles County, California, USA between 2000-2007 and were recruited for the study in 2009. Main Outcome Measures Center for Epidemiologic Studies depression scale and the PedsQL 4.0 quality of life scale. Results Three distinct acculturation classes emerged. All classes displayed a high probability of endorsing all Anglo orientation items. One class additionally demonstrated a high probability of endorsing all Hispanic orientation items and was labeled bicultural 40%); another demonstrated low probability of endorsing the Hispanic items so was labeled assimilated (32%); and the last demonstrated a high probability of endorsing only the Hispanic items related to language use and was labeled linguistically Hispanic/culturally Anglo (LH) (28%). Conclusions The assimilated group had significantly more depressive symptoms and lower quality of life than the other two groups. This may indicate that loss of the Hispanic culture may be associated with poorer psychosocial health among CCS.
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Affiliation(s)
- Jessica Tobin
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; Los Angeles, CA
| | - Kimberly A Miller
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; Los Angeles, CA
| | - Jennifer B Unger
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; Los Angeles, CA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; Los Angeles, CA
| | - Joel E Milam
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; Los Angeles, CA
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Racial Differences in Four Leukemia Subtypes: Comprehensive Descriptive Epidemiology. Sci Rep 2018; 8:548. [PMID: 29323237 PMCID: PMC5765036 DOI: 10.1038/s41598-017-19081-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/19/2017] [Indexed: 02/03/2023] Open
Abstract
Leukemia is a malignant progressive disease and has four major subtypes. Different racial groups differ significantly in multiple aspects. Our goal is to systematically and comprehensively quantify racial differences in leukemia. The SEER database is analyzed, and comprehensive descriptive analysis is provided for the four major subtypes, namely ALL (acute lymphoblastic leukemia), CLL (chronic lymphoblastic leukemia), AML (acute myeloid leukemia), and CML (chronic myeloid leukemia), and for two age groups (≤14 and >14) separately. The racial groups studied include NHW (non-Hispanic White), HW (Hispanic White), BL (Black), and API (Asian and Pacific Islander). Univariate and multivariate analyses are conducted to quantify racial differences in patients’ characteristics, incidence, and survival. For patients’ characteristics, significant racial differences are observed in gender, age at diagnosis, diagnosis era, using radiation for treatment, registry, cancer history, and histology type. For incidence, significant racial differences are observed, and the patterns vary across subtypes, gender, and age groups. For most of the subtypes and gender and age groups, Blacks have the worst five-year survival, and significant racial differences exist. This study provides a comprehensive epidemiologic description of racial differences for the four major leukemia subtypes in the U.S. population.
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75
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Tai EW, Ward KC, Bonaventure A, Siegel DA, Coleman MP. Survival among children diagnosed with acute lymphoblastic leukemia in the United States, by race and age, 2001 to 2009: Findings from the CONCORD-2 study. Cancer 2017; 123 Suppl 24:5178-5189. [PMID: 29205314 PMCID: PMC6075705 DOI: 10.1002/cncr.30899] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/14/2017] [Accepted: 07/05/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. This report describes the survival of children with ALL in the United States using the most comprehensive and up-to-date cancer registry data. METHODS Data from 37 state cancer registries that cover approximately 80% of the US population were used. Age-standardized survival up to 5 years was estimated for children aged 0-14 years who were diagnosed with ALL during 2 periods (2001-2003 and 2004-2009). RESULTS In total, 17,500 children with ALL were included. The pooled age-standardized net survival estimates for all US registries combined were 95% at 1 year, 90% at 3 years, and 86% at 5 years for children diagnosed during 2001-2003, and 96%, 91%, and 88%, respectively, for those diagnosed during 2004-2009. Black children who were diagnosed during 2001-2003 had lower 5-year survival (84%) than white children (87%) and had less improvement in survival by 2004-2009. For those diagnosed during 2004-2009, the 1-year and 5-year survival estimates were 96% and 89%, respectively, for white children and 96% and 84%, respectively, for black children. During 2004-2009, survival was highest among children aged 1 to 4 years (95%) and lowest among children aged <1 year (60%). CONCLUSIONS The current results indicate that overall net survival from childhood ALL in the United States is high, but disparities by race still exist, especially beyond the first year after diagnosis. Clinical and public health strategies are needed to improve health care access, clinical trial enrollment, treatment, and survivorship care for children with ALL. Cancer 2017;123:5178-89. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Eric W. Tai
- Division of Cancer Prevention and Control, Centers for
Disease Control and Prevention, Atlanta, Georgia
| | - Kevin C. Ward
- Georgia Center for Cancer Statistics, Emory University,
Atlanta, Georgia
| | - Audrey Bonaventure
- Cancer Survival Group, Department of Epidemiology and
Population Health, London School of Hygiene and Tropical Medicine, London, United
Kingdom
| | - David A. Siegel
- Aflac Cancer and Blood Disorders Center of
Children’s Healthcare of Atlanta, Emory University School of Medicine,
Atlanta, Georgia
| | - Michel P. Coleman
- Cancer Survival Group, Department of Epidemiology and
Population Health, London School of Hygiene and Tropical Medicine, London, United
Kingdom
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76
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Furutani E, Rodriguez-Galindo C, Green AL. Early death in pediatric cancer: remaining questions and next steps. Oncotarget 2017; 8:96478-96479. [PMID: 29228545 PMCID: PMC5722497 DOI: 10.18632/oncotarget.22257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/29/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Elissa Furutani
- Adam L. Green: Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
| | - Carlos Rodriguez-Galindo
- Adam L. Green: Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
| | - Adam L Green
- Adam L. Green: Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
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Hwee J, Tait C, Sung L, Kwong JC, Sutradhar R, Pole JD. A systematic review and meta-analysis of the association between childhood infections and the risk of childhood acute lymphoblastic leukaemia. Br J Cancer 2017; 118:127-137. [PMID: 29065105 PMCID: PMC5765221 DOI: 10.1038/bjc.2017.360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 01/02/2023] Open
Abstract
Background: To determine whether childhood infections were associated with the development of childhood acute lymphoblastic leukaemia (ALL). Methods: We included studies that assessed any infection in childhood prior to the diagnosis of ALL in children aged 0–19 years compared to children without cancer. The primary analysis synthesised any infection against the odds of ALL, and secondary analyses assessed the frequency, severity, timing of infections, and specific infectious agents against the odds of ALL. Subgroup analyses by data source were investigated. Results: In our primary analysis of 12 496 children with ALL and 2 356 288 children without ALL from 38 studies, we found that any infection was not associated with ALL (odds ratio (OR)=1.10, 95% CI: 0.95–1.28). Among studies with laboratory-confirmed infections, the presence of infections increased the odds of ALL by 2.4-fold (OR=2.42, 95% CI: 1.54–3.82). Frequency, severity, and timing of infection were not associated with ALL. Conclusions: The hypothesis put forward by Greaves and others about an infectious aetiology are neither confirmed nor refuted and the overall evidence remains inadequate for good judgement. The qualitative difference in the subgroup effects require further study, and future research will need to address the challenges in measuring infectious exposures.
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Affiliation(s)
- Jeremiah Hwee
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada
| | - Christopher Tait
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.,Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada.,Public Health Ontario, Toronto, ON, Canada.,Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, Canada
| | - Jason D Pole
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada.,Pediatric Oncology Group of Ontario, 480 University Avenue, Suite 1014, Toronto, ON, Canada
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Nassour I, Mokdad AA, Minter RM, Polanco PM, Augustine MM, Mansour JC, Porembka MR, Wang SC. Racial and ethnic disparities in a national cohort of ampullary cancer patients. J Surg Oncol 2017; 117:220-227. [PMID: 28968918 DOI: 10.1002/jso.24835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Racial and ethnic variations have been described in the different malignancies, but no such data exists for ampullary cancer. The aim of this study was to present an updated report on the epidemiology, treatment patterns, and survival of a national cohort of ampullary cancer patients. METHODS Patients diagnosed with ampullary cancer between 2004 and 2014 were identified in the National Cancer Database. Overall survival was estimated and compared between racial/ethnic groups using the log-rank test. RESULTS A total of 14 879 patients were identified; 78% of the patients were White, 9% Hispanic, 8% Black, and 5% Asian. We noted significant differences in disease presentation, socioeconomic status, and outcomes. Blacks had the lowest median overall survival at 18.9 months followed by Whites at 23.9 months, Hispanics at 32.7 months, and Asians at 37.4 months. On a multivariate Cox proportional-hazards model, being Black was associated with worse survival compared to being White while being Asian and Hispanic were associated with better survival. CONCLUSIONS Overall survival of ampullary cancer patients was independently associated with race and ethnicity. Further studies are needed to clarify whether these disparities are primarily due to socioeconomic status or biologic factors.
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Affiliation(s)
- Ibrahim Nassour
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ali A Mokdad
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rebecca M Minter
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patricio M Polanco
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mathew M Augustine
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - John C Mansour
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew R Porembka
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sam C Wang
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
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79
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Ridgeway JL, Wang Z, Finney Rutten LJ, van Ryn M, Griffin JM, Murad MH, Asiedu GB, Egginton JS, Beebe TJ. Conceptualising paediatric health disparities: a metanarrative systematic review and unified conceptual framework. BMJ Open 2017; 7:e015456. [PMID: 28780545 PMCID: PMC5724162 DOI: 10.1136/bmjopen-2016-015456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE There exists a paucity of work in the development and testing of theoretical models specific to childhood health disparities even though they have been linked to the prevalence of adult health disparities including high rates of chronic disease. We conducted a systematic review and thematic analysis of existing models of health disparities specific to children to inform development of a unified conceptual framework. METHODS We systematically reviewed articles reporting theoretical or explanatory models of disparities on a range of outcomes related to child health. We searched Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus (database inception to 9 July 2015). A metanarrative approach guided the analysis process. RESULTS A total of 48 studies presenting 48 models were included. This systematic review found multiple models but no consensus on one approach. However, we did discover a fair amount of overlap, such that the 48 models reviewed converged into the unified conceptual framework. The majority of models included factors in three domains: individual characteristics and behaviours (88%), healthcare providers and systems (63%), and environment/community (56%), . Only 38% of models included factors in the health and public policies domain. CONCLUSIONS A disease-agnostic unified conceptual framework may inform integration of existing knowledge of child health disparities and guide future research. This multilevel framework can focus attention among clinical, basic and social science research on the relationships between policy, social factors, health systems and the physical environment that impact children's health outcomes.
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Affiliation(s)
- Jennifer L Ridgeway
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Zhen Wang
- Department of Health Sciences Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle van Ryn
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Joan M Griffin
- Department of Health Sciences Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - M Hassan Murad
- Department of Health Sciences Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gladys B Asiedu
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason S Egginton
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy J Beebe
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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80
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Frazier AL, Piñeros M, Fuentes S, Bhakta N. The global burden of childhood cancer: Knowing what we do not know. Pediatr Blood Cancer 2017; 64. [PMID: 28409882 DOI: 10.1002/pbc.26532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 12/29/2022]
Affiliation(s)
- A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Marion Piñeros
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Soad Fuentes
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
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81
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Wang L, Gomez SL, Yasui Y. Racial and Ethnic Differences in Socioeconomic Position and Risk of Childhood Acute Lymphoblastic Leukemia. Am J Epidemiol 2017; 185:1263-1271. [PMID: 28369160 DOI: 10.1093/aje/kww164] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/29/2016] [Indexed: 11/14/2022] Open
Abstract
Racial and ethnic differences in associations between socioeconomic position (SEP) and risk of childhood acute lymphoblastic leukemia (ALL) were investigated using data from population-based cancer registries in the Surveillance, Epidemiology, and End Results Program in the United States. The study included 8,383 ALL cases diagnosed at age ≤19 years in 2000-2010. Census tract-level composite SEP index in quintiles was assigned based on residence at the time of diagnosis. Incidence rate ratios and 95% confidence intervals associated with SEP and race/ethnicity, adjusted for sex, age, and year of diagnosis, were estimated using Poisson regression models. The incidence rate of childhood ALL was negatively associated with SEP among Hispanics but was positively associated among children of other races/ethnicities. As compared with the lowest SEP, the adjusted incidence rate ratios for children with the highest SEP were 1.29 (95% confidence interval (CI): 1.15, 1.44) for non-Hispanic whites, 1.67 (95% CI: 1.20, 2.34) for non-Hispanic blacks, 1.57 (95% CI: 1.17, 2.09) for Asians/Pacific Islanders, 2.33 (95% CI: 0.93, 5.83) for American Indians/Alaska Natives, and 0.70 (95% CI: 0.60, 0.81) for Hispanics. The findings of a reverse association in Hispanics need to be confirmed and further explained in future studies using different measures of SEP.
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Affiliation(s)
- Linwei Wang
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (Linwei Wang, Yutaka Yasui)
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California (Scarlett Lin Gomez)
- Division of Epidemiology, Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California (Scarlett Lin Gomez)
- Stanford Cancer Institute, Stanford, California (Scarlett Lin Gomez)
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (Linwei Wang, Yutaka Yasui)
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82
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Ballantine KR, Watson H, Macfarlane S, Winstanley M, Corbett RP, Spearing R, Stevanovic V, Yi M, Sullivan MJ. Small Numbers, Big Challenges: Adolescent and Young Adult Cancer Incidence and Survival in New Zealand. J Adolesc Young Adult Oncol 2017; 6:277-285. [DOI: 10.1089/jayao.2016.0074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kirsten R. Ballantine
- National Child Cancer Network NZ, Auckland, New Zealand
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Heidi Watson
- AYA Cancer Network Aotearoa, Auckland, New Zealand
| | - Scott Macfarlane
- National Child Cancer Network NZ, Auckland, New Zealand
- Starship Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Mark Winstanley
- Starship Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Robin P. Corbett
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Ruth Spearing
- Department of Haematology, Christchurch Hospital, Christchurch, New Zealand
| | - Vladimir Stevanovic
- Health and Disability Intelligence, New Zealand Ministry of Health, Wellington, New Zealand
| | - Ma Yi
- Canterbury District Health Board, Christchurch, New Zealand
| | - Michael J. Sullivan
- Children's Cancer Research Group, University of Otago, Christchurch, New Zealand
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia
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Jain N, Roberts KG, Jabbour E, Patel K, Eterovic AK, Chen K, Zweidler-McKay P, Lu X, Fawcett G, Wang SA, Konoplev S, Harvey RC, Chen IM, Payne-Turner D, Valentine M, Thomas D, Garcia-Manero G, Ravandi F, Cortes J, Kornblau S, O'Brien S, Pierce S, Jorgensen J, Shaw KRM, Willman CL, Mullighan CG, Kantarjian H, Konopleva M. Ph-like acute lymphoblastic leukemia: a high-risk subtype in adults. Blood 2017; 129:572-581. [PMID: 27919910 PMCID: PMC5290985 DOI: 10.1182/blood-2016-07-726588] [Citation(s) in RCA: 241] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/26/2016] [Indexed: 11/20/2022] Open
Abstract
Philadelphia chromosome (Ph)-like acute lymphoblastic leukemia (ALL) is a high-risk subtype of ALL in children. There are conflicting data on the incidence and prognosis of Ph-like ALL in adults. Patients with newly diagnosed B-cell ALL (B-ALL) who received frontline chemotherapy at MD Anderson Cancer Center underwent gene expression profiling of leukemic cells. Of 148 patients, 33.1% had Ph-like, 31.1% had Ph+, and 35.8% had other B-ALL subtypes (B-other). Within the Ph-like ALL cohort, 61% had cytokine receptor-like factor 2 (CRLF2) overexpression. Patients with Ph-like ALL had significantly worse overall survival (OS), and event-free survival compared with B-other with a 5-year survival of 23% (vs 59% for B-other, P = .006). Sixty-eight percent of patients with Ph-like ALL were of Hispanic ethnicity. The following were associated with inferior OS on multivariable analysis: age (hazard ratio [HR], 3.299; P < .001), white blood cell count (HR, 1.910; P = .017), platelet count (HR, 7.437; P = .005), and Ph-like ALL (HR, 1.818; P = .03). Next-generation sequencing of the CRLF2+ group identified mutations in the JAK-STAT and Ras pathway in 85% of patients, and 20% had a CRLF2 mutation. Within the CRLF2+ group, JAK2 mutation was associated with inferior outcomes. Our findings show high frequency of Ph-like ALL in adults, an increased frequency of Ph-like ALL in adults of Hispanic ethnicity, significantly inferior outcomes of adult patients with Ph-like ALL, and significantly worse outcomes in the CRLF2+ subset of Ph-like ALL. Novel strategies are needed to improve the outcome of these patients.
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Affiliation(s)
- Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kathryn G Roberts
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ken Chen
- Institute for Personalized Cancer Therapy, and
| | - Patrick Zweidler-McKay
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Richard C Harvey
- Department of Pathology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM; and
| | - I-Ming Chen
- Department of Pathology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM; and
| | | | - Marcus Valentine
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Deborah Thomas
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jorge Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Steven Kornblau
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan O'Brien
- Division of Hematology/Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange, CA
| | - Sherry Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Cheryl L Willman
- Department of Pathology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM; and
| | | | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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Walsh A, Chewning J, Li X, Dai C, Whelan K, Madan-Swain A, Waterbor J, Baskin ML, Goldman FD. Inferior outcomes for black children with high risk acute lymphoblastic leukemia and the impact of socioeconomic variables. Pediatr Blood Cancer 2017; 64:267-274. [PMID: 27650428 DOI: 10.1002/pbc.26222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/14/2016] [Accepted: 07/28/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND While significant improvements have been made for children with acute lymphoblastic leukemia (ALL) in the United States over the past 20 years, black patients continue to have inferior outcomes. The full impact of socioeconomic variables on outcomes in this minority population is not entirely understood. PROCEDURE Disease characteristics, demographic, and socioeconomic status (SES) variables were collected on black (n = 44) and white (n = 178) patients diagnosed at the University of Alabama at Birmingham. Cox proportional hazard regression was used to evaluate the influence of SES and insurance status on survival. RESULTS As a cohort, 5-year overall survival (OS) was 87% (82-91%), with a median follow-up of 99 months. In univariable analysis, black race was not significantly associated with a higher risk of death or relapse and death. White and black patients with standard-risk leukemia had excellent outcomes, with 97% (91-99%) and 96% (75-99%) 5-year OS, respectively. In contrast, for high-risk disease, white patients had a statistically significant improved 5-year OS rates compared with black patients (79% [68-87%] vs. 52% [28-72%]). Black children were more likely to have public insurance, and, in multivariable analysis, this was associated with a trend toward an improved outcome. Black patients also had poorer census tract-level SES parameters, but these variables were not associated with survival. CONCLUSION Our study demonstrates significantly inferior outcomes for black children with high-risk leukemia. These outcome disparities were not related to SES variables, including poverty or private insurance coverage, suggesting the involvement of other factors and highlighting the need for a prospective investigative analysis.
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Affiliation(s)
- Alexandra Walsh
- Department of Pediatric Hematology and Oncology, Children's Specialty Center of Nevada, Las Vegas, Nevada
| | - Joseph Chewning
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Xuelin Li
- Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama
| | - Chen Dai
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kimberly Whelan
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Avi Madan-Swain
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - John Waterbor
- Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama
| | - Monica L Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Frederick D Goldman
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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85
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van der Plas E, Schachar RJ, Hitzler J, Crosbie J, Guger SL, Spiegler BJ, Ito S, Nieman BJ. Brain structure, working memory and response inhibition in childhood leukemia survivors. Brain Behav 2017; 7:e00621. [PMID: 28239531 PMCID: PMC5318374 DOI: 10.1002/brb3.621] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/09/2016] [Accepted: 11/11/2016] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Survival rates for children with acute lymphoblastic leukemia (ALL) approach 95%. At the same time, there is growing concern that chemotherapy causes alterations in brain development and cognitive abilities. We performed MRI measurements of white and gray matter volume to explore how variation in brain structure may be related to cognitive abilities in ALL survivors and healthy controls. METHODS The sample included 24 male ALL survivors who had completed contemporary treatment 3-11 years prior, and 21 age- and sex-matched controls. Participants were between 8 and 18 years old. Working memory and motor response inhibition were measured with the N-Back and Stop Signal Tasks (SST), respectively. Participants underwent 3T structural MRI to assess white and gray matter volumes overall, lobe-wise, and in cortical and atlas-identified subcortical structures. Mental health was assessed with the Child Behavioral Checklist. RESULTS ALL survivors performed more poorly on measures of working memory and response inhibition than controls. Frontal and parietal white matter, temporal and occipital gray matter volume, and volumes of subcortical white and gray matter structures were significantly reduced in ALL survivors compared with controls. Significant structure-function correlations were observed between working memory performance and volume of the amygdala, thalamus, striatum, and corpus callosum. Response inhibition was correlated with frontal white matter volume. No differences were found in psychopathology. CONCLUSIONS Compared with controls, a reduction in volume across brain regions and tissue types, was detectable in ALL survivors years after completion of therapy. These structural alterations were correlated with neurocognitive performance, particularly in working memory. Confirming these observations in a larger, more representative sample of the population is necessary. Additionally, establishing the time course of these changes-and the treatment, genetic, and environmental factors that influence them-may provide opportunities to identify at-risk patients, inform the design of treatment modifications, and minimize adverse cognitive outcomes.
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Affiliation(s)
- Ellen van der Plas
- Physiology and Experimental Medicine The Hospital for Sick Children Research Institute Toronto ON Canada; Psychiatry Research The Hospital for Sick Children Toronto ON Canada
| | - Russell J Schachar
- Psychiatry Research The Hospital for Sick Children Toronto ON Canada; Department of Psychiatry Faculty of Medicine The University of Toronto Toronto ON Canada
| | - Johann Hitzler
- Department of Pediatrics Faculty of Medicine The University of Toronto Toronto ON Canada; Department of Haematology/Oncology The Hospital for Sick Children Toronto ON Canada
| | - Jennifer Crosbie
- Psychiatry Research The Hospital for Sick Children Toronto ON Canada
| | - Sharon L Guger
- Department of Psychology The Hospital for Sick Children Toronto ON Canada
| | - Brenda J Spiegler
- Department of Pediatrics Faculty of Medicine The University of Toronto Toronto ON Canada; Department of Psychology The Hospital for Sick Children Toronto ON Canada
| | - Shinya Ito
- Physiology and Experimental Medicine The Hospital for Sick Children Research Institute Toronto ON Canada; Clinical Pharmacology and Toxicology The Hospital for Sick Children Toronto ON Canada; Pharmacology and Pharmacy Faculty of Medicine The University of Toronto Toronto ON Canada
| | - Brian J Nieman
- Physiology and Experimental Medicine The Hospital for Sick Children Research Institute Toronto ON Canada; Mouse Imaging Centre (MICe) The Hospital for Sick Children Toronto ON Canada; Ontario Institute for Cancer Research Toronto ON Canada; Department of Medical Biophysics The University of Toronto Toronto ON Canada
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86
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[Acute lymphoblastic leukemia: a genomic perspective]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2017; 74:13-26. [PMID: 29364809 DOI: 10.1016/j.bmhimx.2016.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/14/2016] [Accepted: 07/07/2016] [Indexed: 11/22/2022] Open
Abstract
In parallel to the human genome sequencing project, several technological platforms have been developed that let us gain insight into the genome structure of human entities, as well as evaluate their usefulness in the clinical approach of the patient. Thus, in acute lymphoblastic leukemia (ALL), the most common pediatric malignancy, genomic tools promise to be useful to detect patients at high risk of relapse, either at diagnosis or during treatment (minimal residual disease), and they also increase the possibility to identify cases at risk of adverse reactions to chemotherapy. Therefore, the physician could offer patient-tailored therapeutic schemes. A clear example of the useful genomic tools is the identification of single nucleotide polymorphisms (SNPs) in the thiopurine methyl transferase (TPMT) gene, where the presence of two null alleles (homozygous or compound heterozygous) indicates the need to reduce the dose of mercaptopurine by up to 90% to avoid toxic effects which could lead to the death of the patient. In this review, we provide an overview of the genomic perspective of ALL, describing some strategies that contribute to the identification of biomarkers with potential clinical application.
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87
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Kaur M, de Smith AJ, Selvin S, Zhang L, Cunningham M, Kang MW, Hansen HM, Cooper RM, McKean-Cowdin R, Wiemels JL, Metayer C. Tobacco Smoke and Ras Mutations Among Latino and Non-Latino Children with Acute Lymphoblastic Leukemia. Arch Med Res 2016; 47:677-683. [PMID: 28476195 PMCID: PMC5424620 DOI: 10.1016/j.arcmed.2016.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/23/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Childhood acute lymphoblastic leukemia (ALL) is a biologically heterogeneous disease, and mutations in the KRAS and NRAS oncogenes are present at diagnosis in about one-fifth of cases. Ras mutations were previously associated with environmental exposures in leukemias as well as in many other cancer types. This study examined whether Ras mutation could define a unique etiologic group of childhood ALL associated with tobacco smoke, a well-established mutagen and carcinogen. METHODS We included 670 children with ALL enrolled in a case-control study in California (1995-2013), including 50.6% Latinos. Parental and child exposure to tobacco smoke was obtained from interviews. Sanger sequencing was used to detect the common KRAS and NRAS hotspot mutations in diagnostic bone marrow DNA. ALL cases were also characterized for common chromosome abnormalities. In case-case analyses, logistic regression analyses were used to estimate odds ratios to describe the association between tobacco smoke exposure and childhood ALL with Ras mutations. RESULTS KRAS or NRAS mutations were detected in ∼18% of children diagnosed with ALL. Ras mutations were more common among Latino cases compared with non-Latino whites and in high-hyperdiploid ALL. No associations were observed between parental smoking or child's passive exposure to smoke and Ras positive ALL. CONCLUSIONS The apparent lack of association between tobacco smoke and Ras mutation in childhood ALL suggests that Ras mutations do not specifically define a tobacco-related etiologic pathway. Reasons for racial and ethnic differences in ALL are not well understood and could reflect differences in etiology that warrant further examination.
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Affiliation(s)
- Maneet Kaur
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California
| | - Adam J de Smith
- Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Steve Selvin
- Divison of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California
| | - Luoping Zhang
- Division of Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, California
| | - Marc Cunningham
- Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Michelle W Kang
- Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Helen M Hansen
- Department of Neurological Surgery, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Robert M Cooper
- Department of Pediatric Hematology/Oncology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Roberta McKean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joseph L Wiemels
- Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; Department of Neurological Surgery, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Catherine Metayer
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California.
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Kumar AJ, Gimotty PA, Gelfand J, Buck G, Rowe JM, Goldstone AH, Fielding A, Marks DI, Litzow M, Paietta E, Lazarus HM, Tallman MS, Luger SM, Loren AW. Delays in postremission chemotherapy for Philadelphia chromosome negative acute lymphoblastic leukemia are associated with inferior outcomes in patients who undergo allogeneic transplant: An analysis from ECOG 2993/MRC UK ALLXII. Am J Hematol 2016; 91:1107-1112. [PMID: 27468137 DOI: 10.1002/ajh.24497] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 07/24/2016] [Accepted: 07/26/2016] [Indexed: 11/08/2022]
Abstract
Adults with acute lymphoblastic leukemia (ALL) have a poorer prognosis than children due to a high risk of relapse. One explanation may be variable adherence to dose-intense chemotherapy. However, little is known about risk factors for delays in therapy and their impact on survival. We conducted an analysis of ECOG 2993/UKALLXII trial to study delays in postremission chemotherapy in adults with newly diagnosed ALL. Logistic regression was used to identify risk factors for a very long delay (VLD, >4 weeks) in start of intensification therapy. Cox regression was used to evaluate the impact of delays on overall survival (OS) and event-free survival (EFS). We evaluated 1076 Philadelphia chromosome negative (Ph-) patients who completed induction chemotherapy, achieved complete remission, and started intensification. Factors independently associated with VLD included duration of hospitalization (odds ratio [OR] = 1.2, P < 0.001) during Phase I; thrombocytopenia during Phase I (OR = 1.16, P = 0.004) or Phase II (OR 1.13, P = 0.001); chemotherapy dose reductions during Induction Phase I (OR = 1.72, P < 0.014); female sex (OR = 1.53, P = 0.010); Black (OR = 3.24, P = 0.003) and Asian (OR = 2.26, P = 0.021) race; and increasing age (OR = 1.31, P < 0.001). In multivariate Cox regression, patients who underwent allogeneic stem cell transplant (alloHCT) had significantly worse OS (HR 1.4, P = 0.03) and EFS (HR 1.4, P = 0.02) after experiencing a VLD compared to alloHCT patients who experienced ≤4 weeks delay. Specific populations (female, older, Black, and Asian patients) were more likely to experience delays in chemotherapy, as were those with significant toxicity during induction. VLDs in therapy negatively affected outcomes in patients undergoing allografting. Am. J. Hematol. 91:1107-1112, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Anita J. Kumar
- Division of Hematology/Oncology; Tufts University Medical Center; Boston MA
| | - Phyllis A. Gimotty
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA
| | - Joel Gelfand
- Department of Dermatology; University of Pennsylvania; Philadelphia PA
| | | | - Jacob M. Rowe
- Rambam Medical Center; Haifa Israel
- Eastern Cooperative Oncology Group; Brookline MA
| | - Anthony H. Goldstone
- North London Cancer Network, University College London Hospitals; London United Kingdom
| | - Adele Fielding
- Haematology; University College London; London United Kingdom
| | - David I. Marks
- University Hospitals NHS Foundation Trust; Bristol United Kingdom
| | | | - Elisabeth Paietta
- Cancer Center, The North Division of Montefiore Medical Center; Bronx NY
| | - Hillard M. Lazarus
- Case Comprehensive Cancer Center, Case Western Reserve University; Cleveland OH
| | - Martin S. Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center; New York NY
| | - Selina M. Luger
- Abramson Cancer Center, University of Pennsylvania; Philadelphia PA
| | - Alison W. Loren
- Abramson Cancer Center, University of Pennsylvania; Philadelphia PA
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Jaime-Pérez JC, López-Razo ON, García-Arellano G, Pinzón-Uresti MA, Jiménez-Castillo RA, González-Llano O, Gómez-Almaguer D. Results of Treating Childhood Acute Lymphoblastic Leukemia in a Low-middle Income Country: 10 Year Experience in Northeast Mexico. Arch Med Res 2016; 47:668-676. [DOI: 10.1016/j.arcmed.2017.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/13/2017] [Indexed: 10/19/2022]
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90
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Sun W, Orgel E, Malvar J, Sposto R, Wilkes JJ, Gardner R, Tolbert VP, Smith A, Hur M, Hoffman J, Rheingold SR, Burke MJ, Wayne AS. Treatment-related adverse events associated with a modified UK ALLR3 induction chemotherapy backbone for childhood relapsed/refractory acute lymphoblastic leukemia. Pediatr Blood Cancer 2016; 63:1943-8. [PMID: 27437864 PMCID: PMC7451261 DOI: 10.1002/pbc.26129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/25/2016] [Accepted: 06/08/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND The UK ALLR3 (R3) regimen has been adopted to treat pediatric relapsed acute lymphoblastic leukemia (ALL) by many centers in the United States and has become a preferred therapeutic backbone for testing novel agents in clinical trials. A detailed toxicity profile of this platform has not previously been reported. The toxicity and response rates for its use beyond first relapse are unknown. PROCEDURES We performed a multi-institutional, retrospective study including children with relapsed ALL treated with the R3 reinduction chemotherapy backbone block 1 across five pediatric centers. Data were extracted from medical records and analyzed. RESULTS Fifty-nine patients were included in the study, including 16 patients with ≥2nd relapse. Ninety-seven percent of patients experienced at least one Grade ≥3 nonhematologic adverse event (AE). Grade 3 or higher infection was reported in 90% of patients. Other nonhematologic Grade ≥3 AEs included electrolyte abnormalities, elevation in hepatic enzymes, and pain. Eighty-five percent of patients achieved a complete remission (CR). There were no significant differences in the incidence of AEs, CR rate, and rate of minimal residual disease negativity between patients with 1st or ≥2nd relapse. CONCLUSION Our study confirmed that R3 block 1 is a highly active reinduction regimen in childhood relapsed ALL. However, it was associated with a high incidence of severe toxicities, particularly infection. The toxicity profiled in our report should be used to inform optimal supportive care and future clinical trial design with the R3 backbone, particularly when new agents are combined with this regimen.
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Affiliation(s)
- Weili Sun
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, California.
- Keck School of Medicine, USC-Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
| | - Etan Orgel
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, California
- Keck School of Medicine, USC-Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Jemily Malvar
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, California
| | - Richard Sposto
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, California
- Keck School of Medicine, USC-Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Jennifer J Wilkes
- Department of Pediatrics, Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecca Gardner
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Vanessa P Tolbert
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Alison Smith
- Keck School of Medicine, USC-Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Minjun Hur
- School of Medicine, St. Louis University, St. Louis, Missouri
| | - Jill Hoffman
- Keck School of Medicine, USC-Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
- Infectious Disease, Children's Hospital Los Angeles, California
| | - Susan R Rheingold
- Department of Pediatrics, Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael J Burke
- Pediatric Leukemia and Lymphoma, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alan S Wayne
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, California
- Keck School of Medicine, USC-Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
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91
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Jiang D, Li Y, Hong Q, Shen Y, Xu C, Xu Y, Zhu H, Dai D, Ouyang G, Duan S. DNA methylation and leukemia susceptibility in China: Evidence from an updated meta-analysis. Mol Clin Oncol 2016; 5:193-207. [PMID: 27588182 PMCID: PMC4997969 DOI: 10.3892/mco.2016.959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 05/20/2016] [Indexed: 12/16/2022] Open
Abstract
Mounting evidence supports a role for DNA methylation in the pathogenesis of leukemia; however, there no overview of these results in the Chinese population. The present study performed a comprehensive meta-analysis to establish candidate genes with an altered methylation status in Chinese leukemia patients. Eligible studies were identified through searching the National Center of Biotechnology Information PubMed and Wanfang databases. Studies were pooled and overall odds ratios with corresponding confidence intervals were calculated. A total of 4,325 leukemia patients and 2,010 controls from 94 studies on 53 genes were included in this meta-analysis, and 47 genes were found to be aberrantly methylated in leukemia patients. A further subgroup meta-analysis by leukemia subtype demonstrated that hypermethylation of 5 genes, namely cyclin-dependent kinase (CDKN)2A, DNA-binding protein inhibitor-4, CDKN2B, glioma pathogenesis-related protein 1 and p73, contributed to the risk of various subtypes of leukemia. In addition, a strong association between CDKN2A and leukemia was identified in Chinese (P<0.00001) but not in European patients. The aberrantly methylated genes identified in the present meta-analysis may help elucidate the mechanisms underlying the development of leukemia in Chinese patients.
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Affiliation(s)
- Danjie Jiang
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Yirun Li
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Qingxiao Hong
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Yusheng Shen
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Chunjing Xu
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Yan Xu
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Huangkai Zhu
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Dongjun Dai
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Guifang Ouyang
- Department of Hematology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Shiwei Duan
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
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Prevalence and Predictors of Overweight and Obesity Among a Multiethnic Population of Pediatric Acute Lymphoblastic Leukemia Survivors: A Cross-Sectional Assessment. J Pediatr Hematol Oncol 2016; 38:429-36. [PMID: 26989911 PMCID: PMC4955650 DOI: 10.1097/mph.0000000000000555] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
As previous studies of obesity in survivors of pediatric acute lymphoblastic leukemia (ALL) have primarily been conducted among non-Hispanic white survivors or children treated on older protocols, our objective was to describe the prevalence and correlates of overweight status among an ethnically diverse population of pediatric ALL survivors, largely treated with more contemporary therapies. We evaluated the overweight/obesity status of pediatric ALL survivors (n=406) followed in the Texas Children's Cancer Center between 2004 and 2014. Survivors were classified as underweight, normal weight, overweight, or obese on the basis of their body mass index at their most current follow-up visit. Our results showed that Hispanic ethnicity (39% of the subjects) was associated with being overweight (adjusted odds ratio=1.88; 95% confidence interval, 1.13-3.14) or obese (adjusted odds ratio=2.84; 95% confidence interval, 1.59-5.06) at follow-up, even after adjusting for cranial radiotherapy (CRT) exposure. Body mass index z-score at diagnosis was also associated with overweight/obesity at follow-up. In addition, there was a statistically significant interaction between younger age at diagnosis and CRT, indicating that younger age at diagnosis was associated with obesity among patients who received CRT. These findings may help identify pediatric ALL patients that are at increased risk of being overweight or obese after treatment.
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Stern MC, Fejerman L, Das R, Setiawan VW, Cruz-Correa MR, Perez-Stable EJ, Figueiredo JC. Variability in Cancer Risk and Outcomes Within US Latinos by National Origin and Genetic Ancestry. CURR EPIDEMIOL REP 2016; 3:181-190. [PMID: 27547694 PMCID: PMC4978756 DOI: 10.1007/s40471-016-0083-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Latinos have lower rates for most common cancer sites and higher rates of some less common cancers (gallbladder, liver, gastric, and cervical) than other ethnic/racial groups. Latinos are a highly heterogeneous population with diverse national origins, unique genetic admixture patterns, and wide spectrum of socio-demographic characteristics. Across the major cancers (breast, colorectal, prostate, lung, and liver) US-born Latinos have higher incidence and worse survival than foreign-born, and those with low-socioeconomic status have the lowest incidence. Puerto Rican and Cuban Latinos have higher incidence rates than Mexican Latinos. We have identified the following themes as understudied and critical to reduce the cancer burden among US Latinos: (1) etiological studies considering key sources of heterogeneity, (2) culturally sensitive cancer prevention strategies, (3) description of the molecular tumor landscape to guide treatments and improve outcomes, and (4) development of prediction models of disease risk and outcomes accounting for heterogeneity of Latinos.
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Affiliation(s)
- Mariana C. Stern
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Laura Fejerman
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA USA
| | - Rina Das
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD USA
| | - V. Wendy Setiawan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Marcia R. Cruz-Correa
- Department of Medicine and Biochemistry, University of Puerto Rico Medical Sciences Campus and University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Eliseo J. Perez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD USA
| | - Jane C. Figueiredo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
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94
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Singer AW, Selvin S, Block G, Golden C, Carmichael SL, Metayer C. Maternal prenatal intake of one-carbon metabolism nutrients and risk of childhood leukemia. Cancer Causes Control 2016; 27:929-40. [PMID: 27294727 DOI: 10.1007/s10552-016-0773-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 06/04/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Folate, vitamins B12 and B6, riboflavin, and methionine are critical nutrients for the one-carbon metabolism cycle involved in DNA synthesis and epigenetic processes. We examined the association between maternal intake of these nutrients before pregnancy and risk of childhood acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) in a matched case-control study. METHODS Maternal dietary intake and vitamin supplement use in the year before pregnancy was assessed by food frequency questionnaire for 681 ALL cases, 103 AML cases, and 1076 controls. Principal component analysis was used to construct a variable representing combined nutrient intake, and conditional logistic regression estimated the odds ratio (OR) and 95% confidence interval (CI) for the association of ALL and AML with the principal component and each nutrient. RESULTS Higher maternal intake of one-carbon metabolism nutrients from food and supplements combined was associated with reduced risk of ALL (OR for one-unit change in the principal component = 0.91, CI 0.84-0.99) and possibly AML (OR for the principal component = 0.83, CI 0.66-1.04). When analyzed separately, intake of supplements high in these nutrients was associated with a reduced risk of ALL in children of Hispanic women only. CONCLUSIONS In conclusion, these data suggest that higher maternal intake of one-carbon metabolism nutrients may reduce risk of childhood leukemia.
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Affiliation(s)
- Amanda W Singer
- Division of Epidemiology, School of Public Health, University of California, Berkeley, 1995 University Avenue, Suite 460, Berkeley, CA, 94704, USA.
| | - Steve Selvin
- Division of Epidemiology, School of Public Health, University of California, Berkeley, 1995 University Avenue, Suite 460, Berkeley, CA, 94704, USA
| | - Gladys Block
- Division of Epidemiology, School of Public Health, University of California, Berkeley, 1995 University Avenue, Suite 460, Berkeley, CA, 94704, USA
| | | | - Suzan L Carmichael
- Division of Neonatology and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Catherine Metayer
- Division of Epidemiology, School of Public Health, University of California, Berkeley, 1995 University Avenue, Suite 460, Berkeley, CA, 94704, USA
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95
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Bona K, Blonquist TM, Neuberg DS, Silverman LB, Wolfe J. Impact of Socioeconomic Status on Timing of Relapse and Overall Survival for Children Treated on Dana-Farber Cancer Institute ALL Consortium Protocols (2000-2010). Pediatr Blood Cancer 2016; 63:1012-8. [PMID: 26913850 DOI: 10.1002/pbc.25928] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/08/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Population-based evidence suggests that lower socioeconomic status (SES) negatively impacts the overall survival (OS) of children with leukemia; however, the relationships between SES and treatment-related mortality, relapse, and timing of relapse remain unclear. PROCEDURE We examined OS, event-free survival (EFS) and cumulative incidence (CI) and timing of relapse by community-level poverty for 575 children aged 1-18 years with newly diagnosed acute lymphoblastic leukemia (ALL) treated on consecutive phase III multicenter Dana-Farber Cancer Institute ALL Consortium Protocols between 2000 and 2010. Children were categorized into high- and low-poverty areas for the analysis using aggregate U.S. Census data linked to zip code. RESULTS Children living in high-poverty areas experienced a 5-year OS of 85% as compared with 92% for those in low-poverty areas (P = 0.02); poverty remained marginally significant (P = 0.07) after adjustment for immunophenotype, age, and white blood cell count. There were no differences detected in EFS or CI relapse by poverty area. However, 92% of the relapses observed in children from high-poverty areas occurred <36 months from complete remission, compared to 48% of those in children from low-poverty areas (P = 0.008). CONCLUSIONS U.S. children with ALL living in high-poverty areas have a higher risk of early relapse when compared with those living in low-poverty areas despite uniform treatment. This may in part explain decreased OS observed in these children. This finding highlights disparities in childhood cancer outcomes by SES despite uniform treatment. Further investigations of the mechanistic pathways underlying this finding are needed.
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Affiliation(s)
- Kira Bona
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Traci M Blonquist
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donna S Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lewis B Silverman
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Joanne Wolfe
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
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96
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Shi Y, Du M, Fang Y, Tong N, Zhai X, Sheng X, Li Z, Xue Y, Li J, Chu H, Chen J, Song Z, Shen J, Ji J, Li X, Hu Z, Shen H, Xu J, Wang M, Zhang Z. Identification of a novel susceptibility locus at 16q23.1 associated with childhood acute lymphoblastic leukemia in Han Chinese. Hum Mol Genet 2016; 25:2873-2880. [PMID: 27094129 DOI: 10.1093/hmg/ddw112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/13/2016] [Accepted: 04/11/2016] [Indexed: 12/11/2022] Open
Abstract
Recently, genome-wide association studies (GWAS) have identified several susceptibility loci for childhood acute lymphoblastic leukemia (ALL) in populations of European descent; only a few loci could be confirmed in Asian populations because of those populations' genetic heterogeneity. To identify genetic factors associated with childhood ALL risk in the Chinese population, we performed a three-stage GWAS of 1184 childhood ALL cases and 3219 non-ALL controls. The combined analysis identified a new locus (rs1121404 in WWOX) at 16q23.1 associated with childhood ALL susceptibility (odds ratio (OR) = 1.38, P = 5.29 × 10-10), especially in the subtype of B-ALL (OR = 1.39, P = 2.47 × 10-9). The functional studies subsequently revealed that the expression of WWOX in ALL bone marrow was significantly lower than that in normal bone marrow. The G allele of rs1121404 displayed significantly decreased levels of mRNA expression of WWOX These results suggest that WWOX plays an important role in the development of childhood ALL and provide new insights into the etiology of childhood ALL.
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Affiliation(s)
- Yongyong Shi
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China .,The Affiliated Hospital of Qingdao University, Qingdao 266003, China.,Institute of Social Cognitive and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Mulong Du
- Department of Genetic Toxicology, the Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China.,Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing 211166, China
| | - Yongjun Fang
- Department of Hematology and Oncology, Nanjing Children's Hospital Affiliated with Nanjing Medical University, Nanjing 210000, China
| | - Na Tong
- Department of Genetic Toxicology, the Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China.,Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing 211166, China
| | - Xiaowen Zhai
- Department of Hematology and Oncology, Children's hospital of Fudan University, Shanghai 200032, China
| | - Xiaojing Sheng
- Department of Children's healthcare, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Zhiqiang Li
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China.,Institute of Social Cognitive and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yao Xue
- Department of Hematology and Oncology, Nanjing Children's Hospital Affiliated with Nanjing Medical University, Nanjing 210000, China
| | - Jie Li
- Department of Hematology and Oncology, The Affiliated Children's Hospital of Soochow University, Suzhou 215025, China
| | - Haiyan Chu
- Department of Genetic Toxicology, the Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China.,Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing 211166, China
| | - Jianhua Chen
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China.,Institute of Social Cognitive and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Zhijian Song
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China.,Institute of Social Cognitive and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jiawei Shen
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China.,Institute of Social Cognitive and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jue Ji
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xingwang Li
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Zhibin Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Hongbing Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jianfeng Xu
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois 60201, USA
| | - Meilin Wang
- Department of Genetic Toxicology, the Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China .,Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing 211166, China
| | - Zhengdong Zhang
- Department of Genetic Toxicology, the Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China .,Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing 211166, China
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97
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Abrahão R, Keogh RH, Lichtensztajn DY, Marcos-Gragera R, Medeiros BC, Coleman MP, Ribeiro RC, Keegan THM. Predictors of early death and survival among children, adolescents and young adults with acute myeloid leukaemia in California, 1988-2011: a population-based study. Br J Haematol 2016; 173:292-302. [PMID: 26847024 PMCID: PMC4833652 DOI: 10.1111/bjh.13944] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 12/07/2015] [Indexed: 01/07/2023]
Abstract
A better understanding of factors associated with early death and survival among children, adolescents and young adults with acute myeloid leukaemia (AML) may guide health policy aimed at improving outcomes in these patients. We examined trends in early death and survival among 3935 patients aged 0-39 years with de novo AML in California during 1988-2011 and investigated the associations between sociodemographic and selected clinical factors and outcomes. Early death declined from 9·7% in 1988-1995 to 7·1% in 2004-2011 (P = 0·062), and survival improved substantially over time. However, 5-year survival was still only 50% (95% confidence interval 47-53%) even in the most recent treatment period (2004-2011). Overall, the main factors associated with poor outcomes were older age at diagnosis, treatment at hospitals not affiliated with National Cancer Institute-designated cancer centres, and black race/ethnicity. For patients diagnosed during 1996-2011, survival was lower among those who lacked health insurance compared to those with public or private insurance. We conclude that mortality after AML remained strikingly high in California and increased with age. Possible strategies to improve outcomes include wider insurance coverage and treatment at specialized cancer centres.
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Affiliation(s)
- Renata Abrahão
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Cancer Prevention Institute of California, Fremont, CA, USA
| | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Rafael Marcos-Gragera
- Epidemiology Unity and Cancer Registry of Girona, Girona Biomedical Research Institute, Girona, Spain
| | - Bruno C Medeiros
- Division of Hematology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michel P Coleman
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Raul C Ribeiro
- Leukemia and Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Theresa H M Keegan
- Cancer Prevention Institute of California, Fremont, CA, USA
- Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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98
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Bailey-Olson M, Cowan M, Dvorak C, Mueller S, Owens A, Wahlstrom J, Horn B. Evaluation of Pre-Hematopoietic Cell Transplantation (HCT) Brain MRI and Neurologic Complications of Pediatric Patients Undergoing HCT for Hematologic Malignancies. J Pediatr Oncol Nurs 2016; 34:65-73. [PMID: 26902499 DOI: 10.1177/1043454216631509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adverse neurologic complications (NC) occur commonly in pediatric patients with hematologic malignancies both pre- and post-allogeneic hematopoietic cell transplant (HCT). Given this known risk, we previously obtained pre-HCT brain magnetic resonance imaging (MRI) to document baseline abnormalities but utility of this and findings are not well described. This study aimed to ( a) determine the prevalence and risk factors for abnormal brain MRI and ( b) determine prevalence and risk factors for development of new NC during and 2 years post-HCT. Retrospective chart review included 102 patients with hematologic malignancies who underwent allogeneic HCT between 2000 and 2009 at University of California San Francisco (UCSF) Children's Hospital and included standard HCT data, brain MRI reports, and NC and symptoms pre- and post-HCT. Forty-three percent of patients had abnormal findings on pre-MRI, most commonly nonspecific white matter changes. Neurologic symptoms pre-HCT was the only significant risk factor for abnormal MRI. Eleven patients (11%) developed post-HCT NC. Non-Caucasian race was the only significant risk factor for new NC. Although abnormal pre-HCT brain MRI is common, these findings are not predictive of subsequent NC post-HCT. Therefore routine surveillance may not be informative for that purpose, particularly when general anesthesia is required, which can have detrimental neurocognitive effects. Etiology of NC in pediatric HCT is likely multifactorial and may include genetic and ethnic predispositions.
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Affiliation(s)
| | - Morton Cowan
- 1 UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | | | - Sabine Mueller
- 1 UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Abigail Owens
- 2 Children's Hospital Philadelphia, Philadelphia, PA, USA
| | | | - Biljana Horn
- 1 UCSF Benioff Children's Hospital, San Francisco, CA, USA
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99
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Francis OL, Milford TAM, Martinez SR, Baez I, Coats JS, Mayagoitia K, Concepcion KR, Ginelli E, Beldiman C, Benitez A, Weldon AJ, Arogyaswamy K, Shiraz P, Fisher R, Morris CL, Zhang XB, Filippov V, Van Handel B, Ge Z, Song C, Dovat S, Su RJ, Payne KJ. A novel xenograft model to study the role of TSLP-induced CRLF2 signals in normal and malignant human B lymphopoiesis. Haematologica 2015; 101:417-26. [PMID: 26611474 DOI: 10.3324/haematol.2015.125336] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 11/24/2015] [Indexed: 12/20/2022] Open
Abstract
Thymic stromal lymphopoietin (TSLP) stimulates in-vitro proliferation of human fetal B-cell precursors. However, its in-vivo role during normal human B lymphopoiesis is unknown. Genetic alterations that cause overexpression of its receptor component, cytokine receptor-like factor 2 (CRLF2), lead to high-risk B-cell acute lymphoblastic leukemia implicating this signaling pathway in leukemogenesis. We show that mouse thymic stromal lymphopoietin does not stimulate the downstream pathways (JAK/STAT5 and PI3K/AKT/mTOR) activated by the human cytokine in primary high-risk leukemia with overexpression of the receptor component. Thus, the utility of classic patient-derived xenografts for in-vivo studies of this pathway is limited. We engineered xenograft mice to produce human thymic stromal lymphopoietin (+T mice) by injection with stromal cells transduced to express the cytokine. Control (-T) mice were produced using stroma transduced with control vector. Normal levels of human thymic stromal lymphopoietin were achieved in sera of +T mice, but were undetectable in -T mice. Patient-derived xenografts generated from +T as compared to -T mice showed a 3-6-fold increase in normal human B-cell precursors that was maintained through later stages of B-cell development. Gene expression profiles in high-risk B-cell acute lymphoblastic leukemia expanded in +T mice indicate increased mTOR pathway activation and are more similar to the original patient sample than those from -T mice. +T/-T xenografts provide a novel pre-clinical model for understanding this pathway in B lymphopoiesis and identifying treatments for high-risk B-cell acute lymphoblastic leukemia with overexpression of cytokine-like factor receptor 2.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Zheng Ge
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Department of Hematology, Nanjing 210029, China Pennsylvania State University Medical College, Department of Pediatrics, Hershey, PA, USA
| | - Chunhua Song
- Pennsylvania State University Medical College, Department of Pediatrics, Hershey, PA, USA
| | - Sinisa Dovat
- Pennsylvania State University Medical College, Department of Pediatrics, Hershey, PA, USA
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100
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Siegel RL, Fedewa SA, Miller KD, Goding-Sauer A, Pinheiro PS, Martinez-Tyson D, Jemal A. Cancer statistics for Hispanics/Latinos, 2015. CA Cancer J Clin 2015; 65:457-80. [PMID: 26375877 DOI: 10.3322/caac.21314] [Citation(s) in RCA: 341] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cancer is the leading cause of death among Hispanics/Latinos, who represent the largest racial/ethnic minority group in the United States, accounting for 17.4% (55.4 million/318 million) of the total US population in 2014. Every 3 years, the American Cancer Society reports on cancer statistics for Hispanics based on incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Among Hispanics in 2015, there will be an estimated 125,900 new cancer cases diagnosed and 37,800 cancer deaths. For all cancers combined, Hispanics have 20% lower incidence rates and 30% lower death rates compared with non-Hispanic whites (NHWs); however, death rates are slightly higher among Hispanics during adolescence (aged 15-19 years). Hispanic cancer rates vary by country of origin and are generally lowest in Mexicans, with the exception of infection-associated cancers. Liver cancer incidence rates in Hispanic men, which are twice those in NHW men, doubled from 1992 to 2012; however, rates in men aged younger than 50 years declined by 43% since 2003, perhaps a bellwether of future trends for this highly fatal cancer. Variations in cancer risk between Hispanics and NHWs, as well as between subpopulations, are driven by differences in exposure to cancer-causing infectious agents, rates of screening, and lifestyle patterns. Strategies for reducing cancer risk in Hispanic populations include increasing the uptake of preventive services (e.g., screening and vaccination) and targeted interventions to reduce obesity, tobacco use, and alcohol consumption.
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Affiliation(s)
- Rebecca L Siegel
- Director, Surveillance Information, Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Director, Risk Factor and Screening Surveillance, Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - Kimberly D Miller
- Epidemiologist, Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - Ann Goding-Sauer
- Epidemiologist, Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | | | | | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
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